By: Anthony W. Clay, D.O., F.A.C.C.

Did you know smoking is the leading cause of preventable death in the United States each year? Tobacco kills more than 440,000 people in the United States each year. Most people are well aware that smoking is the leading cause of lung cancer but this seems to minimize the other health risks that derive from smoking. Smoking is also the leading cause of heart disease, stroke, emphysema and peripheral vascular disease. For women who smoke and also take birth control pills, there is an increased risk of blood clots. For women who want to become pregnant, smoking can lead to low birth weight of babies which also increases mortality risks. The rate of miscarriage in women who smoke is also increased. The CDC reported in the year 2000 that an estimated adult male smoker lost an average of thirteen years of life compared to a non-smoker. In females the average is fourteen years of life, all effects of smoking.

Smokers sometimes can only see themselves as smokers because they have been addicted to the habit for some time. If a smoker is presently in good health they often do not see any benefit in discontinuing smoking. Also, frequently patients who have already suffered a traumatic event, such as a heart attack, feel that now they have made it through, what’s the benefit in stopping now?

There are always benefits to discontinuing smoking. These include not just health benefits but can also affect all aspects of your life. A moderate smoker can be expected to pay about $3,000 for cigarettes alone. That doesn’t include other costs associated with smoking such as well known phenomena of decreased productivity at work. Smokers take more sick days than non-smokers. They have more episodes of respiratory tract infections, bronchitis and pneumonia. Smoking causes premature wrinkling of the skin, bad breath, and stained teeth. Smokers’ clothes and hair frequently smell of tobacco. They also have a significantly increased risk of gum disease. Heavy smokers frequently have stained fingernails. There are also issues to address, including how smoking affects others. The most obvious is the risk of secondhand smoke. Also consider this; one of the most frequent reasons for your children or grandchildren to start smoking is that you smoke. It is obviously very difficult to tell a loved one not to smoke when you yourself are a smoker. There is also a greater risk of house fires and damaged property when smoking is involved.

Patients in our office will frequently ask questions about ways to improve their health such as taking different vitamins, changing their diet, or starting an exercise program. All of these are commendable, however, in some patients who continue to smoke it is somewhat exasperating to see such efforts go towards improving their health when one of the biggest risk factors is that they continue to smoke. For example, in the hospital, when a chest x-ray is being performed in a patient’s room frequently the people around the patient are using lead shielding and the people in the near distance are scurrying to get behind objects to block the x-ray beams. It is estimated that the dose of the chest x-ray is equal to just one pack of cigarettes to the lungs, yet some patients continue to smoke regardless.

Consider these facts. Twenty minutes after quitting, blood pressure and heart rate decrease and the hands and feet become warmer. Eight hours after quitting, carbon dioxide levels normalize and oxygen levels increase in the blood. Twenty-four hours after quitting you already have a reduction in your risks of a heart attack. Forty-eight hours after quitting, taste and smell usually improve. Over the next three months both circulation and exercise performance will improve. Over the next nine months, there will usually be decreased episodes of cough and sinusitis. At one year, your heart disease risk is cut by half. After fifteen years, you obtain the same risk as a non-smoker. Someone who has not smoked for five to fifteen years significantly reduces their risk of stroke. At ten years, lung cancer risk is cut in half. Peripheral vascular disease risk is also decreased and at more than 15 years after quitting, most of the risks of both heart disease and lung cancer are equal to that of a non-smoker.

To most people it is obvious that smoking is not healthy but knowing how to stop is very difficult. Smoking is one of the most addictive habits that physicians deal with. There is no easy way to recommend how to stop smoking, but there are steps to take that seem to be more successful in people who discontinue smoking. Clearly, the first step is making the decision to stop smoking. It sounds easy, but frequently people see themselves as smokers and cannot see themselves as being smoke-free. Even some of the imagery of not smoking and seeing yourself as being a non-smoker is part of the change that one needs to take. Once you have decided to not smoke the next step would be to pick a date to help reinforce this. Tell friends or make a friendly wager with someone at work. This will help try to reinforce that you are going to discontinue smoking. With these steps, even if there is a small setback, continue to try to reach your goal of being a non-smoker. It is also important at the time to eat healthy, including vegetables and protein; these things may decrease your urge to smoke. Try to eat multiple small meals instead of large meals; keeping your sugar levels even will help decrease urges as well. Some people would recommend taking B complex vitamins as well.

Almost everyone who does this routinely recommends drinking frequent glasses of water. It helps to frequently brush your teeth with baking soda which can change the pH of the mouth and also decrease urges. Giving your mind, as well as your hands and your mouth other things to do is frequently part of cessation. Frequent exercise can also help. Going to places where smoking is not allowed can also decrease urges; take museums for example. Imagine all the fresh air you are taking in now that you are no longer a smoker. If one has an urge, use these things to delay the urge and it will usually pass. Reward yourself at times for staying off cigarettes. Some people do this cold turkey. Others use multiple nicotine replacements such as gums, patches, inhalers, lozenges. There is also the aid of Bupropion.

There are other non-pharmacologic measures to help one quit, such as using hypnosis. I, however, would recommend going to someone who does this on a one to one basis and not a large forum where many smokers are seen at once. Acupuncture has also been used. Obviously it is important to remove a lot of these urges; taking ashtrays out of the house, changing associations that frequently go with smoking. People frequently have coffee with a cigarette; think of changing to tea in the morning. Decrease your alcohol intake if you frequently smoke with alcohol.

In addition to the above measures it is a good idea to keep the number of someone who can support you or one of the quit lines which are toll free including the Delaware Quit Line at 1-866-409-1858 or National Cancer Institute Quit Line at 1-877-44U-QUIT. If you are a smoker think about the best thing you can do for yourself and your family; take the challenge to be a non-smoker. With this change in lifestyle, everybody benefits.

Cardiology Physicians, P.A.

One Centurian Drive, Suite 200, Newark, DE 19713 302.366.8600

1401 Foulk Road Foulkstone Plaza Wilmington, DE 302.478.5055 www.cardiocppa.com

Meet the Physicians of Cardiology Physicians P.A.

ANTHONY W. CLAY, D.O., F.A.C.C.

After practicing for seven years in Philadelphia, Dr. Clay joined Cardiology Physicians, P.A. in 2003. He is a clinical assistant professor of medicine at Hahnemann University and co-instructor of medicine at Philadelphia College of Osteopathic Medicine. Dr. Clay received both his Bachelors and Masters Degrees from Villanova University. He then went on to attend medical school at the Philadelphia College of Osteopathic Medicine. He did his internal medicine training at Hahnemann University where he was awarded Resident of the Year. Dr. Clay then served at Chief Resident of the Internal Medicine Program. He remained at Hahnemann University for his Cardiology fellowship and served as chief cardiology fellow there.

Dr. Clay has strong interests in teaching. He has been a lector at national conventions regarding congestive heart failure and coronary artery disease. He continues to teach regularly at medical schools in Philadelphia and has been a preceptor for hundreds of medical students.

Dr. Clay has also served as chairman of the Physician’s Fund Raising Committee for the American Heart Association, Southeastern Pennsylvania Chapter. He is a member of Alpha Omega Alpha honorary medical society and the Pennsylvania and Delaware medical societies. He is also a member of the American College of Cardiology, American Heart Association and American Medical Association. He has recently been recognized by the NRCC as their 2006 Delaware Physician of the Year. Dr. Clay has a special interest in consultative cardiology as well as echocardiography, nuclear cardiology, and CT angiography.