Time to put those cigarettes away

Buerger’s disease is a condition wherein the blood flow to the arteries is restricted due to the constant use of tobacco. Continuous smoking leads to peripheral vascular disease, loss of tissue and in major cases, amputations of the limbs explains vascular surgeon Dr S. Bala Kumar.

Q. What is Buerger’s disease? What is the incidence of this disease in India?
Buerger’s disease is chronic, inflammatory, obstructing tobacco-associated vasculopathy found in small and medium-sized arteries. It is largely found in young smokers. The flow of blood supply to the arteries and adjacent nerves is affected due to constant use of tobacco products like cigarettes, cigars and beedis. Acute cases of Buerger’s disease result in tissue loss and major amputations of limbs. The incidence in India is between 77 per cent in males and 11 to 23 per cent in females.

Q. Which age group is affected by this disease the most?
The median age of diagnosis is 34 years. This disease is a relatively common cause of peripheral vascular disease in young people and a cause of disability in patients of all ages. It manifests with decreased blood supply in a smoker before the age of 45 to 50 years. Nearly 95 per cent of the patients have a history of smoking and using other forms of tobacco. The other risk factors are nutritional deficit and poor oral hygiene, which also aggravates the disease.

Q. How does this disease affect women? Does it also impact the women using tobacco in their pre and post menopause stage differently?
Tobacco does not affect the uterus and hormonal changes associated with menopause. Other factors like poor nutrition and oral hygiene indirectly have impact. This can lead to an immune-compromised condition whereby the person is susceptible to infections and diseases.

Q. What are the symptoms of this disease?
Coldness, burning pain in the feet and hands, ulcer in lower limb and edema of the limb are some of acute symptoms that are seen. Chronic symptoms are pain while walking, trophic nail changes, gangrene and chronic ulcers. There are also psychological problems like primary anxiety and severe
depression.

Q. What is the treatment for the disease?
The first and foremost requirement for effective treatment is cessation of active smoking. There is a need for the patients to maintain foot and hand hygiene and avoid exposure to cold and trauma. Therapy is applied to prevent ischemic ulcers and medication is given to improve the blood supply. Surgical treatments are offered in cases where medications do not work. Amputation is the last resort when the other treatments do not work.

Resorting to amputations
Amputations are above-knee, below-knee or hand amputations. Disease history across the country shows that 16 per cent of patients have two limbs, 41 per cent have three limbs and 43 per cent have four limbs affected. Pain recorded in upper and lower limb is in 46 to 89 per cent patients.

Amputation fears often trigger a major psychological breakdown. It then becomes very challenging for medical professionals and family members to manage the patient.