Do you know what are the blood uric acid levels before and after the surgery when there were no gout attack? Those info can help explain why you have the gout attack.

Jyy2...I have not had the surgery yet, but have considered it. I have a friend that did have it and has no problems with gout, but I will ask her to check with her physician as to what the uric acid levels might do as a result of the surgery.

Kingsmonarch

Surgery and hospital stay are known to trigger gout attacks in 20%~86% (?) of the gout patients. Fasting and rapid weight loss (and the results of gastric bypass?) are also known to trigger gout attacks. Therefore, gastric bypass patients seem to be facing with double whammy from the procedure. I have not read any report in this regard. The following are my unqualified thoughts about what I would do:
before surgery:
1) keep taking allopurinol to lower and stabilize the blood uric acid level.
2) start taking colchicine a few weeks pre-op to prevent possible attack. (you will be prohibited from taking nsaids 10 days or so pre-op & post-op to prevent excess bleeding & hematosis.
After surgery
1) treat myself as if there is a gout attack for a week or two without using nsaids (and baking soda?)
2) go on high purine diet post-op to stabilize the blood uric acid level to reduce the chance of gout attacks.

I suggest you discuss the problem with your doctor and the surgeon for advice. Would you pass it on to us? Thanks and good luck.

It will be a while before I can afford the surgery if I decide to do it, but I will pass on any information I get, you can be sure!

Just came across "gastric bypass -- for doctors only" by alvarado bariatric surgeons. Here are a few quotes:

* "post-op regimen ... Eat 2-3 meals per day...In the form of lean meats (chicken, turkey, fish) ..."
* "hyperuricemia frequently occurs during the period of rapid weight loss, associated with catabolism of large volumes of tissue. Patients with a prior history of gout, or hyperuricemia, should be maintained on allopurinol..."

Thanks dmonty & jyy2, both very informative sites.

I began suffering from gout a few months ago, started allopurinol about a month ago and had gastric bypass surgery 10 days ago.



I am recovering fairly well from surgery but have had terrible pain in both feet the past few days which I assume is gout related. The really bad news is that after gastric bypass one is supposed to never again take nsaids except perhaps celebrex.

You are right to be concerned about the issue.

Very sorry gout hit you and you can't take nsaids. Check with the doctor to see if it's ok for you to have a shot of corticosteroid or adrenocorticotropic hormone (acth). They can relieve the gout attack almost instantly. You can also ask about taking colchicine or steroids by mouth. The above meds work in different pathways than nsaids; it may be ok for you to use them. You can also ask about suppositories.

I understand once you started allopurinol you are not to discontinue it even when there are gout attacks. Celebrex doesn't work very well for gout attacks; it's not for treatment of gout attacks in uk. Check with the doctor about these points too.

Good luck and take care.

After careful consideration I have decided to not have the bypass surgery. In speaking with people who have undergone the surgery and in researching it I have found that it does not cause gout, unless you already have a tendency towards gout. My lifestyle changed have already helped me start to slowly loose weight without triggering a gout attack (see my other posting "no gout in 8 months"
I am told, though, after the body adjusts to the severe change (takes about a year to fully adjust) that those who got gout in relation to it suffered fewer to no attacks, so if you are considering the surgery due to immediate health reasons (and not just to loose weight) do not let me discourage you.

I got the colchicine and it was very helpful and significantly reduced my foot pain. Unfortunately I developed severe pain in my abdomnial area two weeks ago and was diagnosed in the emergency room with a kidney stone. Since then the kidney stone still seems to be knocking around with only occasional moderate pain.

However besides that the gastric bypass seems to be working as promised and I am losing weight.

I am very glad you are in good health. As you know, uric acid stones are caused by hyperuricemia and acidic urine. In case you are not taking alkalizer such as sodium bicarbonate (baking soda), you may like to talk to your doctor about taking it. It can raise the urine ph to make uric acid more soluble, thus can dissolve the ua stones and even reduce the blood ua level slightly. You may also like to avoid low ph foods and drinks as they can increase the acidity of urine and body fluids. Take care.

RE: kingsmonarch's "... gastric bypass ...does trigger gout in those who have that tendency,..."
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Surgery and hospital stay are known to trigger gout, especially in gout patients. In addition, certain anesthesia can lower the blood uric acid level rapidly and potentially can trigger gout attacks. For example, in a study, anesthesia Propofol lowers the blood uric acid level from 4.7 mg/dL to 3.0 in one day whereas another anesthesia Sevoflurane lowers uric acid only from 4.9 to 4.0. You may like to discuss the issue with the anesthesiologist ahead of the surgery to select the most appropriate anesthesia that has the least potential to trigger a gout attack. Good luck.

JYY2 - thank you for the information regarding anesthesia and gout (see Gastric Bypass and Gout.) I will review the information with my Anesthesiologist before the surgery. I am still waiting on insurance approval. (My company just changed insurance carriers so I have to go through the process all over again! It still will be worth it.)

The reason those who have had Gastric Bypass cannot take nsaids is because the stomach pouch is so small, there is an 80% or more chance of developing a bleeding ulcer from the medication even if taken with food. This is not something you want to mess around with!

Check out JYY2's web page on how he cured his gout! Baking Soda is something you CAN take after the surgery. It really helped my last gout attack end quickly. Hopefully it will work for you.

I thought it was time for an update: Due to loosing two jobs to the economy, thus loosing my insurance, I have not had the gastric bypass surgery as planned. I have, however, remained on a lifestyle change of eating that has enabled me to remain free from gout attacks AND loose weight. I have lost 25 lbs a year for the past two years. (This is an average of 1/2 lb a week.) Loosing this slow has helped prevent me from having a gout attack. I continue taking allopurinal throughout this time as well. I eat a high fiber, low fat diet, and eat 5 small meals a day. I eat foods high in purine levels, but I space them out throughout the day. It used to be that high acid foods like tomatoes and citris would bother me, but I also eat them in moderation. It has been wonderful to be gout free for six years! Now, if only I could do as well with arthritis pain!!

this is very encouraging. what about alcohol consumption, in moderation or not at all?

Due to religious convictions, I do not drink alcohol, so it was not a factor. Knowing how painful gout is, if I were a person who had a few drinks a week, I would give them up to remain pain free! I have pretty much given up soda drinks because they are highly acidic. I limit myself to one a week.

I also recommend checking out JYY2's postings and website regarding baking soda!