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Hi guys, I'm really at a lost here, and I hope I can find some help here.
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I got my first gout attack a little more than 2 years ago when I was 25. I've always had a bit of a tummy, with a BMI of around 25.1 for most of my life. So, it's generally on the heavier end of the acceptable spectrum. I didn't really excercise, and I have always had a sweet tooth, though I didn't really drink. I've known my UA level was elevated for a while, but I wrote it off as not important.
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Then one day, 2 years ago, I had my first attack. I believe it was triggered by a bowl of liver soup I ate 3 days prior. You all know how it feels like. It was in my feet, and it took over a month for me to walk without pain. After the attack, I went to my GP, and found that my UA level was at 9.4, which is quite alarming. However, my GP told me that since I was young, this can be controlled by diet change and excercise. So, unless I have another attack, it's all I had to do. And so I did what I was told.
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I cut shellfish from my meals, I stopped eating intestines, and I drank more water. Little by little, I excercised more. I still succumbed to my sweet tooth (2 sweetened iced lattes a day). All have been well in the last two years, and I managed to lower my BMI to an acceptable 23.2. So, a week ago, I went to my GP and did another blood work. When the result returned, I was shocked to find my UA level at 9.2. I have been drinking a bit more red wine lately due to lunar new year celebrations, but can 2 weeks of drinking really elevate my UA that quickly? My thought was, excercise and diet really wasn't enough to combat uric acid for me.
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I'm about to discuss this with my GP, and my question is, what should I do? I've always been afraid to be on medication for the rest of my life, but at this point, I'm more concerned about the long term damage the high UA level would do. Should I request my GP to put me on allopurinol even though I haven't had a second attack? What if he tells me I don't need it since I haven't had another attack?
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My biggest concern is, if I go on allopurinol, is it really a road of no return? I'm really afraid of going on med for the rest of my life. Is it possible to use it just to get my UA to a more manageable level, then stop and control it with diet? Lastly, do people normally start with 300g? I seem to see that number quite a bit. Thanks for the help, guys.
Diet and exercise will not have a dramatic impact on your uric acid levels.? But just because you have high uric acid doesn't guarantee you'll have a second gout attack.? I doubt your doc will put you on Allopurinol until and unless you have a second attack.? A small percentage of people never have a second attack and you may fall in to that category.? I would ask your doc for Colchicine or, alternatively, Indomethacin and keep it handy in case you get another attack.? These are anti-inflammatories that will help keep the pain in check.? These are not long-term solutions but, in your case, having had only one attack, you may not need a long-term solution.?
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I went on Allopurinol after my third attack and a uric acid level of 8.3.? I went through the psychological stress of knowing that I would need pills every day for the rest of my life.? Before long, though, you grow accustomed to it and, for me, the 'rest of my life' anxiety was nothing compared to the stress of waiting for the next attack to come.? Now, after four months on Allopurinol, my gout is more or less under control and after about another year, once all the residual crystals have melted away, I'm hoping to be completely free.?
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300mg/day seems to the most effective dose for most people but because some people have allergic reactions most docs will start you at 100mg/day and work you up to 300mg over a period of weeks.? I think once you experience the benefit of the drug you won't want to stop.??
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Best of luck.
Thanks for the advice, drmarclevine.
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My doctor also wanted me to wait for a second attack. However, I'm getting conflicting information on this very forum. I keep reading how you're supposed to demand Allopurinol, and how you shouldn't live with an elevated UA level.
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So, I'm not sure if I should wait longer, and try to cut more stuff out (such as fructose), or just get on allopurinol. Even if I never get another attack, 9.2 is no good, right?
bakabakakun said:
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So, I'm not sure if I should wait longer, and try to cut more stuff out (such as fructose), or just get on allopurinol. Even if I never get another attack, 9.2 is no good, right?
Cut out excess fructose for your general health. The links to gout are tenuous at best, though absolutely nobody says fructose improves gout.
9.2 with no attacks is fine. The general advice with high uric acid and no gout attacks is do not treat, because this appears to be the highest risk group for adverse reactions. At the moment, nobody knows exactly why this is, but the culprit is probably genetic. I.e. if something in your genes allows high uric acid without gout flares, then that seems to link with poor toleration of allopurinol and febuxostat.
I will not speak for others, but my personal view is that you have the right to determine what meds you take, or at least the right to a proper explanation why your doctor will not do it. If he is refusing because of what I said above, then I believe he is within his rights to lower your risk of adverse reaction, by waiting for a more compelling situation. If he is just trotting out some inexplicable mantra, then he is a bastard.
The problem with waiting, is that we do not always recognize gout attacks for what they are. The typical big red toe does not always happen, and you might just experience discomfort or medium pain. This is an indication that uric acid deposits are building up slowly, destroying your joints as they grow. It has a good chance of being spotted by a rheumatologists joint fluid analysis.
I do understand the scary nature of the first gout attack. It is not helped by doctors talking rubbish about diet. You clearly have a uric acid imbalance, and the best you can expect through acceptable diet changes is 10% improvement. If you go extreme, you might get a further slight reduction. This means a miserable life ruled by a stringent diet that controls purines, calories, and iron. You also have to emphasize?foods that are known to have uricosuric or xanthine oxidase inhibitions, as long as you can tolerate these foods. Diet for gout is very very difficult above 8mg/dL
Your uric acid imbalance needs monitoring with uric acid tests at least twice a year. You need to be mindful of pains in joints that do not reach the crippling stage – everything down to numbness and tingling are a potential sign of uric acid crystal deposits.
You must have pain relief on hand. The best solution for gout is one or two colchicine per day which should stop inflammation getting worse, combined with anti-inflammatories. NSAIDs, if you can stomach them, such as ibuprofen or naproxen are usually the best. I cannot speak for naproxen, so consult your doctor or pharmacist. For ibuprofen, gout requires the maximum dose of 800mg – the OverTheCounter dose is simply not enough. You can alternate this with other analgesics that are not NSAIDs. Such a package should allow you to stay mobile during gout attacks.
Beating gout is all about getting a personal plan.
Getting a personal plan is all about finding ways to work with your doctor, or in extreme cases move to a new doctor. Working through your fears here in these forums will help enormously. Use the forums to help understand what your doctor has said to you. Use the forums to get advice about what to ask in preparation for your doctors visit. Forget all the rubbish you may have read elsewhere, especially if it relates to gout and diet.
After one attack, rest assured that a 9.2 Uric Acid WILL cause another, the only variable is timing. Even if it did not, there is increasing evidence that high uric acid is damaging to coronary arteries.
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I feel waiting for the second or third attack until committiing to a life of drugs is a good idea because every attack AFFIRMS a diagnosis. Same goes for a blood test, becasue labs screw up. Nobody should go onto a life of drugs without SOLID confirmation of the disease/illness.
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I think it was the Fourth or Fifth attack that got me on allopurinol (and colchicine) but that last attack was SO perfectly defined with the big purple bunion joint that could not even bear the weight of a SOCK. The earlier ones, albeit VERY painful and needing crutches for 3 days,?were not definitive (ankles, instep, metatarsal.)
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I guess everyone has slightly different stories leading to the eventual life of allopurinol.
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