[Yorkiemom]

Yesterday, I went back to the Mineral Metabolism department at the school here. The initial reason I was evaluated there was for Osteoporosis or bone loss, probably exacerbated by a long intake of steroids... "Probably?"

Something odd showed up in the testing. Uric Acid was elevated to almost twice the normal range... He started me on Allopurinol...This, in itself is a concern, because I have a fatty liver and it can be toxic to the liver... Great, who is supposed to follow my liver and how? Liver enzymes? Internist? Rheumy? Whoever? This doc is a diagnostician, not one of my "many" regulars... Enzymes have been elevated in the past, esp w/NSAID's...

I know this is elevated in Gout, but I have never been told I had Gout, or even tested for it, as far as I can remember... Hyperuricemia is a term that keeps coming up in Google. Any idea why I would have this elevation? I do take a lot of AlkaSeltzer, and note a connection to aspirin...

Great, now I cannot feel a little safer taking something with aspirin to help avoid a heart attack or stroke...

In Gout symptoms, burning is mentioned, although I think it is supposed to be in the joints. My joints do burn (a lot, while I am trying to cut steroid dose), but I have burning in other areas too. Can Uric Acid burn in other areas?

Anyone have a clue here???

Cathie

[daniella]

As you know I am clueless so people correct me anyone. I had a very high liver for many years and went for many tests like ct scan. Anyhow now they are normal but a few things I would look at and are they sending you for ct scans so on?I know when in pain meds are needed but they do elevate the liver as you know. I don't know about asprin but yeas back I was not even aloud to take tylenol unless I had a fever over a certain amount and a very small amount. Also I had to go on a special diet because fats and carbs can add stress to your liver and digestion. This was key and each meal was in a certain ratio. Random I know you are trying to lower prednisone but does that cause liver issues?Back when my internist followed it but I also may be wrong a gi doc does too. Ok please correct me if this is mis info. Just sending thoughts alwasy to you and trying to offer 1% of what you help me with.

[mrsD]

1) use of diuretics

2) low fluid intake

3) rapid die off of white cells. Often after an infection, there can be a temp
elevation of uric acid because purines in the die off of the white cells may overload the clean up.

4) genetic inability in handling purines

5) high fructose intake

drugs:
Drugs that can increase uric acid measurements include alcohol, ascorbic acid, aspirin, caffeine, cisplatin, diazoxide, diuretics, epinephrine, ethambutol, levodopa, methyldopa, nicotinic acid, phenothiazines, and theophylline.

Drugs that can decrease uric acid measurements include allopurinol, high-dose aspirin, azathioprine, clofibrate, corticosteroids, estrogens, glucose infusion, guaifenesin, mannitol, probenecid, and warfarin.

[cyclelops]

Alka Seltzer is sodium bicarbonate.

It will alter pH.

'Excessive use of sodium bicarbonate can result in increase acid secretion or systemic alkalosis.'

We can at times get into a bit of a 'pickle' by having more than one doc prescribing, and/or in addition taking over the counter substances.

If you are having gastric distress, there are other options. If you are not seeing a GI, and have gastric issues, perhaps you need to see one....ALSO touch base with your primary. Primary docs, who care for patients that see a lot of different specialists, can not possibly keep track of all the different drugs, tests etc, that the specialists oversee.

We have to keep the primary in the loop.

While it is good to be drinking the fluids with the Alka Seltzer, I am concerned that the sodium bicarb. is doing a dance on your system.

Let the doc know how much of the 'bubbly' you have been taking. You may want to call the doc and speak with his nurse regarding the Alka Seltzer issue....don't expect her to know off hand that it causes this..tell her you have just become aware of this, and wonder if it is necessary to take the allopurinol or if you can come in a few days from now....after stopping the Alka Seltzer.

[mrsD]

uric acid is not used by the body to buffer the blood.

In fact when excess uric acid is present bicarb is often given to prevent stones:
http://www.springerlink.com/content/y07563vg47418p13/

While this is complex, it is still interesting:
http://www.medscape.com/viewarticle/407789_5

I would like to know how many times a day, Cathie, you are taking AlkaSeltzer.
Once a day should be enough for pain relief., for the burining I suggest it for.
I only use it at night and then only when burning is awful.

But bicarb is not causing your elevated uric acid..in fact it is used to treat people to prevent uric acid from crystalizing in the kidney:
http://www.peacehealth.org/kbase/top...614/detail.htm

Excess aspirin, however is an issue. But I think when aspirin is listed it has to be in "arthritic" amounts...that is used to treat RA = very high doses. Very high aspirin creates an acidic load in the blood. Raise acid= acid issues. Uric acid is acidic, obviously.

[cyclelops]

Aspirin (ASA) is associated with hyperuricemia.

I assume ASA is in Alka Seltzer....they don't tell people that in the commercials tho.....you think it is just plop plop fizz fizz.

I know it is basic, not acidic....aware of that, just concerned about how much bicarb she is ingesting on a daily basis.

I can't say how sodium bicarb ingested orally affects uremic acid if at all.

I did not find how much ASA is in the stuff. I imagine medscape drug reference has it.

I have no idea what Cathie's drug profile is, other than she is taking Alka Seltzer....that is pertinent.

[Yorkiemom]

Alka Seltzer contains 325mg aspirin per tablet. I take maybe 2 tablets daily.

Prednisone 8.5 mg daily (struggling to keep at this dose)
Zantac 150 1-2 times daily
Klonopin .5 mg daily
Darvocet N-100-trying to keep down #'s, 1-2 daily if that
Doxycycline 100 mg daily
Nystatin oral table one daily
Injectible B12-1 ml weekly (1,000 mcg)
Valtrex-500 mg. Can't recall if on that during test
K+ 10MEQ daily
GFN 600/Phenylephrine (mucus thinner, I think)
Provigil-200 mg daily (don't always take)
Singulair-I probably was on this at test time (oral)

Prenatal Vitamin-daily
Biotin-5,000 mcg (older bottle may have diff amt)
SloMag-2 tablets 212 mg Cal/128 mg Mag/373 mg Chloride)
Calcium Citrate-w/D 630 mg Cal 400 IUD-twice daily
B12-oral daily, I am out of it, probably Metho type
AlkaSeltzer-maybe 2 a day lately, trying to cut Darvocet by using this when possible

Started yesterday on Allopurinol-300 mg, was not on this during test

By the way Uric Acid-1152 Range 65-630
AST 20 Range 10-35
ALT 25 Range looks like 6-40
Thanks all for looking. I am going to try and figure out what you are talking about above.

MrsD: The only cause I can relate to is #2, where I might not have enough fluid intake. I am positive for MGUS, gulp, hope this does not mean it could be turning into Multiple Myeloma... Don't know what other labs are pertinent in that...

Don't think I am on that much aspirin...

Cathie

[dahlek]

curiouser and curiouser?
I too, without any hints have looked into gout simply because my autonomic lymph systems are malfunctioning....Nothing in all my blood works come to any clear conculusion in any given directions...
As Daniella, MrsD, and Cycleops have said..we all can be far more sensitive/sensitized to medications than most normal docs will consider or even believe. I too, am going thru testings...and how any treatments for which conditions are to continue will be dependent on recent and future tests. It IS discouraging...But, what are the alternative options? Give up?
We all are on serious medications for all of our variety of medical issues....the medications [upon reading all the warnings and caveats] really scare me. The options are equally devastating for either the short term or long term. Get relief now and function for a while --at a price; or avoid relief and pay a different price all the while. It can become even worse when there is no substantive diagnosis and one must just grin and bear it. As many here have experienced.

Cathie, in my case, the osteo was brought on by the seizure-meds to help the PN pain-first showed up in the teeth, then it was I who suspected bones and sure nuff...but it only got worse once I was on post-cancer estrogen blockers...And I was trying to chomp calcium tabs [thanks to Mrs D and Rose] as much as I could tolerate in the interim...Obviously not enuf...At times? Honestly I do not think it can ever be enough to offset all the meds.
I would call each med manufactuer and ask if there have been reported incidents of accelerated calcium loss....then report it to the mfrs, and also the FDA. WHY? because these things go into different computers that are checked cross/checked and documented. Especially in regards to combinations of meds...That's where I got my own very RUDE wake up calls.
Scares me to the point of chills at times tho.

Rite now tho? I truly wish I could just wave a magic wand over you and POOFF! More calcium, just where needed! We know it simply doesn't work like that tho...So...I'll simply send you heaps of soft gentle and warm hugs-'s OK? - j
Just saw your post about meds...Promise to look up tomorrow morning and see which meds don't play well with other meds Substantial list, by the way! Since I've cut out most of mine, I'm feeling like I should have more to 'do' with the morning routine! You know what I mean?

[cyclelops]

This one I have to hand to MRSD, and her persistence on balance....(see I do listen)

Intestinal flora processes one third of uric acid.....

doxycycline.

The remedy, I yield the floor to you MRSD---every bottle looks the same to me in the health food store....

(me? I like yogurt but that doesn't go over well with everyone, and may of course not be enough here...no to mention it is constipating.) ASA hikes up uric acid too, but likely Cathie isn't getting all that much from the Alkie....

[shiney sue]

Does your big toe hurt,back of foot heel area,I know you said it was
not for gout,and it probaly isn't. They usually start you on a nasty
pill,can't think of name but it gives you diahrhea foe 2 weeks,,if you
live,they give you allopurinel.Ha.

Your Primary Dr. or mine checks the liver for me..She always throws
her face in her hands and crys out no not me,she's a joy.But she does
get stuck with a lot,everything is on computer. Good she says if the
Dr. takes good notes many don't.,others don't read notes and repeat
thinks that have just been done..I know she reads it all where I can
see it. I take 100 mgs in the morning and 100 mgs at night. Mine
is for gout hmm Glen said something yesterday about Neurontin I want
to check.. Boy how you do that Prednisone,I admire and wow I couln't
do it,woww upset tummy. My cat on the liver,it is not pretty and smooth
it has pollups.but they all ,Drs. clam there ok one's.. My primary works 3 days a week,she is doing research on Darvocet,won't let anyone have
it,just claims it's bad for memory problems,and upsets tummy. It helped
my pain,but I believe in her. But many Drs feel different,listen to your
Dr. 2 days there is another very good primary who has 4 children,well
is works out.

I agreee with Alkaseltcer 1 time a day,if your on more you need to ask
to see GI Dr. (sorry) didn't you have those tests not to long ago,
or was that fanfaire at Mayo. hmm the way my memory is lately
my Dr. might be on to something with the Darvocet.lol

We have all been pushed around,so be it yuk,my tummy feels puky
more then well alot. I'll have to do it as well. I use to use something
the insurance won't pay for anymore,it worked..I'm sorry your
going through this Cathie. Oh Bob is having so much fun in Las Vegas,
my darn kidney. But his calls ticking me so,he sounds like a kid again.lol

How all this gets straighten out soon,been wondering about you..I saw
a Yorkie Poo the other day,looked more yorkie then poo. Hugs to all
Sue