- December 17, 2015 at 10:55 am #597
Personal gout facts for Ayman Roshdy ( @ayman-roshdy )
Birth Year: 1976
My Gout Symptoms: Swelling and pain in my right big toe, it happens but on rare occasions to my left toe
How I treat symptoms: Medications mainly, sometime in the past I used to have something called UroSolvin and Zyloric. Now I am treated with Colchicine and Donifoxate (FEBUXOSTAT), plus I use Voltaren Gel which I don’t think makes any difference
My uric acid level: With Donifoxate 80 mg it was 3.7, for Donifoxate 40 mg it was 3.8 and it went up to 6.8 on stopping
Uric acid treatment preferences: Pharmaceutical Medicine, Natural Medicine, Lifestyle Changes
How I treat Uric Acid: Medications mainly, sometime in the past I used to have something called UroSolvin and Zyloric. Now I am treated with Colchicine and Donifoxate (FEBUXOSTAT)
Other personal gout facts: My elder family members say that I inherited this from my grandfather
- December 17, 2015 at 10:55 am #592
This is Ayman. I just read your reply to my (Help me please message – link above) and I really appreciate all the information that you shared with me so far, I probably need your help to identify a gout management plan.
Currently I am almost recovered from my last flare and I was on Colchicine only as I stopped Donifoxate durign this period (wrong move)
Before we start the plan, HYG the answers to the few questions that you asked on this other forum:
Regarding Zyloric it was never prescribed to me as a medication that I should use for long terms but it was prescribed to me as a medication to take during/after flares for some time which I believe was a wrong thing to do based on what I read and heard from you
I don’t know the term “simple mindfulness training” please share the resources
Regarding the food list which contains the purines and uric acid amounts I got it from a website but I failed to remember which one, it is not a reliable source of information anyway
Please let me know if you need specific information so that we start working on the gout management plan?
- December 18, 2015 at 10:51 am #601
Zyloric (allopurinol) and Donifoxate (Ulori/febuxostat) both do the same job. They reduce the level of uric acid in the blood by slowing down the rate our bodies produce it. When this is low enough, old uric acid crystals start to dissolve. When most of your uric acid crystals have dissolved, you never get gout attacks ever again. On cost grounds, and because it has a longer safety record, allopurinol is usually preferred over febuxostat. However, the decision has to be a personal one, taking all factors into account.
We can create a treatment plan around either of these uric acid lowering medicines. The choice is yours. If it’s not obvious which one you want to use, then we can start the plan by comparing them and making a choice.
I’ve copied your Personal Gout Profile from the old gout forum to a new profile forum: Personal Gout Profile: Ayman Roshdy. This is your area to note down all your gout facts. You can also use it to note your personal gout goals. There is no fixed format for your profile – it’s your area to use as you like. You can add as many posts as you wish, and edit posts as facts change.
In the old forum, I mentioned 3 possible topics for gout management plans: uric acid lowering, pain control, and diet.
For each of these plans, we start with the reasons why you want to start the plan, and what you hope to achieve. This is normally a sentence or two such as:
I want to reduce my uric acid to stop getting gout attacks within six months
I want to stop getting gout attacks so I can play soccer again
It’s best to make it as personal as possible. That helps inspire you if things get tough. So, Ayman, please start with your personal reasons for starting whichever plan you want to start with. You can start as many plans as you like.
I’ll prepare some notes on mindfullness training. You might need to remind me about this after a week, as my social life is hectic at this time of year.
- December 20, 2015 at 10:39 am #620
Thanks and sorry for the delayed reply as I was out of my computer for the past few days so I will add now a few things to my profile, let me know if I should add these to some other post as we got 3 different threads now 🙂
- December 20, 2015 at 6:38 pm #623
There’s no need to worry about delays. We’ll go forward at your pace.
Your gout profile is a reference area to keep all your personal facts about gout. It’s main purpose is so that when anyone responds to other topics, we can see what is relevant for you. It’s a longterm thread that helps you all the time you are a GoutPal Member.
Remember, you can ask questions any time, and have as many open questions as you like. Simple questions are probably best in the main gout forum. This area is for more complex topics that don’t have a single simple answer. Again, you can have as many as you like. Instead of starting these with a question, you start them with a reason.
This is where I pass it back to you, as it has to be your reason, not mine. I realize this is tricky when you don’t have any other plans here to use as a template. I’ll try to get some general templates done as a guide.
Let’s start with a pain control plan. May I suggest your reason is something like:
I want to minimize gout pain until my uric acid is fully under control. I'm happy with colchicine, and I want to use it in the most effective way.
I know from experience that this works best if we start with your personal reasons for starting the plan. If you can provide something that is more meaningful to you, then please post it as a reply here. If not, just post a reply saying ‘Let’s start pain control with that reason’
Thanks for your patience, and your support, for this new service.
- December 21, 2015 at 9:41 am #632
Ayman, I’ve just had another thought about this.
I’ve been suggesting three separate plans for uric acid, gout pain, and gout diet. I do this because my brain likes to separate ideas into different topics. I have to remember that this is your gout, and we should move forward in the best way for you. If you want to start a single plan to manage your gout, I can certainly do that. The advantage is that it keeps all your tasks in one plan.
It’s entirely up to you, so please let me know what’s best for you.
- December 21, 2015 at 12:07 pm #633
I believe that I need:
1) For the long term plan -> Control the Uric Acid level through medication & diet
2) For the short term plan -> Put a solid plan to reduce the pain when the flares happen or to know what should I do when I anticipate that a flare is about to happen
So if we had these 2 items as a target and accordingly put the needed plans then I would be a happy person knowing that I have the longer term plan to eliminate the problem at some point in the future and that I have a short term plan to deal with it so that I can start having a normal life
P.S. Yesterday night I started to feel this sensation just above my right big toe which usually happens before I am attacked with a flare so I took 1 Colchicine tablet just before going to sleep and this morning I didn’t receive the flare, don’t know if the Colchicine made a difference or not but thought to share with you this which falls under the short term plan that I am looking to have “How to deal with flares when I start feeling that I am receiving one and how to deal with it in case I wasn’t fast enough to stop it”
- December 21, 2015 at 12:10 pm #634
BTW what you wrote in the earlier post is excellent for me as a personal goal, target or reason and it matches what I wrote in my last post
“I want to minimize gout pain until my uric acid is fully under control. I’m happy with colchicine, and I want to use it in the most effective way.”
- December 28, 2015 at 5:19 am #678
I’ve started the plan for pain control at Pain control during uric acid lowering with colchicine. That is currently waiting @ayman-roshdy input for specific pain control medicines.
With the festive season, I forgot about the febuxostat dosage part of the plan. I’m on with that now. Sorry for the delay.
- December 28, 2015 at 5:50 am #680
I’ve now finished the introduction to Lowering uric acid with febuxostat. The first task is to establish testing and dose of Donifoxate 80mg. Please let me know in that topic, Ayman, how you are placed for resuming Donifoxate 80mg and scheduling blood tests.
- December 4, 2017 at 12:55 am #6076
Just a quick heads-up [Ayman ( @ayman-roshdy )], as it’s some time since you posted here.
Periodically, I remove inactive users and their posts. So your account is due to be canceled soon. If you want me to retain your info, just post a message letting me know. Then, I’ll keep this active for as long as you like.
Thank you for your support.
- December 20, 2015 at 10:44 am #621
For the ongoing medication to lowering the Uric acid I am using Donifoxate now as per my doctor’s advice so I believe I will continue using this one since it didn’t cause any side effects and I don’t have an issue with it
For the cases when I get the flare I’m using Colchicine so I believe this is the most effective way, wrongfully I was stopping the Donifoxate when I get the flare so I believe this should not be stopped from now on
My personal goal is that I stop getting the flares as soon as we can so that I have a normal life
For the 3 possible topics for gout management plans: uric acid lowering, pain control, and diet. I don’t have a problem on having all the 3 plans running in parallel, if this would be the fastest way to reach my personal goal then let’s do this
- December 21, 2015 at 2:40 pm #640
The reason for this plan is:
I want to minimize gout pain until my uric acid is fully under control. I’m happy with colchicine, and I want to use it in the most effective way.
There are two main targets:
- For the long term plan -> Control the Uric Acid level through medication & diet
- For the short term plan -> Put a solid plan to reduce the pain when the flares happen or to know what should I do when I anticipate that a flare is about to happen
Please post the steps needed for uric acid control, and for pain control
[admin: I’ll do separate topics for the details, then we can summarize progress here. It will become an overview of the plan]
- December 21, 2015 at 3:38 pm #643
I’ve added a topic for short term pain control: Pain control during uric acid lowering with colchicine.
Ayman, please can you reply to that with my questions about anti-inflammatories and pain-blockers.
I will do a similar topic for the long term uric acid control, and report back here when it’s done.
- December 21, 2015 at 3:35 pm #642
Gout Pain Control during Uric Acid Lowering
The overview is that we need pain control during uric acid lowering until the burden of uric acid crystals becomes too small to cause gout flares.
Gout Pain Prevention during Uric Acid Lowering
There can be an element of daily prevention in the plan. In this plan, that would involve taking one colchicine tablet at night. This is usually done for around two weeks whenever there is a dose change of febuxostat. It is a personal choice, best discussed with your doctor. You can switch the prevention part on or off depending on how you feel.
As this is a short term plan, I would say “if in doubt, take the daily preventative.” You can always try without it the following day.
Even when preventative colchicine is taken, you might need extra pain control if you feel the onset of a gout flare the following day. This is because colchicine tries to stop inflammation spreading. Sometimes the inflammation has already started. Sometimes the gout flare is too intense for a single colchicine tablet.
At this stage in your treatment program, you have already chosen to take colchicine as required. It is very significant from
Yesterday night I started to feel this sensation just above my right big toe which usually happens before I am attacked with a flare so I took 1 Colchicine tablet just before going to sleep and this morning I didn’t receive the flare, don’t know if the Colchicine made a difference or not but thought to share with you this which falls under the short term plan that I am looking to have “How to deal with flares when I start feeling that I am receiving one and how to deal with it in case I wasn’t fast enough to stop it”
It’s important to give yourself time during the day to do exactly this: watch for early onset, and take action as soon as you can. You did exactly the right thing, so now I’ll consider what to do if the sensation returns in the morning, or if the flare develops.
Pain Control As Required during Uric Acid Lowering
There are 2 possibilities:
1) The first colchicine worked, but the sensation of a possible attack returns within 24 hours.
2) The first colchicine didn’t work and the gout flare has started.
In either case, take a second colchicine immediately, and take a dose of anti-inflammatory medicine.
Now, we need to determine which anti-inflammatory is best for you. This is best advised by your doctor. It’s important to get maximum strength, as over the counter dose is not usually strong enough for gout. Common anti-inflammatories are ibuprofen and naproxen. They belong to a group called NSAIDs, and there are many different types. They include diclofenac, which is the active ingredient in the Voltaren gel that you have tried.
Can you see a doctor or pharmacist to get a supply of a suitable anti-inflammatory?
At the same time, you should ask about a compatible pain-blocker. I was advised to use paracetamol with ibuprofen. But there are many other combinations.
It is the combination of different types of pain relief that stops gout pain quickly.
Colchicine slows inflammation spreading, but does not reduce it. It has no immediate effect on pain.
Anti-inflammatories reduce inflammation, which reduces pain. They have some immediate pain relief, but often not enough for serious gout attacks.
Pain blockers stop any residual pain. This allows you to stay mobile and get on with your life until the anti-inflammatories reduce inflammation completely.
Ayman, if you can find suitable anti-inflammatories and compatible pain blockers, we can complete an hour-by-hour pain control plan for when colchicine needs some help.
- December 28, 2015 at 5:47 am #679
The general guidance for managing gout long-term, is to aim for uric acid below 0.30mmol/L. This ensures that most people will eventually get rid of old uric acid crystals, and gout attacks will cease. It takes several months for old crystals to dissolve. Therefore, it makes sense to divide uric acid management into separate phases.
The overview is that we need to control uric acid over 4 different phases:
- Titration phase: increase Donifoxate dose to get lowest possible uric acid level.
- Debulking phase: usually around a year of uric acid level well belo 0.30mmol/L during which the bulk of old uric acid crystals dissolve.
- Adjustment phase: decrease Donifoxate dose to get uric acid to safe level (no higher than 0.30mmol/L).
- Maintenance phase: Annual testing to maintain uric acid at safe level for life.
In the first 2 phases, there is risk of gout attacks. We can control any pain using Pain control during uric acid lowering with colchicine. Once started, Donifoxate should not be stopped, unless advised by a doctor. All uric acid tests should be accompanied by kidney function tests, and liver function tests. These give your doctor reassurance that any potential adverse events can be controlled before they become serious.
In the titration phase, we adjust febuxostat upwards until the target uric acid level is reached. That target needs to be agreed between you and your doctor, Ayman. In your case, you have already experienced Donifoxate 80mg. I strongly recommend you return to this as soon as possible.
Then we can monitor uric acid results, and see if it is possible to go even lower.
There’s no need to discuss specific targets for the other phases yet. Most of the work in this plan involves scheduling testing and dose changes to ensure the swiftest, safest resolution of excess uric acid.
Thank you for visiting GoutPal's Gout Network
Did you find the personal help you need with your gout?
I will help you understand and manage your gout.
If you did not find the personal gout help that you need, please tell me:
Information on GoutPal is provided by a gout patient to help you understand gout and related issues. Gout information is provided by a layman, with no medical training or qualifications. It should not be used for diagnosing or treating any health problem or disease. The information is given to help you understand your doctor's advice and know what questions to ask. It is not a substitute for professional care. If you have an actual or suspected health problem, you should consult your doctor.