Dr George Karimundackal on Tobacco Side-effects & Prevention of Thoracic-Lung cancer

Hinzugefügt: 2026-06-01

[00:00:22]Heat. Heat.

[00:00:48]Heat. Heat.

[00:01:12]Hello and welcome to Health Live at Seniors Today.

[00:01:16]It's the last Saturday of May and May 31st every year is observed as world no tobacco day. In fact, it's also called world tobacco day and we try and have a session every year on the side effects of tobacco and the various health ailments it leads to. And today we've invited a senior uh enco surgeon who will be speaking about tobacco side effects and prevent and prevention of uh lung cancer. Uh we had announced that we would have uh Dr. George Kermanal who is a senior surgical oncologist but you know it's a Saturday evening there are OTPs surgeries to uh to be conducted and Dr. George is not able to make it but we've fortunate to have a senior uh encouat uh max hospital Dr. Vive Mundere and he is going to be speaking to us. Before I invite him to speak, I must introduce him. So as I mentioned, he's a consultant for thoracic uh lung cancer program, cancer reconstructive surgery. He is associated with the center for robotic surgery at the Nanawati Max Hospital which is in Mumbai. Um he has uh uh been with the Nanavati Hospital since November 2022 and before that he was with the Institute of Chest Surgery at the Midanta Medic city at Gurubam and uh before that at the Delhi state cancer institute and the Asian Cancer Institute in Mumbai and he was also associated for briefly with the PDA Hinduja Hospital.

[00:03:04]He has uh uh done his MBBS from the Lok Matarak uh municipal medical college in Mumbai that is the scan medical college.

[00:03:12]He's done his DNB from the Baba Saba Merkar Hospital in Bala in Mumbai. Again fellowship in thoracic surgery from the Tata Memorial Hospital and the DNB in thoracic surgery from the Gangaram Hospital in in in in in Delhi. He is um uh you know several areas of interest.

[00:03:30]He's done a lot of research papers u uh that he has presented and we are fortunate to have him here. He will be speaking about as I mentioned uh about the uh bad effects of tobacco and how it could lead to lung cancer and welcome to health live at seniors today Dr. Vive Mandre how are you?

[00:03:50]>> I'm good thank you so much for a very kind introduction that was so nice of you. Uh I first of all I would like to be you know would like to thank SAS today to having to have me here to present about tobacco. Uh I I I'm really sorry on behalf of Dr. George. He actually had to travel at the last minute and so he couldn't make it and that's why he requested me if he could I could fill in. But I'm actually happy I get this opportunity opportunity and I do want to congratulate this initiative of seniors today. It's a very it's a very good initiative you know to be uh you know breast about all the knowledge related to health. I'm sure you'll be you know uh uh discussing about other aspects of life as well. But it's a very good initiative. I congratulate you all for that and uh without further ado I think let's start with our presentation.

[00:04:39]Uh so I do have a PowerPoint presentation. I'll not be going into each and every aspect which are mentioned in the slides because it's going to be very busy slide. But at the end of it, I would want you to understand how tobacco affects uh you know person's life and at the end of it one disease which everybody is worried about uh the lung cancer which has the you know it's number two in prevalence in in India and it's one of the major killers in cancers in India how to prevent it because prevention is better than cure as we all know. So I'm Dr. Vive as uh Mr. Mahwari kindly introduced me. So uh is everybody able to see my slides or no? Not yet.

[00:05:18]>> No, we're not able to see your slides, doctor.

[00:05:20]>> I'll share it again. Sure, sure. Sure.

[00:05:22]>> So even as doctor is getting his presentation ready, remember this is being recorded on May 30th, 2026. If you're watching this two years later, do note that there are advancements in medical science. So do update yourself.

[00:05:35]We will be conducting these sessions on a regular basis. In any case, um do remember that a session like this is advisory in nature. In case you do have any concerns, you should speak meet uh a qualified medical practitioner. You can of course also speak meet Dr. Vive Mund at the Nanavati Max Hospital and also look at various options for teley consult. Over to you doctor.

[00:06:03]So good evening all. So I'll be discussing about effects of smoking and prevention of lung cancer. uh we all know smoking is bad but we all still know that the you know people still smoke people who know that it's bad still continue to smoke so what it is in the smoking so before going on to that let's see the global burden of smoking as mentioned all these values in billions and millions there are total 1.3 billion tobacco users uh you know worldwide out of which you know 8 million plus deaths you know uh of all the deaths in the world 8 million plus deaths happen because of tobacco out of which 7 million are because of direct tobacco use and 1.2 2 are because of secondhand smoking and this number is actually next to you know deaths related to hypertension uh you know related causes. So if we look at uh smoking prevalence in India, India stands here you know it's there are 29 it's 29% of population which is using tobacco in some extent to some extent what so uh deep deep diving into the prevalence of smoking when it comes to gats analysis that's global adult tobacco use when uh analysis was done in India so 28.6% 6% was you know found of population was found to be using tobacco to some extent out of which 42.4 Four were men, 14% were female and 19% were using smoked uh smokeless tobacco. But if you this is adults so you know of all the total population actually uh 7 to 11% of people are using tobacco to some extent 4% of it as you know people are actually using BD and around 7 to 9% will be uh cigarettes. But if you see the global youth the GTS that's global youth tobacco uh uh index still there are high number of people who are using tobacco. So around 4.6% of population is of youth population is actually using tobacco.

[00:08:09]So why is tobacco or smoking bad? It affects almost all the system. You name it and it has an effect. And see in body is a single machine. You know we have you know divided into respiratory system, respiratory medicine specialty, cardiothoracic surgery specialty you know gastro gastrointestinal specialty but all in all body you works as a unit.

[00:08:34]So if one system falters it the body is going to hit get a hit and it is going to be affected and smoking is affecting almost all the systems. The main impact will be on the respiratory system. As we all know people have COPDs, they have emphymas because of smoking and it actually increases the uh risks of developing lung cancer. Second system it affects is the cardiovascular system.

[00:08:58]The people are going to have more of heart attacks, more of hypertension, more of strokes or more of any peripheral vascular disease where you know the people have gangrinous limbs.

[00:09:08]All this is imminently life-threatening and it can lead to death. If not death, you are going to be affected by it. The morbidity of it is going to be so much that your life, your work and your life, your the quality of life is going to get affected. When it comes to cancers, the you know uh smoking increases the risk of lung, oral, throat, even esophagial cancer, even bladder cancer, pancreatic cancer, the risk of it increases once you are a smoker.

[00:09:39]Other systems as you know a female who is a smoker if he if she is a childbearing female the the child itself gets affected even if the p if the person has been an old smoker uh the vascularity or the vascular effects of the smoking are so much that the child may have issues. Now uh a fine point u you know when we are treating patients who are smokers is that uh apart from smoking they might have other coorbidities which might affect their vessels blood vessels especially the smaller blood vessels. So when we are doing some complex surgeries the healing depends upon the blood supply reaching to that site of surgery or to the site where the repair is required. with more and more vascularity especially after smoking or maybe be diabetes what happens the blood supply is pretty much lesser. So there are these people are actually at more chances or a more you know probability of having complications after surgery. So be it it's not only you know about developing cancers even if we are undergoing treatment you are at risk of developing complications more common more commonly.

[00:10:48]So you know if not cigarettes what about ecigarettes they are equally bad they are not as bad as smoking but you know it doesn't mean that you should go on smoking ecigarettes they have a lot of harmful material be nicotin beat formaldihide be it uh alihides be acryine there are a lot of common chemical uh you know especially even heavy metals which are there in the vaping smoke. So all in all the underlying factors that you should avoid vaping as well. It has equal amount of uh harmful effects on your systems. So if we compare to you know tobacco smoking might say it's not going to be as harmful but doesn't mean that they're good. So it should be avoided. There is no particular data per se as of now. The data is yet to be mature. You know where a vaping is attributed as or like a particular cancer or particular disease is attributed to vaping. Slowly and steadily as the years pass as we get more and more data, we might be able to attribute vaping as one of the risk factors to one of the cancers or one of any of the illnesses. So it's always better to avoid vaping or ecigarettes as well.

[00:11:56]Now when it comes to smoking, if you compare it with alcohol, smoking is actually more addictive. There are, you know, a person there are more chances of, you know, you getting hooked to smoking than you getting hooked to alcohol. Of course, both are bad. I'm not denying that. But you know the effect of smoking is so powerful. Once you take one drag, it takes a few seconds for the nicotin to reach brain.

[00:12:22]And that's how quickly the brain gets and it gets you know used to such a quick uh uh kick of nicotin in your brain a kick of dopamine after you know which gets released after the nicotine reaches inside and after that you get more and more hooked to it so that you want a quick release of dopamine in your system compared to that alcohol leads to release of dopamine a bit slowly. So you know there are people who will be moderate or you know low-level drinkers and still not be addicted to it.

[00:12:57]And in here in this top statement as it mentions it's tobacco smoking can be actually comparable to heroine or cocaine smoking or cocaine addictions.

[00:13:07]That's how bad it is. It's very difficult for smokers to quit smoking than for alcoholics to you know quit alcohol. uh we you know during our general surgery training we had seen a lot of patients who had lower limb uh eskeeia the lower limb uh vascular issues uh and so much so that their nerves never used to get adequate oxygen or adequate blood supply and that these nerves used to cause a lot of pain it's called cry of dying nerves the patient will be in severe pain so much so that it makes them suicidal but still they'll be smoking if I tell them please quit smoking they said drops we'll not be able to do it that's how strongly you get hooked to it and you know it is causing so much of a bad effect so why go that way so that's how I explain patients when they come to us so now we know that smoking is bad smoking you get hooked to smoking easily then how to you know prevent uh you know how to prevent uh smoking or avoid smoking so all the strategies which are mentioned are most of counseling part of it. So on the right side upper corner there is one column of school and youth programs. So when it comes to preventing something there are various levels of preventing.

[00:14:26]One is a primordial prevention, one is primary prevention, then is secondary and tertiary. Primordial prevention is one where you know X is a risk factor for a disease. So if you want to stop prevent that disease stop that risk factor only from developing right so you know you are going to get hooked to smoking smoking is considered to be fancy it's considered it has a aura to it you know Bollywood say Bollywood movies or whatever the reason it has an aura to it so people are or youth can go into it so it's always better to target youth because they're going to be future of the country if they can stop or they are enlightened. They know that smoking is bad. Whatever has been portrayed as wrong and smoking is actually bad for you. You can actually make a more impact on the society. It will be more impactful when it comes to you know growth of nation as well. So I know all you are senior citizens all of you are going to have grandchildren. I would you know urge you to you know tell your grandchildren so that you know they are well ab breast with the knowledge when it comes to policy and legislation we per se as general public have a very low kind of a control uh in uh but uh you know government is trying to do uh you know bring in policies which can stop smoking but there's a lot of resistance to it as well again increasing the cost of cigarettes I personally feel it's not going to help but still government has done it.

[00:16:01]Secondly, putting you know goddy pictures on the packets which will you know make people uh you know averse to smoking. These are other things u other sorry jump to next sorry yeah in healthcare settings when the patient comes with smoking we always try to counsel them. You ask, advise, assess, assist and arrange. Of course, there are other ways in which you can uh deaddict a smoking person. We'll see it later. So, how do you de-addict? So, now we have seen how to do primordial prevention that you know do counseling and do uh you know ways in which people will be will not go the smoking way. But now once the person is hooked to smoking, how do you stop him from smoking? Uh am I audible because there's few messages I can see on the chat.

[00:16:56]No, it's okay. You are you're audible >> perfectly. Okay.

[00:17:00]So, uh one is behavioral therapy. Most of the patients uh you know we will uh benefit by behavioral therapies be it individual behavioral therapies or joining a group or joining a you know a cult where you know you are going to uh like in alcoholics anonymous. So any group or group activity will be more helpful. uh you know certain people just suddenly stop smoking. So it is basically your mental framework or your it's a mental and addiction is a mental state which can be controlled by effective uh uh counseling. Secondly you try and give body nicotine through other other uh sources like nicotine patches, nicotin loenes, nicotine gums. So all these can be tried. If not then you can uh go for a pharmacotherapy. There is a specialty of uh doctors which practice this deaddiction tobacco de addiction and they are generally uh you know very good at it. So if there is somebody who has a severe uh problems of smoking, you can actually go and uh consult such behavioral or tobacco uh specialists and sorry it's jumping like anything.

[00:18:23]Okay. So uh once you stop smoking you have to take care of withdrawal symptoms as well because patient is person is going to have a lot of withdrawal symptoms and that's where your specialty management centers will come into picture.

[00:18:37]Unfortunately India doesn't have such a strong smoking sision program but you know as the years pass the uh awareness is getting better. there are more and more specialist especially uh you know institutes like Tata Memorial is actually working towards it and I'm sure they'll you know we'll come up with a better and a solid program for de addiction in smoking so we know smoking is a risk factor for lung cancer what are other risk factors so as we see on the pie chart 85% the risk factor 85% of uh lung cancer patients you know you can be attributed to uh smoking but there are other multiple risk factors like air pollution Now it's been found to be a grade one uh carcinogen. Uh be it uh air pollution, be it uh secondhand smoking, be it exposure to aspestos, arsenic, chromium, nickel, redon as well. So all these are risk factors for us common people smoking be it active smoking or be passive smoking that's one of the risk factors. Then is air pollution and people in cities like Mumbai, Delhi, all the metro cities are exposed to it. So we are at risk of uh lung uh lung cancer especially when the PM 2.5 goes more than 60 it is a high-risk kind of a scenario. Most of the times when I was in Delhi it used to cross 300. So PM 2.5 means uh you know particulate matter which is less than 2.5 microns in size.

[00:20:06]The smaller the particle the more and more distal or distal inence deeper it can go into the lungs and it can get deposited into the lungs.

[00:20:14]which is what is going to irritate the lungs and start you know developing cancer there. Bigger particles generally get trapped in your upper airways and get extered out but these smaller particles are the ones and these are the particles which get released by your your uh vehicle emission your construction work which happens and the other industrial activity which happens.

[00:20:38]So when it comes to smoking as we see on downstairs how much do you smoke is also important. So who has said anything more than 30 pack years. Now it you know the risk factor has been changed to 20 pack years. What 20 pack year means is if you uh smoke one pack a day continuously for 20 years that makes 20 pack years. If you're smoking half a pack for 20 years it's still 10 packers. So it's one pack year into one pack per day into 20 makes it 20 pack years. If you're having half a pack for 20 years it's half into 20 makes it 10 pack years. So uh when a person is having 20 pack years history they are more prone definitely more prone to develop cancer.

[00:21:29]But that doesn't mean that person who's having lesser than 20 uh 20 packers even cigarettes between 1 to 9 per day significantly increases the risk.

[00:21:40]So now how air pollution is going to cause cancer. As I said your PM 2.5 is the most important factor. The smaller the particle size the more it is going to you know affect. But other pollutants like PM10 even they can cause cancer because they can go up not up to the most distal parts or the most distant parts of your lung but even proximal a little proximal or you know some parts of lung uh uh things other chemicals which can cause nitrous dioxide even ozone is a risk factor uh diesel exhaust particles.

[00:22:14]So you know all in all we as city dwelling people are exposed to all this you know every day. So uh other uh fine point about uh population in India or in uh you know Asia is we do have something called as an EGF or mutant uh mutation which might be innately there which you know which makes us more prone to develop lung cancers when we are exposed to such pollutants or smoking. So you can imagine a person who is staying in city who is exposed to who is exposed to uh these pollutants on top of that if he's smoking the risk is actually going to be double or maybe triple.

[00:22:54]So as I discussed earlier there are levels of prevention. The best is primordial prevention. Hit the risk factor itself and the disease will be prevented. But not always you can do it.

[00:23:06]So primordial prevention as we said you know you target the general population you expose them to the knowledge that the tobacco is bad smoking is bad so that they don't go the smoking way.

[00:23:17]Uh primary prevention is when the patient or the person is smoking you try and stop the smoking so that he doesn't develop lung cancer. So primordial is when you don't let them go to smoking.

[00:23:31]If they are smokers try and dissuade them so that they go into de addiction programs so that they don't develop cancer. Secondary prevention is where the patient has smoked adequately or patient has got a cancer but you catch it early. That is where the role of lung cancer screening comes. Now there have been multiple trials for lung cancer uh lung cancer screening in the world but they had you know included only the smokers and there were strict criteria which you know uh of patients which they had included. It's now a worldwide standard to start screen them. So the criteria is if you are a a smoker aged between 50 years to 80 years 50 to 80 years with a smoking history of 20 packers or more then you are a candidate for lung cancer screening. Okay. Now uh if you have left smoking so if you say you know I've left smoking like 5 years back. So if you have left smoking less than 15 years back but you had a history of 20 pack years in the past you are still a candidate. A person who has left smoking for more than 15 years can be termed as a non-smoker and if he has not developed cancer in those 15 years more likely that he will not. Now mind you these are all guidelines. These are not you know absolute principles. A person who wants to wish to screen himself as uh you know for lung cancer can definitely go ahead and once uh so it this is early diagnosis. So tertiary prevention is when you have been diagnosed but to expedite your treatment in such a way and give you the best treatment in such a way that you know you don't have to uh deal with recurrence of cancer or death.

[00:25:21]So strategies for lung cancer prevention prevention is first is tobacco control uh which is going to be the most impactful because most of the lung cancer is attributed to smoking. So once you stop smoking or you prevent smoking it's going to be best. Uh then is air quality improvement. uh although it is also part of government strategies to improve air quality, it's as citizens it's our job also to be uh aware about it and to contribute to it. So you know uh when Modi G had said key please don't uh please try and go uh use the public transport try and use vehicles less it was for a different uh reason but such strategies are going to give you a better air quality and if we work towards our own you know air quality to be better nothing like it so more and more electronic vehicles uh you know adoption of electronic vehicles more and more use of public transport this is going to increase the air quality index.

[00:26:22]More and more tree plantation, more and more green areas. This is going to be you know make uh your uh air quality better and mind you you are only the ones who are going to uh breathe the air. So it's it's your responsibility as well to keep the air clean. So if but if you're staying in a uh area which is polluted, you can use uh uh masks. Uh the recommended masks are N95. If you want a protection, the best protection is given by N95 masks. But not everybody is going to be privy to have it. Not everybody can manage it as well.

[00:26:57]Sometimes it's very suffocating. But any masks mask is better than no mask. So whatever mask you can tolerate, you should take it. Generally surgical masks which you get outside, triple air surgical mask are generally good. So you can use it. Other things are occupational safety. People are working in construction site, working in petroleum industries or other industries should have some protective gears. Uh generally in India uh you know being protected is considered to be sign of weakness which is which it is not and we should not look at it as a person's weakness. In in fact one such efforts should be praised and should be encouraged.

[00:27:38]Uh the others are lifestyle modification and other chemoprevention. So there is no data per se for you know eating something which will prevent cancer.

[00:27:46]It's still in you know in a nent kind of a uh nent kind of a way. So uh it's still not mature. It's so it will not it'll be immature for me to say you do do this this things which will prevent your cancer. But generally eating green leafy vegetables and fresh fruits this is known to you know uh hold cancer growth be it of any system be gastrointensive system or be be it your lung cancer. So eating healthy fresh uh vegetables and uh fresh fruits will avoid cancers.

[00:28:23]Second is you know uh uh uh you know it's a soft part like it it's a part of tobacco control only. If you have somebody who a smoker you avoid uh exposure to smoke whenever he's smoking you just don't go he or she is smoking just don't go around him so that you can avoid smoke then is a lung cancer screening. Now as I said the top left corner uh shows you the criteria for smoking. So age between 50 to 80 with a more than 20 pack year smoking history or who has quit within less last 15 years only they are you know are the most benefited from screening. So because there are multiple trials which were done and they showed almost close to 25 to 30% uh uh you know benefit in avoiding death. So it was a gross uh benefit which we got. So uh what we do in lung cancer screening is something called as a lowd do CT scan. So routine CT scan has much higher radiation exposure. So if you put a person through uh a lot of CT scans like this they are going to have ill effects of radiation. So to avoid that something called as low do CT is used. Uh so uh this is a non-contrast CT scan which you have to do annually to get a check. Now uh the benefits of screening are definitely there. It's been proven without doubt. But in India it's still not started. There are multiple reasons for it. Uh why India cannot adopt a widespread screening program is because you know in city the scanning centers the imaging centers are pretty rampant.

[00:30:07]You are able to go to a nearest city uh scan center and get your scans done. But it's not true in rural population in in rural areas. So they don't have such facilities. That's one. Now Indians uh you know Indian subcontinent is known for having infective diseases. So once in a you know multiple times in your lifetime you get infected with some respiratory pathogens be tuberculosis.

[00:30:32]So you know such diseases do have some impact do have some changes which you can see on CT. So you might be chasing those non-specific changes when you are screening for lung cancer. So you might add up to the burden onto the healthare system. That's why it's not rampant in India. It's not you know adapted by the Indian government.

[00:30:53]But what we do as clinicians is if a smoker is sitting in front of us, we can ask them to get screened. It's called as opportunistic screening. If somebody's sitting in front of us who fits the criteria of lung cancer screening, we tell them why don't you get screened.

[00:31:06]Now one more question which you might be having. So I've been harping upon air pollution being one of the you know grade one carcinogen in causing lung cancers. So why not all the city dwellers get screened you know altogether. The point is that it's still not proven by studies. You know there are multiple trials which were done to prove smoking or lung cancer screening in smoker will will avoid death. Such trials have not happened in uh air pollution and it's very difficult to conduct such trials. Till such time we will not be able to you know uh put guidelines as to who should get uh screened. So there is no point in uh getting worried about it.

[00:31:53]It's the best thing is to prevent yourself from getting exposed to air pollution.

[00:32:00]So what as a common man we should do is smoke stop smoking. It should be you know if you're a smoker you should stop today. If you have known that it's going to be a risk factor for your lung cancer you should stop today. You should avoid lung a secondhand smoke. Anybody who smoking you can go away maybe for 5 minutes. Be many important discussion but your health matters more. Reduce air pollution exposure. We can do it by improving the air quality in and around our area. And secondly, wearing masks where you are not exposed to air pollution. Uh air pollution doesn't only happen outside. Even uh you know domestic air pollution is also a risk factor. But in our cities we always have CNG uh the pipe gases or LPGs. So our cleaning methods are particularly okay.

[00:32:48]But whatever smoke gets generated during the cooking uh you know the smoke evacuators should be installed. they will definitely protect you. Uh as I said earlier, eat healthy diet. So fresh fruits and fresh vegetables are known to prevent cancers. Exercise regularly that will help you in avoiding a lot of diseases. It's not only cancer but a lot of diseases. It makes your body you know healthy in in a holistic manner.

[00:33:16]Uh then is to know your warning signs.

[00:33:19]So this this were all to prevent from cancer to coming. But if you have if you get a cancer, you should not be uh ignoring warning signs. So the guiding principle or a rule of thumb is that any respiratory uh symptom or rather be any symptom which is lingering on for more than 2 weeks despite you getting treatment, you should investigate it further. You should uh you know notch up your investigation. You should meet a specialist because it can be cancer. If it's not cancer, fantastic. It's good.

[00:33:51]But if what if it is? So if you catch cancer early especially lung cancer early your survival you know a first stage cancer disease is going to be around 90 to 95%. So which is like a normal population. So that's the impact if of uh you know you're going to get uh if you detect the cancer early. So watch out for warning signs. So any respiratory symptom getting you know lingering around for more than 2 weeks should be investigated. Uh generally blood in sputum is uh very alarming. So people do get investigated without stopping. But any other symptoms like cough or you know uh fever which is lingering on for a long time some mild chest pain, mild chest discomfort, some bit of breathlessness. All these are ignored because we do have a lot of tolerance.

[00:34:40]So we ignore even I ignore. But that's not right.

[00:34:49]Thank you very much.

[00:34:51]>> Thank you so much for your patient attention for your I hope that I did justice because I'm sure I'm as good as Dr. George.

[00:34:58]>> Very comprehensive presentation. Uh we'll just wait for you to uh switch off the >> sharp sharing.

[00:35:09]>> There are a couple of quite a few questions that have come in. uh uh one is uh what is smoker's cough and how harmful is it?

[00:35:21]So smoker cough is see it's a generic term uh when you get exposed to smoke for a long time your lung shows something called as COPD or emphymatis changes and any uh you know smallest of irritant it's going to lead to a lot of uh any smallest of irritant is going to cause cough. So uh there is no way you can prevent it if you have been a smoker and if you have got it you can just you know mask it by giving some inhalers like uh uh you know your airway becomes very much reactive when you are exposed to smoke. So anything any medication which will reduce the reactivity of your airway be it inhalational steroids or be it steroids through tablets or be inhalers these are generally which you know which are given our routine cough syrups are generally not helpful in stopping such smoke uh stopping such cough. So first is stop smoking, stop irritating your airway. Then is to reduce the reactivity of airway. You should have uh some inhalers be it steroidal or non-steroidal.

[00:36:26]>> Right. We have a few questions on passive smoking. Say aal says >> somebody sometimes a person smokes somewhere nearby it smells bad but is it harmful too? Then there's a question from Shobha Shivast. She says if someone smokes in the house >> how can we protect ourselves?

[00:36:47]>> So best is no other issue which is there somebody has also messaged me saying that uh there's nobody smoking in our home but our neighbor smokes a lot >> and that uh smell comes in what should we do? So overall passive smoking and the smell of smoke whether it's in the same uh house or from outside.

[00:37:09]So uh so a neighbor smoking and you being exposed to is a very difficult uh situation to manage. Again as I said you can try explaining them so that they can avoid it. So uh in-house smoking is going to be even worse because inhouse it's not going to be as ventilated as the you know outside world. So any area which is not ventilated and if you're exposed to smoke you're going to get a concentrated exposure for a longer time.

[00:37:36]So it's a good idea not to smoke in a house. Uh you know that that doesn't mean that you should continue smoking but first of all stop smoking. If not it should be outside. It should be a well ventilated area so that you know the smoke gets dist dispersed and uh the neighbors or nobody's getting exposed.

[00:37:56]When you are you know a neighbor is smoking and you can smell it. uh uh I don't know if anything you can just close off the windows so that you know you can uh don't get exposed to that in a bit air purifiers might help you but there is no particular data where air purifier might help or not it's it's a very you know catch 22 like a situation or else you'll have to sit in your home wearing a mask. It's a sorry situation but you know you have to deal it in you know in a way >> but you know and you know in a typical city scenario whether you are in a Mumbai or Delhi or Pune or whatever uh yes >> uh it's a fact of life you do have neighbors who smoke >> you know you also have if your if your housing society or your you know wherever you stay is close to uh the road and there are these tea stalls where people smoke or office folks come and smoke >> uh true >> you know how harmful can that be >> of course it will be see it will not be as concentrated as uh you know you standing next to a smoker when he's smoking it's not going to be as bad but any chronic exposure over say years together that's going to be harmful yes it will be so uh you know it's again it's a very difficult you know when government had this anti-tobacco program I could see a few rickshas having a image of a tobacco farmer holding hands saying that we also have you know we also have to survive. So there are other you know uh bodies or other uh you know uh powers which are trying to avoid it avoid government from acting on these tobacco issues. So it is difficult but it uh the question uh the answer to the question is it is harmful.

[00:39:49]We have a question from again three three people have asked Madu Gupta who spoken about Subupari Khana then there is u Mina Goyel >> uh Santosh Gag who's spoken about pan and you know also pan masala some something which may have tobacco something which may not have tobacco >> just as the various pan masalas that you get in the market. Uh >> yes. So pan masala is harmful. Uh uh just uh the the pan which you get the plain pan which you get is not harmful.

[00:40:26]But the pan masala is harmful. The kata is harmful. Your supare is harmful.

[00:40:32]These are all harmful uh ingredients which can lead to you know your head and neck cancer the oral cavity cancers. And once what happens in these people is that since they are exposed to tobacco the oral tobacco or the direct and Indians actually have a very concentrated uh you know tobacco exposure it's not uh and it's actually specific to India where the tobacco is put into the mouth. I don't think so any western country has that except for a few Asian countries only. Uh so uh it your whole mouth is actually getting exposed your whole oral cavity is getting exposed to this harmful uh chemicals. So if you have you know cancer at one particular uh position where it get detect it it gets detected and you treat it but the rest of the oral cavity can still develop a cancer.

[00:41:18]So such patients are at risk of developing cancers again and again in the oral cavity. So any tamaku any gutka pan masala uh the kata the tupari these are all harmful should be avoided even these patients can so these patients can have esophagial the the food pipe cancer as well. So should be avoided at all costs.

[00:41:40]>> But even in the pan there is some kata which is put right. So >> so that is harmful. Yes that's harmful.

[00:41:48]>> Um there's u you know somebody who's asked about uh hoka bars uh you know they're very popular uh these days you know what should one do? I guess uh there's not much that you can say. How effective are nicotine patches?

[00:42:06]is a question which from Shamla Ravi asks are there any side effects of a patch?

[00:42:11]>> Uh no not actually you might have uh some giddiness or something but generally they are not because you are already exposed to nicotin so much that you have uh tolerance for it. So uh they are if so it's not a singlestep uh intervention which you know which you should do. It's counseling plus nicotin patch if required medications all these you know come in together to uh for you to fight off smoking >> and um you know people uh people consume various things like silver pearls >> or chewing gum etc just to kind of ward off the entire tobacco urge. Uh what would you >> So nicotin gums or chewing gums are okay. They're they're not harmful except for they're having our common chewing gums have a lot of sugar. That's the only opt that's the only harmful way harmful thing but other than that the routine chewing gums are not going to be you know a problem. Uh silver silver pearls are something new. I really I frankly I don't know I'll need to read about it. I'll get back to you with that because I don't know what the silver pearl is going to have. We do have silver you know foils on our met and all. So I'm sure silver is not going to cause issue. But what is there inside the silver pearl? If it is the same ingredient as your pan masala or your good kai, it's going to be as harmful.

[00:43:32]>> Thank you very much doctor. We've asked we've got a few questions which are not tobacco related. So I'm not going to ask those. But uh thank you very much once again uh Dr. Vive Mur for being here uh at very short notice because Dr. Dr. George.

[00:43:45]>> No, no, it's my pleasure and >> thank you to the team at Nanavati Max Hospital also to facilitate this and uh you know clearly uh May 31st is is observed as no tobacco day world no tobacco day. So those of you who are addicted to tobacco, I know it's easier said uh uh to to break the habit, but those of you who have uh people in the family who who are are smoking or your grandchildren are uh in the habit of smoking or chewing anything including pan you know I I know it's a challenge out there but uh as as Dr. Dr. Vive Mundra has said the only way uh out is uh a clear full stop to it because you know life is too precious and I think we must make all efforts to uh to ensure that we have a great life. There are various other forms of en enjoyment.

[00:44:47]Uh I wouldn't say there are various other forms of addiction but do enjoy yourself. do um watch some films instead if you if you are interested in in uh in in you know if you want something to to divert your attention but it's important to kick the habit. Thank you very much again for being here and to all of you here. We will be back again next Saturday at the same time 5:00 pm for another session of health life at seniors today. Thank you very much.