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Linda, I’m totally dumbfounded by this. Is that a real doctor, or someone who has advised you over the Internet?
If it is a real doctor, please supply his/her contact details.
Your uric acid is dangerously high, and I am concerned that you get the right treatment. This goes way beyond gout diet. You should be getting help with lowering uric acid to 300. Switching from beef to chicken in your situation is like trying to empty the Atlantic with a teaspoon.
I’m anxious to help you out of danger, so please get me your doctor’s details so I can send some relevant information that will guide your treatment. If you want some practical advise on gout diet, tell me your favorite foods, and I will suggest some recipes/meal plans that will not harm your gout.
Thanks @g-man. I look forward to your updates.
In an interview that I have lost the link to, one of the rheumatologists on the American guidelines team sought to clarify ‘less than 6.’
He said that 5 was the optimal target, but 6 might be acceptable where kidney disease or other health problems prevented lowering to 5.
If anyone can help me find that interview, I will be extremely grateful, and I will amend my article accordingly.
The only time you should settle for 6 is if other health problems, usually kidney disease, stop you getting it down to 5.
5 is the safe upper limit recommended by professional rheumatologists in America (goutpal.com/4235/taking-gout-guidlines-to-task/) and Britain. If crystal deposits have left to increase over several years, then it makes sense to aim lower than 5 for at least one year. This reduces the period of time you are in pain.
If your genetics are against you, it might never be possible to achieve 5 with dietary means alone. In my opinion, it is good to aim for beating gout through lifestyle improvements as long as you accept that it might not be possible. It takes many months, if not years, before you can get uric acid low enough. Therefore, it is wise to take allopurinol for a year to clear out as much of the old crystals as possible. The sooner you do that, the more chance you have of joint recovery without surgery.
As far as fluid intake is concerned, it is better to be flexible, accounting for temperature and exercise. You might need less than 2 liters on a cold inactive day, and more on a hot, active day. Coffee is good for gout (goutpal.com/gout-diet/gout-diet-foods-to-eat/coffee-and-gout/).
There is evidence to suggest that tomatoes are good for gout, and less evidence to suggest that edamame beans are (goutpal.com/gout-diet/gout-food/).
If I were in your situation, I would increase my allopurinol dose, then review in 6 months. I believe that by getting uric acid below 300 for a few months, you increase the rate at which uric acid crystals dissolve. That means less time needed for colchicine, and less time you are at risk of another gout flare. Once substantial deposits are dissolved, it is quite likely that you can reduce your dose.
Hello, @haoleboy. It’s nice to hear from you. Boy, have you been mistreated by your medical team! How do these people get away with it?
“doctors in the US including an orthopedic surgeon” – gout should be easy to treat by a family doctor in straightforward cases. If not straightforward then a rheumatologist with gout experience is the only answer.“I have done the colchicine” – many doctors don’t understand colchicine. It works well to stop inflammation spreading, but you usually need anti-inflammatories as well, to take down the inflammation if it has already started. You might also need analgesic to block pain for a while. Colchicine should be avoided if you have any form of infection or any immune system weakness. It is best used to prevent flares during the early weeks of uric acid lowering treatment.
“one injections kicks my gout right in the [email protected]@!” No! It has not kicked your gout anywhere. It has temporarily got rid of your pain. Your gout is still there, getting worse everyday.
“This drug has not been FDA approved” Because of safety issues. The rejection is not clear, but revolve around safety issues. Pfizer haven’t pushed it since rejection in 2005. My guess is they make enough cash from alternatives, and there is nothing exceptional about parecoxib. (That’s medically speaking – I know it’s exceptional to you)
“If any of you know of any side effects or long term problems with this drug than let me know.” The specific problems of parecoxib seem to relate to post-operative care, where the drug is usually targeted. There are side effects with all the common forms of pain relief prescribed for gout. They all revolve around gastro or cardio. The serious effects tend to increase with longterm use, and with age. That is why all gout pain relief should be seen as a temporary cover while you treat the real problem – excess uric acid.
“For now i am enjoying relief for the first time in years” This is great news! I think it is very important that gout sufferers learn to take control. It’s fantastic that you can live your life without the threat of losing work, or just having those miserable, painful weeks of “a funky limp and a gimping look.”
I find it incredible that anybody has to suffer gout pain in the modern world. Pain freedom is easy when you tackle it in the right way. It’s a heavyweight fight though. If you don’t smash it in round one, you are going to get a battering. You’ve found your way to take down gout pain. Just don’t forget that the gout pain heavyweight has a management team that’s going to find bigger and better fighters. Your parecoxib is protecting you now, and that is a very good thing. It tells you that you can control gout pain.
Anyone can find ways to beat gout pain if they are serious about it. I learned from hospital nursing staff. The last thing they want is fat old men like me wailing in the night, so they really know their pain control. It’s a good feeling when you beat the pain, so I’m glad you’ve found something that works for you. There are thousands of similar options that do have FDA approval. Unfortunately you have been talking to the wrong people. Your quacks have hidden the good stuff from you. I don’t know why they should do that, but the stories on these forums tell me you are not alone.
Now that you’ve found a way to stop gout pain, it’s time to think about stopping gout. Unless you get uric acid down to 5 or below, your gout is going to get worse. Eventually, the parecoxib will not be strong enough. What do you do then? There are certainly stronger options that will take the pain away. You can keep moving up the pain league with stronger pain relief to fight stronger gout. The trouble with that way is you die early.
A better way is to remove gout completely before it destroys your joints and spreads to your organs. I have shared your joy at finding a way to control gout pain. I cannot describe how much better you feel when you control uric acid properly so you know you’ll never get gout pain again.
If you need advice and help getting uric acid controlled so you never need pain relief, I’m always here.
Uric acid levels in the blood change from day to day, and through the day. That is why I recommend uric acid blood tests to be taken at the same time of day, unless you are using a home uric acid test kit to analyze fluctuations.
@sheldon, I don’t understand how you can still be getting gout attacks with uric acid below 300 (?mol/L) for over 2 years.
@gjsml2014, as I replied to your previous post – 8 (mg/dL) is not low enough for uric acid. Just because you are not having a gout flare, uric acid crystals are still damaging joints, and will also spread to soft tissues risking heart disease, kidney disease, and other organ damage.Wow! Thank you @sorepaw. That is great advice, and very helpful for UK gout sufferers.
“Also I dont have to worry about getting more drugs every 28 days which is already becoming a pain and I?ve only been taking allopurinol for about 7 months.”
That is as beneficial as the money saving. I once ran out when I decided to stay longer at my daughter’s to help with some jobs. I had to return home, just to get a repeat prescription. If I was on a six month repeat, I would definitely have arranged that before I left home.
Hello @sandra-boletchek. Thank you for joining the forum.
I do not have much more to say about plantar fascia than I’ve already said. I linked to my article Running On Gouty Feet, above. In that report is a DECT scan of a foot, and if you click on that image, it gives more information. The quick way to get there is: Gouty Foot DECT Image.
The most important thing to remember is that, left untreated, uric acid crystals will spread everywhere, and affect more joints every day. It is not enough to control pain – you have to get uric acid below 5mg/dL. Gout does not go away when the pain stops. Uric acid crystals continue to grow and spread. They weaken bone, cartilage, ligaments and tendons. This is a very slow process, but the longer you leave it, the worse it gets.
The most important information we get from this new technology is that we can now see very early damage to joints in places where we never noticed a gout attack. Our bodies are very good at repairing themselves, but we have to allow them to do so by getting rid of the uric acid crystals. The longer you leave this, the harder it is to get rid of the crystals, and the less chance your body has of repairing any damage caused.
Thank you @sorepaw
Please let the rest of us Brits know how you get on with the private script.
Very nice to hear about the lack of flares. Gout Freedom land is a seriously good place to be. 😀
I’ve also been thinking about the logic of this, as I can’t find any specific research.
When you get a gout attack, white blood cells start to grow, divide, and multiply. That is the phagocytis that produces the glowing terror of a gout attack. That means WBC count must go up, at least temporarily. But the research I’ve read so far relates to joint fluid. If WBC count rockets at the site of the gout flare, does it fall in the blood stream?
Moving on:
“The problem is I don?t think my diet is very bad to begin with. I avoid dairy for the most part and limit breads. I don?t eat fast food very often. I do however eat red meat so I will cut back in that area and see if it helps.”Never forget that gout is a uric acid metabolism that is genetic in most cases. Yes, bad diet can make it worse, and in extreme cases it might be the only cause. People have very different ideas about what a bad diet is. In gout terms, the causes are excess animal purines, excess calories, and the big one – excess iron. Minor influences are dehydration and rapid weight loss, but those tend to be temporary.
Even that does not give an absolute answer, as people have different ideas about what excess is. Excess animal purines happen when more than 15-20% of your calorie intake is from animal flesh. Excess calories are when you are fat. Excess iron is harder to judge and requires careful analysis of your blood test results and diet.
If none of those three apply to your diet, then it is not bad, and no amount of dieting will save you from gout. If you have borderline or risky uric acid levels, you might be able to tweak your diet. This involves a lot of work making food choices that lower uric acid, and confirming the action with your own uric acid meter. Personally, I find allopurinol easier, but I’d be happy to work with anybody who wanted to try the diet improvement way.
Hi @sorepaw, thank you for joining the forum. As this is not a strictly medical issue, I hope you won’t mind me ranting on a bit. You hit a nerve. 😉
You and I are in the same boat, though I have a slightly more positive spin on it. Basically, you either make the most of it, or get out of Broken Britain. We’re bailing out the bankers, though it’s probably more to do with the landed gentry and their stakes in the financial markets. The government has to do everything it can to milk ordinary citizens, so we get ripped off with prescription charges. Yes, not even the sick are safe.
You’re asking where the positive spin is? Well, I’ve yet to find a better country to live in, so I make the most of what I’ve got. I get 28*900mg for my ?8.05, and I can’t be bothered complaining about that price for Gout Freedom, when I’m so busy complaining about the price of beer and wine 🙂
The 28 day maximum prescription length stinks for gout sufferers. I believe there are concessions for some illnesses that require lifelong treatment, but not gout sufferers. Despite gout being a largely genetic disease, there is a common view that it’s a lifestyle issue. Take it up with your MP – it’s what they get paid for. Better still, persuade your MP to take you and I out for dinner to discuss it. That way we get something out of the expenses scandal.
Apart from my ranting, I’ve tried to look for ways around the 28 day prescription limit. I’ve not had much time to do this, but recommendations I’ve found so far are:
1. Buy online as you suggest, but beware counterfeits – I remember a serious problem in Hong Kong a few years back. [but if you poison yourself it’s a massive NHS cost, so they might change policy! 👿 ]
2. Check all local doctors – apparently, some are more sympathetic to extending the time period.
3. Say you are going abroad, and need a larger supply.Has anyone got other suggestions?
Hi @airjs22, and thank you for joining the forum.
First, I’m not a doctor, I just know about gout. My information comes from experience, and researching medical literature.
I cannot find any specifics relating to serum tests, only synovial fluid. Even then, it is complicated and changes over the course of a gout flare, so the only meaningful data comes from a series of tests over a few days.
A little research on WBC outside the field of gout tells me that the total itself has some significance, but again, unless it is dangerously low, a series of tests over time is required to get a better picture. More importantly, it is not the total count that you consider, but the total and the ratio of different types.
It’s similar to cholesterol. People panic when they get told they have high cholesterol, but there is much more significance in the ratio of HDL to LDL.
I’m approaching 8 years with this forum now. If I had a dollar for every panic caused by too little information I’d be a rich man. Discuss it with your doctor. Do not assume that it is connected to gout unless thorough tests by an experienced rheumatologist tell you it is.
What you should be worrying about is the 7.7 uric acid level. You need to get it to 5 or lower to stop your joints crumbling. Don’t settle for anything higher than 5.
Do you want a side bet on the WBC? My $10 says you’ll be normal on the next test.
I wouldn’t know an RA symptom if I fell over it. I know gout from personal experience and research. What you have described is outside either of those. In cases of unclear diagnosis where gout is suspected, the best way forward is to see a rheumatologist. They can rule gout in or out, and arrange treatment or further investigation as appropriate. If you do go to a rheumy, please let us know what is said and done.
I should explain that point 2 better. I don’t mean take pain relief for 6 months constantly. I mean take it as required. After 6 months you should not need it any more, because gout should be controlled by allopurinol.
I have to say that from everything you have said, I do not believe you have gout. I strongly recommend seeing a rheumatologist.
Hi @thefridge, you have made some interesting points.
First, I’m puzzled by your blood test result. Uric acid can fall during a gout attack, but 4.5mg/dL is quite low. Do you have earlier test results with higher values? I am very critical of a sight-only examination of your ankle coupled with a 4.5 reading. That should have prompted the doctor to refer you to a rheumatologist for joint fluid analysis. It is a painless process that rules out conditions that mimic gout.
If it is gout, allopurinol is a good idea, but it needs good pain relief support for the first few months. Colchicine is the obvious choice, but other options are usually OK. A combination of pain killers is usually best, with something to reduce inflammation, and something to block pain.
Again, if it is gout, the uric acid crystals can grow anywhere in the body. Plantar fascia is involved in less than 5% of gout cases. With such low frequency, I did not specifically include it in Running On Gouty Feet. Without a thorough medical examination, we will never know if it is gout or something else.
If you cannot get a proper medical examination, the only other thing I can suggest is to proceed as if you do have gout. That means:
1. Monthly uric acid tests to make sure uric acid is as low as possible, but definitely below 5mg/dL
2. Pain relief for up to 6 months, as required
3. After 6 months, review progress.If pain and swelling is gone you are OK, if not, you need a specialist examination.
Very pleasing to learn that your uric acid is below 300! 😛
Personally, I wouldn’t reduce the dose until I’d gone 5 months without a gout flare. If you are going to reduce it, the half life of benzbromarone is only about 3 hours on average. 1 report (Rapid and slow benzbromarone elimination phenotypes in man: benzbromarone and metabolite profiles) describes how elimination varies from person to person. A range of 1.77 to 5.24 hours in normal responders, but in one subject with an elimination defect, the half life was just over 13 hours. Logically therefore, it is best to spread the dose and 25mg per day would be better than 50mg every other day.
If you are getting fluctuating blood test results, it is correct to test every month. You can extend the period when results stabilize. Because of the rapid effects of benzbromarone, I’m wondering if results are affected by the time of day, and the interval between taking the drug and taking the test. The answer to that is beyond me, but something you might like to discuss with your doctor. I believe this could be important if it means you are only below 300 for a few hours per day? I’m a bit out of my depth on benzbromarone. Other uricosurics, probenecid and sulfinpyrazone are normally taken up to 4 times a day.
Not the best answer I’ve ever given, but I hope it helps.
No, @dc2400969, you should not stop taking the allopurinol. At least not until you have had a uric acid check and discussed it with your doctor. It seems a long time to be taking colchicine. It should not still be necessary if allopurinol has brought uric acid below 5mg/dL.
I know that gout can cause tendinitis, but I’ve never heard of the other way round. Having said that, any damage seems to make gout worse. Certainly, two health conditions together are going to make pain relief difficult. I can’t add much to @tavery’s point 4, except to say that some pharmacists have a clearer idea about pin control than some doctors.
On the allopurinol dosing, it is a fact that on average, doctors have failed to provide a high enough dose to get rid of uric acid deposits quickly. I imagine average doses will rise, as the 2012 Rheumatologist guidelines become more widely read and doctors change their procedures. One thing is clear from the guidelines – doctors should never adopt average or standard allopurinol doses. Gout patients must be treated to target so that uric acid is made safe.
4mg/dL is safe, but it may take some time for old deposits to go. Taking all these points together, it seems to me the best way forward is to carry on and be patient, but also see about effective pain relief.
I hope you are taking the colchicine to help you during the first few months of uric acid lowering treatment. If that is the case, have you tried a combination of gout strength NSAID (ibuprofen, naproxen, indomethacin etc.) with an analgesic such as Tylenol (paracetamol)? That always worked for me, and has been recommended by several doctors, both in and out of hospital. Nothing beats a good combo, though I have also had excellent results with colchicine.
Indomethacin is just a pain killer. Quite good for lowering inflammation, but if you are not doing anything to lower uric acid, it doesn’t have much chance. Every day that you have excess uric acid is another day of crystals growing in your body.
Indo eventually is not strong enough. It might have worked in the past, but now your joints are really bad.
You need allopurinol to get uric acid down to 5mg/dL or below, and indomethacin to help with pain until uric acid is safe. You should also see your doctor about colchicine or other pain meds if indomethacin is not enough by itself.
Welcome to my club of gout sufferers who leave it too late to control uric acid. I should have known better. Now it’s your turn to get your doctor working for you. If you need any help asking the right things from your doctor, or any help understanding what he is saying to you, then just ask.
Paul, point 4) is wrong. I can see you are having prolonged problems, but if you had not done something, your gout would be a lot worse, and you would be in a lot more pain than you currently are. You have not created a monster, you are defeating a monster, but it takes time.
1) and 3) You say you are in worse pain than before, but that is what happens with gout. Pain gets worse. Nobody knows how bad your pain would be if you had done nothing. Gout can cause tendinitis. You need to get this checked. You might be unlucky to be suffering long term effects of gout. If this is the case, it is just a coincidence that it is happening after starting allopurinol. Of course, it might be something else unrelated to gout. It’s just guesswork without some medical input.
2) You haven’t told us how long you have had gout. Your uric acid has only been safe for 6 months. The allopurinol you took in your first six months might have helped limit the growth of uric acid deposits, but it will not have done much to reduce them. Being below 5 is a start. I find it shameful that doctors do not react to the evidence, and aim for the lowest uric acid possible. I got mine down to about 3, and got pain free in 6 months. That’s after untreated gout for at least 16 years. If you don’t get it low enough, it slows down the rate at which old uric acid deposits dissolve. While they are still in your body in significant numbers, they are going to cause pain.
To offer any more, I really need better information. How long have you had gout? What is your allopurinol dose. What is your probenecid dose? On balance, I’d say you just need to be more patient, but your extra information might offer other clues.
Sorry for the delay in replying.
Yes, you can, and should take pain killers with allopurinol.
Some doctors recommend every day for 2 to 6 months. Others recommend keeping them available to take at the first sign of a gout flare. All the combinations you mention are OK.
Colcrys is available at discount to qualifying people. More info from NeedyMeds at http://www.needymeds.org/drug_list.taf?_function=name&name=Colcrys&gname=colchicine&coupon=1
I found a combination of ibuprofen and paracetamol (Tylenol) to be almost as effective as colchicine-ibuprofen combo. Your pharmacist should be able to advise other effective combinations.
Wow! Great post @davidk.
If anyone is holding back from getting gout under control, this sqays it all:
After the 6 months, I?ve not had another flare up in 3 years. I ski with my kids and enjoy a normal life completely free of any gout symptoms.
Wonderful.
Actually, @cujo, the question isn’t very unusual. It has been discussed here a few times before, unfortunately without conclusion. You can see the discussions if you search for allopurinol infertility in the search box above.
I’ve also tried this search on a couple of science databases, but I still cannot find anything conclusive. It might be that a fertility expert has better access to relevant science. I have seen a small number of references to allopurinol in books about male infertility. Unfortunately, these are in lists of substances, with no explanation of where the data has come from.
Colchicine is also listed, but that makes sense to me, and studies have confirmed it. Colchicine helps gout pain by interfering with the inflammation process at cell level. It restricts cell growth, which is good for limiting inflammation, but not good for fertility.
It might be that allopurinol has got onto the “bad for fertility list” because self-reported side effects could be from gout sufferers who have reported all medications. That’s a ‘might be’ and a ‘could be’ in one sentence – as you can see, I’m clutching at straws.
My starting point would be to assume there was no connection. If difficulties arise, you should consult a fertility expert, who might have better information. By the way, I did find nearly 500 studies of anxiety and infertility, so maybe my best advice is to stop worrying.
If allopurinol is at fault, it is OK to stop it for a while if you are very careful. Uric acid crystals grow very slowly. If uric acid has been at 5 or below for over a year, taking a break from allopurinol should not cause gout attacks. You would need to monitor uric acid levels monthly, and restart if it rises above 6.5.
Good luck.
Hey @alvin5791,
No worries! Well, just one – I’m Keith. No one calls me Mr Taylor – I wondered who you were replying to at first 🙂
It’s me who needs to be sorry. I mistook your post for something else. My bad. Thank you for explaining about the anti-inflammatory properties of curcumin. I’m sure it will help other gout sufferers.
Please share more when you have time.
Hi @alvin5791,
Won’t you share your research with us, otherwise it just sounds like a sales pitch (and only I’m allowed to do that 😉 )How does your research into curcumin for gout match with my research, linked in my previous post? Also:
Why is it “strongest and best quality”
How did you determine that “there’s no better one on the market”
Where is the research that decided “the only side effects of cucumin is that it makes your blood thinner”Thousands of gout sufferers (including me) are desperate to know where you get your information from. Please share.
