Med­i­cal Bytes with Dr. K

mailife - - Contents - with Dr. K

Sera walked down the street with a cig­a­rette in one hand, wisps of smoke float­ing from her mouth, and car­ry­ing a very ex­pec­tant ab­domen. Her doc­tor had ad­vised and en­cour­aged her to quit smok­ing. But she just couldn’t give up the smokes. De­spite be­ing 32 weeks preg­nant, she con­tin­ued to smoke up to 20 cig­a­rettes a day. Then one morn­ing Sera woke up at 5am with ab­dom­i­nal cramps and vagi­nal bleed­ing. She was rushed to the hos­pi­tal. On ar­rival there was no fe­tal heart sound and un­for­tu­nately, a still­birth. Tears rolled down her cheeks. This was her sec­ond still­born child. Mean­while, 45-year-old Ramu started smok­ing when he was only 12 years old. Now he smokes up to 30 cig­a­rettes a day. He’s had nu­mer­ous at­tempts at quit­ting – all un­suc­cess­ful. For the past three months he’s been cough­ing pro­fusely, feel­ing tired, and los­ing weight. Fi­nally he paid a visit to his Gen­eral Prac­ti­tioner who or­gan­ised a chest x-ray. Un­for­tu­nately Ramu was di­ag­nosed with ad­vanced lung can­cer and sur­vived for only two months af­ter the di­ag­no­sis. On the other side of town, 70-year-old Jim was di­ag­nosed with chronic lung dis­ease 10 years ago. He had to cough every morn­ing with co­pi­ous white phlegm and con­stant wheez­ing. His doc­tor had pre­scribed reg­u­lar in­halers to im­prove his con­di­tion. De­spite this, he con­tin­ued to smoke up to 40 cig­a­rettes a day. Jim’s spe­cial­ist had ad­vised him that his oxy­gen lev­els were low and that he needed home oxy­gen to im­prove his sit­u­a­tion. But be­cause Jim was a smoker, he could not be pre­scribed oxy­gen as he could set fire to him­self while smok­ing. So Jim ended up house bound as he could barely walk with­out feel­ing short of breath. All three of th­ese peo­ple have one thing in com­mon - the ad­dic­tion to a thin cylin­der of finely cut to­bacco rolled in pa­per - the dreaded cig­a­rette! There are more than 7,000 chem­i­cals in cig­a­rette smoke and more than 70 of th­ese are linked to can­cer (US Food and Drug ad­min­is­tra­tion). Th­ese chem­i­cals in­clude nico­tine, tar, car­bon monox­ide, am­mo­nia, formalde­hyde, hy­dro­gen cyanide and ar­senic to name a few – some of the same in­gre­di­ents used to make rat poi­son, lighter fuel, bat­ter­ies, and rocket fuel. The cig­a­rette’s ad­dic­tive na­ture comes from nico­tine’s stim­u­lant ef­fect. With every puff it causes a per­son to crave for more and more. Glob­ally about 15 bil­lion cig­a­rettes are sold daily or about 10 million every minute. There are 1.1 bil­lion to­bacco users in the world – equiv­a­lent to the en­tire pop­u­la­tion of In­dia and more. This num­ber is ex­pected to in­crease to 1.6 bil­lion over the next 2 decades. What’s alarm­ing is 80% of the 1 bil­lion smok­ers live in low-and mid­dle-in­come coun­tries. This in­cludes Fiji. Ac­cord­ing to the lat­est STEP­wise ap­proach to chronic dis­ease risk fac­tor sur­veil­lance (2011), 16.6% of Fi­jians smoke every day, and the av­er­age age for tak­ing up smok­ing has gone down from 22.2 to 20.7 years. In 2016 the World Health Or­ga­ni­za­tion (WHO) re­ported the preva­lence of smok­ing in per­sons 15 years and older. Fiji ranked num­ber 38 with 25.7% preva­lence. Iran ranked 84 with 11.1% preva­lence, which was the low­est. The preva­lence in New Zealand was 16.3% and in Aus­tralia was 14.9%. We can see that Fiji has a fairly high preva­lence of smok­ing amongst peo­ple over the age of 15. It is four times more com­mon in males at 23.6% of the to­tal smoker pop­u­la­tion in Fiji, com­pared to women at 5.1%. May 31st marks World No To­bacco Day. This year the theme is “To­bacco - a threat to de­vel­op­ment.” About six million peo­ple die from to­bacco use every year. This is ex­pected to grow to more than eight million a year by 2030 with­out in­ten­si­fied ac­tion. To­bacco use is a threat to any per­son re­gard­less of age, gen­der, race and cul­tural or ed­u­ca­tional back­ground. It brings suf­fer­ing, dis­ease and death. It drains fam­i­lies and na­tional economies. To­bacco use de­creases pro­duc­tiv­ity and in­creases health-care re­lated costs. To­bacco use wors­ens health in­equal­i­ties and ex­ac­er­bates poverty as poor peo­ple pri­or­i­tize cig­a­rettes and spend less on ba­sic ne­ces­si­ties -- food, health­care and ed­u­ca­tion for their chil­dren. Other than the ef­fects on hu­man be­ings, to­bacco use also af­fects the en­vi­ron­ment. Grow­ing to­bacco re­quires a large amount of pes­ti­cides and fer­til­iz­ers. Th­ese can be toxic and pol­lute wa­ter sup­plies. To­bacco grow­ing uses about 4.3 million hectares of land re­sult­ing in global de­for­esta­tion be­tween 2%-4% (WHO). With all the in­for­ma­tion that is avail­able about the harm­ful ef­fects of to­bacco, why are we still con­tin­u­ing with this prac­tice? What can we do to elim­i­nate to­bacco from so­ci­ety and the world? If you are a smoker and have de­cided you want to quit, mak­ing a pact with your­self is not enough – oth­er­wise you’d likely have quit al­ready. It is, how­ever, an es­sen­tial first step. Then there are a few meth­ods that you can try, if you want the best chance of suc­cess. Most peo­ple suc­cess­fully quit smok­ing when they use some sort of nico­tine ther­apy. This could in­volve ap­ply­ing a nico­tine patch, nico­tine lozenges or gums. For most peo­ple who smoke, there are cer­tain trig­gers that cause them to crave cig­a­rettes. This in­cludes smok­ing when stressed, at lunch breaks or when out with friends. Trig­ger avoid­ance is im­por­tant so that you ac­tively avoid the sit­u­a­tions that make you feel like you need a cig­a­rette. For ex­am­ple if you nor­mally smoke at lunch time, then do some­thing else to keep your­self dis­tracted and en­gaged. Go­ing cold tur­key is a very suc­cess­ful method. This is when you de­cide that you will never take an­other cig­a­rette again. Of course this re­quires a lot of plan­ning, sup­port from peo­ple around you and in­tense willpower. The other op­tion would be

to slowly cut down on cig­a­rette use un­til you no longer need an­other cig­a­rette. Quit­ting is some­thing per­sonal and each in­di­vid­ual has to find the method that works for him or her. On the global scene the WHO frame­work Con­ven­tion on To­bacco Con­trol (WHO FCTC) guides the global fight against the to­bacco epi­demic. It is an in­ter­na­tional treaty with 180 par­ties (179 coun­tries and the EU) and Fiji is a mem­ber. To­day at least half the world’s coun­tries, rep­re­sent­ing nearly 40% of the world’s pop­u­la­tion, have im­ple­mented at least one of WHO FCTC’s most cost-ef­fec­tive mea­sures to the high­est lev­els. Fiji has adopted some of th­ese mea­sures. In 2010, the govern­ment of Fiji To­bacco Con­trol De­cree came into ef­fect. This de­cree in­cludes pro­hibit­ing ad­ver­tis­ing and pro­mo­tion of to­bacco prod­ucts. It also looks at la­bel­ing of to­bacco prod­uct con­tain­ers so that there are oblig­a­tory health warn­ings and tar and nico­tine con­tent la­bel­ing. There are also re­stric­tions on sale and smok­ing of to­bacco prod­ucts and pro­hi­bi­tion on sup­ply­ing to­bacco to per­sons under 18 years old. Smok­ing is also pro­hib­ited in cer­tain pub­lic ar­eas and build­ings. There is a spot fine of $200 for smok­ing in pub­lic places that needs to be strongly en­forced, as there are many peo­ple who con­tinue to smoke in pub­lic places with­out con­se­quences. At the moment, 44% of the cost of cig­a­rettes is tax. Increasing this tax may fur­ther dis­cour­age cig­a­rette sales. Nico­tine re­place­ment ther­apy is quite ex­pen­sive in Fiji and if the cost of this were sub­sided by the govern­ment, it would en­cour­age more peo­ple to try this method to quit smok­ing. A quit-line would also help sup­port those who are at­tempt­ing to quit. This is es­sen­tially a free tele­phone ser­vice that sup­ports peo­ple through the ef­fort to stop smok­ing. Ban­ning all forms of di­rect and in­di­rect ad­ver­tis­ing can also cre­ate a more pos­i­tive at­ti­tude to avoid­ing to­bacco. So on 31 May, let’s vow to make every day a “no to­bacco day”. Wise words from Ian Fleming: “Smok­ing I find the most ridicu­lous of all the va­ri­eties of hu­man be­hav­ior and prac­ti­cally the only one that is en­tirely against na­ture. Can you imag­ine a cow or any other an­i­mal tak­ing a mouth­ful of smol­der­ing straw then breath­ing in the smoke and blow­ing it out through its nos­trils?” Till we meet next month, live, love, laugh and have a smoke­free time!

“If you are a smoker and have de­cided you want to quit, mak­ing a pact with your­self is not enough – oth­er­wise you’d likely have quit al­ready.”

DR. KRUPALI RATHOD TAPPOO is an Aus­tralian qual­i­fied Gen­eral Prac­ti­tioner, a Fel­low of the Royal Aus­tralian Col­lege of Gen­eral Prac­ti­tion­ers and the Med­i­cal Co­or­di­na­tor for Fiji-based NGO Sai Prema Foun­da­tion. Dr. Krupali is based at Mitchells Clinic in Tap­pooc­ity Suva and has a spe­cial in­ter­est in women and chil­dren’s health.

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