A mammoth undertaking

It sounds faintly Victorian and somewhat amusing, but I’ve recently been through an attack of gout and I can assure you it’s no laughing matter! I thought that a full-on migraine was painful, but an episode of gout is right up there in the pain stakes. It was horrible.

It started completely out of the blue when I woke up in the morning with a sore left ankle. It felt like I’d bashed or twisted it, except that I was sure I hadn’t. At that stage there was no redness or swelling, just a tenderness that got worse when I walked on it. By lunchtime, the ankle boots I habitually wear were pressing too hard on the bony bit of my ankle. It was so uncomfortable that I changed into my only pair of lace-up shoes that still gave support but avoided the ankle area. I haven’t worn those shoes for several years, and it soon became apparent why I’d consigned them to the very bottom of the hall cupboard. They avoided pressing on my tender ankle bone, sure, but they also gave me huge blisters on both of my heels! So now I was limping with both feet rather than just one!

During the evening of the first day of the attack, the pain got steadily worse, and the bony lump on my ankle went first pink then red, and started swelling up. Ibuprofen gel did absolutely nothing to help, and in fact it was very painful just trying to rub it in. Socks were now too painful to wear. Oral ibuprofen helped a little bit but not much, and I got virtually no sleep that night. Even the weight of the duvet on my ankle was unbearably painful, and I had to shove a spare pillow down the foot of the bed to make a sort of tent to keep the bedclothes from touching it. Fine until I turned over and accidentally brushed the ankle against the pillow! Ouch…..

By 06:00 on day 2 I was pretty much bed-bound. I couldn’t put any weight on the foot at all, and the pain was excruciating. I swallowed some more ibuprofen, in the hope that might take the edge off the pain. I was pretty sure by now that it was gout that I was dealing with, though I was surprised that it was in my ankle rather than in my big toe joint, which is where you generally hear stories about people getting it.

By mid-morning I thought I’d better get some medical advice on how to deal with it. Searches on the internet had given some general guidance, but I’m always uncertain about the quality of the information out there. I didn’t want to try for an emergency doctor’s appointment, as the surgery is at the far end of town and at that stage I could barely walk so there was no way I could drive. So I decided to call the non-emergency NHS line, 111. I got through to ever such a nice chap, told him I strongly suspected gout, and simply wanted some suggestions on how to deal with it. He insisted on running through the full computer questionnaire, and I must have given the “wrong” answer to one of its questions, because the only advice I got was that I was “very strongly” advised to see my GP within the next two hours! I suppose I was lucky not to be told to go straight to A&E which seems to be the default stock answer if you believe the newspapers.

I thought about ignoring the advice totally, but then thought that there’s no point in phoning the help line if I’m not prepared to listen to what it said. And, though I really didn’t expect to drop dead within the next two hours, it would have been extremely annoying and frustrating if I’d misdiagnosed myself and did in fact have something more serious. So I phoned the receptionist at the surgery, explained what had happened and that I really didn’t want to come in to see the doctor in person, but was there any chance of a telephone appointment? She agreed that was a sensible compromise and that the doctor would call me back.

In the mean time I kept on with the ibuprofen, which took the edge off the pain enough that I could bear to put a cold gel-pack around the offending ankle. That also seemed to help. It was now very pink and definitely swollen, but very localised to just the bony lump on the inside of my ankle. The surgery didn’t phone back until late afternoon, and that was to apologise that the doctor had been run off her feet all day and hadn’t had time to call me. Would I please come in to that evening’s “emergency surgery” so that she could see me in person?

The attack was already easing somewhat by then, and I reckoned I could just about cope with the pain involved in driving to the surgery – which I couldn’t have done a few hours earlier. I did go a different route to normal though, to minimise the number of traffic lights, roundabouts, and (particularly) hill-starts I’d have to do, as changing gear and holding the car on the clutch was very uncomfortable. Socks were still out of the question, but I dug out my sandals and hobbled down to the surgery.

There I got confirmation that I did indeed have gout, and a prescription for some Naproxen, a much stronger NSAID, to treat it. That has done the job, the pain is well under control, and the swelling is going down. I also got some good advice about how to treat it should I get a recurrence.

Take an anti-inflammatory straight away. Ibuprofen if that’s all I’ve got, though I intend to keep a few of the prescription pills to one side just in case.

Gout is nearly as common in the ankle as in the big toe joint. You can also get it in the knees and elbows.

Rest and elevate the offending limb. In fact, that advice is pretty much redundant. It’s so painful that you physically can’t do anything but rest it!

Drink lots of water, to keep really well hydrated. The idea is to stop any more uric acid crystals precipitating out of your blood stream, and hopefully to try to dissolve the ones that have already.

One factor completely out of my control is the weather. Apparently, the doctors expect to see a cluster of gout cases after an unseasonably warm spell!

All in all, it was an exceedingly unpleasant experience, and it bothers me that it appeared overnight out of the blue with no warning signs. A susceptibility to gout does run in my family, but I very much hope this will turn out to be a one-off attack.