Gerald's Gout

by Rosie Peters

Gerald eased himself on to the sofa and pulled off a shoe and sock. "Sorry Jen, I can't do line dancing tonight."

"Why ever not? We never miss. I've got our gear laid out."

"There's something wrong with my big toe. It's been hurting all day but now it's really bad."

"Have you stubbed it or dropped something on it?"

Gerald shook his head. "I just can't think of anything that could cause this pain. I've certainly had no accidents."

"Goodness! That looks terrible. Is it a boil coming?" As Jen leaned over Gerald's foot, her long brown hair brushed across his inflamed big toe.

"Oooh that really hurt. Be careful," Gerald yelled. "The slightest touch is awful. I've had two lots of paracetamol and they've just not helped. I feel feverish too."

"You need to see a doctor with that. It's all red and shiny and twice the size of your other one."

"I'll rest it. Put my feet up in front of the telly for a change. Get me some cans would you love? A few beers might take my mind off it."

The next day a visit to the surgery was organised. "You'll have to drive," said Gerald, easing himself into the passenger seat. His right slipper clad foot rested on a cushion on the floor of the car. He felt each bump in the road as Jen slowly drove over the speed humps outside the surgery. "That was awful," he said limping towards the reception area.

Gerald felt such relief to see Doctor Strong who he felt sure would soon identify the problem. "Thank goodness you could see me. This pain in my toe is dreadful. I couldn't bear the weight of a sheet resting on it last night. I had to have my foot uncovered the whole time and I still didn't sleep."

"It certainly looks tender. Have you had anything like this before?"

"Never! What can it be?"

"Looks like gout. We'll know for sure after some blood tests. I suspect you'll have a raised level of uric acid in your blood. That will confirm the diagnosis."

"My father had gout but he was a boozer. I thought it was only people like him that got it, or those who eat rich food all the time."

"Gout can be hereditary but there could also be a connection with what's consumed. Excessive alcohol, especially beer may well cause the problem in your blood. How much do you drink?"

Gerald flushed, "I have a few cans most nights and Jen and I go to the pub on a Tuesday and Friday after line dancing. I'm never drunk though."

"It's surprising how the alcohol units add up if you're drinking most nights. You could well be supping more than recommended. I suggest you cut down for the time being."

"So you think it's the beer then do you Doctor that's caused my bad toe?"

"It's certainly possible."

"What about food? Could it be anything I've eaten?"

"A normal well balanced diet shouldn't bring on gout but there are some proteins such as herring, sardines, mussels or heart that can lead to abnormal blood chemistry."

"I don't eat much of them," said Gerald. "Is this condition rare Doctor?"

"Not really. Its been known for more than two thousand years and it affects about one in every two hundred people. The raised uric acid, also known as urates, cause crystals to form in joints and cause pain. It's usually middle aged men that get gout for the first time but it also happens to women and younger people. Being overweight doesn't help you know."

Gerald shifted in his seat. "I've been meaning to lose weight but just not got round to it."

"You might find that the Practice Nurse could give you some lifestyle advice to help you with weight reduction. In the meantime I want you to have a blood test and then come and see me in a couple of weeks to discuss the results. I'll give you a prescription for some anti-inflammatory pills to reduce the redness and stop the pain. I'll also give you leaflets to read. One's about gout and the other one's about alcohol and safe drinking."

"Thanks, Doc." Gerald hobbled out to the reception area where Jen was sitting. He was pleased to find he could have his blood test that morning as there had been a cancelled appointment with the phlebotomist. Gerald handed his papers to Jen while he went to have his blood test.

Once home Gerald was pleased to see Jen had cooked his favourite meal of cottage pie.
The smell was wonderful and his mouth watered in anticipation. As he reached the table he felt dismay. "Is this all? Did you make it in a smaller bowl?"

"Yes, love. We both need to eat less. I've been looking at the information from Doctor. Did you know that getting some weight off could help lower your level of uric acid?"

Gerald nodded, unsmiling. "I suppose you're going to say something about the beer next."

"I was coming to that," said Jen. "The leaflet said aspirin, water tablets and certain cancer drugs can cause gout. Well you've not been on any medication till now, so it can't be that. It must be food or drink that's done it."

"It might not be. It can be hereditary. My dad had it."

"So he did. I remember at our wedding he barely touched his wine because he was getting over gout. Was in his knee wasn't it."

"That's right. And I remember he had white pimple things on the edge of his ear. Tophi I think they're called. You can get those with gout. Dad called them his crystal bumps."

"Have you got any?"

"No, but I know now why doctor looked at my ears. He checked my hands too as you can get them there."

"Well things could be worse. At least you've got some medication. Is it helping you?"

"The pain's much better thanks. I remember when Dad was bad and they didn't know what was wrong he had to have some fluid taken from his knee joint for examination. It showed up some crystals. That's what proved he had gout."

"It's good you haven't needed any fluid removing. Let's hope you'll be better soon, I know you don't like missing line dancing."

Gerald frowned. "I'll miss the beer and big dinners more."

In three days Gerald's toe looked less sore and swollen so he was pleased to be able to go back to work. Many times he thought about the blood tests and was glad when it was time to visit Doctor Strong again to discuss the results. "You come in with me this time Jen in case I don't remember all he says."

"It's definitely gout," said doctor. "Your blood test showed a raised urate level. The toe's looking better though," he said, peering at Gerald's foot. "The redness has gone. Did the anti-inflammatory tablets help the pain?"

"Yes. And the other thing that helped was the ice pack treatment. We made sure it didn't stay on longer than twenty minutes didn't we," said Gerald turning to Jen.

"Good," said Doctor Strong. "As long as the tablets suit you, it's wise to have some in reserve in case you get another attack. There are other medicines we could have used but I think we'll leave you with just these. Depending how things go, you may at some stage need allopurinol tablets as a preventative. They don't work during an acute attack but if we find that we need to give it to you to control your urate level it's a life-long treatment."

Gerald nodded. He felt glad that his toe was feeling so much better and that he didn't need any new tablets.

"You'll need another blood test to re-check your uric acid and remember to see the Practice Nurse for a lifestyle chat," said the doctor.

"Thanks a lot Doc," said Gerald as he stood up and walked steadily out of the surgery.

"Soon be able to start the line dancing again Jen," said Gerald once they were home. "At least I can wear a pair of shoes now."

"I think you're going to need some new line dancing gear soon."

"Am I?" Gerald frowned.

"Yes, my dear. When you've lost that extra weight you're carrying."

"It'll be worth it to avoid gout again."