Should a 22 Year Old Alcoholic Get a Liver Transplant?

July 20, 2009

UPDATE: The 22 year old patient that I speak of below passed away.  Very, very sad.

There is an interesting debate in London right now as to whether or not a 22 year old alcoholic deserves a liver transplant.

First a little background.  The patient in question started drinking alcohol with friends when he was 13.  Now nine years later he has the worst case of cirrhosis doctors have ever seen in someone this age.

As you can imagine livers are in short supply, with 400 people dying on the waiting list last year in Britain alone.

Doctors at University College Hospital in London have given Reinbach the most advanced therapies, including a one-off treatment with an artificial liver from San Diego, Calif. But all have failed and they believe only a transplant will save him.

The problem is they don’t want to give him one.  In Britian you must be able to prove that you can be abstinent if you want a transplant due to excessive drinking.  Wait, WHAT?  How on earth can you prove that you will be abstinent?  Supposedly they send you home for a period of time and if you don’t drink you are getting your liver.  Fantastic, but what about the day after the patient gets home, is abstinence still a requirement?

Look, maybe this person can prove that they will stay abstinent, although I have no idea how.  This raises a fascinating question.  Should we be able to decide who gets organs that they need or should everyone go into the candidate pool?

Aren’t we heading down a really slippery slope here?  If a smoker needs a new lung do they have to swear they won’t smoke again?  Easy answer says yes, however, what if they start back up again?  Can we take the lung back?

Let’s look at something more murky.  What if a person needs a new heart, must they swear off hamburgers for the rest of their life?  What if they are poor and can only afford junk food?

Can you see the problem here?  What if I live under a power line and get liver cancer as a result, must I move?  What if I can’t?

Is it possible there may be some class warfare here?

In the case of this young man, he began drinking at 13, well before he could possibly understand the consequences of his actions long term.  I am all for personal responsibility here, however, 13 is way too young to grasp the consequences of hardcore drinking.  Of course the question that you could ask is where were his parents???  His mom reports that she was working full time and had no idea that he was drinking this heavily.

All of this makes me nervous as we go forward with our healthcare debate in this country.  How are going to reasonably make the decisions on who gets what when it comes to health care.  Should we spend less on the 86 year old grandmother when trying to save her life as opposed to the 34 year old?  If we think a person is likely to keep smoking should we really try to save their life if they have a heart attack?

I wish I had the answer…I do have an idea though.

I will write about how I think health insurance should be address in the next couple of days.  It is too big for this post.  Sorry for the tease!!!

I am very interested in how you think Britian should proceed, please comment below.

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Acetaminophen is Getting a Closer Look

June 30, 2009

Acetaminophen (ACM) is the most popular over the counter drug for pain relief in the United States. There was an estimated twenty nine billion units sold in 2005. Twenty nine BILLION! Whoa, that is a lot.

The FDA recently released a report urging stronger warnings and stricter dose limits for drugs, like Tylenol® that contain ACM. The concern here is the apparent liver failure that people are experiencing after taking drugs with ACM in it. Research has shown that hundreds of people are experiencing liver failure and approximately 100 die each year from overdose whether intentional or unintentional.

One of the major problems is that people don’t realize how many products contain ACM. There are currently over 200 products that you may not even think about. Products like….Robituson®, Alka Seltzer Plus® and Sudafed®.

When the max recommended amount is 4,000 milligrams, one can see how it is not too hard to exceed that when one isn’t feeling well.

Now onto the rant portion of the blog.

I am not licensed to dispense drugs, I cannot legally give you advice, etc. What I am about to share is my opinion and should no way be construed as advice from an MD.

In my humble opinion most of this stuff is crap. It is bad for you, it covers up symptoms and does damage to vital organs. Do I understand there are situations where you need to take it…of course.

However, there is a large portion of the population that are taking these drugs for the completely wrong reason. If you need to take 4 Tylenol® before tennis and 4 Tylenol® after tennis just so you can play….STOP PLAYING.

Let’s assume that it is your neck that is bugging you. If you take the 4 Tylenol&reg before and after, you can swing the racket pain free. If you don’t you can’t. Now we know the pills aren’t fixing the problem, they are just covering it up.

One question then, “What is causing the pain?”

Shouldn’t we look into that?

“Oh, Doc I don’t have the time”….”It will go away”……”I think it is genetic, my mom used to get this when she played tennis”

Look you may not have the time now, but I can assure you, if you keep covering this problem up, you will have time in the future……your body will make sure you get it fixed.  I have seen this too many times.  What starts out as a small problem, can very easily escalate into a major problem if you keep patching it up.

End rant.

The experts say these drugs are safe if taken as they are intended and I don’t doubt them. When you sell 29 million units and only a small number of people get real sick from them, the problem is small. What I am more worried about is the prevailing attitude that we can just patch stuff up and it will go away.

Sometimes it will, sometimes it won’t, do you want to gamble with your liver, kidneys, etc?


TV Reduces Young Kids’ Language Development

June 8, 2009
Child spellbound by TV

Child spellbound by TV

So TV reduces children’s language development?  Funny, some of the words that have come out of my young son’s mouth are 100% attributed to TV.  I mean where else can a 6 year old learn about priapism?  Well I am sure that erectile dysfunction is a popular topic around the dinner table, most people I know stick to school and sports when talking to their children.

The gist of this article is that the more a child watches TV the less they are interacting with their parents or siblings. No doubt that is true.  They followed a bunch of children around with a digital listening device and measured how much they spoke or heard people speaking while watching TV.  The results showed that each additional hour of television exposure by the child was associated with a decrease in 770 words (7%) that the child heard from an adult during the recording session.  The study also showed less speaking while watching TV.

The moral of the story is, in case you don’t already know, turn the TV off and watch your interactions with your children go up.  Unless it’s NASCAR, then crank the volume, the race is on!!!


I’m Sorry, Oh Wait, I am a Doctor, I Can’t Say That

May 27, 2009

Imagine if your loved one went into the hospital and passed away.  The Doctors tried everything that they could, yet, just couldn’t save this persons life.    If that doctor made a mistake saying sorry can be used against him/her in a malpractice lawsuit.

Currently there is a debate on Capital Hill as to whether or not doctors should be allowed to say sorry and not have it interpreted as an admission of guilt.

Let’s say your loved one had a stroke and the doctor knew there was a small chance to save her.  That doctor goes in and perfoms the procedure but unfortunately the patient dies anyways.  That doctor goes out to the family and says sorry, I tried to save Ethel’s life but the procedure didn’t work.   If that family decides to sue the doctor, the fact that they said sorry can be used against them.

I hope the lawmakers on the hill, who should have WAY more important things to worry about, use some common sense and allow doctors to express their sympathy without it hanging them in court.


Are Insurance Companies Penny Smart

December 4, 2008

I recently had a patient hurt himself.  He called me for an exam and possible treatment, however, was dismayed to hear that his insurance would not cover the visits.  Since he was in a considerable amount of pain, he went to the ER, his primary care physician and a specialist.  Total cost of all those visits:  over $9,000.

One week after seeing all his docs, he was no better.  At this point he came into the office, we agreed on a fee, and got to work on getting him better.  After his first visit he was 75% better, leaving the office stating that he had not been able to breathe this well in a few weeks.  By the third visit the patient was released from care 100% better.

Total cost to the insurance company would have been less than $300.  Most health insurance companies put huge restrictions on chiropractic care.  Yet they will gladly pay and pay and pay when a patient goes into a hopsital or doctors office for diagnostic tests.

Imagine the money saved if 60,000 chiropractors had this type of case 3 times per week.  $4,700 x 3= 14,100 dollars per chiropractor per week.  Now take the roughly 60,000 chiropractic offices in the country and the number jumps to $846 million per year.  Not a bad number.

I often ask patients how many insurance companies they have had over the last 10 years.  It is not unusual for that number to be 5, 6 or even 10.  I then ask them how many spines they have had in that time period.  Of course the answer is 1.

You only have one body, it is not up to the insurance company to take care of it.  If you don’t have insurance or your coverage is very limited, please talk to your chiropractor if fees are a concern.  You may be surprised at what he or she has to offer.