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<Hi Robert,
I’m intrigued to know which pain relieving patches you are using for your gout pain. Also, what is the active ingredient(s) that help you recover from a gout attack.strong>
Hey all. Been on vacation but still following up with you all. Anyway, if it’s like most pain relieving patches, it’s more than likely a topical Lidocaine patch. Lidocaine has some really good analgesic qualities and is good for short term pain management, especially for those who don’t like opiate based, oral pain medication.
But as you state, it’s not doing anything for the root cause of the issue itself. Robert, eventually those short term pain patches will not be sufficient.
@Patrick – tell me about it mate. It’s driving me insane. I’m just worried it’s the allopurinol causing this? I’ll definitely ask my doctor about Methylprednisone packs when I next see him. They sound helpful. Can a local GP do direct steroid injection? I’m based in the UK and the last attack I had she mentioned she can’t do a joint fluid test to confirm gout, Is it as difficult or tricky to perform? By the way Patrick, do you still get attacks whilst being on allopurinol?
James,
I’m not sure about a GP doing a steroid injection. I’ve always had my Rhuemotologist do it, or his assistant do it. It’s actually a Prednisone injection right into the area where the pain is. For instance, my trouble spot was my left ankle. If I couldn’t control the pain within a few hours, I’d head over to my Rheumotologist and he would give me the steroid injection and within an hour or two, the pain was gone completely. Now I’m sure you understand that this was just strictly for the pain, not the actual cause. You are already dealing with the cause, as you’ve stated.
I’ve been lucky. Since I’ve been on Allopurinol (over 18 months now), I’ve had one Gout Flare, last June. I felt it coming, immediately took Colchicine and 4 Methylprednisone tablets and within 2 hours, it was gone. I then continued the steroid pack the rest of the week, supplemented a few Naproxen in there for good measure, and haven’t had an episode since. Nor have I had any lingering pain. Occasionally, I DO get tingling in my big toe, but nothing like a major flare up, and usually I can kill that with 600-800 mgs of Naproxen.
I hope that helps, brother. No one should be living with this pain for as long as you have. Keep us posted.
James,
When I first started getting Gout Flares, they would last about a week because I didn’t know what they were nor how to treat them.
Let me ask you, have you tried Methylprednisone packs? It’s usually a 6 day pack that starts with 6 tablets the first day, then 5, then 4….and so on. If you haven’t used this antibiotic, I’d highly suggest you do. For me, I always keep an extra pack on me at all times, just in case. Usually, if I felt a Gout flare coming on, I’d hit it with the Prednisone and some colchicine and within 2 hours it was gone. But I’d make sure to finish the 6 day supply.
Try that. You can also get a steriod injection into the site which really helps also. Try the medication first. 12 days is way too long to be suffering brother.
Hi Elizabeth. Great advice form the posters here. The first part of the problem is a doctor problem. ANY doctor worth his/her salt should NEVER,EVER prescribe a patient a drug like Allopurinol without a current kidney test and a liver test. Especially a patient with a family history of kidney problems. Your second doctor’s opinion was spot on. And you are right, Gout is often genetic so you are fighting that also.
I do agree with the posters, though. If your blood tests are showing normal results, what is the issue of taking a pill every day to help keep your Uric Acid in check? As you get older, your bodies ability to regulate itself is going to slow and Allopurinol is going to help you in that regard. The side effects are mostly minimal, and as long as you are continuing to have your blood work, kidney and liver functions checked, and regulating your diet and health, you should be fine.
As James stated, it’s a matter of choice. Gout attacks suck, and with a family history of Gout, I’d be willing to bet with even the most strict lifestyle changes, diet, supplements, etc. you’d be fighting a big uphill battle.
Patrick,
Much of what you wrote is I think correct but…
There are doctors who use colchicine as a diagnosis tool in some cases. It’s much cheaper and easier than arranging an ultrasound and joint fluid test with a skilled hand.
And there also are doctors who discount the results of tests done on blood drawn during an attack.
I wish diagnosis was as simple as a blood test. I have had several tests coming back well under 6 without the benefit of UA reducing drugs. Do you think that means I don’t have gout?A couple things. I can only speak for my experience, but using Colchicine as a diagnosis tool because it’s much cheaper? I don’t know about that in my experience, and it may be indeed true, but where I’m from, Colchicine is NOT cheap. As a matter of fact, it’s damn expensive. My insurance is billed almost $700 for 90 tablets of 0.6 mgs. I pay a $50 copay, but if I didn’t have insurance, $700 bucks is a steep price to pay for what may, or may not be Gout. I’d rather have more convincing evidence.
For me (again, I only speak from my experience) I had several blood tests, none were taken during an active Gout Flare. Most often, it was taken afterward, then 4 weeks afterward. The highest reading I ever had was 9.6 mg/dL. When I first started Allopurinol, my doctor had me at blood test intervals of 6 weeks for the first 6 months. My Uric Acid is currently at 4.4 mg/dL, but I never take it for granted that I won’t have a Gout Flare, so I’m careful.
With YOUR blood work well below 6 without meds, maybe you’re one of the lucky ones. I hope you are. I could NEVER get my levels below 8 without medication, so I really had no choice. But just because your blood work comes back well below 6, I wouldn’t say you don’t have Gout. You just don’t have symptoms. Keep up whatever you’re doing and be healthy.
John,
Sorry to hear the news, but welcome to the World of Gout. First off, as a 50 year old male getting his “first” gout attack, consider yourself lucky in that regard. but guess what, brother? Colchicine is NOT your answer. Certainly not your LONG term answer. You will find here on this site that the first question asked will be “what is your CURRENT Uric Acid at?” Meaning….get a blood test and find out where you are with your Uric Acid. I find it odd that your doctor gave you Colchicine sight unseen, for big toe pain. That’s a little odd, if he didn’t do any blood work.
Colchicine is a common anti-inflammatory prescribed for Gout. It doesn’t have any pain reducing principles, so any relief you are going to get from Colchicine may take a while as it isn’t really doing anything for your Gout cause, if indeed you really have Gout. You certainly have a symptom of what CAN be Gout.
Also, your “social weekend” most likely didn’t have much to do with you getting Gout. It may have pushed you over your Uric Acid threshhold, which in turn caused your Gout Flare, but it really had little to do with you getting Gout itself. Many of us, through the magic of genetics and DNA, inherited this condition. I beleive the percentages put it at around 75-85% of Gout sufferers inherit it.
The only TRUE way to determine if you have Gout is to get a blood test, first and foremost. ffind out where your Uric Acid is and if it is indeed high (over 6.o mgs/dL in the US) then discuss with your doctor potential remedies. But until you know for sure where you stand, you may be subjected to future Gout attacks, and believe me, they will get more painful and last longer as they progress.
This is by far the best site on the web for Gout information. There is a good group of people just like you who are experiencing the same things. Read, learn, and engage. Keep the group posted on your progress, John.
John,
Sorry to hear the news, but welcome to the World of Gout. First off, as a 50 year old male getting his “first” gout attack, consider yourself lucky in that regard. but guess what, brother? Colchicine is NOT your answer. Certainly not your LONG term answer. You will find here on this site that the first question asked will be “what is your CURRENT Uric Acid at?” Meaning….get a blood test and find out where you are with your Uric Acid. I find it odd that your doctor gave you Colchicine sight unseen, for big toe pain. That’s a little odd, if he didn’t do any blood work.
Colchicine is a common anti-inflammatory prescribed for Gout. It doesn’t have any pain reducing principles, so any relief you are going to get from Colchicine may take a while as it isn’t really doing anything for your Gout cause, if indeed you really have Gout. You certainly have a symptom of what CAN be Gout.
Also, your “social weekend” most likely didn’t have much to do with you getting Gout. It may have pushed you over your Uric Acid threshhold, which in turn caused your Gout Flare, but it really had little to do with you getting Gout itself. Many of us, through the magic of genetics and DNA, inherited this condition. I beleive the percentages put it at around 75-85% of Gout sufferers inherit it.
The only TRUE way to determine if you have Gout is to get a blood test, first and foremost. ffind out where your Uric Acid is and if it is indeed high (over 6.o mgs/dL in the US) then discuss with your doctor potential remedies. But until you know for sure where you stand, you may be subjected to future Gout attacks, and believe me, they will get more painful and last longer as they progress.
Patrick, following your last post, I just wanted to say I admire people like you (firefighters). It’s people like you that make a huge differences in people’s life let alone saving lives.
I’m constantly worried about doing any physical exercise in case I cause an attack whilst finding my optimum allopurinol dose. 🙁
James,
First off thank you for the nice compliment. I’ve learned a lot from working in the city of Los Angeles for 27 years doing this job. It’s a great job and a rewarding profession. My son has followed in my footsteps and he is also a Firefighter in Los Angeles, and has been for almost 5 years. Occasionally, we work together on the floor. I love that, my wife hates it.
As for the apprehension of physical exercise, I understand that, but physical exercise is actually beneficial for your condition. That is, if you are capable of doing it. I know that since I’ve been diagnosed with Gout, I have lost a lot of mobility in my left ankle. I try and power through it, but I can’t run long distances anymore because of it. Anything longer than 5 miles is painful.
Instead, I mountain bike and swim. Both are easier on the joints, and really beneficial for your overall health. Especially swimming. My advice is do what you can to stay active. Walk at a brisk pace, swim, bike, etc…as long as you do something. I take some ibuprofin and Glucosomine and it seems to help. Try that.
Could these joint pains be a result of crystals dissolving despite not yet finding a stable therapeutic dose? I mean will crystals still dissolve at lower then a patients usual UA (originally 580 in my case) but far greater then the 350 safe limit? Or are these pains completely unrelated?
Thanks 🙂
James,
I’m not sure. I can tell you in my case specifically, I used to get severe Gout pain in my left ankle. Then it started to happen in my right ankle. Once I got my UA under 4.5 mgs, the pain in my ankles went away, and has been for over a year (knock on wood). BUT….in the last 2 months, I’ve developed pain in my left shoulder. Now, several things may be happening here. In my line of work (firefighter) I may have injured it on an incident. Or, as an active guy, I recently dumped my mountain bike on a trail, but I don’t recall falling on my shoulder. I fell hard on my back, so I’m not sure. ORRRRRRRRRR, it may be Gout related. I am scheduled for an updated blood test next week, so I’ll have current UA results.
Either way, I found it weird that all of a sudden I had pain in an area I’ve never had pain before. I’m leaning toward an injury, but I’m hesitant to go to the doctor because I don’t want to be put on injury leave at work, if indeed it is an industrial injury. I’m one of the lucky people who actually loves their job and loves going to work.
Andrew,
I agree with Keith. I don’t think I ever read Keith or the website ever saying not to take more than 1 tablet a day. As a matter of fact, I think I’ve read many times Keith’s remedy for Gout Pain Management as taking up to 4 Colchicine tablets in a day (correct me if I’m wrong Keith). The remedy was to take 2 tablets immediately, then take 2 more later if pain doesn’t subside.
I think people may have been talking about taking Colchicine as a prophlactic in which 1 tablet a day may be sufficient. The dose I take occasionally is 0.6 mgs, but as I’ve discussed many times before, Colchicine in the US is quite expensive. I pay a $50 co-pay and my insurance is billed $600 for a 3 month supply. That’s ridiculous in my opinion, so I don’t take it very often.
Daniel,
It sure sounds like a Gout Flare. With a Uric Acid at 8 mgs, even on Allopurinol, you are susceptible to Gout Flares. Gout can start in your Big Toe, or several toes, then spread to your ankles and progress higher if left untreated.
Questions…How old are you, how long have you been on Allopurinol, and how many mgs are you taking? If you have just started on Allopurinol, this is a somewhat normal occurence. If you’ve been on Allopurinol for a while (over 3 months) and your Uric Acid is still at or above 8 mgs., you may need to up the dose of your medication. Of course, this will have to be done in conjunction with blood work and under the watchful eye of your doctor. Any doctor worth his/her salt would not up the mgs of Allopurinol without a full blood screening to make sure your kidneys and liver would be able to handle it. That’s why I ask how old you are.
Anyway, your signs and symptoms sound like classic Gout. Use the Google custom search in the upper right corner to help you with Gout pain management. There are many helpful people on this site, and it’s without a doubt the best site on the Web in regards to Gout, Gout information, and Gout management.
Maury, congrats on your total Uric Acid reduction buddy. That’s awesome. 3.9 is great. Keep up what your doing, and welcome to your new lifestyle.
James, you might need to up your dose in a bit. I started at 100mg (which is normal) but in 3 months my UA went from 7.8 to 7.6 on 100mgs. Not working. My Rheumotolgist bumped it to 300mgs and within 4 months it went from 7.6 to 4.3 and has held around 4.0 for a year. I’d expect a bump up in your dose after your doctor can clear you on your next blood test, if your liver and kidney function test show your body can handle it.
James,
There are actually 2 types of sleep apnea, but for purposes of this thread, and not to go on a tangent, I will focus on obstructive sleep apnea. That is the actual obstruction of the opening of the trachea, usually caused by the collapsing of the soft palate in the back of the throat.
The only connection that a layman like myself could draw that Gout and sleep apnea would be connected would be that people who tend to be overweight usually have sleep apnea. SOME gout sufferers tend to be overweight, linking diet, lifestyle, and health issues as contributing factors. Notice I said some, because what these doctors who use these contributing factors are failing to say is that for the majority of Gout sufferers, it was inherited through family DNA. In my OPINION, this could be a link. I don’t really understand how sleep apnea itself could lead to higher Uric Acid in your blood stream, in and of itself. But then again, I don’t tend to read JAMA or other medical journals for light reading.
The only connection that I could link all this together is that being overweight has significant health risks. One of those issues is kidney problems, which can be linked to Uric Acid filtration and Gout. So in a roundabout way, there may be a connection, but several other factors would have to come into play. Again, I’m not a doctor and this is just my opinion, FWIW.
In layman’s terms, colchicine to block inflammation. Naproxen to fight any inflammation that gets through (usually, because you took the colchicine too late). Medically (ish), naproxen blocks enzymes. But, colchicine blocks immune cell replication. Entirely different battle scenarios.
It reinforces what I learned a long time ago. Never ask a doctor about pain control. Hospital nurses know what works.
And this, my friends, is the kind of information that keeps me and others coming back. My wife tells me I should try and learn at least one new thing every day. This suffices that requirement. Thanks Keith
3. Should I also be looking to add colchicine to this as a preventative measure, or is it one or the other with Naproxen and Colchicine?
Many thanks
Ryan,
I only like to give advice through my own personal experience, whereas Keith is more of “the guy” when it comes to more knowledgable medication advice.
I will tell you what my Rhuemotologist told me. I asked the EXACT same question, because on my medical sheet, I disclosed that I often take Naproxen as a preventative. But I also have a standing prescription for Colchicine (0.6 mg). He asked, “why are you taking both of these medications? Naproxen is like a BB gun, where Colchicine is a Bazooka.” I told him that I only take Colchicine very infrequently. Like when I feel a flare up coming, or if I’ve had “more than moderation” in indulgences.
Often, a GP or Rheumotologist will prescribe Colchicine as a preventative in conjunction with Allopurinol when it is first prescribed because of the possibilty of a Gout flare. I alternate taking it for a couple weeks, then go off of it. Is this the right thing to do? I have no idea. But one thing I DO KNOW….even with my great insurance, I have a $50 co-pay for Colchicine. That’s quite a bit of money.
So if I can stretch the prescription out, I will. But I would definately recommend taking it in conjunction with your first batch of Allopurinol until you and your doctor know where your levels are. That’s probably a pretty smart thing to do. Once you get your Uric Acid levels more stabilized, then you can decide whether or not you want to continue taking Colchicine.
Again, this is just my 2 cents.
With regards to Sleep Apnea, I’ve never had myself checked / diagnosed however to be honest I think a significant proportion of my sleep problems have only recently become an issue and are a result of “worry or stress” of a Gout flare possibility when waking up. (Ridiculous I know). 🙂
I’ve started using an iPhone App to monitor my sleep over the next month or so to better understand what could be the problem. Making small adjustments to see what can improve sleep. I can guarantee that being in the IT industry doesn’t help however 🙂
Regards,
JamesHey fellas. Just got back from an awesome snowboarding trip up north and thought I’d check in. Sleep apnea and Gout….hmmmm.
First off James, if you are REALLY going to do a comprehensive sleep study (not an iPhone app) better be prepared to pay. They are very expensive. I’ve had guys at work do them and they are $4,500 to get them done. But the flip side to that is the guys I know, state they have never felt better in the morning. The machine is called a “CPAP” machine and it works wonders. I’ve never been dianosed with sleep apnea before, but I know a lot of guys that have. Yes, the facepiece is odd and cumbersome, but once you get used to it, it works amazing.
I suppose there could be some correaltion between sleep apnea and Gout. My first reaction would be to say it’s because most people (not all) who experience sleep apnea tend to be overweight. Again, most….not all. In my opinion, there would tend to be some connection there between sleep apnea and Gout just due to that fact alone. I’d have to read more about it.
Just wanted to let you know about the cost for the comprehensive sleep study. Yes its expensive, but it also could be a life saver. The connection between sleep apnea and hypertension, stroke and sudden respiratory arrest are valid. So if you look at it that way, it’s really a small price to pay.
If GP is helpful enough and happy to prescribe the Allopurinol etc is there any need to then see the Rheumatologist also?
Cheers
Ryan,
If you are happy with your GP then stay with that Doctor. A rheumotologist is a doctor who specializes in Arthritits and joint issues. That’s their specialized field. I went to my particualar Rheumotologist because he came highly recommended by a friend, but as I’ve stated here many times before, even he was reluctant to put me on Allopurinol until I practically begged him to do so.
You will find that some doctors, even Rheumotologists, who can be very “behind the times” as it pertains to Gout and Gout treatment. Same for GP’s. Some will fall into the traps of internet myths and old school mentality. Find a doctor who you feel comfortable with, who knows the latest about Gout and Gout treatment, and stick with that person. It’s really that simple.
