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hansinnm said:
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You “thought you knew the difference between ionized and non-ionized”. Please, tell me what it is,
Hans, the posts I made on 22nd are exactly what I think the difference is. Do you think I just conjured it up to annoy you?
I guess I'd better explain why I think what I think, cos it don't look like I'm gonna get any help unless I crawl (before you blow, remember the humor that NEVER comes across properly in the written word).I think an ion is a charge due to an imbalance of electrons and protons. I also think that is what determines if something is classed as an acid or base (alkaline). I believe that when salts are formed, a bond is made between the acid and the base which balances out the negative and positive charges. I assume that this state is what is meant by non-ionized, i.e. protons and electrons in the salts are equal.
Now, if those memories of high school science and assumptions are wrong, I would love an explanation of why they are wrong. I know I can spend time searching for the answers, but I would expect members of this forum to save me some time. I have no doubt that Internet is full of the same crap about basic chemistry as it is about basic gout. In my defence for being too lazy to research it, I was not the one who raised the subject in the first place – if I had done, I would have created a separate topic. 🙂
OK, back to my knowledge and my explanation of why I wrote what I wrote about ionized and non-ionized states. As I'm not allowed to use Google, I cannot remember if acids are positive and bases negative or the other way round. I'm sure if I go for a walk I will remember, but I don't have time as my wife is finishing work soon and she needs me more than you do.
When I apply my limited knowledge of chemistry, to uric acid I see that in it's pure form it has a proton/electron imbalance. I call this ionized UA. When it combines to become monosodium urate, I see that as the non-ionized SUA. I recall from my studies of organic chemistry that, unlike inorganic chemistry, the bonds are far from permanent. I also recall that heat and pH are primary factors in the stability of the bond. I have an inkling that there may be other factors, but your Google ban prevents me from looking (I hope your ban is only temporary, Hans – I can't live without my Google 🙁 ).
That is why I refer to uric acids in the way that I did. That is why I think of UA and MSU as two states of the same thing. That is why I thought I knew the difference between ionized and non-ionized.
There is no point in discussing the rest if that is wrong, but you can be sure that, once you have pointed out the error of my ways, I shall tackle your original questions and subsequent comments.
Please be gentle with me – I've had a particularly hard day following a particularly hard few months.
ctrlkeys, everything you say makes perfect sense, but there is one very important thing missing ? your uric acid number.
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I have experienced the same opinions that your wide range of experts provide. Chiefly because I go to a practice where there are several GPs, but I've also had some hospital involvement. It makes me cry in my overtaxed beer that all our tax money that has been spent funding experts to determine what a safe level is gets ignored.
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Not only does it get ignored at the diagnostic stage ? so the 0.3 medically safe level gets changed to a meaningless 0.4 statistical normal value. It also gets ignored at the treatment stage, so doctors talk about a 100mg dose, or a 300mg dose instead of talking about a dose that is sufficient to make you safe.
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I do not know whether to wish I was a doctor, or thank my luck that I'm not. In any event, I wish you all the best in getting your gout freedom.
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Help with hosting is always extremely welcome. There is a donation button and explanatory link below each of my posts in right-hand side of the signature area. If it isn't working, it might explain why I'm brassic.
[For our lovely non-UK visitors and uneducated Brits, that is a bit of Cockney – brassic = boracic lint = skint]
bestest, there is no on-off switch with gout. It is a series of processes that center around uric acid.
The feverishness is a natural part of your immune system fighting uric acid crystals. If they are newly forming crystals that is very bad. If they are dissolving crystals that is good, but you still have to deal with the pain.
At 6.57, you are only just below the crystallization point of uric acid, so you can quite easily be in the worst of worst gout places where crystals are dissolving then reforming as your uric acid naturally changes through the day. The way to stop that is to get the level down to at least 5mg/dL. I have explained elsewhere that my goal is much lower, but that is your minimum. You might also see earlier references where I have said that 6 is low enough. I no longer believe that, as it does not give enough margin to deal with naturally fluctuating uric acid levels.
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5mg/dL = 0.3 mmol/L = gout safety.
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That is your foundation for fixing gout, but you still have to cope with pain until all old crystals are dissolved. Knowing that you are in control is one of the best forms of pain relief, or at least it is for me. There are thousands of ways to deal with pain, some of which are medical. You need to find what is best for you.
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Pain relieving medicines work for me, but I've had to find out what is best. I've been lucky to have found what works through being hospitalized, but if that did not work, I would speak to a pharmacist, then my doctor – in that order.
For gout pain, a combination treatment is always best. Colchicine is the best thing for stopping the pain from getting worse. However, it does nothing to help relieve the pain, so you need something else. Anti-inflammatories make sense, but are not essential. Any type of analgesic will get you out of the immediate pain. Your low uric acid level will lead to a permanent reduction in the frequency and intensity of future episodes, and after a few months, the pain will cease.
I thought I knew the difference between ionized and non-ionized – otherwise I would not have written what I did. I'm not looking for a lecture, just an explanation if I got it wrong. Or are you saying only Google can give me an explanation?
hansinnm said:
Keith Gout Advisor said:
?but from all I've read, for gout control the difference between MSU and UA is not significant?.
“? is not significant…”
?That's where I very much disagree. It's MSU that make up the tophi, not UA. And my tophi are still there. It's UA that goes through your blood, not MSU.
I do not think your final sentence is right, but I could be suffering from mumbo jumbo overload. Surely the serum uric acid test includes both uric acids – the non-ionized UA and the ionized MSU???
From this, the reason that there is little or no non-ionized UA in tophi is to do with the pH of the fluids in which tophi are found, or originate. Studies of kidney stones – the equivalent of tophi in urine – seem to dwell on the non-ionized UA form, as this is predominant when pH is less than 5.75 (from Walter G Barr, Uric Acid, on PubMed). pH can't get that low in blood or synovial fluid, so the prevalent sodium ion attaches readily. I can''t find any data on how long it takes for UA to ionize to MSU, but does it really matter?
Allopurinol gets rid of tophi. Who cares about anything else?
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By the way, the Barr reference contains some hideous nonsense about normal uric acid levels, which is the main reason it does not get a link. And the answer to who cares is (among others) me.
Having spent similar hours tearing out what little hair I have on a similar quest, I came to the conclusion that we can just keep it simple by referring to urate. This can be pure uric acid (UA), or combined with sodium to form monosodium urate (MSU). Crystals of both compounds usually exist in gout, and it does not really matter which form the urate takes. The important thing is to get rid of it by lowering urate level to dissolve the crystals – UA or MSU doesn't really matter.
There may be some significant differences when studying kidney stones, but from all I've read, for gout control the difference between MSU and UA is not significant.
But, I've never been a chemist, so I could be fooled by the mumbo jumbo.
The good news is that it now works as it should have done. Underneath the persons picture (or the Member symbol if you have not uploaded a picture), there is a little button that looks like a person ? the Profile button. Click that, then near the bottom of the profile are buttons to list all topics, or all the ones started by the member). Note that the total number found will not match the total posted (shown in stats near the bottom of the page). This is because old posts eventually get deleted.
The bad news (or actually good news if you have plenty of time on your hands) is that zip2play’s list stands at 54 pages! And that is 54 pages of topic titles, not actual posts.
What a huge debt of gratitude we all owe. Thanks again, zip2play, for your continuing support.
There are a small percentage of people who react badly to allopurinol.
Starting at 100mg should identify these and allow alternative or de-sensitizing. For the majority, a quick jump to 300 and beyond would be the next step.
I am actually more worried about the doctor showing an understanding of uric acid, and the need to monitor regularly and keep it under 6mg/dL, than the exact dosage pattern.
Hemochromatosis is excess iron in the body. If you search for iron, using the search box near the top of this page, you will see several references to the potential for excess iron to cause gout.
There is also a strong link to pseudogout, so it pays to have your joint fluid analyzed by a rheumatologist to be certain that your attacks are true gout, pseudo gout, or a mixture of both.
In fact, the oxidative damage from excess iron may play a significant part in diseases of many organs (brain, heart, kidneys, liver, pancreas, spleen, etc.)
Excess iron is a little known curse of the typical Western diet. Next time you go shopping try the “Where am I being nailed” game. How many products can you spot with added iron? Once you get to 5 (should take less than 1 minute), feign a heart attack, crippling gout attack, or some other serious disease. When you get the store managers attention, ask her why she's killing her customers (note for UK readers – if you're in the Co-op, the answer probably lies in their extremely lucrative funeral service)
