Should I ask for a different pain medication?

[bkd]

Sunday night, six days ago, I started having pain in my left foot at the base of my big toe. I didn’t remember jamming it or anything, so I suffered through Monday and Tuesday and figured out through reading online that it could be Gout. Wednesday morning I made an appointment with my GP and they agreed with me that it seemed like gout but did both an xray and uric acid blood test. At this point the swelling was minimal and I was controlling my pain somewhat with ibuprofen.
Thursday afternoon I got a call from the doctor that the xray and blood test had come back normal and if I still had pain in a week to call back and they would refer me to a podiatrist. By Thursday night my pain and swelling were worse, so I called them back Friday morning, talked to a nurse, and they made me an appointment for next Thursday at the podiatrist. They also gave me a prescription for Meloxicam since ibuprofen wasn’t helping. I was taking 4 200mg ibuprofen every four hours and not getting relief. I quit taking ibuprofen and started on the Meloxicam at noon Friday and as of Friday night it didn’t seem to be working at all. in desperation I dug through the medicine cabinet and found a couple tablets of oxycontin. I took 1 tablet and it significantly reduced the pain and allowed me to sleep. At this point I am concerned about having to deal with the pain for another 5 days before seeing a doctor again. Is a podiatrist normally the next referral for a situation like this? Shouldn’t a joint fluid analysis be done to confirm gout or not? Should I continue to try different NASIDS for pain or is a narcotic more appropriate? I have been over the last week drinking lots of water and supplementing with vitamin c. My normal diet does not normally include high purine foods, I don’t drink alcohol, and the only food related issues are my consumption of soft drinks an relatively low vegetable/protien ratio. I’ve given up sugared drinks this week, but still drink several glasses of unsweetened caffeinated tea.

Also, I’ve been hobbling around all week on this inflamed toe, and I’m guessing that wasn’t the smartest thing to do since putting on shoes and walking on it seems to have made it worse. Should I just stay home sitting down until this thing heals or should I find some crutches or something to get around without stressing it? Without a clear diagnosis I haven’t been sure what to do.

Any advice appreciated.

[MyFootHurts]

Advice: Find out your exact serum uric acid level (SUA).? “Normal” is not enough information.? A SUA in the 6-7 mg/dL range is “normal”, but will caused a goutie much grief.? Call your doc and have him prescribe generic colchicine. Try to have the script filled for less than $5 per pill.? If colchicine helps, you probably have gout. Also try Aleve (naproxen).? It's an over the counter NSAID that seems to work for gout. ?

Joint fluid analysis to confirm gout is definitive, but I don't think it's anything most GPs (or podiatrists) are prepared to do.? You'd need a rheumatologist for that.

Rest is good.? Prop your sore foot up and take it easy for a few days.

[zip2play]

You are in a tough spot bdk.

Without a clear diagnosis it is hard to say with assuredness what to do.

Yes, indeed?you need a diagnosis and I think it is quite primitive to make you wait 5 days to get one.

?

What?I would do is call your doctor or nurse MONDAY morning (or today if you think they are “home”) and get your PRECISE uric acid reading. As MFH said, “normal” has no meaning in gout.

?

NSAIDS generally suck for a gout attack. But for the colossul fu#k up at the FDA in awarding a patent for colchine and pricing it out of the stratosphere I would say get 30 colchicine from your doctor and take about 16 of them?but it will cost you $150 now (instead of $4 last year.)

Ideally, the treatment for an acute attack is 2 colchicine to start, then one an hour until the pain stops or diarrhea starts and an offshoot is that if it works well, it is almost diagnostic for gout.

So if colchicine is off the table, an RX for prednisone is probably best + any narcotics that you like.

?

Now here's what I'd try?don't take it as a recommendation because I am a bit more devil-may-care about myself than I am with others. Six GRAMS of aspirin, every day for a week. Yep, that's 18 adult aspirin per day in divided dosing. The fact is that aspirin will dump out more uric acid than perhaps any other drug. The dumping seems to take about three days to kick in but then the output is immense. BUT a big proviso, you CANNOT use lesser doses because then the effect is exactly the opposite, urate is retained. And don't start this unless you can commit for the whole week, the first three days you don;t excrete much urate (but you DO get?some pain relief.)

The question becomes, can your stomach tolerate that much aspirin.

This was standard treatment for rheumatoid arthritis before the thousand NSAIDS were developed, so a lot of people COULD bear this treatment year in and year out. It will probably work even better with gout.

Like I said, this is not a recommendation, merely something I would try given your constraints.

[hansinnm]

zip2play said:

…zip2play said:

…

NSAIDS generally suck for a gout attack. But for the colossul fu#k up at the FDA in awarding a patent for colchine and pricing it out of the stratosphere I would say get 30 colchicine from your doctor and take about 16 of them?but it will cost you $150 now (instead of $4 last year.)

…

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Sorry to butt in: You still can buy Colchicine in Canada and India for less than $50/30 pills. I posted the URL sometime ago.

bkd: If you can afford it, stay of the foot and use crutches to move around.

Aleve will only work on your pain, but not on your inflammation which causes your pain. Cochicine is your inflammation fighter.

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