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cjeezy,
It sounds like you might turn out very AVERAGE and thus need 300 mg. allopurinol like so many of us. Although I wouldn't up the dosage until this attack subsides.
As we know, while 6.5 urate might be fine for non-gouties, it is too high for us because we have permanent re-crystallization sites and thus cannot maintain uric acid in supersaturation. If you recall, I tried 200 mg. allo for several months and got a 6.7 at the doctor and felt it wise to retun to 300 mg. We need what we need.
Also the theory goes that when crystallization starts the serum UA falls so probably during the night you were even higher than 6.5.
Sorry you are revisiting the pain and I hope just a very few colchicine are needed becausue you acted so quickly.
Let's get definitional: a gout attac is an EXTREMELY painful attack on a joint…emphasis on EXTREMELY.
There seems to be little point is dwelling on subtle and persistent DISCOMFORT.
Gout is most defintitly FAR beyond discomfort.Let's face it if we concentrate on ANY joint we can recall reall bouts of discomfort.
So a slight feeling of discomfort on walking is probably caused by humans deciding to walk on twos rather than all fours.
All foot pains are NOT gout nor are most knee pains gout.
marty,
Let me share a personal experience: My brother in law had a painful knee swell up and stay swollen for weeks…it was crippling for him. The first probable diagnosis was gout but they didn't leave it lie there. Instead he was given a battery of antibody tests and lo and behold he had LYME ARTHRITIS; they judge he was infected something like 2 years before…he had a cabin in the mountains and was fond of fishing. Always be leary of a gout diagnosis unless it is podagra. This is ESPECIALLY true of knee pain which can be casued by SO many injuries.
After 30 days of some potent antibiotic combo he was right as rain.
So make sure they rule out LYME DISEASE.
What were the symptoms that brought you to the doctor and how did he diagnose gout? In your case, I think a second opinion might be wise because gout is VERY uncommon ina young woman.
Gout and RA are different but very similar processes…one will not lead to the other but I see no good reason that one PRECLUDES another either. And I would not be surprised if it is common for uric acid to exacerbate RA attacks.
You need to have your serum uric acid measured.
It's just a marketing gimmick.
For example one could take isolate soy protein, isolated whey protein, or even isolated beef protein and add a couple tablespoons sodium bicarbonate per pricey cannister and call it ALKALINIZING.
In fact you could take your OWN cheap bicarb right after your protein shake.
In fact, from the very first website I pulled up on the subject:
http://www.pureliquidgold.com/…..-foods.htm
it indicates that WHEY PROTEIN POWDER is alkalinizing. Personally I think that this fake alkaline/acid rating is complete “new-age” nonsense: a lemon is ACID and anyone who says otherwise has never had a a chemistry course (or eaten a lemon.)
I have electric heat and live in an area of priceyelectricity ($.18/kwhr) and if I get profligate, I can look at a $200 electric bill in the dead of winter. So I keep my bedroom coldish in winter and use an electric blanket. Of course my hands don't stay under the blanket so in the coldest months I try to wear gloves. I HATE the feeling but I think it is wise.
I think these precautions are most important at night when our circulation is slowed down and our homes probably the coolest…AND all my attacks have started at 5 AM.
I think the socks in bed is a very good idea.
Just one addendum: the toe attack is usually at 5 AM not 5 PM. Probably has to do with low blood flow and a cold foot overnight. I would recommend when you go to sleep tonight to wear a couple socks over the offending foot. Keeping it as warm as possible is a wise way to spend the night because urate solubility is directly proportional to the temperature of the joint.
fubar,
IF it is gout, then two or 4 colchicine in the first hours of an atttack will very often stop it completely. It is a nice insurance blanket to keep in your medicine chest.
Your next step is to get your uric acid tested and if high, get on allopurinol. BUT you don't want a lifetime of drugs if it is tendidnitis (which itself can hurt like Hell.) Gout without foot involvement is somewhat rare so consider your diagnosis still tentative. Many of us are sure only when we get THE TOE which is pretty much unmistakeable, so perhaps your rheumy will want to wait and see if you have another attack…some like to see 3 in a year before allopurinol.
Make sure they X-ray your wrist to see if you have a repetitive stress fracture from all those perfect swings.
Let us know how you make out at the rheumatologist.
I think there is nothing wrong with settling on 5.5, BUT if it has to be achieved with meat and alcohol restriction then one must ask oneself if that is sustainable forever.
I have recently gone back to the 300 mg.dose and I find it conventient and cheaper that the pill is available as a 300 mg. dose. (Many of my discount chain pharmacies have a 30 pills/$4 price so 30 x 300mg. cost the same as 30 x 100.) And it makes it SOOOO easy to pop ONE allopurinol with my morning raft of pills and vitamins and minerals and lecithin and cod liver oil, OY! (It took me 20 years to realize the 300's make more sense than a bunch of 100's…I suppose becasue I started with a 400 mg dose.)
Remember too, that as uric acid spikes and troughs during the course of the month it might be wiser to have slightly too much allopurinol than too little, because a SINGLE gout attack can be so disruptive. Our goal is ZERO attacks and a uric acid that is ALWAYS below 6.0. After all who can be certain what our serum uric acid is at 4:30 AM preceding an attack, no matter WHAT number we got at the doctor's office last month?
Peter,
Firstly, how many times have you taken the 12 dose colchicine? When was the last time?
There is no problem upping the allopurinol to 300 on your own becasue that is the common dose…BUT DON'T DO IT NOW. The worst time to begin or to up your allopurinol is at the very beginning of an acute attack…it will only make it worse.
If I were in you shoes, I would abort the attack even if it's a day early with colchicine. If you start immediately maybe you can stop the attack with less than the 12. But do the first 2 pills as soon as you read this then and one and hour…if you have to take the 12, you do. Stop at diarrhea because usually the pain relief follows quickly.
(I hope you have stopped the dicolfenac, it is singularly bad for gout sufferers becasue it retains uric acid.)
Continue taking the 100 mg. allopurinol and have your uric acid tested as soon as you get to the doctor but you should soon be on a higher dose becaue almost no gout sufferers get low enough uric acid on 100 mg. Your goal will be a uric acid level below 6.0 mg./dL.
(I think there is something to the gout attacks in early Fall but I have never seen anything about its seasonality in print. I've got a similar phenomenon…migraine attacks in April and October.
)Marty,
It is extremely important that you have your serum uric acid measured regularly. THere is no way too control it unless you know what it IS. Do you have any numbers from past doctor's visits? UA numbers before and after treatment with allopurinol and uloric will be extremely helpful in moving forward.
Yes the 24 hour urine test is a good follow-up once you have determined that you are hyperuricemic. And if you need it, probenecid is a very good drug but a little harder to take than allopurinol.
Long term I would take only one or two a day for a month or two when initiating uric acid lowering treatment with another drug.
For an ACUTE attack that has persisted for several days I follow the dosing maximum given on my original packing slip with my first Rx: 2 to start, then one and hour to a maximum of 16, pain cessatiion, or serious diarrhea. If you start immediately upon feeling the pain 2 or 4 should do the trick. I can attest from personal experience that one does not QUITE die from taking 22 pills in a day,
but I don't recommend it.fubar,
My earliest attacks were diffferent. Over a period of 3 years I would get very painlul attacks in my instep, arch, ankle, plantar facia and they would cripple me so that I needed crutches but after 3 days, POOF, they were gone completely.
Then I got THE TOE and I was certain it was gout and I waited 3, 6, then 9 days and I could beariti no longer and took my first intense round of 22 colchicine in a day. The pain, swelling and redness disappeared completely 45 minutes after the last pill.
Have you ever had any unexplained pains in your feet, seriously hurting pains?
If your doctor is certain that your wrist is gouty, he should not object to prescribing a bottle of colchicine since it seems clear that the Vicodin isn't doing much. Try some hot water soaks or a heating pad…crystals dissolve more readily when warm.
John,
To repeat what Gout Pal strongly implied: your physicians assurance that your Uric Acid numbers are NORMAL is meaningless, ask him for the NUMBERS and then YOU judge whether they are normal.
The AMA considers 8.3 to be NORMAL but once gout is established a uric acid anywhere near that high will keep its sufferer in constant torment…and attack can occur with a uric acid of 6.0, but a NON-gouty person can have a 9.6 without triggereing gout.
If any doctor looks at the reference range and proclaims normal with anything above 6.0 AFTER the patient has told him he has gout, that doctor has announced to you very cleartly that he doesn't understand gout and should not be attempting to treat it.
It just happened to me with a new doctor who proclaimed my 6.6 as normal, and I corrected him by saying for people without gout that is a risky level.
If by the little yellow pills you mean colchicine, you are correct: 2 pills per day will do little to stop and established attack, you need more. John, I strongly recommend you try allopurinol 300 mg. again and DON'T STOP taking it. Take 2 colchicine with it, 4 id needed. Just waiting around til you have another attack is NOT the way to deal with gout because eventually there will be no pain free periods. You just cannot assume that you have the problem taken care of becasue you are in a pain free period. Since early gout comes and goes, it is too easy to misjudge cause and effect. Just because you stopped eating peanut butter on Tuesday and the pain stopped Wednesday means nothing more than if there was a full moon on Tuesday.
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Anyone with vision disturbances remember that after age 40 presbyopia is “normal” condition and the effect is on the ability to focus on small close stuff.
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Utubelite,
Take you allopuinol any way you wish because it it the first metabolite, oxypurinol, that does most of the work and it has a half life of several days. Ultimately the dosing schedule has little meaning and in fact I think one COULD just as well take 600 mg. every second day. I take my 300 mg. as a single dose after breakfast.
Good muck, momoy.
Since you have had so very many frequent bouts, I recommend daily colchicine, perhaps 2 a day for a month or two, when you initiate your allopurinol treatment. If you start with low dose allopurinol I would take the colchicine until you start getting low UA levels.
Personally I think the best way to start might be 100 mg./day for a week to test for any RARE hypersensitivity, and then go right to 300 mg. and test UA after a month, or else right to 300 mg./day to start. I am not fond of torturing patients with an ineffective low dose for months for no actual good reason.
I don't think so.
I think it's more like ultimate damage is the cumulative effect of attack after attack after attack, each depositing more crystals and each causing the immune system to do yet mor damage to a joint or joints.
So someone with ONE attack will likely be wary but someone with 100 attacks will be permanently crippled and in continuous pain.
A lifetime of untreated gout from hyperuricemia will inevitably shorten the lifespan unless something intervenes, like a runaway bus.
Do NOT be afraid of allopurinol, it is FAR safer than either colchicine or Celebrex. To be 100% certain make sure that every doctor's visit you have a liver panel run along with your routine uric acid…and anything else you are testing for. Don't even go in for a cold or a flu shot without your blood draw. Tell your doctor ahead of time to ALWAYS run these so you don't have to remind him every time.
Allopurinol is among the least toxic of drugs for long term use.
Having an attack every MONTH for 2 YEARS seems like masochism to me.
(Yes, the small tophi are permanent reminders that gout is destroying your joints.)
You must change your way of thinking so that your goal is switched from relieving pain to maintaining a uric acid below 6.0… or 5.0 if you want to SLOWLY get rid of tophi.
What it DOES say is that you are excreting a rather acid urine at pH 5.5. My last one was 7.0, completely neutral.
I recommend you add some daily fruit and veg, or even some alkaline salts like magnesium or bicarbonate becasue you want to avoid urate kidney stones. Also it seems from “common knowledge” that an alkaline urine will excrete a bit more uric acid…maybe yes, maybe no.
I think low impact aerobic excercises are the safest. Something like an elliptical trainer or a stationary bike being better than running (which is a lot of foot and knee impact…just what we want top avoid.)
HEAVY strength training breaks down lots of muscle tissue and liberates lots of nucleic acid, so these might not be wise for someone “on the cusp.”
But if your allopurinol level is high enough to keep you at 5.0 say, you can probably do almost any exercise you want as long as you don't dehydrate, so choose a nice air conditioned gym rather than an outside track in 90 degree heat. Alas for us, very little uric acid is exreted in sweat. Dammit, becasue I love to steam and sauna.
I can do any exercises I want and I do a lot of strength training. But yesterday I got caught in the rain (which I hate) and did a reasonably long run home (several blocks.) That run made me realize how very hard it is to subject knees to pavement pounding under a 200 pound man in his 60's…I don't think I will be repeating that exercise anytime soon. Lesson learned, and the lesson involves an UMBRELLA!!
ruff,
It seems the normal course of gout progression is that attacks get more severe, last longer and take more analgesics to eliminate the pain and swelling.
Let us know what uric acid reading you get.
High triglycerides often point more to what you had to eat (or drink) the day before than anything else…not to worry unless you see it happen over and over.
Dehydration ALWAYS mattes becasue if you lose ENOUGH water you raise the concentration of uric acid from soluble to insoluble.
Don't concern yourself with blood pH because buffers hold the pH in a VERY narrow range…like 7.4 (like 7.35 to 7.45.) Your urine is better for testing, easier and any pH papers will work.
Yeah, you were done a disservice. First thing I tell a new doctor is that every time blood is drawn for blood lipids, or blood count, or liver function, I want uric acid tested as well.
I am fond of taking a great deal more colchicine in one day rather than doling it out over days or weeks. One and hour til pain stops, diarrhea gets vicious, or you reach 16 pills.
Perhaps 400 mg. allopurinol is in your cards.
(Are you CERTAIN that you are suffering a gout attack rather than a broken bone or some mangled tendons?)
Personally, I think those home testers have too much variablility…I'm not a fan.
My first attack wasn't until my early 40's but it WAS an attack in the ankle and had me on crutches. But the attack lasted exactly 3 days and disappeared as mysteriously as it had arisen with no lasting consequences.
Advil is pretty decent but make sure you take it in a therapeutic dose of at least 400 mg, 4 times a day.
When the attack subsides, wait a week and have your uric acid tested.
I suspect the jump from 6.5 to 8.4 was caused by meter fluctuations, but if NOT, then all I can say is WOW!
If caused by the wine that's REALLY food for thought.Perhaps you had some high purine food digesting over those couple intervening hours?
See if you can repeat the experiment sometime down the line…maybe on an empty stomach?
Good for you on the 5.6…that's EXACTLY what allopurinol is supposed to do. Remember, the active ingredient oxypurinol has an EXTREMELY long half life so you are still building up to steady state. It will take a total of nearly 2 weeks to build to your therapeutic dosage level and I think you will see numbers at 5.0 or below soon.
High uric acid eh? OOPS!
But in Marijuana's favor I would add that any author who refers to “marijuana ADDICTS” is highly biased. Sounds like something out of REEFER MADNESS!
I think any success is likely caused by marijuana's slight ability to deaden pain, any pain…or at least cause you to forget about it temporarily.
To bad they couldn't somehow modify Allopurinol so that it didnt get oxidized by mistake.
No, that's it's FUNCTION. It is chemically hypoxanthine and is identical to xanthine except for placement of a couple atoms so that xanthine oxidase attaks IT and turns it to oxypurinol whicch ALSO is attacked by xanthine oxidase. Keeping xanthine oxidase busy while allowing the REAL xanthines to be excreted instead of converted to uric acid is the beauty of allopurinol. It acts as a sacrificial lamb to save us from perdition…
and podagra!
Don't worry about what you eat and drink once you get steady-state low uric acid. You will be able to enjoy the weekly sashimi and beer night…but that's WEEKLY, not DAILY!
One of my favorite restaurants in Manhattan has an all-you-can-eat sushi (40 varieties), sashimi, yakitori, gyoza, seafood salads, teriyaki (beef, pork, chicken, salmon,) raw clams and oysters, crab galore and 100 others all lined up on a block long table with about a dozen chefs refilling the table…oh, and SEPERATE dessert and soup tables. Seating for about 250 patrons.
This goes on from 11AM to 3PM every day. By the time I leave I need a forklift or 4 bearers to carry me to the subway…but it's never caused a gout flair.
Allopurinol doesn't exactly lose its effectiveness when confronted with high purines like a fish diet, it just has more to do and cannot keep up with all the xanthine oxidase produced. Xanthine oxidase is produced to convert purines (purines>>xantnine eventually) to uric acid and this enzyme is fooled into wastinfg it's efforts oxidizing allopurinol to oxypurinol instead. (Allopurinol is almost identical to xanthine.) There is some evidence oif several other routes by which allopurinol lowers uric acid.
Don't hold me exactly to precision here…I need to brush up on the exact chemistry every so often.
So basically, the more fish, beer, sweetbreads, kidneys and liver you eat the more allopurinol you need to block excess uric acid production.
Your intervention was wise, cjeezy, and it just might have prevented an acute attack or two this month or next. I think 5.5 is an excellent target.
Are you bothering with any of the natural and “healthful” dietary interventions or letting allopurinal do all the work. (I use the latter method :))
