u/Alarmed-Nothing6538

First flare of my life two weeks ago exactly. felt like a broken toe, got an x-ray, confirmed it was likely gout. pain increased to agonising levels for about two/three days. got colchicine from the doc, took that over three/four days. it's been a week since finishing the colch and two weeks since the pain and stiffness started. I still can't walk flat footed without significant pain (not agony but not... manageable) and I definitely could not return to sports.

I have a blood test in about two weeks but apart from that I want to get on with things. how long should I be waiting for this to last? I guess I can go back to the GP and ask for other stuff?

(hated colch btw. probably was given it too late to make a big difference and I'll take it again if I have to but... egh)

So, I had my first gout attack ever a week ago. Absolute agony, now a dull pain when I walk. Not gonna try anything until it's completely painless - not yet started allo, that's gonna be in a few weeks once I've had a blood test (doctors orders).

pre-gout I was super active - I've done martial arts my whole life, I'm 27 years old and I Thai box four times a week which is obviously a lot of twisting and kicking with the shin and foot. I also run and hike.

I'm seeing some mixed things from people - obviously I can't train if I'm having a flare, but if I'm not flaring and I'm on Allo and I keep my uric acid levels under the trigger number... do you guys think maintaining an active lifestyle with specifically thai boxing is possible? lots of kicking with the foot and shin?

I would be absolutely heartbroken if I couldn't do this sport again at the same intensity. I am really hoping that being quite young, starting allo early, and cutting out alcohol and red meat (apart from maybe Christmas) will let me return to that apart from the odd flare.

Thoughts?

As far as I can see, colch reduces your immune response and reduces inflammation and pain, but it doesn't actually dilute or deal with the uric acid in your body. That's what the allo is for.

I'm just curious what would happen if I can't take it - the diarrhoea is honestly so miserable. first flare in my life was a week ago, nearly through it now, so just want to get some opinions while I am fumbling through it.

(a friend of mine who is a doctor is also convinced that it breaks down the uric acid in the body.... I don't want to necessarily dispute him, but the medical professionals (and, shamefully, Google) that have been dealing with me tell me colch is for inflammation, allo is for long term reduction.)

woke up with agonising pain wednesday last week, thought I'd broken my toe kickboxing. ER confirmed it was gout and sent me to my GP, who has given me colchicine and told me to come back in a month to test my bloods. currently feeling very sorry for myself - big toe is still stiff and painful, and I use a crutch to limp around without putting too much weight on it if I need to travel more than around my apartment. as I am learning, it's appeared incredibly suddenly without any real warning signs.

I know I'm not gonna absolutely know until I've had some blood tests and spent a bit longer with this, but I really want to try and weigh up my odds of this being a one-off or being a thing I now have to think about forever. The ER nurse thinks that this is an acute gout, one-off, caused by a sudden diet. the GP thinks this is chronic because in his words, it's 'usually' chronic.

I am 28 years old, have never eaten excessive red meat or fish (once or twice a week), I don't drink caffeine, I have a pint or two once or twice a week (literally a pint or two). I cook all my own stuff from scratch and it's pretty varied, and grab a modest takeout or dinner out once or twice a month. I hike and camp once or twice a month, I box and kickbox at the amateur level (I'm working out like 4/5 times a week). I'm kinda... average shape? a little chubby but my arms and thighs have got some decent muscle there. some of that is relevant, some of it is there to illustrate that getting a grip of this is really important to me. I'm 6'1, 87kg.

the big relevant thing is: I have in the last two weeks decided that I want to get into a little bit better shape and lose the chub. I started tracking my macros and calories in. I used Myfitnesspal which recommended I eat 2000 calories a day so I went in slightly under and also increased my workouts to maintain a deficit. turns out that 2k was ALREADY the deficit (I thought that was the maintenance, very stupid of me, I know). so I've been eating 1600-1800 every day for the last two weeks and drinking about 1L of water every day (again, retrospectively very stupid, I know) when my maintenance is more like 2500 calories and I should've been tripling the water at least.

(weirdly I felt great doing all this. felt a little more tired, but I felt like a brain fog had lifted also.)

(may be relevant - just had two years of back to back family deaths and stress, one death of which was my dad's suicide. it's been enormously stressful and I only tied up the estate a month ago. idk if stress is relevant here.)

so the person at the ER said that this represents a crash diet, whether I wanted to do a crash diet or not, and she feels that this is tied directly to the gout. 1k+ less calories every day is pretty on the nose. she thought that my kidney function was impaired by the massively reduced calories and inadequate hydration. she said that returning to maintenance for a week or two, rehydrating, getting the pain and swelling under control, and getting a handle of uric acid levels and then making the deficit more realistic would resolve things. no timeframe on resolution, but she was very much like "this is a reaction to a major fuelling change imo".

the GP the next day told me that whilst this was possible, it was unlikely. he wants me to look at this as though it's a thing I have for life. I don't disbelieve him but.... he was very quick to dismiss the possibility of the recent diet changes being relevant. he was immediately talking about further lifestyle adjustments and medication doses.

I'm going to accept all the help I can get from the doctors regarding this. they want to put me on allo once I've done my blood tests, which I'm totally fine with. the colchicine is.. fine.... I had my first set of 'stomach issues' with it this morning and made a mess everywhere which was super embarrassing. been on it for three days. it's not massively helped my toe - most of the improvement was on day one of the colch, and now it's still very stiff and quite painful (I can limp around on it but not much else).

I'm happy changing my diet to be more gout friendly but honestly... I am not sure what else I could change. the big triggers seem to be things I have at least rarely, at most in moderation. I could go to having fish and meat on special occasions and cutting out alcohol completely, which again, I'm super on board with but the idea that it's caused problems so far just doesn't... feel correct to me. I really think my recent accidental crash diet is a bigger deal than the GP was letting on. I'm also very on board with getting at home uric acid testing kits to keep an eye on it in my day to day life, if that would be of any help.

so: do you guys think that my sudden crash diet has triggered this? and (I know I don't have any tests to help you guys out) - what do you think about chronic vs acute gout in my situation?