# Tuesday, January 29, 2008

Canadian Weedless Wednesday

Last week was National Non-Smoking Week across Canada, with the focal point being Weedless Wednesday. Started in 1977, National Non-Smoking Week is one of the longest running Canadian public health education efforts. It's goals are to educate Canadians about the dangers of smoking, to prevent people from starting to smoke, and to help smokers quit. Coincidentally, this national event took place on the heels of Wolfville Nova Scotia's ban on smoking in vehicles in which children under 16 are present. Presently Nova Scotia, British Columbia and the Yukon have had bills or motions introduced to make this ban province-wide.

Most Canadians are unaware of just what makes smoking so lethal. Not only is the smoker as well as non-smokers who breathe in second-hand smoke exposed to nicotine, but many other toxins are in cigarettes. All of these toxins are harmful to anyone who inhales them. A sample of the toxins found in cigarettes are:

   • Tar: found in tobacco smoke. Tar is a sticky black residue that contains hundreds of chemicals, most of which are classified as carcinogenic and/or hazardous waste. Found in tar are such chemicals as polyaromatic hydrocarbons, aromatic amines and inorganic compounds
   • Nicotine: is the addictive substance in tobacco. It occurs naturally in tobacco plants and is harmful to cardiovascular and endocrine systems in humans. It causes chemical and/or biological changes in the brain. Nicotine is extremely poisonous in large amounts
   • Carbon Monoxide: is in tobacco smoke as a result of burning tobacco, and is responsible for the reduction of red blood cells delivering oxygen to human tissue. This has the greatest potential for causing damage to the heart, brain and skeletal muscles.
   • Formaldehyde: Is registered in Canada as a pesticide and causes eye, nose and throat irritation as well as other breathing problems
   • Hydrogen Cyanide: One of most toxic chemicals in tobacco smoke; frequent exposure to low concentrations of this cause weakness, headaches, vomiting, nausea, eye and skin irritations and rapid breathing.
   • Benzene: has been declared toxic by the Canadian Environmental Protection Act and is believed to be harmful at any level of exposure. It has been described as a Group 1 carcinogen.

It is obvious from this list that smoking and/or exposure to tobacco in any form is extremely harmful. Smoking is directly related to such potentially fatal diseases as:

   • Cardiovascular Disease: This includes heart attacks, strokes, hardening of the arteries and/or dilation or rupture of the aorta. Cardiovascular disease is responsible for 2 out of 5 tobacco-caused deaths. It is responsible for the death of approximately 17,500 Canadians every year.
   • Cancer: This includes lung cancer, cancer of the mouth, pharynx, larynx and/or esophagus, cancer of the pancreas, cancer of the kidneys and cancer of the bladder. Cancer is responsible for 2 out of 5 tobacco-caused deaths, and kills approximately 17,700 Canadians every year.
   • Respiratory Disease: Including pneumonia and influenza, chronic bronchitis, emphysema and chronic airways obstruction. Respiratory disease is responsible for 1 out of 5 tobacco-caused deaths with a mortality rate in Canadians of approximately 9500 per year.

Smoking is also directly related to other serious health issues. Smokers are more likely to suffer from peptic ulcer disease; the ulcers are also slower to heal and more likely to reoccur. Smoking is also a risk factor for Crohn's disease, also known as chronic bowel disease. Smoking affects oral health; as well or oral cancer, smokers are more likely to experience tooth decay and/or gum disease. As smoking reduces bone density, it can cause and/or aggravate osteoporosis. Smokers with osteoporosis have increased chances of bone fractures. Because smoking decreases blood flow in the small blood vessels in the skin smokers are more likely to experience premature aging and more skin wrinkles. For women who smoke, they can experience menopause 1 to 2 years earlier than non-smoking women. For men, smoking may cause impotence.

The statistics surrounding the life expectancy of smokers is highly alarming.  The Canadian Council for Tobacco Control estimates that for every 1000 Canadians age 20 who smoke, about 500 will die from a tobacco-caused death if they continue. Out of these 500 deaths, half will occur before the smoker turns 70. Approximately 45,000 Canadians every year die from tobacco-caused illnesses, and smoking causes the highest number of preventable illnesses, disabilities and/or deaths in Canada.

Obviously, it is vital that Canadians quit smoking in order to prevent death and/or illness. There are many different theories about the best way to quit smoking. However, it is up to the individual to choose a plan and/or method that works for them; not everyone will benefit from the same method. For smokers who wish to quit, it's important to find a method that works for you and to be prepared for what quitting smoking entails.

While there are various unproven methods such as hypnotherapy, acupuncture, etc, the 2 major smoking cessation aids are:

Prescription Medications: Your doctor can prescribe certain medications like Varenicline tartrate which may reduce the sense of satisfaction that you get when smoking. It can also help reduce the cravings and help alleviate withdrawal symptoms. This drug works by weakening the chemical reactions in the brain caused by nicotine that make smoking feel pleasurable. However these types of medication are not recommended for women who are pregnant or breastfeeding. It is also not recommended that nicotine replacement therapy products such as patches, gum or inhalers be used when taking this drug. Certain anti-depressants can also be helpful in quitting smoking. Although it is not certain how this works, studies have shown that smokers who have been treated for depression with certain prescription drugs reported that along with the symptoms of depression going away, so had their urge to smoke. These medications are only available with a prescription, so consult with your physician to see if this is an option for you.

Nicotine Replacement Therapies: Nicotine gum and the patch.

   • Nicotine Gum: Releases a dose of nicotine that when chewed helps with the withdrawal symptoms. Chewing nicotine gum can satisfy the cravings quickly and also helps to keep the mouth busy. It is available without a prescription, and can be purchased at most pharmacies. It is available in different doses for all levels of smokers.
   • Nicotine Patch: This consists of small self-adhesive patches that slowly release nicotine into the bloodstream. It can be placed anywhere on the skin between the waist and the neck. The patch allows the smoker to gradually reduce the amount of nicotine they use. It can however, cause the skin surrounding the patch to be irritated and may also cause headaches, dizziness, upset stomach and blurred vision. The 24 hour patches may cause sleep problems as well. Although this is available without a prescription, consult with your physician about using it, especially if you have angina, irregular heart, have had a heart attack, are pregnant and/or breastfeeding and if you are taking other medications.

It is important to be prepared to quit smoking. Consult with your physician; discuss the above-mentioned options to see what is right for you. You should also come up with a strategy to help avoid the pitfalls. Some good ideas for planning ahead to quit are:

   • Pick a quit day. Try and pick a date within 2 to 3 weeks of making the decision to quit. This deadline will help you decide how to handle the situations which make you want to smoke. Try and choose a time that isn’t very stressful. Remember, there’s never going to be the "perfect" time, so pick your date and stick to it.
   • For some people it can help to cut down first. You may also want to purposely leave your cigarettes at home when going out, cutting down on your cigarette breaks at work, etc.
   • Make a list of all the reasons you want to quit smoking and post them in every room of the house and/or work.
   • Get rid of all your ashtrays and make your usual smoking areas as uncomfortable as possible.
   • Plan ahead for ways to combat the urge to smoke. This can include going for a walk or working out; make sure you also have plenty of healthy snacks on hand for when the hand-to-mouth urge strikes.
   • Through the first few days, take it hour by hour. View each smoke-free hour as an accomplishment. It can be daunting when thinking of never smoking again, so break it down into manageable time frames
   • Drink lots of water to help flush the nicotine and other chemicals out of your system.
   • Change your routine for your usual times to smoke. For instance, if you smoke right after a meal, you need to replace that activity with another one.

Most relapses occur within the first three months of quitting smoking. They are usually caused by triggers, i.e. an incredibly stressful event. However, relapsing does not mean that you have to become a smoker again. If you do happen to slip and have a cigarette, don't overact, but become recommitted to being a non-smoker.

Being able to identify the symptoms of withdrawal can better prepare the smoker for what to expect, as well as how to alleviate them. Knowing what to expect and the general time taken to be rid of these symptoms can help the smoker come up with an effective quitting plan. Nicotine is physically addictive and it does take time for the body to expel itself of not only the nicotine, but the other chemicals that are being ingested with every cigarette smoked. Most smokers who quit experience physical effects such as:

   • Irritability: This generally lasts 2-4 weeks and is caused by the physical craving for nicotine. It is important to recognize that this is a withdrawal symptom and spend extra time devoted to relaxation methods such as hot baths, music, etc.
   • Lack of energy: Nicotine is a stimulant and keeps your brain active. The body generally takes 2-4 weeks to readjust to living without this boost. During this period don't push yourself too hard; if possible take naps when needed.
   • Insomnia: Nicotine affects brain waves and sleep patterns. Sleep pattern disruption usually lasts for a week. During this time try to avoid caffeine, especially at nighttime
   • Dry throat and cough: This usually only lasts a few days, and is caused by the body getting rid of trapped mucus in the airways. Make sure to drink lots of water and juice to help get rid of the mucus.
   • Dizziness: As your body is now receiving more oxygen, you may feel dizzy for 1 to 2 days. Make sure to get up slowly after sitting or lying down.
   • Difficulty concentrating: This can last for up to a few weeks and is caused by your body readjusting to not having the constant stimulation from nicotine. Reduce your workload and take a lot of breaks if possible.
   • Chest tightness: Chest muscles may be sore from excessive coughing as well as muscle tenseness from the cravings. This usually lasts for a few weeks; deep breathing can help alleviate the soreness.
   • Stomach pain, gas, and/or constipation: This can happen as bowel movement drops very briefly. When you quit smoking, make sure your diet is high in fibre as well as fruits and vegetables.
   • Hunger: Your body may confuse nicotine craving as hunger pains. As well, the hand-to-mouth action from smoking can be hard to break. This can last anywhere from 2-4 weeks. Make sure to have lots of healthy snacks such as raw vegetables, popcorn, fruit, pretzels, etc on hand so you can enjoy lots of guilt-free munchies.

The actual nicotine craving is usually the worst in the first few days of quitting, although some people can experience occasional cravings for long periods afterwards. Nicotine generally takes around 3 days to come out of the bloodstream. Recognize the cravings for what they are and try to wait them out, they tend to only last for a few minutes. Keep yourself busy with another activity during the cravings to take your mind off of it. If using nicotine gum as part of your plan, then this is the time to have a piece.

Smokers who quit before they experience irreversible heart and circulatory disease can greatly improve their health. In fact, after 20 minutes of quitting, blood pressure, pulse and body temperature all start to return to their normal state. Within 8 hours the oxygen and carbon monoxide levels in blood return to normal and smoker's breath disappears. In the first 24 hours of quitting smoking carbon monoxide will be eliminated from the body. As well the lungs will begin to clear out the smoking debris and mucus. 72 hours after quitting lung capacity begins to increase and breathing becomes easier. 3-9 months after quitting lung function increases by up to 10%. Being smoke-free for one year reduces the risk of heart disease by up to one-half of a smoker’s. Within 10 years the risk of lung cancer falls to one-half of the risks of a smoker’s, and within 15 years the risk of heart disease is about the same as someone who has never smoked.

Along with improved health, quitting smoking can be financially beneficial. For instance, Canadians who smoke one pack per day at $8.00 per pack will save $2920 in the first year alone. Smokers who quit will also experience savings in their health and life insurance premiums. As these premiums are based on health status, the more healthy you get, the more you can save. When you quit smoking let your health and life insurance broker(s) know so that they are aware of your new and improved health status.

For more information on the effects of smoking, and advice on how to quit please visit these websites:

Canadian Cancer Society
The Lung Association
Health Canada Quit4Life


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