Personal Gout Diary: LManion

[Lance]

Stats

Start: 2/21/17
Age 45
Height 5’9″
Weight 225lbs
1st attack: 2/18/17, left big toe, interphalangeal joint.
Duration: 3 days
Meds: 600mg Ibuprofen every 6hrs
Blood test 3/22/17 UA level 7.7. Started weight loss program and gout diet.

Updates

3/29/17
weight: 214.4

[Lance]

Not quite sure how to add a post to my diary just yet so I’ll reply to it until I figure it out!

Until now been roaming GoutPal with little direction. This morning I’ll start my structured plan per the instructions.

My Gout Group: Arthritis sufferer
I have a gout diagnosis based on symptoms, a doctors visit confirming symptoms, and a blood test indicating a UA level of 7.7. I asked my doc about a referral to a rheumatologist for a synovial fluid test. She felt we could best manage the condition at the primary care level until attacks become more frequent and we need to move beyond pain management with Ibuprofen. I think this puts me in the arthritis sufferer group because I don’t have a conclusive diagnosis. My question for all is whether a wait and see approach is best. Should I see a specialist to a) get a firm diagnosis through a joint fluid test and b) find a specialist early on that I like before things heat up. Am I on the right track?

Oh, and if anyone can tell me how to add a new post to my diary I won’t have to keep replying to myself. 🙂 Thanks!

[Keith Taylor]

Lance, I believe there is a complete breakdown of logic in some aspects of current recommended practice for gout management.

On the one hand, all the latest research warns of the dangers of long-term excess uric acid. Also, other gout research tells us of the benefits of prompt treatment. Yet, the recommendation to start uric acid lowering therapy is to wait for a second gout flare within a year.

I agree with you, Lance, that it is best to do something immediately. You quite clearly have gout. So, the question is do you accept you must lower uric acid?

To explain, I think your gout diagnosis is clear. But, your recommended treatment plan is not fully agreed with your doctor. So, in this sense, you are a rare case. Because there are many more gout sufferers who go down the gout diet route. When, really, they should be thinking about temporary uric acid lowering to prevent more damage until gout diet works. But, those are long term gout sufferers. So, I suggest we turn that on it’s head.

To clarify, I suggest you class yourself as Gout Dieter for now. Or , Gout Herbalist, if you prefer. Then, if we’re lucky, we might see enough improvement in your uric acid levels without starting medical therapies.

Finally, apologies again about my lack of direction in these services. I got it wrong. I thought I could create documentation based on real gout diaries. But, it seems I have to formalize and encourage to get more committed member examples. I guess it’s very hard to see any immediate benefit of creating daily/weekly records. I need to work on helping gout sufferers see the advantages. So, if anyone has ideas on improving commitment to gout diaries, please add your thoughts in GoutPal Suggestion Box.

[Keith Taylor]

Hey Lance, this replying to yourself thing is catching! 🙂

I wanted to wrap up some other half-finished tasks before I started on creating your forum. While I was doing so, I posted about the Dash diet for gout report.

Will DASH Diet work for your Gout?

More importantly, for you, I spotted this within the report:

For patients with borderline-high SUA (between 6–7 mg/dL), it is reasonable to encourage implementation of the DASH diet with the expectation that SUA will be lowered by about 1.29 mg/dL, getting the patient to goal SUA. As a greater benefit was seen in patients with higher levels of SUA at baseline, it is also reasonable to attempt to lower SUA with a DASH-style diet prior to pharmacologic intervention for higher SUA level if the patient is amenable to trying this tactic [my bold]

I’m confident we can work on improving the 1.29 mg/dL. Because, I feel that a gouty version of the DASH diet should be achievable. So, I’m encouraged about the prospects of you succeeding with the Gout Dieter route to Gout Freedom.

Is the patient amenable to trying this tactic?

[Lance]

Thanks for the reply Keith, I’m encouraged by the report you found! I’m going to spend tomorrow reading up on the DASH diet! However, the more I educate myself on gout the less confident I am that a strict diet approach is wise at least until my UA levels are safe. Your piece on Allopurinol is very convincing,

“But if uric acid is still near 7 or higher, the gout patient is not safe. Uric acid crystals continue to grow slowly, often without gout pain. After several years, the burden becomes too big. Gout attacks happen every week, and tophi grow risking fatal complications.”

My question: Reducing UA levels through diet is measured in years rather than months. If true your recommendation of shorter term UA reduction through medication (and diet) to an acceptable level seems prudent. Can I then stop the meds and treat this through diet?

The consensus seems to be once on Allopurinol always on Allopurinol. I’ll admit that I’m in denial that I have something that requires daily meds for the rest of my life. On the other hand I don’t want to be naive about what lies ahead if I don’t treat this with the necessary urgency.

Keith, your site is amazing! Thank you for what you do!

[Keith Taylor]

Thanks for your closing comment, Lance. In fact, thanks for all your comments. Because, I need gout sufferers like you, who bravely ask all the right questions, instead of lurking silently.

Following another new Gout Diary requester (Ian), I’ve continued to refine the rules. So, I hope that you have seen my update at http://goutpal.net/forums/topic/how-to-post-your-personal-gout-profile/#post-2919
If you haven’t seen it, please consider subscribing to my updates by email service. Just click below on the button labeled ‘Subscribe to Gout Network Updates’

Now, I need to clarify the rules about asking questions.

If you ask questions in the normal gout forum (i.e. Click the green Ask Now button), I try to answer them. But, if you ask questions in this gout diary, I assume they are prompts to yourself. Because, it’s useful to jot down working questions before you are ready to ask publicly

I realize that is pedantic, but it has to work this way. I need to keep Gout Diaries for Personal Gout Facts. Then separately, the Main Gout Forum answers specific questions.

Once we get that process established, we can move on to Structured Gout Help projects. By which time, you might have several questions that will form the basis of a structured help project. Sorry it’s a bit messy. But, you’re a trailblazer, so you have to be patient, as well as daring.

To be clear, you should post that question about short term vs long term allopurinol use, if you want me to reply. Otherwise, I assume it’s your personal note to yourself as you gather more facts.

[Lance]

Thanks for the heads up Keith. I suspect I’ll need to be set straight more than once on posting. 🙂

I’ve never spent a lot of time in web based forums as I usually get scolded for posting a redundant comment or question. I’ll take your advice though and hit the green button with questions as they pop up…

Thanks for the props on being daring, but the more I read the less confident I am that I can or want to tackle this through diet alone. i.e. Gout Hell?!

[Keith Taylor]

I owe you a million apologies, Lance.

My reply about rules is absolute trash. As is the link to stupid rules. I’ve trashed them, and I’m so pleased they didn’t put you off. I replaced the rules with something I hope is more helpful: http://goutpal.net/forums/topic/how-to-post-your-personal-gout-profile/#post-3001

It’s your diary forum, and you should use it however it suits you. Why did I ever think that it matters where you ask a question?!?!?

Anyway, you can organize your diary however it suits you. And if you need to ask questions, just ask them! Wherever you like.

[Lance]

Spent time going over articles on diet vs meds for UA reduction. Pretty set on beating this without meds until I read Keiths article on Uric Acid Crystals

“The immune system cannot kill uric acid crystals as it would a virus, so white blood cells surround the crystals to form tophaceous deposits. This process stops the inflammatory response, which is why gout pain goes in a few days unless another attack occurs. However, these deposits grow in and around joints and will cause permanent damage to bone, cartilage, and tendons. Uric acid lowering is crucial to stop this process, and to dissolve existing deposits.”

This led me to read several other GP articles on UA lowering meds and recovery pain and it appears to me that success is more about guaranteeing a happy and healthy future over the satisfaction of saying that I did it without meds.

Key takeaway today: UA reduction by dieting seems to be an effort measured in years. While I may be lucky enough to avoid symptoms during that time, the science is clear that urate deposits take place above 6 and potentially doing damage to my system. How long will it take to go from 7.7 to 6?
Early use of meds can reduce my UA to safe levels at which point I can consider med reduction and try to beat this on my own.

Keith gave me some info on the DASH diet that looks promising and gives direction on meal plans (makes my wife very happy). Will look to use this plan either way.

[nobody]

I don’t know how the forum works and whether this will appear at the right place but in reply to #2924 (and other posts)…
I think you’re jumping to conclusions and, just in case, I want to make sure you aren’t doing it in part on my say-so. I wanted to warn you about one possible outcome but I don’t know why lowering UA through diet would necessarily need to take years.
It’s an (very common as far as I can tell) inability to lower UA enough through diet which might make improvements very slow. And I have no way to know how much of a UA reduction you could expect from a serious diet in your particular situation. I doubt anyone can make a good guess you without a lot more information and additional medical tests.
If you try a diet and get many more blood tests, it shouldn’t take years to get an idea of what a diet can or can’t do for you.
Then again, why not help the process with UA reducing drugs if there is no medical reason for you to avoid them and you have no fundamental objections to using them? If you really have gout and get on an effective diet, I would not count on your luck to avoid symptoms completely. In all likelyhood, UA reducing drugs would help you not just with the pain but also would reduce the need to take other drugs.
For what that’s worth, my rheuma is of the opinion that one shouldn’t be afraid of discontinuing UA reducing drugs… provided of course that there is a sound reason to do so and that one’s UA is going to be monitored afterwards.

[nobody]

In my non-expert opinion, it makes sense (as is common practice it seems) to wait until you get more than just one flareup to worry about tests, specialists and other drugs.
However, your ability to manage the problem with Ibuprofen shouldn’t be a reason to be complacent. This class of drug can work wonders but they are also potentially dangerous and you could possibly paint yourself into a corner by relying on them for too long.
Furthermore, if you succeed at mitigating the root cause by losing weight and being careful about what you eat and drink, you could possibly end up with a milder chronic condition which becomes more difficult to diagnose over time.
To clarify: I’m talking about years, not weeks.
In any case, you’ll want to repeat that blood test if you can afford it. Results can vary quite a bit from one test to the next.

[Lance]

You make some very good points. As a newbie to gout I’m basing my thought process on the initial flare-up and from all accounts it seems to have been comparatively short and mild. I suspect the next will not be as forgiving.

My expectation is to have monthly blood tests run to see what’s working and what’s not. My doc is more of the opinion of every six months to a year. I think I may talk to her more about this…

[Keith Taylor]

Hi Lance,
“Not quite sure how to add a post to my diary just yet so I’ll reply to it until I figure it out!”

I’m sorry about this. I’m still evolving both gout diaries, and structured help plans. So, I need to focus on refining and documenting the procedures. That is probably going to take a day or two.

Very soon, I’ll convert your opening gout diary post (i.e. this topic) into your own personal gout diary. Once we get that going, we can discuss a structured help plan.

[Lance]

Definitions
SUA = Serum Uric Acid, i.e. the uric acid level in your blood.

[Lance]

Food Resources

Alkaline diet aka Alkaline Ash diet
Replace acid-forming foods with alkaline foods can improve health.

http://www.goutpal.com/2153/alkaline-foods-for-gout

A pH level measures how acid or alkaline something is. A pH of 0 is totally acidic, while a pH of 14 is completely alkaline. A pH of 7 is neutral. Those levels vary throughout your body. Your blood is slightly alkaline, with a pH between 7.35 and 7.45. Your stomach is very acidic, with a pH of 3.5 or below, so it can break down food. And your urine changes, depending on what you eat — that’s how your body keeps the level in your blood steady.

[Keith Taylor]

It’s not the Alkaline Ash diet, which is scientifically disgraceful. Yet perfectly designed to help Internet Marketers make loads of cash. Even the “alkaline diet for dummies” book uses it. I’m trying to battle against it with the correct way to score alkaline diet. But, I’m finding it difficult to get time to keep that site alive.

Also, I found “In defense of food” and realized that food scoring systems are probably overvalued. So I turned “Eat food, not too much, mostly plants” into EFSEP. Another grand idea of mine that needs some effort. Ah well, maybe next week. Anyway, thanks for reminding me of it in your Week 6 update. I think I need to spend some of my gout time on my nutrition websites.

The more I read, the more I realize how healthy food is more important. Drugs have their uses in correcting diseases. But, I think it’s wrong to use them to correct bad diet. To be clear, I’m not saying that gout is an eating disorder. But, treating gout with allopurinol without correcting bad diet will just allow other diseases to hit us. So, we end up with gout fixed, then get heart disease, diabetes. Or, one of the other metabolic syndrome X diseases.

[Lance]

Treatment Plan
Goal: Sustained UA levels below 5.0mg/dl
http://www.goutpal.com/8637/personal-gout-treatment-guidelines-2016/

1. Relentless curiosity of condition and ways to improve.
2. Diet Plan. Develop and stabilize diet and exercise plan (90 days)
3. Medication Plan. UA lowering meds to below 5.0 (3 months to a year)
4. Sustain UA <5.0 through diet only.

Diet Plan
1. Eat food. Not too much. Mostly plants.
2. Utilize nutrient tracker daily to measure progress.
3. Create data base of recipes for ease of use.
4. Measure UA progress through blood test 90 days from 1st flare

http://www.goutpal.com/gout-diet Home base article.
http://www.goutpal.com/gout-diet/gout-treatment-diet/40-30-30-gout-diet/
http://www.workingmanfitness.com/2013/03/the-gout-diet-how-to-eat-during-and-after-the-gout/ Mostly hype, but I like the Rocky Balboa/Eye of the Tiger approach. For some reason appealing.

Medication Plan
Titration, Debulking, Maintanance
1. Measure UA results through blood test 6/1/17
2. Start UA lowering medication if diet plan shows no measurable progress since 3/22/17 UA level.
3. Allopurinol daily to lower UA level, Ibuprofen or Colchicine at the onset of flares.
4. Start Allopurinol at 100mg/day for 1 week followed by blood test for liver/kidney function. Increase to 300mg/day per doctor recommendation.
5. Have colchicine on hand at all times. .6mg twice daily at first sign of flare up. Discontinue as soon as inflammation subsides.
6. When UA levels of <5mg/dl are reached, discontinue medication
7. Blood test 30 days after discontinuation of meds to measure UA
8. Quarterly then semi-annual blood tests if UA levels are sustained
9. Return to meds if sustainment not achieved.

http://www.goutpal.com/1629/is-allopurinol-a-lifetime-drug/
http://www.goutpal.com/gout-treatment/gout-cures/natural-gout-cures/
http://www.goutpal.com/gout-treatment/avoid-gout/allopurinol/allopurinol-dosing/
http://www.goutpal.com/gout-treatment/gout-cure/colchicine/colchicine-dosage/
http://www.guideline.gov/summaries/summary/38624

Pain Plan
consult Keith. does meds plan cover the bases?

http://www.goutpal.com/9942/ouch-why-does-gout-recovery-hurt/
http://www.goutpal.com/972/allopurinol-medication-why-it-hurts-to-get-rid-of-gout/

[Keith Taylor]

Lance, this is awesome! I’m kicking myself for an unscheduled week off. I’m back tomorrow and I’ll study this better.

[Lance]

Week 6 update
Weight 213 (down 12lbs)
Diet: Six weeks per the approved gout food lists and vegetarian only. 1600 calories per day, 40-30-30 is my goal. Not as hard mentally as I imagined but eating a lot of the same things on a daily basis. In time expect to have a robust meal plan to choose from. As I read more into labels starting to see deficiencies (protein) and blow outs (iron!). Using ‘my fitness pal’ to track nutrients. I like it as it keeps me focused on whole foods I can track. Still learning but happy with progress. Reading “in defense of food” which is inspiring. No exercise regimen yet. Want to get my system used to the diet change-up before I stress it out in the gym.

Week 8 update
Weight: 210 (down 15lbs)
No flare ups. Roaming sensations from toes to tops of feet to hands have disappeared.
Next blood test: June 1
Diet: Made it through Easter unscathed, no deviations from my plan. Managed to find several breakfast cereals that have less than 10% iron. Eating 4-6 hardboiled eggs daily, limit to two yolks. Substituting tofu in anything that would normally be chicken. Two TB of Cherry extract daily. Not sure if it helps, but it’s the sweetest thing I’ll eat all day. Bonus! I am eating a few things off the naughty list: Mushrooms, cauliflower and I’d like to work spinach back into the diet. Water consumption still hit or miss to target. Structure 1 pint per hour awake. This helps me keep track but is overkill by most accounts.
Exercise: none yet.

[Author]

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