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How could the costs of vegetables (WTF?) possibly explain their ridiculous prices? Encountering scammers in the land of the scam? What a surprise! Just the name “Whole Foods” ought to be a warning.
I’ve had a couple of weird chats with people living in the US about food prices. Evidently they often have no idea what wholesale prices are and what their money pays for.I understood you were talking about oil and sugar… which again have no place in something deserving of the name of breakfast cereals.
Like, if you’re calling something dried apples it should be made of apples without the addition of oil, sugar and so forth. Else you’re selling apple-flavored junk food.First, it would indeed be safer for you to cut a bit off the 120mg pill than to combine two pills. I think the risk is neglibible and I would combine pills if I needed to but I’ve never actually tried it, I of course have no proof it is safe and I understand if you don’t want to take chances…
I have however been splitting a single pill in order to take it over several days for quite some time. And the blood tests have been consistent with the dose being controlled as one would expect by splitting. The test results aren’t subtle or overwhelmed by noise.
However it is conceivable that there are differences from one day to the next between the actual doses I’ve been taking and that these differences cancel out over time. If what mattered most for uric acid as well as the side effects I’ve experienced is how much febuxostat one takes over a week rather than over a single day then of course it wouldn’t matter much if the stuff was poorly distributed through the tablets I’ve been splitting.
Subjectively, I did experience different side effects over the course of a single day from taking half a pill as opposed to a quarter of a pill but these side effects haven’t been as consistent as the test restults and might conceivably have been driven more by the dose I thought I was taking than the dose I was actually taking. That’s kind of a strech since I was initially suprised by the side effects but I can’t rule it out nor can I prove it wrong with objective measurements.
Other potentially deadly side effects might conceivably show up if you were to take more than 120mg over a single day. I have zero experience with this and can’t rule it out either so again, I understand if you don’t want to combine pills.This stuff about non-absorption in the stomach however is laughable considering that they do sell scored tablets which have no film between the scored halves of the pill. There also are ingredient lists on the packages… what do the scored tablets contain that would prevent absorption in the stomach? And the studies backing their marketing authorization in several countries look at the effect of 40mg which you can only get by splitting these tablets. Are we to believe than they spend money on separate manufacturing processes for no other purpose than to harm people who split non-scored tablets?
Please consider you are basically talking to a non-sadistic but murderous psychopath when you’re talking to people representing certain pharmaceutical interests. What they are doing kills people and they are doing it for profit. There are cheaper, less dangerous and more conveninent pills and dosing recommendations in many countries and there is no medical reason we couldn’t use them. But we have to put up with this shit for no other purpose than to create a monopolitic rent.I have no idea what “natural” is supposed to mean in this context. Do they guarantee the Holy Ghost wasn’t involved in the processing? Regardless, surely beets and canola are not cereals and have therefore no part in anything deserving the name of breakfast cereals.
I normally wouldn’t even consider looking at stuff made by companies such as Quakers simply because their stuff is too expensive. So I find the notion that fresh produce, non-GMO foods and suchlike should be some kind of luxury item rather amusing.
Like, 6-dollar cucumbers in a country where workers are paid so little as the USA? That would be amusing if it wasn’t sad…You’re talking about junk food. I said “non-processed”.
I wouldn’t buy these so-called “bacon bits”, “maple syrup” or “breakfast cereals”. Neither of us eats bacon, actual maple syrup wouldn’t be GM and so far as I know the only actual breakfast cereal that’s likely to be GM regardless of price is corn flakes (which I happen to loathe).While the nasty burgers probably contain GM corn or something, most non-processed food is likely non-GMO even though it’s not advertised as such. No doubt scammers will try to make people pay through the nose for stuff with a silly label on it but so far as I know only a handful of GM species are routinely grown.
I don’t actually know what dose and schedule would work best for you. Your situation is a bit unusual since you recently discontinued a strong dose. No study is going to ask participants to discontinue their therapy like you did so I doubt there is actual evidence to guide you anywhere.
I therefore think you have to go for a balanced compromise between the various concerns without knowing if being careful actually makes any difference: don’t go back to the full 80mg suddenly but don’t wait several weeks to get to an effective dose either. You could take 20mg for a few days or go straight to 40mg. Taking 40mg for a week or two sounds reasonable. After that, I think taking no more than 60mg until your next blood test would also be a decent compromise between likely efficacy and side effects (again, there are 120mg Adenuric pills out there which would make taking 60mg easier) but we know you can survive 80mg so you could justify taking the whole pill for a month or two after taking 60mg for a little while.
For all I know, none of this will help. If you already triggered your immune system into a chronic gouty state, possibly the only thing that’d help is hitting your immune system with a nasty course of corticosteroids or colchicine.
Even without any help from anti-inflammatory drugs, the worst bout of chronic gout will stop when there is no more solid uric acid for the immune system to get upset about anyway. And taking at least 60mg Uloric ought to get you clean sooner or later. Your next blood test will confirm that (if at all possible, get it done it in 4 to 6 weeks rather than in 10 to 12 weeks).I would also not pick codeine even though it wouldn’t be the worst thing to take in your situation. I don’t want to recommend a particular analgesic considering the issues some people across the pond have with such drugs. This isn’t like Uloric which is a pretty uncommon drug. Most professionals do know their analgesics. If you explain the whole situation (which is why I laid out the three-part rationale for you above), you should get a decent recommendation from any compassionate professional.
And while I’m nobody, you have a name and so it may be wise (depending on your acquaintances) not to advertise on a public forum that you have a supply of the good stuff or even that you are planning to ask doctors for it.We know these pills, unlike doctors (mine didn’t know the pills they were pushing either). Your pharmacist was unsurprisingly equally clueless. They work just fine when split.
Codipar should indeed be avoided in your situation as it contains paracetamol. If it didn’t, it wouldn’t be a problem for your liver which is why you should ask for the real thing.You can split Uloric pills. You don’t want to take a pill every other day (it’s something you can do with allopurinol however). Depending on what pills you have, they may be difficult to split but they still work after having been split (the blood tests would show if the split pills were ineffective anyway).
See if you can get 120mg pills which you could split in half because I’m not sure 40mg is a high enough dose for you. It’ll probably work in the long run but it may not provide enough relief during the months ahead. You can also obtain about 60mg from a 80mg pill by cutting off a quarter (precision is not important).
In any case it might be prudent not to go back to a strong Uloric dose from one day to the next. You could perhaps raise your dose in two or three steps lasting a few days each.So you aren’t taking a PPI anymore? That may be reckless. Be very mindful of any stomach pain. Prolonged Difene use may even require progressively stronger PPI doses if you are prone to such side-effects which can evolve into very serious problems. And taking a stronger Difene dose seems unwise considering the side effects you’ve described above.
Steriods are trouble. But considering the trouble you had with colchicine, they seem like the logical option. After a few weeks on Uloric, if you could use steroids to stop the inflammation, it might not come back. You might have to take them a bit longer or take a stronger dose but I have no personal experience with that.
That leaves us with analgesics. Usually people are told to take paracetamol but since there is a suspicion of Uloric causing liver stress I would recommend against that for the time being. So see if you can get your GP or another doctor to prescribe you a moderate dose of a stronger analgesic. To recap, the rationale is as follows:
-you are already taking a serious anti-inflammatory dose and need something to reduce the pain and the stress it causes as well as to help you relax, especially in the afternoons and evenings
-you are taking a uric acid lowering drug which is known to stress the liver and your latest blood tests showed mildly elevated liver values, something you want to monitor without adding another drug known to elevate these values into the mix
-you are undergoing effective uric acid lowering therapy as your latest blood test demonstrates which means that you’ll be able to discontinue the analgesic before it becomes a habit (assuming your pain is indeed caused by gout)As you surely know, there are exercise devices which allow you to perform smooth work with your leg while sitting or even laying down. If that’s not practical for some reason, you can probably manage to lift your own weight without using your toes by putting your weight on your heels and holding something with one arm for balance.
As to your fragile joints, you could try mild stretching (non-weight-bearing). You could also try to use these joints’ muscles to carefully push against the strength of your arm using some kind of rope. Obviously that’s not meant to replace cardio but you want to keep moving these joints even if you avoid using them for weight-bearing exercise.
Something else: you don’t actually need to swim to exercise in water. As the water holds most of your weight you can stand in a moderately shallow swimming pool (perhaps one designed for children) without hurting your feet. See if your local swimming pool (or spa) facilitates something like that.He’s right that Uloric can cause more pain than allopurinol. But that’s only because clueless doctors give their patients too much Uloric too suddenly.
What dose did he just tell you to take?About controlling the swelling and pain while you are cleaning your system, my understanding is that you are currently taking 150mg Difene per day but no corticosteroid, colchicine or analgesic. Is that right? Are you still taking a PPI? You’d probably benefit from taking something on top of the Difene and a PPI but I want to get the facts rights first.
Are you having trouble sleeping? Do you have a history of addiction or drug abuse (any drug, including nicotine and alcohol)? Have you discussed your entierly natural feelings of hopelessness and doubt with a doctor? Are you getting your blood pressure checked?
In any case I recommend you get some mild exercise which does not trigger redness, swelling or pain. You want to do smooth movements and avoid shocks as well as heavy weights. Swimming in moderately warm water would be nice for instance. Make sure you have solid shoes which protect your feet well and be careful while walking as long as it seems to trigger such symptoms. If you feel that would be helpful, you can use a walking aid. Certainly it would be prudent to have something at hand to help you walk in case you get a violent attack.
I have no experience with Epsom salt but bathing your feet in warm water is a good idea anyway. Never let your feet get too cold by the way. You might also want to try raising your foot above your body for a little while before putting it back down as often as that is practical during your day. I noticed you reporting that evenings are especially difficult for you. This suggests to me that you are either having a poor posture (or clothes which restrict your blood flow) during too much of the day or that you are tensing your muscles too much during the day. Better pain medication could help with the latter problem but you could also try to pick up some kind of relaxation routine.
I also recommend experimenting a bit with your diet. In particular see if avoiding certain fats or limiting your salt intake seems to help with your symptoms. Different people’s immune systems react to different foods so see what works for you (possibly nothing will make any difference). Among the things which reduce uric acid and might therefore be helpful in combination with a lower Uloric dose are low-fat dairy products such as yoghurt. And be sure to drink lots of water (2.5 litres per day may not be quite enough depending on your size).Obviously I don’t understand what’s going on in your body either considering I haven’t even seen your foot! But if you are indeed suffering from gout (which sounds plausible), I know you need to keep your uric acid down for many months in a row. And I know 100mg allopurinol is inadequate in your situation. As far as I can tell, you only had about a month of low uric acid starting about 6 weeks ago.
If getting a better diagnosis with more specific tests isn’t realistic in your situation, best assume you have gout and see if the treatment works. That’s better than simply waiting without a treatment. If you don’t have gout, the treatment will not make your foot worse and if you do, the treatment will do wonders for you in the long run even if it causes increased pain for a little while. If you have gout, the more you delay, the harder it’ll be for you to get rid of it.
We can’t give you medical advice. Ideally, a doctor (it doesn’t need to be a specialist) would approve the daily medication you take. If you want to restart Uloric on your own authority because you can’t get an appointment with a reasonable doctor, that’s on you. It wouldn’t be crazy in my opinion considering you didn’t experience serious ill effects from taking for 40 days but I obviously can’t recommend it or take responsibility for any consequences. In any case you’ll need to keep seeing doctors and getting regular blood tests for liver function and so forth as long as you take any drug on a daily basis.Since gout treatments work very slowly, you could also get better relief from gout symptoms in the meantime and I’m sorry for not posting about that but the main thing you need to work on right now is to get your uric acid down as quickly as you can.
Unfortunately Dean’s uric isn’t at a good level anymore since a doctor saw fit to discontinue the treatment without explanation after the blood test.
You’d need the results of “clean” (drug-free) blood test for comparison before you can get a good picture of what’s going on but these numbers are not worrying as such. I had much worse alanine aminotransferase results on only 40mg Uloric for instance. And there are guidelines only recommending you quit such drugs when the numbers are much higher as well.
So unless you have symptoms of liver distress outside of the blood tests, I’d say your situation merely warrants more frequent blood tests to see if these numbers get worse over time. Having aspartate transaminase numbers would be useful as well in my opinion. If your liver values are stable, you’re probably OK. But like I said earlier, a slightly lower Uloric dose might be a good idea considering the balance of risks.Yes, the “crushing news” is basically my opinion… my unqualified opinion I should add.
I don’t know of anyone in Ireland but I think any open-minded doctor would understand the situation if you showed them the numbers and the relevant medical guidelines. Trouble is, how are you going to get a doctor to take enough time out of their day to give a good look at your case? Hopefully you know someone who knows a doctor or something.
One problem with allopurinol is that you reported what could be gastrointestinal side effects. Another is that it may well cause the same liver stress as Uloric once you reach an effective dose (you haven’t tried one yet). A third is that you’d need to ramp up your dose quite quickly which would initially require frequent blood tests and a serious doctor.
The exact tests results for your liver matter. See if you can get ahold of them because being a little out of range is typically not a problem. But considering the unspecified stress on your liver (which may be caused by Difene or other drugs rather than Uloric for all we know), I would recommend you try a slightly smaller Uloric dose such as 60mg (half a 120mg tablet if you can get hold of one of these). There should be a dose small enough that your liver would not be bothered even during the first months before your body gets used to the drug. Only that dose is going to be different in every case.
I double-checked and 267 umol/l is indeed about what you’d expect on 80mg. There are more or less random variations in test results which is why you’d ideally want several test results before drawing inferences but, based on the information I have, the minimum effective dose for you might be 40mg (this figure will have to be revised once more data comes in). It’d be best if you took a bit more but you most likely don’t need twice as much.The burning and swelling are not unexpected when you are curing gout. Any inflammation you get from gout when your uric acid tests low (as it did when you were on Uloric) is only temporary. It’s something that you’ll have to deal with once and for all or your condition will get worse over the years.
The one thing you need to make sure is that the inflammation isn’t caused by an infection. This is very rare but you never know. If you have a fever or other signs of a an infection, get that checked very quickly, espeically if it looks like an infection that might be spreading or if your body’s temperature gets very high.Hopefully I’ll get around to writing about other drugs before too long but the most important thing is to keep your uric acid low and your most realistic options to achieve this are allopurinol and Uloric. So work on that first! If they are both proven to be unsuitable for you, other options might be explored but you need to give at least one of these two drugs a serious try first.
For future reference, besides gout-specific drugs you mentionned a corticosteroid, five NSAIDs (diclofenac, ibuprofen, etoricoxib, exketoprofen and naproxen) as well as two PPIs (to counteract a suspected NSAID side effect) and two unrelated drugs supposed to help with gastrointestinal symptoms (possibly brought about by colchicine though such side effects are reported in relation to other drugs as well). No side effects were reported in relation to febuxostat or the corticosteroid however. And no analgesic was mentionned.
More later…I’m so sorry Dean.
You should really get your doctors examined! Unfortunately, it may prove difficult or even hopeless to find better ones in your area.
Where to start?First, Uloric 80mg is much stronger than allopurinol 100mg or even 300mg. So your 267 umol test result should not have been any kind of surprise (tests do not naturally drop anywhere as low during an attack!). If you had stayed on that drug, it would have cured your gout about as quickly as it can be cured. Unfortunately, as you noticed curing gout is painful and takes a long time. And delaying treatment means it’s only going to take longer to cure down the road.
Going from nothing to 80mg Uloric is crazy. Aside from the drug’s potentially dangerous side effects, brutal drops in uric acid is known to increase the risk of serious gout symptoms. And that drop was brutal indeed.
But once you have gotten your uric acid that low, you shouldn’t let it climb back. And there’s no way the allopurinol doses recommended by your rheuma will keep your uric acid down!
So my main recommendation is that you promprly get a doctor (any kind of doctor… even a veterinarian if that’s what it takes) to put you back on Uloric or to give you a stronger allopurinol dose (it’s prudent to ramp up allopurinol rather than to suddently take a huge dose but you’d need to ramp up your dose faster than 100mg a month).
Note that I’ve been assuming you really have gout. You certainly have the signs that way but you never know without a definite test.
Another disclaimer: we’re talking about dangerous drugs and you haven’t shared your blood test results (other than uric acid) so I don’t know if you liver looks like it can handle 80mg Uloric for instance. So get some doctor (again, any doctor!) to do some due diligence about the side effects.I’ll post about inflammation and pain drugs later since I’m not familiar with every drug name you’ve posted. Maybe some of these are brand names and I’d recognize the name of the actual drug. I’ll look that up.
There’s other stuff in your post that would require comments and corrections like the red meat thing but we can’t deal with everything at once.
As horrible as your experience was, it does sound like you were on the way to getting your life back for a while. I know curing gout doesn’t feel like you’re getting better but the blood tests don’t lie! You just need to keep at it a bit longer and stop the doctors from harming you more than is necessary.
Nobody doesn’t know but agrees it’s not a problem.
Kidding aside, like many others I’ve taken similar drugs together so I wouldn’t worry and take the diclo tablet on top of everything else. I can’t vouch for this exact combination of drugs and I’m sure you’re aware of the disclaimers aboiut mixing drugs but really, you should be OK.
Ask a pharmacist anyway so you’ll be able to tell your insurance you didn’t take anonymous advice from the web. Just in case.About colchicine being anti-inflammatory, I bet you’d get different opinions from different pharmacists. Let’s just say it works very differently than dicolfenac and most anti-inflammatories.
High temperatures have a way of triggering attacks when you’re curing gout. In my opinion, it’s mostly because you’re losing water. Make sure to drink lots and lots!
Certainly we seem to have had different experiences with doctors, Keith.
Their expertise is obviously vital in some situations and I would sooner trust a NHS doctor than most others but I would still not trust everything the best doctors say because the demands of their jobs take a heavy toll on their ability to reason systematically… assmuming they are even willing which is in my experience generally not the case.The way I see it, your website’s most valuable contribution comes from the effort you invested in selecting and presenting some of the evidence about gout in an accessible manner. Even when I think you’re wrong, your work is typically helpful anyway because you’ve put int the time necessary to reference facts in a fairly unbiased manner.
I’m afraid I don’t have that much patience. And even if I did, the effort would typically be wasted in a web forum post.
