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drknow, you sound like me a few years back. ?Starting AP was the best and only effective solution I tried in over 5 years of trying to solve the attacks. ?I tried all the usual things you read and hear about but the attacks just kept happening more frequently, more intensely and lasted?longer. ?My last big attack lasted almost two months with glimmers of hope mixed in but it just came back and lingered and lingered. ?SO with my history and a new doc I was given predisone to stop the attack which works very well for me and 300mg a day habit for AP. ?I started AP right after my first round of Predisone(8 days). ?I was attack free but had another within a few weeks and even another a few weeks after that but I stuck with the AP and each time Predisone got rid of the pain. ? ?When I returned for follow up blood work I was bumped up to 600mg a day and have been there since. ?Another light attack just after the increase and now my UA levels are under 5 and I have been attack free for over a year now. ?I hike and bike alot but my diet is pretty much what ever I want in moderation. ?I eat and drink all the forbidden stuff and never have a problem. ?My experiences with AP have been uneventful. ?I miss half dosages once or twice a week and it has never been an issue. ?Depending on how long you have been taking it and other factors in your life can impact what missing a dose does. ?I have missed doses a day here and there but just took it at my next scheduled time with no issues. ?I thought taking a pill for the reat of my life would be difficult to keep doing but having attacks is much more difficult so I take those pills and smile while doing it. ?If you have a good and on hand treatment for the swelling and pain then jump in with the AP because it is a long process to drop your levels and disolve existing deposits but in time things will stabliize. ?
Yep sounds like my Achilles incident. ?My?Achilles incident kept me from walking, it was real bad. ?You could see?noticeable?swelling and felt like it was going to come apart at any moment. ?The knee has been much less painful, only to the touch but sharp when you do. ?I saw my doc with the?Achilles?incident because I thought it was or about to get very serious. ?When I brought up gout as being a?contributor he shrugged it off?basically?saying that uric acid does not affect bursa?sacks but I have read the contrary. ?He pinned it on over use which is a fair?assessment?as well but the onset of that issue was a week after my “overuse”. ?It seemed very similar to gout attacks I would get post hikes before I started AP. ?As I was trying manage my gout without AP I would frequently go on long day hikes or backpacking trips, about 3-6 days after returning I would get an attack and it would be a sustained attack for a week plus. ?The time between the activity and the onset of symptoms is what I seem to be focusing on when making a link between the two types of incidents. ?I think it may be time to get another docs opinion,?dang, and I thought I had a winner this time around.
I have some experience with cannabis and having Gout. ?I find that cannabis tends to make me focus way too much on the affected area, I actually think it makes it worse and it tends to make me wreck my diet
On the other hand my wife suffers from Cauda Equina Syndrome and has spasms and nerve pain on a consistent basis in the lower half of her body. ?The MDs prescribe the usual narcotics that really have just made things different and in some aspects worse. ?We live in a state where MMJ was just voted in but have used cannabis for her condition in the past. ?She prefers it to the variety of pain meds prescribed to her. ?I can say as an individual living with her that cannabis has made things?as normal as we can expect. ?The crap the gov'ment says is?OK?is not?OK?and I find those narcotics did far more bad then good. ?I always hear people rambling on about proof in data, scientific research. ?You know what, live with a patient it has benefited and then tell me you still need data. ?
Then there is?the?alcohol question for the?modern?day Gouty. ?Pre AP I would not dream of having a single drink and gouties still want to get their swerve on. ?Most of the really negative and stupid things in my life came as a result of alcohol use and Gout is just the crown on it all. ???BTW I understand alcohol did not cause my Gout, but it sure does nothing to help it. ?I think gouties should use cannabis for recreational purposes. ?If you have your uric acid under control why dump the toxin that is alcohol into your body and risk the?consequences of that. ?Smoke, eat or vaporize a little cannabis and enjoy yourself a little, lord knows the cops, judges and?politicians are with alcohol, f'in hypocrites. ? The stigma created is wrong and harmful and it needs changing. ?The old guard and its tactics will no longer work in this day and age. ?Voters here will be voting on this topic on way or another for years to come. ??
Short story long, cannabis is not going to help your attacks, only?controlling?your Uric Acid will do that. ?But when you have a handle on that spark it up and act like your 19 again, you will be dead before you know it and why have a bunch of hypocrites run the life you have left. ? This time is special enjoy it as much as you can. ??
I have been on AP since late Jan 2010. Started at 300mg and am now at 600mg a day. I was in the midst of a month + sequence of attacks when I started, Prednisone was taken for the swelling. I had a few more ove rthe course of the next two months. My last attack(June) came from my increase from 300 – 600mg a day, that attack was a short one thanks to an aggressive Prednisone treatment(started at 90mg a day). I have not had any since, I eat what I want and drink in moderation.
You cannot judge the results of Allopurinol from the pain that you feel. The only way you know if AP is working is by checking your Uric Acid levels. If they are not dropping then you need more of it or AP is not working for your condition. This process can take months, not weeks. I had been on 300mg of AP for 3 months and my Uric Acid levels were hovering around 6, a very bad place to be. Riding at the upper threshold for safe Uric Acid Levels can cause lots of pain because you never start disolving and your levels never stay low. They upped it to 600mg and I had an attack within a few days of taking the increased dose, this was expected. Went on prednisone and away it went. I read some folks on here have endured months of pain before it got better for them, so I guess it is normal for some gouties. I think I was fortunate to have so very few issues after starting AP. Understand your Uric Acid levels and treat the pain as needed. Prednisone worked best for me, no stomach issues but it did make me eat like a horse and display a little roid rage from time to time. There is other options if Prednisone is not working out for you but they all come with some sort of side effects.
They are both helping you. The Allopurinol is working on lowering your Uric Acid level, you will likely take this forever, it is just something you do now. The Prednisone is for the swelling only, this keeps the swelling down and your doctor should have a plan to ween you off it, if you are unaware of it you should contact them directly and get a good understanding of the plan. I was on the same combo and only used Prednisone on two seperate occasions, started at 90mg a day and over the course of 9 days I weened off it. For me Prednisone basically elimanted my Gout symptoms. The Allopurinol prevents Uric Acid from being created in your body for a short time(hours) after you take it. The idea is to lower the amount being created so your bodies normal processes can process out what you do have, over time this will reduce the overall Uric Acid level in your body. Once you get below a certain threshold(Typically 6mg/dl) the existing deposits you have will begin to disolve and over a longer time if dosed correctly those deposits wil go away and your Uric Acid levels will stay low. The pain is not the most important item to focus on, the Uric Acid level is. If you fail to get and keep your Uric Acid level below 6mg/dl you will continue to have Gout attacks and continue to accumlate deposits and you will just continue to get worse then you are now. In the beginning of your Allopurinol consumption you will get additional attacks as your Uric Acid level drops, this is expected and you should not stop taking Allopurinol or you are simply setting yourself back in your treatment. Continue to treat the pain and swelling with prednisone if that works for you until it is manageable without it, stay with the Allopurinol, get your Uric Acid levels checked every 4-6 months and know them and eventually you will be pain free.
limpy said:
Is the reason you can't run. That it beats your ankles and feet to much? My feet and ankles still hurt every day and I've been on 200mg of Allopurinol since May 22nd.
limpy, I gave up running and dramatically cut back training hikes because by right big toe joint(most common atack point for me) was always in some sort of pain. I have had attacks in other parts of both feet but that joint is ol reliable when its comes to hurtin. I started AP back in Jan @300MG. In May my levels were hovering around 6, most attacks were gone but I still had issues with pain in that foot. At this point I was still hiking 5-6 days a week, 6 miles a day and some days I was trail running. When I saw the doc in May he upped my dose to 600MG and talked to me about how I exercise and the issues I may see ongoing. He suggested a bike to take some of the abuse off the foot. Spring time is a busy backpacking time of year, I went on several trips and had pain on all of them, I also had a small attack brought on by the increased AP dose. After my last trip I decided to give up on backpacking and cut back hiking for the short term and give the bike a try to see if that would make a difference. Within 3 weeks I was pain free and have been so since mid June, this is something that has not happened for a few years now. I don't have any trips til October when I wil spend about 12 days in the Grand Canyon, until then it is heavy biking, moderate hiking(no more then 3 days a week). If you are running and still have pain in the foot, stop running and jump on a bike or other activity that will give your feet a break.
Goutful, careful with that hiking that bit me in the arse when I was trying to get things stabalized. I started biking and that made a huge difference. I take 600MG of AP now everyday, started at 300MG but I do hike 8 miles a day or ride 20 and my doc felt it prudent to up my dose because of that activity. I had a few AP induced attacks but things have gotten much MUCH better. I dare not run ever again
toofast said:
I know it is a bit late in many places…but I found this forum recently and today finally got the nerve to start asking questions.
I have searched everywhere on this forum for a explanation as to why beer is so bad…if it is balanced against a good diet and you stay hydrated (lots of water).
Can someone point me to an explanation…sorry I've always wanted to know why since I was a kid.
From what I understand the issue is two fold:
1. Brewers Yeast – This is high in purines, which will increase your Uric Acid levels.
2. Alcohol – This makes your kidneys process it vs. processing Uric Acid, which cause that increased Uric Acid to hang around in your system longer.
First one to create Good Gout friendly beer wins the a pile of money.
I have had issues were my sweat smells of Ammonia right after work outs. I discovered that if the body burns Amino Acids for energy this will happen. Basically I was needed to eat a light snack of complex carbs before my workout. I wonder if that could have an impact on the smell of urine.
I would not focus on the sports drink but your UA levels. When I started on Allopurinol 300mg I was not able to get below 6 and after some detailed discussion with my doc about what I was doing phyiscally he immediatly upped my dose to 600mg. When you put your body through the paces like you do for triathlons you are actually increasing your UA levels just the same as if you went on a beer and liver bender. I have been doing some reading related to intense exercise and Uric Acid levels. From what I understand Anaerobic workouts will cause increase UA levels because of cell breakdown and Lactic acid competes with Uric Acid for kidney bandwidth. I am sure it is more complicated then that but I keep it simple for my own good. I am a distance hiker and backpacker. It is not uncommon for me to push 10+ miles a day for 3-5 days across, up and down mountains, canyons and everything in between. On daily basis I do about 1-2 hours of cardio either on a bike or out hiking/running cross country. I have seen positive results since increasing my AP dose and my attacks have gone from ~monthly and very persistent to non existent. My UA levels are now in the 3-4 range when I test at home. If the your UA levels are high enough for you to be depositing crystals in your joints it will just continue to get worse, get the UA level checked and you may even consider monitoring at home.
Kate,
I can tell you this, I started Allopurinol during an attack. Had no choice really, that attack had not let up for a month and as your son is seeing there appeared to be no relief in sight. My experience is limited but since late Jan 2010 when I started Appopurinol I have improved but have still had attacks. Two things will have to happen, the Uric Acid levels will have to get stabilized an this will happen via meds(Allopurinol, Uloric) and/or diet. This is a long term commitment that will have to be for life. It is true that during an attack you will not recieve reliable results regarding Uric Acid levels. The second part is addressing the acute attacks, this will doing nothing for the UA levels, only address the swelling and pain of the attack. Prednisone so far has worked well for me treating acute attacks. I did use indomethacin as well but it would randomly give me digestive fits, not fun. If the culprit is Hyperuricemia then over time the meds will stabilize the UA levels but he will have to be taking a proper dose, too little and things will just teeter along with no real sign of progress. I started at 300mg Allopurinol and am now at 600mg.
This whole thing is a process and I found that understanding the difference between treating the UA level and treating the acute attack has made a big difference in how I approach dealing with it. Those two items are very different and should be addressed individually. Formulating a plan with your doctors that you have confidence in is crucial. The attacks can persist for months after starting Allopurinol but stick with your plan, stopping will do nothing but prolong this process. One other thing to mention, I have gone through a half dozen doctors during my process. Shaking up the staff may help as well, most of my docs had me on a course of suffering vs. resolving and this was very frustrating. It was only through information I have gathered on my own that I was able to begin to challenge my docs and understand how this really needed to be treated. Once I was armed with the enough knowledge to be dangerous I found a doc that I could have confidence in.
Just wanted to follow up on this. Been on 300mg of AP since mid late Jan 2010. I went back to the doc in late May and he took some more blood. He found that I was right at 6. We discussed in detail what I had been doing in relation to exercise and diet. He was not really that concerned with my diet but was with my exercise. At least once a week I was hiking 10+ miles a day and exceeding 2000 to 3000 feet of elevation gain on those hikes. It is not uncommon for me to do 2-3 days a week with similar miles and elevation gain/loss. He was pretty confident that this was contributing to my high numbers so we upped my dose to 600mg. This of course triggered another attack and I am just waiting out the tail end(hopefully) before I strike out again. I introduced a bike into the mix now because I find my joints just feel so much better when I bike more often. I will admit I feel safer with the rattle snakes on the trail then I do with the traffic on the roads. I find the affect of exercise on Uric Acid fascinating and a little misunderstood. It is amazing the advice I recieve about gout from the general population and alot in the medical community. Just after it was confirmed gout I was lifting weights and hammering the cardio in an effort to improve my overall health, to make that lifestyle change. My numba$$ doc at the time did not even blink at this, he actually encouraged this. No wonder my attacks increased with a vengence over the last few years, any progress I may of had from diet changes were being blown away by the exercise I was performing. My current doc left me with this advice, eat what you want in moderation. Avoid benders and long stretches with highly questionable foods. Exercise the way you want so you will continue to do so and improve. We can adjust the meds to suit your lifestyle but the most important thing is to get healty and stay healthy and that won't happen if we stick you on a program that you hate. I just wish I had that advice 4 years ago.
Hi Jeff,
I can speak to the heavy training part of your misery. I am 39, 5'9″ and 195#. I have had active Gout attacks for about 9 years. I have lost 55 pounds in the last few years mainly through running and hiking/backpacking. I was always a runner, hiker and then I gained quite abit of weight in my late 20's while I was focusing on work and making my millions, I got the weight but not the millions 🙁 I treid to go med free for a long time and it never worked for me. I found I was having serious problems when I ran more then when I walked so I eliminated running and increased the walking. I would normally walk 1.5 hours a day cross hilly terrian all off road(~7 miles). This helped for a while but I found I was having serious attacks days after completing any type of long distance trip or steep intense trip. The last straw for me was an attack I had 3 days after completing a rather tough 14 mile ridge hike with a very steep ending, we completed this in about 6 hours and 3 rest days later an attack started that did not let up for a month. At the time I just took indomethicin but found that was messing with my stomach way too much. At this point I decided to get on the meds so my doc started me on Allopurinol 300mg. I was also given prednisone for when I got attacks and I knew I would. Since then I have had 3 attacks and have followed up with my doc for another blood test. He found my levels to be hovering around 6 and after some discussion he wanted me to increase my dosage of AP to 600mg day on days I did intense exercise. So I started the 600mg dose straight away due to the fact that I am either currently hiking or biking just about everyday, rest days get worked in a couple times a week max. Just a few days after upping my dose I got hit with another attack, somewhat unexpected because I had been a few months without and it had been a very long time since I was able to go 2-3 months without one. So at this point I am sticking it out through this next set of attacks and continuing on with my workouts when the attack subsides. I have added in biking because I have found that all hiking is boring after awhile but also I am finding the pain in my feet and else where to be much greater when I just hike day in and day out. Biking has offered a huge relief to the joints and now I do a pretty even mix. I will know more when I follow up again in 3 months to get another lab test done. I have resigned myself to the fact that running is over for me, we had some great years but it just compounds issues. Just as eating foods high in purines elevates your levels all that exercise does the same, stick with the meds, test your levels every 3-4 months and don't be shy about increasing your meds to account for your lifestyle, after all that is what makes the meds great it will allow us to still do things we otherwise would never be able to do again.
To summize 600mg Allopurinol daily, prednisone for when attacks occur and water intake, easily two gallons a day. This has been working for me. I found that during the years of expermintation with diet and attack suppression meds that combinations of things could make life miserable on all fronts. Find the combo that works for you. From what I have learned and understand you need the daily meds(Allopurinol, Uloric) to get your Uric Acid levels below 6 and while this is happening something to address the attacks that you will get, for me prednisone has worked great and as a bonus it really fires you up 😉 Indomethician really messed with me bad, I will not touch that stuff again. It gave me digestive issues from hell. On the diet front I have changed things but by no means am I a great eater. I love junk food now and again so I have been sure that I do not try to stick to a diet I know I will not be able to stick to long term so while the daily meds are addressing the overall Uric Acid levels it does so with a diet that I can easily stick with long term.
In regards to damaging the joint, my doc has taken x rays on my problem areas a few times a year over the last few years. I was trying to make a go at it without AP they thought this was a good idea to ensure damage was not happening. I have always pushed being outside and always have a trip on the horizon, gout has really messed with that the last two years. I do get what I consider mild pain in the foot, both feet actually but this usually clears up when it happens within 10-20 minutes of starting my walks. Overall I find I am in better spirits and feel better phyiscally if I am getting out 5-6 days a week. My problems in the past have always started by taking more days off then on, sometimes I think if I am slacking I am just inviting trouble.
I have had a similar issue related to trail running. I have been on AP now for almost 3 months and I have been slowely working back to running. I feel like a hamster when I workout in a gym, I like the terrian, I like the outside far too much and if you feel the same way you will never be successful working out in a gym. Currently I have been hiking at a good clip(3-4 MPH) in the hills 5-6 days a week. I typically do a 6 mile route(800 feet elevation gain) most days with a 10+ mile route( 1500+ feet elevation gain) thrown in once a week. I do mix in running while I am out there but not a whole lot, the amount has been increasing. Do a workout you love, more importantly a workout you will do, just be cautious in opening up the throttle.
Thanks for the replies! zip2play, 40 years to too long to not see that place, I try to make it 2-3 times a year. I do monitor my levels with a kernel meter. Right now I am seeing anything from 5.1-7.1 but it is still early in my AP career. I will go back for labs in May and take it from there. So far I am very excited with what AP has done so far, I never saw my levels below 8 when I was not on it and am very anxious to get hammering again at the long steep and remote miles. My heart pounding trips are at the end of April so I should have a real good idea by then of what AP is doing for my levels by then. Right now I only experience sorness in the typical places but it goes away over night. I have been very cautious not to jump the distance or frequency too fast, I just remind myself what all of Dec. and Jan. was like
My mom, my aunt and my older sister all have gout. My little brother had stones at 19 and I started to get gout attacks in my early thirties. Growing up I was always very active, a runner, football, basketball, served in an Airborne Regiment, hiker and backpacker, none of it mattered the gene pool got me. I was very fit when it started but through the years it has seriously affected my life. It took 4 years before I could get a MD to listen, they figured I was just injured from my lifestyle, even when I gave them the extensive family history. Welcome to the club
embrace it cause it will only get waaay worse if you don't. I started AP 2 weeks ago this Friday coming up. When I started I had little pain but within two days I had another attack coming on. I am not on colchacine but prednisone for when the attacks happen and at this point I am pain free for the most part(I can put shoes on!). I test UA at home with a meter and after being sure to take very careful tests I find my readings in the low to mid 5's, prior to taking AP they were always 8+. Prior to this I had no Tophi but had major pain in all parts of my right foot and ankle at various times over the course the last 8 years. I hike/backpack frequently and have not been able to do so in the last 3 months, after this short time on AP I feel I will be back on the trail within the week. I will not have follow on lab work til May. So far that has been my experience on AP, I see others that have very different experiences.
