February 13, 2010 at 6:49 pm #3179
Would appreciate any advice/opinion re dealing with the interim period between settling my husband's gout and starting allopurinol.
He has had 2 full blown attacks in his knee, and ankle (but less so) recently, one lasted 4 weeks. About a month later a second attack lasting 3 weeks (terminated with a steroid injection directly into the knee joint).
Really although it was quickly improved by the steroid injection it has remained tender, with a particular spot under his patella that he thinks is aggravating the gout. He has literally had a day when he could walk reasonably well, did a mile walk & was encouraged, only to find the next day it was threatening to start all over again.
He seems to have averted a full blown attack with Diclofenac, and a multitude of all the anecdotal gout helps several times. This morning he thought he had lost the battle, but yet again, although his knee has swollen & it is bulging out at the back too, it is not the usual full-blown attack (thanks to black bean broth, etc etc?).
He has the UA monitor and has be closely watching morning and evening & managed with reduced protein intake (more than 50% less), extra fluids etc to reduce it from approx 8-10+ to around 6-7.5 & has even been in the 5's.
My question is – could he be a victim of his own success by lowering it around the level to dissolve crystals (& recrystalling!) or is it that he has turned a dreaded corner into a chronic sufferer? He has still eaten chicken & fish but much less of it & also less frequently.
His problem is that he cannot stop the gout long enough to get onto Allopurinol (not that he relishes the idea of drugs) but realises he has to get on top of this. I don't think he is a candidate for colchicine due to a really bad reaction that he had about 35 years ago that may well have been that. His GP has said she will inject it again with steroids in a weeks time if it is still not settled (can you have too many of these?). Actually although the steroid stopped the acute attack, it has never been back to normal despite yet another intramuscular injection of a steroid about 3 or 4 weeks ago now.
Should he eat more purine rich foods to keep him above the UA dissolving level until he starts AlloP? He is reluctant to go back to his old eating habits now!
Sorry this is not in the “first person” – can't persuade him to join in, not into technology at all – doesn't even wear a watch so no hope – would fit into the Okinawan life style brilliantly!February 13, 2010 at 11:23 pm #7674
Juliana- your H is already round the 'gout corne'r – once an attack has occured it is potentially capable of re-occuring. It's very hard to know what's going on under the skin even with numbers on UA.
One thing , though- I reckon it will take time to get a balance and you may be expecting too much, too soon.
The progress on UA reduction has been really good, in fact very encouraging- and shows just what can be done.
Are you both just suffering from 'gout weariness' that can often hit in, almost like gout itself?
Doing a mile walk is stretching things rather if attacks and UA transients are occuring. The steroids are good at masking a problem that is telling the body important info – Rest Me!
I don't think AlloP does any more than do the 'dirty work' for the body and whatever gets UA down will have the same effect -only in different time scales.
IMO, the slow route is best. I had a bottle of wine last night with barely a twinge this am- and I'm far from 'over the hill' on the UA problem. 4 pints of ale would have been different!February 14, 2010 at 6:37 pm #7680
Thanks for advice Trev. Yes, we are both very weary of gout!February 15, 2010 at 8:05 pm #7701phofabParticipant
I thought it was the Allopurinol that your husband had trouble with?
The Colchinine if taken in an attack will bring on severe diarrhea (can be quite scary) over about 12 hours, was this the reaction your H received. This is normal and rapidly clears the intestines. Refer Posts on my POST Your Gout – Gout for 36 years and elsewhere about Colchinine.
Only in the past couple of weeks have I isolated that walking and cycling after a period of inactivity with Gout , brings on the Gout flare or attack. I am reading this that I have reduced my UA to a satisfactory level and the activity frees up crystals from my joints allowing them into my blood stream, where they are attacked by the bodies immune system bringing on a flare or attack. I just take the Voltaren and get moving again as soon as possible.
Question : It is always advised by Doctors to start taking Allopurinol when you have been clear of Gout for 7/10 days. Why?
From my personal observation the long term sufferer, taking Allo for the first time is going to bring on an attack anyway so why not just get on it, as it is supposed to be the one of the only drugs to be able to reduce your UA. You may get a doozy of an attack, but after a few months the attacks do reduce in intensity. A question for your Doctor!!!!!
But start the dosage low as I earlier suggested and gradually step it up over months. Prolongs the agony but if I took the full 300mg immediately, I would have had to cease all activities and I was very unwell.
You appear to be doing most things well, it is only that your H condition has developed over many years and the cure will be slow.
Stick with it is not going to be a fun ride, but there are others who are going through the same thing.If that is any comfort.
Later:- Re the comment about Purine rich foods, can't advise on that but I have found that all things in moderation have been OK. I also located a table on the old Gout Pal Site grading foods as Alkaline and Purine rich, but young Keith has been busy and it has been relocated to cyberspace.
From this table I was surprised that most of the meats- fish , poultry, beef etc had ratings that were in the same area, so it would appear that eating less meat and more fish was not of a great benefit. Maybe Keith will pop up and guide you to these tables.
But in reverse I have found that the more alkaline foods, celery, lettuce (Cos lettuce), carrots, beetroot have a real beneficial effect and are used in a daily glass of juice.February 16, 2010 at 3:37 am #7711
There are many , often confusing lists of gout freindly or alkaline foods.
Two points on the current discussion re this :
I suspect fish is rated for purine content with the skin kept in the equation.
I pretty well always have mine skinless now. Last few years like this.
Also, for protein support in diet -the only obvious candidate seems Whey protein, though its' cost has kept me off so far.
The sports people and body builders use it a lot and it lends itself easily to shakes and juicing. I will have to get onto it more soon ,as my protein intake must currently be less than it should be, trying to alkalise my diet as a veggy!
I think this has helped my UA downwards- but is not the best long term solution for all round health.February 16, 2010 at 4:21 am #7712
Thanks phofab & Trev – just perused your posts. Have to rush out now but will inwardly digest & come back later today. Much appreciated.February 16, 2010 at 6:05 am #7713
I saw recently a diet that really stressed the benefits of lettuce. It seems such an innocuous plant, but nature is very like this. Subtle and often against modern advertising etc. Bitterness in taste is often a plus in health benefits. I really can't stand those curly ones for this reason.
I think it was certainly highly alkalising and probably also good for Gout diet, as Phof stresses.February 16, 2010 at 10:33 am #7715zip2playParticipant
SUA of 6.0-7.5 is a terrible place for a gout sufferer to be at. It is just too high.
His problem is that he cannot stop the gout long enough to get onto Allopurinol (not that he relishes the idea of drugs) but realises he has to get on top of this.
He should just bite the bullet and get on allopurinol today. It is NICE if it can be in a gout free period, but if it cannot be, it cannot be. It is quite possible that the ful dose, 300 mg. allopurinol will put a stop to all this “is it or isn't it” suffering.
Suffering for months to find a good window to start the drug seems foolhearted to me.February 16, 2010 at 1:28 pm #7719UtubeliteParticipant
I would agree with z2p ( Sorry Zip, I am using your new Avatar z2p).
I had started Allop twice in my life so far. Once 10 years ago when I was in the peak of the attack( 3-4 days of gout attack and full swollen foot), and recently 6 months back while I still had pain and swelling.
Both times, I did not get any gout trigger. Allopurinol actually stopped the gout attack and reduced the swelling.
Though I have also read to wait for a clean window before taking Allopurinol, my own experience says it does not matter, rather it is better to start early rather than letting gout do more damage.February 16, 2010 at 7:16 pm #7722
Hi Phofab, nice to see you around again!
Thanks for your considered advice.
My hub could not remember the name of the drug that caused the reaction years ago. I presumed it would probably be Allop, the rheumy proff wasn't interested – just take it or leave it. His GP however said it was more likely to have been the colchicine, which does make sense. It wasn't the side effects people here have mentioned though. He literally only took one, no sickness or diarrheoa. He said that he just felt like he had been poisoned and was literally dying. Obviously he was wrong as he didn't! He is not normally prone to allergies or etc. Anyway, I asked if they could try and retrieve his old records & see if the drug was recorded, they are trying. He apparently didn't frequent the docs very often so shouldn't be too much to read through even though it was 35-40 years ago. Hopefully we will soon know.
I suspect you have something about increased physical activity, hub had recently started going to the gym & even though I suggested he took it easy following gout attacks he still didn't reappear for a couple of hours! In fact he is still waiting to get back, saying he will just “do” the 'top' half!
The reason the doc gave previously for not wanting H to start on Allop during an attack of gout was that it would probably prolong it. I didn't understand the mechanics of this and so just accepted it. It is reassuring to me to read yours & Zips comments on just getting on with it in that waiting for a “gap” is not vital. I think to encourage a gap he would have to deliberately eat more protein foods again for a short time to prevent dissolving UA. That on the other hand doesn't seem sensible if it makes no difference whether UA is lowered naturally via diet, or by drugs.
The doc has gone on hols for a week & wants to see him in 6 days. She plans to inject his knee again with steroids if it hasn't settled & then start Allop. We are now both of the opinion however that it would be better to save steroids for a crisis, ie if he gets another agonising bout that seriously immobilises him for a long period.
Personally I found your post very reassuring & confirmed what I had been thinking but was unsure of. Also it nice to know we are not on our own. Really helpful to hear of other people's experiences. I would love to hear that your toe tophi clears up ….. if effort & perseverance counted than I don't know how it dare hang on!
I was under the impression that meat was worse than fish as far as triggering gout. I have taken Trev's advice though and remove skin from fish.
H eats all of the things you mentioned although hasn't had beetroot for a while.
He has the idea that a poultice of some sort may help – personally I doubt it would as he doesn't have tophi. He had a couple of soft lumps over joints recently that disappeared completely in days – no idea what they were, suspect they were gout related though.
Anyway Phofab – look after those chucks down-under & all the best to you.February 16, 2010 at 7:31 pm #7723
Trev – thanks for info re fish skin, I wonder if purines are higher in the fish oil too in that it seems to be oily fish that are the worst culprits.
He does eat lettuce but I cut it down a bit after reading something abut lettuce being bad for something – unfortunately though I can't remember what! I am not yet sure what the merits of an alkalising diet are – I will do a bit more reading.
Thanks for reminder about not over doing it following steroids (or other analgesia) – good point, tend to forget when pain is improved that still not fully recovered as masking.
You were taking a risk with a full bottle of wine. That would be a huge benefit of taking Allop for H! I bought him a vaccum suction pump thing recently so that he could just have a glass or two & the rest of the bottle would be ok for a while – hasn't use it, gone completely T- total. never thought I would see the day!February 16, 2010 at 7:41 pm #7724
Zip – thanks for advice – I like your straight no John Bull approach. Confirmed what I suspected (thanks to being educated via goutpal) re dangerous UA levels – will have to wait until doc back in a few days time though. Meanwhile think he should take your advice to Hansinnm re stopping ALL fish, meat until then (as I cant persuade him to eat more now!). Only a few days but may satisfy curiosity later to see what diff it makes to his UA readings. He has come to the same conclusion re “biting the bullet”.February 16, 2010 at 7:47 pm #7725
Thanks to you too for great advice & confirmation re not waiting for a gout free time before commencing Allop. (Sorry Trev – think we gotta go that way). Hoping that if he tolerates it & that it actually does the job, that he may be able to control with a low dose. Thankfully we have the UA monitor which is a great help.
Nice thought to think it might actually stop an attack in its tracks – speculating now!February 16, 2010 at 10:21 pm #7728
@ Sorry Trev – think we gotta go that way
Hey! I'm all for choice..I think the benefits of AlloP outweigh the disads.- but will not encourage other lifestyle changes so much that could be a better option long term.
A bit along the steroids line- but without the option of short term usage.
On the wine- I used to use a vacuum pump but now save those small 2 glass minature bottles and re-use them [3 to a bottle] . That way, it's not so tempting to finish the bottle- though I have been known to hiit three minatures in a row on occasion, ruining the effort somewha!
On the fish oil, I take Omax daily and found it OK. A PhD doc also mentioned the good effects of Co Q10 for heart health support, and anything that works 'to the good' has to be given a fair trial. He was, incidently quite a 'meds junky'- as I saw it, but obviously it's filterinhg through to mainstream medics that supplements have a place in the armooury of good practice!
There may be reasons for not taking them with gout, but I've not noticed.
Beer is altogether different -even though some effects are appreciated short term!
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