Once you get your uric acid below 6.0 you will not need any analgesics at all, well, not for gout at least. 

Keeping colchicine on hand is for those periods when, unbenownst to you, the UA number slides up.

Like GP said, you MUST get that 10.3 down fast because you have no idea how much an acute attack of gout can hurt. The language limps in trying to describe the level of pain that podagra can rise to...it hurts much worse than merely breaking a leg.

John, You need to get that number down!

john

For previous attacks in other parts of my foot (before the gout diagnosis that generally ran about 3 days each, I used crutches to get around. Not sure why I didn't use crutches for the BIGGIE..perhaps a narrow hallway or perhaps just letting the painful foot HANG was too painful.

I guess I never experienced “lingering tenderness” because the attacks stopped as abruptly as they started and I was immediately good as new. “Throw away your crutches and WALK”…it was positively BIBLICAL.

I guess what I am saying is that there is the kind of attack that is orders of magnitude more painful than "soreness." The pain can reach the level of crucifixion and my exaggeration is only slight.

Maybe for those with lingering tenderness, a trial with some of those OTC gel sole orthotics, or even the foam cut-to fits is wise. They are cheap and comfortable.

You're right, GP…maybe this thread is getting a bit “RUN-ON.”

One comment about GP's post above. Walking is great, but you should avoid overextending the toe. If you are still having pain movement helps keep it loose and increased blood flow. However, attempting to forcefully stretch the toe (i.e. stretching it into a semblance of full range of motion) may cause additional damage from the crystals.

The crystals are spear-like in shape. Grinding them around the joint by trying to force a range of motion will just make them jab into the surrounding tissue and cause more damage. Look at the link before for a pictureof what they look like (in this case in a petri dish)

http://www.diseaseaday.com/wp-.....-thumb.jpg

Keep the joint warm at all times (except perhaps for 10 minutes if you are applying ice, though this seems more use to me in reducing acute onset pain rather than lingering tenderness).

Keep youself wet - i.e. drink plenty of water and other soft drinks.

Walk as much as you can, or other gentle excercise to keep the blood flowing. Don't overexert, and when you do rest, try to keep the effected area above the heart.

On the earlier point about instructions for allopurinol, my mind was on OTC meds, forgetting that Rx stuff is just left to the doctor to explain. Silly me.

Tavery said:

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.

Tavery: That is very good advice. I am new here and just recovered from my first bout attack about 4 weeks ago. But I am left with a bunion that is tender but not painful. It's a little red and swollen. I am just wondering when it will go away altogether. I am now only taking Advils. I have tried ice pack, but it didn't seem to work. Thanks.

GoutPal said:

Can I ask both cjeezy and Tavery if your allopurinol came with instructions that I mentioned earlier?

I looked at the bottle/paper this morning and the instructions say "Take 1 daily preferrably with food or as prescribed by your doctor."...or something like that.

The poor dear looked confused.

trev,

Simvastatin at 20 mg. will give you some benefits (equivalent to 10 mg. Lipitor or 5 mg. Crestor) but don't bother with a 10 mg. dose.

Coincidentally, shortly after my last post, when I was completely askance at the lack of care taken by doctors regarding alllopurinol dosing, I found an interesting report from U.S. Pharmacist.

They seem to have picked up on report from last year, where rheumatologists are keen to educate Primary Care Physicians about some gout essentials. In a nutshell, the rheumatologists see a real need to educate the PCP's about some key gouty issues, and now the pharmacists are joining in with their own views on filling some gaps. True to form, both miss some key gout patient issues. I'll start a separate topic on this soon.

I am only on 10 or 20mg of Zocor. Both I think are too low to do any good. I will schedule an appointment to go back next week I think.

trev,

Yes, they can tell the effectiveness of simvastatin (Zocor) in a month: it's a very good drug. Did they start you on 40 mg?

How about going to the doctor with a gun and when he dismisses the risk of a gout attack in 90 days, shoot him in the foot and say "See how much it hurts?"

3 months on an inadequate dose!

If it wasn't so maddeningly, saddeningly true, it would be funny. Almost.

Can I ask both cjeezy and Tavery if your allopurinol came with instructions that I mentioned earlier?

I.e. 100mg dose should be retested WEEKLY until uric acid falls below 6mg/dL. If so, can your doctors explain the 3 month wait?

cjeezy said:

I asked the nurse about the appropriate time frame to increase my Allopurinol dosage and she said 3 months if needed when I come back for a check up.  I explaned that I did not want to wait this long to gauge if the 100mg is not working.  She said I could make an appointment in a month and if needed the Dr would then issue another UA test.…...What I'll do is start taking 100mg of allopurinol today.  Track my UA results with my home test and bring them back in to a Dr in 30 days or less.

My doc said the exact same thing. Come back in 90 days and we will retest. I dont want to wait that long because its been a month for me at 100mg and my numbers are averaging 7.2 at home. I am going to go back early and get a retest and hopefully jump to 300mg now that we all know I am not experiencing any of the rare side effects.

I started Zocor for cholesterol at the same time as Allopurinol, I really wonder if they can know this soon if the Zocor is working or if that actually requires a full 90 day wait between test?

Just got off the phone with my Dr.  I got the rest of my cholesterol results back.  I was a little bit off with what I said previously (I didnt have a pen handy when they called).  Anyways, they were:

LDL- 121

HDL- 36

Trig.- 133

Total Ch- 184

I asked the nurse about the appropriate time frame to increase my Allopurinol dosage and she said 3 months if needed when I come back for a check up.  I explaned that I did not want to wait this long to gauge if the 100mg is not working.  She said I could make an appointment in a month and if needed the Dr would then issue another UA test.  She also said not to take 2 Colchicine everyday unless it is needed. So long story short... I think I'm gonna find a new Dr :) What I'll do is start taking 100mg of allopurinol today.  Track my UA results with my home test and bring them back in to a Dr in 30 days or less.  Hopefully I won't need any Colchicine before then due to the low ineffective dosage. 

The allopurinol now or in 2 weeks is no major issue, but please don't misunderstand the process. Nothing is definite here. As I said before, you are at risk of a gout attack from new crystals if you don't start allopurinol. You are at risk of a gout attack from old crystals if you do start it. There is absolutely nobody who can predict which is the higher risk - hence keep the colchicine on hand.

When you are walking round the city avoid tight socks and shoes. Keep legs straight when resting (preferably elevated). A long walk, then sitting for a meal is a classic gout-bringer if you tuck your feet under the chair and restrict blood flow. Carry water.

I appreciate your comments and I certainly don't take them the wrong way.  This board is about support and education and I value everyones feedback.  Maybe I am worrying a little too much, but all of these health issues just popped up out of know where so I'm just trying to adjust...actually I was fine until this whole HDL thing! Anyways, I agree that I need to start Allpurinol, I just don't understand what the difference is if I wait 2 weeks to start?  I have only had 1 attack in my life and don't want to be limping around when company arrives...we have quite a bit of walking to do in the city.  I'm not saying this with the intention of never taking the drug because I certainly will.  What, I'll probably do is start the 100mg today (since that is what my Rx is for), and take 1 Colchicine/day and see how that works.  I will go back to the Dr in a couple weeks and see if he'll increase dosage if I'm still not below 6.  My thinking (or hoping) is that I do not have many crystals since I'm starting this drug after my 1st attack.  Anyways, in regards to my cholesterol, some things I'm going to do to help improve it:

- I quit smoking cold turkey yesterday...yes I can do it!

- I'm doing 20-30 min of cardio everyday...if I can walk :) (target heart rate of 150)

- I'm eating fruits and vegetables and fiber (I never really ate these things consistantly)

- I'm taking fish oil everyday

- I have a meeting with a Nutrionist today to discuss improving my HDL.

- I will have a follow cholesterol test in 3-6 months.

You KNOW that you have to start the allopurinol and get the urate crystals out of your system.

You KNOW that you have to raise your HDL, and maybe have a minor issue on the LDL. Everything so far in this topic tells me that if you make some of the changes to increase your HDL, the LDL will probably take care of itself.

Do these things, and only worry about how you can make your friends stay more enjoyable. The colchicine will get you through it. Maybe your friends can help you pack in smoking - it is actually one of the easiest things in the world - the hard thing is wanting to.

cjeezy, I'm not trying to stifle the debate, and I don't want to discourage questions. I for one, have learnt more about cholesterol just because of your question than I ever knew before. I just want you to enjoy your life, and make those few simple easy changes that will improve it. You can always make a few more later if you have to.

cjeezy said:

Hi Zip,

My concerns for the Allopurinol immediately:

- I only have 30 Colchines so I want to make sure I get confirmation that I an get another Rx if needed.
- I have someone coming for a visit for the next couple weeks and would hate to risk anothe attack. I’m finally feeling 90%+ now.
- I think I only have a Rx for 100 mg of Allopurinol for the next 90 days until my next Dr appointment (I’ll have to check)

I'm kinda nervous and anxious about my cholesterol. My comments about:

- I didn’t fast the morning of my tests. Could that have skewed the numbers? I don't think that effects HDL

- It's hard to do cardio when you foot hurts!

- I smoke about 1 pack of cigarettes a week. I'm gonna quit entirely soon though.
- I’m glad you don’t think my 120 is too high! They made it sound like it was pretty bad.
- I haven’t had the best diet over the past years (very little fruit and vegetables) so I’m trying to eat more balanced meals to see if that helps.

- Is the low HDL startling right now? or is it just something I should watch? Also how long does it take on average to see an improvement from lifestyle changes? 

Thanks again for your input

Start the allopurinol...and start with a 300 mg. dose. Basically, not having taken allopurinol, I would assume your 8.1 and 6.8 UA readings to be statistically the same given the fact that you really didn't do much to lower it except maybe precipitate more into your foot.  You can always cut back on the allo later if you find you are getting uric acid in the llow 4's.

Okay, let's go with your cholesterol numbers: a goal of below 80 in LDL is for people with proven heart disease taking statin drugs; your 120 is considered near optimal and the current recommendation for normal people is <130. Of course the lower the better but I doubt that anyone would medicate a 120 mg. without high proven heart attack risk. That goal of 80 is for me with proven atherosclerosis and a stent in my right coronary artery. Of course if you DO have heart sdisease, let's talk more!

Your HDL level is somewhat low and is a seperate risk for heart disease. It should be >40. It is TOUGH to get up. I have the same problem. Two agents work, and probably only two: daily booze and high dose niacin, I love one to excess and have tried and tried but I cannot take the other without murderously uncomfortable flushing to the point of swollen lips and eyelids (angioedema).  Give niacin a try at a dose approaching 2 grams a day...maybe you can bear it?

They SAY hard cardio raises HDL...but I have found that to be an old wives' tale.

If for some reason you DO find you need to take a statin drug, atorvastatin (Lipitor) has been shown to be somewhat  uricosuric AND to raise HDL while cutting LDL in half.

GP said:    "reports a link between too little HDL and gout"

I can personally attest to that...back BEFORE they diagnosed heart disease or gout I was walking around with an HDL of 28.

Also,  I only have about 30 or so Cochicine's left and I want to make sure my Dr will prescribe me enough to take 2/day for the next month or so before I begin Allopurinol.  In addition, I have a friend coming in from out of town for the next couple weeks, and I dont want to have any major attacks while they're here.  Hope this makes sense. 

If you are taking allopurinol, the omega 3 from fish oil should not be a problem, otherwise go for the flax oil or crushed flax seed as I suggested.

I only recommend a home uric acid test kit if you are not getting tested by your doctor, though if you want extra data for your own interest, then it will do no harm. Go with the official test results and get your level down below 5.

If it goes in the first hour, then there is no need to start the hourly routine.

The HDL cholesterol link with gout is an interesting one. As I said, there is no clear explanation of this link, but I have looked at some of the recommendations for improving HDL, and they tie in quite nicely with good advice for gout sufferers:

• No Smoking - though I cannot find any gout and smoking research, smoking is clearly linked to causing, or worsening rheumatoid arthritis. This pro-inflammatory factor is unlikely to be good for gout.
• Maintain Healthy Weight - raising HDL and lowering uric acid is a double bonus if you are overweight (check BMI in Gout Diet section).
• Physical Activity - aerobic exercise like walking, cycling, and raking leaves, raise HDL. Although excercise can raise short-term uric acid levels, long term exercise lowers uric acid. Also, it makes it easier to lose weight. Personally, I experience shorter gout attacks if I walk a few miles (with rests and water).
• Healthier Fats - saturated fats, and especially trans-fats (hydrogenated), increase LDL and are inflammatory, therefore bad for gout. Polyunsaturated and monounsaturated fats are anti-inflammatory. Omega-3 fatty acids are good for improving your LDL cholesterol to HDL cholesterol ratio, and they are good for gout.
• Moderate Alcohol. Slightly misinterpreted by some, I have always preached moderation in alcohol intake - in fact moderation in all things. Two drinks per day increase HDL, but lest I be misunderstood again, I want to make it clear this is 2 glasses of wine - not 2 bottles.

A recent study, "Atherogenic serum lipid profile is an independent predictor for gouty flares in patients with gouty arthropathy," reports a link between too little HDL and gout, but this is just a numbers game, with no explanation of what the link might be.

Sorry, that doesn't really answer your question, but it is all I have for now. You need some better information about your cholesterol, and increasing HDL cholesterol might be useful for gout. Lowering LDL is probably a good idea for general health, but I know of know link with gout.

There isn't any info in your profile about previous uric acid tests or history of gout attacks, so the allopurinol question is hard to call.

On the one hand, taking it will reduce the risk of a gout attack from new crystals forming. On the other hand it will increase the risk of a gout attack from old crystals dissolving. These are risks, not facts and there is no way to tell what will happen if you take allopurinol or not. In either event, keep colchicine on hand and take 2 at the first sign of an attack, then one an hour until it goes. (zip2play's method is highlighted in the Gems at the top of the gout cures forum)

If you and your doctor, after reviewing your test result and gout flare history, do decide the allopurinol option is right, then the process is laid out in my recent uric acid numbers article. Go for 3 or 4 at first, then consider relaxing the dose in phase 3 when you are fairly certain that all old crystals are dissolved.

You don't want to risk going through it all over again.

What are your plans for alllopurinol?

Go for it with 2 tomorrow. Better safe than sorry...you've invested a lot of your intestines.

Can I assume your pain is pretty well gone?

1. I don't want to EVER get insensitive to the wonderful drug. I don't know if it happens, but it does with many other drugs so I won't abuse it.

2. I don't want to diminish my supply in case I ever run into some doctor who needs to be coerced into prescribing it. I will NEVER be without a colchicine bottle within 20 feet of my bed.

I think I've taken 8 or 10 pills this year...4 of them this weeekend.

(Yeah, still coughing with a low grade fever and a chest cold as of this morning. Bah humbug.)

 4 can be quite laxative…even 2 yesterday made me “nervous” at the theater!

But correct, I have only had to do “the routine”, 22 colchicine in 20 hours, only once in my life.

When that attack subsided I KNEW that in a single lifetime that amount of pain could/would be borne only ONCE, no matter WHAT I had to do to prevent it. Had the colchicine not worked (I had already taken indocin for a week) I think my next drug of choice might have been potassium cyanide. :D :(

When I went down to 300 mg. allo: maybe 8-10 colchicine per year.

Now on 200 mg., I'm taking more for twinges: maybe 2 colchicine for a twinge a month? But with age whether or not these are gout or just sore feet, who knows.

(I lost 8 pounds in 2 weeks and after a long hot bike ride on an island without potable water (who knew)  I had/have more than a bit a bit of a foot flair yesterday and took 2 colchicine…I may take 2 today,  but that's an anomaly.)

I may have an old fashioned “bunion” but I don't exactly know what that IS or what kind of pain a bunion usually gives?

THis year I inflamed my quadricepos tendon (that's the one that connects the front thigh with the kneecap) doing machine leg lifts with 150 pounds fors several weeks. It hurt for months, I took maybe 6 colchicicine experimentally and stopped the lifts completely The pain is gone, the tendon healed…whether there was uric acid involvement or just repeteive injury pain, who knows?

Over the last 20 years, maybe 4 Rx colchicine at 60 each and I have 100 or so left…or probably 98 after today?

Since allopurinol I have never had to do the whole colchicine magillla. no acute attacks. <Bless you Zeus>

Where I go from here will be partially dictated by my last blood draw on Friday.

I'm glad we got to the bottom of the spelling issue.

(Also something to suspect if colchicine and allopurinol don't seem to achieveing their expected results.)

So now I know where the sesamoid bones are.

cjeezy,

If I were to start allopurinol today, I would probably take 2 colchicine per day for a month.

GP,

In Britain a case of the trots is spelled differently because when Queen Victoria took her first dose of cochicine, she was heard to utter a loud, piercing “O” from the royal privvy. So they added the letter “O” to the spelling out of respect. THis is clearly detailed in Disraeli's memoirs.

cjeezy said:

 Could it be Pseudogout or sesamoiditis maybe? Or something else perhaps? I just don’t understand why I can’t get to 100%. .... If my UA levels are high based on my labs, should I start Allopurinol? I’ve never had a joint fluid test but my Dr says he 90% sure now its gout and does not want to draw fluid. Thanks again for everyones advice during these past weeks!

If there is any doubt on the diagnosis, I wouldn't recommend joint aspiration from a general doctor. Find a rheumatologist, preferably one with some gout experience. Misdiagnosis is quite common between gout and pseudogout, septic arthritis and bursitis. Sesamoiditis is a new one on me, but it's definition is a little vague. More than one report indicates that this is not really a condition, but simply inflammation of the sesamoid bone area. At least one report seems to indicate that gout might be an explanation of sesamoiditis.

Doctors seem to think that elevated uric acid is no justification for taking allopurinol if there is no obvious history of gout flares. This seems a little short sighted to me - "we can see you are at risk, but until we have real evidence of painful joint damage we are not going to prescribe a preventative." That probably sounds acceptable in Latin.

You were lucky wth just a kidney and a liver…I lost them, both lungs and my splleen. Colchicine diarrhea is almost indiscribable, isn't it?

Can I introduce a little jingoism here? Incomprehensible spelling rules indicate that diarrhoea lasts longer in the UK. (or perhaps, )

I'd start the alllopurinol on the basis of the doctor's being 90% sure it's gout because I think you can judge your ACUTE attack over. I hope you're better tomorrow morning.

Perhaps taking it every HOUR brings on diarrhea AND cure faster than less frequent dosing. I think there's a connection between the two.

2 pills to start,

1 every hour to a max of 16, pain cessation, or extreme diarrhea.

Wait another day to judge the effect…maybe you will luck out with a delayed effect and tomorrow will be GOLDEN. I feel sad that the 12 pills didn't help you immediately.

Perhaps take 2 colchicine today and 2 tomorrow morning. (This is my best guesstimate but only a guesstimate.)

If you DO decide to go for the whole  “16 pills in 14 hours treatment,” don't do it for at least a week to get the stuff out of your system. Itis a good drug but it is also a toxic one.

There's more than a little evidence out there  if colchicine doesn't work, it AIN'T gout! So that may be food for thought.

Keep me posted.

After about 30 dumps, I was right as rain the next day, 4 pounds lighter but feeling a bit “drained” as might be imagined.

I went on 400 mg. allopurinol the next week and was pain free for a decade.

But I guess my post is moot because it's 5 hours later and your decision has already been made.

Tavery said:

After three weeks of 100mg Allopurinol I am still self-testing with a uric level of 6.6. I am starting to think I need to not wait the full three months to go back to the doctor and isntead go back in a few weeks and jump to 300mg if the doc will let me.

I think 3 months is a long time to wait during the first phase of allopurinol treatment. I have recently seen one week advised as the best time period. I.e. start at 100mg then test every week until 5mg/dL uric acid is achieved.

As for the acidity, the claimed effect is that colchicine alkalyzes an inflamed joint thus preventing more uric acid precipitation but I don't know the effect on urine pH?

Stop at 8 tabs if you feel you must today, I wouldn't,  but DON'T stop at just 6 unless the pain stops, etc, etc.

Yes, I've noticed that “burn blister” effect over a tophus…I think it means the topus is pretty close to the surface any maybe trying “to get out.”

Keep us posted how the day goes.

THis is from the bottle attachment from West-End Pharmaceuticals, the manufacturere of my first bottle. ANd word for word:

DOSAGE AND ADMINISTRATION:

Colchicine should be started at the first warning of an acute attack; a delay of a few hours impairs its effectiveness. The ususal dose is 1 or 2 tablets initially, then one tablet every one to 2 hours until pain is relieved or nausea, vomiting ot diarrhea develops. Some physicians use two tablets every two hours. Since the number of doses may range from 6 to 16, the total dose is variable. As interval treatment, one tablet may be taken 1 to 4 days a week for mild or moderate case, once or twice a day for the severe case.

(I PROMISE I won't type that out again!)

cjeezy,

I'm glad they finally relented on the cochicine script. If it's renewable, RENEW in 30 days so you have it on hand.

In retrospect I thought perhpass my earlier rant against the morons/criminals at the FDA and their stupid Colchrys approval was a bit over the top.

THen I picked up a copy of today's Wall Street Journal at my gym (I don't pay for papers especially not Rupert Murdoch's) and notived two separate articles:

DRUG CHIEF AT THE FDA IS ACCUSED OF CONFLICT:

by Aliicia Mundy...

The inspector general of the Department of Health and Human services is investigating a conflict of interest allegation involving the official in charge of drug approvals at the FDA, said the FDA.

Janet Woodstock is the director of the FDA center for drug evaluation and research. It seems a drug that has been held up for 6 years is competing with another (blood thinner) company that Dr. Woodcock has coauthored a paper with.

Story No. 2:

FDA MEDICAL-DEVICE REGULATOR RESIGNS

by Alicia Mundy 

Top medical device regulaator resigned after critics accused him, Daniel Schultz of being too friendly to the industry. Dr. Schultz overrode the decisions of his own staff in approving expensive and useless devices. His own staff of 9 doctors complained to congress about his behavior.

I mean really, how awful IS this crap...Colcrys indeed!

If you take anything over 8, or certainly anything approaching the maximum of 16 you CANNOT go to work. Although If you see the doc during the day, you can go start them at, say, midafternoon and be home for dose 4 or 5…that should be safe.

But then you have to dose hourly through the night and that's torture. Best to start at 6 AM Friday and stay home and enjoy a few Netflix choices between runs to the throne in the evening…and then a good night's sleep…and then a weekend.

You CANNOT risk a 20 yard run in the office, no way...or WORSE, a 20 yard HOBBLE!

I cannot BELIEVE your doctor will not call in an Rx for 16 colchicine (better yet, 32 to take care of NEXT time.)

Is his  name Dr. de Sade?

I would FIRE him.

I asked via e-mail one of my last GP's for profylactic amoxycillin to have a tooth impanted becasue I have a stent in my coronary artery and didn't want to risk endocarditis. He said he though I could do without it. I e-mailed him and said I had decided to do without HIM instead.

Whether he was right or wrong I expected him to honor my wishes. My dentist gave me the Rx.

Sorry for being a bit irritable.  I feel better now that I vented :)

It is as sleazy as drug complanies can get and alas with a satchel full of money they get the FDA to play the game.

Colcrys is exactly the same .6mg dose of colchicine and nothing else…only the price has been changed to protect the guilty. It was approved by the FDA exactly 2 weeks ago…and is now a pretty purple pill. If your doctor prescribes it, ask him if he plans on paying your additional charge over the cost of REAL colchicine.

I had hoped that Obama would appoint someone less gullible to head his FDA but I guess I was mistaken.

A parallel would be, assuming that BAYER hadn't done it already, fro Merck to come along and patent ASPEERIUM, consisting of aspirin which has existed LONG before anyone could spell FDA.

Or a patent on the wonderful new ASCORBIUM for treatment of scurvy.

cjeezy said:

Also when I got off the phone with my Dr's office today I asked them what my UA level was when I had my test last month.  They said normal UA levels are 2.4- 8.2 and my level was an 8.1.  Can't wait to see what my family doc says next week

That range is only normal for Gout Virgins. Please ask your doctor to refrain from the "normal" designation for anyone who:

• has a gout history (personally or in the family)
• is over normal weight
• has personal or family history of heart, circulation, kidney or diabetes problems

For them, anything over 6.5 is a risk.

If he has any patients who that doesn't cover, I'll think of some more categories.

Anything over 6.5 is a risk (conservatively, over 6). The gap is statistics - "normal" assesment is based on averages that include gouties.

cjeezy said:

Hey GP.  Is Colcrys available yet?  I did a quick search and see that patients do not need to take it as frequently as the Colchicine.  When I go into the Dr next week I just want to know whether to ask for Colcrys or Colchicine

Colcrys IS colchicine. I'm not sure I fully understand what is going on here, but I believe that generic colchicine is so old that it has never been officially approved by the FDA (by which I mean, not subject to today's rigourous trials and approvals procedure). URL Pharma are a long-standing generics manufacturer who appear to be trying to improve their profile in the branded medicines market.

They have sponsored studies that have tested the effectiveness of dosing, and shown that, with a .6mg tablet, 2 tablets followed by 1 an hour later is as effective as the "traditional" dose of 8 tablets, hourly.

The Colcrys guidelines give doctors leeway to extend the hourly dosing, so zip2play's tried and tested approach, splattered () over several topics around here, is still acceptable.

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

Is this an insurance issue? I can easily imagine a situation where practice insurers insist on "disclaimer consultations" for medications that are deemed to be at risk. Given the bad publicity surrounding accidental overdosing and bad interactions with colchicine and drugs like Biaxin (clarithromycin), I would expect insurance companies to insist on tighter controls.

Hopefully, the FDA guidance on the new brand of colchicine, Colcrys, will eventually lead to regained trust.

You've earned a place in the new Gout Symptoms Hall of Fame.

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.

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.

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.

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.

cjeezy

(Indomethacin makes me dizzy)