Updated: Sep 27
Welcome to the official Newsletter of Advanced Medical Care.
Society at Large is Winning The War Against
The Tobacco Industry!
Smoking prevalence among adults was 50% back in the 1960s and dropped to 21% 18 years ago and today is 11.5%. (National Institutes of Health)
Are You Winning Your Personal Battle?
As a society, we are definitely winning. But many individuals are still losing their battle as we still have over 28 million smokers in the US.
The tobacco industry does not play fair and they have used deceptive tactics for many years. Four of the 5 biggest tobacco companies in the US still deny in court filings that smoking causes cancer, and all 5 deny that 2nd hand smoke is a problem.
But we know that smoking kills and maims and the only way to beat the tobacco industry is to quit smoking. The U.S. Surgeon General has said:
"Smoking cessation [stopping smoking] represents the single most important step that smokers can take to enhance the length and quality of their lives."
Unfortunately, quitting can be very difficult. Some people seem to be able to set their mind to it, and they quit. Others struggle for years and don't seem to be able to let it go.
Here is some information that may help you, or a loved one quit smoking.
To Quit Smoking You Need to Overcome 2 Problems.
One is the physical addiction to the nicotine. When you reduce or stop the nicotine, your body will crave it and you will experience physical withdrawal. The good news is the physical craving/addiction is over in 3 days. And if you taper slowly, you will largely avoid physical withdrawal.
The second problem is the habit of smoking. The actual habit of pulling out a cigarette, lighting it, puffing on it, playing with it, etc. Some people take up other things to play with like little fidget spinner toys. Something to keep their hands busy, to replace the cigarette habit.
Your First Choice: Quit Cold Turkey or Taper?
Let's say you currently smoke a pack a day and you choose to TAPER.
Get some ziploc baggies and a magic marker.
Put 19 cigarettes (1 less cigarettes than you currently smoke in a day) in a baggie and put tomorow's date on it.
Put 18 cigarettes in another baggie and put the day after tommorow's date on it.
The next baggie gets 17 cigarettes and the date 3 days from now.
You keep doing that all the way down to the last baggie that has 1 cigarette in it.
Put all the baggies in the fridge.
Each morning get the baggie out with that day's date on it.
Make the cigarettes in that baggie last all day. One baggie per day.
In less than 3 weeks, you will be smoking your last cigarette, and you never had to fight through a nicotine fit.
Let say you want to QUIT COLD TURKEY.
Pick a quit date.
Let everybody know.
Get rid of your ash trays and all smoking paraphernalia.
When the quit date comes, any left over cigarettes get flushed.
After 3 days, there will be no more physical craving.
But What About the Mental Addiction?
No easy answers for that. Some ex-smokers report mental cravings years later, when triggered by stress or old smoking situations. Some people report that counseling is beneficial. Some people use hypnosis. Obviously avoiding the stressful situations that trigger the cravings is wise, but life keeps going on. Learning better stress management, including daily walks, prayer and meditation is helpful for many. A common recommendation is to avoid drinking for quite awhile after quitting. Many recent quitters report stopping off for a beer at a favorite pub, and the next thing they know, they have a lit cigarette in their hand. If you do relapse, don't accept that as your destiny. Get right back on the tobacco free path.
Anything To Make Quitting Easier?
There are some options to consider. You can try:
Nicotine Patches (or gum).
This allows you to tackle one thing a time. By getting your nicotine from a different source, you can work on the mental habit of smoking first, the actual habit of lighting up. Then after the habit is gone, you can tackle the physical nicotine addiction by stopping the patches. Some people find it easier to focus on one thing a time. And when you are ready to get off the patches, you have the same choice. Quit cold turkey, or taper by using lower dose patches. Advantages: The patches do help, and they're free or cheap depending on how you get them. You're not introducing a new drug into your system. Disadvantages: Burning, itching or redness at the site of application. Sometimes headaches, or sleep disturbances.
Zyban or Bupropion
This drug helps people stop smoking by reducing the urge to smoke and decreasing withdrawal symptoms. Also, many patients report that cigarettes do not taste as good after starting Zyban. This drug is also used as an antidepresant under the brand name of Wellbutrin. Zyban is the name the company uses when it is being marketed for smoking cessation. This drug is not an SSRI, so it is not a typical antidepressant. You can use Zyban when tapering or going cold turkey. It is FDA approved for smoking cessation, which means there is some evidence it actually helps. Advantages: It does help. It's cheap if you are paying out of pocket. It tends to promote weight loss which is an advantage for many people. It does not cause sexual dysfunction, and may actually increase libido. It may increase your energy level. Disadvantages: You may experience nuisance side effects like headache, dry mouth, trouble sleeping, nausea, dizziness, constipation, fast heartbeat, and sore throat, although they rarely last more than a week or two.
Chantix or Varenicline
This drug is used while you are still smoking. You start Chantix and pick a quit date 2 or 3 weeks away. You keep smoking like normal, with no effort to taper. When the quit date comes, you quit, and most people are surprised that there are no withdrawal symptoms. You don't have any withdrawal, because the Chantix was slowly blocking your nicotine receptors while you were still smoking. So when you get to the quit date, you can quit easily, because you have already tapered off the nicotine. The downside of this drug is that it seems to destabilize mental health for some people. Reports of suicide, suicidal ideation and psychotic behavior are frequent in people with a bipolar or psychotic history. I have prescribed Chantix with good results for many patients, but I won't prescribe it for people with a history of bipolar or psychotic behavior. Advantages: Chantix is one of the most effective options. Disadvantages: Chantix is expensive if you are paying out of pocket. Chantix has nuisance side effects such as nausea, headache, vomiting, drowsiness, gas, constipation, trouble sleeping, unusual dreams, or changes in taste. Serious side effects may also occur, including burning feeling in feet/toes, unusual pain in the legs when walking, seizures, symptoms of a heart attack (such as chest/jaw/left arm pain, shortness of breath, unusual sweating), signs of a stroke (such as weakness on one side of the body, trouble speaking, sudden vision changes, confusion) which require you to stop taking Chantix/varenicline immediately and get medical help right away. And the mental health isssues discussed above.
Cytisine? Natural Chantix?
This natural medicine, sold under the brand name of Tabex is getting quite a bit of attention recently. Apparently Tabex works similarly to Chantix, but without the mental health concerns. Tabex is derived from a plant and is widely used in Eastern European and Asian countries for smoking cessation. Of course, these things are always controversial, and some studies have shown it to be better than Chantix, but a recent study showed it to be slightly less effective. Time will tell if this is a better choice or not, but right now, we do know it is much cheaper than Chantix, if you are paying out of pocket ($68 for Tabex vs $1,800 for Chantix), and it does have a number of other reported health benefits. Advantages: Arguably safer than Chantix. Probably as effective, and possibly more effective than Chantix. Cheap if paying out of pocket. Available without a prescription for those that don't like going to doctors. Disadvantages: Not approved by the FDA, so less is known about it. There could be downsides we just don't know about.
All states have QUITLINES with counselors who are trained specifically to help smokers quit. You can call this number to connect directly to the QUITLINE in your state. Hours of operation and services vary from state to state, but I undertand in Washington they will send you free nicotine patches. Advantages: Free help and free patches, what's not to like? Disadvantages: You have to take the time to call them?
Late Breaking Quit Smoking News!
A recent study found that more people will succusfully quit smoking, if they start with either a medicine or the patches, and then if they need extra help, add a medicine or patches to whatever they started with. Combining therapies for those that need extra help increases the overall success rate.
In My Experience: This is The
Most Important Quit Smoking Aid
When everything is said and done, there are a lot of helps for people to quit smoking but the most important thing is a person who has made up their mind that they are going to quit. When patients have that determination, we can sort through the options above and work out a plan that works for them. Call me at 360-264-2492 if you need help with quitting. This is something that I can do in person or by telemedicine. Feel free to share this info with your doctor if you already have somebody that can help you. If you have used any of these options to quit, we would love to hear about your experience in the comments.
Take care and BE HEALTHY!
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