Well, I am pleased that you took my e-mail in the spirit it was meant, i.e.
to give you food for thought and a few pointers for you to discuss with your
doc.
Hang on a minute while I get down from my podium ;-)
As a lady who is half Scottish and half English and who has a strong
allegiance to Scotland (but a very English accent and currently living in
Germany) I must admit that I was really shocked by your whisky abuse - as
the national drink of Scotland it is meant to be savoured not knocked back.
My favourites include Cutty Sark and Glenmorangie, but I can't drink now
because of the GERD and my meds.
You are very fortunate in that you have a strong genetic make up - perhaps
you should rather get down on your knees to your parents for that. A vast
number of patients of your age are on several different medications for a
number of chronic illnesses. You can certainly consider yourself a medical
marvel. My grandfather smoked and drank in moderation and was never sick in
his life. However, he might have forgotten that he had been sick because he
died of Alzheimer's at around 85 years old.
I have been very health oriented for the majority of my life, but as sick as
a dog for most of it - Crohn's disease - an (auto)immune disease in which
(generally) patches of the gut ends up attacked by the body's own immune
cells. I have always thought that it was a shame that one couldn't sue one's
own parents for passing on dodgy genes to one. However, I have been advised
that it wouldn't stand up in court because of lack of (criminal) intent and
I neither blame them (well not too much) nor any virtual, whited-robed,
benign-smiling individual standing on a cloud for my health problems.
With respect to side-effects of medicines, it is unlikely that a patient
will experience all of the known side-effects and at the other end of the
spectrum some patients will seldom experience side-effects or tolerate a
particular medicine without experiencing any side-effects at all. With your
strong constitution and excellent biochemistry I suspect that you generally
fall in the latter group. I am someone who usually experiences both the
common and the really rare side-effects that hit only 1 in 10,000 patients
or so. I hope that you have fathered hundreds of children to increase the
general viability and robustness of the human genetic pool. You will be
pleased to hear that I have not set any weak, sickly children into the
world.
I reckon that you were put on Nexium (aka Esomeprazole), which sounds a bit
like Mexiane. This is a proton pump inhibitor (PPI) - one of a handful of
its kind and 'state of the art' for the treatment of GERD. Diarrhoea is a
common side-effect and alcohol is known to exacerbate the side-effects
http://www.drugs.com/cdi/esomeprazole.html Pharmaceutical companies
sometimes only include the very common side-effects in their patient
information leaflets with the rarer side-effects ignored. The www.drugs.com
and www.rxlist.com data bases are very good for listing the majority of the
side-effects of the various drugs in addition to drug interactions.
Unfortunately, there does not seem to be a single source of comprehensive
information and one has to hunt around for the pertinent article or
information. Please note that PPIs can also result in increased liver
enzymes - my very low liver enzyme values doubled in 2003 when I first
started on PPIs, but they were still well within the norm values.
Many doctors don't tend to discuss potential side-effects with patients due
to time constraints and the fact that an absolute minority of patients are
very suggestive, i.e. you describe a symptom and then they have it. However,
it is also my experience that most doctors are not aware of the side-effects
of the medications they prescribe - let's face it, it is an awful lot of
information to keep in one's head, but that is also why there are (internet)
data bases and patient information leaflets. For example, my doctor did not
recognise that the chronic hepatitis - elevated liver enzymes since May
2007, which resulted in intermittent liver pains from July 2008 and the
acute pancreatitis in October 2008 were side-effects of the chemotherapy -
well-documented side-effects of any chemo.
You might like to ask your doc. to check your pancreatic function - e.g.
blood lipase and amylase levels:
http://en.wikipedia.org/wiki/Acute_pancreatitis You don't have to be
experiencing any pain for the/any organ to be chronically dysfunctional.
http://en.wikipedia.org/wiki/Chronic_pancreatitis
Be aware that some 30-40% of patients with pancreatic disease do not show
any changes in their blood lipase and amylase levels. Pancreatitis pains are
excrutiating and, in my case, combined with hepatitis and hepatic
parenchymal cell damage (as determined by ultrasound) this meant that I
couldn't take any pain killers so that was challenging. I stopped the chemo
at the beginning of December last year and my liver enzymes are now more or
less normal - down from 3-10 times what they should have been. I should have
been on the chemo for at least 4 years, but only managed just over two
years.
It was my understanding that doctors were notorious for being among the
heaviest drinkers and smokers due to the stresses of the job. However, on
googling the subject (thank goodness for the internet) I stand corrected and
it appears that this is an urban myth and doctors do not drink any more than
the general population
http://student.bmj.com/issues/06/07/education/276.php On the other hand, it
might well be that your current doctor is not too concerned about your
drinking because he also enjoys a tipple every evening. In addition, a lot
of patients in advanced years drink considerable amounts of alcohol in
addition to downing several different types of pills. Some doctors turn a
blind eye to this because they don't want to remove one of or perhaps the
only remaining source of joy from the elderly folk.
http://www.choosehelp.com/alcoholism/its-never-too-late-for-help-alcohol-abuse-and-the-elderly
Alcohol is listed as a carcinogen (cancer causing) by the USA DHSS.
http://alcoholism.about.com/cs/cancer/a/aa000520.htm
Interestingly enough, I read recently that beer is more likely to cause
colon cancer than spirits.However, the literature is conflicting with more
than 9 shots of spirits per week tripling the risk of colon cancer
http://coloncancer.about.com/od/faqs/f/Alcohol.htm Drinking undiluted
shorts is particularly associated with cancer of the upper gastrointestinal
tract: tongue, throat, oesophagua, stomach, etc.
You might want to read this:
http://www.webmd.com/mental-health/alcohol-abuse/alcohol-abuse-and-dependence-when-to-call-a-doctor
I also had a motorbike - don't laugh - a Honda CG125, but I was feted as the
slowest rider in my learner class due to the great stability of the bike. I
swapped bikes with one of the other girls in the class and tried to slow
ride her Harley Davidson , but it was incredibly difficult to maintain
balance on it at a slow pace.
Interestingly enough I have a friend in Scotland of all places who is a
binge drinker (beer) and he has just had a diagnosis of anaemia with his
liver enyzymes perfect. He has been told to eat dried apricots amongst other
things http://www.healthcastle.com/iron.shtml. He doesn't want to take iron
supplements because they cause constipation. I take and iron and vitamin C
fizzy tablet in water each morning - vitamin C aids absorption of iron in
the body and the bicarbonate in the fizzy tablet helps my GERD to the extent
that I only take Omeprazole every 3-4 days - I am on a strict GERD diet.
I hope that your doctor gets you sorted out.
Vanny
Post by IanPost by VannyPlease note that I am not a doctor, but consider myself (like many others on
the internet) a knowledgeable patient and have always striven to maintain a
healthy lifestyle.
Ah, we are poles apart then! I'm looking back at some fifty years, from
21 to 70 years, during which I paid little or no attention to my body's
wellbeing.
I was almost never ill and generally only saw a doctor to have my hide
stitched up in a hospital casualty ward (I rode fast motorcycles
throughout most of my twenties).
So I rarely thought about health matters.
Post by VannyWith respect to your symptoms, (un)fortunately, they don't do clinical
studies to test medication where the subjects also drink 0.5 l whisky each
day so you are in a class of your own (making) with respect to side-effects
and drug interactions.
This recent 16 days of diarrhea is the first time I've noticed any bad
side effects from a medicine.
Post by VannyA litre of whisky contains 40 units of alcohol and, to avoid serious damage
to health, for a man it is recommended that 21 units per week is not
exceeded. http://www.trafford.knowalcohol.co.uk/About-units/Default.aspx
Your alcohol consumption is in the order of 0.5 litres whisky or 20 units
per day, which is equivalent to 140 units per week.
http://www.bpassoc.org.uk/BloodPressureandyou/Yourlifestyle/Eatingwell/Alcohol
Oh my gawd! Way over the top..... I'd never heard of this units of
measurement for alcohol.
When doctors have asked me if I drink, I tell them the approximate
number of double Scotches per evening: every one knows what a double is.
I've never attempted to be economical with the truth on this, as I've
heard some heavy drinkers do.
A doctor can only do his job if he has all the possible facts.
Post by VannyAlcohol consumption also interferes with the absorption of many/most
medication and may increase drug side-effects and drug interactions, thus
alcohol is contraindicated with most medicines. For example, Diovan can
cause diarrhea and numbness and you are advised to avoid alcohol when on
this drug. http://www.drugs.com/diovan.html High alcohol consumption cause
high blood pressure over time.
http://www.medicinenet.com/script/main/art.asp?articlekey=20340
Hmmm. I wonder why my doctor didn't tell me of this when he first
prescribed diovan.
I am to see him on Wednesday next so I'll ask him about it.
Post by VannyI have never heard of Mexiane and I have been treated for reflux since early
2003 and been through a few medications in that time. It is not in either of
the drug data bases www.drugs.com or www.rxlist.com I suggest that you look
up the alternative retail name for Mexiane and look it up in the data bases
for side-effects and use the drug interactions feature to check
compatibility with your other medication.
I'm hoping I have the spelling right: having now no eyesight, I have to
get people to spell the name on a label for me and I didn't do this for
Mexian. I am just spelling it as I hear it spoken: phonetically.
Post by VannyI suspect that the diarrhea was actually a side-effect in your case. Most
medication taken orally has an effect on the gut. However, it might not have
been due solely to the effect on the gut, but also on the liver, pancreas
and gall bladder and due to drug interactions between your medications plus
the alcohol. If an excess of bile is produced by a sick/irritated liver or
gall bladder and hits the colon this can cause massive diarrhea. If the
pancreas is sick/irritated and does not produce enough digestive enzyme this
results in undigested food being expelled into the colon, which is not
equipped to cope with such a situation and results in diarrhea. It is
fairly likely that, as a result of your alcoholism, you have, at a minimum,
a sick liver and/or pancreas. And a mixture of alcohol and powerful drugs is
usually toxic to the body, even more so if the patient has liver damage,
etc.
Astonishingly, after each blood test ordered by my doctor or in a
hospital ER, I've always asked about the liver, knowing of course about
cirrhosis, and every time the reply has been, No, the liver is just
fine.
Apparently if a liver is unhealthy or damaged, it shows up in blood
sample analysis.
Up to now, all my blood tests have been really excellent, with only
little things like slight anemia or lack of iron being reported.
For a man of seventy, who's led an often dangerous and recklessly
unhealthy life, this seems like a miracle to me.
Post by VannyThere are lifestyle changes, which are necessary to adequately manage reflux
(aka GERD): http://www.webmd.com/heartburn-gerd/default.htm
http://www.gicare.com/diseases/GERD.aspx Medication alone will not manage
the condition. Alcohol exacerbates reflux and, in the long term, causes
liver/pancreas/brain/etc. damage, amongst a load of other conditions that I
am sure you know about.
Only the cirrhosis of the liver really, and now I know about the loss of
nerve fiber in the feet I now have.
the stomach specialist said on my visit last Tuesday that I should avoid
fatty food, when I asked about altering my diet.
Since as long as I can remember, I've been enjoying fried food, fried in
a frying pan in lard, that is, animal fat. Most Americans, see this as
akin to gulping down strychnine,as they are very nervous about
cholesterol.But all my blood tests have showed very good cholesterol numbers.
Doesn't make sense, but there it is.
Post by VannyTwo good things to come out of it are that you have given up smoking and have
lost weight - great for your overall health and a few steps in the right
direction to managing reflux. If you have not been screened for cancer of
the colon within the last few years I suggest that you go for a colonoscopy
because your lifestyle is just geared to causing colon cancer.
I did have one about nine years ago, at my GP's suggestion when I first
went to see him on arriving in Texas. He was surprised I'd never had
one: he was thinking about polyps which I've learned are quite common in
the States but I don't think are in britain.
The same stomach specialist who is treating the reflux did it, and found
no polyps.
On my seeing him lastmonth, he said he didn't think itnecessary to do
another colonoscopy.
And yes, he is aware that I am a heavy drinker. However, I'll ask him on
my next visit next month, about your point.
Someone I spoke to today confirmed that drinkers do suffer a higher
incidence of colon cancer; I'd never heard of this before.
Post by VannyI suggest that you read around the subject and then discuss your findings
your doctor before implementing any changes, except of course for giving up
alcohol and following the general GERD lifestyle changes. It is clear that
your current level of alcohol consumption is extremely dangerous and I
suspect that your doctor has broached the subject on more than one occasion,
but he can't force you to stop - that is ultimately your decision.
Oddly, my GP has never once spoken to me about stopping smoking or
drinking, over the ten years I've been seeing him.
And similarly no specialist I've seen over the last ten years here in the
States has either. Ditto the ER doctors in the hospital I was in a few
times last year.
But when I was in for .... dehydration, or dangerously high blood
pressure I thinkit was, told me on December 31st that he was prescribing
a medicine and I should skip the alcohol for that evening.
This was New Year's Eve! Andall Scotsmencelebrate it with out fail....
So I left the Scotch alone that evening and at midnight, poured out a
token amoungt and just took a tiny sip, then put the rest away.
In England, a doctor seeing me for the first time, noticing the
two mahogany-brown fingers on my left hand, would suggest I cut down or
stop. But of course no addict pays any heed to such advice. Nicotine is
maybe the strongest addiction ever, at least it was for me.
I feel quite pleased with myself for succeeding in kicking the
habit/addiction
Well, many thanks for your knowledgeable information and suggestions;
much food for thought there!
I'll take the liberty of printing your f/up out, leaving off any id,
and show it to my GP next week, and we can have a talk about my
situation.
Mind you, he remarked about a year ago, that he sees many patients in my
age range, and they are taking masses of medicines just to keep going.
And last December, when I remarked I would soon be seventy, he told me
jovially that I was doing very well.
And after ten years of treating me, he is well informed about my state
of health.
So who knows, maybe I've been amazingly lucky. After all, 48 years of
really heavy smoking, it appears, have done very little harm to my
lungs. A little emphysema was diagnosed ten years ago but it appears
not to have grown to any noticeable extent.
After almost a year of not smoking, I am completely free of chronic
coughing, no longer get all out of breath as I did a year ago, and I'm
told the various x-rays and scans I've had over the last year show my
lungs to be in good shape. Some healing process has taken place in there
I think.
I find all this almost incredible: if I was a religious type, I'd be down on
my knees every day thanking God for it.
--
Ian.