Eff'n Gout

[jyl]

I've been having a flare in my right ankle for the last couple of days.

Started Fri. Sat am it was painful and stiff/swollen enough that I couldn't walk beyond a groaning hobble. Took 3 colchicine 0.6 mg (?) in 12 hrs and the ankle was okay enough to do the shopping and the marathon cooking for my wife's b-day dinner on Sun night (other thread). Mon it was okay, a little stiff and I limped, but felt like it was getting back to normal. Mon eve I flew down to SF for a conference. Like an idiot I took BART from the airport and walked 8 blocks to the hotel w/ bags, instead of taking a cab. By the last few blocks, it hurt.

Now, 1:40 am Tue, the ankle hurts so much I can't walk at all. I can hop around the hotel room holding on to furniture.

Took 2 colchicine tablets and had them bring up some ice. There is a drugstore across the street. I guess in the morning I will go buy some Tylenol, cherry juice, and maybe a cane (left my folding cane at home since I was feeling "so much better"). If it's still bad I'll skip day one of the conference and stay in the room.

Hope I don't run out of colchicine, I only carry 5 tablets with me, I guess I can call my doctor for a Rx. I've never taken more than 4 tablets for an attack. I don't take it chronically.

I used to carry a couple of Vicodin with me too - this was a pre-gout habit, just liked being prepared, just like I carry bandages etc in my briefcase. But I stopped because, oddly, Vicodin does not seem to have any effect on me. One Vicodin never changes whatever pain I'm having, like if I had a badly sprained ankle or a gout attack, and I'm too chicken to take two.

I don't know if the gout is flaring up or if walking with a stiff ankle caused the muscles to strain weirdly.

Since half the forum seems to suffer from gout, I just thought I'd share.

[azasadny]

What's your serum uric acid level? Are you taking Allopurinol to prevent attacks?

[azasadny]

Lots of good gout-related info here...

Gout Support Forum | GoutPal Interactive

[jyl]

I dont know.

When I had this badly, about 2 yrs ago (?), I got all kinds of tests and imaging from orthopedic doc then from rheumatologist at OHSU. They specifically checked for uric acid level, and said the level was not high enough for a clear gout diag, also no crystals found. But they couldn't find any other cause. Finally the rheumatologist said it was probably gout and gave me colchicine. The attack ended and subsequent attacks have also stopped when I took colchicine. I don't know if this is diagnosis by medication but anyway I've since assumed that I have gout. I only get a couple-day attack every few months so it has been manageable. I don't take allopurinol.

I'll see the rheumatologist when I get back home.

[Tobra]

Steroid injection would shut that right down

[azasadny]

Remember that the Uric Acid level may not be elevated during an acute attack. Mine is at 6.5, which is in the "normal" range, but is too high for someone with gout. Find a Dr who's familiar with gout (not always easy) and get started on Allopurinol, pain meds (I use OTC Aleve) and manage this disease, just like you would manage diabetes. Don't go crazy avoiding certain foods as this is an inherited metabolic disorder and isn't "caused" by certain foods, although you may find foods that trigger flare-ups. Treat this aggressively and get it under control. I'm going through this right now and the Allopurinol is really helping. Steroid injection made me very sick, but I can't take steroids...

[vash]

crap..john. like women living together we are in sync. my first attack was june 08. ate better, exercise..stored up colchicine and indomiacin (i may have gotten that very wrong).

i felt pretty good for the following 2 years. couple days of tenderness, and mild achey-ness. 4 days ago, i sign up for a vitamin C study. thought it would be interesting to see the process..agreed to not take any vitamins and pain killers..then WHAM! a full blown gout attack. WTF? screw the study..i monkey rolled over to the med cabinet and downed one each and i am loads better this morning. quick bagel, and i will down another dose. this is BS.

did a uric test yesterday..and i am on the very upper edge of the high range. BS! i am going to see a podiatrist to rule out any metatarsal joint probs. apparently they can behave just like gout.

[azasadny]

Cliff,
Us "MazdaSpeed3 guys" get the same health issues, I guess. Start on Allupurinol to prevent further attacks. The Colchicine and pain meds take care of acute pain, but don't do anything to prevent further attacks and joint damage. This disease is a genetic metabolic disorder, it isn't caused by foods/drink, although certain things can trigger attacks. I also take vitamins C, D and E for my liver ailment and they are also recommended for gout...

Good website for gout-related info...

Gout Support Forum | GoutPal Interactive

[porsche4life]

You guys make me not want to get old...

[vash]

Originally Posted by azasadny

Cliff,
Us "MazdaSpeed3 guys" get the same health issues, I guess. Start on Allupurinol to prevent further attacks. The Colchicine and pain meds take care of acute pain, but don't do anything to prevent further attacks and joint damage. This disease is a genetic metabolic disorder, it isn't caused by foods/drink, although certain things can trigger attacks. I also take vitamins C, D and E for my liver ailment and they are also recommended for gout...

Good website for gout-related info...

Gout Support Forum | GoutPal Interactive

i checked out that website. daunting!!

i bailed after the info overload. i did learn one thing..it appears it isnt so much "what" you eat..it is "how much" you eat (and drink). i'll wait for my doc to review my bloodtest and ask her about meds.

Allupurinol? i hate meds..this pill is for life right? i think a new version is out.."Uloric" or something. more kidney and liver friendly. so on meds..Zero attacks?

[Soterik]

I'm not usually replying into OT much, but this caught my attention.

I've had it for about 10 years now (I'm 53), runs in my family on my mom's side. We tried allupurinol for a while, it worked and then I went off it to try to handle it myself (sure, I can handle this!). That worked for a couple years, but doc felt my level was too high, so after a recent attack (first in 2 years) they put me back on Allupurinol, but I had repeated attacks for 2 months one right after the other though the level had come down. So, I switched to the new med Uloric at low level (40mg). I'm now gout free for a couple of months, no side effects on the Uloric.

My docs said to stay on the meds as he wants me to avoid long term joint damage even if the attacks were infrequent.

Eric

[azasadny]

Cliff,
I've been on Allopurinol for several weeks and so far, so good, but I'll be on Allopurinol for the rest of my life, or as long as my liver enzymes stay low. You're right about the diet. There is a lot of info there, it's the "PelicanParts of gout" as I see it. There are other meds you can take to lower the uric acid, but that is the key to preventing further attacks! I'm a vegetarian and don't drink any alcohol and I still get several attacks a year. The last attack hit me on the drive down to Oxford, OH for the "Porsches to Oxford" event and I didn't know how I would drive home it hurt so bad. I took Aleve (Naproxen) 220mg x 2 every 4 hours until the flare-up died down...

[azasadny]

Eric,
Did your Dr tell you that when you start Allopurinol, you'll very likely experience some pain as the uric arid is removed from your system and excreted? I had tingling and "twinges" for about 2 weeks right after starting Allopurinol and they have subsided. I'm 49 and I believe I've had gout for 4-5 years but didn't know what it was until it affected my toe (podagra). My 1st attack was in the shoulder... Good luck!

[jyl]

Ankle was better this AM. I can walk slowly w/out much pain. Thanks for linking to the gout site. I need to learn more about what I have.

[azasadny]

Yep, learn and apply what you've learned and you can beat this thing. I'm getting relief from the Allopurinol and I take Aleve (220mg) for occasional pain. good luck!

[Noah930]

Originally Posted by Tobra

Steroid injection would shut that right down

I finally took your advice last spring ('09) and injections have worked like a charm, for me. It's only temporary, as it doesn't protect me from future attacks, but every time I've had an injection the pain has gone away completely within 2 days. To the point where I wondered why I waited so long to get the injection in the first place.

Not saying that injections are the proper way to treat gout. It's more of a get-me-out-of-this-attack-which-is-so-bad-it's-killing-me form of treatment.

I've since started taking Allopurinol and Colchicine simultaneously. Allopurinol is meant as a long-term maintenance drug to prevent gouty flares. It's not meant as an acute form of treatment for an active attack. Colchicine, in comparison, is meant for an acute attack, but not for chronic maintenance/prevention. There's evidence that using Allopurinol in an acute attack can actually prolong an attack, as someone else mentioned.

My dad dug up an article that used both Allopurinol and Colchicine in an acute attack setting. One group was in Allopurinol and low-dose Colchicine (one tablet of each, daily), and the other group in Allopurinol and high-dose Colchicine (one Allopurinol and a regimen of several Colchicine, daily). The two groups did equally as well, in term of pain relief. However, the reason to avoid taking any more Colchicine than necessary was/is due to the GI side effects (loose stools) from Colchicine. The high-dose Colchicine group had more diarrhea than the low-dose group. Interestingly, the placebo group had the same rate of GI side effects as the low-dose Colchicine group. Go figure.

Allopurinol has definitely helped reduce the number and severity of my attacks. Any time I feel a flare coming on, I'll pop a Colchicine per day for a couple days, and the pain will go away. Haven't needed a steroid injection since I started on this regimen. Just watch those liver function tests.

[NO LIFT]

+1 Allopurinol. My Doc has me on 300mg twice a day.

For a flare up, my doc says take as much Colchicine as you want until the pain goes away...but don't get too far from the bathroom. He's right.

I tried and will continue with diet, but the flare ups still come every-so-often.

I suppose I could affliced with something worse.

[NICKG]

indomethicine will really take care of the pain...that and eating dried bannan chip and dried cherries. I have gout, i takle allopurinol and since I started the meds and snacking on cherries and bannana chips, i have not had any flares

[azasadny]

I eat dried tart cherries and drink tart cherry juice mixed with lemonade. I don't know if it helps, but it sure tastes good!

[porsche4life]

Originally Posted by azasadny

I eat dried tart cherries and drink tart cherry juice mixed with lemonade. I don't know if it helps, but it sure tastes good!

Sounds good... Yum!