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Up until about 7 years ago the upper level before the Doctor's got excited was 140/90 then about 2002 it was suddenly agreed that the desired level was to be 120/80.
Ha, Ha…and when they vlaim that 100/60 is the upper limit GP's will make a FORTUNE. My feweling is that GP can do nothing anymore than: Measure BP; prescribe drugs; refer to a specialist for everything else.
Given this scenario they MUST make sure everyone on the planet is being treated for hypertension and the only way to do that is to make the standards preposterously low. Decent studies showing any benefit from medicating to these super-low numbers are nonexistant.
I would cange the progression slightly as such: Stress>>anxiet>>high BP>>High BP MEDS>>gout.
Remember, a “perfect” blood pressure of 0/0 is only achieved by cadavers. (60/40 is the pre-cadaver state.
)A drug company released the most AMAZING study a number of years ago…I cannot find it now so you will have to trust me. It compared the risk of heart attack at different BP's treated and untreated. Believe it or not, the risk of untreated 140/90 was considerably LESS than a treated 120/80…and this was advertising from a major DRUG company, selling the BP pills.
Treating 140/90 relaxed and recumbent with both feet on the ground and and empty bladder is MALPRACTICE.
Actually in the 1970's the general feeling was that Zyloprim was completely without side effects…remarkable for ANY drug.
It is only lately that quibbles are being made about allopurinol, and I suspect a lot of that stems from it's loss of patent protection (and it's old high price) and the emergence of an expensive new kid on the block…patent protected Uloric.
Allopurinol remains in a rarefied atmosphere of drugs that cause almost NO untoward side effects.
(I've run through the almost entire gamut of anti-hypertensives…dozens of them. If a single one of them was as free of side effects as allopurinol, its maker would get the Nobel Prize and deserve it.
)Any rheumatologist claiming that allopurinol causes kidney disease should perhaps talk to a nephrologist who will tell him that he is spouting nonsense. Perhaps another wise course for him is to stick to reheumatology…or retire.
Allopurinol is often used to TREAT kidney disease.
Boy, does THIS open up a can of worms.
In general No BP medication is best but we probably DO need to control BP…a dilemma.
I have found weight control to work wonders. It doesn't have to be to wraith levels but a 10% drop in bodyweight from slightly overweight to normal can often have BP return to normal in 90 days. VERY moderate drinking will lower BP but moderate to high drinking will raise it considerably. Overindulgence in salt, aka the normal Western diet, will raise it precipitously.
Now the harder part, medicinal cures:
With the single exception of losartan (Corgaard) all BP meds will raise urate levels (corrected typo.) The worst offenders are the diuretics, especially thiazides. They work by preventing the kidneys from reabsorbing salt in part of the loop of Henley…don't ask. THing is that the body ultimately tries to stay in electrical balance so some potassium must also be lost (bad) and uric acid must be SAVED (worse.)
Since all BP meds ultimately operate in a similar manner even those that start out affecting other mechanisms will ultimately dump sodium and conserve uric acid. So the body's modest ability to excrete small a,mounts of urate is subverted, day after day after day. (Your doctor may give you an argument about these mechanisms, but the poor dears read nothing but glowing reports on all these meds from drug manufacturers….in 2 paragraph leaflet form.
There is an exception: LOSARTAN (Cozaar) which is uricosuric, single in that distinction. Even others of it's drug class, angiotensin receptor blockers, show no such ability. Even losartan has problems becasue by itself it is a rotten BP regulator, very weak. So look up the oft mentioned study in the GP forum about losartan-furosemide combo and how to take it. BUT that works best for people who are salt sensitive hypertensives (like me) and not so well for those who are RENIN hypertensives, more common.
Even the losartan has another big problem, it dumps urate but ALSO urate homologs (twins) like allopurinol, and oxypurinol…not so good if you are on allopurinol.
There is SO much to say about this but in short, BP meds usually make gout worse, in fact often CAUSE gout in the first place. If you are going to take something try 40 mg. furosemide taken with your allopurinol and then a couple hours later take 50 or 100 mg. Cozaar (losartan.) Alas, in the U.S. Cozaar is still a $$pricey$$ patent med. If it controls your BP, then that's the best you can do…if it doesn't work well, then there's always LOURDES or worse, a very low salt diet!
rucyrius,
If I read you right you have taken the allopurinol for 2 weeks and got a 4.3 SUA. Good going!
They usually are. The best of these for gout is colchicine and prednisone…the worst, aspirin (except in huge quantities) and acetamenophen (useless.)
between these are all the NSAIDS with indomethacin probably the best.
Of course the opiods all work fairly well to control pain but doctors are loathe to prescribe them.
cjeezy said:
Just curious, if colchicine kills off white cells, is a person more susceptible to becoming sick with the flu (or whatever) when on the drug?
I would say yes. That reinforces my ideal use of colchicine as a one day HUGE dose rather than a dribble every day for months.
Flu is usually mediated by antibidy defenses and probably not affected by colchicine but bacterial infections which depend on white blood cell and phagocytotic defenses probably are more likely.
(Oy…27.5 mg colchicine is 55 pills…they must have found her intestines, tonsils, and brain in the toilet.)
Also do many people regularly take >300mg doses?
No, they don't…300 mg/day is pretty standard. I took 400 mg. for a couple years to start becasue my logic was I am a big pretty muscular guy who does weight work regularly and tries for a highis protein diet so I thought I am probably consuming more purines than most people.
Going down to 300 mg/day caused no problems but going down to 200 did. So now I am at 300/day just like most gouties.
But if 300 doesn't work well enough, you can go anywhere up to 800 mg. SOme doctors have miustakenly taken patients off allopurinol becase it wasn't working well enough at the 300 mg. dose. Big Mistake!
Dominic,
Some thoughts:
First and most important thought: DO NOT discontinue the allopurinol.
Weight loss is perhaps the biggest trigger for gout; probably had you remained pleasantly plump the allopurinol would be working its magic after these 4 months. This is NOT an argument for obesity but rather a simple sad fact. We must lose weight when overweight but all the consequences are not necessarily good ones.
Indomethacin has CNS side effects. I was on it short term and got very dizzy…I still have the first bottle. Let us know how the naproxyn works. I have suffered lower back pain since 1973 from an injury…whether gout has been involved these 35 years I don't know. Maybe yes, maybe no (or maybe halfway between.)
A controversial doctor claims spinal colchicine injections work miraculaously for thousands of his patients? Maybe?Yep, test your uric acid. Your doctor should have done it before prescribing allopurinol.
Utube,
Ativan (lorazapam) is one of the worst drugs ever invented. It drove my mother into the deepest depression…she took it efvery night and became addicted, taking it daily for 10 years. The problem with the drug is that it stops anxiety for about 4 hours and then rebounds with a vengeance. She'd take it for sleep and wake up in a panic at 3AM.I gave it to my partner and a single pill caused the blackest depression I've ever seen and it lasted days and days in a person who was NEVER depressed.
I LOVE pills but that one scares the s#$t out of me.
A far better benzodiazapine is Valium (diazapam) with a half life measured in days instead of in a couple hours…no ups and downs, just smooth sailing.
Remember, allopurinol is for life and when judging side effects from it make sure you evaluate it in isolation. If someone is taking a drug for sleep and allopurinol, he should not be surprised to be groggy all day. If he's taking something else for pain, then THAT is a likely candidate for side effects. Problems with allopurinol after the first week (to check for hypersensitivity or allergy) are quite rare. It is among the most tolerated of drugs. And since it is THE gout cure (if you must pay for your meds) and it must be taken forever, be very careful lest you dismiss it without really needing to.
(((I edited this to read correctly now…originally typed Ibuprofen when I meant to say Indomethacin. I guess I typed the “I” and my fingers ran with the ball while my brain took a brieef snooze.)))
However, serious toxicities prevent the use of colchicine in antineoplastic therapies.
I got a kick out of that line. I haave always presumed that most neoplastic chemotherapeutic agents killed ALL cells, with a slightly less fatal rate among healthy cells. After all the first chemotherapeutic agents were variant of mustard gas.
Cynical old me bets that the reason colchicine is dismissed from consideration by pharmaceutical companies is that it is impossilbe to get anyone to pay $1,000 a pill for it.
Another take on basically the same info GP has provided:
Colchicine has been regarded by some as the most powerful anti-inflammatory agent known to man. The beneficial effects of colchicine in the treatment of gout are apparently secondary to its ability to inhibit both the metabolic and phagocytic activity and migration of granulocytes. Colchicine's inhibition of the release of histamine containing granules from mast cells is also believed secondary to its interference with granule transportation by the microtubular system. While beneficial in the treatment of the crystal-induced inflammation observed in gout and pseudogout, colchicine is only occasionally effective in the treatment of other types of arthritides (arthritis).
therickster00 said:
What are the differences between the different gout medications out there? I have had Indomethacin prescribed for me to relieve the swelling and pain of a gout attack; if I understand correctly, Colchecine does basically the same thing. Allopurinol, on the other hand can only be taken after the attack is over, but will keep the uric acid level down to prevent attacks. Am I correct in these positions?
I posted once before about my gout saying that I didn't have insurance and wanted to control the gout w/ diet and exercise. Good thought, but it hasn't worked that way, at least so far. I went in and had an SUA test done but haven't gotten the results yet. I expect a high reading and probably will begin allopurinol when able to. I have been able to keep the gout symptoms mostly in check with the Indomethacin but 3-4 days after I quit the swelling and pain return. How long do I stay on the indo. before starting the allopurinol?
YEs, you got it right with one exception. Both Indocin and colchicine are for relief of pain but colchicine stops the attack and Indocin helps you suffer less. Personally I think colchicine is the best…I've used both but colchicine is troublesome to take, the vicious diarrhea. On the other hand indomethacin (Indocin) is very hard on the stomach wall and readily casue gastritis. (It also made me very dizzy.)
When you get on allopurinol you can take the indomethacin as long as you wish if you get any pain and your stomach doesn't start to burn. With luck you won't need it after getting on 300 mg. allopurinol each day.
Let us know your blood result.
Yep,
Everyone wants to manage his gout with good living, pure thoughts, a good exercise routine, weight control, proper mantras, tithing, and the right herbs… alas, all this right thinking usually yields to the need for drugs. Thank God for allopurinol.
But, good living is still its own reward…one hears.
Make sure that you bring the pictures of your foot with you on the 28th. If that attack subsides the pictures will prove that you aren't just “whisting Dixie.” The VA doctors can be thick browed troglodytes.
I think joints are somewhat encapsulated and dont really have the kind of good blood supply other areas of the body have. Hence a lot can go on there that might quickly arouse the ire of the immune system were it to go on in an area with copious blood, white blood cells, platelets, T-cells etc.
So urate builds up and up until it is so pronounced it forces contact with the bloodstream and BAM! That's why I think that at the initiation of the first gout attack there is copious urate deposited around the body but just little enough to pass under the radar of the immune system.
I guess when that elaborate scanning technology becomes common we will learn a lot more about the how, what and where's of tophi deposition.
Only took colchicine, 2 pills on arising as needed for occasional morning flares/twinges, recently when I lowered my allopurinol dosage to 200 mg. hoping the losartan was pulling its weight. The twinges often followed a hard workout day or an overindulgence in beer.
When I confirmed a uric acid back up to 6.7 mg/dL and I went back up to 300 mg./day, where it is obvious I must remain forever, the twinges and the need for cochicine stopped. But I still keep a large bottleful in my larder, just in case.
Immune suppression is not always a bad thing. Many relatively benign problems are magnified to life threatening by an overactive immune system. Ask anyone suffering from rheumatoid arthritis, Lupus, shingles, or even hay fever or asthma, over-reaction to a bug bite.
In these and many other conditions the goal of treatment is to atenuate the immune system.
Some food for thought is the possibility of using colchicine to ameliorate the symptoms of other immune system caused diseases? (Heck maybe I should work on that for my NOBEL?)
I am confused hans. WHy not Medicare at age 79? Part A is free and Part B is $96/month. Who would say not to that, except someone determined not to get sick? What is the upside of not taking Medicare? All NOT having Medicare gets you is the $400 uric acid test and the $200 visits to Dr. Quack.
(I am a person who avoids medical care like the plague, but that seems not to matter much because fate and the universe don't bow to my wishes. So when I get medical care all is done precisily according to MY wishes, but I am lucky since I have tens of thousands of practioners withing 10 miles <NYC.> )
Good luck with all your home remedies and food avoidance techniques.
Remember though, if and when they don't work any longer, that the mainstays work: allopurinol to contro uric acid and colchicine to control pain.
Ibuprofen for me in pain relieving quantities DESTROYS my stomach with permanent gastritis…I find naproxyn (Aleve) much easier. But to stop a long bout with gout, nothing beats colchicine.
Yes,
They can pop up seemingly overnight and Yes, they are best seen as the cream colored body under the skin when the skin is pullled tight.
Unfortunately cartilege looks very similar so it's often hard to tell one from the other.
mtmoore said:
Thanks for the advice on the maximum amount, I have lost the leaflet so didn't know that.
If the pain does go away now, how long should I carry on taking it, stop immediately, or 1 or 2 after?
The general rule is to stop when the pain stops or serious diarrhea begins but I might be tempted to take one or two extra for “insurance”
if I hadn't yet reached 16.is there any kidney tests that need performed on a regular basis to ensure that kidney damage does not occur
Alas I think that most of the tests that are done are to reveal that kidney damage HAS occurred. Just like there is no test to determine you WILL develop a strep throat, only that you HAVE.
Here's a good list of tests that are commonly done:
http://www.netwellness.org/healthtopics/kidney/kidneytests.cfm
The ones that are routine and part of most blood draws during physicals are BUN (blood urea nitrogen) and creatinine. These waste components are normally removed pretty thoroughly by properly functioning kidneys. When they build up in blood, its a quick and easy sign that the kidneys are not doing their job. Then you do more elaborate testing like creatinine clearance or GFR.
Our kidneys seem to dislike both a high uric acid concentration in the blood AND/or a high uric acid excretion rate into the kidneys.
Hans, that SCREW YOU MEDICAL CENTER sounds like a very good reason NOT to live in NM.
I'm confused about your insurance. Are you OLD enough to get Medicare (and a citizen), if so you should immediately. If you really want to slash your costs, then get into a Medicare Advantage Plan and all you'll pay is a $10 or $15 copay no matter WHAT they do. Only wrinkle is that you must be in a populaous enough area so that there are several medical professionals to choose from who take any particular plan.
On that doctor's inability to prescribe probenecid it is not that he CANNOT it is that he WILL NOT. ANy doctor can prescribe ANY medication, thus a dermatologist can prescribe chemotherapy for brain cancer. Your doctor is what is described in very medical terms, a PRICK. He is interested only in running up charges.
There is a logic though in testing urine for 24 hours before dosing with probenecid. If your urinary output of urate is greater than normal, probenecid won't be the drug of choice. But still there's no reason that it won't work fine, just not as well as somebody with low excretion.
But get another doctor. STAT.
(What kind of insurance do you have now?)
al_pain,
I think my one an hour colchine routine is better than your one ever 2 hours. Try mine next time and see for yourself. ANd don't delay starting; I have found that delaying a day or two doubles or triples your ultimate effective colchicine dose. Fast is Less.
mt,
I think your old colchicine is still perfecly active. I've had an old bottle for 10 years more stay at full strength. (Having us toss our old drugs is just a ploy to increase Pharma sales…USUALLY. Some drugs, like nitrates for heart relaxation, are VERY fragile, but not many.)
If you don't have 16 pills, which is the maximum for a bad attack, then ask your doctor to give you a new Rx.
I've never run a fever with any of my more serious attacks but it's not uncommon, even accompanied by chills. It is after all a full blown immune system stimulation just like you would get with a bacterial infection.
Probably the attacks with fever indicate an even stronger attack.
Be careful though, don't try to treat the fever with aspirin, it is likely to make the attack worse.
Have you thought of colchicine to stop the attack?
modogg,
I think you'll be okay. I make protein shakes to replace a couple breakfasts each week and I've used gobs of both 90%whey and soy protein powders without any problems. (1 egg, 10 ounces whole milk, 1 ounce 90% protein, vanilla, cocoa (3 Tbsp…I like chocolate) and 5 ice cubes.. thickened with 1/8 tsp guar or or a pinch of xanthan gum. Sheer deliciousness and about 20 ounces volume.
I can't imagine that a man's taking allopurinol would have any effect on a child.
Yes, ANY drug a woman takes during the first weeks or even first hours of pregnancy should be of grave concern.
The literature shows birth defects when given in huge doses to pregnant mice but no effects on birth defects when given at 20 times normal human disage to rabbits and rats.
Pennsylvania,
Premenopausal women rarely get gout because there is hormonal protection against a high serum uric acid. What your doctor CAN do is to take a blood draw and measure your uric acid and also run an arthritis panel. If you have a low uric acid, you can probably rule out gout but if it's high you can count this as Gout attack #1 and determine for yourself how many it will take to get you on drugs.
Ballpark is 3 attacks in a year.
More than that and almost everyone cries uncle and gets a bottle of allopurinol (or febuxostat or probenecid.) Yes, good living is great UNTIL it doesn't prevent pain.If the attack goes on for too long or you have exhausted all the homespun remedies, the drug of choice to stop the pain is colchicine… the drug of choice to prevent attacks is allopurinol but for that you really want a strong confirmation that it is gout.
Is your pain in the classic gout joint, the bunion joint …the second joint in from the end of the big toe? If so, that is about 50% of the diagnosis.
mo,
The online anecdotal evidence seems to be that whey protein is good for gout BUT keep in mind that huge supplements of extremely high protein foods provides lots of excess nitrogen and the principal way that we humans get rid of nitrogen is through excretion of uric acid and urea.
Tread carefully.
Remember too that lots of “it's good for you's” are published by somebody selling something.
Okay, I found something that says with some authority the same thing I did:
http://www.arthritistoday.org/…..d-gout.php
Are you a bodybuilder?
I got the results today and it was 8.0. Keep in mind it was near 10 a few months ago. Since my attack started 2 weeks ago, I have since elminated most high purine foods and alcohol from my diet.
mo,
Since 8.0 seems to be the best you can hope for with “good living” you can look forward to soon being on a drug. You need a uric acid of <6.0 and you won't get it otherwise. The most common is 300 mg. allopurinol daily for life. If it is shown that you are excreting very little urate then 1000 mg. probenecid is a good candidate. But generally speaking it will be allopurinol…cheap, harmless, and effective.
John,
Good for you.
I doubt you will have any gout flares but if you do they are usually not as furious as the unmedicated attacks. I started right on 400 mg. allopurinol/day and never had as much as a twinge.
Probably the 300 mg. dose is exactly where you will want to stay for years…I've been there more than a decade. (Lowering to 200 for several months trial caused some suspicious foot and knee pains…and a rise to 6.7 mg./dL SUA.)
Any side-effects the first couple days?
