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Most new visitors reading this discussion have found it after asking Does Allopurinol Dissolve Tophi? Please follow that link for the latest facts.
Also, this is a heads-up that I’m replacing this forum soon with GoutPal Issues and GoutPal Discussions. At the same time, this forum will become read-only. After which, I will slowly absorb forum topic information into GoutPal.com.
GoutPal Discussions are the nearest thing to this forum. Because I intend them to be where gout sufferers can chat about common questions, experiences, and opinions. GoutPal Issues work alongside on the same platform. However, I intend them to be where gout sufferers can collaborate with me to improve information on GoutPal.com. Therefore, the focus with GoutPal Issues is to help people apply my information to their situation. That is similar to some topics in this forum that I have tagged with
Using GoutPal.For this topic, there is a live Issue about Tophi and Allopurinol. So that is where you can work with me to apply my facts to your situation. By doing that, I intend to help you with relevant information that you can discuss with your doctor. Or other health advisers. After which, I can use our dialog to improve my pages for future readers.
Actually, the social login is a throwback to my early forum days. Personally, I like the easy access. But I have grown to hate the Facebook approach. So I started offering the “official” WordPress login as an alternative some time ago. Until today, I thought both of them worked well. Now, I’m not so sure.
I will try and see what the problem is with the reset emails.
Also, I’m aware of the broken links to my profile information. During lockdown I realised that I need to reorganise. But the domain expired before I found time to finish my changes. Thank you for reminding me that I need to stop thinking about improvements and actually start improving things!
Any suggestions for improvement priorities from anyone are most welcome.
Thanks for sharing your husband’s experience of gout pain after taking fish oil supplements, Elizabeth. But might I add a note of caution?
Because gout pain is a complicated beast. That has very different states for most gout sufferers. The most common state is where gout pain results from years of excess uric acid. Resulting in uric acid crystals forming. Then our immune system attacks these crystals just as it attacks viruses, bacteria, etc when they invade our bodies. But uric acid crystals cannot be killed. So our white blood cells smother them.
This can continue for months and years. Slowly increasing the “uric acid burden”. But if uric acid falls below the crystallization point, those old crystals start to dissolve. So you get a painful gout state that is common in allopurinol therapy. Where partially dissolved crystals are again exposed to the immune system. Causing gout attacks during falling uric acid levels.
Now to get a true picture, your husband needs to consult his doctor for uric acid testing during periods with and without fish oil supplementation. Then during those consultations, he might like to discuss the 2015 investigation that showed “Plasma concentrations of triacylglycerol, uric acid, C-reactive protein, and ferritin were significantly decreased after 4 and 8 week supplementation of fish oil, and vitamin B- 12 + fish oil. ”
Huang, Tao, Kelei Li, Sailimuhan Asimi, Qi Chen, and Duo Li. 2015. โEffect of Vitamin B-12 and n-3 Polyunsaturated Fatty Acids on Plasma Homocysteine, Ferritin, C-Reactive Protein, and Other Cardiovascular Risk Factors: A Randomized Controlled Trial.โ Asia Pacific Journal of Clinical Nutrition 24 (3): 403โ11.
Ideally, that discussion would prompt a thorough review of treatment, including diet. Because other factors might effect the benefits of fish oil.The key points for all gout sufferers to be aware of are:
1. Sometimes gout attacks are an inevitable part of recovery. So they need to be managed as part of the recovery plan.
2. The recovery plan must be a joint effort between patient and physician.
3. Fish oil supplements are an optional, minor part of any viable gout treatment package. So patients and physicians have to develop a comprehensive mix of therapies that suit the patient’s individual circumstances.So fish oil supplements might be good for gout sufferers. But only if they understand their treatment needs. And manage those needs in the framework of a patient-physician plan. (in my opinion)
The significant things missing from this thread are allopurinol dose and uric acid blood test results.
This is a bit like watching a game with all players in the same strip and no one keeping score.
Nick, as far as my experience goes…
In 2011, I achieved my target uric acid level after 3 dose adjustments and 2 arguments about the meaning of normal uric acid. The only glimmer of enlightenment was preventative colchicine prescribed alongside allopurinol. So no attacks.
Logic suggests to me that, without a DECT scan to assess diminishing uric acid crystal load, allopurinol patients should be prepared to deal with attacks from dissolving crystals for as many years as they had untreated excess uric acid. [Discuss]
Sorry George, but I believe you need a level of help that is much more personal than anything I can provide on an online forum.
I think you need to discuss your gout pain with your doctor. But if you cannot get an appointment quickly, then a pharmacist might be able to provide you with interim relief.
I suggest you print out the page that I linked to. Because that outlines the three aspects of gout pain that you need to discuss with a health professional:
1. Control spread of inflammation (optional, but most gout sufferers find this effective).
2. Reduce inflammation – the best choice of anti-inflammatory depends on your medical history. But you must consult a health professional who can prescribe gout-strength meds. Over The counter meds are rarely useful for gout sufferers. Except for mild attacks.
3. Tackle residual pain. Sometimes anti-inflammatories need a little help. If pain lingers, your health professional can prescribe pain blockers that are compatible with the anti-inflammatory.Not every situation requires all three gout pain meds. But if you want to ensure gout pain relief within two hours, you and your health advisers need to consider all three components.
At this point I have tried everything.
Everything? Which part of Gout Pain Relief in 2 Hours failed to work for you?
I’ve just noticed you also created a new topic about this.
For clarity, my 6.8 mg/dL is 400 μmol/L. So, you’re slightly below this.
I would highly recommend that you start a personal journal of uric acid test results. Hopefully, you can get historic results from your doctor. Then you can start to take control. If your 377 μmol/L is your first result, I recommend a second test when you are free from symptoms.
It seems to me like you’re lucky to have one of the few doctors who understand that “normal uric acid” is a statistical measurement. Which only shows that statistically, some people will get gout.
Medically, any level above 6.8 mg/dL is hyperuricemia or “excess uric acid”. But a good doctor also knows that uric acid levels in the blood often drop during an attack. Because some uric acid has crystallized out of solution. (as Sam noted).There are other factors that affect individual abilities to form crystals. Also, people react differently to crystals. So the only way forward is to agree a safe uric acid level with your doctor. Personally, I aim for under 5 mg/dL. Others prefer 6 mg/dL. But the important point is to agree that safe level. Then gradually reduce uric acid to your personal target and maintain it there.
If symptoms have gone after six months (maybe longer if you’ve had untreated hyperuricemia for many years), then it was uncontrolled gout. Which then becomes controlled gout – allowing you the freedom to live a normal life.
Actually, it’s a “better than normal” life.
I’ve used home uric acid test kits in the past. The main problem is getting consistency. Because a pinprick of capillary blood is not necessarily representative of your true level. After a lot of trials and meticulous attention to a consistent testing regime, I gave up. But other people have found them beneficial.
I don’t think you can make a quick decision about home testing. Because it’s largely irrelevant without a proper plan that acknowledges full medical history. Including test results from “official” blood tests.
I don’t want to say much more on this until I know some history of blood tests so far. Because options that seem reasonable when uric acid is 6 – 8 mg/dL are pointless if it is 9 – 11 mg/dL
Hi Kurtis and thanks for your story.
First off, I think you need to spend some time thinking about all the points that nobody has made. Then perhaps you can get a clearer picture by discussing them with your doctor or exploring them further in this topic.
As far as cracking the code is concerned, I believe most of it is revealed through the appreciation of how uric acid “works” in gout.
Excess uric acid causes crystals. Everyone has a different crystallization point.
Crystals form over time and get locked away as your immune system engulfs them. Again, people have different reactions. But when uric acid is not controlled, crystals spread to cause increasing discomfort and damage.
Uric acid treatment is the only long-term solution. Whether through diet, drugs, herbs, or a mix. But when treatment starts to become effective it often exposes old uric acid crystals as they dissolve. So pain relief or prevention is important. However, except for some ‘edge cases’, gout pain control has to be managed as part of a uric acid control plan (if that’s not clear, we can discuss why I think this way).
When you understand that, and have a plan for managing uric acid and gout pain, then you can start to assess the part that diet can play.
Cheers Don,
Doc never explained to me about the treatment plan
It’s a common problem. The guidelines say that treatment should be an agreement between patient and doctor. With both parties playing their role. But no one reads the guidelines ๐
We don’t know that Don has gout. We do know that he has hyperuricemia. In which case he should discuss that illness with his doctor and agree on a plan.
Thanks for pointing out that I wrote treatment plan when management plan is a better term. Because the “treatment” they agree on could be further tests, wait-and-see, or something else.
I will correct that now.Hi Don, or with your avatar should I call you SuperDon?
Your introduction to gout is similar to mine in many ways. Except I got a definite gout diagnosis (eventually). Back then, there were no agreed guidelines for gout treatment. But the consensus was to let the patient choose between uric acid treatment, preventative pain control, or pain relief as required.
That’s a simplification but it should be irrelevant because doctors now have guidance on when to treat with uric acid lowering drugs. And everything you say tells me that’s what you need.
So unless you have reasons not to, I think you should make an appointment with your doctor to start a uric acid
treatmentmanagement plan. [Edit: Don, as nobody pointed out below, “treatment” implies that you start some form of medical therapy immediately. But I intended to encourage you to start the consultation process about resolving your uric acid problem. Your doctor has a wide range of options. We can discuss those options as you wish. Sorry for any confusion.]What are your thoughts on that?
By the way, you described “uric level was at 7 which was normal high”. But I would describe 7 mg/dL as Warning/Dangerous https://www.goutpal.com/449/uric-acid-concentration/
Bearing in mind that uric acid blood test results tend to be understated during gout attacks, I lean towards “Dangerous”. So it makes sense to avoid delays.I agree with you Eide, that peer review is more likely to be trustworthy. But the report that started all this is not relevant to patient oriented gout care. Annoyingly, it was also not relevant to the year old thread that had been diligently responded to. (not by me – I must have had insomnia that day)
In other words, you cannot simply take it at face value. So you must discuss it with your doctor or other professional adviser who is familiar with your medical history.
That’s the main reason I stopped providing a library of publications. But I am happy to email anything as long as I can send it to the gout patient and his doctor.
I can’t ignore…
There are 9,200,000 gout sufferers in the United States. 0.2% of them is 18,400 people, who would experience Steven Johnson Syndrome or experience severely negative outcomes with the disease. Of those 18,400, approximately 4,600 would die. So, to my original point, try what you can first, before seeking pharmacological remedies, and be cognizant of the risks those pharmaceuticals pose.
Those 4,600 would only die if they were treated without acknowledgement of professional standards. No one dies from 100 mg allopurinol.
On the other hand, pathologists are failing to detect deaths from untreated uric acid. Because it is not standard practice to test dead hearts for uric acid crystals.
You will not die from properly administered uric acid treatment. But you might die from crystal induced organ failure while you are wasting time with poor diet and irrelevant academics.
I have another anecdote regarding death and gout. But I will save it for another day.
I’ve just had another thought…
Who is the better expert? Someone who has mastered the art of getting research published? Or someone who has successfully controlled gout for many years despite widespread poor quality of medical services?
OK, we’ll discuss it here then.
Here’s my views.
Peer review is simply 1 academic agreeing with or disagreeing with another academic. A large part of their work is statistical. Therefore of little help to the individual gout sufferer. Very few of the academics involved have practical experience.This is not totally wrong. But it is mostly irrelevant to patients. I’m sure they can justify that by saying it was never intended to be practical guidance. But the reality is that gout sufferers read this stuff and get misdirected.
In real life, we each need to recognize different research objectives. Academics will provide lots of untargeted research. Our doctors should be able to filter which studies are relevant to each individual patient. Us patients should attempt to understand the principles. Then discuss the options with their doctor against the background of medical history, best practice, and personal goals.
In other words – never trust anything proffered by an “expert”. Unless they can explain why their recommendations apply in any given situation.