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Hello fellow gouties,
Been awhile since I’ve been on the board. Hope everyone is doing well! So I’ve been on 300mg of AP for about 1.5-2 years. My gout has been pretty much under control and dormant with UA levels typically averaging between 3.5-5.5 (I have a home meter and test regularly). Long story short I’ve only tested a few times over the past few months (Sept- 5.6, 4.5, 5.5, Jan- 4.8, Mar- 3.9). Well this past week or two my UA has sky rocketed for some reason. I woke one night and actually needed to take 2 Colchicines. My latest readings have been:
5/10- 5.0- Am after fasting…Twinges in feet
5/26- 5.0- Tested a couple hours after taking 2 Colchicine
5/26- 6.1- Lunch time test
5/31- 5.6- Dinner time
5/31- 6.8- Immediately after gym
5/31- 6.8- Retested
5/31-6.0- 1 hour later
6/1- 5.5- Am after fasting
6/1-6.4- 5pm after only drinking lots of water and eating an apple/almonds for lunch
Over the course of a couple years, I’ve probably tested my UA over 150 times and only twice have I seen it above 6.0 (6.5 and 6.2). Now here is the thing, I live a very healthy life and NOTHING has changed with my eating or lifestyle habits and I take my AP every day religously. The one thing that concerns me is that my lower back has been slightly tingling and feels a bit uncomfortable at times…and now all of my joints are starting to tingle and get sore throughout the day. I have a Dr appointment (my first visit to this Dr) tomorrow to get my semi annual liver/kidney function tests done (last time was in October when I lived out of state). Perhaps kidney stones dissolving and spiking my UA??? Anyways, I wanted to see if anyone else has experienced UA fluctuations like this or had any opinions? I don’t want an attack to come on but I dont want to increase my AP dosage unless absolutely necessary since 300mg has worked GREAT for nearly 2 years. I know this drug does NOT lose effectiveness so what gives?Thanks in advance.
Thanks for all the responses everybody lol! Just kidding. Anyways, I went to the DR today and they seemed perplexed that it’s so high now (I also tested this morning at home and it was 5.6). They sent off my blood for some tests and I go back on Monday. They said not to increase my dosage until then.
cjeezy,
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Hi again.
I would look into anything going on that might cause lean tissue breakdowm This might account for a flooding of your system with nucleic acid wastes>>>uric acid.
Heavy workouts? Fast weight loss?
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Allopurinol isn't appreciably a drug that we get accustomed to and need more and more of.
Hey Zip! Glad to see you’re still on this board! I typically do heavy weight training 3X week, however I’ve always done that so I’m not sure why I’d see an effect now. As far as my weight, I’m 6ft and fairly skinny. I typically fluctuate between 175-185lbs. If i take a break from the gym for a bit, how long do you think before my levels would stabilize? Another thought, could there perhaps be old urate that has recently been exposed and is now dissolving spiking my levels?
Update, I went back to Dr today to get all my test results. My labs showed my kidneys and liver were fine and my uric acid was 4.2 even though my home meter said 5.6 (I tested about 2 hours before my visit). This makes me think that there might be a problem with my UASure meter (its almost 2 years old) since most of my recent home tests have been 5.5-6.5.
I feel great about the results, but unfortunately my body doesn’t feel good. Both feet, knees and elbow are very sore on and off today. Honestly, i feel like i did right when i firt started taking Allopurinol. Anyways, I ordered a Kernel home meter last week, but prob won’t have it for a few more days since I’m in the US.
Oh well, I guess at this point I’ll just wait it out and gorge on Colchicine if I need it. I took 5 colchicines last Friday. Anyone know how many can be taken in a week?…just in case I have to do the 1 an hour thing soon 🙁
cjeezy said:
Update, I went back to Dr today to get all my test results. My labs showed my kidneys and liver were fine and my uric acid was 4.2 even though my home meter said 5.6 (I tested about 2 hours before my visit). This makes me think that there might be a problem with my UASure meter (its almost 2 years old) since most of my recent home tests have been 5.5-6.5.
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Cjeezy, maybe this will help: All my home tests taken the same day as the lab tests (5) were about 1.5 -1.8 mg/dl ?higher than the lab tests. My take on the subject: The blood is refrigerated while in-transit to the lab from the point where it is taken. Chances are that the temp of the blood at the time of test is about 65-75 degrees. When we take the home test the blood is about 85-95 degrees because we take the test as soon as we prick our finger (body temp ~ 98 degrees) They have proven that the UA is higher at higher temps (more soluble.)
It's great to see some “real life” figures, cjeezy, and great to see that, generally speaking, you are progressing well.
It is difficult to draw conclusions from your data, though time will tell if this is a repeating problem, or a one-off blip.
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The most significant aspect is that allopurinol works extremely well (in most cases 100%) on uric acid from purines that we eat, but less well on the uric acid that our body generates. The most significant factors, other than eating, that affect uric acid levels are:
– Fasting
– Exercise
– Illness / Trauma
Added to that list, which is especially relevant to those gout patients on urate lowering treatments, is the “surge” effect of dissolving uric acid crystals. That factor is particularly difficult to predict, as it varies tremendously according to how well hidden the crystals are, and if they are in clusters, or fairly evenly spread.
I'm guessing you would remember any recent illness or trauma, and there isn't much you can do to avoid them. The best I can suggest is to stay hydrated when exercising, avoid over-exertion, and avoid fasting. On the subject of fasting, there is a long-held myth that fasting is important prior to blood tests, but I believe this is now largely discounted. For uric acid testing, there may be some complications with testing immediately after purine-rich meals, but this will be minimized with allopurinol.
Keith (Gout Admin) said:
1)? is the “surge” effect of dissolving uric acid crystals. That factor is particularly difficult to predict, as it varies tremendously according to how well hidden the crystals are, and if they are in clusters, or fairly evenly spread.
2)? On the subject of fasting, there is a long-held myth that fasting is important prior to blood tests, but I believe this is now largely discounted.
?3)?For uric acid testing, there may be some complications with testing immediately after purine-rich meals, but this will be minimized with allopurinol.
1) I, my test results, and no real attacks (except for a couple of twinges) for almost a year can attest to your statement.
?2) I was never asked/ordered to fast for my Comprehensive Metabolic Panel /SUA blood tests over the last year. (In the past, yes, always)
3) To avoid that problem/complication I am now doing the home test when I get up in the morning before I take in any solid/liquid food (including water), do exercises, or whatever. Thus, I have a fair chance that my body/metabolism has taken care of every crime I have committed the day before.
1)? good
2) good
3) It's about time you acted your age and stopped these crimes (Hans don't need a smiley to know I'm joking, but happy)
Keith (Gout Admin) said:
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3) It's about time you acted your age and stopped these crimes (Hans don't need a smiley to know I'm joking, but happy)
Forget it, Keith. How in hell can you expect me to act my age at 80+ when I haven't learned to do it from 0 to 80?
Hello everyone…good to hear from you again Keith,
I wanted to post an update. I recently received my new Kernel UA meter. Previously I have been using the UASure meter and actually had 1 test strip left from it. I tested sua today with both meters at the same time and got 6.2. Since I decided to purchase extra test strips with the Kernel Meter, I decided to immediately test again just for giggles. This time results were 7.7! I tested again 7.2! Seriously, I don’t know what to think. Make another appointment with my Doc? They just told me my lab results a couple weeks ago were 4.2. I haven’t had any trauma or illness, I stay very hydrated (I drink 100+ oz of water/day), and I’m not fasting. I’d hate to jump up to 400mg of AP but if I have no other choice?
cjeezy said:
I'd hate to jump up to 400mg of AP but if I have no other choice?
Everything I've read convinces me that 300mg is the lazy dose. Lazy for doctors, not you cjeezy
I've got my first assessment tomorrow, and the doc is going to have to justify why I can't have 800mg per day!
That's after I've tested him to see if he has remembered my explanation of what a uric acid test result means (no smiley – I'm seriously disappointed by his fixation with the meaningless 'normal').Keith are you finally making the Jump to AP? In regards to my dosage, I’ll take a large dose if needed, but I just find it very odd that for 2 years my averages have always been between 4-5ish and now they’re always 6-7. The only thing I can think of in terms of my lifestyle that has changed is that I moved to a colder climate. Maybe during the winter crystals somehow formed and now that it’s summer they’re dissolving. I dunno. Still doesnt explain my 4.2 lab though. I tested again this morning after fasting and got 5.8. I guess I’m gonna call my dr this afternoon and get their take. I’m also refilling my Rx. Maybe my prvious 6 mo supply has somehow gone bad?again I dunno but running out of ideas.
Keith (Gout Admin) said:
… to see if he has remembered my explanation of what a uric acid test result means (no smiley – I'm seriously disappointed by his fixation with the meaningless 'normal').
Keith, I don't know if you are the only one with common sense left in this gouty world of ours! I have just read again your page about uric acid test results. You are so right. The word NORMAL in my book is nothing but a bunch of horse manure. My medical records since 1976 to this date show the high for NORMAL: 7.0, 7.4, 8.0, 8.5, 9.0, even 10.0 mg/dl and the lows from 1.8 all the way to 4.0. In some cases the difference of 2 points in the same year, but from different labs. I have come to the conclusion (similar to yours) that the NORMAL ranges are/were set by the lab directors and they are/were the gods whom we ignorant peasants should not dare to doubt them or contradict. And the ones who SHOULD have questioned them, the gods of the medical industries, went or are going right along with them (each for their own personal reasons or ignorance.)
To respond to cjeezy's dilemma: A book, as thin or as thick, could written about the fluctuation of the UA levels and attacks or no attacks, depending on your or one's ?power, scope, size/volume of imagination. I certainly could and I could contradict myself over and over on the same page without a problem.
cjeezy said:
Keith are you finally making the Jump to AP?
cjeezy, I haven't laughed so much since my daughter sent a Fathers Day card with a cartoon of SuperDad flying through the air, accompanied by her inscription '… if only you could fly!' Nice to see the warped GoutPal humor is hereditary.
I'd sooner say the fall to allopurinol rather than the jump to AP, but yours is much funnier. You've inspired me to update GoutPal On The Mend – click on the photograph I've now added properly. And? please don't be upset if this is news to you – you truly have made my day. A tonic for the incompetence of medics.
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Speaking of which, as you've spent good money proving that you have a more accurate testing regime than your doctor, perhaps it is time to press him on his procedures. You know what happens to the blood you test yourself, but what are the storage conditions for your lab test blood? Maybe you could take the meters to your next blood draw, and test a drop of vintage venous cjeezy juice on both meters? This would rule out any discrepancy between capillary and vein blood.
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To hansinnm and anyone else who is interested in the incompetence of uric acid test results, I'm going to start a new topic soon. A second doctor has just called me normal, and I don't like it.
Haha! Glad to entertain. So how about I’m more confused now. I took a UA reading (w/Kernel meter) in the parking lot of my Dr’s office prior to going in (I did not fast today like I did when I had the 4.2 a little while back). The first result was 5.8. I tested immediately again and it was 6.8.
I asked the Dr about storage procedures and handling of samples and she agreed that there could definitely be a variance between “fresh blood” and “stored/handled” blood, but it should not be as significant as what I’m seeing with my home meter. Anyways GP, I took your advice and after they drew blood from my arm I tested it twice with my meter. It came out to 5.6 both times. Just for shits and giggles I immediately test a third sample but from my finger. It came out to 5.2.
One interesting note is that the nurse said that when I swab my finger with an alcohol wipe I need to not just let it air dry but wipe it with a clean sterile cloth too to remove alcohol traces as they can potentially skew results. I don’t use alcohol wipes (mostly soap an water) all the time but when I do I only let my finger air dry.
Anyways, I won’t have my lab work back until Monday or Tuesday next week. It’ll be interesting to see how they play out. Still have no clue as to whether or not I should increase my AP dosage though. I think my Dr is on the fence at this point.
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