[Colin Purves]

In terms of Antacids,Baking Soda was something that I had taken regularly a few years back when I was thrashing around looking for remedies/cures for Gout.I dont recall the Baking Soda having any effect and perhaps some Antacids may have a sticking plaster effect but as Keith points out, the cumulative process of UA deposits in the body will remain. Perhaps part of the answer is to be aware of what acidic foods are going in to the body in the first place and adjust accordingly.

[Colin Purves]

Thanks Keith.The link to it usually takes several months to dissolve old uric acid crystals is particularly interesting,in that it gives a useful reference point.The sharp drop between 3 – 6 months is where I am(based on start of Allopurinol), but closer to 6 months. I can confirm that I have felt a marked improvement in Gout symptoms in recent weeks.
Finding this forum and its knowledgeable contributors has kept me largely
informed about aspects of Gout that I could not have imagined.
I look forward to that day Keith, as you say,Then one day, you wake up struggling to remember the last time you had a gout attack. That’s when you know gout is truly a thing of the past.

[Colin Purves]

Update to Blood UA level.
14th August 2017 – 0.48 mmol/L
31st August 2017 – 0.41 mmol/L
21st November 2017 – 0.29 mmol/L
25th January 2018 – 0.28 mmol/L

G.P. Reckons Gout now under control and to continue on 2 x 100mg Allopurinol
per. day and call back in one year for further blood test.
Certainly happy the way things are going in relation to the Gout, although I
think there is still some way to go in regard to the breaking down of old UA
deposits.Still some obvious red blotchy areas on both knees and smaller toes
on left foot.Less reliant now on Ibuprofen as pain now moving into discomfort zone. Was down to 1 x 400mg Ibuprofen per. day(last thing at night).Now able to stretch it to 1 x 400mg every second day with target of taking only if and when required.

[Colin Purves]

Hi d.q., Yes certainly happy about current blood situation.When next consulting with haematologist will ask about platelet count and Vitamin E. Didn`t know it acted as a mild blood thinner.

Majority of gout attacks have been in the toes,and feet generally especially in the earlier years,and only developed in the knees in the past couple of years.
An interesting observation only recently and just after completing the blood draws was a gout attack on the toes on the left foot and mainly in the smaller toes, was that, after keeping both legs off the floor either by lying on the bed
or on the sofa which gave welcome relief and then when lowering the left foot on to the floor it was as if there was an enormous rush of blood to those toes which I can only describe as a horrible excruciating pain which prevented me from putting that foot fully on the floor,but after waiting for a few minutes it subsided somewhat.
It immediately came to mind,could this be anything to do with the blood draw offs making the blood thinner and subsequently the blood getting round the body a lot quicker than it would normally have done.
I`ve had gout attacks over the years but not in the same manner as that one.

[Colin Purves]

Thanks nobody and d.q for your valued input.

In regard to UA level d.q. another UA blood test is scheduled for about 2-3 months from now. Happy of course that it’s dropped from 0.41 to 0.29.Trying to maintain a healthy diet. Start in the morning with 1 to 2 pints water before breakfast.I believe this is beneficial not just from a gout perspective but can flush out toxins. In total, I never exceed 6 pints of water in a day. Don’t eat meats, fish or fish products. The rest I think from what I’ve read is largely guesswork as doesn’t seem to be anything definitive out there. But as you say moderation could well be the key.

In regard to blood condition,I attended Haemotology dept. to get 600 milliliters
of blood taken off on a weekly basis.This brought Haemoglobin level down from 22.3 to 14.9, and Haematocrit level down from 0.682 to 0.455. This is where they wanted it to be, and await discussion with Haematologist.I looked rather wan and pasty-faced after all that blood draw, as opposed to a usual facial complexion resembling something like a burst tomato.

All in all the gout remains having some nasty flare-ups, and a particularly nasty flare up at the moment in my right knee which was previously docile and has ballooned horribly immobilizing the bend in that knee.From my own experience gout flares usually build up and then peak between 7 to 10 days before subsiding. This is the 7th day so hopefully it has peaked.
On a positive note, Dr. seems to think it will take about 6 months for the overall gout condition to settle. But I’m prepared for longer than that as I know I’ve probably had about 30 years of UA deposits tucked away.

[Colin Purves]

Something that continues to puzzle me in regard to Allopurinol is that,if it is described as an inhibitor of UA then does this mean that only some of the new production of UA is prevented and I wonder what percentage that could possibly be or could that only be ascertained depending on how much purine related foodstuffs are ingested.In my own case I dont eat meats or any fish related products and hardly drink beer or any alcohol and drink plenty water,about 3 litres per day.
I know that old UA deposits are steadily breaking down and which are contributing to frequent gout flares,but I do wonder if I am continuing to add fuel to the fire by consuming further foodstuffs that could also be contributing to ongoing gout flares,or am I getting a little paranoid and should just put it down solely to old UA deposits working there way out the system.

[Colin Purves]

As you say nobody,the drugs seem to be working and lets see what happens at
next uric acid test in 2 to 3 months.
Dr. seems to think it may take about 6 months to settle down.

[Colin Purves]

Update to UA level.
14th Aug.2017 – 0.48
31st Aug.2017 – 0.41
21st Nov.2017 – 0.29
Spoke to Dr. today and confirmed latest UA level from bloods 0.29.If converting to mg/dl and using 16.81 conversion factor as provided by and thanks to forum member nobody then these would read.
14th Aug.2017 – 8.07
31st Aug.2017 – 6.89
21st Nov.2017 – 4.875
Discussed with Dr. as to whether upping the dosage of Allopurinol would be an option,Dr. said to continue on 2 x 100mg and come back in 2 -3 months for further UA test.
In regard to gout flares there have been a couple of hellish episodes which nobody had warned of,however,as I have learned and mostly from this forum
the gout flares will probably be caused mostly or partly due to UA deposits
which have built up over the years.With that knowledge this means there is light at the end of the tunnel.
The other condition which was diagnosed at the same time as Gout,that is sticky blood(Polycythemia)and which Dr.thinks has caused Gout,have now received Haemoglobin and Haematocrit results.These were obtained by taking off
600 millilitres on a weekly basis.
28th Sep. 2017 – HB 22.3 HCT 0.682
5th Oct. 2017 – HB 20 HCT 0.602
12th Oct. 2017 – HB 19.3 HCT 0.586
19th Oct. 2017 – HB 18 HCT 0.56
26th Oct. 2017 – HB 17.5 HCT 0.539
2nd Nov. 2017 – HB 16.3 HCT 0.506
7th nov. 2017 – HB 14.9 HCT 0.455
At this point i`ve been told there is no further need to take off further blood as results are where they should be,and now await further discussion
with Haematologist.It was suggested by the Phlebotomist that the improved viscosity in blood(moving through the body more easily)due to blood draw offs
could well be beneficial to alleviating the Gout.This makes sense.Another plus was my blood pressure is now more in line with where it should be.

[Colin Purves]

Some good points urankjj. If, as you say malic acid could be dissolving excess UA then why not a lower UA blood count.Could that then mean that your body is able to tolerate UA level of 8.0 thus far and that perhaps the UA deposits are not yet full to overflowing, and will malic acid maintain that level or less.Be interesting to see what further UA blood counts reveal.Certainly plenty of unknowns .Long may your gout free days continue.

[Colin Purves]

It gets more interesting and intriguing.Does this mean that in your case urankjj and having been gout free for the past 7 months that perhaps the areas of the body that typically store UA deposits had reduced to safe levels posing no problem,and that in light of the recent urate level reading of 8.0 those same areas have slowly started to accumulate UA deposits and perhaps become full to overflowing, posing risk of gout attack.Glass half full scenario.I sincerely hope you don`t get another gout attack urankjj.

[Colin Purves]

Certainly makes sense nobody that previous deposits become unstable during the taking of Allopurinol and that perhaps physical activity or accidents can be a trigger.I`ve been a keen goer to the gym for the past year(twice a week),mainly the cable machines,with the hands doing most of the work,so it is possible that this could have caused the uric acid deposit instability/release in the hand.Needless to say the gym work will have to wait a while and also have a rethink.
Haven`t discussed colchine or corticosteroids with doctor yet,but will do,as you say,nasty side-effects can occur if large doses of ibuprofen used for too long.

[Colin Purves]

As you say urankjj, its an incredible pain,hellish even.Good to hear you`ve been attack free for 6 months.Long may it continue.
This is 7th day of gout flare up in my right thumb and first finger.Normally from previous experience gout flares last between 7-10days.Swelling and redness have gone down slightly but now hand is badly swollen and spreading to wrist.Had to go back on to 3x400mg Ibuprofen a day to alleviate pain.
I was curious as to why, after all these years of gout sufferage in the feet and knees should it now appear in the right hand and after starting on a course of Allopurinol.
Started to read some stuff on Synovial fluid joints and in relation to uric acid.
One opinion was,that if we think of the Synovial joints(toes,knees.fingers etc.)as temporary parking areas for uric acid deposits as uric acid moves through the bloodstream and out through the kidneys.And then the body later tries to deal with the uric acid that`s been parked up in the synovial joints.But if the blood is continuosly overwhelmed with uric acid and the body is then unable to dispose of the uric acid previously parked up does it then follow that one or more of those joints become full to overflowing resulting in gout flare.
On Allopurinol,I read that it doesn`t necessarily get rid of uric acid but prevents or inhibits the production of new urate.So why do gout flares occur when no new production of urate.Is it because the old uric acid parked up in the joints can now release.
To further complicate,I wonder what, if there is one,a trigger for release.Could it be trauma to that joint or something else.
Phew,that was a speel.
Just a novice here on a learning curve trying to understand more on gout.

[Colin Purves]

I hope others don`t mind me updating on progress or non-progress as it may be from time to time. It certainly helps me to get things down on paper so to speak,and there is always the possibility that others may be suffering from the same conditions,i.e. Gout and overproduction of red blood cells.

Gout has now manifested itself in my right thumb with a vengeance.This is the second day and its difficult to tell if its just getting started or if it has peaked,but the thumb is swollen,red,mis-shapen and very painful.I was surprised and at the same time intrigued as to why the thumb,when i`ve never had gout in my hands or elbows,only feet and knees.The first finger also has a small white lump(Tophi?) developed in the top joint near the nail.Definition in knees continuing to improve(minutely) and feet sometimes cool when previously were on fire .Continuing to take 2x100mg allopurinol per. day.

In relation to the over production of red blood cells,this now has a name(Polycythaemia Vera)PV. All literature that I have read so far,all mention that Gout is one of the symptoms of PV.
Incidentally PV apparently is only discovered on a routine blood test and is a rare condition.
Drawing off of blood is starting point of treatment,So far i`ve had 2 pints taken off on 2 separate occasions over the past 2 weeks.Objective is to reduce haemoglobin level.

[Colin Purves]

Thanks nobody.Trying to learn/understand everything about Gout.One thing seems
certain,is that its a long road.
Next blood test for Urate level scheduled for 2 months.

[Colin Purves]

Consultation with GP today reveals comparison of Urate levels.
14th August 0.48mmol/l
31th August 0.41mmol/l.
To convert to mg/dL I read that a factor of x18 has to be used, but I stand to be corrected.That would then read:-
14th August 8.64mg/dL
31th August 7.38mg/dL
If my calculations are correct that means a 15% reduction in Urate in two weeks.
I have no idea whether this is a significant reduction in two weeks or not,but I feel any reduction must be progress.
I believe the normal range is 3.96mg/dL to 7.74mg/dL. So it looks as if i`ve just sneaked under the upper limit.
GP recommended that the dosage of Allopurinol now be upped to 2x100mg per. day.
GP still thinks Gout is a consequence of over production of red blood cells.
Hemoglobin level 21.9. Obviously too high.
Wont learn anything more until visit to phlebotomy to get blood drawn off and to see if this further alleviates the gout.

[Colin Purves]

Thanks Keith for the links to drawing off blood helps gout by reducing iron and burden of old uric acid crystals. These are very interesting.
Just to briefly throw in to the mix.I had been trying to donate blood to the blood transfusion service over the past couple of years,but was always turned down because my blood iron was outwith their criteria,i.e. too high.Instinctively I had thought that a regular donation might alleviate the gout somewhat but had no proof that it would.
The second article certainly gives a better understanding of the Urate Burden in that,even though gout comes and goes,it never really goes away,and something I hadn`t contemplated was that the urate burden could spread beyond the joints and into the organs.
Will be asking for uric acid figures from previous bloods on next visit to GP,so as to compare with 6mg/dl.

[Colin Purves]

Consulted with Haematologist today.He thinks the Gout and over production of red
blood cells are not related.I had so many questions to ask that I forgot to ask about d.q.s previous suggestion that the breakdown of the dead cells leads to the release of uric acid,but that question is top of the list for next visit.
2 courses of action were suggested.Medication to control the over production of red blood cells or to take a pint of blood off on a regular basis.He suggested taking a pint of blood off as a starting point which I prefer.I can`t help feeling that this might help to alleviate the Gout to a certain degree,whilst the Allopurinol continues to do its work.
I read the Ibuprofen leaflet as suggested by Keith.It clearly states not to continue dosage past 10 days,so have cut down dosage after 10 days from 3 per day to 1 per day and hope to come off altogether as pain subsides.Have started drinking Celery seed,perhaps this will help.
The Allopurinol seems to be working.Where my feet were previously on fire,the past few days my feet are cool and my shoes feel as if they are a size too big.Knees are not as hot as they usually are and red blotches on the knees which were a permanent feature are lightening and mobility improving.
Cant help thinking that perhaps an increase from 100mg Allopurinol to stronger dose might speed up proceedings.
In any case,I think i`ve been naive to think the Gout could be remedied in a matter of weeks or months.As Patrick suggested there could be a massive build up of Uric acid crystals over time which may take some time to break down.
Next visit to GP will ask for comparison of Uric acid level,Haemoglobin,Full blood count.
Awaiting also results of Blood test for JAK2 gene,and Erythropoietin in relation to red blood cells.
Heading for Phlebotomy hopefully next week.
Hope I`m not deviating from Gout issue but nothing has been proven as yet,that the Gout and Overproduction of red blood cells are not related.
Continuing to avoid high purines,alcohol.Drinking plenty water,nettle tea,celery seed,cherry juice.Eating cherries.Cutting down on sugar.

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