Medical Mystery: Alcoholism didn’t cause man’s diabetes and cirrhosis

When the medical resident repeated what other doctors had insisted was the cause of her twin brother’s sudden, serious illness, Janet Janas lost it.

“I think you need to rethink your judgment because that has not been established,” the normally unflappable pediatric nurse practitioner recalls saying. The resident, she said, rolled his eyes, telegraphing his frustration with a relative intent on denying the obvious.

Loading...

Comments

• Weigh In
• Corrections?

Personal Post

More on this Story

• Alcoholism didn’t cause man’s diabetes and cirrhosis
• Read more Medical Mysteries

Doctors had told Janas and her family, who had gathered in the intensive care unit of a Portland, Ore., hospital in January 2008, that her brother Jeff Williams, delirious and combative, was in the throes of advanced alcoholism. Doctors told the family he had 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.

When Williams’s family protested that they considered the 46-year-old electronics engineer, who had been in good health, to be strictly a social drinker, the staff disagreed. “They can hide it really well,” Janas said one nurse told her.

Williams said he confronted similar disbelief during and after his two-week hospitalization. “I said, ‘I drink about one beer a day, not enough to cause cirrhosis, so this just ain’t the cause,’ ” he recalled telling doctors repeatedly. “They just kind of blew me off and said, ‘Well, it is what it is.’ ”

Ultimately it was Williams’s ferocious determination to figure out what was wrong that led to a diagnosis that affected his entire family, especially his twin sister.

Worsening eyesight

In November 2007, Williams spent a week visiting Janas at her Northern Virginia home. She said her normally intense brother seemed “mellower” than usual, even napping every afternoon, which she attributed to his relaxing on vacation.

Back in Portland a few weeks later, he suddenly developed blurry vision. Janas told him to call his doctor; his HMO referred him to an optometrist, who gave him his first pair of glasses.

Within days his vision had gotten worse. Janas urged her brother to call his doctor; instead, he was sent back to the same optometrist. He asked why his vision had deteriorated so quickly. “That can happen,” she replied, before giving him a stronger prescription, denying his request for a referral to an ophthalmologist.

A few weeks later, Williams thought he had contracted a bad case of flu; he was exhausted and achy. On Dec. 28, he had trouble getting out of bed and, severely dehydrated, “drank gallons of Ga­tor­ade,” and went to see a doctor at his HMO’s urgent care center. His blood sugar was alarmingly high at 371 milligrams per deciliter — nearly double the threshold that triggers a diabetes diagnosis. The doctor sent him home with diabetes medication.

Williams said he doesn’t remember coming home but managed to call his 20-year-old daughter, who lives nearby. “I said, ‘I’m in bad shape, and if I don’t get better, take me to the hospital,’ ” he told her. The next day, she discovered him disoriented and barely conscious, and rushed him to the hospital. His blood sugar was above 500, his abdomen was swollen with fluid, his spleen was enlarged and he was vomiting material that looked like coffee grounds, signaling internal bleeding.