Alcohol Pre Treatment

[irishrayne]

I went for my pre treatment psych eval earlier this week. Found out that the docs don't want to start treatment unless the patient has been alcohol free for at LEAST six months prior. I was SO disappointed as I was hoping to begin tx ASAP.
I enjoy a glass of red wine with dinner. I knew NO alcohol during treatment and had planned to not drink for several weeks prior to.
Now I may be delayed into the new year befor I can start tx.
I just wanted to share with those of you who haven't started tx yet so that something like this doesn't hold you up as well.

[miked]

Be prepared for the wrath of hell about using alcohol with HCV.  It's a very emotional topic on this board.

[anise]

I'm sorry that you have to wait.  Can you get another doctor?

When I went for treatment I was asked how much I drank per week.  I can't remember actually how much I said, but it wasn't an issue, they treated me.  However, I have one friend who had to be alchol free for 6 months.  It depends on who is treating you it seems.  

If it were me I would get another opinion if you are able to.

[SonicBandaid]

What nonsense!  Sure, its BETTER if you aren't drinking and I certainly advise my patients not to drink more than 7 standard drinks per week (in fact, alcohol consumption at that level or lower is a prerequisite for funding therapy in Aus), but there is little evidence to suggest low level social alcohol consumption of this sort impairs your response to treatment in any measurable way or accelerates your liver disease (assuming you don't have an alcohol PROBLEM or alcohol related liver disease to start with. We are supposed to practice "evidence based medicine" and I would LOVE to see any evidence that getting people to be completely abstinent for 6 months prior to treating HCV with IFN/Riba makes any difference to outcome (other than the fact you unnecessarily delay therapy)

It is also not realistic. If I insisted on this, I'd wind up treating about 25% of the patients I have. The Puritans have a LOT to answer for.  Several patients I currently treat also tell me that 1-2 glasses of wine (on the nights they inject, only) actually makes the side effects more tolerable.
Cheers,
Sonic

[anise]

That's wonderful - you being a doctor!  Your views and experience are a welcomed asset on this forum.  

If you don't mind - what type of doctor?  You may have posted this, but I may have missed it.

[mikesimon]

Amen! Mike

[Alady1620]

I have heard that some doctors have the 6 month no alcohol rule but mine didn't mention it.  IF somebody is only a casual drinker ie-has a glass of wine with dinner every now and then- how would the doctor know they  have been drinking?  Surely, they could pick out the alcoholics from simple blood tests.

I think the rule is totally understandable when dealing with alcoholics.  

[mremeet]

Alcohol consumption has been shown to increase viral loads in those infected with HCV. I don't recall offhand what threshold of alcohol consumption would start making the biggest difference in increasing VL, but I'm doubtful a very moderate alcohol intake (like 1-2 glasses of wine a week) would do much to increase your viral load.

I'm guessing the reason they want complete abstinence for 6 months prior to tx is for two reasons: (1) To ensure you're capable of abstaining and controlling any possible addiction you might have. Abstinence will help you adhere to your treatment protocol and thereby help to improve odds of treatment success. Alcohol consumption during treatment will further tax your already taxed body and mind, making you less likely to comply with and complete treatment - thereby lowering your odds of treatment success. It can also greatly complicate the management of your emotional side effects. Anti-D's and sleeping meds are common meds used for the management of sides. Generally you don't want to be mixing White Zinfidel with Paxil, ambiem, Tylenol, benadryl, interferon and ribavirin just to name a few.

And (2) to keep your pre-tx starting VL as low as possible. Eliminating alcohol consumption well before starting tx will help to get your viral load down and "re-equilibriated" as low as you can get it prior to starting treatment. Studies have repeatedly shown that those who start off with lower viral loads tend to respond more favorably to the treatment drugs. Those who start out with lower viral loads are more likely to go UND earlier and are generally more likely to get their SVR after completing their treatment. Anecdotally I've seen people report very significant reductions in their VL after stopping alcohol.

So while it's a bit of a mixed bag, in this layman's opinion it's probably best to just stop alcohol altogether well prior to starting treatment. If you're a very moderate drinker (i.e. 1-2 drinks a week), I'd just go 3 months without any alcohol prior to starting tx. I'd also use that time to get into shape - eat right and exercise plenty to strengthen yourself in preparation for your battle. If it's real hard (or impossible) for you to stop drinking, then I'd suggest trying getting the help required to get the alcoholism under control. SOC treatment can be a real tough fight for someone without any addictive monkeys on their backs. Treating while suffering from unmanaged alcoholism is setting the stage for failure, and one hell of a miserable experience. My $0.02 anyway, best of luck.

[GrandOak]

Most alcoholic still in denial will tell you they're only casual drinkers.  Most in recovery will jokingly tell you that they casually drank, just that they casually drank when they were happy, casually drank when they were sad, or casually drank when they were neither happy or sad.

Most doctors can discern the occasional drinker from those who casually drink.

[irishrayne]

I am treating with Dr Fried's group here in the US.
I told them I am completely a casual drinker ( 1-2 glasses of wine at dinner) the 4 oz glasses not the GOBLETS!  lol
I am geno 1-a
O fiobrosis
grade 1 inflammation

I'm a bit frustrated to say the least

[AdamHCV]

What about cooking with wine? Is this just as bad as drinking it?

[SonicBandaid]

Hepatologist. (Aus/UK/US trained MD PhD)

Actually, some hepatologists I know (and who have published on this contentious subject area) will treat HCV in people actively detoxing from heroin on maintenance methadone.  I have issues with that but their stance (and I can't argue with it) is that many of these people will get off drugs but if you wait for that to occur before treating them you may delay therapy too long.  Tough area to work in.

Sure, high levels of alcohol consumption will increase (to a minor degree, not by the 2-3 logs IFN/riba causes it to fall by) viral load in some people, but modest (1-7 units / week) have never been shown to impair responses to therapy.
Cheers,
Sonic

[FlGuy]

In most cooking processes, the alcohol in wine is 'cooked off' or evaporated in the processes.

[Myown]

Well I guess alot of people will be falling off the wagon this week.

[nygirl7]

As far as I am aware my friend who was an addict was told no alcohol or drugs prior one yaer to TRANSPLANT because they didn't want to waste a perfectly good liver (of course he went right back out there anyway and later died) but I've NEVER heard of not drinking ANYTHING prior to treatment.

I was honest with my doc and admitted I am a sober alcoholic/addict.  He didn't really ask me anything more at all.  He told me after treament if I had two glasses of wine a YEAR that would be the utmost that would possibly be allowed.

Told him not to worry I didn't drink anymore anyway (although I sure do want to in the summertime sometimes!).

He said my liver was already severely damaged (stage 3) and from now on NO ALCOHOL was the policy I had to follow.

But - he did not in any way question me as to drinking PRIOR to treatment.

Just about EVERYONE has a glass of wine or two a week prior to treatment in the real world.  I can't imagine why a doctor would think a person wouldn't?

Find another doctor. That's all. Make sure you get a copy of all your records and go.

I've never heard of anything like this before really.

[SonicBandaid]

I'd also take issue with categorising "If you're a very moderate drinker (i.e. 1-2 drinks a week)" as MODERATE alcohol consumption.  I have patients who spill more than that, daily.  Now I'm NOT advocating regular alcohol intake, and personally don't drink at all, but the reality is many people do take and enjoy alcohol regularly and responsibly, and doing so, in my view should not disqualify them from getting proper treatment for a potentially serious disease.

Incidentally, there is also the persistent paradox, demontrated in many countries in well conducted surveys, notably in the UK (but also in the US and Europe), that if you totalled up the amount people ADMIT to drinking you could only ever account for about HALF the alcohol consumed nationally.
Cheers,
Sonic

[mauilady]

I've heard that said before; it makes me wonder, though---I was always totally honest about the amount of alcohol I admitted I consumed; health care workers REALLY must have thought I was a lush!!!  (Ohhh----2-3 bottles of beer a day, followed by 1-2 bottles (not glasses) of wine---red wine...!!)  LOL

[mikesimon]

I personally know a man very well who received a liver transplant 3 days before I did while he was on methadone for prior heroin addiction. After transplant he treated with Pegasys/Ribavirin and achieved SVR. He was genotype 2. He is still on methadone and still undetectable. At my center he isn't the only methadone user who got a liver. I don't think it's a big deal - the MELD score, body size and blood types make up the big deal. Of course, an alcoholic needs to be sober/totally abstinent for 6 months before he/she will be even be evaluated for liver transplantation. Mike

[cajunlady]

Thanks for clearing things up a bit.  Always wonder why my doctor told me I could go on with a normal life after I have cleared 6 months post.  I had little to no damage w/biopsy and mild inflamation.  He asked how much I drank before starting tx, I go to about 5-6 house parties a year. No bar hopping, no gatherings every weekend etc. He never asked me not to drink before I started, but advised not to drink during tx.  

I am glad you clarified these things here, there are alot of issues with this subject and on some peoples part rightfully so.  Most people with serious alcohol problems cannot ever, ever social drink again and they see things in a very different light than a social drinker does and vise versa.

Have a Great Day, and keep the straight up info. coming.

Cajun

[anise]

Sonic, thanks for being here, this is great!

Cajun - I tried to email you with the email but it keeps bouncing back?  

[cajunlady]

I was waiting for you to post so I can correct.  It is a new email for me, it is
***@****.  Leave the last four letter off the beginning.  Sorry, I checked with my husband and he corrected me.  Hubby is doing really, really good for just 2 weeks post of his stem cell transfusion.  Counts were so high he stunned the med. staff at UCLA.  What it takes people three months to get their counts back up that high, it only took my hubby one week.  He still gets very tired easily and has to nap during the day.  We will see in 6 months if it took care of this Hodgkins once and for all, with a pet scan.  

Did you go to your doctor yet.  If so, how did it turn out.  Let me know.

I went Monday to try and asperate the so called cyst in my rt breast, well there is no fluid and it is a solid mass.  I go for a biopsy on Friday morning.  He will take the mass completely out for biopsy since I have high risk breast cancer in my immediate family (maternal).  Then we will take it from there.

My hep doc mailed out my orders for me to get my 6 month post PCR.  I should get it tomorrow.  I will try and have the labs done this weekend; if I am lucky I will have them to go on Friday when I do my biopsy and have them drawn then.  Nervous, but time to see if tx worked for me.

Cajun

[jmjm530]

Amen. Amen. My docs allowed me to drink in moderation both pre-tx and post treatment. In fact, my current liver specialist wants me to drink 5-7 glasses of wine per week to try and raise my HDL cholesterol.

Irish, I don't know your stats, but if you really want to treat, the amount of alcohol consumption you mention should not be a barrier.

-- Jim

[jmjm530]

We've rehashed this in the past and a recent study shows no accelerated viral replications from alcohol, plus a recent study suggests that the warnings about alcohol consumption in terms of fibrotic progression only apply to *heavy* drinkers. http://www.clevelandclinicmeded.com/hcv/litreview1.htm (scoll down to commentary)

-- Jim

[jmjm530]

Good to hear from you. Are you done yet?

[mikesimon]

I have mentioned before that I drink an occasional glass of wine or two with dinner. For the last 6 or 7 months I have been getting labs every two weeks. My numbers have consistently been very good and they're getting better. I got lab results from yesterday's draw: ALT 14 & AST 21 & GGT 13. I am beginning to wonder if wine in moderation doesn't improve my liver function - as well as my blood sugar. Mike