Are my readings high enough to start Allopurinol??

[Alan]

Hi,
First time posting, but lurked for a while.
Now feel I need some advice.
I am a 39 male, 19st, 6ft and I have suffered from gout off and on for about 4 years.
The first attack was bad and was in the left big toe. It went and came back after maybe a year for another bad one in the same toe.
Naproxen was prescribed and after a few days it went.
The doc told me that watching diet and booze would help and also that I should look to drop weight, and whilst I know I am heavy I am not obese (ex bodybuilder).
Anyway I went off and dropped about 4st over about a year and a half.
As soon as I started dropping the weight the attacks stopped and I felt great, however I slowly started to put the weight back on and I started to have attacks in the right toe this time over the last year, not terrible ones like before but still enough to stop me going to work and getting around.
It seems since Jan 2015 I have had twinges and a couple of bad days every month.
Just after an attack I went back to the docs and he sent me off for blood tests.
When I spoke about the results, he confused me a bit as he said my readings were 370 and the normal is about 330?
Upon researching the charts, I wonder if this is what he meant ?
6.2mg/dL – 0.37mmol/L – 369?mol/L
Allopurinol was prescribed, which I haven?t started yet and he also prescribed Colchicine for flare ups whilst starting.

Ok that?s the history, now for the concerns ?

I am pretty worried about starting Allopurinol based on what I have read.
I am worried about rashes and big flare ups and also pain in other joints that didn?t suffer before.
Also I am off on Holiday to Cuba next month and if I start Allopurinol and have big flare ups or a bad reaction I will have a terrible time.

Are my readings considered high? And if you were me would you try to control it with diet and losing weight?

I do eat a lot of meat and did drink a lot of beer (trying to cut the beer out now) but really a change of lifestyle is what I need and I am willing change in order to drop weight and feel better in general.

Does anyone have any comments or bits of advice?
Sorry it was so long!
Al

[Keith Taylor]

Hey Al, don’t apologise for long posts – the more info, the easier it is for me. You’ve started adding info to your profile as well, which is very helpful.

You are right about your interpretation of your uric acid test results. The ISO scales are used in the UK, so your ideal target is 300μmol/L, the equivalent of 5mg/dL. You are not that much over, so diet control may well be possible, if you can accept some restrictions. You might find that your uric acid level is higher 2 weeks after your gout flare subsides, as results are often lower during a flare. Even so, I would think you should be able to achieve a safe level of 350ish, even if you can’t get the safety margin of 300.

I won’t discuss the issues about allopurinol unless you specifically want me to. I’ll focus on lifestyle changes.

Without knowing more about your daily eating habits, I’d say your biggest problem is meat.

That is meat that you eat, and meat that makes up your weight. Both breakdown to uric acid. I accept that, as a bodybuilder, excess weight is not necessarily unhealthy. Unfortunately, for anyone disposed to gout, it is a problem. Muscle mass is the curse of gout sufferers, so many bodybuilders get gout. It’s possible to stay fit without building muscle mass, but that’s the choice you have to make.

If you do want to make lifestyle changes then losing weight is a good first step, but best done gradually so it stays off. Next you need to reduce meat intake. You can still have a varied, interesting diet. But, meat has to become more of a flavouring and an occasional treat, rather than an everyday meal.

Healthy diets include alkaline diets and Mediterranean diets. If this is the best way for you, I’m confident we can create some meal plans that suit you, and get your uric acid safe.

In the meantime, you might be at risk of gout attacks, so adopt a scout mentality, and Be Prepared.
1. Colchicine at first sign of an attack. To minimise risk on holiday, consider one before bed as a preventative.
2. Naproxen at gout strength, as prescribed by your doctor
3. Ask your doctor or pharmacist about a compatible analgesic to take between naproxen doses. This will block any residual pain, which should allow you to work or to enjoy Cuba.

Other things you should do include: staying hydrated, blood donation, coffee drinking, avoiding prolonged exposure to cold. There’s probably a few more, and it’s high time I organised a list of them.

[Alan]

Hey Keith,
Thank you so much for taking the time out of your day to help me with my situation.
The fact that you have said that my readings are not that high has reassured me, and I think may have convinced me that Allopurinol may not be my answer.
There was a long break from when I started to drop the weight to when it started to come back on where I actually thought I was cured!
Oddly enough, when I was dieting I was eating a high protein diet of about 190g a day without a flare up.
The Mediterranean Diet is something that I have actually been talking about starting for a few weeks, so I think this is the way forward!
I will look into shopping lists and recipes and make a start from today.
It?s going to be difficult to cut down on the meat but to be fair, pretty much everyone I know says that I eat too much meat anyway.

Ok, so plan of action –

? Lose weight
? Sort diet
? Stock up my ?Anti Gout Survival Kit?
? Enjoy Cuba

I turn 40 whilst I am in Cuba and I have 6 weeks to get my changes into action and hopefully start my 40?s as a new man!

Once again, thank you.
Al

[Keith Taylor]

Al, I’m really pleased with your positive outlook, and I love your plan of action.

As far as the meat issue is concerned, I did it by cutting down gradually. At one point, I was eating sausage/bacon for breakfast, ham or other meat sandwich for lunch, then a meat-based evening meal. I changed slowly, especially reducing portion size of meat, in favor of more vegetables. Now I rarely buy meat, and just eat it as a treat when I’m out at places that have poor vegetarian options. If I’m cooking meat, I eat it over several days, with very small portions balanced with loads of tasty veg. I’m actually doing that more for heart health than uric acid control, and there are many health benefits from this Mediterranean attitude to meat.

Those changes, plus gradual weight loss, might well be enough to get your uric acid safe. However, once you are back from Cuba, if you’ve made no significant progress, you might also consider temporary allopurinol. That will stop gout getting worse, giving you time for lifestyle changes to take effect.

[Alan]

Hey Keith,
Thanks for the further help and advice.
I actually got my reading wrong, and unfortunately not in a good way!
It was actually 476?mol/L.
I guess this may change things regarding my plan?
DO you think Allopurinol is now looking more likely the way forward or you think I can still get it down with diet and wieght loss?
Staying positive however!
Al

[Keith Taylor]

Oh! I’m sorry that it’s 476. That’s too high for diet alone, but it’s great that you are staying positive.

Healthy diet, which encompasses food, exercise, and weight, is important for avoiding other diseases. It’s good to be positive about that. The way I look at it is – there’s no point controlling my gout, if I ruin myself by avoidable exposure to high risk of heart disease, stroke, diabetes, etc. There’s always room for improvement, but I try to keep fit and eat healthy. I hope you’ll take that as a positive, and improve your diet where you can.

That won’t be enough to lower uric acid down to 300μmol/L, which is your lifetime target, so you need a uric acid treatment plan. Positive thoughts about that are:

• All blood testing for uric acid, especially when you are taking, or considering any uric acid lowering, must include liver function and kidney function tests, so you and your doctor can monitor some good indicators of general health
• All gout patients must have blood tests at least once a year, so you can have a consistent high-quality health monitor for the rest of your life
• By taking action to lower uric acid now, you can avoid years of increasing pain and joint damage through your 40s/50s

I don’t think it matters too much if you start your uric acid treatment plan now, or after Cuba. The important thing now is that you’re happy with your ?Anti Gout Survival Kit? enough to enjoy your holiday. Then, you can add ‘Get Uric Acid Treatment Plan’ to your plan of action.

I know you are:

pretty worried about starting Allopurinol based on what I have read.
I am worried about rashes and big flare ups and also pain in other joints that didn?t suffer before.

Rashes will either happen, or they wont. If they happen under a safe, managed, allopurinol treatment plan, they are a rare minor problem that can be dealt with. It’s right to be concerned and vigilant. It’s wrong to worry.

Big flare-ups are just as easy to control as small flare-ups if your ?Anti Gout Survival Kit? is working properly. So, no worries there.

Same goes for pain in previously unaffected joints.

I know that you know that doing nothing isn’t an option. Rather than your concerns spoiling your holiday, I recommend starting your plan when you come back. I’ll be here to help you every step of the way. We need to make sure that you are happy with your treatment plan, and safe from the worst ravages of gout.

Enjoy Cuba, Al.

[Alan]

Hi Keith,
Yep I was disappointed when I realised that it was higher than first quoted.
I think starting the meds after Cuba is the best plan!
Couple of questions if ok?
1. First one is regarding the Allopurinol ? Do you think if I manage to get the levels down to the acceptable levels and make the lifestyle changes needed, I may be able to come off them later in life?
2. Do you think I should stop taking the colchicine now and take only when needed?
I have been popping them twice daily for 2 weeks as I was going to start the Allopurinol today.
3. Regarding making sure I have what I need whilst away, would you say colchicine and Naproxen will cover it or is there another med that I should be asking my Doc for?
Again, I want to thank you for advising and helping me with this, it?s amazing that you take the time to help people the way you do!
Best wishes,
Al

[Keith Taylor]

Hey, thanks Al. There’s a story behind your last sentence that I’m itching to tell one day. For now, let’s just get on with controlling gout.

1. You’ll always need artificial help to overcome the genetic defect(s) that cause excess uric acid. Today, allopurinol is the first choice for most people. There are a few alternatives now, and more in the pipeline. I hope both of us see the day when there’s a true cure. For now, controlling gout is enough. Daily allopurinol is an easy habit to get when you realise it saves you worrying about gout. Once you’ve debulked, there is no reason why you cannot take a few months off, if uric acid levels and other symptoms are monitored properly.

I expect the next generation of uric acid lowering to focus on short term rapid debulking for a few weeks each year rather than daily meds. You heard it here first 🙂

2. Colchicine use is your choice. If I were in your shoes, I would consider one preventative each night whilst on holiday. However, I’d research general health conditions first, as colchicine is a no-no if you are likely to be exposed to any conditions where you need your immune system at full strength.

3. My preferred combination, for unbeatable inflammatory pain relief within hours, is ibuprofen and paracetamol. I would have considered naproxen if I had any problems with ibuprofen. There are other alternatives. Anti-inflammatories are the core of a good plan. As they reduce inflammation, they reduce pain, but gout attacks vary in strength. For bad attacks, the residual pain two hours after your anti-inflammatory can spoil your life. Enjoying life is paramount, but we’re already on maximum dose of anti-inflammatories, and good gout patients don’t want to risk the horrors of NSAIDs overdose. In that situation, analgesics that block any residual pain signals are a wonderful thing.

I’m no expert on the alternatives, as I found what worked for me first-time, courtesy of the kind Bradford Royal Infirmary nursing staff. When I was hospitalised with what turned out to be gout, they saw to it that I never suffered. Neither should any other gout sufferer.

I hesitate to suggest other viable combinations. Your doctor should know. Your pharmacist will probably know. Nurses know best. Date an intensive care nurse. You’ll be an expert on pain relief and much more before the second drink!

Look at the nonsense I’m writing, Al! I think you’ve got me in holiday mode. I’m enjoying this conversation. Enjoyment, for me, is what life’s all about. A great antidote to certain email and phone conversations I’m enduring today. Time for me to burst into my Life Of Brian song.

[Alan]

I am looking forward to hearing the story!
I too am enjoying the conversation. It?s getting me through this arduous Monday reading medical reports!
Regarding the Colchicine is it ok to take it daily for long periods? The bottle says to take a max of 12 per course, but so far I think I have taken about 30!
I won?t spontaneously combust will I?
When I start the Allopurinol I will have already been taking Colchicine daily in Cuba, so I guess I just start the new meds and run them both together as soon as I get back? What?s recommended? A month of both together and then come off the Colchicine and then get tested?
You must get asked these questions constantly so apologies if it?s as agonising as gout attack answering them!
Al

[Keith Taylor]

That’s the first time I’ve seen any reference to a 12 per course for colchicine. I believe caution needs to be exercised with any medicine, and colchicine is in the toxic area. I guess the reference to 12 is a caution against long-term use. Because that is not what it was prescribed for. Doctors have very wide prescribing powers. So, might give a totally different prescription in different circumstances. A good careful doctor will prescribe the least amount of medicine to do the job he was consulted for. So, my best explanation is that 12 is about right for dealing with a single attack. When used as a preventative, in the UK, you would get a 28 day supply maximum. Again, doctors can override this with private prescriptions that often work out cheaper than an NHS prescription.

The safety issue has to be determined on an individual basis. Some inflammatory diseases can’t be treated, so colchicine is the only hope. Familial Mediterranean Fever is one, where colchicine is taken daily for life. You should not have any serious adverse effects, but just be aware that colchicine works by suppressing your immune system (hence my infections warning).

Your allopurinol-colchicine plan sounds fair. I was recommended to take colchicine for 2 weeks after each dose change, then as required. There’s no set plan, but the important thing is: if you are not taking colchicine daily as a preventative, be sure to take it as soon as you notice a twinge. If you wait until a full gout attack develops, colchicine’s value is limited. It slows inflammation getting worse. It does nothing for existing inflammation or pain, though this will resolve naturally in a few days.

I need the constant questions, Al. I’ll explain why in a minute, but the variety is amazing. It is very rare for two questions to be alike. Even if they are, personal circumstances usually mean that the answers are different. Also, over time, the answers change. That might be new medical advances, or simply that I have learned more. Whatever it is, there are two important reasons for lots of questions.

Firstly, my business model. My life goals are arranged around my concept of spending my life doing what I enjoy, then finding ways to make money from that. So one of my eternal pleasures is writing about gout, especially in the context of helping others. If I wasn’t running this gout forum, I’d be contributing to other gout forums every day. I enjoy doing it and enjoy the challenge of finding better answers. So duplicate questions, rare as they are, are always welcome.

For every person that comes here and starts topics, or replies to other people’s topics, hundreds more read the information. A couple of those will click adverts. The advertisers pay a few pennies, and I can eat.

But if I didn’t need the income, I would not stop GoutPal – I’d just remove the adverts, or probably keep them for charity. That brings me to the most important reason for more questions, duplicate or not.

GoutPal.com has become my life’s work. It is a little disorganized at the moment. But slowly it will become the ultimate guide to best standard practice for gout management. What I’ve learned most is that general guidance is not enough. It is very useful for creating a treatment framework. Then identifying diagnosis and treatment options. However, all treatment has to be personal. The official guidelines stress that there is no “one size fits all” treatment for gout. Gout patient care must be individual. Therefore, my advice must be individual – a personal interpretation of general guidelines that suit each individual. In parallel with these developments, there is lots of research showing that treatment is much more effective where doctors provide individual follow-up care. This might be a mentor, specialized nurse, or gout patient groups. My take on this is to provide these gout forums.

I’ve combined all these improvements in best practice to put more emphasis on the gout forums. To bring that back to your point, Al, it shows that every question is individual. I certainly never tire of them. I just hope to be responsive enough and continue to improve my gout service levels. So, it’s best to start a new topic in the new gout forum.

Sorry if I’ve hijacked your thread for my own purposes, but I think it helps if gout sufferers understand why I do this.

[Author]

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