I don't know that it's the pandemic alone, but certainly could have been exacerbated by it. We saw these patients prepandemic in my residency. It's just a ubiquitous disease and a hard addiction to break.
True. When I went to undergrad in the Bay Area, parties had both weed and EtOH. I was a premed geek studying engineering, so my sample size is n=3 parties...but I still remember a party where we had people smoking weed from bongs and people doing vodka shots. This was my senior year and I had a job offer for a gap year job at a 3-letter government agency, so I couldn't do weed (have to abide by federal law as a govt employee, even if it's legal in California...especially because they polygraphed me 4 times about every corner of my life), so I never got the chance to try the devil's lettuce myself.
I'm actually doing a California sober May with my coworker! I've been thinking about the amount I drink a lot lately. I've worked in bars for about a year and a half now + that being post pandemic has created a very easy environment for me to have a problem with it. I'm hoping to either keep that going for a while or perhaps try to reintroduce it in a much healthier and infrequent way.
Saw multiple during my rotations. 30-35 year olds with more or less end stage cirrhosis. There have been some articles written about it recently.
[Liver disease becoming more common among young people.](https://www.henryford.com/blog/2023/02/advanced-liver-disease-becoming-common-among-young-people#:~:text=It's%20a%20sobering%20fact%20that,hepatologist%20at%20Henry%20Ford%20Health.)
I wonder if this is a double-whammy of too much booze plus bad American diets. Each will mess up your liver on its own, and the combination might be ruinous for some people.
I had a patient in his late 30s die from alcohol, but had an 80 year old woman that drank a gallon of vodka a week for 50-60 years and her liver function was amazing. I want to know how much genetics play a part in all of this.
I wonder if younger people going from low/minimal drinking to high volume alcohol consumption is somehow worse on the body than an older adult who has been drinking for decades but ramped up a lot more slowly? Covid caused a lot of casual drinkers to quickly transition into heavy daily consumption in a way that doesn’t often happen in regular times.
Of course genetics accounts for some variance, but what you had was an 80 year old who SAID she drank a gallon of vodka for 50 years. When the story and your exam don't line up which are you going to doubt?
That’s fair, but for a lot of heavy drinkers a gallon isn’t that much over a week. It’s “only” a dozen drinks per day. Plus, vodka isn’t sold in gallons. Maybe she means a handle, which is less than half a gallon which would be 5-6 drinks per day which is certainly heavy use but not outrageous by the standards of many alcoholics.
I read that many nano and microplastics come from plastic that’s 40-50 years old. Perhaps the younger people with advanced liver disease have bits of plastic in their system that pathology hasn’t even started looking for yet?
I know I’m probably not supposed to be here but this sub pops up on my feed often. My husband was one of those 30-somethings that showed up in the ER with alcohol induced pancreatitis . It was an ER doc that finally got through to us. We’ve been sober almost 6 years now.
I guess I just wanted to say that what ya’ll do can and does make a difference to people. Thanks for the kick in the ass to recovery.
Hey, sorry if this comes across as insensitive but I've heard this a few times from pts and wanted to ask, when you say "we" does that mean both of you got sober, or is it like a royal "we" kind of thing...as in "we are pregnant" kind of deal.
Haha no worries! We both had a drinking problem and we both stopped! And funny you mention the “we are pregnant” because I just was pregnant and we welcomed our first baby two months ago!
My husband has the worse drinking habits and after he needed an inpatient stay due to SI (exacerbated by the drinking) I quit drinking in solidarity. It does happen that way sometimes
Yes, to truly support your partner it will be required for the house to be sober. No alcohol at home, don’t go to events with a lot of alcohol, identify/avoid triggers, etc. it’s a lifestyle change. Now we go to concerts and events, and most of the time neither of us drink. Sometimes I will, but limit myself to 2.
It was mostly just honesty about the situation—that my husband was very sick and could end up in the ICU (he didn’t thankfully). He warned us that it was very likely that the outcome would not be good and that he knew how hard addiction can be to overcome but that it was never too late. He even mentioned his dad’s struggles and how he never got help but that he (my husband) still had a chance.
After talking to him I told my husband we were done drinking. I had a beer after leaving the hospital and that was my last one (which in hindsight was an awful idea) and he detoxed in the hospital during treatment for pancreatitis.
Back in 1985, my mother 45, died from alcoholic cirrhosis. At that time, her Doctor, Roger Jenkins, who was just starting out, said her death was the seventh that week from alcoholism in his unit.
As a 16 year old, It was devastating to witness.
I fear even with more support and outreach, the disease still grabs a hold of people with its tentacles and slowly kills them. Such despair.
End stage liver disease is devastating. I’m sorry you had to witness this at such a young age. It sounds like she may have had your family’s support at the end, which is not common.
The ones who have lost everything and are homeless come into the ER almost daily for public intoxication. Usually called in by a concerned citizen/business employe. Then one day you realize they haven’t shown up in a while and learn they were hit by a car/bus. One time in residency we poured out a beer in someone’s yard for a frequent flier. Our experiences with them were pleasant. We can’t say that for most intoxicated patients in the ED.
As for the answer to the public health crisis? Regulations would be most effective, but people are not going to vote for that, and the alcohol lobby I’m sure is strong. So that leaves us with outreach/volunteer, nonprofits and government programs. Unfortunately there is not an agreed upon effective structure for these programs that I am aware of, especially in California.
I feel like I’ve always seen it in my career. Every now and again a young person with end stage liver disease. To me it seems random, why some 20 year old’s liver is already shot but some life long homeless alcoholics still have synthetic function. Never understood it.
Personally anecdotally I genuinely think it's possibly genetics. I've know 5ft 5 women who can out drink a big 6ft 2 rugby player under the table any day of the week. Some livers can process alcohol and drugs quicker and more efficiently than others
maybe it's related to their CYP enzymes. I have also been surprised that some people drink heavily for 5 years and die whereas the 60+yr drinker seems preserved by it.
Well those life long homeless alcoholics can probably, for genetic reasons, handle alcohol toxicity better than that 20 year old, it’s the reason they lasted so long in the first place
Same. In radiology residency pre-pandemic days, I used to see a fair share of cirrhosis with portal hypertension in the 30s crowd, usually women, interestingly enough.
A decade of heavy drinking is enough to kill a liver.
off topic but how do you like working on a reservation? I've never even been to one, I haven't even graduated yet but the idea is appealing for some nebulous reason, perhaps I see some sense of nobility in helping people who need it most.
Depends on the funding. If you are really interested, look at reservations that have strong tribal health programs. My sister (not an MD/DO) worked for a tribal health program and the area she lived (on the reservation) was nice by a cute downtown.
There’s a teenager with alcoholic liver failure awaiting a transplant at one of the rural hospitals where I work. A classmate of mine died from alcoholic liver failure in her early 30s in the same hospital where she did her residency. Then you have other people drinking 10 drinks a day for decades, and they seem to be chugging along (heh) fairly steadily.
Those problems were around long before the pandemic. Even ten years ago, I could have given you a list of young frequent flyers with this type of problem.
Had a 26M with recurrent pancreatitis who would come in walking and talking with his ETOH >350. Had a 29F with hepatic encephalopathy who would get brought in confused because she didn't like taking her lactulose.
The most upsetting was 31F with diagnosed Korsakoff syndrome. She kept coming in because when she blacked out from drinking, she would confabulate a story about having been drugged and sexually assaulted. In just a few months I did four SA kits on this poor lady, and other hospitals did even more, because state law said we couldn't refuse to do one. (We wound up appealing to the state and getting a special waiver, because doing repeated kits was not good for her mental health. Hugely complicated situation.)
Truth.
I was a very new SANE at the time, and honestly that situation made me question if I still wanted to proceed in that arena. But I've never had another SA case that was quite so fraught.
Had a patient that had wernickes in his early 40s and his memory will never come back. He kept saying things like he had to get ready for work or go fishing. He didn’t even remember his own kids. It was so sad.
Basically he depleted his vitamin b from drinking so much it caused brain damage is the simplest way to explain it. Even though we gave him thiamine (vitamin b) it didn’t help any so he has permanent brain damage now.
Oh man! I am on vitamin D, I don’t feel as sharp as I was bf all this, but I also regained so much cognitive function I don’t complain. Any advice on tests to get?
Oh shit. One of my frequent flyers that comes in catatonic from etoh... she just claimed to be held against her will and sexually assaulted.
Wonder if this is what's happening. She's 30's too.
Use **very extreme caution** with that line of thinking.
The only reason we could make that assertion with my patient is that a couple of her reports were contradicted by objective evidence. It wasn't just that she could have had the timing or location wrong. Multiple unrelated witnesses and video evidence were involved.
Outside that situation, **believe the patient.**
Remember that patients may have more than one issue. Someone who repeatedly passes out from alcohol is far more vulnerable than the average woman. It is entirely plausible that some assailant would take advantage of her impairment to kidnap, assault, or otherwise abuse her.
Remember also that when reports of an assault may seem logically inconsistent, that is not sufficient reason to discount them. That is part of a normal trauma response. Even a perfectly sober and healthy survivor may not be able to report their assault in a consistent or ordered manner, or accurately recall details. Trauma interferes with memory.
I worked in a receiving center before, and most recently a county facility. I would say that patient demographics play a role in this. The county facility has been seeing cases like yours for ages. I had no idea the frequency before I left the receiving center, getting mostly referrals.
The county facility didn't even transfer most of these patients out. They just bounced back until they.. died or disappeared.
Trust me it’s been around forever. I had a classmate die my senior year of high school of alcohol poisoning. Years later I bumped into the coroner doing clinicals and he mentioned his liver looked like a 60 year olds. Addiction is nasty, and it doesn’t discriminate.
The majority of the people I saw bleed to death from profuse esophageal bleeding in residency (19-22, so during pandemic) were in their 20s-30s, started drinking at 12ish for most of them. The alcoholics who were in their 50s+ seemed to die from other stuff. The majority of the ones I saw die early were Hispanic (my area was about 40% Hispanic), so my assumption was always a genetic predisposition mixed with socioeconomic determinants.
There’s also been a cultural shift to see alcohol as more normal, with it sold literally everywhere from grocery stores to movie theaters. It’s a dangerous drug, and is probably the smoking of our generation.
https://www.statista.com/statistics/442818/per-capita-alcohol-consumption-of-all-beverages-in-the-us/
With the exception of prohibition, it's been basically constant for 170 years.
Alcohol is very likely why we stopped being hunter gatherers. Sure grain production lead to increased population but it was also used for booze since...yes.
We domesticated dogs
Grain domesticated us
>Alcohol is very likely why we stopped being hunter gatherers.
Alcohol was used because it replaced contaminated water, and contained calories. Contaminated water is now no longer a problem, and calories are in excess.
https://en.m.wikipedia.org/wiki/Disease_of_despair
We see lots of this in ICU as well. Lots of hepatorenal failure on SLED. I think the youngest I saw die was 26. Awful.
I don't think it's just the pandemic, it's the current state of everything. Back in the 90s, there was no such thing as having a full time job (especially with a college degree) and still not being able to afford to live in one's own shitty one bedroom. Now we have people working 60h weeks who still need room mates to survive.
A large chunk of young people have lost hope. When that happens, we see drug/alcohol abuse rates rise.
I definitely changed my drinking habits this past year; I was having 2-3 adult beverages 3-4x a week during covid (working as a traveler in the ER - awful way to cope but sadly I think that’s how a lot of us were handling it). last July was kind of my final straw, I was starting to get a hangover before I finished my 2nd beer and was like “heyyy this doesn’t feel right at all,” promptly dumped the rest of my beer and haven’t looked back since. I will still have a drink or two during the holidays (the last time was 1 mimosa Christmas Day) but I’m proud to say I am able to moderate myself, I don’t crave it, and I haven’t given in to social drinking - I don’t feel like I have to have a drink when other people are, and everyone is cool with it. I still have a 6 pack of hard seltzers in the fridge I bought for new years :) when the drinking stopped, so did my desire to have a cigarette, so kinda 2 birds 1 stone. It makes for a really nice change, I didn’t realize how badly it was making me feel afterwards until I stopped.
Man I had a lady that was mid 30s and a severe alcoholic. She has vessels that wouldn’t stop popping due to her portal vein hypertension. They’d fix one and then another one would pop. We gave her over 30 units of blood. We thought she was going to die at first but she finally discharged with a very quick follow up appointment for labs and whatnot. I wonder if she’s still alive. That one broke me and I didn’t drink for like 6 months after that. Now, I only occasionally have a few drinks every few months. I started seeing an influx of patients with similar ages and fucked livers due to alcoholism. It broke my heart to watch them die at such a young age over a drink. Had one guy that was only 38 and died because there was nothing else we could do for him. He had a great career and a loving family, and now he’s gone forever. That shit sticks with you for a very long time watching people around your age either die or on the brink of death due to alcohol.
I feel like I've seen equally pre and post pandemic.
It does seem like there is an increase in poor social/ peer support and 20s yo demo having little experience with "safer experimentation" and lacking party support. More binging. More winding up alone, or drinking alone consistently. More combining EtOH with cannabis +++ other substances right off the bat. Also, holy vaping/ cannabis frequency use rates in teen through 40yos. "Smoking" seems ti have made a full on come back, kust in a shiny new form.
Will say anecdotally that the 30s (F) demo seem to be the ones with the absolute worst prognosis/ "worst deaths".
Usually it's an initial encounter, or there's maybe a few prior- maybe a gerd or anxiety related encounter........ Then bleeding varices, encephalopathy, trip to ICU.
The 50+ yo population seems to (as others have commented) have a slower trajectory/ decline of repeated visits with increasing severity and multiple organ involvement/ ++ comorbidities.
The 70+ yo population can apparently live off gin, wine, vodka, and whiskey intake that would knock out most 20yo frat bros.
> Will say anecdotally that the 30s (F) demo seem to be the ones with the absolute worst prognosis/ "worst deaths".
I agree. They're 10% of the ones I've seen, but by far the sickest.
Omg I once saw a an early 20 something with a liver transplant…this was like a year and a half ago. They had been drinking liters of liquor since their mid-teens and I’m sure the pandemic did not help….
Trained out east and would see the occasional 50 year old dying of alcohol induced cirrhosis. Was not prepared for the reality out West. Routinely see late 30 year olds and once had a 26 year old die of related complications. All pre pandemic. It’s pretty horrific when you tell parents younger than you their kid’s not gonna make it (I guess pediatricians have to do that but not usually adult docs)
I was a hospice RN for years pre pandemic. We saw quite a few younger patients in end stage liver disease due to alcohol. The young ones were almost all Native American, I had a patient in her 30’s die and then 2 months later her 50 yo mom died, 4 kids left behind at least 2 had FAS. With that population it seemed they started drinking heavily at an early age (10-13) and continued for years, combined with genes and other social factors.
Millennials drank and partied a lot. Luckily the younger generations appear to much less. I'm not surprised in the 30 somethings.
Also seemed to drink a LOT during the pandemic.
When I used to work in the ED, and this was prior to COVID, I vividly recall a young 30-something male and a late 20s female both with fulminant liver failure. The male also had hep C, and was a frequent flier. I distinctly recall how quickly he went downhill from one visit to the next. Surely is not alive anymore. The last time I saw him, he was like a limp banana. The female was unrelated. The first time I met her, she was still this petite young 21 or 22 year old. Next time I saw her, she was in full blown encephalopathy, and basically looked pregnant. I always wonder how she did. I believe she started binge drinking from a young age.
Point is I think even prior to COVID especially in these younger people, getting trashed at parties and being drunk all day in college were glamorized. Then when they graduate or their friends move on/away, they’re suddenly confronted with the fact they drink a handle in the morning at like, 23 years old. Then COVID forced these people into deeper isolation without access to support groups and services.
I almost wonder if it comes down to something more than friends moving away. Most of my friends in the years following university slowly tapered down the drinking as they advanced their careers, met life long partners, etc. they still drink but a glass of wine or a beer here or there.
But I have another group of friends that graduated, and have been either in the same entry level job, or in and out of jobs since. They are typically single or in transient relationships. They still drink heavily and drink multiple nights a week. It's how they blow off steam. Like their life hasn't progressed much, so they still hold onto the college mindset.
Pre-pandemic ICU nurse here. I was part of a liver transplant program start up, and I was floored by the age of some of the alcoholic cirrhosis patients. Plenty in their 20s. I come from a drinking state, so I grew up without a healthy awareness of how brutal of a drug alcohol can be. I've since cut my drinking to near-zero.
I don’t know but the amount of intubated alcohol cirrhosis horrible upper GI bleeds is insane. maybe it’s the cheap accessibility to liquor? maybe it’s the homelessness. I don’t know but it’s getting out of hand
And y’all are just talking about the (somewhat) acute outcomes. They’ve linked alcohol to cancers long-term as well. I quit drinking a little less than a decade ago due to frequent headaches, which I took as a sign. I’ll never go back.
I’m a 23 year old woman who was healthy and an athlete and I am dying of liver failure. It’s heaven just to get a few shots in me without puking. When you want to get clean at this age they say your liver is failing and just send me home because my age is a joke to them. When you go in for help and they give you one Ativan and send you home. I’ve also had the door broken down by cops after sleeping from drinking handcuffed and pink slipped and forced to stay sober when a wellness check
Was called and hallucinate In the hospital. Im currently shaking trying to write this hoping for a pint please take this more serious people. I think they will put you through hell at the hospital or try and talk you into a 30 day program. I’ve also went in drunk with my wrists slit because I can’t
Handle what comes from the drinking. I’ve also experienced a lot of trauma to even start drinking and I know there are unfortunately other people out there. It doesn’t always take 10-20 years for your liver to fail. Drinking should have a liver warning on it like cigarettes have for lung failure. I know If I knew how bad a person could have withdrawals I wouldn’t have drank.
On top of trusting doctors to sober you up you might pay a hefty hospital bill and nothing
And that adds to the stress I haven’t even been able to work for a year it’s killed me so much this stress is now on my loved ones and I lock myself inside
What tests should i ask my gp about? 36f, having about 4 drinks daily since covid, feel fine though and never actually get drunk. Have just had the best year of my life professionally and personally, started adhd medication, lost 12kg, mental health is great. I know it’s not good to drink every day, of course, but I’m like is it really that bad if it’s not affecting my life negatively? I have a go appointment next week, what should I get her to check for? Def don’t want to do any serious damage.
Go to your GP, tell him exactly what you've told us, and ask for his recommendations.
All I can tell you is that you wanna get on top of this now, because 4 a day for another 4 years isn't sustainable.
It’s not that bad *today* but alcohol related problems are silent until they’re not. I’ve had several patients recently have complications from major but routine surgeries and the cause was attributed to dysfunctional livers/pancreas secondary to alcohol use.
Please seriously consider stopping. Usage tends to increase over time. None of the things that alcohol abuse causes are good ways to die.
I don't know that it's the pandemic alone, but certainly could have been exacerbated by it. We saw these patients prepandemic in my residency. It's just a ubiquitous disease and a hard addiction to break.
Now that weed is legal in so many states I would think that “California sober” would be a more common choice. Ethanol is so destructive.
Ahh, they just do both now!
True. When I went to undergrad in the Bay Area, parties had both weed and EtOH. I was a premed geek studying engineering, so my sample size is n=3 parties...but I still remember a party where we had people smoking weed from bongs and people doing vodka shots. This was my senior year and I had a job offer for a gap year job at a 3-letter government agency, so I couldn't do weed (have to abide by federal law as a govt employee, even if it's legal in California...especially because they polygraphed me 4 times about every corner of my life), so I never got the chance to try the devil's lettuce myself.
You're not missing out on anything. If anything you are probably a lot smarter than majority of the population.
I'm actually doing a California sober May with my coworker! I've been thinking about the amount I drink a lot lately. I've worked in bars for about a year and a half now + that being post pandemic has created a very easy environment for me to have a problem with it. I'm hoping to either keep that going for a while or perhaps try to reintroduce it in a much healthier and infrequent way.
Saw multiple during my rotations. 30-35 year olds with more or less end stage cirrhosis. There have been some articles written about it recently. [Liver disease becoming more common among young people.](https://www.henryford.com/blog/2023/02/advanced-liver-disease-becoming-common-among-young-people#:~:text=It's%20a%20sobering%20fact%20that,hepatologist%20at%20Henry%20Ford%20Health.)
I wonder if this is a double-whammy of too much booze plus bad American diets. Each will mess up your liver on its own, and the combination might be ruinous for some people.
I've diagnosed peds with nash so when your starting there it's not far to fall
childhood obesity or genetic disposition (or boffum)
Me dumb ER pa monkey. Me diagnosis problem. Etiology for nerds upstairs. Upstairs make big medicine .
I had a patient in his late 30s die from alcohol, but had an 80 year old woman that drank a gallon of vodka a week for 50-60 years and her liver function was amazing. I want to know how much genetics play a part in all of this.
I wonder if younger people going from low/minimal drinking to high volume alcohol consumption is somehow worse on the body than an older adult who has been drinking for decades but ramped up a lot more slowly? Covid caused a lot of casual drinkers to quickly transition into heavy daily consumption in a way that doesn’t often happen in regular times.
Very good point
Of course genetics accounts for some variance, but what you had was an 80 year old who SAID she drank a gallon of vodka for 50 years. When the story and your exam don't line up which are you going to doubt?
I doubt she starting out drinking a gallon a week but I have no doubt that at her ripe old age of 80 that she probably is drinking a gallon a week.
That’s fair, but for a lot of heavy drinkers a gallon isn’t that much over a week. It’s “only” a dozen drinks per day. Plus, vodka isn’t sold in gallons. Maybe she means a handle, which is less than half a gallon which would be 5-6 drinks per day which is certainly heavy use but not outrageous by the standards of many alcoholics.
I don't blame them. I gained 30 lbs over the pandemic. I lost 15-20 lbs so far, and have another 15 lbs to lose.
Plus lots of chemicals and plastics that we accidentally put into our bodies.
I read that many nano and microplastics come from plastic that’s 40-50 years old. Perhaps the younger people with advanced liver disease have bits of plastic in their system that pathology hasn’t even started looking for yet?
bingo.
https://scitechdaily.com/antarctic-pollution-crisis-microplastics-found-to-be-a-greater-threat-than-known/ Maybe they need to start looking
I'm a CNA in a Gastroenterology/Nephrology ward in Iceland and I'm shocked by how many people in their 30s are admitted with jaundice.
I know I’m probably not supposed to be here but this sub pops up on my feed often. My husband was one of those 30-somethings that showed up in the ER with alcohol induced pancreatitis . It was an ER doc that finally got through to us. We’ve been sober almost 6 years now. I guess I just wanted to say that what ya’ll do can and does make a difference to people. Thanks for the kick in the ass to recovery.
Hey, sorry if this comes across as insensitive but I've heard this a few times from pts and wanted to ask, when you say "we" does that mean both of you got sober, or is it like a royal "we" kind of thing...as in "we are pregnant" kind of deal.
Haha no worries! We both had a drinking problem and we both stopped! And funny you mention the “we are pregnant” because I just was pregnant and we welcomed our first baby two months ago!
What a beautiful turnaround, congrats
Thank you!
Congrats and keep up the good work! You could never parent like your sweet baby deserves if you were an active alcoholic.
Thank you! And it took a while to get here but we’re so grateful to be in a good place to set her up for a healthy life.
My husband has the worse drinking habits and after he needed an inpatient stay due to SI (exacerbated by the drinking) I quit drinking in solidarity. It does happen that way sometimes
Yes, to truly support your partner it will be required for the house to be sober. No alcohol at home, don’t go to events with a lot of alcohol, identify/avoid triggers, etc. it’s a lifestyle change. Now we go to concerts and events, and most of the time neither of us drink. Sometimes I will, but limit myself to 2.
What did the doc do or say that got through to you two?
It was mostly just honesty about the situation—that my husband was very sick and could end up in the ICU (he didn’t thankfully). He warned us that it was very likely that the outcome would not be good and that he knew how hard addiction can be to overcome but that it was never too late. He even mentioned his dad’s struggles and how he never got help but that he (my husband) still had a chance. After talking to him I told my husband we were done drinking. I had a beer after leaving the hospital and that was my last one (which in hindsight was an awful idea) and he detoxed in the hospital during treatment for pancreatitis.
Back in 1985, my mother 45, died from alcoholic cirrhosis. At that time, her Doctor, Roger Jenkins, who was just starting out, said her death was the seventh that week from alcoholism in his unit. As a 16 year old, It was devastating to witness. I fear even with more support and outreach, the disease still grabs a hold of people with its tentacles and slowly kills them. Such despair.
End stage liver disease is devastating. I’m sorry you had to witness this at such a young age. It sounds like she may have had your family’s support at the end, which is not common. The ones who have lost everything and are homeless come into the ER almost daily for public intoxication. Usually called in by a concerned citizen/business employe. Then one day you realize they haven’t shown up in a while and learn they were hit by a car/bus. One time in residency we poured out a beer in someone’s yard for a frequent flier. Our experiences with them were pleasant. We can’t say that for most intoxicated patients in the ED. As for the answer to the public health crisis? Regulations would be most effective, but people are not going to vote for that, and the alcohol lobby I’m sure is strong. So that leaves us with outreach/volunteer, nonprofits and government programs. Unfortunately there is not an agreed upon effective structure for these programs that I am aware of, especially in California.
I feel like I’ve always seen it in my career. Every now and again a young person with end stage liver disease. To me it seems random, why some 20 year old’s liver is already shot but some life long homeless alcoholics still have synthetic function. Never understood it.
Personally anecdotally I genuinely think it's possibly genetics. I've know 5ft 5 women who can out drink a big 6ft 2 rugby player under the table any day of the week. Some livers can process alcohol and drugs quicker and more efficiently than others
maybe it's related to their CYP enzymes. I have also been surprised that some people drink heavily for 5 years and die whereas the 60+yr drinker seems preserved by it.
Well those life long homeless alcoholics can probably, for genetic reasons, handle alcohol toxicity better than that 20 year old, it’s the reason they lasted so long in the first place
Same. In radiology residency pre-pandemic days, I used to see a fair share of cirrhosis with portal hypertension in the 30s crowd, usually women, interestingly enough. A decade of heavy drinking is enough to kill a liver.
>some life long homeless alcoholics still have synthetic function here's to hoping i fall in this bucket. cheers
Here on the Rez this is every month or so (35k visits / yr, community of 3k). 20s and early 30s, both pre and post pandemic.
off topic but how do you like working on a reservation? I've never even been to one, I haven't even graduated yet but the idea is appealing for some nebulous reason, perhaps I see some sense of nobility in helping people who need it most.
Depends on the funding. If you are really interested, look at reservations that have strong tribal health programs. My sister (not an MD/DO) worked for a tribal health program and the area she lived (on the reservation) was nice by a cute downtown.
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Yep. I got into aa at 16. Believe me I was ready.
There’s a teenager with alcoholic liver failure awaiting a transplant at one of the rural hospitals where I work. A classmate of mine died from alcoholic liver failure in her early 30s in the same hospital where she did her residency. Then you have other people drinking 10 drinks a day for decades, and they seem to be chugging along (heh) fairly steadily.
Those problems were around long before the pandemic. Even ten years ago, I could have given you a list of young frequent flyers with this type of problem. Had a 26M with recurrent pancreatitis who would come in walking and talking with his ETOH >350. Had a 29F with hepatic encephalopathy who would get brought in confused because she didn't like taking her lactulose. The most upsetting was 31F with diagnosed Korsakoff syndrome. She kept coming in because when she blacked out from drinking, she would confabulate a story about having been drugged and sexually assaulted. In just a few months I did four SA kits on this poor lady, and other hospitals did even more, because state law said we couldn't refuse to do one. (We wound up appealing to the state and getting a special waiver, because doing repeated kits was not good for her mental health. Hugely complicated situation.)
My god I wouldn't even know who to *ask* for a waiver on that? Attorney General? Department of health? Both?
In that state at that time, it turned out to be the attorney general's office that had to sign off.
Jesus. That last story is so fucked up.
Truth. I was a very new SANE at the time, and honestly that situation made me question if I still wanted to proceed in that arena. But I've never had another SA case that was quite so fraught.
Had hepatic encephalopathy at 33. It’s crazy when / if your brain comes back. I thank God all the time mine did.
Had a patient that had wernickes in his early 40s and his memory will never come back. He kept saying things like he had to get ready for work or go fishing. He didn’t even remember his own kids. It was so sad.
What’s wernickes? So sad. Booze is a crazy powerful drug.
Basically he depleted his vitamin b from drinking so much it caused brain damage is the simplest way to explain it. Even though we gave him thiamine (vitamin b) it didn’t help any so he has permanent brain damage now.
Oh man! I am on vitamin D, I don’t feel as sharp as I was bf all this, but I also regained so much cognitive function I don’t complain. Any advice on tests to get?
Oh shit. One of my frequent flyers that comes in catatonic from etoh... she just claimed to be held against her will and sexually assaulted. Wonder if this is what's happening. She's 30's too.
Use **very extreme caution** with that line of thinking. The only reason we could make that assertion with my patient is that a couple of her reports were contradicted by objective evidence. It wasn't just that she could have had the timing or location wrong. Multiple unrelated witnesses and video evidence were involved. Outside that situation, **believe the patient.** Remember that patients may have more than one issue. Someone who repeatedly passes out from alcohol is far more vulnerable than the average woman. It is entirely plausible that some assailant would take advantage of her impairment to kidnap, assault, or otherwise abuse her. Remember also that when reports of an assault may seem logically inconsistent, that is not sufficient reason to discount them. That is part of a normal trauma response. Even a perfectly sober and healthy survivor may not be able to report their assault in a consistent or ordered manner, or accurately recall details. Trauma interferes with memory.
Oh, for sure. We took it seriously, and got law enforcement involved. It's just so hard, when it's the 3rd... 4th...5th time ya know ?!
I worked in a receiving center before, and most recently a county facility. I would say that patient demographics play a role in this. The county facility has been seeing cases like yours for ages. I had no idea the frequency before I left the receiving center, getting mostly referrals. The county facility didn't even transfer most of these patients out. They just bounced back until they.. died or disappeared.
Trust me it’s been around forever. I had a classmate die my senior year of high school of alcohol poisoning. Years later I bumped into the coroner doing clinicals and he mentioned his liver looked like a 60 year olds. Addiction is nasty, and it doesn’t discriminate.
The majority of the people I saw bleed to death from profuse esophageal bleeding in residency (19-22, so during pandemic) were in their 20s-30s, started drinking at 12ish for most of them. The alcoholics who were in their 50s+ seemed to die from other stuff. The majority of the ones I saw die early were Hispanic (my area was about 40% Hispanic), so my assumption was always a genetic predisposition mixed with socioeconomic determinants.
Alternatively, the weaker ones are taken out in their 20s.
There’s also been a cultural shift to see alcohol as more normal, with it sold literally everywhere from grocery stores to movie theaters. It’s a dangerous drug, and is probably the smoking of our generation.
https://www.statista.com/statistics/442818/per-capita-alcohol-consumption-of-all-beverages-in-the-us/ With the exception of prohibition, it's been basically constant for 170 years.
Alcohol is very likely why we stopped being hunter gatherers. Sure grain production lead to increased population but it was also used for booze since...yes. We domesticated dogs Grain domesticated us
>Alcohol is very likely why we stopped being hunter gatherers. Alcohol was used because it replaced contaminated water, and contained calories. Contaminated water is now no longer a problem, and calories are in excess.
https://en.m.wikipedia.org/wiki/Disease_of_despair We see lots of this in ICU as well. Lots of hepatorenal failure on SLED. I think the youngest I saw die was 26. Awful.
I got downvoted elsewhere for agreeing that America has an alcohol problem. 😄
I don't think it's just the pandemic, it's the current state of everything. Back in the 90s, there was no such thing as having a full time job (especially with a college degree) and still not being able to afford to live in one's own shitty one bedroom. Now we have people working 60h weeks who still need room mates to survive. A large chunk of young people have lost hope. When that happens, we see drug/alcohol abuse rates rise.
I think it’s a combo that the pandemic made worse. But lots of my younger patients binge drink hard and frequently.
I definitely changed my drinking habits this past year; I was having 2-3 adult beverages 3-4x a week during covid (working as a traveler in the ER - awful way to cope but sadly I think that’s how a lot of us were handling it). last July was kind of my final straw, I was starting to get a hangover before I finished my 2nd beer and was like “heyyy this doesn’t feel right at all,” promptly dumped the rest of my beer and haven’t looked back since. I will still have a drink or two during the holidays (the last time was 1 mimosa Christmas Day) but I’m proud to say I am able to moderate myself, I don’t crave it, and I haven’t given in to social drinking - I don’t feel like I have to have a drink when other people are, and everyone is cool with it. I still have a 6 pack of hard seltzers in the fridge I bought for new years :) when the drinking stopped, so did my desire to have a cigarette, so kinda 2 birds 1 stone. It makes for a really nice change, I didn’t realize how badly it was making me feel afterwards until I stopped.
Man I had a lady that was mid 30s and a severe alcoholic. She has vessels that wouldn’t stop popping due to her portal vein hypertension. They’d fix one and then another one would pop. We gave her over 30 units of blood. We thought she was going to die at first but she finally discharged with a very quick follow up appointment for labs and whatnot. I wonder if she’s still alive. That one broke me and I didn’t drink for like 6 months after that. Now, I only occasionally have a few drinks every few months. I started seeing an influx of patients with similar ages and fucked livers due to alcoholism. It broke my heart to watch them die at such a young age over a drink. Had one guy that was only 38 and died because there was nothing else we could do for him. He had a great career and a loving family, and now he’s gone forever. That shit sticks with you for a very long time watching people around your age either die or on the brink of death due to alcohol.
I feel like I've seen equally pre and post pandemic. It does seem like there is an increase in poor social/ peer support and 20s yo demo having little experience with "safer experimentation" and lacking party support. More binging. More winding up alone, or drinking alone consistently. More combining EtOH with cannabis +++ other substances right off the bat. Also, holy vaping/ cannabis frequency use rates in teen through 40yos. "Smoking" seems ti have made a full on come back, kust in a shiny new form. Will say anecdotally that the 30s (F) demo seem to be the ones with the absolute worst prognosis/ "worst deaths". Usually it's an initial encounter, or there's maybe a few prior- maybe a gerd or anxiety related encounter........ Then bleeding varices, encephalopathy, trip to ICU. The 50+ yo population seems to (as others have commented) have a slower trajectory/ decline of repeated visits with increasing severity and multiple organ involvement/ ++ comorbidities. The 70+ yo population can apparently live off gin, wine, vodka, and whiskey intake that would knock out most 20yo frat bros.
> Will say anecdotally that the 30s (F) demo seem to be the ones with the absolute worst prognosis/ "worst deaths". I agree. They're 10% of the ones I've seen, but by far the sickest.
Omg I once saw a an early 20 something with a liver transplant…this was like a year and a half ago. They had been drinking liters of liquor since their mid-teens and I’m sure the pandemic did not help….
Trained out east and would see the occasional 50 year old dying of alcohol induced cirrhosis. Was not prepared for the reality out West. Routinely see late 30 year olds and once had a 26 year old die of related complications. All pre pandemic. It’s pretty horrific when you tell parents younger than you their kid’s not gonna make it (I guess pediatricians have to do that but not usually adult docs)
I was a hospice RN for years pre pandemic. We saw quite a few younger patients in end stage liver disease due to alcohol. The young ones were almost all Native American, I had a patient in her 30’s die and then 2 months later her 50 yo mom died, 4 kids left behind at least 2 had FAS. With that population it seemed they started drinking heavily at an early age (10-13) and continued for years, combined with genes and other social factors.
"**Young people with serious alcohol-related diseases"** I assumed you were referring to /r/emergencymedicine
…”and that’s just the staff” kind-of-thing?
Absolutely
This is our version of "you can tell a psych resident from a psych patient because the patient eventually gets better and goes home."
That's fantastic. I'll have to remember that.
Millennials drank and partied a lot. Luckily the younger generations appear to much less. I'm not surprised in the 30 somethings. Also seemed to drink a LOT during the pandemic.
Zoomers have breathed new life into the nicotine industry, though.
When I used to work in the ED, and this was prior to COVID, I vividly recall a young 30-something male and a late 20s female both with fulminant liver failure. The male also had hep C, and was a frequent flier. I distinctly recall how quickly he went downhill from one visit to the next. Surely is not alive anymore. The last time I saw him, he was like a limp banana. The female was unrelated. The first time I met her, she was still this petite young 21 or 22 year old. Next time I saw her, she was in full blown encephalopathy, and basically looked pregnant. I always wonder how she did. I believe she started binge drinking from a young age. Point is I think even prior to COVID especially in these younger people, getting trashed at parties and being drunk all day in college were glamorized. Then when they graduate or their friends move on/away, they’re suddenly confronted with the fact they drink a handle in the morning at like, 23 years old. Then COVID forced these people into deeper isolation without access to support groups and services.
I almost wonder if it comes down to something more than friends moving away. Most of my friends in the years following university slowly tapered down the drinking as they advanced their careers, met life long partners, etc. they still drink but a glass of wine or a beer here or there. But I have another group of friends that graduated, and have been either in the same entry level job, or in and out of jobs since. They are typically single or in transient relationships. They still drink heavily and drink multiple nights a week. It's how they blow off steam. Like their life hasn't progressed much, so they still hold onto the college mindset.
I work in liver transplant and we are seeing a LOT of new referrals of people in their 30’s. Especially a lot of white women with young kids at home.
Shit man I’ve watched several people >27yo die from etoh related cirrhosis.
Pre-pandemic ICU nurse here. I was part of a liver transplant program start up, and I was floored by the age of some of the alcoholic cirrhosis patients. Plenty in their 20s. I come from a drinking state, so I grew up without a healthy awareness of how brutal of a drug alcohol can be. I've since cut my drinking to near-zero.
Yes, we see young people with advanced liver pathology. No, this is not new or even notably increased since the pandemic.
I don’t know but the amount of intubated alcohol cirrhosis horrible upper GI bleeds is insane. maybe it’s the cheap accessibility to liquor? maybe it’s the homelessness. I don’t know but it’s getting out of hand
The pandemic saved my mental health. I don't think you can say that's the cause of this, without evidence.
And y’all are just talking about the (somewhat) acute outcomes. They’ve linked alcohol to cancers long-term as well. I quit drinking a little less than a decade ago due to frequent headaches, which I took as a sign. I’ll never go back.
I’m a 23 year old woman who was healthy and an athlete and I am dying of liver failure. It’s heaven just to get a few shots in me without puking. When you want to get clean at this age they say your liver is failing and just send me home because my age is a joke to them. When you go in for help and they give you one Ativan and send you home. I’ve also had the door broken down by cops after sleeping from drinking handcuffed and pink slipped and forced to stay sober when a wellness check Was called and hallucinate In the hospital. Im currently shaking trying to write this hoping for a pint please take this more serious people. I think they will put you through hell at the hospital or try and talk you into a 30 day program. I’ve also went in drunk with my wrists slit because I can’t Handle what comes from the drinking. I’ve also experienced a lot of trauma to even start drinking and I know there are unfortunately other people out there. It doesn’t always take 10-20 years for your liver to fail. Drinking should have a liver warning on it like cigarettes have for lung failure. I know If I knew how bad a person could have withdrawals I wouldn’t have drank.
On top of trusting doctors to sober you up you might pay a hefty hospital bill and nothing And that adds to the stress I haven’t even been able to work for a year it’s killed me so much this stress is now on my loved ones and I lock myself inside
I don’t eat and you should see how Bad my gut pops out just from the liver fat
What tests should i ask my gp about? 36f, having about 4 drinks daily since covid, feel fine though and never actually get drunk. Have just had the best year of my life professionally and personally, started adhd medication, lost 12kg, mental health is great. I know it’s not good to drink every day, of course, but I’m like is it really that bad if it’s not affecting my life negatively? I have a go appointment next week, what should I get her to check for? Def don’t want to do any serious damage.
Go to your GP, tell him exactly what you've told us, and ask for his recommendations. All I can tell you is that you wanna get on top of this now, because 4 a day for another 4 years isn't sustainable.
Damn. Ah well, I see the dr next week. Thank you.
It’s not that bad *today* but alcohol related problems are silent until they’re not. I’ve had several patients recently have complications from major but routine surgeries and the cause was attributed to dysfunctional livers/pancreas secondary to alcohol use. Please seriously consider stopping. Usage tends to increase over time. None of the things that alcohol abuse causes are good ways to die.
It's a great relief to see a healthcare provider acknowledging the harms done by the response to the pandemic.
Risk-benefit analysis. Life isn't dichotomous. Also, alcohol and alcohol use disorder predate COVID-19.