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Hi Guys,
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I am sure this topic might have already been discussed a hundred times over, so please accept my apologies if this is old hat, a bit about myself first.
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I am 34 years old, diagnosed with Gout approx 8 years ago, given diclofenac and colchicine initially, i was also prescribed 100mg of allupurinol, once the attack subsided I didn?t continue with the allupurinol and in the 8 years have probably had 2-3 serve attacks which have gone after a week or two of Diclofenac. In those eight years I also had mild attacks, some which just went same day with no treatment. I did also initially have blood tests which confirmed gout, not sure of the readings. ?
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presently I am in week 2 day 13 of an attack, this one seems really weird and I would like some advice, I get the attack generally around 9-12pm, its serve, like mind bendingly painful, then by 9am my foot is almost back to normal, no extra swelling, I can walk, no problems, then 2 days later or sometimes the next day, another attack (could be the same attack) it hits serve, I pop? the diclofenac (150 mg slow release) and it subsides in about 6 hours and the swelling goes to zero… this has repeated for 14 days so far.
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I did go and see my GP because I am accepting that I need allupurinol or another treatment plan, the GP firstly changed the diclofenac to indomethacin (with stomach coating medication) told me to settle the attack first then I can start 300mg of allupurinol, currently I am taking x2 (occasionally x3) colchicine tabs (total 1.5mg) daily as prophylaxis and if I feel an attack (25mg of indomethacin), I am just wondering if anyone else has had this gout hiding syndrome where it seems to have fully gone, then full on attack which seems to disappear, also since the first attack 13 days ago I have changed my diet, was previously rich in white meat and fish, am being very careful and having 2 litres min of water a day. Also just to note this is my second day on colchicine, so not sure if it will hold off the attack, but will see tonight, any thoughts are greatly appreciated.
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also, this site is amazing, I felt so alone when this kicked in a few weeks ago and now feel like I have people I can talk to, no one else seems to understand, partner, GP, friends.
ctrl,
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That sounds more like the syndrome characteristic of CHRONIC gout, frequent less severe attacks,?rather than ACUTE gout, infrequent and unabatedly?INTENSE,?but there is a whole spectrum of gout manifestation made even broader by use of several pain meds during the long bout.
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If it goes on for much longer, just take the allopurinol rather than waiting too much?longer. When you start, don't stop for anything except a serious?allergic rash. Continue to take the colchicine with the allopurinol for perhaps a month.
You might try a day with 8 or more colchicine to see if you can knock it out.
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Avoid beer for a while.
Hey Zip
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thank you for your reply, attack seems to have gone for now, I did a day of 3×0.5 colchicine and then dropped it to 2 a day for the rest of the week, this is week 3 and ive so far had none, will pop one at lunch time and then not touch it unless needed later.? I had a blood test this morning for urate/lipids/glucose so will get those results on Friday.
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My GP so far hasnt given me a script for allupurinol though I suspect if I push she will, ill see what the results say of the blood test, if im close to the edge I think there is no question I should go for it.? Not sure what sparked this 2 week episode but I dont drink beer so probably not that, however, my diet was previously rich with white meat, coffee, and sweetner…. so perhaps my changing that is helping.
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thanks for your advice, I dont think its chronic gout as perhaps as you said the NSAIDs just did a good job hiding the attack, previously my attacks did tend to last around the 3 week mark before settling.
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After 8 years it is none too soon to start allopurinol in earnest and forever. I recommend you go right to 300 mg. If your doctor talks nonsense about 100 mg. to start, tell her you already DID that and you are not allergic to the drug so no sense screwing around with an ineffective dosing schedule.
Hey Zip,?
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I have actually tried 100mg 8 years ago and it was fine for me, no reactions or rashes or anything, so I will just insist on 300mg, Im sure she will agree, she was asking me what medication I think I should be taking, I work in the Medical Industry in the UK so have alot of contact with Nurses and Doctors.?
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forgot how much I HATE blood tests till today, foot is being weird tonight, just scaring me with a tingly feeling, not swollen but feels like it really wants to swell up, have popped another Colchcine about 5 mins ago, bringing the daily total to 1mg, will see if that holds up, if not will be popping more tonight.?
also, got my bloods back today, had a whole lot of work done, everything is within range, however the urate is 0.4mmol/L which is equal to 6.7 on the american chat I think.? So very much borderline, definitely need to get back to the GP and take on allupurinol.
When you see your doctor, if there is resistance, you must point to the British Rheumatology Society recommendations that any level above 0.3 mmol/L should be treated.
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As I have said, on many, many, occasions, the “normal” range is ridiculous. All the labs do is take a mathematical normal distribution of all the samples they have analyzed during their sampling time. It varies from lab to lab, and it varies from man to woman. That emphasizes how ridiculous the process is. Women have lower average uric acid because the sample includes pre-menopausal women who statistically have lower uric acid due to blood loss and possibly due to hormones. Gout occurs at the same uric acid concentration in men and in women, but the averaging process used to set the mathematical normal values suggests that they get gout at different uric acid concentrations. Absolute and utter rubbish. All those years of training to be fooled by something like that is unbelievable, but true. What really worries me is how many other diseases are assessed and mistreated in this way.
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Use the search box at the top of the page with normal uric acid no thanks to find more. I have not yet uploaded the aforementioned 0.3mmol/L recommendations, but I can email it to your doctor if they do not have it.
Hey Keith
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thank you very much for your reply to my blood results, I have had a quick chat with the my GP and she is happy to put me on 300mg but is advising me to think about it and let it settle, I work in the NHS and have had about 3 opinions so far, 2 gps saying allupurinol 300mgs right now, and one in Camden saying wait and see, I have spoken to my boss, who understands the settling period of starting allupurinol and im lucky enough to be able to get blood tests when I want.?
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I am going to give it a few weeks and then make a decission, however, I think ill be moving to allupurinol as right now im 34 and dealing with this, I dont want to have to deal with it when im 60 and in a weaker state with a weaker system that wont tolerate medication, also let me know do you take donations to your site ? I think your site is amazing and the support is a god send, if there is a way to help you with the site, pay towards your hosting or something let me know if there is a donations link.?
ctrlkeys, everything you say makes perfect sense, but there is one very important thing missing ? your uric acid number.
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I have experienced the same opinions that your wide range of experts provide. Chiefly because I go to a practice where there are several GPs, but I've also had some hospital involvement. It makes me cry in my overtaxed beer that all our tax money that has been spent funding experts to determine what a safe level is gets ignored.
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Not only does it get ignored at the diagnostic stage ? so the 0.3 medically safe level gets changed to a meaningless 0.4 statistical normal value. It also gets ignored at the treatment stage, so doctors talk about a 100mg dose, or a 300mg dose instead of talking about a dose that is sufficient to make you safe.
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I do not know whether to wish I was a doctor, or thank my luck that I'm not. In any event, I wish you all the best in getting your gout freedom.
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Help with hosting is always extremely welcome. There is a donation button and explanatory link below each of my posts in right-hand side of the signature area. If it isn't working, it might explain why I'm brassic.
[For our lovely non-UK visitors and uneducated Brits, that is a bit of Cockney – brassic = boracic lint = skint]
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