[CHUNQX]

odo said

1. Very probably
2. Anything less than 2 weeks & your Dr will probably start getting annoyed with you. 1 month should be fine.
3.KId/Liv panel annually (max) if you’re really worried. I’ve never had one since starting Allo (Aug 2010) & not planning to, any time soon.
4. Try Naproxen; it is generally the best tolerated NSAID, but I can’t take them for more than a few days. NSAIDs are only effective early on anyway. Confer with your Dr about colchicine & defer to his judgement.

Re: kayak induced gout flares. Pedaling will improve blood circulation to the feet, which helps transport urate away from the inflamed area, but physical exercise produces more uric acid in the body. Swings & roundabouts Be careful about too much flexing & extension of the toes – you might not notice with a fish on.
Don’t know what tides are like down your way, but try and avoid mid tide when you will have to work harder to stay over a mark unless you anchor (often the best time to fish though )

Thanks Odo.
My Dr is already getting annoyed with me. That is perhaps the disadvantage of being a patient of his for 11 years. He’s seen me through all the minor and more serious ailments (like WPW). I was contemplating a visit later this week to discuss a kidney & liver function test as well as a uric test to see if I need to up the Allo dose. I can so see it coming. He’ll say “First you don’t want to take the meds. Now you want to take more. Can you make up your mind?”. Again, 11 years relationship. I know I won’t get that from a new doctor but a new doctor won’t have a good knowledge of my medical history. Another reason why I just don’t seem to want to shit nor get off the pot… I know the nice people on this site tells me I should be on 300mg Allo minimum. As right as you may be and I might eventually end up doing that (or more), this doctor knows my medical history. He has a medical degree but most important of all, I see him face to face and have done so for 11 years. So if he tells me to take 200mg Allo, I’ll take 200mg Allo. But I take your advice seriously enough to bring it up with him the possibility of needing to up the dose (and annoying him). If I didn’t regard your advice, I wouldn’t do anything about it at all.

Yak fishing. Ah.. A topic that brings a smile to my face and lowers the blood pressure. Went out again this morning and had an even better day on the fish than on Saturday. Fortunately where I fish (Port Philip Bay, Victoria, Australia) is like a big sheltered estuary in that the tidal influences are not massive which means minimal current flow. Don’t need an anchor most times and I hate anchoring because that’s when I get seasick. Foot feels ok at the moment as it did on Saturday but yesterday there was abit more discomfort on the ball of foot so after dinner, I took a diclofenac and this morning its good as gold. I reckon the cold floor doesn’t help either so I’ll have to be diligent abour wearing socks although it looks a bit weird having socks on one foot but not the other.

[CHUNQX]

Almost typical of what I’ve been hearing about gout… just as it seems to start getting much better, this morning, there is a bit more pain in the ball of foot area around the 3rd toe… Not too alarmed this time, I’ve seen this happen too often the last 4 weeks. I’ve been on 100mg Allopurinol for exactly a week as of yesterday and today I start 200g Allopurinol. A couple more questions:
1. Does this mean I’m not allergic to Allopurinol if I haven’t presented any so far?
2.How long after taking this 200g dose should I go the dr and ask for another blood test to see if I need to go on 300mg? A week? 2 weeks?
3. Also, how do I go about asking about a kidney and liver function test? I get the feeling (from my dr) that he doesn’t think there will be a problem for me or that a kidney and liver function test is not normally done here in Aus for Allopurinol.
4. I’ll also go off prednisolone after tomorrow which means I won’t be taking any anti inflammatories. I have diclofenac and indomethacin but if I take them for longer than 2 days, they cause me stomach issues (gasthritis). I’ve been taking the odd diclofenac pill when needed and its helped. But once I’m off prednisolone, I don’t know if I’ll need more anti inflammatories. Should I ask for colchicine?

[CHUNQX]

It was all going well with the foot inflammation the last few days but then yesterday morning woke up to find the metatarsal joint to the big toe is hurting a bit more than before. Not too alarmed this time given what I’d previously experienced. Took a diclofenac pill after dinner with the hope that it’ll clear in the night to enable my fishing plans to come to fruition. Woke up this morning to find the pain gone so off with my Hobie I went. Wasn’t sure how the foot pedalling would feel and at first I could feel a bit of a soreness somewhere but after a bit of tinkering around, I managed to find a way to pedal without feeling any discomfort. Maybe the non-stop fish biting action helped. There were quite a few moments when I was pedalling around to maneuvre into position or playing fish that I totally forgot I had pain in the foot in the weeks prior and everything just felt normal.
I had previously wondered about going yak fishing this early; on one hand you don’t want to aggravate the inflamed part but on the other hand, the morale boost from going fishing would be a positive and now having gone, I’m glad I did go. I feel better than I ever had in the last 4 weeks since the gout attack started. And more fresh white fish for dinner too.

[CHUNQX]

No stomach problems yesterday and this morning my foot is better than its been in the last 4 weeks even with the reduced dose of anti-inflamm. Still a little twinge at the ball of foot occassionally and still walking with a bit of a limp but much better than before. With any luck, I’d be out fishing this weekend (don’t need full feet function to do that).

Day 2 of no meat veggie diet. Trying to make the food as palatable as possible using avocadoes as spread instead of butter. Gave myself a minimum of 6 weeks (more likely going to be 3-6 months) on this diet to see some improvement on the weight and blood pressure and hopefully the side effect of that is lessening of gouty attacks. Surrounded by meat eaters at every meal, its gonna be a long 3 months!! I love my meat. I’m asian so I love my food (at one stage I almost went into the restaurant business so I can concur that outside chinese food is BAD! The essentials for making chinese foos taste good is MSG and lard) but I reasoned that I’d love to see my 3yo boy grow up more than my food, hence this course of action.

On the subject of fruits and veges, there’s a lot of conflicting stuff on the internet, some say apples are good, others say they are bad for gout due to being acidic, same with tomatoes, what’s the truth wrt to these fruits and veges? Or is it as individual as to their effect as the subject of gout itself?

[CHUNQX]

odo said

Personally, I found Allo worked incredibly quickly, initially – like a couple of days, then went through a period of fluctuation up and down before leveling out at a fairly constant level after 2-3 weeks. But that’s me; your mileage may vary. In any event, I wish you an easy & incident free journey.

I take it you know of the fluctuations because you do the home tests for SUA? I haven’t got the kit yet so I won’t know what levels I’m at or if they are fluctuating. On a positive note, I’ve had a good 2-3 days so far where the inflammation seems to have subsided a bit and stayed down(ish). Previously, while on full dose prednisolone, it’d stay down but when I reduced the dosage (dr’s recommendation to slowly reduce prednisolone), it’d flare up again. It has been good the last 3 days where it had not only gotten better, but stayed down. Not sure why that’s come about. I also started 100mg allo on Sunday, started eating a lot less meat, more veges and not sure if they are contributing factors to this upward trend. But I am cautious about claiming victory just yet given that in the last few weeks I’d seen the ups and downs to confirm what you were saying about the inflammation having a life of its own.

On the subject of allo side effects, the second day I took allo, I had a stomachache just before i went to poo and the stools were soft but not diarrhea. I put it down to possibly the poo being more acidic (hey, I’m no doctor)… Third day, almost to the same hour, I had a stomachache again but this time had mild diarrhea. Both times the pain left once the offending subtances exited but there was a bit of gas/ bloating. Is that normal?

[CHUNQX]

I was thinking of a restrictive diet not so much for the gout (I’m not fully convinced that meat intake will slow down gout recovery based on Keith’s statement of “the meat on you is more significant than the meat you take..”) but more for the hypertension and overweight. In which case, whatever fish portions I take will be small anyway (ie. 6oz).

Another (possibly controversial) question, if I may, typically, how long does it take to get the SUA to a safe level from the start of an Allo regime? Its probably different for different folks and its possibly dependent on Allo dosage as well, but typically, what is the timeframe for hitting safe levels once Allo is started? Someone mentioned that Allo takes effect quite quickly but it will only be able to get the levels down to what it can (plateau) and if dosage isn’t increased, it will not go down further. To rephrase another way, say my SUA is 9. If I take 200mg Allo, it may be able to take it down to 7 only and no further. How long does it take to get down to that 7 point from the start of the 200mg Allo?

[CHUNQX]

odo said

At this stage, a severely restricted diet can make a big difference to quicker recovery. Ideally, you should avoid all meat and go on a low protein veggy diet for a while. For some people this is worse news than having gout, but if you’re overweight/hypertensive, it would probably do you the world of good.

1. How long is “a while”?
2. It is not quite worse news than having gout but not far off…
3. I suppose I’m willing to consider it. But I know nothing of diets so what does a low protein veggie diet constitute? Can I make an exception for steamed/bake white fish perhaps twice or 3 times a week?

[CHUNQX]

Thanks for the reply. I’ve learnt so much more about gout this weekend than I have in the last few years since my first mild attack 3-4 years ago. On one hand I’m better informed and will now be more prepared but on the other, I’m a bit devastated by its implications. Its a bit like being told you’re paralysed and never going to walk again after a car accident (admittedly this is not quite as bad as that).
As for further gout flares, my dr still hasn’t prescribed colchicine but I suppose I have the option of going to another dr to get a colchicine prescription. Not sure if I should change dr because this one I’m with I’ve seen for 11 years and he does seem to know what he’s talking about. Even on gout. I asked him about the possibility of meat intake causing gout and he’s said that he knows of patients who are vegetarians and don’t drink a drop of alcohol but still inflicted with gout so its got more to do with genetics than food he reckons. As for anti-inflamm, I’m still on a reduced dose of prednisolone atm and will be on it for the whole week and he said if the inflamm does get worse I can take diclofenac on a need-to basis.
Once I’m off the prednisolone and if gout flares come up, i might have to look at getting colchicine.
On the subject of diet, my wife is getting a bit sick of having to eat chicken, fish and pork only. Something like spaghetti Bolognese (beef mince in tomoto base), is that a strict no-no or does food not play as big a part in this than popular belief?

[CHUNQX]

Thanks for that, Hans. I think I’ve accepted the medication bit. I’ve just started taking the Allopurinol as of this morning instead of Tuesday like my dr instructed. I can’t see the difference 2 days will make especially for the 100mg dose. The 100mg dose will only be for a week. After that I’ll see about negotiating with my dr about going to 300mg. One question: How do I know if I’m allergic to Allopurinol or not (ie. to the point where I shouldn’t take it)?

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