Cirrhosis, Alcohol, Ignorance and Prejudice: Welcome to the dark world of hereditary hemochromatosis

by Stephen Cobb on June 17, 2011

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Imagine the shock of getting a call from the intensive care unit of your local hospital telling you that your brother has been admitted. The doctor says your brother is delirious and combative and “in the throes of advanced alcoholism.” Furthermore, he has cirrhosis of the liver, internal bleeding, and ketoacidosis—a medical emergency in which a shortage of insulin can lead to coma or death—from newly diagnosed diabetes.

If you’ve never thought of your brother as an alcoholic such a call could be both shocking and disturbing. Of course, the story gets even more worrying if your brother turns out not to be an alcoholic. But such is the story told in this excellent Washington Post article about an almost fatal failure to diagnose hemochromatosis.

Several things struck me when I read this article, in addition to feeling terrible for Jeff Williams, the subject of the story, and his family, who are now living in the shadow of hemochromatosis. For one thing there is an amazing coincidence here. I wrote the following on this blog in July of last year:

Most people are fascinated to learn more about a potentially fatal condition [hemochromatosis] that might run in the family, might be killing relatives, and might explain why Uncle Fred had cirrhosis of the liver even though he swore he never touched a drop. (Here’s a hint: Uncle Fred might have been telling the truth–while drinking to excess is never a good idea, hemochromatosis can damage your liver in ways that mimic the effects of alcohol consumption.)

I wrote that in the context of raising awareness of hemochromatosis, the most common genetic killer in America today. I have found that people are indeed fascinated to find out about hemochromatosis and, because July is National Hemochromatosis Awareness Month in America, I was suggesting ways to make people aware.

The example of “alcoholic Uncle Fred” was actually based on my own father-in-law, who most definitely was not an alcoholic, but got accused of being a secret drinker. This happened when he was admitted to hospital in 1994 because he was feeling very disoriented (e.g. he thought it was 1964). Because his regular doctor was on vacation and unable to refute this drinking allegation–as one doctor speaking to another–the hospital doctors brushed aside the claims of mere family members that he was not a heavy drinker, just as they did with Jeff Williams.

It was only after my father-in-law died and my wife was diagnosed with hemochromatosis that the episode came into focus. His disorientation was caused by liver problems that were not alcohol-related but hemochromatosis-created. Don’t get me wrong, drinking a lot of alcohol is not good for your liver. But hemochromatosis can call cirrhosis in people who never touch a drop. And the chronic arrogance of doctors who contradict family members in blind allegiance to a textbook diagnosis is worse than not good, it is downright deadly, and sadly all too common.

I know this because several similar stories appeared on the Hemochromatosis page on Facebook within hours of me mentioning the Washington Post story. And people were quick to speak up on the Celtic Curse Twitter feed. Apparently, for some doctors and nurses, having an Irish heritage is grounds for suspicion of alcoholism, but not for considering the possibility of hemochromatosis.

All of which leads me to say this: July is just around the corner, so now is a great time to start telling people about Celtic Curse, a deadly genetic defect that occurs in a wide range of people, many of whom don’t consider themselves to be Celtic at all.

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