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Keep at the 300 mg. unless and until you see that your uric acid is too high. I'll bet it will be alright.
Residual deposits from old attacks can causes those twinges for many years afterwards. After all each old attack has slightly (or not so slightly) altered the joint.
Remember, a large component of our serum uric acid comes from breakdown of our own tissues. Two ways to increase that breakdown is extreme exercise and weight loss. So, like the old saw says “Everything In Moderation.”
What is a MORE likely problem than lactic acid after a hard workout, is cellular breakdown releasing a lot of nucleic acid breakdown products>>>uric acid!
34 mile round trip bike ride to work…sounds like an IRON MAN COMPETITION!
We all experience gout somewhat differently. I for one never have any pain from TOUCH at the site of an old major toe attack, but after a long long walk or run, the “sore feet” syndrome that is somewhat normal seems concentrated in that same bunion joint ( and that attack was over a decade ago.) I never run because my knees soon break down and start making life miserable.
I too am fond (if fond is the right word) of the elliptical trainer and I use it regualrly. I have found that my feet are happier if I do the workout barefooted.
So yes, I think one might very well expect heightened sensitivity at the site of an old attack. I think every acute attack leaves a little something behind and the joint is never quite the same. All the more reason to PREVENT attacks rather than settle for TREATING them.
I find something very thought provoking about the first set of pictures, the tophi riddled feet.
The RED of the urate is easily seen, but look at how the BULK of the tophi, especially the right bunion, is colorless (presumably blue according to the article.) Can we presume that the inflammation of gout is INITIATED by uric acid with urate remaining to be slowly replaced by CALCIUM, or bony overgrowth? That would certainly explain the reluctance with which some of these tophi dissolve even in face of preposterously low serum uric acid.
The tophi LOOK like they were created by uric acid and then replaced by a calcium layer and then ANOTHER uric acid layer, replaced again with calcium…each time the urate forms atop the old calcium tophus.
(Perhaps gout and pseudo gout are not that divorced from one another after all???)
Hmmm, problem #2:
Look hard at the blow up of GP's HANDS picture. Can anyone readily differentiate the red blood stream from the gout accretions? I can't and it would seem to be a problem source. Look hard at vast areas of red well away from the joints that look like capillary beds and then look at the affected joints thinking in terms of vasculature. Then the gout deposits aren't so cut an dried? If they can choose any color for the attenuation differences then why does the boloodstream have to be the same color as the urate????
Look at the very tip of the left little finger…urate or bloodstream?
My God, that is WONDERFUL. It seems to be an instantaneous definitive diagnosis if the red stuff is ONLY urate (but I know that nothing is ever quite so straightforward
.)But IF the red stuff is only urate look at the wonderful precision for the SMALL deposits all over the foot BESIDES the two obvious huge tophi on the bunion joints. So yes, it would be VERY good for decting deposits early on before there is any external evidence.
I have never HEARD of those DECT machines but I'll bet that my insurance (U.S.A.) would not cover it although I would LOVE to have my right hand assayed…and my left KNEE.
Fascinating stuff, VegGuy
When I read “A problem in getting doctors to prescribe chronic treatment for gout is that many patients are reluctant to admit they have the disease because of its association with gluttony.
That got my blood boiling. AGAIN it's a case of doctors blaming PATIENTS for the huge number of cases of untreated gout. Wyhich patient isn;t going to walk into a docotors office and say “I think a demon is sawing off my foot.” It's not the PATIENT who is responsible for a proper diagnosis but rather doctors who are incapable of diagnosing even the oldest of diseaases.
For a long while I was wondering why nobody had come up with the enzyme humans are missing, uricase. This enzyme breaks down uric acid and seems such a wonderfully DIRECT way to deal with it. Then I read that it existed and was used in Europe for extreme cases of gout. Of course I wondered why not here in the U.S.. After all humans HAVE the gene to make it but evolution has rendered it inactive (a good argument that early man was NOT much of a meateater.)
Anyhoo, Kryztexxa welcome but it will compete with my allopurinol which was last Rx's at 90 pills 300mg for $10 or $.11 a day. Unless my insiirance company picks up the tab, I doubt that I;ll ever be on any pill that costs $5 bucks a day unless there is NO alternative.
Anyone interested in more on peg-uricase:
tavery
If I were doing my own testing I would test first thing in the AM. That way the variable of how much of what kind of food the body is digesting is removed from the equation. For trends it is always best to compare apples with apples.
With that morning average of 5.7 I would expect you willl not see another gout attack unless you have noticeable tophi.
ACUP (acupuncture?)
The poor guy's been through Hell and his pseudogout is from such an anomalous source (chemo) and at such an anomalous age (23) that you are breaking unique ground with him. If you can turn him around, keep good records because it might be Lancet-worthy.
Really the symptoms are similar and the NAMES are similar but that's about it. It has nothing to do with gout.
Why are CPDD so hard to deal with? Probably becauae calcium phosphate salts are so damn insoluble once they form.
You're going to have to help me with FSM…it strikes a chord with me but that chord is FLYING SPAGHETTI MONSTER (the one and only true god.)
Not familiar with the uses of Java tea.
Jesus, Leukemia AND testicular cancer…sure his name isn't JOB?
trev,
The bigger problem is K+ reduction with loop diruretics, but I haven't had a problem. But I DO take 20 Meq, KCl supplementation (about 800 mg.) several times a week, when I rmmember the horse pills, just in case. Of course I take 250 mg. MgO every day also. I thing Mg++ is a great heartbeat regulator.
He stated that people are too ready to stop the use of Diuretics but the reasons weren't discussed.
That's true and its a shame because they are really such great drugs for a society like ours where we eat extra salt on our salt sandwiches.
I cannot say whether ot not your beta-blocker has caused your attack. A good estimate of culpability is the degree to which it causes diuresis. On morning after a salty day, if you take JUST your beta blocker, do you pee like the Trevi fountain? The more it acts as a diuretic, the more the gout attack risk.
My propranolol is quite diuretic.
Yep, it took me at several years of thiazide use, hydrochlorothiazide 50 mg./day, to develop gout. I think the crystals accumulate little by little by lttle until the immune system can bear no more…then POW! And then like a dummy I took the same drug for another decade even WITH allopurinol.
A drug company released a study a while back where they compared heart and stroke risk wiith BP quantitatively. It turned out that the risk of drug CONTROLLED BP at 120 was higher than UNCONTROLLED at 140. And this was an AD to SELL the drug. I wish I could find that again…perhaps it's been pulled after big Pharma realized what it actually SAID.
It is most commonly thought that even Christopher Columbus died of gout!
A cute read from the TImes a while ago:
But I'll bet other gout sufferers weren't laughing at Harry. Way back in the 17th century physician Thomas Sydenham gave a description of a gout attack which is still regarded as a classic, and there's nothing comical about it. It goes:
“The victim goes to bed and sleeps in good health. About two o'clock in the morning he is awakened by a severe pain in the great toe; more rarely in the heel, ankle or instep.
“This pain is like that of a dislocation, and yet the parts feel as if cold water were poured over it. Then follows chills and shiver and a little fever. The pain which is at first moderate becomes more intense. With its intensity the chills and shivers increase.
“After a time this comes to a full height, accommodating itself to the bones and ligaments of the tarsus and metatarsus. Now it is a violent stretching and tearing of the ligaments, now it is a gnawing pain and now a pressure and tightening. So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of bedclothes nor the jar of a person walking in the room.”
Sydenham was a goutie himself, and noted stoutly: “Great kings, emperors, generals, admirals, and philosophers have all died of gout.”
Famous sufferers have included Nostradamus, John Milton, Christopher Columbus, Isaac Newton, Benjamin Franklin, King Lobengula and Queen Anne.
The most common way that gout kills is by cumulative attacks on the kidneys resulting after many years in end stage kidney failure. But there's good evidence to support high uric acid as VERY involved in atherosclerotic heart disease.
Yes, untreated gout is a killer, no joke.
Let me simplify all that (can't EDIT):
People with gout are divisible into two generalized categories:
1. Those that control their uric acid to 6.0 mg./dL usually with allopurinol and have no further acute attacks no matter what they eat or drink.
2. Those who do not use drugs and try this that and the other between attacks and then this that and the other to stop the attack until the next one.
It if from group 2 that you wll see all the nostrums, food remedies, and do's and don't.
Both I and GoutPal count ourselves in Group 1. I have not had an acute attack in well over a decade. (I won't say that I wouldn't LIKE to get off daily allpurinol
but I take it faithfully!)Jack,
I agree with almost everything you said. My last GP was an incompetent asshole who wrote the most basic recurring prescriptions, too blood pressure, and drew blood to send to labs. Then he read the list the lab sent him and circled everything that the lab said was out of the normal range. For everythin else he scribbles down the name of a friend who is a specialist in something…this include even a simple rash. For any upper respiratory problems he says “there's a lot of that going around.”
For this he makes $250,000/year.
But I have one strong disagreement with you on:
The two common posters here Zip2play and GoutPal cannot even agree on cause and effect.
We agree that the cause is an inborn genetic error in mankind that, unlike many species, does not produce the enzyme uricase which breaks down uric acid to easily soluble allantoin. All people have too much uric acid and those that have MUCH too much get gout. The cure, for those with gout, which I am sure we both agree on is either to make less UA (allopurinol or febuxostat) or to get rid of more of it (probenecid.) We are in strong agreement on cause and effect. I think we both agree that colchicine is a very effective treatment but other pain relievers can work also. We both agree that dietary changes can have an effect on UA concentration but the effect is slight compared to KING allopurinol.
(Correct me, GP, if I have misstated your opinion.)
Now, as for the OTHER stuff:
Tomatoes yes, tomatoes no. Coffee yes, coffee no. And all the ancvient BS about anchovies, sweetberads, and organ meats….when's the last time you ate sweetbreads in an anchovy sauce? Black bean broth, cherries, heat, cold, bicarbonate, Vitamin C megadosing, chondroitin, glucosamine, tea-tree oil and on and on.
Remember, gout was untreatable only a half century ago. With the single exception of colchicine there was NO treatment even for the pain of an acute attack (aspirin is not good unless you eat it like candy.) Quacks abhore a medical vacuum. Before 1950, every quackmeister crawled out of his hole with yet another nostrum…just pay the barker. A lot of this claptrap still exists and where before 1990 it had to pass the muster of an editor and a printing press so you didn't see too much. But now with the internet ANYTHING can be peddled indiscriminately and all of this eighteenth century garbage comes bubbling back up. (In some circles is was thought that it was a demon in the joint that caused the attack.)
My position, and I'm sure GP's is that when someone comes along and says such and such worked for him, neither of us wants to throw cold water on the idea. Maybe there's something to it, and there's always the placebo effect. But I'm sure we both agree on the PROPER way to deal with gout: to lower uric acid and to test it reguarly to make sure it stays low for the rest of one's life.
So I will never be one to say that cherries don't prevent attacks but neither will I ever recommend them to anyone becasue I feel the purpose of the prom,otion is to sell expensive cherries.
And as for the overview of doctors: the health care system in the United States is badly broken…chances of ever fixing it are slim. My answer is, as much as possible, to be my own doctor. If you count on yourself, at least you are counting on someone who CARES. Without too much effort you can make yourself far more competent than ANY GP on the subject of gout. THere's no point in bemoaning their stupidity…it is legion.
And yes, they have the prescription pad and the power of the federal government says that under penalty of imprisonment, only the strongest UNION on the planet, the AMA, is empowered to allow you to get a proper treatment for your disease. If plumbers could get that power it would be a federal crime to change a faucet washer.
Don't look at it that way.
Evolution has played an ugly trick on mankindi in the slow accommodation to a meat-eating diet. It's not your fault that we are eating on top of the food chain.
It's the way it IS.
Other species have acclimated and can readily change uric acid to allantoin which is easily disposed of. We need allopuriol to dispose of it….maybe in 10,000 years we'll catch up.
I am amazed that a meal like the one you had would raise your uric acid even an iota.
Anyways, my point about uric acid testing on an empty stomach is a good one. After all, the solubility of uric acid is not affected by a package insert, it remains what it is. THus there's no advantage to knowing that part of the day, with an empty stomach, your uric acid will remain in solution if post-prandially you will have serum that is highly supersaturated with UA just looking for a joint to hammer. Probably some testing at both times is an excellent idea.
Hmmm, just under a pound apiece…that's a LITTLE cheaper than I thought they were.
mikey,
I have had what you speak of on my eyelid and never gave gout a thought. I have always been able to easily squeeze the little buggers and get a thick white waxy bit out and the “wound” healed invisible in a day or two. Perhaps there were uric acid crystals involved, perpaps not…but out they came.
I may have had one on my ear also but that popped just as easily. The ears are a common tophi site, the eyelidss not.
I would attribute the range (7.8-8.2) to expected testing error. I would interpret them as essentially the same reading, 8.0, with an error of +- 3%. That's quite good for a home test.
Big difference after a meal though, eh. (What was the meal? high purine? meaty?)
Brings up an interesting point though. Since we generally have out blood drawn in a doctor's office on an empty stomach (to get a reliable triglyceride and LDL cholesterol level) we might all be walking around with uric acid considerable above what our lab tests say.
VegGuy…you must be rich because those strips are a couple bucks apiece, right?
Tavery,
There is some decent evidence to show that excess salt casues the kidney to retain certain waste products, among them uric acid so I feel that yes, excess salt can preciptate a gout attack.
Excess salt also produces considerable edema which will increase the swelling and pain of any attack.
Our high salt diets are SO bad for SO many reasons…the worst probably being the increase of hypertension and stroke risk.
Iain,
My best wishes go with you, you're on a tough road.
But don't give up on uric acid control even if it involves a completely vegetarian diet.
Make sure that you remain under the close monitoring of an EXPERT nephrologist; kidney failure is how uric acid kills.
Serum uric acid sometimes plummets during an acute attack. The oblvious reason is that the circulating UA moves out into the joints where large amounts precipitate and cause the attack.
If I were you christy, I'd wait until you stop the attack and pain (I recommend colchicine for relief) and then have your blood tested again. With an accurate and enduring UA reading around 3.9 mg./dL it is virtually IMPOSSIBLE to have gout.
Was you attack the classsic podagra, the inflamed and excruciating pain in the big toe bunion joint?
Iain,
Do you have many tophi?
I wouldn't give up on urate control even if you have to do it alone. Starting with an assumption that you make a normal 750 mg. uric acid a day like most people, that's how much you should excrete to be in stasis…more if you want to lower your serum and joint urate level. So you absolutely need that kidney excretion number from your old tests or from a new one. That will detemine if your kidneys are fully functioning and capable of excrreting uric acid. See if you can dig this number out.
The drugs you are taking now will NOT affect your uric acid and are only for pain control…that's not good enough.
Please don't give up if there's another drug to try or another approach to take.
The risk of is that when you need new knees you may also need 2 new kidneys or permanent dialysis. Alas, since you said the only time you got normal uric acid levels was on dialysis, the strong presupposition is that your kidneys are NOT removing enough uric acid…but there ARE drugs that increase uricosuria. Have you tried probenecid or sufinpyrazone?
Have you tried the allopurinol substitute, febuxostat ?
Horrible to read what you have gone through.
I also am shocked that 900 mg. allopurinol was not sufficient to bring down your uric acid. Have you ever tried probenecid or one of the other uricosurics. I imagine that with kidney failure always in the picture, these might be overlooked.
Have you been tested for a urinalysis over 24 hours to see exactly how much uric acid you are excreting?
Do you suffer any diagnosable conditions that might casue your uric acid to be so high and so unresponsive? Something like cancer, or kidney disease, NOT caused by the uric acid but CAUSING high uric acid, certain drugs?
Let me add my $.02. Probably lots of overlap on previous posts.
Firstly,
You are very thorough VegGuy…and your little feet are kinda cute.
Secondly, I weigh in with a strong NOT gout for several reasons primarily the location of the pain on the top of the bunion joint rather than the WHOLE bunion joint with empasis on the MIDDLE/body center of the joint. THough I can see some slight rednness and swelling, the PURPLE of a podagra attack is not apparent. Add to that the low serum uric acid and the fact of your vegetarian diet.
X-rays: with a huge massive attack the best you see is a bit of fuzziness around the joint until such time as the joint is somewhat destroyed. X-rays will confirm nothing.
Now, what is it? You state that the toe is not involved in calf raises…that is dead wrong. THe bend of the foot is precisely the bend of the bunion joint which is where the true Hell of gout usually manifests. This joint IS the innermost part of the “ball” of the foot. A calf raise demand a strong pull on the tendom atop the bunion joint and that is precisely where your pain is.
So my Dx is tendonitis of the foot, and precisely the “tensor hallicus longus” (I had to look that one up so don't be impressed.
) and my Rx would be to lay off the calf raises for a month or so. Alleve (naproxen) or ibuprofen will probably help with any pain.(I stand warned about too many calf raises…I do them but not a whole lot becasue they are hateful and show so little results.
)charley,
I've never heard of that “dark skin” phenomenon but then I've never heard of someone suffering a 3 month attack. You say it's NEW skin? Does that imply that the lesion broke open and exuded fluid through an open wound?
Best have a doctor rule on that toe because anything bordering on gangrenous is mucho serious.
The pain on the outside of your foot is probably from walking/hobbling on the outside of the foot for so long. It's a natural response to trying to prevent the big toe from touching ANYTHING. But it COULD be from migrating uric acid.
The allopurinol will soon have you right as rain.
Three to four SMALL “pegs” sounds okay but 4 LARGE “pegs” daily (8 ounces of booze) might be pushing the envelope at least until you get your uric acid down for a couple weeks.
Hmmm, 6 attacks in 15 years…I might agree with your desire not to get on a lifetime of meds. But you'll have to be alert to any increase in frequency or severity. For example, it's probably not tenable to suffer a month a year of debilitating pain. Gout tends to get more, not less severe.
Yep, thiazide to a gout sufferer
…some doctors cannot connect the dots even if there are only TWO!Hypertension:
Here's my experience (yep I monitor daily with my trusty LUMISCOPE…cheaper than the OMRON!) Another fact that many doctors cannot comprehend is that there are TWO types of hypertensives V-type and R-type. (V for volume, salt-sensitives<25%> and R-for Renin driven<75%.>) Again, I think many doctors after med school read NOTHING except blurbs from pharmaceutical companies and their monthly financial tallies.
If you are an R-type you will do very well with ACE inhibitors and ARB (angiotensin respeptor blockers) At the risk of repeating myself too often, there is ONE ant-hypertensive drug, and only one, that is uricosuric and that is losartan (Cozaar.) Try it…if it gets your BP down enough, well and good. If you can take an ACE inhibitor without coughing and get good BP control, well and good.
But if you are a V-typer hypertensive, you NEED a diuretic, sad but true. Thiazide is just impossible for us but lasix (furosemide) not so bad. I take a combo of Lasix and Cozaar daily and I get good control without retaining uric acid. If you MUST take a diuretic, take Lasix with Cozaar.
If I had to rate thiazide and rum;s contribution to gout it would be Thiazide 97%, moderate rum 3%.
In reality, I think you can look to a future with daily allopurinol but you will know when the time is right.
Aviator,
I like your innovative self help…a man after my own heart. (Note we can assume that everone on this forum is a MAN…funny and sad.
Anyhoo, I would think that the pool tester is just fine becasue pH is just pH and I doubt that any tes srtrips made specifically for urine are any cheaper than $.15 each. (I'm going to tty to cop a few at my gym but they may use those bottles and droppers and might not want me peeing into their equipment.) The range of the pool strips seems narrow enough to get a good valid reading around 7.0…just the range you'd want.
Why not give colchicine a try…I see no reason to suffer 3 weeks with an attack.
Let me add that it is rather rare for vegans to develop gout because their intake of purines is so very low. So a good guess is that you will turn out NOT to have gout.
Let us know your uric acid level when you get it.
Mark,
It's just NOT going to work.
Daily allopurinol is no more appealing than daily insulin…but both are necessary to cure their respective metabolic flaws. At least allopurinol is dirt cheap and has few, if any, side effects
Your weight loss is applaudable but remember, weight loss is a MAJOR trigger for a gout attack.
Andy,
Back pain is not usually associated with gout but there are some that believe that almost ALL joint pain is uric acid related…so who knows? As a back pain sufferer for several decades, I know that back spasm can radiate all over the area. Thus the kidney pain you feel is quite likely to be the back muscles going into spasm. The only way you would get ACTUAL kidney pain is if you have formed stones and these get stuck on the way out. And then the pain is a SCREETCHING affair…not to be confused with anything else on Earth.
“Back pain at 38 is just AGE?”…the man is a FOOL, get another doctor.
The NORMAL medication for gout pain is colchicine, not cherries and vinegar…sorry.
Get on daily allopurinol but don't count on back relief.
THe perplexing thing about your ruined vacation is that an attack of acute gout USUALLY involves one joint, not both knees, ankles, and big toe all at once. Have your doctor run a compete rheumatoid panel.
How long have you been suffereing from confirmed gout?
