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Just a quickie…maybe more later.
With a negative ANA you can forget about almost all of the OTHER arthritic diseases.
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Good luck with the 300 mg. allopurinol. If you cease to have attacks make sure your boneheaded doctor knows it.
Yes,
I agree that finding urate chrystals in a painful joint, or even an old tophi is an almost foolproof gout diagnosis. Too bad many are not lucky enough to get such a clearcup diagnosis.
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I was lucky in that after about 5 attacks in my instep/ankle/ metatarsal I got PODAGRA. THAT is a diagnosis? to anyone with eyes (and a vervous system able to perceive pain.) After 2 weeks of agony a 22 hour?instant cure with colchicine was a 100% diagnosis.
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But I sympathize with those who get on the diagnosis treadmill without resolution. A thousand years ago your barber could tell if you had gout or not but NOW they have tests and a differential diagosis of 100 arthritic conditions?an one doctor out of a dozen who can make the difffferential diagnosis correctly. Try going through all the testing to rule out Lupus?talk about a treadmill with nothing more than a guesstimate at the end.
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HMMM?gotta love the doctors who will get 5 different results pointing to NOT RA and then say you probably have RA. And I know these quacks exist. Why do the tests if the diagnosis is a priori? That question was rhetorical: because it generate a high income.
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Septic arthritis>>>surgery>>>no sepsis? I hope you sued his ass good.
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So polecat, are you convinced of your gout diagnosis?
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Keith,
Coincidentally, I went into my “tophi is forever” chant on another post only a little while ago. My personal experience was the only way my few tophi went was through the skin…not the bloodstream. But I look forward to your study..and thanks for being the guinea pig.
eric,
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Below 6.0 is GENERALLY safe, 6.5 not so much. BUT fluctuations, perhaps WIDE occur during the day week or month and thus if you get a 6.0 at the doctors office, often on a fasting sample (for cholesterol etc.) who is to say you won't see a 7.5 after a big shrimp dinner with a couple pints of ale.
Precipitation of urate is extrtemely sensitive to the inverse of temperature and thus the 6.0 rule may work in your heart at 98.6 degrees, but not so in your toe at 70 degrees.
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An localized acidic environmnet caused by inflammation of any kind will precipitate uric acid at quite low levels.
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So all of these variable are the reason why a 4.0 is safer than a 6.0, a “safety factor” if you will.
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Personally I do not ascribe too much to the “dissolving crystals” theory. I think most of the crystals that are laid down and scarred over by the immune system will be with us for a mightly long time. The body has isolated them to the best of its ability.?Best to concentrate on NO NEW ATTACKS…and let the crystals fall where they may.
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(Keith is experimenting with 900 mg. allopurinol to try to eliminate some tophi…we await the Lancet article.)
limpy,
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That 5.4 MG./DL? sounds more like it… and it is quite good.
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But if you are? still having pain then the total of 300 mg. is more likely to abate the pain eventually.
No, you really cannot have too low a uric acid. There is no real reason to go in two steps…taking 300 mg. tomorrow should be perfectly fine.
No doctor will calll in a prescription for ANYTHING?without having diagnosed you. It is part caution and part greed.? With a regular doctor you can sometimes get the occasional renewal called in or for an emergency med to tide you over til you can come into the office, but that's it.
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I did get one doctor to call in my first Rx fro colchicine, but he was my regular doctor (and I could hear him frowning over the phone.)
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Add to the list of the $4/month Rx providers, K-Mart and Target pharmacies. Yes, allopurinol is on everyone's cheap generic list. (Thank God.)
limpy,
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We await your next SUA reading.
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If your a-fib? starts acting up again ask for sotalol. It has recently gone generic so the price has fallen from breathtaking peaks to very affordable.
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(I truly hate atenolol?and most everyone on health boards seems to agree.)
Hi limpy,
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Coincidentally I also had 2 bouts of afib?the first, a decade ago, ?was at something close to 250 beats per minute. I went white? with terror. ?I went downstairs and sat with my doorman giving instructions to call 911 if I hit the floor. It lasted about 20 minutes (took 10 mg. valium and 2 aspirin) and suddenly returned to normal.
Second time I went to ER after a couple OLD nitro-pills didn't work (I SHOULD throw out old nitros.) After 2 hours everything was fine with a beta blocker so I checked myself out (overnight on Medicare is $1100 out of pocket.)
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Make sure you take your daily aspirin because afib can initiate clots.
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A friend does reallly well on daily?sotalol after he got sick of monthly trips to the hospital for painful electroversions.
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You know, with gout conjfirmed by crystals, it seems improbabl that you would get a 3.9 mg./dL (not 390 in molar units right?) That seems too low.??Have you had confirmatory results? If I go to a doctor for a cold I ask for a uric acid test.
Make sure you confirm the 3.9 because it sounds suspicious?and shouldn't allow attacks. Definitely do not try to throttle down your allopurinol based on 1 reading AND a continuance of pain.
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There is a little bit of controversy about whether Naproxen interferes with the platelet destickification of aspirin? Some say yes, some say no. (Have you ever done heparin or warfarin?)
Have you ever tried indomethacin for pain? <Mumbling obscenities about the crooked colchicine patent.>
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Why not give 300 mg. allopurinol a shot which offhandedly makes the assumption that the 3.9 reading was wonky? If your pain goes away that will tell you a lot.
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(Well, I forgot most of the rest of the 1000 words but I'll let it go at that.)
hansinnm said:
zip2play said:
…
But then computer programmers may have no clue these days what the term SIGNIFICANT DIGITS means. Few people really do. And the doctor blindly reports what the printout tells him.
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I'm 6 feet 2.000 inches tall. (If measured with a laser.
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They only know the term SIGNIFICANT OTHERS because they cost them money.
You are sure you are not missing the 0.0001 inch???
It's possible becasue I had a high protein meal yesterday…I might have grown
Darren,
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That 7.6 sounds?like a?valid reference point and a strong indicator for gout. Your timing was as good as can be.
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But my question is why didn't the doctor take a reading EVERY time you saw him? More information is ALWAYS better than less.
I would never see a doctor for even the sniffles or a broken leg?without asking for a serum uric acid test.
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NORMAL is normal for those who do not have gout. Once you have had an attack anything over 6 mg/dL must be considered improper treatment. This “normal” estimate by your doctor only indicates he is NOT the man to treating your gout.
Yep,
Hans, you are correct on that overspecification. SOmeone else just reported a 3.90 and I suspected the British molar system.
But then computer programmers may have no clue these days what the term SIGNIFICANT DIGITS means. Few people really do. And the doctor blindly reports what the printout tells him.
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I'm 6 feet 2.000 inches tall. (If measured with a laser.
)limpy,
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Youu say you are taking 200 mg. allourinol but keep having pain? Have you tried 300 mg.? What kind of SUA's do you get with 200 mg.?
It is extremely effective in stopping an acute attack of? gout.
There's a lot I can say about colchicine:
Firstly it is the oldest drug, it was used in ancient Egypt and Greece for gout. It is called an “orphan drug” because nobody ever held the patent on it. (Even aspirin was patened a LONG time ago by Bayer.)
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When I first discovered I had gout 20 some years ago the PDR recommended dosage for “frank gout” was 2 pills (.4 mg.) and then a pill? every hour until diarrhea started, gout pain ceased, or 16 pills was reached. This method works to stop the most vicious attack. The drug cost about $4 for 30 pills retail.
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Big Pharma despises orphan drugs so a company submitted a study on this ancient drug and showed some nonsensical results…that colchine worked for gout…?to the U.S. FDA who, for some reason probably involving satchels of money trading hands, gave the company a patent on the drug and BANNED all U.S. sales of colchicine made by a half dozen generic manufaturers.? The price was immediately raised to about $150 for this 30 pill supply making one company deliriously happy and rich. Gout sufferers got f&*ked.
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To make the price seem palatable the recommended dosing was slashed to a couple pills on the basis of this “study” which showed something?like?half of those studied reported pain was cut in HALF. Wow…a drug dose that cuts pain in? half.? Gee, who would expect a dose that eliminated pain completely?
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Colchicine is rife with side effects and so I hate to see people taking it daily. But since doctors feel obliged to obey the silly 2 or 4 pill dose that will NOT stop a major attack (or cut the pain in half either) then that is what they will prescribe. Few doctors can think beyond what a drug company advert tells them especially if the drug is extremely expensive and the kickback from the drug company generous.
juggernaut,
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As limpy said, 6.7 is not a good enough level for proper gout treatment.
But maybe there was a misunderstanding? He was asking what your level was when you were ON the allopurinol. Is it possible the number you quoted was your level when OFF the allopurinol?
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If a month of 300 mg. gives you only 6.7, then that is not enough of a daily dose.
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If indeed the 6.7 was the result you got with 300 mg. AP, and if the doctor is the same one, it would not seem unreasonable to ask him to start you on 400 mg. allopurinol. There is also the possibility of using 300 mg. allopurinol along with 500 mg. probenecid. You can get VERY low uric acid numbers with the two drugs.
juggernaut,
just tell your doctor that you've already tried the drug and you know you?are not allergic to it and you would like to start with 300 mg. If he gives you a hard time tell him that you see no point in suffering weeks?more of needless pain because of an ineffective dosage.
Test after a month and if you get a SUA under 5.0 mg/dL?then just take that dose til the cows come home. If you cannot get down that low, consider upping your dosage gradually.
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Don't give up on the drug. It will work if you keep at it.
Remember too that gout is a sporadic disease. Because a bout of pain has ceased is no reason to assume that your gout is gone or has even gotten better.
The normal course?of early gout is long periods of normalcy. And, of course, being human, we can then go into denial: it probably wasn't gout; some people only get a single attack; maybe if I drink lots of water; gee I'd hate to take a drug if I didn't NEED it; I;ve got pain killers, what more do I need. And on and on.
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To treat the disease properly you must treat??the disease at it's core: you must lower the amount of circulating uric acid in your serum either by forming less of it or excreting more. And you must KEEP it low forever or at least for whatever passes for a HUMAN forever.
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Laying up stores of indomethacin and?colchicine may be wise but it is NOT the proper?treatment of gout any more than laying up stores of morphine to treat cancer.
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The best and most/only cost conscious way to properly control gout for a lifetime is daily allopurinol in doses close to the average dose of 300 mg./day…more if you name begins with a K.
?For some very few ?who cannot tolerate the drug, then the answer may lie with febuxostat, probenecid, benzbromarone (dependng on country.)
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But agents that stop or ameliorate an attack should be looked on only as adjunctive therapy.
cantaner,
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Firstly, serum uric acid ?6.7 in NOT proper control of gout?you want below 6.0 or better, below 5.0.
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Do not be afraid of slightly elevated liver enzymes (2 x normall upper limit.) Both allourinol and febuxostat temper the activity of xanthine oxidase which makes uric acid and XA is present ONLY in the liver in healthy persons. So perhaps the increased liver activity shows up in some people. I doubt there is much evidence in the literature of liver damage caused by allopurinol after the half century it has been the drug of choice for gout and millions of people are taking it every day of their lives.
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If your numbers keep climbing then consider switching to a uricosuric like probenecid which operates solely in the kidneys.
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If you are on allopurinol there is no need to worry about creating an alkaline urine because you are excreting LESS uric acid. It is those on uricosurics who excrete large amounts of uric acid for whom an alkaline urine will help prevent precipitation of urate kidney stones.
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Don't count on much dietary aid for gout. When that was all there was, it was tried and failed?but then at least doctors could bill for something. (Doctors abhor a vacuum, even more than nature.)
alyboy,
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Given your history it sounds like you are very much into the chronic gout stage, unending discomfort, considerable tophaceous deposits requiring debvridement.
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I think it is unwise for you to put off starting extreme anti-uric acid formation?measures (like allopurinol.) Perhaps even WITH a uricosuric like probenicid.
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With chronic gout, awaiting a time when you are symptom free may simply delay treatment for an extremely long time while gout goes on causing more and more damage.
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I think a proper serum urate goal for you might be under 4.0 mg./dL. (Don't bother with 100 mg. dosing with allopurinol…it will serve no purpose other than to cause you more pain.)
Cobra is mandatory for companies with 20 or more employees. My company probably has 19.5 employees.
That line will have me giggling all day.
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Consider that 26% hike quite good because COBRA hikes are always FAR higher than that.
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It's funny how you don't think about health coverage and how messed up we are over here, until you experience it for yourself.
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It is absolutely appalling and those outside the United Ststes can never grasp how unreasonable, capricious, and cruel the system can be unless you are a multimillionaire or lucky enough to have made it to Medicare.
Hans,
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If you knew what humor was, you'd have a point. Alas, elderly petulence does not not qualify as humor.
And raging and stamping your feet like some tophaceous Rumplestiltskin because someone paid me a compliment is just petty and small minded and ANYTHING but funny!
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Can we presume you live alone?
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Keith,
As we know antibiotics are FAR more likely to have an?adverse, even dealdy,?allergic reaction than allopurinol. Have you ever heard of a doctor prescribing a sustandard dose of antibiotics for weeks or months to avoid the possibility of an untoward reaction? Of COURSE not, the EFFECTIVE dose is the one prescribed.
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Have we not both witnessed time and time again the agony suffered unnecessarily by poster after poster started on a 100 mg. dose of allopurinol. It is NEVER enough. One might call a gout attack slight while one is not having it…but often for the siufferer a single unnecessary attack can be Hell on Earth.
What happened to the Hippocratic prime dictum: FIRST, DO NO HARM! A substandard dose of allopuinol DOES harm.
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Doctors prescribing the go slow are just being stupid, and?thoughtlessly repeating the same stupidity, ?especially? in light of the real possibility that NOBODY ever died from a dose of 300 mg. allopurinol. Any evidence to the contrary?
You cannot say that for aspirin, penicillin, antidepressants, tranquillizers, and probably even diuretics. Rare is the drug that is as safe as allopurinol.
Looking at your desk I was expecting to hear “HOUSTON, WE HAVE LIFTOFF!”
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(I thought everyone had to offer COBRA or is that just for larger companies?)
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I should get one of those postural reminders because I was over 6 feet at age 12 and hunched over to talk to my little friends?thus my posture sucks. Occasionally I try to remind myself to straighten up but then I feel silly?like a strutting marine.
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Plan Coverage ? Group health plans for employers with 20 or more employees on more than 50 percent of its typical business days in the previous calendar year are subject to COBRA. Both full and part-time employees are counted to determine whether a plan is subject to COBRA. Each part-time employee counts as a fraction of an employee, with the fraction equal to the number of hours that the part-time employee worked divided by the hours an employee must work to be considered full time
Does the Obama Plan have anything for you
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?Losartan stinks as a BP med but it is a fairly good uricosuric. A good combo, researched by some Japanese scientists is LASIX (furosemide diuretic) followed a couple hours later by losartan.
The combo gives the best urate lowering of any BP?regimen and gives very good BP control, especially if you are in the minority, volume-driven, salt-sensitive, hypertensives.
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Psst, If you are controlling your BP down to 110, you are taking too many drugs.
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Give a try to 40 mg. Lasix followed by 50 or 100 mg. losartan 3 hours later and see if it gives you good enough BP control. If it works, it really is the best regimen for gouties.
If it doesn't control well enough…we'll find something that does.
Stay away from anything with a thiazide diuretic.
Remeember too Rsholl, that liver damage shows LARGE swings in liver enzymes. Slight elevations of ALT or AST do not automatically signal the need for a panic reaction. Even doubling of the upper values is not usually indicative of anything serious.
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Did your liver enzymes rapidly go back to normal after discontinualnce of the allopurinol (if you can remember back that far.)
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Perhaps you should revisit the issue before you start suffering severe joint (and probably cardiac and renal) damage. Untreated gout just keeps getting worse and worse.
Initial long-term treatment of recurrent uncomplicated gout normally should be with allopurinol, starting in a dose of 50?100mg and increasing by 50?100mg increments
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I can just HEAR that patient screaming in pain?and I have my windows closed. :D:D
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I realize that as site owner you must say ask your doctor about everything, clear it with your pharmacist, test uric acid on a weekly basis, watch for rash, etc.
I on the other hand have the luxury of just spitting out the truth. But then I know if I just give the capsule view, you're there? to fill in the details.
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And then hans is always there to kvetch pointlessly…and rudely.
Trust me jeffros,
Your neck pain IS spasm. Spasm can continue for hours, days or weeks quite unlike a “cramp” in you calf. It is self perpetuating and must be broken somehow. Neck muscles are not meant to hold the head in a single spot for hours, they WILL spasm, just like arm muscles holding a gallon of milk overhead for hours.
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Too bad you cannot move your monitor but in addition to Flexeril (for several weeks to be effective) I can recommend SOMA (carisoprodyl) but nothing will beat getting up ever 10 minutes and moving your head through the full range of motion. The eventual headach is merely an exttension of the spasm up the cranial muscles. Only problem with SOMA and FLEXERIL is that both may impair your judgement, “Hey boss, suck on THIS!”:D…but SOMA is a very pleasant drug
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Can you?aim your chair towards the right and left?periodically so that in order to see the center of your three monitors, you must look alternately slightly?left and right instead of dead on.
ouchiefeet said:
? I am on 100 mgs Allpurinol. I started it a lil less then a month ago.These are my first attacks of gout. They started in mid July.
That is a HORRIBLE dose almost guarantted to increase the number of attacks…go to 300 mg. ASAP.
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?I was dx'd with Takayasu's Arteritis. I am still in soooo much pain and? with that pain comes the inability to get around. I? feel trapped in my own body! I am really in a bad mind frame right now.. I am normally very independant and never ask people for help.??Arteritis is a terrrible affliction,?do you think it was a result of sloppy heart surgery?? Are they treating the arteritis with prednisone?
and 15 Indomethasin.
When I?had my first attacks many years ago, I was prescribed indomethacin (Indocin) and it?helped but I found it unpleasant BUT I was prescribed 3 x 25 mg./day. It sounds like you should have been taking more.
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With 300 mg. allopurinol per day, your attacks will soon become a thing of the past but I wish I could say the same about your arteritis.
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Keith,
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That is the very best CAT AND MOUSE picture I have ever seen. If I can edit it smaller I'm going to use it as my avatar on another buttetin board.
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jefffros,
I hope that cancer is well and truly behind you. I have no doubt that the cancer, the massive weight loss ?and the chemotherapeutic agents used are very much part and parcel of the initiation of your gout. Your story was heartbreaking.
?All that was required for my gout initiation?was a decade of hydrochlorothiazide.
But alas, unlike may illnesses that disappear once the cause is removed, once gout is initiated it is forever becasue the crystals of urate will always make it impossible to superaturate your serum again.
So, no matter the cause, once a goutie ALWAYS a goutie.
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That neck pain is part of your job description, been there, done that. Here are two easy tips:
1. Every month move your monitor from right, to center to left…don't put it off.
2. NEVER cradle a phone between your shoulder and head while you type.
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And two harder ones:
3. try about a month of daily?FLEXERIL (cyclobenzapril…feels like schitte but it eventually breaks the spasms.)
4. try some sort of regular?neck traction
Sorry if my post seemed cryptic?to clarify:
YES, allergic reaction will happen immediately and after a couple weeks one can pretty much forget about allergic reactions like? angioedem and anaphylaxis.
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For me the only problems with my mouth occur when I bite the inside of my cheek!
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drknow,
Since you have decided to stop the allopurinol, I recommend a diet of ZERO purines and ZERO beer until you start again.
White spots on throat usually means strep?I'm amazed no fever, but as we get older our capacity to spike fevers seems to diminish.
I DOUBT it's allopurinol related and I would probably NOT waste time with a doctor unless I wanted to do a course of Azithromycin or some other antibiotic and needed an Rx.
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For comfort I use a throat spray that contains either zylocaine or some other “caine” or one containing phenol (banned in some places but often found in Dollar stores.)
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Keep watching for a fever rise.
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Yes, it COULD be a very?unlikely?reaction to allopurinol but we must remember that if we are going to take a drug for a lifetime, there will be MANY instances where we will ask “Is it allopurinol?” and most often the answer is NO. Because we take allopurinol there is no reason to expect the number of our colds, sore throats, rashes, etc.?will diminish. And if we stop and start allopurinol for no really good reason we are dramatically increasing our chances for acute gout?attacks.
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The most common side effect of allopurinol is rash. I really wouldn't concern myself with anything else after the first several weeks (when the possibility of allergic anaphylaxis and angioedema?become extremely remote.)
