Smoking diseases are diseases caused directly or indirectly by smoking tobacco. The best known is lung cancer but this is only the tip of the iceberg, as we shall see.

Smoking is the single greatest cause of death in the UK, and the World Health Organization has said that the control of smoking would do more good than any other single action in preventive medicine. At least 100,000 deaths are attributable to smoking in Britain each year with an average loss of about ten years of life. It accounts for 90 per cent of deaths from lung cancer; 75 per cent of deaths from chronic bronchitis; and 25 per cent of deaths from coronary heart disease in men under 65. The risk of coronary heart disease attributable to smoking is greater in younger men so that a man under 45 who smokes twenty-five or more a day may have a fifteen times greater risk of dying from a heart attack than if he were a non-smoker. Here are some chilling facts:

• Early studies suggested that relative mortality risks among female smokers were less than those of male smokers, but it is now clear that these studies were comparing the death rates of a generation of lifelong male smokers with a generation of women who had taken up smoking much later in life. The smoking characteristics of the two sexes are now becoming more and more alike, and the rates of smoking-related diseases are drawing closer together.

• Women who take the contraceptive pill and who also smoke cigarettes are more likely to have a coronary attack, stroke, and blood clots in the leg veins which may shift to the lung (pulmonary embolus), than are non-smokers who are on the Pill. One study has shown that for women aged 25-34 on the Pill the relative risk of death from circulatory disease was 1.6 for non-smoking Pill takers but 3.4 for smokers; women aged 35-44 the risks were 3.3 and 4.2 respectively, and for women over 45, 4.6 and 7.4. There is also a considerable increased risk for women on the Pill who smoke and who have one or more known risk factors for coronary heart disease.

• The natural menopause occurs on average 2-3 years earlier in smokers.

• Fetal growth and birth weight. Babies born to women who smoke are on average 200 g lighter than babies born to comparable non-smoking mothers. The relationship between maternal smoking and low birth weight is independent of all other risk factors which influence birth weight including maternal size, race, socio-economic status and the sex of the child. Furthermore, the more cigarettes a woman smokes during pregnancy, the greater the probable reduction in birth weight. However, if a woman stops smoking before the twentieth week of pregnancy, her risk of having a low-weight baby will be similar to that of a non-smoker.

• Children whose mothers smoke ten or more cigarettes after the fourth month of pregnancy tend to show poor progress at school, at least up to the age of 16. In both reading and mathematics tests they do less well than other children. This effect is found after allowing for other factors affecting educational level.

• Spontaneous abortion. Tobacco use during pregnancy causes a two-fold increase in the risk of spontaneous abortion (miscarriage).

• Complications of pregnancy. On average, smokers have more complications of pregnancy and labour, which can include bleeding during pregnancy, premature detachment of the placenta and premature rupture of the membranes.

• Perinatal mortality (defined as still-birth or death of an infant within the first week of life) increases in direct relation to the number of cigarettes smoked during pregnancy. In one large study, the perinatal mortality risk increased by 20 per cent for the infants of smokers of less than twenty cigarettes per day and by 35 per cent for smokers of twenty or more a day, compared with that of non-smokers.

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Questions to ask

Some of the questions that you might like to ask your doctor include:

• Does the doctor have a partner who knows about you and can treat you if your own specialist

is unavailable?

• Can the doctor see you immediately if you have an urgent or serious problem?

• Will the doctor personally answer and return phone calls or will those phone calls be taken

and answered by a secretary?

• Are phone calls answered promptly; does your doctor receive messages to contact you when

Requested?

• Can the doctor be contacted out of hours?

• Will the doctor see you out of hours?

• Will the doctor read out to you the results of pathology reports or referrals, etc., or will the

results be given via the doctor’s secretary.

Getting the best from a doctor

To get the best out of your doctor you need to be well-informed and provide honest and accurate information.

In order to be well informed you should read about the menstrual cycle so that you understand how the cycle works, know about hormonal changes and their effect, and understand what endometriosis is. This can be achieved either by yourself or by your doctor suggesting reading material and other sources of information. You can also contact your local women’s health information centre.

It is important to recognize that your doctor is not a mind reader, and that it is up to you to tell her or him what your problems are so that your doctor can get an overall picture of your illness. Identify the major areas of concern for you – infertility, pain control, improvement of lifestyle.

It may be a good idea to keep a diary in which you can record your visits to your doctor and make notes of any side effects of drugs or surgery or other treatments suggested by your doctor and list questions for future visits.

Be honest about symptoms and make sure the information you give is complete, accurate and relevant. It is of no benefit to you to withhold information.

It is important to be able to talk openly to your doctor and to feel that you can discuss your needs and fears.

If you have concerns about the side effects of drug therapy, you should feel comfortable discussing these with your doctor. If you have printed information about drugs or treatment you want to discuss, take this with you to the appointment so that your doctor can comment.

Always report the positive as well as the negative feelings you may be experiencing.

Vital decisions and concerns such as marriage, sexual relationships, careers and children should also be discussed with your doctor since these make up the total picture.

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Poisoning

Over half the fatal poisoning cases amongst elderly people involve drugs and medications. This is not surprising as people receiving a variety of treatments may become confused as to which medicines to take, when, and in what quantities. Gases and vapours are responsible for a third of the deaths by poison amongst the elderly. This usually takes the form of gas poisoning-from faulty gas appliances or as a result of failing to have flues cleaned regularly.

The dangers of water

Whether you are walking near a pool, boating on a lake, cruising down a canal or sailing on the sea, water is a real hazard that demands great respect.

When at the seaside:

•     Don’t bathe when a red or other warning flag is up. It is not clever and could endanger the life of someone else who tries to save you.

•     Keep a close eye on children -never let them play at the water’s edge unattended. Babies and small children can drown in a few centimeters of water before you even know they are in trouble.

•     Ensure that non-swimmers and all children wear approved and properly constructed life jackets if they are on the water.

•     Look before you dive-many people suffer serious illness because they have hit their heads on rocks or dived into inches of water.

•     If you are on the water either in a boat, water skiing or windsurfing, watch out for bathers. Keep well out of the way or fun can turn to tragedy within a few seconds.

•     Beware of poisonous jellyfish. Most jellyfish are harmless but the Portuguese man-of-war (distinguished by its air-filled bladder that stands up like a sail) is poisonous. Never swim behind a Portuguese man-of-war because the tentacles can stretch up to 45 meters (50 yds) and bear poisonous capsules.

•     Listen to the locals when swimming anywhere unfamiliar. With holidays taking people into tropical and sub-tropical waters today some are getting bitten by poisonous fish. Some of these bites can be dangerous so ask if it is safe first.

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There are other misconceptions which people have about meditation. Some people see meditation as an escape from reality or a selfish preoccupation. It is neither. A normal meditation time is twenty minutes, twice a day. This hardly constitutes an escape from reality, nor can it be regarded as selfish. Everyone needs to have time to themselves. It is not selfish to want time alone, it is natural and normal.

The disorder and agoraphobia mean we cannot contribute as much as we would like to our daily family situation. Practising meditation can mean a major step for our overall recovery. Recovery means we can contribute more, not only to the family but also to ourselves. Wanting to take time out, to help the recovery process, should never be considered selfish.

Taking the time to stop and meditate can be a problem for some people. Meditation is usually practised for two twenty-minute periods each day, although a number of people meditate for only one twenty-minute period each day and still find it beneficial. Other people tell themselves they can spare no time for meditation at all, despite the fact that the disorder may consume them twenty-four hours a day. It is a matter of making a choice in our priorities. It can mean the difference between ongoing anxiety, and our recovery.

Another myth about meditation is the idea that, when meditating, we may be leaving ourselves exposed to other influences. This does not and cannot happen. Even in the deepest phase of meditation we are always in complete control of ourselves. We are always aware of everything within and outside ourselves. When we are asleep we are not consciously aware of anything, yet we will wake up should there be any internal or external threat. In meditation we don’t need to ‘become’ aware because we are consciously aware, and consciously in control, the whole time.

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Psychotherapy has sometimes been the only treatment people have tried. It can be difficult to see the relevance of psychotherapy to anxiety disorders, but if we have a history of childhood abuse, or undergone some other trauma, psychotherapy is very important. Despite the sense of shame many of us feel over these issues, they do need to be dealt with for our long-term well-being. There are very understanding and caring therapists working in the area of childhood abuse, and the local public hospital or community centre can refer anyone who needs help to these therapists.

Even if there is no major past or present trauma, psychotherapy, in conjunction with other therapies, can be extremely beneficial.

Some of us are frightened of psychotherapy in case we find out we are ‘really bad’ people. This is one of the most common fears associated with psychotherapy, but it has no basis. We have this fear because we have never had a sense of who we are.

Take the risk. We will discover there is nothing ‘bad’ about us. Like everyone else, there will be aspects about ourselves we may not like. Only when we know these aspects can we modify and integrate them.

Psychotherapy means more than just looking at the problems and difficulties of childhood. It is not so much a process of who is to blame, as a process of understanding causes and effects. It looks at how we, as children, responded in certain situations. These responses created our defences, motivations and patterns of behaviour that we unconsciously carried into adulthood, but which may not be appropriate now. When we become aware of these responses, we are then able to change them if we want to.

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The disintegration of ourselves and our lives through the disorder and its secondary conditions brings a sense of hopelessness and helplessness. Suddenly, and in major contradiction to the fear of dying, we may find ourselves contemplating or attempting suicide. It begins to appear as the only way out. It is not.

Part of the danger of this development is that most of us will not discuss it with family members or our doctor. The sense of ‘this is not me’, and the shame and humiliation which we feel, counteract our most desperate plea for help. Most of us would never have considered ourselves as ever being suicidal. The realisation we are even considering suicide only causes further fear and confusion, which in turn isolates us even further. If we do find ourselves thinking of suicide, it is very important we seek professional help. Suicide is not the answer. Recovery is-and we can recover with appropriate treatment.

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Almost everyone I have been in contact with brings up this point: ‘If only I had known what was wrong from the beginning. If only I knew from the beginning how to deal with it. The rest— the secondary conditions—would never have happened’. To minimise the disorders and prevent the secondary conditions an accurate diagnosis and appropriate treatment is needed from the outset. A lack of diagnosis and/or inappropriate treatment leaves the way open for the development of the disorders and the secondary conditions.

Causes

Except in the case of post traumatic stress disorder, the causes of other anxiety disorders are still unknown. The disorders usually begin during or after a major life stress, or a period of continual stress. Much of the research has centred on panic disorder, and various theories have been suggested.

Physiological research suspects a chemical imbalance may be involved, although researchers are unsure whether any chemical imbalance is the cause, or a result of, the panic attack. Behaviour theories suggest that anxiety disorders are learned behaviours and recovery means unlearning the previous limiting behaviour. Psychoanalytic theory postulates that anxiety stems from subconscious unresolved conflicts which began during childhood. It is possible that the three schools of thought are each partly correct, and viewed together they form a whole picture of cause and effect (APA 1990).

Another theory currently being investigated is the role dissociation plays in anxiety disorders. Putman (1989) suggests that ‘dissociative phenomena exist on a continuum’ and range from ‘a normal process’ through to the most severe, dissociative identity disorder, which is the experience of separate multiple selves.

Dissociation can also be described as altered or discrete states of consciousness, or trance states. Dissociated states include: depersonalisation, the experience of being detached or out of the body; derealisation where ourselves and/or our surroundings do not seem real, as if we are looking through a white or grey mist; a sensation that our body has expanded or conversely has shrunk; feelings of floating, or of falling into a void; stationary objects appearing to move; and intolerance to light and/or sound.

From what I have found over the years, the ability to dissociate is very common in people who experience spontaneous panic attacks. It is interesting to note that once people who dissociate have an understanding of the phenomena, they report the experience of dissociation as being the trigger for the panic attack. Current research suggests the ‘sleep’ panic attack occurs ‘during the transition from stage two to stage three sleep’ (Uhde 1994). In other words, during an alteration of consciousness. I will discuss dissociation in more detail in chapter five.

Whatever the ultimate cause, people can still learn how to control the disorder naturally, without the use of medications. Learning how to control it means learning how to manage it without fear and panic. Unresolved childhood issues can also play a major role for people who experience anxiety disorders. Such issues need to be addressed and resolved.

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Occasionally people develop psychogenic reactions to food when there is no physical response. This can happen if someone becomes convinced that they are food-allergic or food-intolerant without undergoing proper diagnosis. They may decide that they react to particular foods, on the basis of a bogus diagnostic test or an elimination diet that is not properly carried out. Thereafter the reaction occurs obligingly every time they eat the food – but the response is a psychogenic one. This response is one of the pitfalls of self-treatment, but it can occur just as readily – if not more so – with treatment by fringe practitioners who use ineffective methods of diagnosis.

Psychogenic reactions of this type are most likely to occur in those whose symptoms are purely psychosomatic, but who prefer to think they are ‘allergic’ to food, because they see this as being a more respectable sort of illness. The medical neglect of psychosomatic illness and hypochondria must shoulder some of the blame in such situations, because the stigma attached to these disorders owes much to doctors’ negative attitudes.

Patients who mistakenly believe that they are sensitive to food often put themselves on increasingly strict diets as their symptoms persist, and they may become seriously malnourished. They are in need of sympathetic professional help to identify the true causes of their malaise, and should be persuaded to undertake psychotherapy or some other form of psychological treatment. Such treatment can be valuable even where foods are a major cause of symptoms, so undertaking this type of therapy is worthwhile for a whole range of patients, not just for those whose problems are purely psychosomatic.

Psychogenic reactions to food are important in the diagnosis of food allergy and intolerance, because a challenge with any food may produce symptoms if the patient is expecting symptoms. In order to separate real responses from psychogenic ones, dummy challenges, with foods that are known not to cause any reaction, are included in the double-blind trials. Most patients are expected to respond to some of these dummy challenges, but they should respond to significantly more of the real ones. These dummy challenges are also known as placebos.

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If you’re like most men, you know that a blow to your testicles can be excruciatingly painful, even if the same strike to another part of your body wouldn’t even warrant a bruise. The pain usually lasts for no more than an hour, and no permanent damage is caused.

If, however, you feel a sudden, severe pain in one of your testicles and it hasn’t been struck, you may have a condition known as testicular torsion, in which the spermatic cord—from which each testicle hangs— becomes twisted. This can happen either spontaneously or during physical activity. Testicular torsion can cut off the blood supply to the testicle, resulting in permanent damage if it’s not treated right away with surgery.

An infection in the testicle is also common; it can be quite painful. In men over 35, the usual cause of testicular infection is bacteria that have spread from the urinary tract.

A sexually transmitted disease such as gonorrhea can also be the cause of an infection in the testicle.

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Description and Possible Medical Problems

With many medical problems, we never notice that anything’s wrong until it’s too late. It can flare up—either a new condition or a familiar one we thought we were all through with—and then it’s all we think about. A problem with the intestine called diverticulitis is like that. If you have a fever and pain in your lower left quadrant and find that your bowel movements have changed—resulting in either severe, painful constipation or diarrhea—it’s possible that you have this disease.

In order to understand diverticulitis, you should first understand how the intestine works. The intestine is responsible for both the absorption of food and the disposal of the body’s metabolic waste. Since the feces can sit in the last part of the intestine for a while before being eliminated, the intestine can absorb a wide variety of toxins from the foods we eat. Our modern high-fat, low-fiber diet is frequently the cause of this disease; because the intestinal muscles don’t have to work very hard with this kind of diet, they can become weak. As a result, the intestinal wall in the lower large intestine can also become weak and form small pockets or sacs called diverticula. Diverticula usually cause no problem until they become inflamed or infected, a condition called diverticulitis. It’s believed that seeds or indigestible items such as nuts or popcorn can become stuck in these diverticula and cause an infection. If diverticulitis goes untreated, the diverticula can actually rupture like a bubble on a tire, and the contents of the intestine can spill into the sterile area of the belly, causing a severe infection similar to that caused by a ruptured appendix.

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