DEAR DR. DONOHUE: I am a 37-year-old male who was diagnosed with alcoholic hepatitis superimposed upon liver cirrhosis. Two gastroenterologists assured me that I would make a good recovery. I thought that cirrhosis of the liver was a death sentence. Isn’t it? I have not had a liver biopsy. Would that help? I was not educated on the effects of alcohol on the human body. – Anon.

ANSWER: The progression of liver damage due to too much alcohol roughly follows these lines. Anywhere from 10 to 20 years of heavy drinking produces the first changes, consisting of fat invasion into the liver. Alcoholic fatty liver reverses when drinking stops.

If drinking continues, the next change is liver cell injury and death – alcoholic hepatitis. “Hepatitis” is word applied to many causes of liver cell destruction. Viruses usually pop to mind, but alcohol does the same thing. It too can be reversed, usually, with abstinence. (There is a form of alcoholic hepatitis that can end in death.)

The last stage that results from continued drinking is cirrhosis – replacement of liver cells with scar tissue. Cirrhosis is permanent. No medicine can undo it. Its consequences depend on its extent. When cirrhosis is minimal and confined to only a few areas of the liver, a person can live a full life and have a normal life expectancy.

Not every heavy drinker suffers these consequences, but ignoring them is playing Russian roulette with a six-chamber gun that has five rounds in it.

A biopsy provides definitive evidence for the degree and severity of cirrhosis. However, lab tests and liver scans can provide information that gives a good idea of the extent and degree of cirrhosis. You have had two gastroenterologists – liver specialists – who assure you that the amount of your cirrhosis is not great. Accept their word.

You must, however, not take another drop of alcohol.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

DEAR DR. DONOHUE: About a week ago I started to have a rash on my forearms, stomach, neck and chest. The doctor said it was pityriasis rosea. He gave me Atarax and some lotion. Nothing is working. I am now on day eight, and the rash has gone all the way to my ankles. I constantly itch. Can you suggest something to help me with the itch? It’s hard to work with it. – A.C.

ANSWER: Pityriasis rosea often starts with a single large, round blotch, the herald patch. It’s pink with a surrounding narrow, white border. In blacks, the patch is more darkly pigmented than the surrounding skin.

Within days or weeks, smaller patches break out, and they number from a few to hundreds. Some people have a rash that covers most of the skin.

The cause remains undiscovered. Some feel it might be virally induced.

For the majority, the rash causes no other symptoms. For a few, it itches. For fewer still, it is severely itchy.

The whole affair lasts from two to eight weeks. You, understandably, are a bit impatient. You have to give this another week or two before you start to see things turn around.

For people with an intolerable itch, cortisone creams, lotions or ointments can often quell it. Are you using a cortisone lotion? If you are and it’s not working, an antihistamine, such as your Atarax, can help suppress the itch. If Atarax doesn’t do it for you, there are plenty of others to try. For an itch that is all-consuming, oral cortisone can temper it.

It’s still sunny out, and ultraviolet light (sunlight) can sometimes make the rash fade more quickly.

DEAR DR. DONOHUE: At age 69, I ask what are the safe and effective amounts of vitamins B-6 and B-12. — C.V.

ANSWER: The recommended daily allowance for vitamin B-6 – which goes by many names, such as pyridoxine, pyridoxal and pyridoxamine – is 1.3 mg for men and women 19 to 50 years old. Older women need 1.5 mg, and older men, 1.7. The upper daily limit is 100 mg. There is no reason to take that much unless on doctor’s orders.

The daily requirement of B-12 for adult men and women is 2.4 micrograms. There is no upper limit.


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