September 6, 2011 BLOG
ALCOHOL: NOT SO GOOD FOR THE HEART
He finally killed himself last week. The death certificate said congestive heart failure but the real cause was alcohol.
I first met Devon twenty years ago. His parents were both patients and they asked me to see him. They said he had some terrible rash on his hands and feet and no one could figure out what it was.
I always like a challenge.
He was five years my junior. Worked for the county maintenance department. Said he had a crazy boss who had been coming down on him pretty hard. That’s when the rash started.
Both his hands and feet showed thick skin almost the color of orange peel. The skin of his soles was peeling and raw.
Oh, and did I mention? He reeked of alcohol at his 7 AM appointment.
I thought he had psoriasis, a rare form that affects the hands and feet. But the biopsy showed an unusual condition called lichen planus. He had it in his mouth also, a more common location. It was such an uncommon appearance that I presented him at a monthly grand rounds meeting of dermatologists in Santa Barbara. A couple of the older doctors had seen a case like it, but all agreed it was rare.
Devon’s chief complaint was pain. I went up the scale from Darvocet-N 100 to Tylenol with codeine, to the big guns. Nothing helped.
In practice and at the University, I’ve seen feet that were a lot worse. Patients managed pretty well with minimal analgesics, and were able to keep working.
Devon went on disability and renewed his controlled substances prescriptions regularly. He always smelled of alcohol at our early morning appointments.
Then one day I got a call from the drug enforcement agency. They keep pretty close tabs on things. Devon had been filling three and four prescriptions from different doctors for the same narcotics each month.
He didn’t go to jail. I think he got probation. I refused to prescribe narcotics for him again and within a month or two he stopped coming.
His mother had moved away and I lost contact, but she moved back to town last year after her husband died. At her return visit, she told me how awful it was that Devon had developed heart trouble. “Congenital heart failure,” she described.
It made sense. Twenty years of hard drinking had caused alcoholic cardiomyopathy. Heart muscle cells die from the toxicity of alcohol, and one-by-one they are replaced by scar tissue. Little by little the heart grows weaker, imperceptibly at first. Then, there are subtle signs: leg swelling since the weakened heart can’t clear all the excess fluid from the circulation, then an extra pillow at night to make breathing easier. Then one day, a terrifying inability to take a breath, a wet cough, and blood-tinged, frothy sputum from gray-blue lips.
Devon almost died twice from bouts of congestive failure. He didn’t watch his salt intake, and he kept drinking and taking his “prescription” pain pills. He didn’t realize he was in trouble until he was starved for air and he saw the blood in his sputum. Each time they released him from the hospital, he had nowhere to go but to live with his fragile, late-eighties mother. The last time, he came home so weak that he couldn’t walk. Shuffling back from the john with his mother on his arm, he stumbled and fell on her. His arm raked her shin on the way down and peeled all the skin off down to her ankle. We were able to put it back in place and with biologic dressings, it healed after nearly four weeks.
By then, Devon’s failure had progressed to terminal. Mercifully, Hospice was called in and took over for his mother.
He died a week later, literally drowning in his own fluids.
But wait, you say, I thought alcohol was good for your heart?
In moderation, maybe. In greater quantities it destroys heart muscle. If you really want to know the truth about alcohol, read the studies that purport to show that the French who drink more than Americans have less heart disease. The truth is that they die more from cancer and suicide than their American counterparts.
That’s the part they never tell you. You only hear what Big Alcohol wants you to hear. You never hear that alcohol kills heart muscle cells, is the second leading cause of osteoporosis, the number one cause of insomnia, and is causative in nine types of cancer.
But I will tell you. And I’ll keep telling people until they start to catch on.
People are going to drink. I am not going to change that. But if they drink, they will at least understand the risk they are taking.
And those who drink purely because they read that it is good for their health may have a second thought about it.
They may choose not to drink.
It just may happen.
jh
