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There is no doubt that muscle breakdown caused by intense workouts kill muscle cells and liberate large amounts of nuclear material rich in purines.
I've worked with weights unceasingly for the last 51 years. Sometimes it seems unfair.
Here' a thought to reconcile the old indolent gouties and the active youngsters: aging causes muscle loss. Those who were very musclular in youth will naturally lose a lot of muscle mass as they age even if they try to keep working out…I know from painful experience. If that is true, then the most gout prone segment of the population wouolod be those who were formerly in shape who are getting less and less so as the years move on.
Probably, those who never picked up a barbell in their entire lives, or ever swam, ran or bicycled might be those LEAST likely to get gout.
Another unfairness seems to be the increase in gout attacks with weight loss…thus those fatties who NEVER consider a diet might fair better goutwise. Bah, humbug!
esobogal,
That chart is a big reach. It basically shows two pathways, one indicating that fructose is converted to glucose…yes indeed.
Another pathway is that purines are converted to uric acid…yes indeed.
But thank you, you did as I asked; you provided a chemical pathway from the internet…well TWO actually connected by a couple loops at the top that were supposed to convey meaning.
Relationship between the two pathways…hooey and a bit of quick doubletalk about ATP.
So if you eat some fructose and some sweetbreads, you'll make urate…yes indeed. But you don't need the fructose to get the same effect….the body will break down all foods with the pyrimidine ring fused to an imidazole ring, a purine, to mostly uric acid and you don't need fructose. These rings are mostly nitrogen compounds…fructose is nitrogen free and CANNOT be made into urate, not by God himself.
Hans,
Dr. Lustig starts this half hour by saying basically : “Why does the Atkins diet work?” and goes on from there. Problem is IT DOESN'T WORK. This illustrates a prejudice and makes the rest of the work useless.
It's like a tedious presentation entitled “What are the attributes of GOD?” that begins with the statement ” Since it is obvious that God exists…”
Be honsest with me…did you listen to the whole 90 minutes? C'mon, be honest!
Yes, fructose is fattening, glucose is fattening, and meat is fattening, potatoes are fattening and cheese is fattening…less of any of these or less of their total will lessen obesity. This info doesn't make for books or lectures as witness the very first diet book written by UGGO in pre history. It was in cuneiform on a huge stone slab…it had but two words: EAT LESS. It sold poorly.
So pundits have to come up with GIMMICKS. “Buy my book and I'll show you the single food you need to avoid to get a 6-pack you can grate cheese on AND have huge erections to boot!”
So fructose is today's enemy…last decade it was fat…before that it was STARVATION.
All gimmicks and Mercola is the QUEEN of faddish gimmicks.
If someone wants to ferret out all the HFCS in his diet, go for it. It will not be easy nor will it affect your gout at all unless you take allopurinol also. If you want to eliminate ALL fructose, make sure you never have a piece of fruit again. Maybe easier would be for some brave guinea pig with a UA tester: test your uric acid and drink a 6 pack of UN-diet Coke, all 1000 calories (yecch)…then test again. But then Mercola or Lustig might claim you need SEVEN Cokes…that's common quackery, you didn't take enough to show the effect.
There was a radio food guru named Gary Null (who also wrote 18,000 bad books) who claimed Vitamin C caused cancer. When confronted wiith “We tried, it didn't work” his repy was the same: “You didn't use enough.” When he was finally driven to the absurdity of recommending a daily IV drip of 120 grams (yes, a quarter pound) of ascorbate he finally threw in the towel and stopped gassing about his cancer “cure.” I hope he didn't kill too many people.
The same people yammering about fructose are kind of STUCK when they criticize sodas…they cannot say drink Diet Soda instead (no sugars) because LAST year, the enemy was artificial sweetners, precisely aspartame which caused all disease. (I wonder what the single thing that is killing us will be NEXT year…I'm sure Merdcola will be the first to let us know. I hope it;s canned peas because I hate them.)
I've watched the diet game for a long while. Maybe I'm not the only person who remembers the claims that FRUCTOSE was unique among sugars in that the body IGNORED its calories. Health food stores were selling fructose supplements to lose weight. Anyone else remember that fad? Yep, they had EXPERTS making the claims just like Lusty Lustig.
In 2020, Fructose will probably be claimed to cure cancer.
See, the way it works is that when almost evereyone is agreed something is true like FAT IS FATTENING AND CAUSES HEART DISEASE, an iconoclast like an Atkins can make BILLIONS by telling us FAT IS GOOD FOR YOU AND CAUSES WEIGHT LOSS (he died of cardiomyopathy and fell on his head.) Another fave is the Eat 42 times a day diet to lose weight.
The curse is governmental abdication of Quackery Control…so the Quacks quack to make money, facts and studies and testing are not needed.
We see it with the cherry pushers and the homeopathic cures…and trips to Lourdes.
Something to look for when searching for truth: When anything is shown to cause or cure almost EVERYTHING, you are being sold a bill of goods.
But for those with gout who choose to believe in the gouty horrors of fructose, perhaps you can test for us: give up fructose and also give up allopurinol. Let us know how well you do.
Anyone who is listening to Lustig, somewhere around minute 45 he starts with the chemistry which turns out to be intense minutiae, chemistry is like that, but PRECISE. He makes believe he is being precise. But here's how he BEGINS the last hour: “take 2 pieces of bread…they contain 120 calories of GLUCOSE.” Problem is that is a lie, they do NOT contain that much glucose but far far less. This belies the hour of minutiae of chemical conversions that follows.
Yes, the body can convert starch of bread to glucose…but why begin a chemical presentation with a LIE? The presumption is the rest is a bunch of half-truths also. Again, just like “So now that we all believe in God, we will prove what color his hair is!”
Twenty minutes later he says: “Fructose is sent to the liver to be changed. Now what do we call a product dforeign to the body that must be changed? We call it a POISON!” On the grounds of that sentence alone the man should lose his job because he is a fool. The liver changes almost ALL foods before the body can use them. ALL fat is sent to the liver and changed.
I wonder who paid him for this lecture?
I made it to 1 hour 5 minutes and could bear no more doubletalk and half-truths.
Niacin is a potent urine acidifier. Thus those with high uric acid run the danger of precipiitating urate kidney stones.
I would LIKE to take niacin because I run low HDL's but every time I try even 500 mg. per day, I flush so badly that I feel like a witch in an auto da fe. (Booze raises HDL nicely…hip, hip, hooray!)
Kimmermann,
The odds are very good that nothing you now do will stop your gout attacks short of going on a urate lowering drug.
Mercola is wrong, trev…as he usually is. He is close to beliieving that all the world's ills are caused by fructose. He is a QUACK, par excellence, and thus probably EXTREMELY rich by now.
There is no conceivable chemical reaction that can convert fructose, a simple sugar, into uric acid…none. If you know of one, let me know.
limpy,
Go even slower with your prednisone withdrawal.
I took 4 weeks just to take myself from 20 mg. to zero after using prednisone to combat a bout with shingles a decade ago. It worked like a charm with only 2 weeks of grief because I got started on it within 48 hours.
For a wonky heartbeat, supplemental magnesium (like 500 mg. MgO per day) is a very good idea. I know from personal experience. Give it a try after you get done with the cardiologist.
Hi don,
It's hard to say how many of your problems are related to gout. I share your stent, your statins and your BP meds…most of the last are a curse to those with gout.
It sounds like your circulation could be better and I think it might be related to your keepping your BP too low. It's nice to have a NATURAL low BP but medicating to get artificially low numbers is likely to cause more harm than good. There is very little evidence supporting taking drugs to lower your BP that much…moronic doctors notwithstanding.
If you are taking any thiazide diuretics, consider getting off them…they are absolutely the worst drug a person with gout can take to the point that they should absolutely be discontinued.
Hmmm, even without attacks, bedcovers hurt your feet????? Food for thought there.
If you want that beer, consider upping your allopurinol to 300 mg. (It's also cheaper that way!
)Coffee and vitamin C supplementation could be considered as preventive measures as these can lower urate levels
Personal experience: I was drinking almost 2 Liters of strong coffee for 40 years and 2 or 3 GRAMS of Vitamin C per day (for a couple years before deciding Linus Pailing was a total whack-job) before I developed the worst gout attack on record…not having met Henry VIII!
AND I developed coronary artery disease somewhere along the way.
A friend avoided the coffee but took 2 grams of Vitamin C for 20 years. He developed gout and died of a heart attack.
I hope Mr. Choi has better luck.
For the record and for what it is worth: Vitamin C, ascorbic acid, is a VERY potent urine acidifier.
I'd love to get off the prednisone. I've been on it too long.
If you DO go off the prednisone, make sure you wean slowly…at least a month, maybe even two.
and I can almost put both socks on by myself!
It's a good thing it's not ice-skating season!
Hi guys, welcome to the forum.
Palmetto (so I'm guessing South Beach or Lauderdale?)
As you are doing, the watch and wait is the way to go.
How many is too many? I think that 4 attacks that put you on crutches for a couple days is too much in a year. ONE attack that has you looking for a shotgun to blow your foot off is too many. Know well, that the pain that you suffered that allowed you to STILL go to work is indeed a tiny attack compared to the pain that can be wrought, where the thought of a shoe, a sock, a flip flop or even a STEP onto the offending foot is no more conceivable than flapping your arms and flying . “Impressive” is indeed a good undertated word for gout pain…my thought was how the F*$K can a toe hurt so much. I thought that kind of pain was reserved for the Inquisition.
I think once gout is properly diagnosed, i.e. once you really HAVE it, it ONLY GETS WORSE. So while it is good to wait a big attack for diagnostic purposes, there is no future for CONFIRMED gout in just treating outbreaks. Every attack lays down more urate and permanently damages a joint…every bit of urate makes the next attack more likely. My prediction is that you'll probably have another attack by Labor Day…sorry. Why not go into your doctor's office between attacks and get another serum uric acid done? Between attacks is most likely to yield the most trustworthy values.
(My hat is off to anyone who can take so much ibuprofen…just reading the post made my stomach burn.
)P.S. The skin over my attacks never peeled either.
snoopy,
Unless your serum uric acid levels are very high, you are going to be in never-never land for a while. While one might easily diagnose gout from a big red bunion joint and a screaming patient, such is not the case with a sore knee…the joint is too complicated and there are a vast array of injuries that it can sustain.
If your doctor is amenable, perhaps he can prescribe some colchicine for you. If something like 2 or 4 pills per day result in dramatic relief, that is some evidence for the pro column on the gout diagnosis. If it doesn't help, there is some evidence for NOT gout.
A lot depends on your uric acid. If it's not ragingly high, you will probably have to wail til a recurrence of the classic toe, instep or ankle pain. You don't want to rush into a life of treatment until you are completely sure you have gout.
In general though, most knee pain is NOT gout.
esabogal,
Yes, that is AMAZING…thank you for posting that very illustrative graph.
Lesson to be learned is that getting an annual serum urate level at the doctor and showing “normal” is no guarantee that tomorrow or after tonight's dinner or over the coming weekend, one's uric acid is not going to be high enough to easily precipitate. The swings in uric acid are quite dramatic. That's why I often say that while 6.0 is usually deemed safe, a 4.5 is FAR safer and less likely to give you an 9.0 after tomorrow's delicious shrimp scampi.
(I hope your doctor has you on 300 mg. allopurinol, esobogal.)
Jay,
Of course the worst offenders in the pharmacopeia for CAUSING gout are thiazide diuretics which expel sodium and water and to keep the body's electrolyte balance neutral, RETAIN uric acid. For this single reason I think that they should be banned for middle age men or at the very least for those with high normal uric acid levels.
Now, alas, almost ALL BP meds wave the flag about their various mechanisms of lowering BP, whether by blocking ACE and thus making less angiotensin-2, or by preventing it's attachment, or by acting on the adrenals or the pituitary blocking renin from being made etc.
BUT the main final effect, no matter the mechanism is almost always the exulsion of sodium and water by the kidneys and the same resultant retention of urate.
This is a fact that most gouties learn the hard way…and few doctors understand. Yes, most anti-hypeertensives raise serum uric acid. There is but one exception, Cozaar (losartan.) It is an ARB that is also uricosuric. Alas it is a weak antihypertensive but nevertheless all hypertensive gouties should be on it, even if they have to take other crap with it. Too bad it is still under patent protection and thus still pretty $$$$pricey$$$$.
Aside from losartan, I THINK the least offensive group might be the calcium channel blockers…but don't hold me to that. BUT they have a doozy of a side effect…most of them cause your feet to swell. Nice for gouties, right??
Fred,
Diarrhea is not an expected side-effect of allopurinol. Is there a possibility you are also taking low dose colchicine; colchicine IS a POTENT laxative.
Stay with the 300 mg. allopurinol. In the early stages of treatment a uric acid of 4.5 is FAR safer than a uric acid of 5.5. If you can go a year or so without an attack then MAYBE consider lowering your dosage and tolerating a higher uric acid.
Unless you have a lot of urate deposits, allopurinol will dramatically lower your serum uric acid in just a couple weeks, as you have seen.
Haolboy and limpy,
Welcome to the club that nobody wants to join. You are both on allopurinol…good, that will be the answer the rest of your life.
You are both in the “settling around of the urate phase” that some os us have managed to avoid by getting diagnosed early. So you are both going to have a moveable “feast” as uric acid goes from one joint to another. I hope it is quick for you.
Haolboy, I do not know your allopurinol dosage but I read that limpy is taking 200 mg. I feel strongly that any doseage below 300 mg. is too low ESPECIALLY in the initial settling in. In order to stop moving urate from one place to another depending on temperature, joint acidity, position of sunspots etc. I think it is wise to manufacture as little extra uric acid as is practical. ANd for this I consider 300 mg. a minimum dosage. While a 5.5 mg/dL urate may be good after everything settles into a pain free existence, there is safety in lower numbers…4.5 is better.
Taking 300 mg. instead of 200 will certainly do no harm and will very likely safe you the pain of several attacks. ANd there is no hard and fast rule that says larger men may not do even better on 400 mg. alopurinol.
But in my book, nobody should be on a dosage of 100 mg or 200 mg. in the early stages of gout management. MAYBE after a few years a lucky few can take 200 mg. (but then even for them, why risk it?)
Prednisone is a wonderful drug but it has SO many side effects it cannot be counted on for long term pain control. Colchicine is a better drug for gout.
Good luck to you both. I hope you soon get to join those of us for whom gout pain is only a vey unpleasant memory.
Me too hans…
I have NO dietary restrictions and even enjoy shrimp, scallops, calves liver, and chicken liver pate, gravy on everything, bean soups, wild mushroooms when I can find them, oatmeal once a a week, WHeteana-farina once a week (I'd have it more but prefer eggs to mush.)
I'd even go for Sweetbreads if some kind soul would pick up the tab at some fancy-schmancy French restaurant occasionally.
My only dietary restrictions are the caloric ones…and that's quite enough worl
It's the reason we take allopurinol, so we don't have to live like monks.
Allopurinol stops us from turning all those purines into uric acid so it MIGHT be a different story from probenecid. But it seems likely the net result would be the same.
As an aside: I have proven coronary artery disease and I could torture myself with diet but I choose to eat what I wish and pop 40 mg. Lipitor and that gives me LDL's in the middle 60's which is humanly impossible with diet even eating nothing but mown grass.
Some drugs I DESPISE…but 2 I LOVE: allopurinol and Lipitor.
Just a couple more thoughts John:
Thanks for spelling out the study, I understand completely.
A problem I see is that it was sounds UNBLINDED, which would makes it a poor study. Do I have that right, or was the information withheld from doctor and patient UNTIL such time as part one of the study was complete? (Pity the poor souls that had to go for months getting shots of SALINE every two weeks.)
But IF you can get the stuff in the future, your being in group 3, in essence getting a shot a month and being able to control to 3 mg/dL, it would seem that is all you would need and perhaps could get by with a shot every 6 or 8 weeks and still remain below 6 mg./dL.
It would seem to me that the first thing the company should do to mtitigate side effects, especiially annoying ones like extra deaths
, is to lower the dose to that minimumm doseage to control gout. Certtainly taking uric acid to zero (still skeptical) is certainly massive overkill.While you are waiting I have ONE STRONG RECOMMENDATION: take 300 mg. allopurinol daily, a dose at which your liver enzymes seemed to remain okay. Even if you are not able to assure yourself of readings below 6.0 I guarantee you will lower your uric acid by at least a couple points which might keep you away from any major attacks or lessen their severity. Check your liver enzymes regualrly to make sure you stay in safe margins.
Ask your doctor for a copy of your liver enzyme results from any time period he/she/they have. With them in hand we can talk about their significance. By law they must keep them and by law you are entitled to them.
Now from super-skeptic: I can envision a situation where a doctor is eager for study money…it is sometime $$$HUGE$$$ and I HAVE heard of a doctor or two who are eager for cash, I know, hard to believe. Such a doctor MIGHT be tempted to submit patients for study who do poorly on allopurinol “Oh goodness, his SGPT is a bit high.” “Oh goodness, he is only getting a 6.1 SUA on 300 mg. allopurinol.” Etc., etc. “Ca-ching.”
But again…you must do something besides just waiting for FDA approval. Look on the bright side of the FDA delay/inaction…perhaps you are being protected from having a heart attack.
Doing nothing is NOT really an option for you.
Jeff,
It sounds like some dissolving and reforming is going on with an immune stimulation each time. This is probably resulting in more and more urate being removed each time.
Do these micro attacks always come on after a period of immobility, like several hours sleep?
What serum uric acid readings are you getting?
Consider sleeping with heavy socks to keep your feet warm and urate more soluble. Consider upping your allopurinol and/or your colchicine?
Which liver enzymes got elevated on febuxostat? How high? Your uric acid response to the drug was superb.
Did you REALLY mean to say you got uric acid values of ZERO with the uricase? ZERO to me sounds like a lab error.
Often times in a study, a caring company will offer their volunteers a lifetime of FREE treatment. It seems only fair since you are risking life and limb for their potential financial windfall. Ask them.
Do you have ANY idea how the study was structured? How long, how many people. Those extra three cardiac deaths might be insignificant in a study of 10,000 people but QUITE significant in 100 people. Their excuse that those extra deaths occurred in SICK people is disingenuous at best…if the study was random and double blinded there were sick people in both groups.
DO check into benzbromarone, some Europeans SWEAR by it, and also make sure that any liver irregularities exhibited during the febuxostat trial are evaluated INDEPENDENT of the uricase people. A lot of people walk aroound with slightly abnormal liver readings. I feel pretty strongly that marginal liver enzyme irregularities, which can be quite common, are very often FAR less damaging than a life of untreated gout.
What problems did you have with allopurionol? Did you go to higher doses?
If all else fails, perhaps you can get the uricase in some country that approves the drug even if it means you must administer it yourself…ugh!
I REALLY hate the fact that Savient isn't publishing these results.
It's like blood pressure:
A marginally useful measure is a single reading in a doctor's office. An EXTREMELY valuable measure is a daily average taken at home over a 3 month period.
jfee,
Indocin (indomethacin) is a good joint and muscle analgesic. I tried it LONG ago with some success but found two problems with it: it SLIGHTLY upset my stomach afer only a couple days (tolerable), but worse, it made me VERY dizzy (intolerable.)
My sister likes it for aches and pains.
GoutGal,
How are you making out? Not to be repetitious but for any attack that goes on for weeks and weeks I think the only GOOD answer is high dosage colchicine for one day…up tii 16 pills. It has been the method of choice for 2,000 years and now doctors (who have never had gout) piddle around with 2 or 4 pills with evidence based on NOTHING.
Usually the first couplee attacks last only a few days…mine went away by themselves in 4 days. But then my fourth or fifth attack, the doozy, lasted a full 9 days before I could stand it no moe and did a husge dose of colchicine aborting the atttack.
So after 4 days that attack should stop soon.
Confused?: I see 2 posts by twstephens but the number of Posts under his name says “posts 1”????
From my research it seems that MOST people are fine with 100 mg. aspirin but a significant minority (like 25%) may find this low a dose ineffective. I think a 325 mg. regular aspirin is almost always enough.
But since I have proven but well controlled heart disease, and a stent, I take no chances and do the 2 pills for myself.
Beware that if you are taking any OTHER NSAIDS a day before or at the same time there may be significant interference with aspirin's clot-busting ability.
John,
I am sorry to hear of your failures with Allopurinol, Uloric, and probenecid. Were the failures actually demonstrable with symptoms or merely the result of aberrant liver function dyscrasias… often they can be of little significance. It seems more than a bit odd that ALL these very different types of drugs produced the same liver ailment.
Well as you know, but maybe some here don't Krystexxa is an articficial uricase, an enzyme lacking in humans but present in many animals that breaks down uric acid to a more soluble compound easily disposed of. It is delivered by injection or IV drip a couple times a month. It was developed by Savient Pharmaceuticals in 2008 and submitted to the FDA early last year lyear. Becasue of high side effects it was REJECTED in the Summer and resubmitted.
Nearly a quarter of patients taking the drug in a study suffered a serious side effect, compared to just 12 percent of patients who were taking inactive placebo pills, researchers said. Six patients died while taking Krystexxa in the study, but just three patients who were given placebo pills died. Many of the patients who died had pre-existing heart conditions, but still, twice as many died while on Krystexxa than on placebo, which is concerning.
The patient injuries and deaths apparently raised questions at the FDA.
So John,
it really lowered your uric acid to ZERO…that seems hard to believe, and a bit of overkill. It does not seem possible to attain a zero. Perhaps the testing used too high a dose and thus enhanced the side effects if anything approaching zero was the goal of treatment.
Of course people who have shown resistance to ALL treatments DO need something else but I suspect that number is small, that a lifetime of an intravenous drug administered twice a month is more than a little cumbersome, hideously expensive, and seemingly dangerous.
You aren't iinvolved with Savient are you or a stockholder?
If all is as it seems I can recommend two things for you: benzbromarone from any of a dozen countries overseas (but beware some liver issues,) or losartan (Cozaar) a weak angiotensin receptor blocker drug that is coincidentally uricosuric.
Failing all of that, your only remaining answer seems to be a purine-free diet…appalling though it sounds.
Given all the evidence, it seems to me that the chances of the FDA approving Krstexxa for drug resistant gouties is less than the likelihood of their approving benzbromarone.
Appropos of nothing:
Savient had a 50% stock runup on Friday after being mentioned by the FDA according to this article but the numbers I checked didn't warrant that claim:
http://www.fiercebiotech.com/s…..2009-06-12
As the old miner said: “There's gold in them thar hills.”
The skeptic in me has my ears up.
I was also disheartened to not be abvole to find a single mention of how the studies were done, how long, how many people, how compared, etc.. I thought the FDA last year DEMANDED release of drug tests whether or not they met with the drug coompanies hopes. I guess good ideas are quickly dashed in this non-regulatory environment.
vegetarianGuy said:
Post edited 9:14 am – June 17, 2010 by vegetarianGuy
I got my blood tests done recently as my father has Gout + Type II Diabetes.
My fasting readings were-
Glucose 3.7 (3.9-6.1)
HbA1c 5.6% (4.8-6.0)
Should I worry about my A1c numbers?
Am I walking toward Diabetes too?
No, no worry at all greater than the man on the street; not unless you decide to gain 50 pounds that is.
With allopurinol I am certain that I can tolerate low dose aspirin. But for certainty of my interfering with clot formation I take 650 mg. aspirin each and every day and it has not casued me any gout problems.
Absent the allopurinol, I would think again but few problems are as bad as a heart attack or a pulmonary embolism.
Take the aspirin…and consider taking it every day/
I think there's a residual amount of urate deposited with EVERY attack and this is walled off by the body outside the joint and outside the reach of the bloodstream. Think of it as a scar. I am certain there are tophi that form that are completely impervious to any intervention except surgery…they are FOREVER.
I have a tiny painless tophus (about the size of a lentil near the far end joint (distal?) of my little finger. It formed without ever causing me any pain at all, probably as a result of being the coldest joint in my body.
My right bunion is slightly larger than my left and that was the site of my ONE murder attack 15 years ago. So I guess it is likely to remain larger until the day I die…and then some.
I have had only one tophus resolve…a medium sized one on my thumb. Over the course of a year, it worked itself out under the nail (causing a huge painful lump under the nail.) It was amnazing to watch the inexorably slow progression as my body tried to get rid of it. Finally at mid nail I grew impoatient and pierced the nail with a red hot paper clip and the wound oozed a white chalky cream for about a week. I was CURED: tophus GONE!.
Sometimes you have to have mercy on the doctors (but not too often.)
Recurrent foot pain that is slight, with a low normal uric acid reading, and a good response to colchicine is a vexing issue. One might just make a guess and say “It's gout” but for the fact that the cure is a LIFETIME of drugs. That single item makes it mandatory to be certain of the diagnosis…and that certainty means both doctor AND patient.
So having a doctor say “Let's wait for the big one” is not unreasonable. In the absence of a very high serum uric acid reading, the BIG ONE is often the only way to tell whether or not it's gout. I waited out about 4 “little ones” (but not so little that I didn't need crutches each time) and I only took action when I met Beelzebub face to face…and then he went down on me, and tried to eat off my big toe for 9 days of the most excruciating pain.
monaco,
If you decide to wait for the big one, make sure you have a bottle of colchicine handy so you can abort the attack when you cannot stand any more pain. Have a couple more blood tests while you wait. Who knows, you might see an 8 or a 9 pop up?
Richard,
I'm pretty sure that with 120 mg. Uloric you will be able to eat and drink anything you desire.
After a while, perhaps you will be able to do the same with 80mg.
It turned out that after a fair walk, I started having trouble, intermittent pain in instep and took 2 MORE colchicne, 4 allopurinol and a double dose of losartan (uricosuric BP med.)
All is calm today in spite of 7 beers yesterday.
I guess one is NEVER completely free of an attack risk.
Looking back, I had skipped 2 days of my allopurinol (and my Lipitor) becasue of fear of an interaction with the azithromycin, a strong macrolide with a propensity to mess with MANY other drugs.
It's the first time I've taken 4 colchicine in about a year (so I expect some diarrhea today.)
