[d q]

+1 to everything nobody said.

In addition make sure you add kidney function tests to all your upcoming blood tests as Allopurinol is metabolised there and you don’t want Allopurinol causing issues with your kidneys. Also, if you’ve just started Allopurinol the chances are your Uric Acid serum levels will be high as crystals begin to mobilise and dissolve into your blood and you really don’t want to add additional empty purines (beer) into your blood.

[d q]

Hello again! I think the gout knowledge I’ve accumulated between reading, yourself and Keith has made me into half an unqualified rheumatologist 🙂

Drugs, never took em, never will. Shoes can be tricky at times and this could be one of the reasons I get pains every so often. Physical activity isn’t much at all. Only walking and nothing more. I really want to get into skipping as that is a serious all round yet simple workout but I think it’s early days to push the toe joints and that ultimately is where all the weight will be applied. Do you do any exercise? If so what do you do to keep healthy? Water intake is mammoth. For my size and weight anyway, it is A LOT. I will however start to taper down once I get my next blood test done in about 2 weeks or so. That will probably be amongst the most important.

I have to accept the excretion test is just not going to happen through the government health care system. I’ll have to do that privately but either way it will not really give a clear indication any more since the UA levels are now in the 360-380 range so I am assuming enough is leaving to maintain that level. I use to keep a diary of nearly every change I make but as time passed I became less and less involved. You are right, maybe I should expand on this again. I believe you drink more water because of the Diabetes..? p.s. how much do you get through in an average day? Just a general average day?

No redness is found on the actual troubled joint and foot ball but redness can be found somewhere on the middle toe joint but it is absolutely painless. Maybe some sort of UA collection? Yes, I have suffered enough but the pains all vary to be honest nobody. Sometimes its a concentrated pain and sometimes its the entire foot which is in a dull pain. It’s sort of ‘tired foot pain’ or a ‘weighted foot pain’ despite not much activity on it. I mean the other foot doesn’t get the same feeling anyway. I need to relax it every so often. Maybe its permanent damage and I just need to live with it…. or maybe as you say its a question of time…

I’ve discussed this with very good rheumatologists and the answers have always been so similar. Either its;

a) “if its gout pain as a result of UA build up then after a “while” on ULT it should eventually clear up”.

b) “if its permanent damage you may have to just have to apply a thin amount of Voltarol on the foot on the bad days”.

or near enough anyway.

It’s definitely not low grade inflammation because the foot doesn’t look inflamed at all.. Something else is wrong and I just cant work it out.

Just over 2 years ago I was working abroad and holidaying in such beautiful places. Now walking is a chore and worry is a norm. Sometimes I ponder how can youth health turn so sour so fast. Gout is insidiously evil.

[d q]

Thanks – Hope your well mate.

I’m assuming you mean by watching my diet (behaving carefully)?

Interesting the acidity thing. I’m going to have a read of it. On another note,
this brings me to what I believe is a good question, this water thing.
If Febuxostat blocks UA formation, health benefits aside here, does one still have to drink vast amounts of water? I know this might be necessary in the initial stages (as I have witnessed [debulk, flush out, etc.]) but is this something that needs to be constantly maintained. The reason I ask is I have noticed some weight loss since starting Febux and I am aware this could be the drug but I also think it could be my serious increase in water uptake..?
I’m carrying water with me everything and frankly its getting obsessive!

I have had a few bad days recently actually. My podiatrist required to do a few modifications to my insoles which resulted in me having to use the ones that come with my shoes and after just two days of using them my weak foot is killing me. It get’s better here and there but generally its been pretty bad. I mean can just using different insoles cause such pains? I’m assuming a few things here though; change of weight distribution, change of comfort cushioning; etc. etc. but I was also thinking that it could be the change of bone movement/positioning causing crystals to break off causing this pain affect?

believe me nobody, I am counting each day by day and hoping this stupid pain will eventually disappear. I’ve been keeping as patient as I possibly can but it’s just tearing me apart how long this stuff can take! This slow constant pain is just debilitating on some days. I mean how long can this chronic pain last! How long can it take to dissolve these nasty things!

Sorry for the rant!

[d q]

“Host’s bullishness dosages!” – That had me laughing in tears!
No way – not this time. I’m doing this slowly and carefully.
I’m sure the express method has it’s benefits but I unfortunately I am not one who got to experience them.

I really hope your right in the possibility of achieving 340 at some point. If I remember correctly I think my rheumatologist mentioned something about adjusting the dose after values settle in general. So when they mention 360 as the upper figure, does that include the buffer or is that + a little buffer?

Like you say, all these blood tests are snapshots and don’t illustrate the full picture. I mean take my abdominal pain. I didn’t have any pain at all for a whole week! Yesterday on the other hand it knocked on my door step again. Although, that is when I increased to 70mgs! Psychological or Side effect of the increase, who knows! Maybe it has nothing to even do with Febux and I’m slowly wittering away! 🙂

2017 was a challenging year. 2018 has been so far softer. I just want all this crap behind me. There is so much I’d like to do yet every time I get some pain in my foot I just feel shit again. Let alone start worry of what may come.

Not too sure I completely understand the acidity part by the way, another example would be helpful..?? 🙂

Thank you so much for your last reply by the way. I don’t say this much but your detail and clarity really does help.

[d q]

Totally understand – thank you.

I have noticed on so many occasions when I get pain in the area drinking large doses of water seems to really dampen the pain. I think as you say these might be a large deposits or clusters of them breaking off and the water comes in just in time to flush it all out. I haven’t tried waiting it out without drinking large volumes of water in case it turns into a nasty attack.

Hypothetical here, let’s say 80mgs drops me to a maximum of 340ummol at most. Now from what I understand from you is crystals can dissolve at slightly higher UA values then this but assuming in the darkest of places where the lowest UA value is required for dissolution, what would this number be? The reason I am paranoid or panicking is the worry that the number required will always be lower in order to de-bulk fully then I can achieve with monotherapy.

I mean if its a question of time, then I guess one can just wait it out, the question is if at all its possible in those really dark die hard stubborn areas?

Statistically, does one eventually require less medication after all crystals are flushed from the body (like going from 80mgs back to 60mgs for e.g.)?

There is always a chance I might need less one day too if my hemo condition gets a medical advancement I guess.

[d q]

Thanks @nobody – top man.

Yep, I think it’s best to go for 70mgs for a few weeks and see how that goes. By the looks of things it may be a case of 80mgs for the full safety net but I want to do this slower then the doctors want me to.

The question I did have (in addition to a few more that will crop up) is at 388ummol, are crystals actually dissolving in retrospect to scientific findings and understandings..? The reason I ask is because if they need to be far lower then my current highest result which is 388ummol then I’m worried if the extra 20mgs won’t be be enough?

What if the 80mgs isn’t enough? Do I have to cut a pill and a bit from another one? From what I understand the only next increment is 120mgs!

Thanks guys.

[d q]

Is Febux progressing Gout Recovery or not?

I did my blood test a few days ago and the results are in..!!
UA test a month ago was 366ummol (60mgs Febux).

Update:
This time 388ummol (so +20 from my last result)..!
Liver markers are fine, hemo seems fine so far too!
Are we finally stable? (366 / 388 being small difference)

I haven’t seen my doctor or rheumatologist since these results but they originally recommended I go straight to 80mgs and I was definitely not going to do that so that advice probably wouldn’t change if they did see me anyway.

So I guess that brings us to the cross roads with a few options;

1. Stick with 60mgs for another month to see how it goes?
[I believe no new crystals will form at 366-388..? am I safe..?]

2. Move up to 80mgs for a month and see how it goes?
[Is this actually necessary..?] [are crystals dissolving anyway at 388..?]

I’m sure I’ll have another few questions based on your advice.
Thanks guys!

[d q]

@rich “last summer 30kgs of tomatoes” simply brilliant Well I haven’t cut my consumption of tomatoes either. Tomatoes are way way to delicious! 🙂

@nobody – sorry about the diabetes mate / what type?. Good friend of mines girlfriend has it too. Insulin in the car and her bag. poor girl. lovely person. Personally, never really enjoyed drinking from day one and now I’ve stopped completely. Social pressure initially but now I’ve become totally immune. Dairy is my favourite. Whole Milk Yogurt (onken) with nearly every meal. Simply delicious. Big fan of cheese. Love milk too. I cant imagine what would happen if I cut that all out. After all that might be keeping my UA at 580 rather then maybe 780! Supplements have to meet a criteria to be good. Synthetic crap will eventually do you over. Brother, eating healthy isn’t about what benefits you need to see its about the benefits you don’t see.. 🙂

p.s. got an update for you in a separate post.

[d q]

@jean – you’re welcome mate. I eat loads of potatoes too. I boil them, cut them then add olive oil and garlic! I don’t think I’ll ever be able to become vegetarian so maybe cutting meat out of my diet will have the greatest UA decrease.

I’m just sceptical about cutting any of this stuff out (except meat) as all of these foods (fruits & veg) have so much long term and short term benefits. Gout isn’t the only thing we should be so worries about.

I still have pains in my foot and both an ultra sound and MRI reported small joint effusion and synovial hypertrophy. My rhumatologist did mention however if the constant pains I get are due to gout then maintaining a long term reduction in Uric Acid levels should eventually clear the issue up. They couldn’t find and evidence of gouty damage on both scans but the pains are still present. I get great painless days, good odd pain days and bad pain days. I’ve just been hoping these recent events are due to uric acid crystals dissolving but with the length of time I’ve had them I’m not so sure anymore. But who knows, this stuff takes months.

[d q]

@nobody – ah! Now I’m with you, you mean all that Mercury and other nasty stuff you may find in fish these days. I totally forgot about those concerns.
I was totally clueless to aubergines and peppers being higher in UA then other vegetables. I eat aubergines at least once a week in quantity and peppers almost nightly :/ (maybe it’s time to reduce at least the bell peppers frequency). I have pure chilli sauces almost every other meal too! Maybe I can reduce a few “ummol’s” just altering a few ingredients in my diet.

On a separate note, kiwis.. I’m going to get on this bandwagon because the vitamin C is indeed mugh higher at the cost of that sweet taste of clementines unfortunately 🙁

I do have a little jam on my daily toast too. It’s the good stuff (no added sugar) but yes it’s a natural fructose hit. Maybe it’s time to reduce that to every other day too!

I mean my UA levels have been pretty much the same for the last 10 years (prior to starting febuxostat) so altering now might be a little late to get an accurate picture if diet changes would make a real difference. I’ll never forget the very first rhumatologist visit where he said you’ll never really get more then 10%-15% or so knocked off your total UA value which would only really take me down to 520ummol or so.

The thing is these foods are so beneficial and sacrificing them to shave a few ummol’s here and there is ultimately useless. What about brain function? Heart function? Etc.

Curiosity here, was your diet very strict prior to febuxostat?

[d q]

Hello Evan,

Can I start by asking are you taking any medication for your gout outside of just pain relief for e.g. Allopurinol or Febuxostat..? If not, why?

Secondly can you provide us with your uric acid test result numbers so we can better understand your risk factor level and how easy it would be to treat?

Lastly, and an immediate answer to your question; any exercise that may mobilise crystals in joints can cause gout attacks. This is not just limited to exercise. It could just be falling over. When crystals dislodge in quantities your immune system responds and this response is the pain you feel. So yes, you could be experiencing a gout attack.

p.s. If gout is left untreated over many years then yes, it will end up in most joints and the consequence is gouty arthritis which is not good.

[d q]

@jean – that’s worrying because I eat lots of nightshade vegetables and in large quantities such as aubergines, tomatoes, peppers and chillies (which I believe is a nightshade vegetable). They are all healthy foods from what I understand.

Speaking of chillies which I think you may be mistaken as this research article explains their benefit for osteoarthritis (https://www.ncbi.nlm.nih.gov/pubmed/24941673)

on another note however; this link (https://draxe.com/nightshade-vegetables/) confirms a few of your symptoms.

If you can get the test done why not? It’ll help confirm and widen your food options.

[d q]

@nobody – It’s strange, sometimes I really understand your posts (and love’em) and sometimes they leave me a little bewildered. On this account bewildered however 🙂

Two questions for you;

1. Are you saying rice I am eating is healthier then fish or not? 🙂

2. The question is weather or not walnuts increase uric acid or not. I’m very disciplined when it comes to my handful (partly because they are expensive!).

I noticed a twitch the other day with lots of tomatoes and meat (Bolognese). Was scary but I seem to be out of the woods, pain seems to have subsided.

Triggered by something or another anyway! Well that’s just dandy! Let’s hope its those crystals dissolving rather then forming 🙂

[d q]

Fish is too delicious to avoid and I have regular meals of salmon, monk fish and sea bass. I generally eat very healthy except when it comes to rice dishes as I consume a lot of rice – around 4 times a week.

Maybe time to move onto kiwis then. Vitamin C does lower uric acid levels right? That is definitive?

Walnuts a trigger? That’s really worrying as I’ve been eating a handful daily for the last two months. Why would that be?

Thanks

[d q]

Absolutely agreed on the overall diet approach. These ingredients I specifically consume more of for their health benefits. So I was wondering if that was generally a safe bet. I’m on the febuxostat for now which ‘artificially helps’ I guess though.

But I’ll play your game anyway. Opinions ahoy!

Brilliant!

Tomatoes – exactly, most articles I read state it’s a trigger but this (fantastic) site says the opposite on one of its pages. Keith did mention he wanted to revise and re-check the research but I’m not sure if the results have been posted.

Sweet Potatoes – I haven’t read anything in specific but overheard some TV show saying it should generally be avoided yet a simple Google search returns just how low the purine content is. This is stuff is so good for you, it would be a shame to even reduce it.

Carrots – I eat this stuff almost daily. Beta carotene in this stuff is abundant and seriously good for you.

Extra virgin olive oil (forgot to add) – I love this stuff and have it daily with nearly everything. At least 3 tea spoons daily. :/

Honey – I stopped this stuff a year ago but miss it so much. I’ve only ever used the expensive stuff for the health benefits and I do feel a little less energetic in all honesty. Maybe a teaspoon every other day is ok?

Are Walnuts Good for Gout?

What I did forgot to ask about was clementines and walnuts. I have two clementines a day for the vitamin C which from what I understand helps reduce uric acid levels but other sites mention it as sugar galore? Walnuts are super healthy for you and I have a handful of these daily with turmeric tea. Any worries on the walnuts, it would punish me to reduce them if I had to?

I don’t want to make this a food thread but I just to get an insight into those?

An alcohol free Cheers 🙂

[d q]

Perfect, thanks.

[d q]

I’m not sure why the images haven’t come up so I’ll just post them here.

Originally Prescribed:

How is your UK febuxostat packaged?

Pharmacy Prescribing:

How is your European Adenuric packaged?

(ignore the watermark logo on the picture)

[Author]

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