I Didn't Think It Possible

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After about 15 years without anything more than a twinge, I thought I was free from any serious attacks.
I take 400 mg./day allopurinol and control my serum uric acid to the low 5’s.

I teetotal the first 3 months of every year and in April I sort of go wild.

My fave is Manhattans (giving away my age) and I drank them copiously for the first half of the month and then I did a couple 6 packs of beer…eh. So I bought a 5 liter chateaux cardboard “burgundy” (California, natch) which I drank in 3 days…like I said, WILD. Pain started as soon as the wine was gone.

My right big toe started to hurt but I didn’t take immediate colchicine action thinkiing I had bent the toe wrong, etc. It kept getting worse, not hurting on footfall but rather on footrise…pain is on top and on the outside.

So I dug out the colchicine bottle:
For those who don’t remember me, my method is old school: 2 colchicine, followed by one an hour until pain stops or diahrrhea stops or 16 pills are taken. Now that colchicine was usurped as patented Colcrys at $5 a pill I guard my old supply like a squirrel’s nuts in February. I know the “New” recommendation (for the oldest drug :D) is now to limit to 3 or 4 pills becasue a study was done that showed most people can cure HALF their pain with this doseage.
So, having an open mind I decided on 6 pills and then 2 the following day. Light diarrhea started on day 2. The pain got a bit better as soon as the diarrhea began but then got worse again the next day. I guess I “half cured” myself…and wasted 8 precious pills.

So now my dilemma…go with the old regimen (16) and use about 15% of my colchicine supply (which I want to last the rest of my life) or to go with NSAIDS…I have an old bottleful of indomethacin but as I recall they made me dizzy.

Of course I am continuing the allopurinol and wondering whether to take it to 600 mg..day.

Needless to say, I won’t be having red wine or beer for a long time…May is teetotal and today and tomorrow it’s Manhattans.

This is NOT a severe attack from Hell but neither is it a twinge…I can see the tophus under the skin and there is swelling.
If I HAVE to, I can spend the day in the bathroom with 16 colchicine.

I certainly have no faith in the bullshit new recommendation of the Colcrys people and their slanted nonsensical study.

I will never again ignore the first twinge in my right toe…action on that first day is most important when 2 colchicine has a real place in trreatment.

One other wrinkle. I switched BP med to atenolol (for angina control) and thought it appropriate to cut back on something else so I stopped the losartan 3 days before the pain. That may have been a mistake because losartan is unique as a BP drug that is uricisuric (causes peeing out of urate.)

I bought a quart of cherry juice and am going for a pound of bicarbonate to see what happens. I’m doing 5 ounces of pure black cherry juice a day. Does that seem enough? It really is DELICIOUS stuff.

[Keith Taylor (GoutPal Admin)]

I won’t repeat my belief in the “new recommendations” re colcrys / colchicine, but I will repeat the “new recommendations” re uric acid.

5 is the upper limit.

Low 5’s might simply be not low enough. The new recommendations give a better margin for daily fluctuation. Fluctuation of uric acid can be from big diet changes, or changes to other meds,Fluctuation of crystallization point could be from low temperature, or pH of synovial or other body fluids (blood is well regulated for pH, but I think this makes other fluids a more volatile buffer – don’t quote me),

I’m pretty much grasping at straws here, because I thought you’d got this gout thing nailed.

Did you ever get any of the free colchicine from Derek via Hans? I can initiate an email conversation if you’re interested.

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I?m pretty much grasping at straws here, because I thought you?d got this gout thing nailed.

I am going to say that I too think I really DO have this nailed…but apparently nails can come loose with 5 liters of bad red wine in 3 days bracketed by 2 days of a 6 pack of beer.
My control to the low 5’s (last reading was 5.1) that gives me 10 years attack-free cannot be far off the mark so I will continue with 400 mg. allopurinol.

You know, for 15 years I have had a full bottle of indomethacin in the bathroom medicine chest and onlay last week did I finallly throw it in the BIG BIN…my pharmacy to save the world in the event of Armageddon. Perhaps I will go in with a shovel and try to find it again.

No, I have never gotten any colchine through Hans. I will do a pill count and see what I have left and get back to you.
I took 3 colchicine today (and a quart of cherry juice yesterday) and have not decided if I am going for broke or temporizing. It’s at that tenuous point of hurting but not too much. If I knew it wasn’t going to get worse I would grin and bear it. I can walk with only a little catering to the right big toe.

All alcohol goes bye-bye May Day until July 1.

edit: I have 167 colchicine…I should not worry about taking a full dose. I doubt that I will live long enough to need them all.

But I am strong evidence that once you have gout you ALWAYS have gout…so nobody should ever think they are cured no matter HOW much time goes by without an attack.

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So, having an open mind I decided on 6 pills and then 2 the following day. Light diarrhea started on day 2. The pain got a bit better as soon as the diarrhea began but then got worse again the next day. I guess I ?half cured? myself?and wasted 8 precious pills.

So spent another couple days in pain and yesterday I decided to bite the bullet and go for broke and take colchicine until diarrhea started. Apparently there is a residual effect for a couple days because at the fourth pill I started schytting like mad…total of 13 times in 6 hours with water just flushing through…and one more time this morning.
As soon as the diarrhea started the pain stopped within minutes…there MUST be a connection.

So, if it ever happens again I am not going to fiddle around. And it seems that a 12 pill total might be my sweeet spot. (First time I tried this a decade ago I got to 22…super overkill out of ignorance, but it worked.

I developed a theory:
Kidneys work thusly: almost all material in the plasma is excreted in the millions of ascending loops but then most is recovered in the transversee and descending loops. Thus nearly all the uric acid is excreted but then almost all is reabsorbed.
Diarrhea is the expulsion of huge amounts of water into the colon and the colon has no recovery method.
I am strongly pushed towards believing it is a massive expulsion of urate into the colon that stops the attack.
Yes, I know the cover story that colchicine does not lower uric acid levels but I have read so much oft repeated nonsense about gout that I now consider my own evidence and logic system preferable to the ever repeated old wives tales…probably developed from NO evidence.

So now no booze for 2 months, no pain, and I think I can hide the colchicine and indomethacin again.

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