[d q]

A bowl of cereal (choosing ones that do not increase uric acid of course) could potentially contain all the B12 you’ll need for the day 🙂

[d q]

The inflammation has significantly reduced. I don’t think there is much to worry there. I mean these things have to go at some point as you said and I’m just hoping it will soon. I could take anti inflammatories to potentially speed things up but I would really much prefer to use them when required to avoid plaguing my body with further medication. I want to try and have the most organic start before starting febuxostat. Unfortunately I still get daily pain and on some days it can be bad. It’s such a shame as 2 years ago I was as fit as a fiddle and those memories alone torture me.

Colchicine should be safe during flare ups for those 3 days but I most certainly don’t want to use it for preventative treatment until I see the impact of febuxostat. Starting colchicine now would just delay things further. I need to start febuxostat asap.

Cutting the 80mg to 40mg and then half again to 20mg was and is a little tricky but I’m not taking the risk, in fact I want to do this mildly this time. The fast increase of allopurinol caused this massive attack and my colchince ignorance and NSAID could have avoided this. I know I would have had to stop it eventually but I could have at least avoided the attack.

If 40mgs can keep me at 300-350ummol I would be happy, let crystals dissolve as slow as they want if it provides an easier long term ride.

By the way, do you have any ideas about “vitamin E’s” influence on uric acid. From what I understand its a powerful antioxidant and can potentially extend the life of red cells reducing turnover (which in my case is huge). My assumption is the result would be reduced uric acid release into the blood. I’m going to try a short 2 week course to see if it helps at some point. I’m not sure but I assume it ‘might’ also be beneficial for people without my condition but with gout. That’s just my guess.

[d q]

Pain is most certainly the issue buddy 😉

I agree I should have tested Colchicine sooner but getting to speak to doctors in the appropriate (one recommending, the other appointment a month later) order is not always possible. If you remember I was already given the green light to try colchicine by my haematologist here. For that matter even after I was given the OK to use it I did my own research and found out it has potential to cause some anaemia (less then 0.1%) though. If you remember Allopurinol also took about 2 months to see a clear drop in haemoglobin (although I wasn’t tested during those 2 months so it may have been dropping weekly) so I think a few days using it during an acute attack whilst starting febuxostat should be ok. I hope.

In any case I’ve decided not to use it as a preventative approach as that will lead to higher risks in my case especially with febuxostat running in tangent giving us no clear indiction on what “may” cause a haemoglobin drop (if any). With regards to NSAIDs, yes I have taken them in the past with no issues at all. They didn’t help much in the past during an acute attack but during the visit to new rhematologist he recommended taking 250mgs Naproxen or 25mgs Diclofenec for a week when starting febuxostat and with every potential increase so that may prevent an attack even occurring further reducing my requirement on them. iron stomach here.. haha 🙂

The dramatic drop comment was simply my own since I believe we were discussing 40mg at the time which is a powerful dose. The best approach would be as you say to start at 20mgs watch both uric acid and haemoglobin in 2 weeks and then in another 2 weeks giving us a month in total. If all looks good, bump febuxostat up to 40mgs and watch and wait. Thanks for your pointers on the mushroom. What I would like to mention is I eat a lot of cheese and drink lots of milk. calcium levels are fine however.

i’ll be practising with cutting one of those pills today, how long can I store the cut pills in a jar for? Can I just go -bull in a china shop like- and cut the whole pack up and store them in a jar for easy taking?

p.s. Out of interest, what dose of febuxostat are you taking and what are your current uric acid readings?

thanks buddy..

[d q]

Of course I take notice of your personal gout treatment plan 🙂
All the information you provide on the forum and publish on your site I thoroughly read. Ignorance is bliss but education is clarity.

First and foremost I had an epiphany when I realized gout pain stems from an immune reaction. Prior to that, I had the more typical view that sharp uric acid crystals were forming. So, I understood the importance of getting mobile as soon as possible. Why was it important getting mobile as soon as possible when realising that gout pain stems from immune reaction?

I too am happy with 6-8 hours of sleep when possible 🙂 I was initially wondering what a safe buffer time between tablets was but now I understand the mechanism of timings from you and nobody’s excellent advice.

My rheumatologist suggested two preventative options for me, either 250mgs of Naproxen -or- 25mgs of Diclofenac for one week with every febuxostat increase or a month of colchicine when starting febuxostat.

My first attack was exactly 3 years ago and I cannot express just how much I want to be able to get on with life knowing this is all behind me.

p.s. Did you go to the USA..? 🙂

[d q]

@nobody – Thanks for the excellent advice mate – great help.

Yes, that is indeed true about not knowing what effect Colchicine and Febuxostat have on blood tests. The problem of waiting a further 10 days to get an accurate picture of what Colchicine does (if anything) on my blood tests would mean at least a 2 week delay on starting febuxostat but I do agree safety is far more important then just starting febuxostat. An option might be to do the baseline blood test next week, whilst those results coming back maybe take colchicine for 2 or 3 days to see how I react to it and then stopping. Then finally starting febuxostat.

I am exactly like you in not wanting drug build up and feel that maybe dealing with an attack as it happens with a little extra colchicine safer then a gradual buildup over a month (if anything even happens). Yes, I did have a bad attack on allopurinol but to be honest maybe it was my fault for not treating it aggressively enough.

With regards to febuxostat dosing, I’m looking around for a good pill cutter and I’ll be experimenting with a kitchen knife a little later to try and split the pill even further to 20mgs. I’ll end up splitting the 80mg to 40mg and the 40mg to 20mg. I’m taking your advice on this one as I’d much rather micro manage the situation this time round. Thanks for the advice on that.

Now what I did want your advice on was:

How long should one stay on 20mgs before moving up (if necessary). From what I understand I should stay on 20mgs for at least two weeks as I’ll see a dramatic drop afterwards?

Could I get an insight as to what your rheumatologist recommended for your Colchicine dosing? Also did he mention which was generally safer NSAIDs or Colchicine? I’d just like to have a rough comparison of thoughts. Thanks mate.

@Keith – Hi Keith, I know you get many posts for advice and help here so I think its perfectly fine you’ve forgotten my situation 🙂
Best place for a quick recap would have to be here and here 🙂

$194.93 is extortion! As you know I’m UK based and the rheumatologist that actually gave me those dosage guidelines are infact higher then the ones stipulated at Medicines.org.uk (https://www.medicines.org.uk/EMC/medicine/21325/SPC/Colchicine+500+micrograms+Tablets/). So I guess he is following some other rule or experience as it certainly isn’t the one on medicines.org.uk site. I am assuming the bounds of safety is 6mg in 3 days?

I think my rheumatologist was trying to play it safe since allopurinol didn’t work with me if you remember (haemaglobin) so, taking febuxostat with colchicine with nsaid’s all at the same time might not exactly be safe in he’s eyes. Out of interest, did your rheumatologist actually say it was fine to take Colchicine with NSAID’s?

Stop it in 3 hours! Well thats something I would love to be able to do! Its been 3 months of slight swelling and residual pain that comes and goes since my last attack, please do tell us your secret.

Now I feel in safe hands 🙂

[d q]

@nobody – good to hear from you mate. The information on Colchicine really does vary across the board. My rhumatologist advised me to take two 500micrograms tablets a day in attempt to finally rid me of the slight swelling and pain I still suffer from today. As you know I refused to take any medication until we isolate and try and resolve my haemoglobin issue.

Which brings me to some very interesting findings over the last 6 weeks. As you know I stopped allopurinol on the 31st of May. A week later the haemoglobin climbed slightly to 5.7 which was encouraging but still worrying, if you remember my uric acid also shot through the roof to 700ummol which is what you expected.

Fast forward slightly under a month and a blood test taken first week of July showed uric acid down to 650ummol and a haemoglobin of 7.3. Fast forward a further week to around mid July and uric acid had dropped further to 600ummol and a haemoglobin of 7.5.

So, it “seems” allopurinol was the culprit however my haematologist says it could have been an internal viral infection and not to just rule out allopurinol. He also went on to say that we can follow the rheumatologists opinion to try febuxostat if he feels it may be better suited because the rhumatologist suggested that allopurinol may cause anemia.

Now prior to starting fexbostat I have one more baseline blood test to do next week. I’ve asked them to include liver function, kidney function, full blood counts and finally uric acid. Once we get the results were going to start fexbostat.

I know you are taking it and from what I understand it’s best to start with a lower dose then 80mgs so I’ll be splitting that tablet to 40mgs but are there any other hints, tips, pointers that I should be aware of before jumping onto your febuxostat boat? 🙂

[d q]

Colchicine is used for both prophylaxis treatment(preventative) and as an acute attack treatment when you feel a gout attack coming.

Generally speaking, it is administered when starting new uric acid controlling medication such as allopurinol or febuxostat AND when increasing your dose of allopurinol or febuxostat (if required) to prevent attacks whilst those medications begin working and dissolving uric acid crystals or tophi.

It is also taken on the first feeling that a gout attack is about to begin to stop the spread of inflammation and to minimize the length of the attack.

The dosages should be set by your rheumatologist when prescribing it to you. There are generic dosages that you can use but I would recommend you don’t follow them as colchicine can be toxic if administered incorrectly

Take a look at Acute Gout Attack Treatment Plan for a little information.

It is best to seek rheumatologist advice before taking any colchicine.

[d q]

@Keith – thanks for your response mate.

I think there’s a slight confusion. I was just asking about your three stage prevention plan. I’ll start a separate thread for us to discuss one for me.

My question about colchicine was referring to an earlier thread here where you mentioned you take two tablets and no more then 1mg per day because you’ve never needed to. My question was how many hours apart do you take the second tablet. Is it as you state here (http://www.goutpal.com/gout-treatment/stop-gout/gout-attack/acute-gout-attack/) which mentions 1 tablet then a second 2 hours later or did you take 1 on the first sign of an attack and the other 12 hours later?

The reason I was initially asking was to see how many hours is a safe buffer for a first timer like me between taking the second tablet should I get an accute attack 🙂

[d q]

@nobody – I was just reading through this thread again. Just to clarify you take 2mg a day during an accute attack but no more then 1mg at a time?

1. Are you saying you take two tablets then a further 2 tablets a few hours later? If so how, how many hours later?

2. Do you use any NSAIDs with your treatment package “in combination”?

[d q]

@Keith – no worries mate, totally understand. Take your time.

p.s.
When you’ve got a minute, I’m really curios, those two colchicine tablets you took when you use to get accute flares, would they be an hour apart (one then the second an hour later) or would they be around 12 hours apart (morning / evening)?

Thanks buddy

[d q]

@nobody – Slight misunderstanding, what I am saying is not to wait 6 months before stretching the joint but to have uric acid under control (in the safe zone) and if 6 months pass with no attacks then the majority of crystals should be dissolved allowing a further buffer when attempting stretching exercises. BigA is able to walk and run so why risk it just yet (providing there is intention to lower uric acid in general).

On reversible joint damage, yes keeping joints in the same place for too long may cause this but as stated he is able to walk and run. Secondly if another attack is provoked as a result of stretching he is further increasing chances of joint damage and another load of pain relieving medications.

[d q]

@BigA – Yes, I think we have the same issue. I haven’t tried colchicine for various reasons but I’ve been given the green light to try it. What dose of colchicine did you take and for how long?

My readings from 2 weeks ago were 600ummol but I was previously much lower but had to drop allopurinol for various reasons and its risen again. I’ve got another blood test coming up next week which should indicate what the next course of action to take going forward. I’m in my 30’s.. What about you?

[d q]

@Keith – hope your well pal. Just a bump on this when you have time (specifically the last part) cheers 🙂

[d q]

I’m sorry to hear about your experiences.

Is there a reason why your rhumatologist hasn’t increased your allopurinol dose? as you could be going through what’s called gout hell where crystals are dissolving and reforming.

The reason I say this is because if your uric acid level is 6.1mg/dl you are literally in the worst possible gout recovery position to be in. Have a read of this: http://www.goutpal.com/9942/ouch-why-does-gout-recovery-hurt/

I’m no doctor and you should consult your rhumatologist first but it seems your allopurinol dose definitely needs upward adjustment.

[d q]

Both the above answers are spot on. It is imperative you see your doctor to get a diagnosis or an expert opinion first. A diagnosis may not happen after the first visit but at least get the testing in progress. From there onwards it’s a question of working out the best course of action.

[d q]

@BigA – this is exactly what I am witnessing with my situation. Every time I go on a ‘not so lengthy walk’ I would get aching feet and would need to put them up. I too can run but again, aching feet when I get back.
I personally haven’t taken any ibuprofen or colchicine for the persisting inflammation despite my rhumatologist telling me to go on colchicine to speed up inflammation recovery. I think if the pain is tolerable I tend to try and avoid medications.

One thing I would like to mention is to maybe avoid stretching the joint too much (if at all) at this stage until you have gone at least 6 months with no attacks -and- with uric acid under control with medication or with diet as stretching joints can sometimes in itself cause a gout flare due to the dislodging of any crystals. Be careful on this one mate.

I too have lost some stretch motion but can still run and walk but I will be avoiding any stretching beyond what I can normally do under normal foot power until I get my uric acid under control again and a good few months have passed.

Just out of interest what are your current uric acid readings?

[d q]

@keith – thanks for the detailed response mate.

3. Yes, me too. My pain tolerance is generally quiet high but when it comes to a gout flare I think even the slightest feeling of pain warrants immediate treatment to prevent it getting worse and stop it in its tracks.

2. I guess that ibuprofen being available without prescription even if one intends to take the maximum dose gives the impression that it isn’t as strong as naproxen, diclofenac, etc. So your approach in using a milder NSAID such as ibuprofen is definitely the wiser one. One could argue that you can take a lower dose of naproxen but then it being still prescription only leads me to believe it’s best to try and stick with ibuprofen first.

It’s a little strange that no clear information is available on the matter of NSAID’s with Colchicine. I mean if it can provide effective relief with no major side effects then it should generally be prescribed to help patience get better quicker.

Just to confirm, was your three stage pain prevention plan devised with your rheumatologist or did you do your own research and try it yourself and find it to be safe?

Finally, those two colchicine tablets you take when you used to get an accute flares, would they be an hour apart (one then the second an hour later) or would they be around 12 hours apart (morning / evening)?

Thanks Keith

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