Forum Replies Created
-
Posts
-
Ben, GP will probably want to start you off on 100mg. Try and argue the dose up to 300mg if you can; tell him it makes no difference if you are allergic to Allo at 100 or 300mg (allergic reaction/rash being the reason for this cautious intial dosage) & most people end up taking 300mg. If he won't budge, next tactic is to argue the date of the next blood test down to a maximum of 1 month (he will probably suggest 3) & agree on a target level of 5.00 mg/dL SUA or less.
Wouldn't bother with cherry supplements, unless you like them or want extra Vit C. Nicer fresh I reckon anyway.
Your reaction to reach for the Prednisone is understandable given that Colch & NSAIDs don't suit you, but in time your confidence in Allo will allow you to relax & ignore these minor symptoms (as long as you know your level is steady at ~ 5.00 or less).
I think you're right to be suspicious about changing meds; it can only be for reasons for which your wellbeing is last on the list: i. Dr makes more money from Uloric ii. more data on patient response for drug companies (may have some justification in the long term), but why fix something that aint broke?
1. Seriously consider changing your Dr (or be prepared to educate him about
gout ? downloading a copy of the recent Lancet review would probably help &
impress him that you know what you're talking about )
* tried posting a link to the PDF of this, but GP
won't create the link. Use the Forum search for “The Lancet” (Search link is under Popular Gout Pages on the right of this page)
2. Insist on a blood test to determine your Serum Uric Acid (SUA) level
3. Demand a prescription for Allopurinol, preferably 300mg daily, regardless
of the result of your test.
4. Pain relief, you have a number of options: of the NSAIDS, naproxen is
considered least corrosive on the insides. Colchicine taken prophelactically is
reputedly very effective to minimise attacks which (only) may?occur
when starting Allo.
I'm afraid not Candy, although any recommended dietary precautions e.g. low purine foods, abstaining from alcohol etc. will be helpful at this stage until you get your level down below 5.00; then it won't matter so much.
There seems to be a growing trend to prescribe Uloric rather than Allopurinol, probably because it is a newer and vastly more expensive drug. I'm not saying it's a bad choice, but because it's newer there is less data about the prevalence of side effects in the gout population. Whereas, the s/e of Allo are very well understood. Others on this forum who take Uloric may be able to give you feedback about their experiences with it. But from what I gather both drugs can cause tiredness, dizzyness, headaches etc. until you become accustomed to them- usually after about a month. If the symptoms persist, you should talk to your Dr.
Don't stop taking it though.
At such high SUA levels, it is likely that dietary restrictions can make a what seems like a big difference at first, and if you're willing to risk having flares, it might be worth seeing how far your level will fall like this. However, dietary restrictions are very difficult to maintain in the long term and it is a case of diminishing returns because diet is not the only factor affecting SUA. Even when taking Allopurinol, if you don't take enough, your SUA will not fall to a safe level.(<5.00)
As a rule of thumb you can probably say that SUA drops by between 1-2mg/dL for every 100mg of Allo. I would say from personal experience that the same applies to diet control, maybe 1-3 mg/dL(maximum) ? more the higher your level, and less the lower it is to start with.
I would also say that anyone with SUA of 8.00+ should definitely be on 300mg Allo for life.
Still way, way too high. Be prepared for another attack in due course because your dietery restrictions will not make enough difference to get you down below 5.00mg/dL. Bear in mind also that some fruit/juices contain high levels of fructose, which is bad for gout.
Right on bro! – correct on all counts. Your Dr is an idiot if he thinks 6.7 is OK; get another one if you can.
Whatever dose it takes to get below 5 is what you need to be on. However, increasing it after a week is probably a bit excessive, and I doubt you would get any Dr to agree to that regime. Remember that SUA levels fluctuate a lot and frequent flare ups can be part of the recovery process for anything from 6 months to a year after starting Allo.
Good plan to get your own meter. Test regularly at the same time, same conditions e.g. before food 1st thing in the morning. You need a sequence of test results which shows the overall pattern of your SUA levels. Making a graph to show your new Dr
would be a good idea and impress him/her that you know what you're talking about.drknow said:
Is this “ache” and pain leftover from the attack a month and a half ago or are these simply newly formed crystals hanging in my joint in my big toe???? I'm not clear on this??? Are these crystals the same from my initial attack or are they just reformed new ones???
A combination of both. Until your blood uric acid level is low enough to start disolving crystals, they won't go away. Meanwhile, more will be forming until you eventually have your 3rd attack.
I have beenn eating much better and drinking loads of water and trying ACV and BS rememdy.?
That's a bit like a diabetic saying they've cut down on the sweeties instead of taking their insulin
It doesn't burn and throb like during an attack but if I bump my foot it stll kills.?
Stubbing your toe (or even just walking too far) is enough to kick off a gout attack.
?
You need to have a blood test to see how high your SUA is and then begin proper medication to reduce and maintain it at a level where crystals can disolve and be flushed out of your system. Don't kid yourself that you can do this with natural remedies.
Before I was on Allo, I used Reishi mushroom powder, one summer, for hayfever, but this coincided with one of my bad periods of gout so I stopped using it because of the potentially high purine content. Might give it another go now; it was very effective.
There are 2 tests:
i) Venous blood – usually drawn from the arm> UA level is measured
ii) synovial fluid – can be drawn from the knee but any affected joint is possible> uric acid crystals are checked for under a microscope – the most certain diagnosis of gout
The 2nd Dr may only be using a different unit of measurement. See here:
https://gout-pal.com/reference/uric-acid-levels/
If you do the maths, you will see .39 or 390 is about 6.6mg/dL; this would be a very good result from so little Allo, but maybe not impossible. However, still not safe. You really need to be down at 5.00 or less. Might be worth a visit back to Dr #1, as he seems to be more knowledgeable (didn't tell you to reduce the meds, which is bad advice). Like all scientific tests, introducing variables confounds results.
Keith (Gout Admin) said:
?
3.9 is a lovely number (you are certain it is mg/dL aren't you)
From 10.7 to 3.9mg/dL in a month on 200mg of Allo is highly unlikely. Drs are idiots and only read what they see on a piece of paper. Hospitals often use more than one lab, which can use different units of meaurement. You need to double check your result.
Iconoclast said:
He also started me on another med that I take twice a day but I forgot whats its called.
Is it for gout? If so, probably a NSAID, naproxen, indomethacin etc
Here are my questions.
?
1.? How long should I expect it to take for my uric acid
level to drop to a normal level (around 6) if I keep taking the
allopurinol at 200 mg a day?? I have altered my diet and have been avoiding high purine foods and eating a lot of vegetables. Should I go on a higher dose?
You should probably be on a daily minimum dose of 300mg. Allo does not work cumulatively; you need to find the right dose to reduce your UA to a safe(r) level of around 5
2.? Once my uric acid levels drop to within normal levels, can I go
back to drinking alcohol normally on weekends? If I drink alcohol
again, will my uric acid levels rise quickly even if I continue to avoid
high purine foods? If so, how fast will it rise?
?Impossible to predict
3.? I really like drinking and usually drink at the bar every Friday and Saturday night.? I asked my doctor if I need to quit drinking and he said I should stop drinking beer and spirits, but he said red wine is ok.? How realistic is it for someone with gout who is on meds and gets their uric acid level lowered to go back to drinking on weekends? I dont drink at all on week nights.
Drinking normally is as meaningless a term as normal UA levels. Even serious alcoholics alternate periods of abstinence with binge drinking. Wine appears to be the “safest” type of alcohol to resume drinking after stabilizing UA levels, which may include a period of flushing out urate deposits with repeated bouts of gout attacks as part of the process. Much depends on the individual, their metabolism and how much they avoid exacerbating factors like diet, alcohol, vigorous exercise, weight loss, emotional stress etc etc.
4.? Ive been taking 2000 mg of vitamin C pills a day.? Do you think this will help??
Maybe
Ive also been taking about 1000 mg of EPA pills a day.? Will these help?
Probably not. Most oily fish are high in purines
?
I am getting the results of another blood test on Monday.? I will update with the new information.?
Good luck. Try and persuade your Dr to put you on 300mg asap. Initial lower doses are merely to check for allergic reaction.
Also worth bearing in mind that although cider may be low in terms of purine content, most of the [email protected], mass produced ciders, which are designed for unsophisticated younger palates e.g. strongbow, magners etc are simply fizzy water with added fructose, chemical flavouring and alcohol. Try and stick to the posher, organic ciders that come from a small producer (unfortunately, not many pubs stock them). Personally, I have found wine to be the safest alcohol, but then I don't drink that much anyway and it's usually with food.
Good that you have discovered one of your triggers, but don't kid yourself that you have conquered gout. Knowing your uric acid values via blood testing is key to staying pain free.
azasadny said:
This was the best forum I found when I was looking. None of the other sites had nearly the resources, posts, info, etc… That's why I'm here.
Ditto
Initially, I always took mine in the morning with breakfast. I always try to take it with food. But it's gotten pretty random now and I often miss the odd day, either because I completely forget or can't remember if I've taken it, in which case I don't – to avoid a double dose. Doesn't seem to make any difference to me, but it's probably better to pick a time and stick to it.
How frustrating?
you have my sympathies. Although Allo & SUA of 4.3 should make diet irrelevant, only thing I can think of is maybe just stick to fish. Before I went on Allo, Chicken & tofu were significant triggers for me.Are you sure it's gout? Symptoms sound more like general arthritis. What tests have you had done recently?
zip2play said:
SPAMMERS are such a pain in the ass.
You think colchicine works for them too?
Interesting study. Hadn't seen it before now.?
For trigger point injections read acupuncture: low back pain is one of the few conditions that Western medicine acknowledges acupuncture is effective for. I treat a lot of it (& sciatica) quite successfully in my clinic. Depends on the severity of prolapse though.
azasadny said:
?I thought i was beating this, but apparently not!
Yeah you are. Allo can cause flare ups at the beginning; some people get them, some don't. 4.3 is pretty low, so your urate deposits may be shifting quickly enough to cause minor flares. Stick with it; you will benefit in the long run.
I would just start taking the Allo & risk it, since you are obviously choosing to ignore taking precautionary measures regarding your life style. You could end up waiting a long time, having just as many flares as might occur when beginning Allo therapy, which is by no means certain anyway.
Limpy, are you 100% certain the values you are being given are in mg/dL? It's very easy for (idiot) Drs to get their decimal points and units mixed up. If the 5.5+ you have been told is in fact .55mmol/L or 550 umol/L then you are actually talking 9.2+mg/dL, which would make a lot more sense of your symptoms. In this case, you definitely need to be on 300mg Allo minimum.Values drop during an attack also, so 3.2? or is that actually 5.4mg/dL would also make sense. Double check with the lab because the Dr may lie to cover himself. Give the quack a slap if he got it wrong.
Naproxen is OK in the short term, but like most NSAIDs can cause intestinal problems long term (bleeding). Good for nipping a flare in the bud, pretty useless if it really takes off.
sdgfrofg said:
?Any brands of SUA self testers you or indeed anyone else can recommend it would be appreciated. I think it might be? wise purchase.
This is a good one that many people have:
Get an extra box of strips, you tend to get through them pretty quick at first.
Mild pain could be anything. A true gout attack is characterized by “exquisite” pain i.e. severe. Until you experience this, GP will be reluctant to prescribe a uricosuric and will give you various pain killers/NSAIDs or maybe colchicine if he really thinks it is gout (and he knows what he's doing).
If you do have gout, you appear to be at the early stage where you may not have a serious attack for some time, especially if you?continue moderation in your diet/lifestyle, avoiding “high purine” foods/alcohol. Try and arrange regular SUA tests to get a clearer picture of your levels or invest in a home tester.
