Paula

Age at interview: 46

Brief Outline: Paula’s symptoms began several years ago, but she thinks her GP did not realise how bad they were at the time. She has a kidney problem which may have increased her chances of getting gout. She tries to eat less high purine foods and has not had an attack recently.

Background: Paula works as PA to the Chief Executive of a charity organisation. Ethnic background/nationality: White English.

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Paula’s pain and inflammation in her feet began 2-3 years ago and then became more regular, before she had two big painful flare-ups. A friend suggested it might be gout so she went to see her GP, who sent her to hospital. The rheumatologist took some fluid, confirmed that it was gout and gave her some steroids. She has a kidney problem, which may have contributed to the onset of her gout.

She tried allopurinol but didn’t like the idea of taking medication for the rest of her life. She also found that it gave her a flare-up, and, although the reason for this was explained to her, she was impatient and stopped taking it. She took colchicine when she had attacks. The attacks affected her life, for example, she couldn’t drive to work, although her manager was supportive.

Paula went on the internet and contacted a gout charity to obtain more information, and also talks to friends with other painful conditions. Paula researched high purine food on the internet and tries to eat less of this type of food. She felt it was up to her to work out what caused the attacks but feels it is important to get as much information as possible.

Paula’s GP did not see her symptoms at their worst for some time. After a severe attack she was referred to a rheumatologist who took a fluid sample from her foot and diagnosed gout.

I think it started about two or three years ago. I started getting pains in my feet and inflammation. Every time – by the time I could get an appointment with the GP, because it was quite painful, all the inflammation had gone. So he never really saw it when it was at its worst. 

Then it really started at the beginning of last year. I started to get a sort of regular flare-up of inflammation in my feet. It went very red and very painful. I had months and months and months of nausea; waking up in the morning and feeling really, really nauseous. 

Then it was last autumn I had two really big flare-ups. I had one night when I was just in agony with pain in my feet. I went to the doctor the next morning, and they thought it might’ve been an infection in the bone in my foot. They sent me up to the hospital and I saw a bone – an orthopaedic doctor, who said it wasn’t an infection in the bone. He then referred me to the rheumatologist who thought – he said that he thought it looked like gout, which I was a bit surprised about. And then they drew some fluid off the front of the foot, and they came back a couple of hours later to say that they’d confirmed it was gout and that there were crystals there.

Paula was prescribed steroids. She did not know what to expect but was impressed with how quickly they reduced the inflammation and pain.

Well, I’d never had steroids before in my life, so I wasn’t quite sure what to expect. I mean they said that it was to manage the pain. I’d have taken anything they gave me because the pain was so bad. But I was quite impressed, because they did work very quickly for me. They took the inflammation down in my feet, in my foot, you know, within about two days the pain had gone.

How quickly did you notice that they were having an effect?

I think about 12 hours after I’d started them I was in – that the pain started to subside.

Paula felt like her heart was racing and she couldn’t sleep when she took steroids, but they did improve her symptoms.

They were prednisolone or something like that.

Did you experience side effects from taking them?

Yeah, yeah.

What kind of thing?

Sort of a – palpitations - and after I’d been on them for a few days I couldn’t sit still and I was really hyper. It was horrible. It was a really horrible feeling like my heart was just racing and I just felt really agitated and I couldn’t sleep.

How long were you supposed to take them for?

Well, they kept – they’d give me them every so often when I had a flare-up, so it was usually about five or six days. I mean the GP did one time – you know I went to see him and he did do an ECG, because he said to me that my heart was racing far more than it should’ve been. So he said to, you know, to stop them. 

So did you usually take them for the amount of time that you were prescribed them for?

I did, yeah. It was difficult because of the side effects. But then you don’t want the pain, you know, because the pain’s so bad. 

It’s difficult.

It is.

It’s a difficult decision to make. So when you were prescribed them, what did you expect them to do for you?

Well, I’d never had steroids before in my life, so I wasn’t quite sure what to expect. I mean they said that it was to manage the pain. I’d have taken anything they gave me because the pain was so bad. But I was quite impressed, because they did work very quickly for me. They took the inflammation down in my feet, in my foot, you know, within about two days the pain had gone.

Paula found it reassuring to know that her symptoms and the intense pain were typical of an attack.

I went on a couple of forums on the Internet when I had the diagnosis, just to sort of see what other people are saying and what their experiences were. I did actually find that quite useful. 

What did you find particularly useful about that?

The fact that it was all ages, you know, it wasn’t like I thought - just old men that get gout. People talking about their diets that they’d had to change, you know, what they’d done. And also, talking about the pain, because I did think that perhaps I was just a wus that it hurt so much, but from what I read of other people’s experiences – they all said that thing about just a sheet on my foot being just agony. So I didn’t feel quite such a wus then [laughs].

So it was reassuring?

Yes, it was. To know that actually – within the boundaries it was actually normal - what I’d experienced.