My gout diary (?)

[Marc Fehr]

I am not much for “forums” or group websites and stuff so I find this all very confusing.

Anyway, I started a topic last time under Help my Gout, so I’m not sure if I’m in the right place or am I supposed to continue that thread with my new info?

I’ve been suffering for 5 years and mostly the doctors have been yanking my chain. I finally found this website and am trying my best. I got my blood work done yesterday and went in for results and prescription for Allopurinol today.

I am very happy and excited, hoping this works for me.

My Urate is at 576 umol/L (this is during a small attack and surgery on other foot 3 weeks ago, fyi)

She has started me on 100mg Allopurinol once a day but says after the first week I can start taking 2 pills a day.

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When will you start your Personal Gout Diary?

[Keith Taylor]

I’m sorry about the confusion, Marc. I must find time to document this properly.

Your choice is Casual Gout Help or Structured Gout Help. In both cases, you can ask as many questions as you like. Or share experiences and opinions.

Casual is where you just ask questions whenever you feel like it. Then, other GoutPal members and I will try to answer them. Each question is fairly isolated from others. But, you can often save repetition of facts by linking to an earlier topic.

Structured is where I create a separate forum, just for your posts. The first advantage of that is, you can create topics to record daily gout symptoms, changes to gout medicines, test results, etc. And you can organize it however you like.

Secondly, you can start to ask more complicated questions that I can answer in a step-by-step manner. It’s a form of self-paced learning, where we don’t move on to the next step until you are happy with the current step. This is great for treatment plans, or to get a more in-depth view of a particular aspect of gout.

So, Marc, the choice is yours. You tell me which you prefer. Then, I’ll explain what we do next.

[Marc Fehr]

Yes I would like structured gout help please.

I believe I’ve given a decent amount of backstory, here and on the Help My Gout topic that I made (if you recall?)

So as of now that blood test was 1 week ago, showing 576 umol/L . Liver and Kidney seem to be fine. A bit high suger (I think it was triglycerides?) and a bit high cholesterol but nothing crazy.

Like I say, I had surgery to remove the crystals on my left foot, 3 weeks ago. It was very bad.

And now it is attacking my right foot. I know I’m probably not supposed to do this, but I am using colchicine and indomethacin on top of the Allopurinol I started last week (Tuesday May 16th I believe). Oh and I should note, the colchicine and indo don’t really work on me anymore. BUt I gotta do *something* …

I am going back to work very soon as a Plumber and need that foot in working order or it is going to be extreme pain, as I am used to for the last 5 years, but I would rather get it fixed or taken care of asap, obviously.

THat’s about it for now I think, thanks!

[nobody]

Some people get extra strong attacks after starting allopurinol.
I expect you are now taking 200mg. You might benefit from taking more than that after your next blood test which I wouldn’t delay in light of your situation.

It could be that you need larger doses of colchicine and indo.
I can’t speak about indo dosage because I’ve only taken acemetacin (which I understand turns into indo within the body) and I don’t know how to convert doses from one to the other. But obviously some people have taken pretty large doses for gout compared to what is often recommended for other uses.
Colchicine is most effective when taken before you start hurting. Once you are really hurting, you need to take higher doses and still it’s not effective right away. The maximum dose is very high and the default instructions for colchicine here are to take 3mg the first day (waiting at least 3 hours between 1mg pills) and 2mg the second day if you’re trying to fight an attack as opposed to prevent it. I’m not sure most people would benefit from taking that much but certainly there can be a benefit in taking more than the daily 1mg (or 1.2mg) people are often told to take.
It seems you’re healthy and would be able to tolerate heavy doses but, especially with indo, better talk to you doctor first before taking heavier doses than you’re used to. If you were to take a lot of indo, your doctor might want give you yet another drug in order to prevent some of the side effects.

And if colchicine and indo really have become inadequate, there are other drugs which fight inflammation.
There are of course also painkillers you can take on top of that, though the most effective ones tend to be debilitating which wouldn’t help you if you want to perform at work.

I hope you can find an effective way to stop your attacks dead in their tracks before you get back to work.
This will likely not be your last and in my opinion dealing with the symptoms aggressively when they start would likely reduce your total drug intake.

[Marc Fehr]

oh my goodness what??
They’ve been prescribing me .6mg colchicine with intstructions 1 pill 3 times daily. That might be part of the problem as far as defeating attacks. That’s too low!

And just more history, so you all know, I’ve gotten it all over my feet, my knees, and sometimes I’m pretty sure it’s in my elbows and fingers. I just realized that I made it sound like it was mostly just my left foot. That’s just the one that got out of control.

Okay I’m upping colchicine to try to defeat this little attack on my right foot. I’m also upping Allopurinol to 200mg/day and will get a blood test asap (here in Alberta it’s free so I might go today even and then again next week)

Thanks so much everyone this is the first real hope I’ve had in a long time.

[Keith Taylor]

Can I suggest a note of caution re colchicine? Because, I understand there are different attitudes to dosing. But, it’s my belief that doses heavier than 2mg per day are rarely beneficial. So, I suggest looking at the indomethacin dose as well.

You should understand that colchicine is very effective at blocking inflammation from starting, or spreading. But, it does nothing for existing inflammation. Which is why you need strong anti-inflammatories to support colchicine if inflammation has taken hold. Also, in severe cases, you might need a supporting pain-blocker like Tylenol. Or, whatever your doctor or pharmacist recommends.

[nobody]

.6mg three times a day ain’t bad. It’s not a crazy way to take colchicine. I never tried to stop a serious attack with 2mg or less but if you’ve been taking 1.8mg a day for several days, it adds up and ought to be effective.
I think it’s worth trying a higher dose because we don’t know what dose would be effective in your case (just understand that unlike indo it takes a long time for colchicine to work) but I agree with Keith in that looking at other drugs seems more promising if you’ve already taken 1.8mg a day for several days.

And yeah, I had gotten the impression your gout wasn’t as bad as it seems to be after all (“only came once a year kind of thing” had stuck in my mind) but on the bright side you are now addressing the cause of the problem.
Any gout pain you get while taking allopurinol is almost guaranteed to be temporary. But you still need to find a way to stop inflammation for the last attacks still ahead of you.

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