Forum Replies Created
-
Posts
-
jeffros_gout said:
My original statement about Tramadol didn't really make sense.
Nothing about tramadol makes much sense to me. I was introduced to it earlier this year in hospital. Half the time, I thought I was connected to the Internet, and could control it with my mind. Pain? Who cares.
I came home with a supply (also with ibuprofen and paracetamol), but I wanted to try reduce pain relief, so stopped taking tramadol. When pain became too much, I popped a tramadol – absolutely no effect. Then, after taking as prescribed for a day, I was back in la-la land. Pain controlled, but constipation after a couple of days killed my desire for tramadol. It seems to me that it takes about a day to take effect, but I will not be going near it again. Unless the pain gets unbearable!
By the way, this was not gout pain – just the odd broken bone here and there.
Hi Penny,
You CAN get this under control, but you will need to be determined with the medics. If you control your uric acid, pain will stop eventually, but you need good pain relief for a few months. I only take it daily when I am increasing my allopurinol dosage. After a week, I stop daily, but keep it on hand to take if I feel an attack coming on.
?
I find a combination of anti-inflammatory and analgesic works best, combined with one or two colchicine per day. This is what you need to discuss with your doctor. In my opinion, prednisone is not good if there are alternatives that work. If you get chance to talk to a pharmacist before you see your doctor, ask what they recommend ? pharmacists are usually up-to-speed with the most effective pain relief.
?
The other important thing to discuss with your doctor is your uric acid level. You need the number (not a meaningless high/normal/low) and you need enough allopurinol to get it below 5mg/dL.
jeffros_gout said:
I guess it's a gout only forum here, so I will keep my other issues to myself.
It is best to stick to gout, but some of your other problems are related.
?I wanted to be brief in my first response to focus on what really matters ? your uric acid level.
The reason I was disappointed about lack of earlier treatment is that surgery, chemo, and rapid weight loss are all extremely high on the list of things that cause gout. They all have a huge potential to significantly raise uric acid in the blood. Your medical team should know this, and they should have put you on allopurinol at the start of your treatment to reduce your gout risks.
Personally, I am very interested in your work as a web developer, but you are right when you suggest that this is not the place to discuss it. As for cats…
No thanks!
Sorry for editing your post, Hans. Just removed the salesman's link copied from the original post ? now deleted.
Here is the site info for anyone wanting to show the idiot what gout really feels like:
Registrant:
robert perry
9022 clearlake
rowlett, Texas 75088
United StatesRegistered through: CheapNames.com Domain Names
Domain Name: CHERRIESHEALTHBENEFITS.COM
Created on: 01-May-10
Expires on: 01-May-12
Last Updated on: 30-Mar-11Administrative Contact:
perry, robert [email protected]
9022 clearlake
rowlett, Texas 75088
United States
(903) 258-1318Technical Contact:
perry, robert [email protected]
9022 clearlake
rowlett, Texas 75088
United States
(903) 258-1318Sorry about the editor problems. This forum software will be replaced soon, so why not use the Question & Answer service and the Debate pages as an alternative? [search above to find them, or just click the Home button above, or GP I in the menubar]
They are not perfect, yet, but much easier for me to improve. Please bear with me – this WILL get better.
If you prefer to stay with this forum for now, you can change the editor in your Profile settings.
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
?
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!
?
No, no, no. We celebrate the big 40 with a party, where we might, or might not discuss any lifestyle changes you might need
zip2play said:
There's a long old discussion of solubilities of the various forms of urate but, alas it is a Springer Link and thus $$$$ to read. As I vaguely recall the solubilities of urate forms do not differ much between UA and MSU.
?
zip2play, I love you
Not only do you make sense in all your post, but that paragraph actually got a response from Hans with a link to what he has been reading. OK, it's from 1905, only 106 years ago, but that is when Hans was in his prime.[ducks for cover]
I'll wait until I'm sober before I respond properly
bestest said:
@ Keith I guess knowing I'm in control will be my pain killer to I hope. For now I took 120mg of arcoxia I'm felling a lot better but still has pain in my hands.
?
Arcoxia (trade name for etoricoxib) is good for reducing inflammation. The pain reduction is usually pretty good, but with a severe attack, may not be enough. Back it up with something that blocks the pain signals. Your pharmacist / doctor / hospital consultant can offer advice. Only you can select which works best for you.
Quickest route, in my experience is ER (UK – A&E). If you are in pain, these are the people who know how to stop it.
Next best is a pharmacist. They are usually in tune with the latest amd best pain-killers. In the UK, their advice is free. Anybody have any views on US pharmacists?
Welcome jeffros,
I will be brief for a change.
?
Uric Acid Number?
?
Nothing else really matters, though I do sympathize, and feel sorry that the experts never forced allopurinol on you earlier.
In a discussion on organic chemistry, the best you can come up with is sodium chloride and hydrochloric acid
??!!Don't be thinking of training to be a teacher
.I remembered the missing factor regarding the stability of the bond. Vital but forgotten. It holds all the answers, yet you are adamant that “Those bonds are so strong that it can and will ?stay for years or ever attached like a barnacle to your bones“
So come on, Hans. Earn your smilies and explain that one. Proper references this time please.
When you see your doctor, if there is resistance, you must point to the British Rheumatology Society recommendations that any level above 0.3 mmol/L should be treated.
?
As I have said, on many, many, occasions, the “normal” range is ridiculous. All the labs do is take a mathematical normal distribution of all the samples they have analyzed during their sampling time. It varies from lab to lab, and it varies from man to woman. That emphasizes how ridiculous the process is. Women have lower average uric acid because the sample includes pre-menopausal women who statistically have lower uric acid due to blood loss and possibly due to hormones. Gout occurs at the same uric acid concentration in men and in women, but the averaging process used to set the mathematical normal values suggests that they get gout at different uric acid concentrations. Absolute and utter rubbish. All those years of training to be fooled by something like that is unbelievable, but true. What really worries me is how many other diseases are assessed and mistreated in this way.
?
Use the search box at the top of the page with normal uric acid no thanks to find more. I have not yet uploaded the aforementioned 0.3mmol/L recommendations, but I can email it to your doctor if they do not have it.
Yes, I choose to accept the Mission.
Apart from the crap that is ruining my joints, which is the real reason for my insistence on allopurinol to the max, I have 3 noticeable tophi. A small pea sized one on the left knee, a small collection of grape pip sized ones near my left elbow, and a wobbly mass of varying density about the size of half my thumb near my right elbow.
I was a little surprised that my uric acid levels were only 7 at the start of my treatment, but that was during an attack, and I had lost quite a bit of weight on hospital food. Previously I have been around the 9 to 12 mark. Not very scientific, but I can no longer afford uric acid test strips, so everything now is dependent on doctors tests ? as it should be.
There should be a month scale on the bottom of that chart: April | May | June | July
I still have over 3 weeks to go before I get the results of 900mg dose, when I will report back on any tophi reduction.
All of this is from my obsession with Lower Uric Acid Gives Faster Gout Cure. I cannot explain what held me back from starting allopurinol, except that I was convinced for a long time that I could fix my gout simply by losing weight. A bang on the head brought me to my senses. Never a truer example of “what doesn't kill you makes you stronger”
Hospital worked for me.
If diagnosis is not completely clear, a rheumatologist is your best bet. Gout is often obvious, but when it is not (like in your case) a proper diagnosis is important. There are other diseases that mimic many symptoms of gout, but gout treatment will not help. Get checked at the hospital as soon as you can.
The general rule of thumb is take up to 300 mg at one time, and over 300 mg as a split dose.
?
I have this minute returned from my doc, and got easy agreement to go from 600mg to the max 900mg. Yippee
600mg got me to 0.27 mmol/L (about 4 and a half of your lovely mg/dL). Due to vacations, I got a different doc this time, and either he has more sense, or I had my explanations rehearsed and ready. No trouble getting him to agree to the max, and my target of 0.20? mmol/L (3.4 mg/dL) for a few months to continue shrinking the tophi. Sensible fellow even arranged kidney and liver function tests with the next uric acid test. I love it when a good plan comes together.
?
There are those who will say I will never get rid of all the urate, but it will not be for want of trying.
?
It's enough to make you smile
Wrave said:
And yes I would love that site.
OK, more news on that soon.
In the meantime, you'll remember I mentioned a time cost, but no financial one. Please spend some time finding out how much a uric acid test costs at a lab, or hospital, or clinic. I.e. what are the choices available for uric acid tests, and how much do they cost? I know the cost of home uric acid testers, and I know it costs quite a lot for the test strips, but how does this compare with the other alternatives?
Oh, it is far from free in Britain.
First, tax and National Insurance takes 25 to 30% of what you earn before you see it. There is 20% tax on everything but basic food and a few other things. Much, much more on petrol, booze and baccy. Over $2000 per year in Council Tax and Water Rates. Every prescription costs $12 for each item.
?
I prefer how you do it. At least, I think I do, as I do not fully understand how it works.
?
If you want a website to help earn a little extra cash, just ask. It does take time – no free rides in that sense, but no cash outlay and your mentor works pro bono
Cherry juice will not change your parents.
You are right to recognize your gout is genetic, so there is little point in worrying about diet and dietary supplements, though a well-balanced diet will not harm.
You have a choice today. Either you find a way to get your uric acid tested and get treatment to lower it below 5mg/dL, or you leave it untreated and get more gout attacks every year with joint damage that will leave you crippled in later life.
Being in Britain, I do not understand the financial barriers to getting proper treatment. I do know that if someone explains them to me properly, I will find a way to beat them and ensure your treatment costs are covered.
?
The choice is yours.
I agree with odo's comments, and would like to add something re: “do you guys and gals start treating a twinge,throb,etc as a flareup or take the wait and see approach?”
If you use colchicine, it is pretty important to start asap, because it works by stopping inflammation increasing, and does absolutely nothing for existing inflammation.
Prednisone is different – it replaces (and unfortunately discourages) your own natural anti-inflammatory hormones. You can afford to wait and see, but it is not supposed to be an “on demand” medicine. I have to make it clear that I have no medical training, so this is something to discuss with the doctor, as I could well have collected some misinformation along the way.
Ultimately, the best way to treat gout pain is to remove it's cause by lowering uric acid below 5mg/dL. In the meantime, it is almost certainly best treated by combination therapies. There are so many ways of controlling pain these days, nobody should have to be debilitated by gout. The pain comes from a series of reactions that start with white blood cells attacking uric acid crystals. The resulting inflammation sets off all sorts of pain signalling processes, so if you combine pain-blocking analgesics with inflammation reducing meds, you should get pretty quick relief. There is lots of choice there, including extra stuff to reduce the stomach problems in those with tolerance problems. Generally speaking, you get more sense from pharmacists than doctors, though there are exceptions.
I know the 'curl up and die' reaction, but I also know that it almost always makes gout worse. The sooner you can get mobile, the sooner you get rid of the painful inflammation. I'm a great believer in 'knowledge is power,' mentioned earlier, but you have to harness that power with more than a little determination.
Ravenwood said:
Well, it was gout.? And when it was finally diagnosed, I felt much better – much more in control.? Now that I knew what I was dealing with, I could address it.? Knowledge is power.
I could not agree more.
The rest of your post is equally sensible, Ravenwood, but that paragraph stands out as something I can relate with strongly.
Nice one!
zip2play said:
polecat,
Consider taking 400 mg. allopurinol with an eye towards getting that 5.3 down a little more to give you a margin of safety. After months without an attack you can go back to 300.
?
Opinions will differ on this. It is certainly true that getting the 5.3 down a little will improve the margin of safety, but my view is that this is not low enough.
Recommendations from British Rheumatologists put 5mg/dL (0.30mmol/L) as the maximum, and I am adopting this standard – you might see slightly higher recommendations on several pages, but I am changing these to the lower limit.
The best approach is to set a target. I am personally influenced by the work of Perez showing that levels below 4mg lead to much quicker dissolving of existing uric acid crystals. Logic tells me that the quicker they dissolve, the less chance they have of triggering gout attacks as they melt, but I have no evidence to back this up. You certainly reduce the risk of joint damage by getting rid of the old crystals as soon as you can.
Once you have a target, that determines the dose. Though the Internet is full of stories about side effects of allopurinol (these days, promoted by those with an interest in sales of the alternative), I have seen nothing to suggest that side effects are dose dependant. I believe that you are either allergic or not. Once you have got past the 100mg initial dose, the next barrier is 900mg maximum daily dose. Some doctors have argued that even this limit should be ignored if circumstances and monitoring allow it.
Personally, I'm on 600mg, and have just had a blood test with an appointment to discuss results next Friday. If I'm nowhere near 3mg/dL (approx 0.20 mmol/L), I will be pushing for 900mg for 6 months. Wish me luck.
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.
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
Yes you have to accept it, because it is fact. Harsh but true.
But look on the bright side – you ARE dealing with it now, in the best way possible by taking allopurinol.
It sounds like 300mg is a reasonable dose long-term, but I suggest you try persuading your doctor to increase it for a few months to get your level well below 5. This will speed up the process of getting rid of old uric acid crystal deposits, which will shorten the time you need pain relief.
That might also be a good time to discuss an alternative to prednisone, which is not good in the long term. Experience from other contributors suggests that you drop it slowly over a few weeks, as sudden stopping of prednisone can lead to other problems. I'm sorry you had such a bad reaction to colchicine – how much were you taking?
I can assure you that, by taking control of gout, and seeing improvements, the initial shock will be replaced by a sense of victory. But this takes time.
Don't worry about what to eat – allopurinol removes any gout aspect to your diet – but do try to eat healthily. Regular well-balanced meals are part of your recovery. If you are overweight, try to lose a little weight slowly. One or two pounds a week is best. Keep well hydrated -? 2.5 to 3 liters per day. All fluids count, so just choose whatever you like best.
For me, learning to overcome the fear of gout pain is the most significant thing. It is scary when you do not know where gout is going to strike next. Before allopurinol, I had several years to get myself used to this, and learned very well how to beat the pain. Now that I take allopurinol, I know that I am close to getting rid of the pain completely. There is absolutely nothing like that feeling to help you through the bad times. You really need that kind of positive approach – at least I do. I find that by pushing through the first signs of pain, mobility really does help. You have my sympathy though, as the hardest pain to deal with, in my experience, is the hands or wrist. That is why so much of what I write is nonsense – typing through the pain barrier is never easy. (NO! I'm not doing it now – no pain today).
drknow said:
I hope the allopurinol will help me out and I hope to share my experience here on this informative site so others might learn from me.? Without this site I fear I may have gone on for years trying to avoid allopurinol and other drugs.? Who wants to rely on drugs???? But after reading these pages and forums, I realize now that without knowing and LOWERING your UAL you will never dissolve these crystals and they will lead to more and more bad news.?
?
Thank you KEITH for this incredible site and taking the time to respond to mine and other peoples posts.? I realize, I am a total newbie at this but I feel as though I have been treated with respect but at the same time responded to firmly and realistically.? This is a priceless gift to me and all of us.? Thank again, Really, Thank you Gout-Pal.
WOW!
You really know how to make my day.
?Thank you
drknow said:
For fellow USA gouties, if you live close to Canada, it is much cheaper to fill your script for Colchicine, especially if you have no health insurance.? You will have to go to a clinic and pay a DR. around $30-40 to have them sign your script but you will save a lot money provided you don't have to drive too far.?
Great idea – anything that reduces income for the morally bankrupt URL Pharma sounds good to me.
I am mentally preparing myself for oncoming attacks.?
?
Am I guaranteed serious attacks or is it possible that they could be minor or not at all?? I have only had two attacks in the last 8 months and my Uric Acid Level was 7.1 These were also my first attacks ever.
You're worrying too much. And I'm worried that I've over-emphasized the small risks of painful allopurinol side effects.
?
I also notice that my gouty joint is visibly more pronounced compared to my non gout toe joint even though there is no pain unless I were to hit the sore spot.? Will my foot ever go back to normal and how long would it take?? I do not think my shoes would fit right now!? Good thing it's summer.? My whole toe isn't swollen, just where the main pain was/is.
Unless permanent damage has been caused, the swelling will go down. Just be certain to get your uric acid level well below 5mg/dL so this happens as soon as possible. Personally, I've noticed much more foot comfort recently – stairs are no longer nightmares! 🙂
davidk said:
?To all those still suffering, hang in there.? There is hope.
?Dave
There *is* hope.
Listen only to your uric acid number, and the rest takes care of itself.
It's good to see a good guy good.
Absolutely correct, my friends.
?
I'm pretty good at pointing out the stupidity of a system that bases treatment and diagnosis on mathematical averages. I'm pretty useless at developing a campaign to put that right, so I am putting my campaign on hold. I'll leave it for someone else, as I amuse myself by thinking about similar situations in other walks of life, or indeed other branches of medicine.
?
Intensive care specialist: We've compiled averages of the injuries sustained by a 12 foot fall onto concrete. 2 skull fractures, 3 spine fractures and a knee fracture are well within the normal distribution, therefore our diagnosis is that you haven't really fallen, and we will not be treating you further.
?
Anyone got any more?
Precede allopurinol with one week of colchicine – one tab twice a day. This should clear up any attacks, as you should not normally start allopurinol during an attack.
Start with 100mg per day. This is almost totally useless for lowering uric acid, but it does ensure that if you are allergic to allopurinol (very rare), you are on a low enough dose to prevent serious reactions.
Arrange blood test for three weeks after you start, then doctor consultation at 4 weeks to increase your dose. Guidelines for dose increase suggest 100mg increments, but you want to get your number below 5mg/dL asap, so try persuade 200mg increments at first.
Repeat the test and dose increase procedure until you reach 900mg, or uric acid test drops to 2 or 3.
Colchicine is best for about a week when dose changes, or whenever you get first sign of a gout attack. After a few months, you should find that you hardly ever need colchicine.
Continue with same allopurinol dose until you go for 6 months without a flare when not taking colchicine,, then relax allopurinol to maintain uric acid levels at 5mg/dL.
