Help Please!

[yellowbelly]

I have knowingly been suffering from gout for 8 years. I am now 31. I have had approximately half a dozen attacks of severe note, all of which have responded well to Diclofenac 50mg.

Up until 18 months ago, I would often have periods of say?weeks were I would “hobble” for the first few hours of the day, but this would ease by the afternoon. Nothing to really bother me

Incidently, my left big toe is the main area of pain.

Up until 10 weeks ago, I had gone 18 months approx without any pain. Nothing at all. However, 10 weeks ago, I experienced an attack. Nothing too severe, say a 6.5/10. However, it has just gone on and on.

I visited a GP 3 weeks in to the episode,?and he gave me Diclofenac (28 of) which I duely finished. He pretty much shrugged his shoulders at said “do you drink beer?”

Although the pain subsided, it still continued.

I am now at the point were it feels as though the gout attack has subsided (no throbbing, redness or sleepless nights) but my foot is left swollen, and the joints feel painfull; almost bruised and hard to walk on.

It is also worth noting that the pain has spread/shifted to my instep, and my middle toes, as well as my ankle slightly.

Some days, it feels much better, although, like today, it is verging on being a real nuisance again. I have not walked correctly for 10 weeks now!

I must also add that I have been taking Ibuprofen for the last 6 weeks. This seems to help.

My diet is good. I eat well and a balanced diet. I am not overweight, and am tee-total.

I did change my shoes a month before my attack, which is worth noting. In all honesty, they were a little tight at first.

Please, some advice kind people.

?

Ben

[odo]

1. Seriously consider changing your Dr (or be prepared to educate him about

gout ? downloading a copy of the recent Lancet review would probably help &

impress him that you know what you're talking about )

* tried posting a link to the PDF of this, but GP

won't create the link. Use the Forum search for “The Lancet” (Search link is under Popular Gout Pages on the right of this page)

2. Insist on a blood test to determine your Serum Uric Acid (SUA) level

3. Demand a prescription for Allopurinol, preferably 300mg daily, regardless

of the result of your test.

4. Pain relief, you have a number of options: of the NSAIDS, naproxen is

considered least corrosive on the insides. Colchicine taken prophelactically is

reputedly very effective to minimise attacks which (only) may?occur

when starting Allo.

[Keith Taylor (GoutPal Admin)]

odo said:

* tried posting a link to the PDF of this, but GP

won't create the link. Use the Forum search for “The Lancet” (Search link is under Popular Gout Pages on the right of this page)

---

To protect my readers from spam, I have a choice. Either I hold all messages until I can approve them, or I hold links until I can approve them. I chose the latter option. Just post your link, and it will get approved as soon as I can get to it.

Please discuss this in the Tech forum

[Keith Taylor (GoutPal Admin)]

yellowbelly said:

Please, some advice kind people.

?

Ben

---

Ben, gout is a uric acid disorder.

There are many causes, and you may have more than one, but there is only one way out – know your uric acid number, and learn how to get it below 5mg/gL (0.30mmol/L)

Meds are the easy way, but other plans are possible. Pain relief only makes sense if it is part of a program to reduce uric acid, otherwise you are simply masking the symptoms, prolonging the pain, and increasing the risk of permanent joint damage.

Follow odo's step 2 as a priority. Though I respect his step 1, my experience tells me that you will have little chance of finding a good gout doctor. They do exist, but the patients lucky enough to find them never come here, so we never know who they are. 2 hours reading GoutPal.com will give you more insight and knowledge about gout than the average healthcare professional has.

Your specific point about shoes is interesting. Gout simply means that uric acid has built up to the point where uric acid crystals are causing your immune system to react in a noticeably painful way. Many gout sufferers have years of uric acid build-up without noticing them. We are all different, so there is no point where you can say high uric acid without symptoms (asymptomatic hyperuricemia) becomes gout. Tissues surrounding affected joints often become hot or slightly swollen before the reaction becomes severe enough to be recognised as gout.

[yellowbelly]

Thank you so much to all of the replies. What I like is that you are so well versed on the condition and are keen for me to learn about gout prior to taking meds. I think this a great philosophy to help treat people.

I find that I spend a lot of time?exploring what it is that is causing the gout, when you rightly educate me that this is not always the right question, or indeed, relevant.

I will book to see my GP again. To be honest, I do not have a GP as such, merely 5 doctors at a practice, of which the least busy will see me if I queue long enough.

The GP at the A&E department was very calm about the situation when he saw me a few weeks ago. He just sort of said “this is you, don't worry, and if it continues, see your GP and they will put you on meds to control your Uric acid levels”.

I?guess it is the GP's job to treat, rather than educate. I do however emplore your crusade, and are very grateful.

Is there anything in the cherry theory? The pharmacist was an advocate of cherry supplements.

?

Thanks again,

?

Ben

[odo]

Ben, GP will probably want to start you off on 100mg. Try and argue the dose up to 300mg if you can; tell him it makes no difference if you are allergic to Allo at 100 or 300mg (allergic reaction/rash being the reason for this cautious intial dosage) & most people end up taking 300mg. If he won't budge, next tactic is to argue the date of the next blood test down to a maximum of 1 month (he will probably suggest 3) & agree on a target level of 5.00 mg/dL SUA or less.

Wouldn't bother with cherry supplements, unless you like them or want extra Vit C. Nicer fresh I reckon anyway.

[Author]

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