What kind of doctor should I see for gout?
I was diagnosed w gout early summer and was referred to a kidney doctor (by my primary care dr.) due to a slight to moderate decrease in my kidney function (68yrs old). Primary care was prescribing 10, 10mg of prednisone on request, to take as needed for gout flare-ups which were happening every week. 10 tablets would last me 1-2 weeks and I would only take them as needed.
My kidney doctor replaced the 10mg of prednisone with a 4mg dosepk of methylprednisolone and the dosepk is working well. It is a 6 day regimen of taking 6 tablets on day 1, 5 on day two, 4 on day three and so on. Usually after the first 3 tablets on day one my flare-up is resolved. I followed the directions and took all 6 days for the first two dosekpks, but cut back on the third so I would have some on hand for flare-ups. My kidney doctor told me yesterday he shouldn't be the doctor to continue prescribing flare-up meds and that I should reach back out to my primary care doc or a rheumatologist. I've reached out to primary care doc to clarify. The allopurinol the kidney doc prescribed is slow to work - I've been taking it for 2 months and continue to have flare-ups between the prednisone and methylprednisolone. I've avoided all red meats, shellfish, organ meats, sweet drinks and am drinking at least 60 oz of water and a sugar-free drink (Powerade) daily that contains electrolytes. I have also avoided beer and wine, but have had an occasional bourbon over the last few months but not to excess. On days when I'm not in pain, I'm able to exercise (walk 2.5 miles in 45min) but those days are limited in number. I need to lose 20-30 pounds but is slow to accomplish when mobility is so limited.
My question is, should I seek a rheumatologist or stay with my primary care doctor for treatment? Any recommendations are appreciated. I should hear from my primary care doctor today or tomorrow but would like to hear recommendations based on anyone's actual experience.
Thanks in advance.
B Burris
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You would want to see a rheumatologist—they treat gout. But it may take a long time depending on where you live to get a rheumatologist appointment, so if it were me, I’d follow with my PCP until you get in with rheumatology.
I guess it depends on how often you end up having flare-ups and how long it takes to get in with rheumatology, and which if your current providers is comfortable with helping you manage medication for flares.
My uncle has gout, so I’m not as familiar with it, but I have a different inflammatory arthritis (which is treated by a rheumatologist). But that sounds odd to me that your primary sent you to a kidney specialist only, and not to rheumatology?
You want to be cautious with prednisone; it’s a very strong medication that can cause long-term challenges even when it has to be used that way.
I hope you’re able to get connected with someone soon and get things managed with minimal flares.
The bourbon caught my eye. My dad can drink bourbon and wine, but he can't eat Halibut without having a flair. It's only in his foot, one toe. So he sees a podiatrist.
@bhb30602 It seems like there are advisable diets for almost any chronic health condition, doesn't it?
I well remember my first gout attack in 2013. Yow! URGENT care placed me on a 2 day super high dose of Prednisone. I was concerned because I didn't want to have any after-effects of that, like sending me into a diabetes issue. Since then I have been taking allopurinol everyday, and a recent blood test indicated that even with that, my levels hover right at top of normal range. I do avoid processed meats, pork, shellfish, purines, alcohol. Between my renal diet, and gout diet, it is the joke that I can have oatmeal, apples, and cardboard!
Here is what WebMD has to say about the diet to follow with gout: https://www.webmd.com/arthritis/gout-diet-curb-flares
Gout is considered a form of arthritis, and a rheumatologist is the specialist to best follow this. Having your medical team all informed of different conditions you are dealing with will make a better overall outcome for you.
Ginger
Some 12 years ago I had a severe gout attack in my right foot. I used crutches to be mobile.
I went to my Primary doctor. He gave me a injection of Cortisone. I had immediate results, immediate!
I left crutches with the Docter. He put me on Allopurinol. Two pills every night. No more Gout!!!
I do, however watch what I eat and drink. Good luck to you!
Thank you.
Have you (or anyone here) ever been told how to take two Allopurinol tablets (100mg each) - at the same time or one in the morning and one in the evening? Sounds like you take both at the same time. I take one in the morning and one at bedtime - and shared that w my Dr but curious to know if there are other recommendations.
Thanks again -
B
Steroids didn’t work for my gout. Was placed on Voltaren gel, 100 mg allopurinol, 500mg naproxen, tart cherry caplets and Colchicine for break thru. After it kept happening I asked to see a nutritionist and since I follow it extremely closely I have not had another attack. Last physical I had, My uric acid level was high so now taking 200mg allopurinol as nutritionist said I could try small amounts of some of food on list guess that doesn’t work well for me. I was surprised that there are also vegetables on the list. Nutritionist was extremely helpful because I was getting conflicting information from different online sites
It’s your diet! Fix what you’re consuming that’s jolting your purine load causing flare ups.
bhb30602, My family member takes them both and bedtime.
I believe the primary care dr is necessary and intend to keep mine. I am referred to an orthopedic surgeon, a podiatrist, a physical therapist. I have osteoarthritis in my hip and use a walker.
when I avoided a gal bladder surgery and have not had an attack in 10 yrs. it was by stopping all animal protein including cheeses and dairy. I also took a cleanse for gallbladder that I bought online for $84. I hope that helps