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Trouble with a fee for service plan like you have is there is no limit on what doctors and labs can charge…thus no way to know. Even when you hit your deductible the insurance companies pay 80% of what THEY think is appropriate and you get hit with 20% PLUS any exorbitant overage.
I would think that a total of $50 for the three tests would be appropriate but if you tally in unreal pricing plus the cost of the doctor who drew the blood you might be looking at $500 or more.
I prefer an HMO that covers lab tests completely and charges me $15 to see my doctor.
There is time to loose weight, exercise, and change ones diet.
I see three weakness to this approach:
1. Taking allopurinol does not make it impossible to lose weight, exercise and change one's diet…if it works then one can cut the allopurinol back gradulally, even to zero if possible.
2. Losing weight, exercising, and changing one's diet usually does NOT prevent further attacks. In fact, losing weight often PRECIPITATES attacks, as does exercise. MANY people have found that all their good works are futile in the face of a genetic mishandling of uric acid. Your only prayer is a VERY restrictive diet…FOREVER!
3. Once you have had a gout attack or two, your chances of getting rid of crystals is close to zero without higher doses of drugs than any of us take. Once those crystals are present your ability ot carry a supersaturated serum is completely gone and thus somebody who has NEVER had an attack may stroll aroung pain free with a UA of 8.0 but any gouty WILL have another attack.
ableape,
I have been under a hideous amount of stress and anxiety for the last 6 weeks, and, like you with your bout with pneumonia, in stressful times I have trouble LOOKING at food much less eating it. THus I have lost 11 pounds. The weight loss is welcome and attractive but it has caused a rise in my uric acid level, an increase in my allopurinol needs, and at least 3 suspicious “toe attacks” each of which I have aborted with 3 or 4 colchicine.
I am pretty sure the mechanism is this: When we lose weight it is impossible to do it witout considerable loss of lean tissue in addition to fat and some glycogen (which is quickly replaced.) The lean tissue is made up of cells crammed full of nucleic acids and the route of breakdown of these nucleic acids is>>>>>>Uric Acid.
I think rapid weight loss is perhaps the quickest way to a gout attack in people with gout. Even people WITHOUT gout may inititate their first attack this way.
I have no knowledge or experience with either of these newer fluoroquinolone antibiotics.
An aside: For me, indomethacin is a fairly tough drug to take, but the worst of all on my stomach is ibuprofen, by the second day I have severe gastitis and I too have a strong stomach. For my NON-GOUT pains I think Aleve (naproxyn) is the cat's pajamas (I love colorful old phrases
) It's only side effect is weight gain, probably from water-retention. As a constant dieter, I HATE this side effect…but it's the best OTC drug for pain, IMHO. I am awaiting a letter from Bayer's research department on the effects of Aleve on serum uric acid.To get to you questions Curtis.
Long term use of colchicine is apt to reveal a host of untoward side effects FAR worse than anything possible with allopurinol and you will invariably have spikes of hyperuricemia that break through to cause major attacks. Colchicine is not to be thought of as a long term treatment but rather as an aide for an infrequent emergency. Many people have uttered the dreaded phrase “but the colchicine doesn't work anymore.”The only time daily use is wise is when initialting treatment with a uric acid lowering drug and then for as short a time as necessary.
Yes, you will likely spend the rest of your life on allopurinol but there is no penalty for forgetting a dose every so often becausue it buids up in the blood and levesl take a long time to fall back down…thus skipping every single weekend is not clikely to cause problems if the other 5 days' dose is adequate. But skip a week or two and you might regret it BIG TIME. Don't think of allopurinol as a short term treatment, it's not, and if you stop it you are likely to start suffering gout attacks at LEAST as bad as before…and then you progress to chronic gout which is the slow continuous destruction of many joints, your kidneys, and your coronary arteries, and ultimately your LIFE.
If you take your allopuirinol and you keep your UA levels below 6.0. you can eat all the steak you want. with or without a test kit.
I look askance at any cures like milk thistle. Maybe there's a diamond in the pile of manure but I haven't seen anything glistening lately. Heck, with a disease as old as gout, I'm sure some wizard would have found any natural cure by now and we'd all be taking it. After all, some wise shaman centuries ago found that Autumn Crocus, aka Colchicum autumnale, stopped a gout attack in it's tracks and we know what active ingredient IT contains. (I wonder if his name was MERLIN?)
Muzz,
Like GP implied and pagey stated flat out, IF you are well into an attack you MUST take enough colchicine to stop it. Two or 4 a day will have little effect on an attack that has been allowed to go on for several days.
I wish everyone wasn't so afraid of getting on allopurinol once they got a firm diagnosis of gout, especially with THE TOE FROM HELL. It's not “waving the white flag” or “throwing in the towel,” but rather beginning treatment with a cheap and extremely effective LIFE SAVING drug with almost no untoward side effects. I doubt if 2% of the pharmacopeia can make those claim. But then I guess nobody knows the horrific pain of PODAGRA until he experiences it first hand and only then does it seem obvious that taking a harmless pill once a day is a small price to pay NEVER to experience it again.
A parallel might be a person who resists taking daily aspirin or a statin drug UNTIL he has his first heart attack…how much better off he would have been had he instead PREVENTED that attack.
Muzz, you should be able to drink beer in moderation with allopurinol but beware any amounts like a 6 pack a day for an extended period of time…that can overwhelm allopurinol. But if it gives you a problem, I find that the “hard stuff” is easier on gout. Aim for a blood uric acid level below 6.0…or even 5.0.
The area affected will turn red and shiny.
Good you mentioned the word SHINY, Michael…nobody else has. And you are right, there is a certain SHININESS when the big toe is involved. Almost enough to be diagnostic. The shiniiness is striking the first time you see it.
Gosh,
The mere THOUGHT of combining a gout attack with a cracked big toe bone sends shivers up my spine. THe combination must be near UNIQUE!
Hi Curt,
I think colchicne is an excellent replacement for indomethacin for relief of gout. Colchicine will STOP an attack, indomethacin only manages the pain (and makes me dizzy…and is EXTREMELY hard on some people stomach lining, occasionally causing ulceration.)
Allopurinol vs. Adenuric:
Allopurinol all the way becasue it costs about 1/30 as much and it has been tested for 50 years in millions of people taking billions of doses. Adenuric (febuxostat) was approved in the U.S. only a month or two ago. Why be a guinea pig?
I doubt you'll need anything as glitzy as a low level laser for your gout pain. Control your uric acid correctly and there will be no more pain. Any flairs from initiating alloprurinol or Adenuric will be easily handled by the colchicine.
Yep, it's always that eye-popping pain of the whopping big toe attack that finally gets us into proper gout management…like clockwork! It sends denial straight out the window.
Stop the HCTZ it is a potent cause of gout…it caused mine.
If you need a diuretic, and many of us do, furosemide (Lasix), a loop diuretic works very well and has less proclivity tio retain uric acid. It took me 10 years on 50 mg HCTZ to develop gout, but develop it I did.
Lasix works very well to lower BP.
I have a strange hunch he's diddling you to keep you coming back with more checks. He did his work and demolished the stone and that should probably be the end of it. I am not an expert but your kidney issues seem trivial and the stone was probably caused by high uric acid. Your kidneys seem to be filtering just fine and high creatine is often the bailiwick of muscular men.
My theory: if you hit your finger with a hammer and go to nephrologist, he'll tell you the pain is caused by your kidneys. If you see a chiropractor he'll say scoliosis.
Any GP can treat blood pressure. And if gout is your issue and you want a specialist, see a rheumatologist.
What meds are you taking for your BP. If a thiazide, STOP!
2. Also, another question regarding odorous breath for patients with Gout? Does a skewed Uric Acid level cause halotosis?
No, there is no connection.
My experience, contrary to popular belief, is that halitosis is usually caused by a bad tooth.
And of course, I concur with GP…once started DO NOT stop allopurinol. It will only cause more gout attacks down the road if you do.
No, there is nothing related to goutl except SERUM URIC ACID. When I see the doctor I tell him SPECIFICALLY what to add to “the basic bloodtest” and uric acid is always one of these (Lp(a) is another good one to add…a good measure of heart risk. CPK and homocysteine also wise, ANA if lots of joint pains, etc.)
Uric Acid was commonly done on a “Chemscreen 25″ but I notice it must be asked for separately. Maybe your doctor isn't aware of the change.
Best go back in and have another blood draw…at HIS expense! Anyone with kidney issues should be concerned about hyperuricemia.
How is your kidney function? What kidney issues have you had besides that stone?
First on “bated breath:”
It's taken from “abated breath” as in being so anxious that one forgets to BREATHE.
Alas, I was hoping for a good uric acid from my lasix-furosemide combo along with just 200 mg. allopurinol. Double alas, my last number, and first in 2 years, was 6.6 mg/dL serum uric acid. So it seems that lasix-losartan is not a substitiute for the extra 100 mg allopurinol and I have gone back up to 300 mg starting yesterday.
You gotta do what you gotta do.
So now, GP, you can take a deep breath.
THe arrow on the linked picture is much closer to the usual joint.
And you MUST treat the hyperuricemia.
So whether it's gout or not causing that constant pain your course will be the same, allopurinol
or probenecid (I'm guessing the latter) to get you a low normal uric acid. If it IS gout then your foot pain will be cured.
Have that pee test to see how much urate you excrete in a day.
Yep, the cherry diet works very well…until it doesn't. Probably half the people now on allopurinol had some success with cherries…til they didn't.
(Even I tried them but the diet costs a FORTUNE compared to allopurinol)
Were I in your shoes, I would continure taking a colchicine a day, until I got on allopurinol and then for a couple weeks more. Your doctor is showing a failure of logic when he says you cannot start allopurinol becasue the risk of relapse is too great and then denying you the regimine that is likely to prevent an attack in the next two weeks. I'm not saying you shouldn't listen to your doctor…but…
Besides that obliterated kidney stone, do you have any other kidney issues.
Let us know your bloodwork numbers when you get them.
It's so tough when you have to suffer without a proper diagnosis. I guess I was lucky that my 4th attack was the dreaded podagra that a BLIND doctor would have clearly “seen” to be gout. Seems with regard to gout there are MANY blind doctors out there.
I too have to credit colchicine for immediately stopping that major gout attack and allowing me to get on 400 mg. allopurinol a couple days later.
Veg guy,
Your uric acid is TERRIBLE…so that says gout.
But it's not the typical affected joint which is the SECOND joint from the end of the big toe, the bunion joint that is attacked…so that says NOT gout.
To my eye, it looks most like you got a splinter or someting into the juncture of the toenail and the outer edge of your toe. It is indeed infected but it doesn't look gouty to me. Admittedly it's a hard call from the picture.
In any case you must do something about that hyperuricemia. Since you are a vegetarian, and thus not eating too many purines, if I were you I would have a pee test for 24 hours to determine how much uric acid you excrete. If very little then probenecid might be a good drug for you.
(Okay, who screwed up the HTML coding to make this thread two monitors wide?
Perhaps the big pictures…a natural mistake.)It's tough in the “Is it or Isn't it” stage…but once you get a solid diagnosis and on a good drug it fades into the background.
mjrisk,
Here's what I think might be going on. You imply but do not state how long you went with gout attacks (and a presumed uric acid over 10.)
If this went on for YEARS, you laid down a LOT of urate.
It responded just fine to naproxen again, but I felt that I had gone through a year of agony with the allopurinol (still on 300 mg throughout this) and find myself still in an unpredictable situation.
Why “a year of agony with allopurinol?” It implies you spent 10 years with untreated hyperuricemia and only last year began allopurinol? THe agony part was the recurrent attacks, right”
If the colchicine-allopurinol worked well and you started having atacks again after stopping colchicine, the indication is that you have lots more urate to disperse.
Here's what I woulod recommend…take 400 mg. allopurinol (to get your uric acid into the 4's and take low dose colchicine with it for a reasonably long time.
In a nutshell, untreated got at uric acid of 11 for a full decade has probably become almost chronic gout. Do you have any permanent, prominent tophi? For that you need a pretty long time and probably a lower uric acid than most.
Another consideration for EXTREMELY low uric acid levels to flush maximum urate is to add probenecid to your allopurinol …that might cut down on the need for colchicine because probenecid has the propensity to quickly dispose of any uric acid freed from dissolviong tophi before it can find another joint to torture.
What Im saying is that if it is COMPLETELY controlled, as daily allopurinol can do, there is no reason to EVER think about it. No reason to ever consier the goouut consequences of eating or drinking anything with the possible exception of thiazide diuretics.
And for certain a gout attack is FAR more painful than a heart attack, or angina, or a broken leg, an appendicitis, or tearing a shoulder out of the socket, (although the last one was close.) To these I can attest.
First and foremost, I would never ALLOW an attack to go fuull blown since I can recognize it early and have the guns in the arsenal at a moments notice. It takes DAYS for an attack to get to its “lethal” potential.
If I stopped taking my allopurinol and started taking thiazide again, I think I could bring on an attack as furious as the worst I've had. THis presumes I would leave the colchicine untouched. It might take a few weeks or a few months, but I am certain the attack would come.
Last week's gout mutated to extreme malaise and then a sore throat with a low grade fever. So right now I'm in the differential diagnosis stage, aka, I don't know what the Hell is going on, probably just an annoying Summer cold. (But no pain in my feet…maybe it was from that long bike ride in the hot dehydrating sun with no potable water to be found.)
I'll check today to see if Friday's blood results are done yet, and if so I'll make an appointment with the doctor…I have several issues going on and I haven;t had my uric acid measured in 2 years (nor my cholesterol or Lp(a))
I guess to minimize the likelihood of a patient with a severly compromised heart having to bear an acute gout attack…and telling the doctor LOUDLY about it. A two week delay sounds a bit “over-safe” to me but defensive practice seems the medical operative these days.
“Wait a year and start allopurinol”
“Don't take colchicne, it will upset your tummy!”
But then the opposing flip side is: “Here, take this NSAID, it's new and VERY pricey…we're alll excited about it!”
Why don;t we get good studies about allopurinoll and colchicine? Easy, becasue finding out that allopurinol cures heart disease and cancer won;t make anyone rich. Nobody is interested in mounting a study with cheap generics when they can mount one to sell a pill that nets them $50 a day.
I thought aboout it almost not at all…at least not until I found Gout Pal this year…ROFL!
You wake up and take you allopurinol along with your morning vitamins and that's all there is to it. Every time you see your doctor you ask for a uric acid test along with whatever else you're there for.
On a rare day that you wake up with any foot pain, pop 2 colchicine.
Occasionally I would run into soomeone with foot pain and I'd quiz him about it (it's almost always a HIM!)
THe way I see it, the immune system “walls off” the urate laid down during an acute attack. Until it is walled off, it is exposed to the bloodstream and the immune system visiously attacks it wcausing much pain and inflammation. Once it is walled off, it is hard for the newly UA diminshed (from allopurinol) to reach the urate to dissolve it. But there are little leaks in the walling so you can VERY slowly leach out the tophus over years if you have some luck and a low enough UA.
Apparently a newly HIGH uric acid level that would otherwise be supersaturated can find either this wall breech or else find some tiny crystals somewhere else that were laind down without causing pain. And then BOOM the crystals come out of supersaturation rapidly and cause another acute attack.
I maintain that ANYONE who has had a previous gout attack can never again sustain a supersaturated serum like a non-gout person. So a non-gouty might run around with a UA of 9 without an attack but a 7 is murderous for a goutie.
Too bad if they didn't analyze any of the residue from those stones. Maybe we can PRESUME they were urate?
Why no allopurinol?
