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Patrick Hanmer was 32 and living life to the full when he had his first attack of gout. Over 20 years later, he eats, drinks and exercises and, thanks to effective medication, keeps his gout under control.
"I was a 32-year-old aid worker in Somalia when I experienced my first attack of gout. I woke suddenly in the night to an unbearable pain, as if someone had stamped on the ball of my foot. An area of my foot was shining red, like a snooker ball, and was very sensitive and inflamed. I was amazed. I didn't know what it was.
"I think the hot climate triggered the attack, and I was dehydrated and drinking far too much beer. I'm a very active person and would motorcycle across the desert, not drinking enough water, and then go to lots of parties afterwards.
"The nurse at the British Embassy looked at my foot and told me that I had gout. I was prescribed a medication called colchicine, which helps clear the uric acid (urate) from your blood.
"Three years later, I got my second attack. Again, I was drinking too much, overeating and getting dehydrated, and I was stressed. The urate level in my blood was so high, it felt like my blood was congealing. As the years went by, I had attacks every two weeks.
"I was still taking colchicine, but it gave me diarrhoea if I took too much. I would take the medication during the attacks, which would subside after three to five very painful days. During that time, I'd be lying down, unable to walk. It was very depressing.
"In February 2007, I was walking along a street in London and my foot suddenly seized up. I tripped over the pavement and nearly fell under a bus. That's when I thought, something's seriously wrong here.
"The doctors told me so many urate crystals had accumulated in my blood that a hard white lump called a tophus had formed under the skin on my foot. A surgeon removed it and the other white residue in the joints of my big toe. He said it was one of the worst cases of gout he'd ever seen.
"I started taking a drug called allopurinol, which reduces urate in the blood and helps prevent further attacks. I hadn't taken it before as it tended to trigger attacks, but I now take two tablets a day. It has controlled the gout and I feel great. My joints don't creak any more.
"I've lost weight and my quality of life is great. I can do everything I used to do, although I have to avoid extreme exercise as this produces a lot of metabolites (breakdown products) in my blood, which can trigger an attack.
"I still get gout occasionally, but it's just a quick attack that finishes within one day. Keeping hydrated is the key. I drink a pint of water every morning before I leave my bedroom. I also eat more sensibly and avoid foods like kidney and certain types of fish, which increase my blood urate levels."