A new bout of Gout

[Red from Canada]

Hello all,   I hoipe someone here can help me decide what to do, if anything, about a flare up of gout in my left big toe.  This is only my 3rd episode and the first since dialysis in March.  I am allergic  to Allopurinol and am reluctant to use colchicine or prednisone,  Has anyone just used Tylenol and let it run its' course?  I hate going to doctors, as I see so many of them. I understand gout is common in dialysis patients.  All help will be gratefully received.

[KICKSTART]

I'm sorry i cant suggest what to take , because in the UK we seem to have different medicines from you. Speak to the doctor i m sure they will suggest something. When i had it i took  Diclafenic which is an anti-imflammitory, it did work really well and fast (24hrs) but it upset my stomach really badly ! Hope it clears up soon as the pain is horrible 

[rimbo74]

I'm sorry you can't take Allopurinol, its painful in the big toe.  Although your nephrologist will probably fringe, but I take indomethicin to get rid of gout quickly.  Its suppose to be really bad on the kidneys but its not like our kidneys work anyways.

I used to get gout all the time but have only got it once since I have been on dialysis.  Hope it goes away soon.

[paris]

Is your uric acid levels high?  Somehow the numbers need to come down to beable to stop the gout. There is another thread in the "other medical conditions" that may be helpful.  Gout is an unbelievable pain and I hope you find some relief. Tylenal did nothing for me. Colcichine works, but watch out for the side effects - not too much fun!  I take it daily along with Allopurinol, but still have days of pain.  Let us know how you are doing.

[pdpatty]

I have had bad gout attacks and I can't take Allopurinol, either. My last attack took two steriod paks to get rid of it . It was in my right hand and my ring finger is still very stiff. I used to take indocen (I think this is a generic name) but  they now refuse me this because of my kidneys. Tyleol just would not touch the horrible pain nor does it reduce inflamation. Your best bet would be to contact your doctor. I don't like taking the steroids but it is the only thing that will work now.

[Red from Canada]

Tnank you to all who replied to my request for help.  I called my Neph today and he is putting me on prednisone for 1 week.  He suggested that I could see an allergist or rheumatologist to "desensitize" me from the Allopurinol reaction.  Apparently this is possible by giving small doses and gradually decreasing  them.   Allopurinol is still the drug of choice for gout...especially since prednsone can make a diabetics'  sugar go "wonky".  I also found and read the gout thread in the misc. site.

[paris]

How is your  pain now? Hope your doing better and finding a solution.

[Red from Canada]

Hi Paris!  It's much better now....thanks for asking.  The prednisone is working. Just a short course 6,5,4,3,2,and  1 then done, I hope.

[Lulu]

Hi, I know you posted this a while ago and are already doing the steroids. But, I have had gout for so long. I thought I might share my info with you. I went undiagnosed for over ten years. When I did get diagnosed, the gout pain had spread to every joint. Anyways, my nephro started me on Allopurinol and I had every side effect. It is truly horrible medicine!! I already take prednisone because I have Addison's Disease and I was still having a couple of attacks a month. Lots of down time  . I talked to my doc and we switched to colchincine. I was scared as hell because of how colchicine works, but it does make sense. I take two .6mg pills at the onset on the gout pain and most importantly rest and drink a ton of water (if tolerated for your kidney disease). A couple of other things - as soon as I stopped eating any, and I mean any, not a drop of red meat and no wine (especially red)  or alcohol (not even socially) my gout pain really decreased. Oh how I miss red meat and a good glass of wine! I never ate much meat or drank much because of the kidneys, but even eating a little red meat or drinking a glass of wine tended to make the gout worse. One other thing, don't know if it will help but I also had to start taking sodium bicarbonate becasue my nephro found that I have RTA type 4 (type of kidney disease). Either way, the sodim bicarb seems to help for the gout and it keeps my potassium down. I haven't had a gout attack in months.

Something you should know about steroids, any kind predsinsone, cortisone, whatever - theyhave a lot of side effects. Don't take them lightly. I have been on them for 16 years and now have degenerative tendons in my feet and ankles. I only take 2mg of prednisone a day, it is not necessarily the dosage it is the chronicity of it.

Hope some of this is useful. 

[Lulu]

Sorry - forgot to share this about the colchicine. There are two schools of thought on it. One is to take the colchicine daily and the other is it to take it at the onset of symptoms. The whole premise behind colchicine is that prevents the white blood cells from attacking the crystals in the joints. The reason white blood cells attack the crystals is because there is a protein layer that surrounds the crystal (like a jacket) and for varying reasons (usually - food, alcohol, stress, dehydration) the protein layer sheathes off of the crystal and then the crystal appears foreign to the body and thus---white blood cells come in and attack the crystals in the joints and holy crap the pain sets in. When taking a double dose of colchicine at the onset and some tylenol the gout attack subsides quickly.

The difference between allopurinol and colchicine is:
 :thumbdown;Allopurinol - used to reduce uric acid levels (I had every side effect in the book from allopurinol)
 :thumbup;Colchicine - Prevents white blood cells from attacking uric acid crystals when they sheath their protein layer. Works great when taken on an acute basis for gout attacks. Not sure why some docs prescibe it every day. Seems overkill and not necessary. Some people can build a tolerance to it if they take it every day. Also, if taken when not having a gout attack it can actually initialize one .

The reason the gout pain only happens when the uric acid crystals sheath their outer protein layer is because the crystals look suddenly foreign to the body. That is why the pain is so intense. I find that finding ways to suppress the crystals from sheathing their proteins works best for me.

Hope some of this is helpful. Sorry if I was ranting. I have just spent so many years in excrutiating pain from this and was so pissed off when I finally was diagnosed that it wasn't diagnosed before because it had spread to every joint. Don't know if anyone has any tophies. I just started getting them even though my gout attacks have been minimum ths year.