DEAR DR. GOTT: I have a question about my fiance. He is a 48-year-old alcoholic with cirrhosis of the liver. He also has hypertension, probably from his drinking, for which he takes two medications. 

He swears he is going to stop drinking before we get married. 

I have been a nurse for 33 years. Can a person have a lot (enough to soak through his underpants, jeans and bed sheets) of rectal bleeding (fresh, red blood) because of an ulcer or drinking? He refuses to have a colonoscopy or a lower GI series and won't even tell his primary-care physician. 

DEAR READER: Your fiance needs to see a physician immediately if he is experiencing rectal bleeding, especially if it is as severe as you claim. 

Rectal bleeding can have many causes, ranging from benign hemorrhoids and intestinal polyps to ulcerative colitis and malignant colon cancer. Alcohol abuse and cirrhosis can also lead to easy bleeding. Hypertension can weaken blood vessels, and some medications used to treat it carry the side effects of easy bleeding, ulcers and more. 

Your fiance is behaving very irresponsibly in regards to his health. By refusing to seek medical help, he is gambling with his life and, unfortunately, unless he steps up to the plate and makes drastic changes, the outcome will not be favorable. 

Chronic alcohol abuse has already damaged his liver. If further damage is inflicted, he may well need a new liver, but his chances of receiving one are slim to none because he is an active alcoholic. Further liver damage may be taking place as a consequence of his hypertension medication. 

Perhaps now is the time to call, write or make an appointment with his physician to let him know about your concerns and the current situation. While you are probably not privy to what your fiance and his doctor discuss (because of HIPAA), you can at least inform the doctor so he or she can attempt to provide proper testing and treatment.

Before you marry this man, I urge you to sit down and discuss your concerns and fears about his health and addiction. While you may love him, you cannot change him. Unless he is willing to help himself, you will be further committing to a very unhealthy relationship in which one or both of you may end up emotionally and/or physically hurt. 

I recommend you get your facts together, write down a list of your concerns and talk it out. If he is unable or unwilling to get the help he needs, now may be your best chance to walk away. I don't want to sound cruel, but your future husband is displaying behavior that clearly shows he does not care enough about you to take care of himself. He is making you suffer for his problems, which is highly unfair and inconsiderate. 

There are several options for both of you. Alcoholics Anonymous (www.aa.org) is a great resource for treating alcohol addictions. Al-Anon/Alateen (www.al-anon.alateen.org, 1-888-4AL-ANON) is a support group for the friends and families of alcoholics. There are also hospital detox and inpatient and outpatient rehabilitation facilities available throughout the country.

To provide related information, I am sending you copies of my Health Reports "Mental and Substance Abuse," "Hypertension" and "Consumer Tips on Medicine." Other readers who would like copies should send a self-addressed stamped No. 10 envelope and a check or money order for $2 per report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s). 

Dr. Peter Gott is a retired physician and the author of the book "Dr. Gott's No Flour, No Sugar Diet," available at most chain and independent bookstores, and the recently published "Dr. Gott's No Flour, No Sugar Cookbook."

If readers would like to contact Dr. Gott, they may write him through your newspaper or send their mail directly to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, NY 10016. However, if readers want to request a newsletter, they should write to the Ohio address.

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