The last three days have been good, overall. I was on one pill daily of prednisone. My pain and inflammation have been minimal. The experiment seems to have worked and that's good. At least the first part of the experiment has been a success. The idea of taking down the swelling and inflammation in order to get a level start on the gout medicine was what sold me on taking the allopurinol in the first place.
I had heard the diagnosis before; gout. Immediately I didn't believe. My grandpa had gout. I saw him suffer, what seemed to me to be, a continuous attack of gout from the time I was small. My grandpa ate pork sausage, ham, hamhocks (whatever they are), and bacon every day of his life. He knew it was the pork that gave him gout. He said so and I believed him.
I believed it so well that when my doctor said that I had gout, my first reaction was disbelief. I don't eat pork like my grandpa ate pork. Therefore, how can I have gout? I don't eat rich foods. I don't drink alcohol. I don't have any of the usual suspects for gout in my diet. My conclusion was I don't have gout. And my solution was I'm not going to take the medicine for gout.
A series of doctors and PAs gave me alternating diagnoses; gout, osteoarthritis, carpal tunnel, tendinitis, gout. Along with the varied diagnoses came varied solutions; allopurinol, ibuprofen, ice, heat, lose weight, exercise, bah, blah, blah. Any wonder I was confused? The kicker was; they never did a lot of testing. All this was based largely on clinical diagnoses; you know, "doctor, it hurts when I do this" "so, don't do that anymore". OK so it's an old joke. But I'm telling you that's the way I was treated.
The latest doctor was no different. He listened very politely. Then said, "You have gout."
...It's not that I want to be disrespectful, but good grief. Have some imagination, already.
Then he did something different. He suggested an experiment: run though some predisone and then introduce the allopurinol. Then he spoke condescendingly to my wife. Which we'll cover in a separate blog. It is not a career ending move. But it is a fatal flaw in his care for me, his patient. I'm searching for yet another new doctor at my beloved HMO. I'm not searching because he didn't provide me with the answer I wanted. I'm searching because... I just don't like him.
So, the experiment goes on. And I'm looking forward to the next phase.
Thursday, April 29, 2010
Monday, April 26, 2010
To the Pain: Day 4, 5, 6
So, hey, it's been a couple of days. I guess time flies when your not having constant pain. And that's a great thing for me. I have a sense that life is improving because of less pain. Every step doesn't cost me. Every keystroke doesn't make me hesitate. I like it!
It's even possible that this could be a new lease on life. For example, I went for a walk/ run with my son, Andrew, the other day. It was gorgeous outside and I felt terrific. He said, "let's go for a run." I said, "how about a walk." We compromised and off we went. We covered between 4 and 5 miles. And, actually other than being a little soar from not regularly exercising, I don't have the pain I normally would have after such an excursion.
So, things are good on the prednisone trail. No adverse side effects to speak of; at least none that I'm aware of. (Last night's waterworks not withstanding) And, the direct and desired effect of reducing the inflammation and tenderness in my joints is being achieved. As I said, I like it!
The regimen starts with a higher dose and tapers down for 9 days. This is day 6, so starting tomorrow, I will be taking 1 pill a day. I interested to see if the effects will be lasting. Presumably, this is a temporary fix for the purpose of giving the joints time to recuperate. But I don't think the prednisone has any effect on the uric acid crystals that cause the irritation in the joints.
If that's true, then the next step in this process is critical; namely introducing allopurinol. This is the medicine the doctor says will fix what's ailing me. It's a drug I'll have to take for the rest of my life. That in itself is an interesting proposition for me. But we'll save that for another time.
For now, what is Allopurinal and what does it do. For this we turn to that most reliable of sources, wikipedia:
Allopurinol is a drug used primarily to treat hyperuricemia (excess uric acid in blood plasma) and its complications, including chronic gout
Allopurinol is a structural isomer of hypoxanthine (a naturally occurring purine in the body) and is an enzyme inhibitor, inhibiting xanthine oxidase. [it] is responsible for the successive oxidation of hypoxanthine and xanthine resulting in the production of uric acid, the product of human purine metabolism. In addition to blocking uric acid production, [it] causes an increase in hypoxanthine and xanthine... Allopurinol therefore decreases both uric acid formation and purine synthesis.
Allopurinol does not alleviate acute attacks of gout, but is useful in chronic gout to prevent future attacks.
...allopurinol has two important disadvantages: its dosing is complex, and some patients will be hypersensitive to it. Therefore, use of this drug requires careful monitoring.
It's even possible that this could be a new lease on life. For example, I went for a walk/ run with my son, Andrew, the other day. It was gorgeous outside and I felt terrific. He said, "let's go for a run." I said, "how about a walk." We compromised and off we went. We covered between 4 and 5 miles. And, actually other than being a little soar from not regularly exercising, I don't have the pain I normally would have after such an excursion.
So, things are good on the prednisone trail. No adverse side effects to speak of; at least none that I'm aware of. (Last night's waterworks not withstanding) And, the direct and desired effect of reducing the inflammation and tenderness in my joints is being achieved. As I said, I like it!
The regimen starts with a higher dose and tapers down for 9 days. This is day 6, so starting tomorrow, I will be taking 1 pill a day. I interested to see if the effects will be lasting. Presumably, this is a temporary fix for the purpose of giving the joints time to recuperate. But I don't think the prednisone has any effect on the uric acid crystals that cause the irritation in the joints.
If that's true, then the next step in this process is critical; namely introducing allopurinol. This is the medicine the doctor says will fix what's ailing me. It's a drug I'll have to take for the rest of my life. That in itself is an interesting proposition for me. But we'll save that for another time.
For now, what is Allopurinal and what does it do. For this we turn to that most reliable of sources, wikipedia:
Allopurinol is a drug used primarily to treat hyperuricemia (excess uric acid in blood plasma) and its complications, including chronic gout
Allopurinol is a structural isomer of hypoxanthine (a naturally occurring purine in the body) and is an enzyme inhibitor, inhibiting xanthine oxidase. [it] is responsible for the successive oxidation of hypoxanthine and xanthine resulting in the production of uric acid, the product of human purine metabolism. In addition to blocking uric acid production, [it] causes an increase in hypoxanthine and xanthine... Allopurinol therefore decreases both uric acid formation and purine synthesis.
Allopurinol does not alleviate acute attacks of gout, but is useful in chronic gout to prevent future attacks.
...allopurinol has two important disadvantages: its dosing is complex, and some patients will be hypersensitive to it. Therefore, use of this drug requires careful monitoring.
Side effects of allopurinol are rare, though significant when they occur. A small percentage of people develop a rash and must discontinue this drug. The most serious adverse effect is a hypersensitivity syndrome consisting of fever, skin rash, eosinophilia, hepatitis, worsened renal function and, in some cases, allopurinol hypersensitivity syndrome. Allopurinol is one of the drugs commonly known to cause Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TENS), two life-threatening dermatological conditions.
Allopurinol can cause severe pancytopenia. It can also cause breast enlargement in both males and females.
Allopurinol can lower blood pressure in mild hypertension.
Sounds fun... I guess I give it a whirl.
Thursday, April 22, 2010
To The Pain: Day 2
Well, that went pretty well. Most of the day yesterday I did not have pain in my hands and feet. That is something for me. I haven't been without pain for about 4 or 5 months. It felt great in fact. I walked without a limp and had my normal stride back.
The biggest difference I noticed was that I was able to, for the first time in a month, bend my backwards past 0°. It feels so good to ba able to use that finger after having it out of commission for so long. I had almost come to the conclusion that I would not have the full use of that finger for the rest of my life. I pictured Addison sitting on my lap examining my hands. Then gazing up at me and saying, "Granddad, why's your finger so crooked?"
Yesterday, I moved faster than I have in a while and thought it was near normal speed. Although I must admit that sitting in one position for any length of time is still not a good idea for me anyway. I was glad I could move.
So, as the day progressed, I felt better and better. The better I felt physically, the better I felt in every other way. By the time late afternoon rolled around, I felt GREAT! It was wonderful and I thought when I got home I might go for a walk and Oh, the dogs are there to greet me and aren't they nice dogs and look at the pretty flowers nad gee, I' should make about 10 phone calls, that won't take but about 30 seconds and ....
If I remember the list from yesterday, one of the side effects was euphoria. Yup, definitely euphoria. Yeah, I think I got that one, alright. Around 11:30 last night was when I started to wind down. I may have seen a butterfly net in O's hand at one point earlier in the evening, I'm not quite sure; It's all kind of a blur.
Me likey prednisone.
The biggest difference I noticed was that I was able to, for the first time in a month, bend my backwards past 0°. It feels so good to ba able to use that finger after having it out of commission for so long. I had almost come to the conclusion that I would not have the full use of that finger for the rest of my life. I pictured Addison sitting on my lap examining my hands. Then gazing up at me and saying, "Granddad, why's your finger so crooked?"
Yesterday, I moved faster than I have in a while and thought it was near normal speed. Although I must admit that sitting in one position for any length of time is still not a good idea for me anyway. I was glad I could move.
So, as the day progressed, I felt better and better. The better I felt physically, the better I felt in every other way. By the time late afternoon rolled around, I felt GREAT! It was wonderful and I thought when I got home I might go for a walk and Oh, the dogs are there to greet me and aren't they nice dogs and look at the pretty flowers nad gee, I' should make about 10 phone calls, that won't take but about 30 seconds and ....
If I remember the list from yesterday, one of the side effects was euphoria. Yup, definitely euphoria. Yeah, I think I got that one, alright. Around 11:30 last night was when I started to wind down. I may have seen a butterfly net in O's hand at one point earlier in the evening, I'm not quite sure; It's all kind of a blur.
Me likey prednisone.
Wednesday, April 21, 2010
To the Pain
This is day one of a 9 day round of prednisone to treat the pain in my hands and feet. The diagnosis is gout. Even though I have none of the contributing factors to that call other than the pain and swelling. Although a clinical diagnosis seemingly is enough to prescribe this kind of treament, the "gold standard" is to aspirate the joint of the great toe (stick a needle in it and draw out fluid) and see if there's uric acid present. Well, that's not going to happen, I assure you. And for good reason: I'm deathly allergic to needles. I thought this would be a good way to journal the treatment and see what happens.
According to wikipedia (THE most reliable source known to mankind):
Prednisone is a synthetic corticosteroid drug that is particularly effective as an immunosuppressant, and affects virtually all of the immune system. It is used to treat certain inflammatory diseases... but has significant adverse effects. It is usually taken orally... Prednisone is a prodrug that is converted by the liver into prednisolone, which is the active drug and also a steroid...
Here is a list of the side effects:
I have had prednisone treatment before. Following both ear surgeries, I took it to reduce inflammation and promote healing. It worked with no adverse effects, at least that I'm aware of. So, hopefully this time will be the same.
If this gets rid of the pain, I'm all for it.
I'll keep you posted.
According to wikipedia (THE most reliable source known to mankind):
Prednisone is a synthetic corticosteroid drug that is particularly effective as an immunosuppressant, and affects virtually all of the immune system. It is used to treat certain inflammatory diseases... but has significant adverse effects. It is usually taken orally... Prednisone is a prodrug that is converted by the liver into prednisolone, which is the active drug and also a steroid...
Here is a list of the side effects:
Major
- increased blood sugar for diabetics
- weight gain
- facial swelling
- depression, mania, psychosis or other psychiatric symptoms
- unusual fatigue or weakness
- mental confusion / indecisiveness
- blurred vision
- abdominal pain
- peptic ulcer
- infections
- painful hips or shoulders
- Steroid-induced osteoporosis
- Osteonecrosis
- Long term migraines
- insomnia
- severe joint pain
- cataracts
- anxiety
- black stool
- stomach pain or bloating
- severe swelling
- mouth sores or dry mouth
- avascular necrosis
- hepatic steatosis
Minor
- stretch marks
- nervousness
- acne
- rash
- increased appetite
- hyperactivity
- frequent urination
- diarrhea
- removes intestinal flora
- leg pain/cramps
- sensitive teeth
I have had prednisone treatment before. Following both ear surgeries, I took it to reduce inflammation and promote healing. It worked with no adverse effects, at least that I'm aware of. So, hopefully this time will be the same.
If this gets rid of the pain, I'm all for it.
I'll keep you posted.
Monday, April 5, 2010
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