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The way to tell if you’re still dissolving crystals would be to take a DECT scan… way overkill.
If these aren’t crystals, I guess it could be some kind of tendinitis caused by a gout attack. Either way, it should heal. Naproxen-type drugs should help either way.I’ve taken a drug similar to naproxen at the same time as colchicine. I gather some people have done this a lot more than I did. If the pain/redness seems superficial, you could also use topical anti-inflammatories on top of colchicine. Run whatever drug combination you want to try by a doctor as side effects do not necessarily show up right away.
You did lose weight so you got one thing right at least. But yeah, you could have done it more gently.
I’ve seen people on allopurinol eating meat and drinking alcohol, sure. Your body needs to tolerate the drug and you need to be regular with the pills. It’s as simple as that. Well, first you need to get the dose right.
People have been able to take extended breaks from allopurinol after taking it for long enough to clean up their system but I don’t think that’s like starting over with a clean slate. Once your immune system has learned to target uric acid, you’ll form crystals quicker than people who never had gout. It’s kind of like getting a vaccine. If you are able to keep your uric acid down by working on your lifestyle though, you could in theory quit allpurinol for many years, until aging causes your uric acid to creep back up. Some people have so much uric acid that they’ll need to be taking allopurinol (or something similar) for life. But that’s not your situation.That was some rapid weight loss. That’s known to be dangerous if you are prone to gout. Since you exercised heavily, you probably built muscle mass and so lost even more fat… unless you lost water, which is also dangerous. Heavy exercise itself can raise uric acid. And then there’s the diet you were on when you were losing weight… it can’t have been gout friendly. There have been reports of people developing gout after going on a low-carb diet for instance.
For all I know the anxiety drug did raise your uric acid. Certainly the food you must have eaten to put on 35 pounds over 6 months must have increased your uric acid. Simply being fat has an effect as well.
And then there’s the binge drinking which can cause dehydration (a gout trigger). Alcohol is known to increase uric acid anyway. It doesn’t matter if it’s vodka or whiskey.
In case you didn’t know, having had higher uric acid in the past can cause gout now. At that point, it’s best to drive uric acid way down to clean up the mess. Else uric acid crystals can persist even though the amount in your blood wouldn’t be high enough to form new crystals from scratch.
All in all I’d say the gout diagnosis isn’t implausible. It was kind of quick though. Especially when your uric acid isn’t all that high, doctors will often want to see repeated gout-like attacks before jumping to conclusions.Even if you do have gout, I’m not sure you need allopurinol to get rid of it.
Then again if you don’t have East Asian ancestry, start with very low doses of allopurinol (you can cut pills) and get frequent blood tests during the first months of treatment, allopurinol isn’t very risky. So if you’re comfortable taking a daily pill, starting allpurinol now isn’t such a bad idea. It could be you don’t even have gout (which would make allopurinol pointless) but if you do have gout, there are risks involved in not taking allopurinol as well…
An alternative to allopurinol would be to quit alcohol and change your diet. That’s nowhere as effective as allopurinol but with your test results, it probably wouldn’t take much to get your uric acid test results into the safe zone. Since alcohol and junk food are generally unhealthy, my recommendation would be to try lowering your uric acid without allopurinol. That’s probably your best option in the long run, though taking allopurinol on a temporary basis while your are changing your habits might be helpful.
You could also do nothing besides getting more blood tests for a while. If you get more gout-like attacks or if you see your uric acid test results creeping higher, you’ll know the time to act has definitely come. But at that point, you may regret not having acted earlier.
I don’t think there’s a very strong case to be made for either of these three options in your situation. It’s more a matter of personal preference.Many gout meds are similar enough to diclofenac that I can’t recommend them if you don’t know exactly why your doctor told you to stop taking diclofenac. I was hoping you were still allowed to take it on occasion, just not every day…
If you were told not to take any diclofenac, I’d look into colchicine and methylprednisolone (or similar) which are quite different. I’m only saying “look into” because these drugs could potentially be hard on your kidneys as well.
If you wouldn’t know what to do if your foot started swelling and hurting real bad, best see a doctor and ask them what you should do in an emergency. This could happen in the middle of the night and you don’t want to have to wait in the ER when you are in such pain (assuming you are well enough get to the ER).The “whipsaw” isn’t so surprising.
The conditions of each test aren’t clear but even if each test was done in the same conditions by the same people (the technology used can make a difference), there still are random-looking variations.What is more surprising is that none of your results are high.
Do you have a reason to think your uric acid used to be higher (possibly you used to be fat or you used to take a drug known to raise uric acid)?
Another explanation is that you might have misread the test (that’s not uncommon apparently). There are three different units in active use. 720 or 0,72 is quite high for instance whereas 7,2 is merely borderline.
What is the basis for your gout diagnosis? Merely the appearance of your foot or did a test actually prove you have gout?Make sure you have an alternative to diclofenac on hand if you can’t take that anymore. You just started treatment so you may find yourself in need of a drug than can control a serious attack.
5.9 is not ideal. Hopefully, your UA will test lower next time. If not, ask your doctor whether you could take a bit more (not twice as much!) Uloric.Diclofenac and Uloric work for lots of people. Whether they work for you or not is another matter. And the dosage must be right.
Your blood test will tell if the Uloric dose is right and might also show that your body isn’t coping well with one or both of these drugs.
And what the blood test won’t tell, you should already know: are you feeling any side effects? Has your diclofeac dose prevented gout pain?Fasting can certainly raise uric acid.
But exercise raises uric acid more than fasting, yet exercise is still recommended. It looks like regular exercise can lower one’s average uric acid as one’s metabolism adjusts even though it causes an immediate increase in uric acid. Weight loss also raises uric acid while you’re losing weight but lowers uric acid afterwards. Maybe something similar happens with mild fasting. Bottom line: your uric acid tests will tell.
In any case moderation is recommended. Whether it be exercise, weight loss or fasting, I would take the way you feel as a guide: if you’re feeling fine, you’re probably not overdoing it. Some of us can fast longer than others.So you’re basically doing Ramadan?
As I understand it, 5:2 is something else (violent caloric restriction).I occasionally indulge in this sort of light fasting (without counting calories when breaking the mini-fast). The hunger is typically more stimulating than debilitating, and makes for a change in one’s routine. The most obvious benefit however is simply that not eating saves time during the day.
I didn’t lose much if any weight by skipping meals but in hindsight it may have helped with my uric acid, BP and diabetes numbers. Something certainly helped. Maybe what did the trick was simply eating fewer simple carbs.
I’ve also tried proper fasting (eating nothing for a whole day or more) and I wouldn’t recommend that.While simply losing 60 pounds (aside from any effect one’s eating patterns might have) could be enough to cure some people’s gout, a couple of warnings:
-light fasting might possibly reduce your uric acid during one part of the day rather than throughout the day (so take that into account when planning your tests)
-having merely “normal” uric acid is often not enough to get rid of gout for good (certainly it wasn’t enough for me)These assertions are vague enough to be meaningless but it’s easy enough to find evidence that single-cell cultures such as yeast are as high in purines (as one could have guessed).
Now eating something to which a bit of yeast has been added is of course very different from eating food made out of yeast (yes, that is a thing). There are some strange vegetarian processed foods out there, and there’s at least one study about the effect of some of them on uric acid.For what it’s worth, animal torturers have found that MSG raises uric acid. But I hope no one would voluntarily eat that much of the stuff.
It seems like the NHS failed you pretty badly.
With regard to the medication review, the febuxostat dose your husband has been taking is obvisouly excessive. Keeping this up would be reckless. If you want to frame that in the form of questions, you could ask:
-what purpose could this dose possibly achieve?
-did the medical guidelines change while we weren’t looking or something?
More to the point, I guess you could also ask whether it would be advisable to switch back to allopurinol before seeing how your husband fares on a reasonable febuxostat dose such as 40mg.But the main difficulty here is completely different, namely determing what disease your husband might have besides gout. And I’m effectively clueless about spondyloarthropathy and all that. So I don’t know what questions to ask.
The only way I might be able to help you is by telling you what information I’d bring to the appointment:
-a clear and precise description of what you call flares: location, duration and so forth (if you had pictures, that’d be great)
-a precise timeline of the treatment: you want a list of blood test results to establish for how many months the treatment has been successful in reducing uric acid to the recommended values
-a short report about what colchicine does and doesn’t do for your husband’s flares
-and of course all the relevant medical imagery if the specialist doesn’t have it already
All I can say is that, on the basis of the information you’ve given, it’s too early to rule out residual gout as the cause of some of your husband’s symtoms. After many years without treatment, getting rid of gout sometimes takes even longer. I should warn you some doctors are unaware of that fact. That said, the spine thing is so far as I know not typical of gout.I don’t know how experienced these doctors were with gout-like symptoms but as you know, many things can cause inflammation.
That said, your SUA tested low enough for long enough that it may explain why your hypothetical gout didn’t come back even though you didn’t take your medication regularly. In theory, symptoms should come back if you allow your SUA to remain above 8 long enough.The variations in your SUA are impressive by the way.
Did you change your diet, take drugs known to affect SUA as a side effect or something? Because if 300mg allopurinol was enough to bring your SUA down to 3.4, that dose may have been excessive… which probably means 80mg Uloric is way too much for you.I’m clueless about interactions between ADHD meds and xanthine oxidase inhibitors (that’s what allopurinol and Uloric are). Have you asked a good doctor about this or looked up reports yourself? If my blood pressure read that high at rest, I’d be concerned.
Have you tried other types of gout meds? There’s a BP drug which also lowers uric acid for instance.
The problem with reporting drowsiness as a side effect is that it’s subjective. But if you could bring a doctor a more systematic report about your XOI-driven hypertension, maybe they’d be willing to explore other drugs or drug combinations with you.
Even small XOI doses do have a significant effect on SUA so if the side effects you get are dose-dependent, a small Uloric or allopurinol dose could be part of the solution.Hi,
80mg Uloric is much stronger than 300mg allopurinol. You could try taking less to see if you still get the same side effect.
What are your blood test results like when you are taking either drug every day? Did you check your blood pressure, blood sugar and so forth while you feel drowsy?
Considering you haven’t had a flare in more than two years however, I’m not sure you even need to take a drug. Did any tests establish that gout was indeed the cause of your flares 5-10 years ago?Hi Jesse!
I’m sorry to hear this.
Is there any reason you have not tried other drugs? 600mg allopurinol is obviously inadequate in your case. It looks like you might have a disorder which is making it difficult for your body to excrete uric acid. Some people take a drug to help with that in addition to allopurinol. You could also try febuxostat or simply a higher allopurinol dose but considering your SUA didn’t fall under 12 on 600mg allopurinol, a combination of drugs affecting different parts of the UA metabolism looks like your best option.
It might also be worth looking into pegloticase depending on where you live (or where you could move to receive treatment).
And as you probably know, there are also a bunch of drugs you didn’t mention which can be used in combination with colchicine to reduce swelling and pain.Hi!
If allopurinol is the only medicine you take, yes you should be taking another medicine.
You shouldn’t quit allopurinol. Typically, people take allopurinol their whole life. It takes care of the cause of gout but curing gout takes a long time.
In the meantime, there are many medicines that can help with the pain, swelling and so forth. The most common are a class of fast-acting anti-inflammatory drugs called NSAIDs which includes ibuprofen.Gout attacks do not typically last this long but it is not unheard of.
When people start taking allopurinol especially, they often get frequent attacks. Frequent attacks could of course feel like a single attack of varying intensity if the location of the pain doesn’t change.Finally, you didn’t ask about that but it would be prudent to get another blood test done if you haven’t had one since starting allopurinol. First, you need to make sure your body tolerates allopurinol well (typically, liver and kindney function are checked). Second, the efficacy of allopurinol should be verified because it varies between individuals (some people take a higher dose than you do while others take a smaller dose).
Goof luck!
I have no experience with this connection but:
-in theory, allowing your UA to rise above 0.3 isn’t risky (even if you had taken 200 from the start, you probably still would have experienced symptoms for your first months on allo) because mainstream targets are 0.35 or even a bit higher (everyone’s body is different though)
-you aren’t limited to 100 or 200 but can easily take intermediate doses
-if allo side effects really are a problem for you, there are other drugs you could take
