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I just found this forum and I'm glad I did.? I am a 5 year gout sufferer.? In the past I was treated for gout with Indomethacin which did an OK job against an attack.? However, last February I suffered the worst attack ever while on a cruise (seafood, beer, steak, not enough water).? A couple of months later I had another lesser attack and doctor found my uric acid levels elevated above the normal range (no surprise!).? I started on Allopurinol at that time and have not had an attack until now.? Started using Indomethacin again and it seemed to be doing the trick.? I called the doctor to get some Colchicine that he had mentioned in the past but I cannot take it due to an allergy problem I have with an antibiotic called Clindamycin.? There is some relationship between Colchicine and Clindamycin.? So, he gave me 10mg of Prednisone for 8 days which was helping.? However, I had about 2 fingers of scotch one afternoon and took an ambien later that night for sleep.? Woke up the next morning in more pain than before I started on the Prednisone.? I found that a possible side effect of Ambien is gout.? Now I'm becoming really frustrated.? I understand the Allopurinol reduces uric acid level and as of my last blood test in December it had.? I guess I was undet the mistaken impression that all was finally well except for a minor flare or 2.? Now as I read posts in this forum it may take some number of months for things to settle down.? I know I'll be on Allopurinol for the rest of my life and I can deal with that.? But I've been on it for 8 months and this attack is no fun.? Am I correct in understanding that it takes a number of months (depending on the individual) for Allopurinol to rid my body of the uric acid crystals causing this havoc?? I was not aware that it would, over time, remove the crystals.? Does this mean that at some point I may not have another attack again as long as I stay on Allopurinol and watch food and fluid intake?
Allopurinol Tablets 100 mg What dosage of allopurinol?
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What was your SUA before starting allop?? What is it now?? How often do you test it?
I am on 300mg of Allopurinol.? After I returned home last February during that attack my uric acid was somewhere beyond the high end of the range although I do not presently know the exact number.? On May 6, after I was on Allopurinol for several weeks it was down to 4.9.? It was taken again this past December but I do not know the number and have placed a call to my doctor to find out.? But, I was told by his physicians assistant 2 days ago that I could experience a flare/attack just from a spike in the uric acid level even though it may still be within the normal range.? So, it has only been checked 3 times in the past 10 months.? Right now I have been on prednisone for 5 days.? Last night I finally felt some relief and was elated.? However, by 5:00 am my foot was throbbing with pain.? I do not understand how that can be.? I also want to ask the doctor if I should resume the Indomethacin even though I am on the Prednisone.? The pharmacist has told me there is no problem between the two.? Adding to my frustration is the fact that in less than 2 1/2 weeks we are planning to fly to the Caribbean for 2 weeks and I'm beginning to have my doubts about that.
George- there's no rule of thumb on urate clearance. Some people get twinges ,others attacks for at least 6 months it seems. You're not up to the year?on AP yet- and furthermore don't know your average working level of SUA [nice to know this figure].
Swings in SUA can go up or down so if you had a test at the min. and drift to a max. near 6.5 mg/dl you probably won't be shifting much in the way of urate in your body, as very much wished.
Do what is?always advised and get your real SUA figure every test- this alone will flag you up as 'onto the case' and hopefully stop the fudging that goes on with SUA figures with our friendly medicos! 300 mg AP is not always enough , but the normal dose for most it seems. Can be increased , if necessary.
?I reckon unless your figures? go above 5 much you are on track for less pain- till then keep off alcohol, aspirin and drink plenty of?H2O- you know the rules by now 🙂
See how 1 or 2 Colchicine a day sounds to you HCP for your away trip -rather than the heavy doses used in attacks, which?don't suit you?
I am unable to take colchicine.? I have had a possible allergic to an antibiotic called Clindamycin.? When the physicians assistant prepared to write the order for Colchicine her computer system told her that due to the Clindamycin allergy I cannot risk Colchicine.? At that point the doctor prescribed prednisone.
George,
I too have a clindamycin allergy (incredible colitis)?but I have no trouble with taking colchicine. Perhaps your doctor is being over-cautious? Have you found any confirmatoryon-line data indicating this cross sensitivity??It is an important issue because there is no better drug for gout pain than colchicine, although the FDA has made it prohibitively exopensive to take it in effective doses in the United States.
(Does Canada ban all cochicine that is not patent protected as COLCRYS? Canada is not far from upstate New York.)
Getting that December number is important because there is no mandate against taking 400 mg. allopurinol if?urate is not low enough. I started with a year on 400 mg. and never had a frank attack from day one many years ago, so attacks? are not compulsory after starting allopurinol
. Are you a big guy George?He may be a little cautious with the Colchicine and that is why he prescribed the prednisone.? Further, I am reluctant to try Colchicine without doctors endorsement.? I have not researched? for any confirmatory data.? I asked the doctor last week about increasing Allopurinol but he told me that 300mg was the maximum dose.? I've learned otherwise since then.
I am overweight – 5' 6″ and 224 pounds but I am in fairly good physical condition for 61 years old.
I don't understand why after feeling better last night (took prednisone in the morning) why I am having such pain this morning.? Took prednisone an hour ago and pain is subsiding somewhat.
Additionally, I would not feel so frustrated if I saw some continuing improvement with the current attack but I am not sure that the Prednisone is doing what it should.? And I don't know if I should resume the Indomethacin.
Well, its turns out that the blood work done in December did not include uric acid test.? I'll be having blood drawn tomorrow morning for that test.? Also, was advised by the physician's assistant that I could take Indomethacin with the Prednisone.
Now, I've been reading a number of posts both here and elsewhere about foods to take and foods to avoid and let me tell you that there is a lot of contradictory information around.? For example, I've read that coffee is good for gout and I've read that coffee should be avoided, spinach should be avoided in one article and another article specifies only to avoid cooked spinach (or is it the other way around), another article states that green, leafy vegetables are good.? So, what does a guy believe and what does a guy not believe?? I'll continue to drink lots of water, gatorade after exercising, avoid red meat, avoid beer and I've cut way down on the wine consumption (although I read once that only red wine was bad) and I'll start to consume more oranges, grapefruit, blueberries, etc.? Any other additions or deletions from my diet will be researched carefully both here and elsewhere.? Any comments?
Georgedn said:
? So, what does a guy believe and what does a guy not believe???
Please believe what I've written in Gout Diet Contradictions.
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Keep diet in the gout diet topic.
Georgedn said:
Well, its turns out that the blood work done in December did not include uric acid test.? I'll be having blood drawn tomorrow morning for that test.? Also, was advised by the physician's assistant that I could take Indomethacin with the Prednisone.
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First, you've been badly let down from the uric acid management poin of view. For the first few months, it is vital that you have a clear picture of your uric acid level in the blood. Getting it below 6mg/dL will prevent further deposits forming, but the first few months benefit from an even lower level, as this determines how long it takes to get rid of old crystals.
Come back with the test results, and we will discuss further.
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Until you get rid of the crystals, as you have found indomethacin effective, it is better to stick to that. You need to clarify the best way forward with your doctor, especially discuss the points that I have discussed with doctors and rheumatologists in the past:
1. Discuss the view that NSAIDs such as indomethacin can be used at higher than normal doses to treat gout, as long as maximum dose is not breached, and if kept to short periods (which is valid as most gout attacks only last a few days, especially when urate lowering therapy is set at the correct dose).
2. Discuss the view that prednisone should only be used as a last resort, as it suppresses production of the bodies natural pain relieving hormones.
Keith,
I am disappointed that the uric acid was not checked.? I like my doctor and find that he listens and discusses things with me, however…? When i see him again I plan to suggest that I see a rheumatologist to manage my gout issues.
I asked the doctor last week about increasing Allopurinol but he told me that 300mg was the maximum dose.?
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The man is a fool who apparently knows NOTHING about gout and its management. The maximum dosage is considered to be 800 mg. NOT 300 mg. The reason I asked about your size is that while 300 mg. might be fine for someone at 150 pounds, it might not be enough for someone over 200 pounds. A big guy will EAT more than a small one and break down more tissue as well. Both are sources of purines and more purines need more allopurinol to block their conversion to urate.
It seems only common sense that if I got an attack after 6 months of 300 mg. allopurinol, my body is telling me to try 400 mg. In fact I spent my first year on 400 mg…and NO rebound attacks. I then spent a decade on 300 mg. and at my doctor's urging I went down to 200 mg but started getting the telltale bunion twinges in the morning and a urate of 6.8. I went back to 300 mg. confident I had found my level. (I am 6'2″ and 205#.)
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I would classify indomethacin as the second best analgesic for gout pain despite the fact that it makes me and others dizzy. Last time I took it I almost did a header down an escalator.?
But only colchicine will act to stop an attack. The assholes who get a drug flyer from a prednisone manufacturer and discard two millennia of sensible gout treatment? are truly infuriating. Just DUMB Doras masquerading as medical professionals?and their are enirely too many of them around. THey should recognize their limitations and get jobs delivering mail.
I would dispute ANYONE who thinks that predniisone is a safer drug than colchicine.
Georgedn said:
Keith,
I am disappointed that the uric acid was not checked.? I like my doctor and find that he listens and discusses things with me, however…? When i see him again I plan to suggest that I see a rheumatologist to manage my gout issues.
Though a rheumatologist isn't a bad idea, you need one who is experienced and up-to-date with latest gout management ideas. They are best used when diagnosis is not clear, or treatment is not working, or treatment is compromised by other health conditions.
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Simple gout management doesn't need a rheumatologist, but it does need someone who can measure uric acid in the blood, and adjust urate lowering treatment to suit – not exactly rocket science.
Georgedn said:
Keith,
I am disappointed that the uric acid was not checked.? I like my doctor and find that he listens and discusses things with me, however…? When i see him again I plan to suggest that I see a rheumatologist to manage my gout issues.
You can buy a uric acid test kit and manage your own allopurinol dose.
Be very careful with a rheumatologist
I was told I HAD to go to one?after thousands of dollars of BS tests, wrong drugs, him telling me I DON'T have gout, I found a good Family Physician who UNDERSTANDS what gout really is and how to treat.
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I am (edited and removed not) on my way to solid gout mgmt.? Meaning I found a regular GP that understands gout and I am on may way to managing it nicely.
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Honestly if you go see a rheumatologist ? YOU MUST ask for references of people he treated for GOUT.? Most try to say you don't have gout.
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good luck!
toofast said:
Be very careful with a rheumatologist
That holds true of any physician these days.
I was told I HAD to go to one…after thousands of dollars of BS tests, wrong drugs, him telling me I DON'T have gout, I found a good Family Physician who UNDERSTANDS what gout really is and how to treat.
I agree. If you can find an old-fashion family physician (that is if you really can find one these days) I'd had more confidence in him than the new, young , pharma-instructed, so-called medical industry employee (my definition.)
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I am not on my way to solid gout mgmt.
If you have gout, you better do or you wind up with what I have documented here on this forum in words and pictures.
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Honestly if you go see a rheumatologist – YOU MUST ask for references of people he treated for GOUT.? Most try to say you don't have gout.
good luck!
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