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So I have been dealing with gout for around 5 years and I want to take the plunge and start a medication. I had a flare up about 2 months ago in my foot. Ever since then my foot has never been the same. After that flare up a week or two went by and the swelling was gone but it felt like I had a pulled muscle or tendon on the top of my foot, and top of my toe. Ever since then it would come and go and I would just put my foot in a bucket of ice water and it would be good for a couple of days. I still have the problem but now I have tgis lump on the side of the my big toe that gets very irritated when I wear shoes, work boots, or just around the house. Yesterday it hurt really bad so I pressed on it and it feels like there is fluid under the skin, and like a hard ball of something. Since I did some research earlier today I’m assuming it’s tophi. I asked my doctor a week ago what was going on and he said it was gout, but never used the word tophi, so I guess he was right. He said that I needed to start taking some meds either Uloric or Allopurinol but never said anything about Colchicine. He said he would go with the Uloric and start me at 40 mg so there would be minor flare.up then move me up after another Uric test. I told him I wanted to do some research before I committed to one of them and he said okay just let me know so I can send out the script. Leaving that vist my Uric level was at 11% which he said was bad that’s why he wanted me to start meds. So haven’t went back because I’ve read so much information I don’t know what to do so here are my questions.
1. Why didnt the doctor prescribe Colchicine?
2. Should I go to a different doctor?
3. Which is better Uloric OR Allopurinol?
4. Will this lump on the side of my toe go away after I start either medication?
5. If starting either med how should it be started, like dosage wise?
Another reason I’m having a hard time deciding to start one or the other is because my wife is due anytime with our child and I don’t want a flare while I’m at the hospital so I wasn’t sure if you have flare ups immediately after you take one of the meds.
Someone please help because this is taking a toll on my life, and has been really depressing the last couple of weeks.
Thank You…….
11% is not a valid measure for uric acid. See multicolored list halfway down right hand sidebar.
1. I have no idea why your doctor would not prescribe colchicine or other pain relief during uric acid lowering. What did your doctor say?
2. Why would you change doctors? Do you think you can train another doctor easier?
3. Allopurinol is better than Uloric in terms of cost, and it has a long record. Uloric is better if you are in one of the genetic risk groups, and your doctor doesn’t know about allopurinol sensitivity screening.
4. If your lump is a tophus it should shrink, but might take years to go completely, if ever.
5. Uric acid lowering treatment dosage must be set by blood test results. Primarily uric acid test results, but liver function and kidney function are also important. In fact, if you didn’t get those function tests before the offer of a script, the answer to 2 is definitely YES.Good luck with the baby.
You are at risk of a gout flare if you take uric acid lowering treatment, until the bulk of old crystals have dissolved.
You are certain to get a gout flare and suffer more joint damage if you do not take uric acid lowering treatment.
That is why gout sufferers need effective pain treatment.
It is also very easy to achieve gout pain relief unless you have other medical complications – http://www.goutpal.com/gout-treatment/stop-gout/gout-attack/acute-gout-attack/Tell me about depression! Been about a year for me now. Nobody cares. I did get a lift yesterday. A very kind person sent me a $20 donation so I can eat next week. Whoop! http://www.goutpal.com/gouty/help-for-gout/
Hey thanks for the respond. All my doctor said is I need one of the meds, but never prescribed colchicine, thats why I asked if I need to go to some type of specialist. When I did the blood work he checked everything else, like white blood cells, etc. I wasnt sure if he used the % when I said 11. I just figured he did he said that he wanted me at 5.
I asked my father in law about colchicine and said I’m not suppose to take it every day, but I have read that people take it everyday till the levels go down. He said in the 50 years he has been giving people gout prescriptions he has never prescribed someone to take it everyday only when there is a flare up they take it. I’m just totally lost
Yeah, but is the lack of forum traffic down to:
a) Too hard to use?
b) People get all the gout answers they need from searching GoutPal before they post?
c) Something else?Hundreds register on this gout forum each month, but never post anything. I don’t understand that, because the only thing registered members can do that unregistered guests cannot do is post topics and replies. That may change when I introduce membership with more benefits such as training courses. http://eepurl.com/0pY-9
If anyone has positive ideas for improving the traffic on this gout forum, I’d love to hear them.
I’ll follow up on the colchicine clarification soon
Goof luck with the doctors appointment. Have you had it now?
Do you still need advice on the different circumstances that dictate if colchicine should be taken every day, or as required?
So I went to my doctors he prescribed me Colcrys and Allopurial 300 mg. He said take the Colcrys for a week then start taking the Allo. I’m actually afraid to take the Allo because of all the bad stories I hear about people having really bad outbreaks. And I noticed a lot of people start off at a lower mg of the Allo. Just don’t know what to do anymore.
Sorry been away due to my child being born and there where some complications with the delivery ect
I read on one of your pages that we should start at 100mg so I guess thats why I’m hesitant to start the Allo
It’s easier to answer questions if your profile details are complete. There’s nothing at https://gout-pal.com/users/bl530/profile/
I can make answers more relevant if I know more about you.I’ll give a general response to allopurinol Colcrys dosing soon.
It stinks when doctors don’t follow Professional Guidelines properly.
The routine is pretty straightforward. For those people in high risk ethnic groups, do a genetic screening test first. If you pass that, and for everybody else, start with 100mg allopurinol, then increase by 100mg every 2 weeks until target uric acid level is achieved.
You should also have blood tests for kidney function and liver function whenever you get uric acid test. If those test results, or the genetic screening test results, give cause for concern, then switch to Uloric instead of allopurinol.
Fear of gout attacks is understandable, but I always say:
You might get a gout attack when you start uric acid lowering treatment. You will get a gout attack if you do not lower uric acid.
Taking Colcrys as a daily preventative will remove most of the risk of a gout attack. If you do get a gout attack, take compatible pain relief as advised by your doctor or pharmacist.
When I took the blood test it showed that, my liver, kidneys, white blood cells all checked out fine. At first he only prescribed the Allo and then I told him what about Colcrys he then said well it wasn’t that necessary but he would prescribe it. He kinda was also bothered that I told him I had did some research online and he said don’t believe everything I read and that he has been prescribing gout patients for years, this is just damn confusing.
I will fix my profile when I get to a computer because it doesn’t let me do it on my phone.
I really appreciate your help also
This is where it get’s awkward.
I know why doctors get bothered when patients tell them they did research online. It’s because there is a lot of bad information. I’ve had the joy of seeing a great doctor who kept a list of good websites to encourage his patients to look at helpful stuff. Not many do that.
I get annoyed by so-called professionals who claim what they do is right because they’ve always done it that way. Have they never heard of “Continuing Professional Education?”
The trouble is, we all need our doctors. They are best placed to understand the risks of treatment. They are the only ones who can prescribe medicines we need. I’ve found my way forward is to try and find good doctors who will listen to what I have to say (as long as I’m talking sense). For the rest, you have to carefully prepare and present the relevant facts.
The easy way is to say “I don’t give a **** about your years of experience! Professional rheumatologists in America, Britain, and Europe have invested in guidelines that tell people like you how to treat people like me. Now go and read whichever one you can get your hands on, then treat me according to current standards.” If you want to be really rude, you can give them some words of wisdom about leeches not being used quite so much these days.
My point is, you have to find a way to work with your doctor, or find a new one. You know what you’ve been told is wrong. I know what you’ve been told is wrong. I am not here to tell you what to do next, but when I learn more about what is important to you, I can give better suggestions.
Your doctor said “don’t believe everything you read” That is very good advice, but you have to come back with hard facts. In your case, the important facts are 2012 American College of Rheumatology Guidelines for Management of Gout. Part 1. Your doctor should have a copy, so ask him what he thinks of the new stuff under “Significance & Innovations”. If he doesn’t have a copy, you can point him to https://www.rheumatology.org/practice/clinical/guidelines/Gout_Part_1_ACR-12-0014.pdf
Specifically ask him about “The starting dosage of allopurinol should be no greater than 100 mg/day”. If you want to push him, ask how many of those gout patients he’s been prescribing are fit and well. Is their uric acid safely at 5mg/dL or below? He probably won’t know, but I’m guessing most are still suffering needlessly. Actually, that’s not a guess. Study after study shows that most doctors fail to set a safe upper target for uric acid.
2 Other points:
1. I’ve been looking at the Profile, and it needs to be easier to add more information. At the moment, it is only good for one paragraph, so make that about whatever is most important to you now. I’ll improve it as soon as I can.
2. You’ve inspired me to be more proactive about building the doctor-patient relationship. The best way I can help any gout sufferer is to help them form good relationships with all their medical advisers. I’m going to give that more thought, and try come up with some easy, practical ways to make sure everybody gets better medical help.
Thank you for your support. Sorry if this is a bit of a rant, but you touched a nerve – or rather, your doctor’s attitude did.
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