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I know it's an oldish post but I would be a fisetarian if I could afford it…cod is $14 a pound here. Fresh flounder maybe $5 higher.
Frozen inedibles are less…a lot less, but TASTELELESS is the operative.
For salt sensitive, low renin hypertensives there is only one class of drugs that work…diuretics.
They cause gout but loop diuretics, Lasix/furosemide, much less uric acid saving than thiazide.
I can take ACE inhibitors, ARBS and calcium channel bockers til I turn blue but my BP stays high…unless I have a diuretiic. I share this trait with my black brothers but I am WHITE as the driven snow????? Go figger!
We still come back to the old saying that the success of anti-gout treatment depends on the doctor-patient relationship engendered by proper explanation of his disease to the patient.
You got a typo there; it should read “by proper explanation of the patient's disease TO THE DOCTOR.” And for this you need to be a very PATIENT patient because doctors get very crabby when you point out their inadequacies.
THeir favorite trite comment is “Where did YOU go to medical school?” I;ve got a response I;m DYING to use, but haven't: :”My medical training is MUCH better than yours because I have an MBA!” Think about it.
I would say that SOME patients might come off allopurinol, but I think Kersley's study showing that 2 out of 54 were successful might be spot-on. And 3.7% coming off the drug is near enough to zero for me. Personally I have never heard of a patient coming off allopurinol without a drug replacement. THis of course ASSUMES an initial correct diagnosis of gout after several attacks. ANd even Kersley's study might have 2 people who were misdiagnosed.
As for the watching the patient with uric acid only a little raised and keeping him drugless because he's be afraid of a life of treatment …there is an underlying ugly ”wink-wink-nudge-nudge” that ends with “until he comes in screaming with pain BEGGING me for allopurinol.” Hearty guffaws all 'round the doctor's symposium.
Now, all that said, I MIGHT be a candidate for eventual stoppage of allopurinol because I am relatively certain that I have SECONDARY gout caused by Hydrochlorothiazide. Since I have stopped the thiazide several years ago, its consequential gout may have gone bye-bye. But as a minimum dietary intervention, absent the allopurinol I would have to avoid beer.Hydrochlorothiazide
Trouble is that awful effect that once you have gout, a uric acid level that is completely tolerable for a normal person becomes crystallizable. Perhaps it is because urates, once formed in a joint will NEVER leave completely…and thus always present a site for easy crystallization of a saturated uric acid solution. Another possibility is that the immune system LEARNS its enemies…and thus once an attack is made on uric acid, subsequent attacks become quicker, easier, and more vicious.
This is hard to phrase: But what I am saying is that GOUT makes gout incurable and once gout strikes and is treated you can never get back to a goutless state…and a goutless state is one that can do without allopurinol.
Did that make sense?
I would ignore it until you have more data.
Watch especially for foot pain. Gout usually winds up there oretty quickly.
Ask for an ANA and an arthritis panel next doctor's visit. THey are a good general first step in analyzing joint pain.
Yep,
GoutPal, you got my colchicine routine down pat…feel free to put the words in my mouth at any time.
Yep, Uric acid is apt to drop sometimes precipitously when an attack occur…the logic is simple, it leaves the bloodstream to coalesce in the infected joints.
X-rays are not very good at gout…even for large tophi the effect is just some generalized fuzziness. Not sure what an MRI makes of it. Trouble is that a LITTLE uric acid can cause a LOT of pain.
mathman,
Since you cannot get a good diagnosis
Do the colchicine routine, one an hour until pain relief, hideous diarrhea or 16 pills…if you want to stop at 12, that’s probably okay too. Though it’s not a 100% surety colchicine can be pretty diagnostic and it will give you at least as good an answer as you are getting from your doctors. If the colchicine at high dosage doesn’t work I think you can start looking for another disease. Three colchicine a day might be a reasonable preventative when taking allopurinol but it is NOT enough to abort an acute attack.
But let me narrate my case in short: First attack was a crippling pain in the middle of the top of my foot…crutches for 3 days. I thought maybe I’d cracked a small bone. Several months go by and then crippling pain in ankle…crutches for 3 days. I thought I’d sprained it but couldn’t remember when. Then a nagging long-lasting pain in the bottom of a foot… I diagnosed plantar fasciitis. It went away after a couple of months. I was BEGINNING to think there might be some connection between these mysterious pains that all seemed to start on awakening.
THEN PODAGRA, the death attack to the bunion joint of my left big toe. Big hot purple untouchable mess that I couldn’t even touch with a sheet. Only then I knew what all the earlier pains over the last two years were…GOUT!
(I suffered for 9 days until I called my doctor (not a chance in Hell of getting to see him) and he called in the colchicine. I took 22 and the pain stopped 45 minutes later…(HINT, NEVER TAKE 22 colchicine.) When the pain stopped I went to my doctor and ran my uric acid…like 8. Something and I went on allopurinlol 300 mg for the next 20 years.
So to apply this to you, it is possible that you will not get a definitive diagnosis til you get THE TOE FROM HELL that even doctors in the 1st Century could recognize as gout. With THE TOE gout is an easy call, WITHOUT THE TOE it’s often a dicey call. But in truth, with gout PODAGRA is eventually inevitable.
I will say though that if you see a couple more 5.9 UA readings, gout is not likely…
Allopurinlol = Allopurinol My first dose of colchicine was 22 (I didn't know to stop at 16 because my doctor never mentioned it.) As SOON as the diahrrhea hit like a freight train at hour 21 my pain left my foot within 45 minutes…after 9 days of being crippled on crutches. Diahrrhea took only a couple hours to to empty me out….but that was several dozen “emptyings” with the finale being a glass of water that would run through me in a minute or two. I was lucky and felt no nausea…just cramps. THen a much needed long sleep.
Perhaps the huge dose had everything moving faster than if I had stopped at 8 or 10 colchicine.
But I find a light laxative effect the day after even 2 colchicine on a rare day when I suspect a “twinge.”
I almost think there's some bizarre but unfathomable connection between the diarrhea and the pain relief.
Stephen,
I'm glad they helped a lot with your pain. Perhaps 2 today and 2 tomorrow might be wise…but that's only a guess. (Can I presume you are postponing DisneyLand?)
I will amplify GP's first suggestion.
Call your doctor and have him call iin a pharmacy prescription for 60 colchicine tablets (tiny things that are extremely cheap.) Take 2 immediately and then one an hour until
1. the pain stops
2. Diarrhea becomes intense (a little is okay)
3. You have reached a total of 16 pills.
(Don't plan on leaving the house.)
I think this is likely to end yout attack. Since it has gone on for so long, maybe 2 more cochicine each morining for a couple days is a good idea.
Your doctor should NOT give you an argument on this.
Forget diet, uric acid etc. until you can end this acute attack.
If by this weekend you mean TOMORROW…forget Disneyland, it;s a foot torture worthy of the Inquisition.
But not taller either!
Im 6'2″…and 66!But when I hit 199 again it will be Dom Perignon for anyone who wants to visit!
veggie,
Since the beginning of time people have suffered BUNIONS. They are painful and progressive and are often thought to be a curse of shoe wearing becasue most shoeless people avoid them. It is a diversion from the big toes natural forward nfacing angle to an inward facing one. Do a web search, you'll find a million bunion pictures…the cure is surgery if the pain gets brutal. You can imagine that women squeezed into a pointy pair of pointy Manholos suffer them more than men…little known but these shoes were invented by the SPanish Inquisition.
Now think about a long run or hike…with every footfall, the big toe is pushed inwards.
Does your painful toe bend inwards more than the unpainful one.
Does it feel better if you spend a great deal of time barefooted?
Has any doctor said the word BUNION? Try going several days barefooted or with flops.
Does COLCHICINE make the pain stop quickly?
(To show that I really believe what I am saying, I am the only person in my gym to work the elliptical trainer barefooted…I get funny looks but eventually I will see ANOTHER who thinks tthe same.)
Alas, NOBODY except characters from James Fenmore Cooper can hike barefoooted.
Urea and uric acid…not much relationship. Urea is extremely soluble and represents the final animal breakdown product of nitrogen compounds (I guess mostly proteins.) It becomes of interest as a marker for kidney function…failing kidneys remove less and less and hence, uremic poisoning and death or dialysis.
It has nothing to do with gout or joint pain.
Couple thought:
1. Sometimes vacations are nice, sometimes they suck.
2. Sometimes we have gout attacks someitmes we don't.
3. Never discount the effect of placebo..”You are getting VERRRRRY sleepy” (In my best Transylvanian accent.
4. Never discount the effect of coincidence
5. Have you gone from last October to this month without an attack…any sucky carp involved in the meantime?
6. If it works it works…I hope trips to the far east aren't required too often.
7. If you fiind that the attacks start recurring with frequency, you will need allopurinol and it's very cheap. A trip to Malaysia will buy enough for several lifetimes.
Steve….the fish are BOGUS just like rabbits' feet.
Don't dismiss what I said about hypervigilence. With an acute gout flare you CANNOT walk for 5-6 MINUTES…even with a pot of gold at the end of your walk. With chronic gout5-6 hours walkint is IMPOSSIBLE.
(Don't confuse blood urea with serum uric acid they are VERY different. Do you mean uric acid? Normal blood urea is 7-21 mg/dL…a 21 uric acid would have you looking like Lot's WIFE…frozen in place totally crystallized!)
AND you are a vegetarian…
I mean feet are feet…walking 6-8 hours per day for a week would have GOD screaming in pain…and he hates sweetbreads.
My faith in gout self-testing took a hit when I saw the all-over-the-lot readings that so many here were getting and even some whacked out readings from my labs.
I thought why bother with the time and expense if I couldn't be sure of the results. I guess that's why GOOD studies involve hundreds of people and thousands of readings…the averages will win out.
And then you have to deal wqith post-prandial readings, preprandial readings, excercise induced readings, sleeping readings, stressed readings, and on and on. Uric acid might swing WILDLY over the course of a day.
Reminds me of my old Atkins foray…yes, hit me with a hammer. All the proponents were pointing to LOW triglyceride levels (a main praise point) but all tests were done after a 14 hour fast, NOBODY got tested after they went home and had 6 slices of bacon, 3 eggs and a wasa cracker with an ouncee of butter on it. Obviously all that grease quickly hit the bloodtream but never showed up on any testing.
I mean what is the point of basing almost ALL blood testing on fasting samples when the ONLY time people fast is before a blood test…or they live in Sudan!
I 've never quite bought the idea given out that it is as addictive as H ,I think it's a Habit which can be triggered by association and a myriad other connected feelings.
You have no idea how happy it makes me to read that sentence…I think we are the 2 people on Earth who believe that. I have argued to the point of APOPLEXY with smokers online over this issue. Of course they are just justifying their own inability to QUIT. My evidence was that I used 2 weeks of self hypnosis from a wonderful short book written some 30 years ago. I smoked normally during the period and “indoctrinated myself” against advertising, habits, etc…the crux being that smoking provides a “relaxation response” that can be replaced by 3 deep breaths if trained. Day 14, my last cigarette for 10 years…NO PHYSICAL RESPONSE AT ALL, NONE. Addiction is NOT like that because I often quit drinking for months at a time using the same methodology and let me tell yoou, I cannot do it without a passle of valium for several days. THAT'S ADDICTION. If I miss my coffee in the morning I have a crushing headachee by mid-afternoon. THAT'S ADDICTION.
Double whammy, after the first 10 years I smoked ONE cigarette and was hooked for 2 months…THAT'S HABIT. None for the last 20 years. Smoking is no more addictive than sucking one's thumb, nail biting, or nose-picking (and probably not as nice as either.)
Sorry for the diversion but that topic is one of my hot buttons.
Thanks for the Leptin discussion. The diet flies in the face of what passes for “common” thinking now…that silly 6 small meal routine. My response is that if I had to fiddle in the kitchen 6 times a day, the last trip would be for a sharp knife for my wrists so I never swallowed it. I am fine with 3 meals or even 2. Nighttime snacks though are still a tough bugaboo for me…and that's boredome and habit.
What I have found recently is how very easlily my stomach contracts to accommodate less food and I have cut my portions down considerably with NO difficulty unless I have a humongous pig out…then I suffer discomfort, let's call it welcome discomfort. Not starving mind you but now instead of an entire 3 servings of a Stouffer's 21 ounce lasagna, half will do without hunger…this I found quite eye opening.
Let me throw in just a couple of ancillaries. Cardiac tissue is reallly the only practical burner of fat (forget long distance running and brown fat discussions.) The heart PREFERS lipids STRONGLY, almost as much as the brain demands glucose as it's nearly exclusive fuel. Not QUITE sure how this works into the 12 hour fast each day…but on the simplest level it's a lot of time with NO FOOD!
Thus I think that cardio excercise is a good fat burner if you can keep your heart rate up for an hour. Another reason I hate beta-blockers is that they make it impossible for the heart to operate at high output…natural corollary is no fat burning.
Leptin activity, like every bodily function has evolved to preserve life (not sure about gout though.) Since the days of pre-cave men the major threat to survival was starvation. Fat men lived to procreate and get kids to publerty, skinny guys didn't. Leptin preserves the fat and saves our life when there's no food. Heck it isn't Leptin's fault that the last couple generations want to live to be 90. By the year 3,000 maybe Leptin will catch onto the fact that fat kills too when we reach our “prime.”
trev,
No not in the “cure” thread because gout in incurable!
Why for life? It is ideallly taken by people whose gout is caused by making too much uric acid. Much, if not MOST, of this uric acid is from normal (or abnormal) breakdown of lean tissue. The other more limited source is dietary intake and we all know how well we make healthy dietary changes for life.
Now let me add a third that is my own theory not likely to get published in JAMA: the body has feedback mechanisms and many of them work in a similar fashion. For us BP sufferers, block renin and the body makes more renin, block angiotensin attachement and the body makes more or increases the production of other chemicals that are equally agonistic, inhibit ACE and the body makes Ang-2 from CHYMASE instead, . Block ATTACHMENT of any of these chemicals and the body makes more attaching sites AND more chemicals.
I think it is likely that with allopurinol's blockage of of xanthine oxidase (which converts purines like xanthine and guanine to uric acid) causes the body to make MORE xanthine oxidase. IF that's true you can see the likely effect of cessation of allopurinol and a weeks drawdown of oxypurinol…it's long lasting and very helpful first breakdown product.) Thus I think a week OFF allopurinol for a regular user is more likely to cause an attack then all the beer in Munich!
I wince when I read a post that says, I took it for a month then stopped for a month and then took it again.
I'm tempted myself because I'd like to assess the efficacy of the losartan-furosemide dosing. I have long suspected that it was HCTZ alone that gave me gout, secondary gout if you will. But I'm a big pussy and don't want an attack. So for 2 months now, I have reduced my allopurinol from 300 mg (15 years at this dose) to 200 mg and next month. I'll MAYBE try 100 mg. This would be a LOT easier if I got some firm numbers from the doctor but I HATE doctoring…my bad!
I'd say IF you think you can control your uric acid without allo then GO FOR IT and try, kudos if successful, but to stop and start to “give your body a rest” sounds absolutely wrong to me. You'll set back your treatment big time. Remember, once you drop a load of crystals in a joint it can years or decades to resolve. (Wish me luck on my next foray to 100 mg. allopuinol.)
Tell me about the Leptin Diet…it SOUNDS like a hormone made from fat that tells you eat less…so het big and fat and lose weight? Straighten me out. How do you get the body to make leptin without needing to be fat to do it
I'm getting sick of my 27.5 BMI and I'm getting tired of making believe it's ALL MUSCLE! I need 195# for 25.0 and I'm at 214 today.
how can I determine if I have a problem with my kidneys, or merely a dietery intake problem?
The test is common: you collect all your urine for 24 hours and have it analyzed to see how much uric acid you have expelled. If a lot, you are likely making too much, if a little your kidneys are likely not excreting it properly. If the former, allopurinol is your best bet, for the latter a uricosuric like probenecid will probably be your best choice.
Mike,
A gout attack can last a couple days or a couple weeks.
NEVER go on and off uloric or allopurinol…both are a lifetime's commitment.
CALL YOUR DOCTOR…have him call in a prescriton for 30 or 60 cochicine tabs… Fill it immediately and take 2 tabs. Take an additional one every hour until you have taken 16, the pain stops, or the diarrhea becomes intolerable. It usually works seemingly miraculously well. If your doctor won't do it for you tell him he's fired.
This will end your acute attack but NOT your gout…that's what the Uloric or allopurinol is for.
Good luck with a quick pain stoppage!
What I would have given for a bedpan so I didn't have to hop or crawl to the bathroom.
My technique was to crawl on all fours with the bad foot raised being very careful not to bump the foor on the hall…fortunately the bathroom abuts the bedroom so the hall part was ony a couple feet. It was hard on the knees after 9 days and my first bottle of colchicine.
(I'll bet I screwed up the quote function again.) editL YAAAAY I DID IT RIGHT!
SS will NOT accept gout as qualifying for disability unless you can prove that your joints are damaged to the point of preventing all useful work.
They will, of course, ask “How are you treating it?” Are you taking allopurinol or probenecid?
Gout CAN be crippling…it NEED NOT be and SS knows that.
So then we are certain of ONE FACT: alcohol administration either raises or lowers utic acid levels.
It's good to have something so completely settled.
But it's simple…take allopurinol and enjoy the booze.
Just a quibble keiyh but USUALLY allopurinol dosing is mismanaged on the LOW side. THe problem is the doctors who see problems with 400 to 800 mg dosing.
I think 300 mg to start is quite reasonable…probably most doctors agree with me…now THAT'S a rarity!
I think 100 mg dosing is a waste of people's time.
Mark,
It's NOT the food, it's the inability to manufacture and excrete uric acid in proper proportions.
Chasing after which food “done the deed” is a fool's chase.
Reality is: take allopurinol and eat what you wish! Keep your uric acid below 6 mg/dL.
Reminds me…
It's nearly lunch time and I'm going to make a nice big bowl of pureed black beans (lots of cumin, dash of tabasco, splash of lemon, and some minced onions on top.)
Charles,
I'm glad to read Part 2 of your story.
Arthrosis by the way is DAMAGE from past inflammation, like arthritis, gout (which IS arthritis) or injury. After 20 years of gout attacks brought on by hyperuricemia, you undoubtedly have PLENTY of joint damage and bony overgrowth and damaged cartilege and ligaments. Some the body can heal in the absence of further insults but some will never heal properly. It took me 10 years after alllopurinol for my thumb tophus to resolve by migrating uunder my nail and forcing it's way out…and I still have a small sometimes achey tophius on the distal joint of my little finger.
Assuming you still have a lot of tophi, consider either upping your allopurijnol a bit or adding probenecid to dump more uric acid. For chronic gouties sometimes a level even lower than 5 is a good placee to be. I think things will get better for you but it will be slow. THe lower you can get your uric aciid the faster the old deposits will be removed.
Probably you can loosen up on your diet a bit…it makes life more pleasant and that's what the drugs are for.
Never mitigate gouty arthritis compared to the others…it is the only KILLER among the arthritises. If NONE of your pain is attributable to gout, just treating hyperuricemia will save your heart and your kidneys.
Doctors have a rule of thumb that I once read but forgot but they will NEVER prescribe allopurinol after just the first attack, or even the second becasue they are loathe, correctly so, to commit someone to a lifetime of a drug if there is a chance the injury was a sprain, a crush, a whack, a repetitive motion injury, a microcrack in a bone etc. They have some rule of thumb like 2 or three attacks in a year.
Probably the only DEFINITIVE call can be made with the big purple bunion joint that is excruciating painful to touch and a high uric acid level…and a fast response to colchicine.
But yes, once your gout virginity is lost there's no way to glue the hymen back on your toe. It's becasue uric acid easily supersaturates and causes no problems BUT supersaturation cannot occur in the vicinity of an already formed crystal…and once you've had that first attack, you have crystals that you will probably NEVER be entirely rid of.
Yep, learning to use colchicine is a fine art and once learned, a VALUABLE tool. Just 2 teeny tablets at exactly the right time can save a LOT of time on the throne of perdition after having to take 12 of them.
Appropos of nothing, I started right out with a 300 mg. dose of allopurinol with not a single problem…no attacks and good uric acid numbers, even with thiazides.
Tim,
My vote is that the cessation of your attacks is due almost entirely to the effectiveness of allopurinol.
Two thoughts:
My GUT feeling is that alcohol will preciptate an attack by dehydration BUT here's a little cutie from a Med School in Prague::
QUOTE: The acute administration of ethanol by gastric cathether significantly increases the plasma xanthine oxidase activity in both rats and hamsters without changing other enzyme activities — alanine aminotransferase and aspartate aminotransferase. The plasma xanthine oxidase level seems to be a sensitive marker of liver damage. Its higher activity due to the acute ethanol intoxication may have an impact on ethanol organ damage.
Thus more xanthine oxidase the more readily xanthines (purines) are converted to uric acid. Thus a likely connection between chronic alcohol abuse and gout.
(How can we use quotes properly on this forum?…I've tried HTML coding and Bulletin Board coding…NADA!)
Leon,
Firstly, heel pain is not typically gout but rather plantar fasciitis and the pain can go from the heel all the way under the arch of the foot. It usually passes all by itself, but sometime takes a LONG time and if heel spurs are involved, then surgery is often prescribed.
Your uric acid numbers, a little over 6 mg/dL are not inordinately high just highISH…and probably quite common for those WITHOUT gout. This is not to say you don't have gout nor to say you do.
But don't mangle your life and your nerves over probabilities. If you have gout you will eventually have an attack that is unmistakeable by even a nearly blind doctor.
When that happens you can make a proper decision of what to do about it. There's nothing to fear from one completely definitive attack and nothing to be gained by turning your life upside down beforehand.
So, like trev said, stop smoking, keep hydrated, keep booze to a reasonable amount, expecially beer, and then enjoy all the chicken you want. And did I say, stop smoking becasue if not then I want to say stop smoking.
I think a closely monitored trial with febuxostat is in your cards. You want that uric acid a lot lower than the 7 level.
Yes of course, go with the HRT. There's a good reason that ovulating women have uric acid levels a full 2 points lower than men and I don't think it has much to do with high heels.
(Ask your doctor what he thinks about probenecid and your kidneys.)
Just a few thoughts:
1. On and off allopurinol is NOT the right way to take it. Once started it must be continued, attacks or no atttacks, colchicine or not. A doctor who said take the colchicine and stop the allopurinol during an attack should be summarily FIRED, he's incompetent.
2. For a severe attack, 3 hours of colchicine is just not enough. THe regimen is 2 to start, then one pill an hour until the pain stops, the diarrhea gets severe or you reach a limit of 16 pills. It can be brutal on the intestines but the regimen WORKS!
How much allopurinol is he taking? It should be enough to lower his uric acid to below 6.0. Some people need 800 mg./day, some 200? If he's not getting a good response to allopurinol he should have his urine sampled for 24 hours. If he is a sever uric acid underexcreter, then his drug of choice should be probenecid. But whichever he takes, there should NEVER be a day when he isn't taking the med.
You said that he had a uric acid of 11.1 and THEN the allopurinol was started…what numbers does he get WITH allopurinol.
Rhabdomyolysis certainly means NO STATINS, a shame if his blood lipids are whacked…alas that means extreme dietary control, probably minimal meat and dairy. A nice thing about Lipitor is that it;s uricosuric uricosuric (but not all statins are.)
Gee, lovastatin is among the weakest statins…I'm surprised it caused rhabdo. Alas, though very RARE, allopurinol can also cause rhabdomyolysis…but then so can colchicine…OY!
Remember though, with the rhabdo and hyperuricemia his kidneys will not stand much more so proper uric acid control is mandatory. I think maybe your husband should be in a hospital for a little while under the care of a GOOD rheumatologist and GOOD nephrologist.
Grandma,
I don't think anyone here has given febuxostat a try but you certainly should consider it if your nephropathy is MILD. It's not recommended for people with severe kidney disease and it's not very good for underexcreters.
You should probably have a test to find out if you are an overproducer of uric acid or an underexcreter. But your problem is unique and even a drug like probenecid can harm the kidneys. I think you just need to follow the advice of the very best nephrologist that you can find.
Even colchicine is problemmatical with damaged kidneys.
And of course gout itself is a kidney destroyer.
How bad are your kidneys? Are you hypertensive and leaking protein? If you ARE hypertensive, losartan is a good choice. If your cholesterol is up, Lipitor is a good choice becasue both are uricosuric.
The one thing you have in your favor is that prednisone is also good for IgA nephropathy…I have trouble getting my tongue around that word.
