Thursday, September 16, 2010

Love your Liva...

The liver is not an organ we hear much about. There is no American Liver Association (OK, maybe there is...but you don't hear much about them in the news), no Annual Liver Walk for raising awareness and funds, no special liver healthy diet. The reason for all of this is that your liver, a powerhouse organ that is just as important to your daily life as your heart, lungs, brain or kidneys, is a silent hero. It works nonstop to purify toxins in your blood and it doesn't require the kind of upkeep that your other organs do. You have to exercise to keep your heart and lungs healthy, drink plenty of water and eat a balanced, electrolyte rich diet to keep your kidneys happy, get plenty of fresh oxygen to keep your brain cells truckin' along. Meanwhile your liver, as long as you do those things to keep your other organs happy, is perfectly content and will most likely work tirelessly for you without a single glitch until the day you die.

Your liver, in fact, will outlive you if you have made the decision to donate your organs when you die. A lot of times nurses don't call the organ center when they have an extremely old person who is considered terminal, thinking that their organs are too old for the organ procurement people to possibly be interested in them. However, the organ people will gladly take any liver from an otherwise healthy individual of virtually any age. I had an 82 year old whose liver was hotly pursued by the agency because he was a vegetarian nondrinker who didn't take any medications and they knew that such a well cared for liver would be very useful for someone else who hadn't taken such care of their own.

So, if the liver is so resiliant and selfless, than why should I be so concerned about it? Shouldn't we just let well enough alone and let it keep on keepin' on? Well, yes. And no. Because in fact, I HAVE seen people die of liver failure. Young people. Rich people, poor people, educated and uneducated. In just about every case, the people I saw die of liver failure had one thing in common. They drank alcohol. You're probably thinking that what I meant to say was that they were alcoholics who abused alcohol, but I didn't say that on purpose. In truth, some of the people I have seen die of liver failure WERE nasty old drunks. However, a good number of them were moderate to moderately heavy drinkers. As in, a couple glasses of wine every night. A twelve pack of beer most weekends. A weekly knock down drag out party where everyone got trashed but were all back to their normal, everyday selves by Monday morning. Those are always the people who are so shocked to hear that they are in liver failure. "Liver failure?" they say, bewilderedly. "But I'm not an alcoholic."

Let me lead you through a possible scenario that could culminate in liver failure. We have a person who enjoys a cocktail hour with her friends every Thursday after work. She has two or three and goes home. Friday nights, she likes to get together with family and usually has a few glasses of wine. On other nights of the week, she usually has a single glass of wine with dinner because its good for you now, didn'tcha hear? Only, what she secretly knows and doesn't admit to anyone is that her wine glass holds about a third of a bottle of wine (lots of the wine glasses out there do nowadays) and thats a good three times what "they" are now saying has heart healthy benefits. The serving size that is extolled by the heart people is a teensy weensy 4 ounce glass for women. For men its a tiny bit bigger, like, 5 or 6 ounces.

Now, there's a good chance that this woman will live her life out normally and die contendedly of something completely unrelated to her moderate drinking habit. There's also a chance that she will get morbidly ill at some point in her life. Most of us do have at least one major illness during our lifetimes. This is when the moderate drinker will live to rue the day he or she ever picked up a wineglass. Because during a serious illness is when our body's liver power suddenly gets heavily taxed.

When you're fighting a really bad infection, for instance, the doctors have to throw all kinds of really strong antibiotics at you that are really hard on your liver. A normal liver does just fine. It has lots of reserves. And, once the illness is over, the liver will be able to rest and recuperate and come back to its normal function. A liver that has been steadily detoxifying small amounts of alcohol away all these years, like our example's liver for instance, is a little bit tuckered out to begin with. Its almost like that liver has been getting pinched every day for a long long time. When someone comes along and throws a sucker punch, the healthy liver can take the punch and come back swinging. The pinched liver is already hunched over and in pain. The sucker punch knocks it out and its down.

This is an example of how the way you treat your liver can decide whether you survive a lengthy or catastrophic illness. You can either live to complain about the bad hospital food you endured or leave your family shaking their heads going, "I never even knew she was an alcoholic. How did she die of liver failure?"

This is one scenario that can play out to result in liver failure. Its not the only one. Pill poppers, the ones who never go to the doctor and don't drink at all but who take a few tylenol and ibuprofen every single day because its over the counter so it must be perfectly healthy are also at risk. If you take tylenol on a regular basis, you are pinching your liver. Just like an alcoholic beverage! Drink some water and lay down on the couch for a few minutes if you have a headache! And don't even get me started on people who give their kids children's tylenol for every single sniffle and whine. They are setting their children up for a lifetime of medication-reliance and starting the liver pinching way too early.

On the alcohol front, though, I have another scenario to describe to you. It is a scenario that is all too familiar to any hospital nurse out there. People who drink a few beers religiously every single night or a few servings of wine are not only pinching their livers, they are putting themselves on a medication schedule and setting themselves up for DT's when they alter that schedule at all. What are the odds that you are going to be hospitalized for some length of time in your lifetime? Pretty good, right? You might need some small trifling surgery, you might get an infection, you might have a mild heart attack. It happens all the time. With all those aforementioned examples, we can usually get you fixed up and send you on your way in a few days.

Anyone who has an alcohol consumption history better hope, though, that they do not require more than a single night in the hospital. Because round about the middle of that second night, we nurses have become accustomed to seeing those special signs that someone is experiencing delerium tremens, or alcohol withdrawal. We know it as soon as we see it. And to know it is to love it. Get out the wrist restraints, order up an ativan drip, and notify the family that their loved one will be busy for the next three days. The families often act completely mystified when we tell them that their loved one is in DT's. They have a picture in their head of the typical DT experiencing person and it is NOT their loved one. Sometimes they flat out deny that their loved one drinks regularly at all. Those patients often get sent for CT scans of the head to rule out stroke, they have neuro consults to rule out seizure disorder and neuro disease, and in the end we almost always conclude that it was, after all, alcohol. The family isn't lying. They are in complete denial or are totally unaware of the actual extent of their loved one's alcohol consumption, even though it has been going on under their very noses for years. A six pack at a time is NOT normal. It is NOT minimal. A three rum and coke drinker who doesn't even act drunk IS at high risk for going into DT's. Even if you think they don't do it every single night.

I have seen ministers and PhD's go through DT's. It has been my humble privilege to wipe their asses because they're so gorked out on DT's that they can't even control their own bodily functions. I have lovingly jumped on top of a 240 pound man with an 18 guage needle, as he was being held down by two security guards and a nurse to reinsert the iv that he has forced out of his arm with the violent tremors associated with this condition. I have dried rivers of sweat from the clammy, diaphoretic bodies of perfectly young, fairly healthy people as their family members and friends watched from safely outside the room, shaking their heads in wonder and disbelief. Finally, I have seen a young person have to be completely paralyzed with medicine and put on a ventilator (which eventually caused him to get pneumonia and experience a life-threatening infection) because he was in such a bad state. His wife did not know that he was a drinker. It added about 9 days to his hospital stay. I can imagine what it did to his hospital bill.

So, if you do have a planned hospitalization coming up and you are tempted to gloss over your actual use of alcohol to the doctor or your admitting nurse, you might want to think twice. If we KNOW your drinking history, there are steps we can take to prevent this terrible cascade of events from transpiring. If we don't know, we will know soon enough. And so will every member of your family (even your annoying Aunt Bea who feels the need to spread the news about everything to everyone) as well as your work associates and social circle.

If you think you might be one of these low level alcohol users, one of these social drinkers who socialize a lot, one of these mild headache pill poppers that I'm talking about, you should at least be aware that you are pinching your liver. You are pinching it and if you aren't careful, it might pinch ya back one of these days.

Tuesday, September 7, 2010

Soapbox Post: Dietary Sugar Reduction

We have all heard that excessive fat consumption is related to poor heart health and excessive weight. But did you know that research now proves that excessive sugar intake is just as bad or worse? Increased sugar intake by Americans over the past 40 years is being pointed to by the American Heart Association as a primary reason for increased weight, proliferation of cadiovascular disease and reduced intake of nutrients in our diets. As a result of this compelling research, the American Heart Association recommends that we all minimize the intake of beverages and foods with added sugars, like soft drinks (also known as "liquid candy"). If you have been telling yourself that it is natural to gain weight as you age and blaming it on your metabolism...think again. Maybe it is simply because, on average, Americans are taking in 19% more calories than they were 40 years ago. Where do those excess calories go? Straight to your waistline. To read the entire article, search Dietary Sugar Intake and Cardiovascular Health.


Goal: Eliminate soda from your diet for one whole week. Don't replace it with diet soda or other unhealthy beverages like sweet tea, milkshakes or energy drinks. Simply drink plenty of cold refreshing water. Do you think you can do it? I did it. This is despite the easy availability of soda in my workplace. While everyone else is sipping down the calories (or the unhealthy chemical sugar substitutes that some experts say are even worse), I treat myself to one cup of coffee per shift and about a liter of water. I rarely crave soda anymore like I used to and every once in a while, when I allow myself to have a single serving...I often wonder why I ever thought it was so great. Where else can you eliminate added sugars in your diet? Can you learn to drink your coffee without sugar? Can you experiment with reducing the added sugar in dessert recipes? What about breakfast? Breakfast cereals are a landmine of hidden sugar. Find a tasty one with plenty of fiber and no high fructose corn syrup. I bet you will be surprised at how difficult that is. An easy solution is plain instant oatmeal (plain is the only one with no added sugar) with fresh fruit, nuts, and cinnamon sprinkled in. Delicious! I also like raisins, pure vanilla extract and hazelnut in my oatmeal. I've even added unsweetened cocoa to make it a real indulgance! And for a cold indulgance, try my sister's recipe for homemade granola. Store bought granola has an unearned repuation as a health food. Most have outlandish amounts of sugar and high fructose corn syrup. My sister relies on a small amount of honey and dried fruits to sweeten hers.

Val's Homemade Granola:
3 cups old fashioned rolled oats
3/4 cup slivered almonds
1/2 cup sunflower seeds
1/2 cup unsweetened coconut
1/2 cup wheat bran
1 teaspoon ground cinnamon
1/4 teaspoon salt
1 teaspoon vanilla extract
2 tablespoons butter
1/2 cup honey
1 cup dried fruits (raisins, dried cherries, dried cranberries, etc...)

Melt butter in small saucepan. Add cinnamon, salt, vanilla extract and honey and stir to combine. Combine remaining dry ingredients (except dried fruit). Pour honey/butter mixture over and mix well. Spread on two baking sheets in thin layer and bake 20-25 minutes at 325 degrees F. As soon as it comes out of the oven, break it up and mix in dried fruit. Store in airtight container. Enjoy dry or with milk or soy milk.