Forum Replies Created
-
Posts
-
Allopurinol is the cheapest, most effective medication for lowering uric acid.
Medical alternatives are much more expensive.
Non-medical alternatives are not only more expensive, but much less effective.
I know I bang on a lot about the importance of uric acid testing, but if it is a deal breaker, then I would compromise and reduce the frequency.
Try 100mg to check for serious reaction. After 1 week of no serious reaction, increase the dose to 300mg.
Finding the right dose is hard without a uric acid test (any idea how much this costs wherever you live?). After 3 or 4 weeks, do everything you can to get one test. It is not the ideal way to go, but you could probably manage with one test per year. Surely this has got to be cheaper, and certainly much, much healthier than all the money on pain meds?
One exercise I would bring up for comment is rebounding. It is reported to greatly increase the circulation of the lymphatic fluids in the body. Read that there is more lymphatic fluid in the body than blood. Is there a lymphatic element to gout? I have a 34 year old, 550 lb friend with Lymphodema of the legs. When he rebounds he reports that he is up several times a night to pee, and that he can cut down on his water pills and his legs seem better. Made him a special rebounder like mine. I use a 2″ by 12″ plank(yellow pine) that is 12 ft long. Put blocks under at each end and jump in the middle. His is 10 ft long and I made frame for him to hold onto. Blocks are two 4 by 4's stacked and mounted on a 2 by 6. Board is secured to blocks with black truckers bungies.
Sodium Ascorbate is vitamin C with neutral PH. I would take to bowel tolerance then back off to maintenance dose. Should help with inflamation. Bowel tolerance may be 10 to 15 grams/day or higher. Good referrence is “Curing the Incurable-Vitamin C, Infectious diseases, and Toxins” by Thomas Levy,MD. I have friend with gout. She told me she drinks 6 sodas a day(wonder why she has gout). Studies show 2 or more sodas a day increase chances of gout by 85%( Google “gout soda”). Capacitin ointment is good for inflamation of arthiritis, maybe good for gout too?
GoutPal said:
Don't loose focus guys. Keeping uric acid below 6mg/dL is the goal. Ignore twinges until you have had 6 months below 6 with no gout attack.
Utubelite said: “I guess it is probably the natural recovery process. I told about it to my doctor in my visit to him last week and he basically told me to forget about these minor sensations as it is common recovery process.”
Absolutely.
Hi Dan,
You really, truly, absolutely, undoubtedly need to manage your uric acid levels.
It is the only way to stop the gout affecting an increasing number of joints in an increasingly painful manner.
roosterwes said:
I have plenty of 300 mg Ap from the first time I was too stupid to take it. I don't go to the rheumy until dec 10. I also don't know if my insurance will pay for labs again this soon. I am just wondering……….
What would be a good dosage to go with? 600? Would it it kill my liver?
Not saying I'd ever do that. But if I did.
i
You are in danger here of following the stupidity of whoever prescribed the allopurinol in the first place.
Allopurinol without before and after uric acid testing is stupid. It's beyond stupid, it is negligent.
Allopurinol should only be used to manage uric acid levels. It is part of a therapy that, whilst not over complicated, goes beyond merely popping pills.
If no provision was made for testing when the allopurinol prescription was drawn, get your lawyer to suggest that the doctor pays for the test.
By the way, 600 mg is within the maximum prescribed dose of 800, but I must stress that it is irrelevant without uric acid monitoring.
zip2play said:
I am going to make an iconoclastic pronouncement here: Do NOT ice a gouty joint. THat icing recommendation is a knee-jerk reaction from doctors who see all swelling as from a common cause…gout is different.
So just like one should never ice a severe case of frostbite, do NOT ice a gouty joint, it will only cause more crystallization. HEAT the joint and keep it nice and toasty warm.
Again, a brilliant observation. Sometimes I don't see the wood for the trees, and STILL repeat stuff that others have suggested.
To be honest, I have used an ice pack (OK bag of frozen peas) in the past when my ankle was at a stage where the alternative was a hacksaw. Some relief, but there is clearly a better way.
I'll review as much as I can and make sure my articles warn of the obvious dangers of ice.
Thank you once again.
P.S. to everyone looking at the microwave warmers. These are quite easy to make using rice, grains, even cherry pits and an odd sock or similar. Just search for make a microwave heat pack in the blue leapfish search box at the foot of the page.
Hi rhodri,
Your doctor is not alone in not having a clue about gout, so you must change him. Either change him by getting another, or change him by training him to give you what you need.
I have to assume that you have no other medical problems, so your gout is quite straightforward.
You simply need to up the allopurinol dosage and get uric acid below .35 mmol/L – better still, aim below .3
The different units are explained in the Reference – Uric Acid Levels at the top of each page here. It is a good idea to ensure that both you and your doctor understand the procedure for managing uric acid. The figures in brackets on that page need a decimal point in front of them to match the mmol scale that you use.
You do not need to restrict your diet, though you should eat a healthy balanced diet and avoid sharp weight changes up or down. Drink plenty of water, and if you are not getting enough fruit and veg to alkalize the urine, add lemon juice or bicarb of soda. Alkaline urine helps prevent kidney stones forming.
Avoid pointless expensive supplements.
The fever and pain are symptoms of a battle that is being waged by your immune system because your curent uric acid level is at a nasty point where crystals are constantly dissolving partially, then reforming. Do try to repeatedly stab your doctor if you get chance – the effects will be similar though perhaps slightly less painful. It will give him an indication of what his inadequate dosing is doing to you, and the publicity will help others.
The increased allopurinol dose will allow you do get rid of old uric acid crystals quicker, but you may still have some pain. Coclchicine is usually most effective, but NSAIDs like naproxen and ibuprofen are also useful. Some authorities suggest a lowish, preventative (prophylactic) dose at the same time as allopurinol. Others suggest keeping it on hand to take as needed. Personally, I'd go for the latter, then suggest you discuss it with your doctor. Maybe you'd prefer to discuss it here.
Good luck, and try to avoid any distractions from getting your uric acid number below .3 mmol/L
Excellent, Utubelite.
What a beacon for other gout patients who are starting, or considering, uric acid lowering therapy.
I believe the uric acid lowering phase needs to run for 6 months, below 6mg/dL, without a gout attack, before you can be satisfied that all uric acid crystals that can dissole will actually do so.
Though 6 months is a lot longer than your 5 weeks, it is very encouraging to see how quickly you are seeing benefits. I put this down to getting uric acid low enough to avoid problems with partially dissolved or reforming uric acid crystals.
When the big toe is down to “uneasiness” rather than screaming pain, life must be good indeed.
All excellent points from trev.
I would add some general points.
Most exercise is good, but be careful not to overstress, or traumatize, joints as the resulting swelling can act as a uric acid crystal trigger (but only if uric acid concentration is high enough, and temperature low enough – i.e. a contributory factor).
Prolonged exercise can cause dehydration, which in turn can raise uric acid concentration.
Exertion can raise uric acid levels, probably due to increased muscle tissue metabolism. This is a short term effect, and there is evidence to suggest that regular exertion lowers the threshold – i.e. the resting uric acid levels of those who exercise regularly gets lower.
If you've been on allopurinol for 12 days, you are 2 days away from your first uric acid level test. This will determine if 300mg is OK or if you need to increase it. You need to get down to at least 5, but I would suggest lower, say 3 to 4, to get rid of the tophi quicker. This is a better option than surgery, though if tophi are still causing serious discomfort by the time you see the rheumatologist, you can discuss surgery then.
What's that? You don't have a uric acid test scheduled for 2 days?
Get one.
Thank you SO very much for the reply. I just cannot believe my Uric acid was over 10 sometimes 12 since I was 18 and my Rhoumy. of over a dozen years NEVER said anything about kidneys, every. The guy is so likeable that I guess he gets away with it. I want to confront him but he'll talk his way out of it. He always worried about my UA number but only in a gout flare kind of way. If I would only have had more warning. And yes my GFR was normal 3 or 4 months ago. I feel I am sitting by and watching myself die.
Thanks again to everyone who took time on this wonderful forum to write me. I have more blood work and tests this month and we will see what the Doctors say.
No idea, but it is not relevant without the other part of the equation – uric acid concentration.
In practical terms, there is absolutely no way to measure all the variables that affect saturation point.
What we can do is avoid the cold.
Some excellent points here, and I'll try to avoid clouding the issue.
As zip2play says, you can only easily measure uric acid circulating in your blood stream. At this moment in time, you cannot easily measure, or even estimate the amount of uric acid that is crystallized in joint fluid and other tissues.
Fortunately, you do not need to.
You know from a series of tests that allopurinol is doing it's job. Your body cannot raise uric acid levels by producing more uric acid, so increases are either a bad reading, or old crystals melting.
It doen't really matter which for now, because the main thing is that you are in a good place.
As Tavery suggests, increased water will help flush the free uric acid, and medical authorities also recommend alkalizing the urine to prevent kidney stones.
On a slightly related note, I have just read about some uric acid researchers who found their urine samples had gone cloudy (you wouldn't believe the stuff I read sometimes). They ascertained that the cloudiness was uric acid crystals, and the sample temperature was, from memory, 24 degrees (centigrade). When heated up to body temperature, the crystals dissolved.
Northern hemisphere readers should remember to keep kidney/bladder area warm this winter, as well as the extremities.
No, the honor is mine.
I've never had a Sir here before, and whenever that title is applied to me, they always spell it c-u-r
Woof woof
At the risk of sounding flippant, there is no book that will lower uric acid – you need medication for that. Occasionally radical lifestyle changes can do it, though you won't get that from a book either.
Treatments for gout are unisex, but, just like purines, do not even begin to think about it until you know your uric acid levels. When you have uric acid test results, you will get far higher quality help here than you will get from a book. (Polite notice: please register and login when you do get your results so your message appears instantly rather than waiting for me).
Colchicine is Rx only. See your pharmacist about best non-prescription pain relief.
Just a final note on your symptoms. Gout pain is caused by the immune system reacting to uric acid crystals, in a similar way to a virus or other infection. This type of reaction is caused by many other diseases, which is why joint fluid analysis is so important. Your elbow sounds similar to mine when I have had a gout attack in it, but it could also be something entirely different.
I can understand both doctors point of view, but they really do need to get together and find an answer.
To me, uric acid below 6 is a must. It is extremely serious not to accept this, and the decision to allow it to go higher can only be justified by a clear higher risk of something even more dangerous.
It is understandable to stop Uloric if it seems to be causing a problem, but it should be replaced by something else.
Clearly no simple answers, but a very simple question for your doctors. What uric acid lowering treatment, or combination, will lower uric acid below 6mg/dL without unacceptable side-effects?
Apologies to David Bennet for not approving until now (hint: registering and logging in prevents delays)
To you, and others here, perhaps it is time to name and shame those practitioners who prescribe uric acid lowering treatments but do not back it up with uric acid checks.
Not only is under-dosed allopurinol pointless, it can put you through hell.
The only purpose of allopurinol is to get your uric acid level below 6mg/dL. Nothing else matters.
It is so simple, my 3-year old granddaughter could understand it. Why can't the supposedly qualified idiot whose earning thousands?
Any medical negligence lawyers listening?
Yes.
Another reason why people on insufficient allopurinol get into that terrible place where they are in almost constant pain due to crystals partially dissolving and reforming.
Nasty, sadistic thing, that allopurinol underdose.
In your case, the 3.5 to 4.5 gives you good margin. It might not stop the occasional soreness, but it will prevent the partial treatment hell.
I'm not so creative these days, Sebastians my last name, lol. I start my new job today as a practice manager for medical office so will be having uric acid levels checked as soon as my insurance starts on Monday (the 3 week mark), otherwise I was afraid of the pre-exist as mentioned. Is Colch. only by Rx? No, I have no other locations nor ever had that are doing this and no family history whatsoever. Things I left out…I am very fit, go to the gym routinely. This morning I still have fever in the joint and stiffness, but not the throbbing like last week, so it appears to be subsiding somewhat. During the height of all the fun, my joint appeared to be enlarged, red and the skin all around for 4-5 inches swollen and sore. I accidentally bumped my elbow on my Boxer's head this morning and it is still bringing tears to my eyes at even that tiny touch. Final question, I studied your food chart and the low purine diet is not one that comes intuitively to me, like a low fat or low carb would. Is there a good book in your opinion that I could invest in, if my uric acid levels are elevated? And is there a difference in the treatments preferred for women vs men due to hormones? And I love your site, it's slow but SO AM I!
Excellent points, Tavery. Too many people, most doctors included, are willing to sacrifice long-term control of a crippling disease for short term pain relief.
On a count of 3 – everybody shout
1.
2.
3.
Pain Management Is NOT Gout Management
Sorry for the delay in responding. As it says at the top of each forum page:
Registration is free, and it saves you time when posting, gets you quicker answers and gives you lots more benefits
Has your gout been confirmed by analysis of joint fluid? If not, what makes you think you have gout?
Sorry for the delay in responding. As it says at the top of each forum page:
Registration is free, and it saves you time when posting, gets you quicker answers and gives you lots more benefits
Has your gout been confirmed by analysis of joint fluid? If not, what makes you think you have gout?
If ice cream helps you concentrate on what really matters – your uric acid management plan – then eat it all day, every day.
Please note that this topic has moved to yogurt/ice cream with gout. Where you can continue to discuss ice cream and other aspects of dairy with gout. Also, remember to consult Gout Foods Table for Sweets (including Ice Cream).
JUNE said:
UA was 5.1 mg/dl.
Most likely, old uric acid crystals revealing themselves, aand nothing to do with food/drink
Well, I didn't want to jump to conclusions, but as it has happened many times before, I thought I'd ask.
And if our worst fears are confirmed, why be kind? I'd say criminal negligence rather than mistake in judgement.
