Wednesday, April 15, 2015

"Calling it Quits" on Frankly Speaking About Cancer

It was like being in the dark ages the first time I had cancer when it came to emotional support-there was none. People I knew asked me to not say the "C" word around them, no one seemed to understand the physical, emotional and financial devastation I was going through with being diagnosed with a life threatening disease at age 32.

When I had a recurrence in 2010, I knew that emotional support would help me through my journey with cancer this second time and I joined Gilda's Club immediately. This free resource, part of the Cancer Support Community, seems to have a magically effect on it's members. Cancer is a horrible disease that not only eats away at your body, it can eat away at your soul if you let it. While being a member of Gilda's may not heal your body, it does heal your soul.  It is a place to talk to others on the same journey who know exactly how it feels to be dealing with cancer. Yes there are tears but there is also a lot of joy, deep friendships develop and life is so very real and in the moment at Gildas. Facades drop away, cancer  doesn't discriminate, it strikes everyone, At Gildas you are accepted regardless of race, color, religion, political preference, sexual affiliation, everyone is welcomed.

While I no longer attend support meetings, I still volunteer to help Gilda's whenever I have a chance. It is important for me to give back to a place that was so important in my emotional healing from cancer. So when I was asked to speak on the Cancer Support Community's weekly radio talk show, I was happy to share my knowledge about how to become smoke-free. You can listen it it here: Calling It Quits.

The best way to treat cancer is prevention and I'm doing my part by helping smokers quit tobacco; smoking is the cause of 30% of all cancers, it's not just lung cancer. Instead of thinking of it as "just a bad habit", it is a time bomb that kills 50 to 75% of it's long-term users. There is no other substance as deadly as tobacco that is allowed to exist simply to satisfy the greed of corporate interests. We could make a huge dent in our "War" against Cancer, if smoking cessation and prevention were actually a priority in our society.

I hope you never get cancer but if you do, please reach out to the Cancer Support Community, they can help. If you want to prevent getting it - stop smoking now.

Friday, March 27, 2015

Can e-cigarettes help me quit smoking and are they safe?

I have been doing a lot of research into electronic cigarettes since that is what my next book will be about. There have been many confusing headlines, some saying that they are just as harmful as tobacco cigarettes, while other headlines will tell you they will help you quit. The truth is somewhere in the middle.
The controversies that make headlines are often not the real issues, such as-cig containing formaldehyde--that chemical was only created at very high temperatures--a temperature that no vape users would realistically use.  While w-cigs do have some carcinogens, they are amounts that are 9 to 450 times less than traditional cigarettes.
1. The biggest problem is dual use long term, using electronic cigarettes while you are continue to  smoke and continuing this practice long-term instead of quitting smoking. Using an e-cig for short term while trying to quit, probably isn't a problem, but with dual use, even reducing the number of cigarettes doesn't help with the damage smoking does to your cardiovascular system. Unlike cancer where exposure to a carcinogen is linear (the more exposure, the greater the risk of developing cancer), heart disease is not linear: 50 to 80% of the damage to the cardiovascular system from smoking occurs within the first 3 to 5 cigarettes. For those who do use e-cigs to quit smoking but continue to use them long term, there are no long term studies as to the health effects. Very likely it will not be the same as smoking but e-cigs will have their own unique disease profile and associated risk.
2. The cig-a-likes don't deliver enough nicotine to really help with cessation. The mods or tanks do a better job of that. A lot has to do with the particle size in the vapor. If the particle is either too small or too large, the vapor isn't absorbed. For example, the MarkTen offers some of the highest nicotine content (44mg) but very little of that is absorbed by the smoker, so you can't count on the nicotine content. It is not what is in the liquid but what is absorbed that is important. Almost all users start with a cig-a-like and either find them unsatisfying and go back to smoking, or they switch to a tank/mod which delivers enough nicotine to satisfy.
3. While there are some health risks with nicotine, the real problem is with the flavorings. Vapor shop owners will say that the flavorings are "FDA" approved--which most are--as a food, but not as an inhalant. (Actually flavorings are not FDA approved but approved by FEMA--Flavoring and Extract Manufacturing Assoc and given a "no objection" letter by the FDA). Digestion and inhalation are two very different delivery systems. When eaten, a flavor goes through the stomach and digestive tract where it is subject to gastric juices and then is filtered by the liver where toxins are removed. When inhaled, substances go straight to your blood system with no filtration. Some flavorings are toxic when inhaled--like cinnamon, buttery flavor and cherry. There are probably more but little or no testing has been done on the over 7000 e-cig flavors available. 
4.Users like the hand to mouth use of e-cigs and when compared to the nicotine inhaler which also mimics this motion, users say that e-cigarettes give a better throat hit than the nicotine inhaler, (which is an FDA approved cessation device for cessation). A common issue with people using NRT is that they don't get enough nicotine from one delivery system, so we now suggest combination therapy, such as the patch or bupropion with either the inhaler, gum, lozenge, or nasal spray. This pairs one long acting agent with a short acting one. I have heard of many people using both chantix and bupropion together with great success but I haven't seen any research studies on it, only anecdotal.
5. Up to 90% of these devices are made in China (regardless of what the label says--no one is looking to see if the labels are true), where there are no manufacturing standards, the batteries can be defective and blow up, poorly made atomizers can leach metals into the vapor, contents of the e-liquid can be very different than the label--for example instead of using pharmaceutical grade nicotine, a less pure grade could be used or instead of propylene glycol, they could use diethylene glycol--which is cheaper but toxic. Plus there are many counterfeits on the market, so even if the manufacturer is one who is trying to create a good product, you may not know if the one you buy is real or counterfeit. This is a common problem with products made in China: Lumber liquidatorstoothpastedog and cat treats.
Having said all that, I do believe that once some of these issues are addressed through FDA regulation, there is a place for e-cigarettes as a harm reduction device which will help a smoker quit tobacco cigarettes and hopefully will only be used for a short time instead of continuing a nicotine addiction. 

Wednesday, March 25, 2015

Do the cravings (for nicotine) ever stop?

A. has been quit for 6 months yet she still gets cravings just as strong as the first day she quit. She asks,

"Will it ever get better or will it a battle forever?"
You need to stay vigilant and work on changing your self talk. When a craving comes up--if you keep saying--"this is just like day one" and questioning if it will ever get better--that thought process can lead you back. Instead reframe it to: "I've made it 6 months and most of the time, it is easier but since I'm still having craving, maybe there is something more to learn about my addiction to nicotine." Then see if you can trace back your thoughts to what trigger it in the beginning. After 6 months, it's probably not a "habit" cigarette but one that is attached to strong emotions, (positive or negative) and/or stress. 
This is an activity from my book  How To Win at Quitting Smoking:

Activity: Five steps to train your brain to think of smoking in a different way.

You need to recondition your brain to stop the automatic thoughts that nicotine has planted. It takes time. If you only change your behavior and not your thinking, you may relapse or turn to something else such as food.
Write these five steps down on a card and carry them with you. Whenever a craving comes up use these steps to change what you tell yourself when you think about smoking or have a craving. You can use these steps when you first quit and at any time in the future:
1. “I’m having a desire to smoke right now.” Having a desire to smoke is normal and the craving will go away whether or not you smoke. Just let it run its course.
2. “I can smoke at any time, I’m not deprived.” Nobody is taking your cigarettes away from you. It is your choice and you are working towards what you really want and it’s not the cigarette. Remember what smoking is depriving you of that is more important: money, health, freedom.
3. “I’m a puff away from a pack a day.” It’s easy to fall into the trap of having “just one”. Do not kid yourself.
4. “Right now I have a choice to make for myself. Either I give in to this temporary discomfort and go back to the constant misery of smoking, or I can accept this temporary discomfort and work through it for (. . . name one of your Benefits of Becoming Smoke-Free).”
5. “At this moment, I willingly accept this temporary discomfort because I want (. . . then list your Benefits of Becoming Smoke-Free).” Focus on what you truly want.

You always have a choice! When a craving comes up, you will always have two choices:
• You work through it and remain smoke-free, or
• You slip and smoke a cigarette. 
If you choose the latter, again you have two choices:
• You resolve to remain smoke-free and learn from the slip, or
• You blame yourself, beat yourself up, feel guilty and smoke another cigarette.
If you choose the latter, your next two choices are:
• You renew your resolve to become smoke-free and start anew, or
• You relapse and become a smoker again. Realize you need to work on your motivation, make changes in your Action Plan and/or set another Quit Date when you’re ready.
You can choose to see a slip as a failure or as a learning experience. You can choose to let the events of your life control you, or you can take control of your life. The choices you make are determined by who you think you are, and the benefits and expectations you bring to the situation.