Gout and colchicine

I can't take NSAIDs as I only have one kidney which isn't working as well as it should (according to my last two blood tests) and could be the reason for the gout attack. I just happened to have a hospital appointment for another foot problem (numb toes) a few days after the gout started and I'd hoped they could treat the gout too but not so, he told me to see my GP as he wasn't specialised (although he was the one that told me it was probably gout). I explained this at my surgery but the GP refused to see me until I'd had a blood test to confirm the gout. Unfortunately the first available appointment for the blood test is not until next Thursday! By the following day my foot was much worse and I then managed to get an appointment with a different GP who prescribed the Colchicine. He said I wouldn't need painkillers as the Colchicine would be enough on its own but I can still barely walk as it's so swollen. Thankfully the unbearable throbbing has now stopped though but it is still painful. Is there anything else I can do to help the swelling go down? 

Firstly how much colchicine are you allowed to take in 24 hours?

Second, are you taking any other medication?

Third, do you have any other illnesses which complicate treatment (apart from having only 1 kidney (how did you lose one btw).

Are you over weight?

You are doing the right thing by drinking water (then drink more). Cut out alcohol, and reduce tea and coffee. Cut out anything high in sugar ESP anything with high fructose corn syrup.

I read some research that proved that colchesine was most effective in smaller doses -by cutting the already tiny colchesine tablets in half and taking them more frequently (but half the dose).

You are avoiding oily fish and seriously cutting down on meat ESP bacon and preserved meats?also avoid things high in wheat.

It will go - don't worry - we've all been there!

Thank you for all your help, I will answer your questions in order ok. He prescribed a course of 12 500microgram tablets, one four times a day but since reading your post I'm now cutting the last three in half and taking these more frequently. Yes I'm on quite a lot of other medication as I have many other problems from eczema to ADHD. I am on Dextroamphetamine, Lisponol, Omeprazole, Bendroflumethiazide, Atorfastin and Serequel. I don't think any of my other illnesses complicate treatment. The hospital letter I received today says I have Chronic kidney disease stage 3 following pyelonephritis, this is the first I've known of this, my kidney was killed by frequent infections when I was a teenager (I'm 58 now). I had a cyscoscopy in my 40s which showed I have a narrow urethra preventing my bladder emptying property (why I wasn't given this before I'll never know as since then I've always strained to help the bladder empty and have only had one infection since). Yes unfortunately I am overweight! I never drink alcohol or tea/coffee but drink lots of slightly sparkling flavoured water every day with lots of ordinary water too since the gout started. Yes I'm avoiding all of the purine high foods I read agravate gout. Since starting the Colchicine my appetite has been nonexistent and there's nothing like severe pain to kill your appetite so hopefully I might lose a bit of that excess weight! I can think of better ways though lol. 

 Is it normal for the foot to redden and swell more after treatment starts? 

Ok...Kay.... from what you are saying - you have a kidney infection (pyelonephritis), for which hopefully they have given you a test to see if it's a bacteria (usually E Coli) and if it is an antibiotic will fix it quickly.

I would guess that your gout flare is being caused by the kidney infection. Kidney infection = less urine flow and dehydration. Dehydration will cause gout.

You need to drink water. Not water with stuff in but water. Regularly. You are going to spend a lot of time peeing, but the urine flow will protect your kidney, it will help to flush through an infection, and it will help the kidney flush out the urates (uric acid) which will eventually push the crystals back into solution to solve the gout.

Has the liquid you are drinking any sugars of any kind? That is not only good for you, but somewhat counterintuitively will make you feel hungry and eat more.

Frankly you are already on so many drugs that they - or their interactions could be causing gout too. With so many drugs the doctors have •no idea• what they are doing. Drug interactions are very complicated. Two is hard. Three is very hard. By the time you're on 4 or more, the Almighty himself has no idea what is happening.

You need to lose weight. Stop intake of sugar. Buy a bicycle and use it, or go to a swimming pool. You need to consider alternatives like acupuncture for your skin conditions which would then get you off some medication.

As for the toe getting redder after the treatment has begun...we can only imagine what it would be like without the rather powerful treatment. My basic advice would be drink water (and reduce salt if you use a lot).

Hope you're feeling well soon. Keep us informed of progress.

I haven't got a kidney infection now, I had them constantly from age 12 until one kidney was so damaged it was unable to recover. Then when I was in my 40s the infections started again and eventually they discovered my narrow urethra. Once I knew about this the infections stopped as I always strain to make sure my bladder empties properly. I have only had one infection in the 12+ years since then. But my last two blood tests have shown my remaining kidney isn't working as well as it was and it's this that the doctor said is probably the cause of the gout. I usually have two kidney function tests a year but the doctor asked me to have another test in four weeks time and I'm praying the count will have increased by then. 

  The water I drink is carbonated spring water and yes it contains sweeteners. Do these make you feel hungry? I drink many litres every week and would miss it greatly but so be it if it is doing me harm. I will do anything to try to avoid the excruciating pain this gout has caused. As for the medication, one is for high blood pressure, another for high cholesterol and although I'm supposed to take the latter daily I reduced this once my cholesterol had lowered to about once a week. Next time I visit the doctor (who is unaware I reduced it) I will ask if this one can be completely stopped.    Since the gout I have also reduced my ADHD meds too. I know it's not much  to help reduce the amount of meds I'm on but I am aware that the huge concoction I'm on can't be good for me. As for my weight I recently bought a treadmill (I'm agoraphobic so don't go out much) but obviously I've had to stop using it until the gout is better. 

  I never add salt to my food, rarely eat meat but was eating two large bags of prawns a week which I've stopped. It seems I'll have to completely change the way I eat and drink but that's a small price to pay if it means I won't have to suffer this horrible condition again. Thank you so much for all your help and advice, greatly appreciated x 

Oh yeah I forgot to mention the diarrhoea the GP warned me I'd probably get on Colchicine started today! It's not too bad at the moment but obviously means the need to drink more is increased. And yes I'm peeing loads, I usually have to get up 3/4 times in the night but this has increased greatly thanks to the volume of water I'm drinking and I'm never out of the bathroom in the daytime lol. Is ordinary tap water ok or should the water be filtered? 

The diarrhea is a known side effect but not universal.

If you are getting your water from a ditch, I'd certainly filter it. If it's coming from a million dollar pumping station in a western country, you're probably fairly safe.

:-D

Prawns are a well known trigger of gout. For the poor defenseless prawn, their only way to hit back at us is to hope they give us gout!

Artificial sweeteners do not cause gout. My only observation though would be that water is a perfectly natural product and doesn't need chemical enhancement; but hey - if that's what you need to get a few liters down you - go for it.

I'm sorry I misread the pyelonephritis comment - I missed the word "following" which makes a huge difference.

I can see that you are aware of the multiple mess issue and are on to it.

As for your agoraphobia - can you not get some help for that? Apart from being an awful way to spend your life, it means you can't get enough vitamin D, it is socially isolating (which is bad for you), and it's just more fun to go out and jog rather than using the machine.

As for the gout - high bloood pressure tablets will cause / encourage gout.

I note you are taking serequel - a medication which is not recommended for those with high blood pressure, kidney problems and high cholesterol.

The statin you take is not recommended for those with kidney issues.

By the way - I doubt the competence of your GP. They are recommending a blood test to detect gout. It is however in Med school 101 that you cannot get a proper urate level test result from a patient having an attack of gout.

If you have agoraphobia- how do you get to the GP?

I've had agoraphobia since in my 20s and received help from a specialist nurse as for a few years I was unable to even put the milk bottles out never mind leave the house. She helped me enormously, enabling me to go out in the area where I live and although I don't enjoy going out I knew I had to continue doing so to prevent slipping back and I never want to be in that position again. So I have always made myself go out twice a week come rain or shine. My doctors surgery, dentist and small shopping centre are a 7 minute walk from my home so I can manage this without too much problem but I have an electric moped which proved invaluable when the gout prevented me from walking there. 

  I have lots more I want to add but the diarrhoea has come on with a vengeance, it's almost 2.30am in the UK so I'm going to have to write another post tomorrow instead ok

Just had 3 days of eating nothing but prawns, lol. I believe that every body reacts differently. Been eating prawns all my life, and it's never triggered a gout attack.

Kay

First of all don't worry about tophi - they take years before you get to that point. In the medium term I'd be more worried about kidney stones.

As for your cholesterol that is down probably because of the staton. But IF they put you on anopurinol, one of the side effects is that it lowers cholesterol (!)

As for your other drugs, some of these are pretty specialist stuff (ESP those to do with psychosis), so please don't reduce them until you see a specialist.

I agree that a doctor refusing to see someone with gout is pretty heartless or uninformed; gout is notoriously painful, and the solutions are quick to provide. As for not having a irate test - a) you can't do it during an attack and b) it's pretty easy to diagnose gout looking at an inflamed toe.

Please no, I read that the three most painful conditions are gout, kidney stones and shingles. I've never had kidney stones, had shingles twice and the first time the doctor was amazed as I had no pain! The shingles were on my bum and he left me lying there, bum exposed while he fetched another doctor to have a look as he couldn't believe I had no pain! Weird eh? The second shingles attack was painful but nothing compared to gout and I really don't fancy finding out how painful kidney stones are! 

  I've been reading up more about purine high foods and I'm confused as some sites say mushrooms are a no no, others say they're fine. Tesco do a finest porcini mushroom soup that I love and have around five times a week but now I'm not sure if I can continue having it. It is loaded with mushrooms and unlike any other soup I've tasted. Do you think it'd be ok if I just cut back to say three tins a week? 

Seriously, take the drugs and eat and drink what you want. You can of course try and control it by diet, but that really is a fools game. 

Why? Surely it makes sense to stop all purine high foods, at least while having the attack? I was eating two large bags of prawns a week for months before my attack and feel sure they contributed if not caused it. Now I'm wise to purine high foods I will be much more careful in future. 

You are not taking allopurinol or a long-term irate lowering therapy. In my opinion therefore all you are left with is trying to at least drink lots of water and try to avoid high purine foods. (As for mushrooms they are high purine, but not as bad as prawns or offal for example).

Exactly, I have no idea what Paininthetoe meant by saying to try to control it by diet is a fools game! At the moment the diarrhoea is controlling my diet, the toast I ate for breakfast went straight through me so I've been reluctant to eat anything else. I had a yogurt this afternoon and I've just eaten two slices of white toast as I didn't know what else to try. I'll have to get some low purine foods in when I do the shopping. I normally eat a lot of primula cheese spread with prawns which I love, I know cheese is fine but I'm concerned about the prawns in it, it says it contains 10%. Would it be ok or should I give it the heave ho 😢

There are other drugs instead of colchicine. Get in to see a doctor on Monday to get some!

If you love the prawns can't you chop them finer, use less and use imagination? :-)

I've just read that mushrooms are ok for some people.

At the moment your main line of defence has to be water and try ice packs..... and see a doctor ASAP!

Sorry I've only just read your last post as I failed to receive a notification. I feel reluctant to try other drugs as it's nowhere near as painful as it was and I think the swelling is slowly improving too. I can certainly walk better now and feel it's just a matter of time. 

  I am really struggling with the dietary side though, I can live without the prawns but not bread, I have given up the polish sunflower seed bread I adore and have been eating white bread toasted for breakfast but I find it boring especially as I used to have it with marmite which is high in purine. So I decided to go back to the seeded brown bread I used to eat but feel completely confused as you said to avoid wheat products. ALL bread, white and brown contains wheat flour!?

This is not a subject I've ever been good at and I've known for a long time my diet has needed improvement and the gout has been the kick up the bum that's told me I MUST make those improvements. I hate cooking and don't often make the effort to cook proper meals, having things like beans, egg or spaghetti on toast or baked potatoes with corn on the cob. I do eat a lot of fresh fruit and also yogurt but know I need more fresh veg (which I love) and I intend having these more often.

  Please can you help explain about wheat and bread? I've eaten toast for breakfast all my life and don't feel I can change this as it's my favourite meal.

PS. I forgot to add that I weighed myself this morning and I've lost 7lb. I can't take any credit for it though as both the pain and the Colchicine killed my appetite! 

Long term, losing weight is good. Short term, rapid weight loss will cause gout. Why? The reason is if we lose weight fast lots of cells are consumed by our bodies - and consumption of cells leads to the creation of uric acid - if the blood is already full of urates the extra is simply precipitated into the joints etc giving the symptoms of gout. However, long term weight loss is good in that the fats deposited in and around the liver and kidneys and all the visceral fat crushing our organs, are removed; allowing our organs the space to do their jobs.

The normal thing to do in your situation Kay would be to take allopurinol, which simply takes the chemicals your body makes into uric acid and stops some of that process leaving the material in another form which is more easily flushed from the body (most animals do that anyway without allopurinol - I think it's only humans that have involved this Utica acid thing....hence you don't get pets with gout!)

The problem that your doctors have is that you are already on a bit of a cocktail of drugs and I don't know if they'd want to put another one in. Certainly for you, you •might• be better off changing your diet,losing weight and controlling the occasional attack. Improving your diet and exercising more would be good for all your ailments.

There's are others here that can advise you better than I, but sugars and wheat and offal and lots of sea products will make gout worse. What will help is more green veg and less of things which contain a lot of the above.

••• I note that many of the ingredients you mention e.g. Spaghetti (from a tin), beans (ditto) and yoghurts, are all products into which the manufacture sneak in loads of sugar (read the packs). This has the effect of addicting us to them, but it means we are likely to get fat(ter), and sugars are bad for gout.

If you have toast and love it personally I'd stick to it. But like all things.... dose is important. 1 or 2 slices okay... any more and maybe it's not so good!

It sounds as if my weight loss may be the reason for the slowness of improvement of the gout. My appetite is back now so no doubt the weight loss will stop (I've been trying to lose weight for months without success!). 

To help with this I buy products with reduced sugar (and salt) where possible. The doctor was concerned as a blood test showed low potassium levels 3 weeks ago, she asked me to repeat the test and I ate lots of potassium rich foods while waiting. The other concern was kidney eGFR which had gone down to 46. Second test showed potassium levels are now fine and the eGFR had risen to 54 which is a relief (creatinine is 88). GP is obviously still concerned as I received a phone call asking for a urine sample and she wants the blood test repeating in 4 weeks time. (BTW this is not the GP that refused to see me with the gout!)

Two things I'm finding difficult since the gout are when I'm standing, even just for a few minutes I feel really queasy, hot and ill. This stops once I sit down again and although it's not as severe now it's still happening. The other is a continuous ache in my foot and leg, I feel a need to keep stretching it but this does nothing to ease the aching. Oh yeah and I sweat so much at night the sheet gets soaked. 

Do any of these sound familiar to when you have had gout? 

Hi Kay

"Many forms of arthritis occur gradually, and in the early stages a person may experience only occasional, mild pain. In contrast, pseudogout strikes quickly, severely and without warning. In fact, pseudogout can cause such severe pain that a patient believes the condition is life-threatening; it is not uncommon for an accurate diagnosis to be delayed while more serious medical conditions are considered."

I wonder if you don't have pseudogout? It effects bigger joints and not just the big toe. In women it may produce night sweats. It takes longer to go than gout.

I would however mention the nightsweats ti the doctor.

I'd never heard of pseudogout but I looked it up and it's possible I suppose and certainly preferable as it's not diet related. Every site I checked said it mostly affects the knee joint but no doubt it can affect big toe joints too. I've read a few forums where people were saying their uric acid levels were actually low even though they'd been diagnosed as having gout, maybe there's was pseudogout? 

  I had to go out yesterday to fetch my ADHD meds and I made the mistake of wearing shoes (my shoes are lightweight and very wide as both feet have bunions). By the time I picked my meds up and hobbled round the supermarket for some shopping I was in agony. I was crying with the pain by time I got home and realized I should have just worn a sock on that foot like I had last time. 

 Got my blood test tomorrow although from what you've said the result isn't going to tell the doctor if it is gout! I'll speak to the nurse about the possibility of pseudogout and also mention the night sweats. I'll tell the doctor next time I go too but awhile back I told her about my excessive sweating whenever I'm active but she didn't even comment! I told her that whenever I'm sitting still I feel cold and after about ten minutes of moving about I overheat and the sweat pours off me. It's as if my thermostat is broken and I'm sure it's not right but I'd told her right at the end of an appointment for some other complaint and my time was used up. But had she been concerned I'm sure she'd have told me to make another appointment so it could be investigated but as I said she made no comment. 

  The night sweats happened again last night so I'll see what the nurse says about them tomorrow. I'll also ask her why my foot is still swollen and painful after almost two weeks. It's actually more purple than red and showing little improvement. I'm drinking so much water I'm in the loo at least every half hour. I'm also now drinking cherry juice as I read it can help gout. 

  

A question Kay

Have you got any of your lymph nodes swollen? The most obvious are in your neck or just above the collar bone or in the groin?

The purple red and the pain are both typical of gout and pseudogout. I would have expected the colchesine to have worked on that by now. You are keeping off your foot and keeping it raised a little?

Cherry Juice does help gout - but make sure you have pure product with no added sugar.

I'll have to ask the nurse to show me how to check my lymph nodes tomorrow as I don't know what I'm feeling for! 

Yes I'm staying off it and raising it. The inactivity is what's getting to me the most, just doing essential household chores which I'm not used to. Have got two of my grandchildren staying over Saturday night so I'm hoping I'm feeling better by then! 

  The cherry juice is the best Tesco offered when I did the online shop, it has no added sugar but don't think it's pure! 

I had to keep that last post short as I'd written it four times only to keep getting the aw snap error! Even after I closed all open apps and deleted a few others I still got it so I'm not sure what's going on. 

I have the same issue with the website.

I would certainly mention to your GP that you are sweating a lot at night and have a feeling that you feel colder than others at times and warmer at other times.