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Hi Marc,
Before I address the individual points you’ve raised, I’d like to clarify how I offer my gout help services. Either, you can continue with one-off questions, as they arise (I call this Casual Gout Help). Or, you can start a gout diary. Then, follow that up with step-by-step plans to manage different aspects of gout (I call this Structured Gout Help).
“steel toe boots all day everyday”. Boots are great for supporting gouty feet. But, the issue is standing all day, which would be much more painful with less supportive footwear. So, I suggest we fix your gout. Then, you can make job choices based on what you prefer to do.
As for diet, you have to step back, and look at the big picture. Because gout diet is about managing weekly meals in total, not individual foods. Spinach, broccoli and milk are great parts of a good gout foundation diet (please checkout that survey). Also, chicken and moderate amounts of other meat and fish have a healthy contribution to make. And, supplements can have their place in a healthy diet. In which case, there are strong pluses, and some minuses, with whey protein for gout. But, if all you eat is spinach, broccoli, milk, and chicken, you do not have a healthy diet. So, for the best gout diet, you should only think of individual foods when you are looking to tweak your diet to meet your goals. For instance, you might ask if you can get nearer your uric acid target by reviewing your chicken consumption. Then, in the context of your weekly meal plans (or shopping cart), you could consider changing some of your chicken for something else.
Hey Ruben ( @ruben-k ),
I’m sorry if this general discussion has put you off. Please let us know how your gout recovery is progressing.
Firstly, on: “I have been on allopurinol and uloric at different times in my life. I stopped using them because I did not like the idea of being on meds for extended amounts of time.”
It’s OK taking a break from uric acid control. But, that break has to be managed. So, you have to consider many aspects of gout management and your history. Then, you can plan and monitor a period of “allopurinol vacation”. Remember, there are too many factors to set a general plan for this. It requires accurate gout history, and deep understanding of uric acid control. Also, being on meds for extended amounts of time is always safer than uncontrolled uric acid. Because, excess uric acid is fatal.“is this dosage too low considering my long history of gout?” The important factor that determines allopurinol dose is uric acid blood test result. So, test after 2 weeks, including liver function and kidney function tests. If all OK, increase allopurinol. Then, repeat every 2 weeks until you reach your uric acid target. But, if you haven’t agreed a target with your doctor, we can discuss that.
“colchicine and celery seed extract”. Colchicine is great as a preventative. But, sometimes a flare can still start. So, you need anti-inflammatory support, at such times.
Now, the issue I have with celery seed extract is, I cannot find any toxicology reports. Or, recommendations on safe human dosing. But, there are several laboratory reports of anti-inflammatory action. Also, it might assist with uric acid control. At least, celery seed extract helps artificially induced high uric acid in rats. So, it’s frustrating to see that celery seed extract might help. But, I have no idea if a dose that is effective against gout pain is safe. Anyway, the most important thing is to find something that works for you.
Ruben, in 15 years of gout have you ever found pain medicine combinations that work for you?
I agree 100%, nobody. Unfortunately, I’ve fallen into my common trap of generalizing about comments rather than addressing the specifics of Ruben’s post. I’m concerned that I’ve contributed to the failure of getting any response from the Original Poster. ๐ณ I must try harder.
Wow Cindy, I’m doing a dance of happiness for Mr Tang! ๐
The time between allopurinol dose increases is variable, depending on how quickly the doctor and patient wish to proceed. Coincidentally, I read a report earlier today where a doctor said change after one week was usually OK. But, I prefer a more cautious 2 weeks.
From what I’ve read, most patients seem to wait a month before increasing allopurinol dose. Also, I think anything longer than 6 weeks is too long. Because, it suggests a lack of urgency.
However, the most important thing is to check kidney function, and liver function when uric acid is tested. So, once the tests have proved OK, the allopurinol dose can be increased as soon as the test has been checked. But, if kidney or liver shows abnormal trends, the dose can be maintained or reduced.
To conclude, I think, if liver and kidney functions are OK, increase allopurinol now. Then, test again in 2 to 4 weeks. Otherwise, your doctor should assess your husband’s results carefully.
Hi Christopher,
I’m really pleased you’ve got the answers you need. So, massive thanks to nobody for helping you out. It’s comforting to know that gout sufferers can get answers to questions, even when I’m busy for a few days.
Christopher, I hope you’ll create more new topics with any other questions, experiences, or opinions about your gout. Good luck with your continuing recovery.
Please can you complete the short survey at Mediterranean, DASH, or Alkaline Diet for Gout?
I’ve not included EFSEP, or Zone Diet, in the survey. Because, I want to focus on the food scoring methods I mentioned for Gout Foundation Diets. But, I will include them in the articles I write from results of that survey. So, if you want to see some new ways to manage food changes for gout, please submit the survey.
Hi Marc,
All I can add to nobody’s comments is to suggest you get a uric acid blood test as soon as possible. Because, every day, your gout is going to get worse, until you get uric acid safe. Of course, we have to consider gout pain relief until you get uric acid under control. But, your uric acid numbers are everything now.
So, if you have had blood tests, can you get the history from your doctor? Then post the numbers here. We need dates (can be approximate), and exact uric acid level with unit of measure. But, if you haven’t had uric acid blood tests, can you arrange one soon?
Then, we can work out if you prefer drugs, herbal gout medicine, or lifestyle improvements. So that we can finally end your gout problems.
Personally, I can see no logic in delaying allopurinol treatment at effective doses. Because, the advice to start at 100mg then increase, is mostly safety advice. It takes up to a month for serious (rare) allopurinol side effects to show. So, 100mg; test; 200mg; test; 300mg test is very effective with tests every 2 weeks. Also, the repeated testing, which must, of course, include liver function and kidney function tests makes for an extremely safe form of treatment.
Whereas, delays to clearing old uric acid crystals are dangerous. Because, in the worst case, crystal deposits can fatally damage your heart. But kidney damage, skin infections, and permanent joint damage, are all unnecessary common consequences of failing to control excess uric acid. So, you might think I’m laboring the point. But, excess uric acid is dangerous.
So, I believe high doses of allopurinol, within the bounds of side-effect safety checks, is the safest way for gout patients to recover. Also, Ruben has taken allopurinol before, so it should be safe to move forward quicker than the average gout patient. Assuming adequate safety tests were performed during earlier therapy.
Now, I move on to pain control.
Firstly, there is no guarantee you will get another gout attack, Ruben. As long as you get uric acid safely below 5mg/dL. Because, my mantra is: you might get a gout attack during uric acid lowering. But, you will definitely get a gout attack if you do not lower uric acid. Also, from my above, gout attacks are not your biggest problem.
Secondly, uric acid lowering therapy without gout pain control is like surgery without anesthetic. Because, it’s sadistic, unnecessary, and medically unprofessional. It’s easy to prevent gout symptoms for the six months it takes to get old crystals dissolved. Or, with enough experience, it’s easy to recognize the first signs of a gout attack, and stop it in it’s tracks. But, Ruben, I can assure you that gout laughs in the face of celery seed extract.
Finally, I’ve never seen any evidence to suggest that gout flares during early allopurinol will increase if dose is increased. Indeed, logic tells me that the opposite must be true. Because, we absolutely know that uric acid crystals dissolve faster when uric acid is at it’s lowest. Then, faster dissolution of old crystals has to reduce the risk of gout flares. Also, it must reduce the intensity and duration of gout attacks.
Of course, I’d love to be told if I’ve got this wrong.
Also, d_q, thank you for the links to my articles. I appreciate it.
Hi Rich,
There’s no point in guessing about test results. So, all I can say is, it’s too high, irrespective of gout or not. So, as nobody suggests, now is the time to think about lifestyle improvements.
You said: “i m 31, 64 kgs, with a clean diet, not too much alchool, few beers per week(4,5) not every week. no soda, no processed food (only sometimes)”. But, that’s not necessarily a healthy eating plan.
My absolute minimum standard for healthy eating is the DASH diet. But, I much prefer Mediterranean style eating plans. These are not gout diets. But, they form a good foundation for healthy lifestyle, that can be tweaked for better gout control. At this stage, whether it’s gout or not, you have to assess if your diet is really “clean”. Because, high uric acid is also associated with a host of other diseases. But, most diseases respond well to real lifestyle improvements.
So, if you want a personal healthy eating plan, look at How to start your Personal Gout Diary. Or, we can just wait for your next blood test result.
you can assess the effectiveness of a UA-lowering intervention by looking at the average duration of your symptoms. If most of your symptoms go away quicker than they used to, you are on the right track no matter how unusual the symptoms are.
That’s a great reason for maintaining a gout diary. Because, as well as recording test results and treatment changes, you can also record symptoms. Especially, if you record days with no symptoms, you have good information to confirm gout recovery.
As humans, we tend to focus on the unusual, then forget all the good days when we are symptom-free.
OK, Gary, you now have your own personal space to keep your gout information. So, please let me know if you need any help organizing it. Also, let me know if you want me to move your other 2 topics that you started into this personal forum.
As well as organizing your gout information, you can also ask better questions here. Because, you can flag questions as support requests, which I will answer as my first priority.
It is most likely to be gout. But, you should return for another uric acid blood test once your symptoms have resolved. Because, uric acid in the blood can fall during a gout attack. As dissolved uric acid moves into joints as crystals.
You also need to get gout strength pain relief as soon as you can. Your Ketonal Retard should help with this. It is a Non-Steroidal Anti-Inflammatory Drug called ketoprofen. But, it is unlikely to be strong enough at Over The Counter strength. So, see a doctor or pharmacist about something stronger. In my experience, gout pain resolves better if you can stay mobile, with gentle exercise. Also, opinions differ, but I believe gentle heat is better than ice for gout pain.
Thank you for those numbers, nobody. They definitely support your notion of not getting tested often enough. We can see that January, February and March are all spent assessing allopurinol sensitivity, rather than controlling uric acid. And even if we allow for vagaries of testing accuracy, this seems too long to me.
So, we have a strong likelihood that d_q’s uric acid is only now getting low enough for old crystals to dissolve in any significant number. Therefore this sounds like exactly what happens to most gout patients during the early weeks of uric acid lowering. I.e. gout flares in unpredictable joints.
Now, to many people, that sounds like bad news. But, it’s only a temporary situation. As more crystals dissolve, attacks become less frequent and less intense. Also, it might be worrying if a patient is already on maximum allopurinol. But, even in that situation, gout patients have improved their rate of recovery by adding probenecid to their allopurinol. So, if my view isn’t obvious, I’d better state it:
Titrate allopurinol from 100 to 200 to 300 mg per day. With test and dose change every 2 weeks. Then, if there are no adverse events, increase to 600 ten 900 (800 in USA). Once you have no symptoms for 6 months, reduce allopurinol slowly to a maintenance dose. There is debate in the rheumatology profession if this maintenance dose should be 300 or 350 μmol/L.I hope that we get enough data from DECT experiments to allow us to judge when all uric acid crystals have dissolved. I guess there should be an approximate formula based on how long a patient has had gout, and the level they get down to during uric acid treatment.
The foot pain might have nothing to do with gout. So, if it persists, you should get it examined.
But, let’s assume it’s gout related. If it is, when you’re reducing uric acid, it’s all about the level that you’ve reached. I can’t recall us ever discussing your uric acid targets. But, you should have a target for the debulking period. Also, a maintenance target for when you’ve gone 6 months without any symptoms.
Now, those targets are not strictly related to your foot pain question. But, they put it into a meaningful context. Otherwise, we just end up talking ifs, buts, and maybes. So, can you post your targets if you have them, and the last 2 or 3 uric acid test results?
Moving on to my allopurinol management plan. The truth is, I never really had one. The nearest thing I got was to aim for uric acid as low as possible during my debulking period (which is probably the best plan).
You really do not want to follow my example, d_q. I was spurred into action by a near-fatal accident. 3 and a half years later, I prematurely quit allopurinol because I was too depressed to leave home. Then, I kept making stupid excuses to myself for not restarting. The only good news is, thanks to you, I’m going to make an appointment today, and get back on the allopurinol.
So, I’m not really qualified to give any advice about gout management. Except that, like most teachers, I can explain the theory, even if I have no clue about practical reality. Therefore, my recommendation is to wait until you are fully recovered before you even think about pausing allopurinol treatment. But, I guess it’s good to think forward. So, any break needs monitoring by uric acid tests. Unfortunately, these ideas about allopurinol ‘vacations’ are very new. That means, we have no ideas about how long it is safe to take a break. It would be stupid (like me) to wait until gout symptoms return. So, a year off is probably OK. But, we need DECT for gout before this can ever be a reliable way to manage allopurinol treatment. My feeling at the moment is, once I get back on allopurinol, I’m unlikely to consider stopping it again. But, I can’t guarantee that some foolish action on my part won’t change that!
Reading this back, I suspect I haven’t been particularly helpful. Sorry, I’ll try harder next time.
I’m pleased that I just published Do you know 9 Golden Rules of Gout Management?. Because, it converts my gamechangers into something tangible that should benefit all the gout sufferers visiting GoutPal in future. Next, I will go through each rule, and create practical guides for people to learn these essential gout rules.
Along the way, I’ll close this Suggestion, and replace it with an “Improving” page. But, there’s no rush for that. So, please keep posting your thoughts on Gout Rules here.
Hi Jean,
I wonder if you’ve tried varying the time you take allopurinol to see if that has any effect on your digestive problems. For example, you could try one of the following for a few days:
– Take allopurinol before eating.
– Or, take allopurinol during your meal.
– Or, take allopurinol after eating.Then, if you make a careful note of your symptoms, you can compare strategies to see if any works best. Also, you could vary the amount of time between eating and allopurinol. Or, experiment with breakfast, lunch, or tea.
Also, have you seen the Gout and Antacids topic? We discuss different types of antacid and their possible effects on gout. I haven’t included Gaviscon yet. But, I can see there are different formulas under the Gaviscon brand. So, there could be different effects on gout sufferers. For example, I noticed that one of Gaviscon’s antacid formulas contains Sodium Bicarbonate. Which, is not great for gout sufferers, or anyone else, if you’re taking it every day.
Today I realized how important these Gout Gamechangers are. Because, I believe there are key facts that every gout sufferer should know. Furthermore, these are so important that:
1. We can interpret them as rules of managing gout. Because, if we ignore them, we will reduce the speed and quality of gout recovery.
2. I need to consider training courses for understanding each rule.
3. I must highlight them clearly so they are easily accessible to all GoutPal visitors.Also, I’ve identified 2 more Gout Gamechangers:
– Gout management must be personal on a case-by-case basis. So, the common practice of one-size-fits-all gout treatment plans is dangerously outdated.
– Gout is a killer disease. So, the fact that autopsies are starting to consider gout as a cause of death means enlightened gout mentors will stress the importance of early uric acid control.So, that makes a total of 9 rules, so far. But, I must resist the temptation to number them. Because, they are all equally important to total gout care. Also, we should never forget the unwritten rule of all lists of rules:
Rules are made to be broken! However, you must realize that they can only be broken when you fully understand the rule. Then, you also understand the circumstances that make the rule important. So, you might identify special circumstances that suggest a better way.
Anyway, I’m going to start the process of highlighting the rules of gout management. Because, I’m working on a new article that summarizes these Gout Gamechangers as important rules. So, if you have any rules that I’ve missed, now is the best time to add them.
Please add your comments about the rules that I’ve already identified. Then think about adding any that I’ve missed.
Thank you.
