Question about gout

[FMCoug]

Until I was about 25 I was under the impression that Gout was one of those fake old-timey diseases that they thought were caused by sleeping in a breeze, eating foods in the wrong order, not having enough sex, having too much sex, thinking too hard, etc.

Others in this category include Dropsy, the Vapours, Pleurisy, Grippe, Croupe, etc.

Shingles was in the same group until a guy in my ward got it.

"The disease of Kings". I guess it is now the Disease of Knights too.

[Green Monstah]

Lab work is back. They said I have "mildly high levels of uric acid" which is consistent with gout. Perhaps the mild levels is why I am not experiencing the level of pain others have described?

In any case he wants me to start on allopurinol after this episode passes. Not sure why I have to wait.

Also, after a day on the Indomethacin I can't say it feels measurably better. How long should it take?

Humor aside, input from the docs would be great.

You don't want to take allopurinol during an attack. Correct me if I'm wrong CUF Drs., but your body tries to protect itself against gout by creating an sheath that will form around the chrystals (a protein or enzyme?) based on your uric acid levels. When you get on the meds, your uric acid levels will drop and the body tells the sheaths to go away, thus leaving you with a whole lot of chrystals ready to tear up your joints.

At any rate, the first few weeks on Allopurinol will be touch and go, but push forward, it will be worth it in the end.

[FMCoug]

So after 48 hours (6 doses) of Indomethacin, keeping the foot elevated, and icing regularly, I don't feel like it has gotten the least bit better. So I called the doc this morning and he is switching me to a different drug. Colchicine. Dosage is .6mg ever two hours. Both the doctors office and the pharmacist warned me about the nausea and diarrhea it is known to cause so we shall see.

This sucks.

Of course, it will probably be fine with this stuff in the morning and I won't be able to stay home tomorrow and watch the game.

[wuapinmon]

So after 48 hours (6 doses) of Indomethacin, keeping the foot elevated, and icing regularly, I don't feel like it has gotten the least bit better. So I called the doc this morning and he is switching me to a different drug. Colchicine. Dosage is .6mg ever two hours. Both the doctors office and the pharmacist warned me about the nausea and diarrhea it is known to cause so we shall see.

This sucks.

Of course, it will probably be fine with this stuff in the morning and I won't be able to stay home tomorrow and watch the game.

Colchecine is a poison. They use it to sterilize watermelons so that they produce seedless fruit. Diarrhea is almost certain. But, honestly, if you're on vicodin, there's usually no diarrhea. Indomethacin does nothing to combat it.

[wuapinmon]

You don't want to take allopurinol during an attack. Correct me if I'm wrong CUF Drs., but your body tries to protect itself against gout by creating an sheath that will form around the chrystals (a protein or enzyme?) based on your uric acid levels. When you get on the meds, your uric acid levels will drop and the body tells the sheaths to go away, thus leaving you with a whole lot of chrystals ready to tear up your joints.

At any rate, the first few weeks on Allopurinol will be touch and go, but push forward, it will be worth it in the end.

Exactly what he said. The first few weeks on it are hell. I felt like I had sand in my ankle and hip joints, and it ached everywhere. But, after that, no gout, ever, unless you catch a stomach flu or some other dehydrating event.

[FMCoug]

Colchecine is a poison. They use it to sterilize watermelons so that they produce seedless fruit. Diarrhea is almost certain. But, honestly, if you're on vicodin, there's usually no diarrhea. Indomethacin does nothing to combat it.

Not on anything for pain.

[doctorcoug]

So after 48 hours (6 doses) of Indomethacin, keeping the foot elevated, and icing regularly, I don't feel like it has gotten the least bit better. So I called the doc this morning and he is switching me to a different drug. Colchicine. Dosage is .6mg ever two hours. Both the doctors office and the pharmacist warned me about the nausea and diarrhea it is known to cause so we shall see.

This sucks.

Of course, it will probably be fine with this stuff in the morning and I won't be able to stay home tomorrow and watch the game.

Gout can be treated many different ways. My treatment for flares is 1.2 mg of colchicine, followed by 0.6 an hour later, then 0.6 12 hours later. If one joint, I have patient follow up two days later. If still hurts, I give a steroid injection into the joint. People seem to do well with this treatment. I only inject a joint if this is repeat or I'm certain this is gout and not an infectious process; that would suck.

For those that can't take NSAIDs, I prescribe oral steroids. For those that can take NSAIDs but fail, I prescribe steroids. For those that can't take colchicine (drug interactions, kidney issues), I use ibuprofen 800 q8 and a steroid.

No grapefruit juice if on colchicine.

The oral steroid is the end of the line...after giving a steroid, the next thing I hear from the patient is that they are having another flare and want another steroid since it worked the first time.

I have never given a narcotic for gout, sorry pappi. Maybe I will give Norco for two days. If the patient has significant pain after two days I want to know about it.

[wuapinmon]

I have never given a narcotic for gout, sorry pappi. Maybe I will give Norco for two days. If the patient has significant pain after two days I want to know about it.

That is unwise if they are having an acute attack. The pain is wretchedly awful and feels like someone stabbing a sharp knife into the joint with every heartbeat.

I'd get a new physician if they refused me pain medication for an acute gout attack. The pain is like nothing else I've ever felt, and I had pancreatitis after my gallbladder operation and I had over 70 stitches to close a wound on my right leg once. Gout is an unholy demon and you would be wise to remember that the pain is very very very real in an acute attack.

[doctorcoug]

That is unwise if they are having an acute attack. The pain is wretchedly awful and feels like someone stabbing a sharp knife into the joint with every heartbeat.

I'd get a new physician if they refused me pain medication for an acute gout attack. The pain is like nothing else I've ever felt, and I had pancreatitis after my gallbladder operation and I had over 70 stitches to close a wound on my right leg once. Gout is an unholy demon and you would be wise to remember that the pain is very very very real in an acute attack.

Um, everything I prescribed above is a "pain medicine" and is the correct treatment. I just looked it up, BCR recommends "simple analgesia" as a category C recommendation (expert opinion). So, I'm not the only one out there. Different patients have differing pain tolerances. None of my gout patients take narcs, so I don't need to prescribe them during their acute attacks. I will consider it in the future, especially in the non-naive opioid patient, but my patients haven't complained thus far and continue to see me with many different options available to them.

[FMCoug]

Gout can be treated many different ways. My treatment for flares is 1.2 mg of colchicine, followed by 0.6 an hour later, then 0.6 12 hours later. If one joint, I have patient follow up two days later. If still hurts, I give a steroid injection into the joint. People seem to do well with this treatment. I only inject a joint if this is repeat or I'm certain this is gout and not an infectious process; that would suck.

For those that can't take NSAIDs, I prescribe oral steroids. For those that can take NSAIDs but fail, I prescribe steroids. For those that can't take colchicine (drug interactions, kidney issues), I use ibuprofen 800 q8 and a steroid.

No grapefruit juice if on colchicine.

The oral steroid is the end of the line...after giving a steroid, the next thing I hear from the patient is that they are having another flare and want another steroid since it worked the first time.

I have never given a narcotic for gout, sorry pappi. Maybe I will give Norco for two days. If the patient has significant pain after two days I want to know about it.

Thanks for the input. At this point I was on Indomethacin for two days with no improvement (in fact I think it got worse) so today they switched me to the .6mg colchicine every two hours. I'm usually pretty anti pain meds but he did give me Lortab prescription today that I have been taking. He said he thought I should for sure see improvement by tomorrow morning so we shall see.

[wuapinmon]

Um, everything I prescribed above is a "pain medicine" and is the correct treatment. I just looked it up, BCR recommends "simple analgesia" as a category C recommendation (expert opinion). So, I'm not the only one out there. Different patients have differing pain tolerances. None of my gout patients take narcs, so I don't need to prescribe them during their acute attacks. I will consider it in the future, especially in the non-naive opioid patient, but my patients haven't complained thus far and continue to see me with many different options available to them.

I guess my point is that guidelines are useful, but someone's first acute attack versus a chronic acute phase is a different kind of issue. My first attack wasn't too bad. By the time I was diagnosed, I had a palpable bump on the side of my foot, and I had to stop myself from taking a swing at the physician when she pressed on it with her thumb. And, for the record, I was opioid naive when I was initially diagnosed with gout.

I tried the colchecine and indomethacin route for 4 months. I had to start using a damned cane. I finally got a new physician. Increased colchecine, vicodin, 440 mg Naproxen, 2 gallons of water, and then increasing allopurinol until the pain went away for good.

You're a smart guy, and of course, you'll adapt your diagnosis and treatment based on individual guidelines, but remember that this man, who is not currently taking vicodin for anything, told you that the pain can be searingly wretchedly unmercifully awful during an attack. Not all attacks are the same, and indomethacin just made me feel like shit.

[FMCoug]

The Colchicine side effects have arrived.

The good news is it does seem to be getting better finally.

[FMCoug]

Holy Shit! Pun intended.

You people weren't kidding about colchicine being a "poison". First 24 hours were alright but then I got as sick as I've ever been. Explosive runs ... puking my guts out, etc. Stopped taking it and I'm better now but man that sucked.

Good news is swelling is gone. Still some pain though not nearly as bad as it was. I'm thinking of just switching to OTC naproxen now until the pain is gone?

[ERCougar]

Holy Shit! Pun intended.

You people weren't kidding about colchicine being a "poison". First 24 hours were alright but then I got as sick as I've ever been. Explosive runs ... puking my guts out, etc. Stopped taking it and I'm better now but man that sucked.

Good news is swelling is gone. Still some pain though not nearly as bad as it was. I'm thinking of just switching to OTC naproxen now until the pain is gone?

Why are you guys going on extended regimens of colchicine???
For an acute attack, it's 1.2 mg, followed by 0.6 mg an hour later if you need it. Then you're done.

[FMCoug]

Why are you guys going on extended regimens of colchicine???
For an acute attack, it's 1.2 mg, followed by 0.6 mg an hour later if you need it. Then you're done.

I just took what was prescribed. .6mg every two hours. Next time I will know.