Month: July 2008

My recent post on tobacco poisoning focused on chronic obstructive pulmonary disease, the cause of about one-third of smoking related deaths. Let’s move on to cardiovascular disease (CVD), which accounts for another third.

When we talk about CVD, what are we taking about? The pathophysiology is very interesting…go and read.

Heart disease, which includes heart attacks and heart failure, kills about 100K smokers yearly. This includes people who have a heart attack and die suddenly, but also people who develop heart failure and linger on swollen and breathless.

Strokes kill about 16.5K smokers yearly, which doesn’t include smokers who are only disabled by strokes.

Aortic aneurysms kill about 8.5K yearly. That’s a fun one. An aortic aneurysm is a dilation of the main blood vessel that leaves the heart. When this tears or bursts it causes horrific pain in the chest or abdomen that radiates to the back. Thankfully the pain often doesn’t last long, because if the aorta actually bursts, you bleed out into your chest or abdomen very quickly.

Oh! Wait! I forgot peripheral vascular disease! Who doesn’t like gangrene? (Don’t click unless you’re ready for the gangrene picture.)

Peripheral vascular disease often starts as pain in the calves when walking, but can rapidly progress to loss of a limb. Eww.

I always tell my residents that helping a patient to quit smoking is usually the best thing you can ever do for their health. Smoking is the cause of most preventable deaths in the U.S. and causes about 20% of all deaths. It is impossible to overstate the public health menace that smoking presents. Cessation programs have become more sophisticated, as have the drugs that are available. Patients often ask me if nicotine patches are safe. My usual response is, “Well, are cigarettes safe?” There are very few bad ways to quit smoking. The first step is deciding you’re ready. Then, get educated. Resources abound.

Ach! I forgot to tell you….

Average monthly cost of cigarettes: 350 USD. That’s a whole lot of money.

This is one of those topics I’ve always sort of avoided, and I’m still avoiding it for now. But that doesn’t mean you have to remain silent. Here’s the reader comment/question:

This is off-topic, but I wanted some doctorly input to a discussion that I am having over at another blog.

This lady is hyperventillating about the “sinister” (her word) policy of the Oregon Public Health Plan.

They won’t cover curative treatment for people who have a “less than 5% chance of surviving five or more years”

Instead, they cover palliative treatment, hospice, and Doctor-Assisted suicide.

This lady is setting it up as a moral judgement that the government is making a value judgement on 1,2,3, or 4 years of life.

To me “less than 5% chance of surviving five or more years” doesnt sound like curative treatment doesn’t have a very good chance of buying you even one year of additional life. I think that she has an unrealistic view of what it means to have a less than 5% chance of surviving five or more years” means.

Heres the story:

http://conservablogs.com/haemet/2008/07/28/the-real-face-of-choice/

Teresa

It’s all yours, folks.

Every once in a while I like to do a piece on how real science works. The New England Journal of Medicine was kind enough to serve up a nice example for us this week.

Real science is hard. It’s time-consuming, expensive, and leads down many blind alleys. That’s one of the reasons pseudoscience is so alluring—anyone can do it. It doesn’t require an education, an R01 grant, or really even a grasp of reality.

So on to the current article. Heart disease is a big killer. Over half-a-million people yearly have the worst type of heart attack, called an ST-segment elevation myocardial infarction (STEMI). Coronary heart disease kills almost a half-a-million Americans yearly and around 300,000 people die of heart attacks in American ER’s every year.

So this is a pretty important disease. Here’s how it works…
Continue reading “How real science works”

I frequently get questions by email or by comment. If it’s simple, I might fire off an answer. If it’s about a personal medical problem, I either don’t answer, or send a standard disclaimer to seek medical care. If it’s a really interesting question, I blog. Today, I blog.

The question regarded the ubiquitous commercials for erectile dysfunction treatments (see this excellent post for an overview of the topic of ED drugs). As anyone who has a TV knows, the commercials always have the pleasant warning of “if you have an erection lasting more than four hours, seek immediate medical help.”

An erection lasting more than four hours, in the absence of sexual stimulation, is known as “priapism”. It is named after a Greco-Roman god who was usually portrayed with large, turgid phallus. Priapism is a bad thing. It can lead to permanent dysfunction of the penis, and even to gangrene.
Continue reading “I get questions…”

This comes up every day. Everyone’s afraid of the big “C”, and they should be. Smoking increases a person’s risk of dying of lung cancer by about 12-20 times (whatever that means, but it’s significant).

And while cancer may be scary, other diseases are just as bad. Lung cancers attributable to smoking cause about 125K deaths per year (all numbers US). Add in head and neck cancers, and the number goes up to about 133K. Add in cancers with less clear causative associations and we’re up to 160K.

In contrast, there are about 130K cardiovascular deaths yearly attributable to smoking, and about 100K deaths due to lung disease such as emphysema.

So let’s explore the various ways of dying of tobacco poisoning.
Continue reading “What should smokers be scared of?”