[nobody]

Nobody’s indeed my chosen nick. I’m easily amused.

Yes, your diet and increased water intake is what I meant when I referred to “what you’re doing to reduce uric acid”. Unfortunately such measures sometimes make the problem worse.
In the long run, anything that lowers uric acid is helpful of course but when you throw off an equilibrium, you can end up in a situation like yours for a while.

Diarrhoea is a routine side effect of heavy colchicine doses. It’s not necessarily a reason to stop using it but if your doctor recommended you don’t take it anymore, it’s probably best to heed that advice.
An alternative might be the steroid-type drugs some people take to clobber their immune system in the hope of stopping flareups but the side effects are potentially pretty bad as well. In your predicament however, somewhat extreme measures may be warranted…
Can you contact your doctor to request some kind of pharmaceutical intervention, whatever they think is least risky in your case? That or order tests to confirm that it’s really gout. Because if it is gout, one should be able to stop it with drugs and it wouldn’t merely prevent you from walking: it would probably be slowly damaging your joints as well. As bad as drug side effects can be, weeks-long flareups have side effects too.
And taking that much Naproxen for weeks on end puts you at risk as well (have you gotten a blood test to monitor the side effects of prolonged use?). It might be better to take something nastier for a few days in order to be able to give your body a break from Naproxen.
Me, I’d put up with diarrhoea. But my doctor OK’d that approach and for all I know there may be a very good reason while your doctor didn’t. Every case is different.

Finally, if Naproxen and allopurinol are the only drugs you’re able to take, consider restarting allopurinol right now.
When you have attacks that last days, waiting until they’re fully resolved to take allopurinol makes sense. But that’s apparently not your situation…

[nobody]

Hi!

What you’re doing to reduce uric acid, if it is inadequate (which it probably is, assuming your home testing was accurate) may actually be promoting an unending series of flareups. I have experienced something similar.
What I’d do to stop this nightmare would be to take colchicine in addition to Naproxen. It is slow-acting when you take it after a flareup is well underway but it should help it settle over a few days if you take a large enough dose. It is a dangerous drug so get it approved by a doctor but it is an ancient medication so it should be cheap (don’t overpay for the stuff).

If allopurinol doesn’t agree with you, you should take something else. Testing at 8-9 isn’t OK.

[nobody]

Let’s not jump to conclusions but, assuming you really have gout…
-colchicine plus advil should take care of a flare in less than 4 days if the dose is sufficient… how much are you taking?
-poorly-healed fracture + gout isn’t a good combination
-the way to enjoy beer without fear (though a little beer would probably be OK anyway) is to cure gout which typically requires a daily allopurinol pill
-take care to drink plenty of water, especially after having consumed any kind of alcohol

[nobody]

I know basically nothing about this but evidence has been found that Graves disease is associated with gout. The same goes for other thyroid issues apparently. You should bring that up whenever you get to see an arthritis specialist or a thyroid specialist.
For all I know Graves might be associated with similar conditions like pseudogout so you shouldn’t jump to conclusions but between this, Lasix, obesity and not drinking enough water you seem to have been collecting health issues associated with gout.

I don’t know if one week is enough time for SUA to settle. I’ve had a low result 10 days after the onset of an episode but here’s the thing: especially in your situation (that is, we have reason to suspect your SUA used to be higher), tests results can vary quite a bit anyway.
So unless your doctors are able to find another explanation for your symptoms, I recommend getting your SUA tested several times. You want to know your average value as well as how stable the value is. Don’t rush it or get your blood tested all the time: just make sure your SUA is being tested whenever you have a blood test (I’m assuming you get pretty regular tests anyway between your kidneys, your thyroid and your blood sugar). It’s a cheap extra.

[nobody]

The problem with not having older SUA results is that uric acid crystals can persist for years even with a SUA lower than yours, something which doctors are often unaware of. So they could very well assume you have no uric acid problem because no one thought of testing your SUA before you lost weight and started drinking more water.
You’re not the only one in that situation and I wish SUA was included in routine tests. It’s not like it’s an expensive test.

How long did you take Lasix? That’s known to cause uric acid problems.
If you indeed have gout, that’s more likely to be the culprit than chickpeas. Certainly you can’t rule out gout based on a SUA test carried out after discontinuing such a drug. If you’re still seeing the doctor who put you on Lasix without testing your SUA afterwards, perhaps you could give them an earful.

If you can find a UA drug that’s easy on your kidneys you could forget about purines which would make your diet easier. Chicken is meat and therefore contains problematic amounts of purines (better get your animal protein through dairy or eggs).
Peanuts and hemp are no good to replace beans. The simplest things you could eat to replace beans are other legumes but is there a legume which isn’t problematic from the oxalate perspective? I don’t know but if you can’t find a safe legume, animal protein would do.

[nobody]

I haven’t had an MRI (or X-ray) show a fracture but, in theory…
Is a secondary attack plausible? Yes.
But is it plausible that you don’t have gout at all? Yes.
Is a secondary fracture plausble? No. Or at least: not in your situation.

There are tests that can be used to establish gout (though the most common is normally only attempted when an attack is still going strong) but maybe the most reasonable course of action in your situation is to wait and see. A first gout attack should in theory resolve quickly (certainly much quicker than a fracture). And if you get another attack, except without a fracture this time that will be a big clue.
In the meantime, monitor your uric acid if that is at all practical.

[nobody]

Certainly you could be dissolving crystals at 6.2. It’s a higher value than recommended but that doesn’t mean dissolution won’t happen. It may not happen as rapidly, consistently and thoroughly as one would wish though.
By “first SUA test”, do you mean you have no old SUA tests establishing that you SUA used to be high enough to cause crystals? Have the crystals been observed or are we just assuming you have crystals (and therefore that you used to have a higher SUA) based on your symptoms?
Your symptoms are consistent with SUA lowering, I’ll give you that. As well as inadequate hydration, being overweight can contribute to having a high SUA.
In any case you should get more SUA tests as the results can vary, especially in your situation.

You should also make sure there is a good medical reason to avoid completely the drugs people would normally take in your situation as opposed to being very careful with them.
This is something to bring up with your kidney man as there are many different drugs you could take, either to limit the inflammation (I’ve taken pain meds too but ideally you also want to target the inflammation directly) or to lower uric acid. Possibly there’s a UA-lowering drug which might actually help with your kidneys.

Something else: “of course cut back on the amount of fat free refried beans I was using daily” is a bit of a red flag. Have you made sure your protein intake is adequate? I’m not talking about the gross amount of protein as you can easily get enough from grains but about individual proteins. In particular, in contrast to beans most grains and nuts do not contain much lysine.

[nobody]

As I was going over your post again, I realized I had failed to understand one of your questions so here is the answer: you don’t need to wait to take allopurinol. The recommendation to wait until your symptoms have gone away is probably not baseless but it is kind of old-fashioned.
If you had a proper attack, you could wait it out but since you seem to have something chronic you could end up waiting forever. Better take a regular anti-inflammatory drug or colchicine for a little while along with your allopurinol. Obligatory warning: if you aren’t familiar with these common gout drugs, do not take them without discussing them with your doctor first!

[nobody]

I do not have a similar experience but I don’t understand why, after taking allopurinol for so long, you have become so hesitant.
Did you have a bad reaction? Is your doctor worried about side effects?
You know your UA is high enough to cause gout symptoms without allopurinol and you know you can get your UA to a safe value with allopurinol. Therefore all you need to do to determine whether your symptoms are caused by gout is to take allopurinol regularly long enough to cure gout (5 months isn’t long enough). This is actually a more reliable way to tell whether you have gout than the joint fluid test. Your doctor’s “only way to tell” is actually the cheapest way to prove that you have UA crystals. Another way to prove it would be a DECT scan. That’s more expensive but it doesn’t produce false negatives like the join fluid test. And if you have access to allopurinol anyway, why do you need a proof?
If your doctor has a different therapy they want you to try, fine. But if the choice is between a drug you’ve already taken for years without issues and doing nothing, I’d go with the drug.

If you can cure your symptoms with allopurinol, then you’ll be able to quit taking it briefly in order to try celery seed and what not. Your UA will rise when you quit the drug but once you are cured the symptoms shouldn’t come back immediately so you should at that point be able to perform such experiments without damaging your joints and your quality of life.
If on the other hand allopurinol doesnt cure these symptoms, you’ll know that trying other ways to lower your UA would be pointless.

[nobody]

Chris’ recommendations are also valid for people suffering from gout… except for avoiding dairy. Indeed, I’d say they they’re common sense recommendations (not that I follow every single one religiously).
Low-fat dairy products such as skimmed milk and yogurt made from skimmed milk is generally recommended to people who want to lower their uric acid. And since it is the fat in dairy that some diets want to steer you away from so I think there’s room for comprise on the dairy issue.

[nobody]

Hi!
You should definitely not quit allopurinol while you are experiencing this type of symptom, unless you’ve been able to rule out gout as a cause. It often takes more than 4 months to get rid of crystals and you want to get rid of all your crystals before attempting to live without allo.
Since you test around 3.9 though, you could try to lower your dose a bit. Or you could stick to 300mg if you have no compelling reason to lower your dose as larger doses than necessary may help keep attacks short. I can’t guess what an appropriate dose would be based on the information above and my guesses wouldn’t be worth much anyway. You’ll just have to experiment!
Ultimately it is your symptoms which will tell you what dose is appropriate and whether you can go without allo. But it can take years for your body to give you definitve feedback. In the meantime you can use UA blood tests as a rough guide: while you are still experiencing gout-like symptoms, 5.0 or less is best whereas once have been free from gout for 6 months of more, as much as 6.0 might be fine.

[nobody]

I don’t know whether weight gain is a common side-effect. But I do know that 300mg isn’t the ideal dose in many cases. What are your UA test results like on that dose?
“Several pounds” could just be water or simply your muscle mass being re-built if you’ve become more physically active as your gout improved.

Gout-wise, you aren’t out of the water yet as you’ve only been on the drug for 6 months. And gout sufferers have had trouble with keto and other crazy diets.
So I would recommend sticking with something reasonable, like increasing the amount of low-energy foods you eat. If you aren’t eating enough proteins, fixing that could also lower your appetite (but if you’re almost vegan, you can’t just look at the gross amount of protein you find on labels and such as vegan diets are often lacking in at least one particular protein).

[nobody]

I drink more water than anybody I know. Or at least I’m the only one who doesn’t hide my empties.
I’m not counting liters.

Even assuming you don’t have access to a swimming pool, a bike or exercise machines, you have an upper body. And even if you couldn’t exercise your upper body for some reason, you could still get a workout by lifting your own weight without moving your feet (hang onto something with your arms for balance if needed to avoid using your toes at all). I was advised to balance “shallow” and “deep” flexing to exercise the muscles on both sides of the thighs/knees. Not as fun as swimming and so forth obviously but you could hit a podcast or something while you do it.
If you can’t even do that because of an attack, my fave subsitute to get my heart going has been hot showers. Sauna might be better but if you have access to that, you probably also have access to attack-friendly exercise gear you can use while lying down.

What I call gout-type pain comes with specific feelings and/or redness patterns which have occured together with (what looked like) regular gout attacks as well as less serious symptoms. I don’t recall ever having uniform pain over the entire foot.
Non-specific foot pain/tiredness, I would hesitate to associate with gout: if it could be anything, it could be anything.
Maybe you’ll start noticing more clues over time. Better yet: maybe you’ll stop worrying as these symptoms fade away.

[nobody]

I don’t know their purines content but I’d be surprised if purines were a problem considering the amounts you’re likely to use.
With few exceptions, plant products don’t contain very many purines relative to their volume. They might however contain pretty large amounts of purines compared to their protein or caloric content.

[nobody]

Allopurinol and Drinking Beer

Hi!
It would be best to avoid alcohol entierly for a while. Once allopurinol has cured your gout, you will hopefully be able to consume alcohol without putting your joints at risk.
But if you are going to do alcohol, I doubt an occasional beer would be much worse than wine. Red wine is generally recommended over other alcoholic drinks but I haven’t seen solid evidence that beer is all that bad (though I haven’t gone out of my way to look for it). Just watch the amount you drink (it would be prudent to drink only half of your cold one for instance). Don’t make yourself crazy by denying yourself a sip of the stuff but you really, really don’t want end up binge-drinking.
Also make sure you drink plenty of water, especially if it’s hot or if you’ve been drinking alcohol or coffee-type drinks.
Even while you are still suffering from gout, beer will be safer once you are on a steady allopurinol dose. Right now you are starting a potentially dangerous new drug and I assume you have yet to get your liver function tested since starting allopurinol (and quite possibly the effect of colchicine on your liver hasn’t been tested either). The dose will also have to be adjusted over the coming months. So it’s not the best time to induldge.

[nobody]

Careful behavior goes further than diet. Look up general recommendations for gout sufferers if you need a refresher. That would include drugs, clothing, physical activity and indeed water intake…

I’ve also been carrying water around. Obviously you can overdo anything, even water.
How much you might need water, I have no idea. Other than to carry out an excretion test and read up on what the result implies, I don’t know how a doctor would go about making that determination. But you could try experiming on yourself. Write everything down and before long you should be able to take a good guess at what does and doesn’t make a difference in your case. Keep in mind it’s kind of early for you to take chances though.
In my case I noticed that, rather than having to drink a set amount, water intake needs to balance water loss. Typically, I would drink when I’m kind of thirsty (which means I would still be drinking quite a lot). But when it’s especially hot and I’m sweating for instance, then I force myself to drink.

Sure, in principle changing the way you walk could affect crystals. But it could also be unrelated.
I think that you should be able to pick up clues to determine if any pain is (partly) caused by gout or a gout-like condition. For instance: redness (even if it’s slight, the location ought to be telling). You’ve suffered from this long enough to make a good guess, haven’t you?

As you probably know, in some cases it can take years at the recommended SUA level for crystals to go away entierly.

Drugs can deal with this type of pain, especially when there’s reason to assume it’s temporary. I don’t know your history and so forth so I can’t balance the risks and benefits in your case but if there is no particular reason why you have to endure this, you should talk to people about how to go about getting proper care in your country. I think Keith suggested talking to an experienced nurse.

[nobody]

Hello.

I don’t have definitive answers for you but I mainly wanted to warn you about combining naproxen and ibuprofen. They are the same type of drug so if you take the maximum dose of both at the same time, you are taking too much.

While I’m at it…

If you have adequately lowered the amount of uric acid in your blood with allopurinol, this can induce a phase in which you experience frequent but mostly mild gout symptoms. In this phase, it seems it’s not uncommon for symptoms to occur in places not typically affected by gout. And if uric acid crystals are dissolved soon after coming into contact with your immune system thanks to allopurinol, the reaction might taper off before swelling becomes apparent.

I have on occasion felt the combination of light fever, aches and fatigue while suffering from arthritic pain in a single joint. But these non-specific symptoms haven’t been very serious and I couldn’t say what caused them. Gout being a disorder of the immune system, for all I know it could just as well be a side effect of a feverish state rather than its cause.
So I would recommend talking about this with your doctor to make sure you do not have some kind of chronic infection or possibly an allergy. Just in case.

As far as exercise is concerned, your sugar control probably ought to be the priority but make sure your uric acid is being adequately monitored. Possibly a little more allopurinol than usual would help if you are exercising a lot.
It could also be that temporarily sticking to types of exercise which are fairly gentle on the joints such as swimming might help. Anything that could allow you to reduce the amount of naproxen and ibuprofen you’re taking is worth trying.

[Author]

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