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Hi cjeezy,
I am jut follwoing your footsteps in some ways. Probably you and I are the people regularly checking UA at home and posting the values and trends.
Yesterday evening I felt many twinges in my left foot( I never had gout in left foot)….they continued for hours and even the lower side of bunion was hurting. I checked the UA value at home – it was 4.7. I then got it checked at lab- it was 4.8.
My values have been mostly around 4, so this value was high. I expected it so because it felt like some crystals were dissolving, hence values 4.7 and 4.8.
It looks like that while the Allop is working and crystals dissolving, there are occasions when the UA value goes up than usual. That's why you are seeing these swings in values.
This is negative side of too much monitoring – which probably you and I are doing. Those who depend on lab tests never know the values on daily basis and are probably better of. Sometimes, not knowing the evil helps.
cjeezy,
Your symptoms are very similar to many of mine. I have just written in another post about “Uneasiness” in toe.
I am on 300 mg for 5 weeks with SUA levels of less than 4 most of times. I do get the soreness in the feet, both of them but it is mostly the right foot that my mind gets attached to. No pain in knees( than usual I used to have before sometimes) and no new pain in bottom of feet or arch but I do get sensations around the bunions of both the feet and aches at times.
Top of toe also hurts at times.
I guess it is probably the natural recovery process. I told about it to my doctor in my visit to him last week and he basically told me to forget about these minor sensations as it is common recovery process.
My biggest issue is -Load bearing – as my right foot( it got injury and gout) does not get the load distribution like the left foot. As a result, the load is still more on the middle toes than the big toe. And depending upon which shoe I wear, the pain becomes more or less. As such, my ability to wear shoes is just limited to one or two pairs and I have to wear the tennis shoes even when I go for customer meeting…not a happy situation but I donot know what else can I do but wait for some more time to get it back to normal…
I am taking one Colchicine every other day now for last 4 weeks…before that, I was taking 1 tab every day.
I use home test kit for testing SUA levels and have compared them with the lab results. The home tests seem to be relaible as the home and lab results were very close. I have compared them couple of times.
Besides, I have seen that the results are very consistent, for example, I have seen clear trend based on medication and time of test….nothing out of range or shocking.
Here is the link for testing kit
Interesting topic.
I am now on 300 mg of Allopurinol for last 5 weeks. I have monitored my SUA levels at home and labs regularly. In last 4 weeks, I have tested it about 26 times. The value range is 3.0 to 4.4 including 3 lab tests, with 80% of values ranging 3.5 to 3.9.
The mean average is 3.7.
The values are very consistent – afternoon around 2 pm, it is 3..8 to 4.1 and evening around 6 pm, it is 3.4 to 3.7.
Does it mean that I am not dissolving the Uric Acid crystals, or may be they have turned into hard stones that Allop can't dissolve anymore
I used to get many twinges in the early days but now they have reduced a lot, very few that also last for couple of minutes at the most.
The uneasiness in the big toe joint is still there, though reduced a lot, but that I guess is most likely residual of the toe injury. It is very subjective to the shoe I wear on that day.
Snoring is history now.
I am not an expert but from what ever I know, your treatment sounds very different. I am really surprised that you were taking 300 mg of Allopurinol twice a day ( that is 600 mg daily) wihtout any Uric Acid blood test for 3 months. Generally, the dose is started at 100 mg and then increased weekly with UA tests till time the level drops to target of below 6 ( or 5, 4 etc. whatever the target is).
The Allopurinol should not be started during a gout attack but if the gout attack happens while one is taking Allopurinol, it should be continued.
And now the doctor wants you to stop Allopurinol and then re-start with a dose of 400 mg daily( again too high). I have not heard such a treatment on this forum before.
I do now know what the experts like Zip or Trev or GP feel; If I were you, I will change the doctor asap.
I agree with you….The rash seems to improve now and though it is still there, it is getting back to normal skin color at places….I hope it gets over soon.
I will anyway get it tested this month end.
I showed the rash to doctor. he said it takes 4-6 weeks for the rash to disappear. Why it happened, no idea but most likely some insect bite or touching some poison plant…Should not be due to Allopurinol.
About Lyme, he said it does not look like one.
My next labs are due this month end and I will ask him to include it in those tests.
Thanks Zip.
I agree with you, lower UA level gives much more confidence and peace of mind. As my readings of UA are showing mostly less than 4( mostly lower to mid 3's), he thinks that 200 mg will not make it higher than 5 anyway. I feel more comfortable with around 4 readings than 5.
I am seeing the doctor tomorrow and will insist on 300 mg and also ask him for labs for liver and kidney functions.
I hope so that everyhting works out fine. My home testing readings are now very consistent – Early morning readings are 4.3 to 4.9, before lunch 3.8 to 4.3, evening before dinner 3.1 to 3.6 in last one week.
The residual pain in toe seems to be from the injury as I was given one sleeve with gel pad to wear with shoe and that seems to take the pain away by almost 95%. Looks like the injury has limited the movement of toe, which is taking time to get back to normal motion and the sleeve is helping in that.
The doctor wants me to stop Colchicine ( I am taking it one 0.6 mg tab on alternate days for 10 days now, earlier I was on 1 tab a day for 2 months) and reduce the Allopurinol to 200 mg(from 300 mg I am taking for last 2 weeks) as he thinks that will keep my UA level in range of 4's and 5's instead of values in range of 3's and 4's. More so becuase of the rash as it appeared a day after I moved to 300 mg dose.
I am puzzled as I donot want to be near 6 UA level and stay away from Gout as much as possible.
I will use Cortisone for 2 days more and then stop it as it will be 2 weeks then and doctor told me to stop it after completiing 2 weeks.
From the shape and size of the rash, it does not look like Lyme. I checked a lot of pictures on the web and mine does not come close. But as you said, better check it and get peace of mind. Early treatment is better than complications later.
By the way, any idea generally how much time the rash takes to almost disappear or merge in the skin color?
Thanks Trev and Zip.
I will get it tested for Lyme. I am seeing the doctor next week and will ask for it.
The rash in the mean time is improving but the improvement is slow. The color is getting light. I am using 1% hydracortisone cream twice a day. In 12 days, I will say improved by 50%.
Any idea how much time it takes for rash to fully disappear or near to disappear? The doctor told me 10 days back that it takes a while for rash to disappear. What is this while is what is causing some anxiety.
I do not have any other symptom or itching. And it is stable, getting better but slowly. I checked the websites and it does not seem to be Lyme.
My concern is – could it be due to Allopurinol? Or is it just a minor heat rash due to sweating or something similar?
As I said there is no other rash and there is no itching or any sensation in the rash.
Gary S said:
I forgot to add that I drink the whole thing over a hour or so. I read that someone suggested drinking it daily like a cup of coffee. I would be interested in how well this works.
I think it is unfair to say that if UA is more than 6 mg/dl, the gout attack will happen. I checked my medical records for last 9 years. My UA had been 7.8 to 8.0 all the time( and it was always considered normal). I did not have any attack of Gout though I never have tasted cherry juice or ACV. I did not have any diet control either as I was eating at my will. Though I eat less meat but I was heavy eater of Legumes, Mushrooms, Spinach and similar high purine items. I had no idea or inkling of gout attack during these years.
This year when I got my right big toe injured by a direct blowing hit, I got the Gout attack. For me the trigger was the toe injury.
I think, we do get paranoid that if UA is above 6 the attack will happen. It is more than just the UA number, it is also body temperature and some other factors that determine at what level the Gout attack will be triggered. The 6.3 mg/dl is a statistical value for crystal formation but it does not mean that crystals would be formed at 6.3.
Of-course, from treatment point of view, doctors would try to bring UA level much lower than the flash point for everyone as they would not know what would be trigger level for a patient. I am myself targetting to keep it below 5.0.
Quote – Any thing more than low 5 means strict diet control till time we get them below 5.
I meant – diet control or medicine.
I think the debate is going on if it should be 3 or 4 as the minimum level. Some interesting facts are coming up though like the oxidation theory and immune system impacts.
You and I both seem to be new Gout patients and we may not have that many tophies or crystals to resolve. So, we may be OK with 4 plus numbers or near low 5 like you said.
Any thing more than low 5 means strict diet control till time we get them below 5.
cjeezy said:
It's definitely interesting. My last 3 tests on 300mg of AP were 4.0 (lunch), 4.7 (dinner) and 3.8 (after fasting for 10 hrs).
Hi cjeezy,
I tested UA again today morning. This time, I had a cup of tea with 3 cookies and then went out for a walk of about 3.5 miles in 50 minutes. I did not have any water during the walk.
Came back home and tested it within 15 minutes of the walk. The reading is 4.4 mg/dl. I was trying to see what would be the effect of the exercise.
One interesting fact is that my readings have been very consistent in last 4 days. It was 4.3 on 9/28( lab reading was 4.4) with 5 hrs fasting, 4.2 on 9/30 tested 90 minutes after lunch and 4.4 today 10/1 after 50 minutes walk. I will test in the night and on fasting to see what the readings are.
I do not know if it is good or bad to have consistent readings and what does it really mean?
Good question to ask. I am in almost similar situation like yours. I am on 300 mg for 4 days now. Had a banana, rice crispy treat, potato bread and a petite vanila scone from Starbucks at lunch. Tested UA at home after 90 minutes of lunch and the reading says 4.2.
All other times, I have tested after 4-5 hrs of fasting but this time it was after food. My reading was 4.3 two days back.
Mine question is also same like yours – how much time for crystals to dissolve and do I have that many crystals? Mine attack started 4 months back due to big toe injury by direct blow to the bedpost. The Allopurinol treatment started exactly 2 months back.
The reference of 2.0 to 8.5 is what I get from my hospital lab while the 2.4 to 8.2 is from the Personalabs.
The range of 3.5 to 7.2 is listed in the booklet provided with the UASure home test kit. The range of 3.4 to 7.0 is listed on the website when I check about uric acid testing( I do not recall the exact website though).
I tested with the home test kit yesterday and got value of 4.3. At the same time( 30 minutes apart), I gave the sample to Personalabs and got the value of 4.4, which are alomst same.
I have seen when I test at my hospital lab, the value is .2 to .3 higher than the personalabs.
I will compare it with my Home test kit when I get the sample tested at the hospital(sometime next week).
Hi cjeezy,
I hope you should be out of this drug interaction mode soon.
I have couple of friends who have Gout experience and they rely on Aleeve. They actually talk so high about Aleeve and have never taken a Colchicine( one of them heard this name from me for the first time).
I have no experience but Aleeve may workout as an alternative to Colchicine and help you till you can resume Colchicine.
Hi cjeezy,
I hope you are feeling better now. I think ZIP and GP are correct. We seem to be in a denial mode that lower dosage will work. I think, it makes sense to go to 300 mg dose and get the extra cushion for “incase” elevations of UA due to food or exercise or whatever. More cushion we have, betterof we will be.
I got my results of the blood test yesterday and the UA numbers are 5.0. Tested at 2:30 pm. It was 5.1 a week back and 5.5 two weeks back.
As suggested by GP, I am planning to move to 300 mg. I am however having some dizziness issues and difficulty in focussing for last couple of days( similar to vertigo) and am not sure if it is due to Allopurinol. I showed it to doctor and he says these are not related to Allopurinol. But I will wait few days to let them resolve before I increase my dose.
I also had some extra pain in the toe today( at a particular point where the toe bends upward) and uneasy feeling. I am not taking extra Colchcine and wait to see if it improves. It seems better than what it was in the morning.
Let us know what your status is at this time.
Hi Trev,
Actually, I have shown it to one GP and 2 foot specialists. Currently the GP and Podiatry, both are treating me.
As you rightly said, they have limited Gout knowledge and feel happy with the fact that UA is in normal range.
They are all more aligned towards bone fracture causing these residual pains as many of them are due to stretch under the toe bone and they feel the physiotherapy is helping. They are aligned that there was gout and I have to continue on Allopurinol.
I think, the fact that everything started with toe injury and Gout was slow to set in in a non-classic way, it creates some confusion, which I can understand.
I only hope that both the concurrent treatments that I am undergoing are complementing each other, not conflicting.
I jogged 1 to 1.5 miles about 3-4 times last week( this week I am walking only though plan to jog tomorrow). I do get some soreness sometimes after jogging but my joggings are in the morning. Only twice I did some jogging ( may be 2 laps) in the evening but it did not cause any soreness next day in the morning.
I have been applying Biofreeze before I sleep to take care of any soreness.
I have my doubts that your symptoms could have converted into full blown gout attack. I also get burning sensations and pains in the big toe and surrounding areas but they go away at their own. I have not taken extra Colchcine to cure them. My dose is 1 tab 0.6 mg after dinner( or lunch sometimes).
My jogging is also at slow pace, around 5.5 to 6 miles pace. I am trying to keep it low impact for some time and observe before going for higher pace.
Hi Trev,
It is probably my second attack of Gout. First was 10 years back when I was exposed to -30 F temperatures for couple of months and my feet were in the snow for extended durations. The pain was very acute( like described in books) and full right foot was swollen like hell and could not be touched even by the bed sheet. I was directly given Allopurinol 200 mg on the day 3 while my foot was very painful. Allopurinol worked like a magic and the pain was 70% gone with first Allopurinol tab and went away completely in 3 days. In less than 7 days I was normal without any pains or swelling or any residual feeling of gout. I stopped Allopurinol after 3 or 4 months. There was no other medication, not even pain killers after 2 days of Allopurinol. I did not take any diet precautions in last 10 years though I am low on drinks and low on non-veg foods by choice. Some doctors say that it was not gout as Allopurinol at its own cannot cure the pain in 3 days. The symptoms were of gout though.
The current one is my second attack but in this case, my pain was not acute, it developed over a period of 3-4 days after the injury, very unusual way of getting the gout pain. May be gout pain developed due to injury happens this way.
You have a solid point. I am sure that Allopurinol is playing its part in correcting the problem while still attacking the root cuase(UA Crystals), which adds to some discomfort at times. I do feel itchy, burning sensations in my right toe( and at times left too). The doctor also told me the same thing that ignore these sensations unless they cause swelling or more than average pain. I have actually felt couple of weeks back that my foot was really sore before I went to bed with lot of twinges. Next mroning, my thumb movement was improved by more than 50% of the night before and foot was much more free.
I am not heavy athletic though till about a year back, I had my routine of 5-6 miles jogs min 5 times a week, which started hurting my knee and I started getting some ankle pains. That could have been start of Gout, can't say but everyone suspected too much of jogging was causing it. I also lost 30 lbs in 2 years and got my BMI down to under 20.
Lately, even before the gout attack and the injury, I have reduced the exercise to 2 miles jog with 2 miles walk for 3 times a week. I am not underweight but in the normal range. BMI near 22 to 23. So, I hope harmonal factor is not causing anything here.
I hope, it gives more information about my history of gout.
Thanks everyone for sharing their thoughts. I agree that all the pains are not Gout and that's what confuses my situation more. At the same time, people having gout do experience symptoms similar to what I am experiencing( after-effetcs of Gout) – cjeezy symptoms are similar to mine. And I did got Gout attack, so there is reason to get these lingering pains.
I went to the Physio today and also showed to foot specialist. They feel it is mix of 3 things – Fracture, Gout and Mindplay( Like Zip said).
They actually let me do the thumb 360 degree rotation today and also let me pull my thumb out(stretch it). I could feel the buckling sound as well as the breaking sound as if the thumb is trying to pull out. So, there is element of the bone getting direct blow( my fracture was in the bone which directly links to the balls under the toe and it terminates near one of the ball. So, there may be still some internal swelling in that area not visible to eyes.
I have taken 200 mg Allopurinol for 4 weeks now(includes 250 mg for 2 weeks). Since last 2 weeks, my readings are near to 5. That might be helping to make my foot free as major improvement has happened only after I started 200 mg dose. But there may still be crystals causing the residual pains.
The doctor says that there are lot of stress related pains which we all get but the mind simply ignores them. With gout or injury, mind gets focused more on the minor stress related pains as well. Besides, we get into tendency of checking if it still pains and put extra pressure on the joints further stressing it. So, this is mind cycle, which makes us feel many pains which other people simply ignored.
All things seem to make sense but the fact is that there is still pain and its taking its own sweet time to go away. I do not know what else can I do except to continue with the current treatment and wait for the things to settle down.
One clarification on the point 3
3. When I walk, at times I feel pain in the right toe, more so when it gets bent a bit more
The pain is more on the bottom side of the right toe at the point where the right thumb ends..
I never tested at home. All the times, it was lab test only. I was able to reach 5.5 with 2 weeks of 200 mg, so I think, if everything goes fine, I may be able to cut it back to 200 mg. For the time being, it is 250 mg and I will test next week to see where the numbers are….I hope, below or around 5.
One other thing to note is that I have been now exercising ( light jogging and walking) for an hour a day for a week, which was my routine before I got the toe injured followed by gout. So, the numbers include the exercise impact. I did lose about 3 pounds in a week time.
Let's see view of others on numbers 5.5 v/s 5.
I am waiting to see your numbers.
I got my Uric Acid tested yesterday at 2pm before I ate my lunch. The numbers came down to 5.1. I am on 250 mg of Allopurinol( 200 am and 50 pm) since last one week.
My last week reading was 5.5 on Sept 8( with 2 weeks on 200 mg and 4 weeks 150 mg prior to that). All of these tests were done in labs.
My trend has been consistent with the dose and passage of time with UA levels falling every week.
I guess, I do not have to go to 300 mg dose as the numbers may go down further with 250 mg as it builds up its concentration in the coming days. I will get tested next week again.
I am on very strict diet without alcohal, meat or any other high purine product. I plan to start eating now in small quanitities as the numbers are now considerably below 6.0.
Any advise?
Thanks!
My gout got triggered due to rught toe injury on the Memorial day weekend. Before this attack, I haad one 10 years back when I was exposed to “- 30F ” temperatures for long time and my feet in the ice almost everyday while cleaning the car. There was no other attack though there were episodes of minor sprians that would come and go away in 1-2 days. As I used to do heavy treadmill jogging, it was blamed on the jogging and aging
I did not have any diet control though I never have been heavy drinker or red meat /sea food eater.Anyway, this episode is now 3.5 months old and Allopurinol 6 weeks now. My right toe is still not free..it pains many times when I walk though it is much better as I can now wear tennis shoes and jog for couple of minutes. The doctor say it is due to injury but I also suspect it may be due to some crystal residual that is restricitng its movement and causing pain.
Hi GP.
What do you feel, with my current 5.5 reading in 6 weeks of Allop(2 weeks at 200 mg), do I need to really go down a lot on Uric acid for crystal dissolving?
By the way, I have increased dose to 250 mg..200 in the morning and 50 in the night…I hope the split would not cause any issue, Any thoughts?
Thanks,
It is interesting. you have been testing it in the morning whereas my all tests(except first one which was on 14 hrs fasting) we in the afternoon between 2 to 5pm without fasting.
Hi GP,
In one of your article, you mentioned that readings are low after fasting as compard to after food. I have been testing without fasting, though not immediatly after the food( gap of few hours)
Does it matter when do we test the Uric acid, or it has no impact on the numbers?
Thanks!
