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The truth about social smoking Treating frozen shoulder Health Notes
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The truth about social smoking On the first occasion, I only just made it back to the youth hostel where we were staying before passing out. I was comatose for 12 hours. On the second occasion, a few days later, I became a gibbering wreck within minutes. My father’s bribe was wasted on me. There was no way I could have become a smoker. When my two boys were growing up, I made them the same offer, upgraded for inflation to £500. Did it have the desired effect? This is hard to say. Both smoke, but they are occasional smokers. They do not smoke every day and when they do, it is one or two in the evening. One of the frustrations I feel about the debate over smoking is the way the world is divided into smokers and non-smokers. Are all smokers the same? Clearly not. Some smoke 60 a day, some 20 a day and some, like my sons, one or two, and not every day. So when we talk about the risks of smoking, what do we mean? They cannot be the same for all smokers. Sir Richard Peto, Britain’s foremost expert on smoking, told me a decade ago that this was not a problem because all smokers eventually end up as 20-a-day smokers. But this is not the case. Occasional or social smokers exist — but they are rare. They are defined in two ways: either as not smoking every day or as smoking an average of less than one cigarette a day. Surveys suggest that between 10 and 18 per cent of smokers smoke five or fewer cigarettes a day. The surveys are now 20 years old but there has been little recent research. Professor Robert West, an expert on smoking at University College London, is updating a study of light smokers he made with his colleague Peter Hajek in 1995. They found occasional smokers were predominantly middle class, better educated and viewed smoking as a social activity. However, they were still addicted. Some 80 per cent of occasional smokers find they cannot stop when they try. But this challenges our understanding of addiction. How can you be “occasionally” addicted? Professor West says: “Nicotine addiction is not just about keeping the level of the drug topped up to avoid withdrawal symptoms. One way addiction works is by forming an association between situations where a person would typically smoke, which then creates the impulse to smoke when they find themselves in that situation again. A lot of daily smokers report very strong situational cravings.” Not all occasional smokers are the same, however. Some used to be 20-a-day smokers who are trying to give up, while others will be 20-a-day smokers in a few months’ time. Relatively few are stable occasional smokers. Switching from daily smoking to occasional smoking is possible — but it’s hard. Most smokers can’t do it for the same reason that most alcoholics can’t return to controlled drinking. It is all or nothing. Yet some can remain occasional smokers — neither increasing their consumption nor reducing it. Figures suggest there are high numbers in North America, though this is unexplained. What protects them from escalation into dependence on nicotine and prevents the development of tolerance and withdrawal discomfort? There may be genetic factors, family influences or what experts call “dimensions of social adjustment that may accompany higher levels of educational attainment”. Or it may be down to simple bribery. Occasional smokers pose another question. What are the health risks? Clearly they must be smaller than those faced by daily smokers — but they are not as low as you might think. Smoking causes a wide range of diseases but the key ones are cancer and heart disease. With cancer, the risks are proportionate to the amount smoked. “The excess risk of cancer for a daily smoker is 15-fold higher than for a non-smoker,” Professor West says. Heart disease is different — the risk is not proportional to the amount smoked. It is much higher, proportionally, for the first one or two cigarettes — hence the risk from passive smoking. There is some fascinating evidence that demonstrates this. Helena, a small city in Montana, banned smoking in public in June 2002, only to have the ban rescinded six months later. During the ban, heart attack admissions to the local hospital fell by a staggering 40 per cent. After the ban was lifted, the heart attack rate increased to its former level. Following publication of this research, the Centers for Disease Control and Prevention in Atlanta warned that even 30 minutes of exposure to other people’s smoke might be enough to trigger a fatal heart attack in people at risk of heart disease. Scientists have been puzzled by this disproportionate risk. A non-smoker who lives with a person who smokes 20 a day has one-third of the risk of their partner, even though they are actually exposed to only 1 per cent of the smoke. Laboratory evidence suggests this is because toxins in tobacco smoke peak at low levels of exposure, increasing the stickiness of the blood (the tendency of the platelets to aggregate) and inflaming the arteries, increasing the risk of thrombosis — a blood clot that can trigger a heart attack. What applies to passive smokers, of course, also applies to occasional smokers. Professor West says the mechanism is similar to that which puts people with heart disease at risk on days of high pollution. “Inhaling particulates has an immediate, same-day effect on people whose vasculature [the state of their arteries] is compromised. Getting an increase in the stickiness of the blood affecting millions of people means that, by the law of averages, some will hit the dust.” Figures published last month show smoking continues to decline among young people. Nevertheless, 27 per cent of school pupils had tried smoking and 5 per cent smoked at least one cigarette a week, girls more than boys. Most of these will become 20-a-day smokers. Pupils who were regular smokers were likely to show signs of dependence on the habit. Around two-thirds reported that they would find it difficult not to smoke for a week, while almost three-quarters said they would find it difficult to give up smoking altogether. Almost two-thirds of regular smokers had tried to give up smoking. The proportion of pupils who thought it was OK for someone of their age to try smoking to see what it is like has steadily decreased from more than half in 1999 to around a third in 2010. Of course, it is not a good idea to smoke. Apart from anything else it makes your legs fall off (I find this morsel of information works especially well with children). More people undergo amputations because the circulation in their limbs has been destroyed by smoking than for any other reason. But if you have to smoke, it is better to smoke occasionally rather than regularly and it is better to smoke a little than a lot. It confers some health advantages, though they are not great. It may be easier too to give up, though not much. And yes, bribery works — but only a bit. —The Independent |
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Treating frozen shoulder The shoulder joint is a ball and socket joint. The frozen shoulder involves an underlying inflammatory process. The joint fluid thickens and the capsule surrounding the shoulder joint contracts. This leaves less space for the upper arm bone (humerus) to move around. In olden days this condition was not so common as people undertook various activities like spinning, drawing water from the well, weaving clothe on handlooms and charkhas and cutting fodder which involved rotational activities. Indulging in certain sports activities like badminton, tennis, cricket also prevents the occurrence of this condition. Patients suffering from diabetes, thyroid problems, etc, are more prone to frozen shoulders. The other predisposing factors include a period of enforced immobility resulting from trauma, overuse injuries or surgery. Symptoms The usual complaints are difficulty in lifting the arm above the head. Pain in the midway between the elbow and the shoulder joint Inability to sleep on the affected side. Reaching behind the back Combing hair Closing the bra hook Treatment Treatment of the frozen shoulder can be frustrating and slow. Most cases will eventually improve, but it is a process that takes months. Anti-inflammatory medication may be prescribed. An injection of steroid with a long-acting anaesthetic may bring the inflammation under control. A doctor has to counter a lot of queries from patients when advised steroid injections. Patients are apprehensive, as they tend to think that these injections are similar to oral corticosteroids. A layman generally relates oral corticosteroids to side-effects. Steroid injections are used in different kinds of sports injuries, orthopaedic problems like arthritis, tendinitis, frozen shoulder, etc. They are primarily used for their anti-inflammatory properties. Manipulation can help in breaking the adhesions, which leads to a decrease in pain and an increased range of motion in the shoulder joint faster than allowing nature to take its course. Stretching and strengthening exercises can reduce pain and inflammation, and can increase the range of motion. Here are some:
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Shoulder shrugging-Rotate the shoulder in the backward direction and then in the forward direction 10 times each side. l Wall walk: Standing in front of a wall, place the hand of the affected shoulder on the wall and slowly crawl upwards. Return to the original position. Repeat 10 times. l External/internal rotation: Bend the elbows at the shoulder level. Rotate the elbow downwards and upwards 10 times. l Shoulder flexion: Clasp your hands together and lift overhead while lying, sitting with elbows straight. l Pulley exercise: With the elbow straight and the thumb facing upward, raise the involved arm out to the front of the body as high as possible. Assist as needed by pulling down with the uninvolved arm. l Pendulum exercises: Support the body by placing the unaffected hand on the table. Hold a dumbbell and rotate clockwise and anti-clockwise 25 times. l Band exercises — External rotation with elbow flexed. l Sitting — Elbows bent and tucked in, go in for a wide clapping movement in a horizontal way with the hand parting. l Standing — Grasp a stick in both hands, lifting and putting back behind the shoulders. l Household activities — Scrubbing, cleaning, etc. Treatment for a frozen shoulder must be started as early as possible. Otherwise it can cause pain and stiffness and may take a longer time to become normal. The writer is a former doctor/ physiotherapist, Indian
cricket team. E-mail: chadha_r2003@yahoo.co.in |
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Health Notes PARIS: Chocolate may be good for the heart but cardiologists are not giving you a license to indulge. New research presented at Europe’s biggest medical meeting Monday suggested chocolate consumption might be associated with a one third reduction in the risk of developing heart disease.
Snuff harms babies more than mother's smoking
NEW YORK: Babies born to snuff-using mothers were more likely to have breathing problems than those whose moms smoked cigarettes while pregnant, in new data from Sweden. Snuff-ground tobacco that is high in nicotine but doesn’t generate the same additional chemicals as cigarette smoke because it’s not burned-is generally assumed be safer than cigarettes, said the authors of the new study.
New breast cancer gene may help predict risk
NEW YORK: Screening for mutations in a gene known as CHEK2 may help determine a woman’s odds of breast cancer if the disease runs in her family, Polish scientists suggested Monday. A woman harbouring a CHEK2 mutation, for instance, would have a 34 percent risk of developing breast cancer if her mother or sister had the disease, they estimate.
Doctors join boxing debate as “vigorous” opponents
NEW YORK: The nation’s largest group of pediatricians on Monday urged its members to “vigorously oppose boxing for any child or adolescent.” In a statement, the American Academy of Pediatrics (AAP) said thousands of boys and girls participate in the sport in North America, despite risks of serious brain and facial injuries. The group’s position mirrors the stance at many other medical organizations and was applauded by some experts.
New iPhone app offers rewards for exercising
TORONTO: Need some motivation to hit the gym? Perhaps some free merchandise will do the trick. At least this is the premise that Nexercise is built upon, a free iPhone app that tracks activities ranging from running and weightlifting to fencing and polo and rewards users with free and discounted merchandise in the hopes that users will adopt long-term exercise habits. —
Reuters
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When I was growing up, my father bribed my brother and sister and me not to smoke. He offered us £100 if we could stay off the ciggies till we were 21. Despite this incentive, I naturally experimented. I have, however, only ever smoked two whole cigarettes in my life, both when I was 16 and on holiday with my mate, Hugh, in France.
Frozen shoulder is a painful condition, which results in a severe loss of motion in the shoulder. It may follow an injury to the shoulder, but may also arise gradually with no warning or injury.