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Re: ankylosing spondylitis and ...From: Ealgail@aol.comSun Apr 28 07:33:37 1996
Regarding the 61 year old woman, smoking 2 ppd..... I assume you have Rx'd the nicotine patches for this lady. The last stats I saw were a 30% success rate with the patches and 5% without them (not a drug co. sponsored study). They do help, especially with the high consumption patients. It's true the patient has to "want" to stop smoking, but we can help that along by actually saying, "It's the MOST serious threat to health you have...greater than osteopororsis, greater than ulcers, greater than the ankylosing spondylitis.." and "if you only do one thing for your health....quitting smoking is the thing to do". In my experience, they need counseling and it takes 15 to 20 minutes of office time, so charge for it...there is a code. Smoking is not just a habit, it is a lifestyle. I tell patients to clean out the entire house of all cigarettes, all ashtrays (they should not let anyone smoke in their house or car), and to throw them away, not just put them away. They must tell everyone they know they are quitting and to please help them. In the home there is usually a favorite chair or place they smoke...I tell them to move the chair to the garage (they always smile at this) or if it is too nice a chair to put in the garage...move it to another room or spot in the room. I tell them to stock up on a favorite, strong tasting hard candy, like lemon drops, peppermint, cinammon candies, or butterscotch and put out bowls of it everywhere they sit or work. I also tell them to get suckers, tootsie pops, and popsicles or frozen fruit bars, for a "hand to mouth" substitute always available. Then, I caution them about the patches, that they can NEVER smoke while wearing one. If they decide to smoke, they must peel the patch off, and wait 30 minutes for the drug to clear, before smoking. And finally, most smokers get up in the morning, smoke a cigarette, drink coffee and read the paper. I have never had one tell me they eat breakfast. So, I recommend they eat breakfast, and if they don't like breakfast food, to eat a grilled cheese sandwich, left over pizza or anything else they actually like; but to eat something. And, many women smoke to control their weight. If you think that is a motive, saying something fairly harsh about the irrationality of smoking with its cosmetic effects on skin, face and teeth and how unattractive that is, will usually quash or diminish that motive. After I spend all that time, they usually feel obligated to at least try again. Asking them to call you in a week to tell you how they are doing is good, too. They don't feel "off the hook" when they walk out. Since, developing this spiel, my success rate in getting women to quit smoking has increased significantly. On estrogen, I would go ahead and give it also. You can be sure this lady has osteoporosis from the smoking and prednisone. I only use bone densometry studies when I am in doubt or to follow the disease. Good luck! Linda Morrison-Boczar, M.D.
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