Say No to Alcohol !!!

    ,,First you take a drink, then the drink takes a drink, then the drink  takes you’’                

                                                  Scott Fitzgerald                          

                                                                                    

         Today is the national screening test for alcoholism in US and is a very good idea for us also, to raise awareness about this subject.

          I will make some references to the smoking subject in the sense that, the people who have problems with drinking, will surpass also some steps in order to recognize they have a problem and looking for help.

     When a patient is confronted with the idea that he is an alcoholic, the first reaction is denial. It is common sense for him. Even though the family is there and stresses the importance to get help,he will deny the fact, he has a drinking problem. The doctor with patience and diplomacy must to seed in the patient mind that it is a help available, in case he is interested in.

How can we know if the person has really a problem with drinking?

      A  CAGE questionnaire helps us know if the patient is addicted and the questions below are just the most important from the questionnaire.

►Did you feel the need to cut down drinking?   

►Did you feel annoyed when others people speak about your habit?

►Do you feel guilty about your drinking habit?

►Did you feel the need to drink first time in the morning after waking you up?

       Having the score for this type of questionnaire, we will know if the person has a problem of dependency, meaning alcoholism.  

      We can also know if the person consumes alcohol on a regularly basis, making some blood analysis, looking for liver tests or making an ultrasound and seeing an enlarged and very bright liver in hepatic steatosis or a granular liver and ascitis in cirrhosis.

There are many manifestations we can see on them:

      Red spots on the skin, a yellowish skin, itchy skin,  a tremor of the hands  called asterixis, we can see caput medusae on the abdominal skin, which means a dilatation of the portal  and umbilical vessels, a sensibility on abdominal palpation, breast growth in men and impotence, hemorrhoids and varix, bleeding tendencies, capillary fragility. Not to mention, unsteady gait with large base of support, confusion, agitation, sometimes amnesia and confabulation (lying because they don't remember facts). The risks are higher for the pregnant women, their children suffering by fetal alcoholic syndrome.

      In our society, there are a lot of occasions to drink; there are people who drink in order to dare speaking in public, to let the shyness or the panic behind, but also people who cannot stop this habit.

     We as individuals, we haven’t the same quantity of alcohol dehydrogenase in the bloodstream, an enzyme we are born with and which is necessary to metabolize the alcohol in the body. That’s why, we react differently to the same amount of alcohol. Some can tolerate well the alcohol, but some are not, because they don’t have enough enzyme to metabolize the alcohol. We must also have this particular aspect in mind, before judging or stigmatizing someone. If a person becomes drunk very rapidly, it is because of this enzyme, which is low in their bloodstream.

       Also the heredity is important, in the sense that, people with low enzyme will have offspring’s with the same problem.

     It is also a problem of education, meaning the example of the parents is important when a teenager became alcoholic. We say about an obese family, that they all eat on the same table but we can enlarge the definition, saying they drink also on the same table.

       It is like a vicious circle in the same family or in the same entourage, which must to be broken.

       At some point, the effects of alcohol will be present medically and also present in the social or professional life of our patients. They will look for help and then, the role of the family and the doctor and why not of the entourage will be a crucial one.

      We must to intervene before hepatic steatosis will become cirrhosis, the first one being reversible in nature instead of second one which necessitates a liver transplant.

     Treatment will be followed in clinics of rehab, with AAA meetings, passing 12 steps, taking treatment with Naltrexone and Antabuse, which modifies the behavior in front of alcohol, sedatives for a while to prevent seizures in withdrawal, peers group sessions, motivational sessions, psychologically aid, ergo therapy, sessions of relaxation, yoga classes, all that help people to relax and let behind this habit. Not to forget the medical and psychological follow-up, because some of them will recur.

The alcoholism it’s an illness and must to be treated in consequence!

  

Stigmatization and Anti-Stigmatization Trends

   This week was the antiracial movement week. I will not enter in this subject, but I will raise the awareness about a similar trend in the health system: The stigmatization or anti-stigmatization trend.

    In the health field it is something very frequent.We just know that we encounter a lot of people who bullies others human beings for any imperfection, for any visible handicap or for any mental or physical illness. This is not correct but it is still present in our society. Apparently we cannot intervene in situations like that, but we can raise the awareness on this issue.

   In my opinion it is a problem of education, which apparently not everyone has.

A very good proverb says to not judge somebody, until you don’t walk a mile in their shoes. And how much truth it is in these words.

    In our society, we encounter blind people, deaf or mute people, people with neuromotory handicap, paralyzed people in their wheelchairs or using canes and people born with all sorts of handicaps which suffer physically and psychologically.

       Ideally, our society has to be a very accommodative one. And clearly on this point, the medicine has made a lot of progress in order to help these people. Politically speaking, we can also see progress, in the sense that we can encounter nowadays, a lot of organizations or foundations which fight for the well being of these people.

       But the problem still and will exist because a lot of ,,healthy” people continue to stigmatize these sick or unfortunate people.

In my childhood, I was very used to have people around me, with all sorts of problems but I was educated to consider them like everybody else and I can assure you, they really are.

     As a doctor, I have worked with children with all sorts of disabilities and it was an enriched and enlightened experience for me. I was always amaze, how these people have such a capacity to accept things which are not their fault, to move on with their lives, to develop new capacities or new abilities or to acquire new knowledges.

       A lot of people have the inferiority complex and they really fight against it. The most of them try so hard to surpass their temporary or permanent disability, giving us such a good example of survival , open-mindness and elevation of the spirit.

   In mental health, the stigmatization is more often, because people didn't acknowledged the fact, that these people are sick, some of them are born like that or some of them became mentally instable after different shocks in their life.

    The society nowadays became so senseless and intolerant, having no compassion for these kinds of people. In the same time, I can assure you, the sick people don’t look for compassion, but for the right to be seen and treated equally.

    We must to see the good and beautiful part in them, to see what they are capable of and using theirs capacities and capabilities to the fullest. We must to help them also being autonomous, helping them to become employed, to treat them equally, giving them the same rights in our society and why not, reaching the well being, things we also want for ourselves.

We must to treat the person near us exactly, how we want to be treated! No less, no more!

Depression

   In the last two decades, the incidence of this illness is so  increasing that clearly deserves at least a  briefly approach. 

It is very important to be very attentive to ourselves, because we and our entourage are the first to observe the changes in our behaviour .

   In the most cases this illness is misdiagnosed or the patient doesn't consider to pay a visit to a doctor. Not to mention that some of us consider we just have a bad time,  this is temporary and don't look for any medical advice. 

  I will resume for you some of the most important changes in our mental health .

     Firstly, we will be sad for a long period of time , more than  2 weeks,without reason or being under the drugs influence.       
    Secondly, we will lose all interest for any pleasurable activities which we loved before . No one  from these will make you happy again. 

    Thirdly, we feel guilty all the time , with /without reason, but in general is a fabricated guilt. 

We will lose the energy to do things and have an easy fatigability on minor activities. We lose our concentration, we cannot focus on things, we cannot learn, read, we can see that very easily when the patient is an academic. We lose the attention, which means we will be easily distracted. We can have an phsychomotor instability,being in general very agitated, sweating all the time. Sleeping is very disturbed, we cannot sleep or if we sleep, we wake up in the middle of the night and cannot fall asleep again. Irritability will be just a side effect of this involuntary sleep deprivation. Eating also is a problem, eating to much or less, losing or gaining weight as in the eating disorders.  

Some patients will contemplate suicide , some of them will make a plan, and others just contemplate the idea , but this will be in general in the major depression.

   The most important triad in depression is Worthlessness-Hopelessness-Helplessness, which make the patient think he is not worth to live, he is not useful to the society, he has no hope , he is desperate, a lost cause and he cannot be helped by other peers. Not to forget, this is a treatable illness in which you can see changes in minimum 2 weeks after you begin the treatment. The compliance to the treatment is mandatory. 

Did you remark these symptoms on you for a period longer than 2 weeks? Is it anything which can relieve these symptoms?

    Maybe is the time to pay a visit to your doctor, if you remark at least five from all these symptoms and for a period longer than 2 weeks.
 Definitely, depression should not be a life sentence.