Discouraged

[patrick]

I had my first diagnosed gout attack last year when I was 35. Over the course of a few months last year, I had maybe 5 flareups, each of which lasted 3-5 days even with use of colchicine and indomothecin (which I really hated).? My uric acid level was tested variously at 7, 8 and 10.? The GP I saw encouraged me to make lifestyle changes.? I never drank much (maybe 3 drinks a week), but I cut it all out. I also cut out meat.? Wasn't overweight so no need to do anything there.? These changes didn't work though.? I finally went on a “raw” vegetarian/vegan diet (nothing cooked), during which time I had no flareups. But I lacked the will and time to keep that program up for more than a month, after which I went back to a vegetarian diet.? Within a week I had another major flareup after eating a big plate of lentils.? At a loss, I went to see a rheumatologist.? She told me that she'd watched a lot of people drive themselves nuts with the “diet cure” and convinced me to go on Allopurinol.? I was hesitant to go on a drug for the rest of my life since there is clearly an unhappy relationship between allpurinol and the liver, but I didn't feel I had any choice.? I was basically crippled for 2 out of every 4 weeks during the period of flareups.?

The allopurinol worked great at first.? With 100 mg I was down to a uric acid level of 7.? I could tell that, at that level, I wasn't going to have any flareups.? The Doc told me that I needed to go to 200 mg anway to get myself to a uric acid level below 6, which is the magic level as everyone on this site knows.? That worked for the past ~6 months, where I've had a UA level < 6, but on my most recent visit to the Doc my liver test came back bad.? My AST enzymes are at 60, and ALT at 85. ?? I re-tested and the enzymes are still high.?

It looks like I'm going to have to go off of allopurinol, and the Doc has suddenly become less certain what I should do.?? I'm really afraid of going back to the way things were before, where I never know if a stressful day at work or a little bit of meat in a soup is going to cripple me for a few days.

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Any recommendations on what to do next??

[zip2play]

I recommend going to 300 mg. allopurionol to control your gout.

The increase in your liver enzymes are slight and inconsequential?actual liver damage shows numbers well into the hundreds. Probably the slight increase is transient and you will test normal upon retesting.

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Untreated gout will kill you early, an AST of 60 wiill not.

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From medicinenet.com:

Mild to moderate elevations of the liver enzymes are commonplace. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT levels in such cases are usually between twice the upper limits of normal and several hundred units/liter.

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If you are truly panicked (did I spell that right?)?about the liver numbers you COULD give $$$Uloric$$$ a try?or one of the uricosurics. I think allopurinol is the most innocuous choices but the others ARE available. You cannot go off allopurinol without using something else, and as you proved to yourself, that something else isn't fiddling with a ?diet. Don't treat gout as anything other than life threatening.

I've taken 300 or 400 mg. allopurinol/day for nearly 20 years and have never shown anything except perfectly in range liver numbers.

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Practical advice: Try 300 mg. allopurinol for 60 days and then retest your liver enzymes?make a decision THEN.

[patrick]

Thanks for your advice.? The various docs seem to think that the elevated liver enzymes might be the beginning of a sensitivity.? I had a little bit of skin rash on my hand, which I thought was ecsyma but they weren't sure.? I want to see a hepatologist to rule out cancer, etc.? Some form of liver disease could have been the cause of the elevated uric acid levels, I think, since the liver is the source of uric acid production.? I don't have a diet that creates high uric acid — no fructose, 90% vegetarian — so there is clearly something wrong with one of my organs.? Or else I did something very bad in a prior life ?? I wish to God Allopurinol had worked for me, but it looks like I will have to try the other options to see.? Problem is that docs say that first I need to get the liver enzymes under control. Their logic makes sense to me — liver trumps UA level.? Then I get to try a different drug, either Uloric or Probenecid.? So for the moment I'm back in the situation of not taking anything and worrying about every twitch and whether it might signal the return of a gout attack.

[zip2play]

It is YOUR body after all so you must choose.

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But I would not allow things like “might be the beginning of sensitivvity” and slight rash about which the “doctors are not sure” to carry an overreaching amount of diagnostic influence.

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What you KNOW is that you have gout…all else is conjecture.

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As to “there is something wrong with one of my organs” I think that the consensus of most researchers is that the KIDNEYS of gouties?seem not to excrete enough urate. I tend to agree to some extent.

As for “liver trumps gout”…no boubt. BUT that is not to say “suspected beginning of liver sensitivity” trumps gout…it likely doesn't.

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But, like I said, the choice is yours but do not be surprised if the choice is made by an attack so horrific you will entertain the possibility of a quick death as a reprieve. Gout hurts like nothing else. We gouties don't take meds for fun, we are DRIVEN to it.

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If you cannot take allopurinol you CANNOT, but don't toss it aside without being certain…the alternatives are few and one of them $$$$$$$$$.

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