Jean

Age at interview: 78

Brief Outline: Jean had two attacks of gout in her right big toe joint last year. Both of her big toe joints were replaced with artificial joints in 1998 because of arthritis. Jean takes allopurinol every day and has not experienced another attack.

Background: Jean is widowed and lives with her daughter, son-in-law, and two grandchildren. She is retired, and previously worked as an Accounts Manageress for a furniture company. Ethnic background/nationality: White English.

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Last year, Jean’s foot became very painful. Her right toe joint was swollen and the pain was severe and continuous. She tried cooling her foot with frozen peas and taking painkillers but they had no effect. Jean assumed that the pain was due to an ingrowing toenail for which she had already booked an appointment with a chiropodist. When she went to her appointment, the chiropodist examined her foot and said that it looked like gout, but that he was not sure if it was possible for her to have gout because she had artificial toe joints. Both of Jean’s big toe joints were replaced in 1998 because she had bad arthritis in them.
 
The chiropodist told Jean to go and see her GP, so she went to her GP practice later that day. Her GP expressed a similar view to the chiropodist, and did a blood test. Jean’s uric acid levels were quite high, so the GP prescribed allopurinol for her to take every day. Jean’s symptoms went away and she had no further problems for four months. However, the pain then returned in her right toe joint. She went back to her GP practice where she saw a different GP. He did a blood test to check for infection which came back negative. Her uric acid levels were lower, but still outside the normal range. Jean’s GP prescribed her a higher dose of allopurinol to take.
 
Jean has now been taking allopurinol for nearly a year, and has not had any further attacks of gout. Her uric acid levels are now within the normal range. 

Jean saw a chiropodist and two GPs who were unsure whether it was possible for her to have gout when she had artificial toe joints.

When it first started it was very painful, and I actually had an appointment with the chiropodist, sort of, a couple of days after. I assumed it was due to the in growing toenail. So I went along to him and I said to him, “Was it?” and he said, “No, it’s not,” and he checked it, examined it, and he said, “Well, if I didn’t know better, I’d say you had gout,” he said, “But you can’t have gout because you have artificial toe joints.” So I said, “Oh,” but he said, “I’m sure it is.” Anyway, when he’d finished, he said to me, you know, “You really have to go straight to your doctor and have a word and get it sorted,” he said, because it was very, very hot. 

So I went there and she saw me more or less straightaway, which, I was surprised, and she again said, “Gout,” she said, “But I don’t see how you can have gout with artificial toe joints.” So, she did a blood test and the uric acid level was quite high, and she put me on allopurinol, just one a day, and, it was fine, it was fine. And then in June, July, in July, it came back again. So I had to go and I saw a different doctor, who also told me that I couldn’t have gout because I had artificial toe joints [Laughter], but then he just did a blood test for an infection which, of course, came through negative, and they increased the allopurinol. So I’ve been on two a day ever since, and it hasn’t come back [laughter].

Jean takes several tablets a day for other conditions. She has wondered about stopping allopurinol because it would mean taking fewer tablets.

So there’s always a possibility that I will decide myself not to take them anymore and see what happens, but just keep a few in, in case.

And why would you be thinking of stopping taking them?

Well, because I have so many other tablets to take, you know. I take, one, three, six, eight, eight a day, plus however many painkillers I have to take. So, and two wouldn’t make an awful lot of difference, but it would be two less.

Jean says it makes a difference knowing that she has family living with her who can help if needed.

There’s always somebody here that will, sort of, fetch and carry and do bits for me, and, sort of, get me the cold water or the warm water or the... I’ve got so many things to help with the arthritis that I, sort of, try anything for any pain I get [laughter].

So that was the...?

It does make a difference having people in the house, yes.

Did it affect your mood and how you were feeling at the time, when you were in pain?

I suppose I got fed up. I, sort of, thought, “Well, it’s something else that I’ve got to put with,” you know, but you get over it. 

When you were feeling fed up and you were in pain, do you think it made a difference to your relationships with other people, so maybe other family members or...?

Not really, no. It wasn’t their fault, you know, they did all they could to help me, so...I was probably a bit more ratty, I don’t know. They wouldn’t tell me if I was [Laughter], but I was quite possibly a bit more ratty, I suppose [laughter].