[Keith Taylor]

Happy days again Mark.

I’m a bit worried about your Dad.

NSAIDs is the general name for anti-inflammatories like indomethacin, ibuprofen, diclofenac, naproxen, etc. They are generally regarded as safe for a few months. It’s good to control gout pain with NSAIDs until allopurinol gets uric acid low enough to stop the source of pain. It’s not good to use them instead of uric acid lowering treatment. If you don’t control uric acid down to safe levels, gout gets worse. Even on days when you don’t have a gout attack, the crystals are destroying joints and damaging soft tissues (heart, kidneys, skin, etc). Febuxostat is a valid alternative to allopurinol. A 24-hour urine test can give more treatment options if Dad is an under-excreter.

Anyway, don’t go telling the marketing guys at Novartis that diclofenac is hard to get. With the massive spend on Voltarol pushing advertising, they’re not going to be pleased. 😉

Keith

[Keith Taylor]

“The new GP is not a fan of blood tests and believes in bog standard 300mg dose Allopurinil to fix gout.” That’s madness. A serious breach of the Hippocratic Oath!

Anyway, it sounds like you are managing OK despite him. Certainly, at 0.33 you should be debulking uric acid crystals slowly. For USA readers, 0.33mmol/L uric acid converts to 5.55mg/dL.

Neil, it’s terrible news about the plans to introduce blood test charges in Oz. Blood tests are vital for safe gout management. I’d go so far to say, it’s a lottery without the test. All gout sufferers need to know accurate uric acid levels. But, everybody on the planet needs to know liver function and kidney function is OK.

Only this morning, I was thinking about ways I might help needymeds.org raise awareness and funding. Do you know if there is anything similar in Australia, Neil?

And to readers from other countries, what is the situation where you live? In the UK, testing is free to everyone regardless of income. I think this is a basic human right that everyone on the planet should have.

Anyway, Neil, this topic is about you, so I’m pleased to see you are recovering. I can’t wait to see you go 6 months without a flare.

Keith

Unresolved Support Requests
When you are happy that the problems you have raised have been resolved, please change the status of your topic.
You have to log in first. Once you are logged in, you will see a dropdown at the top of your first post. Change it from Not Resolved to Resolved. There’s nothing else to click. There’s no need to post any additional information, unless you want to.
Changing the status does not stop you from adding information later. It just lets me know that your problem is no longer urgent. If your problem becomes urgent again, you can change status back again.

[Keith Taylor]

Hi Francesca,

I’m reviewing old support requests that are “Not Resolved”.

I hope you’re happy with your uric acid control at the moment. If your allopurinol is working OK, please mark this topic resolved.

You have to log in first. Once you are logged in, you will see a dropdown at the top of your first post. Change it from Not Resolved to Resolved. There’s nothing else to click. There’s no need to post any additional information, unless you want to.

If you want to post more, you can reply here, or start a new topic. Please note that my responses are a little slow at the moment. I expect to get back to normal speed soon.

[Keith Taylor]

I think gout control is the same whether you rely on pharmaceuticals, herbal medicines, or something else.

Some things help uric acid. Some things help inflammation. Rarely, some might help both.

Whichever mix you chose, you can only control gout if you measure the results of whatever you are taking. Gout will never go away until you get uric acid below its crystallization point. If you know that uric acid is below that, then any gout pain is a sign that old crystals are dissolving, and you are recovering from gout.

Returning to Rhys’ original question about omega 3. I think there are enough studies around to prove the benefits of omega 3. My problem is that I can’t relate these to gout in any meaningful way. The science suggests that they should help inflammation. I cannot see any difference between different sources of omega 3. As for uric acid, I reviewed a 2011 investigation at http://www.goutpal.com/5334/flaxseed-and-gout-a-uric-acid-update/. I cannot see any improvements on this research to include humans. If anyone knows recent research on uric acid and omega 3, please share the links.

The biggest issue for me is context. I.e. is it right to worry about different sources of omega 3? Or is it more important to correct bigger problems with gout diet first?

We know from recent research that vegan diets are generally the worst diets for gout. Now, those are just statistics, so what really matters is the individual.

There’s one thing I’m certain of. Nobody will ever prove that omega 3 is good for all gout. It has to be considered on an individual basis. That individual has to be prepared to keep some detailed personal records.

Does everybody realize that gout diet has to be personal?

Is anybody prepared to share there own experiments with managing their diet to control gout?

Sorry! Reading back, that’s not particularly helpful. I’ll repeat Rhys’ question:

[has] anyone else has done the hard lifting on [omega 3 and gout]

[Keith Taylor]

John, it’s a shame about the rash. I think the best way to tell if it’s due to allopurinol is what you are doing. Stop allopurinol for a time, to see if there is a correlation between taking allopurinol, and getting the rash.

The only thing I’d say is, I don’t think 2 weeks without allopurinol is long enough. The main action of allopurinol comes from it’s by-product: oxypurinol. This takes up to two weeks to clear from your system. You then need a period of time for any rash to recover. For that, I’d suggest asking your doctor.

When the rash has cleared completely, you can try allopurinol again. If allopurinol does prove to be the cause, you should ask about febuxostat. A better alternative to that, is to take a 24-hour urine test to see if you are a uric acid under-excreter. If you are, you have more treatment options available. Because of the effects of allopurinol, you have to stop it for at least 2 weeks to get accurate results from a 24-hour urine test.

[Keith Taylor]

Great news on the uric acid test, Linda! Let’s hope it’s the start of much less pain for you. If you have other causes of joint pain, solving your gout won’t make that better. But overall, you are bound to feel better.

I think that’s a great reason for celebration. Completely in keeping with my new philosophy of ‘meat as a treat’ 🙂

As it sounds like you’re an under-excreter of uric acid, a glass or two of skim milk will probably counteract any increase from a small steak. (Disclaimer: that is a guess, not scientific analysis)

[Keith Taylor]

I discovered that fructose is part of biochemical pathway that makes uric acid from purines

Linda, do you have any references for that?

Substituting water has made me feel better. Maybe it a psychosematic thing, who knows but I actually feel better.

Patrick, there’s lots of complicated theories about that. I think, if it makes you feel better, it’s a good thing. Switching to water can’t be a bad thing. It might be marginally healthier, and if you feel better, you’re winning the battle against gout 🙂

[Keith Taylor]

Colchicine Safety
Linda is absolutely right to warn about colchicine safety. It works by poisoning the immune system. The overview of that is, it’s a balance of pain control over toxicity risks. This is common in treatment of many severe pain diseases.

I look at it this way:
If colchicine helps you during your uric acid lowering treatment, it’s a good thing. But, I have several caveats:
1. Uric acid lowering should be managed properly to make the period when you get benefits from colchicine as short as possible.
2. Never take more than 2 colchicine in 24 hours.
3. Avoid colchicine if your immune system is compromised. That might mean some other viral or bacterial disease that you are fighting. It also might mean exposure to sick people.
4. Colchicine should be part of a comprehensive pain management package that also reduces inflammation, and blocks residual pain. Without that, patients are tempted to take too much colchicine, which is wrong. It’s wrong because it’s not safe, but also colchicine above 2 per day has little or no effect, other than to poison you.

Colchicine during lowering uric acid
Kevin, Great news with your uric acid test results! 🙂
I think it’s important to understand why you take colchicine when you start with allopurinol. Until most of your uric acid burden has reduced, you are at risk of a gout flare. It takes time for old uric acid crystals to dissolve. The way to reduce that time is to go even lower on your uric acid levels, but that’s a different topic.

What you should find, is a decreasing need for colchicine. There are different ways to manage that. You could go ‘as required’ now, or reduce to one tablet per day. Whichever you chose, I think it’s best to make a note of your gout symptoms. You can post that here if you like. Or, I’ll set up a personal profile area for you. That gives you historic data to help planning colchicine dose in future. It also focuses the mind. When you reduce dose, or go ‘as required’, it’s important to act fast if you do get signs of a gout flare.

Personally, I reduced my colchicine to zero within a few weeks of starting allopurinol. But, there’s no right or wrong way. Just reduce colchicine at your own pace, Kevin. You can be happy in the knowledge that uric acid is reducing. Any discomfort you get at your uric acid levels is a sign that old crystals are dissolving. It will become less as the days pass.

Thanks for inspiring http://www.goutpal.com/8959/gout-medication-names-colchicine/

[Keith Taylor]

I was diagnosed with primary gout and primary hyperurecimia whatever the hell primary stands for

Primary gout is gout that is not caused by anything other than your own genetics. So, you have excess uric acid that has no avoidable reason. In those circumstances, playing about with diet is not going to have much effect. To have any effect, gout diet has to be planned in detail and must be part of a comprehensive gout treatment plan.

Whatever I do without drugs it doesn’t go down. I really wanted to avoid taking drugs.

Pharmaceutical gout medications are usually the easiest way to go. If you do not take the right drugs at the right time, you are wasting time and money. If you want to avoid them completely, are you prepared to commit to time-consuming diet monitoring and adjustment combined with frequent blood donations?

One thing you must not do Georgi, is avoid the issue. Your uric acid is dangerously high. If you do not deal with it now, your quality of life will reduce each year. After many years of increasing misery, you will die early.

So, if you are not prepared to correct your inherited condition with proven pharmaceutical treatment, what will you consider?

I’ve got the stamina to create a drug-free gout treatment program. I’ve not met anybody yet who has the stamina to follow one.

[Keith Taylor]

I hope other people share their views on this.

Additives like High-Fructose Corn Syrup (HFCS), artificial colorings, and sweeteners such as aspartame bring out the devil in gout sufferers. Many people, including myself, never give such things a thought. Then gout strikes, and we analyze certain parts of our diet in minute detail. I’m not trying to speak for everyone. This is just my view, and my experience.

I lived life at 100mph. Like Patrick, I drank lots of Diet Coke. I wasn’t trying to kid myself it was healthier than regular soda. I just hate the taste of sugary drinks. When I look back now, that Diet Coke was probably one of the healthiest parts of my diet. Then the gout devil bit me, so I stopped soda and other things.

On reflection, I see where I went wrong. It’s analogy time.

Let’s take a literal 100mph drive on a 70mph road. We get stopped, fined, and we realize 100mph is wrong in those circumstances. We moderate our driving, respect the rules, and think more about safety of ourselves and other road users.

But, the knee-jerk reaction with gout, is to go from 100mph to zero.

The other name for that is “Getting nowhere”

[Keith Taylor]

Linda, thanks for the extra info.

Getting that flare after two weeks of changing meds can be one of two things:
1. It would’ve happened anyway.
2. It’s a result of uric acid falling, and more partially dissolved uric acid crystals waking up the immune system.

The only way to know is from your uric acid test results. Increased uric acid takes months to cause a flare. Decreased uric acid might cause one sooner because of the aforementioned partially dissolved crystals. Until your uric acid burden is dissolved, you run a risk of gout flares. There’s very little you can do about that except to go as low as possible to shorten the risk period.

[Keith Taylor]

Excellent point of view, Linda. The logic to break that cycle of inaction is clear:
1. Control gout pain. In 21st century gout pain after a few hours is a sure indication of a bad gout pain treatment plan.
2. Control uric acid. Those uric acid crystals are just as much a threat to mortality as obesity is, so start ASAP.
3. Get healthy. Slow steady weight loss and healthy exercise are much easier when you know you’ve beaten gout. With respect to Robert’s heritage, I lost over 3 stone once I recovered from my gout illness. For my American friends, that’s over 40 pounds. 🙂

[Keith Taylor]

Hi Simon,

There’s lots of alternatives to allopurinol for controlling uric acid levels.

It’s important to control uric acid to stop it getting worse. As well as more gout pain, untreated uric acid crystals cause serious damage to your body.

Tell me more about your allopurinol allergy.
What did your doctor say?
Have you tried any other uric acid lowering treatment?

[Keith Taylor]

I also like pollock but I’m not sure I’ve ever had swaii or talipia. I guess we should get together and swap recipes.

I’m not sure what I can do on this. Purine numbers for individual foods are extremely hard to come by. I spent weeks researching my original list of foods high in uric acid. Later, I learned that vegetable purines don’t make gout worse. I spent some more time researching detailed purines for meat and fish.

Since producing those epic lists, I’ve learned that purines from food are only ever important when you are micro-managing food and drink for your gout diet. For gout sufferers who are micro-managing their gout diet, I’d like to make my lists easier to use.

Please can you tell me more about the way you manage your gout through gout diet control. My experiments on this failed many years ago, so I cjanged my approach to gout control. I now rely on allopurinol to control gout. And, I adopt healthy nutrition principles to try and make my diet gout-friendly.

Please let me know the details of how you use my gout food lists to control your uric acid.

[Keith Taylor]

Chris, it is all down to your uric acid level. I would never settle for OK. Uric acid is either safe or it isn’t.

If it has been consistently lower than 5mg/dL for the five years you’ve been taking allopurinol then you are safe. Are you in the UK, Chris? If so, the scale will be different. You are looking for a max of 0.30mmol/L.

If your doctor is one of the tiny minority that understands that, then you should be seeing a radiologist/rheumatologist to investigate the real problem. Personally, my money is on bad uric acid control. That might be because I’m gout-fixated. Or, it might be because I’m right.

Easy to tell with the uric acid test result numbers.

Uric Acid Crystals

I feel there is an awful lot drs don’t know about gout and there is more to it than just the crystals tearing into your soft cartridges .

Uric acid crystals do NOT tear into anything. They are too small, and their shape is a red-herring. Gout pain is caused by an immune reaction.

Joint damage from gout is a different process. Our bodies are designed to wear out. We grow new cells all the time to grow and to repair the natural damage. In our joints, specialist cells grow to replace damaged bone, cartilage, tendon, etc. Like little babies, they grow to become important parts of our skeleton and connective tissues. Except, when uric acid crystals are around, those little babies die. Very sad 😥

Something should be done about it.

[Keith Taylor]

I don’t know if this will help Ross, but I appreciate everything about your last sentence. Here goes…

Gout pain happens because our immune system goes crazy when it’s overwhelmed with uric acid crystals. It’s nature’s way of telling us that we are in danger. So, I say ‘Thank you, Nature. How do I cope?’

Colchicine
First, colchicine can slow your immune system down. That’s an infection risk, so be careful if you are exposed to any viral or bacterial infections. Assuming you are not infected, colchicine is a friend to gout. But, a stern friend.

Colchicine will not help immediate pain. It does not reduce inflammation. It just slows it from getting worse.

If you are taking it as required, take one colchicine as soon as you notice the slightest twinge of gout. If your twinge does not go in 2 to 4 hours, take a second colchicine. Never more than two per day.

If you are taking colchicine as a preventative, take one at bedtime. Next morning, take a second if you need it, as advised by your doctor. Never more than two per day.

So, if your immune system hasn’t gone crazy, that should be enough. But if the gouty inflammation party is swelling, it needs a party-pooper.

Indomethacin
Indomethacin will reduce the inflammation caused by your immune reaction. In doing so, that will reduce most pain. Indomethacin is a great combination with colchicine because it’s fighting inflammation on two fronts.
The recommended dose of indomethacin for gout is 50mg three times a day.

If it’s been a really heavy party, your immune system hangover might linger. If a good nurse wants you quiet in your hospital bed, she will intersperse each indomethacin dose with a compatible pain-blocker.

Ross, if your colchicine-indomethacin combo is not quite letting you dance and sing, I’d recommend talking to your doctor/pharmacist about a compatible pain-blocker. Alternatively, get round to your local hospital, and chat up a nurse 🙂

[Keith Taylor]

And, Linda

Since I wrote that, I’ve spotted you’ve joined in with some other topics here on the gout forum. That’s really good news for me. We all learn so much more when the discussions have different points of view, and different experiences.

Thank you Linda. I can’t wait for your latest test results. I can see from Robert’s topic about tendinitis that you had uric acid of 10.9 at one point. I wonder when that was, and how much it has fallen since then?

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