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Yesterday, I started my review of crawfish for gout sufferers at Is Crawfish Bad for Gout?
I will continue with the details for dieting and for uric acid control. Then I’ll delete this old discussion.
Note that the new gout forum is active. But there is only one small reference to crawfish in the fish and uric acid discussion. So rather than commenting there, it is best if you start a new topic about crawfish and gout.
There has never been much interest shown in mobile apps for gout. But if you are interested, I hope you will contribute to the latest discussion at Gout Patient Mobile App Survey.
Recently, I’ve seen the ideas for a smartphone app related directly to Uric Acid Test Strip Boxes.
For facts about febuxostat see Uloric info.
For latest discussions about cutting Uloric in half, see Can Uloric be cut in half? Also, when you are on that new website, search for ‘can uloric be cut in half’. Because there are several other discussions that mention this.
I see many people still asking “Does altitude affect gout?”
I used to think that flying had little or no effect on gout. But I’ve spotted a report that suggests otherwise:
Jefferson, J. Ashley, Elizabeth Escudero, Maria-Elena Hurtado, Jackeline Pando Kelly, Erik R. Swenson, Mark H. Wener, Michel Burnier et al. “Hyperuricemia, hypertension, and proteinuria associated with high-altitude polycythemia.” American Journal of Kidney Diseases 39, no. 6 (2002): 1135-1142.Serum uric acid levels were elevated in groups chronically living at high altitude compared with sea-level controls
Note, this is about living at high altitude rather than flying to high altitudes. At least one other study about aircraft and uric acid mentions decreased uric acid excretion.
Kramer, E. F., H. B. Hale, and E. W. Williams. “Physiological effects of an 18-hour flight in F-4c aircraft.” Aerospace medicine 37, no. 11 (1966): 1095-1098.But that might be related to reduced fluid intake during long flights. Or I might just need to dig deeper.
So let me know if you want me to investigate further into the effects of flying and/or altitude on uric acid and/or gout. Either start a new gout forum topic. Or use the feedback form below.
As far as podagra is concerned, I’ve included it with other ancient names for gout.
Though it’s incidental to the main part of the article – we’d get better treatment if we stopped talking about gout. Instead, use Uric Acid Arthritis, or some other name that encourages serious treatment.
I’ve recently seen a report about high white blood cell count and gout. In this case, it looks at the problem of diagnosis where both gout and septic arthritis are suspected.
These cases show the potential difficulty involved in differentiating the synovial fluid in gout from that of a septic joint based on white blood cell count and differential alone. Furthermore, these cases highlight the importance of crystal analysis in cases of suspected septic arthritis. Given the current diagnostic capabilities available to clinicians, it is difficult, if not impossible, for the clinician to know definitively at the time that a treatment decision must be made whether a patient with a significantly elevated white blood cell count has pain as a result of septic arthritis or gout. Certainly, clinical judgment plays a role in deciding what treatment is most appropriate for these patients.
That could be dangerous if the wrong treatment is given.
Do you want me to do more research on the dangers of septic arthritis, high white blood cell count, and gout? Please let me know in the new gout forum. Or use the feedback form below.
It’s interesting for me to look back at old forum topics. Especially when I see something that resonates with one of the plans I was working on yesterday.
Here we see a young gout sufferer surprised to find that gout is progressive. So it spreads from joint to joint with increasing intensity and destruction. Then comes the stage that Jason hadn’t (yet?) experienced – when gout spreads into soft tissues and starts to damage your organs.
In my revamped Gout Victims Plan, I cover progressive gout in step 3 as I explain many myths about uric acid. In case that doesn’t persuade gout victims to seek uric acid treatment, I re-emphasize the dangers in step 6.
So it’s nice to look back and wonder if old forum visitors found gout recovery. Or if they are still gout victims. But it’s also nice to look forward to renewing my efforts with Gout Sufferer Plans. I hope 2020 is the year I finally finish that 4-year-old project.
Soy Sauce is Good for Gout
I’ve been researching soy sauce for a planned article and I found a useful study:
Li, Huipin, Mouming Zhao, Guowan Su, Lianzhu Lin, and Yong Wang. “Effect of soy sauce on serum uric acid levels in hyperuricemic rats and identification of flazin as a potent xanthine oxidase inhibitor.” Journal of agricultural and food chemistry 64, no. 23 (2016): 4725-4734.Although it’s about rats rather than humans, it’s encouraging to see that soy sauce reduces uric acid. So I hope there’ll be more studies into soy sauce with human gout sufferers.
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This post is part of a forum reorganization test. So you can probably ignore it. Also, I may be running more tests this week. In preparation for doing something different here.
Remember, this forum moved a long time ago to the new gout forum. Also, you can share your views by:
- The feedback form near the end of almost all GoutPal pages.
- Replying to any GoutPal update emails – see the updated list at Gout Info Updates.
- Raise a new ticket at my help desk.
Anyway, I’m moving this forum topic to an updated Colchicine Shelf Life.
Do you have any questions, experiences or opinions about stevia and gout? Then ask in the Feedback Form below.
Better still, join the discussion about Food suitable for gout and diabetes in the new gout forum. Please note, that is currently the only live discussion about stevia. But with new research, I expect there to be more gout-related stevia discussions. In any event, if you start a new topic, we can soon create a vibrant stevia, gout, and uric acid forum.Earlier in the discussion, I mentioned a lack of research about stevia, uric acid, and gout. However, that has changed. So I have now started a research project into Stevia & Uric Acid.
Does Gout Qualify for FMLA?
This topic raises various related questions about FMLA for gout. Including:
- Is gout covered under FMLA?
- Can I get FMLA with gout?
- Does gout qualify for FMLA?
Is gout covered under FMLA?
FMLA is the United States Family and Medical Leave Act of 1993. So, as a legal matter, it is beyond the scope of GoutPal. However, I can apply my research skills for any employer or employee who wants to find more information about FMLA & gout before you consult a lawyer. That way, you can be clearer about your questions for your legal team. Which might help to reduce some costs.
Returning to the question, we can see that gout is covered under FMLA. But besides legal considerations, you should also seek professional medical. Because every gout case is different. This means that your case needs a professional medical review that also considers the legal issues.
Can I get FMLA with gout?
The test is whether gout is considered a "serious health condition"[1]:
You may take FMLA leave for a chronic serious health condition, like epilepsy, diabetes, depression, or asthma. This category is intended to include conditions that are long term and may wax and wane, causing episodes of incapacity or disability.
In the forum, I pointed out that if I were in this situation, I would rather treat my gout and remain working rather than take leave. But my situation is different from many gout sufferers. Because:
- I no longer have gout attacks due to long term allopurinol.
- When I used to suffer attacks, I had a good gout pain control plan that allowed me to relieve pain within a couple of hours or less.
Does Your Gout Qualify for FMLA?
So you have to decide. Can you get your doctor to treat gout well enough so that you don't need FMLA? I can help you arrange that. But if you have no option, what must you do to qualify for FMLA. Well, you can see from the studies I've found so far that every case is different.
FMLA & Gout with Comorbidities[2]
Under the employer's FMLA policy, Lahey consistently approved Tayag's requests for leave over a three-year span, which typically lasted a day or two, in order to care for her husband. Tayag's husband "suffers from serious medical conditions, including gout, chronic liver and heart disease, rheumatoid arthritis, and kidney problems." Tayag assisted her husband by, "transporting him to medical appointments, helping him with household activities, preparing his food, aiding him in moving around the house, providing medication, and providing psychological comfort."
Gouty Foot & FMLA Dismissal[3]
Missy has been diagnosed with gout, a medical condition characterized by recurrent attacks of inflammatory arthritis. Attacks are spontaneous, but when an attack occurs, it causes an excruciating pain in her foot, rendering her unable to perform her job as a waitress. […] Missy brought a retaliation claim against her employer, alleging that she was actually terminated for taking Family Medical Leave Act (“FMLA”) leave
So tell me your story and I can do more research for you. Then you have evidence and strategies for dealing with your professional advisors. All you need to do is click the New Ticket link near the top of this page. Or click 'No' below in answer to "Did you find it helpful".
FMLA for Gout References
- Guerin, Lisa, and J.d. “Is Your Disability a Serious Health Condition Under the FMLA?” http://www.disabilitysecrets.com. Accessed March 19, 2020. https://web.archive.org/web/20170826121339/http://www.disabilitysecrets.com/resources/your-disability-serious-health-condition-under-fmla.htm.
- Korn, Lindsay. "Taking Care of the FMLA: Traveling with Family Members Under the Family and Medical Leave Act." Hofstra Lab. & Emp. LJ 34 (2016): 453.
- Shaffer, Melissa J. "Hey Employer, Did You “Notice” My Text Message?." Louisiana Law Review 77, no. 3 (2017): 12.
Shelf Life of Allopurinol
I got a related question recently on my gout help desk. When someone asked about the allopurinol expiration date. So that caused me to revisit this topic.
I’m preparing a full review. But for now, some facts are:
- Half-life is actually “elimination half-life”. That is, the time it takes for drugs to be excreted from the body to half the maximum concentration. It’s really a separate issue. So it’s best to start a new topic. Or ask in the help desk. But the main issue is that allopurinol quickly changes to oxypurinol. That is the important uric acid inhibitor. Studies indicate that the half-life of oxypurinol is 23 hours on average[1]. With a range wider than 17 to 39 hours. So missing a day is not as serious with allopurinol as with some drugs. Note that you must confirm this with your doctor. Because your situation might be different – especially with kidney problems.
- I can only find 1 study related to the shelf life of allopurinol[2]. But it relates to allopurinol tablets crushed into a liquid. So not a definitive answer. But it found “The shelf-life (t90) of the suspension was found to be 8.3 years at room temperature”. Note that shelf life is measured as the time it takes for allopurinol to degrade to 90% of its original concentration.
I’d like my review of the shelf life of allopurinol to be as comprehensive as possible. So please share your questions, experiences, and opinions. You can use the new gout forum or my help desk.
Allopurinol Shelf Life References
- Day, Richard O., Garry G. Graham, Mark Hicks, Andrew J. McLachlan, Sophie L. Stocker, and Kenneth M. Williams. “Clinical pharmacokinetics and pharmacodynamics of allopurinol and oxypurinol.” Clinical pharmacokinetics 46, no. 8 (2007): 623-644.
- Alexander, Kenneth S., Nipun Davar, and Gordon A. Parker. “Stability of allopurinol suspension compounded from tablets.” International journal of pharmaceutical compounding 1, no. 2 (1997): 128-131.
It brings me great joy to re-read this today as I start writing about 15 Years of GoutPal.
I should point out to other gout sufferers reading this that all the credit for his gout recovery goes to David. Because he worked hard every day to learn more about his gout. Then he discussed it with his doctor until everything came right.
So it takes effort. Maybe not every single day. But certainly once a week it’s good to discuss questions, experiences, and opinions about your gout. Note that besides that new gout forum, you can also get email help using my help desk. Or even easier – use the Feedback Form near the end of each GoutPal page. Because that is also part of my help desk.
Thank you Nate and Bob.
Your last 2 comments have really got me thinking these past few days. Because in real life I’m a friendly guy. Also, in my helpdesk, I’m very careful to consider the individual I’m communicating with.
But on the forums, maybe because I feel publicly exposed, I get very defensive. Which you’ve told me comes across as aggression.
So I’ve had a long hard talk to myself about my forum behavior. Hopefully, I’ll stop getting snarly when things don’t go my way. Then I hope I’ll make myself clearer and more useful.
I’m making no excuses.
Looking forward, as soon as I get time I’ll explain:
– Why banaba extract is probably good for most gout sufferers.
– Why some people might need to be vigilant.
– What the latest toxicity investigations say.In a nutshell, banaba is safe within the rules of herbal supplements. But certain tests would need to be carried out if it was to be recognized as completely safe in some countries.
In the context of good gout treatment, everyone should have blood tests at least once a year. With more frequent testing during treatment changes. Until results have stabilized.
The important tests for most gout patients are uric acid, kidney function, and liver function. But doctors might advise more tests if patients have other diseases. In any case, these tests will confirm that banaba extract is safe and effective for uric acid control.I’m surprised to see this topic re-opened after 6 years. Especially as I thought I’d closed this forum in favor of the new gout forum at GoutPal.net.
Anyway, if people want to discuss banaba and gout here, that’s fine by me. Especially, as there have been no recent discussions apart from a passing mention in Gout with chianca piedra, and or banaba leaves.
But I do wish statements like “It states on drugs.com and web MD” were backed up with some links. Or even a page title.
If you are reading this old topic because of references to PPIs, please see the latest discussion about Proton Pump Inhibitors and gout. That topic is also good for discussing other aspects of antacids and gout.
For different gout topics, please start a new gout topic with your questions, experiences, and opinions.
This old topic is generating a lot of interest from gout sufferers who are concerned about bone broth for gout. Also, lot’s of gout sufferers are also interested in relieving gout pain with Aspercreme. Unfortunately, there are no relevant discussions on the new gout forum. But, it’s easy to start a new topic. Then, I can give you up-to-date personal help.
If you want to discuss bone broth for gout, it’s a good idea to include a list of all the foods you eat regularly. Because individual foods are never to blame for gout attacks. So, we have to look at the big picture. Then, we can plan to incorporate favorite foods, such as bone broth, in your healthy gout diet.
If you want to discuss Aspercreme for gout pain relief, you need to be aware that it is a brand name for lidocaine. Now, this is unlikely to give effective pain control by itself. So, include all other prescription and OTC gout drugs that you are taking. Also include any herbal supplements, and treatments for other conditions. Then, we can plan a combination pain relief package that may, or may not, include lidocaine (Aspercreme).
Please start your topic in the new gout forum, now,
Prompted by a current discussion in the new gout forum, I added a photo to the original post. The photograph of tophi surgery is in an archive from American Society for Surgery of the Hand. It includes a discussion of the risks of all surgery, and a particular risk of tophi surgery. Tophi surgery is unpredictable. Attempts to remove tophi might cause them to spread. This can lead to tendon damage that might be severe enough to require a tendon graft.
That’s not to say that tophi surgery is wrong. But, as that surgery archive explains: “medical management is the first line of treatment”
In the new gout forum, John describes his Krystexxa experience, with tophi shrunk due to medical gout treatment. Though that is not allopurinol specifically, we do discuss allopurinol, and its capacity to shrink tophi.
If you have any concerns about tophi removal, or any other aspect of gout, please ask in the new gout forum.
I think we’re both probably defending errant doctors more than we should. But, your last paragraph says it all.
I’m aware that people look up health information on the Internet. Then, guess what, they suddenly get the symptoms next day (or imagine them). I know it’s a problem for doctors, but I don’t think it’s changed much over the years. Pre-Internet, the source was ‘my mate down the pub’ or ‘my sister’s brother-in-law who once went out with a senior nurse’ etc.
I think it’s different when we’re actually prescribed something. I’m heeding your words Mike. Next time I get a prescription, I’ll definitely be researching the active ingredients before I start the treatment.
Almost 6 years on, and opinions about the uric acid test kit are still divided.
Everyone is agreed that uric acid tests are vital to control gout. The opinions divide when we discuss if test should be done at home, by your doctor, or at a walk-in lab.
I think it has to be a personal decision based on your own circumstances. I can help you make that decision. If you decide to get your own uric acid meter, I can help you get the most from it.
The best place for personal discussions about any aspect of gout, is in my new gout forum. Please discuss uric acid home test today.
It’s many years since David posted about Epsom Salts for his gout. I wonder if @phofab is still lurking anywhere near here? If so, now would be a good time to tell us if soaking in epsom salts is still helping his gout.
There are still hundreds, if not thousands of gout sufferers reading this to find out about epsom salts for their gout. After all these years, it’s probably time for a new discussion to see if epsom salts help gout.
Of course, you can still post here during 2016. However, I’d like it much better if you ask about Epsom Salts & Gout in the new gout forum.
So, it’s nearly 5 years since someone mentioned Bert Middleton, aka “The Gout Killer” and his infamous views on alkaline water and other snake oil.
I really can’t believe how much money that guy must be making! I wish I was half as good at marketing.
Anyway, who needs all that money? I’d rather have hundreds of readers who control gout safely.
If anyone wants to save money, why not discuss these over-hyped “cures” before you buy them? I’m happy to give you an objective view on any form of gout treatment. And I will never charge you for advice (unless you really insist on giving me money!).
You can continue to discuss alkaline water here, or any other snake-oil that you want me to review. However, I would prefer if you post your messages in my new gout forum.
See what we’re discussing there with the new gout update service:
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Aw Mike, that’s terrible!
How upsetting that it might be avoided if doctors had thought a bit more about uric acid implications. I have to say that I’ve seen it from there point of view. Doctors have explained to me that it’s very difficult to check all possible side-effects when they have a problem to deal with right now. Maybe they could do more. But, the common approach in medicine is to deal with the immediate problem, then make adjustments if more problems arise.
All we can take from your experience Mike, is the need to be vigilant. Anyone who has ever had any worries about gout needs to ask the question about any other treatment. I have a list of meds on my gout guidelines site that can increase uric acid. The trouble is, it is not a static list. Therefore, gout sufferers need to adopt a strategy for other meds:
1. Always ask the question.
2. Always get a blood test after starting a new drug. You’ll have to wait for the drug to reach its full effects. But, your doctor can easily find out how long this is for different drugs.I really hope it doesn’t happen to you again, Mike.
And, I hope other gout sufferers will take note, and maintain vigilance against similar problems.
Bloody Hell! If I’d known great posts like these were coming, I might have planned the move to my new gout forum a little differently. Actually, forget that! There’s still thousands of people reading this every day. And, I’ll continue to run this gout forum for at least the rest of 2016.
As with gout control, I prefer steady gentle changes. 🙂
Barry! Your news is brilliant. Everything you’ve said and done has been right. I think you deserve to be gout free now. I understand the lingering fear. Even after 4 years, I wonder if the dreaded gout may return. And, I’ve been lax about my annual checkup, so thanks for the reminder.
I also drink less than I used to before I got serious about handling my health. I’ve realized as the years pass, I can’t drink all night, every night. Fortunately, I still manage too much occasionally! 😀
Jasper! Great to hear from you again. Very wise words indeed.
“Apologies if its long” ❓ ❓ ❓
No Way! You could write that stuff all day, and I’d never tire of reading it.Please let us know when and where you are running. I’m sure there will be some local gouties who would love to cheer you on.
Gee G-man! Great post. Lots of lovely diet facts.
I’m so pleased you are still taking care of your diet. Too many people think they can do as they like once allopurinol starts. I think your healthy attitude gives you much better chance of a long, fulfilled life.
I’m not sure about the tophi. What have your uric acid blood test results been like?
Barry, Jasper, and G-man,
Thank you so much for taking some time to encourage fellow gout sufferers. You’ve really made my day. 😀Hi Jason,
Diet can certainly work in some circumstances. Gout diet is just another form of gout treatment. For some people, it is all they need. But, just like any gout treatment, it all comes down to controlling uric acid.
If you really cannot get a blood test, it obviously limits your options. Some people use uric acid test kits at home. Even that needs a finger prick. If it sounds like you could cope with it, it might be a way forward, but not ideal.
I’m quite worried, because 15 years is a long time for uric acid crystals to accumulate. They get increasingly dangerous as time passes. In your position, I would talk seriously to someone about that phobia. There’s nothing that can’t be overcome with patience and understanding.
Obviously, I can give general advice about healthy eating for gout. I just worry that it would be pointless if your real cause of gout is genetic. I’m happy to help you improve your diet, even if you can’t test if it is helping your gout.
Anyway, Jason, have a think about this, and tell me how I can help you best. I am continuing to reply in this forum when I can. However, my priority is posting in my new gout forum, where you will get faster responses.
As I mentioned in his other thread, Frank has now moved to my new gout forum, where he is discussing Allopurinol And Colchine Dosage.
As he has knowledge and experience about febuxostat also, you might want to ask Frank how allopurinol compares with febuxostat.
Please join Frank, and post in the new gout forum now.
As Frank has moved to the new forum, I?m going to close this febuxostat discussion.
I will continue to respond to other posts in this forum, but I will focus most attention on the new forum.
Please make sure you switch your gout updates to the new forum at https://feedburner.google.com/fb/a/mailverify?uri=GoutpalNetwork
Frank has now moved to the new gout forum, to ask about Allopurinol And Colchine Dosage. Why don’t you join Frank and share questions, experiences, and opinions about gout. Maybe you could ask Frank about his febuxstat experiences, and how it compares to allopurinol?
Febusostat has many different brand names around the world. Feburic, Adenuric, and Uloric are all pretty common. I’d love to know what it’s called in your part of the world.
As Frank has moved to the new forum, I’m going to close this febuxstat discussion.
I will continue to respond to other posts in this forum, but I will focus most attention on the new forum.
Please make sure you switch your gout updates to the new forum at https://feedburner.google.com/fb/a/mailverify?uri=GoutpalNetwork
Hi Richard,
It’s easy:
1. One colchicine at bedtime.
2. If any gout symptoms next morning: second colchicine (max 2 per day) plus 120mg Arcoxia (Etoricoxib).
3. If pain persists: Max strength Tylenol (acetaminophen / paracetamol) every 4 hours.That should keep you mobile, so gentle exercise will resolve pain even quicker.
When you say “stopped drinking,” I assume that means alcohol. When I suffered gout pain, I always found it easier to tolerate and quicker to resolve with a few pints. Everyone is different, so be guided by your own experience. Don’t be led by a single day. You have to repeat drinking days and none drinking days. You have to record your symptoms in a diary. Whichever you choose, always ensure adequate hydration. That means sufficient fluid to ensure urine is pale straw color.
It’s a bit late for avoiding flesh purines now. Gout attacks come from uric acid crystals that started forming many months ago. As soon as your vacation is over, get uric acid control (best to ask in my new gout forum). Free Fatty Acids (FFAs) are thought to trigger attacks, but the science is too new to make specific diet recommendations. Make sure 80% of your food is fruit and veg. Low fat dairy helps, but as I say, probably too late for current attack.
Believe it, Paul! You’ve worked hard to control your gout, so now’s the time to reap the rewards.
As for allopurinol, it’s important to get a uric acid test at least once a year, forever. Wisest to get kidney function test and liver function test at the same time – most UK practices include these automatically, but it’s always best to check.
I was hooked on channel 4 last night, so…
Live long and prosper \\// 🙂
That’s great, Ayman.
I’ve responded at http://goutpal.net/forums/topic/new-gout-management-plan/#post-601
