Steriods versus nsaid
For a week now I have been recoverying from gallbladder surgery. I am suppose to be on Allpurinol, Colchicine and 2 NSAID (diclofenac) pills daily. I am on the NSAID daily becuase I started Allpurinol several months ago and my doctor noticed and increase in gout attacks. But I stopped everything right after my surgery since I was very concious about taken any drug during the healing process. Both my reumatoligist and surgeon said to stop the NSAID becuse of the blood thinning properties, a week before surgery. Which I did. Well 6 days after surgery I came down with a bad gout attack in my left foot which forced me to use my cane to get around that day. For my severe attacks I have a prescription from my reumatologist for the a steriod dose pak. I have figured out that if I do on the first day four 4mg doses then tapper of with 3 pills the next day and 2 pills the day after and then one more pill on the fouth day. I normally have full results by the second day but still have to do the tapper process. I have not tried a 3-2-1 series thinking I want the pain gone, why risk it. In a four day series I consume 40mg of steriod. I compare that to my spouse that has Multiple Sclerosis. When she has an attack she get 1gram a day for 3 to 4 days thru IV. So I am not sure what side affect I am suppose to be worrying about with my 40mg dose compared to 3 to 4 gram doses that she gets. Does anyone else use steriods for severe attacks? I have tried the NSAID for attacks for several years now but it seems to take maybe a week to get the same results that I get from the steriod. My thinking is that the pain causing more tissue damage and relieving the pain faster is better in the long run. When I have used a NSAID it tends to relieve the pain but then pain would move the next day to another area of the foot prolonging the attack. So could the steriod be doing other things to prevent more attacks since I must be in a higher state of uric acid levels. By the way comparing results…my Uric Acid level was 13.5 mg/dL back in 2/28/2003 when I saw my regular doctor. My reumatolgist resently tested me in June and I was at 4.1. That about two month into my Allpurinol use. Well I tried to get my surgeon to suck out some fat while he had me cut open that would have been an ideal way to remove those uric acid filled fat cells.
Sabina Shamel on July 24th, 2007
Complicated indeed but I believe that you are making a mistake bystopping the allopurinol.
The only thing the NSAIDs or the steroid treatments are doing istreating the symptoms, making your pain temporarily disappear anddoing nothing at all about the real problem which is the productionof uric acid faster than your excretion system can get rid of it.
Moreover, allopurinol, particularly when taken with vitamin e, hasbeen shown to have a dramatic healing influence during and aftersurgery.
Some of the most delicate and sensitive heart bypass surgery is donewhile the patient is on allopurinol and that allopurinol wasperscribed specifically to promote healing.
If you have shown a specific and well defined adverse reaction toallopurinol then you might consider stopping it. Without specificside effects from allopurinol, I believe it is just plain silly tostop taking your allopurinol. It will take about 6 months for it towork completely.
When you stop taking your allopurinol, you end up getting a doubledose, so to speak, of uric acid because all the enzyme that has beenblocked by allopurinol can now go back to work and make uric acid.There has been speculation in the literature that when the enzyme isblocked from doing its thing, that is from making uric acid, (that’swhat allopurinol does) that enzyme ends up being produced in largerquantities because the body somehow seems to sense that the enzymaticfunction is not working so it makes more enzyme to try to make thetransformation happen. Therefore, when you stop your allopurinol,you have more enzyme in the system to make uric acid, no protectionfrom its formation and therefore a spike in total uric acid.
Terrance Molock on July 25th, 2007
am suppose to be on Allpurinol, Colchicine and 2 NSAID (diclofenac)pills daily. I am on the NSAID daily becuase I started Allpurinolseveral months ago and my doctor noticed and increase in goutattacks. But I stopped everything right after my surgery since I wasvery concious about taken any drug during the healing process. Bothmy reumatoligist and surgeon said to stop the NSAID becuse of theblood thinning properties, a week before surgery. Which I did. Well 6days after surgery I came down with a bad gout attack in my left footwhich forced me to use my cane to get around that day. For my severeattacks I have a prescription from my reumatologist for the a sterioddose pak. I have figured out that if I do on the first day four 4mgdoses then tapper of with 3 pills the next day and 2 pills the dayafter and then one more pill on the fouth day. I normally have fullresults by the second day but still have to do the tapper process. Ihave not tried a 3-2-1 series thinking I want the pain gone, why riskit. In a four day series I consume 40mg of steriod. I compare that tomy spouse that has Multiple Sclerosis. When she has an attack sheget 1gram a day for 3 to 4 days thru IV. So I am not sure what sideaffect I am suppose to be worrying about with my 40mg dose comparedto 3 to 4 gram doses that she gets. Does anyone else use steriods forsevere attacks? I have tried the NSAID for attacks for several yearsnow but it seems to take maybe a week to get the same results that Iget from the steriod. My thinking is that the pain causing moretissue damage and relieving the pain faster is better in the longrun. When I have used a NSAID it tends to relieve the pain but thenpain would move the next day to another area of the foot prolongingthe attack. So could the steriod be doing other things to preventmore attacks since I must be in a higher state of uric acid levels.By the way comparing results…my Uric Acid level was 13.5 mg/dLback in 2/28/2003 when I saw my regular doctor. My reumatolgistresently tested me in June and I was at 4.1. That about two monthinto my Allpurinol use. Well I tried to get my surgeon to suck outsome fat while he had me cut open that would have been an ideal wayto remove those uric acid filled fat cells.
Hi..and BEST! of luck!GOOD luck in your recovery!
Yes I have tried..been on the maximum dose of steroids..I wasseverly warned before this..you get this for a very short time..thenno more..back to the gout pain..then you get to go back to maximumdoes of colchicine.. The steroids did NOTHING for me..I simply could not feel ANYeffect from them..or the Nsaid’s..they were all like taking nothing. Meanwhile as I was fiddling around with that for a while..it wasa little bit harder ro get the colchcine back up to speed. I would stay on the colchicine.Colchicine is getting more popularagain..it is being used more and more now..especially formaintenance..but started at a much lower dose.Started at a dose thatdoes not upset your stomach..even cutting the tablets up..taking abit at a time..then buiding it up. You have gone from 13.5 to 4..that is a drastic plunge in uricacid levels..I am not a Dr..nor an expert..but from what I know..DR’sI have talked to..your gout attacks are now not caused by your uricacid levels per se..average levels..BUT by the old nasty secondaryuric acid deposits.I know there are those that don’t believe thereare or can be deposits..but here you are my friend..clearly with alow enough overall uric acid level to stop the attacks..IN THEFUTURE..but not now.I have had mind bending attacks..not hobbling butcrippled at a uric acid level of 3.Obviouslly there are deposits ofuric acid/crystals..probablly mired in a mixture of white bloodcells..swelling..and none of this can get diluted/dissolved..backinto the bloodstreaam and filtered out. Getting rid of these deposits can take time. Sometimes too strong a dose of allopurinol at the beginning cancause this..but on the other hand..to weak a dose can do nothing. I don’t see any alternative..stay on the allopurinol..it willwork..give it time.You have to get rid of thedeposits/crystals..somehow. I would get on/stay on the colchicine..build up the dose.
As for mechanically removing uric acid/crystals..deposits..theyare often in locations where they are inaccessible..buried in jointtissues.Give the allopurinol enough time..they will go.
Once you can walk ok..painfree..I’d get a cushy pair of high archsupport runners..walking..a lot of flexing..will really get thingsworking down there..circulation etc.
Going off allopurinol..it doesn’t usually work.