Raising the voice against tobacco use.

TOBACCO : THE INSIDIOUS GLOBAL KILLER ADDING TO THE SUFFERINGS OF MANY. --- by Dr. Bibhash Chakravorty. RAISING THE VOICE AGAINST THE NASTY HABIT OF TOBACCO USE IN ANY FORM ESPECIALLY SMOKING : ----- From the mouth of a past addict, victim and as well as a successful quitter too ! ------ Though habits die hard, the power of the human spirit is even harder ! ( The pictures enclosed with this post is a health education leaflet narrating about the dangerous side effects of tobacco use especially smoking and the beneficial effects of quitting.) I am ashamed that I was smoking cigarettes for a very long time indeed until almost 2 years that I can tell you with pride that I have successfully quitted smoking, not having indulged even in a single drag ! Well I started smoking from 2nd or 3rd year in College along with some of my friends. Since then it had been more than 30 years that I continued smoking, a prolonged period of this time being a heavy, chain smoker ! I had meanwhile successfully quitted for 2 and half years from sometime in 2006 to 2008. The fact that I again started smoking after successfully quitting for this stretch of time was not due to failure to control the craving for nicotine but due to some foolish circumstances. My wife was involved in a car accident and I had been called at the local police station where she was already present. The police officer who was looking after the matter asked me to buy him a pack of Classic cigarettes apart from other expensive negotiations which you can jolly well understand, for letting my wife go home that night before appearing in court the next day. I had in anger (অভিমান ), restarted smoking from that very evening, very foolishly ! Tobacco use in any form especially smoking is a nasty habit not only because it damages your health but passive smoking endangers the health of others and giving up smoking is one of the most difficult job not only because of the physical and psychological dependence to nicotine but also owing to the relative social acceptance of this dangerous addiction over others like Cannabis ! A person smoking cigarette will not be frowned upon so much as a person smoking Cannabis in front of you. But if you ask me as a doctor to choose between the two I will definitely choose Cannabis though I do not condone any form of addiction. But Cannabis has medicinal values and has wide application in medicine such as, it is prescribed in cancer pain and depression, to calm the mood in mentally challenged young patients suffering from autism or other violent mood disorders in patients etc. Cannabinol oil is sprinkled over the food of young mentally challenged , somewhat excitable patients to make them calm as well as to avoid the knockout feeling of Cannabis smoking, the oil being slowly absorbed from the intestine ! Well, in the not so early past the Bengali aristocrats did indulge in opium (আফিম ) use, didn't they ? Passive smoking is said to harm more than the active part. The wandering sadhus and yogis of India have used Cannabis from times immemorial not only because it is considered Lord SHIVA'S prasad (প্রসাদ ) but also because it elevated their mood against the cold and hardship ! Some states of USA have already legalised Cannabis smoking, one brand I know manufactured by the makers of Marlboro cigarettes, called Marlboro Green ! But sorry to say, I didn't have the opportunity to taste it ! Cigarette smoke is supposed to contain more than 4000 different harmful chemicals of which nicotine is the substance causing addiction by producing a sense of well being and satisfaction by secreting the neurotransmitter dopamine from the brain. There are many harmful substances like the tobacco tar which causes lung cancer and chronic bronchitis, emphysema, COPD which may cause severe shortness of breath and serious lung diseases. Due to the harmful effects on the respiratory cilia, smokers are prone to repeated respiratory infections. Smokers are also prone to heart diseases and retinal eye problems. Carbon monoxide is another dangerous product in cigarette smoke. There are even radioactive substances present in cigarette smoke. The temperature at the tip of a lighted cigarette is about 600 degree Celsius and during a drag it becomes more than 1000 degree Celsius. Many inert chemicals become active at that temperature. Smoking also causes cancer of our voice box, vocal cord, even gastric and pancreatic cancers. The good ( ???) side effects of cigarette smoking that is there for the false sense of security and consolation of the callous smoker weak enough not to try kicking the habit are, 1. Parkinson's disease is rare due to dopamine release 2. Pr- eclamptic toxemia is rare in pregnancy. Nowadays the number of women smokers are increasing. Tobacco use in the form of guthka, khaini, pan masala jarda chewing are the major causes of intraoral cancers rampant in India adding so much to the morbidity and mortality. There is a joke, giving up smoking is very easy, I have done it many times ! But believe me, it is one of the most difficult job that you may come across in your life. Many smokers need counseling, different types of medicines, nicotine patches, nicotine chewing gums before they even contemplate on quitting. Sometimes they succeed only to relapse. The relapses are often due to the severe craving for nicotine which can also lead to the dangerous nicotine withdrawal syndrome where the patient becomes psychotic and violent if nicotine intake is denied ! More common but lesser problems during abstinence of smoking or nicotine intake are mood changes, irritability, anger without reason, depression, changes in appetite, etc. The key to success is holding on to your strong ground of mental resolve of not to smoke whatever the excuse. I had taken the help of nicotine chewing gums for a long time before I quitted smoking. But before I quitted I had found myself smoking as well as chewing gums until I made up a strong mental resolution of not to smoke. Now I find the smell of tobacco smoke not only a nuisance but also unhealthy to cause me breathe with difficulty and effort ! I also had to quit chewing the gums because contrary to a smoker's belief, they too can cause side effects of acidity, GERD and rarely features of nicotine poisoning, if taken in large quantities. Infact you are advised to quit chewing the nicotine gums within 12 weeks of starting it properly as advised in it's leaflet of instructions. And you are also strongly advised not to smoke after starting chewing the gums ! Actually you start with chewing a gum keeping it between your teeth and cheek until a strong, bitter taste of pure nicotine is felt by your tongue, when you stop chewing and let the nicotine be absorbed by the buccal mucosa. When the bitter taste is no longer felt you again start chewing and repeat the same process until you no longer taste the bitterness, and spit out the gum. Initially you may require one gum whenever you feel the crave for smoking, if you were a heavy or chain smoker. But as a guide you can go through the instructions leaflet and titrate the dose of nicotine gums. Heavy, chain smokers naturally may need more to start with but beware of nicotine toxicity ! The dose schedule of the nicotine gums over a period of 12 weeks is like a pyramid, you start with many and as you go up you reduce the dose daily until you will only be taking 1 or 2 on the last day of the 12 th week, when you are expected to stop using the gums. Remember, you had already quitted smoking ! The quality of the nicotine gums has vastly advanced since I first used it in 2006, when it was manufactured by Elder, called Nulife. My bosom friend Dr. Saumitra Biswas, ( Paediatrician ), now settled in USA had at that time kindly presented me with multiple boxes of Nulife on more than one occasion as far as I can remember, because I know from the core of my heart, he is not only my intimate buddy but he is also my sincerest well wisher ! Infact I am lucky to have so many dear friends. Later, 2 yrs ago, I had used Cipla's Nicorette and later Cipla's Nicotex too. This time too Saumitra had kindly contributed as he has been doing in so much more capacities, apart from presenting nicotine chewing gums ! The quality of Nicotex is much better, the gum not disintegrating in your mouth like Nicorette or the previous Nulife of Elder. There was another brand of Elder but I didn't use it. I don't know the current scenario. If patients who sincerely want to give up smoking but needs help, complains that the gums are expensive, I tell them they might have to spend much, much more in hospital bills, lest they should fall sick due to smoking or tobacco use ! However each and every smoker cannot tolerate nicotine gums. I have written in details regarding the gums as it suited me and might help someone else ! So, unless you have a strong mental resolve you won't be able to kick the nasty habit for good ! I will try to enclose a picture of a leaflet narrating the bad effects of smoking and the benefits of quitting. We should also be aware of the dangerous nicotine withdrawal symptoms both physical and psychological, which may need institutional treatment and supervision by medical specialists and psychiatrists specialising in drug addiction ! I would like to end by mentioning a conversation between me and a young male teenager whom I saw buying a cigarette from our local neighborhood general shop store, a couple of days ago. I am including this here because I felt that I had done my part of our social duty and obligation to raise our voice against all forms of tobacco use, especially smoking, particularly in the younger age group who lack the necessary foresight to understand the longterm serious adverse effects of smoking to themselves and others as well, and also to rise against all social evils, starting with an anti-smoking campaign !---- I exclaimed, Why are you starting this nasty habit brother ? You have no right to smoke in front of others and cause them harm and offend them with the smell of your smoke. He quipped, isn't there a place Sir where I can smoke alone ? I rebuked him, Yes there is brother, in the U.K. hospitals at one time, there were some secluded rooms for the old nurses to smoke, why don't you plan to go there ? He felt ashamed, but I tried to make him realise ---- Man, I am trying to help you out, do you know why I am telling you all this ? Because I had smoked for a long time and I have suffered and I don't want the same to happen to you, son. But I am also proud to tell you that I am strong enough to kick the habit for good. So please do not start with something that you cannot handle. The lad nodded his head and went away. The young shopowner who was listening to our conversation intently, congratulated me afterwards. I was afflicted with compartment syndrome of both my legs in 2006 when I was a senior EMO at AMRI hospitals Salt Lake, due to insufficient blood supply and had to undergo many surgical operations including fasciotomy for release of compartment pressure and later many other debridements of severely infected leg muscles of both legs. Infact I am lucky to survive the septicemia and amputation of my legs as my doctor friends know the saying in medical parlor, Limb over Life ! I think this was due to smoking. Apart from this my lung function has been compromised ! It would not be inappropriate here to thank my surgeon friends and college buddies, Dr. Sandip Chakrabarti and Dr. Anupam Golash, who patiently performed my surgeries, at AMRI hospital Salt Lake and CMRI respectively with compliments and needless to say free. I remain indebted to them, AMRI hospital Salt Lake for kindly considering my inadequate financial backup as my medical insurance was denied, CMRI, my departed and beloved wife Madhurima for providing me solace and constant, cherished company which I miss so much now and also for enduring the burden of so much hardship which we can't forget and thus wouldn't want even my worst enemy to experience the same and last but not the least, Dr. Sekhar Chakrabarty, Sr. Faciomaxillary Surgeon and my elder brother whom I respect like my father, for doing everything from admitting me to CMRI to finally restoring me on my feet apart from lifting the burden of finances, because at that time I was really scared about my chances to be able to walk on my feet again ! -------All these due to cigarette smoking ! I shall remain grateful to all these people. Happy reading and all the best wishes to you, if you are presently trying to give up smoking ! It cannot be over-emphasized that tobacco use is a silent and insidious global killer, not only taking the life of millions of people but threatening to kill more in the future and also add to our suffering if something worthwhile is not done to stop the real menace! As a doctor and a responsible citizen I have at least raised my voice against it and have tried to make people aware of the dangerous habit. You will be glad to know that now I can breathe much freely and suffer from much lesser respiratory infections, my exercise tolerance and lung function have definitely become much better than before. THOUGH HABITS DIE HARD, THE POWER OF THE HUMAN SPIRIT IS EVEN HARDER !!!