Sunday, September 21, 2014


    The law of cause and effect is known to all of us from childhood to adult life . As a child we learned that if you touch a hot pot , we will get burns.Or if we don't get good grades , our parents are not going to be happy. As adults we know that if we do not follow the speed limits and get caught, we will get speeding ticket. But in spite of that we don't change the behavior all the time. We know that eating too much and getting obese is not good. But we still indulge and get fat. Some of these things are obvious,at least to most of us . But then there are things that are not either obvious or not accepted by some .Many years ago , when I was new in my medical practice , I met a cardiologist. He was older than me by may be 20 years . When I met him for the first in a parking lot , I told him that I was a lung specialist.He lighted cigarette and told me that smoking is harmful was all bogus and there was no proof that it causes any health issues .There was no way I was going to convince him otherwise .Now this is very obvious today and even in those days , it was known though may be not accepted by 5 or 10 % of the people.But then there are situations where the cause and effects are not known.
      I was told this story many years ago by some one . In India the rain fall was low and there was water shortage and the summer was hotter than before . So the Chief Minister ( Governor ) appointed a commission to investigate the cause . After meeting several times and spending lot of money they came with a report. They stated that "the cause of water shortage is that Indian couples are spending too much time in Bedroom" The Governor was stunned . He did not know what was the relationship of couples spending time in bedroom and water shortage.Then it was explained that when the couples spent too much time in bedroom, they had more kids and that caused increase in the population.When the population was increased, they needed more land to build houses . So they had to cut trees and so the forests were gone and this led to reduction in rain and increase in temperature. Sp sometimes the cause and effects are not obvious . I know I have a very long introduction in my story.
      I saw this Asian patient in ICU . he had pneumonia . He was a smoker and had cardiac issues and had bypass done and and also needed a heart valve replaced.He had other issues and We had a hard time weaning him of the respirator. I did couple of Bronchoscopies and had to give steroids and antibiotics. We came quite close to doing Tracheostomy. After 14 days of struggle, we weaned him off the and he did OK . There ware several days before he was out of ICU and then took few more days before he went home . I continued to see him as out patient. He continued to smoke and continued to have lung problems. Over period of next year and half, he continued to have more problems . He ha d blood loss from stomach and intestine and had congestive heart failure and anemia with drop in blood counts. He was admitted to hospital several times and even went to Mayo clinic. Then he was diagnosed to have a disease in which body (bone marrow ) does not produce enough cells. So the blood counts drop and he needed frequent transfusions. He continued to smoke, The he was started on chemotherapy. This caused his immunity to get worse and he ended up with an episode of sepsis . He ended up on respirator.We worked him up and were successful in weaning him off the respirator.
     So I have a question . Is there any relationship of him having all these diseases and continuation of smoking ? Certainly the cigarettes have many toxins and I am not sure if there is direct relationship between them and all the problems that he had , but then we don't know why the smokers have higher incidence of all sorts of cancers including breast cancer or bladder cancer.But I am sure that there some cause and effect between smoking and at least some of his medical problems .

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