I recently received a plea from a well-known figure in aviation: "Jonathan, can you please help me? I have been smoking for years and know I need to stop but cannot. I am 61, have some problems with my blood pressure and have had blocked coronary arteries that needed stents. What can I do?"
A smart man, a pilot, he knows he is doing harm but cannot stop the self-destructive behavior. Why? Because these evil things are hideously addictive. Let's be perfectly clear, smoking is disastrous to your health, limiting oxygen and blood supply to the brain, heart, and every other organ. And many problems besides. For instance, smoking raises blood pressure; causes arteries to become narrow and unyielding; wrecks the lungs, filling them with tar and other noxious substances; narrows the airways; causes multiple different cancers; damages vision and sense of taste; ages the skin prematurely; renders one impotent; and makes the smoker, and all in his or her presence, stink. And at $14 for a packet of 20 in New York, or even $4.96 in Kentucky, a smoker puffing through a pack a day spends enough avgas cash to take the average Cessna 172 from the East Coast to the West Coast and back. A much better use of $4,000 methinks.
The media has done a good job slowly eroding the vision of a smoker as a cool dude—the days of James Dean and James Bond dragging moodily on a ciggie have thankfully been condemned to the ashtray. Unfortunately, the tobacco industry now markets aggressively overseas, and young women continue to take up the foul habit, delighting in the appetite suppression that comes with cigarette use.
But what of ways to stop smoking? The first step is a desire to stop. The desire comes from comprehending that the habit's bad effects can, and most likely will, affect you—many kid themselves into believing they are immune. When faced with a patient who has the desire to stop smoking, I would first spend time going through all the effects to make sure there is no doubt about the harm being done. If I spend one hour with a patient, I tell them that while we were together, eight people died in the United States from smoking-related diseases.
Next come a series of psychosocial maneuvers that can be helpful. First, dispose of all smoking materials and paraphernalia in your house and car. Throw ashtrays, lighters, and matches away, and duct tape the car ashtray closed. Put a Post-it note on car windows that they are not to be opened to allow smoking. Designate something you will do with the money you will save and have a jar into which you drop cash every time the desire to buy cigarettes pops up. Engage the support of loved ones, asking them to remind you of the stated goal. One nice trick is to ask your partner if every time you mention the wish to have a cigarette, you could instead steal a passionate kiss.
Much is made of the Freudian oral fixation of smoking and that can be addressed by chewing gum—go for the sugarless type—or noshing on a carrot or celery stick. Have something to chew on with you at all times. To deal with the finger frustration, buy a set of worry beads. Also, identify what situations have usually called for a smoke; for instance, if it has been your habit to take a drag while on the phone, treat yourself to a doodle pad or executive toy to play with while on those interminable conference calls.
What of electronic cigarettes or nicotine patches, gum, lozenges, inhalers, or nasal sprays? While they have their proponents, I am not a fan as they continue a set of behaviors and rewards that we associate with smoking. However, there are some pharmaceutical aids that can be helpful such as Zyban or Wellbutrin (bupropion) and Chantix (varenicline tartrate), and you should discuss these with your doctor. While using these medications may help you stop firing up a cigarette, you will definitely not be firing up your airplane engine as all three are unacceptable from an aeromedical perspective. Weight gain is a particular concern for many when they stop smoking; conveniently, some of these drugs may help with that, although the average gain is only a few pounds. With new-found commitment to being healthy and having improved lung function, most ex-smokers can lose the extra weight with an exercise program. Certainly enrolling in a formal cessation program can help, but avoiding the chastisement of other smokers and engaging family support is key.
I have been criticized for not encouraging the adoption of alternative therapies in my columns. I have nothing inherently against such tools; if the data are there, fantastic, bring them on. For instance, acupuncture and hypnosis have both been recommended as ways to help smokers quit, but to my knowledge these methods, and a range of herbal supplements, are not proven by rigorous scientific trials. They are, however, unlikely to harm you; so if they help, I say go for it!
It is never too late to quit, each day without cigarettes is a good day, and more than half of those who say they will stop are successful. Let's add other tobacco products: cigars, pipes, snuff, chew, dip, and smokeless tobacco. All contain stuff that we know is bad for you. So don't do it.
As a doctor I have seen the widespread damage tobacco does to the human body, and it is horrific. As a son, I watched my father die a slow and wretched death from years as a smoker that I was powerless to stop. For nine years he needed oxygen to move a few yards; he coughed and gasped while wincing in pain from the tenuous blood supply to cold fingers and toes; eating caused him abdominal pain from diminished supply to his gut; and prostate cancer brought him stress and concern. My father was a sweet and kind man, and I loved him dearly. I am writing this in honor of my dad. And the chap who called me about his smoking. And if one person out there reads this and stops smoking as a result, my work will have been rewarded.
