Start Treatment w/o Doctor?

[roundtheworld]

Hi All, I have newly discovered that I most likely (99%) have gout and after fully pursuing gout pal and the forums really have an important question to ask the group. A little background: I am 37, work internationally and currently reside in Dushanbe, Tajikistan. Needless to say, the availability and quality of medical care here is not of Western standards. I am now hopefully at the end of my most recent attack, which started on (maybe before) December 27 in my right knee and then moved into my left foot (big toe) about 7 days ago. The pain associated with both the knee and foot was the most excruciating that I have ever endured. Had it just stayed in the knee and cleared up I don’t think I would have made the diagnosis as I’ve had bad knees since a teenager due to sporting injuries. By the time the toe exploded in pain I went to the only international clinic in town and the Russian GP made me take a blood test as based on the symptoms and appearance she thought it was gout. My uric acid level was at 494.49 ?mol/L, which is clearly in the danger zone. I am overweight and never been shy with the booze so I’m guessing this is part and parcel to my problem. Prior to this flare (by far the worst of my life) I did spend a week in Brussels and mussels and beer were on the menu for sure. Prior to this attack and looking back on past foot issues, it seems clear that I’ve been having attacks for at least the past 3-4 years, with the last attack in my toe this past October 2013. They were never severe enough to have me think of them being anything other than over-use/strain/tendonitis. She gave me Indomethicin and Colchicine, which stopped the pain within 1 night. Swelling and redness remain but are going down slowly. She also gave me Allopurinol, and told me to start with 100mg/day as soon as the pain, swelling, etc. is gone and the toe/foot feels normal. She also gave me 300mg pills and said that at some point I should increase to this but it wasn’t clear exactly when. She didn’t mention about taking Colchicine alongside but reading through the site it seems that it is recommended. I have 1mg pills that can be halved, but what dosage to take is unclear. For the immediate relief I took 1 mg and then 1/2mg one hour later along with 50mg Indomethicin 3x day, which I’ve now stopped as the pain has subsided.

I will not be able to see a rheumatologist without leaving the country. Not a problem, but not something that cannot happen quickly. I was actually supposed to travel to the UK on Monday but have canceled due to this current attack – it doesn’t look like I’ll be able to put on a pair of shoes by Monday! So my question is – is it a good idea to go ahead with starting on the Allopurinol without seeing a specialist? I likely won’t be able to get anywhere to see a rheumatologist for likely 1 month. The good news is that I can get the requisite blood tests here as often as needed, as well as meds, so this is not a problem. Just wondering if I should wait or start. I would really start to get this under control as soon as possible but understand there are risks of starting any medical program without proper supervision. Regardless, due to my work and travel, it is anyway very difficult to develop a long term relationship with any one doctor. Most of the places I live/work have very limited western-standard medical care, so being able to independently manage this as much as possible is a requirement. Regardless, I do intend to see a specialist out of the country asap. Any thoughts on this would be much appreciated.

[Cujo]

Go and see rheumatologist as soon as you can but i’ll tell you what my rheumatologist said to me. She said colhicine works only on gout, so if that drug works on your pain it’s almost unquestionable you have this desease.
If you can, wait with allopurinol but rules with this medication are pretty simple: take daily as much miligrams as you need and what you need is stay on or below 5 mg/dL UA. Test your uric acid monthly. That’s all.
Good luck!

[Keith Taylor (GoutPal Admin)]

@cujo, your rheumy needs a refresher course. Colchicine only for gout is so last century.

@roundtheworld, if I were you, I’d start 100mg allopurinol immediately, and get blood tests in 2 weeks. Include kidney function and liver function tests, as these often give an early indication of intolerance. Increase to 300 if all OK, and test every 2 to 4 weeks, increasing dosage until you get below 300.

Pain relief is either preventative or as required. Preventative is half a tablet each day. If you get a twinge then follow with another half. For .6g tablets the maximum is two per day, so I guess you should stick to one, though some would argue that 1.5 might be OK. Do not take colchicine if you have any infection or are exposed to infection risks. Colchicine limits inflammation spreading, so take at earliest sign of an attack. Indomethacin reduces inflammation, so take it alongside colchicine for fast gout recovery.

[roundtheworld]

Thanks for the advice. I started on the allopurinol and colchichine on Sunday and so far so good. I’m hoping this is the beginning of the end of my gout attacks!

[Keith Taylor (GoutPal Admin)]

Good for you, @roundtheworld. I hope it is as easy for you to control gout with allopurinol as it is for me. If you get bad days, we’re here to help. When you are celebrating Gout Freedom, please call back here to remind fellow sufferers how much better life is when gout is under control.

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