This topic contains 23 replies, has 8 voices, and was last updated by vigrom 1 month ago.
August 19, 2016 at 3:28 pm #1624
Painful feet and gout.
I’m not sure if I have gout but I know I cannot continue in pain any longer. I have painful feet – it feels like I’ve got broken glass inside my feet – its the tops of my feet and toes as well as my ankles that hurt when I walk or stand. My feet also hurt at night in bed if one foot is on top of the other. X-rays reveal arthritis and blood test shows slightly elevated Uric acid levels. GP says I should try to reduce foods with purines as he does not want to prescribe any Meds to reduce the Uric acid at this stage. He also told me to lose weight(I’m overweight). He has prescribed a natural product called Piascledine (soya and Avocado extract)for arthritis, which I have been taking for 5 weeks with no improvement. I take anti-inflammatories twice daily, but nothing seems to help. I discovered this site and thought that perhaps I have gout or gouty arthritis and was hoping that I could find a way to ease the constant pain. I would appreciate any input and advise.
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August 19, 2016 at 7:37 pm #1630
“slightly elevated Uric acid levels” doesn’t give me enough information to help. I need the exact number. I’ve heard doctors call 8mg/dL “slightly elevated”. It makes me mad. Anything above 7 is dangerous, and needs urgent treatment.
I hate the idea of withholding treatment because you’re overweight. That’s just nonsense. I’m still overweight. But I found it much harder to lose weight before I got my gout under control. Some doctors don’t understand.
I understand your situation completely. I can help you through this. But I need very specific information.
As well as your exact uric acid numbers, I need to know exactly what meds you are taking with their daily doses.
Help me to help you, Irma. Gimme the numbers! I’m a data geek ❗ 🙂
August 19, 2016 at 8:08 pm #1631
I just spotted you said “gout or gouty arthritis”, Irma.
They are the same thing. Gout is a form of arthritis. Gouty Arthritis is the long name for gout, often used by the medical profession.
August 21, 2016 at 1:53 pm #1661
I have been reading your advise and recommendations of finding a rheumatologist and am trying to find one in my area. I live in a small town in the Western Cape, South Africa and have managed to locate one in a larger town 110 kilometers away. So I intend to collect my X-rays and blood tests to show the rheumatologist once I can get to see him. Is there anything specific I should ask when I see him? I am quite excited as it may be an end to this constant pain in my feet and ankles. I have started at the gym – Stationary bike and weights 3x weekly.
I will give you the Uric acid numbers when I get the tests back.
I take the following supplements and medication:-
Premarin o.625mg (conjugated oestrogen) 1 X daily evenings
Coxflam 7.5mg (meloxicam) 2 X daily – morning and evening
Piascledin?? 1 tablet daily mornings (soya & avocado extract for relief of osteoarthritis)
Paracetamol 500 with codeine. 1 tablet nightly (sometimes another during the night if in pain.
Omega 3 – 500mg daily mornings
Turmeric Curcumin – 1000mg daily mornings
D3 – 400iu daily morning
Probiotic – 1 daily mornings
Vitamin C – 500mg daily mornings
Co-Enzyme Q10 – 50 mg 1 daily mornings
Supercal bone food – calcium/magnesium/zinc/manganese/boron/vit d3 1 daily evenings
Chelates Zinc – 22mg 1 daily evenings
I have on occasion used colchicine for a few days, which has helped when I’ve been really sore.
Thank you once again for your help. I am so grateful to have found your site. Keeping fingers crossed.
August 23, 2016 at 2:19 am #1689
And, thanks for reminding me that I used to wonder about the difference between gout and gouty arthritis. It prompted me to include an explanation in Gouty Arthritis Sufferer Or Not?
In fact, that could be written for you Irma, as it deals with the common situation of the uncertain gout sufferer. That article is the starting point in this situation. I’m wondering if I’ve included all the different types, though. As an uncertain gout sufferer, do you identify yourself as
one of the following three types:
1. You have a doctor’s diagnosis of gout, but you doubt it is true.
2. You think you have gout, but your doctor doesn’t agree.
3. You think you have gout, but you will not consult a doctor.
Is there a fourth type – “doctor not sure?”
As a starting point, I’m only interested in people identifying themselves as members of GoutPal’s Arthritis Sufferers Group. One of my important pieces of advice, depending on the answers to my 2 questions, is “consult a rheumatologist”.
I’m pleased to see you are doing that, Irma. Would you indulge me, and give me your opinions on my article?
August 23, 2016 at 12:21 pm #1704
Thank you so much for all you do for us. I have read your very informative article on ‘Gouty Arthritis Sufferer on Not’. I am in the second category ‘I Think I have gout but my doc does not agree’. I am encouraged by your article because even if it turns out that I do not have gout, there is still a whole lot of help there to manage pain.
I collected my blood tests results and am not too sure on how to read them. I have used your Uric acid calculator and I think my level is 6.5.
My serum analysis is as follows:- please will you help me to discipher the numbers.
S-urate 0.38 H 0.15-0.36mmol/L
I forgot to mention that I have Vogel Multiforce alkaline powder first thing every morning in an attempt to become less acidic as I thought it was acidity that was causing the pain and also have a teaspoon of ginger powder in hot water as my early morning drink. Ugh! I’ll try most things to try to alleviate or control my discomfort.
Re weights – I thought I would try out for Tokyo Olympics!…
August 23, 2016 at 9:02 pm #1705
uh oh! Big error! I tried to upload a copy of my blood tests in the wrong place. Sorry! I created a support ticket and have given you extra work. Silly me. My apologies
August 26, 2016 at 4:04 am #1711
Please don’t worry about the blood tests photo you sent. That’s exactly the right thing to do. It’s very useful to see the actual result. It means I can see exactly what you see.
You’re right about the numbers. You are just below 6.5 mg/dL. I’m guessing the H means High. This is significant. Many doctors will not treat below 7mg/dL (0.40 mmol/L). I find that very odd. The correct target for treatment in most patients is below 5mg/dL (below 0.30mmo/L).
Returning to your meds:
– Premarin (conjugated oestrogen) is associated with reduced uric acid in women.
– Coxflam/Mobic (meloxicam) is associated with slightly reduced uric acid in rats.
– Piascledine – no information relating to uric acid found.
– Paracetamol/acetaminophen – the jury is out! Unlikely to have any effect at normal dose.
– Omega 3 – new research suggests this is excellent for reducing frequency of gout attacks. I’m investigating further.
– Turmeric Curcumin – Again, I’m investigating some new research which adds more evidence to show how curcumin from turmeric helps reduce uric acid.
– Vitamin D – recent research suggests a genetic influence and a link that is “clinically very small”. To be honest, “Potential causal associations between vitamin D and uric acid: Bidirectional mediation analysis” is very difficult for me to understand. I don’t think it’s significant: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586492/
– Probiotic – too little evidence. 1 study shows insignificant increase in uric acid. Another shows insignificant decrease.
– Vitamin C – Vitamin C lowers uric acid. But note that other studies have failed to find significant benefits in gout patients.
– Co-Enzyme Q10 – little evidence. I only found one study, and that found no link between Co-Enzyme Q10 and uric acid.
Nothing on the other 2.
I’ll talk about meds in your new thread.
Supplements are a very personal topic. As far as uric acid is concerned, many effects depend on the individual. I think the best approach is to have a healthy diet, then use supplements for specific vitamins and minerals where necessary.
I’m particularly forthright on that topic when it comes to alkalizing. It goes against everything I believe healthy to take alkalizing supplements. pH balance should come from natural food and drink. But, that’s just my opinion of course! Alkaline diet is good for gout.
September 16, 2018 at 4:20 am #7743
First off, millions of thanks for your very helpful newsletter and for the tremendous effort you are putting into it!
Second, have you ever considered a connection between gout and vitamin D? If per chance not yet, this URL might be a good starting point (I am not affiliated with that website in whichever way) – [link to spurious site removed]
Thanks again and kind regards,
[Posted via replying to email update service. But note that you should not reply to email updates. Because there is no way to post these automatically to the forum. In this case, I could not work out what you were replying to. So I posted it to the only recent topic that mentions Vitamin D with respect to gout]
August 28, 2016 at 8:30 pm #1740
Wow Keith! You are so right – I should not be taking alkalising supplements, but I am feeling desperate as I am in pain and I thought that it might help. Your article on alkaline diet is really interesting. There is so much info that I am struggling to absorb it all and can’t remember what have just read, so I keep re-reading. Maybe some will stick! I am trying to plan a diet to help my gout and arthritis. I need to loose weight which I know will help, but at this stage all I’m trying to do is get my pain under control. I think that I normally have a healthy diet, although I do go off the rails now and again. I can’t get to see the rheumatologist for 3 weeks, which seems like such a long way off. Today was particularly bad, as I had a bad night and am very tearful and depressed. I am encouraged when I browse this site, because it gives me hope. Thank you again.
August 29, 2016 at 1:42 am #1741
Carolyn PoulterParticipantŦallars: Ŧ -6.17
Hi Irma, I have nothing factual to add to Keith’s advice, he has done the research and thanks to this site I have researched more and more and am beginning to find answers to my particular situation.
What Keith gives us is access to answers to our many questions and, perhaps most of all, the reassurance that we are all different when it comes to gout and how to overcome stereotypical thinking by our doctors.
Any old how, as they say on corny US sit-coms, I feel your pain. I know just how you feel at least for me, the pain over-rides all sensible or ludicrous thought. On a scale on 1 to 10 with 10 being childbirth – and in my day no epidurals unless you pre-booked them so for me it was ‘Like or lump it girl’. When I had my third son he was over 9 pounds I did grab hubby’s chest hairs through the gown and said ‘This is all your effing fault!’ and he did get a vasectomy a couple of weeks later but I am digressing, yet again – on that scale 1-10 I would say gout is a firm 11 or 12.
It is just horrible and until you have experienced it first hand, you just can’t understand how painful it is. Nor can you convey that to other people like doctors. If they’ve never had it, they will never understand.
Hang in there, keep asking questions and don’t take their (doctors) answer as gospel. Doctors, GP’s, are great, they work hard, but they are basically clearing houses. They identify and send you to a specialist, or they identify and say ‘it will go away’.
Please keep sharing your experiences. It might not match or ‘fix’ my problem but everything I learn about the condition helps and I fell more in control because of that. Hope I am making sense here. Just took my daily Allopurinol tablet and that always sends me a bit squiffy.
August 29, 2016 at 8:34 am #1742
Hey Carolyn. Thanks for that. Somehow it helps knowing someone understands. I love reading your posts – so amusing – makes me giggle. Pain is just normal today not like the past 3 days so it is manageable. I’m never sure whether to take the colchine (just in case) or just to stick to my regular anti inflammatories and painkillers and only take the colchicine when I’m going through the roof. Going to omit it and see how it goes.
I can’t wait to start on a programme to remove the Uric acid crystals, so waiting impatiently to see the rheumatologist and work with him. Have a great day.
September 1, 2016 at 2:51 pm #1762
Oh no! Pain back with a vengeance. Started taking the colchicine again yesterday 1 milligram daily, plus a new anti-inflammatory ‘Vimovo’ – ingredients 500mg naproxen 20mg esomeprazole, twice daily. Apparently this med has built in stomach protection. These were prescribed for my husband when he had a knee replacement and so I just had a repeat script filled for myself, after discussing this with the pharmacist. I had been taking an over-the-counter anti-inflammatory but it’s not strong enough. I know! I know! I shouldn’t do this but I’m not coping with the pain. I also take paracetamol with codeine as needed. I just can’t understand why the pain is so out of control as the moment. My feet have always been painful but now the pain on right foot, the top inside is unbearable. I’m going on holiday for 2 weeks and seeing rheumatologist when I get back. I can’t wait to start get a diagnosis and to start treatment to reduce the Uric acid.
September 2, 2016 at 2:15 pm #1768
Irma, your last response is very close to what I was about to suggest.
Gout pain lingers, for most people I encounter in this forum, for one simple reason. They don’t take pain meds at gout strength. OTC doses are fine for those days when the gout pain isn’t too bad. For a full blown attack, it has to be a medically prescribed gout strength dose.
The other thing is that a combination is almost always required.
Colchicine slows inflammation but does nothing for immediate pain. It should be taken daily as a preventative (usually at the start of uric acid treatment), or as required. If taken as required, you have to take it at the first sign of an attack.
Anti-inflammatories are good for reducing inflammation, and this reduces pain.
Paracetamol blocks any residual pain.
Always check with your doctor, or a pharmacist, that combinations are safe. They will also advise what is the safe maximum for bad gout days.
The only other thing is to keep mobile. When pain hits, you often want to curl up in bed. But, the pain goes quicker, in my experience, with gentle exercise. Therefore, once the meds have made pain bearable, go for a walk, or a swim. This is vital advice for holiday enjoyment. Once you take control of gout pain, the tears pass. Then, you can focus on controlling uric acid, and stay gout free forever.
September 3, 2016 at 4:51 am #1772
In a hurry, I said “The only other thing is to keep mobile.”
That’s not strictly true.
The 3-pronged attack on pain is vital: Block Inflammation (colchicine). Reduce Inflammation (Anti-Inflammatory). Block Pain (Paracetamol/Acetaminophen, etc, etc). And, it’s vital that the package is dosed to gout strength and safety checked by a qualified doctor or pharmacist.
If that is done right, mobility should not be an issue. You might have some residual stiffness for the first 20-50 yards. But, that should pass. If not, do not push too hard – residual pain after your 3-pronged combination is an indication the package isn’t right.
The most important “other thing” is personalization.
I do not know of alternatives to colchicine, so leave it out if you can’t tolerate it. Some people opt for a steroid shot instead of colchicine/anti-inflammatory combo. Not for me, but it’s your choice. There are hundreds of anti-inflammatories and pain blockers. If your current choice isn’t working for you, ask your doctor for something else.
September 2, 2016 at 3:37 pm #1769
Carolyn PoulterParticipantŦallars: Ŧ -6.17
Irma, I am so sorry to hear the pain is back.
I have been on Allapurinol now for about 6 weeks and once the huge flare up had finally started to wane I have been trying to cut back on the pain-killers. Paracetomol with Codeine is prescription only here and I didn’t bother to ask the doctor for that. He did give me seven days of an anti-inflammatory, no idea if it helped or not, the pain was so bad I would have been happy being hit over the head with a mallet and knocked out so I fully understand you being a bit naughty and taking your husband’s pills.
BUT this Tuesday I woke up and said to hubby ‘I can feel my feet and they don’t hurt!’ Then I got up to go to the loo and ouch ouch ouch ouch, but not as bad as before. Wednesday I finally got outside, albeit with a walking stick, sighed because of the drought my garden is toast and came back indoors. Yesterday I walked down to the mail box, 500 yard driveway and very steep and only twinged a bit. Today it seems even better, just the odd twinge in my feet and base of my thumbs. Slow release Ibuprofen keeps it to a dull burn.
I am going to ask the doctor to keep me on the Allopurinol, he might resist, but I am going to try to stand my ground. Here we have to pay the full price of drugs, it’s not like the UK prescription charge thing, but Alan’s insurance is covering 75% of it at the moment. I am not very good at standing up for myself with authority figures like doctors but I will try. You should see me going through customs, I always feel like my face looks guilty and I’m not!
I do hope you feel better soon. I have been looking into rapid weight loss/crash diets/anorexia and gout. I also had a dip back into anorexia way back in my late 20’s and had gall bladder problems. Gall bladder removed when I was 30. In a mental hospital which my husband just loves to tell people about – long story I won’t bore you with here, maybe on an off-topic discussion.
I am also trying to be more mobile as Keith advises. I am sure he is right though it is oh so tempting to just curl up and whimper. Ballet dancing is probably now in my past but then, even after 13 years of classes when I was in school I was always more of a Fantasia Hippo than Swan Lake. Instead I am planning on walking more and more each day. Alan is off work next week and I have booked a couple f nights away – hotel, swimming pool, hot tub, nice meals and not quite real champagne, and if the weather is good, a trip on the Thousand Island Cruise – which is basically us with a bunch of others on a boat, drinking wine while we look at very posh houses on private islands which I am sure the rich people hate as we float by waving at them! Heh.
Get well soon Irma!
September 12, 2016 at 6:58 pm #1941
Gout PatientParticipantŦallars: Ŧ 1.76
I’m also a SA member so feel free to pm me.
First of all switch docters – I’ve battled for 30 years with this deadful disease and the main cause was that docters think they are Gods gift to Mankind.
You can take 300mg Puricos twice per day combined with a 5mg Colchicine each time and 2 tablets Panamor Diclofinic to help break the pain initially
Ideally you must start with 100mg for week one, then 200mg for week two and three and then 300mg from week four.
This is necessary to get your body used to it. Believe me it is necessary.
I’ve been taking 600mg Puricos for going four months and it is only getting to work now.I’m also seeing some tofu shrinking for the first time ever.
You can also get a cortisone injection which will give immediate relief – but it is poison.
The Banting diet is excellent for losing weight – follow the Low carbs high fat on facebook. Personally I’ve lost 15 kg in 4 months with no effort.
And yes, it is advisable to gettting a bloodtest done on your kidneys and liverfunctions. It can always be used as the base case when evaluating results. Prolonged use of Diclofinic will lead to a loss of kidney function. 70% in my case! Don’t let this happen to you.
September 13, 2016 at 6:23 am #1944
It’s great to have another new member from South Africa. You’ve made some great points.
It’s fantastic that you’re seeing positive results with Puricos. Am I right in thinking that Puricos is 100% allopurinol? It’s good to see your gradual introduction: 100mg rising by 100mg increments. To make this a perfect introduction to allopurinol, dose should be guided by uric acid blood test results. The only reason for taking allopurinol is to get uric acid to your target uric acid level. That means you have to have a target that is safe, and suits your personal situation. It’s usually below 5mg/dL. But, every Gout Patient should have their own target. And, Target Uric Acid should be reviewed annually.
We don’t know anything about your uric acid levels Johan, so I can’t comment on whether 600mg is the right dose for you. If tophi are shrinking, it seems right without considering anything else. But, if the aim is tophi reduction, then I’d usually recommend maximum allopurinol for at least six months. Everyone is different.
Finally, on allopurinol dosing, it’s usually better to review and change dose every 2 weeks. That’s because it takes 2 weeks for allopurinol to stabilize. 1 week is probably OK if you have tophi. I say that because tophi sufferers should be aiming low as possible, so weekly blood tests are really a safety check rather than a dosing guide. That implies you are doing blood tests right, and getting liver and kidney function tests with your uric acid tests.
I agree with your recommendation against long term use of diclofenac, but that’s the first time I’ve seen a warning for kidney damage. I thought the biggest threat from long term NSAIDs was heart attacks. Anyway, it’s best to limit NSAID use for a few weeks while uric acid lowering does it’s job. I also agree that steroids are a very bad thing, but I respect other views if cortisone is a necessary last resort. My beef with steroid use is when they are used as a lazy first option before trying other effective remedies.
Finally, Johan, I’m intrigued by your Bantang diet. I’ve never heard of it before. Please would you be kind enough to start a new topic about Bantang diet and gout? I’d love to know what Bantang diet is, and how is it beneficial to gout sufferers?
September 13, 2016 at 1:43 pm #1970
Thanks for your input Johan and your clarification Keith. I’m on holiday in the Kruger Game Park at present with limited internet coverage so a quick reply. I’m just trying to get through the holiday and to cope with the pain so am living on paracetamol with codeine, colchine and NSAIDs for the next 10 days. Long stretches sitting in the car plus safaris vehicles over rough roads have taken their toll on my back and I can hardly put any weight on my right hip😢. It is really spoiling what should be a wonderful experience getting back to nature and seeing all the wild animals and birds. My appointment with the rheumalogist should hopefully provide some answers.
September 13, 2016 at 1:47 pm #1971
Oh by the way Keith. The Banting diet is similar to The Atkins Diet.
October 30, 2016 at 8:34 am #2206
Gout PatientParticipantŦallars: Ŧ 1.76
Original post by Johan
Midfoot Gout Problems
Had to visit a top foot specialist in South Africa this week.
Reason was the severe pain inside the top of my right midfoot.
Now, this has been ongoing for most of my adult life – am turning 62 soon.
Even this extremely experienced gentleman did not have an explanation of why the cartilage in this area has disappeared or why there are holes in my cartilage.
All I can say is that I had suffered from gout in this foot in all its forms for years.
Fourteen years ago(cannot believe it was that long) I was infected with an Aureus virus from a doctor’s injection for the start of a gout attack. Fortunately, I survived that incident. But it destroyed a lot of the tissue in the area and caused damage to the cartilages.
So now I am destined for foot surgery with a painful recovery period of at least 6 months. It is also a very expensive procedure. Don’t even mention the word uncomfortable. Just Google midfoot surgery on Youtube. You’ll probably faint.
The reason why I mention all of this is to warn you against the probable long-term consequences of gout attacks which our doctors conveniently forget to inform us off.
ANY infection of ANY sort between two joints must be considered the same as you would view a heart attack.
Please don’t play around with uric acid levels and such. Later in your life, you just might regret the decisions you made when you were young.
May 5, 2018 at 4:15 pm #6987
DaveParticipantŦallars: Ŧ 0.45
Ball of foot gout pain and swelling
Been controlling my gout daily with 300 mg allopurinol, cherry complex and uric acid support supplements along with major diet changes. I’ve been monitoring my UA weekly with a monitor for the past four months and I’m averaging 3.9 mg/dl.
All has been going well until a few days ago when the ball of my right foot has all the signs and symptoms of a acute gout attack. With my UA levels controlled and low, I’m thinking this may be the crystals breaking down from the metatarsal joints.
Right now I’m treating with prednisone to relieve the inflammation, OTC pain control and increasing my H2O intake.
This may be totally unrelated to UA and something along the lines of metatarsalsia which I’ll have to get a consult from a podiatrist.
My inquire is to see if anyone else has experienced this same condition and what if any the findings were. Additionally I’m wanting to reduce the dosage of the allopurinol and at some point not take it anymore. This begs the question: how does one know when this is?
May 5, 2018 at 4:47 pm #6988
nobodyParticipantŦallars: Ŧ 478.51
You should definitely not quit allopurinol while you are experiencing this type of symptom, unless you’ve been able to rule out gout as a cause. It often takes more than 4 months to get rid of crystals and you want to get rid of all your crystals before attempting to live without allo.
Since you test around 3.9 though, you could try to lower your dose a bit. Or you could stick to 300mg if you have no compelling reason to lower your dose as larger doses than necessary may help keep attacks short. I can’t guess what an appropriate dose would be based on the information above and my guesses wouldn’t be worth much anyway. You’ll just have to experiment!
Ultimately it is your symptoms which will tell you what dose is appropriate and whether you can go without allo. But it can take years for your body to give you definitve feedback. In the meantime you can use UA blood tests as a rough guide: while you are still experiencing gout-like symptoms, 5.0 or less is best whereas once have been free from gout for 6 months of more, as much as 6.0 might be fine.
May 8, 2018 at 11:14 am #6998
Steve BatesonParticipantŦallars: Ŧ 3.99
Ball of foot is certainly where it gets me the worst. Last spring it started as a lump on top of the foot and after some massage seemed to morph through and I had a large swelling underfoot for about three weeks. Can be either foot, often starts in one then travels to the other.
It was that that finally (after 9 years of random symptoms) got me a referral to a Rheumatologist who quickly determined gout was the cause.
Ultrasound showed Synovial thickening, MTP joint effusion and small erosion.
Its not confirmed, but I believe this has led to splaying of the gap between 2nd and 3rd toes that has been growing for some years.
At the moment I’m on 2oomg allopurinol daily (6 months now) and Colchicine as required. Also Vit C, H2o and cherry extract. Urate is coming down so hope to reduce the drugs in a bit.
Colchicine, Naproxen and co codamol are always close at hand.
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