Smoking

In 1999, many sports writers declared Tiger Woods athlete of the year. Unfortunately, his father, Earl Woods, is battling heart disease and cancer. Tiger Woods does not smoke. But his father continues to smoke inspite of ill health. A father, who is so proud to have raised and trained a complete golfer, is unable to quit smoking! Why?

Earl Woods is not alone hooked on this. Millions of people all over the world are in the same boat. Their pockets and health have been high jacked by the tobacco industry. The advertising technique used by tobacco industry has millions of people on the “weed”. Once they get hold of us, the noose tightens slowly.

But some smokers are fighting back. Over the last 30 years or more, many smokers have realized the damage done to their health by tobacco industry and have sued the tobacco companies for millions of dollars.

On July 15th, a headline in “San Francisco Chronicle” says: Big Tobacco Bashed by Verdict – Jury awards record $145 billion in punitive damages to thousands of sick Florida smokers. The report says that in the largest damage award in U.S. history, a jury in Miami-Dade County ordered the tobacco industry to pay $144.8 billion in punitive damages to 500,000 sick Florida smokers.

The report says the case was history making in other ways as well. Top executives for the tobacco companies, who rarely testify under oath, took the stand to say that their companies have changed, that they are spending millions to discourage underage smoking and are repentant on the way business was done in the past.

Have we noticed any change?

A document produced by Alberta Cancer Board, called: Cancer and Tobacco – The picture in Alberta, March 2000, has interesting statistics on Smoking Behaviour in Canada.

About 21 percent fewer Canadians use tobacco now than did 30 years ago, an encouraging statistic that is unfortunately offset by a grim one – smoking among teens increased by 25 percent over a four-year period in the early 1990s. But, it adds, fortunately, the percentage of teens smoking has decreased since then.

What about Alberta?

Twenty seven percent of Albertans aged 15 years and older were smokers – 2 percent higher than the national average. Twenty seven percent of Alberta males and 28 percent of Alberta females were smokers – the same as national average for males, but 5 percent higher than the national average for females.

Should we rely on the tobacco industry to help us quit smoking and prevent our teens to stay away from cigarettes? Well, that is a ridiculous question!

But the simple answer is – NO, we have to do it ourselves. We cannot even rely on our governments. Governments can pass as many laws as we want. But there are always people who can find loopholes to abuse the system. And we do not have enough money or the manpower to enforce these laws. So, they are no good anyway. What is good is our will power. And we have to search for that within ourselves today, not when our life is threatened.

That is tough. But if it was easy then we would not lose 3,500 Albertans and 45,000 Canadians each year from smoking – more people than killed by heroin, cocaine, alcohol, AIDS, fires, murders, suicides and car crashes combined.

So, be tough and do it today!

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Colon Cancer

Dear Dr. B: I have a strong family history of colon cancer. I would like a blood test done every year for early detection of colon cancer. What about CEA blood test that colon cancer patients get so frequently? Why cannot my family doctor order this test for me to make my life easy? Asks Mr. C.

Dear Mr. C: CEA stands for carcinoembryonic antigen. This test has been available for 35 years. It is currently used for patients who have been diagnosed with colon and rectal cancer. Enthusiasm for this test among surgeons and cancer specialists has fluctuated over the years. Originally, the use of this test was poorly controlled. But now the dust has settled and CEA has emerged as the test of choice for patients with colon and rectal cancer.

This test is not good for early detection as there is 30 percent false positive and false negative results in patients who have had no previous colon cancer. Patients with false positive results end up getting many unnecessary investigations. And patients with false negative results may have a false sense of security that they do not have colon or rectal cancer although they may be harbouring one!

CEA is also elevated in other cancers and benign conditions. Therefore, it is hard to be sure if the high level is due to colon and rectal cancer or due to other cancers or benign conditions.

Therefore, the surgeons order CEA after the diagnosis of colon and rectal cancer has been made but before the cancer is resected. CEA provides some idea to the surgeon about prognosis and whether the tumour has already spread. Lower levels indicate limited spread. In about 50 percent of cases, high CEA and increasing CEA after the cancer has been resected, indicates that the cancer has already spread or recurred.

If CEA is high before surgery then it dramatically drops after surgery if the patient has no spread. Then CEA is tested at frequent intervals to see if the level remains the same.

After 33 years of CEA use, the experts have not been able to agree how often CEA should be ordered after successful resection of the cancer. Some do it every month, others every three months for the first two to three years as most recurrences are expected to occur during this critical period. Then the frequency of the blood test is reduced as longer one survives, better the prognosis.
So what is there for early detection of colon and rectal cancer?

Examination of stool for occult blood on regular basis combined with or without endoscopy (flexible sigmoidoscopy or colonoscopy) are currently the best screening tools. Again, each test has its advantages and disadvantages. The optimal method for early detection remains uncertain and people’s compliance rate very poor, as the tests require certain amount of preparation and time. When it comes to colon and rectum, the tests are not very comfortable.

But screening is very important. It has been shown that screening for colon and rectal cancer has reduced mortality by 15 to 33 percent in those who undergo screening routinely. Colon and rectal cancer is the second leading cause of cancer-related deaths in Canada. Therefore, besides screening, early investigation of symptoms like rectal bleeding and change in bowel habit is very important if we want to improve prognosis and survival.

So, Mr. C, discuss with your doctor other methods of early detection as CEA is not a good test for screening for colon and rectal cancer.

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Prostate Cancer

Dear Dr. B: What is PSA? I believe this a blood test to check for prostate cancer. If this is true then why is my family doctor reluctant to order one for me? Can you please tell me more about this test, who should get it and how often? Yours, worried Mr. P

Dear Mr. P: PSA stands for Prostate-Specific Antigen. Yes, this test is now widely used for early detection of prostate cancer and to follow the progress of patients who have had prostate cancer.

Prostate cancer is now the most commonly diagnosed cancer in Canadian men and second most common cause of death from cancer in men. Prostate gland is present only in men at the junction of the urinary bladder and the urethra. PSA was thought to be produced and secreted solely by the cells of the prostate gland. But this is not true anymore. PSA is also found in breast cancer and other cancers.

Once upon a time, digital rectal examination was the only crude way to pick up early prostate cancer. Then came PSA blood test. PSA was expected to replace the embarrassing and uncomfortable digital rectal examination. And it was promoted as an ideal test for screening and early detection of prostate cancer. But this hope has not materialised. And the controversy continues.

In a recent edition of the Canadian Medical Association Journal, there are two commentaries on this issue. One is written by two family physicians and the other one by a urologist.

The family physicians feel that PSA testing in men over 70 should be avoided. They restrict the use of PSA screening to men between 50 and 70 years of age unless they are at higher risk (e.g. black American men and those with a family history), in which case screening is initiated at 40.

How often the test should be ordered?

According to the family physicians, the literature survey suggests that PSA should be ordered anywhere from every 2 years to every 5 years. Normal value should be less than 4 ng/mL. Another report suggests that men with PSA results of 4ng/mL and below should be tested every 6 months for at least 3 consecutive tests.

Currently, these family physicians recommend PSA every year for eligible patients but feel that screening every 5 years is a reasonable alternative.

The urologist’s commentary agrees that PSA testing for all men between 50 and 70 is a good idea. But PSA screening every 5 years may be inadequate. The urologist feels that yearly testing is reasonable unless the PSA level is below 1 ng/mL, in which case testing every 2 years is acceptable.

In about 20 percent of patients with normal PSA results, diagnoses of prostate cancer will be missed, which supports the idea that digital rectal examination is an important additional diagnostic tool. But digital rectal examination on its own will miss a substantial numbers of prostate cancers.

The urologist feels that the upper limit of normal (4ng/mL) may be too high and it would be prudent for family physicians to refer patients to a urologist if the PSA result is above 2.5-3.0 ng/mL.

So, Mr. P, have I confused you? If yes, then you are now on par with other doctors! The last word on this subject is yet to come. But I hope this information will help you put your doctor’s advice in proper perspective.

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Father’s Day

Recently, my neighbour died. It was unexpected. We were shocked. When I gave the tragic news to my son, his first reaction was: Dad, what will we do without Mr. Link?

On this Father’s day, my thoughts are with Waldemar Link. Waldemar was not only a good neighbour but he was like a father to us and grandpa to our children. When we moved into his neighbourhood 15 years ago, Waldemar and his wife Herta showed us the selfless true spirit of good neighbourhood. Whether it was to mend a fence, check a leaking roof, build a deck, take care of the dying cedar trees or check the mail and look after the house during our holidays, they were always there.

Just a week before he died, Waldemar was there helping my son, Hussein, get a CB radio antenna cable into his room through a tiny hole in a window. If we had a problem in the house or the backyard, our first reaction was: Let us check with Mr. Link!

On Father’s Day, we usually pay tribute to our real fathers. My father died nine years ago. My wife’s father died one year ago. Both had long and happy life except at the end when they suffered from painful illnesses that made their life uncomfortable. Both were lucky to live long enough to see their large families grow and settle down in life. Both were quite satisfied before their death that they had fulfilled their role in life as good fathers. They were always there when we needed them. And they gave us the security and education to be independent in life.

We were lucky to have our fathers when we were growing. But what about those young children whose fathers have been taken away from them by accident or illness? And there are fathers who have chosen to abandon their children due to reasons, which are difficult to understand by third parties. Then there are fathers who have committed or continue to commit acts of terror on their children. These young children are being raised in one parent family. Do we really understand how they feel on this day or rest of the year?

What about single parent fathers who struggle to be good mothers as well? Does society understand and appreciate these fathers?

Most fathers try very hard to be good role models for their children. But not all fathers are paragons of virtue. We, as fathers, make mistakes like other humans. But the important thing is to learn from these mistakes. Father’s day should be that day of reflection to see where we failed and where we can make a difference. What counts is the learning process of self-improvement. There are no schools for fathers to train except what our own fathers taught us. Are we true to those teachings?

Sonora Smart Dodd started Father’s Day on June 19th, 1910. Sonora was raised by her father after her mother’s death. Sonora’s father was born in June. So, for 90 years, third Sunday of the month has been celebrated as Father’s Day. On June 18th, 2000 let us reflect on our past and plan a future for our children so that they can carry our message to their children.

Happy Father’s Day!

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