[Luke Haymond]

Ok, let’s try this again…

1) have you seen periodic “rebounds” in UA levels during Allo dosage search phase – I was expecting steady, albeit maybe unacceptably little, change in UA

2) assuming liver and kidney levels are unchanged – I’m guessing you would increase Allo and continue search for correct dosage

[Luke Haymond]

You’re the best Keith…. stay tuned

[Luke Haymond]

First Keith – I appreciate any guidance and realize that it will be on your schedule – as it should be. It sounds like I’m pretty close to a plan of attack. May I ask for a bit of clarification? If I understand your comments from above – the colchicine is taken preemptively as long as there has been no previous adverse effects? I seem to tolerate a single colchicine dose without any problem. Given that – and I realize we are all different – if you were me, you would take a single dose daily in hopes of avoiding any flare as a result of the allopurinol? And, once I land on a dose of allo that gets me to the sub 5 UA reading continue colchcine for two weeks and then suspend – realizing that I need to begin at first sign of flare.

In summary, I have taken my first dose of 100mg allo and would take a dose of colchicine at bedtime if I am on target above.

Thanks

Luke

[Luke Haymond]

OOOps – I think I found my answer…. so in the interest of preserving your time does this sound correct:

100mg daily for two weeks – test
200mg daily for two weeks – test
300mg daily for two weeks – test

holding with whatever dosage gets me to less than 5 UA reading. Comtinue for one year with a test every 6 months to confirm less than 5 UA maintenance

Report back for guidance.

Good?

[Luke Haymond]

Keith – After one day of steroid pack – I am seeing significant improvement – pain down from 8/10 to 5/10. I have been convinced that I need to surpress my UA levels to less than 5mg/dl to purge my system of hibernating crystals.

1) I have read a fair amount of information on Uloric vs. Allopurinal, but can’t quite understand your apparent preference for Allopurinal beyond price (which is enough of a reason, I would just like to be armed with any additional rationale prior to having the conversation with my GP). Any additional selling points?

2) Assuming I begin the reduce UA effort – i should expect a flare response, right? Are there some of us that have not had negative fallout?

3) If fallout is all but guaranteed – all the more reason to start while the steroids seem to be addressing my pain, right?

4) Finally – you seem to be big on activity. When I am not gout stricken I am in the gym three days a week – Crossfit (burpees box jumps, pushups, running stairs etc) and tennis on the weekends. Is it your position that I can resume my activity as soon as I can tolerate the discomfort?

Thanks for all your guidance

Luke

[Luke Haymond]

UPDATE – Keith – I just heard from my GP and they are calling in a prescription for a “steroid pack”. They also reported a uric acid level of 7.2 – mind you this was taken prior to any colcrys.I am completely onboard with taking steps to monitor and reduce my uric acid level going forward – first things first…. does it sound like we’re doing all we can to get me over the current bout? When should I expect results from indo+colcrys+steroid pack?

I guess you know how helpful you are to us gout neophites?!

Best,

Luke

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