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Saturday, July 25, 2009

The doctor woke me up: Patient-physician partnering in gout treatment

Concern about well-known side-effects of certain gout drugs got Robert Jones into trouble. In 2007, the former superintendent for the Brockton Public Schools in Massachusetts developed classic gout symptoms. "I woke up at 3 a.m. with my right toe the size of a sausage," he said. "It was so painful, I couldn't even keep a blanket on." He made an appointment with Dr. Gerald Miley, a rheumatologist at New England Baptist Hospital. The doctor prescribed allupurinol for maintenance and colchicine in case he had an acute attack.

But Robert read about the potential side-effects of both drugs, and didn't fill the prescription. Instead, he decided to watch his diet. In April, he flew to Italy, where he rents an apartment. "I had a terrible gout attack that affected my ankle, knees and feet," he said. "I came home in a wheelchair."

He went back to Dr. Miley's office, and is now on a combination of drugs, including Uloric. He is doing well. "Dr. Miley woke me up," he said. "I don't need to suffer unnecessarily."

In becoming a well-informed patient, Robert had learned about likely side-effects. He made his own decision, possibly without telling his doctor that we wasn't going to take the prescribed drugs. After learning the consequences, he talked again with his doctor, perhaps determining a more acceptable set of drugs and instructions he could live with.

Advice to people concerned about their drug side-effects: Discuss with your doctor how to minimize the side-effects while getting the most benefit from the drugs.

Read a story on patient-physician partnership. Thanks to Laura Duffy for this reprint from the Summer 2009 issue of "Innovations at New England Baptist Hospital," and to Joan Seidel for the photo.

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