Dear Doctor: I heard about a guy who tested as drunk but hadn’t had any alcohol. Is that really even possible, or is it some kind of urban legend?

Dear Reader: It certainly sounds like the product of an overactive imagination, but the scenario you’re referring to did happen. According to news reports, a young Chinese man who had moved to Australia to attend college suddenly started getting drunk. The catch was that he swore he hadn’t imbibed any alcohol. Upon returning home to China, the breathalyzer tests he took during subsequent episodes showed a blood alcohol level up to 10 times the legal limit.

In 2014, he became gravely ill and was admitted to the hospital, 10 years after the onset of the mysterious episodes. He was diagnosed with fatty liver disease, in which a buildup of fat in the liver causes inflammation that leads to organ damage. The condition is common in people with chronic alcohol abuse, which outstrips the liver’s ability to manage and clear the resulting toxins from the body.

The Chinese man was eventually diagnosed with auto-brewery syndrome, a rare condition in which the carbohydrates that a person eats or drinks are fermented in the gut and turn into ethanol, also known as grain alcohol. As it turns out, the young man wasn’t drinking alcohol, but he was drinking a lot of fruit juice and eating carbohydrate-rich foods, thus giving the rogue microbrewery in his gut plenty of raw material to work with.

While this case is interesting on its own, it also holds promise for people with nonalcoholic fatty liver disease, or NAFLD. As the name suggests, this is a type of fatty liver disease that occurs in the absence of heavy alcohol use. In NAFLD, inflammation and cell damage can be severe enough to result in fibrosis and scarring, and can even lead to cirrhosis or liver cancer. The cause of NAFLD isn’t known. But recent studies have found that the guts of people with NAFLD were far more likely to contain certain alcohol-producing bacteria than the guts of healthy individuals. This not only opens new avenues of research, but also offers hope for an eventual cure.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My boyfriend let a friend of his pierce his earlobe and cartilage, and both places got infected. He says things will get better on their own, but I’m worried. What should he be doing?

Dear Reader: When you pierce your ear, whether it’s the soft and fleshy tissues of the lobe, or the thick and dense cartilage that makes up the outer ear, you’re creating an open wound. On top of that, you’re introducing a foreign object into the wound to keep it open until it heals from the inside. Earlobe piercings take from six weeks to two months to heal completely. Cartilage piercings take even longer.

Infection can occur when the site of the piercing isn’t cleaned thoroughly with an antiseptic beforehand. That means bacteria on the surface of the skin can be pushed into the wound, where they can multiply and fester. A needle that hasn’t been completely sterilized can also introduce bacteria into the subsequent wound. Touching an unhealed piercing with dirty hands can introduce bacteria, and failing to keep it clean and dry can lead to infection. So can wearing an earring that’s too tight, which puts stress and pressure on the wound and keeps it from healing properly.

The symptoms of an infected piercing can include warmth, tenderness, swelling, itching, burning and redness at the wound site, and a yellowish discharge that looks like pus. In more serious infections, the swelling can move beyond the immediate area of the piercing and begin to involve the rest of the ear. Because cartilage doesn’t have a lot of blood vessels, infections in that area are harder to treat than those in the earlobe.

Unfortunately, your boyfriend is wrong about infections resolving on their own. If the infection hasn’t progressed very far and is just some minor redness or swelling, he can care for it at home. Start by cleaning both sides of the piercing several times a day using a sterile saline solution. You can make one at home by mixing salt with distilled water. Don’t remove the earring. The wound has to stay open as it heals, otherwise bacteria may become trapped inside the piercing as the hole closes. Hands must be washed thoroughly every time before touching the site or the earring. Other than when rinsing the site, be sure to keep it dry. It’s important to continue this regimen of wound care until the piercing has healed completely.

If things don’t visibly improve in a few days, your boyfriend must seek treatment. If the infection grows or spreads, if there is fever along with the infection, if an abscess develops or if the earring becomes immobile or embedded in the skin, he needs to see a doctor.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: My husband has fallen into a strange sleep pattern. Some nights he’s awake until 3 a.m., tosses and turns all night, then wakes up tired. I’ve read that strange sleep cycles may be linked to Alzheimer’s disease, which his mother had. I’m worried, but what can I do?

Dear Reader: First, a bit of reassurance. More than half of older adults report having problems with sleep, including difficulty falling asleep, too much time spent in light sleep, waking up too often during the night and having trouble staying asleep. These can be the result of illness, anxiety, depression, life changes, a side effect of certain medications, too much electronic screen time or poor sleep habits.

It’s true that disrupted sleep is common among people who have been diagnosed with Alzheimer’s disease. They sleep less during the night, and the quality of that sleep is often poor. As a result, they spend their days feeling drowsy and will often take naps or sleep for hours at a time. Recent research suggests that the onset of fitful or fragmented sleep can also be an early indicator of Alzheimer’s disease, one that precedes the more well-known symptoms of memory problems and cognitive changes.

A study published last year in the journal JAMA Neurology found that people with no obvious cognitive issues, but whose sleep cycles had become altered, were more likely to have clumps of certain types of proteins in their brains. Known as amyloid plaques, these clumps collect between neurons and disrupt the cellular function in the brain.

Another study, published earlier this year in the journal Science Translational Medicine, also assessed sleep patterns in people with no memory or behavioral problems. The researchers found that a drop in the quantity of slow-wave sleep that someone got each night -- that’s the deep sleep that leaves you feeling rested and refreshed -- was associated with a buildup of a brain protein known as tau. Elevated levels of tau brain proteins, which form tangles in the brain and lead to atrophy, are commonly seen in people with Alzheimer’s disease.

Since your husband’s family has a history of Alzheimer’s disease, we suggest that you consider broaching the subject with your family doctor. There is no single test for Alzheimer’s disease at this time, but your doctor has access to a variety of diagnostic tools that can be helpful. This includes taking a detailed medical history, and using specially crafted verbal tests designed to assess cognitive function. If it appears to be necessary, your doctor may suggest a neurological exam that includes brain imaging. Taken together, these will establish a baseline for future comparison.

Cognitive issues aside, getting an adequate amount of high-quality sleep each night is important to many areas of health and well-being. We encourage your husband to discuss his changing sleep patterns with his doctor. It’s possible that they can uncover and address an underlying cause of the change.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)