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Goutgal said:
Post edited 2:53 pm – April 25, 2010 by Goutgal
I'm still on 100mg Allopurinol, and my doctor prescribed 0.6mg Colchicine twice/day at the onset of each attack, only. I've not checked back with my doctor after this second attack, which has peaked and left. Am I assuming that I should stop Colchicine now, after taking it 2 weeks? I could call my doctor to ask, but I'm beginning to feel like a whiner calling him with various questions. (not that the doctor has made me feel that way). Besides thinking Colchicine has served it's purpose, I want to save some stash for any other surprising attack which may occur. Am I on target with this?
I think you are pretty muuch on target.
Colchicine is pretty much just for pain relief.
(And ALWAYS have a “stash.”)
At a big disounter in the U.S. (Walmart, Costco, Target, ShopRite, etc.) expect to pay $4 for a month's supply, 30 pills, regardless of size) or $10 for a 3 month supply.
Anything that begins with a line like this:
This information-packed article by Dr. Bernarr shares the remarkable discoveries of over a dozen health care practitioners throughout medical history, including Dr. Herbert Shelton, Dr. C. W. Saleeby, Arnold Rickli, Bernarr McFadden, Hippocrates. Part 1 of this article teaches that only sunburn has been shown to cause skin cancer, while proper sunbathing will heal skin cancer and remove wrinkles. Included is a list of over 50 health conditions that are improved by proper sunbathing.
SICK? WELL? … SUNBATHING HELPS YOU AND EVERYONE
is quackery, plain and simple.
The writer is a jackass…or more likely a crook or BOTH!
There's a lot of gimmiicks out there to separate you from your pain. Most just separate you from your money.
cjeezy,
No, probenecid is NOT considered safer than allopurinol. I cannot speak to Uloric safety yet. I think the major problem is fear of coagualting kidney stones with high urate output. Also there is cross sensitivity with the sulfa drugs which makes probenecid quite dangerous for those with sulfa allergy.
Nate,
If you DO decide to do the pee-pee test, stop allopurinol for at least 2 weeks beforehand for it to have useful meaning. Maybe not worth the risk of an attack though.
goutgal,
Colchicine is most effective when taken in small doses at the first sign of a gout attack. Arfter the attack has worn on for days or weeks much larger regimens of cochicine are needed for effectiveness.
The old cure is two colchicine tabs to start, then one more every hour until pain relief, extreme diarrhea intervenes, or 16 tablets have been taken.
After an attack has gotten serious, there isn't a lot of effect gained by one or two colchicine.
Ken,
Using my imagination there are conversions to molar units that would possibly transpose 6 mg/dL to 360 micro-moles/liter and this would be .36 millimoles per liter or it might be expressed as 3.6 micro-moles per cubic centiliter (or cc.) If so, then a 3 would be normal but not preposterously low. Yes one could have an attack and show 6 mg/dL.
I'm not sure what they use is NZ?
(Wouldn't it be nice if the world would standardize…preferable to the U.S. system because I'm willing to BET that most doctors cannot define what a MOLE is (even though they learned it in chem class.) After all a milligram is a milligram and it can be weighed, unlike a mole which differs from chemical to chemical.
Knees are very hard to diagnose with gout without an actual aspiration showing crystals.
Two things to consider here:
1. GoutPal is correct, there is absolutely no point in getting urine urate output when you are taking allopurinol.
So,
2. Maybe there is ANOTHER reason your doctor wants your urine?
but is what it basically boils down to is that my doctor was accusing me of being addicted to prescription drugs.
A word to the wise.
Pssst, MY 24 hour urine test was with a GALLON bottle…and I almost filled it.
When this hit the fan, Nate, several months ago several of us immediately ran to the doctor and pharmacist to get layaway stocks of the generics, mostly Indian, at the old price like $4 for 60 tabs.
Even if you don't take colchicine, anyone with gout should have a bottle on hand because things change; at these prices it is especially important to be prepared. It's also nice when in screaming, cripppling pain not to have to go 'round town for supplies.
Incidentally, colchicine has been used to treat gout since the First Century and the active alkaloids were isolated by two French chemists in 1820.
So now some clever but greedy and rapacious company DISCOVERED it in 2009…a new black mark for the graft riddled FDA tranferring money from those in pain to a wealthy drug company who had NOTHING to do with colchicine's discovery.
I agree with those who find that exercise helps with gout. Crystallization takes time and little disturbance with cool conditions, just the opposite of exercise producing heat, rapid blood flow and muscle and tendon massage. It is is no accident that most gout attacks wake us from an immobile sleep of many hours.
Thus the worst thing a goutie can do is sleep.
But the alternative is pretty tough.
How about
1 ounce black cherry concentrate
2 ounces Vodka
Lots of ice
Top up with seltzer or tonic.
Call it the GoutBuster? Whether or not it works, after about 4 you won't care.
Breath not being held.
Somehow using a few $million worth of genetic engineering with implanted frankengenes seems a tough way to get “the same results as allopurinol.”
I guess these pie in the sky articles keep researchers in grant money.
I would not be surprised if there was a high correlation between gout and migraine. Add me to the pile who has gout and gets Migraines/Clusters.
Same aura…same blind spot and then radiant colorful vanGoghish patterns. All so pretty and then the PAIN.
I got a trick…a beta blocker, propranolol my choice and a quiet bed, at the first inkling of that blindish spot.
Fortunately I am down to only a couple a year…usually APRIL! {{go figger}}
I don't think you will be able to easily post an MRI.
I read a friend's last year and I cannot remember the form the images took. Perhaps if .JPEG you might be able to do it…but I seem to remember it more likely being a .pdf (adobe) format. Alas, I was more interested in helping her understand the pictures rather than the formatting. So I cannot be sure.
edit: More thinking and .pdf is becoming more certain.
They are fascinating though.
utube,
In your first post you mentioned “possiible fracture”…you mean they aren't even sure if there was a fracture this far along in the game?????
Again WOW…that is a lot of allopurinol (but within rational bounds.)
There is no need for sustained release allopurinol, in fact this is the first I;vew ever heard of it. For sustained release why would there be a need for 3x a day dosing.
But to your questions:
1. Your serum uric acid is probably below 6.0 already.
2. You should quit smoking but it doesn;t affect gout.
3. That's pretty heavy drinking if you do it every day. Cut back. The allopurinol is very forgiving but you have a liver to think about. Maybe 100-200 is reasonable. Beer is not a good beverage for gouties. Occasionally okay but not on a daily basis.
4. Exercise helps in a lot of ways, but not specifically for gout.
After about a month or two you can revisit the dosage of allopurinol with your doctor…you can probably get away with less. I would expect your current regimen will keep you free of pain. You will also propably want to get off the colchicine soon. Unlike allopurinol it is not a forever drug.
YOU are NOT his doctor, so, please, don't advise him to take 16 Colchicines a day.
I will advise precisely what I wish to advise and if you don't like it, LUMP it.
Advise whatever YOU wish but don't presume to tell me what I can or cannot post. My post to someone else is none of your business and nobody has appointed you my editor.
We are all adults and we take or leave information as we choose. Grow up!
sean,
A YES to allopurinol if this is your third or fourth attack. A NOT YET if it's only your first or second. If you choose to start the drug it is best to start AFTER this attack has abated lest it get even worse. Allopurinol will do nothing to stop an active attack.
Your immediate goal is to stop this attack and nothing will stop it faster than a proper dosing with colchicine. Call your doctor to call in a prescription for a bottle of 60 tabs or so…you may need 16 of them in one day. Since your attack has gone on so long, I think you need need all 16.
The method to take the stuff is repeated several times in GoutPal. You might see it referred to as Zip's method or Zip's cure. If you cannot find it, just ask after you get the Rx filled and I'll repeat it.
I sympathize with you both about not being able to get out in this gorgeous weather…I am into day 4 of a horrible cold so no bike for me either. We had a solid MONTH of rain and I was fit as a fiddle…God LOVES to toy with us!
Go with the averages and stay on 300 mg./day for a long time. Since the drug is forever you will soon know when and if to adjust the dose and you'll have plenty of time to do it. THere's a reason they make the pill in a 300 mg. size.
But there's no reason to take the minumum for the minimum's sake. With the daily swings in Uric Acid, acidity, and temperature it always is wide to have a little extra for “insurance.”
My MOST painful experience was ripping my shoulder out of it's moorings and having my arm hanging by my side and sticking straight out. It was atop a mile high mountain and I had to be taken down on a ski sled which pitched right and left with arm waving with each mogul….I screamed til I was hoarse.
If I had had a cyanide pill I'd have happily chewed it.
Second was my gout attack.
Third was an infected tooth that sprayed blood and pus on the doctor, the lights, and the CEILING when it was pulled.
Fourth was a broken leg.
So gout wasn't QUITE my WORST pain.
(Oh and tthere was a cluster headache somewhere in there that had me thinking about driving my car into a pole to relieve the pain.)
Ain't life GRAND.
I started allopurinol 400 mg. a week after stopping a horrific acute attack, my fourth. I never had another acute attack of frank gout (that's the official term
) and that was nearly 20 years ago. For this I am eternally grateful.I think those that get attacks after starting allopurinol usually are those who started with too low a dose or those with large tophi and a ready supply of lots of urate. It's also hard to ever say with certainty whether allopurinol has triggered an attack or whether the attack started IN SPITE OF the allopurinol.
The infamous Allopurinol drug… My doctor (same dude) said that it's usually prescribed for recurrent cases and that unless it comes back, I shouldn't worry about it. I feel like getting a second opinion on this as I think that lowering the Uric Acid is a good thing. I understand that 36 years of accumulation will require some time…. or does it? What are your thoughts on the doing Allopurinol to lower UA and then following a strict diet?
As much as I love allopurinol I wouldn't recommend it until someone has had at least one killer attack and several limparound attacks. (Or someone finally makes the definite link between UA and heart vessel disease.) Since it's a lifetime drug it would be a shame to get someone on it because of a misdiagnosis. Take it when YOU are sure you have gout and that you don't want to live with the inevitability of crutches two or three times a year.
yep,
2-4 of the .6mg (or the .5 mg.) colchicine.
Three months is probably not long enough to get rid of all the urate deposits and even 3 YEARS might not be long enough. Some urates are probably so well hidden by the body that they may NEVER surface. But out of sight out of mind because these permanent deposits will not trigger attacks.
Law,
What if anything is the significance of the abscissa numbers that go to 202. At first I thought those were days but your inital post says no to that.
You must have dropped a FORTUNE on test strips.
The most startling effect was the U-shaped uric acid swing on your 200 mg. period coinciding with the incidence of a bad attack. Probably casued by a burst of urate that had been quietly stored somewhere.
I really prefer people starting right on 300 mg. allopurinol; that 100-200-300 progression often seems to cause attacks that might have been avoided.
Your last attack seems to show as a lie the theory that uric acid drops precipitously when an attack starts…yours soared coincident with the attack.
Thanks for the hands on (or feet-on) research. There's no substitute for our own facts.
Every gout attack leaves behind some residual damage and probably some urate crystals covered in scar tissue, so it is not completely surprising to always feel the joint is not quite the way it was.
With time perhaps the joint can be restored 99% and we can almost believe it was never attacked.
So all you can do is watch and wait. Every day on uloric is a step in the right direction.
My big attack was amost 20 years ago and still I can see that my right bunion joint is ever so slightly bigger than my right.
Exercise breaks down tissue and the nucleus of cells is rich in purines which break down to uric acid as an endpoint.
Exercise also CREATES lactic acid from partial breakdown of glucose during anaerobic work, thus acidifying the body slightly and uric acid precipitates more readily in acidic joints and tendons.
Both situations predispose to a gout attack.
But of course, moderate exercise has so many other benefits it remains a wise choice in spite of not really being particularly good for our gout.
rucyrius,
If you settle things down with this attack, make sure you watch vigilantly for another. What you do in the first couple hours of an attack is SO much more important than what you do in day 2 or day 3.
A bottleful of colchicine in your medicine chest will give you YEARS of insurance at a rate of 2 or 4 pills with each threat of an attack, but it's got to be fast action to be effective at such a low dose…don't delay.
Yep,
The 10 1/2 D's of my twenties are now the 13 EE's of maturity. Seem to be spreading like pizzas.
sputnik,
Sulfinpyrazone and probenecid are infrequently used because they generally cause MORE undesirable side effects than allopurinol. Is sulfinpyrazone available in the U.S.? I saw some conflicting info.
You are right, the chance of allopurinol side efffects are enhanced with an ACE inhibitor but only slightly and the causal evidence is scant. Your dosage of rampril is on the high side so maybe best to err on the side of caution.
I tried my hand at two of the ACE inhibitors, enalapril and captopril and both made me cough my head off…usually at the most incredibly inappropriate times: last straw was at the MET (Metropolitan Opera)…those around me were SO happy to listen to me hack before I got the good sense to go home and waste my $100 seat.)
So serendipity had me switch to losartan (Cozaar) an ARB which coincidentally is the only antihypertensive that is uricosuric…a good combo for gouty hypertensives.
If the sulfinpyrazone gives you a hard time consider allopurinol and losartan. Alas, it's the weakest of the ARB's and some of us must take it twice a day for much of an effect.
Let us know how the sulfinpyrazone treats you. Nobody else here has been on it…if my memory serves me.
Utube,
Vegguy spelled out my feelings pretty well. Before tophaceous gout, an MRI, just like an X-ray, is almost useless. So, on the basis of hypertrophy (swelling), edema (swelling) you have been told your toe is swollen.
Aren't doctors clever?So the swelling is caused either by your injury that refuses to heal, by gout or by a combination of the two…or something all these doctors overlooked, something only Gregory House could ascertain like a rare virus prevalent only in Southern Nigeria.
So, cutting to the chase:
I HAVE NO PROBLEM WITH ALLOPURINOL AS OF NOW. THE BODY SEEMS TO TOLERATE IT WELL NOW AND IT SEEMS TO HELP ME IN OTHER AREAS AS WELL – LESS SNORING, BACKPAIN GONE( I USED TO HAVE CHRONIC BACKPAIN AND HAD TAKEN MORE THAN 50 PHYSIOTHERAPY SESSIONS…IT HAS DISAPPEARED MAGICALLY) ETC….
that implies to me that the wise course is to continue the allopurinol even if the only effects are the magical results you seem to be having with it. Who knows, maybe even your now gone backpain is gout.., buth there's no denying that gone is GONE.
Of course, if you MUST know for sure, then stop the allopurinol and for every meal for a month eat either delicious calves liver, or sardines washed down with some hearty lager. If you REALLY want to put the icing on the cake, take a thiazide diuretic. If that doesn't have you screaming in pain, then you know for sure you have “non-gout.”
I know…a tad extreme.
Although I know every back disorder is unique, I find that any exercise that opens up the rear of the disc spaces is idea because all of the spinal root nerves go out through the rear sides…and they like the extra space.
Given this structural setup I find for myself the very best exercise to preserve back fuction is bicycling with a slight lean forward…but no need for the pronounced lean of those old racing bikes, unless of course you are training for the Tour De France.
I destroyed my back in 1973 and have tried everything. I get occasional sciatica now but DID go through an almost interminable year with sciatica every day, every hour, every minute. I have reached an accord with my back…I won't antagonize it and it won't antagonize me. For a very infrequent achey-breakey day and that certain electrical shock down the leg I immediately use 2 x 325 mg SOMA (carisoprodol…another wonder drug) and hit the bed, but usually a couple of ALEVE do the trick for just a run of the mill sore back that is more frequent…like after 2 days of Spring cleaning this weekend.
I have often wondered about the connection between backache and gout…now THERE'S a doctoral thesis for someone. But so far, it's maybe yes, maybe no.
I have two thoughts on allopurinol.
1. I take a uricosuric (losartan for BP) so I don't want to take allopurinol within the 8 hours when the losartan is active…why pee it out?
2. Since allopurinol works TWICE, once to tie up xanthine oxidase while it is converted into long term oxypurinol. The first step is quick, a few hours. So my thinking is to utilize that first product when most useful, with a high purine meal or with a bout of heavy exercise.
The long term oxypurinol lasts for days, so it doesn't matter much when you take the allopurinol in that regard.
The usual recommendation is to take it with food presumably to prevent stomach upset.
Nate,
Stop going on and off the allopurinol…it is NOT a short term drug. If you want to explore the effects of the GOOD life why not do it while taking 300 mg. allopurinol. If you find you can get through a year without an attack, then perhaps you can titrate down to 200 mg. if your SUA allows it.
On and off allopurinol is a recipe for the worst kind of attacks.
Congrats on the 82 pain free days but that's still 9 attacks every 2 years…or 180 in the next 40 years. I doubt if any joint in the body can survive anywhere NEAR that.
