General gout stuff…
I’m going to go to a podiatrist and see if they’ll let me get onAllopurinol. A few questions about this…
1) Do you take it daily (i.e. like vitamins) or just when you feela “flare up” coming on?
2) Does is eliminate gout or just make the outbreaks less painfuland less severe? By “eliminate”, I mean does it stop the gout fromspreading to other, larger joints (hip, elbow, fingers, etc.)
3) What, if any, side effects does it have? I’m working on changingmy diet to include more water if anything and about the only realvice I have is beer (sorry, that won’t go until I’m old andwithered).
As I mentioned, I’ve had only three outbreaks and I’m figuring if Ican “nip this in the bud” now, I’ll be better off in the future.
Lastly, I’m a swimmer, but haven’t been actively swimming for over ayear. With my last outbreak in my ankle, I noticed while swimmingit was a little stiff, but once I got going, it kind of feltbetter. Is something like swimming better for gout as it hasno “direct” contact on the joints as opposed to something likerunning?
Malia Berthelette on September 19th, 2007
I’ll answer a few of your questions from my experience.
Some basic background first: I’m an almost 40, far too inactive,systems designer who formerly competed in a wide variety of sports,including swimming in my teens and twenties and most recently ballroomdance with my wife. (and a bunch in-between) I have had 4 “attacks”over 3 years and a large number of “twinges” since the last of the four.All four of the attacks were during high stress times, where my obesitywas also near it’s high point. Since the last attack in January 2003,I’ve been slowly shedding the pounds and ensuring I remain very wellhydrated. These two things alone have been effective so far, but myanecdotal experience is by no means scientific.
When you say you’ve had 3 attacks that “hurt,” that sounds like thefirst three I had. They kind of felt like I’d somehow gotten a sleightfracture in one of the bones near the big toe. However, the fourth onemade me take gout seriously. Up until then, I’d just heard from the docthat I’d better straighten out my diet, get some exercise, and lose someweight. When you become fully disabled by gout, even for a short twoweeks, like I was, and take 2 months to recover, you then take thingsmore seriously.
(so I commend you for doing so before then)
As I haven’t taken Allopurinol, I won’t answer those questions, exceptto say, that YES, nipping gout in the bud is important. Don’t waituntil you have a bad attack that damages the joint in question. How you”nip it” is a matter for you and your medical advisors to determine.
Regarding swimming, experience is that, yes, it is much better for goutthan weight bearing exercises. I’ve noted that our dancing irritates myproblem great toe joint, and I have to be very vigilant about hydrationand getting several days of healing rest between sessions. In contrast,with swimming, I can do so almost every day, as long as I am notpractising starts or turns, and in a cool pool the water eases my painfrom twinges. (a full blown attack would not find me in a pool though -OUCH)
I attribute most of this difference between exercise types to notstressing the joint, but I also have the hunch that swimming, being aless aerobic form of exercise (except on sprint days), is a slower fatreducer than most aerobic exercises.
Sabina Shamel on September 19th, 2007
If you study the literature, you will find that the older you get,the worse your gout will become. Each attack will be worse than thelast one and the crippling effect that you suffered for two weeks canstretch to months and then to years. The medications that relieve thesympotoms by reducing, or eliminating, the bodies inflamation to themonosodium urate crystals in and around the affected area tend tomake the pain less, and reduces the time you are in pain, but you arefooling yourself if you think that you are going to control orsomehow manage your way, with diet and extra water, into being goutfree. It isn’t going to happen and it is only a matter of time beforeyou start to be permanently disabled from the dammage gout will do toyour joints.
It is true that a very small percentage of people have only oneattack and then never have another attack but both of you are pastthat situation and there is a 100% chance now, that is it is a deadcertainty, now that you have had three or more attacks, that yourattacks will continue and that they will get worse.
There is no cure and when you prolong your next attack by drinkinglots of water and by being oh so careful with your diet, you are justgoing to make the next time you do get an attack, much worse than thecombination of all the other attacks you had before.
You will not get cured from having gout. It will not go away and itis only a matter of how long it will be before you get your next oneand how severe it will be, not whether or not it will come. Moreoverif you can clasify your attacks as having been mild, then you arevery lucky but it is not worth the risk of really damaging yurself tostay off of allopurinol.
Take your medicine and live without gout. You take it every day andfor the first two years or so, you will probably experience miniattacks. They only last a day or so and they are not nearly as bad asthe attacks you get when you are not on allopurinol.
Before going on allopurinol have your serum urate measured and thenhave it measured again every six months for the first two years. Whenyour serum urate level falls to 3 or 4 you can think about reducingyour alloppurinol dose. It will probably take two years for you tobring your urate level down to 3 or 4 and I suggest the blood testto make sure you understand just where you are on getting rid of theextra uric acid. It took you 10 or so years to accumulate that uricacid and you are not going to get rid of it overnight.
Gout is not something that has just sprung up on you. Over the yearsyou have been accumulating excess uric acid in your system and yourgout attacks are the result of some of that uric acid being convertedinto Monosodium Urate Crystals. Particularly if you are over weight,your body will store uric acid in your fatty tissue and as you loseweight, paticularly if you lose it too fast, you will be overloadingyour bodies water system, with uric acid. This overload is likely totrigger very severe gout attacks.
Allopurinol works by blocking the formation of uric acid in yourbody. It stops the last step in the decomposition of DNA and RNA thatyour body must do all the time. All your cells have DNA and RNA andwhen those cells die and have to be replaced, like muscle cells, theyget reabsorbed and broken down and uric acid is the end product.Everything you eat also has cells ant therefore the RNA and DNA ofthe cells you eat must also be broken down. With us gout sufferers,our bodies do not get rid of enough of the uric acid through ourkidneys and we get percipitation of urate crystals. Many paople, bythe way, go through life with uric acid levels much higher than thenormal gout sufferer and never have a gout attack and it is not knownwhy this is true. However, it is known with certainty that once youhave had your first attack and then your second, that you willcontinue to suffer from gout for the rest of your life.
There are dangers from taking allopurinol and you should not treat itlike a vitamin. It is medication and it can have bad side effects.The most dangerous sign that you are having an allergic reaction toalloppurinol is a skin rash. If you develop a skin rash, particularlyon your head, when you are on allopurinol and that rash will not goaway in a few days or a week at most, you better get to yourphysician and talk about allopurinol side effects. About 2%-4% ofpeople who take allopurinol develop some form of side effect thatlimits how much allopurinol they can take. However, it is a drugthat your body apparently gets used to taking and if side effects dodevelop, it is often helpful to cut back on your dosage and then re-increase the dosage later after your body gets more acclimated toallopurinol.
In summary, you have gout, it isn’t going to go away, it canpermanently cripple you, and you are not going to be able to keep itaway by chanting incantations, by eating or drinking any kind of homeremedy, by being good on a diet or by drinking lots and lots ofwater. The water thing, by the way, is probably the most effectivething you can do short of taking allpopurinol.
Find a physician who will perscribe allopurinol. It is not anexpensive drug and you can get a years supply for under $30. For anormal male a dosage of 300 mg is the minimum you should have untillyou are both gout free for 6 months and until your serum urate levelgets into a comfortable range.
Good luck and have a Happy, pain free new year.
Malia Berthelette on September 21st, 2007
I realize that yourvery-pro-allopurinol stance is based on many years of positiveexperience and probably also from hearing a bunch of nincompoops toutingsnake oil cures too. There certainly seems to be a sizeable group ofquacks who try to sell crap to gout sufferers. We’ve also heard frommany on the list about the benefits of allopurinol and almost nothing ofside effects, so clearly it is a very beneficial drug for goutsufferers. I am quite comfortable that you are such an avid proponentof it.
However, the literature you describe does not necessarily describe mycase, and certainly not my father’s case of gout.
My father and my uncle had gout in their late 30’s and early fortiesrespectively, when they were at their highest weights. They both lostweight and have not had attacks since, and they are now in their 60’s.In my father’s case, he had had several attacks, two of them notallowing him to walk for two or three days. My uncle had severalattacks as well, and was unable to walk at all with any of them forbetween 2 days and a week each time. Note that neither of them havebeen permanently damaged, nor permanently afflicted with gout. Notethat their physicians at the time were not wrong to prescribe exercise,healthy diet, and increased water intake. They are pretty safe commonsense prescriptions after all.
I will continue to consult with my physician regarding the risk ofdamage to my joints and the risk of gout attacks. I will also continueto avoid the use of prescription medications as much as reasonablypossible. I will also continue to take my physician’s and my father’sadvice, which is consistent, and which has been successful so far.
I have no doubt that you will continue to imply I am an idiot for doingso. I wish you would be more open minded, but if you will not, c’est lavie.
Sabina Shamel on September 23rd, 2007
Well, I mwish you well. You and your family may be a statisticalanomaly and if you are talking about a large swing in weight, and ifyou are able to “Pull it off” so to speak, then perhaps your goutattack is a result of the process of reversing the excess weithtwhich will bring your uric acid level into a saturated sondition andwhile you are in the reversal process, which usually takes a year forpeople with truly large weight excess problems, then yes, you may notbe a true gout sufferer.
I don’t think there is a name for the ph0enomenon but it isunderstood and it hads been described. If you lose the weight toofast you will percipitate attacks and you will be particularlysucceptible as you tapedr off and go into a steady state.
It will not hurt you to know what your serum urate level is and if itis, and remains below 7 or 6 then you will propbably be in prettygood shape.
Thje rest of us who have gout need to look at our situations on acase by case basis and live from there. Statistics are against youbutfamily history obviates statistics in every case and you may not be atrue gongenital gout sufferer. It is a heridity disease and it iscrippling.
Good luck and especially with the weight loss. How many pounds a weekare you targeting, achieving?
Malia Berthelette on September 24th, 2007
Good to know, thanks. I’ll try to get my doc to regularly test this tohelp me assess the risk of getting an attack.
I’m targeting no more than 5 lbs a month on my doctor’s advice, but havelost 20 lbs in three months, so must slow down a bit. So far it hasbeen easy though, just dropping the extra “empty” sugars like soda andchocolate and walking briskly every day or two at lunch.
Terrance Molock on September 26th, 2007
One thing that IS KNOWN about gout..is that the longer it is leftuntreated(without allopurinol)..the worse and longer the attack tocome will be..I have had far too close to me people that have NOTheeded the warnings..their next attacks are in my other posts.
With all due respect..attacks of a few days.I have had attacksthat left me in bed..20 hrs a day..for 8 out of 18 months.
FEW can match my diet..and I have been on it forever.
As for health,exercise..again..pretty hard to match.
As for general health..I have almost perfect blood etc., tests inEVERY area..
I have had in the words of one rhumatologist “the worst case ofgout he has ever seen”..
I have been on allopurinol for years now.The gout is notgone..pretty much..but it does resurface a little bit..in a veryminor way.Allopurinol can take from 1 to 3 years on average beforethe uric acid deposits leave..up to 10 years..depending on theseverity.
My last visit with the rhuematologist..I told him casually..I hadforgotten about a “lump” I had had.This raised hiseyebrows,interest..and he began writing.Asking.My first “officialattack” was in 1999..classic big toe..10 day attack..hospitalized.Mynext attack was stunning..in 2001..leaving me onallopurinol,colchicine,and indomethicine a few times a day..and inbed 20 hrs a day for the 8 out of the next 18 months.Such was thisattack that they began DIGGING into my medical past trying to figurethis out.It was pretty much determined that due to the particularsavagness of this attack that 2 earlier debilitating problems with myhips..right and left..in 1990..then 1996 were gout attacks too.SOooowe go back to about 1988..gout for 15 years..
This “lump” I had had..was in the 1980’s..at the base of myneck..on my clavicle..and it grew..and I saw a doctor..and he didn’tknow..and it grew..and I saw another doctor and he didn’t know.Maybeaswollen lymphgland..?And it got EXCRUCIATINGLY painful!..I beganapplying hot cloths..compressing it..finally what came out was achalky,substance..and a lot.That was the end of that.I thought nomore of it.I did see evidence..pictures of chronic gout..tophi..andit didn’t register..somehow I “knew” that first their was gout..andafter a decade of no treatment there was tophi.Wrong.This is NOWmaking much more sense to me and the experts I see.I have now hadchronic gout since the 1970’s..after a decade of this..even withoutsymptoms..the excess uric acid was being deposited at thisjoint..about 10 years later..it came through the skin.
It took probablly 25 years..1970’s untill 1999 for this excessdepositing of uric acid in my joints to actually show up in myjoints..my toe first.BUT my feet joints were FULL of the stuff TOO!The Dr’s now have NO idea as to whether the gout in my elbows is aresult of a 25 year period of time with no treatment..or a result ofthe STILL excess deposits being moved around and finally flushed out.
As per a recent discussion with a rhumatologist about the weightloss/change of diet/by bye gout and no allopurinol.He too agrees thathe would like to see clinical evidence,tests.He too hasseen “miracle” gout cures by weight loss..not because the gout hasgone..but because their is a lot less weight,stress on the joint now.
I am not disbelieving anybody..but hey..in all fairness..I mean Igotta see the proof.Here is the gout.Here is the suffering.Here isthe solution.Problem gone.
This stuff where it has been “cured” without allopurinol..and onlyto resurface almost always GUARANTEED WAY,WAY worse..is simply commonin gout sufferers of 10 years or so.I hear it ALL the time.I alsohear ALL the time..WITH NO EVIDENCE..that my friend..had it and didthis..and cured it..and it never came back…yadayadyada..
Sabina Shamel on September 27th, 2007
There once was a man in the front seat of a municipal bus tearing uplittle pieces of paper and droping them on the floor.The bus driver asked him, “What are you doing?”The man replied, as he continued to tear up the little pieces ofpaper, “I’m keeping the Elephants away?”To which the bus driver replied,”But sir, there aren’t any Elephants for thousands and thousands ofmiles.”"Good!” replied the man, “It’s working!”
Keep tearing up those bits of paper……