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To a certain extent, this is a little premature, as I am currently researching professional attitudes to how gout is managed. Completing that review might change my opinions, but I doubt it will change my philosophy. Prompted by comments in the gout and ice discussion, I'll try to explain more here.
hansinnm said:
Keith (Gout Admin) said:
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A final thought on the pain vs uric acid issue. I was chatting with my gouty brother-in-law over the holiday. He is firmly in the gout pain camp. “What's the point of taking a pill everyday, when I only need a few pain-killers once or twice a year?”
A perfectly valid point of view, and I imagine he'd welcome the ice pack.
Keith, I hope that wasn't you who said that is: A perfectly valid point of view...
?That is about the dumbest view point a rational, intelligent person can have!!! While s/he cuddles her/his pain brain, Mother Nature says: Have at it! I'll make damn sure you'll remember your stupidity down the line while I increase your uric acid in your blood.
Your gouty brother-in-law should apply for a job with the pharma industry. Since their motto is: Treat the symptoms, not the cause, he'd make an excellent salesman for them.
(Keith, I am really angry with you. I would have expected that statement from any body else, but not from YOU
, who always says: Manage your GOUT. I have NEVER heard you saying: Manage your pain.)
On most levels, I find gout a very simple disease. It starts with an imbalance in uric acid metabolism, therefore the logical approach is:
1. Investigate likely causes of uric imbalance and correct them if possible.
2. If causes cannot be removed, or if correction will take several months/years, take urate lowering treatment to control uric acid.
3. Accept the risk of pain until old urate deposits dissolve and decide on preventative (prophylactic) pain relief, or as required.
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It really is that simple, so it raises the question of why people become so emotional about gout, and why 80% of gout sufferers fail to get proper treatment.
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Now, I have the ammunition to start endless debates in the gouty community about the failings of the medical profession. I have the ammunition to start endless debates in the pharmaceutical community about greed and profiteering. And I have plenty of ammunition to start endless debates in the medical community about patients who will not listen & will not take medicines as directed.
But these debates are meaningless without considering the key point – What is the context?
We all have our own personal beliefs, fears, experiences and goals. Only by seeing gout questions in our own personal context can we make sense of the answers. My 3-step logical argument about the “correct” treatment of gout is worthless in the context of people who believe that gout is caused by “too much high living” or “taking a pill everyday means premature aging has arrived”, and several other emotive gout myths.
None of us live our lives in a perfectly logical atmosphere. Those lucky enough to reach their 80s see life much differently from people 30 or 40 years younger. Logically, we know that 30 or 40 years of excess uric acid is likely to cause problems. But life moves in phases, and no amount of explaining the consequences of risky behavior is going to change attitudes to risk. This applies in all aspects of life – not just gout. In practice, we all seek a better life today. Then there is a range of attitudes to how possibilities of future consequences will change today's behaviour. Instead of lifetime logic, we think more of what is acceptable. Instead of optimal results, we settle for what is satisfactory.
By way of analogy, I used to smoke. Like most ex-smokers, I'd like to see less people damage their health in this way. Unlike the self-appointed tobacco police, however, I respect people's right to choose their own lifestyle, and therefore smoking is a valid option. People will tie themselves in emotional knots debating that issue, just as they will by the “treat the cause not the symptoms” debate. In my opinion, nobody has the right to impose their beliefs on others, because the context of the decision to smoke, or to treat the symptoms, is different for each individual. And in different contexts, each different choice is valid.
So my approach is to establish context before considering the best options. In the context of a strategy to give the best possible method to permanently get rid of gout, then my 3-step logical approach described above is the best solution, though it needs some specific details added based on individual circumstances. That is my primary aim during the discussions here, and in the articles I publish at GoutPal.com.
In the context of a man generally in good health who is unlikely to submit to a daily regimen of pill taking, treating the pain symptoms once or twice a year is a valid option. It is valid because it produces a satisfactory result, if not an optimal one. If gout attacks increase to four or five times a year, he might be prepared to listen to a more permanent solution. In his context, gout pain is far more relevant than uric acid. I am in no position to judge, but I believe his choice seems valid for him. That may change in future, but the changed context will reveal different acceptable solutions.
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To summarize, I think any plan for managing gout is only relevant in the context of how it meets the individual gout patient's situation and expectations. Plans are only workable if they recognize that contexts change through time. My 7 stage process for revealing these pathways to Gout Freedom is gradually working it's way into my sites as you read this.
Keith (Gout Admin) said:
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None of us live our lives in a perfectly logical atmosphere. Those lucky enough to reach their 80s see life much differently from people 30 or 40 years younger. …
As I have said in an earlier Post: Keith, “you come through with flying colors” ?and an excellent dissertation.
I can only say in my own defense for having been so “rough and tough” in my comments to other gouties was? because I have reached the 80's and having lived an ignorant, arrogant, stubborn, conceited life for more years than I care to admit or readily accept, I, now, want to save some of the ones in their 30's and 40's (I was there, too, once) what I have been going through in the last 12 months. Don't forget, I was approaching my 80's before Mother Nature really saw fit to let me have it. And in all honesty, it wasn't Mother Nature who let me have it, it was my ignorant, arrogant, , stubborn, conceited attitude which let me have it.
My gout problems started when I was already in my mid fifties and it was tolerable for almost 20 years, despite or because of my ignorant, arrogant, stubborn, conceited attitude, but the “finale” if it is/was the finale, is NOT anything I wish on any one.?
For me it was easy.
After going several years waking up with a sore ankle or instep for no apparent reason but requiring crutches to get around. Every time I thought it was a tendon tear or sprain or plantar fasciitis?done without my realizing it. How often do we register overtreading an ankle?
Each event would be a tedious 3 days with difficult driving and even more difficulty walking then poof all gone with normal analgesics.
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After about 5 of these attacks that were getting more perplexing and more frequent I got the podagra attack in the big toe. It was truly the ATTACK FROM HELL and unmistakeably GOUT. The slightest research told me I needed allopurinol, so off to the doctor I toddled after taking 22 colchicine and stopping the 9 day attack. He yammered some nonsense about my 8+ uric acid being normal and I told him basically “Spare me your nonsense and prescribe alllopurinol.”
I was grateful that I had FINALLY gotten a handle on what had been bedevilling my feet and?upon starting the daily allopurinol?I have been gout pain free for almost 2 decades. Like the man in the bible, I was able to “throw away my crutches and walk!”
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I think that not treating gout properly by controlling uric acid, the road is nearly always downhill and every person with gout will eventually rue their decision to treat only symptoms. Would you treat bacterial pneumonia with cough syrup alone when antibiotics are available?
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But I know it is hard for a person who has never had the AFH to commit to a lifetime of medication, albeit cheap and safe, but once an attack comes that is truly beyond bearable, one will SCREAM for a med that will guarantee it never happens again.
I agree Zip. very few people [a few % ?] are likely to get away with SUA figures staying the same in life.
If they did, than diet and lifestyle would have a better chance. SUA will go up slowly- it's not a self reversing condition unless caused by external issues like radiation?treatment or??longterm ?meds etc. and then -only before an actual attack has occurred.
On top of the actual level of SUA building up over time -there's the day to day swings that cover up the results of personal trials to manage the 'threat'. I have tried this myself- and it's not easy to get 1 or 2 mg/dl lower.
So , with the impossible task of predicting how a varying amount of urates will stay around for too long,? deposit &?then trigger immune system to finally flare and?probably cause eventual?attack- it's no wonder Medics and sufferers alike get lost in the process, often enough.
Essentially, sufferers?have to establish- [not an?exhaustive list]
1.?Their SUA 'profile'? ie: blood figures and variations due to diet,exercise etc. plus flare/attack profile.
2. How much they are prepared to do?to?manage these figures without medication for urates reduction and at the risk of some severe?pain &? [probable] long term damage.
3. What finally,if out of time on the above factors,? what medical approach they are going to do to?manage the 'SUA critical' level back to acceptable. [ say 6mg/dl MAX]
With the practical working knowledge gained here and elsewhere, this approach seems capable of success for the general case. Some cases will be a lot more complicated- or risk more, but that's what medics are supposed to be dealing with?anyway.
The sufferer HAS to take an enlightened interest in this condition, to win well.??? My 2cents !
I wonder how much a UA tests costs…
I went 8 years with multiple attacks a year…3-4 complete physicals (for work insurance) and no one EVER tested my UA.
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Wasn't until I got lucky and found someone that said, hey lets take your UA level.
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So to add to your plan, wonder if a simple UA test, starting with men say in there 30's, might help solve some of the pain mystery so many of us have for so many years.
Around the ?120 and then about?mark initially? then $15 for replacement stock lancet and strips/swabs every few weeks/months depending on testing rate.
On the routine testing, not a bad thought , but asymptomatic hyperuracemia is the rule rather than the exception unfortunately. This means that repeat tests would be needed and some diet/lifestyle info taken? and really a dual energy? scan in early joints pain issues.
it's never going to happen, let's be realistic- that'ws why we're in this state with the 'devil illness' now!
Easier to blame overconsumption and bad lifestyles etc- as gets done, but this is just showing the holes in what passes for health care in the modern age.
Now , a prescription- that's easy, Sir!
[Side effects un-answerable for- that's for big pharma and a yard long list of 'get outs'!]
So, Yes ? It would make sense to test? SUA -but you couldn't even get one easily, once gout was triggered- so NO practical chance of the scourge being nailed soon [like ever?]. Notice I said 'supposed' to be dealing with in my post above.
We need a Gout Pressure group really- Keith for life president. Hoorah- a new dawn?. and a Royal Wedding to distract us from the pain and cost of keeping ourselves fit [for taxpaying purposes]
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