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1) Was it my switch from 600mg to 300mg per day of Allopurinol?
2) Was it the two mistaken (small) pieces of pepperoni pizza I ate last weekend?
3) Was it the smokey tasting trout I ate at the Konigsee?
4) Was it over-taxing myself by taking hikes in the deep snow for three days?
5) A combination of all of the above?
I felt the twinges in my left toe and ankle coming on early Monday morning and on Tuesday, they hadn't become any worse. On Wednesday, things started picking up a bit, almost to the point of limping by the end of the day. Today (Thursday), I had trouble putting my shoe on and the throbbing in my left foot has become quite noticeable and painful. I would still consider this a minor attack, but it has been a couple of months since I suffered from one of this magnitude. It's one of those attacks that feels as if it's going to get progressively worse – I just hope not that much worse.
I did go in to the clinic yesterday for a scheduled blood letting. I'll get my uric acid results back sometime next week. I'm assuming it should still be around 4 since I've been so good about diet, taking the Allo, getting light exercise and have completely abstained from alcohol for over six months now.
I just wish this would all end. I was even thinking of giving some downhill skiing a go this coming weekend. Looks like I'll be relegated to the all-too-familiar couch again, however.
Nope, still drinking tons of water. 3-4.5 Liters/day depending on what I've been doing + whatever tea and coffee I drink (which isn't more than half a liter a day).
I would suspect the Allo level change then, firstly.
If you're expecting SUA levels of 4 you must have a fair amount of urate backlog to clear- if on 600 mg till now.
Your next reading will help on this but, whatever is going on, you will be vulnerable till the old deposits are gone- and the snow walking would have been an ideal trigger to catch you out whilst urate was moving around! Keep feet warm always…
Just curious, why would you switch from a 600 dose to a 300 dose if you are not completely sure of your SUA level? That sounds kind of risky IMO. Was this a GP recommendation?
cjeezy – docs instructions. I get my SUA levels checked monthly and have been for 6 months now. They have been between 3.8-4.2 for a few months now.
trev – I was wearing my interior Alaska Sorrel -100F snow boots. Love those things! I don't know if the snow had much to do with it. I suffered through really bad attacks while living in Hawaii too. I don't think the environments I've lived in (cold, hot, wet, dry, high pressure systems, low pressure systems, etc..) have had much to do with any attacks I've ever had. The change in the Allo dosage, however….. That is the culprit I'm leaning towards. I'm curious to see my test results next week.
Nate- Your figures are important here as well to you. Little gets back on results of treatment in the public arena and it will help others to hear of direct experiences. Very few report 600mg AlloP.daily!
On the foot warmth- remember my words when you're older and I'm long gone! 🙂
Circulation never gets better with age… so don't lose those snow bootsm ;~)
Yeah, I didn't want to mention the age thing
I'm sure it will be a factor as I do get older. I'm a weather nerd so I'm acutely aware of both the weather and my attacks. I just see no correlation so far.
600m/g is rare. Boy, did I suffer the first couple of months, but it may have been worth it to get the excess and built-up UA out of my body. I didn't notice any side effects from taking such a high dosage either – not-a-one. I do realize that this would not be for everyone.
As a general comparison, a few of my posts on here from I think Nov and Dec of '09 pretty much started out with
*$#@#! this son of a ^&)(#! go& d^#% gout attack!
This latest attack is NOWHERE near that level. It still hurts like heck, but definitely not as severe as before! I just think that any big switch regarding meds, diet, weight loss, etc… is bound to be a trigger for a lot of people.
Hey Nate. Last week, I almost posted the same questions. My UA has been below 5 (4.5 and 4.9) for 2 months now, but I've had 2 major attacks the last 5-6 weeks and I could not for the life of me figure out why. The only thing I could figure is the generic answer of — still cleaning out old deposits. My last rheumatologist said that could happen for up to 6 months. (I had gout for at least 2 years with UA running 9-10 for at least a year before getting on UA lowering meds– thanks to GP, no thanks to doctors who never did realize what treatment was needed).
yesterday, I went to a new rheumatologist. To my surprise, he told me to double my uloric dose (I take uloric because I can't take allopurinol) and my new target ua is 3.0. His reasoning is that with UA below 5, I should not still be having flare ups. Also, in my unique case, I am on a medicine that causes problems excreting uric acid (cyclosporine for kidney transplant). He said for most people the target of 5 is right, but for my situation he wants to get it down to 3.0.
So, not knowing how long you have been on Allopurinol and how much old crystal you have to get rid of, perhaps you needed to stay on the 600 mg for a while longer?
Perhaps the 600>>>300 was too abrupt a change. It sounds like you might be happiest with something in between. But let a couple of uric acid readings determine it for you.
Are you sure those Alaska Sorrels arren't allowing your tootsies to become a little cooler than you think? The solubility curve of uric acid falls off dramatically as the temperature of the joint drops.
Sorry to hear that you had an attack in spite of 300 mg. allopurinol.
Hey zip,
I'm pretty sure it was the drastic change in dosage that caused this – or the exercise. I don't think the cold, or lack there of, in my feet had much to do with it. I'm always out in the snow and have never noticed attacks from my feet being cold. I have some really good gear, too, and rarely have a problem with cold feet. Now, my hands…………
I'm thinking it may have been overdoing it on exercise more and more now. I was feeling pretty good this weekend, but last night I decided to do a little cardio and went pretty hard. Even though it was on a low-impact eliptical, I can really feel the twinges in my right ankle and a couple of my left toes. I don't think these will manifest in to full-blown attacks, but they are bothersome.
I go to the doc Thursday for my test results. I'll report back after I get them.
david – almost missed your post!
I'm at the same stage. Still cleaning out old deposits. It's been six months that I've been doing this now and I am seeing some very positive results. I spent the last 15 years suffering from gout quite badly, so I'm sure I've still got some time to go until I rid myself of everything that has built up.
The doctor that put me on 600mg of Allo basically had the same theory as your rheumotologist – get the UA level as low as possible in order to cleanse the body more quickly. However, one large difference is that he told me to expect some bad attacks while my body was going through this process. Lo and behold, he was correct. The attacks have been less and less frequent and not nearly as severe. I'm definitely on the dowhill side of the gout bell curve right now and look forward to hitting the bottom of it soon. I know there will still be some aches and pains and possibly even some bad attacks. It will all pay off eventually, though. I just need to continue being dilligent with my diet, try to get some exercise and let time do its thing.
From your picture you seem to be a pretty big guy, and thus you might have more cells than most processing more purines than most. So maybe something more than 300 mg/day allopurinol, the dose for the average Joe, is a little too little for you.
Seems logical that bigger people might need bigger doses.
Could be zip. I'll ask the doc about that tomorrow when I see him. I'm just under six foot but weigh 215 and have a fairly athletic build. I have a heck of a time finding clothes to fit me! I darn near hulked out of an XL (american) work shirt the other day when I bent over to stretch. XL sizes fit me fine – except in my shoulders! Finding pants that fit is even worse!
Well, I recieved my test results back today. My UA reading was 5.8 – higher than it has been in months. I really have no idea what could have caused it to go this high from the previous levels of 4.2 and 3.8. Also, my liver enzymes were a bit elevated, most likely due to the 600 mg of Allopurinol. The doc said that he wants to keep me at 600 m/g in light of this higher UA result. We will continue to monitor the levels monthly. He didn't seem too concerned about the elevated liver levels but we will be tracking that too.
some good news – my blood pressure was 128/84 which is much lower than it's been in the past when I visit the clinic. The diet and no drinking at least are paying off in those regards. This is down from the usual 145 to 155 / 85 that my BP is usually at when I visit there. At home, it's normally around 135/85. I really hope I can keep it at this level, or better yet, even lower so I don't have to complicate my gout treatment with BP meds.
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