DR. PAUL DONOHUE and DR. KEITH ROACH
Your Good Health
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Dear doctors: I was washing the clothes of my 17-year-old son when I found a tin of chewing tobacco. Needless to say, I was very upset. I confronted my son about it after school. He told me that a lot of his friends use it and that it is 鈥渘o big deal 鈥� at least I鈥檓 not smoking!鈥� I told him it is a big deal because it is just as dangerous as cigarettes and I reminded him of our family鈥檚 history of cancer. My father, his two brothers and two of his sisters all died of different cancers.
Can you please try to explain to my teenage son the danger of chewing tobacco? Thank you.
A.M.
As the parent of three teen-agers, I empathize with your frustration. Trying to explain the increased risks of disease to someone who knows perfectly well what it means but doesn鈥檛 really believe that it could ever happen to him is nearly impossible. But I will try, since there is a belief that smokeless tobacco is safe. It isn鈥檛.
The major risk of smokeless tobacco is in head and neck cancers 鈥� lip, mouth, tongue, throat. Having taken care of many of these patients, I can attest to the terrible pain and disfigurement that come from the disease and its treatment. But your best bet may be to talk about your son鈥檚 family members who died from cancer. Discussing real people who have been through it may get through better than statistics about increased risks. A family member with esophageal or pancreatic cancer also would be important, since there is incontrovertible evidence that chewing tobacco causes these as well.
Is it safer than smoking? Yes. The same way playing Russian roulette with one bullet in the chamber is safer than playing Russian roulette with two.
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Dear doctors: My mother was 82 when she died. She had Alzheimer鈥檚 disease. My brother, who is 68, is beginning to show the same symptoms that my mother had at about the same age. I am 14听months younger than my brother, and I am wondering what, if anything, my brother and I can do to slow the possible onset of Alzheimer鈥檚. I understand that genetics plays an important role in the odds of us having this terrible illness.
L.F.
This turns out to be a very difficult question to answer. The risk of having Alzheimer鈥檚 disease at age 65 is about 13 per cent overall. However, if both of your parents had Alzheimer鈥檚, your risk at age 65 is about 36 per cent. Having a parent (or sibling) clearly increases the risk. The risk goes even higher as we get older.
There are blood tests that claim to predict risk of Alzheimer鈥檚 disease; none of them is perfect.
There currently is no proven method of prevention that is generally accepted; however, most authorities believe that reducing risk of vascular disease, by controlling those risk factors, also can reduce risk of Alzheimer鈥檚. These include not smoking and controlling blood pressure, high cholesterol and blood sugar. Some evidence also suggests that keeping an active mind throughout adulthood may be important. There are promising treatments on the horizon for early Alzheimer鈥檚 disease as well.
