Smoking is one of the most dangerous habits for any person with heart disease and is a major cause of premature death around the world. One of the ways in which smoking kills people is through premature heart disease. Every year millions of people die years before they should, only because they smoke. More than premature death is the effect smoking has on one’s health and well-being.
Smokers have less stamina and are less fit than non-smokers. Smokers are likely to spend more on medical expenses than non-smokers and they will be absent from work far more often than non-smokers. For someone who already has heart disease, smoking is like playing Russian roulette with oneself.
Cigarettes contain nicotine and tars that are released when the tobacco is burnt. The tars are irritants that can cause cancer and destroy the inner lining of the lungs. Because of this many smokers suffer from chronic bronchitis and infections of the respiratory tract. Emphysema is another condition that affects smokers. Tobacco smoke destroys the air pockets in the lungs and this leads to difficulty in breathing because enough oxygen is not absorbed into the body. It is due to this that the smoker has reduced stamina and gets out of breath quickly. These effects on the respiratory system multiply the problems of a cardiac patient.
Nicotine is a highly toxic substance and it is absorbed from the lungs into the bloodstream. It leads to a constriction of the blood vessels and the release of sympathetic hormones. This causes rapid fluctuations in blood pressure and leads to damage of the endothelium lining the arteries. Cholesterol is deposited in these arteries and this leads to further blockage of the artery. Tobacco smoke also raises the level of LDL cholesterol and increases the furring of the artery.
For someone who already has blockages, smoking can lead to the artery going into spasm and causing an infarct. Also, smoke contains carbon monoxide which binds with the haemoglobin in the blood and prevents it from carrying oxygen to the tissues. This can cause tissue damage and increase the damage to the heart.
Smokers often suffer from bad breath and their sense of taste and smell are affected. Fortunately, once the smoking is stopped, these changes are reversed and the person is often surprised that he can taste and smell again. It takes time to reverse the adverse effects of cigarettes on your health. A year after stopping smoking the heart attack risk is halved and over the next five years the risk reduces near normal. However to do this it is necessary to stop smoking completely. Research shows that smoking a single or a few cigarettes a day is harmful. Even a cigarette once in a while is harmful.
One reason why you should stop smoking permanently is that most people start smoking again after having a few cigarettes. They start with the occasional cigarette. Once they have smoked a cigarette, they get back the craving and then they go on to smoke another. Within no time they find themselves back to chain smoking again. This is why you need to decide to stop smoking even that occasional cigarette.
Pheroze made his living out of horses. He owned and raced horses. His life was lived at a frantic pace looking after his stud farm and incorporating a hectic social life. Pheroze considered himself the outdoor type and at 48 could still be found riding every morning even if he had been painting the town red the previous night. A medical examination revealed evidence of a healed heart attack. He could not remember having had any chest pain but often suffered from indigestion after a bout of drinking. His doctor told him that he could have had a heart attack at any time in the last few years and asked him to take things easy and to stop smoking.
Pheroze stopped smoking. A few months later however, he started smoking the occasional cigarette, especially at parties and after a few drinks. He soon progressed to smoking a few cigarettes a day and by the end of the year he was back to smoking 40 cigarettes a day. Needless to say, his coronary artery disease progressed and his doctor advised him to have a bypass as his left coronary artery had nearly closed down. This time Pheroze stopped smoking and went in for surgery. Soon after, he went into a deep depression and started smoking again.
His surgeon recommended that he consult a holistic physician for his depression and his suicidal behaviour. The doctor helped him with his depression and then suggested that he try self-hypnosis to stop smoking. Within a few weeks, he had stopped. He felt much better and was able to resist smoking even when offered a cigarette. Pheroze admitted to his doctor that he was aware that if he had stopped smoking earlier he could have avoided the bypass operation. Unfortunately he was unwilling to change his lifestyle and despite cholesterol lowering medication he had a third heart attack and died a few months later.
Nicotine is a very addictive substance and it is difficult to give up. It is not uncommon to see heroin addicts who have given up heroin but are unable to stop smoking. As patients with coronary artery disease usually do not have the severe emotional problems of heroin addicts, they find it easier to stop smoking.
Nicotine is a stimulant and it is often used by the person to perk up and feel alert or awake. Some people find that it distracts their mind and gives them some release from tension. Craving leads to tension and smoking is associated with the release of tension. Many Type A personalities find that it acts to soothe and calms them down when they are angry or irritable.
Some find that they get pleasure inhaling and watching the smoke curling up into the air or blowing. For others, it is an excuse to take a break from work and or socialise with others while they have a smoke. Often, especially among the younger college set, it is a way of being a part of the crowd or a peer group. Many see smoking as a part of their identity. They see themselves as being a ‘man’ or ‘cool’.
The most bizarre reason I have heard was from a senior executive of an addiction facility, who said that it was a sign of her ‘freedom’ to smoke.
People often start smoking when they are young and confused about their identity and smoking makes them feel grown up and sophisticated. Young people deny the possibility of illness and feel it could never happen to them. They continue smoking but over the years cigarettes no longer give them much pleasure, till one day it makes them ill. The main benefactors are the owners of the cigarette manufacturing companies who end up making huge profits.
With women’s liberation, smoking has also become popular among women. Often they start smoking because it is the ‘chic’ thing to do. The advertising industry has increasingly started targeting women to promote smoking. The increasing rate of heart attack in women is partially due to smoking. Smoking is much more dangerous for women then men. Women who smoke have a higher risk of developing disorders caused by blood clots, like strokes.
The best way to give up smoking is to stop immediately and throw away your packet of cigarettes. You may feel some discomfort to start with but gradually, you will find that the discomfort will pass away in a week or two. The commonest symptoms are a mild insomnia, restlessness and in some case a little anxiety or depression. Some people get preoccupied with the idea of smoking and will continue to think of cigarettes or experience cravings.
The other alternative is to gradually cut down and then stop on a day that you set in advance. Tapering down the number of cigarettes rarely reduces the amount of withdrawal symptoms and you may be tempted to put off stopping. If you already have heart disease you must consider the possibility that during the time you are tapering off your consumption of cigarettes, you may have an attack. Therefore I suggest that you get rid of your packet of cigarettes and start now. Throwing away all the cigarettes that you have has great symbolic significance and is a good way to start.
Your doctor may prescribe some tranquilisers for a few days. This will reduce chances of relapsing due to insomnia or anxiety. Do not take tranquillisers for more than a week or two. If you find yourself getting depressed after this, ask your doctor about using antidepressant medication because some heavy smokers get depressed after they stop smoking and this often triggers a relapse.
The best option is nicotine chewing gum that provides small amounts of nicotine in a safe form that is quite helpful in eliminating discomfort and craving. The patch, while available, is not as effective and much less effective. Most smokers, especially heavy ones, prefer the gum as they can adjust their intake of nicotine. I prefer the patch as some patients get addicted to the gum. One gradually decreases the dose of nicotine over a few weeks and this reduces the amount of craving during this period. Relatively inexpensive Nicotine gum manufactured locally is available in India. When combined with self-hypnosis it makes for a very powerful way to stop smoking.
For patients who suffer from intolerable withdrawal symptoms or cravings. The anti-hypertensive medication clonidine is an effective medication that suppresses these symptoms. A non-addictive tranquiliser, buspirone, is helpful for patients who suffer anxiety, agitation or get very irritable after they stop. It needs to be started at least two weeks before quitting. Bupripion (zyban) an anti-depressant is often recommended to help people stop smoking but the there are concerns about drug interactions and safety some unexplained deaths and convulsions (fits) with this drug. However in some cases it is helpful as it reduces relapse craving and relapse.
Note:
Please check with your cardiologist before you use any of these medicines as they may interact with your other medication and cause dangerous side effects. Many family physicians may not be aware of these drug interactions.
Craving for cigarettes is common soon after one stops smoking. But gradually, over a few months the craving become less and dies out. Nicotine binds to certain receptors in the brain which get habituated to the nicotine being present. If nicotine is not available at the receptor sites, the craving starts. The craving is associated with certain physical sensations and a preoccupation with cigarettes.
The process of craving is very much like a small child who wants something. If he does not get it he will cry for sometime and then ultimately stop crying. Often, before he stops, he will increase his volume or even throw a temper tantrum. Even after the child has stopped crying, if he sees the thing he wanted or if something reminds him of it, he will often ask for it or throw a small tantrum to try to get it. In a similar way, the primitive part of the brain uses craving as a way of trying to get the nicotine it is used to.
Therefore, if one does not reinforce the craving by smoking occasionally, it will gradually become less and gradually die out. Occasionally you may re-experience craving in response to certain stimuli that remind you of cigarettes. For some people the trigger can be the smell of cigarette smoke or the sight of others smoking, while for others it maybe certain emotional states such as depression or anxiety. One person only experienced craving for cigarettes after sexual intercourse.
The important thing to remember is that if the craving is not reinforced then you will find that it gradually dies out. Once you are confident that you can manage it you may want to seek out situations that bring on the craving and wait them out. One may first try this using fantasy.
One needs to have a plan to deal with the craving in case one feels tempted to smoke. For instance, you might decide that when you experience the craving you will practise deep breathing or use chewing gum till the craving passes away. In case this does not work the next step could be an exercise workout or talking to a friend or spouse on the telephone. Finally if nothing else works, you may want to call your friend over. In an emergency it helps to mentally rehearse the ‘coping plan’ and visualise yourself carrying it out. This will increase the chances that you will follow the plan in an emergency.
People who smoke get some pleasure out of this and often feel deprived for sometime when they stop. Because of this it is important to deliberately increase a number of pleasurable and healthy things that you do so that you do not feel deprived. Exercise, cultural activities, music, social groups, hiking and sexual intercourse are some of the things that can increase the amount of pleasure in your life. Pleasure leads to the release of endorphins and this reduces the craving
If you follow this advice there is a very good chance that you will give up smoking. If however you relapse into the habit, remember that most people who quit smoking do so after several attempts. So firmly decide once more to stop smoking. Use the information you have gathered from your last attempt to modify your approach so that you will be successful this time.