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You need to start treating the hyperuricemia which is the cause of gout (and also urate kidney stones.)
Having a kidney stone is no reason not to take appropriate amounts of colchicine, nor a reason to avoid allopurinol, which you are likely to need on a daily basis.
(If you PASS that stone, be sure to save it for analysis…that's VALUABLE information.)
With a stone the only thing you might want to avoid is probenecid…a drug that causes extra excretion of urate.
I agree with gout pal, a single colchicne a day is not likely to have much effect on an attack in progress.
When to take Tylenol (acetomenophen, paracetamol) for a gout attack: NEVER. It is useless and damaging to the liver.
(Send me a PM and tell me where you usher…
)Phoenix,
Yes,
You really DO need the colchicine, even if you never take it. Having it in your medicine chest is the very best thing you can do to avoid a BIG attack. IF you have a flare after starting allopurinol, and I give the odds at 50-50 on that, and then you have to bear it for a few days and then see your doctor and THEN get a Rx for colchicine it will be FAR more dire than if you popped two little pills the first moment of the first morning you felt foot discomfort. That's when colchicine does its best work and you cannot use it that way if you don't have it.
I think EVERYONE with gout should have an emergency supply of colchicine on hand. The singular differentiator between colchicine and ALL other treatments is that colchicine STOPS the attack and ALL the others merely treat the PAIN from the attack…”more morphine please doctor!”
With a uric acid that has gone from 8.9 to 9.8 trust me, you do NOT have very much time before your next severe attack. Have your doctor put you on 300 mg. allopurinol immediately and have him prescribe colchicine, 60 or so, to have on hand to combat an attack at the first sign of eruption. Perhaps one or two colchicine a day propylactically is a good idea while you brring your serum uric acid down to 5.
THat furiously high uric acid concentration is just LOOKING for another place to crystallize and the odds are good for it to find your bunion joint…and then you will know the pain of the damned…with SATAN chewing on your foot.
Forget diet! If you had a uric acid of 6.5 maybe it would help, but NOT with an 9.8.
Time is of the essence here, lancer. It really is. I hope you act fast enough.
A doctor who would NOT prescribe allopurinol (or probenecid) to a person with a uric acid of 9.8 and proven gout is guilty of MALPRACTICE. NO jury would disagree.
snaporaz,
How high was your creatinine? It can go high simply becasue you had a large meat consumption the day before, or had a hard workout resulting in muscle breakdown. Was you BUN (blood urea nitrogen high?)
You will probably need to have your creatinine clearance measured (a urine gathering test) although your probably first order of business is to have creatinine RE-measured after a day of little or no meat. It sounds like that''s what you have in the cards. Remember, labs make mistakes…OFTEN!
Let ius know.
If you are taking alllopurinol to achieve a level around 5., I think there is very little chance of dehydrating yopurself to the point of precipitaion.
In fact on a hot beach, the solublility of UA is apt to be high everywhere on your body. After all, where do we get hoter tootsies than running on a blazing beach.
Maybe drinking half a case of beer might increase the odds a bit though.
I HATE swimming because I am denser than water…do not float, thus it takes more energy out of me than most people.
That said, it has LONG been known how good an exercise it is for people with ANY kind of joint pains (well except maybe rotator cuff issues…got them) becasue it takes the weight off the legs…and more important to goutiies, THE FEET.
So swim your way slim and pain free.
DeGoutMe,
I'll bet at 340# you have NO problems staying afloat (I just couldn't resist!)
Good luck with the weight loss…100 pounds in a year is extremely tough but not impossible. My guess is that about 1800 calories per day will do it with continued hard aerobic work.
Have no fear on the dosage. I am a firm believer that the 100>>200>>300 eventual progression is just staving off the inevitable. It's done for the very rare case of hyperesensitivity that will likely show up on the first dose. It ususally results in an extra attack or two or several that could have been avoided. A dose of 300 mg. is very common becasue that is the dosage that has been found to WORK.
My first dose of allopurinol was 400 mg. (I was surprised when I checked back…I had forgotten those first couple years at the 400 dose.)
I mean, after all, when you go in with a severe sore throat, what doctor will start you off with ONE penicillin tablet a day? Or ONE aspirin to cure pain?
I concur 100%.
Once you have had several attacks you will NOT get your uric acid to safe levels without medication.
Ask your doctor if he is well versed in treating gout and if he says no have him recommend someone who is.
The only limit placed on how often you should have your uric acid tested is your insurance comany's willingness to pay.
Phoenix,
Siince your uric acid is so very high I recommend starting with 300 mg. allopurinol. If it turns out that is too much (which I doubt) and get's your uric acid into the 4's you can always attenuate the dosage down and even supplement with “good living” habits. But if you let that 9.4 hang around very long you are going to be in unremitting misery.
THere's a wonderful old protest song called IT ISN'T NICE…that can translate to allopurinol vs. “good habits.”
“It isn't nice to block the doorways,
It isn't nice to go to JAIL
There are nicer ways to do it
But the nice ways always FAIL
It isn't nice, it isn't nice
You told us once, you told us TWICE,
But if that is freedom's price it's okay”
Get a second opinion! A competent doctor does not make a diagnosis of rheumatoid arthritis or ankylosing spondylitis (a progressive degenerative disease of the spine and ONLY the spine) by default.
Doctor says that colchicine is dangerous.
Methotrexate:
http://en.wikipedia.org/wiki/M…..thotrexate
I am glad if you don't have gout and multiple attack sites makes gout unlikely, but make sure they give a proper diagnosis BEFORE they start prescribing useless NSAIDS (Celebrex) or potentially deadly (methotrexate) drugs for “maybe this, maybe that” guesswork.
ANy competent rheumatologist should be able to differentially diagnose rheumatoid arthritis from ankylosing spondylitis. Someone who cannot is not competent.
Gout is rather remarkable in that it will not be nay-said. A million doctors can say NO but eventually the answer comes screaming through with THE TOE FROM HELL. Gout ALWAYS has the final word. Everyone with untreated gout will eventually get PODAGRA.
So perhaps the best way to diagnose gout is to wait for that first UNDENIABLE attack. It's how I found out for sure.
GoutPal,
I have always made the assumption that you have been on allopurinol for a long time. Your last paragraph confuses me. Is it just what an allopurinol avoider WOULD say but you put it in the first person?
'Splain, Lucy!
If you haven’t been a long time allopuurinol user what has been the mainstay of your uric acid control ?
Allopuurinol = Allopurinol THe claimed possible long term consequences of allopurinol is a particular rash, and some evidence of damage to the immune system, probably anecdotal.
I think gout on average will deduct some time from a lifetime, but it;s also possible that by focusing attention on health, it might INCREASE lifespans.
UNtreated gout however will severely truncate the average lifespan.
I think people resist it for the same reason that people wil resist ANY lifetime drug, even insulin, statins, antipsychotics etc. A pill a day FOREVER just sounds so unsavory.
I've been taking allopurinol for 2 decades after breakfast and have never noticed that side effect…or ANY side effects for that matter. I have not heard the l;ethargy complaint from anyone before.
If it DID occur, I would switch to dosing before bedtime, when drowsiness is a PLUS.
Is it possible that you are trying to operate on too little sleep and the allopurinol drowsiness is a coincidence, or else that the effect is there but very slight except in people who are sleep deprived.
Taking it a few days a week:
1. You CAN get away with it if you are judicious because its first metabolite, oxypurinol stays around for a long time and is very effective at lowering uric acid…but if you cut your days in half, you will have to double the dose to keep oxypurinol levels the same.
2. If it oxypurinol that is making you lethargic, then there's no point fiddling your dosage because oxypurinol concentration changes ever so slowly from day to day.
How much sleep do you get in an average day?
Aspartame (Nutrasweet), saccharine(yech), and sucralose (Splenda,) and acesulfame are used in such small quantities that I think the effects on urine acidity must be close to nil. Proabaly far less than any effect from sugar…or from the citrates that give most of these drinks their taste or the carbonation that gives them bubbles.
I get mine only in the morning and only in my right bunion. It is a deep ache that feels painful when weight is applied to that foot. It feels like it is in the precise middle of that large toe joint. It is usually correlatable with stress, beer, or both.
I give it about 10 minutes to abate and then mosey to the medicine chest…and 2 colchicine.
Fritz,
With a UA of 8.7 that is duplicable even ONCE, you should be on allopurinol post haste. If you want to cover all bases, have the pee test to see if you are an overproducer or an underexcreter. Underexcreters offten prefer probenecid.
But allopurinol will work for both.
Remember, as life goes on, untreated gout only gets worse, FAST.
Don't try to lose weight until you get on allopurinol. Weight LOSS is a VERY frequent trigger for gout becasue you liberate a lot of nucleic acids from lean tissue breakdown…and you cannot lose fat without losing lean tissue (except in “magical” diet books from the land behind Alice's looking glass.)
Wow, if I couldn't bear the taste of my tap water, I'd probably have to move. I really sympathize with anyone with sour or suphury, petroleumy or RADIOACTIVE water. I guess I'd have to resort to building a STILL (I'm a Chem Engr.)
Distilled water with a pinch of MgO might help. Ice cold and shaken to aerate with some O2 cannot hurt.
I am very fond of those CrystalLight, Wyler's packets. I add a GALLON of water (instead of a half gallon) and then toss in an additional 2 ounces of “RealLemon” generic for $.99/quart and 1 or 2 sachets of Equal. This cuts down on the cloying sweetness of the 1/2 gallon recipe. I Like the Wyler's raspberry best. I'm permanently fighting weight gain and this gives me a cheap tasty everyday drink with close to ZERO calories.
I haven't a clues on what the effect this concoction has on my urinary acidity.
mathman,
You are right: colchicine works best, fastest, and at the lowest dose the earlier it is started. After a long attack you need the full whammy!
My worst flare in the big toe was allowed to go without treatment, except for some low dose indocin which I had on hand which proved totally ineffective, for a full 9 days virtually bedridden before colchicine treatment was begun. THus, unaware of the 16 pill sensible upper limit, I took 22 before the diarrhea began and the pain stopped in 45 minutes afterwards.
The diahrrhea is so severe at this kind of dosing that after a few hours there is nothing left in you. Drink lots of water to avoid dehydration and when coffee colored water is all that comes splashing through, that's pretty much the end of it.
Remember though, stop at 16 pills. Stop at the onset of diahrrhea or the cessation of pain.
Figure 24 hours after the diahrrhea before safely wearing a white suit…stay close to home.
Next attack you feel starting, take 2 colchicine immediately…if it works, fine, If not, take 2 more. THat should do it. At 2 or 4 pills, you'll feel only the slightest laxative effect the next morning…like after eating a cupful of prunes. 😀
Colchicine is the oldest drug. The only argument is whether it has been extensively used for 6,000 years or just 2,000 years. Diclofenac is 40 years old.
My best guess is that colchicine has been prescribed perhaps 1000 times as often as diclofenac.
Find a doctor who knows something about gout…your doesn't.
Colchicine can give you the worst case of the runs ever…diclofenac could cause a fatal stomach bleed and over time will almost certainly cause long term gastritis. And the biggest difference: cochicine will probably work but the diclofenac you are taking is NOT. I wonder why your doctors are tellingyou to take a drug while admitting that the drug isn't working. In my book that sounds like the definition of psychosis?
But, it's your call, MM.
Tell your doctor that you don't want colchicine “LONG TERM” just 2 days worth. Ask him if the treatmment he's using to stop your attack will need to be taken “long term”…does he anticipate the attack lasting a year or two?
Basically you are telling him, depending on your country, to GET STUFFED, or to GO F%$ HIMSELF.
If you wish to be gentle with him just say “YOU'RE FIRED” in your best Donald Trump accent.
Your gout is being improperly treated.
Doctor AND a rheumatologist I've been to say that this is one attack that keeps flaring up –
That's the best line of all…they are telling you that THEIR method, NSAIDS works…and then saying you have one attack that is not reponding to treatment. Did these doctors get their Medical Degrees in HIOGH SCHOOL
Gout in the knees is a VERY hard call to make with assurance becasue the joint is SO complicated and so fragile and thus prone to MANY types of injury.
I KNOW I have gout but I can never say with any assurance what causes my knee pains when I get them…not infrequently.
I wouldn't drink ANYTHING that came in plastic unless it was at least 80 Proof.
There is a problem with styrene leakage…a carcinogen.
And if I see one more Poland Spring bottle tossed out of a car Im going to LOSE it.
Tap water in Jersey City is crystalline and delicious and a planned move to Manhattan would give me much of the same. (Consumer Union rated New York City water as better tasting and freer of contaminants than ANY bottled water.)
I think distilled water tastes too dull…it's for irons and contact lenses.
I don't think that it makes much difference one way or another. It IS important to avoid dehydration and concentration of blood serum but any kind of water should do the trick. I think extremely hard water with a high mineral content will be mor alkaline but not enough to matter much.
My youth was spent with EXTREMELY hard water that had to be chipped out of plumbing regularly but the last 40 years has been with extremely soft water…nearly distilled water out of the tap. Never a deposit on anything.
How do you treat your attacks? Have you had your uric acid monitored regularly?
Or perhaps what they thought were very rare gout attacks were something else. I think gout attacks tend to breed gout attacks and would consider someone with just one or two real gout attacks a decade a rarity indeed.
MM,
I think your doctor's hesitation against allopurinol will soon vanish. Some rules of thumb are to await the third attack in a year but probably each doctor views it differently. SInce you are at your third attack in a matter of weeks, early allopurinol intervention might be just around the corner. Remember each attack deposits more uric acid that has consequences for a long time. So the fewer attacks before intervention, the better.
If there is still doubt, ask your doctor for an Rx for colchicine and “do the routine” starting today; the method is all over this forum. If it quickly aborts this attack, then go on allopurinol.
Here's something you might try if you can: Since every basic routine blood test includes uric acid, dig out some old blood test results before you started with these bouts (I have all my results back to 1973.) If you are not quite so diligent go to your doctor's nurse/secretery and have her xerox some results from a year ago, 2 years ago or 5 years ago. Those numbers might be higher than the ones you are seeing now that you are immersed in these repeated attacks. I call this the Agatha Christie approach.
Oops,Something's funny here. I responded this morning but poof.
I reread that “quote” of June's though I cannot recall having seen it before.
To recap, I have been on allopurinol for 22 years and have not had an acute attack since. I have had a relatively large tophus on my thumb resolve and have developed a small but painless one develop on the last joint of my little finger…the only visible tophus….and I actually got a picture in…BIG but clearly visible. (Dimensions are skewed in the vertical, my fingers are NOT that long and narrow…or I'd have been a pianist!)
Allopurinol for me is a COMPLETE success although I am sure that as long as I liive I will carry some urate deposits with me that are isolated totally from my bloodstream and immune system. That is what gout is. It is never cured but being pain free and attack free for 2 decades is good enough. Without allopurinol I would be crippled. (Without Lipitor I would be dead)
If I had to nominate the best drug ever invented, even over peniciillin, it would be allopurinol.
Okay,
Come clean…who do you know?
I keep running up against a wall with JAMA!
But thank you for finding it…I'll re-read every word. I read it the FIRST time in the paper version in my doctor's office. I asked if I could take it home and he said sure, nobody ELSE will read JAMA.
I'm impressed with myself for remembering as much as I did…it was 15 years ago so I guess I'm holding Alzheimer's at bay!
EVERYBODY, please read GP's link!
I can posit only two situations of a gout attack with low serum uric acid. Severe cold hands or feet, where uric acid becomes extremely insoluble and an inflammatory process that results in an extremely acidic joint (all inflammation is acidic.) And in an acid medium, normally soluble uric acid becomes insoluble at relatively low levels.
So yes, it can happen but it's not common.
A decade ago I read a great article called GOUT WITHOUT HYPERURICEMA, it read like a mystery. I believe it was in JAMA or NEJM. I cannot find a free link to it…but basically a whole hospital was buffaloed by a homeless man who kept coming in with low uric acid but clear gout that responded very well over and over to colchine. After months of this someone soiehow measured the temperatur of his feet when he came in and they were 40 degrees colder than his mouth. The cold feet precipitated uric acid.
Thanks GP,
I had to laugh becasue that is a somewhat newer one than mine. The .pdf starts with Colchicine Use in 6000 patients and my brochure in entitled COLCHICINE USE IN 3000 PATIENTS WITH DISKAL (AND OTHER) SPINAL DISORDERS.
Aha, mine was dated Oct., 1985 and the .pdf was Dec., 1989.
He sounds like he was a busy man those 4 years, and probably rich as Croesus.
cjeezy,
Interesting idea but I think the lines betweeen the two get fuzzy. I am CERTAIN my gout was secondary to overuse of thiazide diuretics but then the question remains, is there a hereditary proclivity that ALLOWED the secondary gout where someone else might have eaten the same tons of thiazide and never got gout.
As for recognizing the secondary quality of gout it might not be so simple to remove its cause. Problem arises from the seeming fact that once uric acid is laid down in joints it is almost impossible to be completely free of it and thus it may be indistinguishable from PRIMARY gout forevermore.
