GOUT, 7 weeks now! Losing hope- when will it end? R.D. please (x-post)

I am at my wit's end and tired of the excrutiating pain! I have posted before but never thought It could last this long. I am losing hope and wondering if this will last until my weight is stabilized. It began at 3 weeks post op. I have been suffering with at least 1 flairing attack once a week. In between it never goes away. Right now I am in a terribly painful flair that is not responding to anything...why is this happening to me?? I never had it pre -op and the Dr & NUT feel it is due to rapid weight loss. my Uric Acid is very high @ 11.5. My body is not processing the acid. The pain is dibilitating. I can't exercise...or even walk most of the time - it is unbearable.  The Drs don't know what to do because of the gastric side effects of the meds. I am afraid to take them and when I do, the gut irritation (diarrehea) is not good for my new stomach.  I am getting zero help from anywhere...please, any ideas or thoughts? Because It looks like this is all up to me. I am trapped in my RNY ( sad, because everything else has been great!) and there is nothing I can do about it. I can't even slow down the weight loss if I wanted to.  I just posed the question to the dr..  am I over-producing Uric Acid or under-excreting it? I asked for a 24 hour urine collection which won't be read till tues. There is another medicine thta is used for under-excretion ( Probenecid, anyone know it?) It has "gastric irritation, nausea, vomiting" as side effects, as opposed to Colchicine's effects of "peptic ulcer, nausea, vomiting and diarrehea"...which is better??  I think it makes sense that I am unde-excreting UA due to the rapid weight loss and dehydration issues, particularly because this began so early post-op. although, I have always done well with water intake, I am getting 64-80 oz. of  water in for the past several weeks,so don't understand why it is continuing. I went to the NUT to find out if I need to change my diet. She thought due to the small amounts of protein I/we eat , it most likely isn't the problem. But of course we are on a high protein diet. However, since this has been going on for so long, should I change my diet?? If I had to cut back on some of my protein sources, it would be very difficult to maintain my 60 grams /day. I am eating: whey protein shakes, tuna, tilapia, salmon, chicken, turkey (deli & ground), edemame, beans (chili, refried, black), eggs, cottage cheese, fage yougurt, cheese. I think that's about it, really not the typical GOUT causing foods of red meat, alcohol, shellfish etc..  Any thoughts on diet change? I am so confused and tired of choosing between possible ulcer, less protein and excrutiating pain.   I am hoping for someone with experience to see this, I just feel so alone in this. Thanks for letting me whine & vent.  Take care, Jo

I tend to look for natural, as well as medical solutions. I found this site that mentions several idea. Many folks here seem happy with the Apple Cider Cure. I don't know how that would work with WLS, but it may be worth a try.

http://www.earthclinic.com/CURES/gout.html

 

The gout is very likely caused by the rapid weight loss, rather than your diet.  I wouldn't recommend making changes - simply keep trying to meet your daily goals for calories, protein & fat.  Fluid is very important - the more the better. Lower fat & higher carb is recommended after you meet your protein needs. No alcohol. Consider a Omega-3 supplement to help reduce inflammation. You will have some answers after your urinalysis comes back. As far as the meds. colchicine is one of the oldest meds - probably has the most testing done on it.  Some of the newer ones combine NSAIDs in them to help with pain, so keep in mind the potential peptic side effects of those.  Medications are likely to be your best bet at this point over the more "natural" cures because they are specific to the condition and will work quickly.  Don't choose a med by its label - every drug has nausea, vomiting, and diarrhea on its label even if it doesn't cause it very often.  Also, many anti-gout medications can cause reduced absorption of nutrients so you may want to talk this over with your pharmacist so you can take extra vitamins to compensate.  For example, B12 is poorly absorbed with colchicine - and you also don't absorb it well post-RNY so you may need to up your supplement.  Other drugs for gout: Anturane (works like probenecid), Allopurinol (blocks uric acid formation), Indocin or ACTH The natural cures include cherries and cranberries - the info is widely available on naturopathic websites if you search for gout. Good luck!

Danielle, Thanks for responding and for the heads up on the B12, I hadn't read that. I am at the tail end of a flair and although you are supposed to wait several weeks, without gout, to begin the Allopurinol as a preventitive, I am starting it now. There has never been more than a week and usually just a few days, between flairs.  My 24 hour Urine showed that I am under-excreting UA. I asked my PCP to start at a low dose, taken with the colchicine, to prevent a possible flair initiated by the dose. He wanted me to start on a full dose @ 300mg At this time, I don't care if I get an ulcer & will just have to deal with the gastric side effects ( i.e. diarrhea, etc. ) ... I just want to live some life again.  BTW, my Son In Law is a surgical Resident at Yale and he searched his available resources finding only 2 small studies on WLS & Gout. Conclusions were thta there is a definate connection. However, the occurance is seen in people who have a history of Gout. Well, I have NO history. Unfortunately my pre-op bloodwork did not include UA. I must assume it was high, even though I was asymptomatic. I would suggest UA be included in pre-op labs, so preventitive measures can be taken. So... I beleive Gout & reative Hypoglycemia ( from seeing a new post or 2 every week on the OH board), should both be added to the list of complications to consider before haveing WLS. Thanks for your help, Jo

There is still relatively few GOOD studies on the complications post-op from WLS.  The data is getting better, but there is still a long way to go before we know all of the potential complications and side-effects of these procedures. For those of us who work in the field, we know the anecdotal evidence is compelling for some complications (gout, tooth decay, glycemic changes - etc.) but there is no reliable data we can go on for course of treatment.  Much of what we recommend is by evaluating potential problems and recommending measures to counter what MAY happen.  The big studies have focused more on BIG problems such as organ failures, complex osteoporosis, and diabetes.

I look forward to more research in the coming years.  Good luck with your gout - I hope this flare up ends soon!