Ian

Brief Outline: Ian was diagnosed with gout in 1996. He had attacks every few months in his knees, ankle, wrist and elbow, and managed these with diclofenac tablets and ice bags. In 2010 Ian started taking allopurinol, and has not had an attack of gout since.

Background: Ian lives with his wife and two children. He works as a business consultant. Ethnic background/nationality: White English.

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In 1996, Ian woke up in the morning with severe pain in his big toe. He could hardly walk, and thought that he might have broken his toe. He went to see his GP who did some blood tests and prescribed diclofenac to reduce the pain and inflammation. The results of the blood tests came back two weeks later, and Ian’s GP told him that he had gout. Ian did not have much knowledge of gout, but was aware that his Uncle had suffered from it. He was relieved to have a diagnosis of gout rather than something more serious or life threatening. By the end of the first day of taking the diclofenac tablets, Ian’s pain had substantially reduced.
 
Ian continued to get attacks of gout every two or three months. Each time he would take diclofenac tablets. Initially the attacks were in his feet, but from 2000 onwards, he began to get attacks in other parts of his body. He had attacks in his knees, his ankle, his wrist and his elbow. He remembers the attacks in his wrist and hands as being particularly painful and difficult to manage. 
 
Ian could recognise the pain of gout straightaway. It started as a dull pain and then grew in intensity over a period of two to four hours. The pain of gout was the worst pain that Ian can remember ever having. It was painful even to have a sheet resting on the affected joint, and felt like being stabbed by a knife. Walking was difficult and painful if Ian had an attack in his foot, and other attacks meant that Ian’s work activities like writing or typing were severely restricted. He was sometimes unable to drive.
 
Ian found that, as he had more attacks, the pain would take longer to stop. After taking diclofenac, the pain would dull progressively over time, but it would take at least three days for it to stop completely. Ian found putting a bag of ice on the area was helpful for pain relief. He tried to remain active during an attack, and felt that this helped him to recover more quickly.    
 
In 2010, Ian went to see a different GP, who did a blood test and told Ian that his levels of uric acid were high. He suggested that Ian should consider taking allopurinol on a daily basis to prevent attacks of gout from occurring. Ian was initially concerned about taking a daily tablet because he believed it was better to try and have a healthy lifestyle and diet than to take medication. After discussing his concerns with his GP, Ian decided to start taking allopurinol and has not experienced any side effects. He now takes 300mg daily.
 
Ian has not changed his diet or consumption of alcohol, but believes that it is important to have a balanced healthy diet. In the past he tried eating celery and drinking cider vinegar, but did not find that they made a difference to the number of attacks he experienced.
 
Allopurinol has exceeded Ian’s expectations because he has now been taking it for three years and has not had an attack during that time. He still has concerns about the implications of being on a long-term medication, and has regular health checks with his GP to monitor his situation. The inevitability of getting an attack would play on Ian’s mind in the past, so it now gives him peace of mind to know that he is unlikely to get an attack. 

Ian woke up one morning with severe pain in his toe. He made an appointment to see his GP even though he could hardly walk.

Well I first - actually got the symptoms of gout in - back in 1996, overnight, I woke up one morning, got a real big pain in my big toe, and I thought that I'd broken my toe and slept funny in the night or something of that nature. But I had a really - I could hardly walk, had a real pain, as though it was - a bit like a fracture almost. So I made an appointment at the doctor, and they took some tests and found out that was gout.

Ian learnt to recognise the first signs of an attack. He used ice to cool his joint and found that moving around was helpful.

I think you soon get to realise after your first couple of attacks, you know exactly when you get - start getting the dull feeling, you know you're going to get an attack, well I can only speak from my experience, but yes, you know that, you start getting a dullness and a lack of mobility around a particular joint, and then the dullness starts and then it gets more acute, so you definitely start to recognise that, you know about it. I was never recommended to put ice around it but that’s what I did myself because it felt quite hot and whatever and quite red so I'm a great believer in putting ice on many an injury, so I tried it on gout and it - it did make a - make an impact on it, it did reduce down the - the pain and it made - gave me greater mobility quicker, so I would recommend people trying that as well, so that's what I did learn through experience. They were the two things really I did - probably the third thing was you know you'd rest and put your leg up, particularly if it was obviously in your foot and things like that, but I - as you get used to getting the attacks you just sort of get on and get up with it, you don’t stay at home feeling sorry for yourself, you get on, carry on with your normal day, because I think it does wear off. If you stay immobile and - and just - with your foot in the air or whatever, or lying on the settee - I think you'll have it for longer than if you get up and move around. 

Ian did not tell his first GP about all the attacks he was getting. He now wonders if he should have asked his GP for more information about treatments.

Whether I just grinned and bear it, and didn't really tell my first GP all the attacks I was getting all the time, and how painful it was and whatever, they might have then have put me on allopurinol. I just sort of took the tablets, put a bit of an ice pack on it and got on with it really. As most blokes tend to do, don’t they? So I might have - I might have pushed a bit more maybe in the early years and months to understand more from the GP about what options there would have been, and that would have - could I have started taking allopurinol earlier, is that right? Those are the questions I haven't got any answers to, but that might be something for other people to consider and talk to their GPs about. 

Ian feels that allopurinol has been very effective for him. Gout no longer affects his everyday life.

It has more than met my expectation about not getting an attack, I thought it would reduce down the level of attacks or it would help, but it's just eradicated it totally for me, so you know it's beyond my expectation really because it - it has made - it has made the situation a hell of a lot better really. I wouldn't say my life was blighted by gout in any way, shape or form, but it was really inconvenient. And it was something I could certainly do - live without. And now allopurinol has provided that for me.

Ian’s first few attacks were in his big toe joint. He then had attacks in his knees, ankle, wrist and elbow.

For the first four, five years it always was around the bunion part of your big toe. And in the knuckle part of the big toe, never in the other toes, it was just the big toe area. And then progressively from about 2000 onwards, I started to get it in other parts of - of my body. So that was anywhere where a joint was. So sometimes I got it in my knees, ankle, wrist and elbow. Particularly one in - the one in your wrist was very painful from memory and obviously because you try and move your hand more than - if you're sitting down you're okay really I guess from a foot perspective, but - but your hands when you're trying to work and whatever and you’ve got a problem with it, that was very painful, yes. And so then that really…as - as that started to spread and whatever, when I spoke to the GP he said well let's do a test and my uric acid was high, that’s when I went on allopurinol.

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

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.

Ian feels that GPs need to understand how painful gout is. They need to think about preventative treatments, not just treat the symptoms of an attack.

What message or advice would you give to health professionals who are working with patients who've got gout? 

Yeah - understand that it is painful, that’s the - getting across how painful it is, and really understanding that, and it can blight you for a day really, because of it. Understand that. I - the second part is my opinion rather than I base it on any fact, you know, can you prevent the gout happening in the first place or are you treating the symptoms? And I think that would be important for GPs to understand learning it, and get plenty of information about - and I wouldn't - if somebody keeps coming and is, you know, is regularly being prescribed pain relief for gout, as a GP I would say, “is there a - we'll have to do something else here”.