September 8, 2013 at 12:25 pm #15191GoutRonParticipant
First attack was in my right knee at about age 40 in the middle of the night. If I had owned a gun, I very well may have killed myself to escape the pain. My family doctor – who KNEW of my high daily beer intake and I don’t drink Bud Lite, ok ? – referred me to an orthopedic ! He didn’t recognize gout. In deference, I told him it flared up a couple days after heavy firewood splitting activity, but c’mon, he should have known. Ortho guy did an X-Ray on the spot, MRI 2-3 weeks later, and finally labeled it a severe sprain, Rx’ing me Celebrex and Vicodin. I found that 800mg of ibroprofen (get the Rx tabs, they work better than taking 4 OTC pills) worked better than BOTH Rx’s. I went back after a month or so of no improvement (other than some pain relief) and he drained it and did a Cortisone shot. I was 80% better the following morning. After months on end of severe pain, I hailed Cortisone as the greatest thing since sliced bread.
Second bad flareup was in the same knee again a year or so later, this time the ortho guy suspected gout, did a fluid sample check, and yep, uric acid crystals. He then said this is something your family physician should handle. Doh. Repeat drain and Cortisone. Family doc prescribed Indomethacin, which didn’t seem to do much for me, but I don’t know if I gave it a chance because I hate swallowing capsules.
My family physician at that time was also a sports medicine guy. I cannot stress how much I would avoid having a family practitioner who has that specialty interest: The solution to every problem was: Exercise. When that guy finally went to teaching vs. practicing, and I saw my current doc, the new doc told me that based on my family history, 50% of my (minor, thankfully) health issues were hereditary, something my prior doc would have been loathe to state. I fully believe that what many of my long- deceased relatives had was not arthritis, as they called it, but gout.
That prior doc also refused to give me pain killers because of my alcohol use. Mind you, I still had Vicodin sitting in my house, largely untouched. My experience is that gout can and often does hurt much worse than a broken bone, and if your doc won’t Rx painkillers, find another doc or go to the ER. As I told my current doc, the flare ups were getting more often, more painful.
By now over 5-6 years I was used to moderate flare ups in my right knee and left ankle, about 3-5x a year. 800mg of iboprofen always knocked it back fairly well, but late in the day the pain could be pretty bad / it was painful to walk. Then 2 years later (8-10 years since initial attack) I got a flare up in my middle finger joint. A harbinger from the gout. 😉
Low and behold, the right knee came back worse than ever about 4 months later. Percocets were a Godsend at night. My knee was 3x its normal size, and doc drained and Cortinsoned. I was good for about 3 weeks, then the gout … came right back. I never had it come back that fast after Cortinsone. Tried black cherry juice for the first time, as well as cutting back on alcohol by 2/3, and that seemed to help a lot and the flare was greatly reduced.
My doc would not start Allopurinol unless the flare was gone, and this is a doc who graduated about 10 years ago, so that mentality is still out there. I just took my first tab of Allo / 100mg, with currently only minor stiffness in a few joints. Doc also was not aware that Allo could (I told him probably WOULD) flare gout. I know he started me on a low dose as a precaution, new med. (Why we didn’t start Allo years before is a bit of a communication issue – I had confused Colchicine and Allopurinol).
I’m looking forward to adding cold cuts back to my diet in the next few months, if the Allopurinol does its thing.
I have a lot to read in the forums, but FWIW, this is the majority of my experience. (I don’t know my uric acid number off my head, I know that sounds stupid to you guys, but I have seen the number / am aware that’s the focal point).September 9, 2013 at 1:30 am #15192Keith Taylor (GoutPal Admin)Participant
“so that mentality is still out there” Yes, it’s a shame. Anyone else in this situation, the best approach is to insist that your doctor checks out “Initiation of allopurinol at first medical contact for acute attacks of gout: a randomized clinical trial” from the November 2012 American Journal of Medicine. More info in my Start Allopurinol Quickly, But Carefully article. It depends on the doc, but it’s usually best not to say you read it on the Internet. Just say your friend’s doctor told him about it, or something similar.
@goutron, I hear what you’re saying about the uric acid number, but you are probably going to have to become more aware of it – probably to remind your doctor that it must be 5mg/dL or lower. Indeed, I would suggest much lower for a year or so, to get rid of old crystals as soon as possible.
Thanks for sharing your experience. Please keep us informed about your progress with allopurinol. Personally, I’m sticking with my 900mg per day for as long as I can to clear out the old uric acid deposits. The only gout pain I ever experience these days is what visitors tell me about here in the gout forum. 😀September 9, 2013 at 5:38 am #15193CujoParticipant
It is amazing that you had to experience so much pain and dealing with quacks before some doctor prescribed you allopurinol.
There is a big chance that your life gonna be better now.
Personally, I am for two months at 100mg and I manage to keep the uric acid level beetween 5 and 5.5mg/dL. I eat everything I want and drink alcohol (especially red wine) on the weekends.September 15, 2013 at 3:04 pm #15284GoutRonParticipant
Thx for your replies and support.
One week report – Allopurinol did flare the gout in my usual location – right knee – but it was not a worse case scenario. It also hit my right ankle / foot a bit, somewhere it has never been before.
I am getting side effects from the Allo: A general feeling of malaise and a slight sore throat. Overall just lethargic. It feels like my body is fighting something, like the feeling you get going into a bad cold or flu. My head often feels like I have a low grade fever but I don’t. Probably something to do with white blood cells going ape-sh!t.
After about the 5th day, the flare in my knee subsided noticeably. At that point I’d pop 800mg ibuprofen (yeah, I butchered the spelling in my first post) on an empty stomach in the morning (not recommended) and 1.5 hours later I’d be doing good on the pain front.
I don’t see my doc until the first week of October, and that’s when he’s gonna order blood work. I’ll post a before and after uric acid count closer to the beginning of November.September 16, 2013 at 12:07 am #15294Keith Taylor (GoutPal Admin)Participant
Thanks for that, @goutron. Very interesting.
Getting gout attacks in previously unaffected joints is a real insight into the nature of gout. Uric acid crystals grow very slowly. Recent research has shown that uric acid crystals alone rarely (if ever) cause gout attacks. It seems that our immune systems need something else to trigger the massive inflammatory response. The most likely candidate is Free Fatty Acids. Whatever the mechanism, we can see that slow uric acid crystal growth is often painless. Hence the reason why some people get horrendous tophi growth yet never experience gout. But when uric acid crystals start to dissolve, they do so very quickly. The white blood cell coating drops away, and the resulting large number of crystals can provoke an immune response. This often happens in multiple joints at the same time, including places that have never troubled us before.
On a practical note, my doctor knew of this possibility, and prescribed preventative colchicine for two weeks with every dose change. It usually prevented gout attacks for me, though I occasionally had to help it with 800mg ibuprofen.
Your feverishness has been reported by many gout sufferers. I guess it’s quite common when the immune system has gone into overdrive. Plenty of hot tea is my best advice. Or celebrate your path to gout freedom with liberal doses of your favorite alcohol!
I look forward to reading about your October results.September 16, 2013 at 1:55 am #15299CujoParticipant
At the beginning of taking allopurinol I felt like an old man. All day I felt weak and tired. I had a small attacks lasting up to three days in the worst case. Colchicine has always helped in those moments. Interestingly, the pain seemed to move to other joints than the usual big toe joint, but mostly it was not strong pain but rather a feeling of stiffness and numbness.
Know that it will pass, most likely after the first few months. Be glad that you belong to a group of people who are not allergic to this drug.
I highly recommend home testing kit of uric acid in the blood. Personally, I have Uasure. It is not very expensive stuff but it is very accurate.
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