Bad experience with rehab hospital

General health and lifestyle
1

A bit of background first and then onto my question. Last year I had a massive stroke and spent two months in hospital. At the same time I went jaundiced because of my drinking, so they had to treat me on two fronts. It was fairly serious, my local hospital couldn't deal with me, but could not move me the 10 miles down the road to the specialist hospital, until they had stabilised with a blood plasma transfusion under general anesthetic.

At the new hospital in the one step down ward, I became jaundiced and they had to detox me, do a drain on my liver of about 10 litres, fit a catheter and various other things. The consultant told me (in a nice way), I should not be here, he was amazed that I still was.

So, I kept off the drink until Christmas day (8 months) and up until June this year, it was fairly manageable at about one bottle of wine per week. It got dangerously worse in June, so I went to seek help. I went to the local addiction organisation and said, I need help and quickly.

Well, it seems to be meeting after meeting, and apparently some group therapy and then in about 8 to 12 weeks, I'll get detox. I tried to tell them I need detox now, in that timescale I will be worse, that I've kept off of the spirits, but for how long. I told them I am on 8 prescription meds a day, things like Thiamine, folic acid, b1, lactulose (encephalopathy) and some even more serous ones that I can't recal off of the top of my head.

I said, contact my GP, contact my hepatoligist at the local hospital (they deal with him, so they knew him), they will tell you how serious it is. It Fell on deaf ears, so I said that I would deal with it myself and my GP would be the first port of call. She rather arragantly said, he probably just send you back here. Inside I was fuming, my GP is pragmatic, but I was thinking, you don't know my GP and you obviously aren't listening to how ill I am.

So, I went to my GP, he helped but asked me to keep quiet, because the GMC might see it as interferring and he may be in trouble. He didn't want to proscribe the full on stuff, but did proscribe stuff that might take the edge off of it. As it was, it didn't really help and I've suffered, nausia, retching, cold sweat, shakiness, dizziness, disorientation, muscle spasms, cramp in the feet overnight (look that up on the NHS website, usually prolonged, it is a sign of liver problems). It has been a torrid few days, I did it before and I knew I wasn't going to like it. Quite often fluid cames straight back up, so you suffer dehydration just to cap it off.

 

I told her if all else fails, I'd go cold turkey, she said you don't want to do that, but I've tried to impress the seriouness on you and you are intransigent, you leave me no alternative. I was so bad that I also presented myself to the A&E, I could walk, they would have had to come to the car (wife drove) and help me out, it was days in bed at home, the only I could cope.

My question is, did I get a bad rehab organisation and was unlucky, or are they all like? I told them I knew all about trigger point, changing routines and findings to occupy yout mind/time that kept you away from temptation, but they weren't having any of it.

2

They are now NHS ,prescription tablets for alcohol, to stop craving etc, l think u had a bit of bad luck.

3

No, you got the standard NHS approach, RHGB.

It is a scandal that people with alcohol addiction are not offered medical treatment, but are told to go and talk about their problem in groups or one-to-one counselling. It doesn't help the vast majority of people, it doesn't work because alcohol addiction is a medical condition caused by a pre-disposition built into you. It is NOT your fault, anymore than cancer is anybody's fault.

Changing routines, talking about your habit, standing up and expressing your shame and guilt, accepting that you are a terrible person who has hurt your family is old-fashioned and ineffective treatment which simply doesn't work.

There is a treatment method called The Sinclair Method which has a 78% success rate. This compares to less than 10% success rate for any other method available in the world, today. Google it, read about it on this forum (you will also see discussions of the drug Nalmefene, which is also called Selincro, here which are well worth reading. It is a medical approach which is based on more recent research and targets the physical cause of your addiction.

You are a little more complicated due to your liver problems. Although the Nalmefene wouldn't cause more damage to your liver, carrying on drinking (which is what you would do, in a controlled way, with The Sinclair Method) may not be an option for you, depending on how much damage has been done to your liver previously. However, drinking in a controlled way is preferable to killing yourself quickly by getting back into difficulty every so often and drinking vast amounts.

I am not sure what your GP was doing by 'not giving the full on stuff'. You either do a detox or you don't, you can't do a partial detox. Going cold turkey with alcohol addiction is seriously dangerous and can even kill. Detox is necessary although, in some circumstances, with medical complications, it needs to be done in hospital.

4

Just to clarify. Nalmefene (and also Naltrexone) are used for The Sinclair Method.

5

When I said full on, I was carefull that I didn't want to give too much away, just in case someone was reading this from the rehab and put two and two together and it got my GP in trouble. It was Diazepam, which was obviously given to me for anxiety (nudge, nedge, wink, wink if you get my drift).

But I did a cold turkey earlier this year and it doesn't really seem to be any easier this time around. Maybe it is because I am a bit further down the line and the drinking has increased.

I will go and look at the things you suggested to read up on.

6

Probably because you DIDN'T get the 'full on' detox, which means that you didn't get high enough doses to stop your withdrawal symptoms. A proper alcohol detox should stop you having any withdrawal symptoms at all. The dose given for anxiety is way too low to be effective for a detox.

You are anonymous here RHGB, don't worry that anybody can guess who you are or who your GP is. That's very unlikely and you could easily say 'what site? Nah, never heard of it'

7

I hope you dont mind RHGB - I just wanted to ask Paul a question - you say a detox is for 7 days - if you have home detox the nurse comes to you with what?  Does this withdrawal also take away the cravings that you have .

8

Whilst you wait for Paul to answer, I'll go with what I know and my experience right now. My understanding from the rehab organisation (I accidently typed hospital in the title).

The community nurse comes to see you each day, check your blood pressure, see how you are coping and probably gives the meds on a daily basis so you don't overdose and that you haven't relapsed and your health is okay, no irregular heartbeat etc.

I'm on day three, because I probably didn't have the right amount of meds/strength (thru my GP), I have had a torrid two days where I wanted to die and couldn't get out of bed. I think the detox just stops you being violently ill during the detox period.

I feel better today, not perfect but I'm out of bed and can move around. However, if a mate came walking past my house as I was on the drive and said, come on RHGB, it's a lovely sunny day, fancy a couple of cold ones down the pub, the mind would say no, but the body if it had the chance would be on its way. I have a lovely village pub three doors away from me and a couple of cold pints of Thatcher's would go down in minutes, probably followed by more.

That is why when I thought the rehab was going to help me, I wanted to go to hospital to take me out of the 'environment'. You have to be a special case for that.

Paul may correct me, but the detox makes it easier for you to stop, but doesn't kill your craving, you need willpower and lots of it.

9

I am not sure what happens in every area. I only know what we do privately. We firstly do a medical assessment over the phone to ensure that it is safe to prescribe Librium for our client. If all is ok with that (which it normally is), I visit the client and the person who has agreed to supervise them (partner, relative, friend), get them to sign all the paperwork, which outlines their responsibilities and ours, and leave the medication with the supervisor.

Obviously, because I treat people anywhere in the UK, I can't do daily visits, so I give telephone support at every dose. The supervisor gets the blood pressure and pulse of the client and calls me with those. I then tell them what dose to give. We start on high doses and reduce over a period of 5-7 days. Those who need higher doses initially, take longer to reduce to zero but it is very rare it runs over 7 days.

Occasionally, at the beginning, there is a lot of adjusting of the dose and some people need a 4 hourly dose at the beginning because they start rattling again after about 3 hours. VERY occasionally, we will allow a top up dose even earlier than 4 hours after the last dose. Because of this need to adjust and ensure that the client doesn't suffer badly, I feel that it is inapproriate to simply give someone a bottle of pills and say 'take 2 three times a day.' You can't know what they will need. If you tell them to take what they need, you run the risk of them taking more than is recommended and causing themselves breathing problems or low blood pressure. Detox is a safe procedeure when done correctly, but can be very dangerous if too much or not enough medication is given.

The Librium does help to stop a person craving a drink, during the detox. It is VERY rare that a person drinks while doing a detox if the doses they are taking are sufficient. However, at the end of the detox itself, although the person will have safely withdrawn from alcohol, the cravings do returnand then it comes down to willpower (to avoid drinking) or The Sinclair Method to return to controlled drinking. Again, the Sinclair Method needs a lot of support to ensure that it is used properly.

Previously, when working in the NHS, I set up and ran a home detox service across South Staffordshire and I used to visit daily and leave the pills for one day at a time. I think a few detox nurses operate in this way. However, it was always necessary for the patient to have somebody with them and I would have them go and stay with somebody such as their parents if they normally lived alone.

10

Yes, you are correct RHGB. Detox, done properly, ensures that people don't have serious withdrawal symptoms. We aim to eliminate ALL withdrawal symptoms, but that isn't always possible if a person has been drinking massive amounts as we have to adhere to safe limits and cannot exceed the maximum dose per 24 hour period. So occasionally, people have to bear a few symptoms but nothing like what they would be like if they had no medication.

Alcohol detox is a life saver. People CAN die going cold turkey from alcohol. We ALWAYS tell people to carry on drinking until we get to them with medication.

11

Cold turkey can kill you, but so can heavy drinking for three more months.

I really did try to tell them I have a hospital liver specialist, a hospital dietician because my liver doesn't absorb food properly and a neuro consultant for a massive stroke (which obviously weekens the body).

Lactolose for encephalopathy to remove the ammonia that my liver can't, so to stop it rising to my brain and making me go a bit mad. Carvedilol for mild heart failure. Thiamine b1 to stop alcohol dimentia. Amlodipine blood flow to the heart, reduce chance of angina. Spironolactone is a medicine which is used in nephrotic syndrome, treatment of cardiac failure, ascites, liver cirrhosis and aldosteronism.Vitamin B compound strong, as if Thiamine wasn't enough. Omeprazole - too many possiblities too mention. Folic acid (know I am not trying for a baby) it is used in conjunction with Thiamine to prevent Wernicke–Korsakoff syndrome.

And still they never thought to ask what my 8 meds a day were for. I'm going to have fun on Thursday, telling them I've sorted myself out, but did it not occur to find out what I was on and how another three months drinking could finish me off. But they still try to get me to come to their group therapy.

12

Yes RHGB, another three months drinking can kill people who are at that stage of liver disease. But I don't expect people to have to wait 3 months for a detox. They certainly don't with us, it's a matter of days, but I am aware that the NHS send people off the cousnelling services who expect them to wait 6 months or more for any medical treatment, it's a scandal!!

Group therapy helps some people and I would never try to put people off doing what they find helpful, but it just doesn't work for some. Alcohol addiction is a medical problem caused by a medical pre-disposition to alcohol addiction so it isn't going to be totally fixed by talking about it.

I wish you all the best with finding the best way forward for you.

13

Well, there is a big complaint coming the way of the recovery partnership/addaction.

I had a feedback meeting to tell then where I think they went wrong. I could hardly get a word in edgeways, I just gave up in the end. I've been in middle management and at 6'2" I have the ability to talk over the top of anyone, but it seemed pointless.

I was reminded of a previous company saying, two ears, one mouth, use them in proportion. They suggested if I was that ill, I should have called into the hospital, perhaps if they had listened the first couple of times, they might have realised this and sent me to hospital. They asked why I didn't go to my GP, who quite clearly said, if he was seen to interfere at that point, the GMC might pull him up about it - I don't know if that was a trick question.

At the end,the manager said she would write a letter to me stating what would be done. I had a glazed couldn't care less face, whilst thinking about taking the dog for a walk and what I would have for dinner - I thought it was quite blatant and obvious, but no. She gleefully said how happy she was that I trusted her to make the changes. These people must get government funding from somewhere and that will be my target.

Oh look,

We were thrilled to hear in October that we had been

successful in securing a grant of £25 million over

seven years from the Big Lottery Fund

On this basis, our group income for the year was £65 million, £7 million or 11% higher than in the

previous year. This resulted from successfully bidding for new grants and contracts and from

adding KCA to the group. Expenditure also grew during the year as a result of our expanding

activities and in line with agreed financial budgets and forecasts.

Including the consolidation of KCA we added £2.3 million to our unrestricted reserves which

totalled £7.4 million at the end of the year. This was represented by increases in the assets under

our stewardship, including £0.8 million in freehold properties and £0.7 million in cash. Cash

balances remained high at £7.7 million, putting the group in a strong position to meet the dynamic

challenges of the future.

14

And not one mention of what they actually do with that money?