Forum Replies Created
-
Posts
-
Cindy, do you have Han Chinese, Thai, or Korean ancestry? If so, you should talk to your doctor about a genetic screening test before starting allopurinol. Also, I believe the starting dose should be 50mg or 100mg daily.
Cindy, it’s a United States FDA corruption thing. Use the search box near the top of each page to search for Colcrys Price, or similar. I believe it’s made worse by the collusion of medical insurance companies and pharmaceutical companies. But, what do I know. Be thankful you’re in Hong Kong. One of my favorite places in the world 😀
Phil, if you are coping OK with just the colchicine, it’s probably best to stick with that. Also, best to talk with your doctor about additional pain relief, if you need it. But, let’s hope you are over the worst.
OK, James, this is for you: Ouch! Why does Gout Recovery hurt?
Thank you for the inspiration. It’s been one that I particularly enjoyed writing. 😀
In fact, I got so distracted writing it, I’m late for an appointment. So, my other lovely gout correspondents must wait for my responses tomorrow. 😳
How will you avoid joint pain during gout recovery?
Sorry, Phil. I didn’t realise you are a fellow Brit. So, I assumed you would have a nephrologist, as I’ve been led to believe that’s common in The States. All I meant was, I’m not a doctor, so you should make sure any pain meds you take are compatible with your surgery.
If there are complications, the gout specialist should be a rheumatologist. But, the only complication here seems to be medical staff who advise about gout. But, they haven’t read the professional gout guidelines that our taxes paid for.
Don’t bother with paying private consultants yet. Send me the train fare from Yorkshire. Then, I can take you step-by-step through the guidelines that frontline medical staff should read. I know we can do it here in the forum. But, I fancy a day out! 🙂
Joking apart (i.e. ignore that last paragraph), we can probably fill in the gaps here, online. Have you ever had any other pain control, besides colchicine?
Colchicine is something you will have to experiment with a bit (within individualized guidelines provided by your doctors) for best result with the lowest possible dose.
That’s very true. In fact, it’s true for all gout pain therapies. Find what works for you!
Phil, thanks for taking the time to explain your situation.
I can’t give specific help without a proper history of your uric acid test results. I need dates and numbers. For uric acid results, “slightly raised” is in the same ballpark as “a little bit pregnant”. It tells you which medical condition you have. But it’s meaningless in terms of treatment and care.
Generally, there are two dosing schedules for colchicine. And, anything I say must be cleared with your nephrologist. First, you are right to say colchicine is a poison. It stops your immune cells from replicating, because that is what leads to inflammation. But, it does nothing for existing pain.
So, if you are taking it ad-hoc, take it at the first suggestion of a twinge. But, if the flare has taken hold, you need anti-inflammatories as well. Otherwise, it can take 2-3 days for the existing inflammation to subside naturally.
That’s why, when you start allopurinol, most doctors advise preventative pain relief for up to six months. It has to be managed case-by-case, and depends on your reactions and test results. Personally, I was advised to take colchicine for two months as a preventative, then review. In fact, I was confident enough with my pain control procedure that I changed the colchicine to ad-hoc very quickly. But for anyone not confident, I’d recommend preventative colchicine, if you get no adverse events.
My main worry, from what you’ve said, Phil, is that your colchicine prescriptions haven’t been supported with anything for when you take the colchicine after the flare has started.
I’m sorry it’s not as simple as colchicine as a course, or ad-hoc. I understand that doctors don’t have the time to explain different pain control combinations. But I feel, once you understand how different drugs work on different aspects of gout pain, you can control it better.
I think we might have to go back-and-forth with more bits of information before we can tie things together properly.
To summarize:
1. Your uric acid test result history will give me a better picture of where you stand now.2. Your future uric acid test schedule will give me more confidence that you have an effective uric acid control plan.
3. Your attitude to (and tolerance for) colchicine and anti-inflammatories is important. Colchicine alone is rarely enough to support gout patients during the first six months of uric acid lowering.
Thanks Steve,
Here’s my thoughts on uric acid meters, off-the-cuff.
First, consider reasons for uric acid tests. Initially, they are diagnostic. Is the result over 5mg/dL? Then, gout is the most likely diagnosis, so start treatment.
Uric acid lowering treatment always works best when you have a plan. It does not need to be elaborate, but it needs to cover:
1. Long term target – less than 5mg/dL, unless there are confounding factors.
2. Short term target – doctors are never trained in this. So, only the ones who can think for themselves give valid responses. It’s OK to consider this each time you have a uric acid test. But, the key point is that there is a period of time when you are getting rid of old uric acid crystals (debulking period). It is the worst-managed medical phenomenon I have ever encountered. The short form of that rant is “For first six months of uric acid lowering, get uric acid level as low as possible”.
3. Pain control during the debulking period.So, now we have a setting where uric acid tests are needed to monitor and adjust the treatment plan. So, I can answer:
Regarding a blood level monitor: are there any comparison tests out there as to which monitors are more accurate? Also, what is the general opinion about how often do you use the device. Every day? Every week? Every month?
Uric acid test monitor comparison
To my knowledge, there are no such comparisons. The innards of uric acid test kits are very similar. But, it’s a product, and so it needs product support. Therefore, do research on the company before you buy. Or, give me names of the ones you are considering buying, and I’ll research them for you.Uric acid test frequency
The reason I wrote about uric acid lowering plans because testing frequency is governed by the plan. And, my usual advice is: if you are using prescription meds of any kind, leave testing to your doctor. Because, it’s vital to monitor liver and kidney function when you are taking gout medicine. I also believe those tests are vital if you are taking herbal gout medicine.But, if you are self-treating with lifestyle changes, a uric acid meter can be useful. But, only if you make testing an integral part of your plan.
I wasted a lot of time with daily testing when I used my meter. But, at that time, I didn’t understand gout properly. Like you, Steve, I didn’t understand gout triggers. I cannot conceive of a uric acid treatment plan that would benefit from daily testing. Surely, weekly is the minimum intervention time? However, there is another science principle that says more data makes analysis more reliable. So, you can consider that.
My best advice is:
Uric acid test every month for the first six months. Then, increase frequency depending on stability of results. Always test at least once per year, for the rest of your life.But, you need a good uric acid treatment plan for that to make sense. For most gout sufferers, it’s best to leave uric acid testing to your doctor.
Great! Let us know what happens next, Cindy.
You’ve probably attracted a million lurkers to this topic, with similar concerns about blood glucose and allopurinol. So, they’ll all be anxious know what to do next.
Thanks for the update, Leo.
You say “she was happy with my UA levels”.
My question is – are you?Leave the answer until you get back from your trip, if you like. Going anywhere nice?
Have you noticed Ŧallars? It’s the points score that shows beneath your profile picture when you post in the forum. I also display it elsewhere. Like, the “Gouty Commitment” list of members at the bottom of the right-hand sidebar.
By “Gouty Commitment”, I mean the amount of effort you are putting into discussing your gout. The more you post, the more you learn. Then, you learn to control gout faster. Which is why, it’s your GoutPal.
Recently, I’ve been thinking about taking it further, and developing a rewards scheme. I’ve got some ideas about recognizing the value that members add when they contribute to my forums. But, I’d really like any rewards to be valuable to you. So, what rewards you like me to make available?
I think the toe pain is most likely to be uric acid crystals dissolving. So, increasing allopurinol dose to hasten that process is a very good idea. If you want me to explain why you get pains where you never got them before, please ask.
I’m sorry, I can’t comment on the iron blood test. I don’t understand the blood chemistry of iron enough. And, I can’t find anything to make me think it would be allopurinol related. But, I’m always happy to learn, if anyone has relevant information.
Leo, your doctor does not understand gout! Nobody in their right mind would start gout treatment with 300mg allopurinol and .6mg colchicine. Your experience shows exactly why it’s a very bad idea.
Over the next 2 weeks every joint in my body (not really, but it felt like it) was sore, stiff, and has limited motion (without pain). Specifically my knees, ankles, shoulders, and wrists. Keep in mind I’ve only ever had a gout attack in my knees or ankles.
I hope I explain why that happens at Allopurinol Medication: Why It Hurts To Get Rid Of Gout. It’s time I reviewed that article. So, if you need a better explanation, please let me know.
Yes, your gout attack could explain the raised ALT. So, best keep an eye on it. Anyway, you need to keep monitoring liver function and kidney function when you are on Uloric. So, your doctor should know if your meds need to change.
I suspect that the reason you got less pain with Uloric is:
– Either, it isn’t as effective at clearing old uric acid deposits.
– Or, substantial old crystals have already dissolved.Whether you take allopurinol or Uloric, you need to be prepared for gout attacks until most old crystals have dissolved. The typical timescale is 6 months, but every gout patient is different. The way to reduce that timescale is to get uric acid lower.
Leo, it’s your choice about “So I’m wondering if I should ask her to put me back on Allopurinol and see if my body deals with it better now that my UA is lower. Or just stay on Uloric since it’s working and my ALT wasn’t “that” high.”
It’s a pity you’ve had unnecessary pain. But, you might well be over the worst by now. Personally, I’d recommend allopurinol. But, the most important thing is to keep going in your “right direction” with uric acid numbers.
If there’s anything I can clarify, to help you decide, please ask.
Sorry, Cindy, I’m not a doctor, and I have no idea why blood glucose results of 6.39 would indicate against using allopurinol.
As a layman who understands gout, I would have thought allopurinol would be of value. Your husband needs to get more information about why the doctor won’t prescribe. It’s very important not to ignore excess uric acid.
If you can get more information, I can help better. All the research I have read shows allopurinol to be beneficial to diabetics. But, I know very little about diabetes, and I don’t have enough information to convince me that this is a problem that your husband suffers.
My belief is that when you start uric acid lowering, you should have a good pain treatment plan in place first. Then, there is no need to wait for the flare to subside before you start. I believe this because of the work done by Taylor (no relation!) in 2012. Which, I reported in Start Allopurinol Quickly, But Carefully.
But, this only works when you have a supportive doctor. By that, I mean a doctor who understands gout pain. Which usually means a combination approach that the informed gout patient can vary according to their degree of pain.
sorry for the bombardment of ques……one more and i’ll shut up.
Please don’t shut up. I need the questions! Without them, this forum fails.
I do wonder though, Carroll and Mark. Why does a discussion about uric acid test results not have an actual test result?
Anyway, the general rule is that uric acid varies naturally. So, although you get an exact number, it’s better to think of a range. For example, if your result is 7, best to think it’s 6.5 to 7.5. And, it’s better to test at the same time of day. I’ve no idea why “aspirin/ibup. alcohol and vit.c ” might skew results. If you give me a reference to where you read that, I can assess it.
It’s a very bad idea to start allopurinol at 300mg per day. The safe way to start allopurinol is 100mg. Then, 2-4 weeks later get blood tests for uric acid, kidney function, and liver function. If test results are OK, increase allopurinol to 200 mg. Then repeat until uric acid is safe.
The attacks that you are getting now are because your uric acid is too high. So, new crystals are forming.
Uric acid crystal dispersment – where can they go?