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Hi Guys,
okay here we go, again, ill do a brief history and three month break down and I need opinions and help please. I have posted before but am redoing this just because I have blood results now and more information.
34 year old male, 180cms, 79kgs, good general health, diagnosed with gout approx 8 years ago, done through blood tests, had high Uric Acid, responded to colchicine and NSAIDS, in 8 years have probably had several minor flare ups lasting from 1-7 days diet and weight have changed significantly over the years, as the weight went down the attacks went down.
So back in Feb this year I started getting a full sleeve tattoo, no problems, however no activity, no gym, sitting around at home eating whatever I wanted, 3 months ago August the first attack hit and its also when I wrote for the first time in this forum, the attack lasted 4 weeks, it was an on and off attack 1 day strong attack while sleeping but then eased off and swelling went down the next day and then the process repeated again in a few days, so four weeks of it and calmed it down with regular Colchicine and Indomethacin, GP told me she wouldn’t give me allopurinol unless I had three attacks in a year. The next attack hit in September, again same foot same place, lighter than previous month because I had changed my diet by then lasted about a week, same pattern one night attack, next day swelling goes down, then next night attack. I decided I am going on Allopurinol and went back to GP, she said I know it hurts but bear with it and see if it goes this time (****ing ****h) so I said okay.
Current attack, has moved from right foot to left foot joint next to left big toe, feels like gout with a few weird things, it started last monday, so 8 days today, same pattern not too bad during the day, though today walking is harder, around 4am it kicks in and i would say on a scale of 1-10 the attacks are about a 5, however, my left foot doesnt feel hot to the touch, it doesnt look massively swollen, like my right use too, but the shooting waves of pain are exactly the same as what I use to get in my right. Is it gout ? so of course went back to GP, this time i demanded that I wanted allopurinol once this episode is over, he turned around and said I think you have RA, I have had gout for 8 years, however, he had my blood results from august which showed my urate level at .40, I said I know I have gout and exercised my rights to demands medication, so from that I got a new blood test to test for everything under the sun, a Rhumie referral and promise to give me allopurinol once this episode clears IF I still want it…. *breathes* okay so I saw the doc last Thursday and had the bloods done, now heres my idiotic stupid shoot me in the head part….. the attack semi cleared up on Sunday, I had a tattoo appointment booked on Monday, which I had already cancelled once before and lost my ?100 deposit on, so I didn’t cancel it, its my last session to finish my arm, so I went and sat for 7 hours and had my arm finished, I have to say a tattoo is NOTHING compared to a gout attack, anyway, foot was fine through the session, however now 2 days on its doing its weird swelling minor flare up thing. Anyway got my blood results back last night and have listed the ones I think are significant below, the urate is lower than last time and I am hoping this is because I was mid cycle through an attack, because if its not gout, what the hell have I got 🙁
bloods
RF – Negative
ANA – Negative
ANA Hep2 – Negative
ESP – 5 (normal range 1-10)
FBC – all in normal range
LFT – all in normal range though my serum billarubin was at 17 (normal 1-17)
Gloucose – Normal
Urate .37 ( <.44)
So I’m confused, I am sure I have gout, I have GP app this Friday and I KNOW the GP will say oh well if it was gout your urate would be high, but what else could it be ??? I have had gout for 8 years and I know the pain very well and I do respond to Colchicine, though since Monday (when I got the tattoo done) i haven’t touched any medication as the tattoo needs a few days to set, any NSAIDS will probably interrupt its healing process, another reason im in more pain than I would normally be.
So sorry for the rant but that made me feel better, and you guys here are the ONLY people who understand the stress, pain, worry gout causes.
thank you just for reading and any advice you can give.
I Have Gout Tattoo Is It Gout?
I am a 32 year old female – I don’t fit the “norm” of a person with gout. I have just had my first attack and am in the process of complete diagnosis (blood test, etc.) I am not overweight, no diabetes, don’t eat the foods that are known to cause uric acid buildup and no family history of gout.
I have searched the internet for similar circumstances and can’t seem to find any. Do you know of any others that don’t fall into the “norm” that have been diagnosed with gout? Are there other ailments that I should look into for an explanation of these gout symptoms?
Though incidence of gout in pre-menopausal females is lower than in men and post-menopusal females, it is by no means unknown.
Uric acid production and excretion is an extremely complex process, or rather series of processes. There are many reasons for excess uric acid leading to gout, and these are in no way restricted to the typical overweight middle aged male.
There are 2 other conditions that are commonly confused with gout, and also other rarer conditions. The two common ones are pseudo gout (calcium deposits rather than uric acid) and septic arthritis (infection in the joint). One or both of these can co-exist with gout.
The test for all three of these conditions is similar. Fluid from the joint must be analysed. This simple procedure is usually done by a rheumatologist who is the best type of doctor to consult with this type of problem. Joint diseases are notoriously difficult to diagnose properly, so it is best to seek expert advice.
Tattooing obviously kicks off your inflammatory resonse – not surprising
really, as even a stubbed toe can bring on an attack. Urate levels are
often lower during an attack; any Dr worthy of the title should know
this, and anyway, .37 is not low enough to prevent attacks for a goutie.
Stick to your guns & get the Allo. Insist on a maximum of 1 month
on 100mg then increase to 300mg & re-test after 1-2 months. Agree on
a target level of .3 SUA (~5.00mg/dL) or less with your Dr; if he disagrees, change Drs.hi odo,?
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thank you for your reply, I thought that too, I am going to insist on 300mgs of Allopurinol on Friday, I can tolerate it as ive had 100mg years ago and just stopped as my diet and weight changed I didnt seem to need the medication, wish I had stayed on it now.?
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but ill aim for .3 as standard, I believe my levels normally ride higer than that but because I only ever get a urate test when Im having minor flare ups I think the level shows at the top end of normal, but do my symptoms seem consistent with gout, I am just worried because the attacks disappear during the day and come back at 4am, its almost like a pattern, previously an attack would rage for days and not go, but when it did it was quite safely on its way out, now it seems it goes, but comes back, could be the same attack not settling ? or just new attacks each day ? im edging on same attack not being resolved, I tend to ease of meds very quickly and dont follow through for days, soon as the attack pulsing pain goes, I stop meds, but of course there is always remaining swelling which I think brings on a new attack ?
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thank you again for your advice, I see your a fellow londoner :D?
Just a quickie…maybe more later.
With a negative ANA you can forget about almost all of the OTHER arthritic diseases.
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Good luck with the 300 mg. allopurinol. If you cease to have attacks make sure your boneheaded doctor knows it.
hey ZIP (my fav gout replier) thank you for the reply and the info I should have listened to you 3 months ago when I posted and taken the meds then when you said you thought I had chronic Gout from the frequency and intensity of my attacks, I will be taking your advice this time around and agree re the negative ANA, and also the normal ESR and all the other readings, I feel like starting a name and shame website for GPs who have no idea what they are talking about, the GP initially said to me that uric acid crystals never dissolve so I could forget about trying to get rid of them, I blinked and just said errrr okay….?
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if you can post more later, please do :)?
ctrl,
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I hate to do this to you but I pretty much agree with your doctor in saying ?that tophi are more or less?forever (much like James Bond's diamonds.) I have heard that there were some results using allopurinol and probenecid taking urates down below 3 and seeing some tophi reduction.
The GOOD part is that when they are effectively sealed off they cannot cause attacks?only the occasional subtle ache (my case anyway.)
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I have 2 very small tophi (small rice grain size)? on the last joint of my little finger.?My?first one?was solidly on the joint and then I did a LOT of beer for a month…another formed almost overnight?and moved the first one aside up? towards my hand. A big one from long ago on my distal thumb joint (that one hirt a bit) slowly moved down under my thubnail and halfway out I perforated the mound with a red hot paper clip through the nail. Out came a slippery liquid that dried to microscopic dendritic crystals that oozed for a week and no more tophus.
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It seems to me there is only one way to get these buggers out.
Hey Zip?
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I dont think the GP ment Tophi, I have no visible Tophi at present, he meant the build up crystals around the joint, I thought those mealt as your urate level in your blood drops, which is why starting Allupurinol can cause attacks once started, because the build up protien coated crystals begin in dissolve, or am I wrong in that, glad I have no visible Tophi though im sure there is probably some lodged in my joints, but again not I can feel or see.?
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imi
okay quick update, I have seen the GP today, discussed my results, and he still isnt sure its gout because of my low urate level, inspite of the fact I was diagnosed 8 years ago from a different GP when my urate levels were sky high, however, after looking at my foot and finding out that the pain is in the classic gout joint and only been there, coupled with my test results, he thinks its PROBABLY gout, lol, so funny, but he doesnt want to prescribe allopurinol till the Rhumie has seen me and confirmed gout… ?
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so…. he gave me a script for naproxen and colchicine and said that will keep me goint till the Rhumie appointment in a few weeks, I got those and got myself a 3 month supply of allupurinol from someone I know 300mgs, I will wait till I see Rhumie but if he tries to fob me off ill start the allopurinol, im actually tempted to take it, because if I dont have gout (which I know I do) then 2 months of allopurionol isnt going to kill me, but if I DO have gout then at least im ahead of the game.?
what do you guys think ??
okay just realised something, the GP isnt sure ive got gout but keeps giving me colchcine lol… and tells me the best way to take it when I have an acute flare up of gout… but not sure I have gout LMAO…. sorry I found that amusing for myself.?
If it were me and?I had a strong attack I'd hit it hard with Colchicine and if that stopped it. That would be enough for me to?be 99% sure?I had gout. Limpy?
hey Limpy
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so funny you should say that and not, last night when I got home from taking the girfrlend to watch “the help” i had the atttack from hell, it kicked in while watching the film and havent had a wink of sleep yet, I hit it with x3 .05 colchicine and X100mg of indomethacin (not all at once over 16 hours) and the pain is just about under control, was thinking should i keep on the indometh or just hit it with my colch ??
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if it were you on a day 2 attack from hell and it was still twingy but not raging, would you stick with the NSAIDS or hit hard with colch ?
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thank you in advance for your advice ?
Please understand I'm no doctor.?I myself would stick with the Colchicine to see if it completely stopped the attack. But the main reason for that?is Indomethacin tears my gut up. We are all a little different in that what works for one of us may not do as well for other. Has the Colchicine kicked in where your not wanting to stray to far from the bathroom? If not it will, it really cleans out the pipes.?I hope some others will chime in on this.?Good luck. Limpy
hey Limpy,?
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thank you for your reply, I completely understand where you are coming from with the not wanting to give out dosage advice, I am 100 percent with you on not doing that, I can tolerate 4mgs of colchicine before I have to run to the toliet, so 1.5 doesnt do anything to me, indomethacin does seem to workish, last night i was confussed what to do, so i tried the colchcine and when the attack didnt stop i switched to indomethacin but in all honesty that didnt help either, it was one of those attacks where all you can do is ride it out and no amount of meds seem to touch it, right now its sore, swollen but stable, IF i get another major attack like that again ill use colchine only, when i was younger I would use only colchine and just let it knock the attack out, I should do that now really.?
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thank you again, really appriciate your replies as they are keeping me going throught his painful time?
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imi
I am going to drop a colchicine bomb:
In my well reasoned personal opinion, I have found and firmly believe that diarrhea and pain relief go hand in hand with colchicine.
I don't know why, I cannot imagine the relationship,?and could only guess but it seems to work that way.
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I wonder if anyone has ever analyzed the liquid portion of colchicine induced diarrhea for the presence of uric acid? I'll bet not. Wouldn't that make the sloppiest science fair project ever?
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If somebody paid me I'd do the study
You'd all have to mail me quart jugs full of slop. If anything I'll bet it would discourage postal agents rifling through my mail.
HAHAHHAHAHAHAHAHAHAHAHAHAH………. oh Zip that made my day which has been full of limping and pain seem not so bad lol…. thank you for that, and well if you like ill comission the study if you wanna go ahead and examine poop, infact if I get another attack tonight ill even find a bucket to give you test samples with…. okay now thats grossed me out, I retract that statement.?
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but seriously ill spank the Colchcine if tonight goes like last night, for some reason whenever I think the gout has settled it comes back again like it doesnt care it just gave me an attack the night before :(?
ANOTHER QUESTION?
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I do have another quick question guys, is it normal for a gout attack to hit around the same time every day for some unknown reason my attack which has been running for 2 weeks now seems to come to me at 2-4am is that normal for an attack to always pop up around the same time ? last nights lasted an hour with 50mg of indomethacin knocking it out but any particular reason why the timings are so constant ?
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could it be my dinner which is practically purine free ? or something to do with fluid or just crap luck, totally depressed with the whole gout situation right now and waiting for the Rhumie referral, looks like Monday and no work for me because walking is painful right now :(?
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imi
Theres a?thought that it may have to do with body temp. That your feet being the coolest part of your body because their the farthest from your core. They cool down after you go to sleep and more crystals or acid starts to settle there.?I don't know if it's true or not. But if it is?I would think a heating pad or some wool socks?would take care of it. Let us know if you try it and it works. Good luck. Limpy
hey Limpy,?
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I do wear like super thick wool socks to bed, but i do know when i first lie down my feet are freezing and the covers on my bed warm them up, so I am going to try a hot water bottle in the bed and see if the instant warm up makes a change, will try tonight and let you know if i sleep through the night tomorrow :)?
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imi
ctrlkeys said:
I do have another quick question guys, is it normal for a gout attack to hit around the same time every day for some unknown reason my attack which has been running for 2 weeks now seems to come to me at 2-4am is that normal for an attack to always pop up around the same time ? last nights lasted an hour with 50mg of indomethacin knocking it out but any particular reason why the timings are so constant ?
Could have something to do with the fact that this is the body's lowest time of metabolic activity i.e. your defences are down, blood pressure & temperature drops. Very common time for sickly/old people to pass away.
In Chinese medicine, 3am marks the end/beginning of the human 24 hr cycle. All transition periods being considered when we are more susceptible to disease (e.g. Spring/Autumn).
Just thought I'd slip that in to annoy all the scientists
I think 2 AM -4 AM is common but 5 AM the most common (I read that somewhere.)
I think the reason is twofold…cold feet and inactivity. Large crystals precipitate most readily in an absolutely still solution, so the less motion, the easier crystal formation.
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If I were in your shoes, ctrl, I would start taking the allopurinol now. Downside is it would get hairy in 3 months when you go back with very low numbers…you'd have to admit your sins and ask fordoctoral absolution and put up with several “tsk tsk”s with your head bowed in submission.
There is a limit to how long you need to let some doctor fiddle fart when he cannot make a proper diagnosis.
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But the call is yours.
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Indomethacin (INDOCIN) makes me dizzy.
hey Odo and Zip,?
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thanks for both your replies, ill try a hot water bottle in the bed an hour before i got there so it should keep the covers warm and today ive been trying a hot water bottle under my foot to keep my foot warm, i have riduclously cold feet and hands, yes i have the best circulation lol.?
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with regards to allopurinol zip, my girlfriend read your comments and is in total agreement with you, she feels i have the 3 month supply and a gp in the health centre i work at willing to keep that going indefinitely, so i should just start instead of waiting for my “official gp” to get the rhumie referral to me. I am slightly conflicted about what to do, one part of me thinks just start the allopurinol soon as I can walk another says, bo**ocks, just wait for the Rhumie to see you and give you the diagnosis, even though I know its gout.?
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so if I start the allopurinol ASAP (when im at least semi clear of this attack) it cant do any harm can it, other than lower my urate level (obviously possibly give me more attacks) if for whatever reason i dont have gout (which if i dont ill eat my shorts) it cant give me a condition, only lower my urate, however right now food triggers attacks, over activity triggers an attack, it looks like gout, it was initially diagnosed with gout 8 years ago with elevated urate levels, why am I even debating why it could be anything else, well I am because my GP wasnt sure….okay rant over again.?
ctrl,
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I see no downside of starting on 300 mg. allopurinol. Just keep a watch out for the?VERY VERY?rare hypersensitivity reactions like rash, swollen lips and eyes, things you would watch out for with any new drug (or even food.)
hi Zip?
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thank you for that, I have already had allopurinol 100mg about 4 years ago so I know I can tolerate it, just an update too, I have rejoined my old GP who initially diagnosed me with gout some 8 years ago, had to lie about my living location but this old doctor was really on point with my condition, and she will probably slap me for leaving allopurinol all those years ago but at least ill be back with a GP who actually knows what gout is.?
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