Forum Replies Created
-
Posts
-
Hans,
Have you considered adding Uloric to your probenecid regimen.
Alas, I realize that you, like may of us, have an issue with high pricing for these new patent meds. I could not afford a lifetime of Ulroric (at an average price of $168 a month.
)Have you ever rechallenged yourself with allopurinol, in the hope that your first failed attempt was a fluke?
Does a Canadian pharmacy beat Wallmart or Target pricing at $10 for a 3 month supply of probenecid?
Hans,
The pictures inspire me to only two words: JESUS CHRIST!
You should consider a combination of Uloric AND probenecid and consider surgical removal of the bulk of those tophi (and repair by a plastic surgeon.)
You will NEVER get all that urate out through your kidneys.
(How can you resist slicing through the thin skin of your finger to let those harsh white tophi right under the skin out? I;d be at work with a sterile razor blade in minutes.)
Are you in continuous pain with only degrees of difference?
***********Thank you for sharing those pictures. If they don't keep people on their meds, NOTHING will.
This is going into the notebook as a possible reason to try – IF, and only if, I can't maintain the good years' progress to date. That is still open to proving.AlloP
Yes, we are all biding our time hoping another will see the light.
It's just a matter of time before everyone with gout will start to take the meds. Gouties are divided into two groups:
1. those taking allopurinol, uloric or probenecid,
2. those who have not yet started their eventual meds.
parag,
If you are taking 300 mg. allopurinol and getting a 4.8 uric acid, then consider this an ideal dosage and plan to continue it forever. DO NOT go off the drug or cut back to 100 mg.?
For extreme pain I am particularly fond of colchicine. For excruciating pain that hads gone on for several days the regimen is 2 half milligram colchincine. Then one an hour until pain relief, diarrhea, or a total of 16 pills have been taken. It seems that when the diarrhea begins the gout attack stops…there is some weird correlllation between the two.
(If you try this method, please read up on expected side effects (horrific diarrhea) in earlier posts so you are not caught by surprise.)
Nick,
From what I have observed, 300mg. is the most common and safest dose.
Those who are on 100 mg. tend to be those who have one attack after another…it seems to be just enough to irritate gouty deposits without resolving them. With tophaceous gout (knob on bunion) resulting from many years of improper treatment, the 100 mg. dose will prove totally inadequate, probably worse than nothing.
Consider following your doctor's (and my) advice regarding that 300 mg. dose. I would likely consider it a minimum dose.
Congratualtion GP, but how on Earth did you manage to lose 4 pounds a week?
(Youu weren't a contestant on THE WORLD'S BIGGEST LOSER were you?
Antibiotics ASAP…but it sounds like that;s what you are doing.
The usually horror is for an annoying insect bite to push in staph, always present on the skin, into the body. The infection rages quiickly and can be life threatening.
I was badly bitten on an ankle by a blackfly or two at a picnic. Next day I went to work with a sore foot. By 11 AM my SHOE had to be cut off and blue lines extened up my extremely swollen calf to the knee. Hospital by 11:30 AM and IV penicillin given in large dose. Better by the next day.
Doctor said a few more hours and septicemia would have been likely: he said most likely from staphlococcus.
I don't think gout is involved here, trev. (But DO tend to those readings over 7.0)
I was prescribed AP 300mg (100 x 3) every day. I took that for 2 months. Monitoring it every 2 weeks. When UA was bellow 6, I was asked to lower the dose to 200 and take it for 4 weeks and then reduce it to 100 for 4 weeks.
You were obviously treated by Marquis de Sade, MD or else Doctor Iman Asshole.
That allopurinol regimen was GUARANTEED to cause your controlled gout to flare again into acute attacks.
He should have left you on the 300 mg. FOREVER. Apparently he was trying to find exactly the right amount of allopurinol to CAUSE an attack…he did. In good treatment the goal is to PREVENT the attacks.
Alas, ppkul, it is rare for a large tophus to resolve without either rupturing or surgical removal. The body has successfully walled this off and it is pretty much outside the effects of drugs.
Good study VG. I would have expected as much. To my way of thinking it is only PEAK exercise, in this case 1 minute at 120% capacity (that's BRUTAL,) that will destroy muscle tissue and release copious nucleic acids whereas a modest couple hours at a lollygag pace wouldn't do much.
I guess heavy weightliifting would be the ULTIMATE peak exercise. Incredible output over a VERY short time. Something that has always stuck with me was the claim that a SINGLE repetition of a lift at one's ABSOLUTE maximum capacity was the ultimate muscle builder (and perforce, muscle destroyer.) That's more theoretical than practical becasuse the thought of a maximum lift right out of the starting gate sounds like the PERFECT recipe for injury…but the principle remains valid.
It is extremely unlikely that anything LIKE allopurinol is available naturally. The body take purines (mostly xanthines and guanines) from food and oxizes it with the enzyme xanthine oxidase…as the name implies.
)The beauty of allopurinol is that it is almost IDENTICAL to xanthines and fools the xanthine oxidase to attack IT and change it to a rather soluble product that the kidneys can readily excrete. It keeps the xanthine oxidase busy NOT making so much uric acid.
It's not Big Pharma that is pushing allopurinol as VG correctly said because you can treat your gout with 300 mg./day for the princely sum of $40 PER YEAR, in the United States WITHOUt insurance. Try treating yourself with cherry juice and you'll spend 20 times that amount.
What it boils down to is if you have faith in the non-drug claims…and there are THOUSANDS…then try them. If the pain recurs your choices are to try something else and then something else, and then something else. If you are very lucky and persistent one of these may work. But remember, THAT method, too is FOREVER.
If nothing works, you get sick of the regimentation, or you have the atttack from HELL that makes you consider jumping from a high window or sawing off your foot, the allopurinol is waiting at the pharmacy.
Remember also that controlling pain is not the same as controlling gout. The extreme is someone who spends his life on a morphine drip to treat gout: he will feel no pain but the progression of the disease will destroy his joints. Analgesics are fine when we need them but that is NOT the way to manage gout.
For me the choice was easy. I spend every day controlling my weight, I spend every day at the gym trying to fight the muscle loss of aging, I spend every day keeping my drinking to manageable levels. If I had to also fiddle with purine intake, cherry juice, black bean broth, no meat, no shellfish, etc., I'd go NUTS.
Oh, and I did have the crippling attack from Hell bedridden for 9 days, so my choice was easy.
Thank GOD for allopurinol…15 (or 20?) years and no attacks.
nina,
Allopurinol won't “cure” a current case of acute gout (inflammation) but that attack will subside eventually by itself. Having a uric acid as low as he does will probably guarantee that once the current attack ends, he will problably not suffer any more attacks.
Be patient.
Alas, with a history of stomach ulceration, there are few analgesics that are wise. He could get away with colchicine if necessary.
(I am assuming you are using the words INFECTION and INFLAMMATION, with swelling, redness, pain synonymously)
Counting my coffee, maybe 4 to 5 liters. Hot coffee and COLD water.
When drinking beer add a liter or two.
I don't think allopurinol would affect allergies. It is most likely a coincidence. There are a lot of Spring pollens in the air this time of year.
A way to find out for sure is to stop the alllopurinol for a week or two and note your symptoms then restart and note your symptoms.
(Of course this risks an attack so maybe some prophyllactic colchicine during this period might be wise…like 2 a day.)
Get those old uric acid numbers.
“Normal” and”High normal” means something different to those who HAVE gout, those who DON'T, and doctors who don't know what they are talking about, merely reading a printout.
If you give us these numbers we will get you on the right path.
K
Get your uric acid tested ASAP now that this attack is waning. If it is high enough, then get on allopurinol (yep available in the U.S. for $4 a month at Target, Costco, or Walmart.) Same for colchicine…at least until the “patent protection police” get to it.
If uric acid is NOT too high, then you can wait and see if more attacks occur. You can try adjusting your diet, although all those tables seem like gibberish to me also. But to each his own.
I can attest to ONE thing about cherry juice though…it is absolutely DELICIOUS if too pricey for me.
Bok Choy IS a cruciferous vegetable.
But I believe that anyone trying to control his gout attacks with diet will benefit by eating ANY vegetable in place of meat or fish. For gouties vegetables are all different degrees of good. (And animal flesh is different degrees of bad.)
And remember, those sulfurous cruciferous veg have been shown to be cardaic beneficial…and HALF of us die from destroyed hearts.
Is this your FIRST attack of foot pain or have you had bouts of unexplained pain before, usually starting on awakening, in your instep or ankle?
I think that colchicine is by far the best drug for an acute attack because it interrupts the attack where it is happening probably by alkalizing the joint.
The good news is most early attacks lasst about 3 days to a week…
Are you any better today?
Doctors hate ONLY drugs that work really well. They are very happy to push drugs that do their job very poorly, if, and only if the useless drug is VERY expensive.
Useless drugs with kickbacks AND horrific side effects are always a special favorite.
“No we cannot give you hydrocodone, it works so well that you might LIKE it. Take this Celebrex instead: it's useless, it's expeensive, and it MAY stop your heart…the perfect drug!”
Did you ever the CLARINET or SAX? (We share that right thumb tophus.)
Anyhoo,
I find Tramadol to be SINGULARLY useless for pain…of any sort. It doesn't even help me sleep. Friends with bad backs and knees me the same thing.
Have you tried Aleve (naproxyn-sodium?) I find that the best non-prescription (in the U.S.) NSAID.
EVERYBODY seems to get Vicodin Rx these days for EVERYTHING…they must have a good sales staff.
But I don' have any experience with oxycodone or hydrocodone. Somebody here a while ago praised them for gout.Also I've come to the conclusion that whichever side you have gout on seems to be determined by which kidney is weaker than the other in processing uric acid. Left leg, left kidney, right leg, right kidney. Any thoughts on this?
Sorry, I don't like that theory at all.
Here's why:
The heart pumps blood to the body (not the lung ciirculation) through ONE pipe, the aorta. It descends and has two side branches while passing into the abdomen, the right and left renal arteries. So both kidneys are getting the SAME blood. Then the kidneys process waste from the portion of the blood supply that was routed to them and expel the cleaned blood through the renal veins (one for each kidney) and each of these two veins enters the Vena Cava, the largest vein in the body, where it is mixed completely and pumped directly to the heart. Then out through the lungs and back to the heart where the circulation does another cycle.
Thus that kidney circulation is just from total blood pool to total blood pool and both sides of the body get exactly the same well mixed stuff.
In fact one kidney could be dead or gone and the body barely notices.
19 speed mountain bike
How on Earth do you gear a 19 speed bike?
Do you have any analgesics to help you get through the joint pain, Nate? Do you have any visible tophi.
That's my thinking Richard, but listening to the first of those conference lectures (which thread for some reason I cannot reply to) has scared me.
Although I knew viscerally that ALL crystals would never dissolve, the thought of all those deposits remaining, moving reforming even after YEARS of no attacks is tempting me to go up to 400 mg. and make sure my SUA stays in the 4's. The implication from Schumacher's lecture is that even with no acute attacks the low grade inflamation of those “microtophi” is continuing to damage joints…and some of my joints, knees, lumbar back, and shoulder, give me ENOUGH trouble already. My old view that a tophi once formed and covered was out of harm's way was a bit oversimplistic.
Although my old theory that once you have gout you will never NOT have gout is reinforced a bit.
So I am tempted to draw the conclusion that safety MIGHT dictate that we take our uric acid lower than previously thought and PRAY it's low enough to stop the progressive inflammation.
One must muse whether once you have frank gout in your big toe is it likely you have subclinical gouty inflammation in 20 other joints? An ugly thought is it not?
My jury is out on coffee.
I KNOW caffeine is xanthine, a purine, and present in large quantities in coffee. It is specifically TRImethylxanthine. Both DImethylxanthines: theobromine and theophylline, have occasionally been damned as causing gout but caffeine (which breaks down to both of the DIMX's) gets a free ride???
So maybe caffeine is unique in being the single xanthine-purine that is GOOD for us, or maybe the coffee industry is big enough to write commission its own studies.
(I once saw an elaborate breakdown of caffeine metabolites and there at the bottom stood uric acid…somehow that chart has disappeared from the web.)
I, a sample of one, am a heavy coffee drinker…addicted to the stuff. Maybe, or maybe not, that is the reason I am also a heavy allopurinol user, addicted to the stuff.
I just do not know.
aaron,
When it is time to start the meds, YOU'LL KNOW.
A minot attack once a year can probably be ignored or treated with diet. Two or three might be cause for concern. If to one of these scenarios is added the annual attack that is totally crippling, incredibly painful, and goes on for weeks then you KNOW it's time.
If you have been able to walk in the two attacks you've had, I'd watch and wait a bit longer.
What was your last uric acid reading?
Usually my reading is in the 5's…once in a blue moon I'll see upper 4's.
Last was an experiment for several months at 200 mg. allopurinol (instead of the long term 300/day) to ascertain the effect of furosemide-losartan BP regimen. Reading was 6.7, I had hoped for better and I got scared and went back to 300 mg. allopurinol I will test (at doctor) in a week or two but I expect to see something in the 5's again.
I think at 400 mg. allopurinol I could do the 4's but I see no need (especially since the 300 m.g single pills are so cheap and convenient. With decades of 300 mg. under my belt I am pretty much assured I'll get nothing more than the occasional twinge (even after something horrific like 20 x 8 = 160 bottles of beer in a month. Don't judge me harshly becasue there are only three months of the year like this…and April is ALWAYS one.)
Very ballpark off the top of my head:
I think the math seems pretty simple. Purines convert to urate almost on a one to one basis. Allopurinol blocks urate formation on a proportional basis. Kidneys max out at about 750 mg./day urate. So the ANSWER to gout control is to get enough allopurinol to make sure that there is no more production of urate than the kidneys can excrete.
Sounds tougher than it is. Take 300 mg allopurinol. After a year you likely will have no more attacks. If you DO, then up it to 400 mg. If you DON'T your choices are two: go to 200 or stay at 300.
To me it seems superfluosly difficult to TAKE the drug and then add the burden, probably unnecessarily, of adding torturous dietary restraints. Do one or the other. I find the drug route easy cheap and effective and I cannot speak to the efficacies of diet plans devised before the age of allopurinol becasue I haven't had the slightest urge to try them…visions of Henry VIII and malformed joints on the internet keep popping into my head and the memory of when I actually met SATAN while he was ripping off my right foot.
Richard, I have no special bias against the EFFICACY of Uloric, only the dual facts that it is extraordinarily expensive because of artificially imposed patent protection and it does not have a track record. I would feel the same about a new STATIN introduced last year, or an anti-hypertensive introduced last year, especially if they cost 50 times as much as the drugs they were meant to replace.
I think it is likely that with the proper dosage of Uloric, you will be pain free regardless of WHAT you eat, just as I am…within reason (watch that sweetbread overdose at La Cote Basque…but enough to cause an attack might cost $72,000.)
And for those seeking to control their gout without drugs, I am sure it is POSSIBLE, just as sure as I am that for me that it is not.
But for those who go the drug route there is but one word: ENJOY!
I guess I should consider myself lucky because as long as I faithfully take my allopurinol I can eat ANYTHING. This month I have even pigged out almost every day with beer…dark and strong. (Yuengling's Black and Tan and Yuengling's Bock..8 bottles a day…going on the wagon in May.)
I eat lots of shrimp and fish at least once a week, usually tilapia, trout or salmon. Meat with almost every meal, even organ meats.
I love gravy on everything.
Knock wood!
The prices I quoted were indeed WITHOUT insurance.
Once competition enters the market these penny pills get charges at REAL value…and there is competition among the generics.
(Last time I bought I demanded my insurance company NOT be billed becasue it was cheaper for me to buy WITHOUT insurance than to pay my co-pay.)
Yep, $10 gets anyone off the street 3 months of allopurinol.
Funny, I just re-read your thread title but I must have been reading your mind and I answered what you MEANT to ask…guess the old ESP must have been sharp yesterday.
On what you actually ASKED…those internet sites that sell without Rx overcharge hideously and I guess people pay it to avoid getting an Rx from a doctor who overcharges even MORE hideously.
