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Richard, I hope you realize, you’re dicing with death. Lifting a cup without pain is good, but allowing excess uric acid to destroy your body isn’t. When tennis elbow is caused by tennis, it’s an indication that you need to exercise differently. When tennis elbow is caused by gout, it’s an indication you’re in serious trouble.
Watch the Allopurinol for Gout video to see the dangers of stopping allopurinol without a good alternative plan.
I highly recommend that you start a new topic about tennis elbow and gout. Then work towards a proper treatment plan before gout ruins your life.
Brilliant, Ron 😀
I’m glad you did Vegas justice, and I’m looking forward to seeing your uric acid test results later this month.
Good inspiration for http://www.goutpal.com/7754/driving-blind-with-gout/
Don’t be driving blind with gout. You must see your uric acid levels. You must know your gout direction. Open your eyes. See how to control your gout today.
I hope people get some value from this thread about gout diet.
I want to emphasize personal aspects of gout diet. Rheumatologists have realized it is wrong to dictate a single way to treat gout patients. All gout medicine must be prescribed according to an individual patients needs. That means understanding their medical history, blood test results, the stage of their gout, and their personal preferences.
Gout foods are just another form of gout treatment. It’s more complicated than prescribing a few pills, but the principles are the same:
What’s your Food History? Allergies, height, exercise levels, weight history over the years. Record the facts in your Personal Gout Profile.
What are your Blood Test Results? They are just as important for gout diet control as they are for gout medicine control.
What Stage of Gout are you at? Pain control, avoiding long term damage, between attacks, during an attack, etc. Different stages of gout need different interventions. Diet changes that help one aspect of gout might make something else worse. Gout patients are beginning to understand that uric acid lowering can sometimes trigger a gout attack. Foods that lower uric acid are no different.
What’s your favorite food? A very important part of gout control that is often overlooked is your personal preferences. I’m never going to say stop eating your favorite food. I prefer to explain the consequences, and let you make the choice. Likewise, I’m never going to tell you to eat or drink something you don’t like. I much prefer to explain the benefits, and find a recipe that makes good gout food palatable to you.That’s why gout food is all about you, so take your favorite foods, and change the question: How can I make food that I like better for my gout? to be more personal.
So, alan said:
i do miss having a beer and shrimp and my wonderful chicken liver casserole and tukey with gravy..etc
The questions should be:
How can I make beer better for my gout?
How can I make shrimp better for my gout?
How can I make chicken liver casserole better for my gout?
How can I make turkey better for my gout?
How can I make gravy better for my gout?These are all great questions, but I have to throw each one back, and ask:
Are you allergic to beer, shrimp, chicken liver, turkey, or meat stocks?
What’s your uric acid level, and do you have any history of how it has changed?
What’s your height, weight, and activity levels?
Are you most concerned with uric acid control, or pain control?With the right personal information, I’m pretty sure I can work out recipes and eating plans that include any of alan’s favorite foods, and most other foods. That way, you get your own personal gout foods lists: Banned, Bearable, and Beneficial.
Personally, I’m more concerned with making the information accessible. I hope I’ve explained why generic food lists are quite useless for gout control. The vital missing ingredient is YOU!
For me, it’s always a challenge to make the pages on GoutPal.com meaningful to most visitors. On the main menu I have a link to my opinions on the most important aspects of diet, treatment, and symptoms. So, for gout diet, I ask: What Gout Foods Can I Eat? on every page. I’ve just updated that page to try and emphasize the personal nature of gout diet.
Does it make sense?
This thread about allopurinol started drifting into areas that have nothing to do with pharmaceutical ways of lowering uric acid.
I urge visitors who want to avoid daily medication not to hijack threads from other people who do not want to take that route. I believe in the right to choose.
You can choose allopurinol, or other medical alternatives. You can choose better diet, including all lifestyle improvements. You can choose a combination of both, if you wish.
I’ve moved some of the obvious diet posts to https://gout-pal.com/gout-pal-forum/please-help-my-gout/how-can-i-make-food-that-i-like-better-for-my-gout/#post-20122
Please go there, to discuss ways of treating your gout through lifestyle changes.
Apologies to @1oldswabby who came to ask about allopurinol. George, if you still need help with adverse reactions to allopurinol and Uloric, let’s get this thread back on track.
One of the things often missing with uric acid lowering medications is proper preparation and monitoring. Many doctors seem to neglect proper care.
Blood work is very important. Uric acid is the obvious test, and you cannot have proper uric acid control with drugs unless they are prescribed according to regular blood test results. Otherwise, you’re driving without a speedo!
Also vitally important are kidney function tests and liver function tests. Your doctor should have your baseline results on file before you start allopurinol, Uloric, or any other type of uric acid lowering medication. That way, if you do start to display adverse reactions, blood test results will tell your doctor if meds should be stopped, changed, or prescribed differently. Otherwise, you’re driving without oil and temperature warning signals!
1 I’ve had that itchiness. I put it down to uric acid crystals under my skin dissolving and causing small localized reactions. It went away after a month or so. What really matter here is for your doctor to see it when you discuss the results of your follow-up blood tests. When you take any uric acid lowering medication, you should always get blood tests between 2 weeks and one month from any dosage change. The tests are uric acid, kidney function, and liver function. Your doctor can then assess the severity of any reactions to your drugs. Also, it is a good idea to login and record these results, on your Personal Gout Profile.
2. Are loose bowels anything to do with colchicine? If yes, this should recover. If not, try taking allopurinol at different times, e.g. before a meal, with a meal, or after a meal. You probably need to maintain each option for a few days before noting effects. What does your doctor say about this?
Please do not rely on personal uric acid meter test results alone. They are a useful measure of progress, but it is important that your doctor also monitors progress with the blood tests I mentioned earlier.
How is your gout treatment progressing?
I’ve changed the profile information since your last visit, so now’s a good time to login and update that.
Hey, @wpack3
How did you get on at the rheumatologist?
Anything new to report about your gout?
Maybe what your doctor was saying Martin is that you should only be on 100 or 300 now, because you haven’t yet had an “official” follow-up blood test.
Safe allopurinol dosing is:
1. If Han Chines, Thai, or Korean descent, consider genetic screening test for allopurinol hypersensitivity risk.
2. Start on 100mg.
3. Get blood tests between 2 weeks to one month later. Tests must be at least uric acid, kidney function and liver function
4. Adjust dose to achieve first year uric acid target
5. Same 3 blood tests within 2weeks to one month of dosage change.
6. After one year, gradually decrease allopurinol dose to achieve safe maintenance dose.This has to be a personal plan. First year uric acid target could be 3, 4, or ‘low as possible.’ Safe maintenance dose is normally 5mg/dL, but might be 6 if other health problems prevent the lower target.
Personal plan should include pain control either preventative or as required for first few months. (Because your foot pain is typical)
By increasing your dose to 500mg daily without corresponding blood tests, you risk adverse reactions. You will probably be OK, but why take the risk?
Hi Luke, were those posts about doctor’s reluctance to prescribe safe doses of allopurinol here or on a different website?
If they are old posts, they might not be relevant. However, there are still a lot of doctors around who haven’t yet read the latest professional guidelines.
The American College of Rheumatology are very clear on this. There is no such thing as a standard allopurinol dose, except that the first dose should be 100mg daily. After that, gout patients must be ‘treated to target.’ That means that allopurinol dose must be increased to bring uric acid down to safe levels, with regular personal follow-up to ensure safe levels are maintained. For the majority of patients, the safe level is 5mg/dL. For some gout patients with other health problems, they might have to settle for 6mg/dL.
Therefore, standard doses for allopurinol are a thing of the past. However, in my case – 3 and half years ago – 3 our of 4 doctors I consulted were not familiar with the equivalent UK guidelines.
My view on that is, it is our duty as enlightened gout sufferers to point doctors towards the latest professional guidelines. In my opinion, it is sufficient to ask them to look at the latest guidelines from whichever professional rheumatology organization is most relevant to your country. Other gout sufferers might react more strongly. It depends on your relationship with your doctor. My approach is to not mention the Internet, but to say something on the lines of “A friend told me about rheumatologists guidelines that say 5mg/dL is the maximum – do you know where I can find out more about this?” I’d love to hear how other gout sufferers approach this.
All that matters to me, Luke, is that you get uric acid safe, you get blood tests within a month of a dose change, and you get blood tests at least once a year once your uric acid is stable.
I wouldn’t worry too much about other forum members experience. What really matters is that you have a relationship with your doctor that allows you to safely control gout. If we have to educate her, then so be it.
I’ve often thought about trying to build a database of good gout doctors. Unfortunately, it relies on lots of members sharing their experiences in enough detail to be useful. As the patient-doctor relationship is very personal, I cannot see that happening. My related idea is to produce some high quality gout treatment booklets that I could ship to doctors, and create a record of those that endorse the safe personal approach to uric acid control. At this time, I do not have the resources to create such booklets, or to distribute them. When I get my gout sites back to where they used to be, I’ll definitely think about this again.
A tophi is an obvious lump. It starts quite soft and jelly-like, then gradually hardens.
Allopurinol will not cause tophi, but if they already exist, you might get a flare as the crystals within start to dissolve.
Uric acid crystals grow very slowly, and you don’t always notice them. When allopurinol lowers uric acid enough, large quantities can start dissolving. It might hurt in a different way, but it’s a good thing because it means your body is recovering.
Use my 3-pronged attack on pain, because colchicine alone is often not enough.
Colchicine = stop inflammation spreading
Anti-inflammatory = reduce inflammation
General analgesic = block painBy general analgesic I mean something that your pharmacist recommends as compatible with your Indocin.
Give it a few weeks, Martin. You’re doing most things right, and I’ll be back with more details next week. Please keep posting – it helps!
Thanks for that, Alan.
I’m a bit busy today, but I’ll take a look at your comments on the individual pages next week, and try and come up with some improvements.
You say about pages linking to next page, etc, but that’s how websites work. Do you think I should take the info and reformat it into a book? I’m not sure if I could do any better than hundreds of gout books already out there? What do other people think?
Not sure what you mean about purines, but I hope this will be clearer when I find your comments on whichever purines page you are concerned with.
What is OK for gout sufferers to eat = everything that is a whole food, in moderation, with a healthy balance, and mostly plants.
What foods gout sufferers must avoid = processed foods, especially processed meats, excess calories, excess iron, meat more than twice a month, fish more than twice a week.
Those are basics, but all gout sufferers might identify some specific OK and Avoid foods according to there own unique health history and personal preferences.
Peanuts are fine, in balanced moderation, unless you have a peanut allergy.
Thanks for flagging up the specific pages that need improving. Sorry I can’t get to them today. I’m off to party now (remember, I’m 8 hours in front of the forum time)
Wow! Wow! And thrice wow!
1. Martin: Welcome to the forum and thank you for an inspirational first post. Your overall plan is staggeringly good. Some of the detail needs work.
2. Martin: Thank you so much for putting useful gout facts in your Personal Gout Profile. You cannot imagine how much easier that makes it for me.
3. Ron: You instantly homed in on exactly my concerns.There are lots of detail that I can add over the next few days. Here’s my problem:
I have a real long working day today. I have a birthday party tomorrow (All welcome if you can get to Ilkley Weatherspoons 3:30pm Saturday https://www.facebook.com/events/871239059581894/ ). I have a recovery day Sunday.Martin, I would definitely increase allopurinol, but as Ron says, stay on 500 until you get those 3 vital blood tests (ua, kidney function, liver function). Take one colchicine at bedtime. Repeat in morning if any twinges or signs of inflammation. Never more than 2 a day. Max safe dose of your anti-inflammatory Arthrexin (indomethacin). If needed, see pharmacist or doctor about helping the anti-inflammatory with a compatible pain-blocker. After a few weeks, you can probably drop the preventative colchicine and move to “as-required”
Maybe back later – off to work now. Thanks Martin and Ron 🙂
Ask and ye shall receive!
I’ve just been told that Class Health have extended their 20% off deal to cover my entire birthday weekend!
You’ve got until 9am Monday morning (UK time) to grab a bargain.
Try that special gouty arthritis deal now!
NB the code is ARTH2015 not ARTH15
Great news! Special #arthritis bk 20% discount extended! Now ends 9am Mon 2 Mar 2015 so get there quick! Code: ARTH15 http://t.co/QZcJT7rR9T
— Class Health (@Class_Health) February 26, 2015
I’m still waiting for some feedback on the pages you were complaining about, Alan.
I’ve added a comment feature to all the pages on http://www.goutpal.com/
Can you go to the page(s) where you were expecting to find a list of good vs bad, and leave some comments. Tell me what you were expecting, and why you’re disappointed.
I’ve just added extra fields to your Personal Gout Profile.
This will make it much easier to keep track of your personal gout facts. These facts are very important for helping you manage your gout. They keep you focused on what is important, and they give information to others that helps us all give better advice.
I’m about to write some guidance notes about each of the new profile boxes. I hope they are easy to use, and I’d like you to update your profile now.
Please tell me if I need to clarify anything.
Ah, doctors! Wonder where he gets 5.5 from? I can guess, but I’ll refrain.
You can’t go too low with uric acid. In extreme cases of intolerance, the intravenous Krystexxa is used, which knocks out uric acid to almost zero. It only lasts a few months, but that’s all you need. Horrendous tophi gone in weeks! http://www.goutpal.com/3408/best-tophi-picture/
Also, there is a disease that renders people unable to produce uric acid. I can’t remember what it is caused, but people with it seem to suffer no ill-effects through lack of uric acid.
OK, I’m back to deal with:
What do you think of the crazy rash? Is this something you?ve seen or heard of before?
What about the old injuries? Is this typical of gout to seek out these and attack?Rash is common with gout, and has been discussed here many times. It’s one of the hardest symptoms to deal with, because it can have 2 different causes. Also, when it comes and goes, is it coming back for the same reason each time?
On reason for rash is uric acid crystals under the skin. This often occurs near gouty joints, and seems to be the most likely explanation based on your description of your symptoms. The solution is to maintain uric acid no higher than 5mg/dL. You might still get rashes at first, but you should notice, just like gout attacks, they get less frequent, less intense, and less widespread.
The other reason is a reaction to your treatment, or other changes, e.g. application of essential oils and the like. The only way to test that is with a month on, month off approach, together with a symptoms diary.
Gout often attacks old injury sites, and new trauma can start gout near the trauma site. This becomes irrelevant after your Uloric has got rid of the bulk of old uric acid crystals.
Family doctors have to know a bit about a lot of diseases. When we get gout, it takes over our lives. We read about it. Talk about it. Live it!
Doctors don’t seem to have the sort of quality control systems in place that I had to learn in business. They bury their mistakes. Things should get better with many guidelines from top professionals around the world. But too many doctors are still stuck in the “We’ve always done it this way” mindset.
I agree with doctors that say controlling gout without meds is the best approach. But all they see is you not going to bother them because you minimize pain, or deal with it. They should be calling you in at least once a year, making you understand if your uric acid levels are safe, borderline, risky, or dangerous. They should be helping you plan a diet that includes food that you like without damaging your gout. They should be advising you on exercises that do not cause more damage to gout-ridden joints.
This year, i hope to spend some time with one of the UK’s top personal trainers. Hopefully we can come up with some great gout exercises that suit all levels of activity. (Yes, Alan, I know – another ‘coming soon’). Also, another ‘coming soon’ are the safety stats for low dose allopurinol. I know that when I went on allopurinol, I checked these stats first, but I’m struggling to find them today. I was happy that 100mg never caused severe damage, though I was sure to look out for it. The stats are incorporated into the British, European, and American Rheumatologists Guidelines for gout treatment. I’ll need to check through the references to find the stats.
One point is that the British guidelines suggest 50 – 100 as the starting dose. Given your concerns, and risk aversion, I recommend 50mg if you do start. You’ll probably need to get a pill splitter for this. Rather than go into detail on the exact routine now, I say, if you want to start allopurinol safely, let’s start another thread to do it step by step.
I don’t agree that you can ignore excess uric acid as long as the heart and kidneys are OK. There’s enough evidence to prove that untreated high uric acid will eventually attack both those organs, along with every other organ in your body, except the brain. Therefore, it is a doctor’s duty to advise on proper uric acid control.
There are problems with avoiding beer, shrimp, chicken liver casserole etc. What do you replace them with? How do you know that the choices you make are the best ones, if your doc doesn’t check your uric acid every 3 months? He’s going to be in work as your health deteriorates as you get older. Why should he care?
There’s a lot you can achieve with gout diet, but are you prepared to test your urine pH every week/month?
Are you able to put percentage numbers against the part these food groups play in your weekly food intake:
Grains
Meats
Cured meats
Eggs
Cheeses
Legumes
Potatoes
Vegetables
Fruit & juices
Milk & dairies
Bread
This is where most people fall down with a healthy diet, because over half their weekly food intake is processed ready meals, takeaways and other food-like substances that are difficult to analyze, and very bad for gout.Anyway, I’ve gone on long enough about this.
Rather than jumping around between here and facebook with loads of random questions, it is far better if you start a new topic with a single question. You can start a hundred of these if you want – eventually, it all comes together in a plan.
I think it’s best to start with what are the most important things to you, Alan. Do you want to go with easy allopurinol in a way you feel safe with? Or do you want to spend some time planning a gout friendly diet that works for you?
If your uric acid level is the 7 that you mentioned earlier, either way will be successful if you play by the rules. If your uric acid level is 9, you are unlikely to be able to survive much longer without uric acid lowering treatment, but a combination of good diet, and appropriate herbal medicine might do it.
Only you can judge which is best for you.
Hi again, Ray. Thanks for adding some facts to your profile. The more info I have, the easier it is to help.
I can see that you want to try to beat gout without using drugs. This might be easy, hard, or impossible, but only your uric acid test results will tell us. Using your test meter should be fine, but the strips go out of date, so you have to get new ones. Personally, I think it is your doctors job to test for uric acid, but if you want to use your own test kit, that is fine.
Some people test everyday. That is good to get more data and practice. Once a month should be OK, but there is a problem. Though home uric acid meters are accurate, the blood collection process is far below the standards applied to a proper clinic test with venous blood. Contamination, droplet size, and test site, can all confound the results. Therefore, with home tests, you should ignore upper and lower readings, and focus on the average. Once or twice a week should be enough. Whatever you choose, all gout sufferers must get uric acid tests at least once a year from their doctor. Liver function and kidney function should be included.
I need to discount external causes of gout. Do you take any meds for other health conditions? Are you exposed to lead or other environmental toxins?
To build a proper gout treatment plan that suits you, our main focus should be on lifestyle. Diet and exercise form the basis of the plan, which we might consider tweaking with supplements and herbal remedies later. We start this by getting more facts in your profile. If you live alone, the easiest way to start this is your shopping list – just record all food and drink you buy every day. Otherwise, record each meal that you eat. I strongly recommend logging in each day to do this, but if you have to do less, just try to be as accurate as possible.
Many gout sufferers have favorite foods that they think they can’t eat, so if that applies to you, make a note of it. Also make a note of physical activity. In your profile, you mention workouts, so please add details of these. However, the best exercise for gout sufferers is to incorporate it into daily life. Walk more, and use stairs before elevators.
The sooner we get good information to assess your current lifestyle, the sooner I can start to prepare a Personal Plan for you. If you can put some recent history of diet and exercise over the last month or so, that would make for a quicker start. If you get stuck, shout out here, or use the Support Button on the left.
Ray, I must leave this for now, so I’ll return later to discuss gout rash and your other points.
Hi Stuart, thanks for a good question.
I have a vague memory that this has been discussed before, and a pill-cutter was discussed.
So try searching for Uloric pill-splitter. But if you cannot find one, please start a new gout resources topic.
There’s also a link there for the discount scheme that you mention. Other financial help is available from needymeds.org.
Pill-splitting is generally considered acceptable for all common uric acid-lowering pills. These are not something that are normally enteric-coated. However, some patents have been applied for, so specialist versions of febuxostat might become available. It will be obvious from the labeling if these are coated or not. Uloric is not enteric-coated, despite what you might read elsewhere.
My first reaction is: go ahead! Then I thought a bit more.
Uloric, just like any other uric acid lowering treatment, must be dosed to meet your target uric acid level. As you have 40mg now, you really must get uric acid tests after 2 to 4 weeks. If 40mg does not bring your uric acid down to 5mg/dL, or lower, you might actually need the 80mg. Also, I believe that there is a very strong argument for aiming much lower than 5mg/dL for your first year of treatment. That gives you the fastest way to reduce your risk of continuing gout flares.
Also, you might have the option of alternating an 80mg dose over two days. This is easier with allopurinol, which stays in your body about twice as long as Uloric. This is something you need to discuss with your doctor, as the effects of missing a day on Uloric might be more serious than missing a day on allopurinol. If you have that discussion, please come back and share your doctor’s advice.
My main concern is that you get the right dose of Uloric to get your uric acid safely down to 5mg/dL or lower. If you don’t achieve that, it is a complete waste of money.
My secondary concern is that 80mg Uloric tablets are tear-drop shaped. I believe this is a deliberate ploy by the manufacturers to discourage pill-splitting. With a good quality splitter, you should be able to split the pill horizontally along it’s long axis. See the picture about a third of the way down Uloric Prescribing Label http://www.goutpal.com/gout-treatment/avoid-gout/febuxostat-fixes-gout/uloric-prescribing-label-2012/
I don’t think you need worry too much about the accuracy of the split. An important part of uric acid control is that we must account for natural variations in uric acid level. The 5mg/dL target gives a safety margin.Stuart, I realize that what I’ve said complicates a fairly simple question. I feel I must point out all the important aspects. If I have not made it clear, then please tell me, and I’ll try again. I don’t want to complicate matters unnecessarily, but I do want you to be aware of all the salient facts. Similarly, I want you to be aware of the need for proper follow-up blood tests, but we can leave that for another time.
Gout sufferers should make sure they get a uric acid test at least once a year. If you take any meds, you should also definitely get liver function and kidney function at the same time. I recommend these extra tests even if you are not taking meds. Untreated excess uric acid often leads to organ damage, so these tests once per year could save your life.
Stevens-Johnson Syndrome (SJS) caused by allopurinol only happens if the doctor prescribes recklessly. Many drugs are poisonous, so we should expect doctors to take care, and follow safe prescribing guidelines. But we know that some doctors are negligent. It is the negligent doctor that should be avoided, not the treatment. All medicines are a matter of risk management. A good doctor balances those risks carefully, to make sure that the patient is safe. International guidelines are now very clear on this. For most people, allopurinol is completely safe. People who are at risk of SJS and similar reactions can be identified by genetic screening. For everyone else, 100mg is safe, and that should be the starting dose. Monitoring patient reactions and bloodwork is the doctor’s responsibility throughout the treatment. How many doctors do this?
The simple fact is – yes, prolonged uric acid of 7mg/dL can kill you. It takes a long time, but it is a real risk. The common reason is heart failure or kidney failure. Kidney failure is usually the result of damage by kidney stones. Heart failure takes two forms that I know of, but there might be more. It can be as a result of valve damage caused by uric acid crystals around the heart valves. It can also be a more generalized cardiovascular reaction to inflammation in the blood system.
It’s right to worry about the dangers of allopurinol, but only if this is in the context of your own personal situation.
As I listed in my earlier response, there are 3 alternatives to taking drugs for lowering uric acid. If all these fail, then you can make an informed choice – do I risk death from drugs or death from gout? These risks can be quantified to a degree, but all we are really talking about is risk management. It is good to make the personal choices that are right for you. In my opinion, it is wrong to close your mind to real dangers, and it is pointless to choose some dangers but ignore others.
It is my responsibility to point out that gout can be fatal. If you turn round to me and say you fear drugs more than a painful lingering death from gout, then I can accept that. There isn’t much help I can give in those circumstances, but I’m happy to discuss it. What I really hate is gout sufferers making the wrong choices because they ignore the truth, or because their doctor takes an easy way. There’s not much I can do about that, except to be here when people seek help.
On a final note, Alan, it’s almost an interesting fact that you’ve had gout for 15 years. I had it for longer than that, and thought I had it under control. Then as I passed 50, all hell broke lose. More joints affected. Attacks nearly every week. Lumps forming under the skin. Restricted mobility in knees, ankles, elbows and shoulders. So I took control. I will still be here in another 15 years if you decide to take excess uric acid seriously.
I hope you will be.
Hi Ray,
No worries – this is a great place to rant about gout.
If you want to do more than rant, we have to take control. That means getting your uric acid safe.
There’s hundreds of options, so I won’t list them all. You need to tell me which way you want to go, and I also need your uric acid test result history.
It’s easier for you if you login, and put those facts in your Personal Gout Profile. Get your uric acid test results from your doctor, then add them to your profile in date order. Uric acid test results are a number with a scale that is either mg/dL, mmol/L or μmol/L. Your choices of which way to get uric acid safe are:
1. Find a way to get back on Uloric
2. Find a pharmaceutical alternative to Uloric
3. Find a herbal alternative medicine to Uloric
4. Investigate lifestyle changes
5. Investigate your cause of gout to see if it can be avoided.As I say, let me know your preferred way, and I’ll help all I can.
Or if you just want to rant, feel free to do it anytime! 😉
Your right, it’s possibly gout.
Without a physical examination, and appropriate tests, I can’t say if it is, or if it isn’t.
After your appointment, please be certain to get your exact uric acid levels. This should be a number with a scale that is either mg/dL, mmol/L or μmol/L. I strongly recommend you login here, and add your uric acid test result to your personal gout profile.
Before your appointment, and uric acid test result, there is little more I can say. However, if you are unsure what to ask your rheumatologist about gout, please let me know. I’ll try to think of some good questions that are appropriate to your circumstances.
It’s fairly common, Gabriel.
A bursa (plural = bursae) is a part of joints that allows tendons to slide easily over bones. Uric acid crystals cause damage to all parts of your joints, and when a bursa becomes inflamed in this way, it is called bursitis. It seems to be particularly common in elbows. One member called his gouty elbow with jelly like swelling as his “jelbow”
The answer is to get uric acid under control which dissolves uric acid crystals, allowing your joints to recover.
I hope your doctor is giving you the right advice to get uric acid safe, in a way that is right for you. If that is so, please share your plan to remove excess uric acid, as a way to end your gout and bursitis. If you don’t have a good personal plan, please login and ask.
It’s great to get personal examples of what works for gout sufferers, so thanks for that Eric.
To Elsa’s fiance, and anyone else who wants to control gout properly, I say take that advice. But personalize it to suit your own circumstances. Because it is very important to be able to control gout pain. However, you need to be aware of long-term risks of excess uric acid. So, by all means, do everything you can to reduce the risk of gout flares. But always make sure that your uric acid levels are safe.
When levels are much over 6mg/dL, crystals will form. Then that can cause serious joint damage and fatal organ damage. As Eric says, early gout symptoms can be interpreted as a blessing in disguise. Because you can learn the importance of uric acid control in your twenties. Then you are well placed to avoid crippling damage in later years.
Note: this sort of damage occurs very slowly. But happens even when you are not experiencing a gout flare. So, keeping uric acid at 5mg/dL gives you a safety margin that ensures you never get serious damage.
Avoid being scared of gout
On Eric’s specific points, I’d like to comment:
1. If you do stop low dose aspirin on the grounds of gout risk, be sure to discuss this immediately with your doctor. It seems pointless to me to avoid a gout attack, only to die of a heart attack. Your doctor should be able to come up with a plan that minimizes the risk of gout attacks and minimizes the risk of heart attacks.
2-7 are all valid points to consider in a good gout diet. However, I do not think you should look first at individual points. To get a good gout diet that will minimize or replace medical treatment it is important to create an effective personal plan. Such a plan looks at your current food and drink intake over a typical week. We also need to consider your mobility and exercise levels. Most importantly, we have to consider your personal likes and dislikes.
If you don’t like black cherry juice, consider other dark berry juices such as blackcurrant, or the Black Bean Broth celebrated elsewhere in this forum.
Instead of Apple Cider Vinegar, consider other herbal medicines for reducing inflammation, such as turmeric.
If you don’t like plain water, choose other drinks. Type and quantity are not as important as ensuring your urine is always light straw color.
Choose the vegetables and fruit you like and make sure these makeup at least half of what you eat. You should eat at least twice as much veg than fruit, and as much variety as possible.
Exercise as much as possible, choosing the activities you like. Aim to walk 10,000 steps per day.
Be aware of the bad foods that you must moderate. Purines are only one of the five bad parts of gout diet.If anyone needs help, start a new discussion about your gout diet and what you hope to achieve.
It always worries me when people say they control their gout but never quote uric acid levels.
There are lots of alternatives to allopurinol, and they fall into 4 groups:
1. Identifying root causes of excess uric acid, and removing them, if possible
2. Lifestyle changes
3. Herbal medicines
4. Pharmaceutical alternatives such as febuxostat (Uloric), probenecid, and others.All 4 of those groups are widely pushed on this website. That’s because this is a website that helps individuals find their own best way to control excess uric acid. All people need to do is state which of these they prefer, and I will give the best advice to make uric acid safe.
The 5th alternative is ignoring excess uric acid. I do not help people do that, because it is dangerous. It is more dangerous to ignore excess uric acid than to treat it. Any doctor that causes Stevens?Johnson syndrome, is a dangerous fool. Anyone who thinks people take allopurinol just to eat meat and drink beer is misinformed.
The real issue here is:
Will @1oldswabby ever return to respond to thread he has started? If you’re listening George, don’t risk the dangers of untreated excess uric acid. Tell me if you want to avoid pharmaceuticals, and I’ll help you with your preferred solution. I can’t do it if you don’t respond here.Cheers Ron 🙂
I see it very much as a two-way partnership, or better still, three-way if you include your doctor.
I see my job as being to help gout sufferers, and I can’t do that just by writing pages of stuff on GoutPal.com
My knowledge, gleaned over many years of investigations, and personal experience, only comes to life when I discuss it here. It gains meaning, and I learn to express myself better through interesting discussions.
Trust me Ron, I need you, and people like you, just as much as you need me. Your posts mean a lot, and I’m grateful you intend to post weekly.
Many gout sufferers understand their own gout more when they respond to the questions and experiences of others. I’m currently committing as much time as I can to encourage people to post here as regularly as possible. Thanks, Ron, for doing your bit.
I hope you’re enjoying your weekend, Ron.
Thank you for the inspiration for http://www.goutpal.com/7734/make-room-for-gout/
I couldn’t have done it without you. 🙂
