How Do I Make My Doctor(s) Understand?

[brandy]

I have recently been diagnosed with gout. I am a 31 year old female. It is in both my feet. It usually starts in the ankle and ends up on the top of my feet and inside my arch up to my big toes. My grandfather and uncle also have gout. I do NOT eat shellfish, liver, etc. I do eat an occasional hamburger. I do not drink at all either. I mostly stick to chicken and ground turkey. 

I do take Dyazide for borderline hypertension. I have read more than once that this can make gout worse or even cause it. I have taken it for three or four years now and summer of 2008 was my first attack – now that I realize it is gout, I can look back and tell that is what I was going through. 

The doctor that originally prescribed me the Dyazide says that none of her other patients have complained of gout and she does not feel it is the cause. The doctor who diagnosed me with gout feels that the Allopurinol (300mg a day) he put me on will counter act the gout affects that Dyazide causes. 

When I was first diagnosed my uric acid level was 12.3. Two weeks later it was 7.6. It is going down, but the doctor wants to see it get to a 6. Two weeks after my second uric acid level check (which again was a 7.6) I had a flare up. Is this because of old crystals? Dyazide? 

What should I do to talk to my doctor about changing me to another water pill? Think the Dyazide is the cause along with family history?? HELP!!!

[zip2play]

Your first doctor is the worst kind of quack who diagnoses by AVERAGES, as in MOST of my patients don;t get it, WOMEN USUALLY don;t get gout = you don't have gout. I had one like that tell me that MOST upper repiratory inferctions are VIRAL>>>therefore I don;t have a bacterial infection.

A google search for averasges is more useful than doctors like this.

Dyazide causes Gout, plain and simple. It causes it frequently. Thiazide caused mine and hydrochlorothiazide is the main diuretic in Dyazide.

Of course a uric acid of 12.3 is GOut City…and so is the 7.6 for a woman.

What happened is that many crystal have crystallized out over the time you were on dyazide and it will take some time for the allopurinol to resolve this. It is likely that you will need to lose the diuretics (I know, not easy) so a search for another class of effective antihypertensive is your next order of business, perhaps an ACE inhibitorif you donlt cough from it…cheap and effective for the majority of people. If your old doctor persisits in the Dyazide nonsense tell him that “doctors should crack open a book every decade or so.” He'll get your point.

Now the problem: about 25% of the population is “salt sensitive” or “volume driven” and for this minority, no antihypertensives work as well as diuretics. If you MUST have a diuretic, I recommend a switcht Lasix, a LOOP diuretic, which retains less uric acid.

For flairups of pain ask your doctor for an Rx for colchicine, it stops the attack in its tracks.

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