[nobody]

Hi,
I understand people do not usually get gout symptoms there but I had a weird gout-like thing on the ribs at one point. Unlike the typical foot/knee/hand symptoms, it didn’t last long nor was it very painful. No redness either so the location where I felt the pain might not have been the inflamed location.
I’ve also had definitely non-gout pain in that area. Better make sure it’s not the stomach, the gallbladder or something.

[nobody]

Hi,
I hope these ulcers will heal well. But what were those “pain pills” if I may ask? It sounds like they were anti-inflammatories (the Irfen type of drug) but if other drugs can have that effect as well, others here taking the same pills might want to know.
In case they were indeed anti-inflammatories and you never tried colchicine, that drug doesn’t hurt my stomach in that way.

[nobody]

Depending on what causes the allopurinol side-effect, it might take a few days to go away completely after you stop taking it or reduce the dose.
And while marijuana alone may not make you dizzy, it could be that the combination of allopurinol and marijuana is the problem (assuming you didn’t already try staying clear of marijuana a couple of days).

There are alternatives to allopurinol so don’t give up until you’ve tried them!

I’m assuming 100mg colchicine is a typo by the way.

[nobody]

Are the doses you listed what is contained in one pill? If so, what’s the maximum number of pills you would be taking each day?
Could you elaborate about “liver function”? Because many of the drugs you listed can affect the liver. I for one wouldn’t take Tylenol (or Tramacet) for pain.

[nobody]

It’s good to hear you like milk because if you do not eat meat, lentils, beans, or soy you may need to consume a lot of dairy. A relatively small amount of cheese would be sufficient since that is very nutrivtive but if milk is the only dairy you consume, you may need (depending on how tall you are and so on) as much as a liter per day (including the amount used in cooking). You probably need less and your daily egg in particular reduces your need for milk so my wild guess considering what you’re eating and so forth is that be you’d need half a liter per day.
Some veggies like cauliflower or spinach could bring that figure down when you eat large servings (uncooked cauliflower is worth about two-thirds of its volume in milk for this purpose). If you ate large cereal servings (not recommended for weight loss!), that might also bring down the figure.

Most veggies have similar benefits but some have special properties (see above). Tomatoes and zucchini help lower the acidity of your urine more than most vegetables for instance.
If you eat a lot of different vegetables, you don’t need to worry about whether this one or that one is best. Even plants you might not think of as nutritious such as coffee actually contain nutrients lacking in most other plants. So variety is the one thing most likely to provide you everything you need and I would therefore recommend all veggies.

What’s your concern about spinach by the way? Obviously if you don’t digest it well or it makes you sick, you shouldn’t force yourself to eat that.

[nobody]

.6mg three times a day ain’t bad. It’s not a crazy way to take colchicine. I never tried to stop a serious attack with 2mg or less but if you’ve been taking 1.8mg a day for several days, it adds up and ought to be effective.
I think it’s worth trying a higher dose because we don’t know what dose would be effective in your case (just understand that unlike indo it takes a long time for colchicine to work) but I agree with Keith in that looking at other drugs seems more promising if you’ve already taken 1.8mg a day for several days.

And yeah, I had gotten the impression your gout wasn’t as bad as it seems to be after all (“only came once a year kind of thing” had stuck in my mind) but on the bright side you are now addressing the cause of the problem.
Any gout pain you get while taking allopurinol is almost guaranteed to be temporary. But you still need to find a way to stop inflammation for the last attacks still ahead of you.

[nobody]

The “thought processes” worrying Keith are explicit, and very simple: carbs are bad, cereals are loaded with carbs, therefore cereals are bad. Surely you are aware of the enduring low-carb diet fad.
Now it is correct that a gout diet ought to be low in sugar and fructose. But conflating cereals with sugar or fructose-based sweeteners is asinine.
It may well be that the consumption of all carbs (cereals included) is pathologically excessive in many countries. But that doesn’t mean individuals can’t over-correct and end up with excessively low carb consumption. In the same way, it is certainly possible to eat too much oatmeal but avoiding oatmeal on that ground is silly.

Full disclosure: I occasionally eat rolled oats.

[nobody]

Some people get extra strong attacks after starting allopurinol.
I expect you are now taking 200mg. You might benefit from taking more than that after your next blood test which I wouldn’t delay in light of your situation.

It could be that you need larger doses of colchicine and indo.
I can’t speak about indo dosage because I’ve only taken acemetacin (which I understand turns into indo within the body) and I don’t know how to convert doses from one to the other. But obviously some people have taken pretty large doses for gout compared to what is often recommended for other uses.
Colchicine is most effective when taken before you start hurting. Once you are really hurting, you need to take higher doses and still it’s not effective right away. The maximum dose is very high and the default instructions for colchicine here are to take 3mg the first day (waiting at least 3 hours between 1mg pills) and 2mg the second day if you’re trying to fight an attack as opposed to prevent it. I’m not sure most people would benefit from taking that much but certainly there can be a benefit in taking more than the daily 1mg (or 1.2mg) people are often told to take.
It seems you’re healthy and would be able to tolerate heavy doses but, especially with indo, better talk to you doctor first before taking heavier doses than you’re used to. If you were to take a lot of indo, your doctor might want give you yet another drug in order to prevent some of the side effects.

And if colchicine and indo really have become inadequate, there are other drugs which fight inflammation.
There are of course also painkillers you can take on top of that, though the most effective ones tend to be debilitating which wouldn’t help you if you want to perform at work.

I hope you can find an effective way to stop your attacks dead in their tracks before you get back to work.
This will likely not be your last and in my opinion dealing with the symptoms aggressively when they start would likely reduce your total drug intake.

[nobody]

Yes, 6.2 is too high.
If you know for a fact the dizziness is from allopurinol and the side effects don’t improve over time, ask your doctor about alternatives to allopurinol.
If you haven’t tried it yet, the main alternative is febuxostat (sold as Uloric in the US and Adenuric in Europe). The effect on uric acid is basically the same but the side effects are different. Just a warning: the normal dose might be stronger than you need.

[nobody]

The main issue as I see it is: do you think you could obtain and afford better medical care?
If the doctor you’ve seen is realistically the best you’re going to get, I think you should simply follow their advice. I think you need a doctor to make a solid diagnosis because your blood tests are not typical for a gout patient. So I think there is a chance you might have a different problem. If you follow your doctor’s advice and it doesn’t help, the doctor should then be able use that information to move on to other treatments or order tests for conditions other than gout. But if you decide to be your own doctor, what will you do if your new diet doesn’t help you?
If on the other hand you want to see a different doctor before starting a new drug, that makes more sense in my opinion.

One problem with changing your diet is that it could possibly take a long time for the effect to become clear, especially if you are malnourished or losing weight. How will you know if your new diet is working? Can you get frequent blood tests? Are you willing to purchase your own testing kit? And how long are you willing to wait?
Your blood tests for uric acid are low enough that if gout is indeed your problem, you might well be able to manage it without medication. But taking Miluric for a while would make the transition easier for you. Once you are free from gout symptoms, you would be able to stop taking the drug and see if a healthier diet is enough to keep your uric acid low.

[nobody]

Hi,
Having gout pain while taking allopurinol is to be expected and is not a sign that anything is wrong. But I assume gout doesn’t make you dizzy.
Hopefully you simply caught a bug and these symptoms will go away.
But if you think you might be experiencing serious side effects from allopurinol and your symptoms don’t improve quickly, better see a doctor.
The benefit of allopurinol doesn’t go away very quickly so it’s not a big deal if for a single day you don’t take allopurinol or take only half your regular dose.

[nobody]

Hi,

A few commendts…

There are limits to what you can accomplish with diet.
Even if some day you end up gout-free without meds (it’s not a given that it’s even possible), that would take time. Doing without meds in the meantime will cause extra suffering.

Having more frequent gout symptoms can be a sign of improvement. And rapid weight loss can temporarily make gout worse.
So doing the right thing doesn’t mean you’ll feel better immediately.

Your diet puts you at risk of malnutrition and protein deficiency in particular.
Your diet should be more varied and contain more vegetables. I also recommend you make at least one of the two following changes:
-eat/drink a lot more dairy
-add generous servings of the lentils/beans type of plant to your diet and refrain from excessively restricting the cereal servings (rice, bread and so forth)

[nobody]

@DQ: Rich has just been prescribed allopurinol. But as you know, the initial dose is low.

[nobody]

Yes, these drugs can damage your liver but they don’t do that to everybody. I don’t know about the kidneys (so far as I know, mine are healthy) but it sounds like your kidneys are being properly monitored anyway.
See here for general information about liver tests: https://en.wikipedia.org/wiki/Liver_function_tests Maybe you are already being tested regularly but you didn’t realize it. The most basic tests are GGT, AST and ALT. Febuxostat is known to increase ALT in particular.

There are many causes for high uric acid.
There are tests you can do such as measuring the total amount of uric acid in your urine which could help with determining why your uric acid is high. It could indeed be a problem with your kidneys which have trouble getting rid of the stuff but your body could also simply produce way too much uric acid when you’re not taking medication.

It sounds like 300mg allopurinol would be sufficient for you in the long run but one problem is that you may still have uric acid crystals in some parts of your body. Blood tests do not detect them and they can cause your uric acid to spike back up in between tests and possibly lead to kidney stones in spite of your low uric acid tests. These crystals should go away slowly if you keep taking medication and might be a reason to keep your uric acid unusually low for a while.
So considering you had a stone in spite of 300mg allopurinol (have I got that right?), maybe 40mg febuxostat would be a bit too low. If you can get the 120mg pill, perhaps you could split it in half to get 60mg for a while and then try switching to 40mg later. You could also try to get around 60mg (precision is not important) from 80mg pills with a pill cutter or other tool. Allopurinol is easier to fine tune because there are 100mg pills everywhere while many countries do not have low-dose febuxostat pills.
Exercise, doing drugs such as alcohol during the weekend and many other random variations in your diet and lifestyle could also raise your uric acid in between tests and possibly contribute to the formation of stones. Having very low uric acid test results would provide a buffer against all sorts of changes.
To be clear: I’m no doctor and have had no kidney stones. I’m only making guesses here based on my experience with these drugs, what I’ve been told by my doctors and so forth. I can’t provide you a medical opinion on what your uric acid target should be.

[nobody]

The 80mg pill is designed to be split in half. No problem there and splitting ought to protect you better than taking one full pill every two days or to stop it for a week. But after diminishing your dose you would need to monitor your uric acid to see if it creeps back up above your target.
You could also go back to allopurinol, but take more than 300mg this time. There are people here who take more than 300mg every day. The distributors of febuxostat (Adenuric) in Europe and the USA would have doctors believe that their product is stronger than allopurinol but actually it is only stronger than 300mg, not stronger than the maximum dose (unless you take even more than 80mg). Again, you would need to monitor your uric acid after switching back to allopurinol.

Below 3.5 is in my opinion too low (except possibly for a few months to help with the dissolution of crystals) and you ought to cut the pill.
It could be that what you are feeling in your foot are uric acid crystals dissolving. Temporary discomfort aside, that would be in my opinion healthy in the long run and you ought to consider not allowing your uric acid to climb above 5 for a while assuming that your liver is toleraring the strong dose your are taking (your livers markers are being monitored, right?).

Don’t take my word for it but I seem to recall that diet can also affect your risk of forming uric acid stones.

[nobody]

Eggs are like milk products products in that they give you proteins which tend to be lacking in plants other than the lentils/beans type.
You can of course eat eggs but I didn’t mention eggs because the problem is that you’d need a whole lot of eggs (like 30 per week which is in my opinion too much) if you were to rely on them to replace meat without eating either milk products or the lentils/beans type of plants regularly. But as a complement, eggs are fine.
Eating meat is better than being malnourished so if you can’t or don’t want to eat a decent vegetarian diet, just avoid what your doctor told to avoid as well as processed meat if you don’t know what’s in it and stick to things like steaks.

So far as I know, depression doesn’t cause gout but could certainly have triggered gout if it caused you to change your eating or drinking habits for instance.
Thinking about suicide sounds like a warning sign. You can’t solve all your problems at the same time of course but I hope you have someone reliable in your life or a good doctor you can discuss this with.

I have gout in my family. 31 seems like a typical age to start having attacks.
If you can tolerate the drugs, it doesn’t have to be bad. Even without treatment, you wouldn’t suffer from gout all the time.
I never tried to lead a normal life (look at me typing a long message to a stranger on the web!) but I’ve known people with worse gout than mine who have been leading midsize businesses, sending their kids to college and so forth.
Finding the right drugs, testing them and so forth takes time but in spite of its painful wakeup call, gout is typically easier to manage than things like diabetes or heart disease.
If gout is the cause of your pain, going by the blood tests yours is pretty mild and should be easy to fix.

In the meantime you may be needing a stronger anti-inflammatory treatment than 100mg Aflamil so ask your doctor about that if you’re not satisfied with the effect of that pill.
In answer to your last question, gout attacks can take a long time to resolve, especially without colchicine. But you’ve just been presecribed new drugs so now may not be the best time to test yet another unfamiliar drug.

[nobody]

GoutPal has a purine content list which seems standardized per weight. You could convert those values into whatever serving sizes you like to use but I don’t think there would be much point because there is no particular amount of purines you should be eating in the first place. Purines aren’t like proteins or what have you in that the ideal amount in your diet is simply zero. But of course you need to eat some.
My assumption would be that if you’re told to go on a low purine diet that simply means you ought to try eating less purines. And for that purpose, even if you wanted to bother with counting purines the amount per serving wouldn’t be useful. What you might be able to make use of instead is the amount of purines per calorie or relative to the amount of protein in the food.
Realistically though, the practical way to achieve a low purine diet is simply to avoid the especially purine-rich foods. The difference between the purine content of cheese and meat for instance is so large that the actual values don’t matter: if you have no reason to avoid dairy (lowering the amount of purines you eat ought not to be your only dietary concern!), getting most of your protein from dairy is the easy ticket to a low purine diet. It can be that simple.
Most of the plants containing little protein also do not contain much in the way of purines so you can eat your fill of that stuff without counting purines.

In addition to limiting purines, noteworthy among the things which might help you lose some uric acid are:
-eating enough vegetables containing lots of magnesium, potassium and calcium to help your body get rid of the uric acid it produces
-avoiding alcohol
-limiting fructose, especially when used as a sweetener (see HFCS)
-losing weight (if applicable)

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