Forum Replies Created
-
Posts
-
The properties of these two drugs are quite different but there is no reason to believe that one would remove tophi better than the other. With both drugs, it’s the dose which matters. Your Uloric pills are probably stronger than the ones you used to take but you could have taken more than one allopurinol pill every day instead of switching to Uloric.
The good news is that you seem to be tolerating allopurinol.
The bad news is that UA result: it is significantly higher than the “between 3.2 and 4.8 mg/dl” results you were getting from your chemist. You could re-test but I think you could simply assume your chemist’s test are biased low and increase your allo dose to 150mg or even 200mg without further delay. In principle, you should only do that with your doctor’s approval but we’re only talking about moving from a tiny to a small dose…Hi Fred!
Diclofenac should help all gout sufferers but how much it helps would depend on the dose. So it would be helpful if you specified the doses you’re talking about when comparing its efficacy to similar drugs such as ibuprofen.
Gout in the ankle or knee is supposed to be pretty common. Certainly it didn’t take long for me to get gout-like symptoms there after getting them in the toe. But there are other joints which are normally not affected by gout.
Finally, in case you weren’t aware… diclofenac will not stop the progress of gout and only prevents part of the damage it does to your joints. If you don’t do something about your uric acid, your gout is likely to get worse over time.Aspargus and spinach are not very high in purines so I don’t know that a special explanation is called for. They contain more purines than most veggies but broccoli has more than aspargus for instance. Spinach has a fair bit of one type of purine but none of the most troublesome purine which you do find in a few other veggies like eggplant.
Whatever. No vegetable contains as much purine as animal flesh. The way most people eat veggies, the purines they contain isn’t going to amount to much. It’s only if you eat unusually large amounts of such vegetables (for instance because you’re vegan) that an issue might arise.Your description of these migratory aches doesn’t sound much like gout to me. For one thing, widespread gout should also affect the fingers and the smaller toes where redness is more obvious. But each case is different.
You should stay on alloputinol anyway since you do seem to have gout based on the following:
-big toe pain on low carb
-SUA as high as 8 mg/dl
-textbook gout symptoms after starting allo
And allo is going to tell: whatever pain goes away for good after being a couple of years on allo, that was almost certainly gout. Whatever pain remains, that’s almost certainly not gout. Only you need to confirm your dose is sufficient and that your body tolerates it by getting this blood test we’ve been talking about.
In case it looks like some organ of yours hates allo, there are alternatives.Calcium oxalate can cause gout-like symptoms in the joints but it seems that’s quite rare (unlike having it in the kindneys). There are a few other chemicals known to cause gout-like joint disorders. Hopefully allo will take care of all your symptoms and you’ll be able to forget about the menagerie of non-gout joint diseases.
Pain often becomes more frequent after starting febuxostat. That would be normal. But if your pain actually became more intense, that’s not so normal. It’s not a big surprise but it’s not typical.
You are a special case anyway. The way you reduced uric acid is definitely not normal. Most people take a more gentle drug than 40mg febuxostat to begin with. And most gout patients start with more uric acid so they never go as low as 200. This must have created a unusually strong chemical imbalance in many parts of your body. There is research showing that when uric acid is lowered gradually (the opposite of what you did), there is less pain.I wouldn’t fault the doctors you’ve seen too much. Typically people who have gout test higher than you did. Many doctors around the world would not consider gout when uric acid is under 450.
My uric acid used to be higher and many doctors still wouldn’t consider gout because my uric acid was “normal”. I’ve seen so many mostly clueless and non-cooperative doctors from different countries (all of them Christian countries though) and have been given so many explanations for my joint problems over the years! I was told my shoes were the problem, sure. But I also apparently have several different bone deformations not to mention nervous problems. Even my veins/arteries were supposed to be diseased at one point.
I don’t doubt that medical malpractice is a problem in your country. But when it comes to gout, medical malpractice is everywhere.All drugs have side effects but they do not always affect everybody. It’s a relatively new drug but some people have been taking febuxostat for many years. Based on your blood test, you seem to be having no problems. Did you notice anything unusual?
You do not want your uric acid to fall to zero but it should not fall much lower anyway. Since it’s very low already, you shouldn’t keep taking so much febuxstat for several years. If you were to take 20mg for instance, it would probably rise to a more normal value while remaining low enough to ward off gout.The pain should vary so it should sometimes become stronger.
But pain is difficult to explain in writing. I don’t know exactly what you feel so I can’t rightly guarantee you it’s normal. If you feel something very different from what you’ve experienced these past years, best see a doctor just in case this unusual pain is caused by something else requiring a different treament such as antibiotics.Yeah, it’s mainly the neck glands thing which would make me ask a doctor if it could be something else.
As to the migratory pains, you’d have to describe them a bit more but while gout can move from one place to the next, typically it doesn’t cause pains all over the body. Pains which move from place to place are also more typical of gout that’s been allowed to fester for some time or of the early phase of treatment. Typically, gout starts by affecting a single joint. So migratory pains aren’t surprising at this stage… but getting them right from the start is another matter.
Do you know for a fact what caused your kidney stone by the way?Besides the fact that the liver and kidneys are rather important organs you don’t want to risk over a little money, it would be prudent to save the cash for a more formal blood test than you can get at your local chemist in order to make sure the tests you’ve been getting lately aren’t underestimating the amount of uric acid in your blood. There’s more than one testing technology out there…
Your ankle problem affected a more extensive area than mine. You seem to have had more swelling but less pain in response to pressure. Possibly someone who had more uric acid than I did (my tests were never anywhere near 600) would find your description more familiar.
With a test reading as high as yours and gout in your family, it certainly ought to be suspected in any joint pain.The interaction between uric acid in the blood and gout is complicated.
When you go from being symptom-free to experiencing serious gouty inflammation, the immune system can contribute to uric acid going out of solution. This could turn into a bit of a chain reaction and the process can end up significantly lowering the amount of uric acid in the blood. Likewise, the blood of people who never had gout can sustain more uric acid in solution.
On the other hand, if the gout flareup is caused by a largish deposit of uric acid being activated, dissolved uric acid may cause the amount in the blood to rise.Yes, you’ve understood correctly.
People who have deformed hands and feet because of uric acid should see an immediate improvement as uric acid is removed from their body in proportion to the decrease of the level in their blood.
Uric acid should also be in the process of being removed from your body but the amounts are much smaller in your case. Even a very small amount can cause a lot of pain so you may not notice much difference until most of the uric acid has been eliminated. Also, small amounts can be isolated from the blood and persist for a long time. So in your situation the improvement is more in proportion to the duration of the treatment than to the level in the blood.So far as I know, there is no reason for you to stop febuxostat so yes, keep taking it! Gout patients normally keep taking it for the rest of their lives.
The dosage seems too strong for you so what you might want to do is to switch your dose to 20mg. But the latest recommendations for gout I’ve read say it’s OK to have uric acid that low for a year or so I recommend waiting until the pain has gone away before lowering your dose.
Of course if your doctor ends up finding a completely different problem and decides you never had gout, they’ll tell you to stop taking febuxostat. If you want to quit the drug for any other reason, you should first look into other ways to prevent the amount of uric acid in your blood from going back to 400 or so after you stop taking it.Yeah, that diagnosis was kinda quick if no other tests were done. If you have gout, you’ll probably know before very long as your symptoms become more obvious.
But in my modest experience, ankle symptoms are more like you describe than the classic gout symptoms in the toe. Then again, I’ve never had very bad ankle symptoms.
When you talk about the tendons around the ankle, was that more up the leg, towards the foot or both? How did it feel when you pushed on the area next to the tendons or when you tried to move your foot in a sort of circle around your ankle? Would simply lying down in the wrong position cause serious pain?
Any gout in the family?
If the pain and swelling have gone, it might also be worth re-testing uric acid. The result might be even higher now (which would be another clue).Do get ahold of a pair of crutches. That will save your from crawling next time.
And ask the doctor how much ibuprofen you might take exactly, considering that you wouldn’t take that much every day. A green light to take a higher dose might come in handy next time as well.I have no idea what collagen does or doesn’t do. I guess it’s worth looking up whether there might be a connection.
You might also want to post the full composition of the supplement here in case someone might recognize a troublesome chemical.There are plenty of reasons to eat eggs and plenty of reasons to abstain. I don’t know what health issues you are dealing with but I can tell you that, unlike animal flesh, eggs do not increase uric acid while providing a type of protein that people usually get from meat, fish, dairy or soy. You can read any amount of nonsense on the Internet which is why you shouldn’t waste your time with random websites. If you’re willing to read boring stuff, I can provide a citation or two to document my claims (just tell me exactly what you are unsure about).
I guess eggs may interfere with HRT as well but that’s a problem with so many foods provifing that type of protein that trying to get rid of all foods which contain or affect hormones is a ticket for protein deficiency if one’s not extremely careful.
Now one’s diet should be evaluated as a whole. It would of course not be wise to eat nothing but eggs! How many daily eggs you’d need for protein depends on your size and on what else you’re eating.More imporantly, 7.6 is high enough that I’d recommend asking for a drug which lowers uric acid.
The number isn’t so high that there’s zero chance of fixing the problem without such a drug but it doesn’t look good and I’d need details (in particular: your size, everything you usually eat and drink, any drugs you’re taking) in order to venture a guess as to your actual chances. Really, you shouldn’t bother with the details and simply take a pill. It works so much faster than lifestyle modifications. You’d still be able to experiment with diet and lifestyle later on to get rid of the pill. But doing such experiments after curing your gout would spare you much misery in the long run.
One thing you could perhaps do before deciding on a pill is to get a second test (the number sometimes varies). That would also be a good opportunity to get a baseline for liver and kidney function if you don’t have one already.Assuming we use the same units, all your values are great. If febuxostat caused even a little stress to your liver, your ALT should become much greater than your AST which is obviously not happening so as far as I can tell you’ll be able to keep taking this drug without concern for a very long time.
If your problem is indeed gout as your doctor suspects, you’ll have to be patient.
But in the meantime there are drugs you can take to suppress gout symptoms such as colchicine and ibuprofen. You should discuss that with your doctor. Based on your blood test, there is no reason for you to avoid taking more than one drug at the same time (but of course your doctor may be aware of other reasons for you to be especially careful… all I’ve seen is a few numbers!).
If the pain is increasing a lot or your see something wrong with the painful part of your body besides the redness and swelling you can expect to get from gout, do see a doctor just to make sure you aren’t neglecting a completely different problem.Gout pain should be relieved gradually after starting febuxostat, but that process doesn’t start immediately. What you might notice at this stage is shorter but more frequent painful episodes as well as pain in locations which were rarely painful before you started febuxostat.
Since the blood test confirms the drug is working very well, you can be confident that the cause of gout is being removed from your body. And as long as you keep taking 40mg daily, you can eat whatever you like.
If your pain finally goes away, I recommend waiting a few more months before lowering the amount of febuxostat you take. If on the other hand your pain does not improve by the end of the year, you’ll have to ask your doctor to investigate other disorders.Gut bacteria make B12 which is how B12 as well as deadly strains of bateria end up on the skin of unwashed plants. You know why ruminants are called that, right?
A major reason why animals contain more B12 than plants is that they’d be dead if they didn’t.You might be healthy now but that doesn’t mean you’ll remain so after cutting your calorie intake.
Obviously meat eaters have also ended up in the ER because they wanted to lose weight. You just have an extra challenge.Can we say eggs?
The protein issue is more complicated than most people have patience for but, while one-word answers can be misleading or even dangerous, not saying anything to someone on a dangerous path is its own kind of irresponsible.
What am I talking about? Well, combining calorie counting with the notion that animal protein can be replaced with nuts is a good way to end up with protein deficiency. Soy products are a decent way to replace animal protein (hence their popularity). Like eggs, soy products also happen to be uric acid friendly. Nuts on the other hand need to be combined with other foods such as lentils in order get enough of all protein types. There are alternatives to legumes containing a lot less calories but they may raise uric acid if you consume very large amounts (which would be required to make them a major protein source).Whether gout is genetic or not is irrelevant. If the hyperuricemia is mild, you might be able to treat it with dietary modification.
So the starting point is to measure uric acid.Hi!
As you probably know, if you had untreated gout for 8 years, it’s not surprising it would take more than 6 months to go away.
Neither your uric acid or your gout ever seems to have been very bad so taking a bit of allo to lower your uric acid wasn’t such a radical intervention. It makes sense allo didn’t trigger a bunch of attacks as you ramped up your dose. Indeed, you didn’t ramp it up at all.At the same time, it looks like something else might be bothering your immune system.
I agree: it’s too early to tell. Keep taking allo and see how things turn out. Possibly the weird pains will go away before long.
If you test under 5 mg/dl, your dose is probably sufficient. But if you want to drink wine and eat meat and assuming your other blood tests look fine, maybe a slightly higher dose would give you a safety margin?Drinking wine may not have been the only risk you took two weeks ago. If you live in the northern hemisphere, it’s probably getting hotter where you live. Have you increased your water intake to compensate for the resulting water loss?
Summer temperatures alone may be sufficient to destabilize uric acid deposits in the colder parts of the body anyway. There’s not much you can do about that, except making sure such deposits do not get a chance to form anew.Something I also experienced (and which isn’t specific to gout) is joint pain in the arm/hand climbing up (so to speak) to the shoulders or the upper back.
I guess this might be similar to how you can get back pain from limping badly (or using crutches) because of joint problem in the legs/feet. Or there may be a different nervous/process process (locking muscles as with repetitve stress injury perhaps?) that occurs only with the arms as opposed to the legs. I have no idea how the pain spreads to the next joint but I’m not the only one who experienced it.
