[Unknown]

Hi Kipper,

Glad to hear that you are doing well and that you’re having no problems with the Allopurinol. Are you playing sport at the moment and do you think that it is helping to prevent any attacks that you might have thought would have happened had you not been taking it? I notice that your level of 5.0 is not actually lower than some of the previous readings you were getting before.

I’m afraid to say that I have mostly taken Option 1 from my earlier post and done not a great deal about things. I have not had another attack since the last one finally wore off back in December, but then I have not really done a great deal of sport or anything likely to injure my toe either (mostly deliberately) up until last week when I played both squash and hockey. Other than the usual stresses and strains of the match, I did nothing to think I might have injured anything and although my toe has been stiffer and certainly a bit more swollen, it hasn’t turned into anything.

I have cut out beer during the week (I used to have one beer every night) and now have at least two days a week totally alcohol free. I’ve also bought a standing desk and a foot warmer to promote circulation in my feet (which I do think is a prime cause of my troubles). I think my toe is just worn and damaged from all of the sport I have played in the past and the lack of circulation means it heals slower and less completely each time, as well as retaining fluid while it does so.

I am still reluctant to take Allopurinol because, despite the blood test results and all the other evidence, I’m still not 100% convinced that this is gout (I’m aware this is me being a bit of an Ostrich about things and that I’m struggling to think of anything else that might cause such disproportionate pain compared to the initial injury). If I am to take something, I want to be certain that I’m doing so because it’s totally necessary, especially when the attacks happen so infrequently and with a trigger (injury) that I can more or less control (for the most part). If they were more frequent, or if I had at least one that came from nowhere then I’m sure my attitude would change. Also, I dislike taking anything, even painkillers, unless I really have to.

My intention now is to wait and see what happens and, should another attack strike, this time insist on the needle in the joint to check for crystals. If that were to come back positive then even I wouldn’t be able to deny things any longer and I would start taking the Allopurinol. Until then though, I’m hoping that not stressing things and a bit of positivle lifestyle changes will keep me, literally, on my feet.

Cheers,
Mark

• This reply was modified 6 years, 8 months ago by Unknown.

[Unknown]

Hi Keith (and others reading),

I had my second blood test on Friday and this time it came back as 0.47 (it was 0.37 back in October). I’d left it longer to have the second blood test as I was still (and am still) having some discomfort in my foot/toe. It’s not what I would call painful – it’s slightly swollen most of the time, which I can only tell once I have put on shoes and it is tighter than the other foot, but it does occasionally get hot, red and more swollen from time to time (but without any accompanying pain fortunately). Occasionally it will jarr when I bend it to much or swivel on it quickly but I can walk just about OK on it now.

I had thought gout was more short sharp attacks, which can occasionally last longer rather than this constant low level swelling and mild pain?

Anyway, the 0.47 has done enough to convince the Doctor that I have gout so I’m now left with three choices as I see it:

1. Do nothing – hope that eventually the swelling and discomfort finally dies off, as it did (but much more quickly) three years ago. I only ever seem to get attacks after I injure my foot and this is the first for ages. Maybe I just grin and bear it (and take lots of painkillers).

2. Try lifestyle changes and hope that helps – drink cherry juice, stop the beer, wine and red meats etc. I had deliberately not changed anything up to the second blood test as I wanted it to be a measure of what the level was without doing anything. I think though that from your past posts, lifestyle changes alone would not be enough to take the level down from 0.47 to the safe level of 0.3 or below. Presumably though, if I do lower it even a bit, it lessens my chances of another bad attack (or is that not how it works?).

3. Take the Allopurinol that the Doctor has prescribed and see how that works. I am a bit worried about potential side effects though and have heard that there is a small chance of suffering and extreme, and potentially fatal, reaction to it. Also, the thought of taking a drug for the rest of my life is depressing as I prefer not to take anything if I can help it.

Be interested to hear your thoughts Keith (as always) as well as anyone else who wants to chip in? Maybe Kipper has had his second test too?

Thanks,
Mark

[Unknown]

I haven’t started the Allopurinol yet – I was waiting for this attack to end, then have a blood test in 3-4 weeks and confirm that my uric acid levels were the same if not higher before starting on it. Only problem is that this attack seems to be going on for ever.

[Unknown]

So it’s now been 2 1/2 weeks and it seems to have got stuck in a pattern where it is just about back to normal when I go to bed, but then if I don’t take the painkillers I get woken up by the pain gradually increasing after about 2-3 hours asleep.

When I wake up in the morning, the pain has slackened off a bit but it’s now swollen, stiff and painful to bend but then gradually through the day it eases off, the swelling goes down and by evening it’s almost OK again.

I have read that you should keep the joint rested and raised as much as possible, here and elsewhere, but for me resting it and raising it (as it is in bed) seems to bring back the pain. The more I move it during the day, the better it seems to get (after the initial pain). Is that normal? Should I be trying to exercise it more?

At the moment I’m beginning to think that this is the way it’s going to be from now until forever. I also worry that, going on as long as it is, it is doing some kind of more permanent damage 🙁

• This reply was modified 7 years, 1 month ago by Unknown.

[Unknown]

I haven’t tried pillows at night but I have found that, when it is particularly swollen, then raising the foot works, but when it is hurting but not too swollen, as has been the case the last couple of nights, then raising it actually makes it worse – go figure! Also, I’m one of those people who simply cannot go to sleep on their back unfortunately.

I think distraction during the day certainly plays a part sometimes, but this is definitely a case of there being little or no pain (when not moving) when I first get into bed, which then gradually grows into extreme pain over the next two hours. Last night fortunately the co-codamol did it’s job and I was able to have a relatively pain-free few hours.

I have been trying to keep my foot warm but not hot, as you advise, by wearing thick socks and slippers (when it’s not too painful to get those on) but I struggle to keep my hands and feet warm at the best of times. I have a feeling my poor circulation really does not help my cause and may be one of the reasons I am still suffering after almost two weeks now.

[Unknown]

Well the Doctor I spoke to today was much better. She seemed much more willing to listen and also more clued up about gout in general, as well as being fairly happy with the diagnosis of gout. She was aware that test results can be lower during an attack, so I will need to arrange a blood test for a few weeks time, once this attack is over (hopefully).

I was prescribed so Co-codamol to help with the pain I am currently getting at night and also some Allupurinol and Naproxan, to be taken after the blood test to see how that gets on with lowering my uric acid levels – the doctor was of the opinion that as I am not overweight, a heavy drinker or regularly eat purine-rich food then any lifestyle changes I might make would have a fairly negligible impact on my levels.

Edit: Oh and I should just say that despite keeping my foot out of the bath last night and keeping it fairly cool, I still suffered just as much during the night as the previous night, so maybe heat wasn’t to blame. Still, its very odd (and frustrating) that I should be pain free during the day (unless bending my toe) but in such pain about two or three hours after going to bed. Any thoughts as to other reasons that should be happening?

• This reply was modified 7 years, 1 month ago by Unknown. Reason: Additional info

[Unknown]

Hi Kipper,

Thanks very much for taking the time to post. Although I’m obviously sorry you have suffered these attacks, it’s nice to read that someone has experienced the same kind of triggers and symptoms as I appear to have. Interesting that your level was higher on your own test and outside of the attacks (I presume you meant your previous results were 4.2mg and 4.9mg?)- it would be interesting to see what mine is in similar circumstances as I do understand, from Keith here and other sources, that the level does often drop during an attack.

Have you had any further attacks since taking the Allupurinol? Any side effects from it?

Finally, how is your circulation normally to your hands and feet? I ask because mine is very poor and I wonder whether that has an effect on when I get the attacks – the injury or over use prompting an unusually high rush of blood to the area that activates the gout crystals that have gathered in the joint.

Please let us know what your blood test results are and whether you do have further attacks. I am off to the doctor again later today (a different one) so I’ll see what she has to say about things.

Mark

[Unknown]

Thanks for that very detailed response. Much as I might not want it to be true, I do agree with you and the evidence appears to be fairly compelling that I do have gout, regardless of the ambivalence shown by my doctor(s) so far.

Like you, my surgery is a group practice with an online booking system so I will try a different doctor next time to see whether they are any better, or at least show a little more concern than the first doctor I went to.

I did try to book an appointment today as I had a particularly bad night last night, having thought things were improving up to then. I’m not sure why it suddenly flared up again after a pain-free night the night before, though I suspect that the hot bath I had before bed was the cause – like the warm wheat bag before, I suspect that suddenly warming up my foot is not a good idea.

To be fair, the doctor I spoke to about the results over the phone did agree that I should book a second appointment to discuss further options when I told him that I was still in pain and unable to walk properly. When I get that second appointment, I will do my best to get them to refer me to a rheumatologist (and I have company-provided private healthcare if required so hopefully it should be fairly swift) who will presumably have more understanding of the problem and also do the joint fluid analysis to confirm gout beyond all doubt.

I shall try to take comfort in the fact that this, so far anyway, has only ever been brought on my injury or overworking my foot rather than any spontaneous attacks and that this is my first proper incident for three years, so I suppose things could be worse!

[Unknown]

Hi Keith,

I now have the results back. Again the doctor has said that the level is ‘normal’ but I did ask for the actual numbers for this test and the previous one which are:

2014 – 0.37
2011 – 0.40

which are both slightly over the 0.35 on the gout calculator, though according to the doctor it is only over .42 that it is classified as ‘high’.

The doctor I spoke to over the phone suggested I make an appointment to discuss these results with a doctor but seemed to suggest that it now did not seem likely to be gout.

What do you think?

[Unknown]

Thanks Keith. I had a look and from the boxes I ticked, my result so far is a 0.5 if I assume that previous events were gout/arthritis related too?

Male
Previous reported attack
Joint redness
MTP1 involvement

If my uric acid test comes back over that limit, the result goes up to a .86

I’m not too sure what it means when it says onset within one day, but ticking that box didn’t make much difference to the result anyway.

[Unknown]

Thanks for the info Keith. My foot is still very painful and last night was particularly bad, possibly because I wrapped a warm wheat bag around it before I went to sleep as it was cold and swollen (my feet are always icy cold at the best of times). It varies now between feeling like constant cramp with the occasional shooting pain if I move it in the wrong direction.

I had the blood test this morning so will report back with results when I get them next week.

[Unknown]

Thanks Keith.

I did actually have some x-rays done privately when I went to see a podiatrist after the second occurrence in 2011. He said they looked normal (and having looked at them recently and compared both feet, they do to my untrained eye too), but whether a rheumatologist would spot anything different I obviously don’t know. In the end, he was unable to say why I was having a problem but at that point the pain was very sporadic and there was little swelling to see.

I’m not great with needles and having read about the fluid test I was quite apprehensive, so it’s good to hear it was painless for you!

Once my blood test results come back, I’ll try and get some more specific information about the uric acid levels both for this one and the one I had back in 2010.

My thought that this might be gout is that you would expect a traumatic injury to get worse quite quickly after the event, not wait for 3-4 days before suddenly exploding. Maybe the trauma drives a sudden increase in blood to that area (and I have very cold feet at the best of times) that gradually activates the gout crystals as well over the next 72 hours – is that plausible though?

I guess what really bugs me is the total lack of concern shown by the doctor I saw, despite the fact that this has happened several times now and makes life very difficult for several weeks each time. If it is gout, surely there should be more than a ‘Take these painkillers and wait for it to get better’ and if it isn’t, I need to find out what it is to see if I can stop it happening again (and again).

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