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I guess we are all pretty skeptical, but until someone can explain all the mysteries of gout (e.g. why certain people get gout with uric acid at 7mg/dL, whilst others tolerate much higher levels without gout), then I say – if it works for you, then it works.
I’d love to see other people’s experiences of Garra Ruffa
Hello. I first posted on here some ten months ago after I had visited Malaysia and had had a rather interesting experience in a 'Fish Spa.' I have been a gout sufferer for some years and so extreme were the attacks, these resulted in me being left housebound on several occasions. In Malaysia I subjected myself to dipping my feet in a pool full of Garra Rufa fish for thirty minutes. The purpose of this is that the fish are supposed to remove toxins and dead skin from your feet by sucking on them leaving your feet in a pristine and smooth condition. I noticed that three of the larger fish refused to move from my left large toe whilst the smaller fish just moved around my feet nibbling randomly. Its now almost a year since I experienced this and I have still not had a solitary flare up. I have frequently drunk alcohol, not modified my diet and do not weigh less than I did last year. If there was some element of disbelief at my first post outlining my findidngs I understand completely but I do want to share this. Gout caused me a lot of anxiety and pain and if this helps anyone else I would love to hear from you. I know that the fish spas are becoming more common in the UK now and that they can be found in many major towns and states in the US. I genuinely believe that the fish that spent so much time devouring my left toe broke down the uric crystal in my joint through the strong sucking motion. I know the majority of you will think Im mad but of one person can become gout free after reading and trying this, well, my work here is done.
Forgot to mention in my previous post that my URIC acid was in the 8 to 10 range for more then 20 years.
Just had a meeting with my doc to talk about my progress with Uloric. My URIC acid was at 6! This was after approx 4 months of 80mg. I have tophus in various locations and a very large one on my knee is gone. My doctor is excited and so am I.
The most important thing is to check your uric acid levels. You can only manage gout by keeping uric acid levels down.
The reason for this, is that old crystals can cause gout flares when they dissolve. I have explained how allopurinol can cause this gout pain, but this is true for any form of uric acid lowering treatment – including diet.
Your doctor can check kidney function to see if this is an issue.
Dietary assessment is simply a question of analyzing the facts. How tall are you, how much do you weigh, and what is a typical day’s food and drink?
I do not usually bother closing topics, but as this has the perfect ending, it is now closed.
zip2play said:
But it's simple?take allopurinol and enjoy the booze.
Please see my summary of allopurinol and alcohol
The discussion is now at https://gout-pal.com/allopurinol-and-alcohol-debate/2011/08/
Wow – I can't thank all of you enough! I have, (just the first week into this as of tommorow0 but i have changed my eating habits. Atually, it's lunch now and I am eating tilapia with double helping of mixed veggies. I really appreciate the advice. I will pursue the meds ( Allopurinol)with the Dr. as well. I do not plan to live a life of “deprivation”. I will try to take all the good info on this site (and there is soo much!) and use it. I plan on “moderation and the “right mix” of foods. Yes, this first month, I have full plans to “lean heavily” to the “low acid” foods but then balance out slowly. I hope that is a sensible approach. What's funny is, I didn't drink alcohol for 17 years (just started 2 yrs ago (another story, another time) – and not excessively (ie- like the night before my first attack!) so, it's not a biggie for me to swing to “moderation awareness” at all times or just stop again. I am not happy about the gout but there are many worse things that can happen – with all the good info, I am confident things are manageable and that, if nothing else, it gives me a reason to be more careful (and healthful!) abourt what I put in my body. I will see the Dr in about 6 wks for a test and post updates.
goutorarthritis said:
I didn?t know what PRAL meant till Gary S mentioned it; did a short search and found this page: bitterpoison.com/archive/calculate-acid-alkaline-with-pral-formula/
Of course, there is an even better one at http://www.goutpal.com/potenti…..-load.html with a link to a full set of tables. 😉
Overall, I think you are on the right track, and now it is just a matter of hanging in there and let the allopurinol do it’s work. Good fluid intake is important, but you do not need to worry too much about it. Unless you have a very controlled work environment, 2 to 3 liters a day should not be a problem. Remember, this includes all soft drinks.
Fluid aside, your focus needs to be on uric acid level. Maintain it below 6mg/dL, and you are on the right track for fewer and less painful gout flares. Below 5mg/dL and you will get there faster.
Diet is something most of us can improve, but I always feel that you should consider this as a secondary goal for fear of overwhelming yourself and going off track on the uric acid level front.
I know most people will get away with a 300mg starting dose, but it certainly isn’t the best approach. Allopurinol dosing has been shown in a few studies to be spectacularly mismanaged, so it’s one of those issues that I tend to bang on about far too often.
I can understand doctors not prescribing allopurinol on the first attack, but I cannot forgive them for not starting a uric acid monitoring schedule. Any f-f-pharmacist can manage pain. Uric acid management needs a little more finesse and professionalism.
My first thought is “What is your uric acid level?”
Without this, and a month by month history, it is extremely difficult for you to know where you are heading and what you need to do.
Doctors will tend to say that, if this is your first attack, then with an alcohol ban and severe diet restrictions, you can manage your gout.
This is wrong – you can only manage gout by tracking your uric acid level. Without that, you are only managing pain, and you can be fairly certain that the gout will bite you again – harder, more often, and in more joints.
I do believe that it is possible for some gout sufferers to manage uric acid through diet and lifestyle changes. This starts with keeping a record of uric acid levels (at least once a month) and you need good discipline to maintain a very strict, probably vegetarian, diet until you maintain uric acid level below 6mg/dL for two consecutive months. After that first phase, you can introduce some “indulgences” slowly, but never allow uric acid to rise above 6.5mg/dL.
By way of a challenge, I’d like to say that few gout sufferers have the patience and willpower to get through the first phase of this. It is also largely irrelevant for gout sufferers whose gout is caused by heredity, environment, trauma, or other medical conditions. For those people we are lucky to have allopurinol and other uric acid lowering therapies.
Don’t believe everything you read.
There is absolutely no way that a foot massage can cause gout. It isn’t likely to do much good, but if he is not at the stage where the pain is too much to allow any contact, the increased blood flow might help a little.
You can read pages and pages of stuff about healthier lifestyle, but the most important issue is uric acid management.
If you can get this fixed over the next few months, with allopurinol or whatever his doctor advises to lower uric acid, then you can worry about diet and other stuff later.
He needs regular blood tests for uric acid and medication to get this down to below 6mg/dL. It is vital to do this now.
All your focus needs to be on getting uric acid down, and maybe encourage more water (or tea, coffee, milk, fruit juice etc). Allopurinol will do this, but changing the eating habits of a lifetime is likely to be a much slower process.
Worry about the diet later – you can get good advice hear – but your mission for today is to get that uric acid level permanently below 6mg/dL. Please don’t be distracted by anything else.
Nice to see you are making progress, Charles.
Unfortunately, as you had high uric acid and gout attacks for many years, it is going to take a few months for the uric acid crystals to dissolve. Until they do, you are going to suffer joint pain, but this should get less with each passing month.
It sounds to me that you are doing everything right. Please don’t give up yet.
The only practical advice that I can add to what you are already doing is to drink plenty of water – 2 to 3 liters per day, and you can include tea, coffee and other soft drinks as part of the total.
Here is my understanding of the action of alcohol on allopurinol.
Allopurinol works by inhibiting the enzyme zanthine oxidase (XO) which is responsible for uric acid production. It is only effective for about 2 hours, when it breaks down to produce oxipurinol. Oxipurinol also acts as an XO inhibitor, and hangs around much longer – giving you a couple of days uric acid reduction.
Do not rely on this couple of days – take your allopurinol every day to avoid risk.
Oxipurinol is excreted by the kidneys, but just like uric acid, a large percentage is reabsorbed from the kidneys to the bloodstream before it gets lost in urine.
Just like uric acid, the original excretion and subsequent re-absorption can be affected in different ways by different concentrations of other substances. This is a very complex process, and there is no way that I can describe it completely.
Alcohol can interfere with the re-absorption of oxipurinol, so the net effect is that it reduces the effectiveness.
I cannot find any relevant research to quantify the exact effect.
Let me state publicly, that I am completely willing to act as a guinea pig in any studies that measure the effect of alcohol on allopurinol (or any other aspect of gout). Just post your research info and joining instructions here 😉
I’m not sure where I have advised not to mix allopurinol and alcohol. If you can remember where you saw it, please let me know, as I should correct this.
Allopurinol should mean an end to alcohol restriction, but I believe it can reduce the effect. Therefore prolonged excessive drinking might lead to allopurinol not lowering uric acid enough, and becoming ineffective. I cannot imagine that this would be a problem with 4 units per day.
As ever, the important thing for gout is to get the uric acid below 6mg/dL. Dosage needs to be adjusted in the light of regular uric acid test results. That’s not to say that allopurinol should be used to prop-up an unhealthy lifestyle, as other health problems will soon become apparent.
One of the worst things you can do for gout is drastic lifestyle changes as these often have the effect of raising uric acid. Allopurinol will minimize these effects.
As far as reduced gout attacks are concerned, it’s anyone’s guess. So many things can cause a flare, that it is almost impossible to discern the exact culprit.
The only thing that truly matters is to keep uric acid below 6mg/dL. It does not guarantee complete freedom from gout attacks until all uric acid crystals have dissolved. It will however guarantee that you do not cause further joint damage, and it should allow you to eat, drink and exercise without too much concern.
trev said:
Post edited 1:55 pm ? July 21, 2009 by trev
Wrong post deleted
You just failed your forum moderator interview 🙂
Ah, lovely new gout forum people making some very interesting points. I particularly enjoyed the wisdom and insight of philr…
who said:
I was about to give up, and then I ran across gout pal. This is absolutely the best source of gout information I have found on the Internet.
The Goutpal/administrator drove home the point that it is most important to drive the uric acid level down quickly. Most of the web sites just focus on diet, and giving up pleasures, which may help a bit, but seem drag out your treatment and prolong suffering needlessly.
I kept taking the allopurinol even when it hurt, and after 2 1/2 months, the pain/swelling/redness is disappearing. Even the toe bump is shrinking. Listen to the wise man. The GoutPal is the Best.
[My bold] 😉
On the “allopurinol lifer” question, I believe we need to take a step backwards and consider the real issue. Excess uric acid.
It is a sad state of affairs that the (almost) universal advice from the medical profession, including the world’s leading rheumatology institutions, is to treat pain first, then consider uric acid lowering if gout attacks continue.
Would dentists get away with the same attitude to toothache? Would you continue to use a plumber who simply turned up with mop and bucket (perhaps a portable pump as his version of a steroid shot for worst cases)?
Clearly not, so it is up to us, as healthcare consumers, to insist that our doctors take our uric acid level seriously.
That does not necessarily mean automatic lifetime daily medication. But it does mean a schedule for monitoring. And it does mean a plan for maintaining uric acid below 6mg/dL.
As with all plans, reality will offer choices and results will suggest alternatives. Try diet. Try cherries. Try meditation and prayer if you like, as long as you measure the results by your uric acid levels. Just set yourself a 12 month limit for any and all the different approaches that might work, and if you have not met success, opt for a proven medication that will work.
Once you have had a gout attack, you have lost your gout virginity. You can never return to the no-gout-risk group. You must manage your uric acid levels and accept that every day of your life spent with a uric acid level above 6.5mg/dL is another day’s contribution to bone-crumbling uric acid crystal deposits. This is still happening on the good days when you feel no gout pain. Day-by-day, slowly but surely, you are creating irreversible serious joint problems.
The worst part of that process, is that by the time the avoidable joint problems cripple you, you are older and less able to cope. And you will be on daily lifetime max-strength painkillers as well as allopurinol.
So, I repeat, give yourself 12 months to try alternatives if you are averse to daily uric acid lowering medication for life. Just ensure that you are having monthly uric acid tests to get to know your number, and ensure it is decreasing (it can swing up and down so you are really looking for an average downward trend).
And if you do go for allopurinol, never start on a 300mg dose. Start on 100mg (maybe as low as 50mg if you have other medical conditions). Increase this until two of your consecutive uric acid tests show results below 6mg/dL. You might have to go much higher than the “standard” 300mg dose, but if you do not achieve levels lower than 6.5mg/dL, you are wasting your time.
This is my first post also. My first attack occured in my wrist, which was excruciating and sent me to the ER after a sleepless night. All the staff believed I had been bitten by some kind of spider or scorpian at first, but changed the diagnoses to “celluitus” after I did not recall any encounters with any of those pests recently. The pain was unbearable, and could feel each heart beat felt like a hammer falling on my wrist. The ER sent me home on anti-biotics and pain killers. (I did mention to them that I had been drilling steel all day with a hand drill, but the doctor did not snap to this).
The pain went away after a few days and all was well for a few months. Then I had an attack on my big toe, and finally went to a foot doctor when the pain got unbearable, and the swelling was bad.
He then told me about gout, and the wrist attack made more sense. He sent me home with colchicine, which was very effective. Several attacks though the next few years, each lasting longer, but none quite as intense as the first two. I learned to get the colchicine started quick, and found that less than the prescribed dose was effective for me, without the side effects. I also used a decreasing dose of Prednisone (30-25-20-15-10-5) to kick the attacks quickly. I tried reducing or avoiding the high purine foods, but that did not seen to help. I found out about cherry juice, and it helped some. I still drink it daily because I like it, and 100% black cherry juice is availiable around here at a reasonable price. The gout finally seemed to settle in my right foot, flareing and subsiding every few weeks, keeping the foot swollen, and building a knot on the side of the hinge joint of my big toe.
My new HMO internist saw it and prescribed 300 mg /day allopurinol, but did not inform me about the tendency for the medicine to cause attacks. I was about to give up, and then I ran across gout pal. This is absolutely the best source of gout information I have found on the Internet.
The Goutpal/administrator drove home the point that it is most important to drive the uric acid level down quickly. Most of the web sites just focus on diet, and giving up pleasures, which may help a bit, but seem drag out your treatment and prolong suffering needlessly.
I kept taking the allopurinol even when it hurt, and after 2 1/2 months, the pain/swelling/redness is disappearing. Even the toe bump is shrinking. Listen to the wise man. The GoutPal is the Best.
Steroid injections usually do bring pretty quick relief, but they inhibit the bodies own natural production of steroids, so should always be seen as something of a last resort.
I believe there is a limit to the number of shots that can be given, so it is particularly bad to rely on steroids if there is no plan in place to get uric acid down.
You really have to get on allopurinol, or some other uric acid lowering therapy as soon as you can. This leaves a few months of potential gout attacks which will get less intense and less frequent.
You probably need something to help handle the pain, but colchicine is usually more effective than anything else. Yes, it can lead to diarrhoea, but if it clears the pain that’s a small price to pay (be sure to drink plenty to replace lost fluids).
NSAIDs are the next choice, and there are many to choose from. You do not say in your original post what ibuprofen dose you were on. It is often more appropriate to increase the dose under medical supervision, but never more than 3200mg per day. This should be limited to as short a time as possible, and as low a dose as possible to cope with the pain.
Yes, many people report good results from cherry products for gout relief. The water will help too.
Yes, water is a great gout beater. Tea and coffee do help, as do most soft drinks.
Thanks for that, Glenn60. It’s nice to see someone getting good gout treatment.
Let’s hope that others are inspired by your story to seek early treatment to lower uric acid.
HRT is fairly well known to help with gout – from memory, it is thought that estrogen keeps the uric acid down. (I’ve made a note to do a proper summary of the research)
You don’t mention the dose of allopurinol that is giving you problems.
Many people with reactions to allopurinol can be desensitized with gradually increasing a low dose.
Maybe a combination of HRT for a bit longer, together with very gradually increasing allopurinol might do the trick.
Discuss these options, together with zip2plays advice about losartan and lipitor, with your doctor. It may well be that you can find a good combination that will keep your uric acid levels down and wean you off the HRT.
It’s good to see that your doctor is taking your uric acid level seriously, and getting the level down to something that is going to help you.
It’s a pity about the allopurinol side-effects, but encouraging that you are getting an alternative.
One alternative, particularly useful when allopurinol was the only real answer, is to increase the allopurinol dosage very, very, slowly. This is quite an awkward process involving tiny adjustments with a mixture of tablets and increasing strength allopurinol liquids.
Uloric, from the data released as part of its approval process, seems like a good alternative. Just like allopurinol, it might trigger the odd gout flare until you get all existing uric acid crystals out of your body. If your Uloric dose is right, these will become less severe, and less frequent, as time goes by.
Please keep us posted with how you get on with the Uloric.
BobsWife said:
thank you all for your help! everyone has been just wonderful.
now, how do I delete this post?
Mr. Admin, feel free to delete it.
?? I don’t understand – I can’t see any replies to this anywhere 😕
Anyway, this is amongst the worst examples of a total letdown by the medical profession. Please can others take it as a warning, that you really do need to take control of your own responsibility for gout.
The first important point is that after 20 years, Bob still has uric acid levels over 11 – a dangerously high level.
The second important point is that now Bob is eventually getting proper treatment – allopurinol – it is being totally mismanaged. Though gout patients should usually wait until a gout flare is over before starting on allopurinol, you should never stop it once started, unless it is causing some other problems like severe rash or liver problems. Allopurinol has to be taken every day to keep uric acid down. If you stop taking it, you are soon back where you started.
Related to this are 2 extremely important points:
- Allopurinol dose must be adjusted to make sure uric acid level stays below 6mg/dL. Anything less is a waste of time, effort and money.
- The first few months of allopurinol often cause gout flares. This is to be expected, and colchicine is the best thing to take at the first sign of a gout flare. Other gout pain relief treatments are available.
Thanks guys.
Yes, this is a new feature that I’ve been wanting to add for ages.
The tree icon has always been there for adding images from the web, but it now has the added browse button to access your computer drive(s) – including most directly connected cameras.
There might be a restriction on some very large images, but other than that, you can upload as many images as you like, in any forum.
And Trev, if we were in a foot prettiness competition, I don’t think you would lose 🙂
This seems to be a UK strand, and it's interesting to hear your stories. I wonder how it went in Africa? It's nearly 4 in the morning and that's why I'm posting coz my knee has been a bastard for last week, elbow very tophii though little pain. Ankles starting to talk. I'm not a big 'hydrater', but I've certainly been drinking more coffee and beer and less water last few weeks. Need to work on this as I've been living away from home. My first experience of mu;tiple joint attacks
Good to hear from you
TP
Lancs
To give you the most relevant advice, you will need to share some fairly personal information in public.
If you are happy to do this, we need as much information you can supply about yourself, your diagnosis, your treatment and your test results.
Of course, none of this is as good as a personal professional consultation with a gout expert, but if that is ruled out financially, we will have to do the best we can here.
The following information is relevant, though this is probably not exhaustive so please feel free to add any other information you feel is relevant.
Yourself: – Age, height, weight, gender, length of time you have had (or suspected) gout, joints affected, family history of gout (if any), other conditions, current medications.
Diagnosis – Has gout been confirmed by joint aspiration? If not, how has gout been diagnosed.
Treatment – full history of medication (and any alternative treatments) taken.
Test results – These should be numbers (with unit of measure) not low / normal / high grades. Particular relevance is uric acid, but other results may be relevant.
Could all readers please note that this information is best put into your profile. That way, all contributors can easily find the relevant facts without having to trawl through posting history – which is becoming increasingly difficult as the forum grows in popularity.
What worries me more than the rash and itching, is a nagging doubt that you might not be getting proper monitoring of your uric acid levels.
The best procedure for allopurinol, is to start with 50 or 100 mg, then gradually increase this dose until uric acid levels are consistently below 6mg/dL. Anyone with a long history of gout, really needs to aim lower, say 5mg/dL to get rid of the build-up of uric acid crystals more quickly. Obviously, this involves blood testing for uric acid quite frequently until a stable dose is established.
Your sudden jump from 100 to 300mg appears to have promoted old crystals to dissolve, which is what you want, but this is hard to assess properly without a good history of uric acid test results.
I would consider reviewing this with your doctor to see if a more gradual increase of allopurinol is appropriate. If your doctor does not understand the need for testing and dose adjustment, then you will have to persuade him, or seek a gout specialist – usually a rheumatologist.
It is important to maintain good hydration with allopurinol, as it is for all gout sufferers. All soft drinks count towards your fluid intake. If you take alcohol, try to increase water consumption afterwards.
