Gout Diary – Gary Cork

[Gary Cork]

I have just got my lab results and I have a uric acid reading of 520. My doctor is putting me on 100 mg. Allopurinol and Colchicine (I do not know what mg of Colchicine as yet.
I am 73 years old and have had gout attacks (about 2 per year) for 30 years.
I live on a small island off of Canada’s Pacific coast.
I weigh about 170 # and exercise at a gym about 2 times per week.
I had a gout attack about 2 months ago in my left knee and treated it with 200mg ibuprofen and alfalfa tablets.
After reading articles in this forum I realise I had to take this seriously and so have had lab work done.
Since I have an above normal reading I may be able to get regular uric acid levels checked.
My diet is pretty good I think. I eat red meat possibly 2 times per week. I don’t drink beer and will occasionally have a glass of wine with dinner. I prefer to drink tonic water or ginger beer.
Hope this is enough to start my diary. If any other info is wanted please let me know.

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A Gout Diary is the best way to organize your personal gout facts.

[Gary Cork]

Oh, to add, my liver and kidney function tests are OK. I will get a copy of lab work when I get my prescriptions on Friday.

[Keith Taylor]

OK, Gary, you now have your own personal space to keep your gout information. So, please let me know if you need any help organizing it. Also, let me know if you want me to move your other 2 topics that you started into this personal forum.

As well as organizing your gout information, you can also ask better questions here. Because, you can flag questions as support requests, which I will answer as my first priority.

[Gary Cork]

Hi Keith, Yes I could use some help in organising my personal gout diary, any thoughts would be welcome. If you could also move my other 2 topics to the personal forum that would be great!!
A further question, my doctor gave me the information about my uric acid readings over the phone and ordered my Allopurinol and Colchicine which I picked up at our small pharmacy at the clinic, if I get a flare up do I still take the Allopurinol when I am taking the Colchicine?
Thanks, Gary

[Keith Taylor]

Yes, you must never stop taking allopurinol once you start it. That is the golden rule of allopurinol that should never be broken.

Except, when you first start, which should be 100mg allopurinol, if you feel you are having a bad reaction to it, contact your doctor immediately. On the label, you should see the warning symptoms that prompt you to stop. Other symptoms might tell you to continue, but tell your doctor.

I won’t bore you with other instances when you might break this golden rule. Because all rules are made to be broken. But, you have to have a complete understanding of the rules, and consequences, before thinking about breaking them.

I’ll start a separate topic about helping you with your gout diary.

[Gary Cork]

I have been taking allopurinol 1 tablet per day since May 11th. I have experienced a different type of pain in my foot and began taking colchicine and I am surprised how well it works!! I take a pill .6 mg and the pain goes away after about 2 pills during the day. I have loosely been watching my diet and do drink a couple glasses of wine about once per week ( although there have been parties and I take along some tonic and possibly one glass of wine)
I am about due to get another uric acid reading from our clinic to see what my levels at at and will notify you about my new readings. Cheers, Gary

[Keith Taylor]

Hey Gary,

I’m pleased that your gout recovery is progressing well. Also, I can’t wait to read your latest uric acid blood test results. 😀

[Gary Cork]

Hi Keith,
I just got my Uric Acid lab work back and the result is 397, so I have dropped from 519 to 397 and had been taking allopurinol for 44 days at the time of my uric acid test. I am quite pleased with the results and will keep on taking allopurinol at 100mg. Any ideas on how long the uric acid in my joints and organs will continue to clear themselves? I believe I remember reading in this web site that it can take up to a year and more to clear stored uric acid out of the body.
Cheers, Gary

[Keith Taylor]

Gary, thanks for posting your latest results. But I hate being the bearer of bad news. Because 397 is still too high.

To explain, you don’t start gout recovery until you are down to 360. Even then, progress will be very slow. So, your target should be below 300. Then, when you have gone 6 months with no symptoms, you can relax the dose if you want.

There’s no fixed rules about how long this takes. But, we can certainly say that the more you lower uric acid, the faster the process will take.

The good news is, you have completed the first step very well. Because you have proved that allopurinol works for you. Now it’s time to go to step 2, where you increase to an effective dose. So please ask your doctor to increase allopurinol so you can get below 300.

[Gary Cork]

Thanks for this Keith. I went to my clinic and said that I wanted to up my allopurinol intake and they agreed, so I am taking 100mg. 2 times per day.
Since I am in the normal range for uric acid under the British Columbia health plan I need to wait 6 months before I can get another uric acid level checked. I am almost considering getting my own Uric acid meter.
I have recently had a flare up in my knee and took 2 colchicine over the next 2 hours with no effect. I then took 400 mg. of ibuprofen and that had appositive effect, lowering the discomfort. the next day my knee felt better and since I was visiting someone on my motorcycle I took another 400mg. and my knee felt much better.
Today I took one 200 mg. ibuprofen this morning which has helped but now my left foot has a burning sensation which previously was helped my colchicine and am wondering about taking that over 400mg. ibuprofen. Any thoughts.
Gary.

[Gary Cork]

I have been taking 200 mg. of alopurinol since July 15 2017. I have been getting varying gout attacks ranging from 2 days to 1 week. They tend to happen at night and the pain is different more like an electrical burn or being bitten by fire ants.
The pain responds well to colchicine and will usually disappear with one to two pills. I do experience digestive upset and loose bowels if I take 2 pills.
I have found that taking 400mg of ibuprofen helps and I am glad that I am not incapacitated by my gout pain.
I have also found that DSMO seems to help with the pain.
I had my uric acid checked on September 13, 2017 and found that my uric acid levels were 406 up slightly from 397 in June.
I imagine that the higher levels occur because of the increase of alupurinol releasing the uric acid crystals from my joints and soft tissue.
I would like to get some feedback on this.
Thanks for your help, I find this web site very helpful.
Gary

[nobody]

Hi. Here’s a quick feedback…
There’s noise in test results so 397 and 406 are basically the same.
Both of these values are too high. There was some uncertainty when all you had was the test result from June but it’s now become quite clear that 200mg is not a sufficient dose for you at this stage. So unless you know that there is a medical reason preventing you from taking more, you should talk to your doctor about increasing your allopurinol dose.
The status of your liver and kidneys should have been monitored along with your uric acid so your doctor should be able to tell you if your body is already struggling to deal with 200mg or if it looks like you could handle a larger dose.
Good luck curing your gout!

[Gary Cork]

Hi, Thanks for the above information it follows my thoughts on the situation.
My clinic doctor agreed with the above and gave me a prescription for 300mg of allopurinol to be taken for 3 weeks and then to come in for a uric acid check and also to check liver and kidney function. She also stated that the diahrrea I experienced with taking colchicine is a good thing since when I experience this the loose bowels are also clearing out uric acid. In her opinion colchecine is better than ibuprofen since ibuprofen is harder on the liver over the long term.
I will report in with the results of my new tests in 3 weeks.
Cheers,Gary

[Gary Cork]

Hi, I just got my lab results back after being on 300 mg allopurinol since September 22, 2017, so that is 21 days on the new dosage, my uric acid reading is 387 umol/L. I also had my liver and kidney functions checked and all are ok except my Creatinine is 102 umol/L and the high range of normal is 100. I imagine I can cut back on meat protein although I do not eat that much possibly 2x per week.
Hopefully my uric acid level will continue slowly to drop. It has gone from a high of 519 to 397 up to 406 and then down to 387. This is over a 6 month period increasing my allopuriol for 100mg to 200mg to 300 mg.
Gary

[nobody]

Hopefully indeed. It’s probably too early to tell but you may be one of the more difficult cases who would benefit from using another drug either on top of or instead of allopurinol.
Quitting meat entierly (or being careful about what parts you eat) might bring about a small improvement. And there are other dietary tweaks you might want to try besides getting rid of meat.
But you’d make more progress with drugs. If allopurinol is hard on your kidneys (I don’t know how your tests looked liked earlier or to what extent the raised creatinine is due to colchicine), maybe it’s time to see a rheumatologist.

About your earlier post, my doctors think the same way about colchicine vs. ibuprofen.
But my rheuma says diahrrea may be a sign I’ve taken too much colchicine. I guess it depends how bad it is but it’s apparently more like a sign telling you that you’re pushing against your body’s limits than a problem as such. Certainly mild diahrrea doesn’t mean you ought to stop taking colchicine. Be sure to drink enough water though.

[Gary Cork]

Thanks for this Nobody. I have a question about the rate of lowering uric acid levels. What is a normal rate of dropping the uric acid levels taking 300mg. of allopuriol daily? You seem to be intimating that normally my levels should have dropped more. If you could respond to this that would be great!!
Looking over my lab results going from 1998-2015 are as follows:
1998 – creatinine 115 normal
2001 ” 105 ”
2003 ” 116 high
2006 ” 91 normal
2007 111 high
2009 97 normal
2013 109 normal
2015 104 high
I hope this is not too much but I do seem to fluctuate with my creatinine.

[nobody]

I don’t think the “normal rate of dropping the uric acid levels” is relevant to your situation. Everyone is different. For instance, you are older than most study subjects and you don’t seem to have very good kidney function.
But if you were an average gout patient who tested at 519 before taking allopurinol, I’d expect your uric acid to test around 320 on 300mg. Understand I’m only giving you a number because I don’t want to avoid your question. It’s just a number I made up based on studies I’ve read and it’s not necessarily a problem that you test higher than this.
You do test too high, mind you. But that’s why allopurinol doses have to be customized to the individual. And it looks like you could use more than 300mg. There are random variations so your next test on 300mg could be a good bit lower. But since your results on 200mg were already a little high, I think your latest test result might be further evidence that allopurinol isn’t as effective as one could hope in your case.

What allopurinol does is to reduce the amount of uric acid produced by your body. So if your body isn’t making a huge amount but is instead having trouble getting rid of uric acid, allopurinol is going to be less helpful. It’s going to help a bit in any case and we can see from your test results that it is helping. But maybe your body also needs help getting rid of the stuff in order to get your uric acid down to a healthy level.

In light of your older kidney function tests, 102 is clearly not unusual for you so my concern that allopurinol or colchicine might be raising your creatinine test results seems unwarranted. So perhaps you could take even more allopurinol?
Obviously, your doctor may have access to other test results (creatinine isn’t the only relevant test) and will in any case have a much better picture of your situation than I do. Also, I’m no doctor. So this is something you ought to discuss with your doctor or doctors before taking any action.
All I can tell you is that your uric acid test results aren’t satisfactory yet, that another blood test on 300mg would give us a better understanding of what’s going on and that in some of the more difficult cases, other drugs are used in combination with or instead of allopurinol.

[Gary Cork]

Hi Nobody, Thanks for the above I really appreciate your feedback. I will continue with the 200 mg of allopurinol for now and then be tested in a few months to see how my uric acid levels have changed.
Too bad Goutpal did not exist back when I had my first attack. I could never understand at that time why my uric acid levels were in the normal range and i continued to get attacks. My doctors could not explain in to me and my attacks happened about once or twice a year.
I will let Goutpal know what is happening with my next lab results.

[Gary Cork]

Hi, I just got my new lab work results done and my latest readings for uric acid are 270 umol/L. My hemoglobin was slightly higher than the norm at 6.2, and my creatinine readings were high at 113, the normal range is 60-100.
I find it odd that I had a gout attack on my left small finger about a week after being tested. It is much better than having it in my foot which would incapacitate me from getting around. I found taking 2 300 mg. allopurinol pills helped with this latest attack.
I am realising that I dont drink enough water and am going to start doing this plus am implementing some dietary changes.
I do have a history of borderline normal kidney function and am hoping to improve my results by the time of my next lab work.
I really dont want to take any more drugs if I can help it.
Thanks for this, any feedback would be appreciated.

[nobody]

That’s good news, though you’ll have to keep monitoring your kidney function to make sure allopurinol isn’t making it worse.
Maybe you are one of those people who flush uric acid slowly so that the full effect of the drug takes a long time to become apparent. If your next test shows that your last result wasn’t a fluke you could possibly try lowering your dose a little.

I would recommend against randomly increasing your dose. Allopurinol isn’t a harmless drug. If your body starts reacting to it badly, you’ll be very sorry so don’t take chances. If you have an attack, taking anti-inflammatories on top of your regular allopurinol dose is recommended instead.
And drinking more water when you feel an attack coming to help flush out the crap can’t hurt. You could also try eating more foods which make urine less acidic such as most vegetables. That could help too.

[Gary Cork]

Thanks for this nobody. I am getting into an Ayurvedic way of eating for my body type which seems to process food slowly, hopefully that will help.
When I get an attack I can experience pain in other parts of my body where I have old injuries, seems nerve related. I also get flashes of anxiety attack for lack of a better word. I can control it by meditative breathing. Once an attack is over I am spaced out for a few days and then come back to normal.
My doctors seem to be confused by these and can’t equate them but I do.
Cheers, Gary

[nobody]

Makes sense to me. An attack is an immune crisis. They’re definitely stressful which can cause all sorts of nervous and psychological trouble. A mindfulness practice should help with that (as do the right drugs).
But in contrast with drugs, being mindful will also make the consequences of stress more apparent to you. The same thing might be happening to many gout sufferers, only they (and their busy doctors) haven’t noticed.

[Gary Cork]

Thanks for this nobody. It is great to get an acknowledgement for what I have been experiencing. I am impressed how my Buddhist meditation practice affects with all my spiritual, mental and physical life.
Cheers.

[Simon Daynes]

Hi Gary,
I just wondered how you are doing these days. Last time you seemed to be on the way to a gout free life so it would interesting to have your latest markers….
Cheers
Simon

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