Gout Pal Interactive

Like many, mine started with the pulsating burning, throbbing feeling in the bunion area.  Over the past weeks, the pain has subsided and that area is basically healed.  The odd thing is that now the lingering pain is different spots that are NOT joints.  First I now have pain in between the 2 tendons that stretch  across the top of my foot (big toe and 2nd toe tendons).  2nd, I have slight pain on the pad of my foot (under neath the ball joint of the big toe).   Is all this normal with gout?  I thought it was a joint disorder

zip2play said:

Gout can very readily affect tendons.

Yes indeed.

It was long thought that tendon damage was associated with long-term buildup of tophi – a feature of the most prolonged and extensive gout cases.

Recently, Siemens have developed a DECT (Dual-Energy Computed Tomography) system that uses different CAT scan wavelengths to distinguish uric acid crystal deposits from natural bone and tissue. They confirmed the urate deposits by traditional analysis of joint fluid. More remarkably, the system is capable of identifying small deposits in the early stages of gout – before the painful gout flare alerts the body that there is a problem.

As one of their researchers reports:

“To our surprise, the study showed that uric acid can be initially deposited in tendons and ligaments near and within the knee joint, ankle joint, wrist, i.e. in the collateral ligament / cruciate ligament and deep flexor tendons of the wrist,” says Dr. Nicolaou. “This is very important to know, since these deposits can increase the susceptibility of tendons and ligaments for tears. If we are able to detect the disease in an early stage, we can initiate a treatment to prevent destruction of the tendons and ligaments and joints where sub-clinical tophi are present.”

Let's all pester Siemens to publish details of clinics with this technology, and pester governments to get routine DECT scanning available for all.

Post edited 1:25 pm – August 10, 2009 by zip2play

C…O…L…C…H…I…C…I…N…E!

Post edited 2:50 pm – August 10, 2009 by zip2play

Good luck,

cjeezy

(Indomethacin makes me dizzy)

Its funny to read your posts becuase they are nearly carbon copies of my own posts over the last few months. I was at this stage a couple months ago and asking the same question.

Yes, it will get better. I had lingering soreness for quite a while also and it will eventually fade.

For general soreness, I would stick with Ibuprofen and only go back to Indo if the pain became problematic. In general, if you continue on a path similar to mine, it will go something like this.

• Soreness around bunion, by the end of the day you are ready to put your feet up. Wife gets mad the grass isnt getting mowed and the dog crap needs to be picked up.
• Soreness fades after three days or so, but the area is still sensitive to the touch (i.e. it hurts if you push on the bunion area) This lasts a couple weeks and you spend a lot of time in loose fitting shoes or soft slippers. You mow the lawn, but by the early evening you are looking for excuses to park your butt on the couch in the evening. Folding laundry became a personal favorite.
• Twinge! You wake up one morning and feel something not quite right but its not debilitating either. You pop some drugs and up your water intake. It goes away by the next day.
• You slide back into your old routine a bit and after a few weeks you wake up with that familiar pain of a flareup, except this time its maybe half as bad as your original. You hobble aned whine a lot and the wife reaches deep into her well of patience to keep from killing you.
• You hobble to the computer and spend the $150 to order a home test kit from Britian.
• Drugs, water and a week later you are back to soemthing resembling normal. Just in time to get your new home test kit. Number facination ensues. You spend a lot of time thinking about how to best poke your finger so you get a great blood sample.
• You spend a month or two being attack free and you think that with the diet changes, a bit more exercise and self monitoring you got this gout stuff licked.
• One morning you wake up to yet another twinge and you analyze everything you have eaten/drank for the past week and cant find a solid reason for a gout flareup. Now you are in pain AND pissed.
• Tired of laying awake and thinking about your own mortality and tired of trying to fight it, you then go back to the doctor and request 100mg of Allopurinol and set a date three months hence for another review.
• You are on a pill every day for the rest of your life, but you sleep better. You make a few changes to your lifestyle anyway because you know its the right thing to do.

Once you have had an atttack, a serum uric acid of 6.5 is NOT low enough to avoid others. It may be fine for some one with NO uric acid crystals, but once you have had your first attack you will NEVER reach the poiint of no uric acid crystals and thus you cannot have supersaturation.

Control below 6.0 is minimum treatment and control below 5.0 is optimal. Do not settle for 6.5.

I described my 9 days of MURDER TOE and my 22 colchicine ad nauseum. I immediately began 300 mg. allopurinol and took my UA down to 4.7 by the next week. When the pain ended abruptly on colchicine, there was no lingering soreness at all in my toe…not for a single day.

Yes I get twinges years after if I am walking all day in the Summer sun, but never an attack or what I would call gout related pain. I don't doubt that the attack DID some damage to my bunion joint permanently and it will never be perfect but that is different from a gout attack.

So there are two different scenarios for gout attack aftermath: with allopurinol and without.

The test kit helps you identify trends. It is not always a perfect match for the numbers the doctor gets, but overall it does show you if you are going up or going down. After your initial facination you will most likely test weekly to keep track.

If the doc starts you on 100mg, you will need to go back in 3 months (or sooner if you get a big attack). At that time they will up it if needed. My doc wants to go up 100mg every three months until I stabalize at a nice low number. Zip2play has argued that its a waste of time to start with anything less than 300 and he might be right, but its not the route I have chosen (because I am hopeful 100mg or 200mg might be enough to keep my numbers below 5.0 which is my target)

The hard part will be getting your doctor to agree on what number is right for you. Some doctors are just happy if you dont have any more attacks. Others want your number to be less than 6.0 and still others want less than 5.0. Additionally you need to decide what number is right for you, less than 5.0 might be great, but if the dose required is so high you experience side effects – then it might not be worth it.

Lastly, remember that you will most likely experience minor flareups while on Allopurinol as old crystals dissolve.

Depends.

A low 100mg dose hasnt caused a flare up for me. I suspect if you were to get a major flareup, you were probably right on the verge of having it anyway.

A 300mg dose is more likely to cause a flareup, however at the same time you can mitigate the risks by maintaining strong diet control along with alcohol abstinence and increased water intake. So a little strict living at least in the beginning would go a long ways towards softening any flareup that may occur.

Well finally heard back from the doctor.  They said he would not prescribe Colchicine unless I came in for a visit and the soonest they could see me was next week…when I already had an appointment.  The funny thing is they called me in another pain Rx to get me by.  Interesting, from what I've understood, a narcotic is probably worse than Colchicine! Oh well, at least my foot feels a little better today (without taking the pain meds)

The very best way to get doctors to start prescribing colchicine more readily is for Pfizer or Merck to introduce colchicine-sodium, call it DETOENO and charge $2 a pill for it (with $.25 blown back to the prescribing doctor for each tablet.)

You'd soon see 10 year olds taking it when they stub their toe.