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I have a swollen right foot, and it's been like that for a week and a 1/2.
2 visits to two different doctors about gout and still no improvement.
Taking colchicine every day, and have taken 300 mg of allpurinol every day for 15 years!
Drinking gallons of water, cherry juice etc… and everything seems to be percolating appropriately, but the swelling and slight pain won't leave.
Even stopped drinking beer, entirely. My wife is so happy!
Also taking indomethacin, 50 mg a few times a day to keep the pain down.
But the foot is still too big for any of my shoes!
Any other remedies that anyone can suggest?
Thanks!
Hi ruff, just curious what were your uric acid readings from your last 2 Dr visits? I this the first attack you’ve had in 15 yrs?
No samples were taken, and it was just my initial visit to this new dr. An appt was made to have blood drawn in the near future to establish my account.
I am interested in aquiring the ability to determine my UA and PH at home.
What is your advice or reccomendation?
I have had attacks over the years, but typically they take 24 hours to treat and disappear. And they have occured when I have gone off the diet and eaten the “wrong” things like snow crabs, and split pea soup!
This attack has been perplexing, because the hoof is noticeably swollen, not much pain, and just won't go away!
Thanks again for any guidance.
I would do a search on this site for the UASure Home test kit by Arctic Medical. I think its what most use and is recommended on this board. I’ve been using it for a few weeks. I think it is really good to use to detect trends, but I don’t think its 100% accurate all the time. What were your UA level goals in the past? My thinking is that you might now be producing more UA and your dosage may need increased. Just my two cents though. Also, you mentioned that you “went off the diet…” Did you go off the diet for a while or just for one meal?
I've checked the test kit, and will consider ordering one.
I have never been advised to keep track of my UA levels!!! And I've been dealing with this for 15+ years…
I may take an extra allpurinol daily to see if that affects the issue. I don't have any adverse reaction to allpurinol. Never was advised that there may be any!
The off diet comments were more singular events, months ago, so should not have any bearing to this present condition.
It's just odd that I feel that I am treating it appropriately and the durn thing just does not get better!
But knowing my UA and PH could be a good place to start.
Looks like I'll get to deal with it over the weekend!
I’m glad that you have started to take more concern about uric acic. Please don’t take offense to this, but I guess the million dollar question is “how do you know you’re treating it appropriately (today) with your current dosage?” If 300mg isn’t getting you below UA readings of 6 consistently then you’re almost beating a dead horse. If you’re on the correct dosage of Allop, one “bad/high purine meal” shoulnt trigger a gout attack. I’m sure someone else will chime in on this one too.
No offense taken, it's all good to recieve information from an experienced resource. I'm more than a little dissapointed in the Dr's that I have seen for the past few years, that have just continued the same scripts of alup and others without validation!
BTW.. the foot is shrinking! Not back to the size 13 3x wide… but improving!
I like the idea of a home test kit. Any way to test PH without a blood draw? That appears to be a critical factor as well.
Thanks again, and you can't hurt my feelings!
Don't concern yourself with blood pH because buffers hold the pH in a VERY narrow range…like 7.4 (like 7.35 to 7.45.) Your urine is better for testing, easier and any pH papers will work.
Yeah, you were done a disservice. First thing I tell a new doctor is that every time blood is drawn for blood lipids, or blood count, or liver function, I want uric acid tested as well.
I am fond of taking a great deal more colchicine in one day rather than doling it out over days or weeks. One and hour til pain stops, diarrhea gets vicious, or you reach 16 pills.
Perhaps 400 mg. allopurinol is in your cards.
(Are you CERTAIN that you are suffering a gout attack rather than a broken bone or some mangled tendons?)
Personally, I think those home testers have too much variablility…I'm not a fan.
Yeah, I'm going to have a sit down with the realtively new Dr. She is bright and probably would admit to not knowing everything…
We did to an initial blood test and the liver was reported as normal, and everything else in line.. I just can put my hands on that report!!! But the only thing out of whack was the tericyclydes?
Otherwise I passed the test!
I'm getting the sense that the home testing does have room for improvement, so figuring that this is the first major issue in 4 years… I'll just go for the blood test…
colchine is doing it's job, and I'm tolerating it pretty well. The swelling is decrasing but still not as quickly as it has in the past!
ruff,
It seems the normal course of gout progression is that attacks get more severe, last longer and take more analgesics to eliminate the pain and swelling.
Let us know what uric acid reading you get.
High triglycerides often point more to what you had to eat (or drink) the day before than anything else…not to worry unless you see it happen over and over.
Thanks again for hanging in there with me on this zip2!
I found the analysis…
Not sure if it has any value?
Color Yellow
Appearance Clear
SP Grav U 1.015
Protien Negative
pH 5.5
Glu U, Ketone U, Bilirubin, Blood, Nitrite,U, Leu Est, all Negative.
Not sure if that tells you anything. The swelling is somewhat diminished this morning, tha ankle is still painfull, ( between doses of indomethacine! ).
So I guess I get another free day of sitting with my foot propped up, watching football, and the SpongeBob marathon!
What it DOES say is that you are excreting a rather acid urine at pH 5.5. My last one was 7.0, completely neutral.
I recommend you add some daily fruit and veg, or even some alkaline salts like magnesium or bicarbonate becasue you want to avoid urate kidney stones. Also it seems from “common knowledge” that an alkaline urine will excrete a bit more uric acid…maybe yes, maybe no.
I second zip2play's call for alkalizing the urine – and more fruit and veg is definitely the best way to go. I have some lists of alkalizing food, though to be honest, it is well past the time for these to be redone with values per 100 calories rather than 100 grams.
15 years allopurinol without a uric acid test!!!
The world's gone mad.
Thanks,
I have increased the fruit and veggie intake, and have paid attention to the rest of the diet!
I finally got the blood test done, just waiting on the results to be made available to the Dr, and then her analysis…. This process just takes too long!
The symptoms remain the same, with no improvement! Not sure what else can be perscribed to reduce the swelling?
Again, thanks for the advice…
ruff12two said:
The symptoms remain the same, with no improvement! Not sure what else can be perscribed to reduce the swelling?
Some things that may help (in no particular order):
- Ice pack – just for 10 minutes, then get back to temperature with a warm towel because…
- Avoid cold – keep extremities wrapped to avoid temperatur drop.
- Exercise – gentle walking or swimming, but…
- When not mobile, try to rest with affected joints above the heart
- Keep hydrated (more water also helps encourage more short walks
) - Avoid tight shoes and socks
- Avoid restrictive posture that slows bloodflow
Thanks again for the sage advice.
The new Doc finally got a chance to review the blood word, drawn a week ago!
Uric acid level = 5.4
WBC = 5.9 ( whatever that is?)
Anyway, she's stumped, I now have an appt with a Rheumatologist tomorro AM…
She said that everything looks normal….?
Thanks again everyone!
WBC is White Blood Cell count, but I have yet to learn the significance of the numbers – it is significant because this is an important part of the immune response that is gout. Unfortunately, cell microbiology study is hurting my brain.
Yours is a case for more testing, as uric acid in the blood can fall as it crystalizes into the joints and tissues.
As you are a colchicine taker, please support the colchicine campaign. You have a great opportunity to discuss this looking crisis with your rheumatologist and see if we can get some of the professional ranks on board.
ruff12two said:
Yeah, I'm going to have a sit down with the realtively new Dr. She is bright and probably would admit to not knowing everything…
We did to an initial blood test and the liver was reported as normal, and everything else in line.. I just can put my hands on that report!!! But the only thing out of whack was the tericyclydes?
Otherwise I passed the test!
I'm getting the sense that the home testing does have room for improvement, so figuring that this is the first major issue in 4 years… I'll just go for the blood test…
colchine is doing it's job, and I'm tolerating it pretty well. The swelling is decrasing but still not as quickly as it has in the past!
I found out yesterday that my swelling is not from gout. The Xrays point to “the abnormal appearance of the navicular bone is suspect for avascular necrosis of the Navicular bone ( Köhler's disease)… and other fragmentations… “
Since I am not diabetic, but do have neuropathy in both feet, I have an appointment with the Ortho Surgeon on Monday to plan a resolution.
The Rheumalogists who I am seeing, thought that there may have been a gout related inflamaiton that may have contributed to the fracture of one of the smaller bones in the ankle, and due to the neuropathy, I did not give it much attention. So over a period of time the bone died?
It's not an easy call and treatments as well as causes are extremely varied.
I hope you're in good hands.
What is the cause of your neuropathy?
Hi Zip2play,
The Neuropathy appears to have been handed down from my father. The Neurologist who diagnosed the symptoms, could not determine the root cause.
I do like a beer once in awhile, so that may contribute.
Otherwise, everything else seems normal. Not diabetic…
Thanks for your contributions to this forum. I have spread the word about Gout Pal to all my new found friends in the medical field here in the Tampa Bay area!
One confusing thought ruff, Kohler's is a childhood disease.
You might find this blurb interesting:
Kohler's disease was thought by many to be avascular necrosis of the tarsal navicular primarily based on the radiographic signs. It is now a much more controversial subject. Kohler's disease is can be a very confusing and ambiguous entity due to uncertain etiology and often times vague symptoms. A history of trauma is only elicited in approximately 35% of cases and symptoms that correlate with the radiographic signs are very sporadic.
When a diagnosis of Kohler's disease is made, the typical patient is a young male, typically between 3 and 7 years of age. It is unilateral approximately 75% of cases.
The controversy of Kohler's disease stems from the fact that many authorities feel that this process is not a “disease” at all, but rather a process of altered, but completely normal, ossification of the tarsal navicular which leads to the radiographic appearance.
There are two main reasons for the idea that this often times is not osteonecrosis is the fact that 1) there are a lack of symptoms and 2) it is a self-limiting condition.
The radiographic appearance is sclerosis, overall flattening and deformity of the navicular. But, again, it's the associated signs and symptoms, as described that must be present for a confident diagnosis. MRI or bone scan may help confirm the diagnosis, but because of its self-limiting nature, it most likely is not warranted.
Thanks Zip!
I am hopeful that the appointment on Monday with an Orthopedic surgeon may pinpoint the reason for the swelling, and discomfort.
I am also hoping for a non-sugical solution!
I'll follow up with a report.. the Reuhmatologist did suggest that that gout may play into the issue as well, but could not be certain.
Thanks again for your time and advice.
ruff12two said:
Hi Zip2play,
The Neuropathy appears to have been handed down from my father. The Neurologist who diagnosed the symptoms, could not determine the root cause.
I do like a beer once in awhile, so that may contribute.
Otherwise, everything else seems normal. Not diabetic…
Thanks for your contributions to this forum. I have spread the word about Gout Pal to all my new found friends in the medical field here in the Tampa Bay area!
Thank you kind sir.
I note you've been on allopurinol for a long time, but uric acid tests are few. Without good history, assessment is difficult, but long-term gout can cause bone erosion, so this might be linked to the avascular necrosis.
Well the foot specialist pronounced that I had Charcot's foot. He took another series of xrays and noted additional deteroriation of the navicular bone since the set taken last week!
I am off the foot, for the next 3 – 6 months. And have a TLC, turning leg caddy to place my knee on when walking. It looks like a 4 wheel Razor skate board with a place to plant your knee. Also wearing the knee high “Darth Vadar” boot.
Start physical therapy that includes Anodyne treatments, tomorrow…
The silver lining today was the Colchicine delivery from Medco! Not that I need it at this time, but 180 tabs will last me a good long time!
They are the West-Ward 201 flavored brand.
Thanks to all! I'll keep spreading the news about GoutPal.com. It's great to go into an specialists office with more knowledge than his typical patient, and have handouts for him!
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