The Sobering Truth Blog

2-2-12 blog

Thu, 02 Feb 2012 21:48:55 -0800

February 2, 2012 Blog

Under the Influence.

His drinking had been out of control for years. His wife was terrified that he would not make it home during his long commute from the Central Valley every week. He worked in an emergency room there---four ten-hour shifts a week. He had an apartment near by and she was pretty sure he drank when he wasn’t working. She prayed that he didn’t drink when he worked.

When she mentioned his drinking, he became so infuriated that it frightened her. He claimed he didn’t have a problem. He had a stressful job and drinking helped him to relax.

She had watched the problem slowly progress. She gave him a copy of my book and told him that I would be happy to meet with him. He refused to read it and didn’t speak to her for two weeks.

In October, he got a DUI.

When he was stopped, he was belligerent. Didn’t they know who he was? He berated the officers during the arrest.

They knew who he was. He was a drunk driver. Perhaps they snapped the handcuffs a little tighter to emphasize the point.

His mother called with panic in her voice. When she told me of the DUI, I was overjoyed. Maybe this is what he needed; perhaps this was his bottom.

Wrong. It just made him angrier.

The DUI process for a physician is much more involved than for the average person. Inpatient rehab is mandatory (and expensive). Then there is a diversion program that lasts up to five years.

Rather than feeling shame and contrition, he just grew more irate. How dare they try to dictate the activities of his life!

I was hoping that this very public humiliation would be life changing. It has not been. His chances of maintaining sobriety are remote. One must acknowledge a problem before it can be resolved. He is in denial and acknowledges no problem on his part.

It’s simple really. He’s under the influence.

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January 17, 2012 blog

Wed, 18 Jan 2012 21:15:24 -0800

January 17, 2012 Blog

Maybe wine isn’t that good for you after all.

THE PRINCIPAL RESEARCH LINKING ALCOHOL, PARTICULARLY RED WINE, TO GOOD HEART HEALTH DECLARED FRAUDULENT!

The University of Connecticut has begun dismissal proceedings against Dipak Das, Ph.D., the principal investigator who promoted the idea that red wine and one of its chemicals, resveratrol, were beneficial for heart health. According to investigators for the university and the U.S. Center for Research Integrity, Dr. Das fabricated the results of twenty-three papers he published from 2005-2009 demonstrating these findings. The alterations were, in every case, made to enhance red wine and resveratrol’s roles in heart health. Knowing that alcohol is a $40 billion a year industry, the next logical question is: who funded Dr. Das’ research? Makes you wonder doesn’t it?

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1/4/12 blog

Thu, 05 Jan 2012 06:10:54 -0800

January 4, 2012 blog

A little knowledge is a dangerous thing.

Cindy Sagon, a staff writer for the AARP bulletin, wrote an article dismissing the increased risk of breast cancer in women who drink.

For those who missed it, the study out of Brigham and Women’s Hospital in Boston showed that women who drink 3-6 drinks per week increased their risk of breast cancer by 15%. Those drinking two or more drinks per day had an increase of 51%.

Cindy belittled these numbers showing that the increase was from 12.0% to 13.8%, a trifling 1.8%, not worth worrying about for a woman who needs her wine to relax in the evening after a hard day at work.

1.8% seems like nothing.

But multiply that by the 100,000 women in the study and you get 1,800 breast cancers that would not have happened without that evening glass of wine. 1.8% seems like a tiny number, unless you are part of it. Then it’s not 1.8%; it is 100%.

Cindy reveals her diminutive knowledge of the subject. She is not aware of the ten additional cancers definitely linked to alcohol consumption. For the record, they are cancer of the mouth, throat, esophagus, stomach, colon, rectum, liver, pancreas, prostate, and most recently, lung.

She is probably not aware that although alcohol is not a carcinogen (cancer causing chemical), its first metabolic break down product is acetaldehyde which is a potent carcinogen. Wherever you find acetaldehyde, cancer is not far behind.

She probably knows of the study comparing the French who drank a lot to Americans who drank less. It’s conclusion: the French had less heart disease. Yet, if she had read the study in depth she would have found that though the French died less often from heart disease than the Americans, they had higher death rates from (you guessed it) cancer and suicide.

I am sure she is not aware that alcohol is the number two cause of osteoporosis, another epidemic disease in women.

I doubt that she considered that breast cancer is a killer of young women, women with school-age children and promising careers.

To say that her reassurance to the drinking women of America was ill-advised is a monumental understatement.

I am not opposed to moderate drinking. I am opposed to ignorance regarding its consequences.

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12/1/2011 blog

Sat, 03 Dec 2011 21:00:24 -0800

December 1, 2011 Blog

RE-EXAMINING OUR PRIORITIES

Today is World AIDS Day.

All over the world people are celebrating inroads in treating a disease which two decades ago was a death sentence.

A miracle of modern medical science and political will.

Meanwhile a disease that has been around for centuries continues to leave death and destruction in its wake.

According to the World Health Organization, it will kill 2.5 million people worldwide this year.

That is more than AIDS, Tuberculosis, and War.

An entire generation of young men in Russia is dying from it.

This year in the US it will kill 125,000 people, with only heart disease and cancer causing a higher toll.

President Obama today pledged 50 million dollars to decrease the number of new US cases of AIDS this year.

But there was no pledge to fight an even bigger killer.

That killer is alcohol.

Wake up! Alcohol is in every household, on every doorstep. We continue to allow it to kill our young people, to emotionally scar families with the abuse it causes, and we tolerate billions of dollars in lost work and medical expenses to treat its victims.

The day is coming when the truth will be known about alcohol’s damage to our health and to the social fabric of our culture, when we spend as much for alcohol education in our middle school classrooms as we do for retrovirals in Africa.

If we continue to spread the word, it will happen.

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November 12, 2011 blog

Mon, 14 Nov 2011 10:49:21 -0800

November 12, 2011 Blog

Wise beyond their years.

They filed in to the library as I hurriedly substituted my projector for the school’s malfunctioning one: sixty fresh-faced children from the AVID (Advancement Via Individual Determination) program at Mesa Middle School. Their teacher is a long time patient and friend and after reading my book, she asked if I would speak to her students. In my studies, I have come to the conclusion that this is the ideal age group we need to reach if we are going to have any success educating children about alcohol. Most have not tried it yet and they have open minds and are receptive to learning about it.

They were wonderful: alert, attentive, and very courteous. Hispanic, Filipino, Caucasian, and Asian, they made a wonderfully heterogeneous group.

I started by asking their ages. “Any twelve-year olds?”

“I used to be twelve,” a bespectacled redhead in the front row chimed in.

“I hope so,” I answered, and the children all laughed.

I started by telling them of the drunken nineteen-year-old girl that died in the hot tub at the upscale Shell Beach, CA hotel a month before. I gave her a name, Dana, and they were shocked that the hot water could accelerate her alcohol poisoning.

I had their attention.

I explained how alcohol is a poison and how easy it is to kill yourself with it if you drink hard liquor fast and pass out before you get sick enough to throw up.

I explained in terms they could understand that alcohol makes people feel good because it increases a chemical called dopamine in their brains. I then showed them how drinking all the time lowered the dopamine, and made the alcoholic want to drink more to raise it. They understood that this was the cause of addiction.

I taught them how alcohol makes some people angry and mean, how some people act crazy when they drink, how drunk people sometimes black out and wake up in bed with someone they don’t know.

I showed them how alcohol is a depressant and is the absolute worst thing to drink when a person is depressed. They understood when I related that one-third of all alcoholics die of suicide.

I told them about the pain that teens suffer because they drink: the rape of the girl passed out at the party, the unintended intercourse, the sexually transmitted diseases, the unwanted pregnancies, and the arrests for DUI and MIP.

I presented the many health risks of alcohol: cancer, osteoporosis, hepatitis, insomnia, reflux disease, fetal alcohol syndrome, and many more.

I related how alcohol prevents teens’ brains, principally the pre-frontal cortex, from maturing. That is the area of the brain important for judgment, decision-making, and impulse control.

I told them that they had to watch out for each other when there was alcohol present, that they should always go to parties with a friend, and each should commit to keeping the other safe.

The redhead in the front row began to cry. “How do you get someone to stop?” she almost sobbed.

I explained that the person drinking had to be willing to stop and then told her about the intervention process.

I told them that we have ordered bracelets stating, “I’ve got your back” and that they could have one to wear if they promised to look out for each other when they were at a party.

When finished speaking, I asked for questions. There were many good ones. The best one came from a bronze-skinned girl in the back.

“If alcohol is so bad, how come it is legal?”

Out of the mouths of babes.

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Oct 31, 2011 Blog

Tue, 01 Nov 2011 08:24:06 -0700

OCTOBER 31, 2011 BLOG

AMY’S TRAGIC END

Amy Winehouse, popular singer-songwriter, was found dead in her home by a security guard on July 23. Empty vodka bottles were strewn about. Paramedics arriving on the scene described her as “beyond help.”

Last week, coroner Suzanne Greenaway announced that Winehouse suffered a “death by misadventure”; the “unintended consequence of such potentially fatal levels (of alcohol) was her sudden and unexpected death.”

Dr. Greenaway obviously excels in double speak.

A “misadventure”?

“unintended consequence”?

“Potentially fatal”?

“Unexpected death”?

Amy Winehouse had a serious and recurring problem with alcohol. She had recently relapsed after a brief time of sobriety. As so often happens in a relapse, the disease rapidly progresses.

In June, she abruptly canceled her European come back tour. Swaying and slurring her way thorough barely recognizable numbers, she was jeered and booed off the stage in Belgrade.

Amy reached the point of no return on July 23.

Her personal physician, Dr. Christina Romete, talked with her on the phone the night before her death. While Amy was slurring her words, Dr. Romete asked when she would quit. Amy told her they would talk that week end.

She never made it.

Her blood alcohol was 0.40. Not a “potentially fatal” level, an indisputably fatal level. The small amount of Librium in her system (used to prevent seizures in people withdrawing from alcohol) may have hastened her respiratory arrest.

At 0.40 percent, the brainstem, the center of all vital functions, shuts down. Temperature control, blood pressure, and breathing are suppressed.

Once the breathing stops, the heart can only last a minute or two. A fatal arrhythmia or cardiac standstill is the terminal event.

The beverage of choice for alcohol poisoning is some form of distilled spirits. Vodka is a favorite. The high alcohol content (80 proof/40%) allows the blood alcohol to rise very quickly, taking the victim through the stages of intoxication without the body being able to eliminate it. If the level reaches 0.40 % before the victim vomits, the end soon follows.

Unfortunately, alcohol poisoning is a common cause of death in teens in the U.S.

Parents, please educate your kids on the dangers of alcohol poisoning. Don’t wait. They may not appear to be listening, but they will remember what you say. Better yet, read Chapter 5 “Dying of Acute Alcohol Poisoning” in The Sobering Truth together with them. The vivid description of the process of death by acute alcohol consumption will make an impression.

Alcohol kills 2.5 million people worldwide each year.

You only read the high profile stories.

They are all as tragic as Amy’s.

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October 13 Blog

Thu, 13 Oct 2011 22:13:51 -0700

October 13, 2011 Blog

THE ALCOHOL-BREAST CANCER CONNECTION

Sarah is dying of breast cancer after 21 years. She had surgery in 1990 on her right breast and had two positive nodes in her axilla. She had post-operative radiation and was disease free for five years. Then it came back in one of her ribs and a vertebra.

She has been on chemotherapy intermittently for fifteen years. One by one the chemo drugs were used, initially with success. Eventually, the tumor would become resistant to the drug and they would switch to another.

The latest drugs are novel drugs that prevent blood vessels from growing, thus starving the tumors. Sometimes they are remarkably effective. They were in Sarah’s case. They have been working for over five years.

Until now.

Slowly, she is losing the battle. There are tumors in her liver and the scans show they are growing.

Sarah had none of the traditional risk factors for breast cancer. She had three children and breastfed them all. She had no family history of breast cancer. She never took hormone replacement because of a possible link to breast cancer.

But she did drink a moderate amount of alcohol, and continues to.

Back then we didn’t know that alcohol could cause breast cancer. Now we do. The awakening was finding a group of women in Marin County with a 65 % increase in breast cancer over control populations. Epidemiologists swarmed into the area to determine what these women did that was different than the control population.

They drank wine.

Since then, more evidence has accumulated that breast cancer is caused by alcohol. They have even been able to construct a mathematical formula. For every ounce of alcohol a woman drinks per day, her risk of breast cancer increases by 5%.

Sarah still drinks moderately when she is not on chemo.

The same women that eschew hormone replacement because of its slight and controversial role in causing breast cancer will drink one or two glasses of wine daily.

Less well known but every bit as important is the knowledge that drinking alcohol can facilitate the spread (metastasis) of cancer. It does so by suppressing the immune system, specifically the natural killer T-cells that are critical in the body’s defense against the formation and the spread of cancer.

People refuse to listen to what they do not want to hear.

Ironically, in a move that demonstrates incredible ignorance or ironclad denial, our local cancer society’s fundraiser was…you guessed it…a wine tasting.

October is breast cancer awareness month.

Every month is “alcohol causes nine different kinds of cancer month”.

Spread the word.

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September 28, 2011 blog

Wed, 28 Sep 2011 22:14:40 -0700

September 27, 2011 Blog

Alcohol claimed another young life last week.

This one never made the paper; it is unclear why.

A wedding was scheduled last Saturday at one of the cliff hotels near Shell Beach, CA. Friday night, after the rehearsal dinner, a few members of the wedding party found their way into the hotel hot tub. After a dip in the tub, Chris, tired and drunk, said he wanted to go to bed. Jenny told him to go ahead and that she’d be along soon.

Chris fell asleep immediately. Sometime later, he awakened to find that Jenny wasn’t back. He dressed quickly and rushed to the hot tub.

He was seized with panic as he ran down the corridor, then overcome with shock.

Jenny had sunk beneath the surface. One look and he knew she was dead. Beside her, the bottle of Jack Daniels she clutched until the end.

Hundreds of drunken people drown in hot tubs annually. The hot water and the alcohol cause dilation of blood vessels that can precipitously drop a person’s blood pressure, so much so that they pass out. If they are drunk enough, the shock of breathing water doesn’t awaken them. A minute or two later, the heart stops.

Chris will never recover. He will always be haunted by Jenny’s lifeless body underwater. He could have saved her by insisting that she go to the room with him.

Two lives lost. One continues, devastated. The other ended at age 20.

Tragedy, abetted by alcohol.

The wedding occurred as planned.

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9/20/11 blog

Fri, 23 Sep 2011 22:22:25 -0700

September 20, 2011 BLOG

“EVERY HIGH SCHOOL SENIOR IN THE COUNTRY SHOULD READ YOUR BOOK.”

I have known Bev for twenty years. A special education teacher and a mother of three boys, she is bright, well spoken, and intuitive. Her oldest started college this week. He was an outstanding student at the local high school but she was aware that he had been drinking and experimenting with drugs since his junior year. She shared this with me as I did her annual skin exam yesterday.

“Ginny Taylor and I were talking and we both agree that every high school senior in the country should read your book.”

“Really, that’s very kind.”

“No, I mean it.”

“Did George read it?”

“I asked him to when I brought it home, but he gave me this ‘Oh, brother, Mom’ look. But I noticed that it had been opened, and later, that the pages had clearly been folded, so I am pretty sure he read it. That’s all I want. I want him to read about that young boy who died of alcohol poisoning, and the one who died of cirrhosis. I want him to remember what the DUI felt like, and how the boy felt when he wrecked his car and killed his best friend.”

“It may be a few years from now, but, hopefully, those memories will have stayed with him, and some day they may help him to make the right decision, to see things more clearly.”

“May be it will save his life.”

It has been my mission from the beginning to create a message that will change minds and to save lives.

I can see it happening.

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Stop self-service sale of alcohol

Thu, 08 Sep 2011 14:16:13 -0700

September 8, 2011 BLOG

STOP THE SELF-SERVICE SALE OF ALCOHOL

Go to Alcohol Justice website. There you will learn that there is a bill before California Legislature that will prohibit sale of alcohol at self-service check outs. There you will find the names and phone numbers of the state senators whose vote we need to make this measure pass.

One of the few strategies we have to curb under age drinking is to limit access. This measure will help. Remember that 25% of alcoholics are teens and that the younger a person begins to drink, the more likely they are to become alcoholic.

We all have to do our part to stem the tide.

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September 6, 2011 BLOG

Tue, 06 Sep 2011 21:00:49 -0700

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.

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August 28, 2011 Blog

Sun, 28 Aug 2011 20:56:00 -0700

August 28, 2011 Blog

WHAT WAS HE THINKING?

Dateline: Baton Rouge, LA

LSU star quarterback, Jordan Jefferson, was arrested and charged Friday, August 26 with second degree battery for a fight the previous Saturday night/Sunday morning in the parking lot of Shady’s Bar in Baton Rouge.

At least one person and possibly two were seriously injured. Reserve linebacker Josh Johns was also arrested

Several eyewitnesses reported that they saw Jefferson kick one of the victims in the face.

Jefferson was to lead the LSU Tigers, fourth ranked in the preseason polls, in a quest for the national championship. Their first game of the year, September 3, against the third ranked Oregon figures to be a game that will make or break both teams’ season.

Jefferson has won twenty-four games in his career at LSU. In his senior season, he had a chance to break the record of thirty winning games. He was going to be watched carefully by NFL scouts all year, and a good season might well have ended with a high draft position and a lucrative contract to play on Sundays next year.

With all this on the line, one has to ask a few questions:

Why was Jefferson at Shady's?
What was he doing in the parking lot at 1:30 AM?
Why did he allow himself to get involved in a fight?
How could he put his whole future on the line?

WHAT WAS HE THINKING?

· The answer, of course, is that he wasn’t thinking. He was drinking and the alcohol had turned off the judgment and impulse control part of his brain in the orbitofrontal cortex.

Alcohol does that.

It also made him more aggressive and more prone to become physical.

Alcohol does that also.

Sadly, Jordan may have ruined his senior season. He may have turned a life of promise into a train wreck.

Would this have happened if he hadn’t been drinking?

Not likely.

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Some cracks in Big Alcohol's armor

Wed, 10 Aug 2011 20:46:22 -0700

August 10, 2011

SOME CRACKS IN BIG ALCOHOL'S ARMOR

The website Alcohol Justice (formerly the Marin Institute), a strong voice on the negative effects of alcohol, reported today that the LosAngeles City Council Public Works Committee has recommended banning alcohol advertisements on their buses and a proposal has been made to ban them from the bus benches across the city. The Committee agreed with the Coalition to Ban Alcohol Advertising from Public Property that the research is clear: the more alcohol advertisements young people see, the more likely they are to drink and drink to excess. The proposed 10-year contract with Martin Outdoor Media, LLC, will reflect that change. But...the City Council has to vote to approve.

Changes like these are showing up in cities all over the country. There is change in the wind. People are beginning to acknowledge the epidemic of teen drinking, alcoholism, and suicide.

There is something reminiscent here of the bans on tobacco ads that accompanied the avalanche of scientific proof of the hazards of smoking.

The strategists in the planning rooms of Big Alcohol must be getting a little nervous. There is a tiny crack in the wall of their propaganda armor. For now, they have the money and the public relations and advertising people to increase the volume of their omnipresent ads. Well not exactly omnipresent. They aren't going to be on buses or benches in Los Angeles anymore. That is, if the City Council approves.

You can help. If you live in Los Angeles, call, write, or email your councilman. Visit the Alcohol Justice website for details.

It's a start.

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August 7, 2011 BLOG

Sun, 07 Aug 2011 11:50:46 -0700

August 7, 2011

Last night while I was eating dinner, I saw the last half-hour of the NFL Hall of Fame induction ceremonies. I heard acceptance and thank you speeches from Shannon Sharp, a prolific receiver who played with Denver, Marshall Faulk, whose combined rushing and receiving numbers rank him as one of the best all-around backs of all time, and the incomparable Dion Sanders, aka "Prime Time," the electrifying corner back who literally changed the game.

Of note, none ever had a scandal during their careers: no DUIs, sexual assaults, fights in night clubs, allegations of gambling. In addition to being great players, they were sober and respectful men. They all had one thing in common: mothers who taught them good manners, good work habits, and the ills of drugs and alcohol.

As Shannon Sharp said,"When I went off to college at Savannah State when I was eighteen, my Momma didn't have to tell me not to get involved in drugs and alcohol. She had been teaching me that all my life, and presenting herself a a good role model."

What we say to kids matters. More importantly, how we live our lives has a huge impact on our children and other young people around us.

When I lectured to the leadership class at Laguna Middle School, I asked the young people what predisposed kids their age to drink. One very attentive thirteen-year-old blond girl responded, "Their parents set a bad example."

What we do may be much more important than what we say, much more so than we realize.

Let your kids know what you think about them drinking, and hopefully be a good role model with your drinking habits.

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July 20, 2011 Blog

Wed, 20 Jul 2011 21:23:00 -0700

July 20, 2011 Blog

“I need to warn you. I drink a lot.”

Since I got sober, I am a little insulated from the world of the drinker. I see the drunks falling down outside the bar next to my meeting on Friday night, guys vomiting in the alley, but I don’t get to watch a week’s worth of drinking in the real world very often.

I did last week.

It was a week of scuba diving in Fiji at a beautiful resort. Three groups of divers, each from a dive shop elsewhere, and then a few stragglers, including us.

At table one, there were the ex-military, faded tattooed and big paunched boys from Phoenix, some with large breasted (or implanted) Mamas.

At table two, there was the tea party crowd from Oklahoma, equally paunched but fewer tattoos and smokers.

And lastly, at table three, four rather ordinary middle-aged divers from Texas, a French Canadian couple travelling around the world, and us.

I knew we were in for an interesting week when the bus carrying us across the island on our way to the resort stopped in a small town half way for shopping and a pit stop. When we loaded back on, we were accompanied by ten cases of Fiji Gold beer for the Phoenix crowd, and seven cases of Fiji Gold and Fiji Bitter for the Sooners. There was a big sign above the driver’s seat prohibiting any beverage on the bus, but caps were cracked and there were several beers apiece on the second half of the journey.

That was just the beginning. The party in the bure(cottage) next to ours, housing the dive shop owner from Phoenix, lasted all afternoon, and the shrill voice of his wife rang out between puffs on her cigarette.

At dinner, I heard the owner tell one of the younger members of the group,

“I need to warn you, I drink a lot.”

Not an embellishment.

I was afraid the party would resume after dinner, but the long trip and the beer meant a quiet night for the sober divers from SLO.

The cardinal rule of scuba is never to dive after drinking. It clouds your judgment and decreases your reaction time in an emergency.

Apparently, that’s one the Phoenix and Oklahoma group never learned. Or chose to ignore.

It was clear from the outset that both groups were on a drinking trip where they would dive rather than a dive trip where they might drink.

It was amazing to return to a world that I once lived in: a world where your social life and activities revolved around drinking.

Later in the week, I got a look at some cross-cultural drinking. A Chinese couple from Hong Kong arrived to do some big game fishing. He was a stock broker who texted through dinner, and she a cute pixie who liked red wine. Totally westernized, he drank Chevas Regal on ice, doubles, and Napa Merlots were her fancy. I watched him down four through dinner and she an equal number. She almost slipped off the bridge over the pool on the way to their bure and we didn’t see them at breakfast the next morning.

The beer was gone midweek and the bar got busy. The two-dollar beers from town became the seven-dollar beers on the tab. There was a lot of griping but no less drinking.

From my sober viewpoint, I felt sorry for folks who had to medicate themselves to have fun and whose social acceptance required inebriation. It’s sad but I am sure that is the way it is for many of our young people today.

You are really out of it if you don’t drink.

That’s a high price to belong.

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July 4, 2011 blog

Wed, 06 Jul 2011 17:14:15 -0700

July 4, 2011 Blog

A NEW APPRECIATION FOR FREEDOM

Yesterday, I helped a friend, Jim Brabeck, conduct a communion service at Juvenile Hall.

I arrived at 10:15 AM, met Jim, and entered the facility. We surrendered our car keys, went through four electronically controlled doors, and entered the large multi-purpose meeting room. Fifteen young people entered from different directions, different parts of the facility, and took seats. Watchful staff stood on all sides of the group.

I looked out at the inmates, all clad in green except for a young black man with leg irons in the front row. He was in bright orange. They were not much older than children, and most had a look of sadness and fear. A young woman in the back row sobbed through the entire service, and wrung her hands.

The gospel was so fitting: Matthew: “My yoke is easy, my burden is light.” Jim talked about forgiveness and starting over. The audience was attentive.

After the service, Jim asked me to speak. He introduced me as a doctor who ran 100 miles on foot over the mountains, rode the same 100 on horseback, initiated the Liberty tattoo program in our county, and who diagnosed his good friend with melanoma and, with the aid of medication, gave him seven years of good life before the melanoma came back and took it.

I explained that I was a recovering high functioning alcoholic with ten years sober. I gave them some statistics:

· 2.5 million people died last year worldwide from alcohol, more than HIV, Tuberculosis, and War. The U.S. contribution was 125,000.

· The leading cause of death in their age group, that is men 15-56 years old, was alcohol.

· A quarter of all alcoholics are teens.

· The younger a person begins drinking, the more likely he/she is to become alcoholic.

I talked about how alcohol affected the centers of the brain that control judgment and impulse control and that’s why people do stupid things when they drink. I asked them if they had ever done anything stupid when drunk and most nodded “yes”.

I explained that their brains were not fully mature yet, especially those judgment and impulse-control centers. And the tragedy is, I said, as long as a young person keeps drinking, that maturity never happens.

That’s why we see thirty-five year old alcoholics who are emotionally sixteen. That’s why sixty percent of our prison population has a history of alcoholism.

I told them that someday, if they make wise decisions, they may get their freedom back. I told them to never forget what got them here, and if alcohol played a role, that they needed to remember that. They needed to be honest and consider the cost.

I pray that they were listening and that they will remember. If a single one does, my morning at Juvenile Hall was worth it.

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June 20, 2011 Blog

Tue, 21 Jun 2011 06:02:42 -0700

June 20, 2011 BLOG

WHEN WILL THEY EVER LEARN

Alcohol kills 2.5 million people worldwide annually. That translates into 125,000 annually in the U.S. To put that in perspective, the biggest killer in our country is heart disease, accounting for 500,000 deaths annually. Surprisingly, alcohol accounts for one-quarter the number that heart disease does. That’s a lot of deaths, a great many preventable.

Between 10,000 and 15,000 of those will die in auto accidents. Many are young men.

It happened again last Friday night. Four young men driving west on Avila Drive toward the beach encountered a deadly curve that the CHP have nicknamed “Screech Owl,” presumably because of the sound of rubber on pavement. It is really two curves: a tight left hand turn followed by a tight right.

The driver was drunk and going too fast. He started to slide right, over-corrected left, then back right and lost it. The vehicle rolled off the road onto the golf course.

The results: Two dead, one in ICU, and the driver in jail.

Young mens’ brains do not mature until they are twenty-five. One of the slowest to mature is an area in the pre-frontal cortex that is responsible for impulse control, judgment, and decision-making. There is evidence that with chronic alcoholism, it will never develop completely. That is due to alcohol’s inhibition of cholesterol synthesis in the brain. Cholesterol is a critical building block of nerve cell walls and a constituent of myelin which makes up the sheath that covers and insulates nerve processes, axons and dendrites, throughout the brain and nervous system.

And there are people who want to lower the drinking age to eighteen.

They clearly don’t know the facts.

They clearly don’t read the grim stories in the newspaper.

N.B. If you haven’t already seen it, there is a remarkable video on my website. It was produced in Australia in a campaign to reduce deaths from drunk driving. Go to excerpts/videos and click on Australian campaign. Share it with your children and young adult drivers.

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June 12, 2010 Blog

Sun, 12 Jun 2011 21:42:21 -0700

Carrying your bottom.

I heard a friend share the other night that he had carried his bottom a long time before he finally gave up. I understood exactly what he meant. In the last year of my drinking, I was miserable. I didn't want to drink, but I couldn't help myself. The worst thing of all, when I did drink, it didn't work for me anymore. It just made me depressed. I understand now what was happening. Alcohol chronically decreases your neurons' receptors for dopamine, the feel good neurotransmitter that gives you the alcoholic high. Having less receptors means that even though you might have high levels of dopamine in the synaptic cleft between neurons, without receptors it can't get into the cells and work its magic. The effect is a perceived dopamine deficiency. You feel bad, depressed, like you don't have enough of something you really need. That is true; you don't.

I carried my bottom way too long. A dozen failed attempts to quit but not long enough for my neurons to right themselves. A daily feeling of failure, shame, and self-contempt. It was a terrible time. If it hadn't been for my run-in with the young boy, I might still be carrying it. Shudder the thought.

In the last month I have learned a vast amount more about alcohol, especially about the physiology of addiction. I learned it at the seminar we put on at the Vets' Hall in May and little by little, I'd like to share it with you.

If any of you out there are still carrying your bottoms, but them down. There is a new world of sobriety out there for you and you won't believe the peace and serenity that is waiting.

Peace,

jeff

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May 14, 2011 Blog

Sat, 14 May 2011 21:18:55 -0700

May 14, 2011 blog

THE WEEPING LIVER

Most people in her inner circle knew that Sandra was drinking heavily. After golf at the country club, a couple of glasses of wine with lunch, and martinis in the evening. Lots of people drink that heavily. Nobody thought much of it.

Until her belly started to swell.

Within two weeks she looked six months pregnant.

Then, her eyes turned yellow.

There was no sign this was coming. Almost overnight the cirrhosis became apparent. A scarred liver blocks the flow of blood from the massive system of portal veins coming from the entire digestive tract. The liver is engorged and tender. The back pressure causes the liver to ooze fluid into the abdominal cavity. It is called ascites and it makes the belly swell.

It is a sign of a very sick liver.

The fluid built up to the point that she had trouble breathing, and a lot of pain. They tapped her belly with a long needle and took of several liters of a straw-colored fluid. Then she could breathe more easily, for a couple of days.

On Wednesday, Sandra was at Stanford inquiring about a transplant. Mickey Mantle had one didn't he? Why not her?

She has to have counseling first. She has to demonstrate that she can quit. Then they will consider putting her on the list. In the meantime, the toxins and ammonia that the liver normally detoxifies will build up. The coarse tremor Sandra has is from the ammonia. To a county hospital intern it is a "liver flap", and it is the sign of imminent doom.

A transplant could take a while.

Probably too long a while to save Sandra.

-jh-

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May 5, 2011 Blog

Thu, 05 May 2011 21:15:34 -0700

May 5, 2011 Blog

HE TOOK A LONG TIME DYING

There was an obituary in the paper yesterday for George Larson. I saw his doc in the hospital last week and he told me he was on hospice. I just couldn't believe it. He had end-stage liver disease for a decade. He even quit for a while but he could never stay quit.

I first met George thirty years ago. he came to see me as a patient. He had some problems with eczema and a few funny moles that needed watching. He was a Cal Poly professor and a nice guy. We were both from southern California and born within a week of each other.

I saw him annually for a skin check. I had no idea of his drinking problem until about fifteen years ago when he was hospitalized for vomiting blood. It was alcoholic gastritis and after discharge, he quit for a while.

Over the years, I watched George grow heavy, then morbidly obese. When we first met, he was on no medications. At last year's check-up, he was on drugs for high blood pressure, diabetes, cholesterol, and acid reflux. Alcohol caused or contributed to all of his medical problems.

Ten years ago, he developed a large ulcer on his protuberant lower abdomen. It was deep with a black crust in the center, and I was worried about infection and possibly even gangrene in a diabetic. The ulcer had irregular, angular edges, not something nature could produce. George was creating it himself, out of some dark alcoholic need that went unspoken. I finally got it healed but at weekly visits he showed up very drunk several times and was rude to my staff and belligerent to me. I considered firing him as a patient but he went to rehab and sent me a letter of apology. I gave in.

Six months later, he had his first bleed from esophageal varices. These huge varicose veins are caused by greatly increased back pressure in the portal vein due to a scarred liver. The mucosa overlying these dilated veins was paper thin and prone to tear easily, especially when a patient vomits, which alcoholics are liable to do when they drink. Once torn, the varice can dump five or six units of blood into the stomach in a matter of minutes, and shock and death rapidly follow. In the old days, the mortality from bleeding varices was 50%. Now they place bands around them to reinforce them, and often chronic alcoholics survive multiple bleeds.

George just couldn't stay quit, even after a near-death experience with bleeding varices. Little by little the scar tissue built up in his liver and it was less able to detoxify all the waste products in the bloodstream, especially the ammonia resultant from dietary protein break down. George was given a low protein diet but he observed that no better than abstaining from alcohol.

Several months ago, George reached the tipping point. As the liver failed, so went the kidneys. So-called hepatorenal failure is a common end for many alcoholics who used to die of g.i. bleeds.

As the ammonia and other waste products built up, George began a peculiar flapping of his hands at the wrist. This 'liver flap" was accompanied by stupor and severe jaundice. Yellow skin and bright yellow eyes led the way to coma as the liver and kidneys shut down simultaneously.

Within a week, George was dead.

But George was dying thirty years ago, his fate sealed by the toxic effect of the alcohol and his inability to quit.

One-third of all alcoholics die of their disease.

It just may take a while.

-jh-

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