The Lemon Fool

https://www.youtube.com/watch?v=RX2opvj7WE8

I watched this with some fascination, as there were some home truths in it, without anybody getting overbearing or dictatorial about anything.

One question popped into my mind: if one goes to the doctor and answers "60+ units a week" to the question "how much do you drink", why isn't a liver scan offered as a matter of course? (In the video, this bit starts around 26:50)

I've always answered the units/week question as honestly as I can (seems little point in feeding duff data to somebody trying to give you a health check) and my blood tests have always come back as normal. In the program, Adrian was in much the same situation and only got a liver scan as a result of research for the program.

Is it something you just need to ask for, or under what circumstances might it be offered?

VRD

vrdiver wrote:https://www.youtube.com/watch?v=RX2opvj7WE8

I watched this with some fascination, as there were some home truths in it, without anybody getting overbearing or dictatorial about anything.

One question popped into my mind: if one goes to the doctor and answers "60+ units a week" to the question "how much do you drink", why isn't a liver scan offered as a matter of course? (In the video, this bit starts around 26:50)

I've always answered the units/week question as honestly as I can (seems little point in feeding duff data to somebody trying to give you a health check) and my blood tests have always come back as normal. In the program, Adrian was in much the same situation and only got a liver scan as a result of research for the program.

Is it something you just need to ask for, or under what circumstances might it be offered?

VRD

I see no reason why the scan should not be offered privately with the patient paying. If a patient is willing to pay for 60+ units a week, they should be paying to find out what damage they could be doing.

vrdiver wrote:One question popped into my mind: if one goes to the doctor and answers "60+ units a week" to the question "how much do you drink", why isn't a liver scan offered as a matter of course?

I do not know about a liver scan but, when I have my annual medical, blood is drawn and there are tests for liver and kidney function. So far my results for both have been "Normal".

I probably drink about 60 units a week. Not hard given that a bottle of wine is about 9 units.

Ashfordian wrote:I see no reason why the scan should not be offered privately with the patient paying. If a patient is willing to pay for 60+ units a week, they should be paying to find out what damage they could be doing.

I think that misses the point. Firstly, you'd need to be aware of such a test being available; secondly, you'd have to challenge your doctor's reporting of "normal liver function".

If you tell a patient that is a heavy drinker that their blood shows "normal liver function" then they are unlikely to be concerned with the damage that could be present and getting worse; sclerosis and fatty tissue, leading up to liver failure. The liver function test doesn't (afaik) test for either of these issues.

The cost to the NHS of a patient with liver failure or associated alcohol-related illnesses (and to future tax revenue, let alone personal outcomes) would be, I'd have thought, much higher than referring patients for a scan that would identify the damage and possibly act as a wake-up call to change behaviour?

VRD

vrdiver wrote:The cost to the NHS of a patient with liver failure or associated alcohol-related illnesses (and to future tax revenue, let alone personal outcomes) would be, I'd have thought, much higher than referring patients for a scan that would identify the damage and possibly act as a wake-up call to change behaviour?

That opens up a whole can of worms because there is an argument that dying younger saves the NHS money, and so things like drinking and smoking are cost-neutral or even cost-positive, given that if you live to be older there will be more spend on you, and you may well die of something more degenerative and expensive.

We could do all kinds of other diagnostic tests by the same argument, e.g. a full colonoscopy for every person over 50 every 5 years. But we don't, presumably on cost grounds, instead posting out those "poop test" packages that are known to be a much inferior test.

Lootman wrote:

vrdiver wrote:One question popped into my mind: if one goes to the doctor and answers "60+ units a week" to the question "how much do you drink", why isn't a liver scan offered as a matter of course?

I do not know about a liver scan but, when I have my annual medical, blood is drawn and there are tests for liver and kidney function. So far my results for both have been "Normal".

I presume you didn't see the show. Your circumstances are identical to Chiles - consumes c. 60 units a week. His annual 'well man' blood tests show normal liver function. However, a liver scan shows early signs of damage (fatty deposits, scarring) which could ultimately lead to cirrhosis.

And I'm not lecturing. I'm also in the same boat.

mrbrightside wrote:

Lootman wrote:

vrdiver wrote:One question popped into my mind: if one goes to the doctor and answers "60+ units a week" to the question "how much do you drink", why isn't a liver scan offered as a matter of course?

I do not know about a liver scan but, when I have my annual medical, blood is drawn and there are tests for liver and kidney function. So far my results for both have been "Normal".

I presume you didn't see the show. Your circumstances are identical to Chiles - consumes c. 60 units a week. His annual 'well man' blood tests show normal liver function. However, a liver scan shows early signs of damage (fatty deposits, scarring) which could ultimately lead to cirrhosis.

And I'm not lecturing. I'm also in the same boat.

You are right; I did not see the show.

I suppose it comes down to whether you want a long life at the expense of a less pleasant one.

My mother was diagnosed with a heart condition in her teens. She was told that if she did not smoke, drink or exert herself unduly, she would live to be 90. She replied that if she could not do those things then she did not want to live to be 90. So she did them

She died at age 88. worth it?

I saw the show and thought it excellent and worth a watch by any drinker.

When I look back at my life I note that most of the fun times I have had have involved alcohol or some other drug. I am quite capable of drinking over 25 units in one day but most of the time these days I chose not to and I'd say that 25 units a week is average for me now.

I have known several alcoholics and enjoyed many a long session with them. The two closest to me first sparked my suspicions when inviting me to join them in a stiff drink for breakfast, in one case a large glass of white wine and in the other a tumbler of scotch, neat!

One of those friends died at 51 from liver failure, the other lost several jobs, three wives, his home and his family due to his excessive drinking. I believe he is now in Thailand but he disappeared completely since borrowing money from me for a deposit on a flat to save him from sofa surfing in his 50s. He probably spent the money on alcohol!

60 units a week might be "easy" ie. one bottle of wine a night, but it is clearly too much a will have a detrimental effect on long term health. My friend who died thought five bottles of wine a day was "easy" and I guess it is if you start at 8 o'clock in the morning! I can assure you however that his death was far from easy...dying from liver failure is a slow, painful and messy business.

I love alcohol, like Frank Skinner, who has been abstinent for 30 year now, said in the show, he still misses the buzz that alcohol used to provide. I limit my drinking to the weekend and one session in the week and try not to "binge". It seems to work for me. I have done "dry January" for a few years now just to prove to myself that I can and it is not difficult, thankfully I don't "think" I have a problem with alcohol.

John

Lootman wrote:

mrbrightside wrote:

Lootman wrote:I do not know about a liver scan but, when I have my annual medical, blood is drawn and there are tests for liver and kidney function. So far my results for both have been "Normal".

I presume you didn't see the show. Your circumstances are identical to Chiles - consumes c. 60 units a week. His annual 'well man' blood tests show normal liver function. However, a liver scan shows early signs of damage (fatty deposits, scarring) which could ultimately lead to cirrhosis.

And I'm not lecturing. I'm also in the same boat.

I suppose it comes down to whether you want a long life at the expense of a less pleasant one.

My mother was diagnosed with a heart condition in her teens. She was told that if she did not smoke, drink or exert herself unduly, she would live to be 90. She replied that if she could not do those things then she did not want to live to be 90. So she did them

She died at age 88. worth it?

Indeed. Part of my problem is that I survived bowel cancer so some small, irrational part of my brain still thinks, 7 years on, 'Feck it - I deserve this'.

vrdiver wrote:

Ashfordian wrote:I see no reason why the scan should not be offered privately with the patient paying. If a patient is willing to pay for 60+ units a week, they should be paying to find out what damage they could be doing.

I think that misses the point. Firstly, you'd need to be aware of such a test being available; secondly, you'd have to challenge your doctor's reporting of "normal liver function".

If you tell a patient that is a heavy drinker that their blood shows "normal liver function" then they are unlikely to be concerned with the damage that could be present and getting worse; sclerosis and fatty tissue, leading up to liver failure. The liver function test doesn't (afaik) test for either of these issues.

The cost to the NHS of a patient with liver failure or associated alcohol-related illnesses (and to future tax revenue, let alone personal outcomes) would be, I'd have thought, much higher than referring patients for a scan that would identify the damage and possibly act as a wake-up call to change behaviour?

Yes - I agree on your first point. If a drinker gets a 'normal' liver function test result, he will likely conclude he doesn't have a problem and the majority would be blissfully unaware of the more detailed scan.

But secondly, it's well known that patients consciously (or otherwise) understate their weekly unit intake of alcohol when talking to their GP.

If a patient admitted to regularly consuming 60 units a week, wouldn't a responsible GP try to get to the root cause by opening a discussion rather than immediately requesting a detailed liver scan ?

Lootman wrote:I suppose it comes down to whether you want a long life at the expense of a less pleasant one.

That comes down to what extent, if any, your quality of life is determined by your alcohol intake.

In my case, there's a slight negative correlation: the less I drink, the happier I am. Although I think the relationship is largely the other way around: the happier I am, the less I'm likely to drink alcohol.

I've never been much of a boozer, and drink relatively little compared to most. But I am pretty fit and would like to remain that way (or improve), and so in my mind I consequently have alcohol mentally framed as a self-inflicted hindrance to those goals, which happens to make it naturally unappealing in anything other than modest and infrequent doses, without any sense of denial or self control required.

I'd no more drink a full bottle of wine myself than I would eat several consecutive Mars bars, for example.

But people are all wired differently, seemingly through chance.

My pal has a real lip for alcohol, and if it wasn't for the negative consequences (and thus self control he exerts) he would consume vast quantities of it, getting happier and happier with each drink downed. What would be heaven for him (repercussions aside) would be utter hell for a lightweight like me.

mrbrightside wrote:I agree on your first point. If a drinker gets a 'normal' liver function test result, he will likely conclude he doesn't have a problem and the majority would be blissfully unaware of the more detailed scan.

But secondly, it's well known that patients consciously (or otherwise) understate their weekly unit intake of alcohol when talking to their GP.

If a patient admitted to regularly consuming 60 units a week, wouldn't a responsible GP try to get to the root cause by opening a discussion rather than immediately requesting a detailed liver scan ?

I try not to misinform my GP (who benefits?) but yes, I can see how easy it would be to either undercount or round down to an "aspirationally appropriate" number when having the conversation. I think Lootman* has already mentioned the game of lying to his doctor and his doctor not believing him re alcohol consumption.

I've had several medical checkups where I've been informed with various levels of seriousness that I "needed to cut down" but never had any follow-up, let alone an attempt to ascertain the underlying reasons or whether there was evidence of functional, social, emotional or any other impact. Basically, my GP would ask the question, I would reply, they would make a note whilst trying to look thoughtful, suggest I cut down and then move on to the next tick-box.

I'd never heard of the liver scan that the program used, nor realised that a normal result in the blood test was not the same as having a normal liver. In fact, my blood test results probably gave me a false sense of "I'm the outlier who's getting away with it! All clear to carry on as before..." which the doctor made no attempt to dispel, other than the woolly "should cut down" advice.

VRD

*Apologies Lootman if I have misquoted the essence of one of your previous posts from a different thread.

Interesting production. The graph shown at 9:45 seems a different shape to others that I have seen. (Although not shown, the x axis is, I assume, mg of alcohol per week.) Without reading the article, it is difficult to comment further on why it is different, or to see if I can find anywhere where a possible government conspiracy against alcohol has had an influence. It is freely available so I might read it when I have time:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30134-X/fulltext

There are plenty of examples of J-shaped graphs on the 'net. I found this report that states that the shape of the graph is age-related and that the optimum consumption rises as one gets older,

http://alcoholresearchuk.org/downloads/ ... t_0015.pdf

It would seem from this report that young people are better off abstaining whereas older people are better off drinking in moderation. This ignores the types of drink consumed: Brightly-coloured synthetic concoctions favoured by the younger generation may not be comparable to Real Ale or red wine in their effects upon one's health.

It would be good if a report such as this had the date on it somewhere.

It is easier to pinpoint the negative effects of alcohol than the benefits. "Alcohol destroyed my liver" or "alcohol caused my throat cancer" sounds more plausible than "alcohol prevented me from having a heart attack".

As for me, I drink probably around 35 UK units per week. If I moved to Spain, I would be just within the recommended limit.


Julian F. G. W.

jfgw wrote:There are plenty of examples of J-shaped graphs on the 'net.

There are J curves in the raw data. If you eliminate people who do not drink because drink gave them problems, the J disappears in the most reliable data. The more you drink the worse your health prospects. The government changed its advice because better data became available. The risk at the government recommended maximum consumption corresponds roughly to your chance of being killed in a road accident, if I remember correctly.

GeoffF100 wrote:The risk at the government recommended maximum consumption corresponds roughly to your chance of being killed in a road accident, if I remember correctly.

So negligible then.

John

redsturgeon wrote:

GeoffF100 wrote:The risk at the government recommended maximum consumption corresponds roughly to your chance of being killed in a road accident, if I remember correctly.

So negligible then.

John

Is that the same for women and men? Also, is it the "new" 14 units, or the "old" 21 units for men?

More interestingly, what about those who drink double, treble or quadruple the recommended limits? I assume it's not a linear risk profile?

Does the risk include drunk accidents and other alcohol-induced acute deaths, or just the chronic effects? I assume it's all, but wonder if you stripped out the more idiotic and spectacular fatalities, what the underlying risk really is?

VRD

ap8889 wrote:Right now I am holding a pint of lightly chilled Doom Bar

*chilled*? Doombar? I thought you said you like real ale?

UncleIan wrote:

ap8889 wrote:Right now I am holding a pint of lightly chilled Doom Bar

*chilled*? Doombar? I thought you said you like real ale?

Real ale is generally best served at "cellar temperature". So that is more than the frigid temperature at which lager is served, but less than room temperature. So a "slight chilling" of a real ale seems appropriate unless you actually have a real cellar to store it in.

https://cask-marque.co.uk/beer-temperature/

vrdiver wrote:

redsturgeon wrote:

GeoffF100 wrote:The risk at the government recommended maximum consumption corresponds roughly to your chance of being killed in a road accident, if I remember correctly.

So negligible then.

John

Is that the same for women and men? Also, is it the "new" 14 units, or the "old" 21 units for men?

More interestingly, what about those who drink double, treble or quadruple the recommended limits? I assume it's not a linear risk profile?

Does the risk include drunk accidents and other alcohol-induced acute deaths, or just the chronic effects? I assume it's all, but wonder if you stripped out the more idiotic and spectacular fatalities, what the underlying risk really is?

VRD

That was for the new 14 units. The curve becomes steeper and steeper with increasing consumption. Here is the report:

https://assets.publishing.service.gov.u ... an2016.pdf

I have not studied it. I was reporting from secondary sources.