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Hi Tawrikit,

I assume you are aware that the side effects of ibuprofen and naproxen add up. If this class of drug (NSAIDs) is the only thing you can take for symptoms, I guess that would warrant taking a bit more allopurinol initially than someone who is able to take any drug.

My pain tolerance level is generally very high and I hardly use any pills at all (aside of allopurinol). I only really take Naproxen if I feel an attack is coming and if it doesn’t bring relief within a week I stop it anyway. I then just take a tablet or two of Ibuprofen if I have complications sleeping or if I’m really in pain. Longest Ive taken Naproxen is for 10 days around 2 months ago and the time before that was 3 months ago for 3 days.

Yes, if your test results are temporarily elevated that implies they are expected to go down in the future… two ways of saying the same thing.
Variations are to be expected but the average daily mass of dissolved crystals should diminish over time which is why you can expect your UA to trend downwards.

This is indeed encouraging, frankly speaking I am really hoping that is the case so I can move back down to possibly 300mgs (just the one tablet rather then two) and less drugs in the system.

I hope you’re experiencing pain from exercising injured and under-used muscles and tendons rather than arthritis.
But exercise might cause more crystal deposits to dissolve… which isn’t what you want right now because your system is apparently already struggling with the UA from deposits dissolving on their own. If too many crystals dissolve at the same time, you risk a serious attack.
Once you are mostly free of serious symptoms, you may want to speed up the dissolution of the remaining deposits with exercise. Until then, be careful.

This is exactly my worry. The actual pain from my initial gout attack on my left toe has somewhat gone (minor inflammation is present but the majority of the pain has subsided). What has actually become very painful is the entire ankle/foot. All I did was put those asics on and go out for a 3km walk and all of a sudden this occurred. I can walk on it fine for short periods of time but it does get painful after a while. It seems as if crystals in the whole area are dissolving? Can that be the case? Or do you think this may be a side affect of increasing my allopurinol to 400mgs?

Keith, no worries mate. I’ll start a new topic with the questions I wanted to ask you in specific about how your dealt with your treatment plan.

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Hello Keith,

I’m not too sure if you’d like to convert this into a compliments thread but I think I speak for more then just myself here.

In any case I would like to share my utmost gratitude for all the help you have provided me in the forums. The education, the advice, the encouragement and the friendly way in which you delivered it all.

I think your doing a fantastic job helping the many many gout suffers, researchers and health care workers that visit this site daily.

Keep up the great work 🙂

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Agreed, but I won’t be able to tell if 300mgs or 400mgs is the dose that’s required until I come out of this so far 5 week attack. I mean don’t get me wrong I am able to walk around but I put on my asics today to have an extended walk around the area and now my ankle and the surrounding muscles hurt. The ball of my foot also hurts a little and now it’s got me worried another attack is following. I guess we’ll find out in a few hours. Unfortunately I can’t take colchicine so took 400mgs of ibuprofen before hitting the 500mgs naproxen.
One thing I did notice was you mentioned Uric Acid only has one way to go: Down(3441) as crystals dissolve but a little further down you mentioned that your results will probably be biased high(3484) as crystals dissolve. I think the results would most probably be as your second post suggests (high) as they dissolve.

Keith, I was wondering if you had a chance to take a look at my previous few posts and advise..? Specifically Reply #3440.

Thanks

[d q]

Hi Tawrikit 🙂

At some point you’d experience diminishing returns anyway.

Unless I understand wrong, do you mean damage to health from allopurinol then any more useful gain from it..?

And the faster you’ve increased your dose, the quicker the dose required for you to feel safe ought to diminish.

I’m not too sure why that makes sense, the speedier increase generally assists in debulking quicker so if anything allows to get on and off the dissolve train quicker? That’s as far as I’ve been understanding it so far. Providing no health problems are sought in the first 100-300mgs trail of allopurinol

That said, I wouldn’t drop my dose as soon as pain subsides. Think weeks, not days.

This is why I was thinking of hitting 400mgs for a month or so until this attack has fully healed +- another 2 weeks or so extra for safety (I cannot believe it has taken this long) and to check levels again in a month time whilst on 400mgs and then possibly adjust from there back down to 300mgs to see if that dose is suitable going forward. I would assume that 300mgs is not really enough though because its so close to 350 ummol which is round about were gout hell starts and warning labels kick in. Unless 336 ummol was inaccurate because I was in the midst of an attack and it could actually be much lower.

This is why I was contemplating a heavy debulk with a relatively high dose for 6 months and then relaxing my dose right down or even stopping it for a little (I’m not a fan of medication either but its pain for gain).
I think that’s the approach Keith has taken.

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Thanks for your encouraging words nobody. Yes, I’ve noticed my muscles are definitely not taking too kindly walking the correct way and not on the outer side. I’m hoping that would subside in a few days.

The 336 ummol measurement was taken during the gout attack so I’m not entirely sure just how accurate the reading will be when everything clears up eventually but I’m definitely trying to keep the blood flowing to that area as much as possible and to be honest am hoping that 300mgs is enough. I started the 400mgs to clear things out quicker and because I believe I was in gout hell. Once the attack subsides I’ll be sure to check my levels again and see if 300mgs was all in fact that I required but for now I think 400mgs is my best bet, if it’s significantly lower then maybe I can revert back to 300mgs again. I’m not really an alcohol drinker and might have the occasional beer once every month but nothing really more. Believe me mate, I’m trying my best to find my optimum lowest medication dose as quick as possible as gout is seriously debilitating and I just don’t want anymore attacks. This flare up was two back-to-back and was a disaster. 5 weeks.

I’m also waiting on Keith’s response is on my previous post as I’m thinking of doing the same thing (maximum dose for a period of time to flush out and do a major debulk then taking time off allopurinol or at least taking a very low maintenance dose afterwards).

I’m not too sure what you mean by if I start getting pain that goes away within a few hours to a day? Would that be for a limited time because of final crystals dissolving?

p.s. Do you have a nickname we can use, thanking nobody is a little strange 🙂

[d q]

Hi Keith, I read that article and the logic makes perfect sense to me too, thanks. So I’ve decided to go ahead with the 400mgs dose. I’ve started off slightly slower by taking 400mgs on alternate days for a week and will go the full 400mgs starting Monday.

I’d also like to mention that my attack has finally substantially subsided. The inflammation has almost completely gone and I’m able to walk on it far more frequently. There is still discomfort there but I think that’s just the muscles in the foot adjusting to being able to walk on it correctly flat again (I hope anyway).

The quicker recovery “seems” to have come from the hot foot soaks in Epsom salt and the “possibility” of the increase of allopurinol to 400mgs on alternative days a week ago. That’s inconclusive though but it could be further proof of your article and research.

Once the attack completely subsides I’ll take another blood test to check UA levels on 400mgs daily and update you. I’m also expecting an appointment letter from a new rheumatologist as I’m not comfortable with my existing one due to he’s explanations and treatment plan.

Finally mate, I was wondering how long you too the maximum dose of 900mgs allopurinol and if you managed to check those UA levels for me as I really want to discuss with my rheumatologist if I can do the same and then take time off allopurinol like you?

Thanks for everything Keith, you’ve been so supportive.

[d q]

or simply to get a hot shower because you need to get your heart pumping and your blood flowing a bit. Some people also get hot foot baths to make their blood flow in the foot specifically.
If you can’t walk much, I think it would also be wise to carefully make your foot move while you’re lying down. It doesn’t matter much if you’re only hurting a few days but not making your foot move and bend in every direction for weeks on end can cause damage which won’t heal fast.

Hi @gavin, I can definitely vouch on that statement. Try a foot bath and some Epsom salt. That was like striking a gold mine solution with regards to the pain. The pain subsided soon after and to be honest I think my foot healed a little quicker as a result.

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“Generally, allopurinol should mean that you can eat anything you like. As long as you remember weight control and a good mix of healthy whole foods. But, it takes several months to work fully. So, it is usual to experience some gout symptoms at first. But, you are doing the right thing in getting uric acid checked. So, let’s hope you will soon be fully recovered.”

This is exactly what my rheumatologist pretty much said. As long as it isn’t organ based foods then it only really contributes to 15% uric acid production.

(Although I am changing rheumatologist as he seems to be pretty careless in everything except that one statement when he first prescribed me allopurinol)

The 15% can be enough for some people to control by food only. Me on the other hand loves food too much to fuss around with that 15% for a tablet or two a day. I’ll never be able to get it low enough anyway as I have secondary gout. Rapid cell breakdown and release of their uric acid is what is causing my gout.

[d q]

Hello Gary, as Keith says I can’t find any direct link with uric acid, gout, or pain relief. The only one thing I could link it too was it being a diuretic (https://www.drugs.com/npc/alfalfa.html).

Maybe the increase urine that comes as a result is helping you flush uric acid out slightly quicker which is causing the pain relief.

[d q]

Hi Keith,

Just a few updates, With a lot of effort I finally managed to get myself to the hospital to do that blood test. Results are as follows:
Kidney function is fine, liver function is fine, uric acid has dropped from 388 to 336 as a result of moving up from 200mgs to 300mgs of allopurinol. I also saw my GP and explained that I’m in the middle of an attack that’s been going on for nearly 4 weeks and if I should move up to 400mgs per day. She agreed and said go for it. She also gave me a prescription for naproxen and said start that alongside your allopurinol increase to preempt any possibility of an attack.

I wanted your advice on if I should go for the 400mgs or if I should wait until I come out of this attack (If I ever do)..?

Or should I remain on the 300mgs of allopurinol and at a uric acid level of 336 and let debulking occur at a slower rate?

Finally, or should I wait longer and do another test after a week or so to see what the result would be then as it may actually be lower then 336?

(Baring in mind the 336 uric acid result is while I am in the middle of an attack)

Thanks as always mate.

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Good to see your back buddy!
I was wondering where you went! 🙂

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@Keith, good to know your based in the UK! For some reason I thought you were based in the USA.. 🙂

[d q]

Hi Robert, I too would like to know what pain relieving patches you are using for gout? Cheers.

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@nobody, just wanted to clarify something that may help me. You mention finding a way to suppress the swelling in case it’s caused by an ongoing low grade inflammation which unless resolved will be primed for a full flare up. How does one suppress this..?

The swelling is caused by the inflammation isn’t it..?

[d q]

@Gavin,

I’m sorry about your situation mate and if it’s any consilience I am literally in the same boat as you. I had an attack attack 3 weeks ago yesterday and had my second flare up about 5 days ago (literally back-to-back). The attack started off lightly, got worse then got better then I started walking on it (maybe a little too early) only to be struck by another attack 5 days ago. I too stopped naproxen about 10 days into the primary attack as it didn’t do much. The primary attack came literally 3 days after increasing allopurinol from 200mgs to 300mgs (hoping its me coming out of Gout Hell as Keith explains). I’ve tried to hold out measuring my uric acid levels until the attack subsides to avoid incorrect results but was too worried the increase in allopurinol might be causing liver/kidney problems so decided to get the blood test anyway. I’ll have the results tomorrow so as Keith said we’ll have a rough idea were my levels stand.

To be honest I haven’t changed my diet too much after starting allopurinol. The whole point of allopurinol is to give you a sigh of relief with food habits not changing too much providing you generally eat reasonably healthy. An extremely strict diet will only help so much before medication becomes the most ‘convenient’ way to enjoy life. Holidays breaks, burger with friends, etc.

Finally I too would like to hear what your doctor has to say.
Good luck buddy.

@Keith, which PH stripes do you use mate? Any generic ones from eBay/Amazon? Thanks pal.

[d q]

Hi Keith, I’ll certainly work on a suggestion letter and the reasons why I think it would be great for the public to view. As a secondary gout sufferer I think I can help with other people who have my condition and as a result have gout. 🙂

[d q]

Hi Keith, I think it’s gout hell too. It’s partly my fault for trying to walk on it too soon. I should have potentially gave it another few days or so. All of that healing seems to have gone to waste. I’ll get them done tomorrow while I can still walk. I feel it might be my last chance!

Just out of interest;
did you titrate on your doctors advice or just because you did your own research?
Also what did you get your uric acid levels down to whilst being on 900mgs for those years?
Did you suffer any side effects?
Finally suffer an attack after attack on 900mgs for a few months?

Thanks Keith, you’ve been fantastic in helping me.

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