Looking for a gout specialist

[Panwilai82]

Hi, I'm looking for a doctor that specialises in gout. Also looking for surgery to remove tophi gout. Any recommendations?

[Forkinhades]

Not a doctor, but long time sufferer, now under control through meds. Happy to advise.

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[Panwilai82]

Does that get rid of the uric acid deposits on the joints?

[Panwilai82]

Any advise would be appreciated 

[Sheryl]

Where in Thailand do you live?

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[Panwilai82]

10 hours ago, Sheryl said:

Where in Thailand do you live?

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Nakhon Ratchasima

[lopburi3]

For many people, after recovery from gout attack, use of allopurinol daily, perhaps with diet, helps to remain gout free - no excess uric acid.  In my case has been more than 25 years.

[Forkinhades]

Yes, fully concur with last statement. I made the mistake of stopping to take the meds. Was ok for about a year. Then I just got attack after attack for 6 months. Back on the meds, and now your free.
I extensively changed my diet, but that didn't really work, but the change was good anyway, so stick to the diet with the meds.
Never suffered with tophi.
Good luck, keep us posted.

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[Sheryl]

Surgery is a last resort for tophi, usual approach is first to get the uric acid levels down and see if the crystals dissolve.

 

In Issan the best facility is Khon Kaen Universoty hosputral (Srinagarind), suggest you consult Prof. Chingching Foocharoen there through their after hours clinic

 

http://www.intermed.kku.ac.th/index.php?module=srinagarind#module=srinagarind&1516363522142

 

If you prefer to come into Bangkok, then:

 

https://www.bumrungrad.com/doctors/Virat-Pinyopornpanit

 

[BEVUP]

22 hours ago, Panwilai82 said:

Does that get rid of the uric acid deposits on the joints?

It works before that 1 Colchicine 0.6 mg p/day

I've had the crystal build up on joints a few times & the first being on my knee (couldn't believe it ) I knew what it was & after spending most the day in the emergency room (that's Auss ) they gave me Ibrofun. So I went to a Doctor

Bailed up for 2 days 

& another one concerning wrist, was one handed for 1'2 a week 

 

The hand one was due to one type of Gout medicine that wasn't working 

 

All the above back in home land - But the surprising thing is that the Thai pharmacies wouldn't give me the type of pill that I was taking (the one that wasn't working - due to being bad for stomach )

[Panwilai82]

Thanks for all your input

[BEVUP]

23 hours ago, Panwilai82 said:

Nakhon Ratchasima

Same here

[BEVUP]

On 1/18/2018 at 8:59 PM, Panwilai82 said:

Does that get rid of the uric acid deposits on the joints?

Also since you have reached that stage (this quote is going of Auss Doc's ) You will need to take Colchicine every 4hrs 

BUT it will give you Diahrea in the end that is when you stop taking them 

[Old Croc]

I've suffered from chronic tophaceous gout for several years and am being treated regularly by a rheumatologist. At it's worst every joint in my body was affected (apart from my artificial hips) and I was unable to even roll over in bed.

At one stage the doctor removed 2 large syringes of yellow crystalline fluid from a large protuberance on my elbow. 

I take colchicine and prednisolone daily as well as feburic (febuxostat) to try to bring the uric acid levels down. My gout has now retreated into ankles and toes only, but I still have a way to go 

If your gout has advanced beyond a sore toe and your body is full of gout crystals you need to get professional treatment and regular monitoring as well as probably making massive changes to your lifestyle.

Allopurinol is not the answer for all despite many here who will tell about their experiences.

 

[lopburi3]

No Allopurinol is not the answer for all and did not mean to give the impression it is - it is not even an option until it is under control AFAIK.  But for many of us with it under control the Allopurinol is a very effective tool to keep uric acid levels down and for me has prevented the need to use the much more toxic colchicine for more than a few days some 25 plus years ago and no major lifestyle changes (even occasional bite of liver).  And I have strong family history with all males on fathers side suffering from gout.

[Old Croc]

15 hours ago, lopburi3 said:

No Allopurinol is not the answer for all and did not mean to give the impression it is - it is not even an option until it is under control AFAIK.  But for many of us with it under control the Allopurinol is a very effective tool to keep uric acid levels down and for me has prevented the need to use the much more toxic colchicine for more than a few days some 25 plus years ago and no major lifestyle changes (even occasional bite of liver).  And I have strong family history with all males on fathers side suffering from gout.

Allopurinol is a good preventative if you have a propensity to get gout attacks. My mother took it for most of her life and never had an attack that I was aware of. I took it for some time as a young man until I got sick of taking a pill every day and stopped. Big mistake.

I controlled flare-ups with colchicine and ever increasing doses of strong anti- inflammatories. Bigger mistake. Eventually, when other things started to go wrong, I went cold turkey, and this allowed the gout to take over my whole body. Not a good time.

Febuxostat was the thing that started the recovery, but when the hospital discovered they were importing a non approved drug (from Singapore) I was forced onto Allopurinol for some time until feburic received approval in Thailand.

From my experiences with both drugs feburic is the superior for treating advanced tophi gout. Trails in the US have confirmed this, although recently concerns have arisen about some side effects.  

The OP has indicated his problems may be advanced, so I feel advice to take colchicine or the preventative, may not be the best way for him at this stage. He should consult a rheumatologist.

[Panwilai82]

Thanks for the info.  Checking my UA level tomorrow and will check in the pharmacy to see if they have Feburic. Will keep you posted.

[Panwilai82]

On 26/01/2018 at 11:11 AM, Old Croc said:

Allopurinol is a good preventative if you have a propensity to get gout attacks. My mother took it for most of her life and never had an attack that I was aware of. I took it for some time as a young man until I got sick of taking a pill every day and stopped. Big mistake.

I controlled flare-ups with colchicine and ever increasing doses of strong anti- inflammatories. Bigger mistake. Eventually, when other things started to go wrong, I went cold turkey, and this allowed the gout to take over my whole body. Not a good time.

Febuxostat was the thing that started the recovery, but when the hospital discovered they were importing a non approved drug (from Singapore) I was forced onto Allopurinol for some time until feburic received approval in Thailand.

From my experiences with both drugs feburic is the superior for treating advanced tophi gout. Trails in the US have confirmed this, although recently concerns have arisen about some side effects.  

The OP has indicated his problems may be advanced, so I feel advice to take colchicine or the preventative, may not be the best way for him at this stage. He should consult a rheumatologist.

Where do you buy Feburic from and how much is it? Can't find it in my town.

[joealx]

Colchicine or Prednisolone for pain and Allopurinol. After pain stops, Allopurinol (Puride- the generic in Thailand) for the rest of your life.

[Sheryl]

Please see concurrent thread running on Feburic. Not available in pharmacies have to get at a hospital.

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[Sheryl]

Colchicine or Prednisolone for pain and Allopurinol. After pain stops, Allopurinol (Puride- the generic in Thailand) for the rest of your life.

Prednisolone should never be self prescribed. Very serious medication with serious adverse effects.

Also not legally available over the counter.

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[joealx]

18 hours ago, Sheryl said:

Prednisolone should never be self prescribed. Very serious medication with serious adverse effects.

Also not legally available over the counter.

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Did you ever hear about a "course of medication"?

[Jessi]

I have gout in my big toe and ankle. What is the best medicine to take to rid the gout?

I understand that Allopurinol  is best to take every day after one gets rid of the gout.

[Sheryl]

I have gout in my big toe and ankle. What is the best medicine to take to rid the gout?
I understand that Allopurinol  is best to take every day after one gets rid of the gout.

This is truly not a "do it yourself" proposition. Get under the care of a good rheumatologist.

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[BEVUP]

On 1/29/2018 at 1:38 PM, joealx said:

Colchicine or Prednisolone for pain and Allopurinol. After pain stops, Allopurinol (Puride- the generic in Thailand) for the rest of your life.

Colchicine for pain - I think you may be from the middle east, as it is prescribed there for pain relief concerning another condition

I would be using Ibrofen for pain & swelling relief 

Colchicine is used to get rid of the crystals, & can also be used instead of Allopurinol ( I use Colchicine ), once the crystals are removed by taking 1 p/d

 

Google ( Colchicine ) & read - Webmd

[VincentRJ]

I've suffered from the first signs of gout in the past, such as a spasmodic pain in the big toe which prevents one from sleeping.

 

I was advised by the doctor, who prescribed some pill to take, that a combination of beer, wine, and certain foods such as cheese and prawns, tended to produce the Uric acid which accumulates in the big toe and causes the pain.

 

The solution was to stop drinking alcoholic beverages, which I did. I then heard there were natural remedies such as Celery Seed extract which helps to flush out the system and prevent the build-up of uric acid.
I tried that and began drinking again, but in moderation. It worked, but only if I took the celery seed extract regularly. If I stopped taking it for a week or more, the gout would tend to come back.
I wasn't too pleased with the side effects of celery seed extract, which tends to cause one to visit the toilet more frequently to urinate.

 

I eventually investigated other natural remedies and experimented on myself. Drinking a solution of pure lemon juice regularly, squeezed from the raw fruit and diluted in water, was very effective. That might seem counter-intuitive because lemon is very acidic, as is Uric acid. But apparently, it is the acidity in the lemon which stimulates the digestive system to produce lots of alkalinity which tends to neutralize the Uric acid.

 

Another technique is to take a cold shower at the end of a warm shower. The shock to the system, of the cold water, tends to flush out any build-up of Uric acid, although I guess in warm Thailand the coldness of the water might not be sufficiently shocking. 

 

But finally, what I found was the most effective natural preventative for gout, is Sodium Bicarbonate, which is pure alkaline. Excessive acidity in the body sets the stage for many ailments to flourish, not just gout. When I've taken about half a teaspoon of Sodium Bicarbonate a day, dissolved in a glass of water, I've never experienced any gout.

 

However, all these remedies are preventative. I don't know how effective they would be in treating a serious gout condition.

[Forkinhades]

I've used bicarbonate during attacks, together with 1000mg of effervescent vitamin C. Also concentrated cherry juice. Together with NSAIDs. If you decide to go on preventative meds, like allorpurinol, your gout in the short term will continue to be painful, whilst it tries to flush out the crystals. First sign of an attack, and I take an NSAID asap, which generally knocks it out.

 

NSAIDs: indomethacin/dicolfenac

 

 

 

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[wpcoe]

tl;dr:  Whatever gout meds you are prescribed, be sure to follow up with blood work in 30 or 60 days.

 

Long version:

I was initially on Allopurinol but after 60 days my AST and ALT (Aspartate Transaminase and Alanine Transaminase) numbers went through the roof.  Those tests indicate liver damage and my doctor was concerned so took me off of Allopurinol and put me on a different med (which off the top of my head I can't recall.)  The AST/ALT numbers came down to a less alarming level but still not far enough so that I'm now on a combination of Colchicine and Sulfin.

 

When I was put on Allopurinol:

 

My AST went from 17 U/L to 56 U/L (normal range is 0-40)

My ALT went from 28 U/L to 132 U/L (normal range 0-40) 

 

Without the follow-up blood work, I would have blindly continued with Allopurinol since it got rid of the gout pain with no symptoms which would have hinted at the damage being done to my liver.

[steven100]

OP ...  I suffered gout extensively for 15yrs and finally stopped it with an orange drink mix that can be purchased from the Pharmacy in Bangkok.

There were numerous times I couldn't even move, the pain was so bad, both ankles, sometimes the knee etc ...

Colchicine made me feel sick in the stomach ... Allopurinol does work taking one each day,  BUT THE ORANGE DRINK did the job .... I can't remember the brand name but the doctor should know...

In the can of orange is a packet of test strips that I had to wee on ... and ensure it matched the color chart given to indicate safe level of uric acid in the body.

I don't suffer any more.  Well not yet anyway.

[lopburi3]

20 minutes ago, steven100 said:

Colchicine made me feel sick in the stomach ... Allopurinol does work taking one each day, 

What size allopurinol were you on?  Normal here is 100mg but 300mg or more is often the dose for our larger size bodies.  Also not a good mix with alcohol.