When smoking costs you a leg

One of the most effective pieces of legislation seen in the recent past in Kenya, was the banning of tobacco smoking in public spaces. Overnight, smoking lost a lot of its appeal and may actually have revealed that Kenyans smokers were more likely social smokers rather than actual tobacco addicts. 

Segregation of smokers from non-smokers in public recreational spaces brought the much-needed respite for non-smokers but tobacco smokers didn’t take this ban very well. Manuel*, the real definition of an addict, was one of those who bitterly complained about the ban. He smoked an average of two packs a day, even more on the evenings he spent out in the club with his friends. Manuel did not touch alcohol, hence while his friends downed several bottles, he would sip his soda quietly while taking deep draws from his cigarettes. 

With most pubs segregating the smoking zones to the open-air verandahs and balconies, Manuel’s habit made him compromise a lot of his comforts in order to spend time with his friends. It was not comfortable sitting in the smoking zone during the cold season. Further, most sports lounges have their huge screens indoors, forcing Manuel to choose between his habit and the excitement of watching sports from the life-sized screen indoors. 

We teased Manuel every time he complained, telling him that fate was strongly indicating that it was time he ditched the habit. This upset him every single time and as his friends, we did not let up! We all agreed it was good for his health, a scowl from him wasn’t good enough to scare us into backing down. 

Manuel got a really lucrative job in the development world that took him around Africa. We did not see each other for years and gradually lost contact. Several years later, I ran into a mutual friend and in the course of catching up, he asked if I had seen Manuel lately. I hadn’t. He went on to share his contact and asked me to reach out, that it would boost his spirits. 

This got me curious. I learnt that Manuel had been back in the country for the past year, having undergone surgery to amputate his left leg! Reason? Buerger’s Disease. It was heart-wrenching to hear this. I may have missed his wedding, the birth of his twin children, his mother’s funeral, but this was not something I could afford to miss. 

Calling up Manuel, we caught up on phone for a while before we agreed to meet up for a coffee. Manuel was there before me. I found him seated at the back, a steaming latte before him and a cane against the wall behind him. After hearty greetings and my own latte served, we got on to tackling the elephant in the room. 

With his usual forthrightness, Manuel admitted that it had to take the loss of a body part to finally let go of his beloved sticks. Not even the constant appeal from the woman he loved more than life itself, his beautiful wife. He can only be grateful that she had steadfastly remained by his side through it all. 

Manuel first noticed on and off pain in his foot for weeks. But due to his frequent travels for work, he would blame it on fatigue, long flights in cramped airplane seats and the cold weather in some countries. However, he noticed the pins and needles sensation was now a constant companion. He also noticed the gradual darkening of the skin on the left foot and ankle.

One day while out in the field in Southern Tanzania, he developed extremely severe pain in the foot. This did not pass as expected, instead, it only got worse. He was rushed to the nearby health facility where they were unable to do much. He was given a shot of pain medicine and then evacuated back to Nairobi by the air ambulance. 

The specialists who saw him established that he was suffering from Buerger’s disease, a condition that afflicts the arteries and veins of the upper and lower limbs of smokers, causing these vessels to be inflamed and eventually the irritation leads to blockage. Once blockage occurs, there is no circulation of blood to the affected parts, causing the tissues to die off. 

This blood vessel inflammation appears to be specifically triggered by tobacco ingestion, it does not matter whether it is smoked, chewed, snorted or used as nicotine patches. Studies have shown that people who develop the condition tend to be hypersensitive to nicotine. 

Though extremely rare, estimated to happen in approximately 12-20 people per 100,000 population in the US, it is more common in men than women, with a ration of 3:1. It appears to be genetically linked, common among the Jews of Ashkenazi descent, Indians, Koreans and the Japanese. 

In Manuel’s case, it was too late to save his left leg and foot. He underwent amputation as an emergency and started a slow healing journey. He had to give up tobacco with immediate effect to prevent further disease progression to his other limbs. He struggled with tobacco withdrawal while recovering from surgery. 

He had to undergo extensive physiotherapy to learn how to recenter his balance and use crutches. A few months later, he was finally fitted with a prosthetic limb, which allowed him to get off crutches and use a cane. 

His psychological recovery was something else. Manuel went through depression, blaming himself for his eventuality. He felt unworthy of his wife’s commitment and support. He felt like a bad father who endangered his life yet he should have been dedicated to being present for his children. He acknowledged that psychiatric treatment and prolonged psychotherapy saved his life. 

Today, Manuel is a staunch advocate for tobacco control. He understands that his condition only afflicts smokers and that it is possible to halt the progression of the early effects of the condition by quitting smoking. He could have saved his leg had he paid attention to his early symptoms! 

Dr Bosire is an obstetrician/ gynaecologist