Hi,
I'm a gout sufferer. My disease was brought on by a course of thiazide diuretics which increased my uric acid.
It started with underfined pains in the arch of my foot and my ankles which came out of the blue and crippled me for days then went away as mysteriously.
I also noticed a lump on my right big finger's first joint that sometimes ached dully.
I never put one and one togehter until I got the crucifying attack of PODAGRA, the classic purple bunion joint that strikes at dawn and leaves you a cripple. I had to CRAWL to the bathroom on my hands and knees with my right foot elevated lest it touch anything. It took me nine days to call my doctor and get an Rx for colchicine. I took 22 pills (one an hour) and the pain went away at the 22 hour mark.
I started taking allopurinol, 300 mg. per day, and foot pain has never recurred...but I still have some issues with my thumb which still has it's crystalline "lump", a tophus to name it precisely.
The reason I didn't get immediate help with colchicine is that I had taken INDOCIN (indomethacin) in the past which helped a lot and my "foot attacks" (not yet thought to be gout) never went longer than 3 days.
I had a jackass of an MD who never looked beyond numbers and the old uric acid range on the blood test printouts was HUGE...thus he kept telling me that readings of 7.0 for uric acid were normal. (Yes, I've suffered my share of fools.) So I listened to this "expletive deleted" and doubted my own diagnosis...which was GOUT. Of course the PODAGRA attack put an end to any guesswork.
chickpeas,
Get yourself an Rx for a bottle of colchicine, like 100 pills,...there's only one dosage, .6 mg. You take 2 at the start of an acute attack and then one evey hour til the pain stops to a max of 16. Sometimes the two pills is all that is needed if you catch it at the first sign of attack.
Colchicine does NOTHING for the underlying gout but it causes the joint to become alkaline and prevents further attack by white blood cells...ends the attack.
The usual "cure" is to take daily allopurinol for life...it prevents the body from making so much uric acid. You get periodic blood tests to make sure thaty your blood uric acid ia always below 4 or 5 which is below the saturation point so no more crystals will form.
I have found also that colchicine can help with my occasional backache as well. But one must be careful becasue intestines HATE colchicine and two pills is a mild laxative. THe recommended MAXIMUM of 16 pills in 16 hours is a crucucifixion of diarrhea...unbelievable actually.
Youre right flowergirl, something I learned during my last AWFUL attack of Gouty Arthritis, is there seems to be a large amount of conflicting information. Worse, Gout still seems to be thought by most people (even by some in the medical community) as a condition caused by the old stereotypes: Overweight Alchoholics who eat crap all day. What a joke! I dont fit that mold, and Im finding alot of people who dont, so why that still persists is beyond me.
Before my last attack, I had a couple Gout attacks that were bad but only lasted a few days and, looking back, were NOTHING compared to what my last attack did to me. I was, as Lenin said, literally CRAWLING across the floor so my foot didnt touch anything, and couldnt do anything to get rid of it. The Indocin & Colchicine didnt get rid of it, and not only did it last for weeks---after about the third week it moved over into the OTHER foot and stayed another almost 2 weeks. During this time, my heart would go into sudden episodes where it raced like I was going to pass out, and I now think of Gout as something more than a painful condition that lasts a few days...its something that I think can take you out, in more ways than one.
Considering all of that, I was shocked to find such a vast amount of conflicting information, and a lack of definitive answers for things we can do in the future. I started itching when I tried to take the Allopurinol, and I also have NEVER shown a high uric acid level in even ONE bloodtest, so I am really in a quandry over this. I also have a white "lump" under my wrist now that doesnt go away, and I think it could be the tophi that I had on my feet during my bad attack. There were several of them, but just the one remains. Even this, though, seems to be lacking in definitive answers. Even the diet when you go digging, is conflicted about many foods. There were also many sites that said alot of the people who are diagnosed with Carpal Tunnel are actually suffering from Gouty Arthritis, but since it is still so hard to lock down, it is under-reported.
I recently asked a doctor about the lump on my wrist, who looked clueless and just shrugged his shoulders. That shrugging of his shoulders, is what the entire catalog of information about Gout seems to be like---sort of a "Well....we kinda know some things about it, but...." I would think that Gouty Arthritis should be as important and well researched as the other forms of Arthritis, since it is a documented killer (especially before Allopurinol entered the scene).
Part of the problem with diagnosing based on uric acid levels in the blood deals with some people's ability to have a supersaturated condition without crystallization. The other is that the solublitity is remarkable dependent on temperature and thus while solubility is pretty high at 98.6 F it is LOWER at 80F and VERY low at 60F.
People measure body temperature in the mouth...or some other indiscreet cavity. BUT where does gout typically strike, the big toe, the ankle, the last finger joints, the wrists...the COLDEST parts of the body. NOBODY gets a gout attack in the mouth...or the indiscreet cavity. :D
Thus an upraised toe all night with slow blood circulation in a cool room easily can become 20 degrees colder than the rest of the body...that's why the typical attack of big toe PODAGRA is at 5 AM.
(I read a case history of a homeless guy who was bedevilled with what seemed to be merciless gout but constant uric acid below 4...it took a while for one of the doctors to realize his leg circulation was rotten and the temperature of his feet often went below 60 degrees F. They gave him colchicine and the pain went POOF!)
Too bad though, once crystals form any chance of avoiding attacks with supersaturation disappear because that first crystal serves as an easy starting point for more.
All those dietary recommendations are just so much hooey from days of yore...when there's no cure, doctors WILL devise a way to get paid and the no-sweetbreads, no anchovies diet was just suuch nonsense. I'm sure Henry VIII's doctors were well respected and WELL paid...at least until they killed Henry with dietary recommendation for his gout.;)
I think to get rid of tophi once formed, it takes more than just allopurinol...it take allopurinol PLUS an agent to dump the uric acid; something like sulfinpyrazole. Those uricosurics are hard to take though, lots; of side effects.
I've been takig allopurinol for a zillion years and the tophus on my thumb won't abate.(I've got a story about that thumb for later.)
My favorite gout line, and it was really an epiphany when I read it:
The humorist Calvin Trillin was asked what was the ONE most important thing he learned in his long life. His reply:
"If you have a lump on your thumb, you have GOUT."
(That single short phrase made me realize what a cosmic JO my doctor was.)
Attacks while uric acid seems low: the joint may disengorge part of the tophus into the bloodsteam and cause crystalliztion elsewhere. That's why people often get an attack when first starting allopurinol.
Flowergirl, iirc Lenin has said something about the crystals eventually being capable of doing heart damage. Or maybe it was that, technically, the swelling caused by the crystals is what caused more damage than the actual deposits blocking/sitting in an area of the heart? Im not sure if it was blockage or inflammation caused by them...
Either way wouldnt suprise me, considering how these crystals seem to want to go (after the coldest parts are already infested, lol) into the most damaging and painful crossroads in our bodies (at least thats how it seems). I am still amazed at how inaccurate science is in locking down Uric Acid...its as if the medical community has said "Well, Allopurinol and a few others have covered most people, so we really dont need to make this an exact science." :confused:
Lenin, I wondered if I could ask you about something I mentioned in another post you replied in, or how it might relate to UA/Tophi? The other post was about an "attack" I had in my right arm several days ago, while I was relaxing watching television my right arm suddenly felt extremely "tight/cut-off" causing cold sweat & feeling like I was going to pass out. The ER only checked for heart attack (which it wasnt, as you & Ken agreed). The only visible sign from that is a bruise right in the middle of my under-forearm, where it hurt the most.
My right arm is very sore today, so I am concerned about what is going on with it, and afraid of another attack like that--it was horrible. I have a white lump under my wrist that I think is tophi--and have had some smaller lumps come and go in that same area. I havent been able to take the Allopurinol because of the itching when I take it, so I havent addressed my Uric Acid levels other than eating cherries everyday (frozen, mostly) as the Doctor suggested.
What Im wondering now, is whether that "attack" could have been caused by tophi/crystals going unchecked? Is it possible for tophi/crystals--if left unchecked for months--can cause swelling and/or blockage in the arm? I never thought of that possibly being a cause for my arm pain until today, as I was noticing another possible lump forming under my wrist. Could it get so bad or form in a bad area, that could cause something to happen to the arm? Thanks for any help!!
