Forum Replies Created
-
Posts
-
When we first get gout, we try to find all kinds of links and triggers that might explain it. The true explanation is very simple. Your body has too much uric acid.
This is usually genetic, but there might be environmental factors. It is always a good idea to avoid excess calories, and exposure to lead, iron, or similar contaminants. As you have gout in the family, it is almost certainly genetic. Carrying excess weight is likely to make gout slightly worse. Losing that weight is an excellent plan to reduce your risk of heart disease and other health problems. It may also reduce your uric acid slightly, but it is not likely to get it down to 5, where it needs to be.
I’ll have to hope that someone else can comment on Beano. I’m a limey, and it means something completely different over here.
Generally speaking, for gout, the things to avoid are excess iron, excess calories, and excess animal flesh. If Beano is high in any of those, then restrict it to the occasional treat, otherwise just enjoy your food. There are few specific foods that you should avoid, but total food intake that leads to excess calories, excess iron, or excess animal purines are definitely foods to avoid with gout.
I’ll join your other thread to discuss PURIXA.
On the uric acid testing, you might find fluctuations in your results. Some of this is down to natural daily fluctuations. You can minimize that effect by always testing at the same time, e.g. before breakfast.
Hi Paul,
Best to aim for 5 or lower. 6 is acceptable if medical reasons prevent you from going lower, but it gives little safety margin for daily fluctuations. If you have to settle for 6, be careful to keep limbs well wrapped and generally avoid exposure to cold.
On PURIXA, there’s an active discussion at https://gout-pal.com/gout-pal-forum/please-help-my-gout/started-purixa-today/
It’s an interesting point about cold.
Medics are obsessed with assessing core temperature, which is OK for many health issues, but gout is different. We know that gout almost always starts in the extremities, especially toes and fingers, as these are the joints most exposed to gout.
For the perfect assessment, you should measure the temperature at the joints, as this will affect the point at which crystals form. I’ve just had a quick look at two gout studies: Studies of urate crystallisation in relation to gout and Factors affecting urate solubility in vitro. If joint temperature is 26° C, uric acid crystallization point falls to 4 mg/dL or less.
I think I need to modify my advice about 5 being the safe level for uric acid. 5 is safe at normal temperature, but not low enough if work or lifestyle leaves you exposed to cold for long periods.
Did you try contacting Siemens as I suggested in https://gout-pal.com/gout-pal-forum/please-help-my-gout/is-there-a-dect-machine-in-or-around-portland-oregon/
Looks like local teaching/research hospitals might be the best bet.
If you do have gout, you are very likely to have uric acid crystals in other joints. This can be tested now, or wait a few months and you will get an attack elsewhere.
The other option, as allopurinol is cheap and effective, is to assume that you do have gout, and treat it accordingly. Talk to your doctor about getting uric acid below 5. This will take several months to clear old crystals, but you should see improvement after 2 or 3 months.
Have you seen a rheumatologist?
Allopurinol does not mask gout symptoms. It lowers uric acid, which is exactly what you need to do to control gout. Without evidence that some uric acid crystals remain in your body, I would tend to agree with the suggestion that it isn’t gout. It is very unusual to experience gout attacks with uric acid levels at 5.3. Very low temperatures could cause it, and test results are usually lower than normal during, or shortly after, a gout attack. Get a blood test a week or two after an attack to be sure.
It is impossible in a gout forum run by an amateur to advise anything other than to consult a rheumatologist. Your best hope here is that another reader recognizes your symptoms, and shares their experience.
I have no clue what ESR or CRP mean. What are they, and why might they be relevant?
Hi Cyndi,
I noticed you also asked this in a different topic. Thank you for posting it as a new topic – I’ve deleted the other one so we don’t end with people posting in different places. I will be back shortly to answer the questions you raise, but please can you post your husband’s uric acid levels for as many results as you have available. A good history of uric acid levels is one of the best ways I can give relevant advice.
Thank you for your kid words, Jay.
I’m astounded by the number of gout patients I meet who are perplexed by prolonged gout attacks, despite doing everything right.
To be fair, the American College of Rheumatology have recognized this, and hope that their recent guidelines will get the message across to frontline medical staff.
Doctors must treat to target. That has too important considerations:
1. Allopurinol dose, in isolation is unimportant. For too long, doctors have assumed that 300 mg is a “standard” and if it lowers uric acid, they do not think about if it is low enough.
2. Uric acid target is vital. 5 mg/dL is the safe level for anyone who has ever had gout. It is the most important number, though some patients may have to settle for 6 if they have other health problems, including kidney impairment.Hopefully, the message will get spread far and wide, and we can see an end to prolonged gout attacks despite allopurinol, or other uric acid lowering treatment.
I’m quite interested in technology for helping gout sufferers. But I don’t have any information about Medivo. Does anyone know anything about:
Medivo, Inc.
55 Broad Street
16th Floor
New York, NY 10004
Phone: 888-362-4321Anyways, if any gout sufferers do have ideas for a gout app, please share them here. Once we all decide what we want, we can start doing some deals to get the app developed.
I struggle to see how an app can help diagnose symptoms. I guess a few pictures of typical gout symptoms might help. But the only thing you can really do is consult a doctor. Preferably a rheumatologist. Then tracking symptoms might help you and your doctor monitor your treatment progress.
I’d like to see an Android app that keeps a record of my uric acid measurements. What would you like an app for?
If you are looking to stop gout early, please consider GoutPal’s Stop Gout program for a personal gout treatment plan.
Note that for more discussions about alcohol, you should see the Beer and Gout Forum. Especially, Alcohol abstinence and Gout Flares. But before you do, it’s best to read Best Alcohol For Gout, first.
This topic is now closed.
The title is a misspelling of allopurinol, and you should search for allopurinol not allipurinol to find current discussions.
If you do not find anything relevant to your situation, please start a new discussion.
You can find the search box at the top of every page, or at the foot of the right-hand sidebar. Even easier, please use the gout search page.
Please browse the allopurinol guidelines for best information.
O-oh! I need to vent.
Damn you Simple:Press.
Your upgrades to the software tempted me to change my plans and keep you. Still some bugs in the latest releases, but much tidier set-up looked more promising for the future.
Out of the blue, support for the software becomes chargeable! I wondered what was delaying the response to my inquiry about getting the search fixed.
I do not mind paying for support when it’s upfront, but I hate feeling tricked into paying for it.
It’s back to plan A. I’m working on the details, and will have the appropriate guidelines and procedures finished fairly soon.
How very kind.
If anyone is worried about this, I can assure you it is completely above board – a simple act of kindness from a fellow gout sufferer.
Personally, such a generous thought is a wonderful antidote to the personal criticism that has been hounding me recently. Not easy to take when you are in the midst of a bout of depression. Delboy’s kindness (along with the generosity of spirit of most contributors here) makes me realize it is all very worthwhile.odo said
All you have to do is agree with your Dr on an optimum level for your SUA ~0.3 (or 5.00mg/dL) & the dosage will take care of itself: not low enough – take more. So schedule a SUA blood test after 1 month on 200mg. Your Dr will see the sense in this strategy. Forget about the Liv/Kid panel for the time being or, if you must, include it in the SUA test in a month.
I second every word of this. Dose is always secondary to having a safe target. Liver and kidney function test should be a standard process for anyone taking allopurinol or febuxostat (Uloric/Adenuric).
In my experience, doctors do not object in any way when a patient takes responsibility. If your alternative doctor is at the same practice, he has access to your medical records.
If you search PubMed, or any other decent research database, you will see that there are many herbs that will reduce uric acid. Some work by encouraging excretion (uricosuric), others by inhibiting xanthine oxidase.
Personally, I am not convinced that Gout Care has the right combination, but I will always say, if it works for you, then that is good.
My main concern is that people waste money on this type of product without thinking about what they are trying to achieve. The goal of every gout sufferer should be to get uric acid to 5mg/dL (0.30mmol/L) or below. If Gout Care does that, it is good, but then you should also consider cost.
I think I might have to duck for cover after this, but I am going to go for it despite a nagging doubt in my mind.
I am a firm believer in the cautious start to allopurinol. I accept that there are other valid points of view. I speak of allergic reaction to allopurinol because it is a serious condition, though very very rare. I hate to see it used as an excuse for avoiding proper treatment. If someone truly had an allergic reaction to allopurinol, I doubt they would explain it in half a sentence. If you are a little anxious at the thought of a lifetime taking drugs every day, or just experiencing a strange feeling of getting better, I understand that, but please do not speak lightly of allergic reaction.
I’m sorry if I got it wrong, so please describe the allergic reaction and the medical response as the docs fought to save your life, and I will happily delete this message. If it is just a little anxiety, then I’d like to help with that, as I’ve been through similar, but please do not dissuade people from taking the wonderdrug that is allopurinol
CHUNQX said
[…] the morale boost from going fishing would be a positive and now having gone, I’m glad I did go. I feel better than I ever had in the last 4 weeks since the gout attack started. And more fresh white fish for dinner too.
Going back to the start, Hans said:
4. You have basically only ONE option to deal with gout: CONTROL/MANAGE IT!!!
It is amazing sometimes how much better you feel when you know you are in control, and taking positive action.
Very happy for you, CHUNQX
I’ll add my voice to the “gout is common in the ankle” call. Unluckily for me, the first doctor I saw, all those years ago, ruled out gout because it hit my ankle, and I never had a toe problem.
Only a theory, but I put this down to a lot of driving at the time, with my ankles being the lowest part of my body for hours a day. In the end, it doesn’t much matter – as jasper65 says – you have to insist on a high enough dose of allopurinol.
Hi marud,
There is a lot of nonsense talked about gout, both inside and outside the medical profession. It is not a drinking disorder or an eating disorder, it is simply an excess of uric acid.
There are many reasons for excess uric acid, some of which may involve food and drink, but that is not the point.If you visit the dentist with a cavity, he does not say, that is from too much sugar in your diet, so cut out the sweet stuff and all will be well. He fixes the problem, and if you are lucky, you get advice on how to prevent it in future. So it is with gout – fix the excess uric acid problem as a priority, then look at possible causes and see if they can be avoided in future.
It speaks volumes to me that you have not mentioned your husbands uric acid level, but this is the most important thing. It has to be 5mg/dL (0.30mmol/L) or below. Many doctors do not understand this, so they suggest other things. Tendonitis is a possibility, but if it exists it is almost certainly caused by your husband’s gout.
There are very few cases where 100mg allopurinol is sufficient to lower uric acid to a safe level. It is vital that you find the latest test result value, and insist on dose increases and retests until uric acid is down to 5 or below. There is always the risk of further attacks until your husband has had several months at a safe level, so use colchicine supported with an anti-inflammatory such as naproxen or ibuprofen. This can be daily as a preventative for a few weeks, then as required.
How can it be stealing, he tried to ask innocently whilst secretly stirring vigorously? It is research:
“Allopurinol is an FDA approved treatment for high uric acid levels and gout. In this clinical research study, specialists are studying the appropriate doses of allopurinol. If you take part in this study, the study doctor will see you monthly over the next 6 months to optimize your treatment, with the goal of reducing your gout attacks. This will help researchers to see how people respond to different doses of the gout medication allopurinol.”
?
The colchicine trial that led to Colcrys:
“This study is a multicenter, randomized, double-blind, placebo-controlled, parallel group, dose-comparison to determine the efficacy and safety of a standard-dose of colchicine (4.8 mg) versus low-dose colchicine (1.8 mg) or placebo for acute gout flares.”
?
For the sake of completeness, I should point out that the first quote is from the marketing company for the allopurinol scam, whereas the second quote is from the medical trials official description in the colchicine scam.
It is close enough for me to worry.
The high doses of allopurinol in the reports I have read, about uric acid and heart disease, are 300mg or more. With 100mg or less classed as low.
Though my father was sadly a victim to heart disease, I personally do not have any history, and all relevant tests have been good, except that my weight and cholesterol are on the high side.
Since achieving my urate lowering targets with allopurinol, I have been more concerned about the cholesterol than about the gout. I am trying to lose weight, and failing miserably. I am also putting off revisiting my doctor until I have lost some weight. It does not help that all doctors seem to be obsessed by irrelevant numbers these days. I had a battle to overcome the ridiculous notion that statistical averages of uric acid levels in a general population should dictate medical treatment for lowering uric acid levels. It has left me with a suspicion that these people really do not think about what they are doing, so if the numbers say prescribe a pill, then it gets forced on you. If the numbers do not qualify you for treatment, then no amount of pain and discomfort is going to persuade them otherwise. Sorry about that rant – I'm just trying to justify not going to the doctors. No excuse really, so I'll use the prompt of your message to book an appointment – ma?ana.
?
So back to my allopurinol experience, which is interesting despite having no relevance to heart disease.
?
New readers should be aware that I battled long and hard with various doctors. Armed with professional rheumatologists recommendations that 5mg/dL (0.30mmol/L) is the best, safest target. and armed with reports that lower levels reduce tophi faster, and armed with several visble tophi, I bravely fought the beast of doctorly ignorance, and pushed allopurinol dosing to it's limits to get my uric acid as low as possible. I hit 900mg maximum dose some time last September/October.
Somewhere around here is a chart of my progress, which I will get round to updating when current weariness from man flu subsides.
Anyway, you must be bored with this rambling, so I'll get to the point, and answer your specifics:
1. Uric acid is running around 4.
2. Tophi are shrinking as follows:
Pea sized lump on left knee has disappeared
Grape-pip profusion on left elbow has fewer pips (looking forward to the seedless variety)
Half-a-thumb sized lump on right elbow is now half a pinky. This has a very solid feel in places, so I just prod and squeeze it to try and encourage faster shrinking. I have no idea if this is helping, but it does reinforce my view that it is shrinking.
3. My only thoughts on probenecid to support allopurinol are:
It sounds like a good idea – combination therapies are often much more effective that a single treatment, especially when they target different aspects of the same problem.
Personally, I would only consider it if I was failing to achieve target uric acid level.
It makes sense to take 24 hour urine test before initiating probenecid, then again after one month. Alhtough baseline will be reduced by allopurinol, this will determine if extra uric acid excretion is being achieved. This is my view based on logic, and I have not seen any professional evaluation of such a plan.
4. I have absolutely no cautions about full dose allopurinol, just as I have no cautions about full dose of ibuprofen or full dose of colchine or full dose of any other medication. In fact, I cannot see why anyone would want less than the full dose, until they were confident that all uric acid deposits had dissolved. I have a specific warning about kidney and liver function tests when you take any uric acid lowering treatment. I have been lax about this, but tests three months ago were fine on 900mg, which is probably why I didn't have to fight too much to maintain that dose.
5. I know you didn't ask specifically, but everyone wants to know about gout flares. I seem to remember commenting a few months ago that I was pleased to see that I could manage any gout flare with a combination of a couple of colchicne and some max-strength ibuprofen. Possibly helped by a warm blanket and the tender loving care of my beautiful wife (just in case she sees this – I need help with the man flu). I now get a minor flare about once every two or three weeks, which I put down to some re-awakening of stubborn crystals hidden deep within the joints and tissues. I usually leave these to pass in a day or so as I wallow in the fond memory of former tortures. The colchicine fell behind my bedside table when I last felt the need before Xmas – and there it stays.
zip2play said:
How bizarre, to take skim milk POWDER and add fat extract and water to get some weird version of WHOLE MILK with added whey protein (highly adulterated whey protein.)????
?
If milk is good for gout, the just drink milk…it comes from a cow not a chemical plant.
?
I have just read the webmd review of this investigation which closes with:
Some of the researchers of this study are inventors in a patent application related to milk products and gout.
Not bizarre – bizness!
Zip2play, your article also prompted me to see how allopurimol is becoming significant for heart disease and other diexeases. Did you see http://www.goutpal.com/2927/have-a-heart-allopurinol-helps-more-than-gout/
?
For access to the report, it looks like you can read it page by page following zip2play's link, but if you want to see the whole thing on one page at http://www.medscape.com/viewarticle/472684_print you have to login. As zip2play says, registration is free, or at least as free as GoutPal is (i.e. don't get fooled into seeing adverts as facts).
Most interesting, to me, from that 2004 review, is the conclusion towards the end of the report:
Elevated serum uric acid in hypertensive patients has been associated with a 3- to 5-fold increased risk of coronary artery disease or cerebrovascular disease compared with patients with normal uric acid levels. Collectively, these studies suggest that serum uric acid may be a powerful tool to help identify patients at high risk of CVD. Serum uric acid should therefore be considered along with other risk factors, such as obesity, hyperlipidemia, and hyperglycemia, in the assessment of overall CV risk.
The remaining key questions are whether uric acid has a causal relation to CV disease, whether a reduction would prevent CV and renal disease, and whether uric acid can be reduced to an optimal level whereby it no longer imposes an increased risk for CV disease. The LIFE study findings are encouraging. However, these issues can only be settled definitively through randomized clinical trials. Until then, the belief that treatment to reduce hyperuricemia will be cardioprotective must rest on observational and mechanistic evidence.
Since it was published, PubMed lists over 1000 results for “uric acid cardiovascular.” I didn't spot a randomized clinical trial, but I did see some interesting statistics relating to allopurinol and mortality (the 2002 study is referenced in the Medsape review.
2002: Effect of allopurinol on mortality and hospitalisations in chronic heart failure: a retrospective cohort study.
Long term high dose?allopurinol?may be associated with a better?mortality?than long term low dose?allopurinol?in patients with CHF [Chronic Heart Failure] because of a dose related beneficial effect of?allopurinol?against the well described adverse effect of urate. Further work is required to substantiate or refute this finding.
2009:Allopurinol and mortality in hyperuricaemic patients.
Our findings indicate that?allopurinol?treatment may provide a survival benefit among patients with hyperuricaemia.
2009: Association between allopurinol and mortality in heart failure patients: a long-term follow-up study.
The prevalent high-dose?allopurinol?use had a lower risk of?mortality?than the prevalent low-dose use suggesting that?allopurinol?may be of benefit in HF [Heart Failure] patients.
Only one of these [2002] mentions the definition of high/low dose, with high being 300mg or more.
The Medscape review also mentions potential benefits of losartan and atenolol (common treatments for high blood pressure), but I haven't looked into those.
?
As an allopurinol user, my personal view is, if you accept that allopurinol will help your gout, ffs (that means please), make sure your dose is high enough (after the initial 100mg safety test), and never settle for uric acid levels greater than 5mg/dL (0.30mmol/L).
Personally, the only natural cure I have tried is weight loss. I had limited success with this. Slow weight loss did reduce my uric acid numbers, but I did not have the willpower to lose enough weight.
Generally speaking, skim milk has been shown to lower uric acid levels. Various other reports have been made for various other compounds. My view is that it is too hard to contemplate this when it is so easy to get allopurinol.
I am lazy in that regard, but I respect anyone who tries the natural approach, as? long as they do it right.
Random changes in lifestyle prompted by Internet chatter is not the way to go.
I've outlined the plan with regard to testing, and I feel that anyone serious about this approach has to start with the 24 hour urine test. You will also need to get the support of your doctor for blood tests at least every 4 weeks, or buy a uric acid tester. It requires a very logical approach of test-change-test repeated ad infinitum until you are certain that uric acid levels are at 5mg/dL (0.30mmol/L).
Again, personally, I just do not have the patience, or the will, when there is an easy way out, but I offer my free and full support to anyone who wants to start a serious attempt at control using non-pharmaceutical methods. For anyone who wants to do this, I do not have a formal process yet, but start by posting blood uric acid levels, uric acid excretion rates, an agreement for regular testing or a home uric acid test kit, and a promise to commit to a methodical approach to diet changes (including exercise).
Warning: one paragraph may be nothing more than a poor attempt at humor. I'll leave you to spot which one. Blame the idiots who told me laughter is the best medicine.
There are some similarities with the recent Gout, weight and diet ? Questions – a patient, rightly worried about early gout, and wanting to avoid it getting? worse. With the doctor emphatically withholding treatment until it does get worse.
But, I believe every gout? sufferer is an individual who deserves individual treatment. It seems clear from your explanation, that you have a uric acid problem. It is in the early stages, but even your doctor agrees that it is likely to get worse. The classic view of treating the symptoms, not the cause.
I suggest you ask for a 24-hour urine analysis. This will determine if? you are an under-excreter of uric acid, or an over-producer. With that information, you know if you need uricosurics or xanthine oxidase inhibitors. If your doctor still refuses to prescribe treatment, you have choices:
1. Seek appropriate natural cures. These generally will not provide massive reductions in uric acid, but your numbers indicate that a 1 to 2 mg/dL drop should be enough.
2. Get your lawyer to write a letter, asking why treatment is being withheld. I can supply the appropriate references for the progressive, destructive nature of gout, and the professional guidelines for maximum uric acid levels after an acute gout flare. This may provoke action, or it may provoke return references that present an opposite view. Legally, you are at the point where there are different medical views, so you are unlikely to win a case for compensation. But strategically, it may be enough to get the prescription you need.
3. Lie. Tell him you are getting attacks every month that are so severe, you cannot get to visit him.
Whichever choice, or combination you go for, you need to keep a close eye on your levels with frequent blood tests.
You do realize this is all your fault, with your “nothing that really bothered me” and “none of the pain has been so bad as to stop my daily life.” Doctors expect true men with gout to sit with tears in their eyes recalling tales of suspected broken toes, agonizing crawls to the bathroom, nights spent sobbing in their sleep as their partners suffer fits of concern. Half an hour of that, and they'll give you anything you want.
Markin said:
[…]can it be possible to have gout with mild to moderate pain which may be persistent but tolerable lasting for days and then fades away? How about gout that strikes with warning such as a dull ache that lasts for days and then gradually ?transforms into a full-blown attack with unbearable pain??
Gout pain is an immune sytem response to uric acid crystals, but there is more to it than that.
When a white blood cell sees a uric acid crystal, it tries to engulf and kill it, like it would any foreign invader such as a virus cell or bacteria. If there are only one or two crystals, you will not notice it. With more, you get painful inflammation as your white blood cells go into battle and send signals for reinforcements. I have no idea what the threshold is but I'm certain that it varies from person to person, and also depends on your general state of health. At the top end of the scale you get an acute attack, but in between there are a range of reactions of different severity that include redness, itching, numbness, and tingling, as well as pain.
It is interesting (at least for me) to note that uric acid is suspected as being a carrier for the signals that call for immune system reinforcements, which might explain the exquisite torture that more than one lady gout victim has described as worse than childbirth.
Personally, I suspect I had several minor gout attacks prior to the biggie that hospitalized me, but I will never be sure of that. What I am sure of is the fact that modern imaging techniques (search for DECT at the search box above) have shown that crystals start to buildup in joints before there are any gout symptoms.
Just for completeness, it's worth pointing out that the white blood cell coating around the uric acid crystal is not permanent. When uric acid levels in the blood fall, the coating is often shed revealing partially dissolved crystals. Again, it is a numbers game as far as severity and symptoms are concerned, but it is common to have some problems when uric acid levels fall. That is why you cannot judge any treatment, including diet changes, on pain or absence of it – you must know your uric acid number.
Your doctor is following a well-trodden path, but it is one driven by experience of medicine, not experience of gout.
The biggest problem with gout is that uric acid crystals keep forming unless you get uric acid down to a safe level. Losing weight might be the answer, but 6 months is along time to find that out. During that time, if uric acid crystals continue to form, your problem is worse.
My view is that you have to balance the risks. There is virtually no risk with allopurinol if it is prescribed properly (see recent drmarclevine on My gout story). There is a small, but increasing, risk of osteoarthritis from uric acid crystal deposits in the joints. There is a significant risk of an acute gout flare.
The logical approach is to take allopurinol for 6 months, and reduce weight at the same time. Monthly testing of uric acid levels ensures that you get uric acid below 5mg/dL. You need to start with 100mg allopurinol, and get liver function tests with each uric acid test. After 6 months (though I would suggest 12 months is more realistic), you review the dose, and reduce it if possible. This approach covers all the bases, and gives you the maximum chance of clearing old uric acid crystals out of the joints as quickly as possible. If excess weight was the problem, reducing it will prove that, and you will be able to reduce allopurinol to zero. You should still get tested at least once a year to make sure the problem does not come back.
If I were you, I would try to persuade my doctor of the value of this approach. In my experience, doctors react well to good reasoning, but they often need to be reminded of the need to get uric acid down to 5mg/dL to reduce the risk of joint damage.
There is nothing wrong with your English.
I hope you do not feel uncomfortable with this, but your rheumatologist got a
, and you must have one also.Two, in fact. That's one for sticking to a great plan, and one for sharing your success here.
I know the journey isn't over until you are without a flare for six months without colchicine, but the end is in sight. I hope your gout story inspires other people.
It's unlikely to be diet related, as most gout is hereditary. There is little you can do at the moment about treatment for lowering uric acid, so just wait for the results – but make sure you get an exact number, not something vague and meaningless like “normal” or “high”.
Pain management is important, but gout is controllable. I would avoid ice – it lowers inflammation, but it also encourages uric acid crystals to form. Use warm towels for relief, and avoid chills. Choose shoes, or boots that give good support – preferably large enough to fit an extra pair of socks.
Talk to your pharmacist about better pain relief. There is so much available, you should not have to lose work. Colchicine is good for stopping inflammation spreading. Combine this with naproxen and maybe add an analgesic, and you should soon be back on your feet.
