Help me please :(

[Ayman Roshdy]

Some facts about myself before I write my message:
– My age is 39
– I have developed IBS on the age of 27
– I have developed high blood pressure on the age of 35
– I have developed Gout on the age of 30 but until last August it was not a big deal
– My weight is 90 Kgms
– I don’t do any activities as I have a desk job
– Gout is in my family, at least I know that my grand father had Gout
– I had a very bad diet with a very amount of water intake per day with very little fresh vegetables or fruits per day, which I am trying to remedy recently

Well this is my first time to use such forum where people share their symptoms, ideas, treatments and in my case probably some emotions as well so bare with me please as I am in deep need of help

Today in the morning I suffered a new gout flare or attack, I felt it coming yesterday night and I was hoping that by the morning the worst doesn’t happen but it happened anyway, currently I am in a very bad shape emotionally and not physically, actually I went crying this morning in front of my wife for the first time in 11 years, I was crying like a small child and my tears were not related to the pain but to the fact that I started to feel like a crippled person who can’t walk, can’t have a normal life, all my colleagues at work probably know that I am a sick person who just skip work every now and then because of the gout attacks and the main issue that I am suffering from is this sad feeling that although I am not very old but I feel like a crippled person. I even now get more stressed when people start asking about my health !

I started developing gout like 8 or 9 years ago, and actually I started to develop IBS (Irritable Bowl Syndrome) first like 12 years ago when I was 27, by that time I was under a lot of pressure and anxiety that caused me to develop IBS at the end, after a couple of years I was able to treat IBS as a normal health condition that I need to live with and in fact I am very used to it and how to deal with its attacks when it happens that I forgot about it already, anyway like 8 – 9 years ago and just after I started to deal with IBS I received my first gout flare, in 3 – 5 days and under the correct medicine the attack and all the symptoms went away and since then I got like one flare per year and I believed I was lucky that I didn’t face many attacks. Last August I received another attack and it was the worst attack that I ever had, it lasted for several days and my doctor had to change my medicine this time and since then I am suffering from the flares and even when my uric acid level is within the normal range just walking in a mall or for shopping for a couple of hours will cause my big toe to swell and the pain starts 🙁

I have been visiting my doctor very often, trying to search on the internet for useful information, trying to have a healthy diet and to take my medications periodically but I am still unable to handle it and I need your help and advice, so let me try asking you the following questions since I am the newest member here and all of you are much experienced than me with this nightmare:

1) I was under the impression that having a pair of shoes that support the arch would be useful to avoid the pain after walking for a couple of hours by reducing the pressure on the big toe and have it distributed to the arch, at some point I had a shoes that just does this but unfortunately the company has decommissioned this model and stopped making it so is my impression correct and if ‘Yes’ then did anyone try a specific shoes or some short of an internal insole that can recommend?

2) The medicine that I am following on a daily basis for 3 – 4 months now to avoid high uric acid levels is called ‘Donifoxate 40 mg’, its active ingredient is called ‘FEBUXOSTAT’, is this effective? Did anyone try it before?

3) When I receive a flare/attach I stop the ‘Donifoxate’ and start ‘Colchicine’ (2 mg per day) which seems to do the trick as the symptoms gets reduced in 24 hours and vanishes in 48 – 72 hours, is this the correct way to deal with the attacks? Any other recommendations? (BTW in the last attack my uric acid was within the normal range and my doctor mentioned that this attach was probably related to some walking that I did the day before and this walking has caused the crystals inside the tissues to move causing such pain)

4) I am over weight by 10 Kgms, currently I am ~90 Kgms while I should be in the range of 77 – 80 Kgms, which I don’t believe is the main cause of the uric acid increase, what do you think, should I really go down by this 10 – 13 Kgms? Would it really help?

5) Someone told me that if I play some sports this would help, doubt it really plus with the current state of my foot I don’t think any sport will be helpful, even normal walking causes pain at the end so any recommendations?

6) Another thing that I heard is that Gout or high uric acid might be caused by the anxiety, which I believe might be a nightmare to me as I have already developed IBS on the age of 27, high blood pressure on the age of 35 and I will be 40 in less than a month and I do suffer from a lot of anxiety caused by stress at work so is the Gout really related to stress and anxiety? Anyone can recommend something with the anxiety?

7) I was trying to eat food that doesn’t cause more uric acid where I was following mainly the attached excel file which I got from one of the websites but my question would be how much uric acid should someone take per day to avoid the Gout attacks?

8) Anyone knows of something natural that I should take beside the medicine that will lower the uric acid, I heard that Flaxseed oil (don’t know if this is the correct name) is good, did anyone try it? Or recommend something else?

Finally any other tips or recommendations would be very useful, and don’t consider that I developed Gout 8 – 9 years ago because what I developed back then was probably the ‘Easy Level’ version while what I am facing now is the actual night mare

Thanks in advance
Ayman

[Paul]

Hang in there Ayman,
You’re in the right place for help and advice.
I’m not the right person to offer that advice but the forums experts will be along soon I’m sure. My limited help is this, you will be alright with the advice you receive here. It’s all about getting the right treatment plan for your condition. Gout can be controlled to a point where you will be able to live a normal healthy life again.
I feel your pain, we all do. Help is just around the corner, I look forward to seeing the forum experts response to your pain.
Paul.

[Keith Taylor]

Wow, Ayman, great first post, with lots of information. I’ll make a general observation, then go through your numbered list.

It’s almost certain that you have hereditary gout. You’ve possibly made this worse with bad diet choices, but it’s likely it would have happened anyway. Improving your diet is good for general health, but unlikely to improve your gout much. Though you first noticed gout aged 30, uric acid crystals will have started growing before that, so you have around 12-15 years of uric acid crystals to get rid of before you start to control gout.

1) Gout Shoes. Because uric acid crystals damage joints, you need strong footwear that gives good support to feet and ankles. To help with gout flares, it’s best to get a size larger than you need, then wear extra socks for comfort and to avoid cold. By using two or more pairs of socks, you can vary the amount of padding to match the swelling from gout.

2) Donifoxate 40 mg (febuxostat). Donifoxate is an Egyptian brand of febuxostat, which is commonly sold as Uloric. The only reason to take febuxostat is to lower uric acid below 0.36 mmol/L. However, in order to get rid of 15 years of uric acid crystals, it is healthier to reduce uric acid much lower than this. I can see from your profile, that 80mg febuxostat has not reduced uric acid enough. As I’ve written in Is 80mg Uloric always enough, you might need specialist help to increase your febuxostat dosage, or supplement it with probenecid.

I can also see from your profile that you’ve take Zyloric (allopurinol) in the past. I wonder why you stopped this? Unless you have problems with side-effects, allopurinol is usually the fastest, safest, most cost effective option for uric acid lowering.

3) Medication during gout flare. Colchicine is good and effective, if taken at first sign of a gout flare. Sometimes it is best supported with an anti-inflammatory. In severe attacks, it is also good to alternate the anti-inflammatory with a pain-blocker. A good pharmacist or doctor should be able to recommend a safe combination of pain relief that is very effective. You should not stop Donifoxate during a gout flare. This applies to all uric acid lowering meds – once started, they must be taken every day unless severe side-effects happen.

Your doctor’s explanation of flares during uric acid lowering is wrong. It has nothing to do with walking. It has everything to do with partially dissolved uric acid crystals. It is an expected effect of uric acid lowering. That’s why we need pain relief during the early months of uric acid lowering treatment. It is also why I recommend getting uric acid as low as possible for one year, as this significantly reduces the time you are at risk from a gout flare.

4) Gout weight loss. The significant point is that you have 10 to 13 kg extra flesh that is a big source of uric acid (human meat is very rich in purines, and is usually a bigger source than the meat and fish that we eat). Also, the extra weight puts more strain on joints that have been weakened by uric acid crystals. It is best to lose weight gradually at .5 to 1 kg per week.

5) Exercise and gout. Be careful! As I mentioned above, your joints are weakened from uric acid crystals. Avoid stressing joints. However, exercise is good, so walking, swimming, cycling, etc will help gout.

6) Gout and stress. There’s very little evidence to link uric acid with stress. There used to be a couple of researchers, but at least one has retired. It should not be an issue if you are getting the correct dose of uric acid lowering meds. To reduce anxiety, I recommend simple mindfulness training. Do you need resources?

7) Purines in gout diet. That’s a very strange list. Do you have a source, as I don’t understand how it is linking purines with uric acid. Vegetables do not raise uric acid. Animal purines are easily offset by other foods in a balanced diet. Good gout diet planning is all about what you do eat, not what you should avoid. Excess calories and excess iron are more important than excess purines. These excesses lead to uric acid buildup, but this takes many months. Binge eating, starvation, and Free Fatty Acids (FFAs) can have immediate effects on gout attacks.

8) Natural Uric Acid Lowering. Good gout diet is NOT about adding certain things to your diet. It is about reviewing your entire diet. Then, you might be able to make changes that will make a slight difference. Adding flaxseed to a bad diet is a pointless waste of time and money.

Ayman, my best tip is: get an effective and safe plan for lowering uric acid. As I’ve indicated, this takes a few months, so you probably also need a gout pain control plan. Once those are in place, you should consider a healthy eating plan that supports your gout treatment plan(s).

If your doctor can’t help you with those plans, I can.

I’m in the process of moving this gout forum to a new website. Simply ask for personal gout treatment plans.

[Ayman Roshdy]

Thanks for so many information and the detailed answers, I have posted a new message on the other forum that you mentioned

[Keith Taylor]

That’s great, Ayman.

I’ve responded at http://goutpal.net/forums/topic/new-gout-management-plan/#post-601

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