New to Allop, having an attack now

[Jason M]

I’ve been reading the forums for some time and the site has really helped me along.

Basic story, I’ve been a moderate sufferer for years, having two pretty bad attacks per year but avoiding medicine. At one point, my UA level was >10, but I lowered it to 7.0 with diet and exercise. That didn’t seem to change much and it wasn’t going lower than that.

It was 7.0 when I was having a pretty bad attack in late January of this year. At that time, I started Allopurinol (300mg) daily (forever) and daily Colcrys (for a month). I took the Allop throughout that attack and have not stopped since. I had some blood work done a month later and had a UA test as part of it. My level was down to 4.7. Now, I’m in the midst of a mild attack for about 5 days. It’s very discouraging to have my level go way down and still have this attack.

Do you think this is normal? Is this still old crystals flushing out or will this still be how my future looks? I really didn’t want to go on daily medicine, but I just can’t take the attacks (even minor ones). It really hurts trying to make plans or live life.

Any guidance or thoughts you can provide would be really helpful.

[Ron Avery]

Hi Jason,

I too am new to Allo. I’ve been on 200mg for 2 months. It is normal to have attacks as the old crystals dissolve. I had a minor one in my ankle a couple of weeks back. From what I understand there flareups can occur up to a year after we started the Allo as the old crystals keep dissolving. The good news is that they will become less frequent & less severe.

The main thing, and I’m sure Keith will elaborate as he so eloquently does, is to have some type of inflammation & pain meds at the ready when a flareup does occur so it doesn’t interfere with life too much.

Hang tough & good luck,
Ron

[Keith Taylor]

I?m sure Keith will elaborate as he so eloquently does

Thanks Ron. Your response to Jason is masterful. I’m not gilding the lily.

Jason, I don’t want you to think I don’t care, so please write again if you still feel despondent. Your older self is going to love you for helping him enjoy life. I’ve no idea how old you are, so let’s say you’re in your 40s. That was my age when I knew I should take daily allopurinol, but avoided it. You are not avoiding daily meds – you’re avoiding future pain. I’m not happy with my 45 year-old self, but I celebrate my 53 year-old self every day. I smile at my 80 year-old self, knowing he is gout-free. You’ve done an even better job of loving your older self.

If that doesn’t help, let’s talk about the breaks from daily meds that you can look forward to, if it matters that much. Post here daily, so I can get to know you better. I don’t know if ‘hang tough’ or ‘love yourself’ is the strongest motivator to you. I do know that you have a good gout treatment plan. If you still can’t feel positive about that, let me know, and I’ll try and help more with making plans and living life. If you do feel more positive, let’s talk about making your good plan even better for you.

[Jason M]

Thanks Keith and Ron. I’m only 35. I started dealing with this at a pretty young age. That’s always been concerning. I had pie in the sky hopes of dealing with it all through diet. That was silly. I’m not really overweight.

I’m firmly on board with the daily allo now. I’m mostly concerned right now with knowing that it’s normal to have these attacks after starting the medicine. My hope was that I’d never have another, but I know that’s not realistic. I just don’t want to be wasting more time down a path that’s not towards being gout-free.

I don’t have a great pain management plan as nothing seems to work. I’ll take two colcrys and one an hour later to try to stop the attack from getting worse at the start and then I’ve been taking 4 aleve daily. It’s slowly gotten better, but it’s still bad enough that I can’t do normal things. This attack (and most of mine) is in the big right toe. It’s not horrible but it’s still debilitating.

[Keith Taylor]

Great feedback Jason,

I think it’s time for me to nag you to log in before you post. Just click the Google icon near the top right (or Facebook, YouTube, Twitter, etc if you prefer). As a guest poster, you have to wait each time for posts to be approved. Logged in members only need the first post to be approved, then it’s automatic. Also gives you access to your Personal Gout Profile. That’s a very useful tool if you use it properly.

Here’s a great pain management plan for you:

1. Take one Colcrys at night
2. If any sign of painful inflammation when you wake, one more Colcrys and max strength Aleve dose.
3. If pain uncomfortable after two hours, max strength Tylenol dose
4. If painful inflammation after two more hours, max strength Aleve dose.
5. Repeat 3 and 4 until maximum daily dose reached (usually 4 times)

Never take more than 2 Colcrys in 24 hours.
See your doctor for max strength prescriptions of Aleve and Tylenol. Also discuss other possible combinations if you wish. It’s important to get gout strength doses, but also important not to risk overdose.
Personally, I often extended the two hour interval to three hours (or 2.5 hours) if I found pain was waking me through the night. The principles are the same for everyone, but each individual finds the best combination and interval.
The principles are:
Colcrys (colchicine) helps stop inflammation spreading, but does nothing for existing swelling or pain.
Non-Steroidal Anti-Inflammatories (NSAIDs) such as Aleve (naproxen) reduce swelling. Ibuprofen is also very useful and common, but many others are available.
Tylenol (acetaminophen/paracetamol) blocks pain. Other pain blockers such as codeine or tramadol can be effective, but acetaminophen is usually preferred as it is compatible with NSAIDs and also has an anti-inflammatory effect.
You must discuss this with your doctor who can provide gout-strength combinations that are safe with respect to your medical history. OTC doses simple tickle gout – you need gout-strength to snuff it.

Daily discussion here of your gout, your pain control package, your uric acid levels, your hopes, and your dreams will definitely make 2015 the last year you ever have gout. Beyond that, we can discuss the best lifetime strategy for easy gout control.

Life is fun.

Speaking of fun, Jason, I suspect a common IT background (please accept my apologies for a little harmless stalking). Let’s play at turning my 5 point pain control plan into common programming languages. Everybody is welcome to join in.

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