Friday, August 8, 2014

How to Quit Smoking - Part II - The steps to achieve Quitting

How can I stop smoking?

Quitting is hard. Usually people make 2 or 3 tries, or more, before finally being able to quit. Each time you try to quit, you can learn about what helps and what hurts. Write down your personal reasons for stopping. Be specific. Keep your list with you so you can look at it when you feel the urge to smoke. To help you understand your smoking habit, keep a diary of when and why you smoke. Using information from this diary, you can make a plan to deal with the things that make you want to smoke.
Smokers often say, "Don't tell me why to quit, tell me how." There is no one right way to quit, but there are some key elements in quitting smoking successfully:

1. Making the Decision to Quit
The decision to quit tobacco use is one that only you can make. Others may want you to quit, but the real commitment must come from you.
The Health Belief Model says that you will be more likely to stop tobacco use if you:
  • believe that you could get a tobacco-related disease and this worries you
  • believe that you can make an honest attempt at quitting
  • believe that the benefits of quitting outweigh the benefits of continuing tobacco use
  • know of someone who has had health problems as a result of their tobacco use
2. Get ready:  Once you've made a decision to quit, you're ready to pick a quit date. This is a very important step. Pick a specific day within the next month as your "Quit Day." Picking a date too far in the future allows you time to rationalize and change your mind. But do give yourself enough time to prepare and come up with a plan. Set a quit date 2 to 4 weeks from now so you'll have time to get ready. Change your environment. Get rid of ALL cigarettes and ashtrays in your home, car and place of work. Don't let people smoke in your home. Review your past attempts to quit. Think about what worked and what did not. Practice saying, "No thank you, I don't smoke."
3. Get support and encouragement: You have a better chance of being successful if you have help. Tell your family, friends and coworkers that you are going to quit. Ask them not to smoke around you or leave cigarettes out where you can see them.
4. Get medication and use it correctly: Medicines such as bupropion help some people stop smoking. These medicines do not contain nicotine, but helps you resist your urges to smoke.

5. Keep trying: Be prepared for relapse. What if you do smoke? The difference between a slip and a relapse is within your control. You can use the slip as an excuse to go back to smoking, or you can look at what went wrong and renew your commitment to staying off smoking for good. Don't be discouraged if you start smoking again. Remember, most people try several times before they finally quit. Here are some difficult situations to watch for:
  • Alcohol. Avoid drinking alcohol. Drinking lowers your chances of success.
  • Other smokers. Being around smoking can make you want to smoke.
  • Bad mood or depression. There are a lot of ways to improve your mood other than smoking.


How should I get ready to stop smoking?

Just before your stop date, get rid of all of your cigarettes, matches, lighters and ashtrays.
Quitters can approach their attempt in different ways.
Cold turkey: The phrase ‘going cold turkey’ means stopping smoking immediately. In other words if someone smoked a pack today, they would be going ‘cold turkey’ if from tomorrow they smoked none at all. Stopping outright is most likely to be successful.
Cutting down: Cutting down over a length of time can be particularly difficult, as consumption often goes back to what it was before. Smokers may inhale longer and harder to get the nicotine they want.
Drug therapies It is important to encourage people to consider using nicotine replacement therapies or medications (bupropion) as they have been shown to double the quitter’s chance of success.
Complementary therapies Methods such as hypnosis, acupuncture, and other complementary therapies can and do help some people, but as yet there is no formal evidence that they are more effective than comparable support.

What will happen when I stop smoking?

How you feel when you stop depends on how much you smoked, how addicted your body is to nicotine and how well you get ready to stop smoking. These things happen because your body is used to nicotine. They are called nicotine withdrawal symptoms. The symptoms are strongest during the first few days after you stop smoking, but most go away within a few weeks.
An intense desire to smoke which typically lasts 2 to 3 minutes before subsiding. This becomes less frequent and less intense during the first 3 weeks.
Increased appetite
Nicotine is known to suppress a person’s appetite, which leaves many smokers able to skip meals. When people give up, the resulting lack of nicotine can cause cravings, which may also be interpreted as hunger and an increased appetite cause weight gain.
Anxiety, irritability and loss of concentration - all these can be attributed to the disturbance of breaking a long-established habit and adjusting to the physical problems.
Sleep disturbance
It is not uncommon to have an initial week of sleeping badly followed by a week of difficulty staying awake.
Worsened cough
The millions of tiny hairs designed to keep the air passages clean start to clear away the dirt caused by cigarette smoke. This can cause a temporary cough.
Light-headed / dizzy feelings
This may occur as the level of carbon monoxide in the blood starts to fall and oxygen supply to the brain increases.
Tingling sensations in the body
This could be a sign of better circulation to the hands and feet.
Tobacco has a laxative effect on which the bowels learn to rely.
The above are signs of recovery and all the symptoms are temporary and none of them are life threatening, unlike smoking!


How do I deal with urges to smoke?

If you have tried to quit before, you will probably recognize many of these common rationalizations.
  • I’ll just use it to get through this rough spot.
  • Today is not a good day; I’ll quit tomorrow.
  • It's my only vice.
  • How bad is tobacco, really? My uncle chewed all his life and he lived to be 90.
  • You've got to die of something.
  • Life is no fun without smoking.
You probably can add more to the list. As you go through the first few days without tobacco, write down any rationalizations as they come up and recognize them for what they are: messages that can trap you into going back to using tobacco.
Use the ideas below to help you keep your commitment to quitting:
Avoid: people and places where you are tempted to smoke. Later on you will be able to handle these with more confidence.
Alter: your habits. Switch to juices or water instead of alcohol or coffee. Take a different route to work. Take a brisk walk instead of a coffee break.
Alternatives: Use oral substitutes such as sugarless gum or hard candy, raw vegetables such as carrot sticks.
Activities: Learn how to handle stress and the urge to smoke Try and distract yourself from urges to smoke. Talk to someone, go for a walk, or get busy with a task. Take a hot bath, exercise, read a book.
Deep breathing: When you were smoking, you breathed deeply as you inhaled the smoke. When the urge strikes now, breathe deeply and picture your lungs filling with fresh, clean air. Remind yourself of your reasons for quitting and the benefits you'll gain as an ex-smoker.
Delay: If you feel that you are about to light up, delay. Tell yourself you must wait at least 10 minutes. Often this simple trick will allow you to move beyond the strong urge to smoke.
What you're doing is not easy, so you deserve a reward. Put the money you would have spent on tobacco in a jar every day and then buy yourself a weekly treat. Buy a book, go out to eat, or save the money for a major purchase.


What about nicotine replacement products to help me stop smoking?

When you light up, nicotine gives you the hit, the rest of the smoke does the damage. Nicotine is not one of the cancer causing agents, it’s simply the reason you crave a cigarette. Nicotine replacement products are ways to take in nicotine without smoking. These products come in several forms: gum, patch, nasal spray, inhaler and lozenge.

How does Nicotine Replacement Work?
Nicotine substitutes treat the difficult withdrawal symptoms and cravings that 70% to 90% of smokers say is their only reason for not giving up cigarettes. By using a nicotine substitute, a smoker's withdrawal symptoms are reduced. This lets you focus on the changes you need to make in your habits and environment. Once you feel more confident as a nonsmoker, dealing with your nicotine addiction is easier. It's very important that you don't smoke while using nicotine replacement products. The nicotine contained in nicotine substitutes is absorbed differently to that in cigarettes, so is much less addictive. Nicotine substitutes do not cause cancer.
While a large number of smokers are able to quit smoking without nicotine replacement, most of those who attempt quitting are not successful on the first try. By reducing these symptoms with the use of nicotine replacement therapy and a support technique, smokers who want to quit have a better chance of being successful.

Will I gain weight when I stop smoking?

For most people the increase after a year is small, approximately 4kgs. The small amount of weight gained is a lesser health risk than that of continued smoking. Dieting while you're trying to stop smoking will cause unnecessary stress. Instead, limit your weight gain by having healthy, balanced diet with plenty of fruit and vegetables, low-fat snacks and being physically active.

Maybe you, too, have quit many times before. You can use the same methods to stay quit as you did to help you through withdrawal. Think ahead to those times when you may be tempted to smoke, and plan on how you will use alternatives and activities to cope with these situations.
More dangerous, perhaps, are the unexpected strong desires to smoke that occur sometimes months (or even years) after you've quit. To get through these without relapse, try the following:
  • Review your reasons for quitting and think of all the benefits to your health, your finances and your family.
  • Remind yourself that there is no such thing as just one cigarette – or even one puff.
  • Ride out the desire. It will go away, but do not fool yourself into thinking you can have just one.
  • If you are worried about gaining weight, put some energy into eating a healthy diet and staying active with exercise.


What if I smoke again?

Staying stopped is the key issue for most smokers. Many quitters can get through their first few days when their own motivation, determination, support and praise from others. But from then on motivation may begin to diminish and other people around them have lost interest while cravings continue.
Lack of success is often related to the onset of withdrawal symptoms. And most relapses occur within the first 3 months of quitting. So don't be discouraged if you start smoking again. Don't feel like a failure. Think about why you smoked and what you can do to keep from smoking again. Set a new stop date. Many ex-smokers did not succeed at first, but they kept trying. In fact, smokers usually need several attempts before they are able to quit for good.
Never condemn the relapse. Use it as an opportunity to congratulate yourself on first thinking about it, and then for managing to stop, even if it was only for one day
Just remember that even one puff on a cigarette can cause a relapse, so don't risk it.

Taking Care of Yourself                                                                                                                   Any past or current tobacco use is important information for your doctor to know so he or she can be sure that you have appropriate preventive health care. It is well known that tobacco use puts you at risk for certain health-related illnesses, so part of your health care should focus on related screening and preventive measures to help you stay as healthy as possible. Periodic checkups should include oral cavity (mouth) exams for any changes or problems. By doing this tobacco users may be able to prevent, or detect early, oral changes, leukoplakia (white patches on the mouth membranes), and oral cancer.
You should also be aware of any change in cough, a new cough, coughing up blood, hoarseness, difficulty breathing, wheezing, headaches, chest pain and loss of appetite, weight loss, general fatigue and repeated respiratory infections. Any of these could be signs of lung cancer or a number of other lung conditions and should be reported to your doctor. While these can be signs of a problem, many lung cancers do not cause any noticeable symptoms until they are advanced and have spread to other parts of the body.
Remember that tobacco users have an increased risk for other cancers as well, depending on the way they use tobacco. Other risk factors for these cancers may be more important than your use of tobacco, but you should be aware of the additional risks that might apply to your situation.
If you have any health concerns that may be related to your tobacco use, please see your doctor as quickly as possible. Taking care of yourself and getting treatment for small problems will give you the best chance for successful treatment. The best way, though, to take care of yourself and decrease your risk for life-threatening lung problems is to quit using tobacco.

Quitting takes hard work and a lot of effort, but you can quit smoking.
If you are a smoker encourage your children not to smoke by:
• Telling them from personal experience why you wish you hadn’t started
• Never letting them try a cigarette, even as a joke
• Never asking them to light a cigarette
• Not giving them sweet or joke cigarettes
• Never asking them to buy cigarettes or matches
• Asking them to work out how much smoking costs each year
• Explaining that the majority of the populations don’t smoke and most smokers want to stop
• Discouraging older brothers, sisters and other family members from smoking in their presence

Questions to Think About

Think about the following questions before you try to stop smoking.
1. Why do you want to quit?
2. When you tried to quit in the past, what helped and what didn't?
3. What will be the most difficult situations for you after you quit? How will you plan to handle them?
4. Who can help you through the tough times?
5. What pleasures do you get from smoking? What ways can you still get pleasure if you quit?

Dr.Kumaresh Krishnamoorthy, M.S (ENT)
Head and Neck Surgery Fellowship (Buffalo, USA)
Neurotology & Skull Base Surgery Fellowship (Cincinnati, USA)
Senior Consultant in ENT - Head and Neck Surgeon and Skull Base Surgeon


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