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This is Darrell.?? My G.P. insists that I do not have gout.? My Uric Acid level last time checked was about 5.5.??? I have severe pain in both hands but no tophi.??? G.P sent me to a neurologist who said I have severe carpal tunnel in both hands.? Nerve damage.?? I had a case of carpal tunnel some thirty years ago.?? This is not carpal tunnel.? I think the uric acid chrystals are causing the nerve damage.? Either that or it is caused by false gout chrystals.?? Here is another reason I think I have gout (or pseudo-gout):?? I was seeing a urologist and had a cystoscope picture done.??? He turned the monitor around and showed my that there were these snowflakes floating in my urine.? When he did this he stated “there is your gout”? “those are uric acid crystals” coming down from inside your kidneys.?? Apparently urologists see these from time to time while doing cystoscopes.? Unfortunately, I did not ask to take some of the crystals with me.
Gout occurs when uric acid crystals grow inside the body. The gout pain normally starts in joints, when white blood cells (part of our immune system) attack the crystals causing painful inflammation. It is common for uric acid to fall during an attack, so you need to organize monthly uric acid checks to get a better picture over 3 to 6 months.
Tophi occur when uric acid crystals form in soft tissues, usually under the skin, but all organs are at risk, especially the kidneys and heart. Some people get tophi without getting acute gout flares, but this is rare.
Tests for uric acid crystals are best performed by a rheumatologist. As I mention in my I Have Gout program, if a rheumatologist needs to involve other specialists, he will do so, but suspicion of gout should always be referred to a rheumatologist first. If the tests reveal internal crystals causing your gout-like symptoms, they will also reveal if these are uric acid, indicating gout, or other health problems, including pseudogout.
I was referred to a rheumatologist who said he couldn’t rule out gout but that he could not perform the joint?aspiration –needle extractions from the joints in my hand because although I had swelling in my fingers he couldn’t extract enough synovial fluid to get a reading for the test with the amount of swelling that I had.? I know I sound like I am trying to diagnose myself but I just want a difinitive diagosis ergo wanting the DECT test.? When I had carpal tunnel before all the fingers in my right had had ben swollen up to the the diamater of quarters; this time only my index, second finger and my thumb are swollen and but?not that large.? In carpal tunnel all the fingers swell up as I understand it.? The nerve damage in my hands that the neurogist thought was carpal tunnel?is only in those fingers I indicated.
Did you try contacting Siemens as I suggested in https://gout-pal.com/gout-pal-forum/please-help-my-gout/is-there-a-dect-machine-in-or-around-portland-oregon/
Looks like local teaching/research hospitals might be the best bet.
If you do have gout, you are very likely to have uric acid crystals in other joints. This can be tested now, or wait a few months and you will get an attack elsewhere.
The other option, as allopurinol is cheap and effective, is to assume that you do have gout, and treat it accordingly. Talk to your doctor about getting uric acid below 5. This will take several months to clear old crystals, but you should see improvement after 2 or 3 months.
Also, I’ve just been chatting with @Devin about the effects of temperature on uric acid crystallization (https://gout-pal.com/gout-pal-forum/please-help-my-gout/need-help/#post-14753). Are your hands frequently exposed to cold? If so, gout can occur as low as 4 mg/dL.
I have to plead guilty to using cold water to reduce gout pain especially at night.? I am trying to taper off of doing that.?? I have been try an almost pure milk protein diet and I seems to work in that the intensity of pain is reducing.
Cold of itself isn’t the problem. Uric acid crystals might form from a combination of low temperature and high uric acid. We have had similar discussions relating to the use of ice to relieve gout attacks. The consensus is that warmth is about as effective as cold for pain relief, so gout sufferers should opt for heat pads rather than ice packs. In this case, try warm water instead of cold.
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