HEALING PLACES - A SERIOUS LOOK AT ALCOHOL

By Claudia M. Johnson MD/Tell Us USA News Network

Walk with me as I make medical rounds in alcohols’ death zone. A scene unfolds that exists in any hospital anywhere and exhibits yet another example of disparity. Arrive at 8a.m. where three trapped lives were all once able to sing in hip-hop tune with phrases like “blame it on the alcohol” or snap their fingers to “pass the Courvoisier” and swing their hips to the familiar vibes of “pop champagne”. But one day they crossed the line between responsible drinking and alcoholism. Now they are referred to as Bed 1, Bed 2 and Bed 3 --- all having hands too weakened to reach for help, voices muffled by the mechanical sighs of respirators and hearts unable to keep their own beat. They lie victimized by life-threatening alcohol related disorders, seldom discussed unless you happen to be family, associates or health care providers of those suffering from alcohol addiction.

In Bed 1 is an 18-year-old Native American female admitted to intensive care after aspirating while gulping “Jell-O shots”. She tried to wash them all down in seconds with a bottle of liquor. She thought it was harmless.

Aspiration refers materials going down the lungs instead of into the stomach. In this case mouth secretions and alcohol laden cubes of Jell-O passed into the patients lungs.

Normally a cough or gag response would cause one to cough up the material. But when inebriated and unconscious this reflex is often dampened.

The resulting aspiration pneumonia quickly became severe and Bed 1 developed respiratory failure. She was incubated and placed on a respirator for life support. Alcohol poisoning or alcohol coma resulting from drinking a concentrated amount of alcohol within a small period of time (in this case, a fifth of vodka in 15 [minutes]), may also result in a condition known as rhabdomyolysis – a long term for a constellation of signs and symptoms including muscle necrosis (death of muscle tissue), muscle pain, abnormalities of vital electrolytes (calcium, potassium) and kidney failure. Her urine is red due to products released during the muscle destruction. Either the rhabdomyolysis or the pneumonia could prove fatal.

In Bed #2 a 27-year-old African American year old male who drank about 1 pint a day of E & J brandy is quickly losing his grip on life. Admitted to the hospital by way of the emergency room 72 hours ago, he was writhing with pain radiating from his belly to his back. It was not relieved by his persistent vomiting. Perhaps he thought the symptoms would soon pass. But he had never heard of pancreatitis. Nor could he imagine that he had the most severe and deadly type of pancreatitis possible – hemorrhagic pancreatitis. He is now in shock with a barely detectable blood pressure.

The pancreas is a 7 inch long glandular organ that secretes enzymes that help in digestion and some hormones (namely, insulin). It lies beneath the stomach and is connected to the small intestine. If significantly inflamed by alcohol, the pancreas releases its chemicals and begins to digest itself. Although rare, the result can be intra-abdominal hemorrhage and death.

The patient is Bed #3 is a 54 year old Hispanic male who never drank anything but beer. His weekend beer binges eventually increased to include limitless cans almost daily. Contrary to a popular misconception, beer consumption can cause cirrhosis liver injury just like any hard liquor. It just takes more beer to do the damage. Now Bed 3 has liver cirrhosis and unrelenting gastrointestinal bleeding. Because of liver damage, his blood can no longer clot. He is bleeding from rupture of the engorged vessels in his esophagus which resulted from the alcohol related liver enlargement. His blood pressure is dropping, rapidly and fatally.

The case studies have an obvious message. Those who accept alcohol as a celebratory drink to be ingested with moderation and common sense get the message; while those who end up in intensive care do not. But there is yet another level of understanding that is just as important to the life of society and that is how alcoholism impacts health disparities.

Alcohol consumption is associated with a wide range of adverse health and social consequences. Some are acute (traffic deaths); while others are chronic (liver damage, stroke, cancers of the head and neck). Ethnic and cultural disparities in alcohol-related problems vary with the problem under consideration and are of pressing public health concern. Alcohol-related death rates (for all categories of alcohol- related mortality combined) are higher among Blacks than whites.

Recent research indicates that cirrhosis death rates are higher among white men and women of Hispanic origin than among non-Hispanic black and white Americans. Women, because of a smaller liver size and hormonal status, tend to develop cirrhosis without drinking as much as their male counterparts. Alcohol-related traffic deaths are many times more frequent among American Indians or Alaska Natives than among other minority populations. African American teenagers may typically drink less than their white or Hispanic counterparts; but their mortality from cirrhosis is substantially higher as they approach middle age. Increases in risky drinking behavior (i.e., drinking and driving) have been reported among Hispanics. Another adverse health consequence also associated with increased alcohol consumption and its related decrease in inhibitions is HIV/AIDS.

As a society, we cannot afford to any longer lose anyone to alcohol’s death zone.