April 16, 2010 at 7:46 am #3242
Has anyone done this? I went in to the clinic today to have my monthly UA test done via blood withdrawl. Once finished with this, the lab technician walked in with a liter and a half jug and told me I was going to have to do a 24 hour pee test. First off, I told him I'd need more than one jug, and second, I asked, why?
I actually don't mind doing this, but it's going to be kind of a pain. What it entails is first emptying my nightly build up of fluids in to the toilet once I wake up, then using the jug to pee in, recording the time of each pee, for a 24 hour period. I have to keep the jug either in the fridge or on ice between pee sessions.
I'm just wondering why this new doctor ordered this. I don't want to reiterate everything I've typed on my blog, but is what it basically boils down to is that my doctor was accusing me of being addicted to prescription drugs. I had to see this new doctor instead of my regular doc because he wasn't in. It was a mess and really pissed me off. He told me that my gout didn't look that bad. He said that if it was so bad, where were all of the tophii deposits? He said that what I've been doing over the last six months obviously isn't working since I'm still getting gout attacks. He was arrogant, antagonistic and smarmy and I wanted to ring his neck by the time I left.
Again, doing this test doesn't bother me. It's just more data for me to crunch in my battle with gout. I just wonder what his motives are. I will be talking to my regular doctor about this visit next week. This doctor knows what I've been through over the past year (horrible gout, blown knee, broken jaw in multiple places, and now a bad back). He knows I'm not making this pain up and knows that I deal with more pain on a daily basis than most people will in their lives. I usually can take it. Some days I can't.
Anyway, I've written more about my doctor visit last week in my blog. See the 15th and 12th of April posts if you're interested. http://goutactiveperson.blogspot.com/
Thanks for listening!April 16, 2010 at 8:02 am #8304trevParticipant
Hi Nate- Docs do vary a lot , don't they. having a good 'one to one' working relationship is important. But the friendly ones are always [necessarily] the best!
Nothing worse than one right up themselves… Docs usually like prescribing more than most like taking meds., for sure!
You will get more detailed explanations on 24 hr urine test from people here who have done it – but the main aim apart from checking kidneys is to see whether you're an under excreter or over producer of uric acid- and thus aid decide the treatment of high SUA, and the subsequent gout .
This is a good test to do- and can only enhance diagnosis of your gout so bear with it, like with the pain- as you know you can!April 16, 2010 at 8:29 am #8306
Hi Trev – that's good stuff to know about the kidneys. This was sprung on me with little explanation this morning. As I (and you) said, the more information, the better!
It will be interesting doing this on Sunday, though. The wife and I are supposed to be attending a spring festival in Nurnberg then. I'll have to bring along a cooler and the jugs! We'll probably have to cut things down to an hour or two as we're just going to relax and take some pictures.
thanks, Trev!April 16, 2010 at 8:32 am #8307Keith Taylor (GoutPal Admin)Participant
Sorry Nate, but you've ended up with a 24 carat medically-incompetent tosser (please feel free to tell him I said so).
The 24 hour pee test is a great diagnostic tool in early gout management. This is where the doctor assesses the patient's condition prior to planning the treatment options for the urate deposit removal phase and the maintenance phase. It allows the physician to assess your kidneys urate excretion rate. This determines if you are an underexcretor or overproducer of uric acid. Underexcretors can often be treated with uricosuric drugs such as probenecid, whereas allopurinol works for both. This test is probably just as useful for those who want to try to manage uric acid without drugs, as it gives you a clearer picture of the best way to tackle the problem.
If you are taking allopurinol, the test is totally, 100%, absolutely pointless. Allopurinol will reduce your uric acid excretion rate because there is simply less uric acid to excrete. The test reults will be totally, 100%, absolutely worthless.
The reason you still have gout attacks when taking allopurinol, or any other uric acid drug is well understood by those who understand gout, and falls into the realms of mystical magic for those who don't (or at least it confuses the dumb bastards). By the way, that smugness is directed to your idiot doctor – I can quite understand how laymen would not realize that uric acid lowering can temporarily cause a gout attack. I cannot understand, forgive, or tolerate a member of the medical profession who shows the same lack of awareness. The words Professional Negligence spring to mind.
Hang in there Nate. It can take several months on allopurinol to clear old uric acid crystal deposits. You are doing all the right things, but maybe a further increase in allopurinol (maximum is 900mg) will lower uric acid below your current 5.8, and speed the urate reducing phase. Probenecid MIGHT help, but this will be hit and miss as you can only assess your uric excretion rates if you stop taking the allopurinol for 2 or 3 weeks.
Please feel free to use any of this on your fasciNAT(E)ing blogApril 16, 2010 at 9:39 am #8310
Two things to consider here:
1. GoutPal is correct, there is absolutely no point in getting urine urate output when you are taking allopurinol.
2. Maybe there is ANOTHER reason your doctor wants your urine?
but is what it basically boils down to is that my doctor was accusing me of being addicted to prescription drugs.
A word to the wise.
Pssst, MY 24 hour urine test was with a GALLON bottle…and I almost filled it.April 16, 2010 at 10:53 am #8312
THANK YOU for that goutpal! Yes, this guy is a tosser. I've come to this conclusion after only seeing him twice. He also has an odd habit of snorting loudly and rubbing his nose every 20 seconds or so. Seems that maybe he is the one that should be taking a pee test 😉
Maybe I'll just fill the jugs with a mixture of lemonade, beer and jellied head cheese at the fest! Nah, I'll do this for him to prove I'm not some Tramadol/Percocet/Vicodin crazed drug addict.
(AND, YES, I still stand behind my regimen of percocet/prednisone to stave off my worst attacks. It works for me and allows me to still go to work and get my job done without taking vacation time or sick leave. It still is very painful and sucks, but it works – again, for me.)
Trev, my regular doc knows what I've been through, what I'm going through and what I need to do to get better. Yeah, I still bitch and moan about my gout (especially on my blog), but I am still light years ahead of where I was just six months ago. Day and night, my friend. I just need to stay the course and be patient, which is not always easy for me! The patience part that is!
Also, I just hope the two jugs he gave me is enough! I may be going in with a couple of extra tupperware containers as well 🙂
Okay, back to another project. Busy, busy, busy!! Thanks guys! Always appreciate it when you all chime in. Means a lot you all taking the time. Thank you!April 18, 2010 at 1:07 am #8332
After speaking with my wife this morning, I have decided not to do the pee test today. I'm going to wait and talk this over with my regular doctor before wasting this sunny day (somewhat rare in Germany!) carrying around a piss jug. Plus, I'm not going to incur the cost of the test if there is no need for it. I may do it later if my regular doc still wants me too, but I want more info first. I don't want to put anyone off at the clinic due to it being one of only two choices I have for doc support in my local area, but I think being armed with a bit more knowledge and hearing the reasoning behind why they want this (unnecessary) test would be prudent.
Enjoy your Sunday!April 19, 2010 at 11:54 am #8352cjeezyParticipant
This is something I've been wondering about for a while and was going to start a seperate thread, but will just add to Nates. Often you hear about people who can use a uricosic like Probenecid or whatever instead of AP or uloric. My first question is, is Probenecid safer and/or more effective than AP/Uloric?
My second question is related to the 24 hr urine test. I never had one done and have been on AP for 5-6 months now. If a person like me wanted to know if they were an underexcreter/overproducer, would it be worth it to eventually have this test done? and what would be the safest way? I'm assuming a person would need to ween of AP for a good 1-2 weeks then take the test…while keeping Colchicine handy and possible a home UA tester.April 20, 2010 at 9:51 am #8357
No, probenecid is NOT considered safer than allopurinol. I cannot speak to Uloric safety yet. I think the major problem is fear of coagualting kidney stones with high urate output. Also there is cross sensitivity with the sulfa drugs which makes probenecid quite dangerous for those with sulfa allergy.
If you DO decide to do the pee-pee test, stop allopurinol for at least 2 weeks beforehand for it to have useful meaning. Maybe not worth the risk of an attack though.April 20, 2010 at 12:59 pm #8360
zip – don't think I'll be doing that. I'm staying on the Allopurinol and that's that! I haven't missed a dose for six months and I'm not going to chance messing with my UA levels for a test such as this if it's completely unnecessary. I'll be seeing my regular doc Thursday morning and will be discussing this with him. I think he will agree. Besides, he already knows that I know more about gout than anyone in that clinic, including him. Kind of scary, eh?August 8, 2010 at 8:32 pm #9590davidkParticipant
Hi Nate- this is an old post of yours, but I wanted to share a couple comments.
First thanks for all your posts and your blogs. I have been on Uloric for over 6 months, UA has been below 5, still having flare ups. Your posts have given me renewed hope that perhaps a few more months and things will get better. Thanks for sharing and I hope you can ski this winter. That's one of my hopes/ goals too. I've been inactive now for about 9 months and it's annoying.
I saw you only have one kidney and have been told it does the work of two. I see you also questioned the purpose of a 24 hour urine test. I had a kidney transplant 16 years ago, so only have one functioning kidney. I'm a bit concerned for you that perhaps you have not been properly informed about your kidney function. But then, I think I saw that you have various lab work done regularly, so maybe the doctors are on top of your kidney function?
A 24 hour urine test (I've had several) measures kidney function among other things. Although my one kidney supposedly does the work of two, I actually only have about 40% to 50% kidney function– keep in mind, my one kidney is functioning just fine and as well as it ever has. you can go down to 10% kidney function before needing dialysis or transplant, but that does not mean 11% is just fine. So, I can only take .3 mg of colchicine per day and various other limitations. The reduced kidney function limits my ability to excrete UA and is the sole reason I have gout.
I suspect you could have reduced kidney function (perhaps not as low as mine because you have your own kidney from birth which should function better than a transplant). If you are not seeing a good nephrologist, I think maybe you ought to consider at least one round of testing- creatine levels, bun levels, maybe 24 hour creatinine clearance, etc. I wonder if your one kidney may well have more to do with your gout than you realize.August 9, 2010 at 7:18 am #9593
david (and Nate if you're still here),
What kind of 24 hour urate excretion did they determine for you on any of your 24 hour tests?
Hmmm, here's a good research topic: Does Uloric cause more initial flares than allopurinol? I wonder if anyone has done the study?August 9, 2010 at 9:13 am #9597davidkParticipant
Hi Zip. I'll check next visit (in about a month). I don't recall the number, but it was a little less than 50% of normal.
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