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Gout - Help !
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Hi,

On Saturday started to get burning sensation in toe next to my little toe, got worse over Saturday night and became unbearable. Burning hot pain that makes sleeping almost impossible. Have stomach problems with NSAID's and anything stronger Diclofenec (or how ever it is spelt) is a real no no. So have been icing joint almost continuously ever since, did succumb to some Nurofen last night and this morning but doesn't touch the pain.

My brother (10 years older) and father both suffered from gout and take Allopurinol to control uric acid levels, they both found no matter what they did diet wise still couldn't stave off a few gout attacks a year at which point a daily tablet to avoid became a better option.

This is my first ever what I assume to be a gout attack, it has all the hallmarks, coming on suddenly burning hot intense pain. Have healthy diet but probably did have quite a bit of protein and a few beers prior to attack but as above diet doesn't seem to fully protect against someone who naturally produces high ulric acid counts but might have tipped balance for me.

Been doing tons of reading and thing that is getting me is a lot of articles suggest first 24 hours are worst and after 3 days things should improve and after 7 should be gone.

I am now on day 5 and no improvement, pain levels still same as first night, wandered what other peoples experiences are of a flare up and how long they last as getting really down about it as pretty much immobile and haven't slept more than a couple hours a night since Saturday. The most I can bear to be away from ice is 20 minutes and then the toe seems to be on fire, the toe is red and swollen and even touching it is painful.

Do flare ups suddenly calm down as the crystals in the joint dissolve ? Anyone had an initial/reoccurrence flare up last long time ?

Been drinking gallons of water with Lemon and eating a very low purine diet but nothing seems to be improving, any advice greatly appreciated as slightly concerned could be infected joint but really don't want to venture to doctors/hospital at moment for other reasons.
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Re: Gout - Help ! [meakinsl] [ In reply to ]
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This is something my father wrote a few years ago. Doesn't exactly address your current situation but may help in the long term.

I developed gout at about age 40, I am about to turn 58. I and went through twelve years of needless attacks and acute pain because I was not treated properly; I finally got on the right medication at age 52 after going to the Mayo clinic in Jacksonville, FL. I went to the Mayo clinic because I was having frequent major attacks. Major gout attacks had moved from a holiday occurrence (times when you over eat) to a regular occurrence (monthly). Here is what they prescribed, maybe it will work for your friend.

The Mayo clinic prescribed Allopurinol, which is effective lowering uric acid levels, but it has to be started carefully. It can actually make a gout attack worse if you start taking it during an attack. Allopurinol lowers serum (circulating) uric acid levels, but in doing so, it dissolves uric acid deposits (crystals) that are then released into circulation and can actually raise serum uric acid levels during the first months of treatment (and cause an attack). With this in mind, I started on 100 mg of allopurinol (1X/day) when I was stable (not having an attack) and then moved to 300 mg 1X/day two months later (slowly moving up the dosing to avoid causing an attack).

I also started taking two tablets of .6 mg colchicine (now trade-named Colcrys) right away. The Mayo clinic told me to take as much as I could tolerate. I had some toxicity (diarrhea) taking two tablets per day, so I went down to one .6mg tab 1X day and that worked fine. Colchicine is usually taken only for attacks (it inhibits the inflammation process), but the Mayo clinic told me to take it every day, and I did.

From age 52 until now (six years), I have not had a gout attack, and that is after having monthly severe attacks. The daily .6 mg colchicine and daily 300 mg allopurinol did the tick for me. Allopurinol is $4 at Walmart, colchicine use to be $4 but the FDA screwed us and now it is a patent drug and costs more (it is $150 for 30 tablets before insurance.)

The other medication to lower serum uric acid levels is Uloric: http://www.uloric.com/febuxostat/allopurinol-comparison.aspx. I would only recommend trying Uloric if allopurinol does not work. Read this website, Uloric is recommended only for patients that fail allopurinol therapy. The combination of allopurinol and colchicine taken every day is very powerful; it certainly worked for me. I never had an attack or even gout pain after taking this combination of drugs (no need to take Uloric).

Now for the hard part.

Six months ago I stopped taking all my gout meds and braced for the worst, but I have not had a single attack. I have had some light foot pain, but I deal with it and manage it (a little ibuprofen, drink more water, etc.) I was able to go off my meds because fifteen months ago I became almost entirely vegetarian; I only eat a small amount of fish one or two times a week (mostly when I eat at restaurants). On this diet, I have had almost no gout issues and no need to take medication. Think seriously about changing to a Mediterranean diet: high in grains/vegetables/whole foods, very little meat (only fish once or twice a week), no dairy products (no fats), clean oils (olive oil), eat and drink regularly during the day (3 – 4X a day, small meals and frequent drinks to keep your kidneys working). It’s a pain at first, but keep at it; soon, it’s like brushing your teeth (you just do it). Do you really want to eat things that makes you sick and take drugs to deal with the consequences? The “American” diet is not for you (and not for most Americans either). It took me seventeen years (age 40 to age 57) to change how I eat and drink and finally get off the drugs. Taking drug so you can eat like a fool is madness. I hope you learn a little more quickly than I did, diet is a much better way to manage gout. It’s a long road, hard at first, but the sooner you start the better you will be.

My Dad is now mid 60s with zero gout flare ups and has stayed the course with his vegetarian (some meat) diet. I hope this helps…
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Re: Gout - Help ! [meakinsl] [ In reply to ]
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Some people have lucky genetics. Welcome to the club. Despite exercise and good diet, your body produces a lot of uric acid.

My flare ups do not seem to calm on their own. Get to a good podiatrist or general practitioner who can prescribe a steroid and pain killers to knock it down. Mine did not seem to take care of themselves in the usual 5 days.

I have not had a flare up since starting alopurinol.

Your joints may have an accumulation of crystals. The existing deposits may dissolve over time once you reduce your uric acid content, I'm not sure. But, a doc can tell you. In my case, multiple docs did not think I had gout, because I did not have any of the other indicators (top health, good diet, yadayadayada). It wasn't until I had a surgery to remove a benign lump in my foot that they confirmed gout-- the lump was a build-up of uric acid crystals.
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Re: Gout - Help ! [meakinsl] [ In reply to ]
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I'm on allopurinol (300mg/day) with uric acid levels (or whatever) high in the normal range and get an occasional flare-up after a long ride where dehydration may come into play. Also worth noting that (**self diagnosis alert**) I get hints of a flare up when I have tightness in my calf(calves).

I have a bottle of Indomethacin (sp?) ready for when I can't get it under control w/ Ibuprofen. with an ok from my GP, I'll take 6-800mg a few times a day and drink a shitload of water (more than I normally do and I'd like to imagine i'm already on the high-end of intake). icing, elevation and thc/cbd ointment sometimes helps take the edge off too. My symptoms usually happen in the big toe (typically right) but occasionally fifth metatarsal area (I'm not a doc so apologies if that isn't technically correct). I'll use bunion and morton's neuroma pads to continue cycling if it's not that limiting. Usually lasts ~3days but if it persists then I'll dive into the indomethacin.

fwiw, allopurional is meant to be taken daily as a preventive measure. If you

Loads of fun eh? Good luck, it sucks.
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Re: Gout - Help ! [exxxviii] [ In reply to ]
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Thanks for quick reply, guess long term it will be daily dose of alopurinol but just need to get over this initial attack first which is agony, day 6 tomorrow, can live with the pain other than night as icing continuously but the ice and NSAID don't seem to be progressing recovery, drinking loads of water and now on purine free diet but no joy yet, interesting you mention steroids as can't help feeling at this point need to try something different than have done so far although stronger pain killers affect my stomach.
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Re: Gout - Help ! [Tim_Canterbury] [ In reply to ]
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Thanks for help as well, great forum as good to get real experiences which is far more helpful than just info sites, 3 days seems to be a common quoted duration and was hoping was going to be case with me but as above moving into day 6 and dreading tonight.
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Re: Gout - Help ! [meakinsl] [ In reply to ]
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These are some good replies thus far. You need to get on colchicine (Col Cry it’s now called) right away for your current situation. That is the only thing that makes my flare ups go away.
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That’ll have to be a prescription through a provider. Mine never get easier until I take my colchicine. Good luck. I wouldn’t wish gout on my worse enemy.
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Re: Gout - Help ! [TriJT] [ In reply to ]
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Great advice in this thread. I developed gout in my twenties and suffered through many attacks before giving in to daily meds. For about a decade, completely under control with allopurinol without side effects.
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Re: Gout - Help ! [meakinsl] [ In reply to ]
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Give your primary care person a call. No reason they couldn't give you some colchicine over the phone. It really does work the limiting factor generally is it can cause vomiting or diarrhea in which case that goes away fast once you stop taking it. Oral prednisone also works well.

They constantly try to escape from the darkness outside and within
Dreaming of systems so perfect that no one will need to be good T.S. Eliot

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Re: Gout - Help ! [len] [ In reply to ]
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Thanks for all the advice, unfortunately cannot take colchicine due to a low white blood cell count, running with nurofen for moment and no stomach impact yet (normally gets me). Day 6 today and a slight improvement, praying this is start of crystals dissolving to get me over the attack, can't imagine what it will be like to be pain free again ! Spoke to a friend this morning who I knew was a sufferer in past and he tried to control it for 3 years with diet, cherry juice, etc but also went for Allupiriol in the end and been gout free for over 5 years so route I am going to take once can get through this. Hoping to return to some level of exercise soon as only thing been keeping me sane in lockdown but to be honest just not to have a burning pain in toe will be fantastic. Seems that once the crystals start to dissolve return to normality is quite quick - hoping so anyway...
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Re: Gout - Help ! [meakinsl] [ In reply to ]
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Gout pain is likely the most extreme pain you will encounter in your lifetime. For me, it is second only to a bone infection. I rode and ran an HIM on a freshly broken and dislocated toe, and that pain did not register compared to gout pain.

Anything your doctor can prescribe now to knock it down is worth it.
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Re: Gout - Help ! [meakinsl] [ In reply to ]
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Gout is incredibly painful - far more than most realize. I had recurring bouts of it, about every 6 months. I decided against allopurinol because it does kidney damage over many years of use. Instead I made a substantial diet change, eliminating the foods high in purine. Try eating mostly vegetarian, the change is amazing. The second thing I did was get to a Dr who diagnosed the other underlying cause: a lack of B6, B12 and folic acid absorption. These conditions are genetic. You CAN overcome it though by diet change and taking a prescribed ratio of b6 b12 and folic acid. This not over the counter vitamins, they are prescribed medical food and my prescription is made by EBM. With these changes I have had zero gout or foot neuropathy in almost 3 years now.

Once you have a case of gout or other inflammation in the foot, I found the most effective treatment was prednisone. It seemed to clear it up within days. Do not ice it if you are pretty sure it is gout - that exacerbates the problem from what I understand.

Good luck I hope you can find a permanent solution like I was fortunate to.
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Re: Gout - Help ! [meakinsl] [ In reply to ]
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I though I was tough until I had a bad case of Gout. I now realize I'm far from tough. I finally found a good Dr. and my last flair up was 4 years ago. The key for me to getting through a flair up is to take NSAID's right away. When the Crystals start forming the body sends white blood cells to kill it but it just makes it worse as they become part of the problem. The NSAIDs reduce the inflammation and the helps the body not to send more white blood cells (and help with pain). I went Vegetarian for a year and no alcohol for a few months to get through the tough times and it really helped. I also lost 20 lbs and the DR said that helps as the Uric Acid is hides in the extra fat cells. The Bad news is that it can take up to 6 months before your Uric Acid levels drop low enough. Training was tough also because dehydration can bring on a flair up. I used Indomethacin when it was bad. I'm now on 200 MG Daily of Alloprurinol (don't start until you have it under control as it can make it worse short term) and the DR monitors my Kidneys and Liver yearly. Best of luck to you! The others had great advise also. I wish I had this advise 5 years ago.
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Re: Gout - Help ! [SlowandOld] [ In reply to ]
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Many thanks for everyone's posts been really helpful. I wish I had the knowledge I have now a week ago but isn't that always the case, perhaps every guy should get a gout leaflet ! Strange someone mentioned calf muscles as had twitching calf muscles which never get on Thursday and Friday before the attack on Saturday. My big mistake was not hitting it with NSAIDs at full dose on Saturday, I always have a reluctance to take medicine as normally affects stomach but in this instance should have gone straight for it. My second mistake linked to the first was instead of taking tablets went for my usual ice routine, in fact had ice on pretty much 20 hours a day as it really took edge off but has caused another problem in that with poor circulation in my feet I have developed a chilblain on the toe which to be fair is nothing compared to the gout pain but annoying all the same especially after my daughter trod on my foot today and it burst, still if she had stood on my foot a few days earlier I think I would have died in pain ! My third mistake which I appreciate probably only plays a small part as likely that given my dad and brother suffer that I overproduce ulric acid but looking back at the week leading up to the attack and now knowing foods to avoid I probably ate one or two of them everyday which would usually be rare for me and washed down with beer, even when attack was happening on first day I didn't hold back not realising what I was dealing with.

So Day 7 now and the burning pain of gout seems to have finally subsided, the chilblain I am left with is a 3/4 out of pain compared with the 9/10 of gout so feel much better - time for a beer - or perhaps not !
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Re: Gout - Help ! [meakinsl] [ In reply to ]
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Developed severe pain/inflammation in index finger right after New Years..sudden onset...bloodwork confirmed elevated uric acid levels (ruled out cellulitis). Found that cold made it worse. Heat helped but still very painful...took ibuprofen and acetaminophen for about 2 weeks before pain started to subside. Swelling did not go away until about 4 weeks after ...still not 100% back to normal but haven’t had another flare up since. No history of gout in the family. The only thing I can think that may have caused it is high intake of orange juice( I was drinking tons at the time)...high fructose intake can cause elevated serum urate levels...eliminated juice intake and all is well now....fingers crossed
Last edited by: dutrihard: Apr 10, 20 14:01
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Re: Gout - Help ! [meakinsl] [ In reply to ]
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My uncle had gout. His doctor told him when he puts any food in his mouth and start to chew, if it tastes good spit it out. If it tastes bad, swallow.
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