I developed gout in my big toe joint 8 days ago and I'm now on the third day of a course of Colchicine. The pain has eased to just about bearable but the swelling and redness is actually worse. I have tried using ice, elevating my foot and drinking lots more water but none of these have helped. I've also cut out the high purine foods I ate before the attack such as prawns and sunflower seed bread and am staying off the foot as much as possible. Can anyone tell me if it's normal for the swelling and redness to get worse?
Colchicine only works if started promptly after the start of an attack, say 12-24 hours. Attacks normally last 7-10 days and get better by themselves but are agonizingly painful while they're doing it. Have you tried something like extra strength Naprosyn or another NSAID like that? Considered seeing your GP?
I can't take NSAIDs as I only have one kidney which isn't working as well as it should (according to my last two blood tests) and could be the reason for the gout attack. I just happened to have a hospital appointment for another foot problem (numb toes) a few days after the gout started and I'd hoped they could treat the gout too but not so, he told me to see my GP as he wasn't specialised (although he was the one that told me it was probably gout). I explained this at my surgery but the GP refused to see me until I'd had a blood test to confirm the gout. Unfortunately the first available appointment for the blood test is not until next Thursday! By the following day my foot was much worse and I then managed to get an appointment with a different GP who prescribed the Colchicine. He said I wouldn't need painkillers as the Colchicine would be enough on its own but I can still barely walk as it's so swollen. Thankfully the unbearable throbbing has now stopped though but it is still painful. Is there anything else I can do to help the swelling go down?
Firstly how much colchicine are you allowed to take in 24 hours?
Second, are you taking any other medication?
Third, do you have any other illnesses which complicate treatment (apart from having only 1 kidney (how did you lose one btw).
Are you over weight?
You are doing the right thing by drinking water (then drink more). Cut out alcohol, and reduce tea and coffee. Cut out anything high in sugar ESP anything with high fructose corn syrup.
I read some research that proved that colchesine was most effective in smaller doses -by cutting the already tiny colchesine tablets in half and taking them more frequently (but half the dose).
You are avoiding oily fish and seriously cutting down on meat ESP bacon and preserved meats?also avoid things high in wheat.
It will go - don't worry - we've all been there!
Thank you for all your help, I will answer your questions in order ok. He prescribed a course of 12 500microgram tablets, one four times a day but since reading your post I'm now cutting the last three in half and taking these more frequently. Yes I'm on quite a lot of other medication as I have many other problems from eczema to ADHD. I am on Dextroamphetamine, Lisponol, Omeprazole, Bendroflumethiazide, Atorfastin and Serequel. I don't think any of my other illnesses complicate treatment. The hospital letter I received today says I have Chronic kidney disease stage 3 following pyelonephritis, this is the first I've known of this, my kidney was killed by frequent infections when I was a teenager (I'm 58 now). I had a cyscoscopy in my 40s which showed I have a narrow urethra preventing my bladder emptying property (why I wasn't given this before I'll never know as since then I've always strained to help the bladder empty and have only had one infection since). Yes unfortunately I am overweight! I never drink alcohol or tea/coffee but drink lots of slightly sparkling flavoured water every day with lots of ordinary water too since the gout started. Yes I'm avoiding all of the purine high foods I read agravate gout. Since starting the Colchicine my appetite has been nonexistent and there's nothing like severe pain to kill your appetite so hopefully I might lose a bit of that excess weight! I can think of better ways though lol.
Is it normal for the foot to redden and swell more after treatment starts?
Ok...Kay.... from what you are saying - you have a kidney infection (pyelonephritis), for which hopefully they have given you a test to see if it's a bacteria (usually E Coli) and if it is an antibiotic will fix it quickly.
I would guess that your gout flare is being caused by the kidney infection. Kidney infection = less urine flow and dehydration. Dehydration will cause gout.
You need to drink water. Not water with stuff in but water. Regularly. You are going to spend a lot of time peeing, but the urine flow will protect your kidney, it will help to flush through an infection, and it will help the kidney flush out the urates (uric acid) which will eventually push the crystals back into solution to solve the gout.
Has the liquid you are drinking any sugars of any kind? That is not only good for you, but somewhat counterintuitively will make you feel hungry and eat more.
Frankly you are already on so many drugs that they - or their interactions could be causing gout too. With so many drugs the doctors have •no idea• what they are doing. Drug interactions are very complicated. Two is hard. Three is very hard. By the time you're on 4 or more, the Almighty himself has no idea what is happening.
You need to lose weight. Stop intake of sugar. Buy a bicycle and use it, or go to a swimming pool. You need to consider alternatives like acupuncture for your skin conditions which would then get you off some medication.
As for the toe getting redder after the treatment has begun...we can only imagine what it would be like without the rather powerful treatment. My basic advice would be drink water (and reduce salt if you use a lot).
Hope you're feeling well soon. Keep us informed of progress.
I haven't got a kidney infection now, I had them constantly from age 12 until one kidney was so damaged it was unable to recover. Then when I was in my 40s the infections started again and eventually they discovered my narrow urethra. Once I knew about this the infections stopped as I always strain to make sure my bladder empties properly. I have only had one infection in the 12+ years since then. But my last two blood tests have shown my remaining kidney isn't working as well as it was and it's this that the doctor said is probably the cause of the gout. I usually have two kidney function tests a year but the doctor asked me to have another test in four weeks time and I'm praying the count will have increased by then.
The water I drink is carbonated spring water and yes it contains sweeteners. Do these make you feel hungry? I drink many litres every week and would miss it greatly but so be it if it is doing me harm. I will do anything to try to avoid the excruciating pain this gout has caused. As for the medication, one is for high blood pressure, another for high cholesterol and although I'm supposed to take the latter daily I reduced this once my cholesterol had lowered to about once a week. Next time I visit the doctor (who is unaware I reduced it) I will ask if this one can be completely stopped. Since the gout I have also reduced my ADHD meds too. I know it's not much to help reduce the amount of meds I'm on but I am aware that the huge concoction I'm on can't be good for me. As for my weight I recently bought a treadmill (I'm agoraphobic so don't go out much) but obviously I've had to stop using it until the gout is better.
I never add salt to my food, rarely eat meat but was eating two large bags of prawns a week which I've stopped. It seems I'll have to completely change the way I eat and drink but that's a small price to pay if it means I won't have to suffer this horrible condition again. Thank you so much for all your help and advice, greatly appreciated x
Oh yeah I forgot to mention the diarrhoea the GP warned me I'd probably get on Colchicine started today! It's not too bad at the moment but obviously means the need to drink more is increased. And yes I'm peeing loads, I usually have to get up 3/4 times in the night but this has increased greatly thanks to the volume of water I'm drinking and I'm never out of the bathroom in the daytime lol. Is ordinary tap water ok or should the water be filtered?
The diarrhea is a known side effect but not universal.
If you are getting your water from a ditch, I'd certainly filter it. If it's coming from a million dollar pumping station in a western country, you're probably fairly safe.
:-D
Prawns are a well known trigger of gout. For the poor defenseless prawn, their only way to hit back at us is to hope they give us gout!
Artificial sweeteners do not cause gout. My only observation though would be that water is a perfectly natural product and doesn't need chemical enhancement; but hey - if that's what you need to get a few liters down you - go for it.
I'm sorry I misread the pyelonephritis comment - I missed the word "following" which makes a huge difference.
I can see that you are aware of the multiple mess issue and are on to it.
As for your agoraphobia - can you not get some help for that? Apart from being an awful way to spend your life, it means you can't get enough vitamin D, it is socially isolating (which is bad for you), and it's just more fun to go out and jog rather than using the machine.
As for the gout - high bloood pressure tablets will cause / encourage gout.
I note you are taking serequel - a medication which is not recommended for those with high blood pressure, kidney problems and high cholesterol.
The statin you take is not recommended for those with kidney issues.
By the way - I doubt the competence of your GP. They are recommending a blood test to detect gout. It is however in Med school 101 that you cannot get a proper urate level test result from a patient having an attack of gout.
If you have agoraphobia- how do you get to the GP?
I've had agoraphobia since in my 20s and received help from a specialist nurse as for a few years I was unable to even put the milk bottles out never mind leave the house. She helped me enormously, enabling me to go out in the area where I live and although I don't enjoy going out I knew I had to continue doing so to prevent slipping back and I never want to be in that position again. So I have always made myself go out twice a week come rain or shine. My doctors surgery, dentist and small shopping centre are a 7 minute walk from my home so I can manage this without too much problem but I have an electric moped which proved invaluable when the gout prevented me from walking there.
I have lots more I want to add but the diarrhoea has come on with a vengeance, it's almost 2.30am in the UK so I'm going to have to write another post tomorrow instead ok
Hi Kaydi, what helps with the toe pain & swelling is ice. You will feel relief if you ice it. 10-15 mins 2 or 5 times a day. One time I was having gout pain I put ice on it, as I read another blogger do it and it worked to kill the pain, by the next day I was pain free and able to walk around normally. It may take a little longer with you but it works.
Thanks Sochima, yes I am using ice which eases the pain but strangely is doing nothing to help the swelling!
Rustygecko, I too have major doubts about that particular GP and even more so after reading your post! I was unaware the statin I'm prescribed is not recommended with kidney problems and I've decided not to take it anymore. My cholesterol is lower now than it was when I was prescribed it so feel it should have been stopped a long time ago and the fact I only take it approximately once a week backs this up.
As for the serequel I was also unaware and would be interested to know if there is another drug that's safer. I have been on this since 2004 after a fourth phychotic breakdown (the first two, peruepual psychosis were after the births of my daughters and another when my marriage broke down). I feel sure it has helped but for the best part of those 14 years I've always cut the tablets up, taking just over half each night.
I found it hard to believe this GP refused to see me knowing the hospital doctor had diagnosed probable gout asking for the blood test that as you've said does little to help diagnose gout. Even after the receptionist told her there are no blood test appointments until next Thursday she still refused to see me, giving a prescription for co codamol instead (which did nothing for the excruciating pain and even the doctor I did eventually see said it's no good for gout!). I have since read on the net "If untreated, gout can create lumps of uric acid crystals (tophi) which can become infected and life threatening". This shocked me and I couldn't believe that doctor would have just left me without treatment! This same doctor failed to detect a friends distended stomach plus other symptoms two years ago and my friend almost died as his bowel was obstructed, he was rushed to hospital for an emergency operation in the nick of time!
I intend to try to avoid that doctor in future.
The diarrhoea became much worse overnight and it has really wiped me out. Anything I eat goes straight through me so I've not taken the last Colchicine tablet and I've increased my fluids even more. All I can do now is wait and hope it improves soon. This is the ninth day so surely it can't last much longer?
Kay
First of all don't worry about tophi - they take years before you get to that point. In the medium term I'd be more worried about kidney stones.
As for your cholesterol that is down probably because of the staton. But IF they put you on anopurinol, one of the side effects is that it lowers cholesterol (!)
As for your other drugs, some of these are pretty specialist stuff (ESP those to do with psychosis), so please don't reduce them until you see a specialist.
I agree that a doctor refusing to see someone with gout is pretty heartless or uninformed; gout is notoriously painful, and the solutions are quick to provide. As for not having a irate test - a) you can't do it during an attack and b) it's pretty easy to diagnose gout looking at an inflamed toe.
Please no, I read that the three most painful conditions are gout, kidney stones and shingles. I've never had kidney stones, had shingles twice and the first time the doctor was amazed as I had no pain! The shingles were on my bum and he left me lying there, bum exposed while he fetched another doctor to have a look as he couldn't believe I had no pain! Weird eh? The second shingles attack was painful but nothing compared to gout and I really don't fancy finding out how painful kidney stones are!
I've been reading up more about purine high foods and I'm confused as some sites say mushrooms are a no no, others say they're fine. Tesco do a finest porcini mushroom soup that I love and have around five times a week but now I'm not sure if I can continue having it. It is loaded with mushrooms and unlike any other soup I've tasted. Do you think it'd be ok if I just cut back to say three tins a week?
Seriously, take the drugs and eat and drink what you want. You can of course try and control it by diet, but that really is a fools game.
Why? Surely it makes sense to stop all purine high foods, at least while having the attack? I was eating two large bags of prawns a week for months before my attack and feel sure they contributed if not caused it. Now I'm wise to purine high foods I will be much more careful in future.
You are not taking allopurinol or a long-term irate lowering therapy. In my opinion therefore all you are left with is trying to at least drink lots of water and try to avoid high purine foods. (As for mushrooms they are high purine, but not as bad as prawns or offal for example).
Exactly, I have no idea what Paininthetoe meant by saying to try to control it by diet is a fools game! At the moment the diarrhoea is controlling my diet, the toast I ate for breakfast went straight through me so I've been reluctant to eat anything else. I had a yogurt this afternoon and I've just eaten two slices of white toast as I didn't know what else to try. I'll have to get some low purine foods in when I do the shopping. I normally eat a lot of primula cheese spread with prawns which I love, I know cheese is fine but I'm concerned about the prawns in it, it says it contains 10%. Would it be ok or should I give it the heave ho 😢
There are other drugs instead of colchicine. Get in to see a doctor on Monday to get some!
If you love the prawns can't you chop them finer, use less and use imagination? :-)
I've just read that mushrooms are ok for some people.
At the moment your main line of defence has to be water and try ice packs..... and see a doctor ASAP!