CVS Quits Smoking!

Congrats to CVS pharmacy for taking a stand for HEALTH and announcing that they will completely quit selling tobacco products by October 1st of this year! While, yes, consumers can choose to walk across the street and head into another store to purchase their cigarettes, I am hopeful that other major pharmacies and grocery stores will consider this same step. As people have heard me say repeatedly, there is NO amount of tobacco that we believe to be actually GOOD for your health.

Every single day in the United States, there are over 1300 deaths attributed to smoking. How can you picture what that means in terms of human tragedy? Imagine two enormous jumbo jets colliding- which would mean approximately 1200 people dying...and think about how many times we would see that ghastly image on our computers and televisions. I want young people starting to smoke to have THAT image printed on their brains, rather than associating smoking with fun, alcohol and parties.  Did you know that the vast majority of long-term smokers began the habit before the age of 21? I cannot tell you how many soccer moms my age, as well as professionals of all sorts, are still closet smokers- hating their addiction and wanting to quit. Many picked up "social smoking" in college fraternities and sororities, thinking it was no big deal...and that they would stop that habit after they graduated. Now it is ten or twenty years later, and they are hiding this addiction from their peers and especially their children. I believe it may be easier for people who smoke openly to quit, because at least they can enlist the support of their friends and family!

If you are still smoking, please talk to your family doctor about all the medical options to help you quit, and think about setting a quit date in 2014. Your habit didn't form over night, and the average serious smoker takes 7 tries to quit for good. Nicotine replacement medications (gum, patch, nasal sprays, inhalers and lozenges)  have been shown to increase your chance of successful smoking cessation by 50-70%. Other medications such as Chantix & Zyban double or triple the success rate as well.

BOTTOM LINE: Smoking doesn't "just" cause lung cancer (and many other cancers), it causes heart attacks, strokes, and really crummy quality of life with chronic bronchitis and COPD (Chronic Obstructive Pulmonary Disease). If you still smoke, please make an appointment to talk to your family doctor about quitting. You CAN do it!

Cigarettes- the Good News & the Bad News

Let's start off with the GOOD news- the CDC's anti-smoking TIPS campaign has turned out to be far more successful than they had dared to hope! Over 1.6 million smokers had a quitting attempt, and at least 200,000 smokers DID QUIT as a direct result of the shocking pictures and stories featured in this unique national program. The Lancet published a wonderful article this week summarizing all the findings: Effect of the First Federally Funded U.S. Antismoking National Media Campaign.

I have always maintained that stories are more powerful than statistics. Sure enough, this campaign is chock-full of stories from former smokers- people sharing extremely painful negative consequences from their nicotine addiction. Virtually every complication from smoking is shared: heart surgery scars, asthma, artificial limbs (from damage to blood vessels), artificial voice boxes (from throat cancer), COPD (chronic obstructive pulmonary disease) and of course, lung cancer, to name a few. Hearing from Terrie- a former cheerleader, points out the dangers of "social smoking" in college. Likewise with Michael, who smoked in the military. Click on the TIPS from Former Smokers 2013 to hear and see more...and share with any of your friends or family or co-workers who still smoke.

The campaign goals are to increase public awareness of both immediate and long term health risks of smoking- both first-hand, and from inhaling second-hand smoke. Note that for every person who dies from smoking, 20 more Americans are LIVING with a smoking-related illness. The CDC wants to encourage and support smokers who are ready to quit, as well as encourage them to limit other people's exposure to their second-hand smoke. 

So that was the good news...now the bad. Just last week, Notes from the Field: Electronic Cigarette Use Among Middle and High School Students- United States, 2011-2012 was published in the CDC's Morbidity and Mortality Weekly Report. E-cigarettes are not a new cell phone app, they are true electronic cigarettes that are battery powered and deliver nicotine and other byproducts via an aerosol. Worse yet, they can add sweet "childhood" flavors- fruit, mint or chocolate. Really??? Does the industry have NO conscience???? Not surprisingly, they are portrayed as "safe smoking" (anyone else reminded of "safe sex" campaigns?) and teens are jumping on board. E-cig use doubled in this time period, yielding nearly 2 million (1.78, lest I exaggerate) students trying out nicotine in this delivery system last year. Please note that although we do not yet have long-term studies on the "pure" damage of these e-cigarettes, we know that nicotine is damaging to adolescent brain development and, hello- nicotine is ADDICTIVE. If you get addicted via e-cigs vs. dipping vs. "regular" cigarettes- the outcome is the SAME. You are ADDICTED to NICOTINE.

BOTTOM LINE: There is still NO AMOUNT of smoking that is GOOD for you, so please, help encourage your friends who are already smoking to QUIT, and parents, please warn your kids that e-cigarettes are NOT SAFE. NICOTINE is ADDICTIVE in ANY FORM.

What Did You Give Up?

Lent came early this year- tough to have Valentine's Day the second day of this season if you gave up chocolates! While certainly not everyone practices Lenten observances, I think most people are familiar with the general concept of offering some sort of self-discipline as part of a religious practice, so this is a good opportunity for me to share a thought about the mix of religion and medicine.

As a physician- especially as a Catholic one- I really appreciate Lent. Just as New Year's resolutions for healthy changes are fading away, in comes Lent to save the day! All kidding aside, while many of us have wonderful intentions of limiting sweets, sodas, alcohol, nicotine, or you-name-it in the name of HEALTH, a good portion of us need that extra nudge of discipline that comes when these intentions are linked to a higher good. One way to do this is indeed the traditional practice of a "fast"from an earthly pleasure. If every time we start to reach for or simply crave our "off-limits item", we instead check ourselves and take a minute for prayer or reflection, how great is that? Not only are we not harming our body with an unnecessary substance or calorie load, but we gaining the peace and lower blood pressure that comes from meditation. Definitely a win-win! (Of course, if we gripe and grumble and feel extremely self-deprived every time, that's a whole different ballgame...)

Whether it is fasting, prayer, meditation, or acts of service for others, religious practices can be a wonderful asset to our health- both physical and mental. In my practice, I have seen tremendous success  when patients combine their spiritual and physical efforts in a very practical manner.

BOTTOM LINE: Harness the power of your religious strength to give you that extra push to stick to healthy life-style choices!

Great American Smokeout!

TODAY, the third Thursday in November, is the annual GREAT AMERICAN SMOKEOUT sponsored by the American Cancer Society. Each year, smokers are encouraged to use this day as a QUIT date, or at least as a day to make a plan to quit. If you have a friend who still smokes, please reach out to them today and kindly encourage them with a reminder that today is a special day earmarked for their health. With this vice, there is NO amount that can be justified as being "good" for you.  Tobacco harms virtually every organ in the body. Everyone knows about the cause and effect of smoking and lung cancer, but cigarettes also greatly increase the risk of developing cancers of the bladder, kidney, pancreas, esophagus, throat, mouth, pancreas, stomach, ovaries, cervix and colon. Smoking directly increases your risk of heart disease- both heart attacks and strokes. Obviously it damages the lungs, causing chronic conditions with increasing shortness of breath and lack of energy.
Finally, appealing to your vanity (hey, whatever it takes!)- tobacco stains your teeth and gives you bad breath. And guys, smoking can lead to erectile dysfunction that evenViagra cannot "cure"...enough said.

Tobacco is one of the strongest addictions, and therefore often the most difficult to quit- if you are a smoker, I don't have to tell you that! The good news is that we have more ways to support you as you quit, and even if you have smoked for many years, quitting now still yields many benefits for your health! Blood pressure and carbon monoxide levels improve the first DAY you quit. In a couple months, both your circulation and lung function start to improve. In just one year after quitting, you will have cut in half your excess risk of heart disease compared to people still smoking. In a decade, your risk from dying of lung cancer falls to half that of a current smoker.

BOTTOM LINE: If you smoke- even "socially"- the SINGLE MOST IMPORTANT THING YOU CAN DO FOR YOUR HEALTH IS TO QUIT SMOKING!!! Talk to your doctor and make a plan TODAY.

7 Ways to Leave Your Cigarettes

SEVEN seems to be the magic number for habits of successful people, right? SO...smokers, step on up to the SEVEN choices to help with QUITTING SMOKING! QUITTING SMOKING is the single most important thing you can do to improve your health. In alphabetical order, here they are:

1. Bupropion SR (Wellbutrin SR)- this is an antidepressant that works via unknown mechanisms to decrease your desire for smoking; you start it a week or two before your quit date, and it significantly shuts down that craving for a cigarette.
Common side effects- insomnia and dry mouth.
2. NIcotine gum- do NOT chomp it like regular gum! It's chew, chew, stash it.
3. Nicotine inhaler- used every hour or two during the day; may cause throat/mouth irritation and cough
4. Nicotine nasal spray- 2-4 sprays per waking hour as needed; may cause local irritation in nose and throat
5. Nicotine patch (now OTC, but ask your doctor which dose)- may cause skin irritation; remove at night so no sleep issues
6. Nicotine lozenge- may cause mouth soreness and nausea
7. Varenicline (Zyban)- blocks nicotinic receptors and sharply decreases cravings; Common side effects: very vivid dreams and nausea.

Are they expensive? Puh-lease! Are cigarettes expensive? YES! These aids are money well spent, and will pretty much equal what you are already spending on your habit.

BOTTOM LINE: If you think you've tried everything to quit, double check the list and head to your doctor for a new cessation aid!

"Just" a Social Smoker?

Stop and think- do you know a teenager who is smoking? Or one you THINK is starting to smoke? If you start smoking in junior high or high school, there is an astounding 80% chance you will be a smoker the rest of your life. Today, the Surgeon General released a report about smoking habits of our American youth. Despite tons of warnings and educational programs, one in FIVE high school students are smoking. Can you believe that for every American who dies annually from cancer-443,000- there are now TWO youths just beginning to smoke? If you do the math, you'll see that an average of 1,213 Americans die every day as a result of this deadly, intensely addictive habit.


Yes, there are those rare adults who can simply walk away from a pack per day smoking habit- God bless them! The majority of smokers, however, tell a different story. I have many men and women patients in their 30's and 40's who are incredibly frustrated that they cannot seem to permanently quit smoking. The typical story is that they started smoking "socially" along with drinks and happy hours during college, and never intended to become a "real" smoker. Many only still smoke on weekends, but they are so habitually tied in with a group of friends or co-workers that use smoking (and often drinking) as their social bond, that it feels rude and counter-culture to quit. Other smokers started out as "social" weekend users, but found more and more that stress was "relieved" with a quick cigarette, and that it served as a legitimate reason to step outside and take a break from work, home, or kids. Women tell me that they CAN"T quit because they will "get fat". There are a million reasons offered as reasons not to quit, including the fact that some simply enjoy it. BUT...there is simply no amount of nicotine & cigarette smoking that is good for you. We can rationalize an alcoholic drink per day, as there truly can be medical benefit from that, but absolutely none from smoking.

Very few adult smokers are thrilled with their habit. Most would like to quit, just as most overweight people would like to lose weight. If you are a smoker, PLEASE schedule an appointment with your doctor to discuss a plan to quit smoking. There are numerous ways your physician can help. The average long term smoker takes at least 5 serious attempts to permanently quit- and many take more than that, but you CAN be successful. Please don't wait for you or your loved one (smoking is rarely a solo sport) to suffer a heart attack, stroke or cancer to get serious about quitting.

BOTTOM LINE: SMOKING is addictive and deadly. Period. Don't let anyone you know START smoking, and help encourage those smokers you to to seek help from their physician to quit.

A WEIGHTy Issue- Quitting Smoking!

Why do people who quit smoking gain weight? Does it always happen, or can it be avoided? Do we really care that weight gain is really less detrimental to our health than smoking?
As a physician, I have found that women in particular choose to keep smoking because they simply do NOT want to gain weight. Period. I will confess that I will occasionally try to appeal to their vanity by discussing the yellow teeth or bad breath that tend to accompany cigarettes, but the reality is that what is important in this situation is helping patients understand why smokers gain weight with quitting, and how it can be avoided. So here are some things to remember:

1. Nicotine is an appetite suppressant, so obviously, when you initially take it away, your appetite is up.
2. Smoking KILLS taste buds, so just about the time the extra appetite from quitting is going away (around a week), suddenly food begins to TASTE better, because now you've actually got healthy taste buds!
3. Happily, ALL FOODS taste better, not only the high fat/high calorie ones.
4. Yes, oral gratification is a habit, so STOCK YOUR FRIDGE with some low calorie, crunchy and delicious snacks like carrot sticks with hummus, or apple slices, or ANY fruit or vegetable. Additionally, suck on sour hard candies the first week or two.
5. Don't forget EXERCISE! Getting and keeping your heart rate up for 30 minutes per day is equal to a low dose of an anti-depressant medicine, so exercise will not only balance extra calories consumed, but will make you HAPPY and less irritable!

BOTTOM LINE: As we approach New Years, move QUITTING SMOKING to the top of your list and know that weight gain is NOT inevitable.

FDA's New Cigarette Labels- Wonderfully GROSS!

Let's hear it for the FDA! Cigarette boxes will no longer carry the simple boxed warning that smokers have come to ignore over the last couple decades. Instead of these simple printed words, now there will be nine different graphic images with accompanying appropriate messages. "WARNING: Smoking is addictive"- showing a man smoking from the hole in his tracheotomy (a hole in the neck surgically created for patients on ventilators long term), or "WARNING: Cigarettes cause fatal lung disease" with a picture of healthy pink lungs next to horribly diseased lungs. I think my favorite, though, is the one I posted above, with the yellowed teeth and cancer sore rotting on the lip.

I believe we need to address tobacco addiction at the age and interest level of the smoker. Teens rightly aren't terribly concerned with emphysema at age 60, nor lung cancers even as early as their 40s. They MIGHT listen, however, to concerns about bad breath and yellow teeth. An older smoker, however, may believe tooth whiteners and listerine will fix any transient problems, but the threat of stroke or heart attack from tobacco-related disease might hit home.

Whatever the age, I am pleased to see new marketing strategies put in place to shake up the routine. The FDA will be rotating pictures/messages to be sure that smokers are barraged with new warnings as they begin to be desensitized to the first batch.
Smoking is VERY addictive, and I have yet to meet a smoker over the age of 30 who doesn't wish they had never picked up that first cigarette- even those who steadfastly maintain they enjoy smoking and "don't care if it kills (them)".

BOTTOM LINE: If you still smoke, PLEASE talk to your doctor and find out what options you have to help you QUIT for LIFE.

Quitting Smoking...a WEIGHTY Issue

Why do people who quit smoking gain weight? Does it always happen, or can it be avoided? Do we really care that weight gain is really less detrimental to our health than smoking?
As a physician, I have found that women in particular choose to keep smoking because they simply do NOT want to gain weight. Period. I will confess that I will occasionally try to appeal to their vanity by discussing the yellow teeth or bad breath that tend to accompany cigarettes, but the reality is that what is important in this situation is helping patients understand why smokers gain weight with quitting, and how it can be avoided. So here are some things to remember:

1. Nicotine is an appetite suppressant, so obviously, when you initially take it away, your appetite is up.
2. Smoking KILLS taste buds, so just about the time the extra appetite from quitting is going away (around a week), suddenly food begins to TASTE better, because now you've actually got healthy taste buds!
3. Happily, ALL FOODS taste better, not only the high fat/high calorie ones.
4. Yes, oral gratification is a habit, so STOCK YOUR FRIDGE with some low calorie, crunchy and delicious snacks like carrot sticks with hummus, or apple slices, or ANY fruit or vegetable. Additionally, suck on sour hard candies the first week or two.
5. Don't forget EXERCISE! Getting and keeping your heart rate up for 30 minutes per day is equal to a low dose of an anti-depressant medicine, so exercise will not only balance extra calories consumed, but will make you HAPPY and less irritable!

BOTTOM LINE: Be proactive with your available food choices and exercise, and you will NOT pack on a bunch of weight when you quit smoking.

Seven Tips to Quit Smoking!

This week I'm focusing on QUITTING SMOKING, the absolute most important thing you can do for your health if you smoke. I've talked about prescription aids, but what can you do on your end? Lots! Here are seven tips that patients have had the most success with over the years:

1. Set a QUIT DATE and TELL EVERYONE YOU KNOW (helps keep you accountable!)
2. Right NOW, only smoke the cigarettes you REALLY want (typically around 6 per day for a pack per day smoker).
3. Do NOT smoke the "trigger" cigarettes-phone rings, starting the car, turning on the tv or finishing a meal.
4. Have your car professionally cleaned the day before your quit date (if you smoke in your car.)
5. Clean out your "smoking area"- throw out or give away ashtrays.
6. Pick a splurge reward and earmark your cigarette money to pay for it! Cigarettes cost a ton of money, so toss those $5 and $10 bills into a large glass jar on a counter top each day and have a fun visual reminder of your savings, or post a picture of your prize and make a money "thermometer" that you can color in as the money grows.
7. Grab some really sour hard candy to suck on the first week as a non-smoker; the sour nature stimulates your salivary glands and really helps with the oral craving portion.

BOTTOM LINE: Start with these seven tips to insure that THIS time you will be successful QUITTING SMOKING!