Hello everyone,
My name is Marc and I recently suffered my first gout attack. No need to describe the pain in my Big toe joint as everyone here knows the pain associated with gout. Anyway, I’ve got questions and this is obviously the place to be.
I sweated throught the pain of the attack for 12 hours with no sleep. Finally I tried a teaspoon of baking soda in water and then took 3 ibuprofen’s. The pain, although still very bad, subsided enough that I fell asleep….or passed out, who knows!
I scheduled a doctor appointment immediately but could only get in 5 days after the onset. ?I continued on the 600mg ibuprofen regime every 8 hours along with some ACV and Baking soda but not?religiously?because I could tell that it was the Ibuprofen that I was?benefiting?from.
While visiting the doctor, the pain had subsided to about half as bad as the original attack but the doctor easily diagnosed it as Gout and loaded me down with anti-inflammatories and pain meds. Very quickly I realized that I could not take Colchicine or Tramadol. Colchicine gave me bad pains in my back in the Kidney area and I assume that the Tramadol was causing my stools to turn pale so I discontinued both and stuck with Indomethacin which I must say works wonders. ?He ordered a Uric acid test and the results came back 6.9 but during a prior visit (8 months prior) the routine blood work came back with a Uric acid level of 7.0. He commented on the elevated level but didn’t not diagnose me with Gout. It is very unfortunate that a person must suffer through at least one attack before being treated for this horrible disease. ?I also had a blood pressure reading during the Dr. visit (for gout) of ?150/90. He attributed this to the pain because during the course of the duration between visits I managed to lose 30 pounds and my cholesterol profile prior was optimal.
I am now on Allopurinol (1 week) at a dosage of 100mg per day. I understand that most consider this a worthless dosage but I assume he is looking for any adverse reactions before upping the dosage. I just had blood tests today which I’m sure is for establishing a base line. He has another set scheduled for 8 weeks from now. Is this the normal progression or should I have Lab test more frequently. I have a history of Liver enzymes?occasionally? spiking (probably from brew) and I am a little concerned. I also take Milk Thistle for Liver support and wonder about drug interactions.
Currently I have back pains, can’t associate them with the Allopurinol but I do think its from gas. Can Allopurinol cause gas?
Are there any things I should be?forcibly? suggesting to my doctor?
Thanks so much for providing such an informative forum
Sincerely, Marc
Hi Marc,
Welcome, and thank you for a comprehensive introduction – it’s a lot easier to discuss gout when you have some key facts.
First, about baking soda. This is a powerful drug that is, in my opinion, not sufficiently safety tested for gout use. Personally, I avoid it due to blood pressure issues. Where it is used medically for gout patients, it is always in the context of dissolving kidney stones. This works because uric acid is more soluble in a high pH environment. I noticed in one or two reports that rheumatologists seemed to be favoring potassium citrate and/or potassium bicarbonate. I have not investigated this thoroughly, but the reasons seemed to be related to excess sodium making uric acid crystals worse.
My preference is to use diet improvements to enhance pH, but I have to admit that I have rarely taken this completely seriously, preferring to simply improve my balance of veg to meat. Maybe 2013 will be my year for serious diet planning – my waistline needs it, and I might as well target gout as well as general health.
I’m not really sure where ACV comes into the equation. I cannot see that there is ever likely to be much research in the usual medical journals. This leaves self-experimentation which I’m not prepared for at this time, though I’m happy to read other people’s efforts.
Your experience with pain relief is interesting. It supports my general principle that you should work with your doctor to find the right pain relief choice(s) that suit you. I’m also firmly in the ibuprofen camp, to the amazement of some people who cannot tolerate it. Each to their own.
The most significant point about pain relief is that it must only ever be seen as a temporary necessity during uric acid lowering treatment. It is not safe to take NSAIDs or colchicine for long periods. They should be used to get you over the early months of uric acid lowering when dissolving crystals can trigger an attack.
I’m a little disappointed that you are having to wait 8 weeks between tests. The minimum is 2 weeks to allow the effects of a change in allopurinol dose to stabilize in the blood stream. You could argue that 1 week would be sufficient, but 8 weeks is too long. It is not intrinsically harmful, but it prolongs the length of time you are on lower than necessary dose, which in turn prolongs the time you are exposed to pain.
I looked into milk thistle once, and everything I read indicated it had very little effect. I would recommend avoiding it for now until the allopurinol is at the right dose to keep your uric acid at 5 or below. Once you feel comfortable that allopurinol is doing it’s job, and keeping your uric acid safe, you can always introduce other supplements if you think they will help you. That will ensure that you have a good history of uric acid results to measure any other supplements against.
I’m a bit worried about the back pain, which is suggestive of kidney problems. The only general recommendation is that allopurinol should be accompanied by adequate hydration, That means maintaining urine output of around two and half liters per day. My best advice is to arrange a blood test after another week of 100mg allopurinol, and make sure the tests include liver function and kidney function.