July 12, 2017 at 1:24 pm #4599
Does anyone know if having bunions can either increase the risk of gout or make you have more gout attacks?
Also started Allopurinol in Feb this year and it has reduced my uric acid a lot. However have had 2 attacks since starting, one in May and one bow. I was told to expect this is that right? Also had conflicting advice from doctors, one told me if I get a gout attack I should stop taking Allopurinol until it subsides. But my family doctor with over 30 years experience said I should NOT stop taking it. What should I believe? Many thanks! Rebecca
July 12, 2017 at 2:06 pm #4600
A gout attack is no reason to stop taking allopurinol.
Possibly you are a special case (drug interactions?) but if someone advises you to stop taking allopurinol, they should explain their reasoning.
Having attacks for many months after you’ve started allopurinol is expected. How many months seems to depend in part on how long you’ve been having high uric acid or gout before starting the drug.
One thing you might want to check though: it’s important that your uric acid has been reduced sufficiently. Reducing it “a lot” might not be enough. There’s a handy colored chart on the rightmost column of this page you could use to interpret your test results.
As to bunions, I don’t know for a fact but I guess it would make sense if they caused you to have more gout attacks.
Do your bunions sometimes feel particularly cold to the touch after you’ve been outside in the winter for instance? That would cause uric acid to crystallize there. As you may be aware, such crystals are the cause of gout.
Some people bathe their feet in hot water to help the bloodflow.
July 12, 2017 at 4:14 pm #4601
Hello thank you for replying! My uric acid levels were just below the borferline so the doctor did say although it is better it still puts me in the danger zone. So what you say makes sense. She said it could take up to a year for them to stop.
My feet go really cold at night during winter almost icy. I have to avoid really hot baths as have noticed just after a hot bath or while in the hot sun my toes on both feet go very red and puff up. I am so cross as woke up today and the swelling had gone down so thought I was getting better. Had a stir fry at lunch with beansprouts and an hour after my foot is red and swollen again. Surely food cannot act that fast and I thought vegetable purines were different. I am vegan and do not drink alcohol its baffling why I get it. For information I believe my first attack 14 years ago was due to being on Atkins plan and drinking red wine.
July 12, 2017 at 5:35 pm #4602
I don’t know what your doctor means by “just below the borderline” exactly but it sounds like you might benefit from taking a little more allopurinol, if only temporarily.
Your doctor should have been monitoring how your body handles the drug (liver and kidney function especially) and so should know whether you can safely take a higher dose.
Some doctors are slow to tailor the dose to each individual and need their patients to demand it.
There’s no need to make foot baths very hot, just hot enough to get your feet a little reddish and a tiny bit puffy. I think that might be helpful if you tend to have cold feet.
If you also have stiffness or loss of joint mobility due to your bunions, that could also contribute to getting gout symptoms in the feet and you might possibly benefit from gentle exercise or physical therapy. I have for instance very gently used my hands or a towel to forcibly flex a joint a bit more than it would on its own power.
In my experience, arthritis can react quite quickly to one’s last meal. Only I don’t think that’s the purines at work. Food affects the body in many ways.
There is for instance a known link between digesting fat (or is that only some fats?) and the type of inflammation involved in gout. I get reactions from large amounts of egg fat for instance (I’m vegetarian, not vegan). But that’s not the only type of food that gets a reaction from my body. For instance I’ve noticed reactions to salt and some yeasts and/or fermentation products (not just alcohol).
I’m not convinced vegetable purines are all that different by the way. Vegetables simply tend to have much less purines and to boot they tend to pack nutrients that help the body get rid of uric acid. Vegans can have pretty high uric acid anyway, in part because dairy seems to be helpful in limiting uric acid and is generally recommended to people suffering from gout.
You might want to experiment with different types of beans and lentils, not combining them with oil or with eating smaller amounts in any single meal but I’m sorry to say that in my experience milk and yogurt are the safest protein source. Then again I’ve not experimented much with things like quinoa and amaranth so that could possibly be an option. Some vegetables like cauliflower and spinach pack a little useful protein as well.
Hopefully in a few months’ time you won’t get attacks any more and you’ll be able to forget about trigger foods.
Finally, this might seem obvious but I don’t know what drugs you’ve tried: some drugs which do not cure gout are nevertheless very useful to deal with gout symptoms, either to prevent attacks or to suppress them before they bloom. Some of us have taken quite the cocktail to deal with attacks.
July 12, 2017 at 8:54 pm #4605
Thank you again. With regards dairy I am vegan for ethical reasons so would not go back to dairy also I previously had estrogen postive breast cancer so avoid it due to its estrogenic properties. What actually is it in dairy that protects though? Are you talking about calcium? If so I do take multi-vits and also have non-dairy milk and yoghurt which has been fortified. Plus eat a lot of leafy green veg, tofu and other sources of calcium. I know all my levels are fine on that score as get my blood tests every 4-6 months. Luckily all is okay with my liver so doctor wants to keep me on the 100mg low dose that I am on just in the meantime.
July 12, 2017 at 10:10 pm #4607
There’s no need to go back to dairy in your situation if you don’t mind taking a little allopurinol.
I don’t know what’s good about dairy exactly. I suppose it’s a bunch of stuff, including calcium and the low purine content compared to alternative protein sources. I wouldn’t be surprised if the effect of dairy consumption on gut microbes was a big part of it.
I hope you won’t mind if I answer your other post here as well…
0.30 mmol/l is fine as maintenance target. It’s also low enough to cure gout. But there’s an argument that pushing uric acid a bit lower while you are still suffering from symptoms might cure you faster and in the meantime make attacks shorter or less severe. I think that makes sense and so I’ve pushed my uric acid a bit lower than 0.30.
If you didn’t have many blood tests while on allopurinol, there’s also the chance that the result you got was anomalously low. Your average value might conceivably be 0.34 (or 0.27 for that matter). From that perspective, it also makes sense to aim a bit lower in order to have a safety margin.
Then there is the issue of your feet often feeling cold to consider. If they are indeed colder than most people’s feet, that would warrant a slightly lower target.
Some people would advocate pushing your uric acid much lower (like 0.22 or even less) and that is in my opinion questionable outside of unusually severe cases.
But I think it would make sense for you to take 150mg instead of 100mg until you are confident your symptoms are gone (assuming of course that your doctor thinks you could tolerate the temporary dose increase). That would still be a very small dose compared to what most people take. Then you wouldn’t have to worry about the modest amount of purines in soy and such.
July 13, 2017 at 10:27 am #4609
Thanks I will mention that to my doctor then when I see her. Just out of interest what high doses are some people on? I have heard of people taking 800mg and just would love to know if it brings any side effects? Woke up today and although the joint is not that swollen/red/hot still feels uncomfortable.
This brings me to another question (I hope you don’t mind all these questions) how much do you stay off your feet during an attack? I know when I get the first stages of an attack, as in early hours of the morning, absolute agony, I can barely put my foot down on the floor when I get out of bed, so I tend to sit with my foot elevate for a good 24 hours until the pills start to kick in. But now that I am not in agony do you think its okay to do light housework, vacuuming, cooking etc..and even going to the shops, walking short distances? I find most of it depends on whether I can actually get footwear on, when its really bad I can’t even put my foot into a slipper. Luckily I have some brilliant velcro sandals that are ideal for gout.
July 14, 2017 at 11:20 am #4626
Firstly, I’m sorry I’m late to respond to you, but the depression hit me pretty hard recently and I (wrongly!) took to my bed. Anyway, my mate and I have come up with a plan to try and prevent recurrences. So, I hope to be more responsive to you in future.
I only mention that because exercise is important in both my diseases. But, it takes a while to sink into my addled brain. Because your description is exactly how I responded to gout, and it’s completely wrong.
As with allopurinol treatment for uric acid control, gout pain control has to be personal. But, it’s absolutely vital to maintain normal walking. Otherwise, you end up with posture problems. And that can lead to pains everywhere, but usually back, hips, knees, ankles, and feet.
As well as personal pain control, the biggest thing I learned was how you help your feet during a gout attack. Soft shoes and slippers seem the obvious choice. But, they give no support at all. What you need is strong shoes or boots, with layers of socks for added support.
I know it can be hard to accept this. I just summarized several years of my life experiments with gout in a few sentences. So, I have to leave now and focus on getting my new personal gout plan service fully operational. Because all your answers lie there.
July 13, 2017 at 11:54 am #4610
People’s doses are all over the place. 300mg is common but people also take 400mg or more. Keith (the site’s owner) advocates the maximum dose which would be 800mg or 900mg but I think that would be pointlessly risky in most cases. In most cases, no allopurinol dose will completely prevent symptoms during the first months.
Some people apparently get no obvious side effects even at the maximum dose. On the other hand those of us who do not take well to allopurinol can get side effects from very small amounts.
As to staying off one’s feet… well, that’s another way in which people are different. You’ve got to figure out what works and doesn’t work for you. It also depends on what drugs you take to suppress symptoms.
Personally, I try to avoid doing painful things for most of the day. I think it’s not controversial that you shouldn’t be completely immobile for long periods but during severe attacks I would lie down most of the day, use crutches, avoid regular shoes if putting them on is painful and so forth.
The main reasons I’m very careful is that I do not do well on many common drugs and that my attacks tend to come back shortly after fading away and I find rest makes that less likely. Others have no such concerns and find moderate weight-bearing exercise helps their feet go back to normal quicker.
July 14, 2017 at 11:03 am #4625
Keith (the site’s owner) advocates the maximum dose which would be 800mg or 900mg but I think that would be pointlessly risky in most cases.
I certainly advocate 900mg allopurinol per day (UK maximum) for me. But, I hope I have stressed that every gout patient must work with their doctor to maintain the correct dose for that person. Importantly, they must consider how to manage dose changes safely. So, the safe way to use allopurinol is:
1. Start with 100mg and assess effects on uric acid, kidney function, and liver function.
2. Increase allopurinol dose over a period of time to achieve target uric acid for debulking.
3. Monitor uric acid crystal debulking to assess when to move to the maintenance phase.
4. Decrease allopurinol dose over a period of time to maintain the agreed long-term safe uric acid levels.
5. Check annually and adjust dose as necessary.
I should emphasize that monitoring your blood with the 3 tests at step 1 is vital throughout. Also, you have to discuss any perceptions you have about side-effects with your doctor. Most importantly, the time periods, doses, and targets are different for every gout patient.
Prior to starting allopurinol, I spent lots of time researching risks. Then, I reached the personal conclusion that the risks of untreated gout compared to allopurinol are an ocean compared to a teaspoon.
The only downsides I found were situations where dinosaur doctors insisted on prescribing allopurinol negligently. The upsides indicated many positive advantages from long-term allopurinol use.
So, I really don’t understand “pointlessly risky in most cases”
To me, risks are only pointless when you take them without consideration. Therefore, taking ANY dose of allopurinol is a pointless risk without the detailed personal allopurinol treatment plan that I summarized in 5 core steps.
July 14, 2017 at 11:57 am #4627
You have recommended the maximum dose to others. For instance here to “most gout sufferers”: http://www.goutpal.com/gout-treatment/avoid-gout/allopurinol/allopurinol-dosing/
The reason I mentionned your opinion in this thread is that, while I disagree, I wanted Rebecca to be aware of your opinion. She might otherwise have assumed my opinion to be the opinion generally held here.
It is well known allopurinol has commonly occurring side effects, some of which are more dangerous than others. The generally-recommended precautions are unfortunately not sufficient in every case.
Obviously untreated gout is harmful as well but the choice isn’t between maximum dose allopurinol and no treatment but between various doses (or when someone has reacted poorly to allopurinol, between allopurinol and alternatives).
July 17, 2017 at 9:02 am #4638
Thanks for reporting that poor quality page. Now, I’ll work on improving it as soon as I can.
Please, can I ask, if you spot any more of my mistakes that you post links to those pages as well. Because that will allow me to fix them quicker.
Thanks again nobody.
July 17, 2017 at 10:14 am #4642
I wouldn’t know what to report because I’m not sure how that page disagrees with your current view.
For instance as recently as May of this year, you’ve advocated the maximum dose to someone who is more at risk of dangerous allopurinol side effects than the general population. I had previously tried to convince them not to increase their dose beyond the amount necessary to reach the recommended SUA level. Since then, they’ve stopped taking allopurinol alogether. See: http://goutpal.net/forums/topic/allopurinol-dose-change-pain-location-change/#post-3631
July 15, 2017 at 12:28 pm #4634
Thank you Keith Taylor sorry I didn’t see you had replied till now. I have requested a gout diwt plan but as you say I am focussing too much on food.
With the shoes/exercise thing. My last gout attack was 4 years ago during a really hot spell and I had been stupidly wearing fashion shoes with tight toe area. Since then in the last 4 years gout free I found the most comfortable orthapefic sandals with velcro fastenings round the toe (ideal with my bunions as can adjust them when my foot hurts. Plus brilliant trainers and slightly wider fitting boots all of which I have qalked in with no issues so would it not make sense to carry on wearing these? If in the past I have bought different shoes and have not got on with them i am unable to get refunds. I saw a physio and podiatrist and she said my footwear was perfect.
July 17, 2017 at 9:10 am #4639
“most comfortable orthopedic sandals with Velcro fastenings” sound good for gout. Especially the Velcro fastenings that I still insist on even with no gout pain. Because I got used to Velcro fastenings which helped me when I had painful feet. So, I still find them much more comfortable, and easier than laces.
Perhaps Rebecca, in your case, the orthopedic sandal is better than a stronger shoe or boot. In my case, I used to get quite a lot of ankle gout pain. So, a boot or stout shoe was best for me. But, your situation is different and you should listen to qualified physio or podiatrist. However, make sure that you mention that you need shoes to support gout-damaged feet as well as help with your bunions.
July 17, 2017 at 9:16 am #4641
Thank you Keith Taylor I will stick with what I wear then. The doctor has reassured me and I like to believe her that my gout will be under control and there will be a day hopefully soon when I am not obsessing over footwear and food! I long for the gout free days when I could slip on a cheap but sturdy pair of trainers, go for a long walk come home and eat a tub of hummus! Not worrying about footwear or chickpeas purine content!
July 13, 2017 at 1:39 pm #4611
Yes thats true. They say that gout does go away untreated eventually but I would rather speed the process up and get back to normal so a few days off my feet is a small sacrifice I guess. I think I am quite susceptible to side effects on pills, both Colchicine and Diclofenac affect my sleep. I find it really difficult to walk with crutches so when I do walk short distances I tend to walk on the side of my foot. Are you based in the UK by the way?
July 13, 2017 at 8:02 pm #4619
Sleep problems are far from the worst side effects you can get from diclofenac in particular. And would you sleep at all if you didn’t take it? Your attacks might be milder but during what I’d call a serious attack, I use a prescription-only painkiller in order to get a little sleep.
I’ve walked on the side of the foot during less serious attacks but you can trigger ankle problems that way.
And no, I don’t live in the UK.
July 14, 2017 at 12:18 pm #4628
Oh okay thank you just checking in case I use any unfamiliar terms on hete. Woke up in agony all swollen and red at joint. Saw my doctor she is putting me on 300mg. She says 100mg starting dose probably wasn’t high enough. I can use up my existing tablets. She said she was not worried about increasing my dose as my blood test results showed my liver and kidneys working brilliantly.
One thing did annoy me. She said I should stop taking Allopurinol during an attack but previous doctors said “no never stop it” she then looked it up on her computer and it said carry on taking it which I think annoyed her a bit! I will carry on the allopurinol but only at the 100mg til the attack subsides then start on 300mg does that sound ok?
I asked about seeing a rheumatologist and she said there would be no point. I am looking down the line at bunion surgety but she said it would be foolish to touch that area now as could make matters worse!
July 14, 2017 at 12:20 pm #4629
Also she said I should take Allopurinol at night but I have always taken it in the morning with breakfast with no issues. I askex my pharmacist and they said it does not matter when I take them! Wish doctors would stop confusing me
July 14, 2017 at 8:12 pm #4630
I agree with you that now is not the most prudent time to take more allopurinol than you ever did. I’d save that transition for when you’re feeling better.
But I agree with your doctor that now might not be the best time for surgery either.
I can’t replace your doctor obviously but for what it’s worth my opinion is that you shouldn’t take 300mg. Or rather: first you should increase your dose to no more than 200mg, wait a few weeks and get a blood test to see what the first dose increase did to you. In fact, you should arguably get a blood test not just after but also before changing your dose.
My assumption based on the data you shared here is that 300mg would be pointlessly risky in your case. Aside from the effects of the drug, having very low uric acid might also affect your metabolism. Certainly tripling your dose brutally would be pointlessly risky!
In my non-expert opinion, the dose increase most likely to help you avoid waking up in pain isn’t allopurinol but colchicine. But of course I have no crystal ball, everyone is different and so forth…
In my opinion, every patient with serious arthritis symptoms should see a rheumatologist. It may not be necessary but I’ve seen enough clueless non-specialists to have an inkling about the damage they can do.
But the situation in which I think a rheumatologist would be most useful is if you doubted you have gout or I you suspected you have another condition on top of gout.
You’ve been trying uric acid lowering therapy for long enough that I think it makes sense to wait a while longer to see if your symptoms finally go away before seeing a specialist.
July 15, 2017 at 12:21 pm #4633
Yes that is true about the rheunatologist its a lot of money. I have had xrays that just show deterioration around the joint perhaps due to the repeated attacks?
The doctor said the next dose up is 300mg what problems could it cause cos thats got me worried now? She seems to think it will not cause me any issues. How does low uric acid affect metabolism?
July 15, 2017 at 1:25 pm #4636
You apparently have one of these doctors who doesn’t like to think too hard about pharmaceuticals.
Allopurinol is in many countries sold in 100mg and 300mg pills because that allows the following simple combinations by manufacturing or stocking only two different pills:
-50mg is half a 100mg pill
-150mg is half a 300mg pill
-200mg is two 200 pills
-400mg is a 300mg pill and a 100mg pill
And so forth. You get the idea.
You can take whatever dose you like. But I would not recommend tripling your dose without intermediate steps!
There are a whole lot of side effects people have gotten from allopurinol, most of which you’ll thankfully never experience. Probably you’ll experience zero effects but for sure you’re never going to have to deal with most of them. So I don’t think there’s much point in researching horror stories.
Instead, I recommend you simply follow generally accepted guidelines such as:
-start low (which is what you’ve done so far) and increase the dose slowly and progressively (this is the part your doctor doesn’t care to bother with)
-take as much allopurinol as needed to reach the desired uric acid level and no more
If you increase your dose slowly, you should notice most side effects before they become a serious problem. Then you could go back to a lower dose or switch to a different drug. Unfortunately, some nasty side effects are hard to notice at first and sometimes there is no going back to a lower dose once you get other side effects. But my assumption is that in your situation the risk would be minimal if you increase your dose slowly.
And if you indeed got down to 0.30 mmol/l after only a few weeks on 100mg, I dare say you clearly have no use for a large dose anyway. But if I may keep harping on the same point: you should get at least one more blood test. Then settling on an appropriate dose would be less of a guessing game.
July 16, 2017 at 12:08 pm #4637
Thing is she is only goint to prescribe me 300mg and the tablets cant be broken in half I don’t think. It is a catch 22 situation if I go my own way and things go wrong as a doctor she will say I told you so. If I follow her instructions the onus is on her which I as a patient/a worrier do prefer as then if I get side effects she will have to put me back to 100mg
It is so hard!
July 17, 2017 at 9:14 am #4640
Rebecca, there’s a wide choice of pill-splitters from Amazon, eBay, and similar outlets. But, if it were me, I would just take a pill on alternate days to get a half dose.
I must point out that won’t work with most prescription drugs. But the way allopurinol works, it ought to be effective. Normally, I’d suggest confirming this with your doctor. Which won’t work for you, as your doctor has no clue. Maybe you can talk to the pharmacist who supplied your allopurinol?
July 17, 2017 at 12:27 pm #4643
When you say my doctor has no cluecwhat do you mean? She is not a very old doctor in her warly 40s but she does seem very clued up on gout. I feel really confused now. Why xan’t I just follow her instructions initially and take 300mg daily (as Keith you do not seem to regard higher doses of allopurinol a problem rather a benefit). I have excellent liver and kidney function surely if I did get side effects I could then suggest taking 300mg on alternate days? From what I have understood on here the 300mg will break up old uric acid crysrals and perhaps 100mg was too low a starting point. I presumed the highr dose, as she said herself, would be a good step in the direction of really attempting to knock this gout on the head and regain my lufe back. She is quite a forthright woman I don’t see the point in lowering the dose, going against what she has advised. Sorry if I come across whiny here but I was feeling generally positive about increasing to 300mg now it seems like its really controversial!
July 18, 2017 at 6:21 am #4656
I based my “no clue” opinion on recent posts to this convoluted thread, including responses to my view on allopurinol dosing at http://goutpal.net/forums/topic/question/#post-4625
I’m sorry if I’ve missed something, but I gained the impression that you were unhappy with your doctor randomly changing your dose from 100 to 300 without proper blood tests and a clear target.
Unfortunately, this is what happens in the casual gout help area compared with a structured help plan. Especially when we get at least 4 threads within a single topic (bunions, allopurinol dosing, gout footwear, and side effects). Because it is easy for me to miss salient points.
In any case, the only controversy for me is moving from 100mg to 300mg without professional scrutiny of blood test results for uric acid, kidney function, and liver function.
So, if you had that scrutiny, but I missed the point somewhere, I suggest you simply get on with the 300mg dose. But, if you have questions about that, then start new topic(s).
On the other hand, you might still be wary of moving to 300mg now. If so, please start a new topic on that subject.
Whichever is your best choice, please remember, there is never a “best way” to recover from gout. Only, the best way for you, or for any other individual gout patient. Which is why doctor’s struggle to deal with gout patient relationships. Because they never have enough time to discuss individual needs and preferences.
My struggle is slightly different. Because I need to learn about each GoutPal member’s unique history, aspirations, and current situation. Only when you teach me about those things can I give you the best personal help.
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