By Dr David Delvin

Does anyone in your family smoke? And does anyone in your family smoke near you, your children or grandchildren? If the answer to either of these questions is 'Yes', then please read on …….

Why on earth are doctors always 'going on' about smoking? Why does the British Medical Association spend so much of it's time and money in battling the tobacco companies, and in trying to persuade the public to give up?

If you think about it, there must be some good reason! Us doctors don't keep rabbitting on about cigarettes just because we've got nothing better to do. And obviously, the BMA is not being bribed to take on the might of the tobacco industry!

No, the reason why we keep warning people about the dangers of cigarettes is quite simple - Every day we see the disastrous health effects of smoking. We see:

People in their 60s, or 70s who are dying of lung cancer.

Tiny children who have developed bronchitis because their grandparents or parents puff smoke all over them.

Men and women of retirement years who suddenly find themselves crippled by emphysema and chest infections.

People who keel over with smoking related heart attacks - when they should have had years of happy life before them.

A typical case was a friend of mine called Peter. He was a doctor - and in those days, doctors used to smoke (scarcely any do now!). He worked hard all his life, and he was really looking forward to a good rest when he retired. But three weeks after they gave him his gold watch, he dropped dead with a coronary. So he and his wife never got that lovely long retirement together!

TIMES HAVE CHANGED
Now if you're in the second half of your life, you'll recall that attitudes to smoking have changed a great deal over the decades. Can you remember the 1950s? in those days, it seemed as if practically everybody smoked - and nobody disapproved.

Even in the 1960s, chaps with pipes were considered to be immensely 'reliable'! Young men and women who puffed at cigarettes were thought to be 'stylish' and 'modern'. Film star and future U.S. President Ronald Reagan posed elegantly for tobacco ads. The Marlborough 'cowboy' was considered to be the epitome of masculinity. (He later got cancer of the lungs and died, poor bloke.)

But things have changed a lot since those times. The medical evidence has piled up year after year, and it has long ago been proven that cigarettes are really bad for your health - and for the health of those around you.

WHY DO WE SMOKE?
So why do we smoke? And why do people carry on smoking despite all the medical evidence?

Well, there are several factors involved:

Smoking can make you feel nice

For some it's relaxing, and helps combat the stresses of life

It's often a sociable thing to do - offering good cigarettes or even a cigar can be perceived as a great way of getting to know people!

Many human beings just love having something in their mouths - remember that childhood dummy?

Finally, and most importantly, nicotine is a VERY addictive drug.

That last point is the one which the tobacco industry has tried to conceal from the public over many years. But the truth is that once you can get a man or a woman 'hooked' on nicotine, it becomes very, very difficult for them to get off it. The brain now CRAVES nicotine - and therefore the person feels really rotten if he or she tries to do without it.

In a moment, we'll look at ways of beating the craving. But first, lets take an in-depth look at the health risks of tobacco.

HEALTH RISKS OF SMOKING
Worldwide, smoking kills millions of people each year. In Britain, it's estimated that the annual death toll is about 120,000. That's around one in five of all deaths!

Why is it so dangerous? Mainly because the fumes that you are inhaling are so blooming dirty! Imagine what would happen if you kept breathing in bonfire smoke every day; your air passages would soon be coated with muck. Well, that's exactly what happens with smoking.

Tobacco smoke doesn't just contain nice-smelling things. It also contains over 400 really toxic chemicals - in other words, poisons. In the same way that they turn people's fingertips and moustaches yellow, they also stain your 'insides' - with disastrous results. Tar, carbon monoxide and nicotine surge into your body with each puff, creating havoc - and (in most cases) eventually damaging your health.

Yes, even though you may THINK that you're OK, the odds are that smoking will shorten your life. The average smoker lives about seven years less than a non-smoker - which is why life insurance companies are now so very interested in whether you smoke (see question and answer below). Non-smokers can expect a healthier old age than smokers. Interestingly, so too can EX-smokers! So it's always worth giving up - no matter how old you are!

The major health problems, which can eventually hit smokers, are:

· Heart attacks (coronary thrombosis or myocardial infarct);
· Angina;
· Hardening of the arteries;
· Blockage of the blood vessels leading to the feet, causing poor circulation and sometimes  gangrene;
· Impotence;
· Stroke;
· Kidney trouble;
· High blood pressure;
· Lung cancer;
· Cancer of the mouth;
· Cancer of the throat;
· Cancer of the tongue;
· Rather surprisingly, cancer of the cervix;
· Smoker's lung - long term inflammation of the air passages;
· Chronic obstructive pulmonary disease ('Obstructive Airways Disease');
· Ulcers and indigestion.

The list is huge and goes on and on and on. I simply haven't space to include ALL the nasty diseases that smoking can give you. So, honestly, it's best to quit NOW!

WAYS OF QUITTING
Alas, because nicotine is so very addictive, it is very hard to give up - as anyone who has tried it will know.

I have to tell you that there's no easy answer to the problem of how to quit. Only real WILL POWER will do it. I'm afraid that neither your doctor nor anyone else can do it for you. However, here are some things that will help;

Tell your spouse and your friends that you are quitting - and ask for their support. Beware of the 'false friend' who keeps offering you the odd cigarette - because 'just one doesn't matter'.

Pick a date on which you're going to quite - and keep to it.

On that day, chuck out all your cigarettes (or other tobacco) - and also all smoking 'bits and pieces,' like matches, lighters, ashtrays, pipes or whatever. Sell your cigarette case!

Do SOMETHING ELSE instead of enjoying a cigarette - make it whatever you most enjoy. Ideas which have proved useful include: having a chocolate, having a sweet, going for a walk somewhere nice, going to a good film - or even having sex!

Occupy your HANDS. Many smokers find that their hands seem to 'yearn' for the support of a cigarette. So do something else with them - writing, chess, crosswords, knitting, sewing, odd jobs, handicrafts, or (if you can do it!) playing the piano.

What about MEDICAL help? Well, your doctor can give you some help these days - though the fact remains that giving up is largely down to you. However, things that doctors can suggest include:

Referral to an anti-smoking clinic for counselling or even group therapy;

Nicotine Replacement Therapy (NRT). This means taking some nicotine for a SHORT time to help you during the weaning off period. Possible ways of taking the nicotine include chewing gum, skin patches, nasal inhalers and nasal spray;

The newish drug Zyban (also known as 'bupropion') - this can help a minority of people to quit. More info about giving up can be found in the Q & A section.

Good luck!

* Beginning with Frequently Asked Smoking Questions *

Q. I've just turned 60, and I really want to give up smoking. Can I get the nicotine patches on the National Health?

A. Sorry. At the time of writing (January 2001), NONE of the Nicotine Replacement (NRT) products are allowed under the Health Service. So people have to buy them.

But please bear in mind that giving up cigarettes will save you an awful lot of money! In the long run, you'll save far more than the cost of the nicotine patches.

Q. Is there some telephone counselling available for people who want to quit?

A. Yes, there are various helplines which can give you a bit of moral support while you're trying to give up. Obviously they're not 'magic' - and YOU still have to put in the will power. But any help at all is useful during the difficult period when you're attempting to quit. Worth trying is a helpline run by one of the Nicotine Replacement Therapy (NRT) product manufacturers - 0800 244838.

Q. If my husband wants to try one of these 'nicotine replacement' things, does he have to go to the doctor to get a prescription?

A. No ma'am: the NRT products are now 'off prescription' in the UK. So your hubby can just go directly to a pharmacy to buy them. The chemist will give him good advice about how to use the stuff.

Q. I have just turned 68. Is it really worth giving up at my age?

A. Yes. You'll gain substantial health benefits - and probably prolong your life. Good luck in giving up.

Q. I think that my wife and I would like to try that new 'anti-smoking drug'. Is it available on the NHS?

A. The new drug is called Zyban. Theoretically it IS available on the Health Service. But many Health Authorities - alarmed by the cost - have placed restrictions on it's use. So you may well find that you have to attend sessions with an anti-smoking counsellor in order to get it. Start by going to your GP.

Q. Because I'm arranging a financial bequest for my grandchildren, I have to take a life insurance medical exam next week. I do smoke a bit, but would it be safe to put myself down as a non-smoker?

A. No, sir. This would be illegal. Also, you'll very probably be found out! Insurance 'medicals' now frequently include a special test to find out if people who CLAIM to be non-smokers are telling the truth!

Q. Are there any dangers for older folk in using the anti-smoking products?

A. Yes, sir. Nicotine products can cause nausea, dizziness, headache and 'flu-type' symptoms. They can be dangerous for people with severe heart disease.

And Zyban - the new anti-smoking drug - can occasionally cause fits.

However, you have to 'balance' all this against the health risks of continuing to smoke! For further information, consult your own doctor or local pharmacist.

Q. I'm 73. Is there any risk to my health from smoking just ONE cigarette a day?

A. Frankly sir, the risks from just ONE a day are so slight that I don't think you need worry.

Q. Is a PIPE safer than cigarettes?

A. A little. But it carries a higher risk of getting cancer of the mouth.


NON SMOKING QUESTIONS & ANSWERS:

Q. Like many of my friends these days, I'm on 'water' pills' from the doc. But soon after I started taking them, I began to get attacks of GOUT. Could the 'water pills' cause this?

A. Yes, definitely! As you say, many people over 50 take daily 'water pills'. But some types can indeed provoke gout. Ask your GP to change the tablets.

Q. I forgot to turn up for a doctor's appointment the other day. Now they are talking about FINING me for missing the appointment! Are they allowed to do this?

A. No, ma'am. NHS DENTISTS can charge you for missing an appointment, but NHS doctors can't. So do not pay!

Q. My wife says I should have my blood pressure taken regularly. But is this really necessary?

A. After the age of 50, it's a good idea to have your 'BP' checked every year or two. Obviously, if it's above normal you'll need it checked more often than that.

Q. HRT has made me feel great - and has been a real boon to my love life! But I'm now 65. is there any age limit for taking it?

A. No, as long as you see your doctor from time to time for a brief 'HRT check up', you can go on taking the hormones into your 70s or even 80s if you want to.

Q. I have never had an eye check up, but my husband thinks I should. Is it worth bothering?

A. Certainly, ma'am. The incidence of unsuspected glaucoma (called 'the silent eye disease' because it produces no early symptoms) is very high in the over-50s. For that reason alone, it's Worthing seeing an optician for regular checks.

Q. I've just been told that I have a slightly enlarged prostate gland. Will this affect my sex life?

A. Almost certainly NOT, sir. Prostate enlargement is 'par for the course' in men of retirement age. But it usually affects only the water works - not the sexual function.

Q. How far back do medical records go? As a young lad in 1947, I had a rather embarrassing illness. Would it still appear on my GP's medical notes?

A. Theoretically, a person's medical records are supposed to be kept forever. But in practice, an awful lot of them get lost over the years.

1947 was before the Health Service even started, so the odds are that this episode does NOT appear in your NHS record. But if you're worried, you're perfectly entitled to ask your GP.

Q. I'm a widow of 52; I've just met a delightful Frenchman, who has asked me to go on holiday with him. Can I assume that at my age, I'm safe from pregnancy?

A. Only if your periods stopped at least TWO YEARS ago, ma'am. If that's not the case, better ask your GP (or local Family Planning Clinic) for a spot of contraceptive advice.

Q. At 68, am I too old to start wearing contact lenses?

A. Not at all! Provided that you have no difficulty in popping the little lenses into your eyes, there's absolutely no reason why you shouldn't use them.

Q. My wife and I are thinking of going to the tropics for our summer holiday this year. Can you reassure me that if we got all the 'jabs' done, we'd be totally safe from any infection?

A. Sorry, no! It's well worth having all the officially recommended jabs. But in any tropical country, there are lots of other infections which are NOT covered' by the immunisations. Far and away the biggest risk are the 'traveller's tummy' bugs which affect so many tourists.