It's school holidays. I'm with my family visiting Malaysia.
This taxi ride took longer than expected as the driver took a number of wrong turns. I didn't mind too much as I was looking and worrying about his hands.
This appearance is that of tophaceous gout.
The lumps are collections of uric acid. These need years to accumulate!
Years of either ineffective treatment or no treatment at all. I can't imagine doctors would not try to treat this.
My experience is that a certain group of patients just seem to accept this and this group does not seek medical treatment.
I don't understand how they tolerate these lumps growing?
I don't understand why they don't do everything it takes to avoid the worsening deformity and damage to the joints.
Or perhaps, we doctors, don't explain it well enough. Maybe we don't make it clear that this should not be accepted.
With this gentleman, it is likely to severely affect his ability to earn a living. I'm not so sure how easy it's going to be for him to drive safely in the future.