First bout of gout.
Posted , 4 users are following.
I'm 45 and in pretty good health, heavier than I like but active. It struck on a Sunday morning and a week later it's still very painful. Dr. put me on some steroids to bring down the pain. I left work today because I couldn't stand the pain even though I was sitting at a desk all day. Reading about this scares me, it sounds like it can really derail your life! I don't know what to ask other to ask what is the best and worst case scenarios? Really broad I know, it is hard sifting through all the information on the internet.
0 likes, 13 replies
rustygecko jay91592
Posted
The very best scenario in your case is that it isn't gout at all as you have had no blood tests to indicate gout. NB the tests have to be done when you are symptom free.
I assume the pain is in your toe?
The next best outcome is that your gout was bought on by simple dehydration. From here on you drink plenty of water NB not plent of liquids - water. You may never have another attack.
If you are even more sensible you will go on a slow diet to gradually get down to a BMI of under 25. You will do more exercise, and you will cut your alcohol intake to something fairly minimal, certainly no more than the government limit. If you eat lots of meat maybe reduce it. Avoid completely sugary drinks. If you do the above you may never have another attack - but drink plenty of water.
Worst case - I guess the worst case is you have almost constant gout and modern medicine can do nothing because you are allergic to all the drugs. *That is extremely unlikely *. The most likely worst case is you will have to take allopurinol for the rest of your life, and do the things above. There is evidence that bromaline (an extract from pineapple) and *tart* cherry juice (not any old cherry juice) helps gout. You could consider taking those of prophylaxis now.
The best advice though is - drink loads of water. Do not get dehydrated.
As soon as you have no symptoms get a blood urate test.
Finally don't worry. With life style moderation you'll be ok. Oh forgot - maybe reducing bread / wheat intake is good.
Gout tends only a serious problem if you are addicted to alcohol because they don't want to give up the thing causing the problem.
And one final bit of bad news - if you have Han/Korean/Thai genes you are likely to be highly allergic to the allopurinol- most Caucasians are not.
I'm sure others will chip in with more advice.
jay91592 rustygecko
Posted
Thanks for the reply. I got blood test result back, uric acid level right in the middle of acceptable range. They say it could be simple arthritis or pseudogout. Neither sound appealing. I don't drink and maintain low carb diet, trying to shed 20-30 pounds but I am quite active in the gym. Are you saying potentially I may need to test for uric acid again, or was that if it was spiking?
rustygecko jay91592
Posted
A test for blood urate during a gout attack is not a test on the patient, so much as a test to show incompetent doctors. During an attack the urate in solution in the blood becomes crystals (the immune response to which causes pain), thus reducing the urate in the blood. If you had a test during a gout attack you waste time money and blood... on the other hand it does clearly show you need a better doctor.
To be clear: blood urate test must be done when you have no gout systems - no pain, no swelling.
It's not impossible that it's pseudo gout but it is markedly associated with those in their 60s and older.
Gout pain tends to come on very quickly - usually during the night (due to fall in body temperature at the extremities). It usually begins in a big toe (but not always). It tends to go in a week (but in some it hangs around for weeks or longer if not treated).
With just one attack the doctors won't consider it to be gout as something like 10% never have a second attack.
The tablet which I find fixes nasty attacks very quickly is colchesine. Colchesine is not to be abused. Take it as it says as stop taking it when the flare is finished. It is toxic but not at the correct dose and if not taken long term. Colchesine gives ~some~ people diarrhea.
jay91592 rustygecko
Posted
Last night the pain was so bad I considered going to the ER. It almost brought me to tears. I've been taking Tylenol with the presnidone and it's brought the pain from an 8-9 down to a 4-5,livable anyway. I admit I am a bit disappointed in my dr. This has been traumatic; if it is gout,I feel he woefully underprepared me for what was to come. I'm going to press him on Monday.
rustygecko jay91592
Posted
You wouldn't be the first to go to A&E convinced they have a broken toe to find out it's "only" gout. It's not until you've had several attacks are you considered to have gout and will get urate lowering therapy - and as I said - if you're lucky this might be a one off.
To understand it - you have mono sodium urate crystals in the joint. If you can put plenty of fresh water into your body it will dissolve them. The other thing is to try to keep the foot warm at night (it's the drop in temperature in your feet which allows the crystals to form). It is generally recommended to try putting the foot in cold water to reduce the pain. Personally I used to put it in hot water at night - it helped the pain and I hoped it would help to dissolve the crystals. Good luck Jay! Keep hydrated!
Wrenster jay91592
Posted
rustygecko Wrenster
Posted
First I've found a really interesting video that I think we should all see (they won't allow me to put in the link so you have to search
in tubeyou ;-) yourself - it's called "gout education video" 4m 17s.
Anyway IMHO the miracle cure is allopurinol for the long term and colchesine (unless your in the USA where it's illegal).
Wrenster rustygecko
Posted
Thanks just watched the video very interesting and informative. Going on medication for life for me would have to be a last resort. I'm going to try other avenues first and see what happens. Any advice is always welcome.
rustygecko Wrenster
Posted
There's one thing I don't understand about your story. That you had a blood test done during an attack.blood urate levels fall to normal during an attack. Indeed your levels at 4.35 are completely normal. For this reason the advice is do not take the test until at least 2 and ideally 4 weeks after an attack.
Gout is for most people genetic - unless you are an alcoholic or an Inuit living of fish and polar bear meat. In your case you aren't a huge meat eater nor an alchi and yet you've had two attacks in a month. You are almost certainly destined for regular attacks. Not only are they painful (and doing damage to your joints), but the deposits of monosodium urate are causing constant (unseen) inflammation in your organs, which over a year or so won't do much damage - but long term it will. Untreated hypereuremia leads to a host of diseases.
My guess is that you will get regular attacks and be forced to drug therapy. I hope I'm wrong and that simply drinking plenty of water will sort you out (if for example you work in a foundry that could cure you); but my guess is that in 6 months, with regular time off work and increasingly frequent attacks, like a diabetic you'll be happy to take therapy.
I sincerely wish you good health.
jay91592 rustygecko
Posted
An update on me. Day ten and the pain is still pretty bad. Doctor had me come in for an X-ray this morning, I have not heard back from them yet. I made it clear I at the very least need something for the pain, it doesn't seem to be a pressing issue for them right now. Came home from work early to get my shoe off and put my foot up. I think next stop is the podiatrist if I don't get relief from the GP I am seeing.
rustygecko jay91592
Posted
If he can give you some colchesine most people find this brings relief within 6 hours. (Not if in USA not on market).
As for pain killers - take plenty of ibufren - it not only helps with pain but also swelling. Do not take aspirin it makes gout worse.
If find it odd that he's not giving any treatment.
Good luck.
Guest jay91592
Posted
Few doctors really know much about gout. They open a book at the right page and write out a pescription. They may tell you not to drink alcohol, and then ask the next patient to come in. Well, that's what it is like in the UK anyway. I had four bouts in three months, and prior to that had only ever had one, and that was about 2 years prior. My uric acid was only the high side of normal, so I am only on 100mg of Allupirinol a day. Since it settled down I live life the same way as I did before. I have two or three pints of beer a day and eat what I want, although I should mention I am a vegi. I still get a little pain in my foot sometimes, but presume this is the same for everyone. In short, gout hasn't ruined my life, and in all honesty hasn't really changed anything.
rustygecko Guest
Posted
I must say my experience in the UK was similar. I was fortunate to be diagnosed by a rheumatologist specialist abroad who sat me down and told me - you are going to go and see GPs who know nothing about gout. He gave me a few tips (like if you are having an attack and they want to do a blood test - just walk out). I went through 3 doctors before I got to one that had an idea what she's talking about - but even she admits that their knowledge is lamentable considering how common it is. I think it's almost a joke non-condition. I have a feeling too that if it were primarily a condition of women it would be treated with reverence and regarded as important. But as it's middle-aged men - who cares?
I agree totally - if you can handle the allopurinol and a blood test from time to time, there's no change at all - except a sensible precaution to drink more water.