by Alan Ho Chok Chan
(This article is dedicated to the Arthurs, Rons, Siew Tees, Peng Boos, Joeys, and Giorgios of our imperfect world…and to their long-suffering spouses.)
In life, especially amongst the Alpha males in Changi, everyone wishes to be known as a fighter, rather than a quitter. Surely, fighting and quitting are at opposite ends of the spectrum of all human behaviour, except, that is, in the field of nicotine addiction. That’s SMOKING , chums.
How serious is the problem? Last weekend, a casual survey of our 19th hole revealed that 5 out of 6 tables of golfers have puffers in their midst. Our incomparable Changi breeze is today poisoned not by industrial pollutants or exhaust emissions, but by exhaled smoke. We have miniature (human) incinerators belching toxic fumes in our midst.
I am making an impassioned plea to all smokers: FIGHT to QUIT.
It pains me to see a fellow golfer light up, be it a cigarette, pipe, cigarello or whatever form of cancer stick he fancies. It conjures up an image of a man knocking a nail into his own coffin. Worse, if that same guy started offering the pack around. He grows horns, hooves, and a tail in my mind.
The Statistics
Cancer, heart attack, and stroke are the three all–time leading causes of death in Singapore. A common thread stringing through all three is SMOKING. Cigarette smoke contains 4000 unsavoury chemicals which are well documented to cause LUNG CANCER, CHRONIC OBSTRUCTIVE LUNG DISEASE, ISCHAEMIC HEART DISEASE, and BRAIN HAEMORRHAGE, plus a whole host of other Cancers, of the MOUTH, THROAT, LARYNX ( VOICE BOX), KIDNEY, BLADDER, CERVIX, AND PANCREAS. It has been estimated smoking shortens the life span of smokers by an average of 14 YEARS. Mull over it gentlemen, how many more golf games, idyllic sunsets, tequilas or Johnnies, and ter-khas ( pig’s trotters) you can savour over 14 wonderful years?
Another issue of some concern to the male members of the smoking fraternity is ERECTILE DYSFUNCTION and IMPOTENCE ( incidence double that of non-smokers )
In females who smoke through their pregnancies, ABORTIONS, LOW BIRTH WEIGHT BABIES, SUDDEN INFANT DEATHS, and ASTHMA in their offspring are increased.
I shall not talk about the ill-effects of passive smoking. Suffice it to say that every year, sizeable numbers of non-smokers perish from smoking-related diseases, their only sin of commission/ omission being this: staying around their smoking friends a minute too long and not exerting their rights.
In the developed world, smoking can be labelled as the most important preventable cause of ill health and death, on par with blood pressure and cholesterol control.
The Benefits of Quitting
“ I have been a smoker all my life, what difference will it make even if I were to quit smoking tomorrow ? ” is the common repartee from the majority of smokers when asked if they intend to quit. Hmm…ingenious. Always answer a difficult question with a more difficult one. In fact , it is a fallacy to believe one has reached the point of no return or diminishing returns. Let me show you some figures :
Upon Quitting,
- in 2 days, smell and taste sensations improve. ( yummy, yummy food )
- in 3 months, blood circulation and lung functions improve by 30% (it may make a crucial difference when scaling the lofty 7th tee box)
- at 1 year, the risk of heart disease is reduced by half.
- At 5 years, the risk of heart disease same as non-smokers.
- At 10 years, the risk of lung cancer reduced by 50-70%
So, there are clearly documented health dividends payable in THIS LIFETIME.
Why People Smoke
The Origin: It almost always began insidiously, in a conducive or tempting atmosphere. A smoking family, or peers. Enticement by mega-bucks advertisements (mountain scenes, fresh spring water, nice music, soothing lyrics, the Matterhorn, the Marlboro cowboy –by the way, he died of the big C) , conformity to peer pressure, knee-jerk reaction to a dare, and the excitement of performing an illicit act, in the school toilet, or the back alley, and they are hooked for life.
The Addiction Make no mistakes about this. Smoking is not about personality flaws or a lack of willpower. It is an addiction, just like alcoholism or heroin addiction. It is all about the Nicotine High. Let me explain :
Within seconds of inhalation, a large bolus of nicotine enters the bloodstream and surges into the brain. This releases :
- dopamine , giving pleasurable sensation and cognitive arousal ( ie sharpens the senses )
- nor-adrenaline and endorphins, enhance concentration, alertness, and memory, also decreasing tension and anxiety.
All these ‘ shiok ’ feelings disappear when the nicotine spike in the circulation fades off, and the smoker gets jittery, anxious, and irritable, (concentration on the tee and the putting green becomes a chore ) he irritates his buddies, barks at his caddy…until the next light up…whoa…Birdie !!
Quitting: There are really four parts in the whole process of quitting.
- Motivation This is the proverbial first step in a journey of a thousand miles , all uphill ! In my limited experience, motivational talks are often most fruitful when the patient is in crisis , medical, physical or otherwise. My late father quit smoking ( and he was a one tin a day man, one tin=50 sticks ) when he had his first heart attack some 15 years ago. Strapped to his bed in the ICU, with tubes going in and out of every orifice, I capitalized on the setting and terrorized him into quitting , aka cold turkey.
Other patients I knew quitted after bouts of infective hepatitis ( cigarette no taste ! ) , getting married, getting out of marriage, child on the way, a myriad of reasons….the important thing is : getting them motivated and seeing them through the nicotine withdrawal phase.
2. Withdrawal Setting a target date to quit. This has practical as well as symbolic significance. One of my smart-aleck patients told me he is motivated, but when it comes down to setting a date? Next year, he told me cheekily. The years shall turn into millennia, and we shall all be worm food before he quits, I told him. The important issue is to set a date to quit, IN STONE. Here, let me digress a bit, and talk about SUPPORT. Family and friends need to rally around the poor guy, who is facing tremendous odds, and is depressed, moody, anxious, irritable, restless, downtrodden, and contemplating the arrival of the Apocalypse. Wives must be more loving, the children, reverse bonding. The patient must be engaged in any and all pleasurable activities, except SMOKING. And the mingling with the Arthurs, Rons, STs, and PBs of this world, all puffing away nonchalantly, is strictly taboo.
3. Medications Basically two classes of medications are available.
- Nicotine replacement therapy.
Whether it be a skin patch, chewing gum, lozenge, inhaler, or nasal spray (some preparations are not available here) , it basically pushes nicotine into the circulation during the withdrawal period, minus the tar and the carcinogens, to smooth out the ride during the first two to four weeks of smoking cessation. It, therefore, has a finite period of administration (max: 6 to 8 weeks) and then slowly withdrawn.
- Non-nicotine therapy.
Bupropion, (trade name Zyban) is an antidepressant mimicking the effects of nicotine on the brain. When taken orally, it increases the levels of dopamine, noradrenaline, and serotonin in the brain, the same chemicals that produce the smoker’s high. When used judiciously, it doubles the quit rate compared to nicotine replacement. However, the treatment is contra-indicated in those with epilepsy (fits) and mental disorders.
4. Prevention of Relapse Tobacco dependence, like alcoholism and narcotic addiction, is a chronic relapsing disease. Most relapses happen early in the quitting process, but others months or years later. Follow-up visits, relapse-prevention interventions, rallying the assistance and support of family members and friends and most importantly, the awareness and avoidance of environmental triggers are the strategies to be deployed.
Let me end on this note, to all puffers :
Do not believe anyone who tells you this : “ Past hope, past cure, past help.”
–Romeo and Juliet.
For: “ to quit or not to quit, that is the question.” —adulterated Hamlet.
Dr Alan Ho Chok Chan is a paediatrician in private Family Practice. He also spends time golfing, swimming, playing tennis, wine tasting, playing guitar and singing. He is also a bibliophile and a voracious reader.
