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Hi. I'm a
28 year old male and was just diagnosed with gout. Im about 5,8″, 170 lbs.? I had a
uric acid level of 10.7 when I was diagnosed three weeks ago. I just
started taking allopurinol 2 and a half weeks ago and am currently suffering a
flare up due to it breaking down the crystals.? I was only on 100 mg for the first week and a half and Ive upped the dosage to 200 mg a week ago.? I don't know how long ive had gout but I have been experiencing fatigue and joint pains for a quite a wihle.? Mostly in my legs and feet but also in my hands, shoulders, and elbows.? I havnt had any pain that was too severe to walk or move but its generally just like an aching or a soreness.? The doctor put me on allopurinol without giving me anything else first so im sorta in a little pain daily now.? He later gave me colchicine to use and said to take it when the pain gets really bad but it hasnt gotten bad enough for me to feel like using it yet.? He also started me on another med that I take twice a day but I forgot whats its called.Here are my questions.
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1.? How long should I expect it to take for my uric acid
level to drop to a normal level (around 6) if I keep taking the
allopurinol at 200 mg a day?? I have altered my diet and have been avoiding high purine foods and eating a lot of vegetables. Should I go on a higher dose?2.? Once my uric acid levels drop to within normal levels, can I go
back to drinking alcohol normally on weekends? If I drink alcohol
again, will my uric acid levels rise quickly even if I continue to avoid
high purine foods? If so, how fast will it rise??
3.? I really like drinking and usually drink at the bar every Friday and Saturday night.? I asked my doctor if I need to quit drinking and he said I should stop drinking beer and spirits, but he said red wine is ok.? How realistic is it for someone with gout who is on meds and gets their uric acid level lowered to go back to drinking on weekends? I dont drink at all on week nights.
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4.? Ive been taking 2000 mg of vitamin C pills a day.? Do you think this will help?? Ive also been taking about 1000 mg of EPA pills a day.? Will these help?
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I am getting the results of another blood test on Monday.? I will update with the new information.?
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Any information/advice is greatly appreciated. Thank you very much.? I was reading this forum a bit and it seems like a lot of you guys really know what you are talking about.? Im just sick of getting so much mixed and contradicting information on the internet.
Iconoclast said:
He also started me on another med that I take twice a day but I forgot whats its called.
Is it for gout? If so, probably a NSAID, naproxen, indomethacin etc
Here are my questions.
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1.? How long should I expect it to take for my uric acid
level to drop to a normal level (around 6) if I keep taking the
allopurinol at 200 mg a day?? I have altered my diet and have been avoiding high purine foods and eating a lot of vegetables. Should I go on a higher dose?
You should probably be on a daily minimum dose of 300mg. Allo does not work cumulatively; you need to find the right dose to reduce your UA to a safe(r) level of around 5
2.? Once my uric acid levels drop to within normal levels, can I go
back to drinking alcohol normally on weekends? If I drink alcohol
again, will my uric acid levels rise quickly even if I continue to avoid
high purine foods? If so, how fast will it rise?
?Impossible to predict
3.? I really like drinking and usually drink at the bar every Friday and Saturday night.? I asked my doctor if I need to quit drinking and he said I should stop drinking beer and spirits, but he said red wine is ok.? How realistic is it for someone with gout who is on meds and gets their uric acid level lowered to go back to drinking on weekends? I dont drink at all on week nights.
Drinking normally is as meaningless a term as normal UA levels. Even serious alcoholics alternate periods of abstinence with binge drinking. Wine appears to be the “safest” type of alcohol to resume drinking after stabilizing UA levels, which may include a period of flushing out urate deposits with repeated bouts of gout attacks as part of the process. Much depends on the individual, their metabolism and how much they avoid exacerbating factors like diet, alcohol, vigorous exercise, weight loss, emotional stress etc etc.
4.? Ive been taking 2000 mg of vitamin C pills a day.? Do you think this will help??
Maybe
Ive also been taking about 1000 mg of EPA pills a day.? Will these help?
Probably not. Most oily fish are high in purines
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I am getting the results of another blood test on Monday.? I will update with the new information.?
Good luck. Try and persuade your Dr to put you on 300mg asap. Initial lower doses are merely to check for allergic reaction.
So here is an update.
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I went to the doctor again on Friday and he got the results of my blood test back.? He said that my uric acid level was already down to 3.9 which I was very surprised but happy to hear.? He said that I should reduce my dosage of allopurinol to 100 mg.? He also said that its totally OK for me to drink red wine but that I should still avoid other alcohol.? He said to keep eating a balanced diet and that the key is not to completely avoid things like meat and seafood but to simply make sure that my meals are well balanced and then 25% or less of each meal should be meat and most of my food should be vegetables and fruit.? He said to go back in a few weeks for another blood test.
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I drank red wine Friday and Saturday night (about 1 bottle each night… maybe a little more than that on Saturday since I was bar hopping) and I felt pretty much the same as I did before I went drinking.? So it seems like red wine doesnt really have much of an effect on my gout.? I drank lots of water so I think that helped, too.
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I still have a good deal of pain and fatigue in my joints, but the doctor said its just the uric acid crystals that are still in my joints being broken down by the medicine and that it should subside soon.? For the time being, he says there should be no new uric acid coming from my blood, so that's good at least.
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Hopefully if I keep this up, once the pain from this attack is over, I wont have one again or for a while, and can continue to keep my uric acid levels down.?
Iconoclast said:
? He said that my uric acid level was already down to 3.9 which I was very surprised but happy to hear.? He said that I should reduce my dosage of allopurinol to 100 mg.?
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Don't you dare reduce the allopurinol until you have gone six months without a gout flare (even a hint of one).
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I can't promise to get to Japan to beat the living hell out of you and your doctor if you do, but I can promise eternal damnation (or at least eternal gout pain)
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3.9 is a lovely number (you are certain it is mg/dL aren't you) and very close to the bottom value in my chart on Lower Uric Acid Gives Faster Gout Cure. 2.9 mg/dL for a year would be even better to speed up clearing out the old crystals.
Keith (Gout Admin) said:
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3.9 is a lovely number (you are certain it is mg/dL aren't you)
From 10.7 to 3.9mg/dL in a month on 200mg of Allo is highly unlikely. Drs are idiots and only read what they see on a piece of paper. Hospitals often use more than one lab, which can use different units of meaurement. You need to double check your result.
odo said:
Keith (Gout Admin) said:
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3.9 is a lovely number (you are certain it is mg/dL aren't you)
From 10.7 to 3.9mg/dL in a month on 200mg of Allo is highly unlikely. Drs are idiots and only read what they see on a piece of paper. Hospitals often use more than one lab, which can use different units of meaurement. You need to double check your result.
I am all the way with Odo and then some: Instead of using the polite term: “highly unlikely” I'd say “Impossible”, unless you found yourself a new metabolism at a bargain price at Walmart and also changed your bar-hopping life to an austere monastary monk's life.
Well, I must say these responses are not making me feel very at ease.? I suppose its possible for the doctor to have given bad results.
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Basically, heres the situation.? I live in the country side of Japan about 3 hours away from Tokyo.? The hospitals in my area are very small.? I often go to Tokyo on weekends to drink and stuff.? Ive been having joint pains and fatigue for a while so I had a test done while I was in Tokyo one weekend.? The doctor there was the one who diagnosed me with gout and said my uric acid level was 10.7 mg/dL.? I had never even really heard of gout before this so I just took his word for it.? So… since Tokyo is rather far, I went to another local hospital and they did the test again a few weeks later which is the one that turned out to be 3.9.? I suppose its possible that the doctor here in my town is using incorrect methods of testing or something.? I guess maybe I should go back to get tested again by the doctor in Tokyo…
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Sometimes its hard to get good medical help here…. I'm acutally going back to the US for a few weeks soon to visit but I have no insurance coverage there so it wouldn't matter anyway….
The 2nd Dr may only be using a different unit of measurement. See here:
https://gout-pal.com/reference/uric-acid-levels/
If you do the maths, you will see .39 or 390 is about 6.6mg/dL; this would be a very good result from so little Allo, but maybe not impossible. However, still not safe. You really need to be down at 5.00 or less. Might be worth a visit back to Dr #1, as he seems to be more knowledgeable (didn't tell you to reduce the meds, which is bad advice). Like all scientific tests, introducing variables confounds results.
odo said:
The 2nd Dr may only be using a different unit of measurement. See here:
https://gout-pal.com/reference/uric-acid-levels/
If you do the maths, you will see .39 or 390 is about 6.6mg/dL; this would be a very good result from so little Allo, but maybe not impossible. However, still not safe. You really need to be down at 5.00 or less. Might be worth a visit back to Dr #1, as he seems to be more knowledgeable (didn't tell you to reduce the meds, which is bad advice). Like all scientific tests, introducing variables confounds results.
I just checked the printout of my test results that he gave me and it does infact say mg/dL right there on the sheet next to the value… so i really dont know what to make of all this…
Iconoclast said:
Well, I must say these responses are not making me feel very at ease.? I suppose its possible for the doctor to have given bad results.
Having gout and getting attacks is NOT a condition to feel/be very much at ease, however, be thankful to have found ?a forum where true gouties will give you honest, well-meant advice.
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Sometimes its hard to get good medical help here…. I'm actually going back to the US for a few weeks soon to visit but I have no insurance coverage there so it wouldn't matter anyway….
If you can afford a round-trip ticket to the USA you can afford paying for a medical blood test at any of the nation-wide medical labs. I am only familiar with and can recommend SED labs, with facilities all over the country. Their charges for a simple blood tests range from $20-$50, depending on location and extent of blood test. However, you MUST have a referral or doctor's request for whatever you want to have tested, in this case, SUA (Serum Uric Acid)?
Using your computer you should be able to locate a SED lab within reasonable distance from where you are going to be visiting. They generally provide address and telephone numbers and with your excellent command of the English language you, also, should not have any problems telephoning them and ask all necessary questions what to do to get a blood test done. With that info your doctor aught to be able to give you the required forms for your test.
One other piece of advice: While you are at a SED lab, get a so called COMPREHENSIVE METABOLIC PANEL TEST (must also be requested by your doctor) which will give you and any doctor the info with regard to your liver and ?kidneys. This info is absolutely necessary for the future of your body and gout, as well as other possible problems associated with liver ?and kidneys. Being as young as you are, you might, can prevent certain deceases down the road of your life. ?
Hansinnm…
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I noticed that you said SUA (Serum Uric Acid) test just now.? Is this different than just a UA (Uric Acid) value?? On the test results sheet I recieved, it has the kanji for Uric Acid (??) and then it says “UA” next to it (and the value for the field indicates 3.9 mg/dL).? Is this the exact same thing or is there any difference?
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Regarding the Comprehensive Metabolic Panel Test… wouldn't I be able to have that done in Japan?? I tihnk what I am going to do is, before I leave to visit the US, I am going to get my blood tested again at the local hospital AND the hospital in Tokyo at which I was originally diagnosed.? That way I should know if theres some sort of difference in the testing methods.? If they are both the same, I should be able to say with confidence that my uric acid level has, infact, gone down.? If the Tokyo one says its still high, I suppose that would indicate that the local hospital is doing something wrong.? Ill get tested again in a week or 2.?
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BTW… I noticed you said “with your excellent command of the English language…” in your post.?? I'm a native English speaker and an American lol.? I just live in Japan for work.
Iconoclast said:
Hansinnm?
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I noticed that you said SUA (Serum Uric Acid) test just now.? Is this different than just a UA (Uric Acid) value?? ?
No, they are one and the same. I guess they use the term SUA to clarify that the UA is in the blood or the serum they extract (in most cases, not always) from the knee. The latter one particularly to ascertain that they are dealing with gout. This is, because the solid, white stuff, called tophi is MSU, the salt of UA.
Regarding the Comprehensive Metabolic Panel Test? wouldn't I be able to have that done in Japan?? ?
Yes.
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BTW? I noticed you said “with your excellent command of the English language?” in your post.?? I'm a native English speaker and an American lol.? I just live in Japan for work.
No wonder, your profile didn't identify you as such.
they never actually extracted any serum from my knee.? all they ever did was take regular blood from my arm.? is it important that I have them extract the serum from my knee as well?? I was diagnosed with gout simply based on high uric acid and the symptoms.
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sorry about the profile, I didnt really bother to fill it out.
There are 2 tests:
i) Venous blood – usually drawn from the arm> UA level is measured
ii) synovial fluid – can be drawn from the knee but any affected joint is possible> uric acid crystals are checked for under a microscope – the most certain diagnosis of gout
Iconoclast said:
? is it important that I have them extract the serum from my knee as well?? ?
Not really, unless there is serious doubt that/if you have gout. It's generally done if a person has other arthritic problems and deposits other than MSU, like, frequently Calcium deposits. X-ray and MRI don't show Urate deposits but Ca deposits. So far only that new equipment: DECT-Somatron, is capable of showing Urates and distinguishing between those types.
Ok.? Well, I sorta doubt it would be another kind of arthritis.? I don't think most other kinds of arthritis are common for someone in their late 20s.
hansinnm said:
Iconoclast said:
? is it important that I have them extract the serum from my knee as well?? ?
Not really, unless there is serious doubt that/if you have gout. It's generally done if a person has other arthritic problems and deposits other than MSU, like, frequently Calcium deposits. X-ray and MRI don't show Urate deposits but Ca deposits. So far only that new equipment: DECT-Somatron, is capable of showing Urates and distinguishing between those types.
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For a few years, there has also been an increasing number of mentions of ultrasound in the gouty journals. Much of this has been speculative, but it does appear that uric acid crystals have a unique ultrasound “signature”(contour)? that the experienced technician can recognize. This technology does not seem to have the clarity of the exciting DECT imagery, but neither does it have the outrageous cost.
Ultrasound is not a mainstream diagnostic tool yet, but I'm encouraged by recent developments enough to report them in?Can You Hear Your Symptoms Of Gout??
To paraphrase the conclusion:
musculoskeletal ultrasound is reliable for detecting urate crystal deposition in knees and big toes in gout and in high uric acid with no symptoms of gout.
Maybe there is hope for something more accessible than dual energy scanners and less invasive than a joint fluid draw? It could also help assess treatment by tracking tophi reduction during urate lowering therapy.
Keith (Gout Admin) said:
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Ultrasound is not a mainstream diagnostic tool yet, but I'm encouraged by recent developments enough to report them in?Can You Hear Your Symptoms Of Gout??
To paraphrase the conclusion:
musculoskeletal ultrasound is reliable for detecting urate crystal deposition in knees and big toes in gout and in high uric acid with no symptoms of gout.
Maybe there is hope for something more accessible than dual energy scanners and less invasive than a joint fluid draw? It could also help assess treatment by tracking tophi reduction during urate lowering therapy.
There is ONE big, almost new, aspect of medical science, discovery, treatment: Ultrasound ?
?I have two contribution to make which I have touched on in the past. I was treated for 4-6 weeks with UT radiation and one type of meds (don't know what) in the late forties after WWII for my liver ailment which kept me well til this day.
And, as an NDT Science graduate with 15 years of experience in the military aircraft industry, as a level III in UT (Ultrasound Tech.), PT (Penetrant Tech.), MT (Magnetic Particle Tech) and level II in RT (Radiography=X-ray? Tech), I am well aware of the possibilities and merits of Ultrasound technology. I am firmly convinced that/if someone would spent the money and effort to devise systems for gout/tophi detection, as “they” have for the detection of the minutest cracks in aircraft parts, it would/could be one of the most accurate and cheapest ways to identify, magnify, and quantify gout deposits and their destructive affects.
Hi.? Sorry I havn't checked in for a while.
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So, I finally was able to go back to the hospital in Tokyo where I was originally diagnosed with Gout and had 10.7 uric acid level.? Well, the doctor said its now down to 4.0 which means that the local hopsital must have been right, too.? I guess the 100 mg of allopurinol combined with changing my diet was enough??
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The thing is, I still get a lot of fatique and pain sometimes after drinking too much even though my uric acid level is low.?
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Could it be possible that I don't actually have gout at all and this is a result of some other health problem?? If so, any idea what it might be?? Ive had tests done and the doctors say my liver and kidneys are working properly so I dont know what else it could be.? I was also tested for diabetes and that came up negative.? I also recently had a test done for just about every STD and they were all negative as well.?
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