Dear Dr. Gott: I have a question about my fiance. He is a 48-year-old alcoholic with cirrhosis of the liver. He also has hypertension, probably from his drinking, for which he takes two medications.
He swears he is going to stop drinking before we get married.
I have been a nurse for 33 years. Can a person have a lot (enough to soak through his underpants, jeans and bed sheets) of rectal bleeding (fresh, red blood) because of an ulcer or drinking? He refuses to have a colonoscopy or a lower GI series and won’t even tell his primary-care physician.
Dear Reader: Your fiance needs to see a physician immediately if he is experiencing rectal bleeding, especially if it is as severe as you claim.
Rectal bleeding can have many causes, ranging from benign hemorrhoids and intestinal polyps to ulcerative colitis and malignant colon cancer. Alcohol abuse and cirrhosis can also lead to easy bleeding. Hypertension can weaken blood vessels, and some medications used to treat it carry the side effects of easy bleeding, ulcers and more.
Your fiance is behaving very irresponsibly in regards to his health. By refusing to seek medical help, he is gambling with his life and, unfortunately, unless he steps up to the plate and makes drastic changes, the outcome will not be favorable.
Chronic alcohol abuse has already damaged his liver. If further damage is inflicted, he may well need a new liver, but his chances of receiving one are slim to none because he is an active alcoholic. Further liver damage may be taking place as a consequence of his hypertension medication.
Perhaps now is the time to call, write or make an appointment with his physician to let him know about your concerns and the current situation. While you are probably not privy to what your fiance and his doctor discuss (because of HIPAA), you can at least inform the doctor so he or she can attempt to provide proper testing and treatment.
Before you marry this man, I urge you to sit down and discuss your concerns and fears about his health and addiction. While you may love him, you cannot change him. Unless he is willing to help himself, you will be further committing to a very unhealthy relationship in which one or both of you may end up emotionally and/or physically hurt.
I recommend you get your facts together, write down a list of your concerns and talk it out. If he is unable or unwilling to get the help he needs, now may be your best chance to walk away. I don’t want to sound cruel, but your future husband is displaying behavior that clearly shows he does not care enough about you to take care of himself. He is making you suffer for his problems, which is highly unfair and inconsiderate.
There are several options for both of you. Alcoholics Anonymous (www.aa.org) is a great resource for treating alcohol addictions. Al-Anon/Alateen (www.al-anon.alateen.org, 1-888-4AL-ANON) is a support group for the friends and families of alcoholics. There are also hospital detox and inpatient and outpatient rehabilitation facilities available throughout the country.
Dear Dr. Gott: I have been diagnosed with intermittent claudication, but I know almost nothing about it. I would like to have as much information about this disease as possible. It seems that the veins and arteries in my legs are not providing the necessary flow of blood. My feet feel like blocks of ice and are painful. My doctors have been referring me to other physicians, but none of them has really explained the condition to me. I have tried to find reading material without success.
I will be very grateful for anything you can provide me.
Dear Reader: You are correct that intermittent claudication is a condition that causes the arteries to restrict oxygen-rich blood to the muscles, usually of the calves, thighs and/or buttocks. This leads to limping and an aching, tired or burning pain in the affected muscles during exercise and walking that disappears after several minutes of rest.
Claudication is generally not a diagnosis but rather a symptom of peripheral-artery disease (PAD), which is often caused by atherosclerosis (a buildup of plaque in the arteries). Atherosclerosis is likely due to blood-vessel damage, which is most commonly caused by high cholesterol levels, diabetes and smoking. Other causes of atherosclerosis and claudication include age, family history, obesity and high blood pressure.
Treatment usually starts with home care. This involves diet modifications. A low-fat, low-salt diet may help reduce cholesterol and blood pressure, limiting further plaque buildup. It is also important to reduce or eliminate alcohol intake. It is necessary to STOP smoking, avoid tight shoes and avoid placing hot or cold items on the leg muscles (to reduce the amount of expansion and constriction of the blood vessels). Modifying exercise routines to include more frequent breaks may improve function by causing new vessels to form, thus bypassing the narrowed section of the affected artery.
Medication to improve circulation may be prescribed, and may include cholesterol-lowering statins and anticoagulants. There are two surgical procedures commonly performed in qualifying patients. The first is angioplasty, which breaks up the plaque by inserting a balloon catheter into the artery and then expanding it. The second is more invasive and involves removing a healthy blood vessel from one area of the body to replace the affected vessel in the leg.
I urge you to request a referral to a vascular surgeon, who can examine you, order any necessary testing and provide you with your best treatment options.
Dear Dr. Gott: Please give me some insight on polymyalgia. Within one year, I’ve had three friends diagnosed with it. What causes it? Is it curable? Is it related to fibromyalgia?
Dear Reader: Polymyalgia rheumatica (PMR) is a disorder that causes stiffness and muscle aches, primarily of the neck, shoulders, upper arms, thighs and hips. While the condition can develop gradually, it can also appear almost overnight.
Because its symptoms are so similar to other conditions (rheumatoid arthritis, polymyositis, etc.), testing needs to be performed by a physician. This primarily consists of a physical examination, patient history (such as when symptoms started) and blood work.
PMR and fibromyalgia (FM) often cause similar symptoms but differ in several important ways. The first is that PMR is caused by inflammation; the cause of FM is unknown. Next, FM is usually chronic, meaning it lasts for many years or a lifetime; PMR ordinarily resolves within two years. And, finally, PMR is thought to be caused by an abnormal immune response, while fibromyalgia is believed to be caused by abnormal brain chemicals and signals.
Treatment consists primarily of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, which can be effective in treating minor pain and stiffness. Beyond that, corticosteroids prescribed by a primary-care physician or rheumatologist should provide relief.
Persistent or severe cases may require the help of a pain specialist or pain clinic. Physical and hydrotherapy and other exercise programs may also help. Alcohol, salt, fat, and sugar intakes should be limited. The diet should consist primarily of fresh produce, lean meats and fish, and whole grains. Diet modifications can aid the immune system and may provide positive results for many conditions, not just PMR. Proper diet and exercise are the keys to a healthful life.
To provide related information, I am sending you a copy of my Health Report “Managing Chronic Pain.” Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a check or money order for $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.
Dr. Peter Gott is a retired physician and the author of the book “Dr. Gott’s No Flour, No Sugar Diet,” available at most chain and independent bookstores, and the recently published “Dr. Gott’s No Flour, No Sugar Cookbook.