Tattoos And Hepatitis Go Together (All Too Often)

When writing these essays, I know I tend to make myself sound like the world’s greatest psychiatrist and physician.  But, hey — I am writing about myself. What do you expect?

Occasionally I will admit that sometimes I get in trouble a little.  But I want to keep you reading my ramblings for a long time, so those juicy stories will be few and far between – just keep reading until you see another one.

The majority of my business now is going in to a clinical situation or private practice and telling people what they are missing and what they should be doing.  It’s a funny life because people invite me to come, they pay me, and then they fight tooth and nail to keep doing what they’ve always done.

Change is a difficult endeavor.

One example is a clinic where I suggested that everyone who had been in prison get screened for Hepatitis C.  This was a privately funded “street people” clinic and outcomes just weren’t very good.

That can happen when someone’s liver is damaged – and many drugs are metabolized by the liver.  Feeding them pills wouldn’t do any good.

I started this long ago because I had read somewhere that 75% or 85% (depending on whom you believe) of the guys in prison were positive for this. I was a prison doc and read about such things – unlike most other prison docs. When the convicts got out, many of them would end up in a clinic such as the one I came in to advise.  It seemed logical to me to screen for hepatitis C.  But not to the staff.

“None of our other doctors have ever said/done that” they uniformly cried.

My favorite phrase – NOT!

Blood tests were another expense, and all health systems are about cutting costs and keeping them down – not about actually helping sick people. Sad but true.

But the staff had to admit that the patients in the system felt rotten for some psychiatric reason and nothing seemed to help.

“Humor me,” I said.

I ordered, for these uninsured ex-criminals (or maybe still criminals) a simple hepatitis screen.  I thought it was awfully insightful of me, and I did catch some cases. This clinic couldn’t handle such treatment, so I promptly bludgeoned the system into finding free clinics for referrals.

Not really great quality care (when you have no money or insurance) and they had to wait for a long time and maybe God knows if they ever got treated.  I certainly do not.

The immediate result was an angry administrator who told me that the bills I was running up for uninsured patients were too much for the meager budget to bear.  What did I think this was?  A county clinic that could bill MediCal?

Hah!  The ex-cons couldn’t qualify for MediCal – but they still needed treatment.  The result?  The administrator decided that the staff could refer such patients to anyplace they wanted – but there would be no Hepatitis C screening in this clinic.

It disturbed me, but it was so clear he was not going to change his mind on this one that I did not pursue. I wanted to strike these victims when the iron was hot and I was not going to be able to do that.

There were some women, too, like the one already diagnosed with Hep C who grabbed her stomach and asked me it if was okay to throw up in the wastebasket (which she never did).  Actually, I was glad she was so flagrantly symptomatic, because I could throw her in an ambulance and get her some help.  (I guess someone did something for her.  I certainly never saw her again.)

Somebody actually got a publication just by showing that Hepatitis C could be treated in patients who were still in prison. These guys must have had academic appointments, and been watching their number to get tenure. A small number of patients — make no mistake about it.

We are in the middle of an epidemic of Hepatitis C. The above cited publication says that people are coming up with screening recommendations. As always the drug companies rule.  The newer meds help more people.

No, psychiatry is not supposed to be like this.  But often, it is.

A lot — I mean a lot, of psychiatric symptoms can be caused by medical problems.  And a psychiatrist or psychopharmacologist can be excessively trained.  When someone is over-trained, they look for the lost keys under the streetlight that they know best.

I always advise that if you can’t get a Hepatitis screen, get a “metabolic panel”  If it is screwed up, maybe there is someone who has another kind of Hepatitis, who is drinking like a fish (not water but alcohol) or something.

If you are in a high risk group, you can still take steps to prevent getting this illness. 2000 deaths a year according to our friends at the Center for Disease Contol.

Contagion is blood borne. I see a lot that were probably from bad tattoos.

Even people with the “older” medicines do better and survive longer than ever before.

The problem is that people who live high risk lives, like those who end up in prison, truly don’t seem to care. People need to value life.  It is not that hard to take the steps to save it.

“Choose life,” I always urge. Maybe the fact that this advice comes straight out of the Bible might help some folks.

Deuteronomy 30:19: “I call heaven and earth to record this day against you, that I have set before you life and death, blessing and cursing: therefore choose life, that both thou and thy seed may live.”

I know it is from the Jewish Bible, but I have told it to Christians, at least those who tell me they are Christian, and it does not seem to make anyone want to seek treatment for their Hepatitis C, which can kill people who do nothing.

The problem may be just people believing they are important enough to live. Or believing that problems should be faced and not ignored, especially when they are soluble.

Maybe it is the bit of analyltical thinking nobody learns in school.

Here is your government weighing in on what diagnosis and treatment are like.

Somehow, I feel it is a weak argument if I have to show that the government agrees with me (or I with them).  However in this case, it just happens to be right.

So whenever you see a person with tattoos – no matter if professionally done or acquired in prison – be thinking, “Hmm … maybe somebody needs a Hepatitis screen.”