New member - gout advice please

[ZeeW]

Hi,

New to the forum.

Okay here goes.

Age 46
Weight 182 lbs
Height 5' 11"
Meds Lisinopril 10mg/day for 15 years

Problem and history:
A number of years ago I got excessive foot pain under the arch of my right foot. Diagnosis at that time was plantar fascitis and I received physio for it.

I then developed pain in the same foot around extensor digitorum brevis in a very small isolated area and fibula retin aculum and sometimes in the left foot. I kept having physio.

At no point did I have the 'traditional' pain in the big toe, but I did have some swelling and heat around the above areas. Ice, NSAIDs had little effect on the pain.

I had MRI scans and x-rays and both showed no structural problems.

At that time I was not diagnosed with gout as the Docs taking my history into account, did not see me as a candidate. Probably, because of my physical condition and that I am a person who cycles and goes to the gym regularly?

My flare-ups became more frequent and more painful and predominately in the right foot. This lead to a blood test to check out if I had gout. The results came back with an elevated urate level 515 μmol/L.

I was put on 100mg/day Allopurinol with no benefits. I was then put on 300mg/day. I got a serious pains in both feet for about two weeks when put on this dosage and pains in my right hip.

After 8 months on 300mg/day I was still getting foot pains in the same areas as originally mentioned and a further urate level was taken. The results were 450 μmol/L. The Docs decided to raise my daily intake of Allopurinal to 400mg/day. At this time I also started to get more severe (and I still have) dull pains in my right hip and right calf.

I am just coming out of a 10 day period where my right and left feet/ankles have been painful, not excruciating painful, but enough for me to take pain killers and NSAIDs. I have attached pictures and shown in red is where the pain was.

I still have a dull ache in my right hip that is now constant.

I have no other joint pains anywhere elese.

Diet:
Having been a former competitive cyclist my diet has always been 'clean'. I limit the levels of high purine foods. I drink over 2 ltrs of water per day. I limit the amount of coffee and only drink alcohol once in a while.

I stopped drinking for 3 months to see if this had a positive effect on me and it didn't. I even tried a bottle of red wine over Christmas to see if would trigger a 'gout' flare up and it didn't.

I am am due back at the Docs on Tuesday and I am at a total loss as what to do next? Can anyone offer any advice or help?

[Rufus]

I tried posting this response with links to some of the sites I was referencing, and it got bounced as spam, so here's my response without the links. I encourage you to google them though!


Have you ever had your kidney function tested? Based on your description of symptoms and history, I think you should see a qualified nephrologist.

I work at a medical education company and have a specialization in hypreruricemia/gout related disorders. My father also has chronic gout. As "well-understood" as it is supposed to be, it's surprising how few doctors really understand this disease.

Based on your history, you sound like a urate "over-producer", this means your high sua levels have little to nothing to do with dietary intake or modifications. (sort of similar to Cholesterol with some people) Most people develop gout after years and years of dietary choices that eventually lead to the bodies inability to eliminate uric acid efficiently enough anymore (similar to type 2 diabetes), so once thresholds are exceeded, urate crystals form and deposit in soft tissues and joints. These crystals do not always produce an immune response which is what a "classic flare" is. The pain associated with that event has more to do with the inflammatory response than the actual crystals. Crystals can accumulate silently for years though without triggering that response.

Once you go on a urate lowering therapy, you should be prescribed either a uricosuric to help eliminate the mobilized uric acid, and/or cholcicine to help prevent additional flaring. Treatment that addresses the underlying cause almost always results in the development of more painful symptoms for awhile, but that’s actually a sign that things are working. I’m amazed at how many docs put someone on allopurinol during a flare without other drugs that can help the body eliminate (converted ) sua, that makes the flare worse!

The key to everything is to lower uric acid. Drugs like allopurinol work well for that, but you still have to be able to eliminate it once its been converted. A uricosuric could be a key for you since it sounds like you may be one of the rare individuals who simply over-produce high levels of uric acid that are then stored as crystals in your soft tissues and joints. That in combination with urate lowering therapy like Uloric might work better for you if you do have some kidney function issue.

Don’t worry about it, just get to a doctor who knows the disease and arm yourself with as much good information as you can. There are a lot of very good resources out there, but it can be difficult to determine which ones are good and which ones are sketchy. There is a guy named Dr. Ralph Schumacher who has a very good website on uric acid and gout. I have no affiliation with him whatsoever, but have refered to his literature over the years and he is what I would consider to be a leading expert in this field.

The truth is gout is a metabolic disorder that be treated with very good results (almost cured) once you have all the right information, a great doctor and a solid treatment plan.

I wish you the best of luck and I hope you have found this helpful!

Rufus

[I_think]

Dear Rufus, can you please post links here pl. I did google but didn't find well enough on it. may be my keywords are not what it should be.

[I_think]

Dear zeeW ,

what I understand from your write up is that your life style is not the problem. but this seems to be the problem with your body tendency or kidney not functioning well. if this doctor is not trying to find root cause, and just treating the symptoms. may be you need a change.But thats just me.

I am new to this, although I had mild attacks before.It subsided on its own. I am waiting for my doc, to do deeper analysis.

[I_think]

Request you to update this thread,http://www.goutonline.net/showthread.php?t=6850

[Rufus]

anything I post as a link will not go make it through the administration filter, so I would search WebMD for or google for the words "Uricosuric" and "Colchicine"

For the website on gout and uric acid, please search google for "Gout and Uric Acid Education Society". There is a downloadable PDF there that is very good as well as a lot of other helpful information. The url is "gouteducation" dot "org". Don't know if that will make it through the spam filter or not, but might! :-)

Hope this helps!

[ZeeW]

Okay guys its been sometime since I last posted and I've seen a rheumatoid specialist.

Rufus.... thanks for your post. One of my problems is I don't know the exact details of what is in my medical records or results of my tests. All I know is I have been diagnosed with gout.

I am now on 600mg/day of Allopurinol and I still get flare ups and not in the traditional sense. I have a flare up today on my right foot on a tendon that runs under the arch of my foot - exactly like the pain I had with plantar fascitis - no swelling, no heat yet very localized pain.

My Doc has put me on 500mg/ twice/day of lyrica and 10mg/day of amitriptyline - apparently for nerve damage - all with no improvements, apart from making me slow and lethargic.

This is really getting to me as I cannot seem to break this cycle of almost constant pain.

[tonyccc]

Forget,purine rich foods,forget meat, forget fish, forget alcohol,being the cause of your gout.The real culprit as I
found out after years of testing is FRUCTOSE.Try and reduce or eliminate that and your gout problems will be over.
You will be grateful to me for giving you this information.your doctors might disagree but what do you have to lose,
trying it for a couple of weeks.For me it worked wonders,after suffering from gout for more than 10 years.

[teboy]

The diuretic is causing the gout. It happened to me. They changed my blood pressure medicine to Benicar.
I'm working it out. Losing weight. My story is similar to yours.
Let me know if you want to contact me.
Tboy
Lafayette, La

[fit foot]

I've been suffering with gout on and off for about three years, I'm pretty sure mine was brought on by a year of drinking a lot of port, like Zeew I exercise lots and am mid 30s, so supposedly young for gout.

Mine has come on usually in my big toe, but recently it got in my ankle... so painful it is untrue!

Went to docs and blood tests showed up nothing major, had checks for liver, kidneys etc.

It seems there is so much confusion online about what causes gout and I've even been in heated debate with a relative who insists he knows all about it and that I need to go on meds for life.

What I do know... is when I've had an attack, as soon as I can, I start my running or cycling again, this actually helps to reduce it and I don't think it's a coincidence, I also have a really good podiatrist/physio who has offered massage in the area and it has really really improved things. I'm hoping mine is a 'come and go' thing, as it can be quite distracting when attacks occur. Would be interested to know any other success stories, I also take cherry juice and tablets which I am told help.

[fit foot]

p.s. I have been told that ice is NOT good for gout. I once sprayed deep heat treatment in and can confirm it is not a good result.

[tonyccc]

Here is my story. It was the middle of the night. I opened my eyes and was awakened by earth shattering pain. My big toe was throbbing. In fact it felt like a towering inferno.
I turned on the light and was startled to see that my great toe was 3 times its normal size. It was bright red and red hot, just like a firecracker and the pain was the most severe that I’ve ever experienced by far.
The suffering that I had to endure was almost unbelievable.
That was over ten years ago. At the beginning I was having attacks
every 6 months. Then gradually I was getting them every 3 months, then every month and eventually
every week.It started at my big toe and then it was moving sometimes in my knees,and generally
all around my joints, in my feet.And the pain was agonising.
I have tried all the cures you can imagine.I tried ACV, lemons, drinking a lot of water, but to no avail.
I tried water fasting, juice fasting,baking soda, again without success.
I almost gave up meat, limiting it to only once a week ,gave up alcohol completely,again no success.
I was living on vegetables, lots and lots of fresh fruit, milk ,cheese beans and so on .My eating habits
could not be healthier ,or so I thought.But my gout was worsening.
Then I decided to increase the amount of fruit I was consuming, thinking that if some fruit is healthy, more
fruit will be more healthy.Some days I was eating fruit only ,others over 10 portions a day.
And alas my gout instead of improving it became chronic ,it was there all the time.
I was desperate I did not know what to do.And then one day accidentally I read an article about fructose,
which is contained in fruit in large quantities.It said that it increases uric acid, in a matter of minutes.
Fructose is also present in table sugar, and in HFCS, which is used in soft drinks.
I put two and two together and realised what I was doing wrong.
I stopped eating fruit and all other sugars, for a period of 3 weeks,and by magic I saw a dramatic
improvement.Pain was gone, swelling was gone, I was fine.
I re introduced fruit again in my diet but reducing them to 1 or 2 a day, and my gout almost disappeared.
I do eat more meat now, and occasionally have an alcoholic drink, and thank God everything seems to be fine.
Fructose was my enemy.

[fit foot]

Will have a look at the fructose issue. Interesting story!

[cwowinningham]

My Gout Story

I am 41 YOA and have had gout flares since the age of 25. For 16 years I have had many attacks and chased the cause for many years. I think the early years it was a case of too much alcohol and purine rich foods. I curbed this way back and continued to have flares more and more often. Doctors...several...wanted to put me on allipurinol for many years...I was stubborn and did not do it. Then a few years back I gave in and decided what other choice did i have? It caused major stomach problems for me. I then tried Uloric when it came out....it was just as bad....My doctor even had the nerve to say...man I feel sorry for you!!!! LOL I felt like I was doomed.
I have damaged joints in both ankles, toes, feet, both knees and my left elbow. I had swelling in my knees from the damage that it caused pain and swelling even when I was not having a flare up.
In the past 5 months I have found a God send and I have had amazing results.
The product is called NATRABURST.
I spoke to a Dr recently about it and it may be alkalizing my system and reducing the uric acid being produced by my system.
Since taking this product I have not had one flare up. I was having them at least every other month for a week or so at a time. I was taking indocin and prednisone at times along with Loritab occasionally for pain.
If you have chronic GOUT you need to look into this.
If you need info, contact me. cwowinningham@yahoo.com

Since finding this and knowing the severe pain and suffering I had been through for 16 years I had to spread the word.

Norm

[MAMAB]

I am newly diagnosed gout sufferer. I have been seeing my family dr. and finally did the blood test for gout. There seems to be alot of information out there, but does seem confusing. I have been referred to a reuhmatologist, so we will see where that goes. Your post was very helpful! Thanks

[fit foot]

Cherry juice in tablet form seems to be quite good and is coming up more and more in positive results. What is there to lose?

[ZeeW]

Well it is now 2012 and I'm still suffering from what the medics have said is gout. I'm now on 900mg / day of allopurinol.

I still get flare ups of 'something' - I didn't say gout as I am not 100% convinced I have gout? I've tried cleaning up my diet even further and still inflammation and pain around the right ankle joint.

I now have hip pain and deep seated muscular pain in my right calf almost all the time.

I've had an MRI scan that showed no joint damage or irregularities around the hip or calf muscle.

I am at a total loss with all of this and I have no idea what to do next or where to turn.

[I_think]

ZeeW, Just try Sodium Bi carbonate. It did miracle for me . but b4 that check in lab ur uric acid level.

when had attack I took 4 liters of water, and 1/2 teaspoon baking soda in a cup of water. 8 times a day with a gap of 3 hrs.(not more than a week).
this sure works. yes along with this have ibrufen for pain killing. this is what worked for me.

after that I am having 1/2 spoon baking soda at morning and 1/2 spoon at night. alternate day. and its a year now it didn't appear again.

[ZeeW]

This may sound a little crazy... but I'll try.

If I get pain in the ankle area and I'm on gout meds why is it that if I drink alcohol that the flare up seems to go away. Is this a coincidence >?

The reason I ask is that I had pain in my right ankle on Friday night and I was feeling that low about this continued reoccurrence that I had a good few slugs of whisky. Result, next morning no pain what so ever.

I've decided to see a different consultant as soon as I can as I am at my lowest mental and physical state I have ever been in - this pain is driving me crazy and is having a really negative effect on the quality of my life and of those around me.

Thanks for listening.

[I_think]

Good you found a cure. well enjoy every weekend. Invite me too, I too have gout. :)

Check this link too he too has same feelings as you. goutonline.net/showthread.php?t=6046

[Jason]

I've had gout for 7 years. Tried most things, but still get the gout attacks quite often. Recently I have linked the attacks to excessive sweating while doing house renovations over the last 7 years. It's summer hear in Australia and I had to move furniture out of the house, took some 3 hours and required heavy lighting etc. Throughout I drank 2-3 litres of water, but sweated excessively and got the attack a day or so later. I've noticed the attacks are less during the colder months and completely stopped when I finished the last house last December 2010, and I had a whole year without any attacks, that was until I started to do work on the new house. However, during that year I did go to the gym 3 times a week for an hour, but drank plenty of water and still didn't get an attack.

Conclusion, for me anyway, moderate the amount of physical activity to 1-2 hours per day and keep drinking lots and lots of water to prevent dehydration. Schedule heavy work that requires extended periods of more than 2 hours to the colder months of the year.

[podagra]

Have your blood ferritin tested, it is probably over 150, which means that you have accumulated a lot of iron and molybdenum for decades. As you aged, your testosterone levels dropped, reducing your ability to retain the copper in food. Vitamin D production also wanes with age, reducing magnesium retention. All this conspired for you to eventually develop gout.

I would donate blood every 2 months until ferritin drops just below 55 (never below 30) and take 2 mg copper/d from GNC and 200 mg/d magnesium (as citrate) and 800 IU/d vit D and then donate once or twice a year to keep ferritin between 30 and 55 in order to prevent gout attacks and many other problems caused by oxidation owing to high (Fe+Mo)/(Cu+Mg). Doing this keeps uric acid levels below 5 (mine are usually between 3.4 and 4). Blood donation is free and helps the person receiving it.

[fit foot]

I've had gout for 7 years. Tried most things, but still get the gout attacks quite often. Recently I have linked the attacks to excessive sweating while doing house renovations over the last 7 years. It's summer hear in Australia and I had to move furniture out of the house, took some 3 hours and required heavy lighting etc. Throughout I drank 2-3 litres of water, but sweated excessively and got the attack a day or so later. I've noticed the attacks are less during the colder months and completely stopped when I finished the last house last December 2010, and I had a whole year without any attacks, that was until I started to do work on the new house. However, during that year I did go to the gym 3 times a week for an hour, but drank plenty of water and still didn't get an attack.

Conclusion, for me anyway, moderate the amount of physical activity to 1-2 hours per day and keep drinking lots and lots of water to prevent dehydration. Schedule heavy work that requires extended periods of more than 2 hours to the colder months of the year.

I'm the opposite where I seem to get the attacks in colder months, which i've read is common as it doesn't help when the foot gets cold.