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That’s good news Mark. I think it’s impossible to identify single factors for gout recovery. Just as it’s often impossible to identify single gout causes. Gout-friendly lifestyle means a balanced lifestyle. So, healthy diet, in it’s true sense of the word, means eating that matches exercise. And, where moderate exercise is built into everyday living. With occasional regular exertion, to promote cardio-health.
I’m intrigued by the phrase “10% vegetarian”. Does that means 10% of your calorie intake is dead animal flesh? Also, I’m guessing your healthy lifestyle means you’re not overweight? Excess human flesh is a huge source of uric acid. Which is one reason for vegetarians with gout.
Thanks for continuing to share your progress Mark. I hope it encourages other gout sufferers to see that healthier lifestyle can significantly improve gout.
Malcolm, I’m sorry that my information about gout groups is confusing. I will correct that, but it might take a couple of days. I should make it clear that groups are just my way of organizing gout sufferers. When I know which type of gout sufferer you are, I can make my responses more meaningful. I hope you can be patient. I’m on vacation at the moment (currently New Orleans), so my time is limited.
On your blood pressure, I had a relevant experience. This might not apply to you. But, I have what is often called “White Coat Syndrome”. When someone measures my blood pressure, it rises. For me, this was proved with a 24-hour portable blood pressure testing unit. So, when I need a blood pressure test, I perform my own test on the equipment provided by my doctor.
I’ll answer your other topic as soon as I can, Malcolm. But, you are already in the Gout Recce Group, if you are trying to decide between pharmaceutical, herbal, or dietary gout treatment. In practice, gout sufferers often choose a mix. If you already know which type you prefer, you ‘move’ to the appropriate group. Then, we can determine the best therapies for your gout pain, and for controlling your uric acid.
An interesting addition to the gout-gallbladder debate was published a year ago. “Сhronic cholecystitis and gout -an unfavorable tandem with dangerous consequenсes.” is an investigation into bone degeneration when gout sufferers also have inflammation of the gallbladder (cholecystitis).
Unfortunately, the published gout research is a translation from Ukrainian. However, I think the meaning is clear:
Due to common pathogenic mechanisms of both diseases, one of the dangerous consequences of such a tandem can be osteodeficit. Both the chronic
diseases of the gallbladder and gout arthritis significantly associated with
osteoporosis. The negative impact of osteoporosis on quality and duration of
life, significant economic costs of treatment and social adaptation of patients make this problem as topical for doctors of any specialties.Don’t ignore gallbladder or gout problems. Both can lead to significant bone loss, if not treated early enough.
That sounds great to me. And, I must try it when I return from vacation.
I’ll probably substitute mixed beans as a protein source. With occasional tuna/salmon. Maybe pulled pork or brisket once or twice a month. For the other ingredients, I worked out broccoli. But, what’s Sarata? Is it Sriracha Hot Chili Sauce?
Maurice, I can’t tell you how happy I am with your positive tone. I’m looking forward to you posting a message in future that you are free from gout. And, I hope you’ll return to encourage other gout sufferers to follow in your footsteps.
As for the allopurinol dose increase, I went from 300 to 600 to 900. That sequence fits the tablet size. 2 weeks after each dose increase, I had blood tests. Uric acid test confirmed that my uric acid level continued to fall. Kidney function and liver function tests confirmed I had no side effects. Those 3 tests are important for all gout sufferers at least once a year. And, they should be repeated whenever medications are changed. Changes include new medicines, or dose increases.
Any new gout patients reading this should note that my 300mg allopurinol dose was preceded by 100, then 200mg. And, if you are of Han Chinese, Thai, or Korean descent, you should get a genetic screening test before starting allopurinol.
There is no advantage from splitting allopurinol doses during the day. Allopurinol breaks down very quickly in the body to oxipurinol. Both help reduce uric acid production. Oxipurinol stays in the body for up to 2 weeks. The implications of that are:
1) It doesn’t matter too much if you miss one day (but try with all your might not to!).
2) Blood test results need 2 weeks after dose changes for results to be accurate.Good luck Maurice! It sounds like you are well on the way to becoming a Gout Champion. 🙂
I’m really pleased to read your positive feedback. If you cannot find a better doctor, we will just need to train the one that you have got. I can provide appropriate medical references if that helps.
Let’s see how 80mg Uloric works for now. In particular, you should get blood tests to check everything is OK. Maybe 2 to 3 months time would be good for that, unless your doctor has advised sooner. Blood tests should include uric acid, kidney function, and liver function. It’s important for all gut patients to get those blood tests at least once a year.
I’d be very interested to read your tips for ant-inflammatory diet. And, I’m sure thousands of GoutPal readers would also like to know more about that.
I’ve got quite a lot of gout shorts to catch up with, in the Helpdesk. But, I would rather split them into different topics for each gout group, if I can.
So, I will just use this topic for short gout questions that do not give enough information to decide the best gout group.
I welcome all gout questions, and feedback about GoutPal. But, if you do not give me information about yourself, I cannot give you good answers. Gout management has to be personal. There is no single treatment that suits every gout sufferer.
So, please give your questions, and comments, enough personal information to allow me to answer you properly.
Uric acid in the 6 to 7 range is hell. You get old crystals dissolving. And, you get new crystals forming. Both those cause gout attacks. So, little wonder you are in constant pain.
Hopefully, your new doctor will prescribe an effective uric acid lowering treatment that gets you safely under 5. It’s not rocket science, so I don’t understand why every doctor can’t do this.
Unless uric acid is controlled properly, gout gets worse every day. That means it is harder to control the pain. That is why you see colchicine failing to stop gout pain completely. That is why, in serious gout attacks, I say it should be supported. An NSAID such as ibuprofen, naproxen, etc is good. Then, pain blocker such as acetaminophen/paracetamol. There are lots of combinations that work. Your doctor should review your medical history to suggest the best combination for you.
There is no excuse for gout pain in 2017. But, it needs clear analysis of the facts. And a flexible approach that is based on individual needs. I don’t know enough about you yet to suggest anything more specific.
Keep posting, and I’ll get to know you better.
To control gout permanently, you have to get uric acid below 5mg/dL. Start by posting uric acid test results.
Allopurinol and Uloric are 2 of the drugs available to control uric acid. The dose has to be high enough for you to get uric acid safe. There is no standard dose – you need the dose that is right for you. Wrong dose is the usual reason why gout never gets controlled.
As Michael says, it takes many months for uric acid lowering drugs to work. During that time, you need proper pain control. The best gout control needs a 3-line plan of attack. That is:
1) Stop inflammation getting worse (colchicine).
2) Reduce inflammation, which also reduces pain (NSAIDS).
3) Block residual pain (analgesics).Your doctor should be able to prescribe a package that is safe and effective for you.
If you need clarification, or more help on choosing the right combination for you, please ask.
There are enough people around who suffer gout like this for it to have it’s own names – recalcitrant gout, intransigent gout, or refractory gout. As far as I know, they all mean the same thing. Ie, gout that cannot be treated by common uric acid lowering therapies.
But, my first question is, what have you tried so far? My second question is, what were your uric acid excretion test results?
Krystexxa is very effective. But it’s far from perfect.
I’d need a lot more detail to say if Krystexxa is the best choice at this stage. Excess uric acid is dangerous. But, only a very detailed analysis can determine if the risks of Krystexxa outweigh the risks of untreated excess uric acid.
Maybe you could add a bit more information, Greg?
Hey, thanks Maurice. It’s nice to get some positive feedback.
My dose of choice might shock you, but there is logic behind it.
First, I started allopurinol properly with a low dose, and increased gradually. Also, I’m not in one of the racial groups that are advised to take a genetic screening test before allopurinol. I say this, not in answer to you. But, other gout sufferers will read this, who are concerned about allopurinol side-effects. I’m not susceptible to any such side effects. So, I see no limits to allopurinol dose.
In the UK, maximum advised dose is 900mg per day. In the USA, it is 800mg per day. Gout PAtients should note that this is not a medical maximum. Under medical supervision, with appropriate liver and kidney monitoring, a specialist might prescribe higher doses.
In short, my dose of choice is 900mg per day. Then, once visible tophi have disappeared, and pain symptoms have gone for six months, the dose can be lowered. At that stage, you can be almost certain that the uric acid burden has dissolved. So, all you need is an annual check for uric acid, liver function, and kidney function.
Of course, a doctor might feel that there is no reason to go for the maximum dose. In that case, I would ask for evidence that a lower dose is better.
Essentially Maurice, it boils down to what you are most comfortable with. You are clearly on the road to recovery. So, it’s up to you if you want to proceed with caution, or race ahead. Either way, it’s a good place to be, compared to most gout sufferers.
“I am struggling to find my way around the website which, whilst informative, has left me decidedly confused as it contradicts what a lot of other sites says.”
I started GoutPal as a personal project to understand my own gout. I encountered a lot of lies, half-truths, and ignorance. So, I used GoutPal to record my research. Thus, I learned the truth about gout management:
1. You can only control gout through making uric acid safe. Medical science gives pointers to safe levels. But, ultimately, each gout sufferer must have their own personal target.2. Gout pain starts years after uric acid began to form crystals. It takes many months to reverse the buildup of uric acid crystals. (There are rare exceptions where that period can be reduced to as little as 6 weeks, but I shall ignore that as it does not seem to apply to Malcolm). I usually refer to that time as the debulking period, or reducing the uric acid burden. During the debulking period, gout sufferers need effective personal gout pain control.
Most websites ignore those basic gout management facts. Also, many doctors stay with out-dated custom and practice. From that mess, we read reams of misinformation about gout. People start to believe that gout is an eating disorder. They start to believe there is some type of “accurate and detailed list of foods as I need to loose weight, lower my blood pressure and my uric acid levels”.
Life does not work that way.
Diet can play a part in an individual’s gout treatment plan. For a small number of obese gout patients, it might be the only therapy necessary. But, for most gout sufferers, diet plays a supporting role.
Malcolm, you’ve found GoutPal during a period of transition. I no longer need GoutPal as a personal project to understand my gout. I now understand gout better than most frontline doctors. So, my aim is to turn GoutPal into a resource for all gout sufferers. I estimate that will take me 5 years to complete. It’s up to you how you use my gout support services:
A) Anonymous gout help. Read GoutPal facts, and discuss them with your doctor, or other health mentor. You’re one in a million that’s stepped beyond that, Malcolm. I’m extremely grateful that you’ve taken the next step.
B) Casual gout help. Ask questions, or share experiences and opinions about your gout. That’s exactly what you have done here. For my part, so I can make advice as relevant as possible, I think about Gout Groups. The groups are just my way of providing a logical structure that leads to understanding, and resolving gout. I’ve found that this helps save time. For example, there is no point discussing allopurinol, if you have decided that herbal medicine is right for you. In your case, Malcolm, you might want to be a Gout Dieter. But that involves learning to eat healthily. And it needs you to understand that yesterday’s lambs liver has little to do with today’s gout. It has more to do with what you ate last year, and before.
C) Structured gout help. Ultimately, every gout sufferer needs personal gout therapies. Therapies for uric acid control, and gout pain control, that reflect individual needs, and changing circumstances. So, the Gout Groups I mentioned are just a starting point to help you develop your own personal gout management plans. You can do that yourself, or with your doctor. Or, I can take the role of gout mentor. For me to do that, I have to learn about you, while you learn about your gout. It requires a lot of commitment on both our parts. (That’s time commitment, not money. I don’t charge, but you do have to commit to frequent posting).
The best way to control gout, is one step at a time. It might seem tedious, when all you want is a quick fix. Certainly, I can give you my quick gout fix. I guarantee it will make 2018, and the rest of your life, gout-free. But, is it right for you, Malcolm?
Anyway, I’m guessing you belong to the Gout Recce Group, for now. It’s up to you what you want to do next. Ask as many questions as you like. And, ask for clarification whenever my comments don’t make sense.
Hi Maurice,
Thanks for all that information. I know it’s heartbreaking if this happens when you are doing everything right. You are lucky to have a doctor that seems to understand gout well. His explanation is correct. And, I refer to that uric acid crystal clearing process as “urate clearance”. Or, reducing the uric acid burden. But, it can’t answer your “How long does this process take” question.
Truthfully, nobody can. There are too many variables. But, I have made up a ‘rule of thumb’. Like all such rules, it is a little vague. I tell recovering gout patients, like you, to expect urate clearance to take about one month for every year you have had gout. Then, the only truth is “the lower your uric acid, the shorter the period for urate clearance”
Because of that, I personally chose to go for maximum dose allopurinol, in order to minimize the time at risk. My doctor gave me full support in that, but I had to try with 3 others before I found a doctor who understood the biology.
So, using my rule of thumb for your urate clearance period. I’m going to guess your gout started when you were around 30. But, I guess your symptoms started many years later. You started allopurinol in January 2016. But, your uric acid will not have got down to 5 immediately. I’m going to guess April 2016. Therefore, my rule of thumb says, 30 months of urate clearance takes you to October 2017.
Obviously, that’s all speculation. There might be a particularly well-hidden cluster of crystals that trigger a small attack on New Years Day 2018. We just don’t know. As I’ve said, you can reduce the risks of an attack. But, it’s always best to be prepared.
If you are the type of person who listens to your body, you’ll recognize the early twinges of an attack. In that case, there is no need for prophylactic gout pain therapy. That also applies if you are confident that you can control an attack quickly, once it starts.
If not, prophylaxis for a few weeks/months might be the answer. But, you have to weigh up the pros and cons with your doctor. Personally, if I was opting for prophylaxis, I’d also insist on an allopurinol dose increase. That might raise the risk of a flare in the short term. But, it would reduce the period of time that prophylaxis was required.
Again, there are no rules for how long it takes. So, I’m going to make up another rule of thumb, on the spot. If you get uric acid down to 2, change the rule to one week of risk for every year of gout. It’s very hard to be precise, but I hope this explains the controllable elements.
That should give you the information you need, Maurice, to improve your gout treatment plan. But, if you need me to clarify anything before you see your doctor, just ask. In particular, I’ve had to guess at things like current allopurinol dose, uric acid test dates and values, etc.
I’m here to help you make the right choice for you. And, we can discuss it whenever you feel the need.
Patrick is absolutely right. It’s really a question of interpreting the language.
This is especially true with tests like liver function and kidney function tests. A good doctor looks at what is usual for the patient, and reacts accordingly. If there is only one test result, it’s hard to know what is “normal” for that patient.
I emphasize safe uric acid levels. But, when I said “assess your safe uric acid level” I didn’t emphasize the personal nature of that assessment. For most people, prolonged periods of uric acid under 5mg/dL is safe. By prolonged periods, I mean every year. But, for people exposed to very low temperatures, that safe assessment might need to be revised downwards.
Rule 1. Gout Treatment must be Personal.
Rule 2. Don’t let language get in the way of acceptable medical management.I think a snappier version of Rule 2 might be “Never Accept Normal”. Because, it is perfectly normal to be ill medically. Though, it is abnormal personally.
But, all I’m really doing is re-wording Patrick’s closing paragraph. His opinion is very sound advice. “Try and get your Uric Acid below 5.0 and the chances of having Gout attacks are lower than they would be if your Uric Acid is 8.0. That’s the reality.” It’s the foundation of any sound gout treatment plan. So, ignoring that advice makes you a Gout Victim. To avoid being a Gout Victim, you should know what is your personal safe uric acid target. Then, you should monitor whichever uric acid control therapy you choose to ensure it stays safe.
Patrick mentions lowering your chances of a gout attack. Every gout sufferer can lower those chances of attack to zero. I’m here to help. But, I can only do that effectively when I know about you as an individual.
So, let me bring this back to the original questions “Is it possible to get attack when the uric acid level is normal? Is it possible to get gout attack in third finger joint.”
Both those are possible. Your doctor should be able to explain that. And, explain how to avoid both possibilities. If your doctor can’t explain, then Patrick or I can. I hope 2017 encourages other recovered/recovering gout sufferers to share their personal experiences.
Happy New Year, everyone.
You know, I get really angry about “normal uric acid“. So angry, that I started that campaigning website to try and remove the phrase from our language. No chance!
But, I now realize, it’s a language problem.
Normal does not mean OK, though it’s often interpreted as such. Thus, it’s normal for traffic accidents, heart attacks, cancer, war, and many other unpleasant things to happen. So much so, that any area free of those things for an extended time period is considered unusual, or abnormal. Thus, any gout-free country would be abnormal.
Achieving normal uric acid simply means that your chances of having gout are the same as every other patient who has blood tests processed at the particular laboratory. This might have some value for the administrators of your health practice. And, for the health department of your government. Those administrators might assess their performance. Which has nothing to do with individual patient needs.
On a personal level, “normal uric acid” has absolutely no medical value whatsoever. It is medically meaningless.
Gout patients must aim to get their uric acid safe.
I strongly recommend you use my help in these forums to assess your safe uric acid level. Then, we can get your doctor to give you the right uric acid lowering treatment to keep you free from gout.
Failure to make uric acid safe reduces both the quality and length of your life.
In a group of doctors I used to go to, only 1 doctor that I saw agreed that 7mg/dL was high enough to warrant treatment. The other 3 thought it was acceptable because the lab reported it within the normal range. It is impossible to avoid the life-threatening risks of gout when uric acid is as high as 7. Yet 3 out of 4 doctors manage by numbers, rather than by patients needs.
André, your emergency doctor was right to generalize that “uric levels are not fail-safe predictors”. But, in most cases blood test results are reliable enough to dictate appropriate treatment. And, cases of uric acid above 6mg/dL that do not warrant treatment are exceptional. As far from normal as you can get.
Oh dear Chris. I was going to suggest that might be the case. It does not always happen, but is quite common. Sometimes our immune system copes at the dull ache stage. Other times, it can’t cope. Then, inflammatory agony occurs as our immune system calls for reinforcements.
If you learn to recognize it, early pain treatment is always best for gout pain control. If you need help formulating an effective gout pain control strategy, please ask.
You need uric acid control asap. Talk to your doctor. Then, as for clarification/affirmation here as you need it.
Thanks James,
Also, thanks for reposting here from the Helpdesk. It’s saved me a job. That might not sound significant, but every little helps when you’ve got presents to wrap.
I’ll give short answers for now. Then, people can ask for more information if they need clarification.
1. Yes, you can do that. At least one eminent rheumatologist has suggested that intermittent uric-acid lowering treatment will become common in future. From memory, he was suggesting annual treatment for a few weeks.
There are dangers with this approach that need to be carefully managed. The biggest hidden danger of excess uric acid is joint damage. Al joint tissues are susceptible. I wrote about tendon damage in gout. But, cartilage and bone will suffer the same fate.
Therefore, the intermittent allopurinol strategy could avoid gout attacks. But, it could raise the risk of bone damage. We also now understand heart valve issues better where they are attacked by tophi. I’m not certain how soon that becomes an issue, when uric acid rises above the safe level. Current research is limited. However, now that pathologists are starting to understand the fatal nature of gut, this issue might get more attention.
To me, daily allopurinol seems a small price to pay for heart and joint safety.
2. That seems to add weight to my response to 1. If you share the links of what you’ve found so far about “about Thalassemia and Gout / Uric Acid?” I might be able to do more research.
3. Perfectly true. Wise rheumatologist. But, gout sufferers need personal management. So, purine intake control can work in rare cases. If the person’s gout is managed properly.
4. No, this is about the conversion of purines into Uric acid production by our enzyme, xanthine oxidase. Allopurinol inhibits that enzyme. Unconverted purines are pissed away.
5. No, sorry.
I hope that helps, James. Please feel free to ask for clarification. And, post more questions as you think of them.