November 13, 2016 at 9:24 pm #2275GoutPal VictimParticipant
My father’s gout rose to the surface and burst through. It started as milky fluid and cottage cheese like gout I guess. The fluid is blood tinged clear now but still clumps of stringy white goo. He now has two considerable holes leaking. This has been 2 days off and on.
Is this an emergency or can it wait a few days to see the regular doctor?
November 13, 2016 at 9:24 pm #2242ClaircrossGuest
have had tophi in the knuckle of a finger for several years but was able to somewhat control it with DMSO. now it has appeared on other parts of the finger and in the palm of the same hand.
I’m not sure if the DMSO has dissolved and redistributed the original tophi or these are new outbreaks. in any event, the tophi in the knuckle is beginning to cause me pain.
is it time for surgery or can this small inflammation be dealt with in some less invasive manner? the knuckle bulge is about 1/4″ above normal.
November 13, 2016 at 10:03 pm #2244
Personally, I would only consider surgery as a last resort. There are always health risks associated with any surgery. And, it seems pointless considering surgery without first considering lowering uric acid levels.
November 28, 2016 at 10:01 am #2285
There is a serious risk of infection. Get the tophi site dressed professionally immediately.
Then, get uric acid safe. As quickly as possible.
Let me know what your father’s doctor plans for uric acid control. Then, I can offer assistance. Hopefully, we can get him safe soon.
February 1, 2017 at 6:06 am #2561GoutPal VictimParticipant
so just had my tophus lanced by a doctor….
wound doesn’t seem like it’s closing due to uric crystals underneath…
what should I do ???
I clean it daily with hydrogen peroxide….
February 1, 2017 at 9:32 am #2563
Get to hospital today. Your butcher has left you at risk of infection. It needs to be properly cleaned and dressed immediately.
Then get proper uric acid control, which prevents this type of disaster.
June 24, 2017 at 8:09 am #4361Gainesville Gout SuffererGuest
I have hard tophus on my hands, elbow, and feet. I went to an orthopedic surgeon and he said my tophus was so hard that it can’t be removed without severely damaging the skin. He said the tophus is so embedded in the skin that trying to scrape it off would damage the skin so bad that the skin would not heal because the blood vessels would be destroyed.
I’ve had gout for 37 years. It’s the worse case ever.
Is there a way to liquefy the hard tophus so it can be removed without killing the skin?
June 24, 2017 at 9:54 am #4369
Hi Gainesville Gout Sufferer,
I hope you can see from my earlier replies that your surgeon was right to be cautious. Because surgery to remove tophi is a risky procedure. But, self-mutilation, under-qualified lancing, or simple neglect are all too common. Then, without careful, sterile, tophi removal, surgical washing, and medical dressing, the risks of infection are high.
Also, burst tophi are often slow to heal. Because the damage you experience with your own tophus can affect skin healing.
However, you should search for tophus removal using the search box at the top of the page. Because the first result is Tophi Removal Without Surgery. So, that picture proves you can ‘liquefy a hard tophus’. But, only by lowering uric acid.
I’m surprised your surgeon hasn’t referred you to a rheumatologist. Because you need to get your uric acid as low as you can. Starting, as soon as you can.
If you need help with that, you can reply to this topic. But, I think it would be better if you log in and start your own new topic.
June 24, 2017 at 11:10 am #4370
Also, I just read a nice summary of this situation[*].
The authors make it clear that the first-line treatment for tophi should be uric acid lowering drugs including allopurinol, febuxostat, probenecid, lesinurad, and pegloticase. However, they also note that some tophi cause “urgent complications” that might warrant surgery. Those complications include infection, ulceration, and nerve compression (e.g. carpal tunnel syndrome). Also, when tophi develop near joints, they can damage joints, restrict movement, and cause function loss.
Finally, they conclude that tophi removal by surgery is generally successful. Although they repeat the warning “surgery should be considered for the rare patient with impending or severe, debilitating complications”.
So, it’s worth repeating that anyone with tophi should be taking allopurinol, or similar, at a sufficient dose to get uric acid well below 5mg/dL. But, each patient must have dose monitored to ensure it is safe and effective for that individual.
Tophi, Surgery, Uric Acid Lowering Reference
Kasper, Isaac R., et al. “Treatment of tophaceous gout: When medication is not enough.” Seminars in arthritis and rheumatism. Vol. 45. No. 6. WB Saunders, 2016.
July 7, 2017 at 3:41 pm #4585Zachary FooseParticipant
Gout Flare in Elbow
One year ago I suffered a gout attack in both of my feet. I could not walk. I was teaching english in Thailand and did not have insurance. I went to the hospital and received treatment that subdued the inflammation. I was able to walk out of there within 24 hours. I was never diagnosed with anything because I had no blood work done. I am aware this is a huge mistake & continued on with a lifestyle high in consuming purines and beer (every once and a while on the weekends)
Fast forward 1 year.
I hadn’t experienced any gout attacks flare ups other than the occasional discomfort in my left big toe. (could have been the result of joint damage). I arrived in Chiang Mai on June 18th and began what I like to call a cleanse and lifestyle change. I have always been in great shape, until i broke my foot this past February and unfortunately let myself go… So I decided to not drink for a while and to start exercising much more.
I started consuming high amount of protein. Red meats & fish. I wasn’t consuming as much veggies as I should have. An extremely high purine diet as i look back in hindsight. This was undoubtedly the cause of my flare up. On June26th, I noticed a bump, not right on the joint of my elbow, but three thumbnails below it (radius and ulna). I thought i just bumped it in the gym; however there was no bruise. 2 days go by and the bump doesnt go away. I think nothing of it, never even thought of gout (havent been diagnosed yet) and continue on eating the high purine diet. The night the flare up escalated, I consumed 2 filets of salmon and some chicken livers/hearts. (not surprisingly these are extremely high in purines) The next morning my arm and forearm were swollen to the point where I needed to go to the hospital. Long story short- I was prescribed colchicine , arcoxia , tylenol and clindamycin. Blood work was done as the doctor suspected gout. I had a uric acid level of 11.6 and my white blood cells were extremely high.
Fortunately, the medication subdued the flare up. Thank you for those who have read this far. This background information is very important to my question that I have now.
At the original site of the bump (3 thumbnails below the elbow) I still have a little bump. It isnt painful at all but it feels like there is something under/ in my skin. When i pinch the skin, it is not loose like my other elbow.
What is this?
If it is uric acid crystals, how can i dissolve them?
What medication can i take to dissolve the crystals?
Length of time I can expect until the bump goes away?
Can i do exercises where the elbow joint is involved?
Use pain as my tolerance?
I have already altered my diet. I no longer eat meats or foods high in purines. I drink nearly two gallons of water a day and I am still exercising.
Any advice is greatly appreciated. Thanks ahead of time.
July 8, 2017 at 11:51 am #4586
I can’t tell what caused this bump.
But I can tell you that having 11.6 mg/dl uric acid is a serious problem and that you ought to see a doctor about that. Excessive uric acid is the main cause of gout, not what you just ate. It would be helpful if you had older test results. If that is your first uric acid blood test, you would ideally do a second blood test and see a rheumatologist afterwards. You’d be able to show your bump to that specialist who may be able to make an educated guess as to what it is or suggest a technologically-assisted examination of the elbow and/or bump.
But if seeing a specialist quickly would not be possible in your situation, you should at least see a general doctor, show them this bump and ask firmly that they do something about your uric acid without delay (assuming the second test doesn’t come back much lower).
You’ll likely end up taking a drug called allopurinol because there’s little hope of addressing such a dangerous level of uric acid without strong medication. But it may be worth doing some tests to try to determine what causes this excess of uric acid in the bloodstream because you might possibly benefit from more sophisticated treatment than simply taking allopurinol.
In the meantime, it’s good that you’re drinking a lot water (but don’t overdo it!). You should ideally also avoid alcohol and make sure you eat lots of vegetables. This won’t be sufficient to solve your uric acid problem but it may help prevent kidney problems.
Not eating food very high in purines is also prudent but if you’re not used to a vegeatarian diet, take care to avoid nutritional deficiencies (if your body can handle lots of dairy, that’s the easiest way to be safe).
And as long as you don’t know why exercising your elbow is painful, I think it would be prudent to refrain from doing anything that hurts a lot.
July 10, 2017 at 7:46 pm #4591morgano70 herbsParticipant
I have had a gout flare or two in my elbow. I take colchicine for 2 or 3 days. Avoid salted peanuts, corn chips. Just snack on low salt potato chips. Eat lots of vegetables and salads
July 11, 2017 at 2:22 pm #4597d qParticipant
I am no doctor so it always best you consult a specialist first but from my experience;
1. It is not gout until it is diagnosed as gout by a qualified rheumatologist. Even then a high uric acid reading is not a ‘confirmation’ it is an ‘indicator’. The only true way to confirm gout is by conducting Joint Fluid Aspiration from the effected joint and checking to see if monosodium urate crystals exist under polarised light or finding a tophus. However; that said, treatment can begin in general to lower uric acid levels in your case as they are very high and that in itself is not healthy for you.
2. IF they are uric acid crystals then one third of your problem is solved. Diet alone probably wont help in dissolving crystals in your case but it can certainly help in reducing the overall dose of allopurinol (or similar) you may need.
3. Allopurinol, Febuxostat. Other medicines also exist which work in different ways.
4. Healthy Diet. The list is exhaustive but increasing intake of vegetables, low fat dairy, cherries and many other foods and techniques. Refer to this as a starting point: http://www.goutpal.com/gout-diet/
5. How long is a piece of string? This depends on your body and what medications (if any) you decide to take.
6. Exercise is generally advised. It is imperative to get your doctors advice on how much (or if any) is right first.
7. I’m not too sure I understand this question, but you will likely feel pain before you feel the gain.
Two gallons of water a day? That is over 7 litres and even more if you are measuring in Imperial Gallons + your usual food intake. I am no doctor but that definitely seems too much. You should really check your blood sodium levels with your doctor before continuing down that path.
December 4, 2017 at 8:50 am #6083Brenda PlumptonGuest
I am a 71-year-old female who was diagnosed with gout 3 years ago after starting on diuretics, beta blockers, and ace inhibitors – I had an ICD fitted because of heart arrhythmia.
My blood uric acid level was 705 at its highest. I was intolerant of Febuxostat and struggled with Allopurinol – I am now seeing a Rheumatologist and receiving treatment for tophaceous gout.
There is a tophus on my left foot which “popped” through pressure from the adjoining toes about 2 months ago. This has now popped again during a gout flare up and my toe is very inflamed but less painful after the white exude came out. Is this normal?
I take Colchicine when I have a flare up and have managed to take 200 mg Allopurinol for the past four months during which time my blood uric acid level has dropped to 447.
I also have osteoarthritis in my knees and was told I had polymyalgia rheumatic for which I am taking 5 mg Prednisolone daily (30 mg on diagnosis decreasing to 5mg over the past 4 months). I had never taken any drugs before the ICD implant (apart from Paracetamol when I had a cold or headache) and am having to adjust to quite a rigorous drug intake.
Is there anything else I can do?
December 6, 2017 at 7:05 pm #6103
I don’t feel knowledgable enough to give you advice considering all the health issues your are dealing with. I’ve never had white exude coming out for instance.
It’s good you are seeing a rheumatologist. If you can’t get in touch with them to ask if what’s happening to your toe is normal, perhaps your GP could take a look at your toe and contact your rheumatologist on your behalf if they think there is any cause for concern?
If you are experiencing much pain, redness or swelling you shouldn’t be shy in complaining to your doctors about this because there are other things they might be able to do to help. I don’t know what would be safe in your situation so I can’t recommend anything.
There’s general information about gout and uric acid you may be missing. Have you read the recommendations for patients issued by your local arthritis/rheumatism-focused organizations or your government?
It’s encouraging that your uric acid dropped so much with 200mg allopurinol but it’s still too high. If it would not be safe for you to take a bit more allopurinol, perhaps you could try to tweak your diet and drinking habits in order drive your uric acid a little bit lower? Let us know if you want more information about that.
There are also drugs or less powerful remedies you could possibly take alongside allopurinol but that would probably be more risky in terms of side effects, drug interactions and so forth than simply tweaking your diet. Even with foods and drinks though, I would recommend you check with your doctors before doing anything drastic.
July 5, 2018 at 1:09 am #7350Bruce MunsonParticipant
To cut or not to cut?
Any suggestions or feedback on surgically removing tophi from fingers and thumbs, versus letting allopurinol work its magic?
WE NEED D.E.c.T.
July 5, 2018 at 7:33 am #7366
Assuming you tolerate allo (or some other ULT therapy) well and the tophi don’t need to go right now for some reason, ULT definitely seems to be the safest option. Also, ULT would be necessary anyway as uric acid gets into places even less amenable to surgery than fingers.
July 6, 2018 at 9:07 pm #7372Bruce MunsonParticipant
July 12, 2018 at 11:11 am #7388Jesse FitzpatrickParticipant
I am 39 years old and was diagnosed at age 23. I took 600mg of alopurinal daily for almost 10 years and colchacine during flare ups always. Both for nothing as my Uric Acid levels have never gone under 12 and most of the time is up at 14. I have had both elbows swell to the point of bursting. I have tried diet, no alcohol, holistic, cherry juice, blah blah blah. I live in incredibly debilitating pain daily even with no flair up due to permanent joint damage in almost every joint. Not sure how much longer I can deal with this….
July 12, 2018 at 3:29 pm #7389
I’m sorry to hear this.
Is there any reason you have not tried other drugs? 600mg allopurinol is obviously inadequate in your case. It looks like you might have a disorder which is making it difficult for your body to excrete uric acid. Some people take a drug to help with that in addition to allopurinol. You could also try febuxostat or simply a higher allopurinol dose but considering your SUA didn’t fall under 12 on 600mg allopurinol, a combination of drugs affecting different parts of the UA metabolism looks like your best option.
It might also be worth looking into pegloticase depending on where you live (or where you could move to receive treatment).
And as you probably know, there are also a bunch of drugs you didn’t mention which can be used in combination with colchicine to reduce swelling and pain.
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