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There is good evidence to show that allopurinol can help heart patients as well as gout patients. However, this is a serious medical problem that needs physical examination by an experienced doctor.
You need to look for a rheumatologist who has experience with gout and with heart disease. If you cannot find a suitable specialist, I might be able to help you find one.
You need to log in to GoutPal, then put your country in your profile. Then, reply here, saying what you have already done to find a specialist. Please add as much relevant information as you can.
Hi Amit. Thanks for your question, and sorry for my delay in replying.
You need uric acid lowering meds urgently. I need more information to help you properly.
Please see GoutPal Log-in Help, then join here and complete your Personal Gout Profile. When you’ve done that, please post a reply here so I know you’ve done it. You can also ask here if you are not sure what information to add to your profile.
I look forward to hearing from you soon.
Thanks for your question, Nainan. I’m sorry it took so long to respond.
There are lots of things you can do to lower uric acid. You need to get down to 5, but for the first year of uric acid lowering, it is better to aim lower than that.
I need to know more about your history and your preferences. Please can you Log In to GoutPal, then add as much information as possible to you Personal Gout Profile. Once you’ve done that, please post again here. I especially need to know about your preferences and anything that you’ve tried in the past.
I look forward to hearing from you again soon.
Earlier I wrote:
(cue a gouty version of Philip Larkin?s This Be The Verse)
Would anyone like to see it?
It will be interesting to see if stopping baking soda leads to a rise in uric acid. If so, you could maybe use it on an ad-hoc basis whenever uric acid rises above 5. Or on a temporary basis until you can improve the alkalizing effects of your diet. Very interesting!
Average uric acid scores are harder to find than I realized. I think it’s because most studies I read focus on gout patients, so average “regular” uric acid is harder to find. In the end, you inspired me to post https://gout-pal.com/gout-pal-forum/please-help-my-gout/regular-uric-acid-levels-without-gout/
If the chart you are looking at is the one I’m thinking of, I think the number is me being over-complicated. It’s probably best if I remove that meaningless, confusing column. If you remind me where it is, I’ll amend it soon.
Hi Max,
That’s a very dramatic introduction to gout!
Gout pain needs a package that tackles different aspects of the pain process. Gout pain stems from an immune response to the presence of uric acid crystals. That response produces inflammation that turns to “most extreme pain I have ever experienced.”
This is totally different from the nerve pain that Liboderm helps to block. There are some pain-blockers that can help gout pain. But these are best taken in rotation with anti-inflammatory meds. Even before anti-inflammatories, gout sufferers have a wonderful med called colchicine. This has been very expensive in America in recent years, due to licensing of Colcrys. You should now be able to buy cheaper colchicine from Prasco.
Colchicine is not a pain-killer. It helps us by tackling gout pain at its source – our immune system. It inhibits the immune system from starting the inflammatory response. It does nothing to reduce inflammation, and nothing to block pain. It is only useful if you take it before the gout pain starts. It is best used every day as a preventative taken at the same time as uric acid lowering meds. If you are not taking uric acid lowering meds, colchicine is still useful. Take one at the first sign of a gout attack. Take another in two hours if there is still any signs of a gout attack. Never take more than two in 24 hours. Never take colchicine if you have any infection, or if you are likely to be exposed to infection.
Anti-inflammatories are your best defense, but they must be gout strength. Personally, I believe you should only use steroids (prednisone, prednisolone, etc) as a last resort. I say this because they knock out your bodies natural anti-inflammatories. You should discuss this with your doctor if he suggests steroids. For people who cannot tolerate NSAIDs (Non-Steroidal Anti-Inflammatory Drugs), steroids might be the only answer. For the rest of us, gout-strength NSAIDs are the main weapon in our anti-gout pain arsenal. Get your doctor to prescribe maximum strength. OTC doses are OK for a gouty twinge, but they will not touch a full blown gout attack. Ibuprofen is my personal choice, and naproxen is also highly recommended. These NSAIDs are gaining popularity over Indocin, which has always been commonly prescribed in America, but is now seen as less effective for most people.
Please note, Max. There is no “best NSAID for gout.” Every gout sufferer reacts differently, so if inflammation persists, or side-effects are unpleasant, then ask your doctor to prescribe something else. What you are seeking is “best NSAID for Max.”
So we have up to 2 colchicine to stop inflammation spreading, and max-strength NSAIDs to reduce inflammation. Reducing inflammation will reduce pain. If, after two hours, pain is not tolerable, turn to pain-blockers. Your doctor or pharmacist can advise which pain blockers are compatible with your current NSAID. Most common, and usually most effective for gout is acetaminophen/paracetamol (Tylenol). Again, get a prescription for gout strength dose.
TL;DR
Colchicine to stop inflammation spreading. Max of 2 per day. Take at first twinge.
NSAID (ibuprofen, naproxen, indomethacin, or others) to reduce inflammation and pain. Max dose. Start at first twinge. Repeat 4 hourly up to max dose.
Pain Blocker (paracetamol, codeine, tramadol, or others) to block residual pain. Max dose. Start 2 hours after NSAID dose and repeat 4 hourly, if required, up to maximum dose.That should get you dancing round the restaurant, Max. As a gout newbie, it’s a lot to take in. Please ask as many questions as you need to. Don’t be afraid of asking for clarification if I’m not clear. The more we discuss your gout, the better I get at framing my answers to suit you.
You’re too kind Dorian. I too have certain obsessive traits, so I should know better. I need to focus much more on what gout sufferers need to achieve as people. Low uric acid is my obsession, but I shouldn’t frighten people with my own fears (cue a gouty version of Philip Larkin’s This Be The Verse).
Moving on…
The confusion about veggie purines is completely down to old science. It changed (from memory around the 1970s). Researchers began to realize that not all purines are alike. The latest professional rheumatology guidelines recognize that vegetable purines are not a threat to gout sufferers. Recent research confirms that, as part of an alkalizing diet, vegetables are the best food for gout. I use this as one of my main tests when I am reading gout information. If there is any mention of avoiding asparagus, beans, and similar old-school gout “problems” I stop reading, usually accompanied by exasperated cussing.
Obviously, you can’t see me at the moment, but I’m dancing for joy. Fantastic uric acid results. Let’s see what we might do to maintain that, and perhaps get lower.
I mentioned alkalizing above. There is some evidence that artificial alkalizing with bicarb can help gout. We’ve discussed it several times over the years. My view is, if you’re determined to choose chemicals over food, potassium salts are better than sodium ones. It’s a long time since I debated this, so I hope someone starts a new topic about which chemicals are best to alkalize the body.
But chemicals? Really?
I’d much rather alkalize with food. Real food, not food-like substances that are packed with additives. I started looking into this when I realized that baking soda has a bad effect on blood pressure. I was worried about that at the time, though it now appears I have normal blood pressure, but White Coat Syndrome. I’m now recognized as a leading authority on Potential Renal Acid Load. It’s one of the best estimates of alkalizing food potential, until I invent something easier.
I like the mention of Chinese medicine. I’ll see if I can wake @odo for some wisdom.
I also like the mention of meditation. That’s the push I need to write about the mindfulness of gout.
Dorian, your wide-ranging comments have made my day. The perfect gout topics – mostly plants and exercise of the mind, with occasional chicken or beef for added pleasure. 😀
Hey Dorian, I’m sorry if I’ve pushed too hard. I know how it is to be overwhelmed by gout.
Sometimes you just don’t know what to do for the best. I’ll try to help more.
I know I keep banging on about best practices, getting the right tests, treating uric acid properly, etc. These are important physical aspects of managing gout, but I need to focus more on the mental aspects.
Is it more important to get manage gout quickly, or is it more important to feel good about the way we are dealing with gout?
I think that, as long as we are not ignoring the longterm implications of excess uric acid, we should try to celebrate every little triumph.
From what you’ve written, I can see that you’ve greatly improved your lifestyle recently, and you continue to have an active life. That’s all good.
I think it’s time to stop worrying, and try to make small steps of progress at whatever pace suits you. I’m going to back off from suggesting how you should do things, and try to understand your situation better. Personally, I took the cheap and easy option of allopurinol. I know that doesn’t suit everyone. To advise you of the best lifestyle changes, I’ll wait for you to ask me about specific things you need to know. So, to answer the questions from above:
1. How quickly do uric acid levels respond to purine intake?
Just a few hours. If you eat a meal rich in animal purines, uric acid crystals will rise within a couple of hours and peak a couple of hours later. It varies from individual to individual. I’ve got some specific research on this if you want the details. I’ve learned that speed of purine metabolism is not particularly important, except for the timing of uric acid tests. Temporary uric acid highs will not usually cause gout flares. Uric acid crystals grow very slowly, and gout flares are usually triggered by something else. Never forget though – if you have no uric acid crystals, you cannot have a gout flare. The thing that is most overwhelming here is the “something else”Scientists are learning about new triggers, and getting better understandings of how a gout flare starts. Because there are many factors, in real life, the start of a gout flare seems random. Despite that, we all tend to get hung up on avoiding gout triggers. That is a truly overwhelming task. My best advice is to split your gout management plans between long term control of uric acid, and short term control of gout pain. That applies whether you choose pharmaceutical or alternative treatments.
2. Are there any good books on uric acid levels that I could recommend?
No.
There are some good texts on different aspects of uric acid, but I’ve never seen a comprehensive up-to-date book. My particular favorite is “Pathogenesis of Gout,” but it’s 10 years old, and our understanding and treatment of uric acid has changed in those years. I once started to summarize it at The Manner Of Development Of Gout but it all proved a bit too much for me.
Let’s think about which aspects of your life can be improved by better knowledge or treatment of your gout. What are your most important concerns? Take it a day at a time. Update your profile as often as you can, and join in discussions here. If it is useful for you, I’m happy to help you write your own gout website – that certainly worked for me! If that’s a step too far for now, I can help you with one or more articles that summarize what gout means to you.
You’re struggling with gout. I’m struggling with the best ways I can use my gout knowledge to help you (and other gout sufferers). Let’s all try to find ways to make it easier.
Hi David, it’s great to hear from you again, but not in theses circumstances.
After so many years around 5mg/dL or lower, I would have thought all old crystals were dissolved. As you say, even if they started growing again temporarily, they shouldn’t have grown enough to cause an attack in such a short time.
There’s only three explanations I can think of:
1. A deep-seated clump of crystals have suddenly started to dissolve, and triggered an attack.
Or
2. It is not a gout attack.
Or
3. Your toe joints are exposed to prolonged low temperatures, giving a crystallization point below 5mg/dLThe best chance of knowing it is gout is to get a joint fluid draw tested for uric acid crystals. That test might also show it to be something commonly confused with gout, such as pseudo-gout, or septic arthritis. As you might tell, I’m clutching at straws here, but it is the first time I have heard of gout returning like this.
Maybe your doctor might be able to advise better, or at least give a medical opinion on option 3.
Stress is an interesting gout topic. Unfortunately, since the retirement of Herbert Weiner over 30 years ago, there is very little recent research. The old stuff is not complete, but best found by searching for Psychosomatic Gout. They are probably interlinked. Gout pain definitely causes stress, but so do many other things. Stress might, in some unknown way, trigger gout attacks, but so do many other things.
The only way to treat gout is to get uric acid down to safe levels. In your case, Mary, that is 6mg/dL or below. There are many ways to do that. The newest drugs take weeks. Other methods can take months or years. Once you reach that stage of gout control, you do not need to worry about gout pain any more.
I’m still very concerned about your doctor’s reluctance to prescribe uric acid lowering meds. Everything I have read about allopurinol and kidney disease says that allopurinol helps kidney function. Obviously, it has to be dosed and monitored correctly, but any half-competent doctor should be able to do that. I hope you can persuade your doctor to think again, Mary.
Hi Paul,
It’s all about your uric acid levels.
I hope you’ll return, log in to GoutPal, then let us know your recent uric acid test results. Or would you like me to explain why the affect of low carb diets on gout is different for every gout sufferer?
Since you posted your question, I’ve had to restrict anonymous posting. If you have any difficulty, please just click the orange Support button. You can also raise a gout support helpdesk ticket, if logging in to post is difficult for you. Responses via the orange Support button, or the helpdesk are always slower, as I always check what active members have posted first.
This is a great discussion, but it got a bit lost. I’ve decided to stop anonymous posts, as they seem to cause more trouble than they are worth. Now, everyone has to log in to GoutPal before posting. If that causes any problems, you can still post via the orange Support button, or GoutPal’s Gout Helpdesk.
For @goutken I’m worried about your uric acid levels. The lumps you describe sound like tophi to me. If they are, surgery is definitely a common option, but never the best. There are new intravenous treatments for edge cases like yours. I’d definitely ask your doctor/rheumatologist about Krystexxa. That’s the drug that inspired my Best Tophi Picture. It’s my best tophi picture because it shows how severe gout cases can be tamed with the right treatment.
For @martydoane – good point about the chemicals. There are some studies that link environmental pollutants with gout. Very difficult to identify and avoid though.
I hope you can both log in OK now. Please let me know if not, as above.
Did my response make sense Mary?
Please let me know if I need to clarify anything about Colcrys, cheaper colchicine, or tart cherry juice for gout.
I can’t answer your safety question about prednisone. I can give my personal views, but I’m not a doctor. As you have a heart condition as well as gout, you must take advice from appropriate specialists.
Colchicine should help you the most. Again, dosage is something your doctor should control. The best approach is to take one at night. If there is any sign of swelling or gout discomfort the following morning, take another. never exceed more than two in 24 hours. For most gout sufferers, this will limit the pain to acceptable levels. Where it does not, you must see your doctor or a pharmacist for advice on blocking or treating residual pain. There are many alternatives to prednisone. Acetaminophen (paracetamol) might be useful?
Most importantly, your pain relief should be a temporary fix for the long-term problem of excess uric acid. It is important that you know your number, and you know what your targets are. Low targets until the risk of attacks is gone. Then, no higher than 5mg/dL.
You are right that 25 is young for gout, but not unheard of. One of my nephews has similar problems. Both me and his father (unrelated except by marriage to my sister) have gout. There are many genes involved with increased gout risk. Obviously, some combinations cause gout earlier. The situation is complicated, as in earlier generations, gout diagnosis was restricted to the rich.
Gary, I’m really sorry you have had problems with your password login. I hope this is OK now. To any other gout sufferers who are having trouble logging into the forum, please use the orange Support button, or GoutPal’s Gout Helpdesk. It might take me a little longer to answer those tickets, but I will get there eventually.
Any more thoughts on this @bil-howard
Have there been any recent changes? How about ingredients in that Aji pepper sauce? Traditional sauces are very simple, but in today’s world, maybe other ingredients have been added?
More importantly, whereabouts in your back is the pain?
@dorian-kramer I just realized I didn’t comment fully on your earlier https://gout-pal.com/gout-pal-forum/please-help-my-gout/banaba-teaextracts/#post-21392
For safety, I recommend getting regular liver function and kidney function checks. This is usually associated with pharmaceutical uric acid control, such as allopurinol and Uloric. However, I think those tests, along with uric acid tests, are advised for herbal gout medicine. Even with diet control, it is useful to be assured that lifestyle changes are not having repercussions.
You said in a recent response:
Herbs must be treated with the same respect as medications, since they are the original medication. That means that you should always monitor yourself while taking them the exact same way you would while on a medication.
In a similar vein, control of gout by herbal medicine and diet needs to be planned. The details are different from pharmaceutical gout treatment. But, the principles are alike.
We have one single uric acid test result (by the way, that needs to go in your profile). We need more test results before we can hazard any guesses about how long treatment might take. In the meantime, we must do all we can to make that time as short as possible.
First, you need to get your uric acid excretion rate tested. That involves collecting urine over a 24-hour period. See your doctor about this as soon as you can. It will tell us if we need to focus on uricosurics or XO inhibitors, or both.
Then we need more information about your diet and water and chianca piedra. I also need to know your height, weight, and exercise levels.
For diet, best to start a new topic, and post everything you eat and drink each day. Include any dietary supplements.
For water, can you confirm that you drink enough to make your urine a pale straw color? There is no fixed amount for fluid intake, as it varies with weather and activity.
For chianca piedra, how much are you taking, and how often.
Whilst looking for that, I also found a summary of several other plants that have shown xanthine oxidase inhibition. I’ll try to summarize these in more accessible form when I get time. Remind me if you get impatient waiting 🙂
Also, if any of these plants have special interest for anyone, please let me know and I will research more facts about their uric acid lowering potential.
Great find, Dorian.
If this works properly, there should be a link to the full report here very soon.
It has details of how the banaba tea was made. Note that the study uses extracts derived from that tea. Also, it is laboratory inhibition of Xanthine Oxidase. The authors call for real-life testing of the tea, and it’s active components, to test if uric acid lowering actually occurs.
Dorian, I’m so glad you overcame the problems of registering. Hope this isn’t causing your head to ache!
I hope you’ll start more interesting discussions about alternative medicine.
When I consider the safety aspect, I’m obviously concerned with potential toxicity. However, there is another safety aspect to consider.
That is the danger of untreated excess uric acid. Though gout sufferers are primarily concerned with the pain of a gout flare, the worse danger is the damage caused by uric acid crystals. In, and around the joints, uric acid crystals cause physical damage to cartilage, tendon, and bone. This can lead to permanent loss of mobility, and amputation or joint replacement. Uric acid deposits spread beyond joints. The first victim is often the skin, as tophi burst through ears, hands, etc. All joints are at risk, with kidney and heart disease common targets that may prove fatal.
So the safety context has to consider how effective a herbal medicine is at making uric acid safe. If it is ineffectual for uric acid control, it is dangerous irrespective of toxicity. Therefore, herbal medicines taken for uric acid control must always be measured by getting regular uric acid blood tests. I believe that kidney function tests and liver function tests are also a vital part of herbal uric acid lowering.
Of course, some herbal medicines are taken for pain relief. In that case, the safety aspect of toxicity remains. But never forget that relying on herbal pain relief without lowering uric acid is extremely unsafe.
Perfectly correct Ron.
I don’t think I’m alone in being more careful about my diet as I get older. I know many gout sufferers who use allopurinol as a prop for continuing unhealthy eating. For me, it worked the other way. Once I realized how easy it is to control gout, I wanted to enjoy my new-found freedom without the fear of heart disease (which is a paternal nightmare) or diabetes. I don’t want to turn into a foodie bore, but I think there are healthy ways to enjoy food. Less meat and interesting, spicy veg dishes is my way forward.
I’d love to find recipes that help avoid gout triggers for my GoutPal friends. As the scientists understand more about what causes gout attacks, I’m hopeful I can make progress on this. For years I’ve been intrigued by the fact that many people with high uric acid do not have gout attacks. That has the unappetizing name of asymptomatic hyperuricemia. It fascinates me.
If we can unlock the key of what combines with uric acid crystals to cause gout attacks, it makes the early months of allopurinol so much easier.
I find my head often in a whirl with some of the scientific journals. It’s very hard when every other word takes hours of research to understand the meanings. But I love these challenges! Of course, my real challenge is to understand it enough to explain it so it can be meaningful to everyone.
?If you can’t explain it to a six year old, you don’t understand it yourself.? – Albert Einstein
I’ve just gained a fresh insight into the situation that gout flares only happen when uric acid crystals are present with something else. That “something else” is believed to be certain Free Fatty Acids (FFAs). Some new research explains some changes at cellular level that affect the way large white blood cells react to uric acid crystals.
I’m struggling to understand the science, so I’ll reproduce what I’ve read to see if anyone can add some clarity. My understanding of this so far is that there are two types of large white blood cells (macrophages). One (M2) fights inflammation, but the other (M1) promotes it. However, to produce inflammation, a signal or carrier (IL-1?) is needed. Uric acid crystals alone will not produce IL-1?, but a substance identified in the following reports as LPS, causes M2 white blood cells to produce IL-1? and thus inflammation occurs.
This is the full abstract of the report with my bold around the crucial conclusion:
ABSTRACT
Background/Purpose: Macrophages have been involved in both initiation and resolution of gout flares. Accordingly, these cells are characterized by their plasticity as the environment modulates their phenotype exerting inflammatory or anti-inflammatory functions depending on their activation or polarization state. Macrophages in the presence of interferon-? and lipopolysaccharide (LPS), what is known as classical activation, acquire an inflammatory phenotype and are also termed M1 macrophages. On the other hand, M2 or alternatively activated macrophages with IL-4 have anti-inflammatory and homeostatic functions. Equivalently, in the presence of granulocyte macrophage colony-stimulating factor (GM-CSF ) and macrophage colony-stimulating factor (M-CSF) macrophages become M1 or M2 respectively. As M-CSF is present in the blood stream at steady state some authors propose that M2 macrophages polarized with M-CSF could represent the population of resident macrophages. In this work we investigated M2 macrophages response to monosodium urate (MSU) crystals in vitro.Methods: Macrophages were derived from peripheral blood monocytes of healthy donors after informed consent. Peripheral blood mononuclear cells were separated from whole blood by centrifugation with a density gradient. Monocytes were then isolated by negative selection with magnetic beads and cultured for 1 week with GM-CSF (1000 I.U./ml) or M-CSF (20 ng/ml) to obtain M1 or M2 macrophages respectively. Macrophages were then stimulated with MSU (200 ?g/ml), LPS (100 ng/ml) or both for 18 hours and quantification of IL-1? and IL-10 in supernatants was performed by ELISA. Activation of caspase-1 in M1 and M2 macrophages was analyzed by flow cytometry with the Caspase-1 FLICA? Detection Kit (Immunochemistry Technologies). Cytoplasmic pro-caspase-1 and pro-IL-1? were analyzed by western blot. Flow cytometry and statistics analysis were performed with the FACSDiva and GraphPad Prism 5 respectively.
Results: As expected, M1 macrophages produced inflammatory cytokines in response to LPS, whereas M2 macrophages were unable. Both M1 and M2 failed to produce IL-1? after MSU stimulation. However, when challenged with MSU and LPS, M2 macrophages produced IL-1? (mean+/-SEM, LPS 2.59+/-1.37 pg/ml, MSU+LPS 111.4+/-30.44 pg/ml, p= 0.0078) and reduced IL-10 production (mean+/-SEM, LPS 3738+/-230 pg/ml, MSU+LPS 1587+/-386.4 pg/ml, p= 0.0039). Resting M2 macrophages exhibited lower levels of active caspase-1 and pro-caspase-1. MSU stimulation increased active caspase-1 levels in both M1 and M2 macrophages and the presence of MSU and LPS had a synergic effect in pro-IL-1?.
Conclusion: M1 and M2 macrophages failed to produce inflammatory cytokines after MSU challenging, according with the fact that MSU crystals can be found in asymptomatic joints. However, after MSU phagocytosis, M2 macrophages were able to produce IL-1? after LPS stimulation, explaining the requirement of a trigger, such as a copious meal or alcohol intake, for the initiation of an acute flare in gout. M2 macrophages also had lower levels of caspase-1 and pro-caspase-1, than M1 macrophages.
Macrophages mediated response to uric acid crystals is modulated by their functional polarization. Available from: https://www.researchgate.net/publication/274699805_Macrophages_mediated_response_to_uric_acid_crystals_is_modulated_by_their_functional_polarization [accessed May 22, 2015].
I need to try and understand the LPS factor, and if, or how, it relates to Free Fatty Acids. I’m also trying to understand caspase-1 and pro-caspase-1.
If anyone can help with explanations, I’d be glad to receive your insight. If none of this makes sense, don’t worry too much. The main aim of proper gout control is to get rid of uric acid crystals. Once you do that, you can never get a gout attack. The science here might help us find better ways to manage gout pain prior to getting uric acid under control.
@yigaljoseph I mentioned latest research earlier. I’m not sure how relevant the following is to your situations. Maybe you could discuss it with your doctor and let us know.
Annals of the Rheumatic Diseases
Impact of Allopurinol on Risk of Myocardial InfarctionL Grimaldi-Bensouda, A Alp?rovitch, E Aubrun, N Danchin, M Rossignol, L Abenhaim, P Richette
Ann Rheum Dis. 2015;74(5):836-842.
Allopurinol may be associated with a reduced risk of [heart attack]. No decreased risk of [heart attack] was found in colchicine users. Besides its urate-lowering property, allopurinol might have a cardioprotective effect.
Cause or coincidence? We’ll never know without lots more information.
Every gout sufferer, myself included, tries to link events and determine gout triggers.
I stopped doing it when I learned one very important gout fact. Gout attacks happen as a response to uric acid crystals forming, and as a response to uric acid crystals dissolving.
Here’s two very important things to think about.
1. Aji Sauce, as I understand it, is simply Aj? Amarillo peppers blended with a little water or vegetable oil. It’s the sort of thing that I would put into the category of “probably helps reduce uric acid as part of a healthy balanced diet.” I have no idea if this sauce did trigger an attack, but if it did, it is most likely to be old crystals dissolving, which is a very good thing. To prove this, abstain from the sauce for two weeks and get a uric acid test. Then consume the sauce for two weeks without changing other eating patterns. Test uric acid again. Repeat this until you get a statistically confident result. (Note – I don’t actually expect anyone to do this, but it is the only way to answer the cause or coincidence question when it comes to any food or drink item)
2. Back pain could well be an early indication of a gout attack. You should definitely check with your doctor about back pain and gout, especially if the pain is in the lower back.
Oh Mary, I could cry.
It’s very insensitive for your doctor to respond as he has done. I will try to do better, but I have to hope that you realize I am not a doctor. In the case of gout complicated by kidney disease, you must get the help of a suitably experienced rheumatologist. I understand that money is an issue. I know that needymeds.org has many resources to provide financial help for Americans struggling with health costs. That includes advice about Colcrys costs as well as help with access to medical facilities.
It is my belief that the license for Colcrys has expired (or been amended), and generic colchicine should be available again. Pester your doctor for information on this, and also ask local pharmacists. There has always been a “get-out” clause with colchicine, though I don’t personally know of anyone who has done it. The “secret” is for your doctor to write a prescription for a dose that is not covered by Colcrys. They have 0.6mg tabs, so if your doctor insists on 0.5mg tabs for health reasons, these can be produced from generic colchicine by a Compounding Pharmacist. I’m informed that this is supposed to become mainstream following an agreement with Prasco Laboratories, but I’ve yet to hear of anyone actually getting cheaper colchicine. It#’s sad that your doctor can’t help on this. Perhaps if you ask him directly for information about Prasco Laboratories, he might be able to help more.
Sorry I can’t offer a more succinct response, but I’m UK-based so I rely on my American friends for local information. If any friendly Americans are reading this, perhaps they can respond with better information. C’mon Guys! Mary needs our help!
Mary, I can see that you are being forced to consider diet control as your only option. Diet control for gout is usually best as part of a comprehensive gout treatment plan. What we must do is create a diet plan that helps you achieve some specific treatment goals. I can’t help you with this unless you give me more facts about yourself. If you want a personal diet plan, just let me know. Start by putting as much relevant information as you can in your Personal Gout Profile. As a starting point, I need to know your uric acid level, height, weight, favorite foods, foods you hate. Without the basics, I’m unsure how much I can help you. I promise you it will be more than the things you have mentioned already. There’s not much wrong in what you are doing so far, but it doesn’t form a coherent plan that you can measure and refine.
One last question: What’s the cost of daily tart cherry juice compared to Colcrys?
Hi Randy, I hope you are encouraged by Ron’s comments.
I was in a similar situation, and I thought to myself, “If I’ve had uric acid crystals building up for 17/18 years, I’ll be happy if the flares stop in 17/18 months”
As it happens, I was about 6 months, but I did max out on allopurinol to try and reduce uric acid deposits as fast as I could. I got uric acid down to around 200. One of the factors that helped me persuade my doctor to go along with this was a large tophi lump on one elbow, and a couple of smaller ones elsewhere.
I’m sure it’s just a matter of being patient, and you will soon be gout-free. If you can’t be patient, talk to your doc about increasing the allopurinol dose for twelve months or so.
Bad news, Melissa.
Once uric acid has built up to the point where it causes a gout attack, it is very difficult to avoid another.
You can definitely stop all gout attacks, by getting rid of old uric acid deposits. Unfortunately, it takes several months to do this. Therefore, you need 2 plans:
1. A gout pain treatment package that will limit inflammation, reduce inflammation, and block pain.
2. A uric acid treatment plan that gets uric acid safe.You can rely on the gout pain package to help you until the uric acid package becomes effective. That might not mean no more attacks, but it should mean no more suffering.
If you are not confident about the level of healthcare you are getting, I can advise you what to ask your doctors, and how to understand their responses.
I have a natural suspicion of podiatrists, but there must be some that are useful. On diet, I do not believe it is ever #1 key. However, it is very important. Irrespective of a specific gout diet and how it might affect your treatment plan, diet is very important to anyone who is overweight. Excess weight is a significant gout factor. It can be outweighed by taking uric acid lowering drugs. However, obesity is also linked to several other health factors. It seems pointless to control gout only to suffer diabetes or heart disease. On Uloric, professional rheumatologists advise is clear – it is only recommended when allopurinol has been considered and found lacking. I know the factors that make Uloric better than allopurinol in some situations. Does your podiatrist know them?
I hope you’ll add your latest test results to your profile, Melissa. Best to put the latest result in the uric acid box, then keep a history in the “Other personal gout facts” box, with list of dates and results.
Hi DJ, that’s an interesting mix of medicine and myth.
The only reason for taking allopurinol is to reduce uric acid to safe levels. With no information about other diseases, the default setting for safe uric acid is 5mg/dL. So I don’t understand why your doctor stopped titrating your dose in January. As Ron said, the 300mg dose works for some people, but it is not, and never has been a standard. The correct procedure is to increase every 2 to 4 weeks until your target dose for the first year is reached. Target for the first year should always be lower than 5, if medically advisable, as it encourages more rapid dissolution of old uric acid crystals. I don’t understand why your doctor is not increasing your allopurinol dose, but I’d love you to ask her and we can discuss it further. There might be impact from your other health problems, but all that I have read indicates that allopurinol is beneficial to heart disease and diabetes (I’ll set myself a note to check latest research.
Drinking sufficient fluid is just as important during uric acid lowering treatment as it is with untreated gout. It’s especially important with allopurinol, as it’s by-products are excreted through the kidneys, and need sufficient urine volume to avoid oxypurinol stones. The fluid does not have to be water. Drink sufficient to produce pale straw colored urine. Increasing your proportion of skim milk in your fluid intake is good for encouraging better uric acid excretion.
Diet can play a part as well. More flora than fauna is an excellent maxim for all gout patients. Actually, all human beings. I can expand on that, but for now I’ll stick to the gout facts. Increasing plants in your diet will naturally increase urine pH. It has been shown that an alkalizing diet is good for gout. This does not mean becoming a vegetarian, though I can see it is a culture shock when 6oz a day of dead animal flesh is viewed as “mostly vegetarian.” That’s an observation, not a criticism. I’m aiming more for 6oz of fauna a week, but rarely achieving it. In any event, I’m at least 25lb overweight, so that excess meat makes my flesh intake rather insignificant.
So the “what more can I do” is:
- Take adequate allopurinol
- Increase skim milk consumption
- Alkalize your diet scientifically
That’s the medicine, so what about the myth?
The extracts you are taking have little or nothing to do with good gout management. There might be minor benefits to some, but if you have healthy diet you should not need supplements. I don’t like the cherry reference that you give. What kind of doctor makes a scientific claim and justifies it with a link to his own ill-researched comment? It’s not that there is anything fundamentally wrong with the extracts you mention (though I have no idea what part lithium plays). It’s just that the contribution to your treatment plan is very unclear.
As for testing your own uric acid level, I really can’t understand why you need that when your doctor should be doing it as part of an allopurinol program. Much better to invest in pH test strips, and make sure your diet changes are actually working.
DJ, that’s just a simple snapshot with reference to the points you have made. As such, it’s a reaction to your comments and questions. I much prefer to create proper treatment plans that match your situation and preferences. Then, choices about dosage, diet, and supplements can be put into context. I hope you’ll return to explore other possibilities that lead to your improved quality of life. That, after all, is more important than the minute details of supplement benefits.
Great plan doctorrazz.
Ease off the pain meds unless you need them. Keep them on hand for swift use. Colchicine limits inflammation spreading, but doesn’t reduce swelling or pain. If indomethacin has done it’s job of reducing swelling, I think you are right to save them for another day.
With good control of uric acid, you’ll soon never have to rely on gout pain relief. I hope you’ll share your uric acid test results here when you next get tested.
