Deadly mar­i­juana and tobacco mix spurns de­bate

The Star (St. Lucia) - - LOCAL - By STAR Re­porter

Ear­lier this week doc­tors at the Vic­to­ria Hos­pi­tal (VH) called on the pub­lic via a press state­ment to de­sist from a dan­ger­ous prac­tice which is lit­er­ally killing peo­ple but not be­fore making them “Res­pi­ra­tory Crip­ples.” Ac­cord­ing to the Med­i­cal Di­rec­tor at Vic­to­ria Hos­pi­tal, Dr. Lisa Charles, over the past ten years she has seen an epi­demic emerg­ing with an in­creased num­ber of young pa­tients suf­fer­ing with Chronic Ob­struc­tive Pul­monary Dis­ease or COPD.

“Pa­tients who smoke mar­i­juana mixed with tobacco are de­vel­op­ing COPD at an ex­tremely young age. We are talk­ing about young men and women in their thir­ties with end-stage lung dis­ease. And by end-stage lung dis­ease I mean they are no longer able to carry out any nor­mal ac­tiv­ity such as cook­ing, walk­ing from the bed to the bath­room be­cause of se­vere short­ness or breath,” Dr. Charles stated.

COPD is an ex­tremely de­bil­i­tat­ing, pro­gres­sive dis­ease, which di­rectly af­fects the lungs, and the ef­fects of COPD can­not be re­versed. Pa­tients with the dis­ease are lit­er­ally con­fined to bed with oxy­gen tubes up their nos­trils 24 hours a day, 7 days a week. “Be­cause any de­gree of ex­er­tion, any de­gree of ac­tiv­ity causes short­ness of breath to the point where you have to stop, you have to sit. You can­not do any of those nor­mal func­tions that you can do for your­self; you can no longer do them,” Dr. Charles added.

The Pan Amer­i­can Health Or­ga­ni­za­tion in­di­cates that Chronic Ob­struc­tive Pul­monary Dis­ease (COPD) is a lead­ing cause of mor­bid­ity and mor­tal­ity in the Amer­i­cas, rep­re­sent­ing an im­por­tant pub­lic health chal­lenge that is both pre­ventable and treat­able. COPD caused over 235,000 deaths in 2010, rank­ing as the sixth lead­ing cause of death in the Amer­i­cas. About 23% of th­ese deaths occurred pre­ma­turely, in peo­ple aged 30-69 years. The World Health Or­gan­i­sa­tion has des­ig­nated Novem­ber 16th as World Chronic Ob­struc­tive Pul­monary Dis­ease Day.

The Med­i­cal Di­rec­tor in­di­cated that avail­able bed space at VH is se­verely com­pro­mised as a re­sult of this in­creas­ing epi­demic of COPD in pa­tients. “So up­wards of 12 pa­tients per day re­quire some de­gree of treat­ment for their breath­ing dif­fi­culty. In terms of pa­tients who are end-stage, which is my pri­mary con­cern, we prob­a­bly have what we call a re­volv­ing door pa­tient pop­u­la­tion of close to 15 – 20. Th­ese are pa­tients who lit­er­ally come to A&E ei­ther daily or weekly be­cause their dis­ease is so far pro­gressed that they need that level and that fre­quency of at­ten­tion in the emer­gency depart­ment and on the wards. We do also have pa­tients who have lived at VH for the last sev­eral months be­cause they can’t take care of them­selves at home and they have no op­tion but to stay with us be­cause they need con­tin­u­ous oxy­gen and full care.”

Sher­man Es­nard was one of the pa­tients whose case was high­lighted via the me­dia this week to drive home the point. Es­nard was shown in a wheel­chair in the A&E depart­ment where he had been for five days, com­pletely de­pen­dent on an oxy­gen tank.

Now con­fined, Es­nard, who earned a liv­ing as a car­pen­ter, was also an avid foot­ball player – things for him which are now no more.

The young COPD pa­tient ad­mit­ted that breath­ing was very dif­fi­cult with­out a con­stant sup­ply of oxy­gen. He spends most of his time be­tween his home and the Vic­to­ria Hos­pi­tal and can’t last a minute be­ing dis­con­nected from an oxy­gen tank.

When asked what he thinks con­trib­uted to his COPD Es­nard lamented, “I know smok­ing has to do with it, smok­ing has a big part to do with it . . . I see peo­ple smoke more than me but they don’t have that prob­lem. Maybe our bod­ies are just dif­fer­ent but smok­ing has a part to play.

“Fi­nan­cially I don’t think any­body wants to be like me at this point. Fi­nan­cially I’m rip­ping a hole in my peo­ple’s pocket right now. I can­not af­ford to buy an oxy­gen tank. The tank you see be­hind me I can­not af­ford that, it’s too ex­pen­sive. . . I can go through three of th­ese tanks, and $200 for one so do the maths. Three of that for a week, for a month, for a year,” Es­nard added.

Dr. Charles re­vealed that the cost of treat­ing COPD is tremen­dous with most of this cost be­ing ab­sorbed by the Vic­to­ria Hos­pi­tal, the gov­ern­ment and the tax­pay­ers. “If you just look at oxy­gen alone, with­out look­ing at the nurs­ing cost, the cost of physi­cians, the cost of other med­i­ca­tions, the cost of neb­u­liza­tion, the cost of treat­ing heart fail­ure and the cost of in­pa­tient hos­pi­tal stays, I wouldn’t even know where to start to mea­sure but it’s very sig­nif­i­cant.”

Es­nard made a strong ap­peal to young per­sons to stop smok­ing and kick the habit: “Well, I know the feel­ing of smok­ing, you feel­ing nice for a while. But it’s only for a while. If you reach that stage where you have COPD, it’s all over. If you’re not strong mentally I think you will be gone even faster too.

“So imag­ine you can­not do any­thing for your­self as a strong young feller just down in a flash. Smok­ing is not worth that. If you’re smok­ing to­day just take a look at me and just try to drop it, ev­ery­thing, just try and drop it. It’s not worth los­ing your life, your fam­ily or any­thing so. Just put down the cig­a­rette and make a change.”

Es­nard said that what he misses the most is not be­ing able to take care of his daugh­ter the way he wanted to as a fa­ther.

The Vic­to­ria Hos­pi­tal is op­ti­mistic that through pub­lic ed­u­ca­tion and sen­si­ti­za­tion the COPD epi­demic will be stemmed, more lives will be saved and less pres­sure brought to bear on the health institution.

Since the VH rev­e­la­tion Dr. Mar­cus Day, the Di­rec­tor of the Saint Lucia-based Caribbean Drug and Al­co­hol Re­search In­sti­tute (CDARI) has chal­lenged some of the as­ser­tions made by Charles stat­ing that the med­i­cal pro­fes­sional was “a lit­tle off” in her con­clu­sions.

“I think the first thing that we have to re­mem­ber is that when­ever you have such in­for­ma­tion from a Clin­i­cian what is seen is prob­a­bly the worst case sce­nario at the hos­pi­tal,” Day as­serted. The CDARI Di­rec­tor ex­plained that in­di­vid­u­als have pre­dis­po­si­tions to lung is­sues, with the re­sult that some peo­ple have more prob­lems than oth­ers.

“So that is an is­sue that I think Dr. Charles did not really take into con­sid­er­a­tion,” Day told the Times.

He said he knew that the Food and Drug Ad­min­is­tra­tion in the United States has ac­tu­ally ap­proved THC as a drug to ad­dress is­sues re­lat­ing to COPD. Day has been an open ad­vo­cate for the le­gal­iza­tion of mar­i­juana and last year told the lo­cal press that the present ad­min­is­tra­tion needs to con­sider le­gal­is­ing the use of mar­i­juana. Dr. Day be­lieves that peo­ple, par­tic­u­larly young men, should not be pun­ished for smok­ing small quan­ti­ties of mar­i­juana. He also called for an up­date from the re­cently es­tab­lished Caricom Com­mis­sion to in­ves­ti­gate the pros and cons of the de­crim­i­nal­i­sa­tion of the drug in the re­gion.

In re­sponse to some of the feed­back her com­ments have gar­nered Dr. Lisa Charles main­tains that the is­sue is a cause for great con­cern and shouldn’t be over­looked.

COPD pa­tient Sher­man Es­nard.

Dr. Mar­cus Day of the Caribbean Drug

and Al­co­hol Re­search In­sti­tute.

Dr. Lisa Charles: Her rev­e­la­tions have

stirred in­ter­est and com­ment.

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