September 2, 2017 at 9:01 pm #5587
I’ve been diagnosed with gout in my left foot, but after I got home from the dr, it (again) spread to my right toes and arch. This was about the fourth attack since the beginning of 2017.
I didn’t realize all this mess was gout. I thought I injured the left foot, then caused problems in the right because I was either hopping on the “good” foot or, after a few days, limping, and causing more weight and stress on the right foot. So in my mind, it was related.
I also blamed the right foot on a bunion and giant hammertoe. I’ve had the hammertoe for years, but it never hurt until gout moved in, and now it swells up double, plus turns purple and red. Looks like it was run over. The bunion, I just thought that because that’s where it hurt, got red, swelled, got hot and skin peeled like a sunburn. Apparently it’s not a bunion. LOL.
I went to my foot and ankle surgeon on this fourth attack, day four (because I could not walk until then). He pretty much knew the moment he saw it that it was gout. Sent me for blood tests (also blood counts and metabolic profile) to rule out infection and check uric acid.
I went back and wham! 9.4 on the uric acid.
“You have gout.”
Dang! I was so sure he was wrong, too. I thought it was a bad sprain.
He referred me back to my GP for drugs. He had already prescribed Indomethicin for pain, and then my GP has now added 100 mg to start of the allopurinol, and the colchicine to use in the beginning of the next attack. Oh, and foot guy offered me a cortisone shot, but I declined. Am afraid of those.
My GP said after the next blood test, he’ll probably up the allopurinol until we get the uric acid under 6. (The next blood test I had, after the attack was mostly over, was 7.9)
This all happened over the last month.
Now I’ve come to realize the gout is in multiple areas. Left foot: top and bottom towards the front, ball of the foot. Right foot: big toe, second toe (the hammertoe), ball of foot and arch.
It’s all the same kind of pain, plus red, hot and swelling. But the left foot seems to be worse and starts first. At least they don’t go full force at the same time!
The first or second attack caused an inability to walk. When the left foot finally started to calm, the right foot went nuts and I was like “You have GOT to be kidding me.”
Now all the gout stuff makes a lot of sense.
The good news, I guess: I don’t have to change my diet. I don’t eat any of that stuff, except spinach. I’m not vegan or anything, I just stopped liking meat except some chicken. I don’t drink, so I don’t have to give up beer or wine.
I naturally drink a lot of water, always have. The foot dr. thought it was mostly genetics in my case. (Grandfather had it, perhaps others…dunno) Also, I had been taking hydrochlorathiazide, my thyroid is out of whack (and being difficult to get under control), and I think my aversion to meat has caused me to be protein deficient.
I have so many questions, and I guess so much to learn. :::sigh:::
My main question to start: I’m trying to figure out WHEN to take these two drugs (the allopurinol and colchicine). I’m supposed to start the all. when my flareup is done. And do the col. when a new one begins.
However, I’m not sure the one that started a month ago is over. I keep getting mini attacks in both feet. They hurt like mad for 15-60 seconds, and then go away. Maybe a few hours later, another spot lights up. It’s goutish pain, and in the gouty areas of both feet. But is it considered actual gout?
Should I start the allopurinol now, or wait until this ALL stops? I’m afraid it won’t ever stop.
And then there’s the other med…I’m supposed to take that within 12 hours of a new attack. But this is all just blending together.
I don’t want to do the wrong thing and cause my feet to explode into millions of crystal daggers!
September 3, 2017 at 3:13 am #5588
Have you discussed alternatives to hydrochlorathiazide with your doctor? If not, I recommend doing so without delay as that drug is known to increase the amount of uric acid in people’s blood. There are gout-friendly alternatives.
If the amount of uric acid in your blood was ever tested before you started taking this drug, it would be helpful to know the results.
Now, as to your question about allopurinol and colchicine…
You shouldn’t wait very long before taking allopurinol. Yes, it would be best if you could start it when you are well but waiting for the ideal time to start is often counter-productive.
That said, I would recommend testing other unfamiliar drugs first (it’s not clear if you’ve already tried indomethacin) in order to get a feel for how they work and the side effects they cause. That’s not a reason to delay taking allopurinol for long however, only a few days to a week. Inasmuch as possible, I would recommend trying any unfamiliar drug without mixing it with other drugs. And since allopurinol will affect your system 24/7 once you start taking it, I would recommend trying that last.
Allopurinol should be taken every day.
Colchicine is most effective when it is taken every day to prevent attacks. So people often take it every day when starting allpurinol. It is less effective when taken after an attack has started but can also be used that way.
Indomethacin is sometimes taken every day to prevent attacks but is usually taken to stop swelling and pain after an attack has started.
If you plan to take a drug when an attack starts, don’t wait 12 hours. That’s way too long. Take a few pills with you when you’re away from home just in case.
It’s important to get frequent blood tests to monitor some of the side effects of these drugs. Once you get used to them and stop adjusting the doses, blood tests need not be so frequent.
Finally, diet: if you are indeed not getting enough protein, that would be a serious problem and could potentially contribute to your gout. Fortunately, it’s easy to get enough protein without eating any animal flesh.
If you can safely (I have no idea what’s going on with your thyroid for instance) drink lots of skimmed milk or eat lots of yoghurt made from skimmed milk, that would be ideal for gout and help remediate any protein deficiency.
Also be aware that consuming sugars contributes to gout. So I’m not recommending sweetened foods such as most flavored dairy products.
September 3, 2017 at 4:28 am #5589
Wow, thank you for such a thoughtful, detailed response!
I should have been more clear: I’ve been off the diuretic for about two months in favor of a small dose of Linisopril. My blood pressure was barely high, but I’ve gone along with it because my mother has vascular dementia, and she also had slightly high BP, but refused to take meds in favor of a quack who laid hands and tapped her head. (Not kidding, sadly)
I’m trying to be a little bit more compliant than she was, to head off vascular dementia.
I have taken the indomethacin, a couple of times. The foot guy gave me that. It made me feel horrible, but it did help with the swelling and pain. I had an upset stomach (severe nausea to the point of retching a few times) and the worst: it made me dizzy and loopy, the way opiates make me feel. Despite that, I thought I would give it another try and see if those side effects lessen, or at least I can learn to tolerate them. It really did help a lot.
But I’m afraid I couldn’t stand feeling like that every day. BTW, the foot dr didn’t believe I got so messed up from that drug, said it was just like taking a super aspirin. ::sigh:: He also said that being like a super aspirin (sorta, but not), aspirin causes uric acid (or keeps it from leaving, whatever), so it was okay to take on a limited basis. Therefore I am surprised to hear people take it daily! (Not doubting you, just surprised.)
I agree about trying one drug at a time. That’s been my policy for a long time, because some drugs I tolerate just fine, and others not so much.
What happened with my thyroid: I have Hashimotos (hypo) and have since I was in my 20s. Severe. My levels have stayed fairly consistent for three decades. Now and then, a little bump up or down, but nothing major. Back in Dec or January, my blood showed I was going hypERthyroid. My doctor bumped me down, and then every six weeks I go back, and my numbers are WORSE. He doesn’t understand it either, and just keeps lowering my dose. My hair has been falling out for about six weeks or so, and now it’s really thin. It’s been a really CRAPPY several months, and now I have gout. Sorry for the whine. It could be worse, knock on wood.
I plan to be very compliant on the Allopurinol, assuming I tolerate it well. (And most of what I’ve read seems to indicate it’s an old drug, effective and safe. So I’ve got a good feeling…) And if I don’t, then I’ll try the other meds. But I think Allopurinol will do the trick.
As for blood tests, LOL. Because of the thyroid (and they keep running various other tests to keep an eye on kidney, liver, etc. They are all fine.), I’m being tested every six weeks, and my GP said we’ll just add the uric acid to the list. HA.
I *can* drink milk, but I’d rather not. LOL. I love yogurt, but have been heartbroken to learn how much sugar is in ALL OF IT. And if it screams low fat, then figure they’ll add another handful of sugar.
I actually gave up all sugar several months ago. I was never much of a soda drinker, so that was easy. And I drink my coffee and tea unsweetened. But what I’ve learned is to read labels, and I’ve been horrified at the way they sneak sugar into everything. It’s an eye opener. But yogurt was the one that really hurt me. I like PLAIN non-Greek yogurt. It even has sugar in it!
I just checked my cartons, and plain old yogurt (not vanilla) has 16 grams sugar in ONE SERVING!
I was not aware that sugar contributes to gout. I guess that means I won’t plan a chocolate binge anytime soon.
What I LOVE: lentils, whole grains and beans. Yes I do. And those are chock full of proteins. I’ve been trying to eat more of those, try new recipes. But when I started reading the gout stuff, they kept saying legumes and beans, NO.
Then tonight I found someplace that said yes you can. LOL. It’s CRAZY. I thought I could try peanut butter, and then realized…legume.
It’s the same way with tomatoes: some say RUN AWAY, and others say no, they’re so good for you.
Are there any guidelines for how much protein a gouty person should eat?
You’re the welcome ambassador into Gout Land. I do appreciate the information, ideas and advice you’ve given me. Thank you.
September 3, 2017 at 12:02 pm #5592
Indomethacin is a dangerous drug which is know to affect some people’s stomach. That side effect causes many doctor and ER visits and can be deadly.
I don’t know if that’s the side effect you got but if so, there are drugs called PPIs you can take with indomethacin to keep that in check. Unfortunately, these drug have side effects too…
I would recommend discussing these side effects with your GP. As you noticed, the class of drug called NSAIDs which includes indomethacin helps a lot with gout symptoms. So even if you barely tolerate these drugs, it can be worth taking a pill or two during serious attacks. Maybe you could try another NSAID. Just be very careful not to damage your stomach and oesophagus.
I would never take indomethacin daily but some people do tolerate it, at least initially (the side effects can get worse over time).
6 weeks is a long time. I would recommend getting an extra blood test or two during your first months on allopurinol (and colchicine if you end up taking that regularly).
Most people tolerate these drugs well but some people do not. You might not notice immediately if your liver takes them badly but a blood test would show abnormal liver function values. Kidney function is also something which should be tested often when starting these drugs.
Thanks for the explanation but as you might have guessed, I don’t understand what’s going on with your thyroid. I don’t know what drug you take for that and how that might affect your gout or interact with gouty drugs or dietary changes.
There is store-brand plain yoghurt with no added sugar in every chain store here. It’s the big brands which tend add sugar into everything. So I would recommend you look around.
I don’t know what your serving size is but yoghurt can have 4-7% sugars when no sweetener is added. The naturally-occuring sugars in dairy are OK. So it’s fine if the dietary information shows a small value in the “sugars” category but you should avoid products which have “sugar” in the ingredient list (often times, you’ll find some maize product such as HFCS instead of “sugar” which is no better).
You could eat other dairy products but some studies suggest you’d do better picking products which contain little fat such as yoghurt made from skimmed milk as opposed to the the ones containing lots of fat such as cheese. Many dairy products are in between these two as far as fat content is concerned. See what’s available in your area.
If you have gout, you need the same amount of protein as someone who doesn’t have gout.
For what it’s worth, I disagree with Keith about protein from plants.
Still, “legumes and beans, NO” is way too strong. Likewise, “yes you can” is simplistic. Of course you can eat legumes and beans. Better eat that than meat. But they’re not necessarily harmless. There are differences between various legumes and larger differences between various plants. Then there is the matter of processed foods made from plants.
Since you mentionned spinach and chicken, I’ll use these as an illustration. Both foods are about as bad for gout if you’re using them as protein sources or energy sources. But of course most people would not use spinach that way because it would require eating very large amounts. Chicken is much more nutritous. If you were to put equal amounts of spinach and chicken on your plate, the chicken would be way worse (like 7 times, possibly more depending on how the spinach was cooked). So spinach is basically harmless the way most people eat it.
Bottom line: you can eat pretty much anything in small amounts and most plants in larger amounts. You should eat lots of vegetables but, ideally, you should get much of your protein from dairy. Grains and legumes are the next best thing. And if you don’t eat dairy, you need legumes to balance the protein mix of grain.
Yes, the above is simplistic (I would not recommend eating large amounts of broccoli for instance) but I dare say my kind of simplistic is better than telling people not to eat legumes or that plant protein is good for gout.
September 3, 2017 at 4:36 pm #5596
Lots of info…thanks!
I only take Synthroid (levothyroxine) for the thyroid. The amount was fine for many years (minor bumps up and down), and all of a sudden it was way too much. Somehow each titration down haven’t been enough, and it’s been an ongoing ordeal.
The thyroid hormone (levothyroxine) takes about six weeks to work through your system, so that’s why the blood tests every six weeks. However, I can call him and ask for more uric acid tests. All he can do is say no. He had said that typically, the ua test is five weeks, but we’d just do it at six because I was already doing the thyroid tests.
Per your comment, I checked my yogurt carton again, and you’re right…there’s no ADDED sugar, just natural sugar from the dairy.
I just googled purine in chicken, because I thought chicken was okay. I came across this very interesting list:
Check out spinach. It’s low, IMO. The FOOT doctor was the one who told me spinach was on the list. Although when we went through my general diet and water intake (and that I don’t drink), he moved on to the diuretic, and oops, was on that for a long time. (Stopped two months ago, nothing to do with gout.) Then I casually mentioned my grandfather had it, and he seemed to place most of the blame on genetics.
This is mostly moot, because for now, I’m going to eat like I have been and try to up my protein with lentils, because I love them. 2-3 times a week. Also some chicken. My yogurt. And I’m going to look into the protein content of cashew or almond butters.
September 3, 2017 at 5:21 pm #5598
The main reasons for getting frequent blood tests early on are:
-the allopurinol starting dose is low so as to minimize the damage in case you don’t tolerate it well but in case your system does handle it well, you’ll want to increase that dose quicker than every 6 weeks in order to minimize the length and severity of the numerous gout attacks people often get after starting allopurinol
-if on the other hand it turns out you do not tolerate allopurinol well, you will want to try an alternative before the side effects turn your system into a mess
It often doesn’t take many weeks for clear clues to show in blood tests.
As to spinach in the purine list you found, it sounds about right. Spinach is only high in purines relative to the amount of protein and energy it contains.
Such lists shouldn’t be used a list of “good” or “bad” foods but as a guide to how much of any food you can eat before it might become a problem in terms of purines. And the amount of purine in the most nutritive foods shouldn’t be compared without adjustment to the amount in the least nutritive foods. Else there would be a way to make anything into a low-purine food: simply add water.
That said, there are issues with the purine list you linked to. There are several types of purines which have a different effect on the body. Most plants do not have the worst purine type. For instance your list might lead you to conclude that soy beans are slightly worse than chicken in terms of purines while they are actually much better.
Unfortunately, I don’t know any comprehensive list of foods which breaks down the purines by type.
September 3, 2017 at 9:55 am #5590
Keith TaylorKeymasterŦallars: Ŧ 1138.53Rank: Scholar
If I were you I would follow nobody’s advice and start allopurinol as soon as possible. As for diet be very careful what you read. Because protein from plants and low-fat dairy is good for gout. As you eat little meat I think you would be very happy with a Mediterranean diet. But don’t include processed foods with additives like sugar.
It’s not too complicated really. But confusing if you read rubbish from people who don’t understand gout. So if you want good opinions it’s better to tell us where you read rubbish about spinach and legumes. Because then I can explain why they are good for you and where the others got it wrong.
September 3, 2017 at 4:53 pm #5597
So if you want good opinions it’s better to tell us where you read rubbish about spinach and legumes. Because then I can explain why they are good for you and where the others got it wrong.
Haha. It was my FOOT doctor who told me spinach was on the forbidden list. (This was before he learned I don’t eat game meats or gross brain sandwiches, don’t drink, etc.) He’s a foot and ankle surgeon, and I think they mostly do repair work, fungal nails, ankle replacements, and so on. In fact, he said he would diagnose the gout and provide pain relief, which he did, but then would send me back to my GP for ongoing treatment because he didn’t do kidneys.
I’ve decided to start the allopurinol tomorrow. I want to first go to the store and load in supplies, particularly things I can eat without cooking. If I get an attack like the others, I won’t be able to walk, or stand at the stove.
That’s why I’m thinking nut butters to hold me over. They’re nutritious and easy to just eat out of the jar. Plus yogurt, maybe chicken lunchmeat.
Now that I know more about all of this, instead of it catching me off guard and unprepared, I can plan ahead. Kind of like disaster planning, except the disaster is gout. (I live in tornado alley.)
September 3, 2017 at 12:56 pm #5594
d qParticipantŦallars: Ŧ 340.34Rank: Scholar
In addition to nobodys posts I’d just like to point out a few things.
You need to look at the macro side of this and not just the micro side. People become obsessed with food and their intake of it. It all becomes about purines, sugars, salts, etc. Whilst minimising most of these ingredients will help with reducing uric acid levels you need to also look at the bigger picture which is they will not solve your Uric Acid Arthritis (gout) issue.
Allopurinol, Febuxostat and a few drugs are there for this very reason. What many people overlook when starting these medications is that they are not just there to ‘reduce uric acid’ they are also there to ‘psychologically hold your hand’ whilst you get on with life which means going on holiday, eating what you like, doing the job you like, doing the sports you like, etc.
Now that doesn’t mean you have to take these drugs for the rest of your life as there are medication breaks, take a read of this.
When choosing food, keep a logical approach but also keep an open mind to life.
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