May 31 was World No-Tobacco Day
Anti-smoking drive must focus on the elderly too
Dr S.K. Jindal

Tobacco smoking, like any other abuse, starts as a fashion during the teens, becomes a habit when one is an adult and almost a compulsion among the elderly. It is a harmful habit throughout life. But somehow there is a greater social and personal acceptance of tobacco use in the older than in the younger age. This, unfortunately, is true with reference to most of the life-style habits, partly due to the fact that the habits get firmly established with age and are difficult, or almost impossible to change. It can also be partly attributed to a kind of patronage which the adults claim over the youth while no one is actually responsible for the elderly.

The world over there is an increasing concern on the issue of discrimination against the elderly, especially on health-related matters. The seniors themselves get somehow reconciled to their deteriorating health and tend to ignore health advice. For example, the elderly people are often excluded from clinical trials on drugs as well as the screening programmes for diseases. An important example of relevance to this article is the lack of adequate attention to the elderly in the anti-smoking, deaddiction and tobacco cessation programmes.

Tobacco smoking as the most important cause of preventable death is now well established. It is responsible for innumerable diseases of lungs, heart and brain. It causes chronic bronchitis, emphysema and several cancers such as those of the lung, mouth, larynx, food-pipe, stomach and other organs. Tobacco smoking causes narrowing of arteries and reduces blood supply to the heart, brain, muscles and other vital organs. The impaired blood supply is responsible for serious and fatal problems like heart attacks, strokes, blindness and gangrene of the limbs. Smoking during pregnancy is blamed for the birth of low weight babies, abortions, etc.

What is not commonly appreciated is the knowledge that smoking remains the leading cause of chronic illness and premature death among the elderly. There is ample epidemiological, clinical and statistical evidence to state that continued smoking in old age not only increases morbidity, but also the chances of untimely mortality. What is even more important to know is the fact that stopping smoking at any age is likely to reduce the suffering and improve the quality of life, especially in old age.

It is commonly argued that an old man who has already developed a smoking-related disease need not be troubled with the advice to quit smoking. Most of the diseases result from the cumulative effects of smoking over several years or decades. Why should we deprive an ailing person of the charm and joy of smoking for the remaining years of life?

There is considerable weight in the above mentioned argument. This, however, is not true for all the diseases related to tobacco. This policy is acceptable only in a patient with an advanced cancer which may not be reversible. On the other hand, many other diseases are likely to show considerable improvement after smoking is stopped forever. For example, patients with even an advanced chronic obstructive lung disease (or emphysema), coronary heart disease and gastric ulcers are bound to benefit by quitting smoking at any stage. Even a patient with cancer is likely to suffer from lesser symptoms, even though the survival chance may not increase. Factually, it is a common observation in clinical practice that a few patients would continue smoking after the occurrence of cancer.

Anti-smoking messages are frequently directed at the youth to stop them from smoking. This, no doubt, is the core of an anti-smoking campaign to achieve the maximum results. But there is great need to focus on the elderly as well. This will not only benefit the individuals who have already developed some problem but also help the overall campaign by setting examples. The youth can no more find an excuse in the cases where fathers or grandfathers themselves smoke.

The writer is Professor and Head, Department of Pulmonary Medicine, PGI, Chandigarh.

Beware! Tobacco use can cause oral cancer
Dr Gurvanit Lehl

Tobacco use is a major cause for premature deaths. It also results in many oral disease like oral cancer, which cause considerable suffering to the patient.

The WHO estimated that 4.9 million people died in 2000 as a result of addiction to nicotine, which is the main alkaloid in tobacco. One-third of the world population uses tobacco in some form and half of these people are likely to die early. What is especially worrisome is that developing countries account for 50 per cent of the deaths attributed to tobacco. There is a sharp increase in the number of youngsters developing this habit, especially in low and middle income groups as the tobacco industry targets them in its campaign.

The estimates are that seven out of 10 deaths related to smoking will be from poorer countries by 2025.

The long delay between the onset of tobacco use and its complications in the forms of cancers or other diseases (heart disease, chronic lung disease, etc) leads to a feeling of complacency.

Tobacco is used in various forms — smoking of cigarettes, bidis or cigars/pipes as well as somokeless tobacco which is present in various paans, paan masalas, tobaccolime preparations (khaini) roasted tobacco (mishri) and red tooth powder. In India 72 per cent people smoke bidis, 12 per cent cigarettes and 16 per cent use smokeless form.

Smoking is well known to cause changes in taste and smell. It also causes a severe form of gum disease (acute necrotizing) ulcerative gingivitis) and periodontal disease. Tobacco use is very harmful for patients having dental implants and is a major factor for implant failure.

What you can do

• Don’t smoke. If you smoke, quit smoking.
• Stop the intake of betel quid or paan.
• Don’t use tobacco in betel quid/masalas.
• Encourage colleagues to give up the habit.

The writer is Professor and Head, Department of Dentistry, Government Medical College and Hospital, Sector 32, Chandigarh.

Women quitting smoking faster than men

NEW YORK: Latest statistics compiled by the US’s Centers for Disease Control and Prevention have found that women are quitting smoking in greater numbers as compared to men.

Data collected by the centre has revealed that the percentage of women who smoke has dropped down below 20 per cent.

While in 2003, the number of women who smoked was a mere 19.2 per cent, the numbers of male smokers stood at 24.1 per cent.

Experts however believe that despite the dip in the national average from 22.5 per cent in 2002 to 21.6 per cent in 2003, the rate is not fast enough to reach the magic figure of 12 per cent by 2010.

“It’s wonderful that it’s trending down. But we still need to fight and keep our guard up about very innovative and clever marketing by the tobacco industry,”

The New York Daily News quoted Dr. Avi Barbasch, an oncologist on board the directors of the American Cancer Society as saying. — ANI

Great toe pain – a neglected problem
Dr Ravinder Chadha

FOOT is made up of bones, muscles and ligaments. In order to perform the functions of mobility, flexibility and support, the three work together. The foot has to absorb the load, provide support and assist during the movement of the body.

Most of the problems afflicting the foot are not because of walking but due to ill-fitting shoes. If the shoes are too tight, the foot gets squeezed, thus increasing the pressure on it. Loose shoes make the foot slide and rub against the shoes causing friction.

Bunion is a common deformity also referred to as Hallux Valgus. The great toe tilts towards the other toes and a bony lump/swelling appears on toe inside of the foot.

The incidence is much higher in women than men. The cause could be the common use of high heels with narrow-toed shoes worn by members of the fair sex. Radiographic findings also corroborate the fact that wearing heels of 3” or more causes the greater toe to move towards the other toes of the foot.

This deformity develops slowly and if ignored can lead to the dislocation of the joint causing instability during walking. In advanced cases, the big toe can overlap the second toe. The defect can initially be corrected with the help of exercises. Chronic deformity is difficult to treat and halting progression becomes impossible. In cases of intolerable pain, with decreased ability to perform duties, when shoes are difficult to fit, the only hope is surgery.

Symptoms

1. Redness, swelling or pain in the great toe.

2. Discomfort/ pain on wearing shoes. The foot becomes so broad that it is difficult to get wide enough shoes.

3. Callus formation over the great toe, which may lead to ulceration.

4. Certain cases may present with a cyst or bursa containing fluid.

Treatment

The following conservative treatments can limit the formation of bunion and relieve pain.

• Apply a pad around the bunion to avoid the formation of callus and corn.
• Avoid high heel shoes. Wear shoes with wide and deep toe box with low heel to reduce weight on the forefoot.
• In case the bunion becomes painful and swollen, elevate the foot and apply ice.
• In some cases steroid or local anaesthesia is given to reduce inflammation.
• Night splint/taping helps in reducing pain.
• Mobilisation is useful in early stages.

For good health of one’s feet and prevention from agonising pain, do not ignore great toe pain. Also avoid wearing high-heel and narrow-toed shoes in order to avoid deformity. Be more comfortable than fashionable.