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My thoughts to a couple of your responses above.
A UA at 4.0 or less is very, very low. I personally would not try to get it lower. Lots of people do take more than 400mg a day – though this is usually a 300mg dose in the morning and second at night. In most of those cases it is for people will moderate to severe tophi. I don’t believe this is your case.
Getting your UA lower for a few months wont help because it will come back as soon as you stop taking the Probenecid. Your body has a natural UA balance and with time you will automatically return to that balance (though on Allopurinol that number is lower than it would otherwise be). There isn’t much you can do to stop it from going up to that balance point. Most foods have some level of purine level even if very small that you just wont be able to avoid.
Without knowing more about you, here are the key things anyone will gout should be doing.
1. Lose the weight. The majority of gout sufferers are above their ideal weight range. You will have less gout if you lose the extra mass. (though you may experience several flare-ups as the weight comes off)
2. Drink enough water. Keeping your system fluids high will help your kidneys flush the uric acid more easily.
3. Exercise. Movement, increased body heat, increased heart rate, etc…breaks up or “melts” uric crystals so they can be flushed.
4. Consider (with a doctor) NSAIDs that will reduce inflammation so the blood will flow more easily through your system.
5. If you are taking the 400mg all at once, consider moving to 200mg twice a day to keep the drug level more uniform in your body.
6. Time. It sounds like you have several things going on at once. The general change of lifestyle you are going through will start to show results eventually, but it will take time (especially as we get older). Its not a sprint but rather a never-ending marathon. (ugh!)Just food for thought. I hope it helps!
Short answer: Yes – a joint injury can cause a gout attack.
Any injury to a joint can cause a gout flare. The swelling associated with the injury (even very minor swelling) causes changes in how the blood flows through that area. As the swelling increases the blood vessels get constricted causing more uric acid crystals to build up (like a beaver dam) in those areas.
My very first gout attack came shortly after stubbing my toe really bad (bad enough to lose my big toenail). I thought I had broken my toe and went to the emergency room.
The rush of white blood cells (which are several times larger than red blood cells) to that area can also cause roadblocks and general circulation changes. Fortunately the NSAIDS you take for your injury will also help with the gout pain.
Not knowing anything about your specific gout I can only hope you are taking Allopurinol to get your uric acid number lower. If not, only time will help the pain go away (though the gout is still there doing damage to your joints).
I find the meter to be more accurate for several reasons.
1. I am able to test myself at a consistent time and circumstance…meaning right after my morning shower, but before any food or drink. Your UA will fluctuate over the day and things like exercise can cause the numbers to change.
2. Testing is more frequent and provides a better overall trend view than the snapshot doctor test.
3. Just because the test is done at the doctor, it does not make it more accurate. The blood in your home test is at body temperature, whereas most doctor offices will chill the blood or let it sit at room temp until it can be tested. With UA the temperature change can cause changes to crystal formation.
4. You know what you have been eating or drinking. Your doctor visits may coincide with peaks due to a recent meal choiceIf you are truly concerned, try recalibrating your meter to a different test series and then back again and retest. Also, make sure you are using the correct droplet size. Too small of a drop can throw it off. Make sure your hands are properly clean and dried and that you have not contaminated the test strip with improper handling (touching the test area is a big no-no).
I would trust my meter over my doc any day when it comes to UA.
@Deano
You have uric crystal everywhere, not just the places it shows/hurts. So as those crystals dissolve back into liquid uric acid you will experience flares and pain in many location. That said, that phase is normally measured in days so if its not getting better then there may be more.More?
Yeah, depends on what else is going on you didn’t mention. Frequently people who are diagnosed with gout will make several changes at once. Their diet changes, they start exercising more, weight begins to drop off, they started some other medications for other conditions diagnosed at the same time and other things that would all play a factor.
Additionally, you didn’t state your dose. A 7.9 to me would warrant a dose of 300 or less once per day. I started off at 100mg daily before ramping up to 300 after a year or so. A big dose right out of the gate can cause a large amount of change in your uric acid levels.
Spend the money on the home kit. Its worth it. Test once a week at first in the morning after your shower (or at least make sure your hands are real clean), but before eating. This should give you a consistent sample to compare to other test results.
One last thought – pain in your lower back and shoulders could very well be from changing the way you walk because of the pain in your big toe. My back hurt like hell because I was trying to keep pressure off my foot when standing.
@Beth,
As an outsider reading your post…what I read was salt, salt, salt, salt, and more salt. Salt-fermented pickles, lox, fish, teriyaki sauce, more fish…plus whatever you added from the salt shaker at the table. Ethiopian food tends to be salty also.
I have no concept of the health risks of salt beside high blood pressure, so I wont comment other than to point out that it seems to be very prevalent in you diet.
Just a thought.
Ah. Makes sense now. Quite classic really.
You had gout (prior to the attack) but had not yet reached the uric saturation threshold to cause an attack.
Think of it this way. Uric acid crystals live in your bloodstream. If you have 6 liters of blood in your body to support your original mass. That 6 liters held a large amount of uric acid. Once your mass starts to decrease, your blood volume will drop proportionally (slightly more slowly than the weight loss), but the uric acid volume in the blood does not drop as the blood volume drops. Therefore it becomes more concentrated which leads to crystal formation which results in 9 weeks of pain.
It will come down eventually, but unless you get on some sort of uric lowering medication (aka allopurinol) it might be a while before you are back to “normal”.
I would pause your weight loss until you get your pain under control. If you keep losing, you will keep having pain. Once the pain stops and you get on the medication, you can continue losing weight. (It is very common for gouties to have an attack during a period of weight loss)
Changing your diet will be a big help. On the plus side, I think you are near the end.
One other thought, (based on my own experience) be sure to flex the joint you feel the pain in. I know you are tempted to baby it, but instead try to purposely work it. The more you use it, the looser and less painful it will get.
I am sorry to hear the drugs are not helping. Here are some things to consider.
1. Cherries, baking soda, celery seed and so forth are all things to help lower your overall number but they are not miracle workers. They wont drop you 5 points or even necessarily 2 points. In general they are good for maybe a point and in general helping you maintain a lower number. If you stop taking them, your number will pop back up.
2. Try bigger doses of the anti-inflammatory. Yes, too much can be bad for you, but if you take it with food, you can do it for a few days at least without any sort of long term problems. I am a fan of mixing different types during the day if I am in a lot of pain. Naproxen, ibuprofen, and so forth. Just don’t do Aspirin since it is a blood thinner.
3. Drastic diet changes. You wont get better unless you change your diet for the long term. Eliminate the red meat, sausage, gravies, alcohol and shellfish (plus any others that increase uric acid). Salad is no longer a side dish…its the meal.
4. Drink more water. The more you drink the more uric acid your kidneys can flush from your system.
5. Try a hot soak. The crystals dissolve at higher temperatures. Do frequent long/hot soaks to see if you can get them to dissolve and reform in some other place. As hot as you can physically stand.
6. Buy the uric acid kit. It isn’t that expensive and monitoring your numbers is the only way to know if you are actually improving or not. Pain just isn’t a good indicator.
7. Exercise. Yes, this one sucks when you are hurting, but increasing your heart rate opens your capillaries and increases blood flow which will either dissolve the crystals or let them flow somewhere else.
8. Weight Loss – I have no idea how big you are, but 90+% of us on this forum are overweight/obese so I will assume you fit in that group. The more weight you lose, the better your gout will be. Shed the pounds and you will generally shed the pain. (with a few notable exceptions)
9. Drink more water. Yeah, I know I already said that. I cant stress it enough though. If it has anything besides H2O in it, it doesn’t count as drinking water….that’s just drinking.
Good luck! Keep us posted!
Additional notes to OP….
#1 – Get a home uric acid test kit. They are not that pricey and worth it. Keith has links somewhere in this site. I test once every other week or so in addition to the testing done by the doctor during my annual visit.
Once you have gout you have it for life. Regardless of what you do, you are never cured. You just don’t experience physical discomfort for a while – but damage is still occurring. at 10.7 I would be surprised if you aren’t developing tophi and just dont know it. You can diet control diabetes and you can diet control gout to the point where you never experience pain, but they differ in that gout is still grinding away on your joints even when you dont feel it.
#2 – I am with Keith, you should up your dosage until you level off at 5.0 or less. Push your doctor to give you more. Remember that doctors are generalist by nature?and frequently dont care about your uric number as long as you aren’t experiencing pain, but damage could still be happening. You need to take control and let them know your expectations.
Yeah taking a drug every day sucks ass. But Allopurinol is one of the oldest and?safest drugs on the market.
I am going to chime in for the first time in years. I have been a member of this site for at least 4 years or so…ever since I was diagnosed with gout (under control with 300mg Allopurinol daily). I remember when hansinnm joined. 🙂 I get the daily email summarizing each day’s postings so I dont visit the site very often anymore except when intrigued by a particular thread.
Hasinnm is both right and wrong. Up until Keith started this site, the information at our fingertips was sketchy and random. Most of it coming from doctors or friends and none of it comprehensive.
Then Keith started this site and a community was born out of the need to coordinate our learnings and seperate the truth from the BS. (I was glad to one of the many praying for him when he took a swan dive to the pavement below his flat.)
A second revolution quitely occurred in the last couple years. Now that new drugs are coming onto the market and more resources become available for gout sufferers, the need for a community is evolving from the (now fairly comprehensive) Wiki-type knowledge repository to a?place for a new diagnosis to get all they need to know while the regulars slowly determine if the new crop of drugs is really an improvement over good old-fashioned Allopurinol. (I would say they are worse…) And build a consensus about how effective they are.
Anyone new to gout can find pretty much everything they need to know in the existing posts and never have to join the community. We have become a gout-wikipedia.
Keith does this out of passion and I am ever grateful for it. I do not begrudge him defraying his costs by slapping a few ads on the page.
What you are seeing is this…All this passion has turned Keith into an expert on gout. All the knowledge and research and discussions about the various treatments has absorbed into his head until he can provide most new people with the information they need right out of the gate instead of the flailing in the dark we used to do just a few years ago. There is less of a need for many of us to write since most of the most important information can be communicated in his initial responses to new posters.
My opinion is colored by the fact that Keith and I beleive the same thing about allopurinol being the best treatment and all the “new” medications are not as good regardless of the advertising millions behind them. I am an allopurinol fanboy. Though, I feel that Keith should push lifestyle changes as strongly as his other advice.
Many of the old guard are still around. We just tend to watch from the sidelines now instead of jumping into the fray. 😛
Note to Keith: Push harder the life-style changes. I truely believe this was 50% of my success. Secondly, encourage them to report back what their doctors say or prescribe. It would help us see trends.
My two cents. I will wander back to my cave now.
The US Government has made a broad law that (unless specifically designed) no pill medication can have a shelf life longer than 36…..well, to be honest, they mandated that any medication that will be advertised as having a longer shelflife will need to provide a whole slate of additional documentation to the FDA in support of that claim. So the drug companies said screw it and now all medications have a expiriation of 36 months or less.
Your Pharmacy does not know exactly when each bottle of medication was manufactured or how long it sat in a warehouse before being shipped to them so they made a general rule that all medications expire about a year after the order is filled. Liquid meds have an even shorter life.
Thousands of tons of medications expire every year and are still completely effective. They are usually shipped to areas such as Africa where people could care less about some arbitrary date set by a government.
Assuming the botttle has not be subjected to moisture, high heat or direct sunlight for long periods of time, most pill medications last five years or more without a problem. If the pill is still firm and looks ok and smells ok, it is still probably good.
Worst case is that it begins to lose effectiveness as it ages. The half-life of most kinds of antibiotics is approximately 7 years. Meaning at 7 years you would need a double dose. I dont know the numbers for Allopurinol.
So, to answer your question. Yes, go ahead and take the older pills if they feel, look and smell ok. Take your normal dose. If it is slightly less effective…its better than taking nothing. Do not try to raise your dosage to compensate though because you dont know how much effectiveness it has lost and the danger of taking too much is worse than taking less than normal.
(full disclosure: I was an avid daily user of glucosamine until this thread got me researching it)
??????
Wikipedia has an excellent summary of the FACTUAL studies done with glucosamine. It distills down to this:
- —There are studies by the NIH that it does NOT help alleviate pain with most common types of arthritis.
- —A major NIH study did prove it DOES help with osteoperosis (reducing cartilage turnover)
- —That same NIH study also showed it does help with osteoarthritis when taken in combination with other medications.
- —If you are diabetic or pre-diabetic glucosamine BEYOND THE RECCOMENDED DOSAGE interferes with Insulin absorption and increases resistance to Insulin. It contributes to the development of diabetes.
So the benefits are gradual and mostly relate to helping cartilage growth and retention. It does nothing for pain.
Since it is not considered a drug in the US and is not regulated, every form of glucosamine available provides far more than the reccomended doses. Those high doses interfere with the bodies abilty to process Insulin. I have been taking it for a couple years and was recently diagnosed as “pre-diabetic”. I know my elevated weight and diet are the primary factors ? but taking the supplement daily only increased my risk of developing full-blown diabetes. Europe regulates it as a drug for this reason.
If you decide to take the supplement, get a smaller dose tablet or consider splitting the pills in half or thirds.
?
Like everything else in the world?too much of a good thing is always bad for you.
- Cant speak for others – but I only had a slight flare after two weeks and it last just a couple days.
- Yes, take allop every day whether you have an attack or not.
- Yeah, no one can tell. Thats what the naproxan is for. You should also take some indomethicin in your bag in cas of swelling. (need Rx from doc)
- I got tired at 10pm and slept like the dead for the first few weeks. Had some funky dreams. Unfortunately that went away – it was some of my best nights of sleep in years…
Go to Russia. Have a good time. You can help prevent a flare while you are there by avoiding red meat, shellfish and booze as much as possible. Also watch your salt intake (i.e. caviar) because that can be a trigger also.
Drink large amounts of water to keep your system flushed. That will also help prevent a flareup.
Bring comfortable/roomy shoes in case you do flare up and just be ready to hit the drugs. If you wake up at 5am and feel a twinge – dont wait…take the drugs with a big glass of water.
Ktimmermann said:
Hi, I'm a very keen triathlete…….Nothing has changed in how I train or eat……the only thing I can see in my food diary is I have swapped energy drink from High 5 to Power Bar powder drink…..Can anyone add to this? Has anyone else had this, especially cyclists, runners, walkers etc…?
Are there any studies about this or experiences by people on here?
Addressing the OP's question…and not the seque into chemistry…I offer a bit of fact and a lot of personal opinion/observation.
I ride heavily. I am currently training for the Seattle Portland bike race taking place on July 17th (~204 miles). I put in 30 miles a day for four days (T-F) and then a 70 mile ride on Sunday. I drink water and Gatorade and eat Clif bars during my rides. I also do the occasional sprint triathalon.
I am a 41yo former frat boy, my beer consumption is down to having a couple light beers once a week. I am also on 100mg of Allopurinol. I am technically obese at 6 foot and 238lbs.
Anyway, speaking from my own perspective here are my thoughts…
1. Watch the sodium intake. Too much sodium is a gout trigger. I take two bottles with me when I ride, one gatorade and one plain water so that I dont overdo the sodium. Think about other areas of your diet you can cut back on salt/sodium to compensate for your heavy intake while training.
2. Most would agree that a flareup normally happens 2-3 days after whatever trigger caused it. So when you get a twinge or attack think about what you were doing 2-3 days before and not just the previous day.
3. The problem with powdered drinks is that they do not dissolve completely after being placed into the water. So you end up drinking large free floating crystals. Since its a liquid drink it tends to wash through the stomach quickly without getting broken down by the acids and the intestines absorb it “whole” rather than microscopically. You have a “large” (relatively speaking) chuck of Maltodextrin, Fructose, Dextrose, Sodium Citrate, Citric Acid, Sodium Chloride, Magnesium Citrate, and Potassium Citrate floating into your blood stream…and the blood stream does not process the parts individually nor does it break it down further. It either uses it as is or it sends it to the kidneys to be removed. If a large chunk flows into a tiny capillary, it might not make it through and end up adding to gout as it stacks in with the other existing crystals.
4. If you are really stuck on using the powder there is one easy way to fix number 3 above…make the drink the day before and use hot water then put it into the fridge to chill. (note – dont put hot water directly in the plastic sport bottle because that has its own problems. Heat will cause the powder to dissolve completely and evenly into the water. Its the same reason why you make jello with hot water instead of cold.
5. Front load the sports drinks and then swap to water. If you have 15 minutes or less left in your training you should swap to plain water. It takes that long for the sport/energy drinks to make a difference anyway. I personally do not believe in continuing with the energy drinks after training and just hydrate with water. I know my body will automatically replenish anything it needs during the next normal meal (which is usually soon afterwards anyway)
I hope this provided you with something to think about. It sucks to see a good athlete still having to deal with flareup and attacks.
I am sure several of us will chime in, but here is my initial thoughts…
First off, by your user name “fatdom” I will assume you are (like most of us) a heavy male. Cutting back on beer while you take control is a critical first step and I want to acknowledge its importance. Everyone who has cut back on the beer has been more sucessful than those who have not. Eliminating beer alone though will not solve your gout problems and the rest of your diet needs to be self-examined. I personally modified my diet to eat less red meat (~1/3 as often and that is mostly by substituting ground turkey for ground beef) and avoiding shellfish as part of my lifestyle changes.
It would be helpful to know your uric acid numbers before Allopurinol and after you started taking 300 daily. Without those numbers we cant tell you if the flareup is because the drug is working well and flushing the acid out of your system or if 300 is not enough and you are having a regular gout attack anyway. 6% of people who start Allopurinol experience a severe flareup within the few few months as crystals begin to dissolve. Those usually go away and become less frequent as you get it under control.
Aches in joints that previously experienced flareups is also expected and will reduce over time also. Crystals form in EVERY joint – not just in the ones that had an attack previously.
The first couple months I was on Allopurinol I slept differently also. I was tired earlier in the evening and tended to sleep more deeply (and woke a bit more tired). That faded over time and I now sleep as I did before I started.
We also need to know what other drugs you are taking. Most of what you described do not sound like allopurinol side effects – but could be a result of a drug combination. (HBP? Cholesterol? Anti-depression? etc) Other than that, I cannot address the mood symptoms you are experiencing because that is too far outside my comfort zone.
As GoutPal said…Yes the numbers can go up as crystals dissolve. You will even feel some twinges as your body reacts.
Crystals come in two forms. The first type are free flowing in your entire bloodstream until they eventually collect loosely in joints or capilairies, but have constant access to regular bloodflow. The secondkind are the compacted ones that make up tophi and/or otherwise dont have regular access to bloodflow.
The first kind will be the first to dissolve. Once your UA numbers start to drop, these will begin rapidly dissolving back into liquid acid and get expelled. Once these are mostly gone, you will see your numbers start to drop again. It takes a long time to dissolve the compacted crystals – frequently years.
I suggest drinking more water for the next few weeks/months to help eliminate the liquid acid. If your numbers dont go back down, then you are producing new crystals as fast as the old ones dissolve. Eventually you want to stabalize at a lower number.
headusher said:
Unfortunately I think it's the same dosage. I'll know in a few days. The good news is that I haven't had a bout of gout in almost 2 months.
Also been watching what I've been eating.
This is the medical equivalent of a game of chicken you are playing. You are betting that you can hold steady with your diet and 100mg of Allopurinol and have no more flareups.
Reality is that you are playing chicken against a train on railroad tracks. The train isnt going to blink first…
Here are my problems with sticking with 100mg.
1. Above a 6.0 means you are still building crystals in your body. Even if you go a while without an actual flareup – you are still causing damage to your joints with crystal formation.
2. Tophi can still develop even in the absense of a painful flareup.
3. When you finally do get another flareup it will be a truly nasty event. There is a reason why the first time is the worst – years of slowly building up until the dam bursts in an orgy of pain. The next time it is likely to be more than just a big toe…knees, elbows and other joints will flare also because they have had just that much more time to build up crystal deposits.
4. No one can be perfect with their diet forever. You will find it wont take much to push you over the line “accidentally”.
5. Even if you are perfect with your diet – your body is continally changing. Your attack threshold is a moving target depending on everything from what you ate recently to how much water you drank to whether or not you exercised. There are more factors than you can control.
These are the reasons why most of the regulars on this site advocate a sub-5.0 average. Less damage to joints via crystal formation and the freedom to enjoy a robust diet that allows a moderate consumption of the “bad” foods (red meat, beer, shellfish, etc).
headusher said:
zip2play
I've been taking 100 mg of allopurinol for a month. Waiting for a new prescription to come in so I'll be out of the med for about a week.
I sure hope your new prescription is NOT for 100mg. You need to be on 300. They did the same to you that they did to me – put you on 100mg to make sure you didnt have any of the bad side effects. Obviously its not strong enough to get your numbers where they need to be.
Therefore, I hope your doc bumped up the dose to 300 which should bring your numbers to somewhere in the 5's.
Keep us posted.
I have some concern about the high doses, especially of the vitamin C.
Its has been proven over and over than most of this stuff just passes through the body and is pulled out by the kidneys. Jacking up the doses just makes the kidneys work harder. Also, the harder the kidneys have to work to pull out all this extra stuff the less bandwidth they have to process uric acid out of the bloodstream.
Frankly, I personally believe that its better to drink as much water as possible rather than add a bunch more crap onto the elevated uric acid in my blood stream.
I do take a regular multi-vitamin each day and I dont think people really need more than that (if even that much).
I am going to take a strongly worded stance to reiterate Goutpal's comments.
In particular I took exception to what the statement “I am afraid of taking allopurinol as it might take a toll on my liver”.
First off, a steady low dose of Allopurinol wont damage your liver. A simple blood test each year test by the doctor can confirm your liver is functioning as expected. If you did experience any change in liver function somewhere down the road you can always stop taking Allopurinol to see if it improves. When Allopurinol is determined to not be the cause of the liver issue you can always restart it (most likely at a slightly higher dose than what you were doing previously).
Secondly, by refusing to take Allopurinol and subsequently having attacks every single month, you are declaring to the world that you would rather be crippled than risk your liver. Allowing frequent and continued attacks will eventually degrade your joints to the point that you will lose motor functions, have constant pain and trouble walking. Just standing or going to the market will become a problem. Tophi will grow larger and larger on your hands, feet and other places slowly deforming them while they destroy your joints.
Lastly, sitting on the toilet every month doing internal blowouts from the Colchicine cant be real great for your body either.
Start with a low dose of Allopurinol. Get tested after a few months to make sure your body doesnt have any reaction and then start bumping it up until you get to 5.0.
Good luck!
I cant relate directly. I started 100mg Allopurinol a few weeks ago and that combined with starting Zocor (cholesterol) which also can cause drowsiness I slept like the dead for the first couple weeks (but woke up fine).
The side effects have now abated for both drugs and I sleep normally.
One thing to consider is splitting the pill in half and taking part in the early evening with dinner and the rest at bedtime. That would help stave off the drowsiness in the morning until you get used to it. Yes your evening will be less productive, but it would be only temporary until you are fully adjusted. Pill splitters can be bought in any pharmacy.
Lastlky, if you feel you have to make a change, moving to a lower dose and taking it every day is far better than taking a higher dose irregularly.
I am not an expert, but here is what I know…
Basically the control solution lets you determine how a new box of test strips will read and it will let you know if the test machine is experiencing problems. For example. In one box of my test strips the control solution read 5.8 (batch #6516) and another batch of test strips (#6518) read 5.9. This lets you know if there is a difference in how each batch will read. This is also why each batch of test strips comes with a its own circuit card to insert into the reader so that it will read as consistantly as possible. Always make sure your circuit card matches the test strip you are using.
I suggest testing each new batch of test strips before first use. If your numbers start to change radically after reading pretty consistantly for a long time (either high or low) or if your reader behaves in any way unusual, you should do another control strip to make sure its your uric acid levels and not the reader. (note the machine also comes with a two ended circuit card that will verify basic system functionality.)
You shouldnt need the control solution very often. Mostly its there to help if you feel something is wrong. After the initial facination, you shouldnt be testing your uric acid more than once a week or so to keep an eye on your numbers. If an attack happens – you might test to find out how high it got before you felt it. Actual control solution tests are maybe twice a year.
One comment about the 5.9 UA reading…
This may be a red herring. Dont trust a reading taken in the middle of an attack. Also, it depends on what test is used to get the UA reading. If you have the option, have them take fluid with a needle directly from the joint. That is the most accurate test.
When they took blood during my first attack it only read 6.5. I am now on Allopurinol.
To my knowledge, it doesnt quite work like that.
The crystals build up in your joints until you finally have a physical flareup. When the flareup is over, you still have almost as many crystals as you did before it just drops off enough to make the pain part stop.
So basically you end up hovering right below the threshold with occasional flareups. It only takes a slip or two to put you over the limit. Mind you, that slip may not be that you ate or drank stuff you shouldn't have – but also can happen if you dont drink as many liquids in a day (so you arent flushing as fast as you normally do) or you get sick and end up a bit dehydrated or any number of other things can cause an episode.
That is why it is sooo difficult to manage gout via diet. You may eat exactly the same thing every single day and still end up with a flareup if another factor changes.
Allopurinol actually reduces the number of crystals you have, but even on Allo you will still have crystals in your body…..its just few enough to not matter.
Veggie,
Any chance you could post a good picture of your feet from the top and side? It might help us to see what you see.
I am just gonna throw this out there….
My wife had foot surgery recently to remove a cyst inside her big toe (and do a bunionectomy at the same time). It was growing between joints causing a lot of pressure (and pain!) that helped form the bunion. The cyst never showed up on x-rays but was found using a combination of MRI and pulling crap out with a needle and testing it for that specifically.
I am no expert…but for the vast majority of people, gout comes and goes. You sound like it never goes away. Just because someone's uric readings are always elevated doesnt automatically mean that they have gout. Your father having gout makes you more likely to be susceptible if you let your diet go to hell and you got fat – but that doesnt mean you have gout now.
Feel free to call me wrong – but if it was me, I wouldnt stop looking for answers outside the gout arena. Cysts, pinched blood vessels, pinched minor nerve, toe dislocation improperly reset, scar tissue from an old injury, torn ligament and other things all could cause constant pain in a toe and not show up on an x-ray.
Do you have flat feet? Do you have circulation problems in your feet (numbness, hot/cold issues, etc)? In other words, do you have any other issues with your foot/feet we don't know about?
Just trying to provide food for thought. Sometimes a discarded dianosis will turn out to be right all along.
One last thing…personally, when I have a gout attack it hurts when I touch it. I pretty much do my best to make sure I dont bump it in any way. Even putting on a sock is dreadful. The slightest movement causes pain.
I apologize, I didnt directly address the question you probably want answered the most…
“So… was this just a freak combo of all the “worst of the worst in three days (whiskey, mussels, salami, lamb and beer)?”
The answer is no. Your uric acid has been building up for years and years – those three days just pushed you over the tipping point. It would have happened regardless, without those specific days it might have been as much as a few more months, but it would have happened eventually. Guaranteed.
Its a surprise to everyone when it happens. I went to the doctor thinking I had broken my toe. I had never even heard of gout. What broke my cherry was a night of casual beers with friends and a wedding reception the next day with 5 more beers and two big helpings of mussels and clams. Three days later – BAM! 5a.m. wake up call via my big toe.
Mark,
If you search this forum you will find posts from me a couple months ago that essentially say EXACTLY the same thing as your did. Right down to the big bowl of mussels just before my first attack. You will also find posts from me about “managing uric acid through diet and lifestyle changes”.
I can tell you that I quickly learned the lesson all new gouties have to learn….once you cross over into goutland, there is no going back. I have been trying to manage my lifestyle and diet carefully and for several weeks I managed to keep my level below 6.0. I bought the at home test kit and use it religously. I bike 15 miles to work and 15 more home every single day. I drastically cut back on red meat, alcohol, chocolate and other foods.
End result is that even after spending months being careful it only took a total of a half dozen beers in a one week period for me to get another attack.
Managing your gout via diet/lifestyle will work for a time….but what is really happening is that you are hovering just below the attack threshold and it will only take a bit of weakness….just one slip of “eating/drinking X just once wont hurt” to bring on another attack. Do you really want to go the rest of your life never drinking alcohol or eating red meat?
You also need to look at the long term impact of uric acid in your joints. You could go as long as a year between the painful attacks but you will ALWAYS have uric acid in your joints and over the years it will cause severe damage to those joints. Potentially crippling you.
I guess what I am saying is the same thing so many people have said – the best way to manage gout is to take a drug like Allopurinol that will reduce the uric acid in your body. Start with a low dose and increase a little at a time until you reach a point where you are stable at a nice low number (like under 5.0).
It took me three attacks in 4 months to learn this lesson. Tomorrow I see the doctor to start the drugs. I HATE the thought of taking a drug every day for the rest of my life – but I would rather do that than be crippled every few months with an attack and not enjoying the occasional cold beer.
The gout community will support you regardless of the path you choose, I only hope your path is one of not just no pain, but also is a path that lets you enjoy what life has to offer (in moderation of course!).
Cortizone (sp?) shot are limited to 6 in a lifetime. I dont think there is a limit to steroid shots.
Amy,
Can we get a bit more information about your condition? It would be helpful to know what types of testing was done to determine you had gout. Did they only do a standard blood draw or did they take fluid from the joints? Have you been tested for calcium related issues? What other conditions did they rule out and why?
Also, info about how long you have been on Allopurinol would help. Did you start at a low dose?
Gout is frequently coupled with other conditions such as obesity, diabetes, high blood pressure and a bunch of others. Can you tell us what else you suffer from? (for the record I am technically obese…but just barely) Do you have any problem with iron in your blood (too high or too low), etc?
In regards to your questions about diet – this site is an excellent place to start. General searches on the internet brings up most of the same lists of foods listed in this site, look through all the posts in the forum also for ongoing discussions about specific parts of diets.
I am sorry to hear about your job. Hopefully we will be helpful in educating you so that you can start to beat this disease and live a normal life.
Stick with us and we will hopefully get there together.
