Wednesday November 28, 2012

There are many reasons why people abuse alcohol. It is often referred to as "self-medication" because people use alcohol to alleviate pain and suffering.

In today's world, it is a miracle that a greater proportion of the population is not self-medicating with so many available substances.

Thankfully, most of us have intact coping mechanisms and we find ways to protect ourselves from the pain of simply living in this crazy world.

When someone starts down the road of alcohol abuse they begin to wage war on one of the most resilient organs in the human body. The liver takes the brunt of the abuse and it takes many years and many gallons of alcoholic beverages to do permanent damage.

Only a few years ago liver experts believed that once alcohol started damaging the liver that the process was irreversible. Now they know that, up to a certain point, some of the damage may be reversed and the liver destruction process somewhat halted if a person stops drinking. The problem is that those points are different for each person and it is difficult to predict when someone has crossed the point of no return.

Once the liver starts feeling the damaging effects of years of alcohol abuse a cascade of events is set in motion. Along the way another organ, the brain, becomes impaired both directly and indirectly. At first the changes are subtle and even someone living with an alcoholic may not notice the memory lapses and behavior changes.


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Eventually all subtlety is gone.

As the liver fails, levels of ammonia build up in the blood and that ammonia affects the brain. The person becomes completely irrational and they often become delirious and paranoid and even their closest relatives cannot reason with them. It is one of the most horrific nightmares of alcoholism.

There is a drug that can lower the ammonia level, but as the liver damage gets worse that drug becomes less and less effective. A person may have already stopped drinking but the liver damage progression can continue to the point where the brain damage is irreversible no matter what measures are taken.

When you consider that the liver is responsible for about 1,500 bio-chemical reactions in the body it is no surprise that the problems caused by a failing liver become very difficult to treat. I remember a doctor friend who once said to me that he felt completely helpless and hopeless when dealing with alcoholics with advanced liver disease because there was little he could do to change the problems caused by liver damage. He knew that his patients were going to consume more and more of his time with less and less hope for a positive outcome.

As the liver begins to fail and other organs, such as the kidneys, are affected it becomes difficult for the body to control levels of basic chemicals such as sodium and potassium. As those things happen a person is at greater risk for seizures or cardiac arrhythmias. One problem crops up and may be fixed for a short time and then three more problems emerge while that one is being treated.

Then there is the scourge of portal hypertension. As alcoholic cirrhosis advances the liver becomes smaller and harder and the result is that the blood vessels of the liver get squeezed and pressure builds up behind them. Fluid is pushed out of the circulation and into the belly and a person develops ascites. They may look nine months pregnant and the fluid buildup often continues until they die. The only treatment is to have a needle inserted into the belly and have the fluid drained every few weeks. Life becomes miserable when someone reaches this point.

When things get so worse that a person is closer to death than life their kidneys may start to fail. It is a common syndrome in alcoholic liver disease called the hepato-renal syndrome. It is generally irreversible and is a good indication that a person should start getting their affairs in order.

As the liver reaches its final stages of failure all of the drugs and treatments in the world have no effect. The only hope is a liver transplant and that is an option for some. For others, they begin to get weaker and weaker as their brains fail them and their bodies do the same. Fluid builds up everywhere and bleeding happens without provocation. Each breath becomes an agonizing effort until all of the poisons build up to a merciful level and the fog of coma takes over.

Richard Davis is a registered nurse and executive director of Vermont Citizens Campaign for Health. He writes from Guilford and welcomes comments at rbdav@comcast.net.