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jba,
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To stop an attack NOW, use colchicine if you have some.
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To prevent further attacks, up your allopurinol to 300 mg. Have another blood test done.
But?there is no better assessment of proper allopurinol dosing than stoppage of all attacks. The gods have just told you that you are taking too little.
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VERY few people can get proper control with just 200 mg. allopurinol.
After one attack, rest assured that a 9.2 Uric Acid WILL cause another, the only variable is timing. Even if it did not, there is increasing evidence that high uric acid is damaging to coronary arteries.
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I feel waiting for the second or third attack until committiing to a life of drugs is a good idea because every attack AFFIRMS a diagnosis. Same goes for a blood test, becasue labs screw up. Nobody should go onto a life of drugs without SOLID confirmation of the disease/illness.
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I think it was the Fourth or Fifth attack that got me on allopurinol (and colchicine) but that last attack was SO perfectly defined with the big purple bunion joint that could not even bear the weight of a SOCK. The earlier ones, albeit VERY painful and needing crutches for 3 days,?were not definitive (ankles, instep, metatarsal.)
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I guess everyone has slightly different stories leading to the eventual life of allopurinol.
The beauty of the drug is that with proper allopurinol dosing, there is no need to give up meat, beer, shriimp, calves liver smothered in fried onlion?(yummm.)
The converse is not true though. You can suffer though all the ancient?dietary recommendations and STILL not properly control your gout.
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There really is no way around the dictum that once you have had a gout attack you will be on a drug for life…nothing else works.
I second probenecid. In the United States it's really all you are left with. I hope you are not allergic to it…a lot of people are.
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Make sure you take urine alkalyzers with it to avoid kidney stones.
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Losartan is uricosuric but only weakly so.
I kept getting what looked like someone started a post and then only posted a big yellow banana. It came and went several times.
Perhaps my new computer is haunted by a chimpanzee?
It seems gone now.
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IHG,
Ask your doctor for colchicine, but alas it is now SOOO freaking expensive in the U.S. now that it got a patent, ?that I am loathe to recommend it. It is the very best way to end an attack. Can anyone get it cheap overseas? (I haven't priced the India suppliers becasue I have a lot of it “just in case.” Canada?
Indomethacin 25 mg. 4 times a day is probably better than ibuprofen.
Your attack is NOT in a common place. Have you had atttacks before? This does not sound unlike Plantar Fasciitis. How high was your uric acid?
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I have nothing against prednisone…I stopped an attack of shingles with it?in?under 3 weeks?days which must be something of a record. But like limpy says , it is purely palliative…it stops inflammation but the inflammation often comes back when the prednisone is stopped and the stuff is habituating, you need more and mopre to get the same effect.
So take it if your doctors wants, but don't use it as a crutch more than a couple weeks.
My last was $310 for 60 pills which was a months supply.
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Oh dear JESUS!
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And what is with that friggen banana????
BIS,
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Aren't you lucky that you didn't get an SUA of 5 or 6 after your trial of saintly eating. That would mean you could avoid allopurinol but NEVER have another beer again.
?Oh gosh, and all that 12-step nonsense!
Take that srticle with a grain of salt. Meta-anaysis usually sucks. Drawing consclusions OTHER the one being investigated sucks (article purported to be studying the relationship to cancer and aspirin.)
Slanting studies with nomenclature like seeing “non-trivial bleed” in the data but maginifying it to MAJOR bleed in the conclusion shows extreme bias. Ignored in comparing PERCENTAGES is the actual number: to wit, more than half of us will die of a heart attack, a HUGE number of people. VERY few will die of “non-trivial bleeds” so a 30% decrease in the former is is a gargantuan health benefit but a 30% inclease in the latter is almost inconsequential.
Like saying don't take a lifesaving drug that will save MILLIONS becasue of a 10% increase?in the death rate from an infected toenail.
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Since the advent of the VERY VERY expensive blood thinner, Plavix and her even more expensive patened sisters, aspirin get pooh-poohed by studies, especially META studies that need only buy one “researcher,”?financed by some “unknown donor.” <tongue planted firmly in cheek>
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I's reminiscent of all the bad press that allopurinol got COINCIDENTALLY at the same time Uloric was being rolled out.
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The cardioprotective effects of aspirin is the most important medical discovery of the Twentieth Centruy. If it could be patented it would be touted as a MIRACLE and cost $100 a pill.
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Perhaps 10 year olds don't need it daily but post-50 year old men certainly DO. Post 50 year old men with gout probably stand 75+%? chance of death by heart disease.
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My triumvirate of the wonders of Twentieth Century medicine are: penicillin, Lipitor, allopurinol, and aspirin (ancient drug but with new?20th Century capability.)
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And don't be surprised if you read more about decreased gastrointestinal cancers among aspirin users?but that will only be icing on the cake. Heck, if aspirin can tear a tiny, undetectable?cancer off of my colon, who cares if the site bleeds a little.
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I am having a problem of my own regarding aspirin. I have many joint pains, back, shoulder, hand, sore feet. AND I am a sexagenarian weight lifter?PAIN! Maybe some gout, maybe some osteoarthritis, maybe some being too old for the gym.
In any case I would like to take naproxyn daily but all NSAIDS tend to interfere with the permanent platelet anti-agglomerating effect of aspirin. I am having trouble finding what I would consider the last word on the subject. Obviously all NSAID manufacturers will show studies that paint there own drugs in a favorable light so I am having “trust issues.”
Having proven cardiac vessel partial blockages, the issue of clot prevention is paramount in my mind.
Thanks GP.
Happy to hear your tophi are shrinking.
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Reading between the lines with my SHerlock Holmes magnifying glass ?I can tell you are on the horns of a dilemma about STATINS. I think they are God;s gift to man right below allopurinol in their glory.
But, since they are not without side effects, I cannot gainsay anyone's wariness about them.
BUT, take an aspirin every day. THIS I DEMAND! :D?There is no lottery win?quite like skipping a heart attack that you might have otherwise?had.
I am voracious in reading anything that will increase my useful lifespan. I have confirmed coronary artery disease that I am trying hard to hold in check or even reverse. I have excellent control over my LDL levels, modest control over my Lp(a) levels and tolerablle control over my urate levels. On the last item, I feel I can do better.
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Let's get personal GP:
I know you are/were taking 900 mg. allopurinol/day to get rid of old tophi as quickly as possible. How is that working out? ?What kind of SUA's are you running on this dose? Are you seeing diminution of your elbow tophi (if I rememberr correctly.)
I will see ANOTHER new doctor soon (Goddamned private insurance nonsense in the USA) and am torn between an increase in allopurinol (to 400-600mg) or the addition of probenecid, perhaps 500mg to my 300 mg alloprinol. I am only getting in the upper 5's and lower 6's with the 300 mg. allopurinol and, although keeping frank gout attacks away permanently, I am having a deuce of a time with joint pains and a wonky right hand with a painful trigger finger.
I know from?a few posters here that alloputrinol shows a rather steep marginal diminshment of benefit with increasing dosage. I presume you've seen the same.
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And of course, I would like to take full advantage of any cardiac benefits from allopurinol and/or very low urate levels.
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So, how is the 900 mg. dose working out for you. (Just between us turkey talkers.
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Do you have any thoughts on increased allopurinol vs. addition of probenecid? Any cautions on very high dose allopurinol, since you are a sample of one, our canary in the coal mine.
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Of course anyone else who wishes to voice an opinion is very welcome.
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(I pray this next doctor will inderstand that I know what I am talking about when I ask for something…otherwise there will quickly be yet ANOTHER doctor, and ANOTHER.
?I should NOT have to argue with my “employees.”)
The new study included 120 patients who had experienced at least two flare-ups in the previous four months. They were divided into three treatment groups that consumed either lactose powder, skim milk powder or skim milk powder enriched with glycomacropeptide (GMP) and G600 milk fat extract (G600).
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How bizarre, to take skim milk POWDER and add fat extract and water to get some weird version of WHOLE MILK with added whey protein (highly adulterated whey protein.)????
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If milk is good for gout, the just drink milk…it comes from a cow not a chemical plant.
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How about SKIM ?MILK + ALLOPURINOL?
(as long as you're making bizarre mixtures.)?
As GP said, if?milk lowers your serum uric acid, it is good. If it lowers it below 5 or 6 mg/dL it is good ENOUGH to treat gout.?
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Don't really want to go on a drug, but at this point I am not sure I have a choice.
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I think that pretty much expresses what each of us has felt when first confronting the disease.
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Nice to see your confirmation of a lowered serum uric acid DURING an acute attack.
Of course, not to beat a dead horse with my colchicine treatment since many of you have heard it timeless times in the past:
For a severe attack you take colcicine, one an hour, until your pain stops, severe diahrrea begins or you reach 16 tablets (8 mg.)
Any dose of colchicine that DOESN'T stoop pain seems quite pointless to me, more like “drug abuse.” Like wanting to get to San Francisco from NYC?on a train?but buying a ticket instead to Kansas City.
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For NSAID analgesics I would recommend indomethacin. It? made me dizzy (so that ended my career as a tighrope walker :D) but it eased the pain by a good deal.
My first dose of allopurinol was 400 mg, After that first dose, I never had another frank gout attack, and I'm talking years and years.
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After a year or two I lowerd my dose to? 300 mg. for a decade. Doofy doctor kept harping about the dangers of allopurinol? so I relented and went down to 200 mg. for almost a year ?and started getting mild, non crippling attacks ?back
Went back up to 300 mg. where I am today?and fired the doctor.
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After agout 20 years my hands are getting suspect with some small tophi , a trigger finger or two and mid hand pain…so I am strongly considereing either going back to 400 allopurinol or adding 500 mg. probenecid (potent uricosuric) to my 300 mg. allopurinol.
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My feet remain fine unless I go on a beer binge…then a dulll ache with overwalking.
Until things firm up diagnosis-wise the only dietary recommendations I would make would be to eliminate beer (spirits or wine are better) and increase dairy.
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Probably your diagnosis will come from yourself when you join the throngs of us who have suffered a horrific, unmistakable,?crippling podagra event that you KNOW you will never allow to happen again as long as you live.
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I sympathize with anyone in the “is it?-is it NOT?” phase, with urates running around 6.0. A big red crippled foot with a urate of 8 is so much more straightforward.
Any doctor who blames a patient for his disease is of no use to the patient.
Flush the jerk ASAP.
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Perhaps tell him that 20% of doctors are genetically incompetent but the other 80% have to work at it. (I'll bet he won't see the irony.)
Markin,
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Just to add a bit to clarify Keith's post. I'm sure he did not mean it to read that you should stay on 100 mg. allopurinol for 6 months. That is a recipe for disaster.
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You want to get to at least 300 mg. allopurinol as fast as possible, I recommend IMMEDIATELY after your SECOND gout attack has subsided (don't treat after only one.)
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Weight LOSS is a very potent gout trigger (cell destruction releases immense amounts of uric acid,) more so even than weight GAIN?so slow and steady weight loss ?WITH the help of allopurinol is best.
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Low-purine diet is very 1940's (and 1740's)?before they had anything better. It just doesn't work. Don't waste your time and energy. If you are going to limit ANYTHING make it beer and ale.
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Yes, the ankles and metatarsal joints of the foot are very prone to gout attacks. The pain can be brutal but NOTHING compared to a cripppling PODAGRA (bunion joint being chewed on by SATAN himself.)
Personal experience tells me these ancillary foot?attacks last 3 days or so?but may still require a crutch. They are NOT a walk in the park. For some reason the podagra attacks can go on and on and on?like the Energizer bunny.
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Yeah, get a new doctor. This one seems to have NO experience with gout.
marc,
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Very often there is no rebound from allopurinol at all. I never had an attack after starting right on 400 mg. allopurinol.
Instead of daily colchicine, why not try none, but at the first sigh of pain (always in the morning)? take 2 colchicine. If that doesn't stop the pain within the hour, take another and maybe a fourth an hour later. If you catch a twinge early enough, two colchicine will ususally knock it out.
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But, like I said, there is no real reason to expect you will have pain. (Don't overdrink beer or ale for a while.)
Can we assume by MTP joint you mean the BUNION JOINT? (We have a bunch of MTP joints.)
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Don't pester yourself with dietary restrictions at this point.? Just wait on the results of your uric acid blood test.
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My experience is that the first several attacks last almost precisely 3 days. YMMV. When I had my first attacks in my arch and ankle, before I knew for sure?it was gout, I used a single crutch for the worst of the 3 days.?
Have you ever had any unexplained foot or ankle pain in the past?
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If you are in the States, you can buy over the counter Naproxyn (or Aleve) that some people get good results with. But continue with the diclofenac (sounds like you are a Brit) if it gives you relief.
Hi loiusgeorge…
I hope you are taking your allopurinol daily. That is the way to manage gout for a lifetime.
Thank you for the CONVERSION widgit.
?It has always driven me NUTS, it is just a number that will NOT stick in my head.
tony,
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The nhs link is not uninteresting but let;s see what we have there:
What were the results of the study?
About 1.5% of the men (755) developed gout during the study. Men who drank more fizzy drinks were more likely to develop gout than those who drank fewer fizzy drinks.
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Men who had more than one fizzy drink a day increased their risk by 45%; two or more drinks a day increased the risk by 85%, compared with men who drank less than one fizzy drink a month. Diet fizzy drinks did not increase the risk of gout. People with the highest intake of fructose doubled their risk of gout compared with those with the lowest intake.
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They are drawing a conclusion by separating the gout population of 755 men who said they got a gout diagnosis. This population excludes the other 98.5 % who did NOT develop gout. Then they compare those who said the has 2 or more fizzy drinks per day (an aside is beer fizzy?) with those who claim to have ZERO fizzy drinks in a month. VERY few people can claim to have ZERO fizzy frinks per month. There are people who think fizzy drinks, like junk food, is BAD for one;s image so they might lie about never having any.
Any estimate of the number of those 755 who had ZERO fizzy drinks per MONTH? Can we envision 2, 3 or 4 people? Is there a good reason they didn't MENTION the number. Can one draw ANY conclusion from a vanishingly small sample? I have a friend who eats NO sugar, or so she says, but then we'll stop for dinner and she NEVER skips dessert. So perhaps ASKING people what they eat does not yield trustworthy results.
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Were the FIZZY people washing down Big Mac's and Double Whoppers with the fizzies?the connection would NOT be unexpected. Were the fizzy people HEAVIER than the abstainers?
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So, I conclude this is a BAD study?the internet is filled with them. It sounds like a possible ploy to sell DIET soda.
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HFCS is found in almost all processed food. If one is going to try to connect it with gout why not measure the entire HFCS in a diet rather than taking one element, CARBONATED (fizzy)?beverages. Carbon Dioxide is a very potent? acidifier, and acid is a well known uric acid precipitator.
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Just a hiint from years of experience: When someone talks about the single food that is causing dozens or hundreds of illnesses, or a food or supplement (usually available from the same someone)?that will CURE many illnesses, the person is LYING.
We should have learned that from the Vitamin C scam and it's hucksters.
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Oh, Mercola believes HIV is not the casue of AIDS?but rather it is the WORRY about AIDS that causes AIDS. Assholes like this are a conceivable ?argument to restrict free speech although it must not be done.
We must simply learn how to tell wisdom from charlettanism.
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But in truth, nobody will harm himself by giving up HFCS, Frustose, Sucrose, glucose, lactose, mannose, honey, molasses and soda. They are all empty calories.
?But don't look for a gout cure.
I cannot speak about Lustig and Johnson but Mercola is a complete and utter charlatan. His voice is the most damaging thing the internet has ever done tothe health of its users (except may extensive sloth.) I have read more stupid ?claptrap requoted from this man than I would have though possible in one lifetime.
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For those who don't know, he is an OSTEOPATH not an MD.
There is a danger in the internet: anyone can post ANYTHING, no matter how invalid and it is only the incessant bombardment of the nonsense that makes it seem, TO SOME, as valid information. It is the price of free speech now available to everyone with a single click.
It uised to be the aphorism DO NOT BELIEVE EVERYTHING YOU READ was valid. With the internet it is valid 1000 times over.
I'd like to introduce you to my sister.?
She can talk for hours on end without ever breathing out??a single period?and every second word is I, ME, or MY.
Let me second odo's claim that 100 mg. is a useless dose ol allopurinol more apt to CAUSE pain than to prevent it.
Go to 300 mg. immediately?after getting a blood test for?serum uric acid. After several months judge whether you are improving.
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The pain never went away (until recently). Mayhem followed suit on my whole body, as very quickly the pain spread thoughout my body, first the neck, right shoulder, left knee, left leg through the foot, ribcage, spine, jaw and face, right leg, fingers, then my hips. I quickly learned, very slowly, that the U.S. medical system is really a very flawed system. Great if you have a tooth ache, or a bout of diarrhea, but to actually find a problem that cannot be looked up in a pamplet that the drug companies have printed out for them to help diagnose their patients, good luck.
It sounds like 22 years of foundry work has taken its toll in repetetive stress injuries. (I once ran a lab in a steel mill so I am familiar with?how gruelling some of the jobs can be.)?Yes, you are so right, I think the only diagnostician left in America is fictional and his name is GREGORY HOUSE. But now the big question is GOUT OR NOT-GOUT? The allopurinol and the blood test should shed some good light on it. Can you have pain from several conditions? Of course, even made up ones like fibromyalgia (which means doctors cannot make a diagnosis)? and Parkinson's can be very painful too…as can Lupus, rheumatoid and osteoarthritis, scleroderma etc.
Your list of aches and pains are not typical of gout but gout CAN hit any part of the body.
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?all anyone could see was a very low vitamin D level. Vitamin D, the new doctor's religion, don't, please don't get me started on Vit D. I'm beginning to believe that rocket ships are powered by Vit D.
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Yeah, me too. What IS it with this latest fad, that everyone has a Vitamin D deficiciency. Decades back any mention of Vitamin D supplementation carried the warning: NEVER supplement more than 400 iu's?it is poisonous in large quantities. Now EVERYBODY is being put on large amounts, up to 5,000 i.u/day. How do doctors spread these fads among themseelves? I wonder what's next?
In truth, I came upon Vitamin D supplementation all by myself when I asked myself the question: Why do people get colds in Winter and my answer? Because there is less sunlight, so I started with 1000 units Vitamin D.
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When can you get a pension?you will certainly soon have the time put in, but there is that pesky age requirement? What 55?
If you lose the job, I guess SS disability might be in your cards. It is bad enough putting up with illness without having resulting job loss hanging over your head. Do you think a career change could be?possible? (I know that sounds a little Marie Antoinettish :D)
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But let's hope the 300 mg. allopurinol sorts out a lot of your problems.
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A caution on?your treatment: a course of steroids will ease the pain caused by a great many musculoskeletal diseases or trauma. Taking steroids with allopurinol may mask the cause.
Firstly: do you mean 1000 mg. probenecid?100 mg. is not a sensible dose.
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Secondly, FINGERS!!!! ?As a long term sufferer let me throw in a unique but?very personal ?thought: even with sufficient control, good enough to prevent acute atacks and foot pain, after years and years the finger joints take a hit.
I can only presume that the fingers are clearly the coldest joints of the body and thus most susceptible.
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I HATE the whole concept but I am seeing a subtle??breakdown of my poor little fingers, and a couple metatasrsals of the hand, i.e, trigger fingers.
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Roger,
If I were you I would consider 300 mg. allopurinol + 1000 mg. probenecid. I am going to ask my doctor for the same when I next see him.
Potassium citrate comes in various preparations. Polycitra-K comes as a liquid and in crystals (packets) that you mix in water. It comes in several flavors which are worth trying. In either case they can be sufficiently diluted or mixed into other juices to minimize the taste. Another option is K-Lyte which comes as an effervescent tablet that dissolves in water, like an Alka-Seltzer. It also comes in different flavors worth trying on your kids. It's a combination of potassium citrate and potassium bicarbonate; that's OK because citrate and bicarbonate are equivalent. It also comes as “DS” or double strength. (You DON'T want K-Lyte/Cl which is potassium chloride and has no alkalinizing property). Another popular form of potassium citrate is Urocit-K, a pill form. They are actually in a wax matrix from which the drug dissolves. People often see the unabsorbed, undissolved wax in their bowel movements; this does not mean the mineral is not being absorbed.
Compare doses of these preparations in milliequivalents (mEq) of bicarbonate equivalents; ignore the number of milligrams. Most people need anywhere from 20 to 120 mEq per day, but measuring the urine pH is the way to determine how much you need. Bicitra and Shohl?s solution are 15 mEq per tablespoon (1 tbsp=15 cc, cubic centimeters), or 1 mEq per cc. Polycitra liquid has 2 mEq per cc (half as sodium, half as potassium). Polycitra-K liquid is 2 mEq per cc, all potassium. Polycitra-K crystals come as 30 mEq per packet. Urocit-K comes in 5 and 10 mEq tablets. K-Lyte comes as 25 mEq per tab, and 50 mEq for the ?double-strength? DS. The standard generic sodium bicarbonate tab (325 milligrams, like an adult aspirin) is about 4 mEq.
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I assume you are talking about your URINARY pH because it is impossible to change Blood pH outside the noarrowest range, 7.35-7.45, ?without fatal results.
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Safest non-pharmaceutical way to raise urinary pH is more fruits and vegetables, less meat.
For an easy to find product, a bottle of Citrate of Magnesia might do the trick…a couple Tbsp periodically?won't have the laxative effect…plus you have a good magnesium supplement, good for the nerves.
Ahhh, the teardrop!
Designed to prevent people from splitting the pill evenly. (Aren't they clever pusses?)
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My only teardrop pill has been Cozaar (losartan) but I managed to split them, if unevenly. I tried along the long axis…it works but hard to orient in the pillsplitter.
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Gee, ?I should have GUESSED they'd do ULORIC as a teardrop.
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Oh greed, thy name is BIG PHARMA.
ctrlkeys,
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What an incredibly generous offer but I am a bit of a sharpy so there was no way I was going to get caught with my pants down and I have at least 200 colchicine in the larder: last Rx filled JUST BEFORE the well went dry in the U.S. but thanks anyway.
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limpy,
I bought my nitro spray bottles from India: $14 instead of $250…I kid you not.
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My goal is to outlive my drugs.
