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First SUA Test Dr. Not Impressed What Next?

Stopping Gout Together Forums Help My Gout! The Gout Forum First SUA Test Dr. Not Impressed What Next?

This topic contains 16 replies, has 4 voices, and was last updated by  Keith Taylor 1 day, 22 hours ago.

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  • #7023

    chris mousel
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    For one year have been following a Diet of complete changes in eating habits. Started it due to 2 abnormal fasting blood sugars. I have a fairly weird set of medical issues and did not want to invite more trouble. The diet changes are as follows: No Sugar,No oil, No salt, No meat, No Fish, No Fowl, No Dairy. The staples of the diet are Beans and Greens, Fruit and Vegtables, Nuts and Seeds. Switch to Almond Milk, Herbs and Spices for flavor and only Whole Grains.
    Very early on about 4 months in I had my first night with the base of the big toe issue. Pain,swelling, red, warm the typical symptoms of a first gout flare. Lasted 3 days.Started reading and of course cut back on the amount of fat free refried beans I was using daily. Diet proceeded for another 3 months without incident. Number two flare was the same foot with 3 spots aggravated and a little more severe but again lasting 3 days.
    Two more episodes have occurred back to back within a week of each other the third attack involved both feet the three spots on the original foot and the great toe on the opposite side. This lasted about four days and was particularly nasty. The fourth episode one week later however returned with a vengeance with both ankles involved and both feet with the various locations red hot swollen this time lasting 14 days. I couldn’t walk. Please don’t laugh but I was riding my swivel office chair down a long hallway to get myself to the bathroom and back.It was that bad. Ask me how I managed? I have a chronic facial nerve pain condition that requires me to wear a 24/7 pain patch prescribed by my pain specialist. And have added pain medication when the pain patch is not enough. The pain meds were still not enough to take away the fury of the attack.
    I also do have a Kidney Specialist who I had mentioned this to who at the time said ” Don’t worry I can give you something”.
    I saw the Kidney man after this last episode and he had to order my first uric acid level and a 24 hour urine. My serum uric acid level was 6.2 and the 24 hour urine came back with a double the normal oxalate level and yes I have a history of kidney stones. So his main concern is me increasing fluids as I don’t drink enough. And following a low oxalate diet regime to decrease the oxalate level. The problem being everything I’m eating now with the diabetic reduction plan is loaded with oxalates. I will make adjustments to my eating to include non fat dairy back in my diet for the calcium intake to bind with the oxylate. And as nobody already mentioned to me dairy will help the gout issue.
    Here’s the question? With the diet changes I made could I be dissolving crystals I did not know I even had? My weight loss so far has been 66 lbs which I hope continues as I was a plump butterball. And if I increase my fluids that should help the dehydration which originally Kidney man thought might have triggered the gout issue to begin with.
    Do I just sit tight tweek my diet? Can I be dissolving crystals with a 6.2 uric acid level? I’m not crazy about taking any more medication with my kidney issues. It’s the main reason I didn’t take anti-inflamatories during the attacks.
    Any thoughts would be appreciated. Thank You.


    SUA = Serum Uric Acid = Uric Acid Blood Test

  • #7024

    nobody
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    Certainly you could be dissolving crystals at 6.2. It’s a higher value than recommended but that doesn’t mean dissolution won’t happen. It may not happen as rapidly, consistently and thoroughly as one would wish though.
    By “first SUA test”, do you mean you have no old SUA tests establishing that you SUA used to be high enough to cause crystals? Have the crystals been observed or are we just assuming you have crystals (and therefore that you used to have a higher SUA) based on your symptoms?
    Your symptoms are consistent with SUA lowering, I’ll give you that. As well as inadequate hydration, being overweight can contribute to having a high SUA.
    In any case you should get more SUA tests as the results can vary, especially in your situation.

    You should also make sure there is a good medical reason to avoid completely the drugs people would normally take in your situation as opposed to being very careful with them.
    This is something to bring up with your kidney man as there are many different drugs you could take, either to limit the inflammation (I’ve taken pain meds too but ideally you also want to target the inflammation directly) or to lower uric acid. Possibly there’s a UA-lowering drug which might actually help with your kidneys.

    Something else: “of course cut back on the amount of fat free refried beans I was using daily” is a bit of a red flag. Have you made sure your protein intake is adequate? I’m not talking about the gross amount of protein as you can easily get enough from grains but about individual proteins. In particular, in contrast to beans most grains and nuts do not contain much lysine.

  • #7026

    chris mousel
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    Hello nobody,
    Yes I have no other previous Serum Uric Acid Levels to judge against.
    This was my very first one. I had one previous clue when I tried BANZA Pasta. Two brothers who came up with Chick Pea to make pasta.That was about 2 years ago. I purchased a sample two boxes when they started marketing the product. I had what would be seen and described as a gout episode in my left foot big toe. I was shocked so I started my Internet search and found reference material that indicated chick peas could cause pseudo gout. I stopped the chick pea pasta and never entertained the thought of eating them or any food stuff comprised of them again.
    I had mentioned this to Kidney man also when I told him about my symptoms the first time I mentioned I thought I might have gout.That’s when he said if I had that issue he could give me something. I went to Kidney man initially because I had two episodes of elevated BUN and Creatinine. Happened about two years apart. The first time I was rushed to the hospital by a Rheumatologist who referred me to a Nephrologist. I was kept in 3 days then released because I was not in renal failure. The second time my internist said it needed watching and my urologist said no you need Kidney man and my pain specialist agreed. So I was originally referred to Kidney man for a totally different issue. He gave me a diagnosis of Chronic Renal Disease Stage 2. Took me off basic and said my numbers were off due to dehydration. So I’ve been fighting the lack of water for some time. I now during waking hours set my alarm every 4 hours to remind myself to stop and drink. I can drink I just don’t have a natural desire to drink much at all. So I’m working at it.
    My renal diagnosis is believed to be related to using Ibuprofen regularly monthly over a 10-12 year time frame. Again a weird off beat issue of menses called Endometriosis. Which again is another pain and inflammatory problem. Again I had not gone into depth about anti- inflamatories with Kidney man. But I most certainly could.
    So yes my Urologist who saw me through passing stones twice on my own and one requiring Lithotripsey
    ( shock wave ) procedure had never done Serum Uric Acid or 24 hour urine. The stones early on had been examined and found to be oxylate. I had not had any gout issues so no one was looking as I had not had the experience. That’s what prompted my question for my current situation.
    Purines and Uric Acid investigation is what led me to look for gout groups. I knew someone had to know more than I did. So I’m thinking I will ask my Internist to take over the gout investigation and ordering further Serum Uric Acid testing as she will be the person referring me to Rheumatology if necessary.
    Kidney man who by the way I like very much no disrespect intended is not affiliated with my group at Northwestern Medicine.
    My Urologist who I came to choose was someone the local hospital ER referred me to when I could not pass the last stone requiring intervention.My Urologist referred me to Kidney man and I selected him following Urologist advice.
    Kidney man and I at my last recent office visit discussed the symptoms I was having which prompted him order the Serum Uric Acid and 24 hour urine.The results only became available 2 days ago by phone when I was given recommendation of Increase fluids, start B6 daily and Low Oxalate diet. Unfortunately my terrific response to the eating changes I made over the last year contain many ” High Oxalate” foods.
    So I will be taking a suggestion from you and add back non-fat dairy. And I may incorporate some organic chicken for protein source. And I’m looking at protein powders now as to Oxalate content. Hemp powder I can’t pin down the Oxalate content yet? But my Peanut Butter powder I was so happy to find is an Oxalate no no.
    I’m just now trying to absorb the nutrition requirements and foods I can have to avoid purines and Oxalate. I just haven’t mastered it yet. I thank you for your wisdom and advice.
    Christine

  • #7027

    chris mousel
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    nobody

    Lasix self corrected to basic in dissertation above. Sorry C.

  • #7028

    nobody
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    The problem with not having older SUA results is that uric acid crystals can persist for years even with a SUA lower than yours, something which doctors are often unaware of. So they could very well assume you have no uric acid problem because no one thought of testing your SUA before you lost weight and started drinking more water.
    You’re not the only one in that situation and I wish SUA was included in routine tests. It’s not like it’s an expensive test.

    How long did you take Lasix? That’s known to cause uric acid problems.
    If you indeed have gout, that’s more likely to be the culprit than chickpeas. Certainly you can’t rule out gout based on a SUA test carried out after discontinuing such a drug. If you’re still seeing the doctor who put you on Lasix without testing your SUA afterwards, perhaps you could give them an earful.

    If you can find a UA drug that’s easy on your kidneys you could forget about purines which would make your diet easier. Chicken is meat and therefore contains problematic amounts of purines (better get your animal protein through dairy or eggs).
    Peanuts and hemp are no good to replace beans. The simplest things you could eat to replace beans are other legumes but is there a legume which isn’t problematic from the oxalate perspective? I don’t know but if you can’t find a safe legume, animal protein would do.

  • #7029

    chris mousel
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    I no longer have the Internist who had me use Lasix. I was on it a very minimal dose and not every day. I had. an incident of leg swelling that appeared after eating some kind of processed food out of the clear blue sky. I was overweight but I’ve always had long thin legs, so to watch them blow up twice there size filled with water was awful. It took several days to subside but I did not experience gout symptoms that I’m aware of unless it was during chick pea time?
    That particular Dr.is no longer my Dr., I was not happy when he balked at my seeing a Kidney man. He had ordered the labs that came back with elevated BUN and Creatinine. Felt he could watch it? I also found out from the nurse my blood sugar was elevated but he never told me about it. I called my pain specialist And told her I was now really afraid he might be missing something and asked her if she would run a baseline of labs just to be thourough. She agreed I followed with her in the office and she gave me a copy of my results and told me to take them right to his office which I did. The Internist looked at results as he was in the office and my story to him was a medication change with my pain Dr. Prompted her to run a baseline set of labs for her records. My pain Dr. did not trust him by then either. He asked if he could have a copy and of course I said yes.
    Later that day my pain Dr. Called and asked if he looked at the results and what did he say?
    I told her he didn’t say anything just looked and took a copy.
    My pain Dr. then told me I needed to see an Endocrinologist right away as something was wrong with my thyroid.
    I called the University hospital and got an appointment right away.After a Thyroid ultrasound and radionuclear testing and lab work I was found to have an Autoimmune condition of Graves Disease and 4 thyroid nodules two if which were cold nodules and required biopsy. Luckily that came back negative. So I promptly attached myself to the University Hospital System and have a Internist I’m happy with and pays attention when I tell her something. It’s quite a relief at this point. So I will take your advice and follow with the woman Internist I see now and have her journey down the gout education path
    With me. I did have the Serum Uric Acid done one week after the last attack of 14 days as I had read the test results could be lower during the active phase? Was one week wait time enough? And thanx for mentioning eggs I did not have them on my list!
    Thank You so much for your time. So well appreciated.
    Sincerely, Christine

  • #7030

    chris mousel
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    Excuse the mispells it’s the pain meds effect on my brain if I’m not concentrating enough.
    C.

  • #7031

    nobody
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    I know basically nothing about this but evidence has been found that Graves disease is associated with gout. The same goes for other thyroid issues apparently. You should bring that up whenever you get to see an arthritis specialist or a thyroid specialist.
    For all I know Graves might be associated with similar conditions like pseudogout so you shouldn’t jump to conclusions but between this, Lasix, obesity and not drinking enough water you seem to have been collecting health issues associated with gout.

    I don’t know if one week is enough time for SUA to settle. I’ve had a low result 10 days after the onset of an episode but here’s the thing: especially in your situation (that is, we have reason to suspect your SUA used to be higher), tests results can vary quite a bit anyway.
    So unless your doctors are able to find another explanation for your symptoms, I recommend getting your SUA tested several times. You want to know your average value as well as how stable the value is. Don’t rush it or get your blood tested all the time: just make sure your SUA is being tested whenever you have a blood test (I’m assuming you get pretty regular tests anyway between your kidneys, your thyroid and your blood sugar). It’s a cheap extra.

  • #7032

    chris mousel
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    Wow Had no idea! As I said all the weird stuff.Autoimmune problems!
    Even now 23 years after the fact the diagnosis of Endometriosis which I was seen and treated for and used Ibuprophen for is now listed as Autoimmune related. I have always run a super high ANA titre which has been run on me since my early 20’s. Maternal Aunt’s one died from Lupus and the oldest sister in the family had a combination of Autoimmune severe Autoimmune disease’s. Only my Mother the baby of the family was never diagnosed with Autoimmune issues. Unless Alzheimer’s turns out to be placed in that category one day.She had no other significant medical issues. I used to joke with my sister that one day I would discover why all those years ago my titre was so high…. I knew one day I would find out! That day started a year ago. And now with your info it just continues……
    I’m almost sitting here having a chuckle.
    Again, thanks so much for the input!
    Now I’ve had my laugh for the day.
    My best wishes to you!
    Christine

  • #7820

    chris mousel
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    Just had second SUA test. Sept.20 2018 asked my internist to include.
    This SUA is 6.8.
    The first one as above May 11 2018
    was. 6.2. I have had no gout flares since the major issues I referenced above so it’s been 4 months. I have added eggs, non-fat dairy ( skim milk and fat -free cheddar) to my diet. My weight has remained stable in the 4 months after my complete diet changes and the 66 lb. at. loss.
    Since I’ve had no further flares in the past four months I have had no symptoms to go and ask to have a needle biopsy at any sites of inflammation. So I have not made any progress to get a firm diagnosis in writing. My water intake is a chore. I once a month have eaten out which included a meat , poultry, or fish entree but consume non of it at home.
    Yes I’m still considered overweight by at least 35 lbs. which I will have to start increasing exercise to achieve the loss. Is exercise the only issue I should be addressing now? My SUA 2nd test is higher than the first- and since vegetable purines are not supposed to effect gout. What else am I missing?
    I can give up the one dinner a month animal protein.
    Any other thoughts on the diet front would be helpful.
    Or do I just wait for a flare but ask to be hooked up with Rheumatology in order to have a source for the biopsy?
    Any thoughts would be helpful.
    Thank you. C.

  • #7821

    nobody
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    The 6.8 test result does bring you closer to a gout diagnosis, especially considering you’ve taken steps to reduce your SUA through diet. A single result can be anomalous though so you’ll want a second test result around 7 to confirm that your SUA is problematic.
    There are random changes in test results but we have a tentative explanation for your 6.2 test result which was probably done too soon after your attack to provide more than a ballpark estimate.
    The good news is that 6.8 is quite mild. Keep this up and you’ll never see the worst of gout. It is too high though so treatment might be warranted if flares recur and depending on the result of further tests.

    If you managed to lose weight responsibly while remaining well hydrated 24/7, treatment might possibly become unecessary. Taking a pill would be easier than the following but I’m going to post it anyway in case you want to know…
    Moderate and regular exercise is recommended for gout patients as opposed to bouts of very taxing exercise. Don’t starve yourself while you’re expending energy and more importantly make sure to drink enough water to compensate for the water you’re losing when you exercise.
    Meat once a month won’t make a difference if you stick to reasonable portion sizes.
    I don’t see why vegetable purines wouldn’t affect gout. It’s just that it’s not worth the bother to look at them in most cases, considering what most people eat and drink. In your case though, it might be worth looking at depending on your vegetable intake. It’d simply be a matter of eating only small amounts of the problematic vegetables such as brocoli (most vegetables are fine). Other things such as weight loss are of course more important anyway so don’t obsess over purine lists.
    I don’t know what else you might be missing since you don’t say what else you’re watching about your diet but you seem to have the bases covered based on your first post (sugar is known to increase uric acid for instance). You aren’t drinking alcohol, right?
    Depending on your fruit intake, you might have to watch the amount of sugar you’re getting from these fruits by the way. There are a couple other things you didn’t mention: mushrooms and single-cell cultures such as yeast can be an issue (and many so-called meat substitutes are made out of that kind of thing).
    Also make sure to check any medications you might be taking for their effect on uric acid since you’ve had issues with that in the past.

  • #7824

    d q
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    I always thought purines from vegetables didn’t make ‘much’ of a difference with regards to UA levels when compared to the benefit gain. I have broccoli almost every other day! From what I’ve read that stuff does wonders for you!

    I was under the impression you’d have to be farming that stuff in your 4 acre backyard and eating kilos of it to make much of a difference to UA levels on an ongoing basis ..? 🙂

    In all honesty food will at best give you a 15% +- affect on UA levels (not including fizzy drinks, alcohol or cow spleen and lambs brains, etc. as that has a big impact). If your on the edge of control then sure you could go ahead and modify your diet but you need to balance that with commitment and maintenance. Can you commit? Or can you commit better to a very low dose of UA lowering medication more?

  • #7838

    nobody
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    Whether you’re honest or not and regardless of how long you’ve known something, it’s equally likely to be wrong. If on the other hand you’d taken the trouble to test your ideas against relevant data, you’d be less likely to be wrong.

  • #7839

    d q
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    I was wondering if you ever managed to do a blood test before a few pieces of broccoli and after a few pieces of broccoli to back that statement as I would really be intrigued to see your results. 🙂 It would be far and few before you find anyone that has a UA problem as a result of eating too much of a problematic vegetable.

    Exorbitant facts can sometimes cause paranoia which can lead to depression which is far more dangerous then just eating all vegetables in moderation.

    nobody, take my answer with a pinch of salt and relax ey 😉

  • #7841

    chris mousel
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    nobody……….

    Thank You for reply!
    At least I don’t feel like I’m nuts now!
    No alcohol…..No wine….No beer.
    I’m pretty boring in that regard, I’m
    on 24/7 pain patch though.
    Excercise daily must be on my plan so I have to set some goals. Water and I will need to become fast friends again. I did add ice tea and coffee with some sweet&low I know chemicals right? But I needed to switch something up. Admittedly fruit is my nemesis, sugar addiction doesn’t go away over night. But sweet&low may be the slippery slope.
    My next test will be March, 2 weeks before kidney man. I’ll check back with you then unless the dreaded flares rear their ugly heads!
    Again nobody, thank you for hanging in with me……..this place makes it easier to soften the struggle.
    Thank You Keith. C.

  • #7867

    Keith Taylor
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    Hi Christine and thank you for returning to update your story. I’d like to add a few words to the great advice from Nobody at https://goutpal.net/forums/topic/first-sua-test-dr-not-impressed-what-next/#post-7821 Especially with reference to your:

    Yes I’m still considered overweight by at least 35 lbs. which I will have to start increasing exercise to achieve the loss. Is exercise the only issue I should be addressing now? My SUA 2nd test is higher than the first- and since vegetable purines are not supposed to affect gout. What else am I missing?

    My theory is that losing that weight could be the single biggest effect on your uric acid levels. The bad news is – it’s a theory unsubstantiated by detailed analysis of your personal weight-urate profile. But the good news is, careful weight loss is likely to improve your general health and longevity. So even if uric acid meds become necessary, you’ve got nothing to lose.

    Coincidentally I spotted a news item about a UK campaign to try and improve general population health through better attitudes to diet. I’m still looking at the details, but a big part of it is based on The Big Fat Fix. At first glance, that seems to confirm everything I like about Mediterranean Diet. Because that considers the true meaning of diet which includes all aspects of lifestyle, not just food.

    A small example is your hydration situation. I know it takes many months to get into the habit of drinking sufficient water. So start today, but try to make it work twice for you. By which I mean, get that water from as far away as practically possible. And skip there and back. The skipping with a full glass of water presents a challenge. But maybe you can adapt that office chair to hold it as you skip??? 🙂

    My point is to think Mediterranean Style. By Western standards, traditional lifestyle was hard with no labor-saving devices and long days tending the crops. So exercise was unheard of because physical activity was part of everyday life.

    As for the food side, I highly recommend the Mediterranean Diet plans from Eat This Much. Because you seem to be following some of the eating principles with restricted (not zero) meat intake.

    Back in June, I started to plan a Foundation Gout Diet using their system. But family pressures meant I had no time to pursue it. Because my plan was to start a course to help gout sufferers establish their own calorie-controlled foundation diet. Then people can establish their Mediterranean-style eating habits Which are essentially gout-friendly. Later, we could tweak some food choices to make even more progress.

    Anyway, you can try this yourself with a free plan at Eat This Much. Also, if you use that link you get a free month if you sign up for a paid plan.

    I believe that you need to get the basics right first with gout diet. So that means establishing a foundation of healthy eating where food intake plus greater natural activity lets you maintain a healthy weight. For most overweight gout sufferers that should be enough. For others, it’s a case of choosing more gout-friendly foods, herbal, or pharmaceutical intervention.

    I hope that helps, Christine. And if you want to collaborate on a diet project, let me know. Because I need all the encouragement I can get! 🙂

    • #7868

      Keith Taylor
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      maybe you can adapt that office chair to hold it as you skip???

      But not like this 😀

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