8 months on Allopurinol and going well until………………

[blacky1974]

Hi Everybody,

I have been reading the forum on and off for nearly 1 year and want to thank you all for all your time and effort spend on the forum. It's a very good neutral forum which helps people like me immensely.

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Any way my story! After 2 mild attacks nearly 2 years ago in?each foot around a month apart?and then another mild one 6 months later? in my knee, the mother of all attacks came in my right foot/big toe which convinced I needed to see the doctor. I'm slightly overweight and a heavy drinker of between 35 to 40 pints of cider a week!?

I was referred to a specialist who after tests eveantually told me i had gout.

I went straight on to Allopurinol as he told me as long as i didn't binge drink i could eat and drink pretty much what i had been doing before! Result i thought!!

Now i don't need any to tell what i eat and drink is not good for me as i already know that but at the age of 36 i still consider myself young enough to be able to have a few drinks without worrying too much about the long term effects!

The way i look at it is once i get to 40 I'll slow down and start to be more responsible for my actions but until then bring on the allopurinol and the booze!!

So i have been taking allopurinol for abouth 8 months now and everything has been fine. I have continued to eat lots of meat,especially chicken, and drink lots of cider with no signs of any attacks!

I'm sure your thinking “i know what's coming next!”

Well i have had another attack, which I'm suffering as i type, but i just wanted a bit of advice as to why it has come back. The reason i ask this is because my supply of Allopurinol ran out last Friday and i couldn't get any more until Tuesday just gone.

Now me being silly i thought i?would be OK carrying on drinking all weekend without the Allopurinol as i had been taking it for 8 months and it would be only?4 days without. I had missed a day or?two before and i had been fine so i didn't give it a second thought.

How wrong could i be!! The tell tale sign started Monday with a twinge in my left foot. Here's where i reach for the Colchicine! Shit i can't find it!

Tuesday comes with more pain but no severe and my allopurinol is ready so i carry on taking those not realising i shouldn't be taking them whilst I'm in the middle of an attack or so my GP says.

Wednesday comes and pain is getting worse. Get an emergency appointment for my gp who tells me to stop taking the allopurinol,until the attack finishes, and take the Colchicine up to 4 day or a max of 12.

Thursday comes and it's full blown now in my left foot and with painkillers i can just about manage to walk although it's extremely painful.

So my questions the you guys on the forum is?can you confirm what i think???That me missing the allopurinol for 4 days caused my uric acid to rise and caused the attack? or Could i still have had the attack any way through my drinking?

Lastly i'd be grateful for any advice on what i can use to stop the pain because nothing so far works!?

Can i get my GP/specialist to prescribe me something very strong?

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Thanking you John

[Keith Taylor]

Welcome John,

I'm almost tempted to say read what I said to ctrlkeys recently, when he could not stop gout pain, but I think you deserve a bit more.

You are my hero to accept that allopurinol gives you your own gout freedom. Well you would be if you had not let it run out. Get a grip, John. Make me a promise that you will never go more than one day without it. More importantly, make me a promise that you will get tested for uric acid every 4 weeks until you get uric acid below 0.3 mmol.L (5mg/dL). After that you can relax testing up to once a year, but you must always know your number. It is the key to telling your doctor how much allopurinol you need, and it is the key to a pain-free life.

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But for now, we have to deal with the pain. Look at the calendar – we are in the 21st century, and nobody has to endure pain. Work with your doctor (or, better still, a pharmacist) and find the combination that suits you. Here are some pointers:

Colchicine is usually very good at preventing gout pain, or stopping it getting worse. 2 tabs a day for 3 to 4 weeks when you start allopurinol, or increase the dose is good. At other times, if you feel a twinge, take one as early as possible. Colchicine will not relieve gout pain once a flare starts, it just stops it spreading, so you have to wait it out, or take something else.

The usual something else is an anti-inflammatory. Ibuprofen does it for me every time, and in worst cases I've alternated this with paracetamol. When the pain is bad, these types of combinations are the best, and the best advisers seem to be hospital medics, who know everything there is to know about stopping pain – at least in my experience they do.

Steroid shots into the affected area bring instant relief. Personally I would not allow steroids anywhere near me, but if you are desperate, they might be an option. I believe there are many better pain-killing choices, but the important thing is to find what works for you.

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Now, can everyone please look away, as I have to share a personal experience with John, and it may shock you.

This is not a recommendation, John, but something that works for me. At 35 to 40 pints a week, your session intake is beyond lightweight, so you might tolerate the treatment. If it does not work, you have lost nothing. Stand at, or near the bar. Drink your quota and do not sit down. You should find, after 3 or 4, that movement gets easier. Keep moving as much as you can. Do not sit down until you go home. Make sure you drink water before bed, and if you have to get up through the night, and when you wake in the morning. Back this up with your choice of over-the-counter pain relief at a dose advised by your doctor. This has only failed me if I forgot the water, or did something like a long drive with no breaks to keep moving. Good luck

[blacky1974]

Keith

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Thanks very much much for your?reply and for all your very good advice. The last bit about the bar and drinking water before and during bedtime made complete sense to me and should hopefully work to keep me pain free along with my allopurinal.

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After an horrendous throbbing pain through out the morning and a little sleep (due to lack of sleep last night) the pain in my left foot seems to be subsiding and i can now walk with a slimp limp and obviously a lot of pain!

What next though!? I can't get to see my specialist till next Wednesday and my GP said yesterday to start the allopurinal as soon as the gout goes away. Now i remember when i 1st started the allopurinal my specialist told me to take with 2 Colchicine a day with the allopurinal for the 1st 2 weeks?so i think I'm going to do that and start the allopurinal as soon as my recent attack has finished. Does this sound about right to you Keith?

Just wondering as my gout came back almost straight away after stopping the allopurinal?does this mean my 300mg dosage was just about right or should i be taking more to reduce my uric acid levels further?

My 1st reading after my worst attack in my right foot put me just over the accepted level and my specialist said the real reading could be higher but because I'd just had a big attack it was showing lower levels.

My thinking is, correct me if i'm wrong,if i were to take a higher dosage of allpurinal i could get my levels down to a low level and after time missing a few days here or there would not be too risky?

The theory behind that is to get my levels as low as possible and then when i hit the big 40 have a big diet/lifestyle change and i might not need the allopurinal!? Here's hoping any way!

By the way Keith I'm glad to hear I'm your hero and yes i promise to never let it run out again!!

[Keith Taylor (GoutPal Admin)]

blacky1974 said:

What next though!? I can't get to see my specialist till next Wednesday and my GP said yesterday to start the allopurinal as soon as the gout goes away. Now i remember when i 1st started the allopurinal my specialist told me to take with 2 Colchicine a day with the allopurinal for the 1st 2 weeks?so i think I'm going to do that and start the allopurinal as soon as my recent attack has finished. Does this sound about right to you Keith?

That sounds absolutely perfect to me. Follow it up with regular uric acid checks to make sure the allopurinol dose is right. Report your results here for discussion if unsure – just a number, not meaningless high/normal/low assessments

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The theory behind that is to get my levels as low as possible and then when i hit the big 40 have a big diet/lifestyle change and i might not need the allopurinal!? Here's hoping any way!

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No, no, no. We celebrate the big 40 with a party, where we might, or might not discuss any lifestyle changes you might need

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