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6:46 am
May 17, 2009
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vegetarianGuy
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Post edited 12:17 pm – May 17, 2009 by vegetarianGuy
Hello there. I have been reading up on Gout for last 5 hours. Not sure if I have it or it's a false alarm. I am 35years old very active and go gym 3-5 times a week to do weights(45minutes) and cardio (45minutes). I am fit and not fat.
10 days or so ago I felt slight pain or shall I say discomfort on the top part of my left toe (I have marked with a pen, black dot inside the green circle in the attached photo). I did not think much of it. It was more irritating pain rather than what I would call full blown pain. I don't remember hurting my toe recently or ever.
5 days ago it went completely away. Then I was at gym and was using calf muscle machine where you basically push some weights with the ball of your feet, toe does not play any direct part. I did not feel any pain so maybe completely unrelated but next day the irritating pain returned to my toe.
3 days ago I went out to do some shopping and on wearing my shoe I realized that it hurt bit more than before. It hurt enough for me to try and transfer my weight to the outside of the left foot while walking with my shoes on. All through out there has not been any clearcut swelling or redness. Since yesterday maybe there is very slight sweeling and very slight redness. Not sure but you can be the judge.
Now I am back to my initial irritating pain level but will go and visit doctor tomorrow to check it out. At no time ever in the last 10 days did I have any pain outside the green circle area that I have drawn on my foot. Just on the top where the black dot is. I have had full range of movement in my toe during this whole period and definitely no pins and needles sensation. Could it be gout?
Some background- I have been vegetarian for last 7 years and have a very good diet. No junk food etc. Mainly fruits, vegetables and nuts. I do eat lot of cashew nuts 200gms maybe every 2-3 days. I ate lot recently but nothing more than what I have been eating for months and years.
My 70+ year old dad has gout attack sometimes and from what he says the whole foot area hurts even with a slight touch. I don't have that kind of pain. For example right now I have to press with medium force on the black dot to feel the pain. I can walk freely but feel that something is not 100% right inside the green circle.
I tested my urine ph level and it is on the acidic side- ph6 or maybe ph5.
So when I see the doc tomorrow what tests should I ask for? I am just a number for doc so I want to be pro active and get to the bottom of this.
1- Blood test? Which specific tests should I ask for?
2- X-ray?
3- Too early to do the liquid from joint test?
What else? Thanks for any advice and opinion.
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I don’t want to cut my foot off any more! Thank you LORD ALLOPURINOL (fingers crossed)
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10:17 pm
May 17, 2009
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GoutPal
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1- Blood test? Which specific tests should I ask for?
Uric acid, but it is not conclusive. I.e. above 7 indicates high risk of gout, but below 7 does not exclude gout, as uric acid is lower in the blood if it has crystallized in the joints.
2- X-ray?
Yes – you need to rule out physical damage.
3- Too early to do the liquid from joint test?
No, but you are probably better seeing a rheumatologist for this, as few family doctors have the experience to do it painlessly and assess the results accurately.
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Current gout status in my profile.
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3:13 am
May 18, 2009
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vegetarianGuy
Tophi Terror
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Post edited 8:41 am – May 18, 2009 by vegetarianGuy
Goutpal thanks for the post. I know you are probably not a doc but visually what do you see in my photo apart from my ugly feet? It is possible that it I have Gout :-(
Regarding the fluid test, don't they make the area numb to be painless?  I have to see the family doc anyway as then he refers me to the specialist, that is how it works here. If I do the joint fluid test then can it 100% confirm if I have or not have gout? Is it not possible that someone has Gout but no crystals at the joint on the actual test day?
Edit- For future use is there no home blood uric acid test? Similar to home urine ph test?
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I don’t want to cut my foot off any more! Thank you LORD ALLOPURINOL (fingers crossed)
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4:38 am
May 18, 2009
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GoutPal
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Though the swelling is fairly slight, taken together with the fact that your Dad has gout, and it is often hereditary, I'd say there is definite suspicion of gout. Of course, as you surmise, I'm no doctor, so it could be something else.
That is really why I recommend the joint aspiration (arthrocentesis) test – because it should be conclusive. According to Courtney and Doherty (Joint aspiration and injection and synovial fluid analysis):
Joint aspiration/injection and synovial fluid (SF) analysis are both invaluable procedures for the diagnosis and treatment of joint disease. … detection of Synovial Fluid monosodium urate and calcium pyrophosphate dihydrate crystals, even from un-inflamed joints during intercritical periods, allow a precise diagnosis of gout and of calcium pyrophosphate crystal-related arthritis (pseudo gout).
So they clearly believe that once crystals get into the joint, they can still be detected after swelling has gone down.
Yes, there is a home blood uric acid test kit available.
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Current gout status in my profile.
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5:03 am
May 18, 2009
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vegetarianGuy
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Very helpful GoutPal. I will stress on the test then. Will keep you guys informed.
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I don’t want to cut my foot off any more! Thank you LORD ALLOPURINOL (fingers crossed)
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8:09 pm
May 18, 2009
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vegetarianGuy
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Post edited 1:34 am – May 19, 2009 by vegetarianGuy
I went to the doc today. According to him it is highly unlikely that I have gout. The kind of very localized pain that I have is not very gout like and not as severe as what gout patients suffer. The cause is definitely the joint and not tendons or anything around it. I will get X-rayed today but he thinks it will most probably come out normal as well. Doc thinks I might have overstrained the joint somehow. Fingers crossed. My blood uric acid level was 4.6 or was it 4.9. I forgot now. It's slightly high?
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I don’t want to cut my foot off any more! Thank you LORD ALLOPURINOL (fingers crossed)
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9:43 pm
May 18, 2009
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GoutPal
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I need a bit more info on that test result. Can you call to get an exact value?
If the result is the conventional mg/dL, then 4.6 or 4.9 does not matter – it aint gout.
However, if the result is some variation on SI units (mmol/dL?), then 4.6 puts you at 7.7 mg/dL – definitely in the high risk group, though not conclusive proof of gout. 4.9 translates to 8.2mg/dL, not far from the “very high risk” count of 9 mg/dL.
More on uric acid units, scales and conversion.
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Unless replying to specific points in this topic, please start a new topic. See new topic link above, or gout forum guidelines.
Current gout status in my profile.
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10:28 pm
May 18, 2009
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vegetarianGuy
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Post edited 3:46 am – May 19, 2009 by vegetarianGuy
GoutPal I am going back in two days with myX-rays and he will be taking my blood urea test again, I will make sure to get all the info that you were refering to.
His words were that normal blood urea is roughly around 4.2 and mine is slightly higher than that (4.6 or 4.9) but no where near the risk area levels. So that would make me believe that it was mg/dL.
To be honest I have driven myself into such a state that everything seemed like a blur when I was there. You won't believe how hard I have been working out on my health for last few years and even the possibility of gout was messing with my head. I was like I take so much care of my health and as a reward I get gout. Whatever happens I have a new found respect for gout sufferers. I will be buying the home kit that you mentioned earlier so I can keep a close eye on my blood uric acid levels, irrespective of being or not being diagnosed with gout.
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I don’t want to cut my foot off any more! Thank you LORD ALLOPURINOL (fingers crossed)
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3:10 am
May 19, 2009
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GoutPal
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One of my great difficulties, probably natural on a site that is dedicated to gout, is the issue of giving gouty advice to someone who hasn't got gout. Once the idea is there, it is hard not to see the situation as gout looking for recognition and treatment. Perhaps if we had better local diagnostic centres (for all common diseases) and fewer managers who need waiting lists to manage, we would get the answers we need much earlier (A bit of a UK slant, but I know that prompt, accurate gout diagnosis is an issue everywhere, despite different health administration models).
Just as an aside, have you noticed that the more that professionals seek to display their professionalism, the worse service we get? Doctors want to be doctors more than they want to heal, and so our health suffers. Teachers want to be teachers more than they want to educate, and so our education suffers. And don't let me start on politicians (or rather DO let me start on politicians). Sorry, rant over.
For your sake, I hope that you have not got gout, but part of me will regret losing a great contributor – especially one that gives us pictures!
Best of luck with the x-rays.
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Current gout status in my profile.
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8:07 am
May 19, 2009
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zip2play
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Let me add my $.02. Probably lots of overlap on previous posts.
Firstly,
You are very thorough VegGuy…and your little feet are kinda cute.
Secondly, I weigh in with a strong NOT gout for several reasons primarily the location of the pain on the top of the bunion joint rather than the WHOLE bunion joint with empasis on the MIDDLE/body center of the joint. THough I can see some slight rednness and swelling, the PURPLE of a podagra attack is not apparent. Add to that the low serum uric acid and the fact of your vegetarian diet.
X-rays: with a huge massive attack the best you see is a bit of fuzziness around the joint until such time as the joint is somewhat destroyed. X-rays will confirm nothing.
Now, what is it? You state that the toe is not involved in calf raises…that is dead wrong. THe bend of the foot is precisely the bend of the bunion joint which is where the true Hell of gout usually manifests. This joint IS the innermost part of the ”ball” of the foot. A calf raise demand a strong pull on the tendom atop the bunion joint and that is precisely where your pain is.
So my Dx is tendonitis of the foot, and precisely the “tensor hallicus longus” (I had to look that one up so don't be impressed. ) and my Rx would be to lay off the calf raises for a month or so. Alleve (naproxen) or ibuprofen will probably help with any pain.
(I stand warned about too many calf raises…I do them but not a whole lot becasue they are hateful and show so little results. )
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8:15 am
May 19, 2009
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GoutPal
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zip2play said:
So my Dx is tendonitis of the foot, and precisely the “tensor hallicus longus” (I had to look that one up so don't be impressed.)
Well, I AM impressed
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Current gout status in my profile.
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9:48 pm
May 19, 2009
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CC_Alaska
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Well…there's another way to diagnose it: Tuff it out this time and if it's Gout; IT WILL RETURN….probably about a year or so from now when you have completely forgotten about the first incident. Sorry…thats my tongue in cheek humor.
Good luck…I really hope it's stress or strain from the gym!!!! If not, life isn't over….you just have to ride out a 'toe party' (my name for it) now and then!!! It can be an reason to get the wife to bring you stuff while you watch TV with your foot up on a pillow. Don't let her breach the 'Do Not Cross' tape making a 3 foot perimeter around your foot though. I have two bouncy 7 and 10 year old kids that love nothing more than to jump and bump my sore toe!!!! I'm in the process of constructing a titanium metal box to encase the foot for these occurances.
I hope you all appreciate the humor. I've had diagnosed Gout for 9 years and I still live a happy life. Remember, there are millions of people fighting life threatening diseases at this very moment…Gout is not one of them…glass half full!!!
Take care…..
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10:33 pm
May 19, 2009
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vegetarianGuy
Tophi Terror
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Post edited 3:49 am – May 20, 2009 by vegetarianGuy
You lot are funny  So I went for the x-ray today. Half way through, the machine broke down LOL So I was sent to another place to get them done (they payed for the taxi). Stripping off twice at two different MRI places was too much for me Anyway I have the x-rays but have to wait till friday to show them to my doc. To my untrained eye the xray does not seem to show anything bad. I compared them to normal x-rays online. Wearing and walking in my shoe is not as painful as it was before, just bit stiff. When I press the black dot with my finger then the pain is exactly same as before though.
I was not doing calf raise. It is a machine for the calf but you push with the lower front part of your feet (not the toe) and rotate with your ankle area. I think it migth still have been the culprit. Once I get better I won't use it for few months.
http://www.reccenter.siu.edu/w…..d_Calf.jpg
Doc did a thorough check of my tendons and tendons don't seem to be the problem. You know he made me push up, down and sideways with the toe and it does not hurt at all, meaning the tendons are ok. The pain is joint related. I might have over driven them without knowing.
Edit- You guys any good at reading X-rays?
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I don’t want to cut my foot off any more! Thank you LORD ALLOPURINOL (fingers crossed)
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2:13 am
May 20, 2009
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GoutPal
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CC_Alaska said:
Don't let her breach the 'Do Not Cross' tape making a 3 foot perimeter around your foot though. I have two bouncy 7 and 10 year old kids that love nothing more than to jump and bump my sore toe!!!! I'm in the process of constructing a titanium metal box to encase the foot for these occurances.
Make it bigger. Put the kids in.
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Unless replying to specific points in this topic, please start a new topic. See new topic link above, or gout forum guidelines.
Current gout status in my profile.
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2:28 am
May 20, 2009
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vegetarianGuy
Tophi Terror
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Post edited 7:28 am – May 20, 2009 by vegetarianGuy
GoutPal said:
Make it bigger. Put the kids in.
Better still don't have any parasites, umm I mean kids
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I don’t want to cut my foot off any more! Thank you LORD ALLOPURINOL (fingers crossed)
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2:31 am
May 20, 2009
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vegetarianGuy
Tophi Terror
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CC_Alaska said:
Well…there's another way to diagnose it: Tuff it out this time and if it's Gout; IT WILL RETURN….probably about a year or so from now when you have completely forgotten about the first incident. Sorry…thats my tongue in cheek humor.
Oh you are evil You might be on to something as I feel that I have had this pain before for past few years. A minor version of it. It's like a deja vu feeling. Maybe I am just going mad 
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I don’t want to cut my foot off any more! Thank you LORD ALLOPURINOL (fingers crossed)
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6:03 am
May 20, 2009
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GoutPal
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vegetarianGuy said:
… Maybe I am just going mad
Then, my friend, you are definitely in the right place
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10:58 am
May 22, 2009
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vegetarianGuy
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Post edited 4:52 pm – May 22, 2009 by vegetarianGuy
Update- Pain is less (not that it was ever extreme) but when I press my toe with my finger then it's still there. Today I even felt slight tingly, electric kind of sensation on the underside of my toe, could be related or just one of those random things. Anyway saw the doc today with my x-rays. X-rays are ok, so no physical damage. Doc took the blood reading again and said he is confident that I don't have gout.
- Pain in not the kind that gout sufferers have as I can walk freely plus touching does not hurt (I am thinking maybe because I am at very early stage so pain is low level?)
- Urea reading is normal (Gout Pal's link says otherwise)
- Visually it does not look like gout (Again maybe because I am at very early stage?)
-X-ray shows all clear (Again too early for X-ray to show anything)
I was pleased and excited but I asked for copy of my readings.
On coming home and analyzing the reading I feel I am not out of jail! My reading as stated in my earlier post was not 4.6 or 4.9 mg/dL like I had thought. My blood urea level when I first went to doc last week was 495 µmol/L and today was 429 µmol/L. I also have a reading from 2007 in my chart which was 455 µmol/L.
Based on GoutPal's link I am in the “BAD” category- http://www.gout-pal.com/refere…..id-levels/
Feel like I am at square one again? Whether I actually have gout or not currently I don't know. The point is that I might as well act as if I already have What the hell am I going to do with my diet? I eat so sensibly already and have been for last 5 years  I work hard in the gym and am very fit and not overweight.
What should be my next step? I will order the blood urea test kit tonight to monitor everything. Should I see a Rheumatologist or see how it goes for next few weeks and months? Am I being paranoid?
EDIT- Googling and came to this link-
http://knol.google.com/k/theod…..locale=en#
Depressing those photos. I think I am going to bed to shut down my mind for now.
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I don’t want to cut my foot off any more! Thank you LORD ALLOPURINOL (fingers crossed)
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4:15 am
May 23, 2009
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GoutPal
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There are different figures given for the saturation point of uric acid. This can also be raised by higher pH and higher temperature. The figure quoted by Roddy and colleagues in “Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations” is 360 µmol/L. I have seen it elsewhere as high as 400. I can find no evidence to suggest that readings in the 429 to 495 range are anything other than a risk for gout, so where your doctors confidence is coming from is beyond me.
Gout is often hereditary, so that is a a second pointer to suspect gout
That is not to say that you definitely have gout, but you must be a candidate for the joint aspiration test.
I have been in a similar situation. Unfortunately (or perhaps luckily), I was in no position to walk out of the x-ray department, so they had to continue testing until they found the gouty culprit.
Your lifestyle is probably helping to inhibit the full effects of gout. However, if you are genetically programmed for excess uric acid (either as an under-excreter or over-producer) then diet may not be enough. And even vegetarian diets may not be gout optimal. Are you taking supplements? Excess iron can be a real gout trigger. And do not forget that you are surrounded by the meatiest source of uric acid – your own body. In fact one of my criticisms of the “pathway to from purines to uric acid” model from the Google knol that you refer to is the equal weight it gives to food intake and cel breakdown as sources of purine. The former should be tiny print, almost invisible, whilst the cell breakdown emphasis should be large enough to cover the whole diagram. Increasing muscle mass through excessive exvercise is not good for gout, though you have to balance the cardio-vascular risks of too little exercise.
If I were you, I'd see a rheumatologist.
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Unless replying to specific points in this topic, please start a new topic. See new topic link above, or gout forum guidelines.
Current gout status in my profile.
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6:47 am
May 23, 2009
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vegetarianGuy
Tophi Terror
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Post edited 11:53 am – May 23, 2009 by vegetarianGuy
Are you taking supplements?
I take Berocca on and off. Nothing else apart from that. Try to get everything from natural food in general. Do you think I should stop taking Berocca? It must have artificial sweetner or something in it.
http://en.wikipedia.org/wiki/Berocca
http://www.berocca.co.uk/beroc…..faqs.htm#7
Gout pal what do you make of my reading spiking to 490s during the pain and lowering to 420s as the pain has eased. Should it not be other way round? Urea near the joint so reading lower during pain?
> Increasing muscle mass through excessive exvercise is not good for gout, though you have to balance the cardio-vascular risks of too little exercise.
I am not body builder or anything like that I don't take any protein shakes or suppliments either to get big. I just go gym to do mid level weights for an hour and step machine for 40 minutes of cardio. This gout business has really thrown a spanner in my works. I don't even know what to do, what not to do and how to balance everything. I guess best would be to take regular blood urea readings and see how my diet or change of gym routine impacts my readings.
Yes I will see a Rheumatologist. Are they the absolute specialists for Gout or is there a chance that they are not too bright? 
Are Arctic Medical's urea readings reasonably accurate?
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I don’t want to cut my foot off any more! Thank you LORD ALLOPURINOL (fingers crossed)
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