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John,
Your plan will work eventually but I think it's a shame to lose a whole month without any uric acid control.
I hope the 2 colchicine a day are sufficent to end your pain but it IS a small dose.
john,
With those uric acid numbers between 8 and 10.3 the presence of big toe pain in MY mind confirms gout to a 90% certainty. (That MRI sounds like just running up the bill…you probably have good insurance so your doctor wants an extra grand to diagnose your gout.)
On the diclofenac: if the drug is sufficiently urate retaining to almost wipe out a species of vultures, caution is advised. After all, there are hundreds of other NSAIDS to choose from, it's not like it is the ONLY analgesic. Several available are available without Rx. Naproxyn immediately springs to mind.
Could someone answer my other question – is podagra another name for gout?
Podagra is the word used to describe the easily recognized gout attack that is extraordinarily painful whether moving or not, hits precisely the bunion joint of the big toe, and is red (or purple) and swollen. This is the classic gout that doctors (and barbers and shamans) 2,000 years ago could recognize before they even knew that blood circulation, the immune system, or even uric acid existed. Rarely similar symptoms can arise from pseudogout.
It is the commonest marker for gout and eventually, almost to a man, a gout sufferer will suffer a bout of podagra…and usually swear NEVER AGAIN…and then swear some more. It hurts like HELL!
There may be something to the sedentary gout hypothesis. All of my gout attacks have hit after 8 hours asleep. Perhaps urate can pool more easily if not disturbed by movement.
I've haven't ever seen any thing in the literature on the subject though.
It sounds a lot llike quackery of the first order.
To wit, from their website:
Primary Alkaline Complex: Calcium, Magnesium, Potassium, Manganese and Iron
The uric acid crystals which collect at the joints, causing gout, can only form in an environment high in acidity. A Japanese study shows that raising plasma pH to between 6.2 and 6.8 drastically reduces crystal formation. 6,7But the FACT is that this just a snippet clipped from somthing unrelated to human life because life cannot exist at a pH between 6.2 to 6.8.
Abstract
Maintenance of plasma pH (-log10 [H+]) within the range 7.38-7.42 is an essential requirement for life, because many metabolic processes (e.g. enzymatic reactions) are exquisitely sensitive to changes in H+ concentration. The range compatible with life is 7.00-7.70 (i.e. a 5-fold change in H+ concentration).
They've gathered together a bunch of anecdotal evidence about this or that herbal reputed to be a gout treatment and stuck them all together in a pill, a little cherry, a little celery, etc. and added some linament (curcumin) to rub on the achey foot and are peddling it to the unwary. In the old days somebody would have sold this from a buckboard with a scantily clad woman going from town to town. Perhaps they;d have sold it with Lydia Pinkham's Lotion to double profits.
This is typical behavior for almost ALL disease and it seems to have gotten a second wind with the internet. It seems the arthritis-type diseases have gotten the most abuse becasue nearly everybody suffers some form for a large part of one's life.
It's a scam.
Jeff,
The consensus is that beer drinking is a fairly potent gout trigger for many people and it might be for you absent the allopurinol. The drug allows us to enjoy life's pleasures without gout attacks in ways that those who are trying non-drug measures cannnot.
You will likely be able to tolerate the beer with the daily 300 mg. allopurinol but be mindful of any toe twinges that might be signalling an upper limit to the beer.
Personallly, I find beer more dangerous than spirits on an apples to apples comparison, i.e., comparable amount of ethyl alcohol.
MEtamorph's link is ver good. let me repeat it here:
Now one of the doctors feel that I probably never had gout.
I have found a school of doctors who will not believe you have a disease unless THEY diagnose it. So for a new doctor, I suppose we are expected to discontinue allopurinol and crawl inn with a big red toe and say “SEE.” It is for these doctors that the phrase “smack upside the head” was invented.
Mike,
I don't think it's much of anything. THese facial tics usually are casued by some pressure on a facial nerve that passes through some tortuous canals around the ear. It usually passes by itself and is almost certainly not associalted with allopurinol.
Perhaps you have/had some small tophus around this nerve.
If it continues for weeks orr months, go see a neurologist and see if he can isolate the problem.
Do you feel any numbness on any spots on your face when you touch with your fingers? See if massanging any spots around your ear helps.
Glad to hear that your allopurinol 300 is doing the job. It's a lot easier on the intestines than eating colchicine on a daily basis.
nokka,Yes, I would think that the tendency for crystallization would be lessened in a tropical climate…I wonder if anyone ever compared gout rates between populations at the equator and those at 40 or 60 degrees Latitude?
Just don't pound your feet too hard, something that might be likely trying to see EVERYTHING in a new land in limited time.
Good luck and keep in touch; online connections are available EVERYWHERE.
(Wear sandals instead of shoes!)
Depakote can have a unintended consequences though not commonly pain (except abdominal)but it's possible your diffuse pain is not gout or at least not ALL gout. It's not usual for gout to be so widespread.
Depakot and diclofenac can both cause unusual bleeding but I don't think there's any interaction with allopurinol.
With gout it is quite common to have an analgesic that USED to work well stop working. It's just an indication that your gout has likely gotten worse.
Can you stop the depakote for a week or two without getting in harm's way. Have you been on it long.
Make sure that if you do a run with colchicine your doctor signs off on any interactions with the depakote. I doubt there are any but it's probably not a combo that is encountered very often. Maybe the intestinal consequences might be more severe?
No, I haven't ever had anything approaching such an attack, but then I would never consider the folly of stopping my allopurinol (wink!) I guess you won't either. Once on allopurinol, one must be committed to it and our doctors should be cautioning us of the dangers of going off it.
You have to stop this attack and diclofenac is clearly NOT doing the trick, nor is waiting for it to stop on its own.
Do the zip regimen (and all good doctors' regimen a couple decades ago.) Take 2 colchicine tablets first thing in the morning and then 1 every hour until one of the following occurs:
1. Your pain stops
2. Extreme diarrhea begins
3. You reach a total colchicine count of 16.
Alas, you will need an Rx from your doctor for the colchicine…be insistent. All the while continue the allopurinol.
Question: How long had you stopped the allopurinol before the onset of this attack? Had it been doing a good job of controlling your uric acid levels and stopping acute attacks?
Yes, we must be very careful how we deal with our children and our doctors…they are both so fragile!
by sirlimpsalot: The paper, written by MD's, also made a connection between all the various notable gout sufferers over the years. I will try to find it and post it here.
I've seen reasonably convincing claims to correlations between high uric acid and high IQ. Perhaps uric acid is either a product of excessive brainwork or else helps the transfer of insformation between neurons.
Yes, many of the most stellar names in history have suffered gout.
I have no doubt that stress and anxiety can bring on an attack of acute gout for those “on the edge.” And since we, as humans, cannot avoid stress and anxiety it is wise to keep serum uric acid levels as far from “the edge” as practicable. I'll bet last Fall saw a HUGE increase in gout attacks among those working on Wall Street. 😀
Here's a way to look at it. If you take allopurinol you will disturb some old deposits, those not quite bound up tight by the immune system but not so exposed as to cause a major attack. IF you set up this disturbance, some urates will go floating about and llikely find a cold acidic place to repark.
Thus my logic is that if you are going to cause this disturbance, make sure that the blood's uric acid level is as low as possible with the RIGHT dose of allopurinol, rather too high than too low. Thus even if urate get's shaken up, if you have an SUA of 5.0 or lower, the migrating urates won't find any place to park and cause an acute attack…the blood will absorb them until they can be carried to the kidneys a couple dozen times and tossed away. Over time these urate deposits that are PARTIALLY sequestered will be emptied of urate, but the key words are “over time.” After a while there will be no marginal stores, only thhose invisible to the bloodstream. Thus I feel the most important time to keep SUA as low as possible is when initiating treatment.
That is why I think it might be better to leave your urates undisturbed rather than to take too small a dose of meds. That's why I am not fond of the 100 mg. allopurinol regimen except for just the shortest time to check for rare hypersenstivity or allergy. I started right on 400 mg. allopurinol and NEVER had one of these rebound attacks, but I DO know that I am just a sample of one…purely anecdotal. After all does a doctror who sees a bacterial lung infection recommend 100 mg. azithromycin to check for sensitivity, or does he prescribe a Z-pak with a potent 1500 mg. antibiotic dose?
After all, if one is hypersensitive to allopurinol, won't a 300 mg. tablet establish that fact and perhaps more definitively than a 100 mg. pill?
And in plain fact, I really doubt that anyone, anywhere has been killed by the first dose of allopurinol nor rendered hospital-worthy and that is after billions of doses over more than a half century. It is among the SAFEST of drugs, much safer than aspirin, penicillin, Tylenol, or any vaccine.
In truth, this new caution on allopurinol started surfacing only when febuxostat began being developed as a pricey patrentable alternative. Before that, allopurinol was spoken of as beijng EXTREMELY safe.
This would not be the FIRST time doctors started pooh-poohing an old well tested, well tolerated, CHEAP generic in faor of the hideously expensive NEW kid on the block. In fact I doubt it would even be the HUNDRETH time these techniques were used to peddle a new drug. The “special care” now being given to people starting allopurinol may well be part of nothing more than a clever marketing ploy.
After all, is anyone started on a 10 mg. dose of Uloric to check for hypersensitivity…no! And that is a drug with NO track record being prescribed for a lifetime.
I wouldn't be so callous if I hadn't seen the same shenanigans pulled innumerable times in the past.
My attacks before treatment were different…brutal assaults and then gone in 3 days. THen a nine-day attack of podagra that was stopped entirely by a huge amount of colchicine. Right as rain the next day.
I guess the only thing that lingered with me, for a couple years, was an achey thumb toplus which is fine now. It eventually worked it's way out under the thumbnail and then out a drilled hole in the nail over a one year period while on allopurinol.
Jeff,
I agree that it might be too late to have the pee test give any meaningful results when on allopurinol treatment. The most meaning would be gleaned BEFORE administering any gout drugs.
I look forward to your serum uric acid reading in a couple weeks.
nokka,
I would go to 300 mg. allopurinol as soon as possible. A week at 100 mg. is long enough to ascertain hypersensitivity like hives, itching, swollen lips and eyelids etc. After 2 months of 300 mg., a blood test will tell if you can decrease the dose but NOBODY stays on 100 mg. as the final dose.
I think fiddling with too low a dose of allopurinol INCREASES the chance of further attacks, the last thing you want when travelling. Better too much allopurinol than too little. In that respects it's a bit like antibiotics…a half dose is worse than none at all.
Everything GP has said is spot on.
Let me add that high uric acid levels can damage kidneys and damaged kidneys excrete uric acid poorly. It is a vicious circle and it's hard to say what came first, the hyperuricemia or the kidney damage.
Get his serum uric acid level checked YESTERDAY and ask for a 24 nour uric acid urine test. There is nothing sacrosanct about 300 mg. allopurinol, he may need more, up to 800 mg. The serum uric acid test will answer that question…you want to see a number below 6.0 mg.dL.
just not as fast as I'd like.
That's often the way with gout. Remember that each past attack has laid down urate crystals that can play hide and seek with the immune system. It sometimes takes a while to resolve those that are capable of “seeking” and make sure those that hide stay hidden.
Just keep taking the 300 mg. allopurinol and if you maintain in the 5.1 area, you will soon see an end to almost all the foot pain.
But remember, 5 years from now some tophus that is hidden might start seeking but you're not likely to suffer a full blown podagra ever again. Eveen the “limpies” will diminish to twinges.
As long as it's not OUR post mortem.
Trev,
What kind of uric acid levels do you run? I've been meaning to ask!
J.
Forget the niacin because:
1. a 500 mg. dosage is far too little to raise HDL to any extent…2 grams is required daily
2. it will cause an increase in urate while decreasing its solubility becasue it is so strongly acidic
3. in useful amounts it causes such AWFUL flushing (which is the wrong word to describe 1000 pins being pushed into your face on a daily basis)
4. it has no effect on LDL (the correct drug treatment is with a statin…probably the strongest generic, simvastatin.)
5. if you DO take niacin, NEVER take it on an empty stomach…the flush is magnified.
EIGHT WEEKS to see a doctor…is he on the other side of the Himalayas and you need to amass a Sherpa team? Why so long?
Your nurse practioner is a WORTHLESS INCOMPETENT…don't waste any more time with him/her.
Is it possible that he CANNOT prescribe drugs and thus is limited to recommending megadoses of vitamins or nutritional supplements? (I don't exactly know how nurse-practioning works?)
John,
I've never tried diclofenac. It's not very popular in the United States and seems to be a UK and European thing. It is known to be VERY hard on the stomach, tends to retain uric acid and may be implicated in increased heart disease risk.
Why not switch to a different analgesic especially if you are getting reflux? Colchicine comes to mind, or naproxyn if you can get it.
Don't start allopurinol or uloric until you and/or your doctor are convinced of the gout diagnosis. What kind of uric acid levels do you run?
Next day or two for me unless pain strikes Friday night
(in USA with health insurace (HMO-Medicare.)But for me too it's something of a moot question becasue I also DESPISE going to the doctor for anything.
Apparently the ability to supersaturate uric acid is almost limitless…unless there is a single precipitating crystal…then WHAM. THe way kidneys work the stuff passes osmotically molecule by molecule which is the ideal way to achieve supersaturation.
But still, 220 mg./dL sounds like they'd have to scoop the urine out with a very tiny spoon.
It seems almost akin to supersaturating a sugar solution for anyone who has tried to make candy or caramel…you cannot leave a single crystal unmelted or you get instant recrystallization of the whole mess.
J.
Whether to treat gout is a two pronged approach. The prongs are uric acid level, and number and severity of attacks.
Hyperuricemia taken by itself may be deemed non-existant in a ormal person given that uric acid at highish levels can remain in a supersaturated condition if someone has no initiating crystals. Someone who has had a single sever gout attack has made super-saturated serum IMPOSSIBLE. So, consider your 7.3 as TOO HIGH by FAR…you are depositing crystals day by day.
On the second prong: You have had one severe attack (and I'll bet several that you've dismissed a sore feet or a twisted ankle) and that does not warrant beginning a lifetime of drug treatment.
You have entered a period of watchful waiting which can be VERY depressing but do what you can to avoid future attacks. Replacing 6 beers a night with the equivalent of 3 ounces of pure ethanol (or 6 ounces of spirits) is a good start. That's 2 nicely made martinis or Manhattans by the way. Test regularly and try your best to keep below 6.0 mg/dL SUA.
But the normal route for a 42 year old is that the attacks will become more frequent and more painful so to keep that depressing thought at bay, know that the drugs do work VERY well and are there for you when you need them. It took me 4 hobbling three day bouts over 2 years and then 9 days of crucifying crippling unbearable pain to make my decision that I needed allopurinol for life. That was almost 2 decades ago and no more attacks. I can eat or drink anything I want.
It's a shame that you needed to surgery to confirm the cause of your pain. Many of these old injuries do NOT need surgery and heal by themselves to a decent enough extent. I have always felt if you have sore feet and go to chiropractor you wilolo get a spinall mnipulation…if you see a homepath you'll get a liquid to take with an eyedropper and if you see a surgwon you;ll get an operation. By picking our professional we determine exactly how we are treated. Good thing you didn't see a cardiologist.
Allopurinol would have been a LOT easier than operating on both your legs and maybe just as effective.
But that's water under the bridge and you got your gout diagnosis.
I see no need to continue fiddling with low dosages of allopriurinol. The tried and true average is 300 mg./day and I think you should be on it ASAP. Look into gettting some colchicine to manage the pain while you lower your uric acid.
How did the surgeries go? Are you up and about?
p.s. A diuretic, 10 years of hydrochlorothiazide, caused my gout too. If I ever read that some doctor was strangled with his own stethescople by a furious patient I'll giggle for DAYS!
But never forget that in the midst of an acute attack there may be considerable relief afforded by a half bottle of Beefeater's!
Yu cites a normal range between 16 and 100 mg/dL.
YOI, can anything approaching 100 mg./dL come out as anything besides solid chunks of urate?
John, you are the first person to report the ear tophi. I searched my ears regularly and several years ago found only ONE that might have been questionable…about half the size of a bb…but it went away after a week or so…or I scratched it off without thinking.
I guess with the ear tophi and the confirmed crystals in your synovial fluid there is zero doubt about your diagnosis.
What is your Uloric costing you?
Rich,
That is a VERY SMALL amount of prednisone. For shingles I took 20 mg. for two weeks.
Colchicine is the ideal drug for an acute attack but at least the vicodin in sufficient quantity will help numb the pain.
PREDNISONE FOR BELL'S PALSY…
Prednisone is a synthetic hormone that mimics a natural steroid called cortisol that the body produces. Under stress (injury or illness) cortisol production is increased fourfold as part of the body's normal reaction to the stress. Prednisone has approximately five times the potency of cortisol. 20mg of Prednisone is roughly equal to the amount of cortisol the body normally produces in a day while under stress.
