Gout

Gout: work and finances

Some people were able to go to work during attacks, but others had to take time off because of the severe pain. Several found it difficult to get to work, particularly if they had to travel by tube to central London. Others found it hard to concentrate because the pain was distracting. 

Ian travelled to work in London despite the pain. Typing and writing were very difficult when he had attacks in his hands.

Ian travelled to work in London despite the pain. Typing and writing were very difficult when he had attacks in his hands.

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The first 24 to 48 hours really are the worst, and that's as I say when you, I’ve been working in London a couple of days or whatever, and I’ve had a particular attack, and you’ve got to go down on the train, it is very, very inconvenient, because you know you're limping - you're trying to force your way through it really, and you just have to grit your teeth and get on with it sometimes, else you'll - you fall over on the underground I think you're toast aren't you really, but there's times when I've had to do that and it's been quite painful and you have to just take your time a little bit, but you just have to get used to get it moving really. So…it can have an impact, and particularly, as I mentioned before, when it settled around the - the problem in my wrist, that was in terms of both left and right wrists, I'm right handed, you can't really - you struggle to write and type and those sorts of things are very painful. So they were more the one off, it was mostly, I'd say probably about 60%, 70% of the time, it was always in the toes.

Naresh was worried about the financial impact of being off work during attacks.

Naresh was worried about the financial impact of being off work during attacks.

Age at interview: 62
Sex: Male
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It does have a bad effect financially, you know, two or three weeks, you know, and because of the kids at that time, you’ve got to pay the mortgage and all these things you know. It was very difficult time for me. But - so my wife is still working and helped me, so I just managed at the time, you know. 

Yeah but it sounds like it was quite a worrying time?

Yeah, yeah. Yeah. Worrying time, yeah. Because I’ve got some kids also, and they're growing up, you know, and they want these things, you know. And if you’re going sick, doesn’t get much money at the time. So it was affecting me financially. 
Some people went to work even though they were in severe pain because they would not get paid otherwise. They worried about the financial impact that their gout was having. Gerald was told that his annual pay rise had been decreased because of the time he’d had off work with gout. Others were glad that they did not have to worry about money because they received sick pay when they were in too much pain to work. Peter was glad to find that the cost of his travel insurance was not affected by having gout.

Runibunar forces himself to put his protective shoes on so that he can work. He dislikes his colleagues knowing why he is limping in case they think he cannot do his job properly.

Runibunar forces himself to put his protective shoes on so that he can work. He dislikes his colleagues knowing why he is limping in case they think he cannot do his job properly.

Age at interview: 38
Sex: Male
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Do you find you have any problems with footwear, because obviously at the moment round the house you can wear…?

Yeah wearing flip flops, yeah. 

Flip flops, but when you go to work…

Yeah because we are using the safety shoes, protective shoes, quite… because if I have an attack it's really - the thing is I think if you're only going to touch the part that - the part that affected it's really worse, it's really painful. So… but the thing is I really have to force myself to - to put it on because you cannot go to work without those things, so…it's just a matter of sacrificing yourself to do that. Yeah. 

So that’s very painful? 

Yeah it is really, yeah. It was really painful, very, very painful. I don’t - I don’t even bother to - because sometimes they're telling me, “Why are you limping?” I just only, you know, sometimes I'm telling them not really the reason why because sometimes if you really tell them they're - that I have an - I have gout they will think that, you know…especially with your boss, you know, they might you know…they might think that you cannot do your job properly. But the thing is I still handle to reach what they required of me, so I really work hard. Yeah.

If Joe didn’t work, he wouldn’t get paid. He would ‘grin and bear’ the pain and carry on working.

If Joe didn’t work, he wouldn’t get paid. He would ‘grin and bear’ the pain and carry on working.

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I was a piece worker so what I made I got paid for, if I didn’t make it, I didn’t get paid, so and, you know, we were, young family then, so - but I’m of the temperament that I go to work, you know, I’ve been to work with pneumonia, that’s because I didn’t know I’d got it like, same as gout, but I worked three weeks with it, the first time, but I kept knocking it, and eventually I just had to give in and go to the Doctors and get signed off for a week or two and any other time after that, I knew what I’d got and my wife would dose me and I’d dose myself with painkillers and foot, same as I say, in a bowl (of ice), just try and get it down, so I could go to work and you’d go back before you were right, but poverty dictates doesn’t it sometimes, so you go back and I come from an age that that’s how you work, you know. Daft really but, you know, I’m stubborn.

Did you tell your colleagues or your employers at work that you’d got gout?

No, I didn’t tell the - well the guys I worked with obviously knew - and I think at that time, management weren’t that bothered with you, or, because in the pottery industry, it is antiquated, or it was at that time, and really all they wanted you to do was do your day’s work and not really bothered, and we weren’t - I mean, in fairness, you know, you clock on, you do your work and you go that’s it, and they pay you a lot of money, you know what I mean, at that time we were very well paid, sanitary casters, probably on a par, at one time in the early 70’s, 80’s, we were on a par with Doctors, you know so; and there’s a worldwide demand for us, but you worked for it, and you’d just grin and bear it a lot of times, take some tablets, painkillers. 
Some people told their employers that they had gout, but other people chose not to mention it. Like Harry, some people found that their colleagues made fun of them for having gout, or for limping or using a stick. (For more see ‘Historical perceptions and myths about gout’).

The people Jeff V worked with found his gout funny. He thinks this was because of historical pictures and ideas about gout.

The people Jeff V worked with found his gout funny. He thinks this was because of historical pictures and ideas about gout.

Age at interview: 68
Sex: Male
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And can you remember whether you will have told any of your employees or people you were working with about having gout?

Oh yes, they’d have a laugh, the boss having gout, yeah.

And is that how they - that's how they reacted.

Yeah, it's one of these old faux pas, isn't it, where you see the picture – off the picture postcard of the guy with his foot up in the air with a big bandage around it, throbbing. Yeah, so they – I perhaps wasn’t as fat then.

Okay. And, and why do you think that gout is often sort of seen as a funny, a funny thing to have?

I think it's just the history of it because they say it used to be the rich man's disease they used to call it isn't it - which isn't funny. 
Gerald’s employers were not sympathetic about his gout. He believes they did not understand the pain he was in. Some people worried that their colleagues would see them as lazy because they did not understand the impact of gout.

Arthur found that colleagues did not understand why he needed time off during an attack. He believed that gout was seen as a joke.

Arthur found that colleagues did not understand why he needed time off during an attack. He believed that gout was seen as a joke.

Age at interview: 63
Sex: Male
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I mean work and what not, when you put, when I rang up and said I’m off sick. “Oh what you got?” “Gout”. “Gout?” You know, “I mean well why can’t you come in?”. “Because I can’t get my shoe on, because I can’t stand up, because I can’t walk” or whatever it is and there’s a general ignorance. I mean if you say to somebody a more common disease, I can’t think of one, they may be more understanding. You know, “Oh I’ve got back pain and I can’t move” or something like that. “Oh fine, okay”. But when you talk about gout, certainly when I was in work, in the job, that’s how it was regarded, it’s a bit of a joke really, “You’re malingering and all the rest of it?” “No I can’t, I literally can’t walk”. 

Harry didn’t tell his employers that he had gout because he thought they wouldn’t take it seriously.

Harry didn’t tell his employers that he had gout because he thought they wouldn’t take it seriously.

Age at interview: 78
Sex: Male
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And did you feel that your employers were sort of - did they know about the fact that you had gout? 

They didn't know it - they knew that I was hobbling around, and they knew that I was walking around, didn't always use a stick, it was just on occasions when it was pretty violent, and if it got even more violent than the walking stick, and I used little aluminium crutches, elbow crutches, and yeah, I developed quite a technique on those, I could get along quite quickly. But again, as long as you turn up for work, and you're doing more or less what you're supposed to do while you're at work, I don’t think your employers are particularly bothered. 

Did you ever consider talking to them about it? 

No. They’ll only laugh won’t they if you - if you tell them you’ve got gout and they’ll have the same reaction as everybody else, "Oh, you'd better come and join us in the boardroom then." And silly things like that. So you - you don’t say anything and you – because it's not something you don’t - you put up with it, and hope it'll go away, but it doesn't.
Others found that their colleagues and employers were sympathetic. John’s employers adjusted his workload. Sam’s employers provided her with a new chair and other equipment to make her more comfortable at work. Hazel was able to work from home during attacks so she did not have to take time off.

Joe and Runibunar were working in jobs that required being physically active. They both went to work during some attacks, but sometimes the pain was too bad for them to work. As well as attacks, the side effects of colchicine (diarrhoea and sickness) also meant that some people were unable to return to work even though the pain had subsided. 

Some people who had desk-based jobs could continue working because they did not need to walk around much. People like Michael who were self-employed sometimes found it easier because they could manage their own time. 

Janette couldn’t drive during attacks. She worked from home so could continue working as normal most of the time.

Janette couldn’t drive during attacks. She worked from home so could continue working as normal most of the time.

Age at interview: 82
Sex: Female
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Well, I mean most of the time – latter years of my working life I was – it was from home, so that wasn’t affected. I saw people in the house, and I was sitting still [laughs] and that was fine, but, I couldn’t have driven when I had a bout of gout. I had an automatic car, which was fine. I had an automatic car for the arthritis really, but my right leg was the worst affected one, and that’s the one you use in an automatic. I couldn’t drive. 

I was just lucky that the kind of thing I was doing was counselling. If I had – if I had gout in my foot, and I was actually doing a session with somebody, I would have to sit and not move. And I could do – I could do that. 

With doing that you found that you were able to….

I could concentrate, aye, aye. 
Gerald eventually had to stop work completely because his gout attacks were so frequent and severe. Jill works as a volunteer because it gives her greater flexibility to take time off during attacks. She believed that this would be impossible if she was in paid work. One woman felt that having regular flares meant she could not look for a new job – she felt that it would be too difficult to explain her situation to a new employer. 

Jeff Z found that putting his joints under stress sometimes triggered attacks. His physical work in the ship repair industry sometimes gave him attacks. Runibunar also found that his work made his gout worse. Several people believed that stress at work had impacted on the frequency of attacks. Simon and Peter both felt that having gout gave them a better understanding of what it was like for other people to live with a long-term condition – something that was helpful in their jobs. 

Simon uses his own experiences when teaching his students about long-term conditions.

Simon uses his own experiences when teaching his students about long-term conditions.

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I actually use myself as an example with some of the students. I teach some of the students and one of the modules we run is about long term conditions. Now gout is listed as a long term condition, so I’m a good example of somebody who has a long term condition. And actually, during my last episode I actually let the students examine me, and they could see the nature of gout and how it’s impacted. 

It’s simple when you read it in a book, but actually when you come to it it’s not that simple. I think it’s made me reflect more and actually, luckily I’ve been able to reflect back to the students and explain that more and try and get that…. I think I’ve always been quite good at that, that long term – because I always worked in that area, but it’s given me, like I said to you, the simple things and probably more understanding of the situation and trying to get that through to students and the importance of it. These things are - the person has to live with it and has to come to terms with how to manage it themselves. That’s one of the biggest things I’ve learned, the fact that you have to actually sort of think about it and manage it yourself, because really no-one else is going to manage it for you. It’s a long term condition and GPs – the medical profession aren’t really interested in helping you manage. They might be interested in giving you – but they’re not really helping you. You’ve got to come to terms with, you know. When you go out of that practice and you’ve got to work out how you’re going to drive, how you’re going to walk, you’ve got to sort that out and people aren’t that interested in – you know because it’s not really a sexy disease, gout, is it?

It sounds like it’s been really important to you to sort of make the most of your experiences then in terms of passing things on and using those in real life situations with your students, is that how you feel?

Yes it is. I mean we often use – we try and use patients and patients’ experiences. We try and get those values and that empathy for people to see that. It’s actually quite useful and it’s something we’ve done and I’ve never – I’ve often thought quite deep about, “Should I?” But we’ve - I think the students find it very valuable that people are actually prepared to do that. I’m very good at setting boundaries about what the students can ask me about and what they can’t ask me about and what I show them etc., but I think it’s quite important. I think if you talk to them, they actually appreciate that real life. We do it with many other conditions as well. Not that we always try and develop conditions with the staff, but it’s – I think people can see that actually people can – they’re not – we are human, we suffer with everybody else etc. A lot of time students don’t think they’re going to be like this and that they’re going to get to a certain age and have a problem. They don’t see it, so I think it works very well. It’s been useful. To be fair, I suppose that’s one of the positive things that’s come out of it. I can’t think of any other positive [laugh] things, but that’s been a positive thing that’s come out of it.

Do you think that that’s almost sort of been a coping strategy for you?

Oh yeah, yeah, I think it is. It enables me to articulate, I think it is. You know I have – I’ve tackled it head-on and I think it helps me, it helps them to talk about – that’s one of the reasons why I’m doing this now. It just shares those experiences. I think you don’t have to – you don’t have to – you shouldn’t expect the medical profession to sort you out, you have to tackle it yourself. And I think talking about it and using the experience is useful. Though again, I think it, to realise it’s quite – at times it doesn’t feel it is quite a – at times it seems like the worst disease you can get, but when you haven’t got it, it seems like a trivial disease. Even now I’m quite trivial about it, because I haven’t – I’m not suffering from the pain, so I can quite joke about it etc. If it starts again I won’t be joking.
A few people talked about how retirement had made a difference. Shirley was pleased that she was retired and so did not have to go to work when she had pain. She appreciated being able to rest at home. Carole is now retired, but was sometimes concerned about having to take time off work before she retired. Other people felt that work had been a useful distraction from the pain when they had still been in paid work.

Last reviewed December 2016

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