Reasons to stop smoking

By LIM WEY WEN

Thanks to anti-smoking campaigns, many smokers know of the common health hazards that come with cigarette smoking. However, before the damage culminates into a major, life-threatening event, health concerns are not strong motivators for quitting.

AFTER 24 years living of with his daily pack of cigarettes, it took S. Vigay-indran a mild stroke, lots of encouragement from his family and frequent thoughts of his two children to stop.

“It was midnight on Sept 21, 1999, when I suddenly woke up and realised that I could not speak,” says Vigay-indran, who is now a senior sales executive in The Star. “I couldn’t raise my hand. I couldn’t even walk straight.

“My speech was slurred and part of my face was paralysed,” he says.

His wife, who is a nursing sister, recognised the signs of stroke and brought him to a hospital where he was treated. “One of the first questions the doctor asked my wife was, ‘is your husband a smoker?’” he recalled. “When she told the doctor I was an occasional smoker (I seldom smoked in the house), the doctor showed her my x-ray and said I already had smoker’s lungs.”

It was upon the realisation that smoking may have been one of the major causes of his stroke that he resolved to quit.

“It is not easy, and sometimes there is the temptation to go for a puff or two. But whenever I think of my health and my two young children, I don’t want to smoke anymore because I want to live longer and see them grow up. My family, especially my wife and my sisters, have also encouraged me a lot.”

Better late than never

While it often takes a life-changing experience to strengthen a smoker’s resolve to stop, Vigay-indran reckons that it is better late than never.

One of the problems we face in the field of smoking cessation is that although we are looking at very shocking numbers – for instance, one billion people die from smoking in a year – smokers don’t think they are going to die, says Dr Alaster Allum, Pfizer’s regional medical affairs director.

And although smokers do know that they are at increased risk of developing heart disease and cancer, they think that it is always someone else’s risk.

“The way I look at it,” says Dr Allum, “is that I’m 39 and I’ve got a five-year-old boy. He’s going to do his degree, and I’m going to see him graduating from college. But if I’m a smoker, I probably won’t see my grandkids, because I’ll die 10 years younger.

And that is really what smoking cessation is about – that we’re going to lose 10 years of life. “If you have two relatives who smoke, you will lose one,” he adds. “It actually touches every one of us.”

In her years of experience in nursing, and recently, her two months experience in the new National Heart Institute (IJN) Quit Smoking Clinic, patient counsellor Khoo Soon Gaik noticed a trend among smokers that are trying to quit.

“Those who are self-referred tend to do better than those who are referred by the doctors. Once they decide they want to quit, most of them could,” she says. “But if they still have doubts, it will be a quite difficult.”

To Dr Allum, people like Vigay-indran – those who quit cold turkey – are extremely rare. To some extent, if a smoker has enough willpower, they will quit, he says. But if they are addicted to smoking, they would probably need some assistance.

“You could really ramp up quit rates if you get some help – whether it is nicotine replacement therapy, non-nicotine drugs or counselling – just get some help,” he says.

It is best not to start smoking at all, but if you already are, the benefits of quitting are immediate, says consultant cardiologist Datuk Dr Aizai Azan Abdul Rahim. “Within 20 minutes of quitting smoking, your blood pressure and heart rate will normalise. And in about 12 hours, the carbon monoxide and nicotine levels in your blood will reduce by half.

“By 24 hours, the oxygen levels in your blood will normalise and your immediate risk of heart attacks falls,” he said. But to reduce your immediate risk of heart attacks similar to that of non-smokers, it will take another 14 years.

Your choices

“Drugs certainly play a role, but they do not play the only role,” says Dr Aizai. “The most successful programmes are those that combine some form of counselling or behavioural therapy with the support of drug therapy,” he adds.

According to the American Cancer Society guide to quitting smoking, there are a few ways you could go about quitting.

There is the nicotine replacement therapy, where you replace the nicotine you normally get from cigarettes with patches, chewing gums, sprays and inhalers to help you through withdrawal symptoms. The dose of nicotine will be reduced over time until you do not need or crave it anymore.

There are also the non-nicotine medications to choose from. Bupropion is a prescription anti-depressant that reduces symptoms of nicotine withdrawal, while varenicline is a newer drug that lessens the pleasurable physical effects a person gets from smoking and reduces the symptoms of nicotine withdrawal by attaching itself to the nicotine receptors in the brain.

Other methods, like hypnotherapy and acupuncture, may also help some people, although there is no strong evidence they can improve your chances of quitting.

“If you looked at the National Health Morbidity Surveys, one-third of the many smokers we interviewed have made an attempt to quit smoking,” says Dr Aizai.

On average, most smokers have attempted to quit at least twice a year. And although they may have failed, 71% still had intentions to quit within the next six months, Dr Aizai notes. “That is why it is clear, we need to help them quit,” he says.

So, if you are ready to quit smoking, here are some of the ways that could help you.

Quit smoking clinics

Abdullah Mat Ali, 39, has been off his 20-year-old habit for two months since he started his quit attempt with nicotine replacement therapy at the IJN quit clinic. “I was referred to the clinic by my doctor because of my health problems, but economic concerns are also part of the reason why I decided to quit. Cigarettes don’t come cheap these days,” he says.

However, quitting was not easy – even with help. “The first week was difficult as I felt anxious and uncomfortable. Now, I still have cravings for cigarettes but I can control it better,” he says. “But I would advise smokers who want to quit to get help because quitting on your own is difficult,” he adds.

In Malaysia, the first government quit smoking clinic was set up in Hospital Ipoh, Perak, in 1996. Now, there are about 336 government clinics nationwide as well as some private quit smoking outlets that could help smokers quit. IJN has just started their in-house quit smoking clinic two months ago.

These clinics combine pharmacotherapy (nicotine replacement therapy and non-nicotine medications) with counselling and the average success rate hovers at about 30 to 40%, according to a health official.

If you are interested in quitting this way, you could call the IJN Quit Clinic at 03- 2617 8585 or the Ministry of Health Stop Smoking info-line at 03-8883 4400. You will be directed to the nearest quit clinic.

Hypnotherapy

Hypnotherapy to quit smoking is a one-off session that works by reinforcing smokers’ will to quit in their subconscious mind, says clinical hypnotherapist Joyce Hue.

“We are also creating in the subconscious mind an image of our clients as non-smokers,” adds Sheila Menon, who is a clinical hypnotherapist and principal of the London College of Clinical Hypnosis.

As some of them have been smoking for a very long time, they could not remember or imagine themselves as non-smokers again, she says. And so, what hypnosis does is create an image – that of a non-smoker – which smokers can better associate with compared to memories of their smoking days, she adds.

James Lim is pleasantly surprised when he went off cigarettes for 10 days after a session of hypnotherapy. “I didn’t think I would go off cigarettes after nine years of smoking a pack a day. Even when I tried to quit several times before over the last two years, I still needed two to three cigarettes a day to get by.

“But now, when I have cravings for cigarettes – it usually lasts just about five seconds – I don’t even think of lighting up.”

While there are clients who slip up after hypnotherapy, Hue says they encourage their clients to come back and work with their hypnotherapists to find out the reasons for the recurrence.

“Sometimes they come because their spouses or family asked them to. But if the client really wants to quit, they can usually succeed,” says Hue.

Those interested in knowing more about the therapy, you could visit the London College of Clinical Hypnosis website at www.hypnosis-malaysia.com.

Acupuncture

Acupuncture helps detoxify your body and changes the way your body experiences tobacco, says acupuncturist and associate professor at the Kuala Lumpur Academy of Traditional Chinese Medicine Tan Poh Choon. “Smoke will start to taste unpleasant to the smoker, and his or her desire to smoke will be reduced,” he adds.

“It usually takes three to five sessions for it to be effective. But sometimes it is difficult to get clients to come back regularly for follow-up,” he says.

French acupuncturist Nadege Lubrano’s interest in using acupuncture to help smokers quit stemmed from her personal experience in quitting smoking through acupuncture.

After many attempts to stop over the 18 years she smoked, she did not succeed. “I tried acupuncture, which is quite widely practised in France, together with counselling. And I have stopped ever since,” she said.

But like other therapies, she notes, acupuncture is often not enough. Smokers must be given enough psychological and moral support to follow through. “I believe that acupuncture is not enough. You need the counselling to help smokers understand their situation and motivate them,” she adds.

Never too early, or too late to stop

There is no guarantee that a treatment that works an individual will work for another. But even if your first few attempts did not work out, there is no reason to stop trying because you will never know when smoking will catch up to you, healthwise.

And if you have seen examples of people who smoke but do not appear to have any problems, Dr Allum says, “Some people smoke but don’t die, but you can see how many people do. We can’t pretend that everyone is alike.

The grandmother who smokes but lives to a ripe, old age may not be one of those who died of smoking, but the point is, she might have been, Dr Allum explained.

“When I had my stroke at age 43, I was already trying to cut down smoking due to health reasons. However, it was too late as I already had the attack before I could stop,” says Vigay-indran.

That is why it is better is you stop early. You never know when you’ll suffer the consequences, he adds.

- THE STAR