Sudden, severe ankle pain

[M.Kaplan]

Another anecdote: When I was 40 and 30lbs more than I am now, I had a gout attack. As Alan wrote above, allopurinal during the attack made it more painful. Much more painful. Thereafter, I pursued a healthier diet, exercised like a fiend (1000 baseballs 3-5 times a week at the local batting cage, turned up as high as it would go) and lost 30. Tapered off allopurinal and all was good for 15 years. 10 years ago I started experiencing gout-like symptoms again, particularly after long airline flights. My PCP ran tests and told me that I didn’t have gout. My big toe didn’t believe him and neither did I. Turned out that the diuretic in my blood pressure medication was causing dehydration. Changed blood pressure med and the gout I didn’t have disappeared. Hopefully, forever. FWIW.

[john_stimson]

As Alan said previously, don’t let anyone start you on allopurinol during an acute attack. It’s surprising how many medical providers are confused about how to manage gout acutely and chronically. And Mark, the diuretic wasn’t doing it via dehydration, it was decreasing your uric acid excretion and raising your uric acid level, but getting off of it was clearly the right idea.

[M.Kaplan]

Thanks for the clarification, John.

[lleichtman]

Just remember that during an acute attack, your measured uric acid level tends to be misleadingly lower than you would usually run. So say you run a level of 8-9 normally, and get an occasional attack. During an acute attack, you might instead get a level of say 6.5. an inexperienced provider might look at that and tell you you can’t have gout because you have a normal level (in our lab for some reason “normal” is listed as up to 8.0!) Wrong.

Agreed, you run the uric acid when there is not an acute attack,

[Scott_Brunson]

Wine talk?
I guess it’s a pairing thread.

[Kirk.Grant]

“I wonder if it’s gout?”, said me as I finished the champagne and reached for a slice of rich frosted cake. (looking for the crying in pain emoji).

Warren,

I hope you get some good news with this. It’s never fun to have unexpected pains.