Catch 22

[Michael]

I've now had a gout attack which has lasted for over a month. Despite adopting a spartan diet and drinking plenty of water I can't seem to break the attack.

The doctors have given me Voltaren and colgout. As the colgout gives me diahorrea, I only take that every 12 hours instead of the prescribed 6 hours and then I stop it when I get diahorrea normally after 3 or 4 days.

The doctor has also prescribed zyloprim but I can't start that until I have been 28 days without gout.

Question: If the medication I am taking is not reducing my uric acid levels then how the hell am I going to stop having a gout attack and then being free for 28 days in order to take the zyloprim in order to reduce the uric acid?

Catch-22!

[Jeem]

I found Vitamin C to be a big help ,

I take 1000mg a day , It quickly stopped the attack

Jeem

[JohnAnderson]

I've now had a gout attack which has lasted for over a month. Despite adopting a spartan diet and drinking plenty of water I can't seem to break the attack.

The doctors have given me Voltaren and colgout. As the colgout gives me diahorrea, I only take that every 12 hours instead of the prescribed 6 hours and then I stop it when I get diahorrea normally after 3 or 4 days.

The doctor has also prescribed zyloprim but I can't start that until I have been 28 days without gout.

Question: If the medication I am taking is not reducing my uric acid levels then how the hell am I going to stop having a gout attack and then being free for 28 days in order to take the zyloprim in order to reduce the uric acid?

Catch-22!


Just for starters, I'm not a doctor by any means, I've just been through this for quite some time and I constantly read up on the subject. So take my advice with a grain of salt. I'm assuming that the 'colgout' you referred to is colchicine, or is a brand name for colchicine. Colchicine does cause, for lack of a better word, insanely uncontrollable diarrhea. It's a known side effect of the drug. However, colchicine is only an NSAID (non-steroidal anti-infamatory drug) used to control pain through controlling inflammation. Gout pain is caused by an immunological response known as inflammation, but that is covered elsewhere on these forums. The special thing about colchicine is that it combats this inflammation without interfering with kidney and liver function. Uric acid balance is entirely dependent upon your kidneys and liver doing their jobs. If a doctor gives you a pain reliever that relieves the pain, but taxes your kidneys (ibuprofen, Tylenol, and their stronger derivatives, i.e. percoset), he's only stalled the pain. These types of strong, pain relieving drugs, have a cost when dealing with someone who's hyperuricemia causes gout inflammation. That's why you will rarely see a doctor prescribe strong opioid based NSAIDs for a gout patient. Furthermore, very few "strong" pain relieving drugs relieve the pain INSIDE the joint. These opioid drugs simply don't work well with gout pain. In reality colchicine itself does nothing to rid your body of excess uric acid, it only serves to manage pain while not interfering with your bodies natural liver and kidney process of handling uric acid.

However, if you have the diarrhea side-effects of colchicine, the colchicine is, in fact, mucking about with your bodies natural system of reducing uric acid. The diarrhea is dehydrating you. When faced with a gouty diarrhea attack, you sure are going to limp, crawl, or crutch to the bathroom when the colchicine explosion kicks in, but are you going to limp, crawl, or crutch to the sink for 24 ounces of water afterward? Probably not. If you can't excrete uric acid you aren't going to get over the attack, and if you don't have excess water, you can't excrete the acid.

Since you are sensitive to the side effects of colchicine I would recommend that you talk to your doctor about using naproxen sodium (main ingredient in Aleve) for pain management. The prescription strength versions might tax your kidneys and liver, especially your liver, a bit. However, this taxation might be much less than the dehydration involved with colchicine. I too get unmanageable diarrhea when on colchicine, but after some discussion my doctor and I have settled on prescription Naproxen, with an over-the-counter ibuprofen supplement for pain.

This post is getting long, but hopefully by now you have found out that there are two, conflicting objectives a gout sufferer must reach. The first is to control pain, and the second is to control Uric Acid levels. Unfortunately, controlling pain usually disables the reduction of uric acid. Hell, if it were easy, it would have been solved long ago.


Furthermore:

Voltaren is another NSAID, your doctor may have prescribed this to treat pain, not hyperuricemia, in the place of colchicine, to help manage your pain while limiting side effects. If this NSAID works to relieve your pain you will likely be off colchicine, and you can forget everything I said above about naproxen sodium, because your doctor is smarter than me.

Zyloprim is a brand name for allopurinol. Please talk to your doctor about Uloric. Allopurinol, in most people, is only effective in pretty strong doses. These high doses have been known to cause their own damage. Recently a new drug was approved which proved to be more effective in smaller, less destructive, doses. Basically, if you ask your doctor "Why allopurinol instead of Ulroric?", and he has an answer, than by all means trust him. But if he says, "What's Uloric?", then talk it out, and get a second opinion on it. I only say this because a new gout drug hasn't been approved since the 1940's, and my first PCP who dealt with my gout refused to go outside any drugs or treatments which weren't popular in the 50's and 60's. Don't get stuck in that time warp.