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Good idea about halving both types of tablets! These tablets halve easily under a little finger pressure. No need for a cutting tool.
After one’s last meal of the day might be a good time to take the drug. But if you’re going to experiment, you might as well try different things. We might be surprised by what works best.I have no idea what might impair febuxostat absorption. Trial and error will tell if anyting makes a significant difference.
For my own use I don’t care about the effectiveness of the drug anymore so I’m taking it pretty randomly. The perceived side effects have become milder over time but they’re still my main guide as to when’s the best time to take it.350 umol/l is generally considered low enough but guidelines recommend aiming a bit lower in some cases. Check out the guidelines and studies for yourself if you have any doubt. Thing is, everyone is different and mesurements are unreliable. Experience might tell you should aim lower than is generally recommended. But it’s way too soon to assume your case in unusual.
Keith has shown evidence that large tophi shrink quicker when you go well under 350 umol/l but you can’t generalize that to people who have already dissolved all their superficial crystals and that study also showed diminishing returns after a certain point. So I can’t say I’ve ever seen any evidence supporting his recommendations on aggressive XOI dosing.
It would be a different matter if 300mg allopurinol was enough to drop your SUA under 300 umol/l without apparent side effects for instance. In that case, ir woudn’t be unreasonable to take 300mg instead of 200 even though the latter dose would be sufficient to reach the generally recommended SUA target. But febuxostat is a newer drug and you’re already taking a dose which isn’t as thoroughly tested as the doses originally recommended by the drug’s developper so there is the balance of risks to consider…
You didn’t try the maximum doses for either Naproxen or colchicine by the way. That said, it may not be prudent to take more than you did in your situation. Anti-inflammatories routinely kill their users.4.8 mg/dl would be consistent with Rebecca’s older test results so I wouldn’t worry about potential mixups. But it’s easy enough to double-check the value and unit.
And for whatever that’s worth, I think it’s worth doing another test considering what changed since June. With a small allopurinol dose, it doesn’t take much to raise one’s uric acid.You apparently get a taller peak but a lower average blood concentration if you take the drug on an empty stomach. So the drug might be more effective if you take it on a full stomach… assuming of course you haven’t eaten something which impairs absorption in the first place. But possibly it might be even more effective to take it at a time of the day when you wouldn’t normally eat (this is a wild guess but taking it in the morning doesn’t sound ideal).
I’m pretty sure none of this would make enough of a difference to warrant postponing your dose increase anyway. It’s just something pretty harmless you could try, like next year or something. If you’re going to have frequent blood tests anyway you could use the opportunity to run some experiments.Congrats!
That sounds like a healthy diet. Hopefully you’ll stop losing weight naturally when you reach your most healthy weight.How long you would take 100mg should depend on your test results, gouty symptoms and the subjective side effects of the dose increase. We’re potentially talking years but maybe you could try to aim for a slightly lower dose such as 90mg after a while depending on what 100mg does.
I don’t know much about the effects of a large febuxostat dose over the day but based on the little I know, I’d cut rather than alternate. My rheuma agreed on that point but we were discussing much smaller doses. You could also try taking your dose at a different time to see if that makes a material difference by the way (tests have shown the effect is slightly different if you take the pill on an full as opposed to empty stomach).
At this stage, I wouldn’t recommend a daily colchicine dose. If you were to feel incoming gouty symptoms a few days after the dose increase though, you could go for a pill just in case (and quit colchicine once that went away).My opinions and Keith’s differ in some respects so I thought it best to let you discuss your issues with him since he was (unusually?) available.
Seeing that your new blood medication doesn’t seem to do anything, yeah: the obvious thing to do would be to increase your febuxostat dose. In my opinion, your should try around 100mg (precision doesn’t matter) rather than 120mg to begin with. 80mg would probably be enough in the long run but a higher dose might help you bet better faster so as long as there are no obvious side effects, a moderate dose increase seems worth trying.
We had discussed all of this earlier but if it encourages you to see me restate it, it only takes a few minutes so here you are.Whether you’re honest or not and regardless of how long you’ve known something, it’s equally likely to be wrong. If on the other hand you’d taken the trouble to test your ideas against relevant data, you’d be less likely to be wrong.
If you can walk at all on an inflamed ankle it can’t be that bad. In my experience the toe is indeed more painful at rest but trying to walk on an inflamed ankle is another matter entierly!
For what it’s worth I don’t think I’ve had crutches-grade ankle pain while my blood tests were satisfactory. I wouldn’t make much of this episode as long as it remains mild. Annoyances are going to happen while you are curing gout.
Crystals should form quite slowly and shouldn’t form at all if your SUA is low enough most of the time. Don’t worry about that.The 6.8 test result does bring you closer to a gout diagnosis, especially considering you’ve taken steps to reduce your SUA through diet. A single result can be anomalous though so you’ll want a second test result around 7 to confirm that your SUA is problematic.
There are random changes in test results but we have a tentative explanation for your 6.2 test result which was probably done too soon after your attack to provide more than a ballpark estimate.
The good news is that 6.8 is quite mild. Keep this up and you’ll never see the worst of gout. It is too high though so treatment might be warranted if flares recur and depending on the result of further tests.If you managed to lose weight responsibly while remaining well hydrated 24/7, treatment might possibly become unecessary. Taking a pill would be easier than the following but I’m going to post it anyway in case you want to know…
Moderate and regular exercise is recommended for gout patients as opposed to bouts of very taxing exercise. Don’t starve yourself while you’re expending energy and more importantly make sure to drink enough water to compensate for the water you’re losing when you exercise.
Meat once a month won’t make a difference if you stick to reasonable portion sizes.
I don’t see why vegetable purines wouldn’t affect gout. It’s just that it’s not worth the bother to look at them in most cases, considering what most people eat and drink. In your case though, it might be worth looking at depending on your vegetable intake. It’d simply be a matter of eating only small amounts of the problematic vegetables such as brocoli (most vegetables are fine). Other things such as weight loss are of course more important anyway so don’t obsess over purine lists.
I don’t know what else you might be missing since you don’t say what else you’re watching about your diet but you seem to have the bases covered based on your first post (sugar is known to increase uric acid for instance). You aren’t drinking alcohol, right?
Depending on your fruit intake, you might have to watch the amount of sugar you’re getting from these fruits by the way. There are a couple other things you didn’t mention: mushrooms and single-cell cultures such as yeast can be an issue (and many so-called meat substitutes are made out of that kind of thing).
Also make sure to check any medications you might be taking for their effect on uric acid since you’ve had issues with that in the past.The amount of fat in one’s post-surgery diet might also have an effect on bile production and absorption.
The surgery will in any case encourage people to change their diets which can in turn affect uric acid, either directly or through weight loss/gain.Arguably, inducing your users to generate ad revenue in exchange for the PDF files means that you are effectively profiting (or trying to profit) from the unauthorized distribution of copyrighted works which is worse than handing out the stuff freely.
Better let people find the material themselves. Some people have free access to this stuff through their work (or their education). Perhaps an anonymous forum user who has previously downloaded all the files (I didn’t) might put the whole library on Bittorrent or something. This would take care of the cost of hosting as well as of the legal risk. Just a thought.I don’t think it’s right that bile is no longer available after gallbladder removal since that organ only stores the stuff.
Also, I had more acute arthritis before mine was removed than afterwards. I didn’t get before/after SUA tests but over the years, my SUA did diminish. Dietary changes and so forth also affected my uric acid but I suspect bile production might actually be stimulated by removals before it kind of (and very slowly) reverses to the mean. Anecdotally, as far as arthritic symptoms are concerned, I had a pretty good year following my removal.DQ isn’t talking about a routine lab test. He’s trying to determine if a new medication indirectly impacts his SUA.
If it has a large effect, the dinner won’t matter. But if the effect is subtle, it might conceivably be masked by an evening’s indulgence.Keith used to recommend eating the exact same thing at the same hour before blood tests. I assume it makes a difference but I’m doubtful as to whether it makes more difference than random noise in test result… unless of course you go out of your way to eat/drink in ways that increase one’s SUA.
So I think it would primarily depend on how much you intend to indulge. Delaying a test a day or two has precious few downsides anyway.More allopurinol should get rid of the tophus faster if it’s indeed made of uric acid.
If allopurinol is what’s stressing your liver, more allopurinol would mean more stress, yes. But it would only be temporary and 69 is no big deal, especially as long as your AST stays put.
100mg per day might be enough in the long run with a few dietary tweaks. You’ll have to see if your liver settles down or not. Maybe once your liver gets used to the stuff, it’ll handle 150mg. If not, there are as you say alternatives to allopurinol (but they can be hard on the liver too).There’s the aspiration thing but there’s also DECT imaging which can detect uric acid crystals non-invasively.
Or there’s the low-tech option: seeing as how you’ve already been on allopurinol a while, you could also simply stick with it for a few more months and see what gives. It needs some time to do its work.Hi,
1.
Technically, you did ignore uric acid for years. But yeah, that was very fast… assuming the tophus is indeed made of uric acid. Do you know that for a fact? Were uric acid crystals actually found in your body or did doctors simply guess that you have a gouty tophus?2. + 3.
Though both the 2016 episode and the circumstances of the onset of pain in 2018 are fairly typical of gout, your pain since hasn’t been typical.
Different people need different doses but 1.2mg of colchicine a day plus regular anti-inflammatories would get rid of gout pain within days in most cases.
Maybe you were unlucky and a nerve was damaged. Maybe that will heal in time. Sorry but I don’t know.4.
I’m no doctor but I’d say it’s not a serious concern at this stage. That said, I would strongly recommend monitoring your ALT for further increases. How is your AST doing?
The culprit may not even be allopurinol. If you’ve been taking colchicine constantly, be aware it also raises ALT and that its side effects can get much more serious if you use it daily for months on end.5.
If you have gout, I doubt you could deal with it without medication. It may be worth a try after a couple of years but considering your symptoms and the suspected gouty tophus, it’s too soon to even think about it.
In fact, you might possibly benefit from increasing your allopurinol dose. Repeating the imaging to see if the tophus is shrinking or even disappearing would be informative as to the effectiveness of your current dose (again, assuming this is a gouty tophus).6.
Careful and moderate exercise shouldn’t make your condition worse. Possibly it might improve it but I would recommend taking great care when it comes to exercising a joint affected by a poorly-understood (at best) pathology.7.
Best ask a professional about that. Generally, it’s not recommended but depending on the circumstances it may be OK. For one thing, I’d say you are young enough to walk funny for a while without endangering your other joints.
Even though using a crutch isn’t recommened either, I used a crutch to spare my foot with (so far as I can tell) no effects other than a faster recovery. A crutch would spare the area under the small toe which may be unduly stressed by constantly leaning on it without support.
