A 42-year-old reader plans to give up smoking in the new year. She is partly motivated by the thought that smoking may induce an early menopause, a wrinkly face and hands, and potentially lethal problems such as heart disease, chronic bronchitis and emphysema as well as lung cancer. The other reason why she wants to give up is that her partner won’t allow smoking in the house. As a result she has to go to a café, or lurk in her porch. Not much fun in the cold. She asks if it is true that smoking will soon be banned in cafés, so that for her in future it will have to be the doorway — or abstinence. The reader hasn’t said whether she has children — if so, there are several good reasons, other than her husband’s objections, why she shouldn’t smoke. Passive smoking increases the incidence of cot death, respiratory infections in children such as coughs and colds, and doubles the incidence of asthma and serious chest infections. The pro and anti-banning smoking lobbies argue about the statistics of passive smoking in adults and their significance, but no one would disagree about its harmful effect on babies and young children.
I would have included two more reasons for not smoking: it not only causes cancer of the lung but also, especially when combined with alcohol, cancer of the tongue, mouth, larynx and oesophagus. There is an increase in several others cancers, including that of the bladder and cervix. The other point is a cosmetic one. Because it affects the elasticity of the skin and connective tissue in men and women, smokers develop heavily lined faces and lax skin on their hands. But what people rarely realise is that the skin and connective tissue of the buttocks and thighs are also affected by this loss of elasticity. Even in their twenties smokers have such poor connective tissue elasticity that they have the saggy bottoms of someone 30 years older. Although this has been observed for years it is only recently that doctors and beauticians have given warning about it.
Smoking in public places where food is served is not yet outlawed, but the necessary legislation is on its way, and is due to become law within 18 months. This week the Primary Care Trust Association, the governing body of the NHS, has called for a total ban, and earlier than the one under the new legislation. Since the prime purpose of the café is to sell food it is inevitable that if our reader continues to smoke she will have to do so forlorn and cold in the doorway — just as office workers do.
Smokers are notoriously bad at giving up. I am glad to hear about our reader’s new year resolution. However, she will probably also need some form of nicotine-replacement therapy to help her. There are now myriad ways of taking nicotine to lessen withdrawal symptoms. Another possibility is Zyban bupropion; these are slow-release tablets that alter noradrenaline and dopamine levels in the centres in the brain responsible for withdrawal symptoms in those previously addicted to nicotine. Zyban shouldn’t be taken by people with any psychiatric history, especially those with bipolar disorder (manic depression), eating disorders or those who are withdrawing from alcohol or benzodiazepine addiction. Zyban should also be avoided by people with epilepsy or cerebral tumours. High blood pressure should be monitored. Zyban is available on prescription only.
Life with her 67-year-old retired husband has become a misery for a reader. She relates the difficulties that she encounters with his behaviour, all of which might try a saint but, alas, our reader is no St Roch and her husband is sorely afflicted by several serious physical and psychological troubles. He has Parkinson’s disease, diabetes and high blood pressure. The Parkinson’s has destroyed his ability to sleep, he is overweight, is a trumpeting snorer, shows no emotion, moves slowly, walks awkwardly and without swinging his arms, doesn’t show any response to affection or kindness, is irritable, impotent and smelly. He has severe dandruff and a fungal infection of his skin. He is depressed.
Only Hollywood assumes that marriage and the initial euphoria that accompanies it remains unaltered and is perpetually blissful. Even the Prayer Book isn’t as optimistic and warns us that marriage is for better or worse. Our reader is now deep in an “or worse” patch and is having to deal with the consequences of the symptoms of two appalling medical problems. It is bad enough for her, but even worse for her husband.
The reader asks if depression is always associated with Parkinson’s. Having read her husband’s catalogue of problems it would be surprising if it wasn’t — but it isn’t. Fifty per cent of patients with Parkinson’s are depressed regardless of their troubles, and in half of these there is also some intellectual deterioration. The husband’s intellect is apparently as sharp as ever.
The symptoms the reader complains of are among the most common of diabetes and include the high blood pressure, the impotence, excess weight and with it snoring. Her husband’s slow stiff walk without swinging his arms are classic features of the Parkinson gait. Loss of libido is associated with depression, his inability to show emotion is an early sign of Parkinson’s disease. When I was a young doctor I was able to help an overseas colleague become established in the UK, and helped him to find a job. We kept in contact, and he came to dinner in London. The once cheery, smiling fellow doctor appeared to be surly, emotionally blunted, lacking in animation and apparently uninterested in our fellow guests, as well as with both medicine or politics, about which he had previously been enthusiastic.
He didn’t join in the conversation, didn’t smile, but sat silent, impassive and apparently disapproving. Several years later he sent me a book he had written about the effect of Parkinson’s disease on a young man. I felt thoroughly ashamed that I had missed the diagnosis and mistook his impassive unemotional face for boredom and irritation. He was no more responsible for his unamused, unfriendly expression than a child is responsible for a swollen face with mumps. The same principle applies to all the other symptoms of our reader’s husband. Even his greasy, itchy fungus-infected skin and excessive dandruff are symptoms of Parkinson’s disease. His smell may not be because of lack of hygiene, but may be the consequence of urinary troubles associated with diabetes.
Difficult as it is for our reader she should try and take a leaf from St Roch’s book. He was able to display love and compassion to sufferers from the plague and smallpox. It might be helpful if our reader could track down a Parkinson’s nurse through her husband’s neurologist, or the Parkinson’s Disease Society. They are great at knowing sometimes simple answers to apparently mundane, but distressing, problems. They are also adept at liaising with GPs and neurologists.
www.parkinsons.org.uk — 0808 8000303
Ask Dr Stuttaford
Send your questions to drstuttaford@thetimes.co.uk or to times2, The Times, 1 Pennington Street, London E98 1TT. Please include the following: the symptoms (and how long they have been present), the person’s age, sex and marital status. Dr Stuttaford’s replies cannot apply to individual cases but should be taken in a general context.
