I’m trying to figure out how much risk a relative has incurred through poor lifestyle choices. All the information I can find online is geared toward helping people, and tends to shy away from the uglier aspects of reality. Assume that this poor individual will not get help: what are the realistic range of outcomes?
Female, late 30s, very heavy drinker, bulemic, vicodin abuser. Alcohol addiction and bulemia go back at least a decade, vicodin at least three years, and all out of control at least two years. Unstable domestic situation, no children (thank goodness). Underweight, possibly malnourished [fat face and bulgy stomach, scarily spindly limbs], no meth or hard drugs.
Assume that the individual will not get treatment, either medical or psychological, except for injuries sustained in the course of substance abuse. How long can a human live like this? I understand that individuals vary wildly, and I’m not asking for a definitive answer. I’m just looking for a range of possibilities, like “one more day to about five years” or “could be another 20 years.”
Please note that this is for my edification (=morbid curiosity) only. I and the rest of the family would prefer to see her under a professional’s care, but I want to know best and worst-case scenarios if she keeps trying to do this on her own.
IANAD, but it sounds like she is already suffering from late-stage liver damage. Or at least some form of serious liver damage. Given the amount (and history) of alcohol abuse, mixed with the vicodin abuse makes her “fat face and bulgy stomach” sound ominous; especially when combined with the fact that the rest of her is malnourished and “scarily spindly”. I’d say she doesn’t have long.
The big problem is that she’s been adding more and more problems over a period of time, and will probably continue in the future. Obviously there’s no way of know which new behaviors or addictions she’ll be adding, so it’s anyone’s guess.
If you’re correct that she “will not get help,” and it looks like the people close to her are just standing around waiting for her to die . . . her future seems very short.
The big problem here is that Vicodin contains acetaminophen, which when coupled with alcohol is hell on the liver. If you could get her to swap the Vicodin for something else, maybe weed? she would be a lot better off.
She’s an opiate addict, as well as an alcoholic. Telling her to “swap” her opiates for marijuana is about as meaningless as telling her to swap her alcoholic beverages with kool-aid. Of course she’d be alot better off, but that’s not the reality of the situation.
Good question, I have a friend that another friend and I refer to his es as the Roach because he is an opiate and meth addict and turns tricks for drug money as well as robbery, and has been in and out of the hospital for the entire 6 years I have known my friend. He is like a cockroach that just will not die, no matter how he abuses his body. Lisa and I are absolutely amazed at Mikey’s ex … if anybody else abused themselves like that they would be dead in months, yet this slimeball [he robbed Mikey’s house twice after moving out once using the door key he kept a copy of, and once by throwing a garbage can through the window and climbing in.] is the energizer bunny Cockroach of druggies.
Standing around waiting for her to die is possibly accurate, but only because all other avenues (and resources) have been exhausted. It makes her family seem really callous which is far from the truth. As she is an adult, there are no legal ways to compel her to change her behavior. (This is California: if that is NOT true, I’d be grateful to know what options we have.) She lives in a mutually emotionally abusive relationship with an enabler, but has no spouse; there are no signs of physical abuse.
She has also developed a tendency to injure herself. I’m not sure if it’s balance issues due to malnutrition, alcoholic blackouts, something to justify a vicodin prescription, or all three. I only know about a badly broken leg from a fall in the kitchen (something rare in healthy women in their 30s) and a “heart attack,” which was probably really a panic attack, but I suspect I don’t hear about everything.
Is there any way someone could persuade her to get her liver checked?
Like jamiemcgarry mentioned, her distended belly (possibly Ascites), among the other things you mention sounds like it could be symptoms of cirrhosis or fibrosis of the liver (not good!), which is very likely due to alcohol + Vicodin (hydrocodone + Tylenol) abuse.
The alcohol and opiate abuse causes her to, (or at least, contributes to her) not eating well and she probably doesn’t take any vitamins or vitamin supplements, either. A calcium deficiency can cause one’s bones to become brittle. Just sayin’…
I don’t know about California, but here in Texas it only takes two family members to swear out a mental health warrant. Of course, that only keeps a person locked up for evaluation, for three days. If it’s determined that the person is a danger to themselves or others, then the authorities can detain them longer. I’ve seen it have a somewhat beneficial effect, the person sobered up long enough to realize what they were doing to themselves and the people that cared about them, and that there ARE people that DO care.
I wish you and your family luck with this problem, and the strength to deal with ‘come, what may’. It’s obvious that you have love and concern for her, or you wouldn’t be posting this on the Dope, IMHO.
That bit right there is a good possible avenue to pursue. If she has a prescription to vicodin, her doctor should be advised how she’s using them. Get someone to look at the prescription bottles to find out who the doctor is, and contact the doctor and let them know that their patient is abusing alcohol along with those vicodin. (It might not hurt to mention the eating disorder, as well.) Let the doctor decide how they should shift her pain medication to something without acetaminophen or whatever. If they are competent, they should also probably do some sort of screening for liver problems.
I don’t know what her outward mental situation is like, but here in Florida we have the Baker Act - I believe it’s known as the 5150 in California.
You mention “fat face and bulgy stomach, scarily spindly limbs”. One poster wondered whether the bulgy (sic) stomach may actually be ascites, which in turn could be a manifestation of cirrhosis. Although that is possible, I think it more likely that what you are describing is Pseudo Cushing Syndrome. Please compare the signs of Pseudo Cushing’s, listed here, with what you wrote. Here are some pictures of Cushing’s Syndrome which shares essentially the same symptoms and signs with Pseudo Cushing’s. Pic #1. Pic #2. Pic #3.
The fat face you note may well be the “plethoric moon face” listed in the Pseudo Cushing’s link. Likewise, the bulging stomach is consistent with “truncal obesity” also as listed there. Her “spindly limbs” actually sound very much like what you get in Cushing’s. For a picture of this sign, look here (I admit it’s not terribly well illustrated, but it’s the best I could find). Although not stated explicitly in the link above on Pseudo Cushing’s, “spindly” arms and legs are not just a feature of Cushing’s Syndrome, but of Pseudo Cushing as well. (For anyone interested, the mechanism for the thin arms and legs is mostly due to the cortisol breaking down the muscles of the limbs, leaving them thinner, with the thinness appearing exaggerated due to the contrast provided by the central obesity. In this regard, note that the obesity in Cushing’s and Pseudo Cushing’s does not involve the limbs).
Finally, and the whole point of this post, please note that a classic cause of Pseudo Cushing Syndrome is alcohol abuse. Other classic causes include anorexia/bulimia, depression, psychosis and, indeed, any state of prolonged and severe emotional stress. Cite. It seems pretty clear that the person you’re describing fits a number of these bills!
So, just to repeat, I think there’s a very strong possibility that this individual has Pseudo Cushing Syndrome.
While I don’t disagree, I think it may be more likely that the alcohol abuse has led to osteoporosis (cite) or that she has Pseudo Cushing Syndrome (as above) wherein the high levels of cortisol also can cause osteoporosis (cite).
Thank you for the interesting information. I didn’t know about ascites, but that does sound like it. (And of course for someone in denial it exacerbates the bulemia: the only reason I heard about the belly was an aunt who said that’s how she’s justifying the “dieting” to herself.)
More details for those expressing concern: she has no insurance and no regular income and therefore no regular doctor. I think her typical care is through the ER when injured. She does report that her liver panels were fine, but then, she has reported a variety of information that simply cannot be true.
She has been held following arrests a few times, and at least one of those times seems to have been a 5150. She was being very violent, screaming at her boyfriend, and obviously under the influence, and was arrested and taken away for about five days. She’s under no obligation to tell us what happened, though, and unfortunately, her next of kin (parents, siblings) are all far away out of state. The Wiki page says relatives have a right to be informed but I can’t see how we’d enforce that.
I’m also far out of town but I’ll ask those on site to look at stomach and fingernails. For sad and obvious reasons, she tends to avoid family members.
The belly wasn’t quite as distended as in the pseudo-Cushing examples when I last saw her, but it’s been a while, and her limbs certainly were. Interesting. Depressing, too, but it’s better to be informed.
Again re: ascites or pseudo-Cushing: I can find lots of information on treatment, but no information on progression without treatment.
It is more likely that she just has a large amount of visceral fat than chronic ascites. I wouldn’t just jump to conclusions without any blood work and a physical exam. That being said, her behavioral habits certainly aren’t doing her any favors.
I agree with this. Assuming of course that it is actual Vicodin and not simply hydrocodone not mixed with acetaminophen.
Is this a drug that the person has prescribed for them or are they buying it from a third party? If they are getting it prescribed to them and the doctor knows about the alcoholism they might be willing to change to a non-acetaminophen formula, and I would assume that if it’s a “no questions asked” sort of doctor that they would probably be able to do so with no fuss.
As far as I know, the pills are mostly aquired on the street. She has had prescriptions in the past, after hospital stays, but given her limited access to transportation and medical care, I seriously doubt she’s still getting prescriptions written for her. (That doesn’t mean she’s not still trying this avenue; she tends not to realize how easily people see through her.)
I also don’t know how much of it is Vicodin, the brand name, and how much is other opiates in pill form or even other painkillers.
Everyone in an addict’s circle has a role. I play the non-judgemental listener that dispenses advice (mostly in the form “Wow, that’s really terrible! I’d seek help from Competent Authority Figure X if I were you. Here’s the first step you’d take to get there”). She pretends to be the innocent victim of circumstances, and I pretend to believe her while getting more of the story from other family members. Unfortunately, this means that most of my information is indirect.
The reason I started the thread, though, is that several of us have independently come to the conclusion that she is going to die before she “hits bottom” and gets motivated to get real help. She has that “I can do it by myself!” attitude which really means “I won’t put myself in a position to be have my addictive behavior challenged.” What I want to know is how long do we have. Only a doctor with access to her could really answer this, but there must be a GQ answer for how long it takes for untreated X to kill someone, “typically X years” or “from X to X years.”
