My First Experience as a Tobacco Cessation Speaker

It was my 3rd day as an observer with Dr. Pawan Gupta, when he told me that I had to accompany him to a Rotary club function for a sensitization (awareness) talk on tobacco and its ill effects. Little did I know what was awaiting me!

We were busy the whole day with patients, and had no time, whatsoever to discuss about this talk. I was sure there must be few other members of the team as well, who will take turns to talk and I felt lucky to be able to get this opportunity to listen more to them and gain more knowledge on this topic “Tobacco cessation and oral cancer”, one of the topics, I felt, have been my favourite, since the early days of my college life.

We were supposed to leave around 2:30 pm, but just as we were waiting for our conveyance, I asked him as to who all are coming with us, and he replied “No one, as they are out of station giving sensitization talks elsewhere”!!! My heart skipped a beat, as a thought crossed my mind, “what if sir is expecting me too, to go up the stage and speak something”. Not that I haven’t talked on stage earlier. I have presented and published numerous papers, have been a Dental college lecturer for around 7 years, given numerous lectures, but I am somehow never too comfortable on stage. Although it would have been a huge honor for me to share a stage with him, but somehow I was too nervous for it.

I thought being direct would be the best option. “Sir please don’t ask me to give a talk as I am absolutely unprepared”, I told him bluntly, but politely, trying to explain that I was completely unaware that the other team members were not coming, and that I need some preparation before delivering any kind of a public speech. On this, sir, Dr. Pawan, replied, “Oh, that reminds me, even I am not prepared !!!!” Then he opened his laptop and started working, but as always, was interrupted within a few seconds and that preparation could never happen.

Our conveyance soon arrived and very soon we reached our destination. It was a small clubhouse for rotary function activities and we received a warm welcome. Very soon the function started. Dr. Pawan and I, were first asked to light up the lamps, along with other dignitaries, and then we were duly introduced and welcomed by the club secretary. During these introductions, I asked sir that how many other doctors are present in this function, to which he replied, “None, other than the two of us”!!!! I was again surprised but kept it to myself. Sir asked me, “Are you sure you wouldn’t be able to speak even for a few minutes?” It was a simple question, but I was feeling bad that he had expected me to help him & now he had to take the whole responsibility alone, so I replied, “Ok sir, I would speak a few lines about oral examination and diagnosis”, this being my specialty, I thought I will be able to talk on this topic even if not prepared. Sir was delighted. He gave a huge smile and his eyes lit up.

He was called up on stage. He started, not by talking about his work as an oncosurgeon, (which according to me, is THE NOBLEST PROFESSION, even among the noblest of the doctors) but, by introducing me and that how I am doing such a noble job of helping the tobacco addicts quit their habit, how I am travelling so much every day and that what a great person I am!!!!! I was totally embarrassed by his words, and kept thinking that how can a doctor of his experience, caliber and status be so polite, humble, and down to Earth. Instead of talking about his achievements, his miraculous surgeries and his passion to make India tobacco free, this man was talking about me, one who has just joined the organisation and just started making small efforts to bring some changes in society. I was totally floored!!! After what felt like a life-time, he finally stopped, and I could take my seat, but during that time, this great man made me take a pledge within, that now I must work really hard to prove his words true.

 He started by talking about how tobacco affects our lives, causes addiction and why it’s so difficult to leave. He was an interactive speaker as he kept asking the audience, engaging and mind boggling questions, some of them making the addicts think hard about how they are simply destroying not only their but their family’s lives as well. He spoke about the huge wastage of money by tobacco users and how they are a burden on their employer as well as the nation. He kept emphasizing that tobacco is not just a habit, it’s a disease, and that’s why it needs proper treatment, which includes repeated assessment, motivation, counselling, drugs and follow up, to help the user stay quit, as that’s the most difficult part.

When he came to the oral examination section, he proudly announced my name. Surprisingly, this time I didn’t feel nervous at all. I confidently marched up to the stage but requested him to stay upstairs as I was unaware of his slide presentation. As I opened up the first slide of this chapter, I got confused, as it was something written in Hindi, a slogan as simple as “Chhota dana bhool na jana”. There he was again, helping me by taking over and explaining the meaning in simple layman’s language. After that he again let me talk. I then talked from my own education and experience for around 5-10 minutes, after which he took over again as the next topic approached.

By the end of the session, he had successfully sensitized most of the audience, and many of them asked for his help, to which he modestly replied, “Ask madam, she would help you to quit”.

At the conclusion of the ceremony, we were felicitated & I was gifted  a beautiful potted plant, which I proudly brought back home.

Pawan sir, as he is fondly known as, is a mentor, in the true sense of the word, as he not only teaches you something, but also guides, inspires, motivates and promotes you, till the very end. And I must say that I am very fortunate to find him as my mentor. Thank you Pawan sir.

Will I Get a Heart Attack from Smoking / Chewing?

Is Your Heart Healthy or Did You Experience a Heart Attack? Write in the Comments Below.

When someone asks you, “What is the health problem of tobacco consumption?” your immediate answer is “It causes Cancer”. Another answer might be “Nothing! I have not experienced anything yet. I have been smoking/chewing since years and I’m still healthy.” However, do you know that tobacco consumption can cause other diseases too? Have you ever got yourself screened to really know the damage tobacco has already caused in your body?

Tobacco consumption causes numerous chronic diseases of which Cardio-Vascular Diseases(CVDs), Stroke, CRD, TB, Asthma, COPD and NCDs are the most frequently caused diseases besides cancer. And, in this blog, I will enumerate on heart diseases caused by smoking/consuming smokeless tobacco products.

Let me tell you a few quick and interesting facts. As per the Factsheet released by WHO in 2018, deaths due to tobacco in India was more than 1 million and 48% of the deaths were due to CVD, 23% due to CRD and only 10% due to cancer. This is extremely alarming that more deaths are caused due to heart related diseases than cancer due to tobacco use. 4,49,844 deaths from CVDs could have been prevented if these people had quit tobacco on time (in 2018).

WHO Fact Sheet 2018

It is true that smoking/chewing can give you a heart attack or any other form of heart disease at some point in time in your life if you continue to consume tobacco regularly and do not quit on time. Smoking increases the risk of coronary heart disease by 200%-400%. I’m sure not many people would be aware about it.

Smoking Increases Risk of Heart Disease by 200%-400%

The question is how does smoking/smokeless tobacco cause a heart attack or disease?

Tobacco smoke contains high levels of carbon monoxide (CO) that affects the heart directly. CO reduces the oxygen carrying capacity of the blood. Vital organs like the heart, lungs, brains, kidney, etc. do not always receive the right level of oxygen to perform everyday functions. This implies the heart has to pump more and harder to supply the right oxygen to the organs thereby increasing the heart rate and blood pressure. Over time, this causes constant “wear and tear” on the cardiovascular system thus causing a heart attack, high BP, blood clots, strokes, hemorrhages, aneurysms and other disorders.

Use of smokeless tobacco products increases the risk of high blood pressure and heart rate. However, no study has proven that a severe heart disease can be caused due to smokeless tobacco consumption. This does not imply that a smoker should switch to smokeless form because oral cancer is caused in 98% of the smokeless tobacco consumers.

Smoking increases the risks for the following diseases:

  • Coronary heart disease
  • Rheumatic heart disease
  • Hypertension
  • Ischemic heart disease
  • Pulmonary heart disease
  • Cardiac arrest
  • Cerebrovascular disease
  • Atherosclerosis
  • Aortic aneurysm
  • Chest pain
  • Arrhythmia

What Else Can Smoking Do?

  • Increase the level of triglycerides in your body
  • Lower the “good” cholesterol level (HDL)
  • Make blood sticky and more likely to clot, which can block blood flow to the heart and brain
  • Damage the cells that line the blood vessels, leading to build up of fatty material (atheroma) which narrows the artery which causes angina, heart attack or stroke.
  • Increase the  build-up of plaque (fat, cholesterol, calcium and other substances) in blood vessels
  • Cause thickening and narrowing of blood vessels thereby harming blood circulation
  • It can also cause sudden cardiac death of all types in both men and women

“Beyond its status as an independent risk factor, smoking appears to have a multiplicative interaction with the other major risk factors for CHD—high serum levels of lipids, untreated hypertension, and diabetes mellitus (USDHHS 1983). For instance, if the presence of smoking alone doubles the level of risk, the simultaneous presence of another major risk factor is estimated to quadruple the risk (2 × 2). The presence of two other risk factors with smoking results in approximately eight times the risk (2 × 2 × 2) of persons with no risk factors.” (NCBI, 2010).

There is no doubt that smoking will definitely cause a heart attack or other forms of heart diseases. It is therefore important to quit immediately, if not, then identify the symptoms as soon as possible before it becomes severe and seek help to quit the habit of smoking.

References

Rostron BL, Chang JT, Anic GM, et al Smokeless tobacco use and circulatory disease risk: a systematic review and meta-analysis Open Heart 2018; 5:e000846. doi: 10.1136/openhrt-2018-000846

Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, January 2019, https://www.cdc.gov/tobacco/campaign/tips/diseases/heart-disease-stroke.html, accessed in July 2019

Amy Lukowski, PsyD (August 2015), https://www.nationaljewish.org/health-insights/smoking-and-tobacco-use/health/coronary-heart-disease-and-tobacco, accessed in July 2019

British Heart Foundation, https://www.bhf.org.uk/informationsupport/risk-factors/smoking, accessed in July 2019

Centers for Disease Control and Prevention (US); National Center for Chronic Disease Prevention and Health Promotion (US); Office on Smoking and Health (US). How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta (GA): Centers for Disease Control and Prevention (US); 2010. 6, Cardiovascular Diseases. Available from: https://www.ncbi.nlm.nih.gov/books/NBK53012/

Self-Care – A Need of the Hour

#knowtobacco
How Do You Self-Care? Write Your Comments Below.

When World Health Organization (WHO) released its first guidelines on “Self-Care Interventions for Sexual and Reproductive Health and Right”, there was an immediate realization of the gravity of self-care interventions. As per estimates, WHO mentioned that the world will fall short of 13 million healthcare providers by 2035 leaving at least 400 million people devoid of necessary healthcare services.

It is imperative to adopt self-care in different facets of healthcare to fill this gap and ensure that people have access to essential services as required for adequate treatment and support. Self-Care implies that a person or their family “promote health, prevent disease, maintain health, and cope with illness and disability with or without the support of a health-care provider” (WHO). This means that one should adopt the following habits in their routine with immediate effect to ensure that they are able to care for themselves and get the right treatment on time without delay:

IDENTIFY ANY CHANGE IN THE BODY

  • One must identify any sign or change occurring in one’s body. It may be a small change or a major one, which does not occur routinely.
  • Search for references on the internet for the cause of the sign and symptoms and self-detect through available kits to identify the cause of the symptom
  • If one is unable to find out the source of the symptoms, then report it to the concerned physician immediately and get it diagnosed to seek proper treatment

STOP LIVING WITH THE DISEASE

In India, it is a normal practice to procrastinate visiting a doctor and people get used to the symptoms occurring in their body. They start living with those symptoms and after sometime it becomes so severe that visiting a doctor become inevitable. There the patient gets to know about the severity of the disease and that they should have visited earlier when the first signs occurred. Make it a habit to not neglect your own health, for not only will you suffer your entire family will suffer and experience a lot of stress and trauma.

GO FOR YEARLY FULL BODY CHECK-UP

Doctors recommend to have a full body check-up once a year to know the current health status and compare it with the previous record. This helps the person to know what they should be doing to keep them healthy.

ADOPT HEALTHY HABITS

Every healthcare professional will tell you to eat healthy and exercise regularly. These are the 2 most important aspects of keeping healthy habits. But there are a few more which are as critically important as eating healthy and exercising.

  • Maintaining hygiene in everyday life both personally and socially
  • Teaching kids to maintain personal hygiene and keeping surrounding clean
  • Not spitting anywhere and everywhere
  • Avoiding smoking in public places, hospitals, children, etc.
  • Not reusing disposables of family members
  • Adopting preventive care

The list is endless. It is upto us how well we adopt the healthy habits, practice, preach and propagate them to the community to make our place greener and healthier to live.

EXTEND SUPPORT

There are many instances that a particular disease is looked upon as social stigma in our society and those suffering from them are completed neglected or socially ignored. HIV AIDS is one such disease. In such instances, the patient becomes morally depressed and loses self-confidence. This impacts their psychological behavior and they give up on their treatment easily leading to their death. We need to become more supportive and prevent the community from inflicting such taboos. We must support the patient emotionally and financially so that they are able to cope with the disease and get themselves treated.

This reminds me of people who want to quit smoking or chewing. They face similar problems while quitting – LACK OF SUPPORT! If we care for them and extend support during their withdrawal symptoms and cravings, they can quit with ease and determination and will require minimum physician’s intervention.

Remember one simple mantra:
जब भी देखो छोटा दाना,
उसकी पहचान जल्द ही करना,
कैंसर को ना बनने दो नासूर,
शिग्रह करो इसे दूर!

#knowtobacco
Get the “Chota Daana” screened and diagnosed asap

Self-Care from tobacco use is the need of the hour. India needs the non-tobacco consumers to adopt a tobacco user and help them quit by acting as a buddy to them. Cessation experts are available for help in case of failing to quit by self. They make the quit process easy and simple. Identifying the early signs, late signs, advanced signs and co-morbidity of the harms of tobacco use will help the individual get themselves treated on time and prevent oral cancer, lung cancer, CVD, Stroke, COPD< Astham, TB, and other NCDs from happening. This is the best and immediate self-care one can do for themselves.

It should be noted here that smoking releases carcinogens and those inhaling it are also at a risk of chronic diseases from this Second-Hand Smoke (SHS). Detection kits are available to let you know the impact of SHS on your body. This makes it necessary for non-smokers to take care of themselves too for they might be exposed to SHS without them realizing it.

In all, Self-Care is extremely essential for everyone for early realization, detection, diagnosis and treatment of the diseases occurring in their body. This is my appeal to everyone to have your own guidelines for self-caring your body. This will help you live longer and disease free. It is also an appeal to all the tobacco users, both smokers and chewers, to start self-caring for themselves as tobacco use will definitely cause them some chronic disease at some point in their lives.