Gout Pal Interactive

I received very valuable advice from this site last September when I was having a major attack and was being weaned onto Allopurinol.

At the time I lived in London and had bloodtests etc until I finally got onto 300mg of Allop per day.

On reaching 200mg per day my UA levels had fallen to 4.2.

Since then I have moved to the tropical climate of Saigon, Vietnam. When I first arrived I had chronic diarrhea for one month and was able to drink alcohol without any ill effects. I have noticed that as my stomach has acclimatised the attacks have been reappearing in a mild form until now.

Last Saturday I drank three glasses of red wine and alot of water. Sunday I had two large Vodkas and alot of water. Monday likewise. I then had the usual quiet day before the gout reappeared. This attack has now gone beyond what I consider to be mild, especially as I'm on 300 mg allop p/d.

Do I revisit the Doctor, get more bloodtests and reassess the quantities of Allop? Do I pack in the booze altogether (please no) Any advice is welcome.

Additionally, I've noticed that diarrhea equates to little or no gout with or without Colchicine?Could I just use laxatives instead, or in addition to Colchicine?

Anyway, you're advice was great last time and any this time would be appreciated equally.

Peter

Peter,

Allopurinol is a drug that is used to manage uric acid. Without monitoring uric acid levels, the progress of gout is impossible to manage – particularly as you have not been on it long enough to get rid of all uric acid crystals yet.

I do not believe your moderate alcohol consumption has anything to do with this.

It is perfectly normal to have a gout attack in your circumstances. It is also common to cast around for causes, but the trouble is, without uric acid monitoring, you will never get a valid answer.

I'm sorry this is more rhetoric than clear advice, but the simple facts are that without clear history of gout attacks, allopurinol dose, and uric acid levels it is almost impossible to provide any clear advice.

My best assessment is that your latest attack is perfectly normal. Comparing the number of attacks per year before allopurinol, with the number of attacks per year since allopurinol will help confirm this, though it is not a complete answer.

In the light of all that, I will attempt to answer your questions:

Do I revisit the Doctor, get more bloodtests and reassess the quantities of Allop?

Absolutely. This should be a regular thing until you are stable. At least every three months in the first year. If travel makes this hard, get a uric acid meter and self-manage it.

Do I pack in the booze altogether (please no) Any advice is welcome.

The levels you mention are compatible with allopurinol therapy, but ensure adequate hydration. Pack in booze if it makes you feel better psychologically, but otherwise why bother? (sorry to throw the question back, but I do not see how the consumption you mention can make matters worse. In fact, I believe the “red wine and lots of water” probably did more good for your gout than any other beverage regime.)

Additionally, I've noticed that diarrhea equates to little or no gout with or without Colchicine?Could I just use laxatives instead, or in addition to Colchicine?

That would make absolutely no sense. Laxatives will not help your gout, and the diarrhea issue is mere coincidence. If you won the lottery on the same day that you accidentally lost the tip of a finger would you chop the rest of them off?