Internal Medicine 1 month in… our patient is a “carrot” & marijuana dude

8 01 2013

We do a lot of scut monkey work: collecting blood work, delivering them to the labs, dropping off consult papers on different floors in the hospital. I’m on the Medicine floors this first month and so far we’ve seen simple cases to very devastating situations where patients have to be intubated. Devastating in the sense that the person is just lying there with a tube in their mouth with poor oral hygiene, foley in their genitals passed thru ureter to their bladder, and most of the time they appear comatosed.

ALCOHOLIC LIVER CIRRHOSIS

One of the patients we work with is a “carrot”. Eyes are yellow-orange, a term we call jaundiced. Skin is yellowish all over her body, legs are swollen, even the hair looks orange. The urine is a dark brown color as seen through a foley bag. I don’t know what happened in this patient’s life, and how the patient could binge-drink even on a chronic daily basis to get to this point. The patient is only 50-something yrs old! Alcohol must have led to dependence without it, the patient could not function without jitteriness. This is a vicious cycle: depression + alcohol = even worse depression. Now with the liver cirrhosis the patient’s depression is even more.  Not to mention, the patient probably shot their own pancreas too with alcoholism.

What is binge-drinking? What is at-risk drinking?
MALE has more than 4 drinks in one sitting or 14 weekly.
FEMALE more than 3 drinks in a day or 7 weekly.

What constitutes as one drink?
12 oz beer
5 oz wine
1.5 oz hard liquor

12 fl oz of
regular beer
= 8-9 fl oz of
malt liquor
(shown in a 12-oz glass)
= 5 fl oz of
table wine
= 3-4 oz of
fortified wine
(such as sherry or port; 3.5 oz shown)
= 2-3 oz of
cordial, liqueur, or aperitif
(2.5 oz shown)
= 1.5 oz of
brandy
(a single jigger or shot)
= 1.5 fl oz shot of
80-proof spirits
(“hard liquor“)
12 fl oz of regular beer - about 5% alcohol 8 - 9 fl oz of malt liquor in a 12 oz glass - about 7% alcohol 5 fl oz of table wine - about 12% alcohol 3-4 oz of fortified wine - about 17% alcohol 2-3 oz of cordial, liquer, or aperitif - about 24% alcohol 1.5 oz of brandy (a single jigger) - about 40% alcohol 1.5 fl oz shot of 80-proof spirits ('hard liquor' - whiskey, gin, rum, , vodka, tequila, etc.) - about 40% alcohol
about 5% alcohol about 7% alcohol about 12% alcohol about 17% alcohol about 24% alcohol about 40% alcohol about 40% alcohol

In this new year, I hope that people drink to merry and celebrate happiness but understand the effects of how powerful alcohol can do and to drink with moderation.

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MARIJUANA YOUNGINS

I had a wonderful opportunity of meeting a 22 year old young man who came in with vomiting and stomach pain. We had great conversation about medical marijuana and why it helps people who are already sick and who has cancer, those needing helping to increase their appetite. We talked about how cigarettes have more than 4,000 chemicals and >60 cancer agents and that marijuana is so much stronger and worse. The young dude did not realize that smoking marijuana messed him up so bad even though it was only twice a week (in what amount, I didn’t ask).  Smoking or marijuana smoking could lead to esophageal lining changes and ruin the tube that brings food to the stomach or esophageal cancer.  This was bad since the patient already had Helicobacter Pylori in his stomach that could lead to stomach ulcers to begin with on top of the smoking and spicy food habits. The other thing was the patient like brushing his tongue. If one consistently put lesions/cuts/openings in the mouth and put over 4,000 chemicals + 60 cancer agents into the mouth this could might as well lead to buccal carcinoma or mouth cancer.

Smoking could put a hole into your lungs without you knowing it and cause a spontaneous pneumothorax.

What is pneumothorax?

It was funny how the Attending doctor said this word to the patient and was oblivious to the fact that he didn’t know what it meant. This is where a tiny hole in the lungs caused the air to go outside the lung pushing back down, causing the lung to collapse on itself. This makes the patient have chest pain and breathing distress. But the patient was lucky his tiny hole closed up on its own. Not everyone close holes by themselves.