You’re the only person on the planet who takes any notice of my personal gout treatment program. And I include myself in that.
My reality is that I read stuff. Then, I talk to medical people about it if I get the chance. Next, I experiment within what I believe are safe boundaries to get a plan that works for me. So, with uric acid control, that’s easy. But with pain control, it’s more complicated. Especially with gout pain control.
First and foremost I had an epiphany when I realized gout pain stems from an immune reaction. Prior to that, I had the more typical view that sharp uric acid crystals were forming. So, I understood the importance of getting mobile as soon as possible. Fortunately, prescription strength ibuprofen (Aleve) kept me going almost every time. But if it didn’t I supplemented with paracetamol (Tylenol).
BTW, a quick aside, where are you buying your pain drugs? Diclofenac and naproxen are both widely available next to ibuprofen and paracetamol at your local Co-Op. I haven’t checked Aldi yet.
When I finally took some of my own advice and started allopurinol, my doctor brought colchicine into the mix as a preventative. Now, by this time, I understood how colchicine poisons the immune system to limit inflammation starting or spreading. So, I started preventative colchicine for two weeks every allopurinol dose change. Then as required.
So, the preventative part is not really part of this topic. But, I’ll explain it anyway because I think it’s where the 12 hours comes from. The best time to take preventative colchicine is at bedtime. But, if you wake up with slight gout symptoms, it’s usually the first sign of an attack. So, you prevent an acute attack with a morning colchicine. Also, consider a first NSAID at the same time. I used to wait a couple of hours before taking the NSAID, then realized I should be best taking them together. But remember I have absolutely no stomach effects, so you might need to carefully experiment.
Now, you might have a lazy 12-hour kip, d_q. But I’m happier with 5 to 8 hours. There is no fixed rule about hours. The second dose is backing up the preventative dose that might not have quite worked. It might not be necessary, but I’m not one to ask for an acute attack.
Returning to your acute gout attack plan. I have to say my advice is quite speculative. Because, since starting allopurinol, I have never had a serious acute attack. Though I have definitely experienced the onset of an attack and stopped it within 2 hours.
So, d_q, going back to your original “let’s say someone gets an acute flare today; what would be your dosing to hit hard?” My speculative answer was my “Dear Someone” letter above.
Finally, returning to the gap between colchicine doses.
Firstly, I’d suggest if you are worried, you switch to a different poison. Because there is always a risk of stomach problems with colchicine. Also, there are infection risks, so you have to be aware of germs from people around you.
If you do go down the colchicine route, I’m sure any doctor would back me up if I say you have to adjust your dose according to your personal experience. That means carefully recording your symptoms and reactions. An hour between doses should be OK. But everyone is different for all sorts of reasons.
I won’t bore you with all those reasons now. Instead, let’s look at the practical approach. The 2-hour cycle that I suggested above definitely works. I can’t think why you would want to take a second colchicine after only one hour, but it should not be a problem if the first one didn’t have you shitting yourself.
Thanks for helping me clarify this in my brain. Now, I need to review relevant pages to make sure all these points are covered properly. But first, I must worry about the grammatical challenges arising from my thoughts: “I can’t do this without d_q and nobody” 🙂