I have many patients who have smoked at one point in their lives, and we typically have at least one discussion about the importance of quitting when they come to see me.
People who smoke have their reasons for doing it. And, people who quit smoking hopefully have even better reasons for quitting.
When a patient I’ll call Sally came in for her annual visit, I talked to her about her smoking habit. I told her the truth: I didn’t think she was a bad human because she smoked, however, as her doctor, I didn’t like that she smoked because it put her at risk for many health issues.
In addition, smoking would very likely shorten her life by speeding up menopause, and putting her at greater risk for heart disease, stroke and various types of cancer. I didn’t want to see Sally or her family suffer because of her choice to smoke. But, at the end of the day, it was her choice to quit or not to quit. It had to be Sally who wanted to quit enough to get through the withdrawals and make changes in her life to make quitting a reality.
Like others who smoke, Sally had her reasons for starting the habit.
She began in college when many of her friends started, and she found that she really enjoyed it. She worked in the accounting department at a radio station, and everyone there lit up. At work, smoking gave Sally a sense of camaraderie—everyone took breaks outside and smoked a cigarette (or two) while they caught up with news and gossip.
As time went on, Sally became more and more addicted and couldn’t imagine starting her day any other way. She really enjoyed the slight rush she felt with her first cigarette of the day, and she especially loved her time in the morning with her coffee and a cigarette, enjoying some quiet time by herself. Even better, smoking made her long commute to and from work tolerable.
Sally was aware that smoking could cause cancer, but her mom had smoked and never had cancer, so she assumed it didn’t run in the family and thought she would be fine.
When pregnant with each of her two children, Sally managed to quit. Unfortunately, she started up again soon after their births. To make matters worse, Sally’s husband smoked and had no intention of quitting, so it was always easy to get her hands on cigarettes.
By the time Sally started seeing me, her two kids were grown and had children of their own. Both of Sally’s grown kids couldn’t stand to be around the smoke anymore. When they were younger, her kids had always bugged Sally about quitting, but she just saw it as nagging and never seriously considered it.
Her doctor would occasionally ask her about quitting, but she would shrug it off. Some years he didn’t even bring it up at her appointment, so she thought that maybe it wasn’t that important.
However, things in Sally’s life began to change and she started to give her nasty habit some more thought. She noticed that over time fewer of her work friends lit up a cigarette anymore, and smoking was becoming less accepted at work. It became more and more difficult to even find a place at work where she was allowed to smoke.
Sally started to add up the cost of her smoking habit, especially as cigarettes continued to become more costly. Of course, the biggest reason Sally found for quitting was the upcoming birth of her first grandchild. She wanted to be alive to see her grow up, and she knew if she continued smoking, that may not be a reality.
Sally also began to notice her periods were becoming more irregular, and her hot flashes happened daily—several times a day. She decided it was time to take action and get some relief from her menopause symptoms, so she made an appointment to see me at the Spectrum Health Medical Group Midlife and Menopause Clinic.
She was shocked to learn that smoking actually made her hot flashes worse, and causing hot flashes and night sweats to happen earlier in her life. Even worse, because of her increased risk of stroke and heart attack as a result of smoking, hormone therapy would be a risky choice for her.
As we talked about her symptoms and the many reasons to quit smoking, I told her about other possible rewards of quitting the habit: fewer wrinkles, better taste buds, the ability to smell different aromas, the pride her children would feel toward her, the ability to exercise longer, and improved overall health.
Sally was excited as we talked about everything, but she was also scared. She knew about withdrawal and how difficult it could be to handle the symptoms and cravings over the upcoming days—and possibly even months. She was worried about becoming depressed, anxious, angry, frustrated and irritable.
I was honest with Sally and told her she would always have receptors that would linger, and she would want cigarettes for the rest of her life. In addition, if she smoked even one cigarette, the cravings would go back to full force within hours. We also talked about weight gain, which could definitely be an issue. Sally would probably be hungrier than usual, and because of the stress and adrenalin (plus perimenopause), she would crave (and most likely eat) simple carbs and sugar.
Even after hearing all the side effects and struggles she may face if she quit smoking, Sally still wanted to move forward and talk about a plan to quit for good. She asked, “If I am going to quit, how do I do it?” I said, “Let’s make a plan.”
So, that’s what we did. The first step was to make a list of all the times she would likely have a cigarette and set up a system to avoid automatically reaching for it. For example, drink her coffee in the car so she wouldn’t have enough hands to drink and smoke at the same time.
Of course, Sally also needed to make sure she didn’t even have any cigarettes in the car. Another part of the plan was to think of something to tell people that she was quitting and she would need their help. We came up with this: “I am quitting, so please help me and do not smoke around me. Do not offer me a cigarette. Please take a walk with me, distract me, support me when I call for support.”
We also talked about medications to help her, including Chantix and Zyban. Both are proven to help with the cravings. I mentioned nicotine replacement therapies—lozenges, gum, and inhaled nicotine—as a way to ease the cravings. And, I reminded her that while the symptoms would be bad, she could remind herself that they were temporary and would get much better.
Sally left our visit with plenty to think about. I asked her to come back in one month to recheck her hot flashes and go over some lab tests I had ordered. When she returned, she was happy to report that she was working on her plan and had also called Spectrum Health Healthier Communities to sign up for smoking cessation classes.
She had set a quit date and knew it would take some time to formulate her complete plan. She was nervous, but it was very clear to Sally that the benefits were greater than the risks and she was ready for the challenge.