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Ron, you’ve really made my day. Thank you for your kind words.
I can’t express how happy I am that you’ve finally beaten the gout demon.
But I’ll try…
Kipper, you said:
I could not remember my original password and my email account is playing up at the moment so cannot retrieve my temp password either.
I’ve assigned your two recent posts to your account.
I can send you a new password but, of course, I don’t know where to send it to. Or, I can change the email address on your account. If you do not have an alternative email address, I highly recommend gmail.com – that also enables one click login here by simply clicking the Google icon near top right.
Please do not post an email address in this public forum. Instead, click the orange Support button, or raise a ticket direct in my Gout Support helpdesk.
On your gout comments to Mark – WOW! Very helpful indeed. Thanks Kipper
To stay updated about my 10 year celebrations of gout support, you should subscribe to my email update service. I’ve only just realized there was a problem with it, but all should now be OK. If you are already a subscriber, normal service is now resumed, and you will get more news about GoutPal 10 Years celebrations soon. If not, please subscribe now:
The discussion was Acupuncture and gout at https://gout-pal.com/gout-pal-forum/please-help-my-gout/acupuncture-and-gout/
The GoutPal Gout Support Circles discussion is:
If that does not appear in your browser, please click https://plus.google.com/u/0/+AcupunctureBrisbaneWoolloongabba/posts/M4c6xbqS56B
I changed to a brown shirt and drank brown beer in support:
#brownout4gout #GoutPal @BrandenCrowl Swapped my shirt for a brown one. Don't need brown now cos white #allopurinol stopped my #gout
— Keith Taylor (@keithtaylor) November 3, 2014
If you cannot see my reply in your browser, see https://twitter.com/keithtaylor/status/529083010772393984
Here’s the tweet:
Allopurinol Initiation and Change in Blood Pressure in Older Adults http://t.co/fO0Rn33hFJ
— Miguel Angel Mar?a (@evidenciasmfyc) October 11, 2014
I need the special powers of my admin account to include social media posts like this. If you spot anything on Twitter, Facebook, Google+ or any other social media, just include the link in your post, and I will try to embed it like this. Please avoid trying to post the embed codes yourself – they will get ignored.
You can also follow the discussion at https://plus.google.com/u/0/+AcupunctureBrisbaneWoolloongabba/posts/M4c6xbqS56B
The diagram about factors affecting gout is:
If the diagram does not show, please click the link above.
Purine control is all related to uric acid levels.
Best thing to do is get your doctor to do a blood test for uric acid, then tell us the result. There’s no point controlling purines in your diet if you don’t know what your uric acid level is.
If you prefer to test yourself, there is some help at http://www.goutpal.com/uric-acid/uric-acid-test-kit/ You need to be meticulous when you test yourself at home, but once you get used to the routine, home test kits can help you measure how much effect your diet changes have.
A better name for gout?
Who thinks gout doesn’t get taken seriously? Maybe it’s the name.
Anyone got anything better than P-JODD?
Progressive Joint and Organ Damage Disease
Take gout seriously; rename it.
— Gad Fly (@QuipBoy) September 8, 2014
It stinks when doctors don’t follow Professional Guidelines properly.
The routine is pretty straightforward. For those people in high risk ethnic groups, do a genetic screening test first. If you pass that, and for everybody else, start with 100mg allopurinol, then increase by 100mg every 2 weeks until target uric acid level is achieved.
You should also have blood tests for kidney function and liver function whenever you get uric acid test. If those test results, or the genetic screening test results, give cause for concern, then switch to Uloric instead of allopurinol.
Fear of gout attacks is understandable, but I always say:
You might get a gout attack when you start uric acid lowering treatment. You will get a gout attack if you do not lower uric acid.
Taking Colcrys as a daily preventative will remove most of the risk of a gout attack. If you do get a gout attack, take compatible pain relief as advised by your doctor or pharmacist.
It’s easier to answer questions if your profile details are complete. There’s nothing at https://gout-pal.com/users/bl530/profile/
I can make answers more relevant if I know more about you.I’ll give a general response to allopurinol Colcrys dosing soon.
Goof luck with the doctors appointment. Have you had it now?
Do you still need advice on the different circumstances that dictate if colchicine should be taken every day, or as required?
This is not the way to deal with gout.
Either you have misunderstood your doctor, or she is dangerously under-qualified.
You must see a rheumatologist immediately. This is far too serious for me to deal with on an Internet forum.
You need urgent medical assistance from someone qualified to treat gouty arthritis. As I have no idea who you are, where you live, or anything else about you, I cannot say more. This forum can only help you understand what your doctor says, and what you have told me makes absolutely no sense.
A rheumatologist will understand that:
1. Allopurinol and Colcrys are used for two different things. Allopurinol is for uric acid lowering. Colcrys is part of a pain relief package that you need until allopurinol has done it’s job.
2. Both medications have alternatives that MIGHT be better for you. This can only be judged with full information about medical history and (for allopurinol) racial group.
3. Different painkillers have different effects, and you need careful guidance on the best choices. This is a personal matter, so it is unwise to listen to general advice on which anti-inflammatory is best for gout. It has to be what is right for you, and with blood loss, you are obviously not getting the right advice now.
4. Draining tophi is a perfectly acceptable treatment, if they do not respond to uric acid lowering treatment.Please seek proper medical attention urgently.
Be very careful about jumping to conclusions with side effects. This applies to any long term treatment – not just allopurinol.
It is part of the human condition to draw connections. Associating cause and effect is a wonderful evolutionary advantage, but it has it’s drawbacks. It is very common to jump to false conclusions.
The only way to test if an event is really a side effect is to repeat it. Mathematical geniuses have told me that you have to repeat at least 50 times to rule out coincidence. 50 repeats sounds like a lot if the side effects are bad. On the other hand – 11 incident is just too little data to make a judgment.
It might be different if your skin was falling off, or you couldn’t breathe. But have you never had sickness and diarrhea before? Is there not just a chance that it could be something totally unrelated to the allopurinol.
I’m very disappointed that your doctor said to cut back, rather than waiting a few more days. I would certainly have tried takinging allopurinol with food and drinking plenty of fluids before blaming the dose increase.
Please consider going back to 200 so you can tame the beast for good.
Yeah, but is the lack of forum traffic down to:
a) Too hard to use?
b) People get all the gout answers they need from searching GoutPal before they post?
c) Something else?Hundreds register on this gout forum each month, but never post anything. I don’t understand that, because the only thing registered members can do that unregistered guests cannot do is post topics and replies. That may change when I introduce membership with more benefits such as training courses. http://eepurl.com/0pY-9
If anyone has positive ideas for improving the traffic on this gout forum, I’d love to hear them.
I’ll follow up on the colchicine clarification soon
” Keep up the great work and I?m sure the members all agree that you are providing a great tool for us”
Thanks for that. Lee. A little encouragement goes a long way.
Hi Lee,
Indocin and other anti-inflammatories are good for helping you cope with pain short term. As I’ve learned more about gout, I put short term at six months. There are two reasons for this:
1. Long term anti-inflammatories carry increasing health risks. I don’t want to be scary, but read the leaflet in the Indocin pack. It carries the same warning that all NSAIDs carry. I took them for many years in my 40s, and I’m not aware of any problems from them, but I’m glad I don’t need them going through my 50s.
2. The second reason is much more important. When uric acid is higher than 6, it is forming crystals more or less every day. You only get a flare when your immune system gets overwhelmed. Most days, your white blood cells just get on with their job. Unfortunately, young specialist cells get caught in this battle. Cells that should grow to repair and renew bone, cartilage, and tendons, die in the fight against uric acid crystals. This is why I recommend against strenuous exercise, as gout has weakened joints.
If uric acid is controlled aggressively for a year or so, then slack off to stay no higher than 5mg/dL, joints should start to recover a little. I’ve not seen any good studies on joint recovery after correct gout treatment. However, it makes sense to get started asap.
Lee, I think your ready for the allopurinol. Try get uric acid as low as you can for a year or two, then no higher than 5. Exercise is good, but not to overstress. If you are worried, get x-ray or ultrasound checks, as advised by your doctor.
Good Luck
Ibuprofen and indomethacin are both NSAIDs (Non-Steroidal Anti-Inflammatory Drugs). As such, they are interchangeable according to personal preference, but should not be taken together, unless advised by a qualified medical practitioner (which I am not).
Uric acid crystals start to weaken all aspects of joints long before you get your first gout attack. This has been proved by recent DECT images of gout, though has not become widely acknowledged in frontline medical practice. Bones, tendons, cartilages, and ligaments are all at risk. I get the impression from what I’ve read that tendons are first to suffer noticeable damage. The mechanics involve young specialist cells that are destined to repair joint tissues as they grow and wear out. These young cells get caught up in the battle between the immune system and uric acid crystals. Prior to a full blown gout attack, such battles often go unnoticed, but joints become weaker.
As I often repeat, I have no medical training, but common sense tells me that in these circumstances, attempts to strengthen and stretch tendons and ligaments carries a very high risk.
I’m as bad as the next man for delaying the treatment to lower uric acid that gives a chance of joint recovery. It took a broken knee that I dismissed as a gout flare before I came to my senses – relatively of course 🙂
In my opinion, gentle exercise such as walking or swimming is good. Gout weakens joints, so it is important to avoid any exercise that could induce stress to any joint. Though you are currently experiencing a gout flare in one ankle, you can be certain that other joints are also being attacked by gout – joint weakness starts before an acute gout attack.
When not exercising, it helps to keep the affected joint area raised and rested.
I believe wraps and braces are far superior to ice for non-medicine gout pain relief. However, they will only provide slight relief. My personal preference is to rely on drugs to ease gout pain, hence my Acute Gout Attack Treatment Plan. Some people find relief in herbal anti-inflammatory preparations or diets, but I have found nothing strong enough to match the pain of acute gout attacks. I have had some success with TENS machine to relieve gout pain, but I never persevered with it beyond borrowing a machine for a short time. In my case, the cost of a TENS machine compared to medical pain relief made me choose drugs. You could also check other forms of non-medicine gout pain relief.
Your units are mmol/L, and the reference range you have been given is statistically valid, but medically pointless. Actually, it is worse than pointless – it is dangerous. I’m not sure which sex you are, but the medical equivalent of this useless reference value is to say that it is normal for an adult human to have 1 breast, or 1 testicle. I’m sure you can see the problems of being treated according to that statistic.
You need to be 300mmol/L, or lower. See Uric Acid Levels for more, or use the Uric Acid Concentration conversion calculator.
Also, I should have made a point about the uricosuric benefits of an alkalizing diet for gout. My Alkalizing Gout Diet Menu guidelines cover this in some depth, particularly the report: Is Alkaline Diet uricosuric?
My main surprise is, in this day and age, medicine sources restricted by international boundaries. What does your rheumatologist think about prescribing probenecid for international fulfillment?
Further to my last reply about the long term use of allopurinol.
There is very relevant evidence about long term allopurinol use from a different perspective. Studies have shown that it is possible to take a temporary break from daily allopurinol. This relies on two factors:
- Gout patients have a good response to allopurinol
- The right dose has been administered to keep uric acid at safe levels for 5 years
For the details of this gout study, please see http://www.goutpal.com/1629/is-allopurinol-a-lifetime-drug/allopurinol-5-years-not-life/
My view on 900mg allopurinol per day (the UK max), is simple logic. Gout studies show that uric acid deposits dissolve faster as uric acid levels decrease (http://www.goutpal.com/368/lower-uric-acid-gives-faster-gout-cure/). The current emphasis from rheumatologists is to treat-to-target. Target is based on individual circumstances, and should initially focus on reducing the amount of uric acid deposited in the body and dissolved in blood (the de-bulking phase). I have no confounding factors, so after trying 3 doctors in my group practice, I got the 4th to agree with me. Tophi on my elbows, with a small one on my knee, probably helped my case. However, I believe this is the best approach for all gout patients who can tolerate allopurinol, as it significantly improves quality of life, and reduces the period you are at risk from gout flares.
When allopurinol starts dissolving crystals, it temporarily increases uric acid in the blood. This is basic organic chemistry equilibrium. If doctors can’t see why a uricosuric would help in that situation, they cannot justify their title. Obviously the uricosuric would not be required in the maintenance phase of treatment, but would be highly effective for under-excreters during the de-bulking phase. I just thought I’d check my logic was sound before posting this. I found this:
“Coadministration of allopurinol with probenecid had a significantly greater hypouricemic effect than allopurinol alone despite an associated reduction of plasma oxypurinol concentrations. Australian Clinical Trials Registry ACTRN012606000276550.” Some general practice doctors have good gout knowledge, but most do not. I always recommend, where there are any doubts or complications, that you consult a rheumatologist. Preferably one that specializes in gout.
It’s good to know that excess water with heat is reducing your inflammation. I’ll update my http://www.goutpal.com/uric-acid/high-uric-acid/gout-sauna/ page to reflect your experience.
The only vitamin that I have seen that has proven benefits for gout is vitamin C. http://www.goutpal.com/gout-treatment/gout-cures/vitamin-c-and-gout/
There may be other vitamins and supplements that can help.When I see your struggles with doctors to recognize I’m reminded of my own fights to get proper treatment. I prepared myself with all the right professional information to argue my case, and finally got the treatment I needed. The difference is, apart from obesity and high cholesterol, I didn’t have any confounding health problems. 900mg allopurinol has always worked fine for me, and I put any early “side effects” down to anxiety. I’m no doctor, so I cannot advise you on your complications. I think the best thing to do is get your doctors to recognize that 4mg/dL is a perfectly good target, then ask for help achieving it. If probenecid isn’t an option, surely they have access to other uricosurics that can support your allopurinol?
Milk protein is a good uricosuric. Without uric acid blood test results, it’s hard for me to say more. I would not describe tendinitis in gout as atypical. Untreated gout is almost certain to cause tendon damage.
Yes, allopurinol tablets can be split. A Pill Splitter
is best for this, which you can get from amazon.com
I am not aware of any studies that show allopurinol becoming less effective over time. After allopurinol has led to substantial reduction of uric acid crystal, many patients find that less allopurinol is needed to maintain the safe upper limit of 5mg/dL. Everyone is different, but we all change as we get older. That is why I strongly recommend getting uric acid tested at least once per year.
Further to my last message, I googled “FMLA for chronic gout” and now I understand better. Forgive me, but I have absolutely no knowledge of the American legal system. Hopefully someone else will read this and provide better information.
My purpose with GoutPal is to prevent people suffering from gout. Though gout has a very bad record for poor quality of care, if it is treated correctly, it should not reduce your ability to work. Rather than advising you how to take time off work, I would prefer to help you avoid having time off work.
I’m not trying to preach here. If you want time off, I can easily argue the case that it is impossible to work if you are not getting the right gout treatment from your doctor. Myself, and several other forum contributors, have had to train our doctors to treat gout properly. I can help you with that. Hopefully someone else reading this can help you with the FMLA issue.
Sorry again for my ignorance, but I have never heard of FMLA before. If you follow the Google search that I did, there is loads of information about FMLA and gout. That includes some discussion on a legal forum about FMLA and gout. I understand the gout part, but I don’t understand enough of the FMLA part to give any help on that.
Please let me know what you decide. If you go down the FMLA route I can provide some references about the nature of gout that prove you cannot work if it is not treated properly. In fact, if it is not treated properly, it becomes a serious threat to mortality. If you decide you would rather get proper treatment, I’m happy to work with your doctor to ensure that you can work whenever you want to.
