Friday, October 21, 2011

A Simple Message about Smoking

Some weeks I write a lot, some weeks I write a little. This week, the message is short and to the point – I have two articles in the works, but I’ve sidelined them for some brief reflection on clinical experience.

This past week, I started shadowing a cardiologist, in an effort to learn more about cardiovascular pathology in order to better serve my patients. So far it’s been an excellent experience. We’ve talked a lot about prevention with diet and lifestyle, when to prescribe pharmaceutical drugs, how to interpret imaging, and how to assess prognosis. Few naturopathic physicians get the opportunity to spend time looking at carotid doppler scans, echocardiograms, and perfusion studies, and so I feel very blessed to have this opportunity.

The main message I’ve taken home from my experience thus far has been this: Don’t Smoke.

Often, health and lifestyle recommendations can seem a bit vague. It’s easy to know smoking is ‘bad’, but aside from a lingering odor, that negative effect can seem distant. A relative may develop emphysema or lung cancer, but even that can fade with memory. The effects of smoking aren’t always immediately obvious, which is part of the reason that it is an insidious killer. While emphysema or cancer seem to come suddenly, the groundwork is laid daily for years.

One place smoking acts is in the arteries. In the cardiovascular system, it contributes to strokes, heart attacks, and a variety of other conditions. The primary method it does this is through atherosclerosis – the hardening of the arteries due to the build up of plaques. To prevent this from sounding like stratospheric talk, let me bring this home by saying that carotid doppler scans allowed me to visualize these plaques in living, asymptomatic patients in a way that I hadn’t been able to before. These plaques become larger and go to either obstruct and prevent blood flow to the brain, or break loose and lodge in smaller arteries downstream, also preventing blood from flowing to the brain. Even for a doctor it can seem remote – we talk about blood pressure, we talk about cholesterol, but to actually see the arteries narrowing brought things home. Imagine it this way: a man shows up at your doorway and casually saying that there seems to be a ticking time bomb in your garage, but that he’s not sure when it will explode, if it will explode, or if it will even cause much damage when it happens – not too worrisome is it? Now instead imagine that he says there is definitely a bomb, shows it to you, tells you how long till it goes off, and says that it’ll blow up your whole house unless you do something about it – sounds more pressing, doesn’t it?

Smoking helps these plaques to build steadily, day by day, for years. It also damages DNA in cells throughout the body, causing cancer to develop, and damages the cells of the lungs, causing emphysema. A few weeks ago, I blogged about a study showing that smoking was the most important causative factor of premature death. Today I’m blogging about it again. Don’t Smoke.