constant discomfort

[Dorian Kramer]

So since I have managed to lower my uric acid to below 6 but usually above 5 I have had a constant state of discomfort for at least two months, usually it is good in the morning and progresses as the day goes on, not really interfering with anything but still there, there will be some swelling and some redness. I wonder if an attack is coming on then in the morning it is gone, or mostly gone. Now I left my gout untreated for at least 7 years if not more, could this simply be the process of the crystals dissolving or could it be something else

[Ron Avery]

Hi Dorian,

Sorry to hear about your discomfort. Until you get your levels to below 5 and keep them there long enough to clear out all the old crystals that are sitting in your joints you can never be sure.

whenever I’ve had attacks they are always worse in the evening so that could be what’s going on.

Are you on any medication to lower your acid levels or are you trying to do it through diet ? Regardless, until you get your levels below 5 I believe you will always be in danger.

[Dorian Kramer]

ron thanks for the reply but I am confused, while I understand that under 5 is a safer number, as I understand from the charts under 6 still causes crystals to begin to dissolve just more slowly, since it is under the crystalisation point of 6.8. am I incorrect?

[Ron Avery]

From what I understand you are not safe unless you get & keep it below 5. Although crystal will dissolve below 6 they can also be created especially when your body is colder. 5 & under is what you should strive for.

Also remember as crystals dissolve that can trigger a flare up and discomfort. Have anti-inflammatories such as Naproxen and pain killers such as Tylenol to deal with it.

As you lowering your uric acid by diet or are you on medication such as Allopurinol ?

[Dorian Kramer]

currently I am managing through diet(vegetarian), low sodium( I found spikes when eating salty snack foods) water, Chinese herbal formulas, and just this week started a course of acupuncture based on numerous studies for proven reduction in SUA and increase in UA excretion, and green tea instead of coffee. I tend to have very strong reactions to meds so I consider allopurinol to be a last resort, though with the current changes low dosage is a possibility. The changes I mentioned have lead a very rapid reduction in UA from a level of 9.2 down to 6 and under in around 1 to two weeks, with occasional spikes as I modified herbs and diet(discovered one herb can increase sodium retention in the kidney’s) to significant weight loss, and a general sense of well being as well. I have also eliminated almost all sugar and no more alcohol. another thing was for other issues with pain management I was taking tramadol off and on, I had strong reactions to it, and wasn’t surprised when I found reports linking usage to uric acid retention. Since I am a practitioner of Chinese medicine and looking at the principles I believe that these changes can be made permanent though the dietary changes may also have to be permanent(currently I don’t really miss the other stuff)

[Dorian Kramer]

Oh yeah except for one blood test I have been testing with a home meter, I will be taking a second blood test son and check it with the meter to see the accuracy

[Ron Avery]

Please let us know what your blood test says and how it compares with home testing. I’ve thought about getting a meter but I not sure how accurate they are. Also, your Ua level fluctuates based on what you eat and I believe how hydrated you are.

Keep doing what you are doing and see if you can get your level below 5.

[Dorian Kramer]

So I think things are going fine I ended up getting a second meter and getting the blood test, the morning of the test I used the old meter which would with rechecks come up with a wide range of results with variations as much as 1.0 in either direction, the morning of the test I tested at 5.4 at home, the test was only about 3 hrs later and nothing ingested 4.9, the next morning I was able to compare the two home meters, the old one 6.1, the new one 4.9 and a second test at 4.7, so I would say the new one is more accurate and shows consistency when two tests in a row are done. Also able to compare the lab results in 3 weeks my uric acid went from 7.0 to 4.9, with dietary changes, herbs and acupuncture. What I will be interested to see is two things I will retest in 1 month(while keeping with weekly UA tests at home). My first test showed that while within normal limits my kidney function was at about 81% which is low for someone my age and expected health level, my SGOT enzyme( apotential marker for liver issues) was in normal range but at the high end of normal, since from an allopathic point of view my treatments all have functions of lowering elevated liver enzymes, recovering liver and kidney function, I would be interested to see the results

[Keith Taylor]

This is a great discussion, Dorian and Ron. It raises some important issues about uric acid testing, but even more important issues about uric acid test results.

Dorian, you are right that the crystallization point for uric acid is 6.8mg/dL. But, this is at normal blood temperature. Most joints are well below normal body temperature, especially if you are exposed to low environmental temperatures.

In extreme cases, even 5mg/dL might be above the crystallization point. I think a review of the facts is overdue, as my explanation at http://www.goutpal.com/uric-acid/hyperuricemia/gout-without-hyperuricemia/ is rather long-winded (as usual??!!??)

However, it is clear from the references that it is quite easy to get crystals forming at 4.5mg/dL.

As Ron points out, even if you get uric acid down to 5, you ca still get gout flares from old crystals that are dissolving.

There’s often no easy answers with gout, but always easier when all individual circumstances are considered.

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