FINALLY Having my Blood Test

[zip2play]

Going in this morning for the first test in two years. Of course I am having a myriad of things measured in addition to Uric Acid (like my Lp(a) which is always cosmically high)

I am most curious to see the effect of my furosemide-losartan BP routine along with my lowered allopurinol dosage to 200 mg. on my serum uric acid. If UA number is super I'll drop to 100 mg allopurinol and count on the furosemide-losartan to sustain me.

I will no doubt have to wait til sometime next week for results and I'll let you all know the results.

Of course my cholesterol LDL will be wonderful but I have issues with keeping my HDL up. It's easy with booze but difficult without…I think therein lies the cardiac benefit of alcohol.

I looked back over my old numbers and the last 3 uric acid readings (back 5 years) were 3.8, 4.1, and a 6.0.)  Not too shabby. The first two numbers might indicate why my big thumb tophus decided to go bye-bye but the last one might indicate why my little finger grew a new small one.

[Keith Taylor (GoutPal Admin)]

I've often wonderered what bated breath is, but whatever – I'm waiting with it.

[zip2play]

First on “bated breath:”

It's taken from “abated breath” as in being so anxious that one forgets to BREATHE.

Alas, I was hoping for a good uric acid from my lasix-furosemide combo along with just 200 mg. allopurinol. Double alas, my last number, and first in 2 years, was 6.6 mg/dL serum uric acid. So it seems that lasix-losartan is not a substitiute for the extra 100 mg allopurinol and I have gone back up to 300 mg starting yesterday.

You gotta do what you gotta do.

So now, GP, you can take a deep breath.

[Keith Taylor (GoutPal Admin)]

Wow. English lessons as well! Is there no end to this man's talents?

Shame about the numbers, Zip, but at least now you know.

[Keith Taylor (GoutPal Admin)]

Got gout attack on Memorial day weekend after I injured my right big toe hitting it very hard against the bedpost. Will write more details in separate related forum. Got complex due to hairline fracture and inability of doctors to diagnose correctly.

After never ending agony for 2 months, in which gout continued and so the fracture pains( they diagnosed it after 2 months), did uric acid test July end. Got Serum uric acid 9.2. Other kidney and urine tests were normal.

Started 150 mg Allopurinol and Colchcine .6 mg once a day. Retested after a week. Uric acid 7.0( reference range 2.0 to 8.5).

Retested Aug 21, after 3 weeks of Allopurinol 150, Uric acid 6.6.

My foot is still not free, I walk very slowly and getting treated for hairline fracture( which has healed mostly) and gout both.

The walking is still painful and not very balanced. I have increased the dose 200 mg today. The doctor seems to see no need to go Uric Acid under 6 and feels happy with my reading saying my pain was due to residual of the fracture and non-movement of thumb for almost 3 months.

I have not taken any pain killer in last one month and there is no pain when foot is resting.

Will keep posting how things go further.

[Keith Taylor (GoutPal Admin)]

Welcome UTubelite,

Firstly, the reference range is meaningless. It's just an average, and one that includes gouty people. Therefore the upper end is real gout country, especially for anyone who has had gout.

Whilst it's OK to maintain uric acid level at 6mg/dL, this is only true if you satisfy BOTH the following conditions:

1. sUA readings consistently BELOW 6mg/dL for 6 months (at least 3 consecutive readings).
2. No gout flare during that 6 months.

If you do not satisfy these conditions, then please refer your doctor to Hershfield and prior similar research, as mentioned in my Lowering Uric Acid article. You need to get rid of urate buildup in your body tissues as fast as you can, and the lower you can get uric acid, the faster this happens.

[zip2play]

The doctor seems to see no need to go Uric Acid under 6.

Alas, your doctor is a moron.

[Keith Taylor (GoutPal Admin)]

First, thanks for the advise to GoutPal Admn. I read the article on need to reduce the Uric Acid level and that is why I have now 200 mg of Allopurinol. Hopefully, it brings it below 6 otherwise I will increase it further.  I have no doubt in mind that I have to work on getting it below 6, close to 5 being the target.

And to Zip2Play, you are right. It is really a pain to find that most doctors who treat us are unware of the facts, due to which many of us are suffering.

Mine is a typical example of missed diagnosis, and I have stayed at home for close to 3 months as I was not able to wear a shoe even. Things are getting better now.

Where should I post my details (history) of the case? It is an interesting (and agonizing) case.

[Keith Taylor (GoutPal Admin)]

UTubelite said:

Where should I post my details (history) of the case? It is an interesting (and agonizing) case.

---

I'm looking forward to it.

I think a new topic in Your Gout would be the best place.

[zip2play]

Gosh,

The mere THOUGHT of combining a gout attack with a cracked big toe bone sends shivers up my spine. THe combination must be near UNIQUE!

[Utubelite]

I got Uric acid tested again yesterday….and it came down to 5.5..

Here is summary of tests so far –

1. July 23, before medication – 9.2, medication started on July 30, tested on fasting of 14 hrs

2. Aug 5 ( 150 mg of Allopurinol, I will call it AP) – 7.0, no fasting, tested around 3 pm

3. Aug 21( 150 mg of AP continued) – 6.6, no fasting, tested around 5 pm

4. Sept 1( 200 mg started a week before – Aug 25) – 6.3, no fasting, tested around 3 pm

5. Sept 8(200 mg continued for 2 weeks) – 5.5, no fasting, tested around 2 pm

Now I am confused. Should I further increase my dose to 250 or 300 as I was planning to do? I took 200 mg in the morning and 50 mg in the night yesterday. Today, I have taken 200 mg in the morning and was planning to take 100 mg in the night. So, the question is stay with 200 or go to 250 /300? And should it be split or single dose? If I take 200 am and 50 pm, will that be OK?

Any suggestions?

Thanks for help!

[cjeezy]

Utubelite said:

Now I am confused. Should I further increase my dose to 250 or 300 as I was planning to do? I took 200 mg in the morning and 50 mg in the night yesterday. Today, I have taken 200 mg in the morning and was planning to take 100 mg in the night.  So, the question is do I stay with 200 or go to 250 /300? And should it be split or single dose? If I take 200 am and 50 pm, will that be OK?

Any suggestions?

Thanks for help!

---

I allso asked the same question in earlier post of mine today.  Your last readings are nearly carbon copies of mine and I'm in the same dilemma with 200mg.  My Dr. is ok if I am at 5.5 but is also ok if I go to 300mg.   I might increase to 300 temporarily just to help flush crystals out quicker but I don't know yet.  I'll probably end up sticking with 200mg while monitoring my levels every couple days over the course of a few weeks just to make sure UA stays at 5.5 or below.  If it does I'm not going to increase my dosage UNLESS I start noticing twitches down the road. 

[Utubelite]

Yup. I think, the question for us is  -Is reading 0f 5 or 4.5 anyway better than 5.5? 200 mg dosage has got it down to 5.5 in 2 weeks and may bring it down further. If  300 mg is taken, it may bring the numbers below 5 or may be 4? The main issue is -will it trigger an unwanted attack?

I am even more confused as my Gout was triggered by the big toe injury(fracture), and I am also getting treated for it by way of physio-therapy. I still have pain feelings in the right toe and stretch is not full, which doctor says is due to the injury that has narrowed the gap. They pull my thumb out and stretch it till it pains and swells, then take the swelling away by icing. It has helped to improve the movement but that may also be due to the fact that uric acid numbers are getting down. The right toe still seems weak when I put body wait on it.

I do not know what is wokring and what not. So, not sure what to do?

[Keith Taylor (GoutPal Admin)]

Lowering uric acid depends on setting a target.

Before I discuss that, the background is that there are 3 phases to urate lowering therapy:

1. Titration – gradually increase medication to achieve target uric acid level.
2. Urate dissolving – this lasts until you have gone six months at target level without a gout attack.
3. Maintenance – relax dose to maintain at 5.5 – 6 mg/dL forever. In some cases, with dramatic diet and lifestyle improvements, this might be zero dosage.

The target really depends on how long you have had gout, whether or not you have tophi, and how effective the uric acid lowering medicine is.

If you have tophi, or have had gout for a few years, it is good to opt for a low target. Hershfield reckons 2 is safe. 3 or 4 might be more easily achieved. The point is that the lower you get it, the quicker you dissolve old crystals. You'll hate me for saying it, but triggering an attack is not the issue – it's all about getting rid of crystals as soon as you can, to reduce the risk of bone and tendon damage.

If you have only had gout for a few months, it may not be necessary to go for such a low target – around 5 is probably OK.

[cjeezy]

Hi GP,

I tested again this morning (week 2 at 200mg) and it measured 5.4.  It seems that my readings are very consistent at this dosage.  I think I have a little tophi in my right bunion area…but hard to tell.  Will 5.4-6.0 get rid of crystals?  What levels do crystals dissolve at? I really don't want to increase to 300mg due to the side effects 200mg is giving me.  I've only learned of my gout on the dreadful day of 7/12/09! so I haven't had effects very long.

[Keith Taylor (GoutPal Admin)]

5.4 to 6 will dissolve any old crystals, as long as you don't get too cold.

As your feet are affected, it's fairly easy to keep the (not too tight) socks on.

[Utubelite]

My gout got triggered due to rught toe injury on the Memorial day weekend. Before this attack, I haad one 10 years back when I was exposed to “- 30F ” temperatures for long time and my feet in the ice almost everyday while cleaning the car. There was no other attack though there were episodes of minor sprians that would come and go away in 1-2 days. As I used to do heavy treadmill jogging, it was blamed on the jogging and aging I did not have any diet control though I never have been heavy drinker or red meat /sea food eater.

Anyway, this episode is now 3.5 months old and Allopurinol 6 weeks now. My right toe is still not free..it pains many times when I walk though it is much better as I can now wear tennis shoes and jog for couple of minutes. The doctor say it is due to injury but I also suspect it may be due to some crystal residual that is restricitng its movement and causing pain.

Hi GP.

What do you feel, with my current 5.5 reading in 6 weeks of Allop(2 weeks at 200 mg), do I need to really go down a lot on Uric acid for crystal dissolving?

By the way, I have increased dose to 250 mg..200 in the morning and 50 in the night…I hope the split would not cause any issue, Any thoughts?

Thanks,

[Keith Taylor (GoutPal Admin)]

Please continue discussing uric acid testing in Uric Acid Blood Test Debate

Testing inevitably leads to treatment, but please discuss that in Gout Cures.

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