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AP certainly looks simpler than Uloric from above pics.
Is the oxidizing effects of AP a possible reason for the formation of free radicals- and hence negative side effects?
I know Zip, you're not keen on this idea, but free radicals do exist and there's very little on AP side effects 'in depth' floating around, at least from what I've seen. It's difficult enough trying to understand the 'up-sides' alone, for us non Chemists!
I had a quite intense lesion start up on AP on my left middle finger a few months back. It's still red but not breaking the surface, as was.
AP now stopped.
The lump there now seems very similar to other bumps I have on finger joints [all other hand] which are sensitive to being hit/pressured etc and I've always thought those lumps to be urate related.
From this anectdotal tale, I would say it would be no surprise if AP did affect urate pool- though it is supposed to 'work' indirectly through the liver etc. Maybe it's just another of those variables that occur in people.
That said, swollen knees I've had on various meds and this is the more likely cause of fluid retention, unless you've got other indications.
Curiously, drinking more fluid can help reduce fluid retention, by the body not trying to store it- by some accounts!
Yeah Baz- that's 10.3 in mg/dl 'lingo' – which is more commonly used online.
6mg/dl is the max for established gouties – so you get the drift… aim for 4 or 5. [ie:Half whatever your reading is now = 0.3mmol/l -or mid range 'normal']
I was nearly your level myself this year, after not getting on with AP, [a bounce on stopping] but it came down soon enough on Sulfinpyrazone later.
I still watch food type [veggy+ skinned fish, small p/w] and 'try' to keep water intake up. [Always a struggle, as we age] -So a low dose works for me.
Get stuck in to the problem and you'll find a lot of support here- as we've all 'been there', to some degree, or other!
Baz- Everyone's different. Sufferers react to meds differently, Drs have different views, and some of those seem off target, often enough.
Post your result, if you have SUA [and the history- if you can get it]. This helps somewhat to pick up the thread.
Otherways, your advice is correct- if not the dire warnings.
People have reported taking and stopping AP long term here without falling over, I recently stopped it and got 3 mini attacks in a row, last few months, even whilst on a uroscoric- so it's a tricky business getting back on track. This goes for starting, adjusting or stopping meds.
They're more reactive, naturally , than lifestyle options- and if you're really high on SUA read you are better off biting the bullet and protecting your future health by getting on one or other available treatments.
I've found that lifestyle can help a lot to reduce the dose of meds [in the last 2 years] but it's your Drs. job- to reassure you and support your choices- not frighten you over a tricky illness, if that's what's happening.
If you get in earlier than you expected to, that's good- but high levels of SUA pressage a few 'possible' episodes and your Doc may be thinking this, so maybe is over sensitive to your condition rather than being dramatic.
If people react to AlloP– they are quickly taken off, so it IS done- and a slow start dose is usual in this event.
Later on- you're better off on a stable dose and lifestyle balance than risking serious gout pain and its complications.
All meds carry some risk, but less so than ignoring the problem, by far!
UP- Alcohol competes for processing with urate excretion, so not a good strategy in handling gout pain [short term] – or urate build up
[long term]. It gets precedence -as it is NOT good for our system, even if a lifter of moods, that many need or just use.
Beer is worse by a factor of 2, over wine- so switch horses to get a better margin of error. You won't need to wear a pink cravat for this 🙂
Spirits a second best option.
On your intake you're double the healthy limit if on strong >6% type beer, I guess- so you know the long term risks.
I don't buy into the time left scenario as an excuse. With big time gout attacks -you will plan to get a sharper act on the day, but by then it's probably well too late for easy resolution !
Changing a factor in your SUA status by diet, even for the better, is able cause flares- Taking a med, under sypervision, does exactly the same thing, often enough.
This whole business isn't about SIN- more cause and effect!
Probably all three of the above- but in which proportion? That is what needs to be determined!
If you're vulnerable already then extra care is needed, many drugs develop side effects mostly early on- but not always and finally the Manfctrs certainly cover their rear ends , as do medics.
Only human, after all..
On a personal note – I would say short spells off med
with a break gives the body time to recover, if that is possible – but on long term urate lowering meds this is not a viable option, due to tendency for flares caused by SUA swings and re-establishment of the urate pool round the body, eventually.Hans- there is a wild card- it's a genetic lack in the enzyme dept! I'm sure Zip can clarify – I think there's info on here about it.
That's why only a few get gout- that could get it, on their SUA numbers.
The common inability to make Vit C is quoted as a possible factor.
That really makes a change, a Doc getting in first- due to a history of gout in family on just one reading!
Bad luck that it went a bit 'sideways'- I suppose he was hoping to 'kill two birds with one stone' and the main thing now is to see your kidneys improve, and worry about gout just a little later?
You will be at risk now, stoppping the AP, as I found out recently- but as you haven't had attacks- bettter off placed to hopefully avoid a major attack and even niggles. Eventually Gout may kick in- with your history, so don't ignore it.
Your Dr will no doubt come up with an alternative strategy -as he doesn't appear to be one who sits long, just looking at a problem!
With Diabetes, matters are always complicated- so discuss it with him and stay posted. I'll be interested to see what gets done.
Gilles- Maybe your Dad knows this and is keeping quiet- but there is a test proof for gout with drawing a joint fluid sample and viewing the crystals, if any, with a polarized microscope that will show urate [or calcium too]. I don't think this is painful, though it sounds it -and it doesn't seem to be done enough.
My personal; view is 10mg/dl is high enough for gout , but not certain 'by the book' -so this test, or the success of Colchicine, would be classic indicators of gout.
I can see why the use of Colchicine would be held back with the risk if post op infections etc. being harder to manage on it [possibly]- as well as the somewhat upsetting stomach , if to be effective at attack busting!
That's why patience is the word , for me – though it's a bad time doing it , for sure!
Best bet is to push hard, behind the scenes, for the fluid draw and test by a specialist.
Gilles- Surgery and radiation therapy can both raise SUA so your poor Dad really did have a TRIPLE whammy- with an existing condition.
it sounds like things are picking up now- so just make sure you discuss what you can on here and don't try to second guess too much.
It needs time to settle for your Dad ,and backing him up as much as possible ,day to day, will help a lot .
As to Drs. using this site- I've heard mention, and wasn't surprised tbh-
Who would be, if suffering like we do, without much medical 'on the ground' understanding?
One thing you've forgotten Nate- Lactic acid!! Exercise creates it -and it competes with urate for excretion…
Ta for good wishes- now ticking along, but it's been a long year on the gout front having lost 3 months decent activity in all !
Did you seriously keep your water intake up with the meds use , Nate?
Also- it seems you been pushing the exercise 'boat out' a bit far -after 15 years of damage.
Patience.. but really sorry you've hit a bad patch!
It seems your other damage is adding to the pile. On that AP dose, would it be allowable to take a uriscoric on top to hasten matters?
My med [Sulfinpyrazone] works very well ,so far, @ 200mg and you're big guy- and have a lot of history on this, to clear!
I drive an automatic btw, so already one step ahead. The Porsche would not be the same , I suppose with this expensive mod- but modern auto transmissions are brilliant! [Esp. German !]
Sandals? – nearly all year round apart from snow!
Maybe the lower square spots? <evil grin> All the same, gout can be whacked in tow [no pun] by 6 months …Art- you could have hung on !!
I reckon there was another reason to your sale . Gout is known to improve psychic ability, you know! 😉
Bit early to get on the alternative trail Jon esp. after your comment about gout triggers doing the knee…
This site :http://www.medicinenet.com/pse…..rticle.htm gives a good overview though.
It can co-exist with gout and is more evenly split male/females- so if you were female about 5X the chance of it being pseudo rather than gout…. but check out the associated symptoms listed if you're game!
The meds listed there aren't the specific I saw in passing a while back- it stuck out to me at the time- so there is a dedicated treatment listed somewhere- always subject to the 'finding which med suits' syndrome though…
That is said, though- is that the gout is usually treated first anywway, due to joint damage being a bigger risk with gout.
Your Rheumy probably knows best!
Jon- 3 months is not long enough to clear gout flares -anything upward of 6 months gerts reported but of course no one knows how many didn't do this feedback & pain levels a re hard to compare too.
As the lower regions have improved -that's good and if you get attacks in your knees then they may just be the worst place for deposits.
My old favourite culprit with knees is Psuedo Gout- caused by calcium retention and just as painful as normal gout. No reason, afaik, that it can't co-exist one with the other! [The treatment is different, however.]
I've not seen much scale of actual 'attack severity on meds' that would be 'normal' on here- but with any luck the next, if it occurs, will be noticeably lighter in severity. My flare severity has reduced in level in 3 months on a different Urate lowering med- but I tread warliy on the diet, alcohol and keep the water intake up.
It's a slow process- so keep going…
Hey TT ! You've been on crutches with gout!!
If you tolerate AlloP well- then be prepared to take it for a long time, like forever- as you will revert back unless you introduce other severe lifestyle changes/meds to compensate.
Once established on the med, you will get used to the balancing effect your body desperately needs for urate reduction. This will risk some attacks in the next few months- as you mobilize those pesky urate stores you must surely have gained , by now!
There are the usual ways to manage this, but they should lessen in severity and length, in time.
Bear in mind, your SUA readings will vary -and be lowered by the recent attack, so your situation may not be so marginal as you suppose.
CJ: Have you considered using a uriscoric in place of AlloP? Probenecid is available in the US, I think.
This could be as a temporary measure to test your reactions cause – or maybe worth a try, in its own right.
Sulfinpyrazone seems OK with me so far, though it's supposed to be harder on the kidneys. My tests so far have been OK.
Always nice to see a happy gouty, Zip!
Just think, on the wagon for >2 months a year would really clear that urate store- but I know it would be hard to do 😉
It would also help your BP.
Concluding phrase from article ref'd by Zip…
“Effective interventions for the underlying emotional and spiritual wounding behind most chronic disease is critical for the reinvention of our medical paradigm. These numbers suggest that reinvention of our medical paradigm is called for”.
Something we Gouties are always getting back to on here- in our more reflective/narky moments!
Cj- On protocol others can speak for themselves- but i appreciate clear heads when worried or in pain are not alwways top of the list!
On the allergy bit I can see why you were worried- even Zip admits to 27 deaths worldwide- which is worrying if one of them esp. !
I looked into this earlier when I got worried by AP use. I figured 16 [or was it 16%?] known deaths from a one in 3000 reaction was worth considering, really! [ Note to acedemic leaners: From memory- I'm not basically lazy 😉 ]
My lesion started soon after AP use and persisted through it. Local 'call in' clinic said it didn't look 'normal' and offered to dress it.They wouldn't advise on what was causing it.
My normal health care was not available right then. I persisted for a week and then stopped AP- within a day or two the lesion settled and now has left a red lump.
I think it was at a typical urate gathering site as I've had pain on the other hand in exactly the same point with the same burning feeling- just no breaking of the surface that side- or topical pain either.
I suspected from the start that yours was an allergy to something external [or maybe just hoped like you].
Some reactions occur on the way in using the med and others after a while, and some get ignored- depending on users withstand and life habits.
This site is where you can get some non specialist re-assurance when medics are wanting- as they were in my recent case.
CJ- As you're lurking -and I'm up way too early, I'll put you out of yr miz-
Hans is fond of the term Lazy,Stubborn amd Dumb! Don't blame me- He's one of yours,
Bad news CJ- I can see why you're worried- but if it's any help my reaction actually caused localized pain at a lesion breaking the surface [on AP].
Lowering your med or stopping temporarily would flush out any connection- it's not a drug to take lightly when reactions occur.
I don't think my replacement med [Sulfinpyrazone] is available in the US. [Not sure why not].
I would hesitate to reduce meds on one reading.
I had a 'Lo' read on Kernel meter recently- and while it suggests chasing this up with your Dr., this will just be playing safe.
On the other hand ,rather earlier I had a 'Hi' – with the same generalised advice about seeing medic.
Likely, the sample was too small, bear in mind daily variations are normal, higher in the early morning -but not always so, I've found.
In reports on other drugs lowering SUA ,levels of 0 [Zero] were attained during trials and this was not stressed as a problem, as I remember it.
It may well be, on examination, that the 200mg is the right dose for maintenence, as you can keep a good eye on blood level of SUA.
Quick reply: SUA can go over 12 in bad cases.[Rep. here, various]
It's important that you get blood checks- you need time to prove your meds are ok with you and see what flares.
Seems like your Dr has a better than usual understanding of gout, and like many cautious of overdoing it in the early stages.
There's no one formula for gout- other than not ignoring it and measuring your blood often. Personal UA meters are popular for this reason.
What you do right now is a slow effect on what has built up over years, imo. Daily changes mask variations too- diet etc. Water is good, but only in time with the right amount of UL meds/diet change -which you have yet to establish @ correct level.
Keep going on AP now assuming no side effects. Your Dr should advise on this and a flare is to be expected ,but not guaranteed..
Colchicine is not a pain killer and needs to be tailored to the individual [trial and error]- it is effective in reducing the immune response causing the whole shebang of gout attack -Stay near a toilet,though!
@OP 5. Apparently 90% of gout cases are treated by primary care doctors, who under-treat the disease (e.g. don't prescribe high enough allopurinol dose) and aren't particularly up-to-date on the disease. This is claimed to be one obstacle to development of more effective gout drugs – drug companies aren't sure there's really a market here.
Sorry to keep seeing this perspective crop up again and again- the medics have been trained by the Drug Co's to create their market by focussing on the limited success meds can only so often bring. They also wear off in effect over time of use.
Added to this is the underprescribing of UL meds, that only trims back the endemic problem – another thread on GP, on unsymptomatic hyperuricemia, touches on exactly the same issue.
Only when blood UA is properly monitored and treatments titrated in accordance- as discussed, will this scourge of gout be managed well.
Until then a lot of the residue is going where the sun don't shine -but failing to make a successful exit thereto!
PS: On the monitoring of this site by Drug Co's- I say good, may they well blush on occasion, and with >1M hits, getting to be a force for good specifically on this issue.
I'm sure GP can resist a buy out! 🙂
You're right Zip- 'Aspirin like' with the same blood thinning and stomach irritating properties as aspirin but not including it.
Reprogrammed in!It took me ages to realise that persistent headaches were assocoated with gout, as I used to suffer them anyway when much younger [and migraine too]. I suspect this is a similar reaction to the fever mentioned where the immune system is being triggered but itdoesn't really know by what as there is no infection, as such.
On the Vit C and Aleve, my personal opinion is that neither are ideal- as Vit C supports immune system and will make reactions worse at a critical time and Aleve, though of minimal side effects compared to many pain killers, is aspirin based.
My pref. is for CoCodamol effervescent tabs, but used lightly and not for more than a few days in a session, as Codeine can be addictive.
Colchicine is the boyo- but it takes time to work!
