Photo by Charlie Alcock for The Sunday Times Magazine (December 2018)
In 2002, writer Rob McGibbon was unexpectedly hit by gout. Years of secret suffering has followed, but here he explains how he turned the agony into a catalyst for positive change…
I have a painful secret: I get gout.
I will save the pain until later, but first I need to explain why I have kept this god-awful affliction quiet.
The problem with gout is that it makes people snigger. It’s hard to think of another serious condition that encourages such mirth, but it’s true, you get mocked. I vividly remember when this first happened to me, early on in my 16 long years of intermittent hell. I had to interview a celebrity, who should remain nameless – but won’t because it’s so annoying when people say that: it was Nigel Pivaro, Terry Duckworth from Coronation Street.
I limped into our meeting and naively told the truth about my condition, as my left foot throbbed inside a loosely-laced trainer. He laughed throatily, then lapsed into a pantomime skit of a bonkers, cheeky-puffing old General: “What-ho, Brigadier, have you been attacking that orful port at the club?” I’m all for heartless laddish banter, but I was a touch taken aback.
Nigel was not alone. That same week, I mentioned gout to one or two friends and they all reacted flippantly. As I cancelled golf, a mate started chuckling and cut away from the phone to yell this hilarious breaking news to his wife. Ha ha. It was clear that gout is for lightweights.
This early reaction made me feel embarrassed, so I decided to keep it private, except for those closest to me. Whenever I have had to venture out with obvious signs – crutches, or a severe limp are a giveaway – I have fudged the reason or reluctantly lied. Michael Barrymore was impressed I got crocked doing the Iron Man and my neighbours must think I’m more injury-prone than Frank Spencer.
To be fair, the jokes from friends have eased, but the disparaging ignorance of others is widespread. My most recent gout attack was last November. I told a friend – 35 and working in the shallows of showbiz – why I was really cancelling dinner. “Gout?” he replied, genuinely challenged. “I thought people got that in Victorian times, or during the plague”. It was time to break cover.
Gout has a PR problem. For starters, it’s such an odd, blunt word that actually sounds silly and light. It might help if it was re-branded to something longer and more medical. Things certainly aren’t helped when newspapers insist on using Henry VIII to illustrate every gout article. It is often described as the “disease of kings”, so mad Henry is our poster boy. Heck, even the current (edition of Tatler has gout in its 32 things that define what you need in 2019 to be upper class. Terribly funny.
The unavoidable reason why gout sufferers are ribbed is its age-old association with port-nosed boozers and gluttonous high living. Mea culpa – I’m pretty certain they’re the main reasons why I suffer, but it isn’t necessarily quite so simplistic. I have had four gout attacks brought on by strenuous exercise, such as football or long bike rides. Here comes the science bit. Concentrate…
Gout is inflammatory arthritis, the super-max kind with extra wincing on the side. It’s not the achy stuff that makes old folk grumble. It is caused when your blood is over-run with uric acid, which is generated when the body breaks down purines. Purines are a protein that is contained in a sweeping array of foods and certain lines of delicious alcohol – especially beer, red wine, and good ol’ port.
Uric acid settles around a joint and turns into urate crystals, which creates a gout attack. Trust me, it is horrendous. The big toe is the most famous location, but it also hits knees, elbows, even fingers. Ankles are popular. Gout particularly loves my left one.
Now for the pain: mine often begins suddenly across the top of a foot and panic sets in as it gradually spreads to the toes. Within five or six hours, the entire foot and ankle is transformed into a hot, bloated, pulsating red sausage of agony.
Traditionally, the fierce grip of gout finally arrives in the dead of night. My wife will hear me dragging a foot across the floorboards and mutter “Oh, nooo”, but she’s used to it. I was on crutches with gout when I proposed in Paris in 2006. Our celebratory ascent to Sacre-Coeur did wonders for my upper body definition. A year ago I dragged a gouty foot around Athens and a party-heavy New Year trip to New York in 2015 saw me convulsed in discomfort throughout the entire flight home. I thought my foot would explode. I needed the beeping golf cart transfer from the gate at Heathrow. Humiliating.
Forget sleeping with gout. You must lie there as motionless as possible, watching the dawn arrive with a foot dangling off the end of the bed to cool it down. Nothing must touch it. I mostly spend the first two days forcing the foot as often as I dare into a washing up bowl of icy water. It twitches as if hitting an electrical charge.
I have a set of crutches are on standby and if I’m lucky, this acute phase lasts 48 hours and then I can get around with a limp. All trace is gone within a week-10 days. The trouble is, at the same time you are also hit with flu-like symptoms and fever because your system is all mashed.
My gout nadir was in 2011 when it holidayed in my left knee. The entire joint ballooned. I couldn’t bend it, or put weight on it, and the slightest wrong movement left me hugging the kitchen island or a bannister, eyes closed, panting through gritted teeth. No pain killer was strong enough. I was on crutches for two weeks and unable to walk comfortably for close to two months. I finally emerged back onto my modest social scene to gushing praise for my leaner, detoxed glow. Gout boot camp. Don’t ever try it.
I have had 24 attacks since 2002, mostly in my ankles. I know all this because I have kept a gout diary – my contribution to “misery lit”. The first doctor to see me in A&E said with certainty that it was “cellulitis”. The next attack came three years later and again there was confusion with the diagnosis. Following five more attacks spread over the next number of years, my GP finally agreed with what I already knew.
A private consultant later explained that I have a genetic pre-disposition to gout that renders my kidneys unable to flush out uric aside fast enough. At times my body is like a cup of tea that cannot absorb any more teaspoons of sugar – except it’s acid. That metaphor cost me £250. Feel free to pass it on.
When you join the gout club, you get a watchlist of foods that have varying levels of purines. It is shockingly long. Red zone: offal, game, oily fish, seafood, yeast. Amber: all meat and poultry, spinach, asparagus, peas, beans, cauliflower, mushrooms, fizzy sweet drinks. It goes on and bloody on. You wonder what’s left. Salad, yoghurt, fruit, pasta, eggs and veg, that’s what. Super. Then it gets to the contraband that really matter, at least to me: beer and wine. And, of course, port, which I hate anyway. Spirits are fine, but I don’t drink those.
It’s all a bit depressing at first. You think you will never demolish a steak with a bottle of claret again, or a seafood platter served over ice in a sunny harbour. And how on earth can you pad up with your mates for a glorious day at Lord’s, the Home of All-Day Drinking. Alarm bells ring in your head just as things are getting merry. Anything north of three pints these days and I start to worry and stop. In the grand schemes of things, this is hardly the greatest burden, but the daft old ways of getting legless now take on a sinister reality, which can be a bore.
You soon learn to keep out of the red zone of food and alcohol except on rare occasions and staying dry for at least a few days a week is vital. Conversely, being hydrated (buckets of water) is essential. But there are plenty of upsides to all this and, bizarrely, gout has had a positive impact on my health.
My GP says that I am in decent shape for 53, so I should be OK in later life, when my hard-drinking pals will probably be dropping like addled flies. That said, gout has chewed arthritis into my left ankle, which means I’m unlikely to enjoy golf and tennis in my 80s. I’ll worry about that if I get that far.
These days, I get one attack a year, two if I’m desperately unlucky, or stupid. I reluctantly started taking the drug Allopurinol in 2010, after finally accepting that lifestyle change was simply not enough. Two little white 100mg pills a day helps neutralise the uric acid, but it is no panacea. I have tried endless supplements to reduce the acid, from sodium bicarbonate, to concentrated cherry juice, cranberries and Vitamin C. These days I just have a nip of apple cider vinegar each morning out of a tequila shot glass.
Medical research on gout seems to be sketchy and largely out of date, but all indicators suggest it is on the rise. Apparently, one in 40 people in the UK get it, mostly men. I find this extraordinary, especially given the amount of inveterate boozers I know, because I have yet to meet a fellow sufferer. Maybe they’re all keeping it secret. Hopefully, they won’t feel the need any longer.
As for the image of gout, I hope it can change. Maybe you can avoid the crass jokes. Simply say: “Ooh, you poor soldier. When you’re up and about let’s have a beer.” That little hope of a better day will ease the pain.
Copyright Rob McGibbon. Please do not use any of the above article or photos without proper permissions. 2019