Need Gout Patient Plan: Any Help Appreciated

[Malik A.]

Where to begin… About three years ago, I suffered a debilitating pain in the joint of my right big toe. It was red, swelled, hot to the touch, and felt like someone was striking it with a hammer. I had to crawl to the bathroom it was so bad. I went to my primary doctor, and he thought it was gout. But when he began to ask me about triggers, he was a bit astonished:
“Did you eat a lot of seafood or red meat?” he asked.
“No,” I responded. “I’ve been a vegan for years.”
“Did you drink heavy this weekend?” he asked.
“No,” I replied again. “I’ve had maybe two beers my entire life.” (I don’t drink.)
So, he sent me to take blood work, and, lo and behold, my uric acid levels were indeed elevated. He prescribed Colchicine twice a day. After days of taking it, I saw absolutely zero improvement. He suggested I see a rheumatologist. So I did. She first prescribed Naproxen, which helped some, but did not get rid of the pain and swelling for long. I then graduated to Prednisone, which again helped only temporarily (some hours, for example) before the pain and swelling came raging back. Next, I went to see a podiatrist. He prescribed indomethacin. Same result. To make a long story less long, I battled with pain and swelling for MONTHS before it finally completely subsided. And, fortunately, I haven’t had another attack. Until three weeks ago. This feels like déjà vu. Went back to the rheumatologist, who prescribed Colchicine and Prednisone. Three weeks later no improvement. On top of that, I am experiencing the strangest headaches (more like a pressure feeling in my head), and my latest lab results show elevated liver enzymes, most likely a result of the Colchicine. Along with the drugs, I have tried every remedy known to man: cherries by the pound, tart cherry juice by the gallon, water by the sea, celery extract, vitamin C supplements, apple cider vinegar, ginger tea, tumeric, etc. (I even wrapped my foot in cabbage leaves. I know what you’re thinking. But I would have wrapped my foot in elephant dung if someone told me it worked.) My latest uric acid test was 6.8. But I know that during an episode, the numbers can be skewed. With all that said, I am at my wit’s end. I don’t think the doctor’s have much else to offer but more medicine, and with the side effects I’m experiencing and the latest lab results, that has me concerned. I don’t think I can do weeks or months of this again. Any advice or direction from anyone here is much appreciated.

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Are you taking the right pills at the right time?

[Keith Taylor]

Hi Malik,

1) Your opening sentences tell me that your primary care doctor knows nothing about gout and how to manage it. But we can educate him. I’m unsure about your rheumatologist because you haven’t described any discussions about treating uric acid. So your first decision is:
Which doctor do you want to work with to develop a proper plan for your gout recovery?

2) Then you describe a series of random pain meds that work well for gout when they are taken in a sensible way. But might or might not be useful when taken randomly. So your second choice is:
Carry on randomly or start to learn how gout pain works and how to stop your immune system going into meltdown.

3) You’re beginning to approach a solution when you mention one uric acid test that is 6.8 mg/dL. But gout control needs, at the very least, a series of uric acid test results with dates. And a commitment to change things to get those results down to a safe level. So your final decisions (for now) are:
a) What do you consider to be a safe level for uric acid?
b) How to get uric acid safe? Drugs, herbs, diet, or a combination of whatever appeals to you most.

For all those decisions, it’s OK to not know the answer right now – we can discuss them in more detail if you need to.

In my opinion, the reason you are feeling “at your wits end” is because everything you described is reactions to events that seems to have very little logic attached. But if you control that situation with a logical plan, recovery is quite easy. Now, I’m happy to share my experiences to help you achieve gout recovery. But I need to know more about what you want. We can start with the three decisions I mentioned. Or we can address other concerns if they are more important to you.

[Malik A.]

Hi Keith,

Thank you so much for responding to my post. You don’t know how much I appreciate hearing from someone who knows what I’m going through right now. As for my primary doctor, I agree 100%. It’s one of the reasons I went straight to the rheumatologist this time around.

As far as discussions with the rheumatologist about treating the uric acid, she said she wanted to prescribe Allopurinol but not during an active attack. She said if I take the Allopurinol right now, it could potentially make things worse. So, she put me on the Prednisone in an attempt to “calm things down.” Once the attack was under control, she said, I could start the Allopurinol to lower/control the uric acid. That was the extent of our discussions about treating the UA.

I agree that what I am doing presently as far as taking the pain meds is not working and that I must learn how gout pain works and how to properly manage it. I can only say that I had been following the advice given to me. But recognizing that it’s not working is what ultimately brought me to the forum.

As far as safe uric acid levels, from what I’ve read, getting below 6.0 seems to be the target. Again, I’m not sure that’s the case universally, but that’s what I’ve come across so far. Is this the goal or would it be different for each individual?

As far as how to get the uric acid safe, I am willing to try whatever will work: drugs, herbs, diet, or a combination of all of these. However, if I could maintain it through herbs, diet, and lifestyle, I would prefer that over the long term. As I mentioned in my previous post, I don’t eat/consume many of the known triggers, and I have since cut out asparagus, mushrooms, etc. in an attempt to get out of the woods. I say that to say I am willing to make the necessary changes to get the uric acid under control.

And, yes, I would love to hear more about your experiences and personal journey. And if possible, I’d love to ask a question: What would you consider a logical plan to combat this problem and how would you suggest one deals with this in the short term, then in the long term? I’m researching day and night and gathering as much information as possible, so any help would be much appreciated.

[Malik A.]

Update: Woke up this morning and found the knuckle of my index finger swollen. First time I’ve experienced this. It was only in my toe before this.

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