By Dr. Kevin Wang
Before I start my column, I'd like to remind everyone of a survey I'm conducting. I'm starting a research project in my program to increase awareness of the LGBT community in the medical community. These surveys ask you what you wish or would like your primary care physician to know about our community. Please e-mail me at the address below and I'll send out the materials. Thanks for your help and on to this month's column!
A breath of fresh air
During my time covering in-patient service, I saw a lot of disease processes that could've been avoided with simple (translation: lots of hard work) lifestyle changes. One of these lifestyle changes that I want to discuss in this month's column is: Smoking.
The reason I bring this subject up is because of a particular patient that our team took care of in the hospital. We had a lady who came in because of shortness of breath as well as difficulty breathing. She's on oxygen at home but didn't have quite enough oxygen the day of admission. In fact, she was so hypoxic (too little oxygen in the blood) that she had what we call mental status changes (completely out of it – she didn't even know the year or where she was). She has a long (three packs per day for the last 25 years) history of cigarette use.
If you haven't already guessed it, she has what we normally call emphysema or COPD – Chronic Obstructive Pulmonary Disorder.
Let me tell you a little bit more about her. She has such severe disease she can't even finish a sentence without getting short of breath. She has difficulty walking short distances because she becomes exhausted. Her disease is so severe that she was recently forced to quit smoking cold turkey and placed on the lung transplant list.
This isn't going to end up being a lecture on how the gay community is made up of chain smokers. It's also not going to be this rant on how smoking causes lung cancer, COPD, ulcers, infertility, osteoporosis, blood vessel disease and heart disease. In fact, that's all I'm going to mention about the horrible things that smoking can cause.
What I want to discuss are methods for kicking the habit!
I'm sure all of you have heard of the nicotine patch or gum. What television has done for Viagra and other drugs, it has also helped bring Nicoderm CQ or other patches out into the public eye. You can obtain these patches either by prescription or as an over-the-counter preparation. You usually begin at the higher dose and stay there until you feel that you can start decreasing the number of cigarettes you smoke in a day. As you control those cravings, you start tapering the dosages by using different patches with a smaller amount of nicotine.
Hypnotherapy and acupuncture have also been talked about in recent years. I haven't seen any studies showing if they're effective in helping people to quit but I've had a few patients who have successfully quit for a year using these methods. In fact, they're still cigarette free!
As far as I know, the only medication that has been approved (and clinically proven) for smoking cessation is Zyban (also known as Wellbutrin). This is a great medication to help decrease the cravings for cigarettes without the side effects of nicotine patches. Unlike nicotine patches, it's okay to continue smoking while taking Zyban. However, you set a quit date 8-12 weeks from the initiation of medical therapy. As you continue taking it, you'll notice a decrease in your cravings for cigarettes and hopefully will be cigarette free by your quit date.
Counseling is also available to aid in your quest to quit. Counseling may come in the form of support groups or frequent visits to your primary care physician. When used alone, you get a pretty decent success rate but it's much higher when used in combination with the above medications/methods.
For me to advocate one method over the other would be a bit much. Each person out there has different needs and goals. Some are completely adamant and will refuse to quit. Others are thinking about it and there are others who really want to do it but don't know how. One of these methods may work great for you but some might be able to do it cold turkey. My suggestion is to take the information above and go see your doctor to decide which one is best for you.
For those of you that I'm hoping to have influenced, remember that this won't be an easy task. But when it comes to your health – not needing to fight for every breath, having excruciating pain in your calves when you've only walked for half a block, feeling that burning sensation in your gut when you eat – there's no better incentive, right?
Good luck to those who want to quit smoking and don't give up!
