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@Colin – building up on nobody’s responses; I think the focus should be on reducing your uric acid levels and maintaining a healthy diet. Keep as close as you can to the line and try not to deviate from it. Too much obsessing on food will only cause you to go mentally feeble. Trust me, been there.

How is your blood condition these days? Another way for reducing haemoglobin is to drink plenty of water as you do but be careful with this. Do not believe the hype that gallons of water will flush and flush uric acid. It does help a lot but as with anything there will be a ceiling to the benefit. Excessive water also causes your sodium levels to drop and you do not want this as you need salts in your blood. Moderation is the key.

Keep us posted.

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Andy, I know this might be a vanilla response but the first thing you need to do is get a blood test to check your uric acid results and post them here. Only then can you really ‘begin’ to find out the cause for these pains. How do you know these are even gout pains? You mention tophi, did you diagnose this yourself? Maybe your doctor is giving you naproxen because he doesn’t think you have gout at all? Naproxen is used in more then just gout problems.

After answering those questions can you begin to narrow your pains down to their causes.

Good luck mate.

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@nobody – exactly. Your spring temperatures may very well be our summer temperatures which further leads me to believe that the heat plays a vital (yet negative) role in when attacks occur.

@Patrick – Yea I’ve heard about those catastrophic wild fires. I’m sorry to hear your going through a tough time mate. It must be even tougher being away from your family for such long periods of time 🙁
I admire people like you honestly. It’s people like you that save lives and families daily. After reading your experiences above (2 major attacks in summer compared to 1) it further cements my theory that summer temperatures can have more of a negative impact then colder temperatures in attack occurrence (well with me anyway).

@Keith – I’d be interested to hear your experiences mate?

Cheers.

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The ultimate question is do you actually have gout or do you and your doctor think you have what is thought to be gout?

These questions can only be answered with specific tests which your doctor has seemed to overlook.

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Ok.

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@nobody

hello mate. Yep I agree you have answered combination therapy somewhere in our comprehensive threads. I too believe Colchicine is some sort of anti-inflamotory for the very same reasons you mentioned. In any case, being told you can use them together obviously means they work in their own unique ways without ‘major’ contraindications outside of general side effects.

Bro it was a simple answer of “I’m currently taking 20mgs/40/80 right now”
It really didn’t require the ‘go check other threads for your answer’

Relax my brother we’re in the same boat.. 🙂

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Gout Hot or Cold

Over the last 3 years / 3 gout attacks I have noticed two have come in the Summer and one has come after starting Allopurinol. Putting the Allopurinol attack to one side for obvious reasons I was wondering when you statistically experienced your attacks more often. I have tried to forcefully believe that colder temperatures are generally a recipe for an attack but from my experience, it seems as if this is definitely not the case. This has got me thinking “Why are my attacks always in summer”. I came up with the following possible findings and was wondering if you believe they merit further investigation/study?

My Experience Approach:
The heat in the foot causes expansion which results in either;
a) crystals being pressured into breaking free causing an attack.
b) the general build-up of temperature inside the foot liquefies or scales down crystals dislodging themselves or others nearby (think polar ice caps).
c) frequent perspiration causes dehydration which increases UA concentration.
d) longer days which results in more exertion on joints

Possible Scientific Approach:

a) The heat in the summer causes additional perspiration all over the body including the feet. The perspiration causes a drop of magnesium which helps control heart rate and blood pressure. Now, as a result, this keeps the blood moving smoothly around the circulatory system until the body can expel uric acid. A little more information can be found here.

b) Cherries and Tomatoes* are more abundant and people consume more of them during these months causing a potential down shit in Uric Acid levels which would naturally dissolve fragile crystals in the joints.

Now, these are just my findings during my experiences. As it stands I am beginning to believe winter is actually a better time for me however I am in total agreement that UA should be constantly monitored and controlled.

I’d also like to hear what the general website visitors experiences are.

Cheers.

*Some say these increase Uric Acid levels, however.

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Oh nobody you do make me laugh.. I think its just we share similar situations here and there that makes our cases unique in their own right.

Well firstly I’d like to thank you for trying the combination therapy, your a true ‘internet friend’ speaking in your words, how did it work for you?

I know everyone reacts differently to medications but the haematology results are encouraging as I need that little bit of assurance with this ongoing pain right now.

I asked my first rheumatologist if it was OK to use NSAIDs with Colchicine and he said it was fine whereas the second rheumatologist said not to. So I guess that means Colchicine isn’t really an anti-inflammatory because they couldn’t be used together otherwise one could use Diclofenac with Naproxen.
I’m not sure if Paracetamol is an anti-inflammatory but I guess a little research answer that for us.

I’ve got my ultrasound coming up and am extremely anxious for the results.

But going back to two questions, how long have you been taking febuxostat and at what dose? Cheers buddy.

p.s. Jason Bourne is an actor in a famous movie called The Bourne Supremacy.
He is a secret agent hence ‘near a border in europe’
(http://www.imdb.com/title/tt0372183/?ref_=tt_rec_tti)

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@nobody (aka Jason Bourne) – Well your hgb stabilising is certainly a relief as it gives me some hope.

Forgive me if I already asked this but how long have you been taking febuxostat and at what dose?

From my understanding your not a great fan of using NSAIDs so why are you currently taking them? If I remember you were mainly a colchicine only approach? Or are you using combination therapy for these milder attacks? Not so sure I understand “unusual considering your ULT” What are your latest liver tests? Out of curiosity do you have any general liver problems?

Gosh I just realised I asked you about 20 questions! I’m just learning (and teaching in some threads) Sorry bro 🙂

I’m still struggling with this painful foot and I really hope febuxostat works for me. It’s been a nightmare these last few months. I just want to complete this Vit E trial first.

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@Urankjj – the link on Urate Oxidase is exceptional. More specifically the statement

It has been proposed that the loss of urate oxidase gene expression has been advantageous to hominids, since uric acid is a powerful antioxidant and scavenger of singlet oxygen and radicals.[5]

This _may seem_ to explain the potential for haemoglobin reductions seen when starting uric acid lowering therapy, more specifically in patients with blood disorders resulting in secondary gout [Uric Acid Arthritis].

You’ve just inspired me to further continue my investigations on how anti-oxidants impact cell turnover.

Thank you.

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In addition to nobodys posts I’d just like to point out a few things.
You need to look at the macro side of this and not just the micro side. People become obsessed with food and their intake of it. It all becomes about purines, sugars, salts, etc. Whilst minimising most of these ingredients will help with reducing uric acid levels you need to also look at the bigger picture which is they will not solve your Uric Acid Arthritis (gout) issue.

Allopurinol, Febuxostat and a few drugs are there for this very reason. What many people overlook when starting these medications is that they are not just there to ‘reduce uric acid’ they are also there to ‘psychologically hold your hand’ whilst you get on with life which means going on holiday, eating what you like, doing the job you like, doing the sports you like, etc.
Now that doesn’t mean you have to take these drugs for the rest of your life as there are medication breaks, take a read of this.

When choosing food, keep a logical approach but also keep an open mind to life.

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I knew you’d appreciate it so I got it tested again: no change, still a touch lower than it used to be but not weird.
Thanks mate, I do really appreciate it yes. Just out of interest it was a touch lower then your original levels prior to starting febuxostat right, not lower then it was when it originally made its first drop after starting?

I think it just came at a wrong time, starting allopurinol then going through an attack then inflammation (which can cause hg drop too). It all happened so abruptly in some accelerated mess. I mean even today some doctors are not entirely convinced it even was allopurinol and still think it was just some internal multifactorial infection/inflammation (not me though).

I would have to agree with you on certain aspects like trying febuxostat and colchicine a little quicker but bare in mind my haemoglobin only really recovered in mid-July or so. Still, as you say thats a month and a half too late. Anyway, I’ve got a blood test coming up to see where we stand. I also silently started vitamin E to see if that makes a difference.

p.s. How are you doing on febuxostat these days? Your previous unexpected attack gone?

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@Keith – Thanks for that interesting article Keith. Gives me some hope!
Funny actually, my foot has been quite well today. Loving the Uric Acid Arthritis approach by the way.

@nobody – near a border in Europe.. Well well Jason Bourne 🙂

brother I had more blood tests since starting allopurinol then I have in the last 10 years so it definitely wasn’t a blood test thing. With regards to haemoglobin, well that doesn’t change in a week or two. Haemoglobin changes need a minimum of 3 weeks between tests to notice, aggregate, and finally create trends. The only delay I see was Colchicine but thats tried and tested now. Way too much time after stopping Allopurinol? It will only be 3 months tomorrow. I’m sure 3 months won’t cause any major changes. Anyway as explained I’m doing my trial Vitamin E blood test to check if there’s been any impact in a week and will be starting febuxostat after my visit with the professor mid-September. I remember you mentioned something about your haemoglobin dropping by 1.0 when you started febuxostat. Do you recall it returning to usual levels a while after starting? I’d really appreciate if you could let me know. Cheers.

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if you’re confident ULT is what you need to do, what’s the point in trying to determine ahead of time what ULT would and wouldn’t solve? You’ll find out anyway.

This sir is indeed accurate and very true 🙂

I also assume you’d get a clearer pricture of the damage done by uric acid once it’s (mostly) gone than in the middle of the process (even if there was a point in having pre-ULT imaging, it’s too late for that now that you’ve spent quite a while under 400 umol/l).

True – to an extent. The reason for the imaging is to see if damage has already been done (I assume my doctor would know what damaged bone/tissue/muscle looks like [I hope]) and if he believes that ULT will actually repair anything that he finds. I assume if he spots a bone deformity then we know where we stand with pain relief right there. If anything its a way to get baseline images too. Ultimately I want to know if permanent damage has been done since the last attack. This constant low grade and occasionally high grade pain is debilitating.

Granted, I saw a bunch of clueless doctors but that kind of damage can’t be easy to miss, right?

Precisely why I forced the MRI on him. I mean if he or other doctors cannot interpret the ultrasound and the high resolution detailed images that will shortly be provided to him then what chance do we really have?

I know the attack was due to some Allopurinol induced ‘crystal dis-lodge or debulk’ or whatever but boy that crystal had a true field day and must have dis-lodged my whole foot with it.

My fault for not talking colchicine or NSAID with Allopurinol..? Probably.
My fault for even starting Allopurinol..? Who knows anymore.

Dissolving, Debulking, Dislodging, De-Whatever you call it.. Sometimes I think to myself this Allopurinol bulls*** really took me to the cleaners 🙂

Whoever is about to start Allopurinol please do not let the above deter you.

nobody – where are you based by the way..? 🙂

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@nobody – yes the injection was just for the pain and not for the inflammation. Even if you did take it for the inflammation it will ultimately solve nothing. Pain relief would come from it and ultimately it will come back unless we solve the UA crisis. Moving onto the MRI Ultrasound, the thing is I already had an ultrasound (twice in fact) once when I had my second attack to aspirate fluid which they couldn’t do and a second time long ago for pain. Fortunately returned a negative response for damage. Now an ultrasound wasn’t done for this particular situation however..! I have managed via my GP to arrange an ultrasound scan alongside the MRI. I agree about any fool can take an MRI however a qualified dude is required for an Ultrasound but the same analogy can be applied to a professional photographer with a rubbish camera or an amateur photographer with all the latest photo enhancing technologies camera. The point I’m making is the outcome of the MRI is simply more detail :). If ULT is 99% the right thing or not well I really have no idea? I mean you took febuxostat so you’ve got the best advice I can ever get about it. I mean I could potentially wait to see what both scans have to say but that would be another 3 week delay in starting febuxostat. The way I see it would be start ULT with febuxostat shortly after the Vitamin E test and then just take either colchicine or NSAID on the side which would ultimately protect me from acute attacks and maybe even solve the current pain.
How does that sound?

@Keith – I think your absolutely right on this point as I also forgot to mention that my rheumatologist suggested that gout pain control is very much down to the individual patient and how they find relief. So while one may find they get better or quicker relief resting another may find they get more faster relief by getting on their feet as quick as possible. Damage on the other hand is harder to predict. I would assume that how long you have had gout and what treatment was taken in the past will impact whenever or not forcing oneself to keep moving during an acute inflammation is actually counterproductive. I think the longer you have had untreated gout the more likely you might actually cause damage. But again, I am just drawing up scenarios in my head. The best way as you say would be to actually study it using a broad range of people over a period of time. 🙂

[d q]

@Keith @nobody – I just wanted to update you both on this.

After speaking with my haematologist Vitamin E is indeed a powerful anti-oxidant and prevents from damage to cells. Now how it will apply to the break down of cells in healthy patients I can’t answer.

The mechanism is all about how it protects cells from oxidation and prolongs the life of cells therefore decreasing the release of uric acid release from there rapid breakdown. The general idea is mainly applied to people with secondary gout as a result of blood condition disorders. I am not sure however if they apply to medications that accelerate blood cell breakdown such as chemotherapies in cancer patients etc.

By no means are my ideas medically based neither are they provided as treatment options by the doctors I see but from my understanding I can see potential gains (decrease in UA) they may provide.

I’ve started a short 3 week course of Vitamin E (400IU) prior to starting febuxostat and I’ll be measuring my blood UA levels in another week or so.

I’ll update you and nobody with the results soon. Should be interesting.

[d q]

@BigA – I know your question is directed to nobody but I just want to step in and explain since my symptoms are almost identical to yours in the way of inflammation and ongoing pain until today. My rheumatologist described this as an ongoing low grade inflammation and that it may never resolve itself until you take ULT (uric acid lowering therapy) such as Allopurinol or Febuxostat (there are other drug options that work in other ways too). He mentioned that when UA drops low enough all residual pain should settle. I’ve even gone as far as decline that possibility and forcefully tell my rheumatologist I want an MRI to confirm if there is permanent damage done since him starting me on allopurinol or not (I got hit with a savage attack at 300mgs and then during the same attack increased further to 400mgs).

I know you are not keen on taking a tablet a day and believe me neither was I as I have had a bad experience on allopurinol and had to stop it (side effect issue). I will be soon moving to febuxostat but in all honesty, you will never beat gout alone. Your body simply cannot get rid of uric acid quick enough or it over produces the stuff. Diet, homeopathy, supplementations all decrease uric acid but all it takes is for you not to have access to the above (or an allopurinol tablet) for uric acid to rise. If you are border line Good / Safe levels then yes, I would most definitely try homeopathy first otherwise it really is a tough battle mate.

If you are going to take a Colchicine tablet daily to help with your inflammation then it may be best to throw a 100mg allopurinol tablet into the mix and get your uric acid lower. That way you’ll get the best of both worlds.

Always speak to your rheumatologist for dosage guidelines however.

Cheers.

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