Or lady, you are 5 times the legal limit.

Yes, you heard correctly blood alcohol of nearly .5. According to health class, that should kill you. It is, however, not uncommon for people with severe alcoholism to reach that number or higher and be coherent while they’re speaking to you. This is what happened tonight.

A very drunk and nauseous patient graced the doorstep of the ER this evening with the need to detox from alcohol. She presented approximately an hour and a half after the last drink, so it is a good chance that the blood alcohol value was far higher.

This is a patient already on a drug to help discourage drinking called Naltrexone. No, not like Antabuse, which will make you sick when you try to drink. Antabuse is no longer widely  prescribed anymore as it is seen as a cruel medication to give someone with alcohol use issues. It makes you sick when you drink. I do see some “old school” providers who are “convinced” that it is part of the treatment to make an alcoholic sick (and they wonder why there is non-compliance in the world). It is a rocky road, and a drug that punishes you for mistakes is just asinine.

An addiction is an addiction and how we approach that should be as individual as each person is. Sure there are a lot of conventional treatments and medications that work. We still need to spend more time at the bedside listening to the story of addiction.

I know, any provider reading this gives the cynical, ugh. Addiction medicine is tough work and is far more complicated than most forms of medicine. The effects of substance use are far-reaching and may involve more than one anatomical system. Time to lace up your “big provider” shoes and deal with the whole condition.

Tonight that addicted person is a person that is under 40 that has severe reflux disease as well as irritable bowel syndrome-related to her severe drinking. She has also developed osteoporosis, a condition often not seen in women under 60, let alone under 40. Her reflux is so bad at times that it mimics cardiac chest pain. Although it is not uncommon for heartburn to make one think they are having heart issues. There is a significant moment comes when you are given a GI cocktail (Benadryl, lidocaine, and Maalox) to drink, and magically you start to feel better. I will tell you from the standpoint of someone who has GERD for other reasons, when that relief hits, it is almost magical. It is also a huge relief to know that the cardiac tests done on you are likely, correctly negative.

GERD is often ignored until it becomes severe. I ignore mine as well as the healthy eating recommendations all the damn time. Hell just now, even with some heartburn and stress over my weight, I managed to chow down on a donut. Yeah, just what I needed after making an effort to have only water and some black coffee last night. That change is tough as fuck and is going to take more work than my brain is thinking.

I have always been on the heavy side. I have had shit-eating habits since I was a kid. In some way, I feel wrong about ragging on my parents for how I was raised, but in many ways not. This is a real struggle, and just like this woman, it has its ups and downs. When you feel you might be making headway, you find yourself with a donut in hand or, in her case, multiple shots of liquor. It is a genuine process that occurs and one that we often are left to ask, “why don’t they just stop?” Well, Chuck, the answer to that question is far from easy. In fact, if I had that answer, I think I wouldn’t have to work nights and could retire tomorrow on the island paradise I have been looking at.

My upbringing was one of gluttony. My mother was a notorious casserole queen who made very caloric rich casseroles. Don’t worry, they were every bit as delicious as you might think, and the concept of a generally balanced meal was a rarity. This part was because my mom was on her own raising myself and my sister (who is as large as I am). With a tight budget, you make cheap, calorie-rich meals to save the meager amount of money you make.

Sugar can be as addictive as anything else and should be treated that way. Tonight’s alcohol intoxication case is indicative of the fact that addiction is everywhere. Treatment is a constant struggle. In her case, one of the meds she took to help her stop drinking was actually facilitating her ability to drink more. We have to watch our patients and patients need to be honest. Adjustments could be easily made that would solve this problem if we only probe and listen.

We quickly write off addiction unless a person is eager to quit. We owe it to them to be anxious to help them, even if it is not their first priority.

Mom, I don’t blame you for anything. Your casseroles were freaking delicious, and many of them I still make today. They always taste like love (and high fat, cholesterol, heart disease, HTN), but I will always love them.

I am actually moving to a more medically managed weight loss next week because. Like my patient tonight, I am really struggling with overeating, and I need to do more than throw my shitty willpower at it in the hopes it may work. Nothing super invasive, more than likely a better exercise program along with dietician support and maybe some weight loss medications. We shall see, and I will definitely be updating my readers with this struggle. Like alcohol, meth, heroin…food can be as powerful an addiction. So join me.

Remember to be the kind of person your mom and your dog hope you are