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FREQUENTLY ASKED QUESTIONS (FAQ) FOR ALT.SUPPORT.STOP-SMOKING (AS3) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Part 4: TECHNIQUES, TROUBLESHOOTING, AND TIPS "I am definitely gaining weight. The added money in my wallet is really weighing me down! Let the weight gain continue!" - Rick Weaver "I'd rather be chunky than a nicotine junkie!" - MaryJane Patterson 31. How do I avoid relapsing during stressful times? You can avoid a lot of the things that trigger the urge to smoke until you feel ready to handle them. But stress, bad news, and sad events come on their own terms, and when they do, they make many of us return to the comfort of that false friend, smoking. There isn't any technique to guarantee that you won't smoke when the going gets really tough, and you'd only be human if you did. But if you can try to remember that smoking is only temporary relief and can't really solve your problem, you might get through. Here's how Nat <email@example.com> put it: "My dad died in March of lung cancer. I had quit a couple of months prior to that and started back during the days leading up to the funeral. What I'm going to say may sound hard, but I feel more compassion than you know. My daddy died. I smoked just one. My daddy was still dead. I smoked some more. He was still dead. The estate pressures were still there. My momma still needed me. My family still needed me. I was once again a fully involved addict with a lot of grief and pressures. I have had to go through the quit all over again. "We learn to deal with our emotions through smoking. A crisis arises after 2-3 years and we want to smoke. The quit process never ends. Every day we must make a conscious decision to either win or lose. If you look at it right, it's an opportunity that the never-smoker doesn't have: victory over the most addictive substance in our culture!" Another way to deal with a strong urge is to beat it senseless. :) Here, Susan <firstname.lastname@example.org> describes her battle with what we like to call the Nicobeast: "... in a drunken stupor, I did the only thing I could do. I got in a barfight with him. I would have slammed him onto the pool table but it's a British Pub, no table. I would have hit him with a beer bottle but I was drinking mixed drinks. So I hit him. Hard. Then I kicked him right where it hurts. Rest assured my friends, there will be no little nicobeasts running around ... if you know what I mean. I was trying not to be too obvious about beating him up as I didn't want my friends to notice. Fortunately, we were outside. So I pretended to be stomping my feet to keep warm. Really I was stomping the nicobeast into so much hamburger helper. I had to sing Ave Maria to cover those awful squeals that he made. I can't carry a tune in a bucket. It was a little embarrassing, but worth it. I walked away unscathed." 32. I dreamt I smoked! The 'smoking dream' is a bizarre yet very common phenomenon among ex-smokers. It might hit at different phases of your quitting experience; it might hit when you think you don't even think about smoking anymore. These dreams tend to be very vivid and so realistic that you will probably believe you actually smoked; you may even wake feeling raw in your throat. But, no matter how real the guilt feels, dreaming about smoking is not equivalent to actually smoking! So when the dreams come, try not to be bothered by them, just amused at the power of the subconscious. 33. What about weight gain? By Michael D. Myers, M.D. <email@example.com>, as published on his homepage. Reused with kind permission. Smoking and Obesity. "When people stop smoking, they commonly gain weight. Most people think that they are substituting food for cigarettes. This is partially correct. Smoking is usually a different form of oral gratification that obviously does not involve the consumption of calories. However, smoking does have another effect - it actually increases caloric requirements. A person who smokes requires approximately 10% more calories to maintain their body weight than when they are not smoking. Therefore, if a person maintains constant food intake and exercise and stops smoking, their body weight is expected to increase between 5% and 10%. "An excellent way to help counter this is to exercise consistently. For example, start walking 30 minutes a day three to four times a week - a very feasible goal. Another approach is recording your food intake. If you write down everything you eat before you eat it, you will become much more aware of what you are eating. This helps you make better food choices, thereby helping you maintain your weight. "It is much more important to stop smoking than to worry about weight gain. The deleterious effects of smoking far outweigh the effects of putting on a few extra pounds. Some people think that when they stop smoking it is also a good time to go on a strict diet. This is not recommended because both are very stressful and it is extremely difficult to do both effectively. Usually, people do not succeed at either and feel like failures. Remember that it is important to stop smoking first. Then you can deal with your weight more effectively. "Disclaimer Statement: The above information is for general purposes only, and should not be construed as definitive or binding medical advice. Because each person is medically different, individuals should see their personal physicians for specific information and/or treatment. For comments, please send E-mail to: firstname.lastname@example.org. I do respond to E-mail. Office Address: MICHAEL D. MYERS, M.D. Inc. 4216 Katella Av. Los Alamitos, CA (US) 90720 phone: 1-310-493 2266." 34. But I don't *want* to gain weight! Contributed by Susan <email@example.com> "Another person in the ng who wanted this information thought others would be interested, so I am passing it along. Walking has helped me a lot, both on the stress side and to avoid gaining weight. Smoking fact: A smoker who smokes 20 cigarettes per day burns approximately 200 calories more each day than if he/she were a non-smoker. To eliminate that 200 calorie gain, use the calculation below: A person weighing 140 pounds who walks 3 miles [roughly 5km] per hour (a 20 minute mile) will burn about 95 calories per mile. 45 minutes at this pace will result in about 2 miles being walked, or 215 calories burned. This alone will prevent weight gain after quitting. Just walk a little longer or a little faster to lose weight. Also remember that 3,500 calories need to be expended or eliminated from the diet per pound of weight. I personally much prefer working out to giving up calories! At 120 lbs, a person walking at 3 mph will burn 80 calories. For every 10 lbs you weigh over 120, add 5 calories burned." 35. Just how does smoking harm my health? [This was posted to AS3 so long ago that the source has been lost. If anyone knows where this is from, please e-mail firstname.lastname@example.org.] * Lung Cancer risk increases roughly 50 to 100 percent for each cigarette you smoke per day; * Heart Disease risk increases roughly 100 percent for each pack of cigarettes you smoke per day; * Switching to filter-tip cigarettes reduces the risk of Lung Cancer roughly 20 percent, but does not affect the risk of Heart Disease; * Smokers spend 27 percent more time in the hospital and more than twice as much time in intensive care units as nonsmokers; * Each cigarette costs the smoker 5 to 20 minutes of life; * A smoker is at twice the risk of dying before age 65 as a non-smoker!! 36. What are some of the less publicized health risks of smoking? We all know that smoking greatly increases the risk of developing emphysema, stroke, heart attack, lung cancer, etc. In addition, there are several less publicized health conditions which are linked to smoking: a. Blindness In October 1996, results of separate long-term studies linking smoking to an incurable form of blindness called age-related macular degeneration were published in the Journal of the American Medical Association (JAMA). In this form of blindness, a person's field of vision becomes increasingly limited. The research found that smoking more than doubled the risk of macular degeneration in women over 50, with similar findings in men over 40. While researchers couldn't pinpoint the exact reason for the increased risk, they theorized that smoking either affects the blood flow to the eye, or causes retinal damage through oxidation. (source: JAMA. 1996; 276:1141-1146 [study of women]; 1147-1151 [study of men]) Thanks to Evan Herberg for calling this study to AS3's attention. b. COPD From The Lung Association Home Page: "COPD (Chronic Obstructive Pulmonary Disease) is a term that refers to a variety of chronic lung disorders, the most common being a mixture of chronic bronchitis and emphysema. "COPD is the result of damage that has been done to lungs over many years. The diagnosis is made when the symptoms become apparent to you and your physician. "COPD results in chronic airflow obstruction, the main symptom of which is dyspnea, or shortness of breath, often occurring with cough and wheeze. COPD affects both men and women. The average Canadian with COPD is 65 years of age and has a long history of smoking. However, COPD can first be diagnosed in patients as young as 40. "COPD progresses slowly and worsens over time. Symptoms can range from being barely noticeable to incapacitating. The rate of progression and extent of disability vary from person to person. "While there is no cure for COPD, the progression of the disease can be controlled first and foremost by quitting smoking. Appropriate medication, exercise rehabilitation and prevention of infection are also important factors in the rate of deterioration and symptom control." c. Depression This is a biggie, and comes up for discussion frequently. The excellent discussion below was posted to AS3 on 30 Sept. 1996: Darcy Binder <DBinder@ifc.org> wrote: "Does anyone know the connection between smoking (or quitting smoking) and depression? I have quit three times in my life, and each time I have been getting seriously depressed. Is there a chemical connection? Is it the lack of stimulant? I don't want to start again -- its been SIX weeks -- but I also would like to stop crying!" Bob Christofferson <email@example.com> followed-up: "Hi! There definitely *is* a chemical connection between nicotine and depression, but as with most matters of brain chemistry, it's less than perfectly understood. What is quite certain is that people who are depressive find nicotine an especially effective drug, and consequently find it especially hard to quit. "That doesn't mean that *you* are depressive, however. It's a normal response to nicotine withdrawal to have some feelings of depression. If you read the posts to this group, you'll notice that many people go through periods of depression while completing the process of smoking cessation. Different people have the experience at different times after they quit, and some people don't seem to have it at all. But, for most people, it's a withdrawal symptom which isn't too severe and doesn't last too long, and they recover from it and feel 'like themselves' again. "In some people, though, smoking cessation does trigger serious episodes of clinical depression which require medical treatment, and which, in the extreme, can be life threatening. In recent years, new medication and therapies have been developed which can help most people with depression, and which often produce dramatic improvement quickly. Many people who could benefit from these treatments, though, are reluctant to get help because they feel embarrassed or ashamed, because they think they should be able to 'snap out of it' or somehow make their illness go away by themselves. Of course, there's no reason for anyone to think that, but symptoms of depression typically include feelings of guilt and hopelessness, which make it hard for the person to see the situation objectively. "So, how does anyone decide if their symptoms are more than the normal consequence of smoking cessation? My advice is that anyone who has any doubt should be evaluated *really soon* by a medical professional qualified to determine whether medical attention is needed. I say that in part because I'm convinced people hardly ever exaggerate the seriousness of their own situation but often will *understate* it, even to themselves -- for perfectly sensible reasons, really. No one I know has ever been eager to get mental health treatment (but quite a few people I know have benefited by getting it). "So, my point of view is that if someone feels they may be more depressed than 'normal' nicotine withdrawal would explain, then there's a good chance that they are -- at least, a good enough chance that they should talk it over with someone who can tell." d. Gastro-Esophageal Reflux Disorder (GERD) Again, I'll let the information come from our impressively well informed members. This was posted 22 Oct. 1996: Luci wrote: "Hi! I need an info buddy... After years of smoking and sinus problems, etc., I've been diagnosed with a new disorder - gastro esophageal reflux disorder. Does anybody out there share my problems??? Any advice???" Ed replied: "I've had GERD for years ... "GERD, according to my doctor, is often caused by cigarette smoke irritating the valve that separates the esophagus from the stomach. It seems that the smoke also goes down the esophagus when we inhale. For some not completely understood reason, the smoke irritation causes a loose closure of this valve and at times stomach acid can rise into the esophagus. The tissue of the esophagus, unlike the stomach, reacts with pain when in contact with stomach acid. A prescription drug - PRILOSEC, has really helped me. It is time-released and I take one each day. On rare occasions, usually at night, I also use liquid GAVISCON and within 20 minutes the discomfort is gone. PRILOSEC is prescription. GAVISCON is over-the-counter. Both are not cheap but they work for me. "Hope this helps you. GERD is not uncommon. Just another reason for me to stop the cigs." e. "Smoker's Face" and Other Dermatological Ailments This phrase seems to have been coined in 1985 by Dr. Douglas Model of Eastbourne, England, who found, in empirical evidence, that nearly half of the smokers he studied looked far older than they were. Similar research was conducted by Dr. Jeffrey Smith, a senior resident in dermatology at the University of South Florida in Tampa. He found these conditions to be directly related to smoking: (From The St. Paul (Minnesota) Pioneer Press, 23 June 96. Originally posted to AS3 by <firstname.lastname@example.org>) "Wrinkles: 'For some patients the threat of wrinkles may be a more powerful motivator to help them stop smoking than the more deadly consequences of smoking,' Smith wrote. He explained that, as with skin that is overexposed to sunlight, smoking causes thickening and fragmentation of elastin, the elastic fibers that are long and smooth in healthy skin. Smoking also depletes the skin's oxygen supply by reducing circulation. It decreases the formation of collagen, the skin's main structural component, and may reduce the water content of the skin, all of which increase wrinkling. "Smoking also interferes with the skin's ability to protect itself against damage by free radicals, highly reactive substances that are omnipresent in tobacco smoke. In women, smoking diminishes the level of circulating estrogen, which in turn fosters dryness and disintegration of skin tissues. "Skin Cancers: Two kinds of skin cancers, the more curable squamous cell carcinomas and the often lethal melanomas, are influenced by smoking. Smith said that although smoking did not cause melanoma, smokers with melanoma were more likely to die of their disease. They are twice as likely to have advanced disease at the time of diagnosis and are more likely to have their cancers spread within two years of diagnosis, probably because smoking impairs the immune system. As for squamous cell carcinoma, even when exposure to sunlight was taken into account, smokers were found to be at greater risk of developing this cancer. In a study of more than 107,000 nurses, for example, the risk of developing squamous cell carcinoma was 50 per cent greater in smokers than in those who had never smoked. Smokers also tend to get particularly 'large, bad' skin cancers, Smith said. "Other Cancers: Cancers of the lip, mouth, penis, anus and vulva are also more common in smokers than nonsmokers. For example, in one study of 903 female cancer patients, 60 percent of those with vulvar and anal cancers and 42 percent of those with cervical and vaginal cancers were smokers as against only 27 percent of comparable women without cancer. Smoking more than 10 cigarettes a day more than doubles a man's risk of developing penile cancer. "Delayed Wound Healing: The problem of slow or incomplete healing of wounds associated with exposure to cigarette smoke was clearly demonstrated in laboratory animals in the 1970s. Then surgeons began reporting on similar problems in patients who smoked: larger scars in women undergoing exploratory abdominal surgery, more complications and skin sloughing after facelifts and a much higher failure rate of skin grafts, for example. The more and the longer patients had smoked, the greater the likelihood of impaired wound healing. Even resuming smoking during an uneventful recovery could lead to adverse effects. Smith linked the slow healing of wounds to known effects of cigarette smoking, which constricts surface blood vessels, reduces the oxygen level in the blood, thickens the blood and impedes the laying down of collagen needed for healing. "Psoriasis and related disease: Studies of both men and women with this unsightly and discomforting skin condition have shown that smokers are about two to three times as likely to develop it as nonsmokers. And the more cigarettes smoked, the greater the risk. Palmoplantar pustulosis, a difficult-to-treat skin condition that resembles psoriasis, occurs only on the palms of the hands and soles of the feet. The skin blisters, then forms a scaly rash. It occurs almost exclusively in smokers and it does not necessarily go away when the patient quits smoking. "Oral lesions: In addition to smoker's face, there is also smoker's palate and smoker's tongue. The tars and heat of tobacco smoke can cause tiny red pimples in the mouth that result from an inflammation of the openings of salivary glands. Smokers also often develop depressions on the surface of the tongue. Potentially more serious, however, are lesions called leucoplakia, which are about six times more common in smokers than in nonsmokers. Although benign, these white patches in the mouth can become cancerous. "Buerger's disease: This blood vessel disease results in poor circulation in the lower legs, causing skin problems like burning, tingling and ulcerations. 'It usually occurs in young men who smoke, men in their 30s,' Smith said. 'But now that women are smoking a lot more, we're seeing it in women too.' "Other Skin conditions: Many skin diseases are associated with diabetes, which impairs circulation to the outer reaches of the body. A study of more than 112,000 female nurses followed for 12 years showed that current smokers faced an increased risk of developing noninsulin-dependent diabetes, and that the risk rose with the number of cigarettes smoked each day. Another study of nearly 43,000 male health professionals showed that smoking 25 or more cigarettes a day doubled a man's risk of developing diabetes. "People who smoke are much more likely to develop the bowel disorder Crohn's disease, which can cause 'big, ugly-looking ulcerations, most often on the legs, and painful red nodules, usually on the lower legs,' Smith said. Another condition more common in smokers is systemic lupus erythematosus, an autoimmune disease that can cause rashes on the face, scalp, hands and elsewhere, ulcerations in the mouth and hair loss." 37. How do the numbers from smoking-related deaths compare to other causes of death? The statistics which follow were obtained from an American Cancer Society pamphlet and are for 1993. Cause of Death : Number per Year (excluding smoking) (U.S.A. only) Alcohol-related: 105,000 Car accidents: 49,000 Suicide: 31,000 AIDS: 31,000 Murder: 22,000 Fire: 4,000 Cocaine: 3,300 Heroin/Morphine: 2,400 ~~~~~~~~~~~~~~~~~~~~ Total (of above): 247,700 Cause of Death: Number per Year (Tobacco only) (U.S.A. only) Total tobacco related: 434,000 38. What is metastasis? By Barry Pekilis: "'Metastasis' is defined as the transfer of a disease-producing agency from the site of the disease to another part of the body. One of the mortal threats of cancer is metastasis. Early detection of cancer can be the difference between life and death. Most cancers can be detected at an early stage mainly because of physical symptoms such as lumps, bleeding, or some other clue. "Unfortunately there are two types of cancer in which early detection is highly unlikely: lung cancer and pancreatic cancer. By a dint of bad luck, if an individual has one of these two cancers, they will probably not know it until the disease has invaded other vital organs and parts of their body. By this time is may be too late for any meaningful treatment or cure. "The five-year survival rate for pancreatic cancer is 5% and for lung cancer, 10 percent. This compares to a survival rate of 50 80% for most other cancers. "This information is being supplied in this FAQ to help provide motivation for those of you who have either quit or are trying to quit. Cigarette smoking appears to be a major cause of both of these two malignant cancers." [For more on lung cancer in particular, including a GIF of a diseased lung, try http://ourworld.compuserve.com/homepages/LungCancer/ 39. What if I quit ... will I ever get better? Smoking cessation has major and immediate health benefits for men and women of all ages. These benefits apply to people with and without smoking-related diseases. The following information is from a booklet produced by the American Cancer Society: Within 20 minutes of your last cigarette: * blood pressure drops to normal * pulse drops to its normal rate * body temperature of your hands and feet increases to normal Within 8 hours: * carbon monoxide level in your blood drops to normal * oxygen level in your blood increases to normal Within 24 hours: * chance of heart attack decreases Within 48 hours: * nerve endings start regrowing * your abilities to smell and taste things are enhanced Within seventy-two hours: * bronchial tubes relax, making breathing easier * lung capacity increases Within two weeks to three months: * circulation improves and walking becomes easier * lung function increases by up to 30 percent Within one to nine months: * coughing, sinus congestion, fatigue, shortness of breath decreases * cilia regrow in lungs, increasing ability to handle mucus, clean the lungs, and reduce infection * the body's overall energy level increases Five years: * lung cancer death rate for average ex-smoker decreases from 137 per 100,000 people to 72 per 100,000 (... almost half!) Ten years: * lung cancer death rate for average ex-smoker drops to 12 deaths per 100,000 (... almost the rate for a non-smokers and a full order of magnitude less than a smoker) * precancerous cells are replaced * other cancer rates (e.g., mouth, larynx, oesophagus, bladder, kidney and pancreas) decrease as well In addition: * ex-smokers tend to live longer than continuing smokers * smoking cessation decreases the risk of lung cancer, other cancers, heart attack, stroke, and chronic lung disease * women who stop smoking before pregnancy or during the first three to four months reduce their risk of having sickly babies, as compared to women who continue to smoke 40. OK, I quit. Why do I feel worse? [From CancerNet from the National Cancer Institute. CancerNet News. Clearing the Air: How to Quit Smoking...and Quit for Keeps. U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health.] National Cancer Institute, NIH Publication No. 94-1647, September 1993: "Immediate Effects "As your body begins to repair itself, instead of feeling better right away, you may feel worse for a while. It's important to understand that healing is a process - it begins immediately, but it continues over time. These 'withdrawal pangs' are really symptoms of the recovery process. "Immediately after quitting, many ex-smokers experience 'symptoms of recovery' such as temporary weight gain caused by fluid retention, irregularity and dry, sore gums or tongue. You may feel edgy, hungry, more tired, or more short-tempered than usual; you may have trouble sleeping or notice that you are coughing a lot. These symptoms are the result of your body clearing itself of nicotine, a powerful addictive chemical. Most nicotine is gone from the body in 2-3 days." [To treat these 'symptoms of recovery,' give your body what it really needs - NOT the poison which it is working so hard to expel! If you're tired, nap; edgy, try camomile tea, warm milk, a soothing bath; when constipated, get some exercise and eat some dried fruit. Keep in mind that these symptoms are temporary and are steps leading to better health than you've known in a long time! -ed.] 41. On the other hand ... why do I feel so potent? Smoking robs the bloodstream of oxygen, causing constricted blood vessels and reduced bloodflow to the fingers and toes, the brain, and er, other extremities. Men who quit smoking have erections which are comparatively larger, firmer, and of longer duration than when they smoked. Enjoy. 42. I've smoked for so many years, what's the point of quitting now? By Barry Pekilis: "LOTS! A new study (coordinated by the University of Manitoba and involving 10 sites in the United States and Canada) proves for the first time that smokers who quit wind up with healthier lungs, no matter how long they had smoked. The study involved more than 5,800 smokers who were victims of chronic obstructive lung disease: a combination of emphysema and bronchitis (the fourth leading cause of death in the U.S.A.). "The study was the first proof that if you stop smoking at any age, you will have healthier lungs. "It was the largest study ever conducted on the prevention of lung disease and showed without a doubt that quitting smoking is the most effective way of preventing lung function decline. "So there you have it, conclusive proof the it worth quitting no matter how old you are or how long you have smoked for." 43. How can I urge someone to quit smoking, or encourage someone who is trying to quit? * Do not pester someone who is trying to quit smoking or who is in the initial stages of thinking about quitting as it is probably the worst thing someone trying to offer support can do -- also do NOT nag, insult, or attempt to shame a smoker into quitting; * Remember that even well-intentioned praise might irritate the quitter at any given moment. Do what you can to gauge the quitter's mood, leave a wide berth where necessary, and forgive what seem to be irrational reactions; * Let your spouse/friend/roommate know that no matter what happens that you value them as a person (even though you may disapprove of their smoking) and that you respect them for trying to break free addiction; * Learn to listen non-judgmentally and attempt to understand and see the problems of quitting a powerful and seductive addiction through the smoker's eyes; * Remember to praise a smoker for even the smallest effort in trying to quit or cut down -- quitting is a process and it takes time! A final thought: "The hard part is staying quit and to do that, you need an armamentarium of alternatives to smoking as long as they aren't other addictions that just serve as a substitute 'friend'. It important not to use anything that will obscure or divert us from finding out that the best friend that we have, in some ways, the only consistent one, is the one inside." - Donna Payne, posted March 1996 -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-= End of Alt.Support.Stop-Smoking FAQ. Good journey, everyone!