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agent,
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Old fart here.
I HATE when doctors diagnose by averages: “Oh that's usually a virus” does NOT mean that bacterial infection no longer exist. “Oh those spots are generally not cancerous” does not signal the end of skin cancer.
I mean really. “Most people aren't run over by buses” shouldn't mean we need not look out while crossing streets.
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What you need is a solid diagnosis and if you have gout you need to get on medication, usually cheap, effective allopurinol.
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A doctor COULD get a solid diagnosis by testing the content of your ear bumps for urate. He could also draw fluid from your knee and check for crytals under a microscope. And actually I doubt if there is any other disease that causes lumps on the ear cartilege.
Ask an Italian?pharmacist what he charges for colchicine. It is highly and quickly?effective against gout pain. If it works it is usually diagnostic because it doesn't work well against other types of pain. You will need about 16 teeny pills.
momoy,
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Are you taking any analgesics with the allopurinol? Don't be afraid to take whatever?eases the pain?it won't interfere with the allopurinol…in fact, it will help by stopping the inflammation>>acidification>>precipitation process.
If I summarize all this correctly, I can expect to be able to enjoy most all foods again, but in moderation.? Would that be correct??
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Yes, Once your meds get your uric acid down below 5.0 you will be able to eat pretty much anything you want. Probably just below 6.0 not quite so safe.
The meds give us a good semblance of a normal life.
ESABOGAL,
Great DATA KEEPING?those two charts say it ALL! I am so impressed, words would not do it justice.
They should be reprinted in the LANCET.
Any goutie who doesn’t see them BEFORE all the bullshit about cherries, strawberries, blueberries, elderberries, witchcraft, prayer, and Lourdes is being paid a disservice.
It really IS so SIMPLE:
For most people with gout 300 mg./day allopurinol “til death do us part” will end all ramifications of this disease.
So, SO simple.
Gerry,
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I had to reread your post. I breathed a sigh of relief when I realized that the picture was the OLD one and not the “new improved” toe.
Why not post of picture of “after.”
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Damn tophi,
I raised another one the size of a small citrus seed on the second joint of my left index finger. I guess I am proving that we can raise tophi, presumably in cold joints, ?without having an attack. I will say that I think STRESS is a stong adjutant to tophi formation.
I tried puncturing it with a carpet needle yesterday but no luck. If it continues to get on my nerves, I'll silce it with a sterilized razor blade.
There are many things that uric acid might or might not do.
But what it CANNOT do in the human body is be oxidized, hence it is NOT an antioxidant, no matter HOW many people, scientists included, mistakenly claim otherwise.
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In their defense, in most species uric acid CAN be oxidized to allantoin and then it is a reducing agent, aka antioxidant. The same can be done in a test tube BUT NOT IN HUMANS.
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So for those fond of antioxidants (like wood, paper, sugar, hydrogen, cheese, or good salami and alcohol 😉 ) uric acid is an antioxidant, but NOT in human biology.
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Perhaps its? evolutionary advantage might be upside down…maybe it's ALLANTOIN that keeps lower species lower? :D:D Is there anything special about the Dalmatian, vis a vie other dogs? Uric acid is not an antioxidant for them either.
When ANY disease is incurable, out will come the 1,000 foods, herbs, nostrums and prayers to enrich the charlatans selling the crap. People with incurable, untreatable diseases are desperate.
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It is a shame that when a REAL and USEFUL treatment comes along, the crap peddlers persist and people STILL fall for the old nostrums.
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It happens with all disease, from plague to cancer.
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Before 1950, gout was virtually untreatable except for pain mediation and was a slow death?sentence? but that did not stop doctors (both real and witch) from prescribing useless remedies while bilking patients in excruciating pain.
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In reality, somebody with an elderberry orchard probably heard the cherry growers were making a FORTUNE on “gout cures” and thought he'd get on the banwagon. Like I said, human nature.
For the elderberry lovers:
- The flowers have been used in Europe for many years to cure fever and colds? It is also used as an expectorant to cure asthma and bronchitis
- It is effective against flu
- This herb is often used to cure and prevent upper respiratory infections. Research shows that elderberry can decrease mucus secretion and can even reduce the swelling in the mucus membranes and can decrease nasal congestion
- The flowers as well as the berries of the elderberry tree are used for making medicines? The berries contain flavonoids, which are known to protect the body from free radicals, boost the immunity, and add flavor to food. Initial studies have shown that elderberry can be used to treat herpes, viruses and maybe even HIV
- The bark of the elderberry tree has been known to be used to cure constipation and water retention? It is also used to induce vomiting
- The leaves of elderberry are often used with creams and in sitz baths to cure eczema, boils, arthritis and other inflammatory problems
- People prefer to use elderberry in herbal mixtures and as elderberry syrup to treat bronchitis, sinusitis and influenza
- Traditionally, elderberry has been used to treat and bring relief to congestion, water retention, inflammation, and to relieve pain
- It also cures infections, diabetes, rheumatism, inflammatory diseases and neuralgia
- Elderberry can act as a laxative, as a medicine to cure skin disorders, can aid in weight loss and as a diuretic
In my experience, any food that is claimed to cure EVERYTHING, cures nothing. Best, and cruelest line: “and maybe even HIV.”
It is a shame that claims like that can escape criminal prosecution.
Let me spout off on another old saw that I also have read dozens of times and that is that uric acid is an ANTIOXIDANT.
I disagree, it is NOT.
Firstly, I get antsy when anyone touts some “new” supplement as being an antoxidant because the phrase merely means a reducing agent, something that GETS oxidized. Thus wood, hydrogen, sugar,?and gasoline all qualify.
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That said, uric acid doesn't even qualify under that broad umbrella. Here's why: There are several steps in the oxidation of purines, enhanced by the presence of the enzyme xanthine oxidase, in the formation of STABLE uric acid. (It can be further oxidized to allantoin?by most species but not by man, so that pathway is irrelevant.)
Thus uric acid is the end product of the oxidation and thus CANNOT be further oxidized. It is NOT a reducing agent and thus NOT an “antioxidant.”
Yes, xanthine, hypohanthine, and a long list of derivatives CAN be further?oxidized and thus are antioxidants, but NOT uric acid. An analogy is that hydrogen is a reducing agent and an antioxidant but water is not?it is formed as the final oxidative product of hydrogen and oxygen.
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If anyone holds to the “uric acid as antioxidant” mantra, he must first demonstrate what iit is oxidized TO. Of course he cannot. Urate, in the human body, once formed, is pretty much inert; all it can do is be excreted or crystallize.
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(Nothing on you trev, the same thing is repeated ad?nauseum and without question all over?the web.)
I just attended a convention with one of the vendors sporting ELDERBERRY VODKA. It was quite delicious and I give “plain” vodka a wide berth becausue to me it tastes like rubbing alcohol.
I'm sure it would give me a rosy glow but I would NEVER consider it a substitute for allopurinol.
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Dan,
You are skating on thin ice experimenting with food replacements for your allopurinol. There are none.
But I guess each of us finds that out in his own painful way.
I was stupid enough not to bring back allo again.?
?GP said it all but let me add that the word AGAIN should never be added to that phrase. The proper phrase is:
“I started allopuinol 2 years ago and I have taken it every day since.”
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Do NOT use allopurinol in a hit or miss fashion. Once started it MUST be continued or there is the devil to pay.
It sounds like you are doing fine. I'm glad your trip to Mexico wasn't kebolluxed?by an attack.
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Perhaps your plan for all that colchicne is overkill but you will find out and adjust accordingly.
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It feel good to have a big pile of colchicine?in your closet doesn't it? (Ay carumba senor, mucha colchicina…ole'!)
hansinnm said:
Now, Patrick, don't you play “gouty god”. It's enough having Zip playing “God Gout”.
Not?”everyone says on this site, it's the only reliable cure“. I, for one, am allergic to Allopurinol, therefore it is NOT the only cure, as far as I am concerned.
I ask you to be careful to make blanket statements on this forum. The majority of people on this forum need sincere, proven statements. They get plenty of bullshit from the so-called “professional medical industry”.
You know, hansinnm,
Sometimes it get REALLY tedious making allowances for crabassy old farts, even if they are carrying around pounds of tophi in their feet from years of mismanagement of gout.Save your smart-ass shit for those around you who find your demeanor “interesting” although I am sure they are few and far between.
Kim,
Not to naysay your doctors but what is sounds like is that you had a horrific?staph infection from an insect bite that caused cellulitis.
I had the same thing?from horsefly?fly bites on my ankle with the need to cut my shoe off at the hospital.
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The day before your attack, were you outside with bare ankles?
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Did you have any blue or purple streaks up the calf?
(My infection was stopped with a massive dose of antibiotics.)
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Gout is terrible but cellulitis is far worse.
Art,
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So sorry you flared up again.
I hope the attack abates soon.
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I would normally say consider upping the allopurinol to 400 mg, but with readings of 4.3 mg./dL that shouldn't be necessary. Are you testing yourself frequently or is the 4.3 a doctor's reading from some time ago. Perhaps hourly, daily, or weekly swings have you far higher at time?
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If it were I, I would up the allopurinol to 400 mg. for several months and see if that stopped the attacks. If it did I would retry 300 mg. again and watch. You are loooking for a lifetime dosage so you have all the time in the world to get it exactly right.
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Have you tried Alleve or indomethacin for the attack?
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(Like GP, I'm amazed the colchicine had no effect and thus tempted to consider other causes of this attack.)
It is YOUR body after all so you must choose.
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But I would not allow things like “might be the beginning of sensitivvity” and slight rash about which the “doctors are not sure” to carry an overreaching amount of diagnostic influence.
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What you KNOW is that you have gout…all else is conjecture.
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As to “there is something wrong with one of my organs” I think that the consensus of most researchers is that the KIDNEYS of gouties?seem not to excrete enough urate. I tend to agree to some extent.
As for “liver trumps gout”…no boubt. BUT that is not to say “suspected beginning of liver sensitivity” trumps gout…it likely doesn't.
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But, like I said, the choice is yours but do not be surprised if the choice is made by an attack so horrific you will entertain the possibility of a quick death as a reprieve. Gout hurts like nothing else. We gouties don't take meds for fun, we are DRIVEN to it.
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If you cannot take allopurinol you CANNOT, but don't toss it aside without being certain…the alternatives are few and one of them $$$$$$$$$.
I am 31 years old and was diagnosed with gout at the age of 20. At the time I was perscribed Allopurionl (100mg) and Indomethacin (25mg) I started the Aloopurinol and lo and behold in a month I was having the worst gout attack I had ever had.
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I hope that before I die I get to throttle a doctor for prescribing 100 mg. allopurinol. I wouldn't do permanent injury but throttling to the point where his toupee flies off will be satisfying. Although maybe an INQUISITION BOOT on the doctor might be more?gout specific.
The BEST way to initiate an attack in a person with gout is to prescribe 100 mg. allopurinol.
A substandard dose of almost any drug is?SUBSTANDARD.
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If you are going to take allopurinol, take 300 mg. because that's where you will wind up anyway and that doseage is the least likely to have you suffer an acute attack. If you get preposterously low numbers (which you won't) you can always lower the doseage later.
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I have taken Lipitor for 13 years and have taken taken colchicine with it several times?no problem. The drugs are NOT contraindicated BUT several drugs slow the liver's breakdown of statins resulting in high statin levels?and for safety sake, one could halve or quarter the Lipitor dose while taking the colchicine. But like trev said, with proper allopurinol treatment, the colchicne is just for emergencies that may never occur.
I recommend going to 300 mg. allopurionol to control your gout.
The increase in your liver enzymes are slight and inconsequential?actual liver damage shows numbers well into the hundreds. Probably the slight increase is transient and you will test normal upon retesting.
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Untreated gout will kill you early, an AST of 60 wiill not.
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From medicinenet.com:
Mild to moderate elevations of the liver enzymes are commonplace. They are often unexpectedly encountered on routine blood screening tests in otherwise healthy individuals. The AST and ALT levels in such cases are usually between twice the upper limits of normal and several hundred units/liter.
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If you are truly panicked (did I spell that right?)?about the liver numbers you COULD give $$$Uloric$$$ a try?or one of the uricosurics. I think allopurinol is the most innocuous choices but the others ARE available. You cannot go off allopurinol without using something else, and as you proved to yourself, that something else isn't fiddling with a ?diet. Don't treat gout as anything other than life threatening.
I've taken 300 or 400 mg. allopurinol/day for nearly 20 years and have never shown anything except perfectly in range liver numbers.
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Practical advice: Try 300 mg. allopurinol for 60 days and then retest your liver enzymes?make a decision THEN.
You are in a tough spot bdk.
Without a clear diagnosis it is hard to say with assuredness what to do.
Yes, indeed?you need a diagnosis and I think it is quite primitive to make you wait 5 days to get one.
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What?I would do is call your doctor or nurse MONDAY morning (or today if you think they are “home”) and get your PRECISE uric acid reading. As MFH said, “normal” has no meaning in gout.
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NSAIDS generally suck for a gout attack. But for the colossul fu#k up at the FDA in awarding a patent for colchine and pricing it out of the stratosphere I would say get 30 colchicine from your doctor and take about 16 of them?but it will cost you $150 now (instead of $4 last year.)
Ideally, the treatment for an acute attack is 2 colchicine to start, then one an hour until the pain stops or diarrhea starts and an offshoot is that if it works well, it is almost diagnostic for gout.
So if colchicine is off the table, an RX for prednisone is probably best + any narcotics that you like.
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Now here's what I'd try?don't take it as a recommendation because I am a bit more devil-may-care about myself than I am with others. Six GRAMS of aspirin, every day for a week. Yep, that's 18 adult aspirin per day in divided dosing. The fact is that aspirin will dump out more uric acid than perhaps any other drug. The dumping seems to take about three days to kick in but then the output is immense. BUT a big proviso, you CANNOT use lesser doses because then the effect is exactly the opposite, urate is retained. And don't start this unless you can commit for the whole week, the first three days you don;t excrete much urate (but you DO get?some pain relief.)
The question becomes, can your stomach tolerate that much aspirin.
This was standard treatment for rheumatoid arthritis before the thousand NSAIDS were developed, so a lot of people COULD bear this treatment year in and year out. It will probably work even better with gout.
Like I said, this is not a recommendation, merely something I would try given your constraints.
Make sure the “something different” is a lifetime of allopurinol 300 mg., every day “til death do you part.”
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Keep some colchicine on hand for flares until the allopurinol kicks in. You might need it you might not.
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Don't torture yourself with diet adjustments, they are just a leftover from the Dark Ages (i.e., before allopurinol was discovered?a half century?ago.) Since you found out that no meat and no alcohol was useless ,move on.
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VA should have no trouble doling out the allopurinol…don;t let them hose around with 100 mg. dosage.
Ah sumguy,
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A man after my own hypertensive heart.
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About 25% of us hypertensives are “salt-sensitive” or “V-type,” meaning volume type hypertensives. Another?nomiker is “low renin hypertensives. They all say the same thing that distills down to ACE inhibitors and ARB's are of very little use becasue they control the effects of renin driven hypertension? what we ain't got.
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BUT what works for us is diuretics and they work very well. But the curse of diuretics is that the work by dumping sodium and then water from our bloodsteams and in order to keep an electrical balance urate is retained in order to dump sodium. Thus they cause gout.
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What I have found is that LASIX (furosemide), a LOOP diuretic, excretes mostly water without salt. You can test this by tasting your urine.
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What I do now for at least 10 years?is combine Lasix with losartan (Cozaar, an ARB) 4 hours later, because that dosing combo has been found to drop serum urate by 15%?Japanese research listed elsewhere on the website.
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Cozaar by itself doesn't do diddley squat for my BP, but the Lasix is amazing at keeping BP low?and if the combo at least combats the? effect of the diuretic, I'm ahead of the game and if the combo actually is uricosuric to boot then double hooray.
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By itself Lasix is thought to retain only 25% of the amount of urate that thiazide does.
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So give?cheap furosemide a shot, 40 mg. in the morning for me, and if it works, consider adding losartan. Alas the latter is still under patent and costs a lot?maybe buy 100's and split the buggers (buggers because they are teardrop shaped and hard to break evenly.)
If the Lasix alone gives you better BP control than you have ever gotten then you KNOW you are a salt sensitive, V-type hypertensiive.
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Incidentally, only losartan among all the ARB's is uricosuric.
And here's a good parallel analogy Hans.
A glass filled with half ice cubes and half water will remain at 32F no matter HOW much heat you apply until such time as the very last ice cube dissolves completely. Only then can the water temperature rise.
Perhaps a sizeable amount of tophi acts the same way.
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I guess controlling your urate to the point of no attacks can be considered good enough.
Ravenwood,
Just history should be enough for your doctor. Ask him what level was taught as desirable? for treating gout when he went to medical school. If he doesn't remember ask him if “BELOW 6.0 mg./dl rings a bell.”
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EVERY medical text for the last 50 years has said the same thing. If he says otherwise he is?a?fool never having read ANYTHING about gout?and should be immediately fired by his emnployer, YOU.
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Honest, I don't mean to sound glib or flip but if your doctor doesn't know even THIS about gout, he can be of no further use to you unleess he accepts his proper position of writing you a script for whatever and whenever you wish. I have had two doctors like this and their cooperation has been better for me than someone arrogant who wants to countermand everything I tell him to do because HE'S the doctor.
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Hans,
Do you think your immense tophi deposits make it difficult to lower your serum urate no matter what you try? It seems?possible that the outpouring of urate into the bloodstream might easily counteract your best efforts at getting a low SUA.
Does that sound plausible?
(there have been various attempts to combine colchicine with products that reduce the associated stomach problems).
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I'm thinking Colchi-Tums or Pepto-Col.
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I?keep thinking that with
lifestyle changes and being 'Good', taking Cherry's, BBB, Bi Carb etc it
may get better. (Yes I already know the comments that will appear, but
it's still a little hope!)??
Gary, don't waste your time. That hope is the kind of hope that Obama preached while running for president, a hope that had not a tinker's damn?chance in Hell of becoming reality.
There is FAR less to fear from “adding” allopurinol to your regimen than from continuing with the REALLY high dose colchicine, and I am colchine's biggest booster. In fact the likely outcome is that there is no “adding” at all but rather REPLACING of colchicine with allopurinol, a FAR more innocuous drug.
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You take 4 x 1mg tablets, 1 every 15 mins on the first day, 3 x
1mg tabs, 1 every 15 mins on day two etc until day four, hey presto Gout
gone! Sometimes it does not always work.The dosage is the manufacturers recommended dose for severe attacks of Gout. (They
have other dosages for less severe attacks but you know yourself, when
your in “The Zone” amputation is a real alternative!)?
Which drug manufacturer recommends that dosing? It sounds beyond bizarre at a time when the major manufacturers (only one in the United States) are recommending less and less to the point of nonexistent treatment.
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Ravenwood,
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That's a good but complicated question. Outside the body, the solubility of gout is complicated and even in water solution it is dependent on many factors,?like temperature, pH, sodium concentration, ligament condition, and a host more, the most bizarre seeming to be TIME. Inside the body the complications multiply more.
We have out plasma urate measured but it is very likely that almost NO urate depositis directly from plasma but rather from interstitial fluids outside the vascular stream and measurement is nigh unto impossible.
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And to complicate matters further, it seems some people are able to tolerat a supersaturated plasma without crystallizing urate into the joints. BUT once anyone DOES have a gout attack that supersaturation is no longer possible, either in a beaker or a foot. This is normal for supersaturation: once a crystal has formed and created a focus, more will quickly join it.
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I doubt if anyone on Earth understands the complications very well but all we need know is the finale and that is ONCE YOU HAVE GOUT, you are not normal and never will be. You will always have crystal focus points and MUST keep your uric acid below 6.0 and since urate concentrations vary a lot with time, below 5.0 is far safer.
No, your 6.8 is not good enough.
I just can't decide if i should take colchicine as a prophylaxis or just take it as needed when I'm having an attack.
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I would take it prophylacticlaly for a week, maybe 2 each morning?and then stop. But if next month you wake up with any twinges, take two and if?discomfort isn't relieved?then one more in an hour and maybe one more after that. But probably the first two will turn the trick.
You can use this technique for the rest of your life?the secret is to do it FAST, as soon as you feel the bugeoning of an attack. The longer you wait the more colchicine is required.
Gary,
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Interesting dosing schedule for colchicine.How did you come upon it? From my reading you are taking 5, 4, 2, 1 mg. or 24 of the?.5 mg. pills. That is even more than I've ever taken (22 in one day?one pill short of finding my eyeballs in the toilet bowl.)
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I agree that THE CURE does seem to go?hand in hand with THE TROTS. I wish I could come up with a rationale besides the speculation that maybe we shit out urate? But since that would be so easy to test with a fall in SUA and nobody has reported that result, I guess I can assume that's a blind alley.
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Next time why not combine days one and two?18 colchicne. perhaps a furious diarrhea is more curing than a slight one. Check the toite bown for your eyeballs.
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I hope the 5,4,2,1 has worked for you for good.
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With that massive 10.6 I recommend you start at 400 mg. allopurinol. (A 300 and a 100 is easier than trying to split a second 300 into thirds.)
You really want to get down below 5.0 to lessen the risk of attacks early in treatment.
I cannot imagine anyone on a bulletin board being able to get into your account. I don't even publish my?e-mail addy on any bulletin board much less my passsword. To get to your address book require a real?falldown of Yahoo security, or so it seems.
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I guess a good Golden Rule: never send money until you verify the legitimacy of the e-mail request.
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So sorry about your mother's theft.
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(Make sure you have a SOLID password, as long as possible with numbers and mixed capital and small letters.)
