The return of Gout!

This topic contains 9 replies, has 4 voices, and was last updated by  nobody 1 year, 9 months ago.

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  • #2382

    GoutPal Seeker
    Participant
    Ŧallars: Ŧ 1.71


    Many years ago, possibly 5, I was diagnosed with gout which was treated with 300mgs allopurinol. With the GP’s support, I eventually reduced the dose to 100mgs and was sufficiently confident with my lifestyle changes,(i retired, so no more night shifts,) a major contributory factor, I ceased taking medication altogether. 6 months later, I followed up with a GP appointment, my levels were checked and found to be in the normal range.

    Sadly, a mild attack a month ago, which I thought was a pulled muscle, two days ago, I was crippled by an attack in my ankle joint. A trip to the GP confirmed that I had been given the wrong information and that my levels had remained high and not normal so had been eating and drinking for well over two years, oblivious to my high uric acid level Additionally, my blood pressure was sky high. Interestingly, last week I drank beer on several occasions an had a large portion of lambs liver for the first time in many years!

    Other than seeking legal advice, I have found this website and am looking where to start. My GP prescribed Prednisolone which has taken away much of the pain already although the ankle joint is still badly swollen. I’m due a follow-up appointment next Monday and will have both my uric levels and blood pressure checked. I anticipate that both will be high so was looking for a diet that would treat both conditions as I believe that should be possible. I am struggling to find my way around the website which, whilst informative, has left me decidedly confused as it contradicts what a lot of other sites says. What I would like is an accurate and detailed list of foods as I need to lose weight, lower my blood pressure and my uric acid levels. I’m 61 years of age and fairly active.


    Gout in Ankle scan

  • #2383

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1170.05

    “I am struggling to find my way around the website which, whilst informative, has left me decidedly confused as it contradicts what a lot of other sites says.”

    I started GoutPal as a personal project to understand my own gout. I encountered a lot of lies, half-truths, and ignorance. So, I used GoutPal to record my research. Thus, I learned the truth about gout management:
    1. You can only control gout through making uric acid safe. Medical science gives pointers to safe levels. But, ultimately, each gout sufferer must have their own personal target.

    2. Gout pain starts years after uric acid began to form crystals. It takes many months to reverse the buildup of uric acid crystals. (There are rare exceptions where that period can be reduced to as little as 6 weeks, but I shall ignore that as it does not seem to apply to Malcolm). I usually refer to that time as the debulking period, or reducing the uric acid burden. During the debulking period, gout sufferers need effective personal gout pain control.

    Most websites ignore those basic gout management facts. Also, many doctors stay with out-dated custom and practice. From that mess, we read reams of misinformation about gout. People start to believe that gout is an eating disorder. They start to believe there is some type of “accurate and detailed list of foods as I need to loose weight, lower my blood pressure and my uric acid levels”.

    Life does not work that way.

    Diet can play a part in an individual’s gout treatment plan. For a small number of obese gout patients, it might be the only therapy necessary. But, for most gout sufferers, diet plays a supporting role.

    Malcolm, you’ve found GoutPal during a period of transition. I no longer need GoutPal as a personal project to understand my gout. I now understand gout better than most frontline doctors. So, my aim is to turn GoutPal into a resource for all gout sufferers. I estimate that will take me 5 years to complete. It’s up to you how you use my gout support services:

    A) Anonymous gout help. Read GoutPal facts, and discuss them with your doctor, or other health mentor. You’re one in a million that’s stepped beyond that, Malcolm. I’m extremely grateful that you’ve taken the next step.

    B) Casual gout help. Ask questions, or share experiences and opinions about your gout. That’s exactly what you have done here. For my part, so I can make advice as relevant as possible, I think about Gout Groups. The groups are just my way of providing a logical structure that leads to understanding, and resolving gout. I’ve found that this helps save time. For example, there is no point discussing allopurinol, if you have decided that herbal medicine is right for you. In your case, Malcolm, you might want to be a Gout Dieter. But that involves learning to eat healthily. And it needs you to understand that yesterday’s lambs liver has little to do with today’s gout. It has more to do with what you ate last year, and before.

    C) Structured gout help. Ultimately, every gout sufferer needs personal gout therapies. Therapies for uric acid control, and gout pain control, that reflect individual needs, and changing circumstances. So, the Gout Groups I mentioned are just a starting point to help you develop your own personal gout management plans. You can do that yourself, or with your doctor. Or, I can take the role of gout mentor. For me to do that, I have to learn about you, while you learn about your gout. It requires a lot of commitment on both our parts. (That’s time commitment, not money. I don’t charge, but you do have to commit to frequent posting).

    The best way to control gout, is one step at a time. It might seem tedious, when all you want is a quick fix. Certainly, I can give you my quick gout fix. I guarantee it will make 2018, and the rest of your life, gout-free. But, is it right for you, Malcolm?

    Anyway, I’m guessing you belong to the Gout Recce Group, for now. It’s up to you what you want to do next. Ask as many questions as you like. And, ask for clarification whenever my comments don’t make sense.

  • #2416

    Malcolm Williams
    Participant
    Ŧallars: Ŧ 0.24

    Many thanks for your detailed response. Sadly, although the prednisalone relieved the pain after only a few hours, the pain and swelling returned with a vengence and during the day I have been confined to a a lounge semi recliner chair with my leg elevated since. The pain is nigh on intolerable at times, particularly when I go to bed and have been self medicating my prednisalone with indometacin for the last three days. I take on board your comments re the cause being what I’ve consumed last year, not last week. Because I was wrongly informed by my surgery at the last test that my levels were normal, my diet has returned to ‘pre gout’ days over the last 18-24 months.

    I have a GP appointment tomorrow, uric levels and blood pressure, the latter being high enough for the GP to advise medication. I declined this on the grounds that it might have been high having just learned that the surgery had given me incorrect information and had, in effect, jeopardised my future health. Hopefully it will be more settled when taken tomorrow! Am I correct in thinking that I need to find my way onto the Gout Recce group or Gout Group. Sorry for being so vague, Id very much appreciate a mentor to nail my condition asap.

  • #2419

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1170.05


    Malcolm, I’m sorry that my information about gout groups is confusing. I will correct that, but it might take a couple of days. I should make it clear that groups are just my way of organizing gout sufferers. When I know which type of gout sufferer you are, I can make my responses more meaningful. I hope you can be patient. I’m on vacation at the moment (currently New Orleans), so my time is limited.

    On your blood pressure, I had a relevant experience. This might not apply to you. But, I have what is often called “White Coat Syndrome”. When someone measures my blood pressure, it rises. For me, this was proved with a 24-hour portable blood pressure testing unit. So, when I need a blood pressure test, I perform my own test on the equipment provided by my doctor.

    I’ll answer your other topic as soon as I can, Malcolm. But, you are already in the Gout Recce Group, if you are trying to decide between pharmaceutical, herbal, or dietary gout treatment. In practice, gout sufferers often choose a mix. If you already know which type you prefer, you ‘move’ to the appropriate group. Then, we can determine the best therapies for your gout pain, and for controlling your uric acid.

  • #2423

    Malcolm Williams
    Participant
    Ŧallars: Ŧ 0.24

    You hit the nail on the head Geoff. White Coat Syndrome in spades. Testing myself all week, it was settling nicely, (I have my own bpm), it went through the roof this morning whilst being tested in the surgery. They have suggested 24 hour monitoring but they cannot facilotate it before I go on a 2month vacation. I have been prescribed another 5 day course of prednisolone, (already taken 3 days at 30 mgs, 4 days at 40 mgs + indometacin 25 mgs x 2 prn at night.) already administered. Additionally prescribed paracetamol / codine pain killers to replace indometacin. My ankle is more badly swollen than since the attack started, but the pain has reduced significantly to the point that I can now weight bare if I’m careful.

    In terms of treatment, given that I’ve been symptom free for 2 years, I’d be looking at diet and herbal remedies in the first instance, but Allupurinol has worked in the past so that’s a possible last resort. My next worry is that the GP never gave any advice re tapering off the prednisalone, perhaps 12 days is a short enough treatment period to make tapering unnecessary? Nervously I ask, how do I move to the appropriate group? Again, thanks for your input, hope I haven’t disturbed too much of your vacation.

  • #2426

    Malcolm Williams
    Participant
    Ŧallars: Ŧ 0.24

    I have just received the results of my bloodtests. Liver and kidney function normal. Uric acid level 356. Two years ago, when I discontinued Allupurinol, my levels were recorded at 536 although I was informed they were normal at the time. Although much less pain, the ankle is still badly swollen. I will continue the medication as prescribed, but have further appointment to review next Monday. I am overweight so hope a gentle diet will brong the levels down further. GP prescribing colchasine in case of further flare up, but will also refer to rhuematology to rule out one sided arthritis if flare up doesnt subside.

  • #2431

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1170.05

    Sounds encouraging, Malcolm.

    On colchicine, it’s good to know how it works. Our immune system fights uric acid crystals. When overwhelmed, immune system cells send out signals for reinforcements. Essentially, white blood cells grow and divide, so our army is bigger. And, this is what produces painful inflammation. Colchicine slows the cell division process. But, it does nothing for existing inflammation.

    It’s best as a preventative. Or, at the first hint of a gout flare. It is useful after that, to slow spreading inflammation. But, once a gout attack has started, you should support colchicine with an NSAID. Ibuprofen and naproxen are the most common these days. But, your doctor or pharmacist can advise on different anti-inflammatories to suit your medical history. In extreme cases, you also need a painblocker such as paracetamol/acetaminophen. Again, medical professionals will advise on safe, compatible combinations.

  • #2466

    Malcolm Williams
    Participant
    Ŧallars: Ŧ 0.24

    I saw the GP today and had both bloods and blood pressure taken. Despite taking predisalone for 14 days, the flare up has not been tamed and is giving me considerable pain. I have been referred to a rheumatologist, and will commence the colchicine x2 daily. I have not been prescribed and anti inflammatory although I have both anti inflammatory and pain relief, but GP did not suggest I take either. I’m surprised at this because you seem to suggest that colchicine should be combined with an anti inflamatory plus pain relief, paracetamol, in severe cases.

  • #2474

    Keith Taylor
    Keymaster
    Ŧallars: Ŧ 1170.05

    Malcolm, the problem with GPs is, they dish out the pills, then send you on your way. The best people for pain control are hospital nurses. They don’t want to be disturbed all night by old men like me shrieking in agony, and sobbing in my pillow.

    A wise man of old used to describe how he trained his doctor to prescribe the right treatments. It sounds like we must do that for you.

    Colchicine is brilliant at stopping gout pain before it starts. But, for existing gout pain, it does nothing. Of course, our natural anti-inflammatories will deal with existing pain within a week. But, I believe anti-inflammatories should be used to give earlier relief. For relief within hours, anti-inflammatories can be supported with compatible pain blockers.

    I understand gout. I don’t understand doctors.

    Perhaps other gout sufferers can share their experiences of how they got effective pain control from a GP? ❓

  • #2487

    nobody
    Participant
    Ŧallars: Ŧ 502.41

    My GP has prescribed me analgesics (including stuff you can’t obtain legally without a prescription) even when I didn’t need them right away. All it’s ever required is being somewhat argumentative and in one instance some talk about getting the stuff from another doctor.

    I once let an attack develop before trying to stop it with colchicine alone. It’s very slow but it works. Of course I can’t prove that the attack wouldn’t have gone away on its own but then I can’t prove it was gout to being with. There are lots of things we can’t prove but I don’t know why colchicine wouldn’t work if you give it time. I agree NSAIDs seem to work much faster but what about people who don’t tolerate them?
    There is also the controversial matter of how much colchicine is effective and whether that amount is going to vary from patient to patient. As with other drugs, GPs may not be confident prescribing a large enough dose.

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