[nobody]

Actually, Keith was confused when you said 2.7 rather than 0.27.
Note that some women might actually have 2.7 in another unit commonly used in test reports. And since 2.7 mg/dl equals 0.16 mmol/l (the unit you use), you can see how that might be confusing…

If you doctor ever tells you “I told you so” after you have an attack, ask “why didn’t you increase my dose in March then?”. Because that’s when it would have done the most good.
My current doctor sometimes makes mistakes too. It’s OK.

[nobody]

After several months of inflammation, a loss in the range of motion is also not surprising. If you can run, it can’t be too bad.
You could try regular and gentle stretching exercises to slowly increase the range of motion. Your muscles and tendons might not be up to the task of giving you the full range anymore. It shouldn’t be painful if you do it gently and only force the range to increase slightly as compared to what you can order your foot to do on its own power.

If you do not see gradual improvement, I recommend you see a professional.
I’ve had very long flareups and while they probably do irreversible damage, my range of motion ended up recovering every time. It just took a good while.

[nobody]

Hi again,

There’s no need for a photo but what you could do is to clarify the history of your test results. Here’s what I guess your history might look like:
February: started allopurinol 100mg
March: uric acid 0.30 mmol/l
July: uric acid 0.27 mmol/l
If that’s wrong (which is probably the case), please correct me. And if you have older test results, please add them.

If your uric acid indeed dropped 10% after a few months, that wouldn’t be surprising. The second result would have provided much-need confirmation that you’re on the right track and would be a sign that the therapy seems to be working.
Testing at 0.27 also confirms 100% that you can quit worrying about the purines in regular plant-based foods.
Finally, your test result would also be an argument against raising your dose as 0.27 is quite fine even considering that you seem to frequently have especially cold feet.

Now you know my non-expert opinion: there’s no real need to change anything or to see a doctor at this stage.
A small increase in your allopurinol dose might be helpful. Or it might be useless. So you might want to try 150mg as the risk would be minimal. Or you might stick to 100mg and be patient. We know that gout symptoms can take a while to go away… sometimes more than a year after starting the drug, even with super-strong doses resulting in a lower uric acid level than yours.
But if your symptoms do not go away by next year, then it might be worth seeing a rheumatologist about the failure of your treatment. If on the other hand your symptoms finally cease, after a while on your current dose you might want to try decreasing it to 50mg.

[nobody]

Neatly-localized redness can appear as swelling subsides. This type of painless redness stays exactly at the same location once swelling has fully subsided and can persist a long time. So far as I know, it’s due to minor damage caused by inflammation and in my opinion is nothing to be worried about nor should it be treated with ibuprofen. If pain and/or swelling returns however, ibuprofen might be warranted.
But I have obviously not even seen your foot… if you were examined by a professionnal (not necessarily a rheumatologist or even a doctor), they could give you better advice.

[nobody]

So far as I know it’s not a common procedure so I wouldn’t be surprised if most ER doctors were unqualified. Gout is also a chronic condition and so not something an ER is supposed to deal with if it can be avoided.
I’m sure they would rather give you pills and get you out of the ER quickly. Have you exhausted the common pharmaceutical options by the way?

Can your rheumatologist’s office recommend another specialist?
Anyone who does joint fluid aspiration ought to be able to give you an injection as well. Maybe your rheumatologist does that themselves. But mine would rather refer you to a skilled hand who is setup to handle emergencies.

[nobody]

Clement’s value translates into 0.298 in your terms.
The normal range is not the safe range. Lots of men have too much uric acid so if you do have gout, normal isn’t quite good enough.

People who have untreated gout have lots of crystals in their system. Yet on any random day, they are typically not in agony but feel just fine. Crystals can be isolated from the immune system. And sometimes, the immune system simply doesn’t bother making a big deal out of crystals it’s in contact with.

[nobody]

Prolonged fasting is not recommended if you have gout. You want to be careful what you eat but you need to eat. Else you’ll effectively be eating an unbalanced diet consisting of animal fat (yours).

I guess ERs might be set up differently where you live but here they aren’t set up to deal with chronic conditions. And they’re very expensive (even if you’re not paying, someone is). They can give you meds for pain (not natural ones) and test you for injuries and infection. That’s about it. While they are unlikely to find anything, it’s of course safer to go to the ER than not to see any doctor.
They can of course also test your blood. And if you suspect gout you shoul get a blood test. It’s very important. You don’t have to get it right now (the result may be more accurate if you waited until the pain has gone away) and it would probably be cheaper if you got that test done outside of an ER.

Any doctor’s office can do a blood test or tell you where you can get one.
But the medical specialty dealing with gout is called rheumatology.
And if the diagnosis is uncertain, when you are having an attack you might want to see a specialized radiologist for an ultrasound and (if possible) joint fluid test. Rheumatologists know who the skilled radiologists are when it comes to gout.
None of this will force you to take meds, only help you understand what’s going on which would allow you to change your diet and pick the right natural remedies.
I have to say the meds work very well though. You could test small doses for side effects before writing them off.

Even if you’re only willing to take natural remedies, there are natural anti-inflammatories you could use to get relief. Be careful about the dosing though! Effective natural remedies have side effects and can potentially be deadly.

If you had many painful episodes you think might have been gout, not getting treatment for the root cause would be massively unwise.
Sure, the pain eventually goes away on its own. But it also comes back. It slowly destroys your joints while the underlying problem is more likely than not to get worse over time. And it might be damaging more than just your joints.

[nobody]

A rheumatologist would be the appropriate specialist for gout and a number of more or less similar joint problems. When it comes to diagnosing gout or gout-specific therapies like allopurinol, rheumatologists are the most experienced. For foot symptoms though, you needn’t see a rheumatologists.
I don’t know what’s expensive and what’s not in your country but other specialties routinely deal with patients’ foot problems and help with symptoms.

You apparently have significantly higher uric acid than Clement. So I’m not sure you’re dissolving a great many crystals yet.
And I would expect symptoms caused by crystal dissolution not to be so long-lasting and to include redness and pain. But maybe your body works differently…

[nobody]

Hi,

You can thank your mother in law for her advice.
Your uric acid level is dangerously high. Most likely this didn’t happen overnight and is a problem you’ve had for a long time (if you’ve had routine tests in the past, looking at old results would settle the matter). It is not immediately painful and the problem doesn’t go away when the pain goes away.
You could try whatever you like to lower uric acid. Allopurinol is a very reliable way to do so whereas I would also be skeptical about saw palmetto. But whatever you do, you’ll be able to tell whether it worked or not by getting more blood tests.
What matters is that you do not forget about this problem when your pain goes away. Unless your gout diagnosis is shown to have been a mistake, you should keep doing blood tests until you find a way to lower your uric acid.
It also matters you see a doctor you can trust because this is a serious problem requiring serious lifelong management. If you are on a short vacation, maybe it’s best to wait until you come back home to make a decision about allopurinol.

There may have been a reason besides your preference for natural medicine why the doctor you saw didn’t want to give you allopurinol: do you know why your creatinine is so high?
If you aren’t a weight lifter or something, you might have a kidney problem. If so, I have no idea how dangerous it would be for you to take allopurinol. Fortunately, there is at least one alternative which is equally effective and convenient. Unfortunately, it’s also synthetic.

Since you don’t like synthetics, I’m surprised you haven’t been give colchicine which has been used for gout since ancient times. But like ibuprofen and vexamet, it’s only used for symptoms and is no alternative to allopurinol.
Maybe the doctors you’ve seen have ruled colchicine out because they are concerned about how well your kindeys are working.

[nobody]

I wouldn’t know what to report because I’m not sure how that page disagrees with your current view.
For instance as recently as May of this year, you’ve advocated the maximum dose to someone who is more at risk of dangerous allopurinol side effects than the general population. I had previously tried to convince them not to increase their dose beyond the amount necessary to reach the recommended SUA level. Since then, they’ve stopped taking allopurinol alogether. See: http://goutpal.net/forums/topic/allopurinol-dose-change-pain-location-change/#post-3631

[nobody]

You apparently have one of these doctors who doesn’t like to think too hard about pharmaceuticals.
Allopurinol is in many countries sold in 100mg and 300mg pills because that allows the following simple combinations by manufacturing or stocking only two different pills:
-50mg is half a 100mg pill
-100mg pill
-150mg is half a 300mg pill
-200mg is two 200 pills
-300mg pill
-400mg is a 300mg pill and a 100mg pill
And so forth. You get the idea.
You can take whatever dose you like. But I would not recommend tripling your dose without intermediate steps!

There are a whole lot of side effects people have gotten from allopurinol, most of which you’ll thankfully never experience. Probably you’ll experience zero effects but for sure you’re never going to have to deal with most of them. So I don’t think there’s much point in researching horror stories.
Instead, I recommend you simply follow generally accepted guidelines such as:
-start low (which is what you’ve done so far) and increase the dose slowly and progressively (this is the part your doctor doesn’t care to bother with)
-take as much allopurinol as needed to reach the desired uric acid level and no more
If you increase your dose slowly, you should notice most side effects before they become a serious problem. Then you could go back to a lower dose or switch to a different drug. Unfortunately, some nasty side effects are hard to notice at first and sometimes there is no going back to a lower dose once you get other side effects. But my assumption is that in your situation the risk would be minimal if you increase your dose slowly.
And if you indeed got down to 0.30 mmol/l after only a few weeks on 100mg, I dare say you clearly have no use for a large dose anyway. But if I may keep harping on the same point: you should get at least one more blood test. Then settling on an appropriate dose would be less of a guessing game.

[nobody]

I agree with you that now is not the most prudent time to take more allopurinol than you ever did. I’d save that transition for when you’re feeling better.
But I agree with your doctor that now might not be the best time for surgery either.

I can’t replace your doctor obviously but for what it’s worth my opinion is that you shouldn’t take 300mg. Or rather: first you should increase your dose to no more than 200mg, wait a few weeks and get a blood test to see what the first dose increase did to you. In fact, you should arguably get a blood test not just after but also before changing your dose.
My assumption based on the data you shared here is that 300mg would be pointlessly risky in your case. Aside from the effects of the drug, having very low uric acid might also affect your metabolism. Certainly tripling your dose brutally would be pointlessly risky!

In my non-expert opinion, the dose increase most likely to help you avoid waking up in pain isn’t allopurinol but colchicine. But of course I have no crystal ball, everyone is different and so forth…

In my opinion, every patient with serious arthritis symptoms should see a rheumatologist. It may not be necessary but I’ve seen enough clueless non-specialists to have an inkling about the damage they can do.
But the situation in which I think a rheumatologist would be most useful is if you doubted you have gout or I you suspected you have another condition on top of gout.
You’ve been trying uric acid lowering therapy for long enough that I think it makes sense to wait a while longer to see if your symptoms finally go away before seeing a specialist.

[nobody]

You have recommended the maximum dose to others. For instance here to “most gout sufferers”: http://www.goutpal.com/gout-treatment/avoid-gout/allopurinol/allopurinol-dosing/
The reason I mentionned your opinion in this thread is that, while I disagree, I wanted Rebecca to be aware of your opinion. She might otherwise have assumed my opinion to be the opinion generally held here.

It is well known allopurinol has commonly occurring side effects, some of which are more dangerous than others. The generally-recommended precautions are unfortunately not sufficient in every case.
Obviously untreated gout is harmful as well but the choice isn’t between maximum dose allopurinol and no treatment but between various doses (or when someone has reacted poorly to allopurinol, between allopurinol and alternatives).

[nobody]

Hi Clement!
It’s actually not surprising at all that symptoms persist.
However you reduce uric acid, the result is the same: uric acid that had crystallized in the past dissolves and that often causes frequent gout symptoms for a few months and sometimes even longer. People are commonly told to take a medication such as colchicine or an NSAID daily for a couple of months in order to prevent redness, swelling and pain.
It’s not surprising that walking might trigger symptoms either. Some of these crystals are stashed away from your blood and dislodged by walking or exercise. Then they start dissolving and your immune system reacts…

Congratulations on reducing your uric acid so much by the way! You’ll have to monitor that to make sure it doesn’t creep back up.
While 5 is fine in the long run, you might benefit from temporarily lowering it a bit more (for as long as you’re suffering from gout symptoms).

[nobody]

Sleep problems are far from the worst side effects you can get from diclofenac in particular. And would you sleep at all if you didn’t take it? Your attacks might be milder but during what I’d call a serious attack, I use a prescription-only painkiller in order to get a little sleep.
I’ve walked on the side of the foot during less serious attacks but you can trigger ankle problems that way.

And no, I don’t live in the UK.

[nobody]

Gout Swelling Won’t Go Away

So you’ve had about three months without pain? No loss of joint mobility? Just constant slight swelling? Odd. Certainly not something I’ve experienced so I’m kind of at a loss…
I think you’d better get that foot examined by someone who knows about many different types of joint or foot problems, not just about gout. You didn’t say if you ever got a solid gout diagnosis. And it’s possible a gout attack did some damage and that the problem you have now is related to but separate from gout.
But whatever the cause of your lingering swelling, if you can’t or won’t try rest and possibly physical therapy to help with the healing, I’m guessing infiltrating or injecting a drug that fights inflammation in your foot might help without as many side effects as you’d get from taking a similarly nasty drug in pill form. But I’m no doctor and I’ve not even seen your foot so that’s obviously a really wild guess.
There are gentler things some of us have tried to get rid of lingering symptoms and help to heal along but… three months? I think you’re past home remedies and the like.
Your symptoms might not seem like a big deal right now but it might possibly the early signs of something that could get worse over the years. Best see a qualified professional and catch that kind of thing early.

Now if you want to try to manage your uric acid without drugs…
You already know about drinking water and losing weight. Good.
But it’s a complicated problem. Many things contribute and there are lots you could do. Some things matter more for some people than others. You’ll have to research this for yourself. But here’s a summary:
-if you’re inclined, become a vegetarian and be careful about shrooms and yeast too (that or you’ll have to be very picky about what meats you eat)
-get much of your protein from dairy instead
-quit sugar, don’t drink or eat stuff containing sugar (especially fructose: watch for “corn syrup” in ingredient lists), watch your consumption of sweet fruits and especially their juices as well (cherries are obviously fine)
-quit alcohol
-eat a whole lot of vegetables containing magnesium, potassium and calcium (which would be pretty much all vegetables, but amounts vary)
-avoid both starvation and very taxing exercise as well as fast weight loss
-review any medication you’re taking or planning to take (including herbal medicine, recreational drugs and such) for potential effects on uric acid
If that sounds like too much of a burden, consider simply taking a daily pill instead.

[nobody]

People’s doses are all over the place. 300mg is common but people also take 400mg or more. Keith (the site’s owner) advocates the maximum dose which would be 800mg or 900mg but I think that would be pointlessly risky in most cases. In most cases, no allopurinol dose will completely prevent symptoms during the first months.
Some people apparently get no obvious side effects even at the maximum dose. On the other hand those of us who do not take well to allopurinol can get side effects from very small amounts.

As to staying off one’s feet… well, that’s another way in which people are different. You’ve got to figure out what works and doesn’t work for you. It also depends on what drugs you take to suppress symptoms.
Personally, I try to avoid doing painful things for most of the day. I think it’s not controversial that you shouldn’t be completely immobile for long periods but during severe attacks I would lie down most of the day, use crutches, avoid regular shoes if putting them on is painful and so forth.
The main reasons I’m very careful is that I do not do well on many common drugs and that my attacks tend to come back shortly after fading away and I find rest makes that less likely. Others have no such concerns and find moderate weight-bearing exercise helps their feet go back to normal quicker.

[Author]

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