My first year without an attack
I just got through my first year without an attack. Alloprinol is the best. The only thing I really changed was no alcohol anymore….well, almost:) 100mga day and thats it. It’s nice to see everyone helping each other with thisgroup.
Olin Hardges on July 21st, 2007
Okay, just saw the ortho. He doesn’t think it’s gout now, since thesteroids did’nt totally get rid of the pain & swelling. Wants me tohave a bone scan, which will pinpoint exactly where the problem is,but won’t tell WHAT it is.
Asked him about drawing out fluid to check for uric acid crystals. Hesaid he NEVER does that because there are no uric acid crystalspresent during an attack. Says that enzymes spit out by the crystalsare what cause the pain, but there won’t be enough there to check, orsomething like that.
Next step after bone scan will probably be an MRI, but I don’t knowwhat that will tell us. I’M SO CONFUSED!!!! Should I see another typeof DR? The bone scan is scheduled for tomorrow. I’m wondering if Ishould postpone it & think about it, do more research, see another DR?
Terrance Molock on July 21st, 2007
Steroids did nothing for me.
I’ll take it that there is a miscommunication/misprint here:
Respectfully..many,many,MANY people have had needle aspirationDURING gout attacks..INDEED this is probablly “THE” hallmark of gout. MANY people have emailed me. I have read of this in mANY,MANY places People on this group have posted this. This is common,common,COMMON..in almost EVERY medical piece ofliterature/medical textbook/training manual etc., I have discussed this with NUMEROUS people in the medicalfield..from Dr.s,internists,rheumatologists,lab technicians,footspecialists,..i/e the people that ACTUALLY take the sample..and seethe crystals..
Actually during an “attack”..the crystals are actually MOREPREVALENT..ALTHOUGH the crystals that are “free” in the synovialfluid..are NOT quite as common/visable.The crystals may(during attacka lot of them will be) surrounded by white blood cells..actuallyengulfed by the white blood cells..sometimes PARTS of the crystalsare actually sticking out of the phagocyte(group of white blood cells) The crystals are more prevalent..because for 1 reason the uric acidlevel(concentration) has risen..MORE crytsals precipitate out of thissolution..THEN the uric acid level falls..THIS confusion over blooduric acid levels DURING ATTACKS(or just before/after) HAS fooled aLOT of people..I’m SURE this is where the confusion is.
There are problems seeing the crystals..USUALLY when there is noattack..as they areen’t NEARLY as likely to be free and NOT underattack by the white blood cells..hence they will be more shrouded byphagocytes.
There have alos been EXTREMLY rare cases where crystals have beenfound and no attack..
Pretty much any medical book..even out here on the net will haveALL the info./pictures.
As for the “enzyme” theory..causing the pain.This is a relativelynew theory.This theory is that when the white blood cells surround aforeign object(in this case a crystal) they engulf it and attempt todestroy it/break it down.The methods they use are not known.It isknown that crystal surrounded by white blood cells in a “protective”phagocyte..does decay..method unknown.One theory is that the attack(the “REAL” attack..NOT the white blood cell attack on the crystal)BUT THE REAL GOUT ATTACK..is when this phagocyte eitherdecays/bursts..or simply starts to leak..the resultantchemicals..HIGHLY COMPLEX nuclear medicine type stuff..are what NOWcauses a reaction..some say that it is ACTUALLY this chemicalreaction that causes a BURNING!!..FEROCIOUS!!!..AND theinflammation..and NOT the actual crystal that causes the pain.Otherssay that it is this “NEW” EXTREME inflammation that creates intensepressure on the phagocytes with these crystals in them and SHOVESthem against the joint lining..
I’ld see another Dr. a rheumatologist..or at the very least tryand get the joint fluid examined at the right time.
This observation of crystals during an attack is actually socommon that MANY DR.s tell the patient that DURING the next attackthey will determine if if is gout by this method..indeed..this isOFTEN a BASIC return..to either CONFIRM..or RULE OUT gout..
Olin Hardges on July 22nd, 2007
I can’t figure out why my dr. has such different ideas about goutcompared to everything I’ve read here and lots of websites. He’s avery good, well-respected orthopedice specialist & surgeon. However,I cancelled/postponed the bone scan & have made an appt. with a footspecialist for next week to get a 2nd opinion on how to proceed.(There is no rheumatologist in my town.)
Terrance Molock on July 24th, 2007
I dunno..I can tell you this though..someone with gout..and a Drwho says it isn’t..VERY,VERY tough for that person to get the helpthey need.I don’t like getting between people and their Dr.s..I don’tmind locking horns with Dr’s..been there/done that..someone suspectedgout..Dr said no..wouldn’t do the fluid sample..they went somewhereelse..it was gout..THEN the Dr said the crystals must have JUSTappeared..ya right buddy.. after YEARS of attacks..I guess we ALLhave to do our homework..this person just found another Dr.
NOT very many Dr’s like internet information regurgitated atthem..I’ve had a few try and catch me..like..”AND WHERE did youhear/read that”…”Out of the Merck medical manualonline”..”oh..oh..the public can read THAT online???”…”yup”…
Camellia Netti on July 25th, 2007
Six weeks on A-train. Couple of attacks. Think I might I havefound a cause for recent bouts. Broccolli. Bd stuff! I love it,my wife loves it and it’s supposed to be good for you. Oh well. Atleast I can walk. Bit of alcohol, no probs. 6 heads of broc!!! Yeow.Funnily enough it has got me twice - in my right foot - which untilthis point has generally been OK. Started in my arch, then intoankle. Previously I’ve had two slight goes at it over 5 years. Notbad.
I’ve been reading previous emails. Feelings and emotions havebeen on the up! Quiet for a couple of days…nice.
Terrance Molock on July 26th, 2007
Glad you’re doing well! ENJOY! the ride..ya brocoli..been the baadboy for a couple years..once you’ve been on “A” for a while youSHOULD be able to eat it again.Attacks on the move..not uncommonwith “A” but they’ll go too..best.