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Stephen, welcome to the forum, especially the way you have joined. More on that another day, but first I must respond to your immediate questions.
Trauma is well recognized as a trigger of gout attacks. As scientists discover more about the intricacies of the gout-pain pathway, we learn more about how this happens. For myself, I’m struggling to apply sufficient brain time to explain it in simple terms. Let’s put that on the “questions to be answered better” pile, and look at the practical aspects.
It doesn’t really matter in the long-term what triggered a specific gout attack. We know that there are many things that can stimulate the immune system into phagocytosis. That is the inflammatory process that we recognize as the agony of an acute gout flare. We also know that most triggers seem to become more sensitive, the longer we have gout. Irrespective of immediate triggers, which we might be able to avoid, gout cannot happen if we dissolve most uric acid crystals. The only way to do that is to lower uric acid below 6mg/dL. 5 is a good long-term upper limit, but to get rid of crystals quicker, we should aim to reduce uric acid even lower.
These are the reasons I emphasize a personal gout treatment plan. Depending on individual circumstances, people have different priorities between pain control and uric acid control. Both these are easily dealt with in isolation, but in practice people get pain control and uric acid control confused. I get the impression that you are very capable at controlling gout pain, so maybe the priority is for uric acid control. Have I read that right?
Now, moving to diet, I believe that gout diet management should always support the treatment plan. We are not yet at the stage where you have a well defined personal gout treatment plan. In general terms, it is important that what you eat does not raise uric acid. Ideally, you could hope that diet might reduce uric acid. I actually prefer to manage specific diets for an individual, rather than generalizing.
My best general advice is that diet can improve uric acid, but we need to know uric acid numbers. Test results allow us to assess if we can rely on diet alone, or if we need to consider diet combined with uric acid lowering drugs. As well as specific foods affecting uric acid directly, excess iron and excess calories can increase uric acid. The only way I can assess all the factors is to get more data. On the question of almond milk, I need to do some more research.
In summary, I need to:
1) Explain, in laymans terms, why trauma can trigger a gout attack.
2) Investigate and explain how almond milk affects uric acid.
3) Review the member profile information, and related information. I must make sure that personal gout facts are easy to record, and that I respond to them in a timely manner.Whilst I’m doing that, I’d appreciate your response, Stephen, to:
1) My assumption about your priorities between uric acid control and pain control
2) Do you have any uric acid test result information?It might be normal. All depends on your uric acid levels.
Please can you tell us your last uric acid blood test results? Also, any previous results might be useful.
Other useful information is the number of years since gout was first diagnosed.
If you would like to login before you post, you can keep those personal gout facts in your profile. That makes it easier for you to track your progress as you get gout under control. Please note, this is entirely your decision – you still get help without logging in.
Please get back with the missing information as soon as you can, and I will try to explain if your pain is normal, and what you can do to minimize it.
I look forward to reading your results Tom.
I was going to suggest exercise in conjunction with beer restraint for weight loss, but I see from earlier that you are already very active. I’ve managed almost 60 pounds this year so far with swapping most meat for vegetables, daily walks, and smaller plates. All I can offer for you to try is the last one.
Also, another important factor could be fats and oils. What are you cooking your vegetables in? In fact, Ian, the more you can tell me about your complete diet, the more I can help.
OK Ian, you’re absolutely right. If you are a vegetarian, you cannot ignore vegetables. But you can ignore the purine content of vegetables. In fact, you can probably forget about purines in your food completely, unless you go back to eating flesh.
What you have to remember is, your body turns vegetables into flesh. Also some vegetables are quite high in iron.
To help you plan what to eat that suits your gout, I have to know a lot more information. Let’s start with some basics: height, weight, amount of exercise, uric acid test result history, and the length of time since your first gout attack.
Thanks for posting this, Benedict. It’s a new area of research, so facts are hard to come by.
Long ago, I learned that gout is not due to ‘sharp’ or ‘needle-like’ uric acid crystals digging into your joints. Rather, it is an immune reaction to the presence of foreign bodies. This works great for bacteria and other infections that can be killed when white blood cells engulf them. Not so good for uric acid crystals. They cannot be killed, so they just get engulfed and remain hidden.
That process explains many unusual aspects of gout. But the immune system, and related inflammatory and anti-inflammatory processes are very complex.
To make it simpler, scientists used mice, as things like injecting uric acid crystals and other torture seems more acceptable in mice than humans. This research revealed a specific Fatty Acid, C18:0 or stearic acid, that is clearly identifiable as a trigger for the inflammation process. I.e, uric acid crystals alone do not cause gout attacks, but they do in the presence of stearic acid.
For real life, things are not so easy. We eat a wide range of fatty acids. Some are anti-inflammatory, and some are pro-inflammatory. I’d love to be in a position where I could spend all day, every day, getting to the bottom of this. However, I think we have to wait for more gout research.
What I can do, is to produce a chart of stearic acid content. In real life, I think we need to consider other fatty acids, especially anti-inflammatory ones, so that we might switch certain foods to better choices for gout pain.
At the end of the day, of course, adopting anti-inflammatory diet practices is like preferring colchicine to allopurinol. We might get short term pain relief, but the constant presence of uric acid crystals is destroying joints. Going back to my opening paragraphs, I described how the immune system attacks uric acid crystals whenever it sees them. This happens every day, but we only notice it when the immune system gets swamped, and calls in reinforcements. That is the painful inflammatory process known medically as phagocytosis. Unfortunately, other white blood cells get caught up in the battle. These include the cells that were destined to repair bone, cartilage, and tendon. With that repair process compromised, you get slow joint destruction.
As I’m writing this, I’m thinking maybe I should restrict my forthcoming stearic acid food chart to people who promise to get their uric acid levels safe. Anyway, I have to produce the thing first, so let’s continue the discussion about free fatty acids and gout, whilst I try free up some time for a new food chart.
I’m convinced that the irregular results are from inconsistent process rather than anything intrinsically wrong with the machine. Of course, it’s technology, and can go wrong, but with care, you can get accurate results. Remember, natural fluctuations will occur with doctors tests also, so it is best to focus on average trends rather than specific results. Much of the consistency relies on that rare commodity – common sense. Wash and dry thoroughly and hygienically. Test at same time of day and same time after eating. The hard part is keeping droplet size consistent, but that comes with practice.
I’d say definitely the colchicine that’s stopping gout flares. It doesn’t help with pain: your ibuprofen will do that. But it does limit inflammation from spreading. Inflammation is an immune reaction, and colchicine poisons your immune system. Harsh, but true. Very effective, but no more than 2 colchicine per day, and never if your immune system is compromised by infection or deviant social practices.
And because you are on that package, starting allopurinol now will not make gout flares happen. Delay just lengthens your exposure to uric acid crystal risk and your exposure to colchicine. If I were a meerkat I’d finish this better.
By the way, Benedict, you’d make life easy for yourself by logging in before posting. You are under no obligation to do so, but a simple click of the Google button (top right) means you don’t have to wait for post approval after the first is approved.
Benedict, I don’t think gout is a disease that can be managed without a little medical help. Some people need a lot of medical help, but the absolute minimum is regular, accurate, blood tests. As we know from http://www.goutpal.com/uric-acid/uric-acid-test-kit/ you can certainly buy your own home test kit for uric acid. But, do you have the clinical expertise to produce consistent, accurate results? I consider myself borderline-OCD personality, but even my attention to detail did not give me the consistency I really felt I deserved for the amount of effort I put in. I’m also a cheapskate, and I live in a society where healthcare is paid through taxation.
If your experience is different, then get yourself a meter, and ask some more questions here. I’ll guide you in using your meter in the best way, but please don’t consider it if you cannot impose strict routines on yourself.
In the big picture, you have to decide on your approach to acupuncture for gout. I truly cannot advise on the complete benefits that might be gained from what the process is supposed to do. In it’s right place, the culture of acupuncture is fundamentally different from my Western view of controlling pain or controlling uric acid. I can only advise you from my own point of view.
If you are only interested in reducing gout pain, then any benefits you get from acupuncture will be self-evident. You don’t need me to tell you if it hurts less. Just be wary of ignoring coincidence, as gout pain comes and goes naturally. Stopping attacks does not save your joints from the slow ravages of uric acid crystals, so that is why I believe uric acid control is vital.
Whether you get monthly uric acid tests from your hospital, or conduct your own tests, you can log your uric acid test results and your acupuncture sessions. You will probably see many fluctuations, and be tempted to match test results with acupuncture sessions, That is not necessarily bad, but the most important thing is to see a downward average trend for uric acid. Ideally, it needs to trend below 5mg/dl, but below 6 might be acceptable.
In order to keep this topic focused on acupuncture, it is better to create new topics for starting allopurinol, and for FFAs. Please can someone who is interested in those topics start new discussions? In the meantime, I’d appreciate you completing my new mini-survey at http://www.goutpal.com/4853/start-allopurinol-quickly-but-carefully/ (about half way down the page).
Cheers Bob. I need to review my advertising policy to make sure it’s clear. I use a trusted third party to host most adverts. As such, I don’t vet them individually, but I do promise to block adverts that members find offensive. Also, third party adverts have an individual blocking facility.
I’d appreciate some suggestions from members to guide me on this. What do you think I should do to improve my advertising policies, or are they OK? Should I remove adverts completely, and adopt a paid membership model?
More importantly, I need advice on how my opinions come across. There is absolutely no way I ever intended my curiosity about the effects of banaba to be aggressive. When I read about natural alternatives to allopurinol, I get very excited. Even more so when laboratory claims are supported by real life experience. This experience is invaluable to other gout sufferers, so I tend to ask questions on their behalf.
The thing about allopurinol, and other pharmaceuticals, is there are thousands of studies about them. I can ask my questions by searching PubMed and Scholar. In this case, I only have one source of information, so I have many questions. Could members suggest how I might have worded my questions better to prevent them being aggressive?
Tom, thank you for your references, and your insight. That’s a great summary of gout and exercise. The mg/dL units are the common unit of measure for blood tests in America. European countries, including UK, use molecular measures mmol/L or ?mol/L. That last one is hard to type, so I keep a handy, multi-colored chart in the right hand sidebar that I can copy and paste from. 5 mg/dL means 5mg of uric acid in one tenth of a liter of blood.
Uric acid levels are quite volatile, I believe. The length of time to clear all crystals with uric acid below 5 is not easy to answer. We know that getting lower speeds the process. The other main factor is how many crystals have already formed. In Krystexxa studies, that reduce uric acid to almost zero, then severe tophaceous gout resolved in 6 months http://www.goutpal.com/3408/best-tophi-picture/tophi-removal/
That knowledge prompts me to suggest that the best treatment is to slowly increase allopurinol from it’s starting dose of 100mg to the maximum dose. Maximum is 800/900mg depending on where you live. Once all visible tophi have resolved, and no gout flares for six months, then you can consider uric acid crystals to be cleared, and adjust dose downwards to maintain 5mg/dL for life.
The trouble is that some tophi are very persistent. Where crystals are locked into lumps of dead cells, they are not likely to dissolve as access to blood supply is restricted. Surgery has to be considered on a case-by-case basis, though is not likely to be required unless tophi are restricting mobility or at risk of ulceration.
nokka, you’re right about continuing to monitor and be aware of urate levels. That takes us back to your original post. It’s madness to me that any medical staff should think it right to go for more than a year without a uric acid test. That’s also the opportunity for a full range of tests to measure other important body functions.
For me, annual testing is one of the few fixed general rules about gout. Most aspects are very personal. Each person has their own profile of uric acid production and excretion, and these change up or down with age. So personal targets and dosing that is adjusted for blood test results are vital. It seems wise to go to 300mg now, but I have an issue with describing it as a standard dose. I do not believe in standard doses of allopurinol – only personal doses that change over time. In a few years time, you might go back to 200 or increase to 400. The only wrong dose is the dose that fails to make you safe. I’ve been personally horrified by a friend who got the ‘standard 300 mg allopurinol dose’ for many years. He never got any dose follow-up testing/adjustment. As a result, the last few years of his life were filled with gouty misery, despite his belief he was doing everything right. I’m so pleased that you have the power to fight for your right to blood tests, and have the knowledge to make your uric acid safe.
If I’ve played a small part in that, your kind comments make me very happy indeed. It’s nice to think we might be swapping gout stories for many more decades.
Great to read some wisdom from odo. The reference to proper scientific analysis of complete, rather than immediate, effects is very interesting. I also look forward to some more information about the “amazing formula for gout”
As we learn more about the science of gout attacks, it is becoming clear that controlling attacks, and controlling uric acid are two separate issues. Yes, you cannot have gout attacks if there are no uric acid crystals. However, the absence of gout attacks is not significant if it is accompanied by silent joint destruction. Indeed, it can be more dangerous if lack of pain symptoms lead to ignoring dangerous uric acid levels. I call that the hidden terror of pain-free gout.
Which leads me on to the latest contribution from Benedict:
1) It’s a pity you don’t have before and after uric acid test results. I’ve a faint memory of a claim that cupping draws uric acid, but I think I ignored it at the time due to lack of accurate test results.
2) I’d be very interested to know who told you “but will have to wait a month or two of gout-freeness before starting allopurinol.” That’s outdated now. Please tell me it wasn’t a doctor’s advice!I?ve tried to establish a link between uric acid and age. The evidence is mixed, with some studies reporting uric acid increases with age, and some reporting decreases. This is complicated, as a lot of the percentages are across different groups of people. I.e. what we really want are studies that track individuals over several years, and compare uric acid levels at different ages. I can?t find anything that simple.
I?ve also looked to see if allopurinol effectiveness decreases with age. There is a suggestion that it might, but again, the information is not based around trends for individuals over many years.
I like that doctors policy is to get below 300mmol/L (5mg/dL). Maybe it is a good idea to go to 300mg allopurinol now, but if you have doubts, best to get another test first.
I agree that cause and effect is hard to determine. It is very easy to associate the wrong cause and effect. All you can really do is to keep repeating experiments to get more certainty.
With gout, it is very important to separate pain and uric acid levels. Pain is very short term, i.e. if something is going to increase gout pain, it will do it within an hour or so. Pain never happens unless uric acid crystals are there, but the crystals do not always result in gout pain. You can get pain when crystals are dissolving, so gout pain is not a good judge of whether you are doing the right things or not.
Thanks for that Tom. It’s an interesting story, and I’m sure many other visitors will recognize that farm animal and also the elephant from the zoo.
BMI is only ever a pointer, but a useful one. From a general health point of view, excess weight in the form of muscle is obviously better than excess weight in the form of fat. Unfortunately, this is not true for gout. Muscle tissue is a greater source of uric acid than fatty tissue. That is not to say you should stay away from weight lifting – just be aware of it. At 6.8, you are at the lower end of gout risk. You might be able to get it lower with some small diet changes. Skim milk has been shown to be beneficial, as has an alkaline diet. The alcohol issue is harder to advise on, as there seems to be conflicting evidence. Best to go with whatever works for you.
Keep getting regular uric acid tests so you get a clear picture of how your numbers are going. Ideally, you need to get to 5 or lower.
sara, it is always a good idea to keep gouty joints wrapped and warm.
I’d like to offer more help, but I need a bit more information.
You should have your blood test results by now. What is your uric acid level? Please give the exact number and unit of measure.
Can you give me the exact names of the 2 gout meds, and tell me what dose you take, and how long you’ve been taking them.
Oh sara, I’m so sorry I missed your post. I always recommend that you login before you post. It is not a requirement, but it does help you.
When you login and post, your post is linked to your personal gout profile. That helps you to keep track of your gout progress. It also allows other people to check your personal gout facts before they respond to you. We can all make our responses more relevant when people login and add gout facts to their profile.
The other advantage of being logged in when you post is that I get a notification so I can respond quickly. I don’t get that for non-member posts, so I often miss them.
I hope it’s not too late to respond to you. I’ll be back soon with some relevant information.
I wish @odo was here to explain this better, but Traditional Chinese Medicine is very different from Typical Western Medicine. It seems to me that it is aimed more at creating wellness than fighting disease. If you are skeptical, then maybe it?s not for you.
I?ve recently had brief correspondence with an Australian acupuncturist. He had good results where a full treatment plan was taken. Not so good with partial treatment. I?ll see if I can find the link to the messages.
Hi Tom,
Welcome to the gout forum, and thank you for your kind words.
I’m so pleased that you had a meaningful discussion with your doctor. They are busy people, who don’t always get the time to discuss gout properly. But these days, all the top professionals are emphasizing the importance of personal care that address each individuals risk factors. It sounds to me like you have done everything that I wish all gout sufferers could have – a personal plan to get gout under control.
I hope you’ll continue to add your wise input to the discussions here.
Thanks again
KeithWow! When I ask members if they’d care to share a little gout experience in the hope of encouraging fellow sufferers, I don’t expect to be told to google it! 😥
Anyways, I tried variations of bob, @czkewr uric acid test results, banaba and gout, but I couldn’t find anything relevant.
One thing I did find however is:
Banabas are extremely poisonous alone, much more so when eaten with milk, a known host to multiple organisms capable of producing toxins as by products of everyday life processes.
Doesn’t sound good.
Very interesting, @czkewr, and welcome to the forum.
The last time we discussed this, @zip2play raised interesting points about possible effects on diabetics and ‘hypoglychemics’.
I raised a few questions about practical issues of banaba for gout:
- How do you control dosage?
- How do you know it is safe?
- Are there any long term health risks?
- What are the costs compared to proven uric acid lowering medications.
So, bob, maybe you have some answers for those. In particular, you say “Follow the directions on the bottle to start, then adjust as necessary.” I’m assuming that as necessary means ‘until uric acid lowers to 5mg/dL, or lower.’
Would you mind sharing your uric acid test results? What was it before you started, and what are your uric acid levels now? How long before your uric acid started to drop?
To other gout sufferers, I’d like to ask if you have any experience of natural xanthine oxidase inhibitors? In our earlier discussion, I mentioned there are many more that have been studied. I’d love to publish some case studies about alternatives to allopurinol and Uloric, but I need the facts. Please share your experiences of natural products for lowering uric acid.
Hey, @danlord78
Unless there is a massive coincidence, I believe you must be the DL who posted this topic when not logged in. If you post when not logged in, the topics and replies do not get linked to your profile, and you do not get all the benefits from the Members menus near the top of the page. I guess I should try to make this clearer, and I have a mind to do so, though no clear ideas on how to make it easier to understand.
Anyway, DL, if you want me to link your post to your member profile, just ask.
The main reason for me coming here today was a thought I had about my diet paragraph, especially alcohol.
I do not want to imply that you are abusing alcohol, or have any other alcohol-related issues. Maybe I could have responded better to “I drink a lot but then so do many of my friends.” So, I’ll try again.
Lots of gout sufferers get worried by alcohol. It’s often overplayed as a gout factor, but it is a health issue. The problem centers around volume, or specifically ‘excessive alcohol intake’
I’m also part of a culture raised on regular social drinking. I know that, occasionally, I drink too much. But, as you say, so do many of my friends. Firstly, forget comparisons with other people. They are not likely to tell the truth about any fears or health issues they have about alcohol. There are 2 important personal questions:
1. Am I drinking unhealthy amounts of alcohol?
2. Is alcohol affecting my gout?If (1.) is yes, then you have to cut down, and (2.) is largely irrelevant.
To answer (2.), you have to measure it against 2 things – gout pain and uric acid levels. These are both separate. It is not simple to find a definitive answer, as everyone is different.Gout pain and alcohol is fairly easy to test, unless you drink every night. Keep a gout pain log, and alcohol intake log. If there is a pattern, you have your answer, but make sure it is proper statistical analysis, and not just picking facts to suit your wishes.
Uric acid and alcohol testing involves longer periods of abstinence, but is quite easy. If you are very careful, you can do it yourself, but best done with a doctor. Agree a test schedule with your doc, then alternate abstinence with normal drinking between tests, then compare trends. You have to repeat this many times to rule out confounding factors. You have to remain true to your abstinence periods. Personally, I’d rather take allopurinol than be bothered with that hassle, but it will give you a definitive personal answer. That is worth far more than all the rubbish that is written about alcohol and gout.
Please login DL, and let me know what you think.
My golden rule is – if diagnosis is not clear, but gout is suspected, then go and see a rheumatologist.
However, there are other ways forward, but we have to break the problem down to consider high uric acid and joint pain separately.
If uric acid is “high” then you may well have gout, but this is likely to be complicated by injury/strain from gym sessions. You might also have another rheumatic condition, but this would need further tests by a rheumatologist to confirm or discount.
As I only know about gout, I’ll have to concentrate on that.
First, “high” is not really good enough to describe uric acid test results. The number is important, and as much history as possible is very useful. The mismatch that we have here is:
A) I am very good at interpreting uric acid blood test results, but I do not have exact numbers and history.
B) Your doctor has exact test results, but might not be good at interpreting them. I say this because 3 out of 4 doctors do not understand uric acid blood test results.If you can supply better results history, I can make my advice more personal. Without this, I will make general points that I believe could be relevant to your case.
I’m going to use common UK units of measure for uric acid test results – mmol/L, with mg/dL equivalents in brackets for all our American friends reading this.
If uric acid is above 0.36mmol/L (6mg/dL) then it is more likely than not that you have gout. The only way to be certain is to have joint fluid tested by a rheumatologist. Your choice is to get that confirmation, or to proceed as if it is gout. To proceed with assumed gout treatment, you need to get uric acid below 0.30 mmol/L (5mg/dL) then wait to see if pain improves. The waiting time depends on 2 facts:
1) Your uric acid test result history
2) The level you can reduce uric acid to, starting ASAP.Of course, this is a very broad brush, because I simply do not have enough facts to advise you properly. In my experience, if a doctor describes uric acid as “high” then I see it as “dangerous” because they usually mean over 0.4 mmol/L (over 7 mg/dL). At that level, people are almost certain to suffer gout at some time in future. The trend these days, for those who truly understand gout, is to keep uric acid safe before it does any damage.
Speaking of damage, this is clearly a concern in your case. Again, without decent history, I cannot guess if your wear and tear is gout-related, or something else. If it is gout related, then recent research has shown that gout-damaged joints can recover if uric acid is lowered enough.
Finally, you mention diet. This can be a factor in many gout cases, but it is never as significant as genetics. I always maintain that, if you follow a healthy diet, then changing it is not likely to improve your gout. On the other hand, if you are obese, or consume excess alcohol, then the other health risks outweigh gout. Obesity and alcohol abuse are likely to cause heart-related death, so need to be dealt with irrespective of gout.
I hope you understand that this is all information that you should discuss with your doctor. I can provide relevant references if required, though your doctor can simply consult the British Rheumatologist’s guidelines for facts about uric acid values. I am not a doctor, and there might be other indicators from your history, or from examination, that point to a different diagnosis.
Many published gout articles claim that gout cannot be cured, only controlled.
Though this might be true for some gout sufferers, it is not a universal truth. Wherever gout is secondary to another health problem, there is always a chance that gout can be cured by curing or controlling that other condition.
Before I look at the cases where gout might be controlled, it helps to understand why gout happens.
Branden has referred to a kidney issue. Kidney problems are often a cause of gout, where insufficient uric acid is passed from the body in urine. We call this under-excretion. Commonly, there is another major cause of gout where the liver produces too much uric acid. We call this over-production.
Recently, some scientists have advocated a third group of gout causes (Gout Causes Report). This recognizes that uric acid should be excreted via the gut as well as via the kidneys. If there is a fault in this mechanism, then this represents a third group of gout causes.
Note that these are not discrete groups, and it is possible for a gout patient to be any combination of uric acid over-producer, kidney under-excreter, or gut under-excreter.
In all these groups, there are specific causes that lead to one or more of the 3 problems. All of these can be controlled by allopurinol or Uloric, which lower uric acid by inhibiting it’s production. For some people, other gout treatments that encourage uric acid excretion are suitable. For most doctors, these treatments are all that is offered, because identifying curable underlying causes is usually very difficult.
There are common situations where gout is cured. The one I have heard about most is cancer related. The combination of cancer treatments and associated rapid weight loss often causes gout. However, once weight stabilizes, and cancer treatment is completed, gout goes away. Another common situation where gout is cured arises when diuretics are replaced with different forms of treatment for high blood pressure. The most common cases of curable gout are simple bad diet. Where the first gout attack shocks individuals into eating healthily, and bad diet is the only problem, then gout can be cured.
For most patients, where it is hereditary, gout cannot be cured – only controlled. In future, genetic engineering treatments might allow our genetic defects to be cured, but that is for the future. However, if underlying causes can be identified and controlled, then gout is cured. Such underlying causes require detailed personal investigation into possible causes in one or more of the following:
- Medication for other health problems
- Exposure to one or more 5 Bad Gout Foods
- Environmental toxins such as lead, mercury, and other inorganic or organic pollutants
Specific factors in those groups can cause over-production or under-excretion of uric acid. Removing those factors will reduce the reliance on gout treatments. In some cases, gout treatment can be withdrawn completely. Sometimes temporary treatment is required until permanent removal of underlying causes is effected.
This shows how gout treatment can be very complicated, and must be planned on a personal case-by-case basis.
This tweet exchange with Branden Crowl just got even more interesting.
@keithtaylor Need a CURE, not a "treatment." It's a kidney issue, not just a diet issue. #brownout4gout
— Branden Crowl (@BrandenCrowl) November 3, 2014
Branden said “Need a CURE, not a “treatment.” It’s a kidney issue, not just a diet issue.” I’m assuming the diet remark refers to me mentioning beer. I only did that because I was actually drinking brown beer in that picture. It was a pointless reference for gout, but I made it because this is #brownout4gout.
I probably don’t understand #brownout4gout properly, but I’m always happy to support anything that raises gout awareness. I understand gout a lot more than I understand Twitter!
I’ve responded with “if kidney issue genetic, you can’t cure parents. If diet, other meds, or environment you *might* cure #gout. It’s personal.” at https://twitter.com/keithtaylor/status/529191735579406337
. @BrandenCrowl if kidney issue genetic, you can't cure parents. If diet, other meds, or environment you *might* cure #gout. It's personal.
— Keith Taylor (@keithtaylor) November 3, 2014
I’m just going to switch to admin mode so I can embed the twitter posts, then I’ll explain more about what I mean by that.
Hey chad, it’s great news that frozen cherry smoothies are helping your gout. Can you share a bit more info to help other gout sufferers?
You see, gout affects everyone differently, and what works for you might not help someone in a different situation.
For instance, you have “horrible gout” that “goes away.”
How horrible is your gout? Have you had it many years? Is it widespread, or just one or two joints? Is it just bad pain or do you have other symptoms such as tophi? Does it stop you working or enjoying yourself?
Do you take frozen cherry smoothies at the first sign of a gout attack, or after a few days? Does it go away within hours or days? How many smoothies do you need to make gout go away?
I know that’s a lot of questions, but I have a couple more.
How do you make the smoothies? Have you got uric acid test results, or is this just a pain control thing?
Now, a question for myself! Why do I ask all these questions about frozen cherries for gout?
The answer is that I’ve seen hundreds of cases where cherries have helped with gout pain for a few months. Sometimes even years. But the gout sufferers never checked uric acid, so gout continued to get worse. Eventually, for many people, cherries just aren’t enough and the results are devastating. I love it when people find something that helps their gout, but I do not want to give false hope to other people if it hides the underlying problem.
I’m no twitter expert, but I dabble from time to time, and join the gout discussions. #brownout4gout grabbed my attention, as does anything that raises gout awareness.
I’m not sure what I can do, beyond changing shirt color, but I hope BrandenCrowl might join us here to give me some tips. It’s very easy if you are already on Twitter. Simply click the twitter bird icon near top right, and that logs you in to this forum.
To Krishna Mohan Mishra: I’m glad papaya is helping you. Instant relief sounds great. Please keep calling back here to share your gout stories.
To @moises 300mg allopurinol is not the best way to start. Can you get 100mg pills first to check for side effects? If you are OK after 2 weeks, you can increase to 200 or 300.
I’m also worried about side effects of many herbal medicines. These never get safety tested, so the golden rule is to start with small doses, then increase slowly. I’d certainly want regular blood tests to make sure basic body functions are not compromised.
The things to know about starting allopurinol are:
1. Start as soon as possible even if you are having a gout flare.
2. Agree a target uric acid level with your doctor for first year of treatment. This is your personal target which should be no higher than 5mg/dL unless you have other health complications.
3. After 2 to 4 weeks, get uric acid test and increase dose until target achieved. Typical pattern is 100mg, 200mg, 300mg, 600mg, but every case is different, and usually depends on how you are responding.
4. Discuss pain relief with your doctor. Preventative daily colchicine is best, but some people prefer ‘as required.’ You will need pain relief for a few months. The time period you are at risk from gout flares is reduced if you aim for lower target in step 2. Personally, I went for maximum dose of allopurinol, and got down to around 2 or 3 mg/dL, with no flares after about 4 months.Once stable, you should arrange annual uric acid check. Always get kidney function, and liver function tests at the same time as uric acid if you are on any uric acid lowering meds.
So yes, colchicine and allopurinol should keep you fairly pain free until the allopurinol does it’s job. On bad days you might also need anti-inflammatories or general analgesics.
One of the comments on that prompted me to search for sacroiliac joint gout. I found an interesting case study regarding a 53 year old gout patient with back pain:
Our case highlights a number of important points:
(1) Targeted history-taking localized her symptoms to the SI joint, even though she was complaining of “back pain.”
(2) Detailed clinical examination confirmed the SI tenderness and also the peripheral joint involvement (which she had not complained of), allowing investigation to be directed to the correct areas.
(3) The importance of attempting joint aspiration: gouty crystals were seen in washings from the SI joint, although no free fluid was obtained.
(4) Plain radiographs of the SI joints may appear normal, despite significant MRI abnormalities.Also, plain radiographs of the feet may reveal erosions typical of gout, even when there is no history of attacks
You can read the full report at http://www.jrheum.com/subscribers/08/10/2076.html
Of course, my advice remains: get uric acid down to 5mg/dL before gout spreads to your back or to your pelvis.
