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With gout, you can’t base reliable conclusions on the symptoms you experience over a short period of time. It can randomly get better or worse from one season to the next. You need more time to see the effects of drugs clearly.
Diclofenac pills have serious side effects as well and using them for a long period of time can be deadly so I can understand a doctor wanting you to change your meds. Omeprazole is supposed to protect you against stomach damage, arguably the worst side effect of this class of drug (different people get different side effects though). But when you change a drug, there is the matter of dosing it right. One pill of the old med might be stronger or weaker than a pill of the new one (the milligrams are likewise not equivalent)…If you’re having a bad spell of gout, you might want to take another drug for a little while to try to break it. Colchicine would traditionally be used in such a situation (it’s not a drug you should take every day for a long time) but of course it’s definitely not something you should try without talking about it with a doctor first! It’s especially important to get the dose right with that one. People have even died just from eating the plant’s leaves.
With gout, I think it’s generally better to take a serious drug combination for a short while and then only allopurinol (or equivalent) than to keep taking a relatively light drug combination daily for months or even years. That’s because if you can completely stop the inflammation, it might not come back for a while. If you only keep it at a low level though, it might last a very long time which is not healthy.I also like mine below 5 but that doesn’t mean increasing one’s allo dose is always the best course of action because there are side effects. I take a slightly different drug but in my case, the most noticeable side effect is the effect on my ALT (liver function test result), something allopurinol is also known to affect. Ideally, you would only increase your dose under medical supervision.
Even drinking more water (generally a good idea) could have side effects if you have a kidney problem.
Naproxen and omeprazole have side effects as well by the way. They’re pretty safe if you only take them for a few days or even weeks but I’d generally be more comfortable taking something like allopurinol every day for much longer periods.There is also the matter of measurement errors and random fluctuations. I like to recommend more testing so that you can average several results.
There is little evidence that it is useful to reduce one’s uric acid under 5 but the noise in tests values is one of the reasons (together with individual and seasonal differences as well as changes in uric acid through the day as you eat, exercise and so forth) that having a safety margin is ideal. .36 is theoretically OK but too high for comfort in my opinion, especially if you aren’t testing often (the more you test, the more confident you can be that your uric acid remains at a safe level).Hi!
That’s a question you should ask the doc. It’s definitely not routine but maybe there’s a good reason to do it once or twice that way in your situation. In any case that shouldn’t replace regular testing (while taking your usual allo dose).The NSAID my rheuma gave me is a different coxib which isn’t approved in the US. I’ve not used it much and can’t possibly comment on its efficacy… but even if I had used it a lot more, I wouldn’t compare drugs without reference to dosage.
I wonder if the difference in efficacy and/or the difference in deadly side-effects might simply be due to dosing. In other words, perhaps a higher dose of a non-coxib NSAID would work just as well for Brad… and would be just as dangerous for the cardiovascular system as coxibs.
In doubt, I think it’s safer to recommend older NSAIDs for occasional use, at least as long as people are not experiencing gastric side effects. For regular use, whether people can afford gastroscopic examination might be a decisive factor.As to Gamebronc’s experience, it’s not even clear the Celebrex did anything considering all NSAIDs take a while to work and they had taken a different drug earlier.
Suyash should clarify but it sounds like they might be taking 160mg febuxostat a day. This is a huge dose which could well be unsafe (considering the rate of serious CV incidents febuxostat users seem to have experienced in the US). There is also the matter of the diminishing returns of xanthine oxidase inhibitors. When you have inhibited most of your XO already, what’s the point of taking an even more ridiculous XOI dose?
In my opinion, the reason why Suyash’s uric acid is so high should be investigated. There may be a kidney problem or another serious problem causing this. And while febuxostat may prevent uric acid kidney stones, it will certainly not fix other kidney problems (and it could in theory even cause xanthine stones). There are different drugs for kidney problems, as well as specific dietary recommendations of course (which are different from the dietary recommendations typical gout patients should follow).Hi!
The reason it is attacking you is that you had untreated gout for many years. You’re probably going to be stuck with this problem for quite a while.Even if your gout could be managed by changing your diet, it would probably take months or years to improve and even longer to go away completely.
The most practical way to manage gout starts with getting the amount of uric acid in your blood tested several times and doing some detective to get your hands on as many old test results as you can by asking your previous doctors and so forth.Be careful about what you’re reading. Most of what you can read about what’s “good” for you is BS.
Switching from red meat to chicken isn’t going to help unless you have an iron problem or were eating the wrong meats. Likewise, fish isn’t necessarily worse than chicken (though some fish dishes definitely are).
Unless you have a different health problem which would require you to avoid high-fat dairy, eating appropriate amounts of cheese is less problematic for gout than eating animal flesh. The general recommendation is to consume low-fat dairy instead but you would of course need to consume unusually large amounts in order to get enough protein.
You could in principle also eat more eggs instead of animal flesh (again, depending on your other health problems).
There is of course more to diet than eating from some kind of “good food” list and avoiding what’s on a “bad food” list. It’s easy to eat too much rice for instance.You’ll be forever chasing shadows if you try to manage gout like a disease which develops over days rather than years. If you’re having a gout attack now, it’s most likely because your uric acid was not controlled before you took the antibiotics. Every year you neglect to control it, gout typically gets worse.
It’s easy to turn coincidences into causes in one’s mind when trying to explain a small number of occurrences. Without sufficient data, people typically end up developing superstitions.
One problem is that uric acid readings can be noisy even when you’re not taking antibiotics. Other drugs can affect uric acid and even if you hadn’t taken any drug, any illness might cause you to behave differently and would of course affect your metabolism.If you know for a fact you have gout, then the general advice (not applicable in every case) would be to reduce the amount of uric acid in your blood considering you are experiencing symptoms even is test results suggest it’s low enough.
If your test result was 4 mg/dl (always check the units!) it would be another matter but 5.5 isn’t quite safe. If you had numerous reliable test results all showing 5.5 or under over a long period of time, that would be grounds for doubting whether your symptoms really are caused by gout. But a single 5.5 result is too high to rule out excessive uric acid in the blood regardless of the circumstances of the test.
You may or may not be able to control your uric acid through diet alone. But you for sure ought not to assume a diet is successful based on a single test or on symptoms going away for a while (even a whole year would not be long enough to know for a fact whether your gout is getting worse or not). You’ll need many blood tests to make sure a diet is actually working.
The danger is that untreated gout typically gets worse even when you aren’t having any symptoms. You could pay today’s neglect dearly down the road. So don’t let it fester for years! The one thing that shows it is under control is test results clearly establishing uric acid is reliably low enough to cure gout.If on the other hand you merely suspect you have gout, you should still get your uric acid tested several times to determine whether gout is a likely explanation for your symptoms or not. But do not rule out other causes in the meantime and get serious symptoms checked by doctors just in case it’s actually an infection which needs to be treated or a more serious disease than gout.
The best information you can get cheaply about whether you are at risk of developing gout symptoms is the amount of uric acid in your blood. Maybe your doctor has already ordered that test for you (perhaps you could ask their office?) considering the result is a number which matters much more than your age. If not, get tested!
Besides alcoholism, some diseases as well as some diets (in particular Atkins, paleo, keto and so forth) can also bring about gout.I assume your doctor gave you pills that target the swelling and the pain regardless of the cause. In case they don’t work well enough, perhaps you could share the details here (exact dose included) and someone might provide other drug names to discuss with your doctor or simply tips to manage your symptoms.
Good luck getting your mental health issues in check then.
I’m very stably abnormal and I’m not feeling that encouragement yet. ๐ I find it quite convenient that much of my engagement has been cancelled for the foreseeable future and unless I count professional-type emails, I think this forum is the only place I engaged with non-relatives online in a month.So you are back to posting here Keith? Is that because you’re cloistered on account of that epidemic?
Anyway I also suspect that tendon problems with gout (and Achilles “tendonitis” in particular) aren’t so rare. I even had a textbook MTP1 episode diagnosed as tendonitis by a doctor who only saw me after I took a dangerously strong NSAID dose.
The risk of serious side effects can be considerably diminished by being careful, more careful than most doctors would tend to be. If there’s no emergency, you can start with very small doses and increase them slowly, getting regular blood tests along the way (and diligently monitoring your vitals).
Depending on your ancestry, I understand there’s a genetic test you can get specifically to prevent very serious allopurinol side effects as well.Most lists are terrible. One problem with lists (even with good ones) is that quantity matters as concentration.
If you eat a lot of anything, even small amounts of purines per cup could become a problem. And becoming a veggie involves eating more (unless you were seriously overeating beforehand). Some plant foods are fine to eat in large amounts thankfully.
Replacing meat with dairy and eggs is much easier to get right than quitting all animal products.Eating less meat (ideally, eating none at all) would help. But what you need from your diet is first and foremost proper nutrition so replacing meat with salad and fruits will only work if you were eating too much protein in the first place (which would probably make gout worse regardless of the protein source).
You really need to consider your diet as a whole as well as your other medical problems. If you are obese, losing weight may matter more than the amount of meat you’re eating for instance. And eating lots of fruits may not be a good idea if you are even mildly diabetic.For most people, the way to get rid of this is simply to take a pill every day.
Hi!
It’s not the proper procedure but you should nevertheless stick with it.
It’s important that you get monitored for side-effects since you have been put on 300mg allopurinol. So yeah, call your doctor to get another blood test (maybe not right now but soon)! You’ll also want to get tested several times to know if the allopurinol is working well enough.
But allopurinol will not get rid of your pain. It takes long time to work. People often take Mitigare as well for a few months when starting allopurinol but that isn’t likely to prevent pain entierly. Certainly taking a little Mitigare wouldn’t provide quick relief. So you probably should have yet another drug on hand and you probably don’t want to be on steroids for very long. So ask your doctor about that (anti-inflammatories have side effects as well)!
If you want advice about meds, you should start by being clearer about what you’re currently taking and what you’ve already tried. For instance, what is “some pain meds”?
Chicken isn’t going to help with gout by the way. The meds are in most cases more important than diet but if you want to improve your diet, you’re going to have to look at everything you’re eating and not only a few things. I’m having trouble making sense of what you wrote but eating only apples, chicken and veggies is of course not a great diet.
Oh, and do make sure you’re staying well-hydrated!Hi Jack!
What I’ve experienced is seemingly random changes in uric acid test results. I’ve given up on understanding them. Maybe this puzzling change you experienced was caused by a virus and maybe there is another cause. Lots of things can affect uric acid.
My solution is simply to look at averages. Of course that won’t satiate your curiosity but chances are, it’s all you really need to get rid of gout.
A spike cause cause problems during your uric acid lowering therapy but after the therapy, spikes shouldn’t be a problem anymore.And hello Keith! Long time no see.
