Doctor's Visit, Tests, and Results

Friday two weeks ago, I had to go to the hospital to help a friend.  While I was there I was able to schedule an appointment for myself.  The reason for my appointment:  recent morning pain in my feet, and a gout attack in the same week.

The doctor was able to get me in this last Thursday for a morning blood test (the fun one where you can't eat in the morning).  Later on Thursday the doctor called me with results.  

Thankfully my liver and kidney function in relation to allopurinol was fine.  Cholesterol and Triglycerides were okay (though the Tri's were a tick too high).  My uric acid level was high enough that the doctor agreed I should up my allopurinol dose 50 mg a day.

So since Thursday I've been taking 100 mg in the morning and 50 mg in the evening.  Hopefully it will knock this recent bout. (which I believe to be seasonal). 

Tell me how your doctor's visits and blood test have gone! Leave a comment.

Seasonal Gout

Oh Spring!  Everyone loves mentioning how spring is the time for birds chirping and flowers blooming, but for me Spring is gout season.

Since the weather has been breaking from lower than 50°F (10°C) to weeks with 60s and 70s F(15-20 C) I've been waking up with stiff joints in my left foot.  If not for my allopurinol this spring might be like last year where I had near daily attacks.

I do have last spring's near-disaster to thank for helping me to seek out the proper help to get my gout diagnosed, but I am not looking to relive it.  So here's some ways I'm going to try to beat my seasonal gout stiffness:

1. If I feel really stiff I will take a colchicine before bed.
I've done this a couple of times and have avoided what I think were incoming attacks.

2. Increased water consumption.
I usually drink 3 liters of water a day, though recently since I've been waking up with stiffness I've been going closer to 4.  It's a lot, but the bathroom trips are increasing and hopefully getting the uric acid out.

3. Scheduling a doctor's visit.
I want to check out the effects of allopurinol on my body and checking to make sure 100mgs is going to continue to do it for me.  I also want to be careful not to overdo the allopurinol, but making sure it's not hurting me and is getting the uric acid level to a proper level.

4. Occasional foot soaking.
A salt soak for gout can be helpful for most forms of arthritis and joint pain. I think this is a worth-while attempt that used with the other methods could help.

What are your solutions for seasonal gout?  I'm interested in sharing solutions with fellow suffers.  Leave me a comment!

App Store Apps for Gout Recommendation: Argus

Howdy friends!  Today I wanted to let you in on an Apple store app that I have been using for about a month and a half now, and feel comfortable enough recommending it as a great app for gout sufferers.  May I introduce: Argus

Argus is meant to be a lifestyle tracker, an interactive daily diary that can be very helpful for the gout sufferer.  After downloading the app you'll be prompted to enter some personal information such as your name, email, weight, height, and gender as shown below.  

After you've done that you'll get to a few different settings.  The main setting I recommend turning on is "Show Steps on App Icon":

The step tracker has been a great tool for my personal life and battle with gout.  The steps tracker lets me see how far I go in a day.  As long as my bluetooth is on the tracker is fairly accurate.  It's amazing to see how far I can go on clean and clear days and how difficult it is on days that I don't.  

It should be pretty obvious the days where I was hitting the colchicine and ibuprofen.  

Another tracker which you control yourself that can be extremely helpful is the water tracker.  

Most days I go well over the "8 glasses a day" requirement, which my 8 glasses is actually right about 3 liters, this helps me ward off the horrid gout.

One feature that I make less use of, but could if I wanted is the food photo tracker.  This can definitely help you remember how much meat and vegetables you've consumed, making gout prevention easier.

The app is free, and you can add friends.  If you do add the app, be sure to add me: james l goode.  Hope to see you there!

Do you use applications or technology to prevent or track your gout?  Leave me a comment!

Gout: That Picture!

“The Gout” by James Gilray, 1799

Even before I had gout, I was familiar with this picture.  I probably first saw it in a history book.  It didn't make sense to me-probably because most of my pain has been in the lateral side (outside) or on the top of my foot in my arch.  Here we can see some sort of spawn of hell attached to the area near the big toe.

If you've never had gout, you don't don't really understand this picture.  If you do, you can imagine that little imp grabbing onto whichever place your affliction manifests.  The redness, the swelling, the feeling of your own personal hell-that's gout.  This picture captures the feeling perfect.

My experience...

When I was suffering from my regular gout attacks but wasn't diagnosed, It was absolutely awful.   I had gone to a few doctors and none had thought to check my uric acid levels, and to be honest I didn't go to the doctor for every attack.  I was afraid!  My major worry was that my body was weak and I was walking incorrectly.

My answer was to get online and figure out the problem for myself.  This was a major mistake!  My personal diagnosis cheated me out of countless weekends with friends and fun because I went years without getting my problem properly diagnosed.  I let this imp ride along for far too long.

If you're experiencing horrible foot or knee pain that can't really be explained: say you do your daily walking and don't majorly twist your ankle or get your big toe injured by some mishap, get it checked out.  Letting the gout imp into your life and not doing anything about can be hazardous to your health (I'll try writing about a few examples and linking them here in the future).

What to Do if You Have Gout... 

If you do have gout and you haven't been given options by your doctor, you should start by drinking lots of water everyday (at least 2 liters!).  If you're a big guy (read: overweight) like I have been a decent bit of my life, you're probably going to have to clean up your diet a bit especially right now while you figure out what foods are going to trigger the pain.

When you talk to your doctor, try to get on allopurinol and an NSAID.  The allopurinol is not going to solve your pain that same day (in fact it will probably trigger an attack or two) but in the long run you'll thank yourself for doing.

Keep your chin up!  If you take these steps and keep in contact with your doctor you'll be okay.  I walk 5 miles a day these days and enjoy a quality of life that I didn't think possible during the dark days.

If you have a question or comment please leave one!  I'll do my best to answer and assist as best I can.

**This website is for informative purposes and should not be substituted as advice of a medical professional.  If you believe you have gout, I STRONGLY recommend scheduling an appointment with a medical professional and getting the problem checked out.

The Water of a Gout Sufferers Life: WATER!

I'm going with obvious information today, but if your new to gout maybe you need to hear this.  Drinking water is one of your best ways to prevent that horrid pain.  Don't believe me, then don't take my word for it?Google: gout water.  This is what I came up with on the front page, If you're going to leave my site, don't worry I'll wait for you:

Water May Wash Away Gout Attacks

Fighting Gout with Skim Milk and Water

NYTimes-Why Do I have Gout? "Many doctors who treat patients with gout advise them to cut down on purines and drink more water."

Water and Gout

Gout: What Can I Do to Help Myself - "Drink lots of water – between 1.5 and 2.5 litres a day (six to eight glasses) to help prevent kidney stones."

Water does a marvelous job of washing away the uric acid in your body, stopping it from forming into crystals that cause the horrid pain.  It should be your first line of defense against the feelings of pain, defenselessness, and fear of walking that can plague gout sufferers.  (In my opinion, Allopurinol with a big glass of water is your second one-after you are well committed to drinking the water.)

My personal goal of water consumption everyday is 3 liters.  I feel like a 50% bump on the always quoted 8 glasses a day aka 2 liters gives an extra oomph to wash out uric acid. Oh-and I should add-coffee seems to assist in lowering uric acid levels (According to the US National Library of Medicine National Institutes of Health). If that link wasn't fun to read you can see some of the same basic information in laymen's terms from MedPage Today.  According to that link tea didn't really have any effect on your uric acid levels, though as long as it doesn't seem to affect you I use it once in awhile to substitute a few mL to get up to my 3 liters for a day.

Of course there is a study out from Medicinenet and the American College of Rheumatology that basically contradicts that other article.  If you've read some of my other entries you know: gout is tricky and seemingly different people get attacks from different triggers.

If you're looking to increase or track your water consumption, might I recommend Argus to you.

For me personally: getting the heavy dose of daily liquids is far more of a help, the only major drawback is I have 5-6 trips to the restroom everyday.  As I recall in the beginning I would wake up once or twice in the middle of the night to empty my bladder as well.

Do you find coffee helps or trigger a gout attack?  How much water do you drink in a day?  If you drink as much or more than me you must go for a leak quite a bit!  Leave me a comment!

**This website is for informative purposes and should not be substituted as advice of a medical professional.  If you believe you have gout, I STRONGLY recommend scheduling an appointment with a medical professional and getting the problem checked out.

The Gout Sufferers Cheat Sheet: The New York Times Gout Report

Are you looking for comprehensive gout info?  Look no further than this in-depth report from the New York Times.  All of the scientific research on gout here is 10 years old or less.  No matter your political opinion on the New York Times, the information contained on this page comes from medical professionals whose jobs are assisting people like myself and some of you who are only seeking to improve your quality of life.  In the future on this site, I will be referencing this page quite a bit.

For today, I want to highlight a couple of interesting things I found reading this page my first time.  I'll come back to this page in the future, but for today:

Dietary Considerations

"While meat and certain types of seafood and shellfish do produce high levels of purines in the blood, research has suggested that not all purine-rich foods are associated with gout. Eating a moderate amount of purine-rich vegetables (spinach, cauliflower, mushrooms, legumes) does not appear to increase the risk of gout." [1]

Some people use a chart to determine their diet to avoid gout.  I am going to tackle diet at sometime or another on this blog, but for right now, allow me to turn off my serious gout blogger mode and say this:

(joke over)...As I chat with other gout sufferers I find more and more that the foods that trigger gout for some people don't trigger it for others.  Science seems to strongly suggest that the intake of purine-rich vegetables is okay.  I'd go as far to suggest to you that it's great to consume any vegetable you enjoy because promoting a healthy lifestyle could help you to:

Maintain a Healthy Weight

"A supervised weight-loss program may be a very effective way to reduce uric acid levels in overweight patients. Crash dieting, on the other hand, is counterproductive because it can increase uric acid levels and may cause an acute attack."[1]

Another reference to how gout is a tricky condition.  Do try to lose weight if you are a sufferer, but don't do it by going crazy with the weight loss-cause you could just trigger another attack.  So if the veggies aren't making your toe, ankle, knee, etc etc etc hurt eat 'em up!  Develop a healthier lifestyle to avoid the pain.

Finally...

I hope you'll take time to read through the report for yourself.  Educating yourself about the horribleness that is gout is one of the best ways to take preventative measures against that awful pain, and that report is a VERY good place to start.  

Do you have a helpful resource concerning gout?  Let me know in the comments section! 

**This website is for informative purposes and should not be substituted as advice of a medical professional.  If you believe you have gout, I STRONGLY recommend scheduling an appointment with a medical professional and getting the problem checked out.

[Sources: 1-http://www.nytimes.com/health/guides/disease/gout-chronic/print.html]

Medicine for Gout Series, Entry 1: Allopurinol

Today I'll begin a blog series on the medicines people take for gout.  Some of them will be treatment when you have flareups and others will be preventative.  For medicines I've taken, I will include my feelings on the medicine and other concerns I've heard from others and found on the internet.  For medicines I haven't taken I hope to inquire with fellow sufferers for input on how the medicine works, side effects, and dosing information.

Why did I choose to discuss Allopurinol first over other medications?

It wasn't difficult for me to choose Allopurinol to be featured first.  This medicine has had a very positive effect in my life and many other gout sufferers. I can remember a year ago from the day I'm writing this, I was not doing well.  Around this time the attacks were coming 3-4 times a month and rather blurring together not giving me any opportunity to feel good between attacks, walking for anything other than necessity was out of the question, and effects on my mental health that I didn't recognize or acknowledge were having their toll on me.

Now on February 21, 2014, I'm proud to report that I've been able to make walking for fun and exercise a near daily thing.  The last week I've made walking 10k (about 5 miles per day) a personal goal, and I've accomplished that goal every day (some days beating it by more than 3000 steps!)  The reason for this, as best I can tell, is my daily dosage of 100 mg of allopurinol.

What does/doesn't Allopurinol do?

Some reading this will be surprised to learn that Allopurinol does NOTHING to stop a gout attack.  From everyone and everything I've heard including this succinct website from Arthritis Research UK you should start taking allopurinol when you're clear of your gout attack.  I'll discuss why shortly.

Another page on Arthritis Research UK has this to say about how it does work:

Allopurinol targets an enzyme called xanthine oxidase which is involved in producing uric acid. By reducing the amount of uric acid produced in the body, allopurinol helps keep the urate in the blood at the correct level. - See more at: http://www.arthritisresearchuk.org/arthritis-information/drugs/allopurinol/what-it-is.aspx#sthash.MbiR2ury.dpuf

By targeting an enzyme which helps produce uric acid (the source of gout), allopurinol can put a stop on chronic gout attacks.

One note though:  if you begin taking allopurinol lookout!  It can bring on acute gout attacks in the first few months of use.  I was no exception to this rule.  I remember my first 2-3 months of taking allopurinol I had gout appear in my big right toe (a place it had never really affected me).  Because of this many doctors will also prescribe you an NSAID like colchicine, arcoxia, or instruct you to take ibuprofen for these attacks.

Dosage

Most gout sufferers will start on 100 mg of allopurinol.  For many this will not be enough to solve your problems, but you will need to get used to the effects of allopurinol at the beginning.  In follow-up doctors visits, the doctor can up your dosage; you should always be careful with taking allopurinol because there can be considerable side effects.

Side-Effects

Unfortunately, this great medication does have some difficult side-effects.  One that many people will experience is a dermatological issues. In many people allopurinol will cause some slight rashes, and in others it can cause a fatal issues (I'll quote wikipedia here):

Allopurinol is one of the drugs commonly known to cause Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TENS), two life-threatening dermatological conditions.^[21]

Because of these issues when going on allopurinol it's a good idea to get checked by the doctors.  If you find any issues with your skin you should let your doctor know as soon as possible so life-threatening conditions can be ruled out.  Other than these issues, wikipedia's gout side-effect entry has a few other very rare conditions.  If you're worried about these side effects speak to your doctor.

Complications with Allopurinol?  There's still hope!

If you happen to be one of those who does have problems with taking allopurinol, you can still get good preventative medicine.  I will be highlighting these other medicines in the future: especially feboxostat.  

In closing:

If you have been considering allopurinol to curb your gout, I highly recommend it.  It has made a major difference in my quality of life.  

Do you have any other questions about allopurinol?  Do you take allopurinol-if so what is your dosage and story?  Leave a comment and I'll do my best to address it.

Other Posts in the Medicine for Gout Series:
Colchicine

**This website is for informative purposes and should not be substituted as advice of a medical professional.  If you believe you have gout, I STRONGLY recommend scheduling an appointment with a medical professional and getting the problem checked out.

[Sources: 1- http://www.arthritisresearchuk.org/arthritis-information/drugs/allopurinol/what-it-is.aspx

2- http://en.wikipedia.org/wiki/Allopurinol]

Preventive Measures Against Gout

For gout sufferers, preventative measures are among the most important bits of information you could ever have as they will stop you from future pain.  However; You may be suffering from an attack now and wanting information about how to stop your current attack, I would recommend starting here though there might be other posts on this blog in the future that talk about treatment.  

Let's again return to the National Institute of Arthritis Musculoskeletal and Skin Diseases website and learn what they say about preventative measures:  

What Can People With Gout Do to Stay Healthy?

Some things that you can do to stay healthy are:

• Take the medicines your doctor prescribes as directed.
• Tell your doctor about all the medicines and vitamins you take.
• Plan followup visits with your doctor.
• Maintain a healthy, balanced diet. Avoid foods that are high in purines, and drink plenty of water.
• Exercise regularly and maintain a healthy body weight. Ask your doctor about how to lose weight safely. Fast or extreme weight loss can increase uric acid levels in the blood. [1]

Most experienced gout sufferers can attest that preventative measure #1 is the drink water.  Some doctors agree with this as well as can be seen here.  I personally make a goal to drink 3 liters of water a day which is more than half a gallon (1 gallon = 3.785 liters source: google).  I have personally seen my gout attacks go down.

Many of the gout sufferers that swear by water drinking would also suggest preventative medicine that can be prescribed by your doctor.  I take allopurinol, which reduces uric acid.  Some of the main side effects of allopurinol that I have experienced include: some skin rashes and initial gout flare ups in the first 2-3 months of use.

This second side effect shows just how much of a tricky condition gout can be, i.e. taking a medicine to prevent it makes you get it.  

Other side effects are more rare but fatal.  So scheduling follow-ups with the doctor would be advisable.  If patients show adverse effect to allopurinol there are other preventative medicines they can take like febuxostat.

One final note:  future discussion on this blog will include avoiding purine high foods, though this subject is another example of just how tricky a condition gout is. Until then: what are your preventative measures against gout?  Let me a comment.

  

**This website is for informative purposes and should not be substituted as advice of a medical professional.  If you believe you have gout, I STRONGLY recommend scheduling an appointment with a medical professional and getting the problem checked out.
[Source: http://www.niams.nih.gov/Health_Info/Gout/gout_ff.asp]