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Horrible experience with alcohol and hypoglycemia on Saturday


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I feel so foolish for even having to share this, but if my story can help one other person on this board, then I've done a good thing.  On Saturday, I went to meet a friend at a comedy club in a neighboring town.  Prior to leaving, I had eaten a couple of hours earlier and had drank a bit of white wine (not unusual for me, I'll have a glass once in a while without any ill effects).  I went to the comedy club and ordered a gluten-free hard apple cider and sipped it slowly throughout the show.  I remember ordering a second one and that's when events became fuzzy for me.  Apparently the show ended and my friend offered to walk me back to my car and I refused and said I was going to stay and have another drink (something I would never in a million years do as a single woman if I was in my right frame of mind!).  I completely lost track of what happened to me between the hours of 8 p.m. and 10 p.m. that night.  From what I've been able to piece together, I was either drugged (very unlikely) or I experienced a hypoglycemic blackout brought on by consuming the two drinks.  Apparently I was conscious, but from what I was told, my behavior was erratic and those around me assumed I was on drugs.  At some point, I left the club and fell.  I have no recollection of this, but I sustained a concussion, split my chin and elbow open, injured my other elbow and my right hip.  Compared to what could have happened if I actually got into my car and drove or if someone had hurt me, I feel like I was spared anything terrible.  The past four days have been awful for me.  Not knowing how I was hurt, how I got home (I know someone brought me, but I don't know who it was) and how much I scared my family has been very traumatic.  My clothes were covered in blood from my injuries when I arrived home, and I was missing my purse, car keys, phone and coat.  The guilt I've been feeling over what happened is awful.  What's worse, as a teacher, I've had to explain 150 times in the last 48 hours that I fell over the weekend and hurt myself because of my visible injuries.  Please, please, please think before you consume any alcohol!!  My story is proof that you just don't know how it will affect you! I am two years out this month and I've never experienced anything like this reaction in my life. 

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Oh my goodness.  I guess bumps and bruises will heal and it sure could have been a LOT worse.  Stay safe, people.  :)

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Oh Danelle what a horrible ordeal. Hugs. I hope your wounds heal quickly. I am sure your story will hit home with someone and you will never know who, but I am sure you helped someone by sharing your story. My heart aches for you. Jen

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Oh, Danelle! I am so sorry this happened! (((HUGS)))

 

Thank you so much for sharing this. I know it must be embarrassing, but you are so brave to lay it out there and I am SURE this story will help someone else think twice and potentially save them from a similar experience.

 

I'm really glad you got home relatively safe. Have you had your items returned to you?

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You poor thing! It doesn't sound like a usual reaction to a few drinks- over a few hours- well to me- although alcohol can have a very strong effect and cause hypoglycaemia- 

The fact you have lost your purse, keys, coat and phone means someone has taken advantage of your situation regardless of how much you had to drink!

Hope you recover soon although it sounds as if the emotional scars will take longer to heal than the physical ones... 

I once fell down a stationery escalator at night- many years ago- after a few too many drinks... was concussed and still feel guilty- don't let that happen to you- forgive yourself and move on- and remember- not everything that happened was entirely your fault! Sending gentle {{hugs}}},,

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I am so very sorry.  Are you absolutely sure that someone did not slip you a rufie and that you were not molested during that black out period? It is very, very easy for someone to slip something into your drink without you being aware. Hate to scare you, but setting aside your surgical history, I'm sorry to say this sounds very much like the typical club assaults that happened near here a while back.  Did your doctor check for that when treating your injuries? Could you have gotten those injuries fighting someone off or trying to get away? Did anyone you know have eyes on you in the club in that entire time period? What happened between 10 pm and when you arrived home?  What about interviewing the wait staff/bartender at the club or asking to see security tapes? You might also check with the police to see if anyone else has had a similar problem at the club or in the area. They can give you advice and help you get support.  

 

Please be sure to change the locks on the house immediately and make other security arrangements for all your personal and financial information.

 

Please take very good care of yourself and stay safe!  Wishing you all the best! 

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That is one scary situation. I hope you get better. I had something similar happen to me in Korea last year I had 5 beers and don't remember a thing. I remember I paid my tab then nothing. What's weird here in the States I can or used to be able to pound 18 pack if I wanted. At that point being inebriated but still coherent. I wish you well.

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All of my belongings were tucked into the safe at the club, so I was able to pick them up on Monday morning.  Not a thing was missing! I cancelled my bank card just in case.  I was so hoping that the staff there would know what happened to me, but so far I haven't heard back from them.  They just remember me sitting there alone at 8:30 p.m. looking very disoriented.  I think the hardest part of the experience is not knowing how I got hurt because my injuries bled so much and were so painful!

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That's terrible! I seldom drink, but this would make me even more careful. I hope you heal quickly.

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I am willing to bet your issue came about from a combo of alcohol and sugar and not any sort of drugging. It actually sounds to me like you were fortunate that someone took care to get you home. Perhaps you could call the police and/or taxi companies that may have been called.

I looked up the sugar content in hard ciders and found between 11and 25 per glass. Yikes!!

Also, this is an appropriate time to point out that bypassers should never drink on an empty stomach. I know it is stressed that we should not eat and drink at the same time, but this is perhaps the only exception. Having a bit of fibrous, protein rich food (like nuts) in our pouches will not only slow the absorption of alcohol (which is absorbed MUCH faster in us), it will also remind us to drink slower and buffer blood sugar changes.

Thanks again, Danelle, for sharing your experience.

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I did file a police report on Sunday, but so far I haven't heard anything back that would clear up any of the mystery for me.  I'm just trying to make my peace with the fact that I'm ok and I learned a valuable lesson. 

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How unbelievably scary for you!  Thank you so much for sharing your story, though.  It's good to know some of the consequences of going beyond our new limits.  You are very brave for sharing.

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Danelle, you might want to follow up with the police rather than waiting for them to call you. Also, why was the bartender still serving you if you were clearly disoriented?  No need to be embarrassed--stuff happens!

 

Thanks for posting your story.  I think it does also point out that RNYers need to be very careful drinking before knowing their limits unless they are with trusted friends. It would be too easy for an unscrupulous person to take advantage of them and possibly do great harm. 

 

Take good care of yourself! 

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I'm so so so so sorry this happened. The embarrassment will fade... just remember you are human and every one has experiences at times and basically.... you live and learn and what doesn't kill you makes you stronger.I'm very glad you are ok btw!!!!!

 

Also, stay away from hard cider!!!! I am an avid wine drinker ( I love a good glass of red wine once in a while especially after a long week of work) but cannot tolerate hard cider. I can definitely feel the difference between being buzzed and when my sugar drops. Drinking hard cider essentially mixes a buzz and a sugar issue. In the past I had to tell my boyfriend to bring us home after 3 hard ciders with dinner out with friends. I woke up in bed wondering how I got there. He informed me i passed out in the car and had been sleeping for about 2 hours. I can tolerate twisted tea, although it has a lot of sugar (i generally try avoid it because of the calories) but hard cider is a no-no.

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  • 3 weeks later...

Thank you for not driving. You did the right thing. Know ur limits, wine for me is dangerous it sneaks up on me.

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That is so scary and I am so sorry. Years ago (before the surgery) I had a very scary alcohol experience and I understand how badly it can make you feel. I love to drink wine and curious how that is is going to change now that I have had surgery. I know I will need to be very careful. Thanks you for bravely sharing your story and glad you are okay!

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I love to drink wine and curious how that is is going to change now that I have had surgery. I know I will need to be very careful.

You're 100% correct. Save it for special occasions. I've had some a few times in eight months and it hits you harder than you think it will. It also sabotages the weight loss you were going to have that day.

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I'm so sorry you had this horrible experience! Very unsettling. I recently read an article that I saved on this subject. Very sobering (no pun intended) information. I really enjoy the occasional drink, but this article makes me re-think that entirely.

Alcohol and the Gastric Bypass Patient

- by Cynthia K. Buffington, PhD

INTRODUCTION

A 32-year-old man, four months out from gastric bypass surgery, was issued a citation for driving under the influence (DUI) of alcohol shortly after leaving his brother�s wedding reception. According to the patient, he had only consumed one glass of champagne, although his blood alcohol content was above the legal limit to operate a motor vehicle (i.e., 0.08%).

A female patient, 50 years of age and one year post-gastric bypass, hit and killed a pedestrian with her automobile after having less than two glasses of wine. When police arrived, she was staggering and slurring her words and was taken into custody. Two hours later, she was still unable to maintain her balance or to speak clearly, causing officials to suspect that she had drunk a bottle or two of wine instead of two glasses.

Were these patients telling the truth about the amount of alcohol they had consumed, or did bariatric surgery affect the way their bodies absorb or metabolize alcohol? In order to answer these questions, we queried our gastric bypass population to identify changes in their response to alcohol since surgery. Nearly all patients surveyed (90%) claimed that they were more sensitive to alcohol postoperatively versus preoperatively. Most patients reported that they could feel the effects of alcohol after taking only a few sips of their drink. More than 25 percent of patients said that they had, on occasion, lost muscular coordination after having only one to two drinks, and several of these patients claimed that they were unable to regain control of their balance and coordination for up to two hours. Nearly five percent of the patients who completed the survey said that they have received a DUI and that the incidence had occurred in the early postoperative months and after having only one alcoholic beverage.

These findings suggest that gastric bypass alters the absorption and/or metabolism of alcohol in such fashion as to increase alcohol sensitivity. In order to determine how gastric bypass may affect the body�s response to alcohol, we reviewed the process of alcohol absorption and metabolism in the non-surgical and gastric bypass patient. This article includes the findings and, based upon such, provides the healthcare professional suggested guidelines for patient use of alcohol post-surgery.

ALCOHOL ABSORPTION PRE- AND POST-SURGERY

Why would alcohol absorption be more rapid and alcohol levels higher for someone who has had a gastric bypass? When alcohol enters the stomach of someone with normal gut anatomy, some of it is metabolized in the stomach by the enzyme alcohol dehydrogenase in a process known as first pass gastric alcohol metabolism.1-4 Conditions that reduce gastric metabolism of alcohol increase blood alcohol levels and its effects. Such conditions include female gender, aging, and various medications (i.e., H2 blockers and aspirin).3-4

The length of time alcohol stays in the stomach also regulates blood alcohol levels by controlling the rate of absorption.1-3 Although a small amount of alcohol is absorbed in the stomach, most is absorbed into the circulation via the small intestines. Alcohol absorption is primarily regulated by the rate that alcohol empties into the intestines from the stomach. The longer alcohol remains in the stomach, the less is absorbed and the lower the blood alcohol content is and risk for intoxication and toxicity. Food slows gastric emptying and, consequently, reduces the rate of alcohol absorption by the intestines. Conversely, alcohol consumed on an empty stomach substantially enhances absorption and increases blood alcohol content and risk for intoxication.5-6

With gastric bypass, more than 95 percent of the stomach is bypassed, including the pylorus. Under these conditions, first pass alcohol metabolism is negligible because alcohol passes directly from the stomach pouch, via gravity, into the intestines where, due to the large surface area of the intestines, it is rapidly absorbed. To make matters worse, when drinking alcohol, many patients obey the postoperative dietary rule of no eating while drinking, causing alcohol to be absorbed at an even faster rate.

A 2002 study published in the British Journal of Clinical Pharmacology7 found that gastric bypass patients have significantly higher rates of alcohol absorption and blood alcohol content than do age- and weight-matched controls. According to the study protocol, gastric bypass patients three years out from surgery and their non-surgical controls were asked to consume an alcoholic drink after an overnight fast, and blood alcohol levels were followed over time. The data showed that blood alcohol levels of the gastric bypass patients were significantly higher (about 50%) than their non-surgical counterparts and required much less time to peak (10 vs. 30 minutes). These findings may, in part, explain why, when queried, the majority of our gastric bypass patients claimed they could �feel� the effects of alcohol after having only a few sips of their drink.

The more rapid absorption of alcohol and heightened blood alcohol levels with gastric bypass would cause the patient to �feel� the effects of alcohol after having consumed less alcohol than before their surgery. Such effects may have serious ramifications with regard to driving an automobile or performing other skilled tasks, such as operating heavy machinery, piloting a plane, or any other task that could jeopardize the safety of the individual or that of others.

ALCOHOL METABOLISM AND TOXICITY

In the non-surgical patient, 60 to 90 percent of alcohol that enters the body is metabolized in the liver by the alcohol dehydrogenase (ADH) pathway. ADH is maximally activated by small amounts of alcohol but activity along the pathway can be reduced by an accumulation of end-products (i.e., NADH, acetaldehyde). Fasting and low calorie intake�such as occurs in the early postoperative period�as well as defects in hepatic mitochondrial function with obesity, per se, may reduce the metabolism of products of the ADH pathway, decreasing hepatic clearance of alcohol.8-10

Furthermore, activities along the ADH pathway may be impaired by steatosis or fatty liver disease,11 conditions that are relatively common among individuals with morbid obesity. The gastric bypass patient, therefore, may not only have higher rates of alcohol absorption, but at least in the early postoperative period, possible defects in alcohol clearance as well.

Metabolic changes that occur with massive and rapid weight loss may also affect the amount of alcohol cleared by the liver via the microsomal ethanol metabolizing system (P4502E1).9-10,12 Activities along this pathway are increased in association with obesity12-14 and are induced both by alcohol intake, free fatty acids and, possibly, ketone bodies.12 Alcohol metabolism by the microsomal ethanol metabolizing system substantially increases the risk for liver damage, while at the same time making an individual more sensitive to the toxic and cancer-promoting effects of pollutants in the air, industrial solvents (such as those in household cleaners), and certain drugs, including acetaminophen.9-10,12

Alcohol use may cause hypoglycemia and, through reduction in the supply of glucose to neural tissue, cause possible neuromuscular and cognitive dysfunction, loss of consciousness, or even death.15-16 To maintain appropriate glucose levels, the body stores sugar in the form of glycogen. Glycogen stores, however, can be depleted in a short period of time with fasting or a diet low in carbohydrates. Furthermore, alcohol reduces the process, glycogenesis, that allows sugar to be stored as glycogen.15

The bariatric patient, particularly in the rapid weight loss period and if on a carbohydrate-restricted diet, may have low amounts of glycogen. Drinking alcohol could deplete glycogen stores and reduce glucose homeostasis. The body, however, has another mechanism to maintain appropriate glycemic status, gluconeogenesis, the chemical pathway that converts certain components of protein, lactic acid, and other substances into glucose. Unfortunately, alcohol also reduces the production of glucose by this process.9-10,15

A decline in blood glucose usually increases the production of glucagon and certain hormones of the autonomic nervous system and hypothalamic-pituitary-adrenal axis to restore blood glucose levels to normal by stimulating glycogenolysis or gluconeogenesis.16-17 However, when someone drinks alcohol, the response of these hormones to a fall in blood sugar is blunted. To make matters worse, counterregulatory hormone responses to low blood sugar are also blunted or depressed in postoperative bariatric patients.18 The bariatric patient when using alcohol may have a higher risk of becoming hypoglycemic than someone who has not had the surgery, particularly in the early postoperative period when calorie intake is substantially reduced and glycogen stores are likely to be low.19

Since neural tissue requires glucose for fuel, low blood levels could adversely affect neuromuscular and cognitive functions, causing a loss of coordination and balance, slurred speech, poor vision, and confusion.16-17 These are all conditions that mimic those associated with intoxication. The patient described in the introduction who appeared extremely intoxicated even though she had not consumed a large amount of alcohol may have been hypoglycemic. Hypoglycemia could also have possibly accounted for the loss of coordination and balance that some of our surveyed patients claim they experienced hours after drinking alcohol.

The use of alcohol after surgery may cause irreversible brain and nerve damage, coma, and possible death by inhibiting the absorption of important vitamins, including B-complex vitamins, such as thiamin (B1) or Vitamin B12. Alcohol inhibits the absorption of thiamin and other B-complex vitamins, reduces activation of certain vitamins, and stimulates the breakdown of Vitamin A, pyridoxine, and folate.9-10 These vitamins may already be deficient in bariatric patients because of nutrient restriction, malabsorption, or impartial digestion of foods produced by the respective surgery.20 Alcohol use, then, could compound the negative effects that bariatric surgery has on vitamin/mineral status and increase the risk for associated health problems, including neuropathy, an irreversible loss of various cognitive functions, defects in metabolism, a decrease in the body�s ability to heal, low immunity, and fatigue.20-21

Alcohol has numerous other toxic effects in the body. Not only does alcohol cause liver disease, but it also negatively affects other tissues.1,8-12,22 Alcohol�s influence on the heart includes myocarditis, cardiomyopathy, arrythmias, and increased risk for sudden death. Skeletal muscle is particularly susceptible to alcohol toxicity with loss of muscle mass and strength. Alcohol causes inflammation of the intestinal tract, gastritis, pancreatitis, acid reflux disease, and increased risk for gastric and esophageal cancers. Alcohol also causes damage�often irreversible�to neural tissue.

ADDICTION TRANSFER

In addition to the numerous health problems that drinking alcohol after surgery may cause, the bariatric patient should also be cautious of alcohol addiction. The prevalence of food addiction and associated eating abnormalities (i.e. binge eating, carbohydrate cravings) are high in association with obesity.23-25 With bariatric surgery, aberrant eating behaviors are considerably improved.18 However, individuals with addictions often transfer those addictions to yet another substance, such as alcohol.23 Our data, presented as a poster at the 2006 meeting of the American Society for Bariatric Surgery, showed that approximately 14 percent of gastric bypass patients have increased alcohol consumption post-surgery.

Drinking alcohol after surgery may also reduce maximal weight loss success. Alcohol has no nutrient benefits and contains high numbers of calories that may cause weight gain or prevent weight loss. For instance, one 12-ounce can of beer contains 150 calories; 3.5 ounces of wine contain 70 calories; 1.5 ounces of gin, rum, vodka, or whiskey contain between 97 and 124 calories; and 1.5 ounces of liquor contain 160 calories.

SUGGESTED GUIDELINES

Are there guidelines for using alcohol after surgery? Presently, there are no official guidelines that have been established pertaining to the use of alcohol after having bariatric surgery. However, based upon knowledge of changes in the absorption and metabolism of alcohol, coupled with the metabolic state of the bariatric patient at various stages postoperatively, the following suggestions are recommended:

1. Do NOT drink alcohol during the rapid weight loss period.

2. When drinking, remember that small amounts of alcohol can cause intoxication or can result in low blood glucose with serious consequences.

3. Do not drive or operate heavy equipment after drinking alcohol�even small amounts.

4. Eat if you plan to have a drink.

5. Make certain to take your bariatric vitamin and mineral supplements.

References

1. West Virginia University School of Medicine. Alcohol Metabolism and Absorption. Available at: www.hsc.wvu.edu/som/cmed/alcohol/metabolism.htm. Access date: September 7, 2006.

2. Buffington CK A review of alcohol absorption and metabolism in non-surgical and bariatric surgical patients. www.barimd.com, 2005.

3. Sharma R, Gentry RT, Lim RT, Jr., et al. First-pass metabolism of alcohol. Dig Dis Sci 1995;40:2091�7.

4. Palmer RH, Frank WO, Nambi P, et al. Effects of various concomitant medications on gastric alcohol dehydrogenase and the first-pass metabolism of ethanol. Am J Gastroenterol 1991;86:1749�55.

5. Jones AW, Jonsson KA, Neri A. Peak blood-ethanol concentration and the time of its occurrence after rapid drinking on an empty stomach. J Forens Sci 199136:376�85.

6. Hahn RG, Norberg A, Jones AW. �Overshoot� of ethanol in the blood after drinking on an empty stomach. Alc Alcohol 1997;32:501�5.

7. Klockhoff H, Naslund I, Jones AW. Faster absorption of ethanol and higher peak concentration in women after gastric bypass surgery. Br J Clin Pharmacol 2002;54:587�91.

8. Merck, Inc. The Merck Manual of Diagnosis and Therapy, Chapter 40. Alcohol Liver Disease. Available at: THE MERCK MANUAL MEDICAL LIBRARY: The Merck Manual of Diagnosis and Therapy. Access date: September 7, 2006.

9. Lieber CS. Alcohol and the liver: Metabolism of alcohol and its role in hepatic and extrahepatic disease. Mt Sinai J Med 2000;67:84�94.

10. Lieber CS. Metabolism of alcohol. Clin Liver Dis 2005;9:1�35.

11. Zorzano A. Effect of liver disorders on ethanol elimination and alcohol and aldehyde dehydrogenase activities in liver and erythrocytes. Clin Sci 1989;76:51�7.

12. Lieber CS. From ASH to NASH. Hepatol Res 2004;28:1�11.

13. O�Shea D, Davis SN, Kim RB, et al. Effect of fasting and obesity in humans on the 6-hydroxylation of chlorzoxazone: A putative probe of CYP2E1 activity. Clin Pharmacol Ther 1994;56:359�67.

14. Emery MG, Fisher JM, Chien JY, et al. CYP2E1 activity before and after weight loss in morbidly obese subjects with nonalcoholic fatty liver disease. Hepatology 2003;38:428�35.

15. Mokuda O, Tanaka H, Hayashi T, et al. Ethanol stimulates glycogenolysis and inhibitis glycogenesis via gluconeogenesis and from exogenous glucose in perfused rat liver. Ann Nutr Metab 2004;448:276�80.

16. Mitrakou A, Ryan C, Veneman T, et al. Hierachy of glycemic thresholds for counterregulatory hormone secretion, symptoms, and cerebral dysfunction. Am J Physiol 1991;260:E67�74.

17. Cryer PE. Glucose counterregulation: prevention and correction in humans. Am J Physiol 1993;264:E149�55.

18. Guldstrand M, Ahren B, Wredling R, et al. Alteration of the counterregulatory response to insulin-induced hypoglycemia and of cognitive function after massive weight reduction in severely obese subjects. Metabolism 2003;52:900�7.

19. Heymsfield SB, Stevens V, Noel R, et al. Biochemical composition of muscle in normal and semistarved human subjects: Relevance to anthropometric measurements. Am J Clin Nutr 1982;36:131-42.

20. Malinowski SS. Nutritional and metabolic complications of bariatric surgery. Am J Med Sci 2006;331:219�25.

21. Gollobin C, Marcus WY. Bariatric beriberi. Obes Surg 2002;12:309�11.

22. Eriksson CJ. The role of acetaldehyde in the actions of alcohol (update 2000). Alcohol Clin Exp Res 2001;25:15S�32S.

23. Simansky KJ. NIH symposium series: Ingestive mechanisms in obesity, substance abuse, and mental disorders. Physiol Behav 2005;86:1�4.

24. Wurtman RJ and Wurtman JJ. Brain serotonin, carbohydrate craving, obesity, and depression. Obes Res 1995;4:477S�89.

25. Herpertz S, Kielmann R, Wolf AM, et al. Does obesity surgery improve psychosocial functioning? A Systematic review. Int J Obes Relat Metab Disord 2003;27:1300�14.

26. Buffington CK, Warthen RT, Daley DL, et al. Changes in alcohol sensitivity and effects with gastric bypass (abstract). SOARD 2006;2:317�8.

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Thanks, FBG, reading that should be mandatory for all of us!

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Glad you are ok and thank you for sharing. My doctor wants me to wait 6 months which is coming up soon and I've considered having a drink or 2 at Christmas time. But reading this and the article perhaps I will reconsider and wait a bit longer, or maybe never.

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Thanks for posting this.  Such a very scary story and I am so sorry for your injuries.  This is a wake up call for me and I will take it to heart.

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WOW! REALLY interesting and informative story.  I'm glad that things didn't go any worse for you and I appreciate you for sharing the learning opportunity.

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Thanks for posting the article ForeverBrucesGirl and thanks for sharing your experience Danelle :)

 

I do have some wine sometimes but:

 

  • Never when I am alone out of the house
  • Only when I have a known designated driver

 

Half a glass of wine is enough to get me feeling "tipsy" so I know not to drink much more than that if I have to remain respectably conscious. It is difficult for me to give up alcohol altogether and if I can keep it under control I should not have to. I am still testing the waters and an experience like the one you had may turn me into a teetotaler.

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I follow the rule of not drinking without a trusted friend or family member with me also.

 

I read something recently that seems to be working for controlling that quick buzz you get. Although we are told not to drink and eat together, alcohol is different. We should eat something high - fiber, hig-protein like almonds/nuts BEFORE we drink to slow down the absortion of the alcohol. I tried it this weekend with red wine and what a difference! Just a suggestion, not a rule...

 

I am not giving up alcohol, but I will drink in moderation.

 

FYI, I had my first drink at 4 months, but I was told not to drink until 6 months to a year. I didn't make it. lol

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