- This topic has 14 replies, 5 voices, and was last updated 7 years, 1 month ago by
.
-
Posts
-
I am curious to know if I have gout?
?During the day (2:00PM on 06/01/11) I stamped on a wooded pallet to break into smaller
lengths of wood. A lot of the force associated with the impact passed directly
thought the toe joint.
Around 8:00PM on 06/01/11 had a slight limp as a result of mild pain in the toe joint.
Around 10:00PM ? 12:00PM on 06/01/11 pain was much worse and limping quite badly. Able to walk but with
difficulty as a result of the pain in the toe joint.
No particular discomfort during the night of the 06/01/11 and able to sleep without any
problem on the 06/01/11. Discomfort is just when walking.
Next day was able to walk to work but with a limp. I arranged to go and see a doctor however
by the time I left (11:00-12:00AM on 07/01/11) ) I had a mild limp, but nothing too serious.
Symptoms with which I presented as follows?
* Sudden onset (several hours for pain to become most severe after
which pain subsided). Pain not extreme, just uncomfortable when walking and limp
as a result.
* Pain localised to toe joint.
* Redness around joint
*
First attack of pain to toe joint.
* Excess alcohol consumption
* Uncle
currently suffering from gout so family history
* Age 44
Note at the time of the attack, took regular exercise, not overweight, excellent diet
with low intake of risk foods at the time I presented.
Doctor diagnosed gout and the following medication was prescribed
1. Colchimax (0.5mg) to be taken twice daily.
2. Ibuprofen
(600mg) to be taken at six-hour intervals.
3. some third medication to
prevent an upset stomach.
Stopped taking painkiller after second pill as not experiencing sufficient pain to justify painkillers. Also stopped
taking medication for upset stomach as not experienced no stomach problems. Blood sample taken 37 hours (09:00AM 08/01/11) after first onset of attack. Still limping when blood sample taken.
During return visit to GP some days (10:00AM 10/01/11) later confirmed normal Uric acid levels from blood test.
No longer taking the painkillers and medication for upset stomach with consent of GP.
Following diagnosis stopped drinking alcohol 100% and completely avoided risk foods.
Been on Colchimax for approximately one month. Reduced does from twice daily to once daily approximately 10 days ago with out consulting GP. Lingering mild discomfort with toe joint. Also now acutely aware of any mild pain, sensation or discomfort in any of my joints which I would have probably disregarded previously.
Based on, ?Janssens clinical prediction rule? (see below) I score 6. Gout is highly unlikely with a total score of? less than 4 and is >80% likely with a total score of? greater than 8:
* Male sex?2.0 points (I score 2)
* Previous arthritis attack reported by the patient?2.0 points (I score 0)
* Onset in <1 day?0.5 point (I score 0.5)
* Joint redness?1.0 point (I score 1)
* Involvement of first metatarsophalangeal joint?2.5 points (I score 2.5)
* Hypertension or one or more cardiovascular diseases?1.5 points (I score 0)
* Serum uric acid concentration >350 ?mol/l?3.5 points (I score 0)
So I would like to know the following?
1. Based on the clinical diagnosis of the symptoms I presented with, have I gout?
2. Is it worthwhile get a synovial fluid analysis to check for the presence of CPPD crystals, to confirm the diagnosis?
3. GP suggested that he would put me onto other medication when I had a return visit which
incidentally is now overdue as I reduced the dose of Colchimax, which I am still
taking. I guess the new medication might be NSAIDs but I have no idea.
4. Is it advisable to try to manage the condition without taking medication in the long term?
sdgfrofg said:
I am curious to know if I have gout?…
Based on, ?Janssens clinical prediction rule? (see below) I score 6. Gout is highly unlikely with a total score of? less than 4 and is >80% likely with a total score of? greater than 8:
* Male sex?2.0 points (I score 2)
* Previous arthritis attack reported by the patient?2.0 points (I score 0)
* Onset in <1 day?0.5 point (I score 0.5)
* Joint redness?1.0 point (I score 1)
* Involvement of first metatarsophalangeal joint?2.5 points (I score 2.5)
* Hypertension or one or more cardiovascular diseases?1.5 points (I score 0)
* Serum uric acid concentration >350 ?mol/l?3.5 points (I score 0)
So I would like to know the following?
1. Based on the clinical diagnosis of the symptoms I presented with, have I gout?
2. Is it worthwhile get a synovial fluid analysis to check for the presence of CPPD crystals, to confirm the diagnosis?
3. GP suggested that he would put me onto other medication when I had a return visit which
incidentally is now overdue as I reduced the dose of Colchimax, which I am still
taking. I guess the new medication might be NSAIDs but I have no idea.
4. Is it advisable to try to manage the condition without taking medication in the long term?
Ad Janssen Rule: Your 6 out of 8 may not be correct. Unless your doctor gives you the EXACT number of your SUA you (and nobody) will know where you are. So before you do anything else get that SUA value. Then we'll talk again.
Ad 1.: Possible, but not for sure.
Ad 2.: Not yet. Again, until you know your SUA value.
Ad 3.: Before you enrich the pharma crooks, you need to know what medication he is trying to push.
Ad 4.: It's unlikely that you will/can manage TRUE GOUT without meds in the long term.
Mild pain could be anything. A true gout attack is characterized by “exquisite” pain i.e. severe. Until you experience this, GP will be reluctant to prescribe a uricosuric and will give you various pain killers/NSAIDs or maybe colchicine if he really thinks it is gout (and he knows what he's doing).
If you do have gout, you appear to be at the early stage where you may not have a serious attack for some time, especially if you?continue moderation in your diet/lifestyle, avoiding “high purine” foods/alcohol. Try and arrange regular SUA tests to get a clearer picture of your levels or invest in a home tester.
Dear sdgfrofg.
?
First let me congratualte you on having the very WORST screen name I have ever seen.
?
Is it gout or not? Impossible to tell.
?
What I recommend is watchful waiting. Don't do too much changing of habits else you screw up the diagnosis. Just go on as before watchfully waiting to see if it happens again.
Even if it IS gout, there isn't much reason to treat it after one attack. Heck, that could be the only attack you suffer in 80 years.
?
What do I think it is if pressed? You damaged either bone, ligament, or cartilege stamping on that wood?a traumatic injury that is unlikely to recur. But time will tell the tale. Not having another attack is a nice prospect.
?
p.s., Never take a drug that you cannot identify?even if GOD gives you the prescription.
?
During the day (2:00PM on 06/01/11) I stamped on a wooded pallet
Where did you buy your time machine, I'd LOVE one for the stock market.
?
p.p.s., Have your doctor X-ray your foot to check for a hairline fracture.
?
Thank you all for your replies!
?
- My
supply of Colchimax is going to run out in couple of days. I have two left
so I will try to get a repeat prescription. - This
will enable me to research the NSAID he is proposing to prescribe. - I
will also in parallel get a SUA test. The links below are the results of
the medical test I had just after the attack. - SUA
home tester sounds like a very worthwhile investment. - I
would love to think it was just a hairline fracture or something. An x-ray
was taken at the time and no fracture was evident. I can upload the x-ray
tomorrow.
I have quite drastically modified my diet since this
condition was diagnosed. I stay away from high-risk foods.SDG- have you got a better handle ?? 🙂
On your results, your SUA during/after attack was high enough to indicate possible gout.
Your next reading will tell you more- better?some weeks clear of flare ups.
If it goes up to 8+ or more then you will be more prone to future attacks. try to watch your alcohol/ purine intake till then to get the lowest daily running SUA possible, both out of policy and also to help with your best?'max' reading.
You have posted your full blood figures, so if inviting comment, I would say the few figures out of normal suggest less fry ups [ use an emulsive spray, if you can't do without] to keep fat intake down and evaluate whether alcohol or medications are pushing your liver a bit hard. [GGT]
Thanks for that feedback!
How about 2CV for a handle?
Yes the SUA was just below the upper limit. I understand also that once crystallisation takes place the SUA can fall after an attack occurs. I will be going back to the doctor probably tomorrow. I will request a repeat SUA test. Any brands of SUA self testers you or indeed anyone else can recommend it would be appreciated. I think it might be? wise purchase.
Prior to the attack I was consuming excessive amounts of alcohol, so this is probably what has brought on the attack. I have not consumed a drop since the attack. It would appear that gout is a difficult enough condition to manage without having also to juggle late friday night, saturday nights etc down the local taberna? I'm in Spain! Just left the UK last July.
I have a family history of diabetes so I was being very careful. Weight OK, diet very careful, fried food almost non existant ,getting regular exercise. However, I didn't realise that gout was also hereditary. If I had I would have backed off the booze?
So now I probably have gout to contend with instead of liver desease. However, damaged liver is also still possilbe. I note that on some of the medication it does state that it should not be taken if liver funciton is impared. Can a damaged liver also bring on gout?
I note there are two mechanisms, one where the blood is overload with purines due to incorrect types of food etc and the other mechanism is where the bodies ability to process the purines is impared. Might this apply in my case?
Prior to the attack I was taking no medication.
?
Based on what I have read, gout attacks appear to be very painful. The pain I had to my toe was not anything like this. Also the pain had stated to subside before I started the the gout medication.
Well 2CV- looks like the 'self medication' isn't a plus! 😉
On the pain, early stages can be just niggly, maybe for years- but if you noticed this after drinking booze like I did-? it's a dead giveaway for gout.
More like just stubbed your toe and it's a bit red and not quite right- next few days clearing .
With your liver, best get it looked into more and view gout treatment? from there, taking the best advice you can get. I think Liver problems are taken more seriously, but there may be a connection to the often?less regarded Gout in that the pathways are all involved together -and people react differently in different scenarios.
Stopping over use of booze is a 'good thing'- the occasional glass of wine is reckoned?'OK' once everything is more settled, and keep the water intake up- 1oz/Kg bodyweight can be done daily, but even half that is good.
[ie: 6 glasses a day]
sdgfrofg said:
?Any brands of SUA self testers you or indeed anyone else can recommend it would be appreciated. I think it might be? wise purchase.
This is a good one that many people have:
Get an extra box of strips, you tend to get through them pretty quick at first.
odo said:
sdgfrofg said:
?Any brands of SUA self testers you or indeed anyone else can recommend it would be appreciated. I think it might be? wise purchase.
This is a good one that many people have:
uric acid test meterGet an extra box of strips, you tend to get through them pretty quick at first.
I second Odo's recommendation. I have used that kit since Dec. 2009 with good results. In order to avoid using/misusing too many strips w/o proper results, make sure that you get a large enough drop of blood. 1/8″ drop always works for me.
An update?
?
Initially I was on Colchimax (0.5mg) twice daily but I did reduce this to once daily. I have now been on 0.5mg daily now for just over three months. Communication was a bit fraught with the Spanish doctor who I saw as I don?t have any Spanish and everything had to be translated by a Spanish friend of mine.
?
I modified my diet quite considerable. No alcohol whatsoever in three months. Also risky foods removed for my diet. My diet is now quite restricted? Eat lots of fruit on a daily basis. Most days I drink at least one litre of water.
?
In Spain last week I did go back and have a blood test. I haven?t seen the result of that test yet as I am now back in the UK.
?
Now I am on holidays back in the UK and yesterday I went to my old doctor and he arranged for a blood test. The results are below?
?
I would be grateful for the some opinions on what these results actually mean?
?
The results indicate that I have a normal urate level. Does this mean I am gout free and the original diagnosis was pseudo-gout? Also as I am on Colchimax could this in any way influence the test result???
?
Good job I like hunting round puzzles, 2cv! Your new figures translate to the same as the old.
If you DO have gout that figure is too high, no longer normal above say 0.300nmol/l by preference [new number results]
Colchicine won't affect your SUA level,, afaik -though if it reduces inflammation I suppose it might alter how urate settles out. Never seen much on that, tbh.?2 a day of these is not enough to change much. try a diagnostiv heavier dose for 2 days with your Docs agreement?
Your diagnosis doesn't seem 100% on the attacks and figures given though. Could just be early days.
If you get a meter to self test you can put off the day when you might need meds- but that day will come should you fail in this or just worsen with age.
NOVEMBER 2013 UPDATE…
I had one relatively minor attack just under three years ago. My UA was quite high at the time (9). About two months later I had a second relatively minor flare up. Three months after my first attack I want on 100mg of allopurinol per day. I change my diet quite radically went off alcohol for 18 months. Gradually, over the past 18 months I have started introducing high purine containing foods and alcohol into my diet. My diet is now completely normal. I can drink alcohol or eat a steak without an issue and it has been like this for some time. There does not appear to be an issue. I took the Allopurinol daily without fail until about 2 to 3 months ago. Now I take the one pill 2 or 3 times per week. I am not seeing any adverse reaction. Very occasionally I do have slight tingling in my toes but not stiffness. Really I have never had another attack since the first one three years ago. Not sure whether I stay on 2 to 3 pills per week or to stop taking Allopurinol completely….
OCTOBER 2014 UPDATE
As a follow on comment from the above about February 2014 i stopped taking Allopurinol completely. I can eat or drink as much as I like with no issue. I was very careful with the size of meat in a meal etc and drank a lot of extra water. Now i don’t really drink additional water to keep my UA down. Over a period of months my UA level went up to about 7. Not sure what it is at the moment as I haven’t measured it for three months. I have no issue whatsoever. Dont really even get any tingling like I did. I do get slight sensations in both my toe joints but no pain or stiffness… Seems amazing but I have returned to a normal diet and stopped the medication with no issue! I guess what I did was live like a monk for 18 months and stopped alcohol and had a very careful diet. Perhaps that is what did the trick! However, had said all that I am very careful about not causing any type of injury to any of my joints…
- My
- You must be logged in to reply to this topic.