Comment by brianleb | Hacker News Reader

Comment by brianleb | Hacker News Reader

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Doctor of Pharmacy here. You haven't actually addressed what he said. None of that indicates that one heavy night of drinking takes a week to recover from (how? mentally? physically? emotionally? enzymatically?). Where's the PubMed or Medline citation?

DTs occur in patients undergoing life threatening alcohol withdrawal. These people have often been drinking upwards of a twelve-pack of beer a day for years.

Almost all alcoholics lie about their drinking. This is expected in both ambulatory and critical care. Implying that this patient's alcoholism killed her because her liver couldn't handle the anesthetic is disingenuous at best. If you're talking about a patient who was admitted with DTs, she should not have even been administered an anesthetic. If it was something else entirely, from the limited information you've provided I have to find fault with the anesthetist. The Glasgow Coma Scale is your friend, and it (and other scales of conscious) must be constantly used.

A single bender is not going to upregulate liver enzymes, just like a single dose of medication won't. It takes weeks or months of consistent exposure to make that happen. Again, this has nothing to do with the original, uncited claim that a single night of drinking takes a week to recover from.

And finally, do not recommend to your heavy drinking patients that they should take ibuprofen. NSAIDs, by virtue of their nonspecific effect on cycloxygenase, decrease the protective prostaglandins that are produced in the stomach to maintain the mucosal lining. Taking Advil after a night of heavy drinking is only going to make it more likely that the patient throws up blood the next day and needs to go to the hospital. NSAIDs have absolutely no positive effect on acid reflux - they will only make it worse. If a patient has heartburn, give them the obvious recommendation: take an antacid. Heartburn is not the same kind of discomfort as hitting your thumb with a hammer.

Coffee before food will make this heartburn worse due to the acidity. Again, a single serving of yogurt isn't going to have an appreciable effect on your gut flora. You need to be eating it regularly for a few weeks before the bacteria can overcome your natural defenses and the other flora to colonize.

This is all misinformation you've provided, and it's not even relevant to what you're replying to.

First, thanks for replying. Perhaps I was to casual in my initial reply. I think we're in agreement that alcohol is a bad idea. I was assuming I was addressing a 20-40 year old entrepreneur, and my impression of these guys, on the forum and those I've met in person, is that they're generally healthy and interested in staying that way, they go to parties now and again, and once in a blue moon wake up with a nasty headache. My goal was to first address that there are generally long term effects and short term effects, and leave it as exercise to the reader to see that there's not much in the 1-week range.

With regards to your specific concerns:

> DTs vs anesthesia

These were intended as two separate examples. I could have made that more clear. I absolutely agree, anesthesia is a very bad idea for someone in DTs. The larger point being, alcohol is a bad idea.

> A single bender is not going to upregulate liver enzymes

I argue a single bender will upregulate liver enzymes. Not a lot, but a little. A single workout will build muscle and improve your physical fitness. Not a lot, but a little. The larger point no doubt being one you're in favor of: alcohol is a bad idea.

> do not recommend to your heavy drinking patients that they should take ibuprofen

I would not recommend a heavy-drinking patient take ibuprofen. That said, alcoholics in the hospital vomiting blood are classically associated with esophageal varices due to a cirrhotic liver, which bleed spontaneously and then they vomit. They are not coming in for gastric ulcers, which generally require days to weeks of NSAIDs, and are more classically associated with aspirin, which irreversibly acetylates the COX enzymes, whereas ibuprofen binds reversibly. The larger point being, alcohol is a bad idea.

> Coffee before food will make this heartburn worse due to the acidity.

I didn't recommend coffee as an antidote to heartburn. I recommended some water and staying upright. The coffee recommendation was for the next morning. The caffeine will activate cAMP, causing some dilation of cerebral blood vessels, getting more profusion to the noggin, helping overcome the headache. The larger point being, alcohol is a bad idea.

> a single serving of yogurt isn't going to have an appreciable effect on your gut flora

Are you arguing against yogurt?

Let me take the opportunity to suggest that I don't advocate drinking as a solution to problems. Quite the opposite. But keep it coming. Glad you came across my comment. Look forward to seeing you around.

I'm glad we can keep it civil. I've been reading HN for a while but don't post often and only recently created an account. Medications are the domain of knowledge, so I try to contribute about that when I can. For better or worse, I don't know much about startups, erlang, emacs, or what have you, so I don't post in those sorts of discussions.

Anyway, I'm glad we clarified things.

Thank you both for your answers.

What I was initially looking for was something to back up the claim "it takes a week to recover from a night of serious drinking.". Niels is arguing that this could be true for alcoholics with DT. While I wont argue that, I don't think the original statement was referring to alcoholics, but rather anyone who goes out for a night of serious drinking. I haven't seen any proof for the original statement.

I'm not a doctor in any way, shape or form, but I would still like to argue the running point in Niels' second post, alcohol is a bad idea.. Overconsumption, yes, but that's true for almost anything. I don't think smaller amounts is a bad idea -- on the contrary. I recently heard a statement that the UK recommended limit (21 units per week) was just made up, and studies have shown that you're more likely to live longer if you drink around 40-50 units per week (somewhere after that number, the life expectancy starts dropping and goes below the life expectancy for people not drinking). I'm afraid I can't remember where I heard/saw it though, so I'll have to leave a [citation needed] for myself for the time being.

There some thinking that this whole finding about a glass of red wine a day being associated with longer survival is probably due to profile of people who drink like that: they have a moderately active social life and have not-to-much stress in their lives. Which is probably far better for you than any amount of alcohol.

Then we get to causality;

Are active, stress-free people more likely to have a drink with dinner, or is a drink with dinner helping to relieve stress?

I quite enjoy having a drink after work, especially if it's been a lot of pressure during the day. It helps me relax, disconnect from the work situation. A couple of beers and non-work-related chat will take my mind off any stressful work I've been doing, which could otherwise carry on in my mind throughout the night.

This is the least flamey / most civil disagreement I've seen on this forum in my 1000+ days on.

Agreed, and I love the fact that we've got all kinds of knowledge on this forum. I want to thank brian and niels again for their input.

I have to post my agreement, because votes aren't shown -- I can't upvote you and let brian/niels see it. :-)

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