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Suggest treatment for alcohol addiction - Online Doctor Chats

Date : 10-Sep-2014
User rating for this question
Very Good Posted in: Smoking and Alcohol Addiction
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1777 Questions
User:Profile Name : XXXXXXX XXXXXXX XXXXXXX Age : 58 Gender : Male Medical History - Heavy Drinking (Average 540Ml. of whisky everyday) since last 20 yrs., Heavy consumption of Pan-masala and tobacco (Average 25 sachets of pan-masala everyday) for last 20 yrs., High Blood Pressure for last 20 yrs., Diabetes for last 16 yrs., Breathing problem, High acidity for last 20 yrs., Tendency to overthink and take too much tension for last 25 yrs., Anxiety patient; no physical activity or routine Current Medications : Consuming Alzolam .5 (1/2 to 1 tablet regularly everyday for last 2 yrs, previously used to take it occasionally) ; Amlopres L 10mg (1 tablet regularly everyday for last 12-15 yrs.)
User:My question: Kindly do read through the medical history and current medication column to get a background of the patient. Patient has been a very heavy drinker and tobacco consumer for the last 20 years along with having a very volatile mental nature/thinking (ex. Occassional yearly bouts of continuous heavy binge drinking for 4-5 days without consuming any food till the patient reaches a stage of hospitalization, tends to overthink and take too much tensions for small things, anti-social, very negative and pessimistic outlook towards life, sleeplessness in absence of alcohol, tends to shout and remains irritated, refuses to listen to doctor and family's advice). Patient has occassionally tried to quit alcohol permanently but has failed due to lack of self-control after 2-3 weeks of trying on 3 occassions till date in last 4 yrs. Offlate since last 15 days, has experienced attack/fit of sorts for 3 times which has lasted for around 25-30 mins with following symptoms - breathlessness, heavy breathing and sweating, heavy coughing with no discharge, feeling of vomiting with no discharge, pain/heaviness sensation on left side of chest, blockage of left nostril. Kindly advice.
Doctor:I have gone through the description provided by you.
User:Sure thanks! Your suggestion plz
Doctor:I would like to know few more things before advising.
User:sure sir. Ask me.
Doctor:Did he have attacks while on alcohol or in absence?
User:Initially 2-3 times it happened while on alcohol and we also thought its related to alcohol. But last night it happened when he had not consumed alcohol the entire day. also, would like to apprise you of the fact that patient has very heavy snoring problem coupled with the tendency of sleeping with tobacco in mouth after drinking
Doctor:Does he have any abdominal swelling at present?
Doctor:i.e., the abdominal girth has increased comparatively from before?
User:Well he has a very large belly by normal standards since last 20 yrs. or so. So, commenting whether it has increased from before is very difficult.
Doctor:How much of alcohol does he consumes regularly?
User:Average 540Ml. (3 quarters) of XXXXXXX whisky everyday since last 20 yrs.,
Doctor:From the description provided by you, I feel that the offlate attacks he is being suffering with could be due to his over weight, snoring.
Doctor:The attacks before these were due to alcohol withdrawal.
User:ok. Fact is he looks very fat because of his oversized belly but his body otherwise is weak. Also over weight and snoring problem has existed for last 20-25 years with these attacks never happening before
User:and these attacks seem to be highly threatning to his ability to breathe. What can be the solution as per you sir
Doctor:Yes, I understand, but here I would also like to the know the liver function tests. As a chronic alcoholic there are very high chances of liver damage.
Doctor:We need to assess the liver functions too.
User:and to your statement of 'The attacks before these were due to alcohol withdrawal' i would like to mention that he had not quit alcohol during that time and was actually drinking on 2 out of the 3 occasions
Doctor:I was thinking of attacks due to over weight as the oversized belly applies pressure over the diaphragm which pushes the lungs up and creates difficulty in breathing.
Doctor:I would like you to take him to a de addiction center where they will reduce his alcohol volume gradually.
User:sure sir. can you please recommend any tests that we need to do for assessing the liver functions and other further solutions
User:Ok. problem is the patient is very stubborn and gets very irritated/angry on mention of quitting alcohol and refuses to go to a doctor or de-addiction center. We are facing helpless situation in trying to convinve the patient
Doctor:Yes, you can get his liver profile done which includes ALT, AST, GGT.
Doctor:Ok. May I know your location?
User: XXXXXXX (U.P.)
Doctor:I will ask the customer care to mail you the deaddiction centers in XXXXXXX where you can get him admitted.
Doctor:All alcoholics are stubborn. You need to force them to a deaddiction center.
Doctor:You can't listen to them and it is for there good.
Doctor:Ultrasound abdomen is also required.
User:sure thing sir. in the menawhile any other medical tests/diagnose you recommend to assess the damage.
Doctor:Initially CBC, LFT along with Ultrasound abdomen will do. If any further investigations would depend upon these reports.
Doctor:Here the main treatment would be to reduce his alcohol consumption gradually.
Doctor:Once that is done and he is free of alcohol we might think in improving his liver functions.
Doctor:Which would increase his life expectancy.
User:certainly sir!
User:is that it?
Doctor:Yes, at this point alcohol reduction is must and get investigations done.
Doctor:further treatment and tests would depend on the reports of this initial investigations.
User:no sir. i think this should be it. i will get the recommended tests done and share the report with the doctors here at helathcaremagic. What kind of speciality doctors should i seek here on the portal? Heartspecialist or de-addiction specialist?
Doctor:You need to see specialist in liver and gall bladder issues on the website and a gastroenterologist for treatment in an hospital.
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