Category Archives: Alcoholism

Alcoholism: A Family Scourge

I miss my father. He should be around to be granddad to my wonderful boys, helping me raise them to be good men. But he’s not around, dying far too early, from alcoholic cirrhosis of the liver. Only in his mid-60’s, he was a wonderfully warm-hearted man with a deep belly laugh, very much the average-guy Martin Crane to my Frasier Crane-like stuffiness. But he was also an alcoholic who slowly drank himself to death.

I have countless fond memories of us over the years, but I also have nightmare memories of holding his hand as he died in the hospital, in a coma, his skin yellow and lungs filled with fluid as his kidneys and liver finally gave up from the years of toxic abuse. These are memories that no child should have — but so many do.

 

Why is alcoholism such a scourge to society? When compared to many other common diseases such as heart disease, alcoholism has a much more devastating social effect — not just on that person, but also their family, who painfully watch for years, helplessly, as their loved one slides into decline. Yes, many diseases are terrible and affect others; smoking can cause secondhand smoke diseases to family members. But alcoholism is a sad disease, and it’s those bad memories that really haunt families of alcoholics — memories of being afraid as we weave across wintry roads as dad drives home tipsy; memories of mom crying as dad refuses to hand over the car keys; memories of watching his belly get bigger and his memory weakening as his liver starts to fail.

So as we honor Alcohol Awareness Month this April, I’d like to use this opportunity to spread the word about alcoholism, hopefully to help a few people out there.

The first step, as anyone in 12-step programs will tell you, is to admit there may be a problem. If you’re not sure, just answer these four simple questions:

  1. Have you ever felt you needed to Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

If you’ve answered “yes”  to 2 or more, then you indeed may have a problem with alcoholism and may already be causing liver damage. These questions above are called the “CAGE questionnaire” and are used by doctors as a screening tool for alcoholism.

What If You May Be Alcoholic?

First of all, congratulations if you’re honest enough to admit you may have a problem. Secondly, you need to know that you are not alone, and many people and organizations can help you:

  • Your family doctor can check out your liver and kidney health.
  • Some newer medicines, like naltrexone, may actually help you quit drinking; your doctor can discuss these with you.
  • Twelve step programs such as Alcoholics Anonymous aren’t for everyone, and there’s contradictory evidence as to how effective they are. But for many recovering alcoholics, they’ve been a source of strength, all over the world. You can find a list of AA sites in the US here.
  • Psychologists and psychiatrists can help you in many ways, from quitting drinking to processing underlying stresses and depression, to fixing family and job problems related to your drinking.

    dad on the twins second birthday
    My dad with us, at 2 years old. That’s me on the right (I think)

My Dad’s Legacy

Clearly, living through my dad’s illness has had a profound influence on me as a doctor, and I do find myself drawn to these patients. I’m sure it’s partly an effort to make up for what I couldn’t do for my own dad.

But despite all the pain of those later years, my strongest memories are the good ones. I will always remember his laugh, and to this day I vividly remember how he could light up a room. I’d like to end with a poem from Ralph Waldo Emerson, which we used at his wake:

To laugh often and much;
to win the respect of intelligent people
and the affection of children;
to appreciate beauty;
to find the best in others;
to leave the world a bit better
whether by a healthy child,
a garden patch, or a redeemed
social condition; to know even
one life has breathed easier
because you have lived.
This is to have succeeded.

This post was originally published on my new blog at MyFamilyHealthGuide.com. Please follow my new blog! (and my Facebook page

Happy Birthday, Dad. You Died Far Too Young.

Dad Alcoholism Birthday

My dad would have been 76 years old today. “Should have been 76,” I need to clarify — but he died far too early, eight years ago from cirrhosis of the liver. He was a wonderfully warm-hearted man with a hearty laugh, but he was also an alcoholic who slowly drank himself to death. I have countless fond memories of us over the years, but I also have nightmare memories of holding his hand as he died in the hospital, in a coma, his skin yellow and lungs filled with fluid as his kidneys and liver finally gave up from the years of toxic abuse. These are memories that no son should have, but death from alcoholism is an unfortunately common disease in all societies, and my heart aches every time I meet a patient who clearly is along this same destructive path.

Why is alcoholism such a scourge to society? When compared to many other common diseases such as heart disease, alcoholism has a much more devastating social effect — not just on that person, but also their family, who painfully watch for years, helplessly, as their loved one slides into decline. Yes, many diseases are terrible and affect others; smoking can cause secondhand smoke diseases to family members. But it’s those bad memories that really haunt families of alcoholics — memories of being afraid as we weave across wintry roads as dad drives home tipsy; memories of mom crying as dad refuses to hand over the car keys; memories of watching his belly get bigger and his memory weakening as his liver starts to fail.

 

But it’s the final stages of alcoholism and liver cirrhosis that really leave their unwanted stains on their loved ones. Our modern society is now very far removed from death and dying, so it’s hard to convey to people just how awful the last months of a cirrhotic’s life can be. As the liver dies, the body can no longer process normal bodily fluids, so a person’s legs slowly fill with fluid, which slowly travels up to the belly. When their skin and eyes turn yellow, a doctor has a dread in their heart that this person is approaching no return. The final, and most disturbing part for families, is the mental confusion they get. Called hepatic encephalopathy, these patients are initially mildly confused and emotional but then can become quickly comatose. During my residency program I saw many alcoholics repeatedly admitted to the hospital for another burst of confusion; they would be tweaked up with medicines, sent on their way, and be back again in a few weeks. And there was always a last time they’d be admitted, where their liver and kidney simply ran out of steam. Their families would sadly stage a vigil at the bedside, waiting helplessly for the end.

If I sound a bit macabre here, it’s because I want to be. I want society to stop glorifying drunkenness as a pleasant diversion; I want people to take a second look at their constantly drunk companion in Sanlitun and actually wonder if they aren’t really crying out for help. I want Chinese businessmen to resist the social pressure to drink endless rounds of baijiu at dinner. I want to wake up my readers and have them look at their own life and honestly answer these four simple questions:

  1. Have you ever felt you needed to Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

If you’ve answered “yes”  to 2 or more, then you indeed may have a problem with alcoholism and may already be causing liver damage. These questions above are called the “CAGE questionnaire” and are used as a screening tool for alcoholism.

 

What If You May Be Alcoholic?

First of all, congratulations if you’re honest enough to admit you may have a problem. Secondly, you need to know that you are not alone, and many people and organizations can help you:

  • Your family loves you and is worried about you; let them know and get them involved
  • Your family doctor can check out your liver and kidney health.
  • Some newer medicines may actually help you quit drinking; your doctor can discuss these with you
  • Psychologists and psychiatrists can help you in many ways, from quitting drinking to processing underlying stresses and depression, to fixing family and job problems related to your drinking
  • Alcoholics Anonymous continues to be an excellent source of strength for recovering alcoholics, all over the world. Beijing has their own Alcoholics Anonymous branch. Their website mentions a hotline number: 13911389075, and email: [email protected]

My Dad’s Legacy

Clearly, living through my dad’s illness has had a profound influence on me as a doctor, and I do find myself drawn to these patients. I’m sure it’s partly an effort to make up for what I couldn’t do for my own dad.

But despite all the pain of those later years, my strongest memories are the good ones. I will always remember his laugh, and to this day I vividly remember how he could light up a room. I’d like to honor him with a poem from Ralph Waldo Emerson, which we used at his wake:

To laugh often and much;
to win the respect of intelligent people
and the affection of children;
to appreciate beauty;
to find the best in others;
to leave the world a bit better
whether by a healthy child,
a garden patch, or a redeemed
social condition; to know even
one life has breathed easier
because you have lived.
This is to have succeeded.

Happy birthday, dad. I love you, and I wish you were still here.

 

Top Ten Wellness Tips For Beijing Newcomers: Part Two

(Click here for part one, with tips #1-5…)

Tip #6: To Every Thing, There Is A Season.

Beijing has a surprising variety of all four seasons, which I think is a great thing. Spring and fall, the best times of year here, are unfortunately short, but in general you can expect the same seasonal variations you would find in New England or northern Europe. But each season has a few particular oddities:

Winter can be monotonously cold, and last year was quite painfully drawn out. The worst health problems usually include colds and influenza, as well as winter depression. The secret to avoiding the winter blues? Pamper yourself! Here are some personal tips:

  • Buy a foot soak. I bought one on Taobao for 320RMB and I love it; there’s nothing better after a cold day than to soak your feet in a warm, massaging tub with epsom salt thrown in. Add a warm brandy and a portable low-back massager, and I’m in heaven…
  • Keep your skin moist. Dry skin is a major hassle in Beijing, and everyone needs to respect this, or soon enough you’ll be scratching yourself crazy. I think a humidifier in important rooms is a must-have, including at your office. And you almost definitely will need daily use of a good moisturizer.
  • Visit a local hot springs. Beijing has a surprising number of hot spring resorts within an hours drive; my favorite is in the south, in Daxing. They have the added benefit of Turkish flesh-eating fish, and you can also stay overnight.
  • Take a weekend break in a hotel. Forecast calls for -13? Check into a city hotel such as the classy Ritz-Carlton (Huamao) on a Saturday night and just relax all day in their plush lobby, then fall asleep after a spa massage.
  • Take vitamin D. There’s growing evidence that vitamin D is an important factor in staying healthy, and since most vitamin D is created in our skin from direct sunlight, it’s easy to be deficient in vitamin D in the winter. Some studies suggest that supplements all winter can help decrease infections like the winter flu — in kids as well.
  • Eat roasted chestnuts and yams. Join your local Beijingers and wait in line on the street corners for a 10 kuai bag of delicious, freshly roasted chestnuts. Also look out for the very common sweet potato/yam sellers on most streets, selling delicious roasted wares for about 2 kuai each. These are some of Beijing’s best traditions.

Spring is a visual feast: in March we get sandstorms blotting out the sun, and in May we have catkin pollen filling the air like snow. OK, it’s not that dramatic, but we definitely have some sandstorm days where the skies are orange and the grit seeps into your nostrils, clothes, bedrooms — everywhere. It actually can be a health hazard, but have a little common sense avoidance and you’ll be fine. As for the catkins, it’s dramatic but not really a health nuisance. However, many Beijingers do have allergic hayfever problems in the spring. Most expats actually have less hayfever problems in Beijing.

Otherwise, you should definitely free yourself from winter’s shackles and join the rest of Beijing by flocking to local parks for the beautiful spring blossom festivals. Enjoy the local outdoors as much as you can, before summer’s always-too-early heat kicks in.

Summer is often dreadfully long; the major health issues are a major increase in gastroenteritis as well as travel-related diseases from expats’ vacations to exotic and malaria-filled southern locales. The best way to prevent a vacation disaster is to do your homework beforehand by researching your destination’s health status on the CDC Travel website; and bring a medical travel kit to help the often-inevitable issues like diarrhea. And prepare early! You may need at least a month or more to get a full course of vaccines like japanese encephalitis, rabies or hepatitis; these are often in short supply in the expat clinics during the summer crunch.

We do get major heat waves as well, but fortunately many July and August afternoons are filled with thunderstorms to cool things off for your after-dinner stroll (another very cool China tradition you should definitely pick up). Other fun traditions include eating the excellent local watermelons and corn on the cob.

If you want a water break (and you will want one), you can drive 3 hours to Beidaihe or take an hour flight to the lovely beach cities of Dalian or Qingdao. And if you just want to cool off, take a drive into the local mountains and visit a temple. I’ve created a small list of my personal favorite local spots.

Autumn is fairly mellow, health-wise, so you should enjoy this all-too-brief moment of perfect weather by exploring Beijing’s mountains and tourist attractions.

Tip #7: Have An Anti-Inflammatory Lifestyle.

I find it useful to picture Beijing as a pro-inflammatory city; we are daily bombarded with air particles and gases both indoors and outdoors, as well as from chemicals in our foods, that are pro-inflammatory — causing free radical damage to our healthy cells, as well as setting off cascades of unhealthy hormones and enzymes that can slowly lead to many illnesses such as heart disease and cancers. So, you always need to think, “what can I do to fight off this damage?” Fortunately, you can do a lot of things:

  • Don’t smoke. Smoking is, by far, the worst toxin you can put into your body. It directly destroys your lung’s membranes, and of course sets off oxidative changes that lead to the cancers and heart and lung diseases we all know about. You’re already breathing in toxins while living here — adding cigarettes will only hasten that inflammatory cascade.
  • Watch your alcohol intake. Your liver is a crucial organ whose main function is to detoxify all the chemicals and pollutants you breathe in and eat. Alcohol should also be considered as a direct toxin to your liver; a moderate amount is fine and fun and may actually lower your risk of heart disease. But the binge drinking and excess daily drinking will definitely wipe out your liver, slowly but surely. Those of you who admit — or are told by loved ones — that your drinking may be a problem, should take heed and find help if needed. Beijing does have an Alcoholics Anonymous branch, and your family doctor can also help.
  • Eat anti-inflammatory foods. Your mother was right — you should eat your veggies. There is overwhelming evidence that healthy foods like fruits and vegetables can dramatically lower risks of developing heart diseases as well as cancers. And some modern foods can be decidedly pro-inflammatory, such as trans-fats and certain red meats like grain-fed cows. Take control of what you put in your body!
  • Consider a supplement. This is a bit more controversial, and there definitely is no medical consensus regarding the effectiveness of many commonly taken supplements — even a simple multivitamin. I personally feel that omega-3 from fish oil (not flax) has a lot of evidence supporting its use to lower risks for heart disease, and its side effects are minimal. Again, supplements are a bit controversial and some may actually harm if taken to excess or combined with certain prescriptions, so you should discuss this with your doctor.

Tip #8: Exercise

One crucial thing to remember is that Beijing may have some unique quirks with air pollution, food issues, etc — but the major diseases and risks are the same here, and China’s #1 killer is the same as all over the world: heart disease. So please keep things in perspective here — you still need to focus on the basics of good body weight, exercise, proper foods, and not smoking.

I’ve posted many articles about exercise for you to review, and a lot of it is obvious, but expats should be especially aware that it can:

  • help manage your stress levels
  • lower your risk of diabetes and high blood pressure
  • help you sleep better
  • fight off depression

How much is enough? You should shoot for at least 150 minutes a week of pulse-racing activity. As for which exercise, you should continue whatever you love. Beijing is filled with gyms and public parks for all sports, and there are many hiking and biking clubs as well. Also, don’t be afraid to exercise outside! As long as the pollution index is reasonable (somewhere way below 200), then exercise outside is still much healthier than no exercise at all. Try to stay at least 200 meters from any major road or highway to minimize pollution.

Tip #9: Take Care of Your Body and Soul.

Last spring I had a series of articles discussing what I called expatitis:

Expatitis (Expat from expatriā “to leave native land” +itis“inflammation, abnormal states, excesses, tendencies, etc”) – a syndrome of multiple physical and mental illnesses brought on by maladaptive coping mechanisms to the stressors inherent to living abroad.

I see a lot of overworked patients who rarely sleep well, are totally stressed and too busy for exercise — all of which lower people’s immune systems and set them up for illness. So I do feel that it’s crucial that we all focus on ourselves — to constantly check in with our heart and soul and ask ourselves, “am I happy here in Beijing? Am I neglecting something or someone, including myself?” For example, it really is a basic that we all need about 8 hours of sleep, and if your lifestyle is constantly preventing that, you increase your risk of more frequent and severe infections, depression and anxiety, as well as more long-term problems like heart disease.

And if you feel that your life is totally spinning out of control, or you are starting to cry often and out of nowhere, or are getting waves of panic attacks, then you should definitely consider getting some professional help. Each clinic in Beijing should have a couple counselors and family doctors who can help you through your tough times. Our clinic has Dr Mike, a psychologist who welcomes anyone to call him on his mobile phone at 158.0131.9796.

Tip #10: Watch Out For Sexually Transmitted Diseases

Beijing is not immune to the worldwide problem of sexually transmitted diseases, and it is frighteningly common here to get exposed to bugs such as chlamydia and gonorrhea. There is also an alarming resurgence of syphilis in China — plus the usual suspects like HIV, herpes, hepatitis and others. So, there are many reasons for you to practice safe sex — that means always wearing a condom with new partners. And be careful where you buy your condoms — there have been recent scares with poorly made counterfeits. Stick to the big chains like Watsons.

And don’t forget that you can carry these infections for many years and feel perfectly healthy, but you can still infect others. One of the major causes of infertility for women is uterus damage from chlamydia, and most women didn’t even know they were infected. That’s why we recommend routine screening tests for sexually active men and women, including the pelvic exam for young women, which is not as routine among Chinese women as it should be. These tests can provide you with a lot of peace of mind, especially if you are entering a new relationship and want “a clean slate”.

People always have a lot of questions about STDs (for example: yes, you can get STDs just from oral sex), so I created an online slide show about the basics of STDs.

Bonus Tip: Immerse Yourself

Many expats eventually leave Beijing feeling they’ve just finished the most rewarding and interesting times of their lives, and a common cause seems to be a deep immersion into Chinese culture. That usually means learning the Chinese language well enough to talk with anybody, and I know how difficult that is (I’m still years away), but clearly you will have a much richer time here.

Even if you can’t chat away with locals, you can still have a wonderful experience by biking around the hutongs; dancing a waltz at night in practically any local park; volunteering to help migrant schoolkids — or countless other small things that add up to a fulfilling and mind-expanding adventure.

(Click here for part one, with tips #1-5…)

Alcoholism: Do You Have It?

My dad My father was a lively, warm hearted man. He was also an alcoholic, and he died far too early of advanced alcoholic cirrhosis (complete liver collapse). I see alcoholism as a big issue not only in my life but also, unfortunately, for a lot of expats and their families. I think it’s partly a disinhibition while living in a foreign land, to “burn bright” and enjoy a bit more personal excess than you would allow yourself back at home. Whatever the case, the consequences of alcohol abuse can be devastating to families and relationships.

Do You Drink Too Much?

The CAGE questionaire is a useful screening test to see how serious is your drinking. All you do is answer the following questions:

  1. Have you ever felt you needed to Cut down on your drinking?
  2. Have people Annoyed you by criticizing your drinking?
  3. Have you ever felt Guilty about drinking?
  4. Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

If you said “yes” to 2 or more, then you may have a serious problem and should think seriously about your drinking habits, or even discuss this with a doctor.

How Much Alcohol Is Too Much?

This is a tricky question, because moderate alcohol actually helps cut down on heart disease! But moderate alcohol means one drink a day for a woman, two drinks a day for a man. Anything more than that starts to cause heart and liver disease. And this needs to be a steady, daily drink to be effective; binge drinking (at least 3 drinks in one sitting) is always bad for your heart and liver.

Who Can Help?

The hardest step is even admitting you may have a problem. Fortunately, there are support groups here in Beijing. You should start with the famous international support group Alcoholics Anonymous Beijing branch. They also mention a hotline number:13911389075, and email: [email protected] If you need to detox, I am told that the best local Chinese hospital is Anding Hospital, the Beijing psychiatric hospital. Their telephone is 5830-3193. They have english-speakers available, from 7-11:30am and 12-4pm. Also, if your insurance covers it, Beijing United Hospital has a Family Counseling unit that may be able to arrange an inpatient stay to detox. You’d have to first consult with one of their Family Counseling doctors and discuss this; the main appointment number is 5927-7000.

Can Doctors Help?

There are a couple new prescription medicines that can mildly help decrease the cravings and keep you off alcohol. But even more valuable are expat clinic psychologists and psychiatrists, who can be wonderful assets to help you cope with this issue as well as guide you — and your loved ones — through your recovery.