Doctors Lounge - Gastroenterology Answers
"The information provided on www.doctorslounge.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her physician."
Forum Name: Liver Diseases
|AspiringPA - Sat Oct 31, 2009 7:18 pm||
I understand that the speed of the progression of liver disease can be highly variable, so let me give you as much information as I can and explain why I'm asking this question so that you have a context. I'm sorry if this is long, but all the information is pertinent and a man's life may be at stake here. You can skip all the way to the end to see the the main question, but it's basically the same thing I asked in the subject line.
I have a friend whom I've known for less than a year. He's been an alcoholic for at least 10 years. He's 40 years old. He has a job, but he drinks several beers during his work day in order to avoid withdrawal (his employer turns a blind eye). He probably drinks something like 15 beers a day and his blood alcohol is probably a consistent 0.4, but he is habituated and he has no problems with coordination/ safety at work.
Unfortunately, I don't know the details of his prognosis. He couldn't explain much to me in detail, other than the doctor told him "it's pretty bad" during his most recent visit. He's mentioned possibly getting a liver transplant from his brother, but that doesn't necessarily imply that he's already progressed to the point of needing a transplant.
My guess is that he's got a significant amount of scar tissue in the liver, but he's not showing outward signs of later stage cirrhosis at this point. Again, I'm working with limited info. I don't know what his test results were. I guess the main thing I want to get across is that there's no jaundice or edema or many of the other symptoms. There has been wasting over the past year or two, however.
This man tried to detox at home recently, which is obviously a very bad idea (he was taking Ativan, at least). He made it through about 3 days, but was ultimately unsuccessful. He's an Army veteran and he tried to detox at the VA hospital once, and I think they locked him up in the psych ward or something. The bottom line is that he DID NOT want to go back there under any circumstances.
He also smokes and has a history of other addiction (mostly methamphetamine but that was in the 90's) and depression (currently being treated with Prozac).
Here's the crux of the issue: He's found a detox center through the VA that he's willing to go to. I asked him when and he said March 1st. I asked him if he could have scheduled this any sooner and he said yes, but that he intentionally scheduled it in March due to job considerations. I told him that he should go in immediately, as any sane person would.Obviously, he doesn't see this as a time sensitive issue. Perhaps it won't be a time sensitive issue, but there's no good reason to wait. He is very stubborn. I need a very compelling argument.
So he's going to intentionally wait 4 months when he could probably do this within a couple of weeks. Like I said, I'm trying to convince him to go ASAP, but I'm looking for something tangible that I can use to persuade him. Otherwise, he just thinks that I'm giving him the standard line. I need more hard information. My fear right now is that he's sitting on the precipice, and that those extra 4 months could be the tipping point. That's just my gut feeling based on what little I remember of his description of what his doctor told him.
I want to be able to say something like, "Research has shown that liver disease can progress very rapidly, and that 4 months could prove to be the the difference between reversible and irreversible liver tissue damage." You know what I mean?
So, finally, back to the question....How fast can the progression of liver disease occur? How fast can fibrosis turn into cirrhosis and ultimately into liver failure? I know it's a tough question based on the lack of information, but I need something, anything to go on. If you were me, what would you tell him from a medical standpoint?
Thank you so very much for reading this. I really, really appreciate it.
|Dr.M.Aroon kamath - Sat Nov 14, 2009 11:44 am||
Onset and progression of cirrhosis are variable, depending on various factors and are unpredictable.
Hepatitis C(HCV) and HIV (said to be highly prevalent in methamphetamine users- especially 'injectors') are known to cause and speed up progression of liver cirrhosis.Prevalence of HCV among the 'non-injectors' is also known (sharing drug equipment, piercing,tattooing, and high risk sex).But your friend obviously has no HIV or HCV.
Acute liver failure following intravenous methamphetamine has been reported
(i can not scare your friend as he is not perhaps using methamphetamine currently).
Acute liver failure following binge drinking has been reported((i don't think i can not scare your friend as he will not be convinced!).
I thought your doctor did a fine job ("the doctor told him "it's pretty bad" during his most recent visit. He's mentioned possibly getting a liver transplant from his brother").
But you say in the same breath... "that doesn't necessarily imply that he's already progressed to the point of needing a transplant". Was your friend scared by what the doctor said?
Finally, as i can sense your urgency, it would be very useful if you could let me have the following details as soon as you can so that i can decide if can ever convince him at all! ...
- does your friend currently use methamphetamine?
- Has he any viral disease such as the ones i outlined above?
- Which part of the world he is residing (mortality from alcoholic cirrhosis is reported to be higher in african americans and hispanics in USA)
- what were the results of his most recent liver function tests?
- Has your friend ever tried Disulfiram(has been in use for adjunctive treatment of severe alcoholism- and has been reported to cause acute liver failure).
|| Check a doctor's response to similar questions|
Are you a Doctor, Pharmacist, PA or a Nurse?
Join the Doctors Lounge online medical community
Editorial activities: Publish, peer review, edit online articles.
Ask a Doctor Teams: Respond to patient questions and discuss challenging presentations with other members.