Alastair

Brief Outline: Alastair has had three attacks of gout in the last 13 years. Two were in his big toe joint, and the third affected his ankle.

Background: Alastair lives with his wife and has two daughters. He works as a teacher and study support tutor. Ethnic background/nationality: White English.

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Alastair’s first attack of gout occurred about 13 years ago. He developed an excruciating pain in the joint of his big toe, and it felt like he must have had some type of accident. The joint was red, and it was so painful he could not even stand to have a sheet on it. He felt alarmed at having such a high level of pain and not knowing what was causing it. Alastair felt that the pain of gout was on a par with a fracture. It prevented him from sleeping, and severely restricted his mobility. Alastair went to his GP who diagnosed him with gout. Alastair’s GP prescribed colchicine which was effective almost immediately. The GP also printed out some information about gout for Alastair.
 
Alastair did not feel old enough to be diagnosed with gout. He felt slightly embarrassed because gout is often perceived by other people as being an older person’s condition. At the time, he did not know anyone else who had gout, but he has since discovered that several people he knows have also had gout.
 
Alastair did not have another attack until about eight years later. He recognised the symptoms and went to his GP to get some colchicine, which relieved the pain very quickly.
 
A few months ago Alastair developed an intense pain in his ankle. He thought he had twisted or damaged it in some way, and went to the local walk-in medical centre. They arranged for an X-ray because they thought that the pain could be due to a stress fracture. In the end, they suggested that Alastair might have gout and should visit his GP. Alastair had not thought that it could be gout because his last two attacks had been in his big toe, and he did not know that gout could affect other joints. Alastair’s GP confirmed that it was gout, sent him for a blood test, and prescribed colchicine to treat the pain and inflammation. The symptoms were gone within 24 hours of taking the medication. 
 
Alastair believes that his attacks were caused by what he had eaten. His most recent attack occurred after he had eaten steak, and the one before that happened after he had eaten seafood.
 
Alastair’s GP mentioned that long-term preventative medication was an option, but suggested that it was not worth taking given that Alastair had only had three attacks in 13 years. Alastair agrees with his GP and is not keen to take medication every day, but would have no concerns about taking preventative medication if he began to experience gout attacks more frequently.  

For Alastair, the thought of an attack without medication is ‘horrendous’. Colchicine has usually improved his symptoms within six hours.

I mean I can’t imagine what it must be like to have to endure it without medication, because the medication, it works so quickly, you know. I mean it’s probably – it’s hours. I mean it works with me, I would say within a matter of five or six hours max. So, you know, now when – well, if I were to have another attack, I would just hightail it to the doctors and get the medication. The thought of enduring it without medication is horrendous, you know. I mean it’s on a par, I would suggest, with a fracture. And, you know, I’ve broken my leg and I know what that feels like, you can’t sleep. Well, it certainly prevented me from sleeping, which is like my litmus test. You know, if it’s stopping you sleeping then it’s serious, you know. 

Alastair felt that gout was seen as an older person’s condition and did not want to think of himself as being old.

When I first got it, I guess I was slightly embarrassed, you know, because you do think of it as an old person’s disease. Not that there’s anything wrong with being old, I mean I’m really rather glad to have got this old [laughs], but one has a tendency not to think of oneself as being old, you know, but gradually, I guess, you just have to accept it. I think there is the notion that it is an older person’s disease and, you know, for that reason, depending on your own sort of self-image, most people don’t want to think of themselves as being old, you know, and to have an old person’s disease sort of shunts you into a category, you know so…

Alastair thinks that people are often judgemental about gout and perceive it as a self-inflicted condition.

I think that as a nation, you know, I think we’re quite judgemental and moralistic and just sort of be able to point the finger and sort of say, “Oh, you’ve been overdoing the good life” is something that we quite enjoy doing, you know, I think. And so I guess that’s why it has sort of persisted, you know. There is a sort of moral aspect to it, that you’ve brought it upon yourself sort of thing. So maybe that’s why – I mean, as I say, it doesn’t bother me at all, but…