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Alcohol during the Holidays

BT Montreal | posted Monday, Dec 18th, 2017

By Dr. Zach Levine, ER physician, MUHC


Overview:  Alcohol is addictive and in excess is bad, dangerous, addictive, but

it gives a buzz, is enjoyable, is a disinhibitor,

That’s why we can’t get rid of it, prohibition in the US failed

Same in the many places where it is officially banned — Northern QC native communities, certain middle eastern nations where it is underground

Russia France Greece ?? Germany USA etc all have alcoholism


Maybe for another time — Alcohol vs Pot


Is alcohol good for your health?

It’s a mixed bag but it’s not worth starting to drink to help one’s health.  Drinking too much alcohol contributes to accidents and injuries and can lead to liver disease, high blood pressure, various cancers, and birth defects, among other health problems. However, moderate alcohol use may provide certain health benefits, particularly with regard to coronary heart disease. Understanding the possible risks and benefits of alcohol is essential to make an informed decision about alcohol use.

HOW MUCH IS ONE DRINK? — Alcoholic drinks come in multiple forms and contain differing amounts of pure alcohol (ethanol). In the United States, one portion of alcohol is defined as approximately 10 to 15 grams of ethanol, which can be found in:

  • One 12 ounce bottle or can of beer (roughly equivalent to the 330 mL cans of beers sold in some countries)
  • One 5 ounce serving of wine (about 150 mL)
  • One shot (1.5 ounces) of 80-proof distilled spirits (about 50 mL)

Moderate drinking is generally defined as 3 to 9 servings of alcohol per week, depending on age, sex, and other conditions. For example, the National Institute on Alcohol Abuse and Alcoholism defines ‘low-risk’ drinking as no more than three drinks on any single day and no more than seven drinks per week for women, and no more than four drinks on any single day and no more than 14 drinks per week for a man.


Binge drinking is defined as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 or above. This typically occurs when men consume 4 or more drinks or women consume 2.5 or more drinks in about a two-hour timeframe (varies a lot depending on size, tolerance)

It is most common in 18-34 year olds.  It is twice as common in men as in women.  Binge drinking is more common among people with household incomes of $75,000 or more than among people with lower incomes. However, people with lower incomes binge drink more often and consume more drinks when they do.

Binge drinking has been associated with unintentional harm and injuries from car accidents, falls, burns, and alcohol poisoning. Due to the altered state of mind, those who binge drink can fall victim to suicide, violence from their partner, and sexual assault.

Repeated binge drinking is associated with Chronic diseases such as high blood pressure, stroke, heart disease, and liver disease, cancer of the breast, mouth, throat, esophagus, liver, and colon, Memory and learning problems, and Alcohol dependence.


Legal limit: In Quebec and the rest of Canada, the maximum legal BAC for fully licensed drivers is 80 milligrams of alcohol in 100 millilitres of blood ( BAC/blood alcohol concentration of 0.08.  This is 17mmol/L in hospital units). Driving with BAC over 0.08 is a criminal offence.  This applies to everyone except drivers 21 or younger and professional drivers who are transporting other people (e.g. bus drivers, taxi drivers, etc.), in which case the limit is 0 mg (zero).


HEALTH CONDITIONS AND ALCOHOL — Multiple studies suggest that consuming alcohol can affect the risk of developing certain health conditions.

Cardiovascular disease — Cardiovascular disease, including disorders of the heart, blood vessels, and blood circulation, is the leading cause of death in North America. However, several studies suggest that moderate alcohol use, as compared to heavy drinking or abstaining, decreases the risk of coronary heart disease (CHD).

High blood pressure — People who consume more than two drinks per day have up to a twofold increase in the incidence of high blood pressure compared with nondrinkers. However, the effect of drinking less than two drinks per day on high blood pressure remains unclear.

Atrial fibrillation — Drinking several drinks at a single occasion, even among individuals who otherwise drink safely, can induce abnormal heart rhythms, including atrial fibrillation (aka “holiday heart”). There may be a slightly increased risk of atrial fibrillation (the most common chronic heart rhythm disturbance) among moderate drinkers, although it is still uncertain if this may result from occasional binges among otherwise moderate drinkers or occurs even within recommended limits of alcohol use.

Peripheral vascular disease — Peripheral vascular disease can cause pain in the calves with walking, also known as claudication. Moderate alcohol use reduces the risk of peripheral artery disease in healthy men.

Stroke — Alcohol consumption has been shown to affect the risk of stroke in contradictory ways, depending upon the amount of alcohol consumed and the type of stroke. A stroke occurs when brain tissue dies as a result of a sudden, severe disruption of blood flow and insufficient oxygen. Strokes may be due to a blockage (ischemic stroke) or rupture and leakage (hemorrhagic stroke) of one of the blood vessels supplying the brain.

Heavy alcohol use increases the risk of both ischemic and hemorrhagic stroke. Moderate alcohol use is associated with fewer ischemic strokes; the risk appears to be lowest in people who consume one drink or less per day. In contrast, the risk of hemorrhagic stroke appears to rise even with minimal alcohol use.

Breast cancer — There is consistent evidence that breast cancer risk is higher for women consuming moderate to high levels of alcohol (three or more drinks/day) compared with abstainers. Drinking as little as one to two drinks per day also appears to increase this risk

Taking folic acid (folate) may reduce the effect of alcohol consumption on breast cancer, suggesting that women who drink alcohol may benefit from a daily multivitamin fortified with folic acid.

Cancers of the head and neck and digestive tract — Alcohol use has been linked to several types of cancer of the head and neck and digestive (gastrointestinal) tract, even at low levels of consumption. People who drink and smoke have a greater risk than would be expected from either factor alone.

Cancer arising within liver cells (hepatocellular carcinoma) has been linked to alcohol use. This may be related to liver scarring (ie, cirrhosis) that occurs in people who consume excessive amounts of alcohol since cirrhosis is a major cause of hepatocellular carcinoma. Low levels of alcohol do not clearly cause cirrhosis.

However, even at low levels, drinking may increase the risk of hepatocellular cancer in people with inflammation of the liver (hepatitis) due to infection with certain viruses (ie, hepatitis C virus). People with chronic hepatitis should avoid alcohol.

Cirrhosis (scarring of the liver) — Low levels of alcohol do not clearly cause cirrhosis. Heavy drinking is generally required to cause cirrhosis in men in the absence of other factors.

Alcohol is the leading cause of chronic liver disease and failure in North America.

Gallstones — Moderate alcohol use has been shown to lower the risk of gallstones. However, heavy drinking may reverse this benefit.

Pancreatitis — Heavy drinking increases the risk of both sudden (acute) and long-term (chronic) inflammation of the pancreas (pancreatitis).

Osteoporosis — Heavy drinking increases the risk of hip fractures because it increases the risk of both osteoporosis and falls.

Pregnancy — There is a significant risk of birth defects related to use of alcohol use during pregnancy. Heavy drinking can cause fetal alcohol syndrome, which prevents normal growth, and may cause intellectual disability (mental retardation), malformations of the skull and face, and other findings (Fetal Alcohol Syndrome).

Moderate alcohol consumption may also be harmful, although this is a matter of some controversy. There is no known benefit of alcohol use during pregnancy. Thus, experts advise completely avoiding alcohol during pregnancy.

Perception of health and quality of life — Excessive and frequent alcohol use reduces quality of life for individuals, their families, and others around them, potentially leading to failure at work or school, interpersonal problems, and physically hazardous situations.

Accidents and trauma — Alcohol use increases the risks and severity of injury from motor vehicle accidents.

Exposure to alcohol is generally measured in blood alcohol concentration (BAC) rather than drinks per day or week. In most of the United States, the legal BAC limit for driving is 0.08 percent, which corresponds to about 4 drinks for a 200 pound man and 2.5 drinks for a 150 pound woman. However, the risk of having an accident while driving doubles at a BAC of only 0.05 percent, and driving ability is impaired with BACs as low as 0.02 percent.

Alcohol also increases the risk of injury from other sources. It has been shown to impair a pilot’s ability to fly and an operator’s ability to control a boat, bicycle, and snowmobile. In addition, occupational injuries, falls, drownings, burns, and hypothermia are more common in those who use alcohol, particularly in heavy drinkers.

Good resource — https://www.facs.org/~/media/files/quality%20programs/trauma/alcoholinjury.ashx

Violence — Alcohol is involved in more than one-quarter of all rapes, at least one-half of serious assaults, and one-half to two-thirds of all homicides.

Suicide — Alcohol abuse is associated with an increased risk of suicide. Although moderate drinking does not appear to raise suicide risk, episodes of heavy drinking cause disinhibition that can increase suicide risk.

IS ALCOHOL SAFE FOR ME? — The bottom line is that it is difficult to weigh the benefits and risks of alcohol. Nevertheless, several important conclusions can be drawn:

  • Beginning to drink alcohol may be inappropriate for people who have been lifelong abstainers. There is no evidence that lifelong abstainers who begin drinking in middle or older age will lower their risk of any disease.
  • The diseases that may be prevented by moderate drinking (eg, coronary heart disease and ischemic stroke) are most prevalent in older adults, men, and people with CHD risk factors (eg, hypertension, hypercholesterolemia, smoking, diabetes mellitus). For these groups, moderate alcohol use may reduce their risk of these conditions.
  • For young to middle-aged adults, particularly women, moderate alcohol use increases the risk of the most common causes of death, such as breast cancer and trauma. Men under age 45 years also may experience more harm than benefit from drinking. In these younger age groups, moderate alcohol use is unlikely to reduce the risk of dying.

Consuming less than one drink daily appears to be safe (that is, if not done before or while operating a car or heavy equipment), although even that level of drinking can be dangerous for some people (see next section).

Reasons to avoid alcohol — Alcohol use is not recommended for individuals who:

  • Are younger than the legal drinking age (18 in Quebec)
  • Are pregnant
  • Have a personal or strong family history of alcoholism
  • Have liver or pancreatic disease related to alcohol
  • Have precancerous conditions of the digestive tract
  • Operate potentially dangerous equipment or machinery (including cars, boats, planes, or construction equipment)

Wine versus other alcoholic beverages — Some research suggests that wine provides the strongest protection against cardiovascular disease, possibly due to naturally occurring compounds known as flavonoids. In France, for example, death from CHD is lower than would be expected from the high rate of smoking and saturated fats in the diet; this “French paradox” has been attributed to frequent red wine consumption.

However, other studies indicate that all alcoholic beverages offer cardioprotective benefits. Whether beverage type matters for specific diseases other than CHD remains uncertain, although most evidence suggests that it does not.

A safe dose of alcohol — As mentioned above, for some people, no amount of alcohol is considered safe.  However, for individuals without such conditions, the healthiest dose of alcohol appears to be in the range of 0.5 to 1 drink of alcohol daily.

Gender differences — Established recommendations for safe levels of drinking do not address an “ideal” level of alcohol consumption. However, they advise

  • No more than two drinks daily for men
  • No more than one drink daily for women

What is the best approach in my case? — The following guidelines may help in making an informed decision about alcohol use:

  • Consult a healthcare provider to determine the specific risks and benefits of alcohol use. Multiple factors must be considered in any such “risk-benefit analysis,” including age, sex, personal medical history, family history, diet, physical fitness, and certain lifestyle choices such as smoking, among others.
  • Women should not drink any alcohol during pregnancy; in addition, experts advise that women should stop drinking when trying to conceive.
  • Never consume alcohol before or while driving or operating any potentially dangerous equipment.


holiday heart syndrome was coined. It was defined as an acute cardiac rhythm and/or conduction disturbance, most commonly supraventricular tachyarrhythmia, associated with heavy ethanol consumption in a person without other clinical evidence of heart disease.


Blood alcohol concentration Clinical effects
20-50 mg/dL (4.4-11 mmol/L) Diminished fine motor coordination
50-100 mg/dL (11-22 mmol/L — 0.08 is 17mmol/L) Impaired judgement; impaired coordination
100-150 mg/dL (22-33 mmol/L) Difficulty with gait and balance
150-250 mg/dL (33-55 mmol/L) Lethargy; difficulty sitting upright without assistance
300 mg/dL (66 mmol/L) Coma in the non-habituated drinker
400 mg/dL (88 mmol/L) Respiratory depression


What is alcohol poisoning? — Alcohol poisoning is what happens if someone drinks far too much in a short amount of time. This is different from being drunk or having a little too much to drink. Alcohol poisoning is life-threatening. A person with alcohol poisoning could stop breathing or choke on his or her own vomit.

What are the symptoms of alcohol poisoning? — Some of the symptoms are the same as those for a person who is “just drunk.” For instance, people who have alcohol poisoning can seem confused or have trouble standing up. But some of the other symptoms of alcohol poisoning are more serious. Alcohol poisoning can slow or stop a person’s breathing. It can also cause seizures or an irregular heartbeat.

Call for an ambulance (in the US and Canada, dial 9-1-1) if the person:

  • Stops breathing or goes 10 seconds or more without breathing
  • Is breathing very slowly (fewer than 8 breaths in 1 minute)
  • Turns blue or very pale, and his or her skin feels cool to the touch
  • Has a seizure
  • Is passed out and cannot be woken up at all
  • Cannot stop vomiting
  • Looks very sick

What will the doctors at the hospital do? — If someone goes to the emergency room with alcohol poisoning, the doctors there can make sure that the person:

  • Keeps breathing. (If the person stops breathing, the doctors can put him or her on a breathing machine.)
  • Gets fluids through a tube in a vein (IV) if needed. (This can be important if the person has been vomiting a lot)
  • Is healthy except for the alcohol. People who have been drinking sometimes have other problems that are tough to spot, because they cannot tell you what they are feeling. For instance, people who have been drinking often fall down or otherwise hurt themselves. Doctors can use X-rays and other tools to spot possible injuries or other health problems.

Is there anything doctors can do to get the alcohol out of your system? — No. Alcohol is absorbed into the body very quickly. It does no good to empty the stomach. There is nothing that can soak up or cancel out the effects of the alcohol. The only thing that gets rid of alcohol in the body is time.

What can you do at home to help keep someone safe? — For people who have been drinking but do not seem to need emergency care, you can:

  • Keep checking their breathing and call for an ambulance (in the US and Canada, dial 9-1-1) if their breathing slows too much or stops
  • Lay them on their side, so that they do not choke on their own vomit if they throw up
  • Check them for bumps, bruises, bleeding, or any sign of injury
  • Make sure they stay warm (use blankets)

If someone you know drinks so much that you are afraid for his or her safety, that might be a sign of a drinking problem. When he or she recovers, it might be good to sit down and talk about what happened. Suggest speaking to a doctor, nurse, or mental health expert who can help diagnose and treat a drinking problem.


Stay safe:

Have a plan – designated driver, sober person, hydrate

Drink in Moderation

Eat food

If alcoholism in family history, be especially vigilant…

Good friends look after each other

Avoid dangerous situations, wild unsupervised parties

Avoid using “other” drugs

Alcohol is not an anti-depressant

Don’t drink and drive!  DUI’s are serious offenses, with very tough consequences


Alcohol vs marijuana — https://www.nytimes.com/2015/03/17/upshot/alcohol-or-marijuana-a-pediatrician-faces-the-question.html

Shingles: Symptoms, Causes, Treatments by Dr. Zach Levine

BT Montreal | posted Tuesday, Dec 5th, 2017

  1. What is shingles?


Shingles is a painful rash that is shaped like a band or a belt. Shingles can affect people of all ages, but it is most common in those older than 50. Another name for shingles is “herpes zoster.”


  1. What causes shingles?


Shingles is caused by the same virus that causes chickenpox. After someone has chickenpox, the virus sometimes hides out, “asleep” in the body. Years later, it can “wake up” and cause shingles. The first time a person is infected with that virus, he or she gets chickenpox, not shingles.


  1. Who gets shingles?


RISK OF SHINGLES — Up to 20 percent of people will develop shingles during their lifetime. The condition only occurs in people who have had chickenpox, although occasionally, chickenpox is mild enough that you may not be aware that you were infected in the past.

Age — Shingles can occur in individuals of all ages, but it is much more common in adults aged 50 years and older.

Immune status — Shingles can occur in healthy adults. However, some people are at a higher risk of developing shingles because of a weakened immune system. The immune system may be weakened by:

  • Certain cancers or other diseases that interfere with a normal immune response
  • Immune-suppressing medications used to treat certain conditions (eg, rheumatoid arthritis) or to prevent rejection after organ transplantation
  • Chemotherapy for cancer
  • Infection with the human immunodeficiency virus (HIV), the virus that causes AIDS


  1. Is shingles contagious?


Yes and no. It is not possible to “catch” shingles from someone who has the rash. But it is possible to “catch” the virus and then get sick with chickenpox. Shingles and chickenpox are caused by the same virus.


You probably will not catch the virus (or get chickenpox) if you:

  • Had chickenpox or shingles in the past
  • Had the chickenpox vaccine
  • Were born in north america before 1980 (most people born before 1980 have had chickenpox even if they don’t remember it)


  1. What are the symptoms of shingles?


At first, shingles causes weird sensations on your skin. You might feel itching, burning, pain, or tingling. Some people get a fever, feel sick, or get a headache. Within 1 to 2 days, a rash with blisters appears. Blisters most often appear in a band across the chest and back. They can show up on other parts of the body, too. The blisters cause pain that can be mild or severe.

Within 3 to 4 days, shingles blisters can become open sores or “ulcers”. These ulcers can get infected. Within 7 to 10 days, the rash should scab over. By then, most people are no longer contagious.


  1. Can shingles be serious?

Pain and seriousness get worse with increasing age.

Yes. Shingles can be serious, but that is rare. About 1 out of 10 people with shingles will get something called “postherpetic neuralgia,” or “PHN.” People with PHN keep feeling pain or discomfort even after their rash goes away. This pain can last for months or even years. It can be so bad that it makes it hard to sleep, causes weight loss, and leads to depression.

Shingles can also cause:

  • Skin infections
  • Eye problems (if the rash is near the eye)
  • Ear problems (if the rash is near the ear)
  • Dangerous infections in people who have other health problems


  1. Should I be treated?


Yes — for the virus and if needed for the pain


Treatment of shingles usually includes a combination of antiviral and pain-relieving medications. The affected areas should be kept clean and dry.

Antiviral medications — Antiviral medications stop the varicella zoster virus from multiplying, speed healing of skin lesions, and reduce the severity and duration of pain.

Antiviral treatment is recommended for EVERYONE with shingles, and is most effective when started within 72 hours after the shingles rash appears. After this time, antiviral medications may still be helpful if new blisters are appearing.

Three antiviral drugs are used to treat shingles: acyclovir (Zovirax®), famciclovir (Famvir®), and valacyclovir (Valtrex®). Acyclovir is the least expensive treatment but it must be taken more frequently than the other drugs.


Pain medications — The pain of shingles and postherpetic neuralgia can be severe, and prescription medications are frequently needed.


Treatment of postherpetic neuralgia — Treatment is available to reduce pain and maintain quality of life in people with postherpetic neuralgia. Treatment generally begins with a low-dose tricyclic antidepressant, and may also include narcotic medications and an anti-seizure medication.

Tricyclic antidepressants — Tricyclic antidepressants (TCAs) are commonly used to treat the pain of postherpetic neuralgia. The dose of TCAs is typically much lower than that used for treating depression. It is believed that these drugs reduce pain when used in low doses, but it is not clear how the drug works.

Anti-seizure medications — Medications that are traditionally used to prevent seizures, called anticonvulsants, can sometimes reduce the pain of postherpetic neuralgia. They may be used instead of or in addition to TCAs. Anticonvulsants commonly used for postherpetic neuralgia include gabapentin (Neurontin®) and pregabalin (Lyrica®).

Capsaicin — Capsaicin is a substance derived from chili peppers that can help to treat pain. Capsaicin cream (Zostrix®) may be recommended to treat postherpetic neuralgia. However, the side effects of the cream (including burning, stinging, and skin redness) are intolerable for up to one-third of patients.

Topical anesthetics — Lidocaine (Xylocaine) gel is a medicine that you can rub into your skin. A lidocaine patch (Lidoderm®) is also available, which you wear on your skin for 12 hours per day. It delivers a small amount of lidocaine to the most painful or itchy areas. However, the benefit of lidocaine is likely to be moderate at best.

Steroid injections — For people with postherpetic neuralgia who have severe pain despite using the above measures, an injection of steroids directly into the space around the spinal cord may be considered. Steroid injections are not used to treat facial pain.

In one study of patients with postherpetic neuralgia for at least one year, steroid injections led to good or excellent pain relief in about 90 percent of individuals [1].


  1. When can I return to work?  How long is it contagious? — contagious until all blisters are dry and crusted over

If you have shingles, you may wonder when it is safe to return to work. The answer depends upon where you work and where your blisters are located.

  • If the blisters are on your face, do not return to work until the area has crusted over, which generally takes seven to 10 days.
  • If the blisters are in an area that you can cover (eg, with a gauze bandage or clothing), you may return to work when you feel well.


  1. How can we prevent shingles?

Who can get the vaccine?


Vaccination — a vaccine is now available to reduce the chance of developing shingles. If you do develop shingles after receiving the vaccine, your infection may be less severe and you are less likely to develop postherpetic neuralgia

There are two vaccines that have been approved for adults over 50 years.