Can employment drug screening detect alcohol use?
DEAR DR. ROACH: I will be starting a new job that requires regular, but random, drug testing. I have never used drugs, so that is not a problem. But I am wondering how long alcohol can be detected in the urine. -- M.M.
ANSWER: Alcohol can be found in the urine in small amounts as long as it is present in the blood and for a short time afterward. This kind of drug testing may be appropriate to evaluate whether a person is consuming alcohol on the job.
However, some labs look for metabolic end products of alcohol metabolism, like ethyl glucuronide. These can be found in the urine for three days after a bout of heavy drinking. This kind of testing is done in a situation when people should not have ANY alcohol, such as for those in alcohol treatment programs, as a part of a court case or in transplant evaluation. These tests are not appropriate for most job testing.
No test is perfect. A memorable case report a few years ago identified a person with diabetes who had a positive alcohol test despite being abstinent. He had yeast in his urine, which was producing the alcohol. The ethyl glucuronide test was negative, since the alcohol was not being metabolized.
DEAR DR. ROACH: Many seniors have difficulty with balance. Do these issues usually have more to do with physical strength or areas in the brain that deal with balance? -- E.M.
ANSWER: Balance problems may result from relative loss of physical strength, sensation, vision and the organ of balance in the inner ear. Often, it is a combination of many of these, and treatment is often aimed at multiple areas. This includes strength and balance training, and tending to vision issues and any other medical conditions that might be affecting the nervous system.
While physical and occupational therapists may be helpful to people with severe issues, just doing simple balance exercises can help. Tai chi is a discipline that has been shown to improve strength and balance as well as to reduce falls. My colleagues at the Mayo Clinic put together a slideshow of some simple balance exercises here: tinyurl.com/Mayo-balance.
DEAR DR. ROACH: I am 73 years old, female and in very good health. I weigh 113 pounds, and I am 5 feet, 4 inches tall. I take no medicines. I recently had bloodwork done for cholesterol levels. My overall cholesterol is 230, HDL 80, LDL 135, triglycerides 48. I exercise regularly and am still working.
My doctor is concerned that my cholesterol is too high. She mentioned putting me on cholesterol-lowering medicine, which I am opposed to. I would like your opinion on whether my cholesterol levels concerning. My blood pressure is normal and I have never smoked. -- N.T.
ANSWER: I don't think of statin drugs as cholesterol-lowering (although they are). Rather, they are medicines to reduce risk of heart attack and stroke. Making some assumptions about your blood pressure, an online calculator (tools.acc.org/ASCVD-Risk-Estimator-Plus) estimates your risk of a cardiac event in the next 10 years at 11.6%. Taking a medication would be expected to reduce your risk to about 9.6%. Put another way, 50 people like you would need to be treated for 10 years to prevent a heart attack, stroke or death from heart disease.
The experts recommend that you take medication to reduce your risk, but the decision is yours. The fact that you exercise regularly is a good sign. Many people can improve their diet a bit. Doing so has benefits that prevent heart disease as well.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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