family practice issues and general life events

Posts tagged ‘smoking’

Stopping smoking

Let me start this by saying, I have never smoked, so I personally never had to deal with that addiction and the cravings.  However, I do treat many smokers as patients and try to help them conquer that addiction.  The first thing I do know, is that everyone who is having problem stopping smoking has that one friend that just decided one day to stop and laid the pack down.  No problems, no cravings, just pure will power.  And to those friends, I say, stop it.  You are not helping your friend by saying,

“it’s easy, I just decided to quit and did it.”

Because for every one smoker who decides to quit like that, I have seen about 20 of the other kind.  Twenty who suffer from the cravings and the desires to smoke.  Those who have dealt with the stress in their lives by smoking.  Those who now struggle what to do with their emotions and how to deal with stress.  

Recent studies indicate that the average smoker tries 7 times before stopping smoking.  That is six times they were not successful.  Six attempts that frustrate and make them feel like a failure.  Looking at it as a failure is part of the problem.  Some studies indicate that tobacco is more addictive than heroin.   And heroin is the drug that everyone fears being addicted to.  In fact, when in an inpatient setting to deal with other addictions, the one addiction that is never dealt with, tobacco.  Rationale, if you take away the tobacco addiction, chances for relapse for other drugs increase significantly.

There are multiple choices of products that help with cessation, many replace the nicotine through patches, inhalers, gum, etc.  The goal is that by stepping down, you can beat the habit.  Then there is Chantix, which makes tobacco taste bad, and makes people nauseated.  Or Zyban/Wellbutrin which is an anti-depressant thought to help with the urges to smoke.  And the latest, the electronic cigarette.  This also is a tobacco replacement system, that removes most of the other products in a cigarette, but initially has nicotine.  Also with the goal of stepping down.  Also includes vapor to inhale.  I am a little skeptical to the claim that it is 100% safe and that you can do it forever without consequences, but as a means to get off of tobacco products, absolutely the lesser of two evils.

Now I live in a state with one of the highest levels of tobacco use.  While there has been legislation preventing smoking in restaurants and state buildings, we also have drive through smoke shops on tribal lands.  The one just outside my town, has three windows.  No need for waiting or getting out of your car.

The reasons for stopping smoking have been endlessly documented for both the individual and everyone they live with, especially their children.  The cost is also well documented.  But if it were easy, all of these products wouldn’t be needed.  Increasing taxes on cigarettes would stop those who couldn’t afford to stop.  

Maybe we should treat it like an addiction.  And maybe we should look to understand the science of addiction, and look at it as a real medical problem and not just weakness of the individual.  


Allergies and Asthma

When you come in complaining of runny nose and congestion, I do feel bad for you.  Really I do.  I can sympathize.  Well up to a point.  If you tell me you just sneezed twice and it was intolerable, well I will try to help you, but that won’t equate to an emergency to me.  Heck it isn’t even a minor emergency.  And if you tell me taking an antihistamine is just too much trouble, well I may even become irritated.  I will try to hide it, but it will be there.  Why?  Because I probably have more severe allergies than most.  

I spent my childhood wearing long sleeve shirts when my eczema was so severe it looked to the untrained eye that I was attempting to shoot up.  Never mind that I was 8 or that I apparently had no regard for where the vein was when I was attempting to “shoot up”  In fact now my skin is tough in my antecubital fossa (crease of the elbow) that while my veins are close to the skin, you have to work to get to the vein when I have to get blood work done.  Additionally, I have spots that are now lacking any pigment at all do to damage that I have done. 

So please believe me when I discuss the importance of proper hydration of the skin, both topical and by mouth.  If I tell you that it will come back unless we can identify the trigger and avoid it.  And if you don’t want to avoid it, well that is fine, but the rash may come back and probably will.  Mine did throughout childhood, because well Pizza Hut pizza was worth it to me.  It is a trade off.

As for your runny nose, well you might have to take an antihistimine, Claritin, Zyrtec, Allegra, Benedryl, etc.  It may not require a doctor’s visit, they are all over the counter now.  Now if they are severe enough, maybe allergy testing and desensitization are worth it to you.  But if it is just once a year, when the flowers bloom it might not be worth it to you.  Sometimes you have to decide.  I can offer the tests, and can offer treatment, but you have to take it, consistently.

And I do apologize but there is nothing about your particular rash that will let me know what caused it.  (Assuming it is an allergy)  I don’t know if you changed detergents, soaps, or if you used that new lotion you got for Christmas.  I don’t know that you ate something new, and I will continue to ask all of these questions to help to identify the triggers.  And sometimes without allergy testing we may never know.  Sometimes it is obvious with questions, but not always.

And if I suggest checking you for asthma, realize that I am following current recommendations, and that the two processes are very similar.  However, I might not be able to tell you if your 2 year old will grow up with asthma.  First of all she is too young for the test, and secondly she may just have a cold today.  So please don’t try to insist that I do all the testing today.  I can’t. She cannot do the test.  Most kids can somewhere around 6, and even then depending on the asthma type and severity their test could still be normal.

What I can tell you is that you as a parent should stop smoking.  Sorry, but smoking in your bedroom travels through the vents of the house into the child’s room.  Those of you who say but I only smoke outside, well most people in cold weather smoke too close to their house to not be sucked back into the ventilation system, not to mention what is brought back in on your clothes.  And many of you neglect to realize that your car is a small enclosed space, and smoking in it regardless of whether the child is in the car or not harms the child all together.  It stays in the car, why do you think the resale value of cars that people smoke in are so much lower than those of nonsmokers?  It stays in the car.  And those who want to lie to me, well if I get secondhand smoke fumes by walking in the room, well you are probably affecting your child, just like me.

And those asthmatics who smoke?  Why?  You already have a hyper-responsive set of lungs.  Why are your introducing irritants that make your condition worse?  I know nicotine is addictive, and difficult to quit, but in addition to lung disease, it also contributes to heart disease, cancers that include not only lung and oral, but bladder, liver, and colon cancer.  If you are diabetic your risk for amputation increases significantly if you smoke, and healing of wounds is significantly impaired.  So much so I know back surgeons who will not operate unless you quit smoking for at least a week before and a month after surgery, and plastic surgeons who have included in their pre-operative consent that you understand that scarring and healing is worse and if you smoke, you will be responsible if the wound does not heal.

And if you come if sneezing and coughing and complaining if you can’t breath, don’t get offended if I tell you, that you need to quit smoking.  And don’t lie to me and tell me you don’t, when it smells like you have had a whole pack right in the room.  I will do what I can tell help you stop smoking if you want help.  But that is something you have to decide for yourself, or your kids.

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