May 31, 2012
Social Health Community
DMA and Heart Care Foundation of India demanded ban on Gutka, Tobacco and Tobacco Products in Delhi on the occasion of World No Tobacco Day.
On this occasion, Hon’ble Chief Minister Delhi Smt. Shiela Dikshit Ji released a poster to highlight the ill-effects of tobacco and how to Quit Tobacco. The poster designed by Heart Care Foundation of India and DMA will be distributed / pasted to all the nursing homes and medical establishments in Delhi for creating awareness amongst the general masses.
Dr. Harish Gupta, President, DMA said that there are more than 9 lakhs deaths, 1.5 lakh cancers patients, 3.7 million lung disease, 8.3 million cases of coronary artery diseases and chronic obstructive airway diseases are attributable to tobacco every year in India.
Tobacco related cancers account for nearly half of all cancers among men and one-fourth among women. Once addicted, rate of quieting tobacco in India is around 5-10% as compared to USA & UK where it is around 30-40%. DMA is working towards establishing tobacco cessation clinics by providing training to its doctors on de-addiction. DMA is creating awareness amongst the public about hazards of tobacco and has suggested ways on how to quit tobacco.
The DMA and HCFI delegation requested Delhi Govt. to start tobacco cessation clinics in all government hospitals and give support to private doctors for taking up this initiative in public interest. Due to tobacco consumption, not only the consumer who suffers and treads his life to death but along with him life of his close one also comes to a grave end.
Dr. Vijay Kohli, Hony, State Secretary, DMA demanded ban on Gutka, Tobacco and Tobacco products in Delhi. DMA will organize various workshops, seminars and lectures for public as well as for doctors to train them and to create awareness in the public about the harms of tobacco. He further informed that seminar on Quit Tobacco was organized at DMA House Daryaganj, New Delhi on the 30th May 2012 on the above issue. Dr. Sandeep Budhiraja (Director-Internal Medicine, Max Health Care) and Dr. Sameer Malhotra (Health –Mental Health & Behavioral Sciences, Max Health Care) delivered their talks on Smoking Cessation Therapies and Tobacco Cessation & Relapse Prevention respectively.
Padmashri & Dr. B.C. Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India said that Tobacco is easy to start but difficult to Quit. Tobacco causes addiction and this needs de-addiction as it is an illness. Quitting needs family as well as doctor support. There are very few trained doctors, or de-addiction clinics and limited numbers of de-addiction centers in Govt.
May 31, 2012
The panelists included Dr. Sandeep Budhiraja, Director, Internal Medicine and Dr. Sameer Amphora, Head, Dept. of Mental Health and Behavioral Sciences from Max health care super specialty hospital. The session was moderated by Dr KK Aggarwal.
1. A combination of behavioral and drug therapy works for quitting.
2. The available choices are Non Nicotine Replacement Therapies (NRT), Bupropion and Varenicline
3. NRT are available in gums and patches. They are devoid of side effects and only marginally increase the success rate of quitting.
4. Bupropion is an antidepressant, which was accidentally found to have anti smoking properties. It has side effects with an overall success rate of only 15-20%.
5. Varenicline (Champix) was FDA approved in 2007. It is the only non nicotinic drug for smoking cessation and by far the most effective drug therapy. Increases quit rate from 40% to 60%. Side effects include nausea, sleep disturbance and some suicidal ideation. Hence, caution should be exercised in patients with uncontrolled depression.
6. Equally important is counseling and behavioral therapy. One prepares the smoker prior to quit attempt and supports the person during the period when he is in abstinence. Equally important is the period of follow up (three months after quitting).
7. A close follow is required to prevent relapse/lapse; however, a percentage of smokers may relapse and need restart of the above therapies.
8. Use of tobacco in India: 40% smoking, 60% tobacco products
9. Varenicline, off label use works in tobacco cessation
10. The smoking trend is increasing in adolescents.
11. Weight gain is common during withdrawal, so counsel the patient for exercise and diet.
12. Warn the patient about the mood swings that may occur.
13. First-hand smoking is by the smoker. Second-hand smoking is related to the environmental smoking and third-hand smoking is the smoking dust on houses of smokers, which can be licked by infants and toddlers.
14. Smoking dependence is judged by FTND scale as mild, moderate and severe.
15. One can also do CO breath test, available like a small spirometry. It can also measure the carboxyhemoglobin levels. < 5 ppm CO is mild dependence; 5-10 is moderate and > 10 is severe dependence
16. Group counseling does not work in India.
17. 24-hour quit helplines are available
18. Brief interventions work at all stages. They are linked to issues with respect to motivation enhancement.
19. The stages are:
a. Pre contemplation: preparing knowledge
b. Contemplation: tilting the balance towards quitting by motivating, feedback, reflective listening, agreeing with him, empathy,
c. Determination quit within a month, push to action, convincing not postponing
d. Action: assist with drugs, counseling, managing side effects
e. Maintenance: follow ups, 3-month acute course, one year 2/7 days then space the follow up
f. Relapse prevention, identifying triggers, lapses and relapses, reassess why lapse, motivating that lapse are transient and does happen,
20. CBT: Visualizing and contemplating the negative consequences of using it (medical, social family), help them getting a quit date, inform people, self belief, self image building and visualizing advantages of not smoking.
21. Others things which can help are: Social support, avoiding nagging, Biofeedback, Pranayama, Meditation, Relaxation, PMR, autogenic relaxation, breathing in different parts of the body plus visualization
22. All want to quit but are not able to quit. Most make attempts but are unassisted and unaided and therefore fail. Give the aid and assistance. Tell them that help is available
23. The “5 A’s”: Ask, Advice, Assess, Assist and Arrange.
24. Nicotine withdrawal syndrome: Dysphoric or depressed mood, insomnia, irritability, frustration, or anger, anxiety, difficulty concentrating, restlessness and increased appetite or weight gain
May 30, 2012
Excerpts from a programme moderated by Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India
Panelists: Dr. Rajesh Malhotra, Professor, Dept. of Orthopedics, AIIMS; Dr. Ambrish Mithal, Chairman, Dept. of Oncology and Metabolic Disorders, Medanta Medicity and Dr. Alka Kriplani, Professor, Dept. of Obstetrics and Gynecology, AIIMS.
22. Exercise: Walking, jogging, cycling are all good exercises. Indian traditional dances like Kathak, Bharatnatyam and Odissi are all good exercises. The traditional skiing, rope skiing are also good
23. Three yoga exercises namely, Surya Namaskar, Tadasana and Vrakshasana, which involve standing on your toes or weight bearing on your toes, are good for osteoporosis.
24. A low BMI is a risk factor for osteoporosis and high BMI is a risk factor for osteoarthritis. Therefore, a balance has to be maintained.
25. In India, menopause occurs earlier and in the west, menopause occurs late. Therefore, in the west it is said that bone mineral density (BMD) should be checked at age 65 and in India it should be checked at age 50.
26. It is recommended that everybody in India should take adequate vitamin D.
27. Indians are deficient in vitamin D and iron. Therefore, everybody should take one tablet of iron (60 mg) per week and one sachet of vitamin D every month. The whole family should take these. Apart from that everybody should take a tablet of albendazole 400 mg to deworm every 3 months.
28. There is a calcium paradox. People think that taking calcium can cause renal stones but this is not correct. In fact low calcium is responsible for formation of renal stones.
29. Calcium citrate is better than calcium carbonate when there is history of renal stones in the family.
30. To prevent postmenopausal osteoporosis, prevention must start as early as school going age.
31. The mid-day meal should have enough calcium and vitamin D. The mid-day meal must be fortified with vitamin D. It must have calcium rich and iron rich diet.
32. Government is thinking of fortifying foods with both iron and vitamin D.
33. If a female is postmenopausal, she needs an osteoporosis evaluation. In premenopausal women, in presence of risk factors, osteoporosis evaluation should be done; more the risk factors, more the
chances of developing osteoporosis in future.
34. The risk factors for osteoporosis include advancing age, past history of fractures, history of steroids intake, weight less than 40 kg, family history of hip fracture, intake of alcohol, smoking, 1.5” loss in the height in the past and height less than 145 cm.
35. The markers of osteoporosis can be checked by x-ray, CT scan and ultrasound but bone densitometry (BMD) is the best. It should be done on hips, radius and spine.
36. In patients of osteoporosis, lifestyle should involve regular exercise, no smoking, no alcohol intake and taking precautions to prevent falls.
37. Soft drinks, if taken more than once-daily, can accelerate the osteoporosis process.
38. One must do 30 minutes of resistance weight-bearing exercise three days in a week.
39. In BMD test, one standard deviation of ‘t’ value can double the risk of fracture.
40. Spine BMD may not be reliable in the elderly because of presence of osteophytes and calcification.
41. If you are taking calcium carbonate, it should be taken with meals but if you are taking calcium citrate, it should be taken on a fasting state.
42. Oral vitamin D rarely causes toxicity.