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First of all, the info on this site has been extremely helpful in educating me about Gout. This site is a blessing! I am 34 and have had an average of 4 attacks a year. They are getting worse. My father is a vegeterian and doesn't consume alcohol and he still got them when he was younger. So genetics is a definite factor. I am also on the lowest dose of ActosMet for diabetes as my mom has given me those genetics 🙂 I am 6'4″ and 215 lbs. I exercise regularly as well. I am just getting over the longest attack (almost 2 weeks) in my ankle and foot. I have been to my doctor and he has prescribed Allopurinol. I will be doing the 24 hour urine test as well to determine if my kidneys are not efficient or if I am producing too much uric acid. Then my doctor will determine the dosage. So on to my questions. Again, I am new and am sure these topics have been discussed in great detail many times over. I would appreciate any and all help! Thanks and have a great 2010!
1) Do the home meter tests work if done correclty? Any particular recommendations?
2) If my doctor starts with 300mg, can I request a lower dosage and work my way up? I am relcutant to start too high as to not endure the harsh side affects right away. I have read a lower dosage combined with a proper diet is a good combination instead of a higher dosage and a slight change in diet.
3) From reading the UDRP cylce, if I get my levels under 6 by natural means (proper diet), will it begin to dissolve the deposits in my joints as well? Or will I have to go on Allopuinal to dissolve these deposits.
3) If I have to go on Allopurinol, my thoughts were to take the Allopurinol until all deposits have dissolved and my levels are below 6. I want to eliminate any long term effects from leftover depostis (tophi). At which time I will cease the Allopurinol and monitor with proper dieting. Has anyone tried this plan and is it safe to stop the drug once the uric acid level has reached the intended goal?
4) I have also read Allopurinal is a short term drug and has to be taken daily. I have read where people take it when they binge into high purine foods and beer to reduce their levels during those days. I know this is not a recommended way to do it, but has anyone tried this as well to manage their condition?
Again, excuse any ignorance on these topics. I just want to get my facts straight before I get on the drug. If I can lower my UA to 6 without the drug and also benefit from the deposits dissolving, that would be my preferred route. Thanks for the advise and answers in advance!
Mohit (Mo) Mohindru
modogg said:
I am 6'4″ and 215 lbs.
Target weight from the gout weight tables is 156 to 168 lbs.
I exercise regularly as well. I am just getting over the longest attack (almost 2 weeks) in my ankle and foot. I have been to my doctor and he has prescribed Allopurinol. I will be doing the 24 hour urine test as well to determine if my kidneys are not efficient or if I am producing too much uric acid. Then my doctor will determine the dosage. So on to my questions. Again, I am new and am sure these topics have been discussed in great detail many times over. I would appreciate any and all help! Thanks and have a great 2010!
1) Do the home meter tests work if done correclty? Any particular recommendations?
Yes, they are accurate, but the weak link is taking consistent, good blood sample. Practice finger pricking to get a droplet size that matches (by eye) the size of the test strip before wasting strips. Be extremely methodical in the way you do the test.
2) If my doctor starts with 300mg, can I request a lower dosage and work my way up? I am relcutant to start too high as to not endure the harsh side affects right away. I have read a lower dosage combined with a proper diet is a good combination instead of a higher dosage and a slight change in diet.
- Start with 100mg to ensure you are not allergic.
- After a week increase to 300 or 400 depending on your uric acid level.
- Test every 2 weeks and adjust dose to get uric acid to around 3mg/dL.
- Test every month, extending to 3 months if stable.
- Continue until you have had no gout attack for 6 months and no visible signs of tophi.
- Optionally get joint fluid analyzed to ensure no crystals.
- Relax allopurinol dose to maintain uric acid around 6mg/dL for rest of your life.
If you have changed your diet effectively enough during the above procedure, you might be able to adjust dose to zero, but do not be surprised if you cannot get low enough with diet alone.
3) From reading the UDRP cylce, if I get my levels under 6 by natural means (proper diet), will it begin to dissolve the deposits in my joints as well? Or will I have to go on Allopuinal to dissolve these deposits.
Urate crystals dissolve when you get uric acid to around 6mg/dL. This happens however you do it – medication or lifestyle. The problem with dietary changes is that it is often hard to make enough difference, but this will depend on personal circumstances. It is impossible to get down to the 3mg/dL I mention in the allopurinol procedure, but that just means, as long as you can get to 6, that the crystal dissolving phase takes much longer.
3) If I have to go on Allopurinol, my thoughts were to take the Allopurinol until all deposits have dissolved and my levels are below 6. I want to eliminate any long term effects from leftover depostis (tophi). At which time I will cease the Allopurinol and monitor with proper dieting. Has anyone tried this plan and is it safe to stop the drug once the uric acid level has reached the intended goal?
See allopurinol procedure above. Once you are sure that all crystals are dissolved, you slowly reduce the allopurinol dosage, and test at each reduction. If you are very lucky, you might be able to reduce to zero. You must be extremely careful to never allow uric acid to rise above 6. It is not safe to simply drop allopurinol without careful monitoring.
4) I have also read Allopurinal is a short term drug and has to be taken daily. I have read where people take it when they binge into high purine foods and beer to reduce their levels during those days. I know this is not a recommended way to do it, but has anyone tried this as well to manage their condition?
Allopurinol has a short life, but it's active by-product, oxypurinol, lasts much longer. Dose cannot be adjusted on a daily basis. You need at least one week (which is why I say 2 weeks) between dose changing and measuring uric acid
Again, excuse any ignorance on these topics. I just want to get my facts straight before I get on the drug. If I can lower my UA to 6 without the drug and also benefit from the deposits dissolving, that would be my preferred route. Thanks for the advise and answers in advance!
Mohit (Mo) Mohindru
It's always a good idea to get your facts straight first. The non-drug route might be possible, but we do not know the biggest factor – your current uric acid number. Lifestyle changes generally only account for a couple of points, though I guess you might push this higher with a really restrictive diet and regular blood donation.
Thanks for the detailed reply! I found this site and it has helped me tremendously. I will definitely keep you posted on my progress. I know I could suffer long term damage if I don't dissolve the accumulation in my toes and ankles. As odd as it sounds, even after a few beers, I feel a rush of pressure into my toes. I do have self-control and will manage with diet. However, I think Allo is necessary to properly rid my body of the deposits. At which point, I will manage my number and control with a lower dose of Allo and diet. Thanks again sir!
Mo
modogg said:
I am 6'4″ and 215 lbs.
Target weight from the gout weight tables is 156 to 168 lbs.
Some murds wixxed there because 156 to 168 lb. would be the SS standards for inmates at Buchenwald. At those weights for someone 6'4″one starts looking for cancer.
Something like 190# is probably ideal but 215# isn't too bad at all for someone so tall.
Very interesting!
The calculator on that page doesn't give an ideal weight as such, but if you keep moving the 'actual' weight towards the recommendation, it stabilizes at 189#, so “something like 190#” is definitely ideal. Reviewing the page, and it's accompanying 'Ideal weight' notes, this seems to be what I would term as a 'social ideal weight'.
The calculator also shows the medically recommended weight to be 156 to 205 lbs, which ties in with the gout weight tables I referred to – i.e. the much-maligned BMI tables. BMI has its weaknesses, but it happens to be the basis used for the analysis of the research I mention. That report actually associates BMI below 21 with a lower risk of gout. That is roughly the bottom 25% of the normal BMI range (where my 156 to 168 comes from).
I've mentioned before that my instinct pushes me to shy away from strict interpretation of BMI. In my own case, I simply cannot remember when my own BMI was anywhere near this low figure. Nobody ever accuses me of being skinny!
Much depends on social context. 'Skinny' in the bodybuilder's gym is 'obese' in the supermodel's changing room. Unsurprisingly, I get many more referrals to my gout websites from body-building sites than from catwalk sites.
I can see that my GoutPal.com page on BMI needs some updating to clarify medical recommendations and social acceptability.
Statistically, low BMI is associated with lower risk of gout. A later study in 2008 confirms “Risk of gout was 16-fold greater for BMI > 27.5 than < 20”. However, that clearly underlines the divide between what is medically recommended and what is socially acceptable. A BMI of 20 equates to 164 pounds for our 6'4″ friend, and 148 for myself and my fellow 6-footers. Figures which I am sure zip2play finds as incredible as I do.
It begs the question – should we aim to be skinny (i.e. socially, but not medically, underweight), knowing it gives a lower risk of gout?
I guess the sensible approach is to decide what ones own ideal weight should be. If it is achieved, and no significant change uric acid reduction results, then it's time to abandon the idea that weight loss is part of your gout management plan.
Having said that, weight loss is only one of the lifestyle factors associated with gout, so a personal plan incorporating all the factors might work where a modest uric acid reduction is required.
I got my blood drawn after lunch last week. I got the results today and it was 8.0. Keep in mind it was near 10 a few months ago. Since my attack started 2 weeks ago, I have since elminated most high purine foods and alcohol from my diet. I am at a point now where I can begin exercising as my foot has healed for the most part. I just turned in my 24 hour urine sample this morning and they drew more blood as I was fasting. I am interested in the results and will keep you all posted. I did have a few more questions……:) You all have been very helpful and I appreciate it.
1) Any insight into the 24 hour uring test would be helpful. Why is this test important? Especially in deciding the dosage of Allo. My doctor did write a 300mg prescription. He said not to get it filled until after he reads the test results. After the test results come back, I will ask for a lower dosage of 100mg as you recommended.
2) I have never had an attack last more than a few days. It has been over 2 weeks on this one. My ankle and toe has almost healed. Can this be b/c I have eliminated meats and alcohol for the past few weeks and my body is trying to dissolve the already accumulated deposits? I never used to get them in my ankle but recently I am. It was usually in the toe.
3) I asked this before and maybe crazy…..When I used to drink a few beers, I could almost immediately feel a rush into my toe. Like it was already accumulating. I told my doctor and he said he has heard this before. Anyone else had this feeling?
GoutPal said:
It begs the question – should we aim to be skinny (i.e. socially, but not medically, underweight), knowing it gives a lower risk of gout?
Good question, although I have gout and am skinny- 6 ft 180lbs with 12% body fat…so I'm thinking if its genetics you're screwed no matter what! lol
@ Anyone else had this feeling?
Before I twigged I had gout- ie: got a good blast- I used to get half canned and then rip my sock off and peer at my big toe joint and wonder what was wrong with it. Glowing in the dark.
It's a shame that people aren't fore-warned about this , as 'early caught' would mean a lot less complications in many cases.
Now you are no longer a gout virgin- this doesn't matter too much- but…
The awareness of where you are heading in attack terms is still very dependant on signals like this.
Two factiors are very puzzling in gout- this sensitivity aspect mentioned with alcohol, which after all usually desensitizes nerve impulses -and the other what causes such pain- it must be connected to nerve function in some way and be natures way of requesting a 'slow down' of activity.
It's been mentioned before that gouties seem to be highly intelliigent, active achievers- so maybe it's what it takes to stop us 😉 …apart from Bacchus- indeed.
cjeezy said:
GoutPal said:
It begs the question – should we aim to be skinny (i.e. socially, but not medically, underweight), knowing it gives a lower risk of gout?
Good question, although I have gout and am skinny- 6 ft 180lbs with 12% body fat…so I'm thinking if its genetics you're screwed no matter what! lol
5 ft 9 inches and 158 lbs….still got gout….Are we in exception list?
modogg said:
I got my blood drawn after lunch last week. I got the results today and it was 8.0. Keep in mind it was near 10 a few months ago. Since my attack started 2 weeks ago, I have since elminated most high purine foods and alcohol from my diet. I am at a point now where I can begin exercising as my foot has healed for the most part. I just turned in my 24 hour urine sample this morning and they drew more blood as I was fasting. I am interested in the results and will keep you all posted. I did have a few more questions……:) You all have been very helpful and I appreciate it.
1) Any insight into the 24 hour uring test would be helpful. Why is this test important? Especially in deciding the dosage of Allo. My doctor did write a 300mg prescription. He said not to get it filled until after he reads the test results. After the test results come back, I will ask for a lower dosage of 100mg as you recommended.
It tests if you are an underexcreter or overproducer of uric acid – a useful insight into possible gout causes. If you are an underexcreter, you have more treatment choices because uricosurics (drugs that increase uric acid excretion) are suitable. Drugs like allopurinol or febuxostat, that inhibit uric acid production, work in both cases.
2) I have never had an attack last more than a few days. It has been over 2 weeks on this one. My ankle and toe has almost healed. Can this be b/c I have eliminated meats and alcohol for the past few weeks and my body is trying to dissolve the already accumulated deposits? I never used to get them in my ankle but recently I am. It was usually in the toe.
Gout is a progressive disease that can effect any joint, as well as causing tophi to build up under the skin. Classically, it starts in the toe, spreads to the ankle and rest of the foot, then the knee. It continues into the elbows, wrists and hands. Shoulders and back could be next. No joint is safe.
It is not predictable. You can go for weeks or months without getting a flare, though the chances are that crystals are slowly building up and destroying bone, cartilage and tendons even when you don't get the flare.
As the disease spreads, the flares become more frequent until they often feel like a continuous gout attack. By lowering from 10 to 8, you are not reversing anything, but might be slowing the progress slightly.
3) I asked this before and maybe crazy…..When I used to drink a few beers, I could almost immediately feel a rush into my toe. Like it was already accumulating. I told my doctor and he said he has heard this before. Anyone else had this feeling?
One thing we all get with gout is an obsession with linking what we put in our mouths with what happens in our bodies. We are also ever watchful for the next twinge that might signal the onset of an attack. Crazy is as good a definition as any, though anxiety might be more medically accurate.
I'm looking forward to some progress reports, but please could you start new topics for new questions. It stops discussions twisting and turning like this one is doing – which is a shame because you are asking the questions that all the lurkers are thinking
(this is a friendly ask – not a criticism)cjeezy said:
GoutPal said:
It begs the question – should we aim to be skinny (i.e. socially, but not medically, underweight), knowing it gives a lower risk of gout?
Good question, although I have gout and am skinny- 6 ft 180lbs with 12% body fat…so I'm thinking if its genetics you're screwed no matter what! lol
Larkin had it right, but I'll sanitize and amend to keep on topic
They screw you up your, Mum and Dad
They do not mean to, but they do
They give you all the gout they had
And add some extra just for you.
(Who is gonna tell him that medically he's overweight?
)I got the results today and it was 8.0. Keep in mind it was near 10 a few months ago. Since my attack started 2 weeks ago, I have since elminated most high purine foods and alcohol from my diet.
mo,
Since 8.0 seems to be the best you can hope for with “good living” you can look forward to soon being on a drug. You need a uric acid of <6.0 and you won't get it otherwise. The most common is 300 mg. allopurinol daily for life. If it is shown that you are excreting very little urate then 1000 mg. probenecid is a good candidate. But generally speaking it will be allopurinol…cheap, harmless, and effective.
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