Avoiding liquids you can light


With alcohol, here is the gist,

For the drink that you hold in your fist

When combined with a virus

It just might require us

To name you on our transplant list.        

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  In May 2010, I left my position of 23 years, and honoring my non-compete clause, traveled for a year doing locum tenens work.  In June of 2011 I joined up with the Community Health Center, which provides care for the underserved.  I’m now working part-time, which, for a doctor, means 54 hours a week.

The patient gave me permission to include more information than I have.

A remarkable organ, the liver can bounce back from terrible damage in the absence of diffuse scarring.  Capable of detoxifying a large number of poisons, it regulates carbohydrate, fat, and protein metabolism. 

When I started into medical school, we knew about infectious hepatitis (now hepatitis A) and serum hepatitis (hepatitis B). By the time I finished residency we had named a third virus non-A, non-B hepatitis, but this creative moniker didn’t last long and we now know it as hepatitis C.   Others exist, but these three very different diseases occupy most of our concerns for viral hepatitis. 

The last hepatitis A outbreak I saw happened in 1986 in on the Winnebago Reservation; the Tribal Health Department rose to the challenge and vaccinated all the contacts in less than 48 hours. 

The vaccines for hepatitis A and B stand as our first line of defense, and we don’t see much of either any more. 

Nobody dies from hepatitis A but people get awfully sick with it. 

Hepatitis B remains the most infectious particle known; a teaspoon of blood infected with it stirred into a swimming pool full of water would still transmit the virus.  Contracted in childhood it can lead to chronic active hepatitis, thence to cirrhosis and cancer; contracted in adulthood, the body generally clears the virus from circulation.

We have no good vaccine for hepatitis C, but in the last ten years I have seen treatment go from 10% curative to 60% curative (but it lasts 9 months and costs hundreds of thousands of dollars).  Better treatments loom on the horizon.

Hepatitis C multiplies the effect of alcohol on the liver by a factor of 20, and if a person can’t stop drinking during treatment, the treatment does no good.  Thus hepatitis C remains America’s leading cause of cirrhosis requiring liver transplant. 

I recently spoke with a newly diagnosed hepatitis C patient, who, to my surprise, has no interest in alcohol, wants to take the treatment, and has insurance to cover it.  At the very end of the interview I asked about Lysol Spray.  It contains 96% ethyl alcohol, which makes it twice the strength of whiskey.  (It also has a small amount of phenol to make it taste bad and destroy the liver even faster.)

The patient in fact weekly used several cans of Lysol Spray cleaning at home and at work.  I talked about its alcohol content for a few minutes.  Then we sat in stunned silence.  I followed with advice to stay away from volatile solvents in general; the term drew puzzlement from the patient.  After an explanation, the patient said, “Ok, then I need to keep away from any liquid you can light.”

I nodded.  “Well said.  Any objections if I hijack your phrase?”

The patient had none.

I was just doing my job.

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