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I woke in the early hours of Sunday with excruciating pain in the instep near my big toe. My wife (a carer) immediately identified it as Gout. This is the first time I have experienced this although I have had foot cramps now for some time.
I have seen the GP who agrees that it is gout and before he decides on treatment (or not) I have had a blood test. The results of this and my next GP visit are not till Friday week. In the meantime I would like to arm myself with a little help off you guys please.
Firstly I have been on a diet for a month and may have eaten incorrectly. I have also exercised – something I haven't done for years. In fact I may have given myself a hernia as a result of sit ups. Although I may have had it a while and it may have only shown itself due to the exercises.
So, in a nutshell what I would like to know firstly is. Could I have borought on the gout through the change in diet, exercise, excess sweating (causing dehydration) or was it something that was always going to happen and awaited a trigger.
If I have brought it on through the above, can a change in diet and rehydration take away the gout and not recur.
Thanks for your help in advance.
caveman38 said:
Could I have borought on the gout through the change in diet, exercise, excess sweating (causing dehydration) or was it something that was always going to happen and awaited a trigger.
Yes to both parts
If I have brought it on through the above, can a change in diet and rehydration take away the gout
Probably, in the short term, and with help of anti-flammatories
and not recur.
Unlikely, if it is indeed gout. As it is your first attack, your Dr will probably want to wait for another, as your SUA reading may come back as inconclusive: levels usually drop during a flare. But you may be able to delay this for quite some time if you drastically alter your eating & drinking habits (difficult even when you know what to avoid, which is rarely the case at the beginning). A lot will depend on what your blood tests show; if SUA is off the scale, then Dr will probably accept it and suggest starting the meds. But there's a lot of ignorance (at GP level) in the medical profession about gout. If you're in any doubt as to whether he knows what he's doing, ask to be referred to a rheumatologist. Should get some sensible answers there (or here
). Good luck
Thanks Odo. If you say that I was responsible for bringing it on, is it not the case then that returning to a proper diet (which I was on for 59 years) and drinking more water. The problem can be kept at bay. Or is the first trigger a catalyst for more attacks regardless. Are the crystals around the problem area formed during the neglectful month or would they have formed over many years and can they disappear or are they there for good waiting to flare up again.
Sorry for the simplification but I really am in the dark with this. This fitness regime has done me no good at all. I was better off “fat”
Well, firstly, don't be too hard on yourself; gout is a genetic condition that can be hastened by lifestyle choices, but you were probably due to get it at some point regardless; if you're 60+ you've done pretty well for it to have taken this long to appear. But make no mistake, it's been a long time building and although recent events may have been the trigger, reversing the process is going to take considerably longer and only with urate lowering therapy i.e. allopurinol. Rapid weight loss is a definite trigger, but you are undoubtedly better off without the extra weight.
Thanks again Odo.
Can you guys tell me please what monitoring aids should I arm myself with. I live in UK and am unable to purchase litmus paper to measure acid in my urine and thought that would be my only indication as to whether my new diet was winning or not.
I have a week before returning to GP to get my blood results but would like to see something for myself. What can I buy?
Caveman- I got got gout progressing at around 60. Definitely keep the weoght off amd the exercise gentle but consistent- it will pay off once you settle your status gout-wise.
However, taking your own tests are a good way of grabbing back control from 'ol Gouty having a munch at you -which can become extremely wearing, if not depressing ,soon enough.
Two other factors implicated in gout are High BP and Stress- both of which factored in my case ,I'm sure.
Make sure you get good advice on your gout and weigh up options before jumping for meds- thought they are sometimes the only way to go.
At our age, there's a slightly bigger leeway and time , day to day, to evaluate and control our situation on lifestyle factors, but gout certainly won't be ignored for too long- it can be a debilitating crippler easily enough.
You sound like you will manage OK once you get your figures [and keep notes- ball park assessments of SUA 'normality' are not good enough ,when it has occured even just one time].
Thanks Trev, I will be back in a week after my results.
In the meantime I have my mouth under the hosepipe and and woofing down the fruit and veg. Trying the Bicarb three times a day and have just bought a dozen lemons.
Hopefully the sod will go down soon as the Naprosyn (which I take for my back) has not helped yet. I may skip that and go on the Ibufren.
cavemean,
All the above advice is very good. Yes, your weight loss and exercise probably brought on the attack which may or may not have been your first. But once you have had a gout attack you CANNOT get ungouted and things that your body may have dismissed BEFORE that attak will not be dismissed now that you have a crystallization point for uric acid. Think back, have you had foot problems before?
Don't make yourself crazy with dietary changes until you get a firm confirmation, the only thing you can do during an attack is to mitigate pain. Your immune system will eventually take care of the immediate problem.
On the testing: when you go in tomorrow to get the uric acid reading, have another blood draw…labs make mistakes, and 2 readings are better than one. If you are still in pain tomorrow and gout looks likely from the blood test, ask your doctor to prescribe colchicinee for the pain.
Not what I wanted to hear Zip. Are you saying that the crystallization on my toe will be there for life (if not somewhere else already) and no medicine or self help can irradicate it. Is it innevitable that I will have subsequent attacks even on a Gout conscious diet and/or medication.
I have suffered with foot cramps for some while, is there any connection?
Zip is right- but the timing of attacks is unknown. We all have to find our 'personal process' in gout!
Cramps are more likely due to salt or mineral defiiencies but this needs seperate evaluation.
You certainly don't want to encourage fluid retention, if borderline/or High BP, by arbitrarily increasing salt intake.
I believe diet and natural methods can assist in gout meaningfully, particularly at the 'lower SUA ball park'.
Are you saying that the crystallization on my toe will be there for life (if not somewhere else already) and no medicine or self help can irradicate it.
Yes, drugs can cause some dissolution and white blood cells can carry away some urate, but the immune system will try to “wall off” a portion of the urate and some is extremely likely to remain with you forever. Thus you will never be in the enviable pre-gout situation where the body can carry a super-saturated load of uric acid without precipitaiton. You have crystals which will act as seeds to cause precipitation the instant you go above the saturation concentration.
When you first notice your gout you probably already have multiple sites of mini-crystallization that may have caused small aches and pains but were dismissed.
I wouldn't be surprised if a lot of people walking around who never had a gout attack, if examined closely enough would show urate deposits.
Another day of pain and no apparent relief from my anti-inflamitary drugs (Naprosyn)
I couldn't wait till next week and phoned GP as I knew my results were in. No appointment was available but he did ring me.
I was told that my count was a little high (I forgot to ask the figure, I will next time) and was prepared to confirm it as gout. He made me a prescription for Colchinine and I am to see him end of next week – hopefully normal. He said on the phone that he won't prescribe Allopurinol till the gout has subsided plus 6 weeks.
Is his procedure in line with your recommendations and why such a long wait for the Allo. He said that Allo shouldn't be taken whilst one is having an attack, is that normal.
BTW, I have afith in my GP but value your advice/feedback.
Yes, you don't start AlloP during an attack, but you keep taking it if you have a flare while on it. Always ask for the numbers of your blood tests- better still, get a print out and start a file.
4 days since the outbreak of my first attack and I am still in pain. I am nearing the end of my prescribed 12 Colchinine tablets and then I am advised to stop them.
I am 60% relieved but the pain is persisting on my bunion and ball of foot. I don't have any swelling and assume at least the drugs do work but where do I go from here. I am told to stay off the Colchinine for 3 days but will the whole episode start again or will the 12 pills inside of me continue to improve my condition or will it only continue to improve when I restart them after 3 days.
Zip suggest in another post that the relief seems to coincide with the loose bowels motions (I cannot spell d******) which so far I have not experienced – lucky or not?
Further help / advice welcome please.
Yeah, Zip's yer man when it comes to colchicine and he is less cautious with dosage, but then he has a lot of experience with it. However, your Dr is following the recommended course of treatment: 1mg initially, then 500 micgr every 4 hrs until pain relief or diarrhoea – up to 6mg total, then a 3 day break.
The Naprosyn might be more effective on the down slope; they generally only work at the very beginning of an attack. Wouldn't bother if you have any gastro intestinal issues though. Just be strict with the dietary restrictions, lots of H2O and keep the foot elevated as much as possible. Got to remember this is effectively the same as having had an injury – walking about normally is going to be in a couple of weeks rather than days and it's really easy to have a set back by over doing things. You can start AlloP 2-3 weeks after the attack has settled if you want.
Let me just add (sorry if repetitious) that after 9 days of the most debilitating pain I have ever experienced my dosage of colchicine had me walking the next day as if I had never had a gout attack at all. No pain at all.
(Lourdes, eat your HEART out.)
I am loathe to recommend high dose colchicine becasue I don't want to kill anyone. But the effects can be truly miraculous.
I guess the level of pain has something to say about what we will try.
I wonder how may people, if any, have ever diesd from a colchicine overdose?
I LOVE the quote at the end:
Old Dosing Recommendations for Colchicine: Take two 0.6mg tablets when you first feel gout pain. Follow with one tablet hourly until you get relief or diarrhea. Dosing until diarrhea occurred probably inspired the old quip, “People treated with colchicine often run before they can walk.”
Zip, see my post on the side effects post. Obviously the dosage recommendations are different from UK to where you are. Reading some Google hits on Colchinine. One can get a bit scared to take too many, perhaps my pain (although bad) is not enough to chance exceeding dosage.
In time I will learn. Although I pray that this is my first and last episode. With the Allo (when I start) and my stricter diet am hoping (or am I kidding myself)
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