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trev,
I gotta admit, if I was going to publish a paperback on gout, that picture would be on the cover…CLASSIC PODAGRA, ala Henry VIII! It hurts just to LOOK at it.
Apology, I only today realized I had an INBOX so I responded to your PM of a couple weeks ago about hypertension dosing.
keith,
Thanks for those good instructions…I'd never SEEN that little tree icon before. Can we upload images directly from our hard drives or do we first have to install them on the web, as with PHOTOBUCKET or one of her sisters. I'd like to show my little finger (although NOTHING can compete with trev's left bunion.
)Reread the instructions so it's directly from our computers….HOORAY!
goutboy,
I have, of course also heard about that allopurinol rash after taking it for years or decades and I like you cannot find anything specific, or a picture.
But take it from me, a groin rash in Texas in July is almost certainly jock rash…a tinea infection sometimes compounded with a yeast infection.
Buy a tube of LAMISIL (or generic terbinafine) and apply it after every shower wherever you see any part of the rash, even down the inner thigh…a one inch strip should take care of both groin joints. It makes short work of tinea, use at least 7 days, and once cured, using it every few days will be prophylactic. It's over-the-counter (check Target…I see 4 around Austin
)If that doesn't work, then you'll need to exclude allopurinol for a couple weeks and see what happens. And then re-introduce it and by then you'll know if you are allergic. If so you have no choice but to stop.
All over itchiness is a tell-tale sign of hepatitis/jaundice. Look for any yellowing of your eye whites. If you see it head for the doctor and a liver function test.
But sometimes itchiness can be from something so simple as a new soap.
Good for you chthomas,
You are home free and the 300 mg. allopurinol will keep you there.
But NEVER think you have stopped needing it.
“Better living through Chemistry”…remember that one!
Well see…
I have this big pair of chain mail gloves that often works WONDERS!
If that doesn't work, then it's pistols behind the church at dawn!
Per-UVE….ROFLMAO
Trouble with euphorbia is it's hard to eat much of it because of those pesky thorns. And that bloody mouth announces your gout to the whole world.
http://www.euphorbia-internati…..godana.jpg
But seriously, Marky, it is such a shame that you have spent 12 years growing tophi and having them cut away. Don't let another week go by without uric acid control, WHATEVER you need to do. Since the disease is an eventual killer, maybe some side effects MUST be tolerated. Perhaps something like LOW DOSE allopurinol mixed wiith LOW DOSE probenecid. The combo of uricosuric and uric acid blocker can REALLY lower your serum UA.
If Britain will not allow febuxostat til December, then consider getting it somewhere else for several months if it becomes your last option. It's clumsy, but it can be done.
Oh trev, that looks like a doozy. I'll bet you cannot even stand on that left foot.
My bad one was a little less swelling over the foot but a much deeper purple/magenta in the swelling over the bunion joint. I couldn't touch it even with a sock.
(You got a bit of nail fungus going on too…Lamisil works wonders.)
Hmmm, NSAIDS and steroids.?
If you have a pair of gloves, take them into his office, smack him in the face and tell him he's fired.
Then go to someone who inderstands gout.
The correct drugs are colchicine and allopurinol, not NSAIDS and steroids!
Yes, VG it could very well be a tophus, or not. THe color is right, the placement is right but it is a good deal too small for “average.” But then I am not too sure of what a “skin involvement tophus” would look like only refugees from an infected joint…and they are bigger.
If I get around to my camera and photobucket, I'll show you a couple typical small tophi that I have left on my little finger.
To answer your early questions.
Once you get on allopurinol there will be no effect on your exercise tolerance.
If you get your uric acid consistently below 6 or even 5 you will be able to eat ANYTHING you want.
Those side effects are quite rare, the most likely after many years is an allopurinol skin rash.
And an afterthought…from your reposted picture: Yes, it looks like a gout attack in your left bunion joint. I can see swelling and redness.
Marky,
It seems you have little choice.
What country are you in? The drug was pulled by it's maker SANOFI due to rare liver toxicity (hepatitis to the point of liver failure) but is still sold in some countries, but I think NOT in the United States.
It is a very effective uricosuric agent generally very well tolerated expecially by people who have trouble with allopurinol.
I would recommend regular live function testing espepecially if you are looking for a lifetime of use.
You also have the option of the new febuxostat but as with all new drugs there's always the question of $$$$expense$$$$.
Colchicine work best if it's used immediately upon the inceprion of an attack. The most acceptable scenario for a gout attack is that crystals form in a joint and the body attacks them as foreign. THis attack causes inflammation which creates an acid environment in the joint. So what was a saturated or supersaturated uric acid status in the joint (or else there would not have been crystallization in the first place) becomes, in acid medium, a much less soluble environment for uric acid…massive crystallization and massive immune response and massive inflammation with even MORE acidity.
Colchicine alkalyzes this joint quickly stopping the cascade. So you can see why it works so much better at the inception of an attack and why it is less effective taken on a day to day basis.
When you learn to recognize the first twinges, you can often stop the attack with only 2 tiny pills. Once the attack gets going full steam, you need one and hour for as long as it takes to a max of 16…stay home and close to a toilet for this kind of dosing.
bulinn,
Knee is always problemattical becasue it's never clear as a gout attack. THus people with or without gout injure their fragile knees and they take long to heal. I agree, keep to the 300 mg. allopurinol.
You should have something to stop an acute attack and the something I recommend is colchicine. Call your doctor and have him call in an Rx to your pharmacy. The stuff is cheap and is quite specific for gout. EVERYONE with gout should have it on hand becasue it works best at the first instant of an acute attack.
Let me add a possible connector between high serum lipids, hight uric acid and perhaps even high blood pressure: excessive meat eating. Perhaps you can even throw high weight into that equation.
But massive dietary change is tough so we have the aids like allopurinol, Lipitor (and the statins) and a zillion BP drugs.
So I presume you are going onto a statin. Make it work for you and choose atorvastatin (Lipitor)…it's the only one proven to be uricosuric. For BP choose losartan (Cozaar) becasue it too is uricosuric. NEVER take a thiazide diuretic.
It sucks to face taking drugs for all these conditions but a lifetime of plenty has forced it on some of us who cannot live an ascetic existence with a crust of bread and a boiled potato for dinner…pass the Chateaubriand a some more of that delicious gravy…ohhh, creme caramel for dessert!
Ohh, honey, you forgot that sweetbreads pate' appetizer…we'll have it while we watch TV!gouty,
Yes, I think your upping the allopurinol to 300mg. is a good idea. For one thing it COMES in a cheaper 300 mg. tablet and your costs willl be even lower. The average dose is 300 mg. so its been well tested at that dosing.
There is more than a little evidence that diclofenac is singularly bad for gout use because it causes the kidneys to retain uric acid.
I think treating a gout attack for weeks with one of the gazillion NSAIDS is the wrong tack when there is a drug which is gout specific, cheap and works very quickly. That drug is, of course, the tried and true COLCHICINE!
John,
Why not ask your doctor for an Rx for it. It's only, but significant, side effect is diarrhea.
Indeed, it's depressing but look at it this way. Gout is a completely manageable disease that is no longer life threatening. With proper management, attacks of pain can be brought down to ZERO.
Think how much more depressing a diagnosis of multiple myeloma, melanoma, or early onset Alzheinmer's or Parkinson's would be. By those standards, gout is just a stroll in the park.
Side effects can be bizarre, but in truth I don't think yours are related to allopurinol.
Of course, the way to check is standard: stop the drug for two weeks and see if all your symptoms go away and then restart the drugs and see if they come back. In fact, for something so important as lifelong gout control why not go two cycles before you are tempted to stop the drug…better safe than sorry.
But this assortment of side efffects from so small an amount of allopurinol over so short a time period would put you in the teeniest imagineable minority. Are you taking any other drugs?
Are you sure you're just not LOOKING a little harder?
Anyway, good numbers which of course will get better with 200 mg.
I tool glucosamine and chondroitin for 6 months. I judged the two drugs useless for joint pain (and pretty expensive at the 1200/1000 mg dosing) to be just the latest “natural” ripoff. I think their popularity has died down somewhat as the guinea pigs got tired of throwing their money away.
duncan,
Of course we can all get arthritis pains but it seems likely to me that your pains might likely be your joints freeing themselves from urate. As long as you don't trigger an acute attack I wouldn't worry about it becasue they should get less and less as the months go by.
Every Valentine's Day (day after), Easter (Day after) and Xmas (day after, ) I buy about 4 pounds of chocolates at 50-75% off.
It is TERRIBLE for my calorie count but now that I know it cures gout, I have an excuse.
Thank you for saving us from SPAMALOT!
Randy, the best way to confirm gout is with a tophus biopsy…the diagnosis is 100% accurate.
Get to work with the allopuinol asap, in fact, WITH the tophi and misshapen feet, perhaps allopurinol PLUS probenecid is your best regimen. You can get good tophi diminishment with serum UA leves below 4.0.
Yes, a rheumatologist is a good idea, but perhaps ANOTHER rheumatologist because the one you have seems a little dense if he couldn't diagnose your gout before you needed surgical removal of a tophus and 60 year olfd feet. But a GP can order the drugs just as well and take blood draws just as well, but that requires YOU become the expert on gout and monitor your OWN treatment.
Perhaps just anecdotal, but I destroyed my back 33 years ago…broke off a process on L-5…disc between L5-S1 has collapsed, been destroyed and probably absorbed and the two vertabra have undergone something of an auto-fusion (Don't do DEADLIFTS!) The joints are a mess all the way up to L3. They recommended 3 joint fusion but I said no out of fear. But the last 15 years on allopurinol have greatly eased the condition…so maybe you can look forward to some back relief also. <<Knocking wood furiously…I don't need GOD to strike me with an cute backache because of my hubris!>>
Muscle pain is NOT one of the more common albeit rare side effects of long term allopurinol use. Most common rare side
effect is persistent rash. (I love “most common rare”)Perhaps you are looking too hard? Those odd pains of 52 don't get better at 66, take it from me.
But in truth those achey legs (front thighs) are something I have experienced just this year…like February and March. I just PRAYED they weren't from a decade of daily Lipitor, because I CANNOT do without a statin drug. I never even THOUGHT about the allopurinol. Blessedly they went away as mysteriously as they cropped up. I have since had two rather mysterious and awful bouts with the “flu” so maybe the achey legs were a precursor.
Hard excercise destroys many muscle cells and releases copious uric acid from their nuclei. Just expect the excess urate and remove it with a little more allopurinol rather than cutting down on your exercise…that would be criminal.
Try a little test…do a brutal bike ride immediately before you go to the doctor for a blood draw…that info might be very valuable.Perhaps we all need these twinges just to REMIND ourselves that we still have IT!
pagey,
Depending on your uric acid test, you might be able to go back down to 200 mg. allopurinol. No sense taking more than you need (or less.)
<<Just on a lark, do you take any statin drug for cholesterol. That achey leg thing is a fairly common side-effect.>>
Anne,
Can't see your post until the Administrator approves it.
Randy,
Twenty is a bit young but not impossible. It is also possible the tophus grew very fast.
The medical profession is fond of compartmentalizing arthritis. But I think there is more of a tie-in between, gouty arthritis, psoriatic arthritis, rheumatoid arthritis, osteoarthritis, and even “bad backs” than commonly thought
Controlling your serum uric acid to below 6 may eventually give you relief from your other pains and psoriasis. Getting rid of your urate is going to be a long process becasue where there is one noticeable tophus, there are likely many not so noticeable.
Are you taking any drugs for gout yet? What is your serum uric acid?
Hmmm, I thought I responded with something akin to : “It looks like you wasted your money on the test kit.”
But thinking it over I remember my first requst to my doctor to test my uric acid. He had forgotten that the test is part of a normal “Chem Screen 25″ a standardized pile of basic results, and he added Uric Acid separately. Thus from one blood draw it was tested presumably in 2 different batches, probably automated. I requested the results as I always do and saw one determination was over 9 and the other only slightly above 6 (both in mg/dL.)
I asked the doctor why the discrepancy and he said “they test it diffferent ways.” This stupid response apparently made some sense to him but not to me
but I didn't feel like a battle and just added it to the list of other stupid things he said.I guess uric acid testing involves some “creativity?”
Perhaps the best we can do is to go with some sort of long term moving average and assume that microtinkering will not yield any valuable results. Sad but maybe inevitable.
But you have certainly disavowed me from any wishes I might have to buy a testing kit.
Tavery,
Be on the lookout for pre-diabetes. If you need to lose weight, do it. Perhaps a cheap glucose tester (they WORK) is in your cards?
I believe they are one and the same and worse than the effect of mixing is the fact that diclofenac is one of the few anti-inflammatory agents that interferes with uric acid elimination, i.e. it is ANTI-uricosuric. It is an absolute no-no for gout sufferers.
It's actually pretty toxic in many respects, gout or no gout…a dreadful drug.
Is that the drug you meant, Jaffa.
Ass Gout is reputed to be the absolute WORST kind…fortunately its rare. That's why Henry VIII had to give up his bicycle.
pagey,
Instead of reducing your gym sessions why not up your allopurinol to 400 mg.?
Maybe those reminiscent little twinges are good, showing that your body is breaking down some old deposits. It would not surprise me if hard exercise, with increases blood flow, and secondary “massaging” of the foot by running, biking, swimming, causes faster breakdown of old deposits.
I have decided to think of my foot twinges after walking far, or running hard in exactly that way from now on. Thanks for making me get that idea.
As you know I am quite skeptical about Vitamin C although I will try to find that study. What is most amusing is that the claim is made in veiled fashoin that Vitamin C acts as an atioxidant to stop uric acid production…but uric acid is an antioxidant. 😀
The Vitamin C people will not rest until there is a citation on the internet that shows Vitamin C cures every possible illness, disease or disorder. How else can one continue to sell shiploads of ascorbic acid.
My fave was the cancer cure that when tested with 10 grams a day showed no benefits, which promted some radio “health” guru, Gary Null, to say that people needed upwards of 100 grams a day INTRAVENOUSLY to cure cancer. It gets too funny. Imagine, a quarter pound of ascorbic acid intravenously DAILY!
As a result of these inflated claims and my own guinea pig research that showed Vitamin C indeed DOES NOT cure the common cold, I give all further claims for Vitamin C short shrift. It's a big con that has been thoroughly refuted…unfortunately none of the old disinformnation ever disappears from the net.
Anyhoo, I would not take mega dosages of ascorbic acid for gout because it is a very STRONG acid which produces a highly acidic urine, which increases the risk of kidney stones.
pagey,
It really doesn't matter because the half life of the first metabolite of allopurinol, oxypurinol, which is responsible for most of the uric acid formation blockage, has a preposterously long half life of several days. Thus whenever you take new allopurinol it is the large residual pool of oxypurinol, several days worth, that is protecting you.
Perhaps with meals is best because anything with food is apt to be less annoying to a delicate stomach.
But whatever is most convenient for you is aok.
