I have a patient on my schedule today who is a heavy smoker. Complaint: "Lungs are hurting."

[Aristus]

Sometimes, there aren't enough faces or palms to do the facepalm a situation truly deserves.

I sometimes wonder why smokers come to me for medical advice. They never follow it.

"Quit smoking".

Nope...

[CaliforniaPeggy]

1. Best of luck, my dear Aristus...

It has got to be hard for you.

[lapfog_1]

2. Schedule a surgery

to remove a part of his or her lung... place in Plexiglas and present to patient... "this is why your lungs hurt and you can't breath"

[csziggy]

43. Almost forty years ago my mother in law lost 40% of a lung to cancer

But she still kept smoking. The f*cking doctor told her that her chain smoking since she was fifteen did not cause her lung cancer. She smoked up until she had to use oxygen constantly - even when she had to use it to move around.

We lost her in January 2017. She died a long and painful death from COPD. For the last three weeks of her life she suffocated since her lungs could not longer provide enough oxygen to keep her alive.

My husband was in the room when her pulse ox stats dropped below 50% and they performed an emergency intubation. he was traumatized since he thought she was dying in front of him. A few days later she was put into hospice care and passed less than twenty four hours after that.

I still want to go back and find the doctor that told her that smoking did not cause her lung cancer and kick his butt. I can never forgive him for that.

[dlk]

3. Denial of Reality is Extremely Difficult to Overcome

You can only share the facts. If your patient rejects them, unfortunately, that is their decision.

[janterry]

4. I met with a guy once who complained about being depressed

He was in jail. I was like, you're in jail. It's kind of normal to feel depressed.

(note, he had lured an underage girl over state lines to meet with him - and got caught with her. I DID refer him to the psychiatrist for a med consult. But........sigh).

[SCantiGOP]

18. Friend of mine serves on the state Workers Comp Board

They turned down a request for a guy who wouldn't show up for work and filed a claim because he "drank too much."
A few months later they got another request from him saying that he was depressed. The reason for the depression was.........that he drank too much.

I get depressed so I drink; I drink and that makes me depressed, so I'm depressed so.......................

[still_one]

5. I am of the view that people in medical services should refrain from value judgements

Smoking is an addiction, and sensitivity to that fact is important

[Laurian]

8. +1000

[Aristus]

9. I know it can seem like a value judgment.

But it's simply a case of wanting a patient to draw a straight line from A to B. She knows why her lungs are hurting. She doesn't need me to tell her that.

She just wants me to fix it with something other than 'quit smoking'.

And every medical provider knows how hard it can be to quit smoking; even the ones, like me, who are life-long non-smokers. We read the medical literature regarding nicotine and addiction.

But people quit every day and stay quit. It requires commitment, and not everyone is willing to devote the necessary level of it.

[Wounded Bear]

22. Pretty much the same with alkies, drug addicts, and the overweight...

Quit preaching, just give me a pill or a shot or something.

[CTyankee]

24. It wasn't that hard for me to quit my 20 year smoking habit...

I was starting a relationship with a man (now my husband of many years) who could not stand cigarette smoke. I decided to quit (disgusted with the fact that even my underwear also reeked of smoke) and just did. I haven't missed it at all since. I feel great.

[Aristus]

25. I'm glad.

[CTyankee]

26. Then he wanted me to marry him...

and that was NOT something I could do for him...

But he came to me and (he says) got down on one knee to ask me to marry him and, with some real mental reservation, decided to take a chance again. At our every anniversary we toast each other and laugh over that...One of these days we will renew our vows...I know, corny as hell, right?

[3catwoman3]

30. Sometimes there's not much difference between corny...

...and romantic.

Sounds like you got a two-for - a good partner and good respiratory health.

[CTyankee]

35. Yep. We're happy today...

[ailsagirl]

56. [phone]

[LanternWaste]

14. Illustrating cause and effect, that B is a direct consequence of A, is not a value judgement.

And 'I am of the view that' responding after the fact to someone who cannot or will not accept Cause and Effect seems such a trivial concern as to be considered little more than petulance masquerading as self-righteousness.

Says this idiot smoker...

[912gdm]

45. I totally agree.

.

[choie]

31. Thank you,still_one!

[mitch96]

33. And as a retired medical worker

Behind the scenes we do a face plant....
Yes it's an addiction and it was the HARDEST THING I've done. At the age of 28 I coughed up a blood clot after a cigarette induced respiratory infection.. I quit.. What a bitch. For 7 or 8 years after I still had that feeling in the center of my chest that I wanted a cig...

Some people get it and some don't.. The addiction is more important than life.. But if you say you can't help them if they continue smoking you are the mean one with no empathy..
Yup, face plant...
m

[912gdm]

6. only thing I can say is it's addictive as hell.

im not trying to use that as a cop-out to why I still smoke, but the times I've tried were horrific.



And I overcame a benzo addiction

[Wounded Bear]

23. Most of the addicts I've met say tobacco is the worst one to overcome...

[appalachiablue]

34. Tobacco is more addictive & harder to quit than heroin, experts say.

Last edited Tue Nov 27, 2018, 10:40 PM - Edit history (1)

Less than 10 years ago, Dick Van Dyke who's in great shape in his 90s said as much. He quit both habits later in life, but said smoking was far harder to stop than drinking. I come from a medical family that fortunately stresses good health including staying away from excess food or anything else harmful, without being fanatical about it. Basically a philosophy of let common sense prevail, cherish life, it's a gift, and "judge not, lest thy be judged" because nobody's perfect. PS Friends who are locked in denial over food, is terribly sad because we need to eat, no abstaining only moderating unlike other habits that can be ended forever.

[kozar]

36. I guess my ? is

why are we as supposed Democrats who care about all,, making light of this topic in this thread?

Koz out

[appalachiablue]

37. Dependency and addiction are serious medical issues, not

matters to ridicule, judge or berate- "I don't understand it, X did nothing for me," or "I quit easily, it why can't others?"

[Wounded Bear]

38. I am one of those for whom quitting smoking ended up being rather easy...

It did take 3 tries, though.

But when I finally put them down, I succeeded. But that was me. I usually try not to join in the joking about addiction of any type. My demon was alcohol, and I didn't kick it until later in life, and paid various prices for it, including some health issues. Part of kicking that habit had me habituating quite a few 12 Step meetings. So, yeah, I hung out with quite a few people fighting their demons.

So, I basically agree that these issues are not good subjects for "humor."

[kozar]

40. Maybe my issues

which I will not address online in whole, is why I took objection to this thread in the first place.

Thanks for your input Wounded Bear

koz

[appalachiablue]

41. Glad you moved on to a healthier life. Serious matters.

[kozar]

39. I so agree,

So why am I reading this thread as light hearted and so easily solved?

Koz

[cwydro]

58. I don't understand any medical professional making mock of any patient.

It simply seems wrong to me.

I agree with you.

[LisaM]

53. My parents both (successfully) quit smoking cold turkey, but...

it was harder for my father than for my mother, even though I'd say she smoked a lot more than he did. I finally figured out that it was likely because his smoking was situational. He was a teacher and of course, all the teachers used to smoke during the day, but once that stopped, he would go all morning without a cigarette, then come home for lunch and routinely have a cigarette at the same time every day. Same thing after school. And so on.....he was also much more likely to get a cigarette out when he was stressed. My mother just seemed to have one going most of the time, often just sitting next to her, so when it came time to quit, situations would arise where he'd want to smoke (and I imagine he had an inner clock telling him that it was the time of day he always smoked). This is obviously a completely non-scientific observation, but I was interested in why the parent who I'd say smoked far less had the harder time stopping.

Anyway, it took, it's been 17 years for both of them now.

[malthaussen]

7. Basically, they want to know how to keep doing what they like...

... without the consequences. Surely, there is some way to avoid them. It's really distressing to hear "Nope, no way out."

-- Mal

[NotAPuppet]

10. Do you diagnose

before or after seeing patients? My wonderful PCP usually diagnoses after he examines me.

Is smoking the ONLY reason for chest pain? As someone who was misdiagnosed by a number of judgemental and incompetent physicians for a number of years, I find your post quite offensive even though it was probably not your intention.

[Aristus]

15. This is a patient I've been visiting with regularly for months.

She has Chronic Obstructive Pulmonary Disease, caused by, and exacerbated by, smoking.

Sure, it's fun to pretend that these things don't matter, and that any ongoing, unresolved medical problem just has to be the provider's fault.

I could propose that she try whistling 'Dixie' every morning to try and cure the problem. But science-based treatment protocols suggest the efficacy of such a treatment would not be very encouraging. Quitting smoking is the evidence-based treatment protocol.

If a medical provider were to tell me that smoking is bad for me (I don't smoke), my first impulse would not be to accuse him of incompetence.

[choie]

55. With all due respect Aristus

the attitude you express about your patients is truly infuriating, and unfortunately, indicative of many in your profession. Do doctors take any mental health training in Med School? Have you never read any research about addiction? Your words show an incredible lack of knowledge about addiction and certainly a woeful lack of compassion and understanding.

[Aristus]

57. It can certainly seem that way when we're expressing our frustration.

It wouldn't seem that way to you if you were in the exam rooms with us and our patients. We use every tool in our toolbox, including and especially compassion and understanding, to get our patients to grok the simple truth that smoking kills.

It's hard not to feel frustration after telling one's patient for the umpteenth time that their complaints aren't going to get any better as long as they keep smoking. And we receive extensive training about the nature of addiction, and frequent updates on the most effective ways of treating those addictions. It would be unethical from a medical standpoint to simply shrug, say "Well, it's an addiction", and then give up. That would accomplish nothing.

For more than sixty years, everyone on the planet who doesn't smoke has been telling everyone on the planet who does not to smoke. We have loved ones, too. We care about those lives, too. But shrugging, giving up, and letting them feed their addiction solves nothing.

[choie]

59. no one is saying to

"simply shrug, say 'well it's an addiction' and then give up." Clearly there are interventions that may help patients battle their addiction. There are professionals, including mental health professionals, who can help. Shaming people and treating them derisively does nothing.

[maxrandb]

61. Here's something I don't understand

If I were an alcoholic or heroin addict, I could get into an in-house, in-patient cold turkey addiction prevention program, but as far as I know, if you're a smoker, which data shows can be several times more addictive, I'm on my own.

Maybe we need to get people that want and need to quit smoking into an in-patient treatment center where there can be help dealing with withdrawal symptoms.

I think the cost of smoking greatly exceeds the costs of alcoholism and drug addiction. The return on investment from a lockdown nicotine addiction program might be huge.

[WheelWalker]

11. You can lead someone to knowledge but you can't make them think.

[A HERETIC I AM]

12. I finally quit. After almost 40 years of it

I had been having COPD attacks/episodes every 8 months or so for the last 5 years. I had spent 2 or 3 days in the hospital getting loaded up with steroids and then sent home with prescriptions and admonishments, but often would smoke one before I got to the house.

I had 3 serious episodes in 60 days last spring, the final one put me in the hospital for seven damned days!

Scared the crap out of me. I thought I had screwed the pooch!

The thing was, I had stopped buying packs of smokes the week of the first episode back in February and had gotten to the point where I would have maybe a drag a day - not even a whole cigarette, and was doing that for 6 weeks or so.

I’ve been an OTR trucker most of my adult life and smoking was something that kept boredom away, among other things. Quitting was not an easy thing.

I smoked a whole cigarette (my last) on about the 12th of April and had walked nearly a mile the day before.

2 days later I had to be wheeled into an ER.

I’m glad i was finally able to get rid of them. No long course of gum or patches, just pretty much had enough.

So... thanks for all you do. Have patience with us.

I’m proof that a long term smoker can quit.

[Kaleva]

13. I quit cold turkey after about 40 years of heavy smoking.

My results:

"Lung screening assessment for 1,000 people like you over the next 6 years

Out of 1,000 people like you who are NOT screened, number who will be diagnosed with and die from lung cancer 19.6
Out of 1,000 people like you who ARE screened, number who will die from lung cancer 15.6
Out of 1,000 people like you who ARE screened, the number of lives that will be saved 3.9
Number of people like you that would need to be screened in order for ONE of you to benefit 256"

http://nomograms.mskcc.org/Lung/Screening.aspx

My results if i was still smoking today:

"Lung screening assessment for 1,000 people like you over the next 6 years

Out of 1,000 people like you who are NOT screened, number who will be diagnosed with and die from lung cancer 28.4
Out of 1,000 people like you who ARE screened, number who will die from lung cancer 22.8
Out of 1,000 people like you who ARE screened, the number of lives that will be saved 5.7
Number of people like you that would need to be screened in order for ONE of you to benefit 176"

[GWC58]

27. Back in December 2013 my wife gave me for

Christmas a vape kit. In the five years since my COPD has not worsened and, in fact, a CT Scan showed “significant lung improvement.” Food I eat tastes much better, my breath and clothes do not reek. Of course I’m sure some will say I “gave up one very bad habit for a bad habit.” All I’ll say is it works for me. 🤔

[OriginalGeek]

16. Doc it hurts when I go like this...

"Don't go like that."


It took me several times of trying but on 4/20/2001 I finally stopped going like that.

I ain't gonna lie though - I miss smoking.

[Aristus]

17. I guess that goes to show how addictive it is.

I tried smoking, and couldn't for the love of God figure out the appeal. It tasted bad, it made my hair and clothes smell bad, it made my mouth hot and dry, and I was spitting all the time.

I put away a pack half-smoked and never tried again. I don't know what inspires people to smoke long enough to get addicted to it. (Although the additives the tobacco companies put in to cause addiction more quickly don't help...)

[OriginalGeek]

20. lol, for me it was a girl

I was 17 and wanted her to think i was cool. She let me hang around with her some as long as I had a smoke she could bum.


That turned into a 21 year, 3-pack a day habit even after she was long gone from my life.

[Aristus]

21. I nearly converted to Judaism for a girl.

In my defense, she was smoking hot!...

[JonLP24]

28. First cigarette made sick and threw up

2nd or 3rd time it is a learned taste. My parents smoked so that probably increased the odds.

I'm down to lozenges. It would have been easier to not use it in the first place but I can't go back to when I was 14. I haven't smoked a tobacco cigarette in years but either exits or lozenges.

It kinda gives a kick like coffee.

[kozar]

29. as a smoker who quit,

and then restarted after 9 years no smoking,started again because I took a promotion.
I read all the replies and am simply stating what I went through without judgment. Turns out, in my case, it was because of the job.
My PCP directed me to psyche visits to find out why I was smoking again, yes, I took it seriously and found out job was the issue. I have since quit the job and smoking again.
So Im just offering that maybe the correct answer isn't so clear cut to the one involved? It wasn't to me until I got asked certain questions that made me think. Those questions came from a great Psychiatrist, who took her time and made me look at myself as to why.

Koz

[struggle4progress]

19. "Couldn't you prescribe some cocaine and heroin to help me forget cigarettes?"

[angstlessk]

32. what about e-cigs?

I was smoking 2-3 packs a day, after years of a pack a day...

I wished my cigarettes were as long as Pinocchio's nose..as I hatted to come to the end of my cig.

I discovered e-cigs, and after a while quit real cigs completely...then I decided to go very low on my nicotine and ended back smoking about a pack or two a month...

I have decided not to buy any more real cigs, and go back to e-cigs only with 18 mg of nicotine and very slowly ease down over a longer time period...probably have a mix of my 18 mg plus 12 mg, just in case, then 12 mg and 6 mg..maybe for a year...then 6 mg and 2 mg..

However long it takes me to wean off the nicotine, it would never happen with real cigs.

[Talitha]

42. It certainly is an addiction - for animals, too.

A friend of many years finally quit a 3-pack-a-day habit... and discovered that his beloved Cat had also become addicted by ingesting the airborn nicotine crud while grooming herself. Thankfully, the Vet was able to help her and they're both doing just fine.

[The Velveteen Ocelot]

44. How does a cat with a nicotine addiction behave?

It's not like they can smoke their own cigarettes.

[Talitha]

46. Well, she started getting very irritable - which isn't like her at all...

She's usually a real sweetheart with a great personality. And she was over-grooming, probably trying to get another hit of nicotine from her fur, but had apparently cleaned it all off already - and because he'd quit smoking, there wasn't any more gunk being deposited on her fur from the air in the house. Like I said, he smoked 3 packs a day and there was usually a haze of smoke in the house and it settled on everything including her.

He finally figured out something was wrong when she kept licking the carpeting for the nicotine that had settled on it. Poor baby, she had no idea what was happening - and he felt really guilty for accidentally putting her through the withdrawals.

He'd been so addicted that he'd take a drag on a cigarette - and then take a hit from his inhaler. I'm SO glad he stopped - he's a good friend and neighbor... everyone just absolutely loves him.

[The Velveteen Ocelot]

47. Wow, interesting. Poor kitty!

A cat licking the carpet to find nicotine residue is about as sad as an addicted human fishing old cigarette butts out of ashtrays. I'm glad the cat and the human are both doing well now.

[libdem4life]

48. I started at 11or 12 picking up half smoked cigarettes

from around the old pot belly stove in the General Store (talking the rural South 50s here) Many only smoked half of the cigarette. My girlfriend's family owned the store, so I was there often.

Then off to the barn...to smoke. Now I know that my mother knew because no one smoked in our house. And now I know that nonsmokers can be hyper-aware no matter how my breath mints you take.

I tried to quit a couple of times in college...remember these were the Virginia Slims days, You've come a long way Baby...and indeed I had...now living in Los Angeles. Twice I failed. Each time I failed, I ended up smoking more until I reached a 3 pack a day habit...many did burn down as I was working during the day, but still...no excuse.

In the meantime, had a real estate career 80 hours a week...stress. After work everyone went out for a drink. I didn't drink, so just smoked and drank 7-up...looks like a drink, right? It was always late and everyone totally stressed out.

Third time...was watching and doing the first meditation and yoga class ever on TV...forget his name...80s. (If someone remembers, please let me know. I want to send him my undying gratitude...psychic route, of course.

One day after doing the routine and feeling great, I looked at the cigarettes, because I had vowed to do my meditation and yoga before the coffee and cigarette routine.

And I swear a miracle happened. One morning, with no warning or fanfare, I had my coffee and "Just Said No". That day it was easy. The next few days, however, got tougher. The class was only once a week. So, in order to play myself, I kept a partial pack in my purse. I finally passed the test. Never took a drag off anything from then on. "Just a hit" was what started me back the second time. That's all it took...one hit. I avoided bars for a few years. (we're talking solely tobacco here)

But...I didn't quit total cold turkey...well kind of. Someone had brought some wine over for a dinner, and left it. I didn't drink, but had tasted it and kind of liked it. Thus...every time I wanted a cigarette, I drank a couple of sips of wine. I had the hand-to-mouth action, and there was a little kick in it. It worked. I had quit...never to take a drag again.

Still didn't like wine, but when I moved to Sonoma County, CA...wine country, it wasn't cool NOT to drink wine. But I went along to get along and now, enjoy my wine and still don't smoke,

The final realization is that I can NEVER, EVER no matter how long it's been...35 years...take one drag off a cigarette. I'd be back to 3 packs a day in no time. That's addiction.

Even after that long smoking habit, my lungs seem to be in good condition, my oxygen count 97-98 and no long lasting effect...thank God.

So, every smoker who reads this please know, there is a way and it's different for everyone. You have my highest regard for questioning and searching. Believe you'll find the answer...don't think it will be like anyone else's experience, including mine.

[Aristus]

49. Thank you for sharing.

It is possible to quit; every smoker needs to know that.

I reserve my deepest anger for the tobacco companies for deliberately developing their tobacco to make it more addictive more quickly.

They put more than 2,000 different substances in their tobacco to make it more addictive; 500 of those substances are toxic all by themselves. Ammonia, for example. It makes the nicotine easier for the body to absorb, speeding the process of addiction. I wonder how many smokers are aware that they're inhaling floor cleaner?

Other stuff adding to the fun include methane (cow farts, basically) and strychnine (rat poison). It's not just tobacco and paper.

The tobacco companies made billions poisoning people to death...

I want my patients not to smoke, not just to preserve their health, but so that the tobacco companies go out of business forever...

[libdem4life]

50. And thank you for bringing it up.

Just the trip back in time made me feel better about myself...and my decisions.

[Eliot Rosewater]

51. Practically speaking, what can you do for lungs that hurt in someone who

is like this.

Quitting aside.

Is it pain you can treat with narcotics? If it is inability to breathe easily, then what?

[Aristus]

54. Inhaled medications, mostly.

Albuterol, etc.

[vlyons]

52. Your patient is addicted

Didn't you ever see the movie, "The Insider?" It's so difficult to quit an addiction. There are nicotene support groups and there are patches to help wean a smoker off ciggies.

[maxrandb]

60. I think WC Fields said; quitting smoking is easy

I've done it a thousand times