Joe

Brief Outline: Joe first experienced gout in his big toe joint, which his GP believed was caused by dehydration resulting from the extreme heat in Joe’s working environment. Joe takes allopurinol every day and has not had an attack of gout for four years.

Background: Joe lives with his wife, and has one daughter. He is now retired, and previously worked as a Sanitary Ware Caster. Ethnic background/nationality: White English.

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In 1994, Joe’s big toe became swollen and very tender. He described the pain as ‘tear jerking’, and the worst he had ever had. His toe joint was so tender that even a feather touching it would hurt. He could not stand having a blanket on his foot in bed, and found it hard to walk. Initially, Joe continued working, but the physical nature of his work meant that this became impossible, and after three weeks, he went to his GP and was signed off work.
 
Joe’s GP told him that it was likely his gout had been caused by dehydration, resulting from the extreme temperatures he experienced in his working environment. He had recently changed from doing mechanised casting, to bench casting, and was working long hours, doing physically demanding work, in temperatures over 120°F.
 
Most of the time, the attacks of gout that Joe had were in his big toe joint, but he did have one attack in his hand. He took painkillers like paracetamol, but would also put his foot in a bowl of ice to try and relieve the pain. Joe sometimes found it difficult to get an appointment to see his GP quickly when he had an attack of gout.
 
Joe felt that during an attack, he had to put his life ‘on hold’. The pain made it very difficult to walk and stopped him going out or socialising. He felt that it was better for him to be on his own when he had an attack, because the pain meant that he was ‘not in a nice frame of mind’.
 
Joe had started taking 100mg of allopurinol, but was still getting attacks so his GP increased the dose to 300mg. Since he has been taking 300mg of allopurinol Joe has not had an attack of gout for about four years. Joe is pleased that he has not had to change his diet in any way, although he has increased the amount of water that he drinks. He is still able to eat red meat and drink beer in moderation without experiencing any symptoms. 

Joe was working in extreme temperatures for hours at a time. His doctor believed his attack was caused by dehydration.

The doctor said it was I’d dehydrated, and he says that can cause gout, so I’ll take his word for it. I was mechanised casting, which, it was very easy compared to bench; bench you just, you run for 10 hours, at that time, and that was the difference, I’d gone from a nice steady job where you know, 8 hours steady; you still produce but it was a lot steadier, and your lifting was more central and everything, better lifting, whereas when I went back on a bench, you just, you know, we’d get there at 5 o’clock in the morning and you wouldn’t stop running about really until 1, you know, get the bulk of your day finished, and you’d be sweating for, and you’d be working at that time, because you had steam under your bench, under your moulds and everything to dry and everything, so you’d got steam all day, so you’re working, even in winter, you’re working in 120 degrees, no problem, every day so, yeah, with coming from an easy job back to a hard job again, you just sweat like there’s no tomorrow, you know, it really; it’s hard work.

And do you think that...

I think it could have been yeah, yeah, yeah. Because obviously I’d drink, you’d drink tea all day because you know, people, everybody brews up, so you know, you’d got like 30 blokes brewing up, so you’ve always got a cup of tea all day, but I wasn’t drinking any water or anything, so it could be, yeah, yeah. Because I went from like, not having a sweat, a bead of sweat all day, to completely covered, soaking wet all, until, well 5 or 6 hours, 7 hours, you know and I think that made a difference.

Joe’s first attack was in his big toe. It was so tender that he could not bear anything touching it.

Well the big toe just swelled up and, very tender, you know, if you put a feather on it, it hurt. You try and sleep with your leg out of the bed and all that, you can’t stand the blanket on it or anything. It’s hard to walk, obviously, and for a time, when I first had it, I did work on it and walk, like on the side of my foot, because I’m a bit stupid like that, but I had to stop in the end, because with it being a heavy job and all, I just couldn’t do it, so I was off until it subsided really, a couple of weeks, which you know, it’s very painful, a very drawn out time, where you just, it just takes you off your feet really.

Joe’s gout is controlled by medication so he has not changed his diet. Eating foods in moderation works well for him.

I’m on allopurinol for it and - the 300mg now - and I’ve been, I haven’t had gout for 3, 4 years, which I’m pleased with because I haven’t really cut anything out, I haven’t cut red meat out, I haven’t cut beer out, and where I’ve got relations who have, and still get it on a regular; he gets it monthly and I’ve been free, like I say, at least 3 or4 years, which I’m really pleased with. 

I think it’s just a bit of moderation. I think you can have everything if you know, you don’t have it to an extent - well my diet hasn’t really changed and like I say, I’ve got a brother in law who cut all - he doesn’t eat mackerel, he doesn’t eat red meat, he doesn’t eat this, he doesn’t drink that - but he still gets it, you know, I think, it’s just one of them things, but I’m sticking to my; you know, I take my tablets regularly every day, and I drink a lot of water, I drink between 6-8 pints a day and I have done for a long time and that seems to work for me, you know. I think everybody would be different, but for me it works, and I’ll stick to it.

Joe says the pain of gout is so bad that many people will try anything to stop it.

I think it is one of them that when you’ve got the pain, you’ll take something, if somebody says that will work, you’ll try it, you know, and if it works for you, great, you know, it might be eating a cucumber, I don’t know, but if somebody says it works, you’d try it, because when the pain is there, it’s, you just want it gone.

Joe felt that he had to put his life ‘on hold’ each time he had an attack.

When you’ve got it, well you don’t really, you just - it’s a case of you go to bed, then you get up, get on the settee or something with your leg up or in a, same as I say, in a bowl (of ice), just try and get the, get it calmed down a bit, and that’s basically it, you know, it’s so, for how long you’ve got it, for me, when I was working especially, it’s a, you know, your life’s on hold.

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

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.