"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.

MORE- A Novel "Diet"

On this last day of the 2010 AAFP Scientific Assembly, I will be speaking about nutrition. As family physicians, we are all motivated to help our patients achieve the best health they can, and often the major issues stem from being overweight. We know excess weight leads to high blood pressure, elevated sugars and diabetes, and high cholesterol levels, which can lead to heart attacks and strokes. So why don't more family doctors talk to their patients about their weight?

Of course, there are many reasons, but here are a few:
1. The doctor doesn't want to insult or upset the patient by telling them they are overweight, especially if the doctor herself is overweight.
2. Weight loss counseling can be very time consuming, and we are already time pressured without opening this can of worms.
3. Many doctors lack knowledge or training regarding current nutrition, and are unsure of which "diet" to recommend.
4. Often patients want weight loss drugs, and most doctors are unsure of the risks and aware of the high percentage of relapse once the medication is stopped.

My goal today will be to teach primary care physicians some simple tools that they can use to help motivate their patients to lose weight. They will learn about BMI, 24 hour dietary recalls and exercise prescriptions, and learn about my MORE philosophy! We all know that MORE fruits and veggies will push us towards better health, but having a concrete plan for More fruits/veggies, Optimizing Snacks, Ramping up Fiber and Exercising daily will be a terrific start! In fact, our surgeon general, Dr. Regina Benjamin, emphasized that we need to stop focusing on what we CANNOT have/eat, and start focusing on what we can and should be eating, which is exactly the MORE message I have been sending the past few years

BOTTOM LINE: Focus on MORE fruits and veggies, MORE exercise, MORE fiber and stop the culture of restrictive dieting!

One at a time...Our Surgeon General's Message

Okay, I'm still on a high from meeting our amazing Surgeon General, Dr. Regina Benjamin yesterday! (I hope she doesn't mind that I am posting this picture.) I want to share a story she told us yesterday -you know how I always say stories are more powerful than statistics, right? Here it is:

A girl was out jogging along the beach. She saw an old man meticulously walking along, bending over and picking up starfish stranded from the tide, and tossing them back into the ocean. He was still there, plugging along, on her return. She could stand it no more, and asked him, "Why bother picking up these starfish? Look a the hundreds of them along the beach! The sun is out, the tide has receded, and they are all going to dry up and die." The wise old man looked at her, then deliberately bent down and picked up the next starfish. Holding it gently in his hand, he turned to the jogger and replied "because it matters to THIS one" and returned it to the sea.

Why bother educating our patients to eat more fruits and veggies when fast food heart-attack-on-a-plate is everywhere? Why take the time to educate about the real risks of physical intimacy and the awkward topic of STDs? Because ONE AT A TIME, it makes a WHOLE WORLD of difference, and together, we will turn the tide!

BOTTOM LINE: Let's ALL follow America's Doctor's advice, and MAKE A DIFFERENCE for at least ONE person today (even if that one person is YOU!)!

Proud to Be a Family Physician!

This week I am in Denver at the American Academy of Family Physician's Annual Scientific Assembly. This is a terrific conference, chock-full of the latest evidence-based medical advice. Each year I leave here with new tools to help my patients, although as I have mentioned in previous blogs, today's hot news may be that yesterday's advice was wrong!

Here are a few things that I learned or reinforced today:
1. Using Tylenol (acetaminophen) and Advil (ibuprofen) together is not only safe, but has a more powerful punch for pain relief than either drug alone.

2. Prescribing narcotic pain relievers for acute low back pain prolongs the disability from the back pain (we should use muscle relaxants and less addictive pain relievers.)

3. Using the Framingham risk assessment tool will help me to counsel patients on whether or not they should take a cholesterol lowering medication.

4. Pushing diabetics to lower their Hemoglobin A1C's (a long term measure of blood sugar levels) as low as possible can actually lead to worse outcomes than accepting a mid-range level.

5. I had the pleasure of hearing and meeting our Surgeon General, Dr. Regina Benjamin, as she addressed our academy. I am proud that she is a fellow FAMILY PHYSICIAN and admire her vision of healthier, more FIT Americans!

BOTTOM LINE: Physicians, like all professions, must continue to learn and re-learn what evidence and OUTCOME based studies teach us really help our patients! Stay tuned for more insights from this week...