Gout vs Sesamoiditis

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Gout attacks

Went to doctor 9/8/2017 in mist of attack that started the Tuesday before (9/4/2017) she gave me Diclofenac Potassium 50 mg 3 times daily  for ten days with 2 refills, it helped finished first bottle then was fine until another attack on 9/25/2017 refilled next day. Have changed diet cut out all white flours, eating a mostly vegan diet, no refined sugar, very limited dairy, mostly fruits, vegetables, tofu (once weekly), vegan/vegetarian meat substitutes and ocassional cheese (about once every two weeks) I do have fish one every other month (usually baked Taplita or seafood salad made with imitation crab or lobster)..I take Allopurinol 100mg daily take Tart Cherry juice twice daily and 500 mg of celery seed twice daily, I drink well over a gallon of water in addition  to 2 cups coffee and water in cooking and foods...Other medications I am are Furosemide 20 mg twice daily and Spironolatone 25 mg twice daily both are for fluid retention.  I had my very first attack in June 2017 ( ended up going to er and was given medicine seen by my doctor the next week and told to start Allpurinol after attack ended ) it lasted over 2 weeks and then went in the opposite big toe but only last 48 hours in that toe, at this time I was able to start Allopurinol. My uric acid level in June was 9.2 mg/dl which is high and on 9/8/2017 after all the diet changes I made it was still 9.2 mg/dl...I am at my witts end not knowing what more I can do.  I have had attacks every 2 to 3 weeks since and not sure what more I can do to lesson or stop these attacks...This attack started 2 days ago and even with drinking extra water almost 2 gallons a day and medicines does not feel any better! Any ideals would be greatly appreciated, thank you all in advance.

 

2 years ago I had back surgery L4 and L5, L5 and S1 fustion and bolts and pins.  Shortly after this I started having pain in my right toe I was diagnosed with sesamoiditis and given pain medicines for short time which helped the pain but the condition never got any better even after resting and changing shoes and adding cushioning and doctor prescribed orthotic inserts and months of physical therapy to date it has never gotten any except after had the first gout attack and was on medicine for gout...is it possible that I had a mild case of gout that was misdiagnosed until the major flare  up in June this year? My pc doctor says no ( she never explained why she felt  no, she just changed the subject when I tried to ask), but I feel that it is possible. 

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  • Posted

    Allopurinol and celery seed?  Did the doctor recommend the celery seed?

    ?I hear that starting to use allopurinol can trigger an attack, it may take a while before it does whatever it does, but I've found celery seed effective at controlling real gout and purine levels.  What does the doctor say?

    ?Now that you know what gout feels like, in those toes, you should be able to tell us and your doctor whether the early diagnosis was correct, the swelling and sensitivity is hard to mistake.

    ?If it wasn't gout it may also have been pseudo-gout, I've had that in practically every joint in the foot (and there are lots of them!), it's not quite the same as real gout, much less swelling - and the gout meds don't prevent it and the gout diet doesn't prevent it.  But pseudo-gout does get better, generally, so if yours kept on then maybe sesamoiditis was right, I know nothing about that.

    ?Now, I've had several doctors who seemed to believe that diuretics might cause gout attacks.  I'm not sure I believe that, but what do your doctors say about it?

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  • Posted

    If you drank 2 gallons of water a day, you wouldn't be writing this.

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  • Posted

    My only observation of this complex story is that you are taking a diuretic. A diuretic will cause gout.  Some diuretics additionally reduce the amount of urate the kidney flushes. You want to get lots of water in you to help the allopurinol work. You may also need something to reduce the immune system attack. 

    This is pretty complicated and I think you need to see a rheumatologist not a GP.

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