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Is there a standard procedure GPs follow when dealing with long term alcoholics..



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Is there a standard procedure GPs follow when dealing with long term alcoholics..

Old 03-12-2012, 10:01 AM
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Is there a standard procedure GPs follow when dealing with long term alcoholics..

that have developed mental/neurological problems.

I came across this on net.
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Diagnosis
The diagnosis of alcohol-related neurologic disease depends largely on finding characteristic symptoms and signs in patients who abuse alcohol. Other possible causes should be excluded by the appropriate tests, which may include blood chemistry, thyroid function tests, brain MRI (magnetic resonance imaging) or CT (computed tomography scan), and/or cerebrospinal fluid analysis.
Acute alcoholic myopathy can be diagnosed by finding myoglobin in the urine and increased creatine kinase and other blood enzymes released from injured muscle. The surgical removal of a small piece of muscle for microscopic analysis (muscle biopsy) shows the scattered breakdown and repair of muscle fibers. Doctors must rule out other acquired causes of muscle breakdown, which include the abuse of drugs such as heroin, cocaine, or amphetamines; trauma with crush injury; the depletion of phosphate or potassium; or an underlying defect in the metabolism of carbohydrates or lipids. In chronic alcoholic myopathy, serum creatine kinase often is normal, and muscle biopsy shows atrophy, or loss of muscle fibers. Electromyography (EMG) may show features characteristic of alcoholic myopathy or neuropathy.
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I had been an heavy drinker for thirty years and not realised I had to take B vits, am also vegetarian, develeloped nerve trouble in last four years, but have never been referred for neurology or brainscan, had asked for psychiatry about 4 times though, was assessed on each occasion and said I was OK, although been pushing for neurology , the GP then decided to refer me for therapy instead , was acceped and just finished the sessions, it helped, but do not feel the real prob has been addressed ie nerve damage/ something effecting nerves. I need to write a letter asking why they haven't refered me for neurology
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Old 03-12-2012, 12:30 PM
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IME there are very few things that are "standard" practice among GPs for most conditions or diagnosis. They each tend to operate from the base of their own training and experience. What resources they are aware of and familiar with in the area, and if they are in an HMO, what the plan will pay for.

Very often it IS up to the patient to keep pushing, searching etc. at least for the appropriate tests etc to establish an appropriate diagnosis. Many drs operate more from "symptoms" rather than diagnosis supported by a battery of tests, if they feel sure they know what the issue is.

Sometimes a younger dr, just out of training, has more familiarity with newer ideas and tests. Sometimes you can find someone who has done a residency in just such a program and is eager to apply what they know.

Do you have an teaching hospitals in your area, perhaps one associated with a local med school?
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Old 03-12-2012, 01:05 PM
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What kind of nerve damage DeLivery? It took a good few years for my nerve damage to be linked to my drinking. Even though it was on my medical record I think the various doctors I saw didn't make the connection and eventually one doctor asked my neurologist to tell me to stop drinking. It is all so much better since I have stopped though, even after a few weeks. It is standard procedure in the UK I think to avoid anything they don't think is entirely necessary. Have you asked them why you haven't been referred to a Neurologist?
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Old 03-13-2012, 09:09 AM
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Hypo...I don't know what kind of nerve damage, I cannot get the tests or help I think I need.

It just seemed obvious to me that if I had been without the protection of B vits being alcoholic and veggie for 30yrs and 20yrs respectively , then the docs would have referred me to people who could find out if and what type of nerve damage I had.

Thresh...In my surgery there are about five doctors and about two stand ins, you just get the first one available, the worst one IMO is the youngest one., she seems to have already made her mind up before i speak and sticks to it, even if i tell her some of her 'facts' are not right.
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Old 03-13-2012, 09:23 AM
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I have also started having bouts of depression (I am sure this is due to a lifestyle change, a lot less excercise) I have not drank since October and do miss that though, I am not going to go to docs regards this recent depression, will just have to get out more, do more walking I think
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Old 03-13-2012, 02:20 PM
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If you have no physical symptoms there probably isn't much point in being tested for nerve damage. Do they know you've quit drinking? I'm sure if you tell them they will give you a prescription for vitamins. It sounds like you're not happy with your doctors though. I can relate to that! Can you change surgeries? Or is there a doc there you like? I know it's difficult to get appointments but I'm pretty sure you have the right to request the doctor you want and make advance appointments if it's for an ongoing condition.
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Old 03-13-2012, 03:17 PM
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Originally Posted by hypochondriac View Post
If you have no physical symptoms there probably isn't much point in being tested for nerve damage. Do they know you've quit drinking? I'm sure if you tell them they will give you a prescription for vitamins. It sounds like you're not happy with your doctors though. I can relate to that! Can you change surgeries? Or is there a doc there you like? I know it's difficult to get appointments but I'm pretty sure you have the right to request the doctor you want and make advance appointments if it's for an ongoing condition.
There were and still are plenty of physcal symptoms, I ended up in hospital about four years back due to nerves on one side of head and neck swelling up and having visual distortions (I was then told I needed B vits), prior to this for years I had pins and needles in hands , blood in stool, grinding rambling speech/thoughts and distorted vision.

These more or less cleared up with prescribed Vits, but other probs occurred , nose bleeds , foggy brain, blurred vision disassociation and panic, trial and error lead me to buying own full range natural B vits, my health has greatly improved since then (also making sure I get B12 as it was not in the prescribed meds)

Recently I complained to head of surgery so will see another GP from this surgery again (hopefuly the complaint will have had an effect, if not I will get another doctor elsewhere),

To me I think if someone presented this history to me the logical step would be to check for nerve damage via neuroligist ie Alcohol use and veggie diet, no B vit nerve protection for thirty years, yet no one seems to think it so, even stopped going to alcohol groups partly because of this, they just say follow GPs suggestions, or go off their own psychological probs, maybe some have undiagnosed nerve dmage that is being treated as psychological dont know.

I have never been through structured detox or rehab, where some of these probs could have been addressed
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