Tuesday, February 06, 2007

Call me Dr Killjoy.

In walks Minerva Bannister, her eighty year old frame propped up by a wheely-zimmer-stool thingy of impressively modern design, which she promptly reverses into place, applies the brakes and perches upon. She’s been summoned to the chest clinic and demands to know why. At least she does when she’s stopped gasping and spluttering after her shuffle down the corridor.

As she sits there it occurs to me, looking at her assorted list of ailments, that it is her atheroma hardened arteries that are holding her up more than her porous bones. Her leathery hide, wrinkled as any elephant, is tattooed with the accumulation of sixty seven years of nicotine exposure. She looks for all the world like a Neolithic peat-bog mummy. Just one with a bit of a cough. Oh, and a ten a day habit and a regular inhaler prescription.

Which last fact should have been a bit of a clue as to why she was in the chest clinic. And yet, somehow, the past six decades of medical advancement seem to have passed her by rather. It seems that when she was a young gel someone had told her smoking was a good and healthy thing to do, and she has stuck with that advice through thick and thin. The fact that she cannot now manage ten yards without gasping must surely be down to something else. And the angina she’s been getting for more than a decade. Everyone knows that’s all to do with cholesterol, and she’s taking her statins so that’s alright isn’t it. And anyhow the inhaler helps her to get about a bit better, and she never goes out anyway, hasn’t done for years, unless you count the shuffles to the newsagent for fags.

We do her lung function, just for fun, and it’s horrible. Effectively she has 20% of her predicted lung capacity and a “lung age” older than Metheusala. But still, her daughter-in-law intones, it would be cruel to try to stop her smoking. It’s the only bit of pleasure she has you know.

Would it be mean of me to speculate if dear Minerva is a woman of substance at this point?


Anonymous said...

What would stopping smoking add to her life expectancy? What about her quality of life? (Genuine questions to which I don't know the answer.)

Doctor Jest said...

Anon-- thanks for stopping by. Good questions. First, re the life expectancy, you're right to surmise that stopping smoking will have a marginal impact at best given that she's already made it to eighty. But, with each drag she takes she absolutely will deteriorate her lung function that tiny bit more. She has already begun to decompensate give she is so breatless on such minimal exertion and so anything that will slow the deterioration in lung function will slow the progress of her symptoms. Furthermore, when smokers quit their lungs "wake up" and resume more normal "housekeeping" through something called mucocilliary clearance.

Anyone who has ever quit smoking after any length of time will tell you that to start with they actually cough up more phlegm for a few weeks as the lungs sprig-clean themselves. Having got through that their breathing can improve a lot, and that is independent of any asthma like airways constriction the smoke might have been inducing, which should also improve if the habit can be kicked.

Sorry to go on, but hope that answers your questions.

sooz said...

Horse, water and 'not thirsty' spring to mind!

She's going to believe she's got 'this far' by behaving the way she has and perhaps doesn't see a future beyond her present days worth 'improving' for.

You could live for twenty years craving cigarettes but dying of misery and resentment that your 'only pleasure' has been taken away from you. I dare say to her - smoking IS breathing!

(why do I feel like I've just stated the obvious? LOL!)

Peat-bog lady - lololol that's so horribly visual and fabulously descriptive!

The dismal thing is that when she's gasping for breath and realises she could help herself - she'll be too late to do so.

Shinga said...

Maybe the DIL has had the conversation so many times that she can't see the point in causing more unpleasantness for no gain?

BBC 1 has a series called Street Doctor which is supposed to be taking the GP surgery to the streets of notoriously unhealthy cities. So far, they have been in Liverpool, Glasgow, Belfast and Newcastle but we have not seen a single incidence of either COPD or CHF.

COPD is wretched but I was entertained when a recent commenter told me that it is described as vanishing lung syndrome in Miroslav Holub's poetry colletion based on medical terms.

I realise that COPD isn't photogenic or interesting but it is debilitating when there is so much that can be done to mitigate some of the symptoms. I wouldn't be so annoyed if COPD were unusual or people were consulting their GPs about it but according to a recent study in the UK, 80% of people with COPD do not have a clinical diagnosis.

Regards - Shinga

Anonymous said...

Well, my Mum died at 68, she had a heart attack. Allergic to the Dr, a heavy smoker (in 'secret' for 20 years)...she was very breathless...this turned out to be heart failure. We all thought it was COPD. 6 months before she died she finally saw the Dr. because the nurse took her blood pressure when she had a flu jab. It was through the roof. Dr put her on blood pressure meds. and gave her ventolin. She started getting stomach pains so stopped eating. Dr changed medication. Lost 3 stone in 3 months, living on water. Had some investigations on her digestive system. Then she died. Turned out the stomach pain was probably the heart not pumping enough blood to the organs. Blood test she had the day before she died showed the heart failure. Why didn't I stop her smoking? Why didn't I make her go to the Dr before?

Nostrumdammit said...

Dear Dr Jest,

Forgive me for post-commenting out of synch but the attached was on my e-desk this morning and having seen it, I thought of you.


Doctor Jest said...

Sorry it's taken so long to get back. i blame the snows, and the flu in equal measure. (Not mine though I hasten to add....)

Sooz-- I fear you are right on all counts, but just sometimes you get to catch a person right at the poiint they are ready to make a change, not perhaps often enough, but sometimes...

shinga-- what a fascinating book. I must admit to being a bit boggled by the concept of a poet-immunologist. tThen again I have always had real problems understanding immunology, perhaps viewed as poetry it might make more sense... or perhaps not. You're right about COPD being under diagnosed. Some of the problem is that as it gets worse folk tend to go out less and less and so are very unlikely to present. Part of it is also the verbal shellacking they expect to get about their smoking when they do...

anon-- don't beat yourself up. No-one can be made to do anything they don't want. If a smoker isn't ready to quit no amount of input will make them. Best we can do for any ailing relative is to be there to offer support and comfort when needed, and from what you write I'm guessing you did just that. No more could have been asked of you.

Nostrum-- no worries and thanks for the reference. Shame it wasn't more widely publicized south of the border.

R Mutt said...

So stopping tobacco will have a minimal effect on her life expectancy, but a lot of effect on her lungs.

What about suggesting she takes up chewing tobacco instead?

Her lungs would clear up and she'd still get her nicotine fix.