Comment on Dr Mathews case study
Your recovery after 3 month attack from hell was very similar to mine
after 6 weeks attack from hell. But low dose Colchicine and high
dose Indomethacin triggered the termination of my problem. I think
that the word "trigger" might be relevant.
Although it took you and me several days to recover fully (exactly
the same recovery rate) how much of that is attributable to straight
forward recovery of damage to the joints and how much to the gout
flare-up diminishing? What I mean is that I wonder if termination of
a gout attack is not in fact remarkably sudden, like turning off of a
tap, but that the recovery of the actual foot lags the termination of
the gout attack because of recovery of the damaged joints.
This might seem nit picking but with much lesser attacks in the past
I have felt gout literally ebb away, over a three of four minute
period. I had assumed that the crystals were simply dissolving, but
could that be right ? I have seen another comment like this on this
notice board in the past but in that case the writer assumed that it
was the deposits being removed flushed off I seem to remember were
his words. But as you explain (and I completely misunderstood)
deposits aren't like that. Deposits are as mono sodium urate, uric
acid, in the fatty tissue (which I had read several times and then
completely forgot !). Clearly such deposits in the fatty tissue
couldn't just flush off.
But in my case I have neither put on nor lost weight so where did the
deposits go to or come from. My shoe size has not altered from 9.
My feet were swollen (the gout moved from one foot to the other)
during, and for a period after the major gout attack, but they have
recovered to their normal size. Could the deposits really accumulate
in the fatty tissue of your feet just because that is where the gout
is ? Could the deposits be clearing from around the body (as others
suggest) ? So that, as the deposits near the other foot (in your
case) clear, so gout is initiated in that foot ?
Of course the crystals could be just dissolving, as I had previously
assumed, but I really wonder if it is the crystals causing the pain
(as Arnold believes) or if it is a chemical reaction caused by the
release of the enzymes from the phagocytes (I have to go back to my
school biology days to remember these words). It certainly feels
more like a chemical burning sensation to me. If there are crystals
everywhere in all the joints and it is the physical broken glass
nature of the crystals that causes the pain, then why don't we have
pain everywhere ?
Also how can the crystals dissolve ? It is possible, though
unlikely, that my serum urate level could have been tripping around
the magic figure of 416 (the approximate level at which urate is
supersaturated in plasma) in my previous attacks but as Arnold points
out, so what ? The only place that matters is in the synovial fluid
could the ph there have been changing so rapidly ?
Maybe I just dreamt this ebbing away thing.
But also, as I say, I have had several minor gout attacks over the
years, what caused this to be the Rottweiler of all attacks. None of
the normal descriptions of acute gout talk about Rottweiler attacks
like your three monther ? But I now discover that it is not rare.
Worst of all your comment that "while taking your Allopurinol you
ain't out of the woods by a long site" is prescient. I had a funny
feeling that that was going to be the case!
In my opinion, and by the way, consistent with what Arnold has
written often, you are exactly correct that the cessation of the -
here I go with my own interpretation-allergic reaction that your body
is having to the crystals, is very fast, literally within an hour of
taking the proper medication I can tell the pain is under control and
will get completely better within 8 hours.
The pain is, I am sure, classic inflamation. Like if you were to cut
your foot in the same area with a dirty knife. Let is sit there with
bacteria and germs in that area and within 8 hours there will be
terrible red soreness, swelling and pain. There will be bacteria in
the area that are growing but the pain comes from the inflamation
that the body causes.
A very dangerous treatment for cuts that can end up being fatal is to
treat a badly cur area with 1% hydrocortizone and forget to put in an
equal amount of antibiotic. (A nurse practitioner in our Hospital
forgot to all the antibiotic and ended up causing the patient to lose
his leg.) The bugs continue to grow, get strong and consume a leg, or
whatever, and the patient keeps treating the discomfort with
hydrocortizone. The cortizone supresses the inflamation and the
patient does not know they have an infection untill the area turns
black.
Our pain is our own bodies reaction to the crystals. The fact that we
have such a reaction that causes us so much doscomfort, does not
mitigate, in any way, the fact that we have the crystals that have to
be dissolved to stop the body from reacting.
One more point that I have stated here often but is not well
understood by very many.
Uric acid and mono sodium urate are not in any way alike. Arnold
doesn't like to think about the difference and in the overall
picture, he is correct that you have to get rid of the uric acid as
well as the urate. However, keep in mind that we are an ionic
solution that exists in contact with an organic solution of
compounds.
Look at it like a bottle that has oil and water in it. You shake up
the oil and the water and some oil will go into the water and some
water will go into the oil but, in reality, damn little of the oil
goes into the water and even less of the water goes into the oil.
Your fatty tissue is oil based and your blood is water based.
Now, add uric acid to that bottle. Almost all of the uric acid will
go into the oil. Some will dissociate and make urate ions but damn
little will do that. If you add a small amount of sodium hydroxide to
the oil, water and uric acid mix, you will make sodium urate that
will all go into the water, nurtalizing the hydroxide. Add acetic
acid and the sodium urate will go back to uric acid and in all
probability it will percipitate out at first and then slowly
redissolve in the oil.
Uric acid is benign in our bodies. All of us have it, in reasonably
large quantities, dissolved in, and sometimes percipitated out as
pure uric acid-trophi-and uric acid dissolved in adipose tissue. As
you suspect, you can alter the amount of urate in your blood
dramatically by altering the Ph of the blood and if you were to
survive the dramatic Ph change- you could alter your gout
progression. For example, it is known that Cherries, Vitamin C and
even vinegar are good for temporary relief of gout symptoms. When you
drink vinegar-acetic acid, Cherry juice-ascorbic acid, or vitamin C,
ascorbic acid, all acids that are very water soluble and move freely
through your aqueous tissue in your body, anyway, these acids,
surpress the ionization of uric acid into the urate ion and therefore
will slow down or in many cases will stop the crystallization
process. Adding an organic, water soluble, acid to a saturated
solution of mono sodium urate, will dramaticzally lower the
concentration of the urate ion and it will cause that urate ion to
revert to the acid form, that is uric acid. Moreover, uric acid is
almost completely insoluble in water and will therefore percipitate
out of solution. Uric acid itself is almost completely ignored by the
bodies defense mechanisims and in my opinion, cherry juice, vinegar
and or vitamin C will end up making the urate percipitate out as uric
acid and it probably ends up depositing itself on the surface of the
crystals which protects us from the crystal and will provide some
relief from the inflammation.
I apolagise for the long winded explanation but it important to
understand that your blood level of urate does not reflect, in any
way, your overall uric acid load that your system is under. It only
represents how much ion is in equillibrium with the free uric acid in
your system. Rumatologists believe that you have been accumulating
your uric acid load for 15 to 20 years and that it will take three or
more years to get that load down once you start taking allopurinol.
You don't need much knowledge to take allopurinol. Make sure you are
on at least 300 mg a day, also take vitamin C, 1000 mg, and vitamin
E, 1000 mg, a day and my bet is you will be rewarded with a
dramatically improved mobility in 6 months and, in a year or two, you
will probably regain most of what you have lost. Your body is
remarkably resiliant and if it does not have to deal with the excess
uric acid, it can repair and make allowances for your years of
problems.
I only wonder why you are waiting to get started with Allopurinol...
????????????????????