[Keith Taylor]

Hi William,

It’s not for me to say what’s best for you. There are arguments for starting uric acid lowering treatment as soon as possible. And, there are arguments against.

Common arguments against medical uric acid lowering treatments are risks of side-effects. Many gout sufferers claim they would rather change their lifestyle to try and lower uric acid. From what I’ve seen, very few people make a real commitment to this. So, they end up as Gout Victims.

Personally, I’m a great believer in allopurinol as an effective treatment for gout. However, there are lots of other choices. My main role is to help you identify what choices you have. Then, when you understand your options, I want to help you manage your gout in the way that is best for you.

Above all, realize that gout is a progressive dangerous disease. There is no such thing as “occasional gout”. However, you can suffer occasional gout attacks. In between those attacks, you suffer what the medics call inter-critical gout. During inter-critical gout, excess uric acid continues to damage you. I mentioned gout is progressive. The progression is:

1. Gout attacks become more intense, more widespread, and more frequent.
2. Bones, tendons, and other joint tissues become permanently damaged.
3. Uric acid deposits (tophi) spread to soft tissues. Skin, kidneys and heart are commonly damaged. But, all organs are at risk, except the brain.

[Keith Taylor]

See a doctor, Darlene.

Now!

[Keith Taylor]

I’ve written about the balanced gout diet solution. And, the balanced gout food solution.

[Keith Taylor]

Thanks for your question about vegetarian gout diet, Sam.

In theory, vegetarian diet is a good starting point for gout. Now, you have to tweak your gout diet to maximize it’s uric acid lowering potential. That can’t work by adding certain foods that might lower uric acid. We need to look first at total food and drink intake. Then, we can identify and test certain food changes.

If you don’t want to do a full diet analysis, I have to ask you more about your ideas on lemon water:
1. What exactly do you mean by lemon water?
2. What will you remove from your existing diet to make way for the lemon water? (i.e. with what are we comparing lemon water, to see if it lowers uric acid?)

[Keith Taylor]

Personally, I would only consider surgery as a last resort. There are always health risks associated with any surgery. And, it seems pointless considering surgery without first considering lowering uric acid levels.

[Keith Taylor]

Thank you for your kind words. And, for your extra information.

The usual explanation for uric acid falling during a gout attack is to do with what happens during the attack. Uric acid crystals forming in the joint reduce the dissolved uric acid measured in the blood. But, other explanations re possible.

The main thing is to establish routines for uric acid tests so that you have a history. Then, we can look at how your uric acid changes over time, and in response to various treatments. Herbal medicines can reduce or remove allopurinol dependence. But, you need monthly uric acid measurement to know if this is happening safely. Allopurinol might be avoidable, but testing isn’t. Uric acid tests should always be accompanied with kidney function and liver function tests.

That gives you a safe environment for testing your herbal products. Remember, if they are any good at lowering uric acid, they are potent enough to have side-effects. Herbal does not mean safe. That is why I strongly recommend the kidney and liver tests.

If you are also struggling with diet, you might consider a combination of herbal medicines and diet improvements. You are absolutely right that it is impossible to avoid purines. First, there is no need to avoid vegetable purines. Second, animal purines should never be significant in a healthy diet. So, twice-weekly fish and twice-monthly meat should not significantly raise uric acid levels.

The easy way to manage gout is to take the correct dose of allopurinol that makes uric acid safe. Usually, safe means below 5mg/dL. Once you move away from the easy option, you have to investigate, measure, and plan in more detail.

I’m happy to support anyone who wants to lower uric acid with herbal medicines and/or lifestyle changes. It’s rare to find a gout sufferer who is prepared to put the time in to manage diet and herbal supplements in enough detail to make a difference.

If I were doing it, I’d start with a gout diary. Then, I’d commit a set amount of time to measure and manage my gout.

I realize that doesn’t really answer your specific question “could that explain my relatively low uric acid level of 5.9 (after day 6)”
I’m afraid it’s impossible to answer that without more uric acid test results. That’s why I’ve fallen back on the most common explanation. But, it’s better to have good data, rather than guessing.

[Keith Taylor]

Hi Bertram, and welcome.

Now what?

Keep taking your allopurinol every day.
Take colchicine as needed for a few weeks.
Return for more uric acid blood tests every 2 to 4 weeks.
Post your uric acid test results here.
Recover from gout.
Live a happy life.

Whenever you feel unsure, or need more information, post here.

Bertram, it’s going to take a few months to recover from a disease that’s been building for 10-12 years. But, you can expect a complete recovery. I’m here to help, whenever you need it.

[Keith Taylor]

Hey, Philip, thanks for that.

I keep running GoutPal, because lots of gout sufferers still don’t get the help they need. For lots of reasons, they lose faith with their doctor’s advice. That can soon spark a descent to poor gout management choices. Often, from poor quality information on the Internet.

I totally agree with your encouragement for sticking with prescribed gout treatment until it has had time to do it’s job. As well as your sensible warning about avoiding further gout attacks, I’d like to add:

1. Those gout attacks will become more intense, more widespread, and last longer, until uric acid is made safe.
2. Uric acid crystals lead to weakened joints and permanent joints.
3. Uric acid deposits eventually spread to organs. This risks damage to skin, kidneys, heart. And, all other organs, except the brain.

I hope gout sufferers will avoid becoming victims, and find a treatment that makes their uric acid safe. I’m delighted that you are encouraging them, Philip.

[Keith Taylor]

I understand why people suggest waiting until gout flare has gone before starting treatment. I know why I would not wait ( http://www.goutpal.com/4853/start-allopurinol-quickly-but-carefully/ ). What really matters is the view of your mentor.

I believe all gout sufferers need a mentor, who will support them during the planning and therapy stages of uric acid lowering. I can improve my explanation of the importance of mentoring. But, for now, my best effort is my first Gout Mentor article. I believe your gout mentor should be your doctor. But, I’m happy to share that role.

Leaving aside the question of starting allopurinol now, or waiting a week or 3, let’s focus on what is more important.

To successfully manage uric acid lowering, I believe you have to be confident with your gout pain therapy. This is because most gout sufferers will experience gout flares, until allopurinol has worked it’s magic. That is why early start of allopurinol works in the study I mentioned. Because, gout patients who take preventative pain relief can start allopurinol without problem. It is logically and practically correct. But, it won’t work if your mentor doesn’t understand it.

In theory, this is simple logic based on established medical facts. In practice, gaps in knowledge cause problems. That’s why I offer diaries for personal gout facts. And structured help for personal gout therapies. My services should support doctor’s medical history, and doctor’s scheduled consultations. Ideally, you don’t need my help. Especially if, your doctor provides the right treatment, with the right pre-treatment guidance and support.

Pain control should address:
1. Limiting inflammation spread
2. Reducing inflammation
3. Blocking residual pain.
Country mainly affects the first of those 3. Limiting inflammation is usually a job for colchicine. I’m not getting any feedback on the latest situation on the Colcrys price problem. Officially, cheaper generic colchicine should now be available. Anyway, I’m visiting the States in January 2017. So, I can check it out for myself.

Sorry, Chris, this has got a bit long-winded. Detailed timing and dosing must be personal. Also, there are individual choices about specific meds. A general guide for effective gout pain control during urate debulking is:
1) 1 preventative colchicine at bedtime for 2 to 6 months. Additional 1 colchicine in morning, as required if gout symptoms justify.
2) As required, gout strength ibuprofen, naproxen or other NSAID.
3) As required, gout strength acetaminophen/paracetamol between NSAID doses.

I hope it goes without saying that this must be doctor/pharmacist approved. It’s a starting point for discussion. Some doctors advocate steroids for gout pain control. To me, that’s a last resort.

As with all things gouty, there are alternative points of view. So long as the final choice suits the patient best, we cannot ask for more.

[Keith Taylor]

Hi, Chris

TL;DR Lingering pain, stiffness, and weakness, is common after a gout flare. This situation worsens as the uric acid burden grows.

So, “What’s the uric acid burden?”, I hear you ask.

Every day that uric acid is above the crystallization point, uric acid crystals form in our bodies. Our immune system engulfs uric acid crystal when it sees them. This prevents further inflammatory response. It hides the problem, but our bodies cannot cope indefinitely, with excess uric acid. Gout flares occur when the immune system gets overwhelmed.

As you’ve experienced, Chris, the uric acid burden can grow over several years, without experiencing a gout flare. Eventually, the burden starts to produce low levels of discomfort, even when there is no acute gout flare. Also, the battle of uric acid crystals depresses the natural repair of joint tissues. So, joints become weaker as time passes.

The crystallization point of uric acid is measured in the lab at usual human core body temperature as 6.8mg/dL. But, our joints are cooler than our core. So, uric acid crystals form at lower than 6.8. Anyway, your levels are much higher, Chris. Extensive, your burden is.

Medics have a policy of not prescribing uric acid lowering until you get 2 gout flares in a year. That’s going to happen to you very soon, Chris.

If you’ve been following my recent posts, you will see that I’m obsessed with Gout Groups. They make it easy for me to focus my help. And they also help me to ask the right questions at the right time. So, my question is, where do you want to go next? Questions for Gout Sufferers has the choices.

You can ignore high uric acid, and join the Gout Victim Group. Or, you can start to consider the best uric acid lowering treatment for you, in the Gout Recce Group. You might even know which type of treatment you want and move straight to one of the treatment groups.

What next, Chris?

[Keith Taylor]

“I will think long and hard about practical ways I can help”

Here’s some thoughts so far:
1. Should Charivertising be a word? You inspired that, Pamela. If it works, I’ll be forever in your debt.
2. We own Uriciplex – Carl’s offering free samples. Let’s persuade him to mail some to Egypt.
3. I have a UAsure uric acid home tester that I no longer need. If someone can fund strips for it, then it might help. What do you think?

There’s got to be lot’s more we can do. As well as my previous 2 questions, please can you post a list of things that you believe will help.

[Keith Taylor]

Hi Carl,

Sorry for my delay in responding to you. What are your thoughts about Should Charivertising be a word?

For your kind offer of free samples, that would be a great way to kickstart my idea. Personally, I don’t need Uriciplex. But, I’m sure there are other GoutPal members who would be interested.

[Keith Taylor]

Pamela, you’ve touched my heart with “for ordinary people in Egypt visiting the doctor is not the casual pop-into-the-surgery’ occasion the way it is in UK and much of USA.” And, your subsequent paragraph.

I spend too much time thinking about how I can help others. But, not enough time actually doing it. I will think long and hard about practical ways I can help people who are not lucky enough to have access to UK NHS brilliance. If you can suggest anything, please do.

I’ll be back later to offer better advice about managing gout without lots of medical resources. In the meantime, there are some basic issues:

1. Why does he think it is gout? I’m looking for anything that gives me more information about his medical condition. The more facts I have, the more I can offer relevant help.

2. For diet, I always start from a healthy foundation. Experience tells me that traditional eating styles are healthiest. Can you teach me about Egyptian eating? [*] I can probably suggest ways to plan Egyptian meals that are better for gout. But, at the moment, I don’t have a starting point. Does turmeric play a part in Egyptian recipes? It’ll do far more good than Devils Claw for inflammation.

[*] I don’t mean the Westernized recipes I’ll get if I Google Egyptian food. I mean the real stuff that people eat every day. What does you your guy eat each day? What do you change in your diet, Pamela, between UK and Egypt?

Drown me in facts, and I’ll find some better ways to deal with Egyptian Gout.

[Keith Taylor]

Text updated. This idea is now implemented and closed.

If you have ideas for improving any GoutPal page, please add your suggestion.

[Keith Taylor]

Ooops 😳 Sorry Pamela

I was bumbling about in the Helpdesk, and I accidentally deleted your response, and never saw it. I’ve no idea how that happened. But, it’s the best of reasons why it’s best to post in the forum rather than using the Feedback form, or Helpdesk. By all means, use the Helpdesk if you are stuck. But, you should have a Windows Live account, so just click the Windows Live button where it says “Connect to GoutPal with” Then, you can post here.

Anyway, please heed my earlier response. Your partner needs a doctor. Or at least, we need your partners medical details so we can respond more helpfully.

Devils Claw for gout? How’s that supposed to help?

[Keith Taylor]

Invited to both update services.
https://feedburner.google.com/fb/a/mailverify?uri=GoutPal
and
https://feedburner.google.com/fb/a/mailverify?uri=GoutpalNetwork

[Keith Taylor]

Yes, for some.
No, for most.

[Author]

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