“CONTROL ALL ADDICTIONS TO LIVE… BUT STILL SMOKE TO DIE!”
There is a mountain of evidence which suggests all addicts in general,
‘I KNOW I WILL NEVER SMOKE AGAIN’ (The Daily Telegraph, Tuesday, March 11th 2003, by Christine Doyle) On the eve of No Smoking Day, Christine Doyle examines the controversial drug Zyban Throw out your ashtrays for ever. Tomorrow is No Smoking Day and, once again, aspiring non-smokers are ready to take up the challenge. Lisa Byrne, 35, who was desperate to give up for the sake of her young children as well as her health and her business - she runs a hair and beauty salon - knows how they feel. “I was on more than 40 a day; a real slave to smoking ,” she says. “For four years I tried everything: nicotine patches, gums, herbal remedies, hypnosis, will power. I made seven or eight determined attempts, but nothing worked.” Until, that is, she tried Zyban (bupropion), the anti-depressant that is the first non-nicotine drug to help smokers stop. Two years later, she remains a non-smoker and says, triumphantly: “I know I will never start again.” Yet, despite many similar success stories, Zyban is the subject of concerns about safety. There have been more than 7,000 reports from doctors of side effects from Zyban treatment, ranging from agitation, shakiness and nausea to sleeplessness, dizziness and blurred vision. About 60 deaths have been associated with Zyban, although no casual link has been established. Most disturbing was a recent comment by a coroner that Zyban may have been one of the factors in the suicide in 2001 of Nick Hirst, a student from Prestbury, Cheshire. At the time, Hirst was studying at Nottingham Trent University and, according to his mother, was a happy-go-lucky young man who was keen to stop smoking. He managed to, she said, but everything else in life seemed to stop as well. So what are hardened smokers to do? Many of those who visit a smoking cessation clinic this week will be advised to try Zyban. Doreen McIntyre, chief executive of No Smoking Day, points out that Hirst died six months after taking Zyban. The coroner also noted, when recording a verdict of suicide, that other factors, including an obsessive personality and heavy drinking, could have contributed to his death. A casual association between Zyban and suicide, or thought of suicide, has not been established, says GlaxoSmithKline, the maker of the drug. “We remain fully confident in the contribution Zyban makes in helping smokers to stop smoking successfully,” a spokesman says. The 60 deaths in question and more than 7,000 adverse reactions have to be put in perspective, says Amanda Sandford of Action on Smoking and Health. “The fact is that one in two persistent smokers will die from smoking-related disease, such as heart disease, stroke and lung cancer. The deaths of those taking Zyban might well have occurred anyway or have been related to something else.” Indeed, the drug might save lives. One woman in her sixties who had emphysema was told by her doctor that she would die unless she stopped smoking. She says that Zyban reduced her craving and she eventually stopped smoking. So how does it work? Zyban both reduces the craving for cigarettes and dulls the physical symptoms of withdrawal - tension, irritability, lack of concentration and restlessness. The idea is to take one tablet for about six days, while still smoking. Then, two tablets are taken each day for about two months. Zyban should not be taken during pregnancy or by anyone who has epilepsy, or a history of seizures, among other conditions. It may also interfere with other medication. Always check with your doctor. Zyban has been used in this country for only a few years, therefore doctors who prescribe it must report every side effect to the Committee on Safety of Medicines. “This is the process that every drug must go through when it is taken by thousands of people,” says McIntyre. “We have to learn more about the patterns of possible reactions and that only comes with widespread use.” Already, more than 600,000 Britons and 10.5 million people worldwide have taken Zyban. Studies suggest that up to 30 per cent remain smoke-free a year later, a slightly higher success rate than for those using nicotine replacement therapy. Not surprisingly, many people who are thinking of taking Zyban will still feel apprehensive. Lisa Byrne, who was part of a trial group in Manchester supervised by Dr Chris Steele, who runs one of the country’s largest smoking cessation clinics, says that careful monitoring and advice helped her. But the treatment was far from plain sailing. “For the first 48 hours on the drug, I was so shaky, panicky and nauseous that I felt quite worried. ‘Should I stop the drug?’, I thought. But Dr Steele had told us about all the possible reactions, and I decided to struggle on. Two or three days later, they had calmed down and I had no further side effects.” Rebecca D’Amato, 34, had a more alarming reaction when she was prescribed Zyban about two years ago. She smoked at least 20 cigarettes a day and, like Lisa, had tried everything. “I even spent more than £240 on a hypnotherapist who, after one session, said that I would never smoke again. Two hours later, I was puffing away. “So I decided Zyban was my way ahead. But within 24 hours, I felt incredibly shaky. It was as if I had been plugged into something. “I contacted the Zyban helpline and I was advised to see my GP. I was so scared that I stopped using the drug and, within 24 hours, was back to smoking 20 a day.” Rebecca is, however, ready to try Zyban again. Recently, she realised that her severe reaction could be linked with St John’s wort, which, until this winter, she has taken to counter seasonal affective disorder. “There are several drugs that might interfere with Zyban, but I did not know that St John’s wort could interact with other anti-depressants.” For those hoping to give up smoking, there have never been so many options available, including advice clinics, stop-smoking counsellors, websites and helplines. Indeed, smoking cessation is one health service that is so well funded - more than £23 million a year - that there are virtually no waiting lists. “We now lead the world in our approach,” says McIntyre. FIND THE BEST WAY TO QUIT Answer the following questions to assess your level of dependence: How early in the day do you start smoking?
How many cigarettes do you smoke each day?
At supper with non-smoking friends, would you:
If you had just one cigarette left after 10.30pm, would you:
If you had a cold would you:
How did you score? a = 1. b = 2. C = 3. D = 4. 5 - 8: 9 - 13: you are a dependent smoker and should think hard about stopping smoking. You are already at risk of a smoking-related illness. Start with the lighter forms of NRT and move on to the stronger dose if they do not work. Patches and gums keep up the background level by trickling nicotine into the body 24 hours a day. This suits people who prefer a constant security blanket. People who wish to stay in control might prefer nicotine lozenges. The nicotine is speedily absorbed to give an instant “hit”. 14 - 20: you are a hardened, addicted smoker. Continue with this pattern of smoking behaviour and you are more likely to be among the one in two persistent smokers who die from smoking-related heart attacks, lung cancer or emphysema. Try the stronger forms of nicotine replacement therapy, such as 4mg gum, 15mg patches or nasal spray. Consider Zyban as a last resort. NRT and Zyban can be used together. Tips: Reduce stress with aromatherapy and relaxation tapes. Try avoidance tactics if you fear putting on weight. Join a gym, go for a walk and eat a little less each day - but don’t diet. Seek support from friends and encourage them to give up. Reinforce your willpower: read Allen Carr’s Easy Way to Stop Smoking. Don’t give up if you slip up. Further help: Quitline: 0800 002200 NHS smoking helpline: 0800 169 0169 No Smoking Day website: www.nosmoking day.org.uk Zyban helpline: 0800 169 1313
If you would like to share your
experiences of quitting smoking, please SO WHAT IS SMOKING DOING TO YOUR BODY? (Daily Mail, Tuesday, March 11th 2003, by Angela Epstein) OF the UK's 13 million smokers, 70 per cent say they can't kick the habit. Here, with the help of Dr Dawn Milner, chairman of tomorrow's No Smoking Day campaign, ANGELA EPSTEIN takes you on a journey through a smoker's body to show why it's so important to quit. BRAIN WHEN you light up, smoke inhaled through the lungs travels via their tiny air sacs to the bloodstream and is then transported to the body's vital organs, including the brain and nervous system. The chemicals in smoke cause the lining of the arteries to become porous, which allows cholesterol, white cells and blood clots to stick to them. Clogging arteries which supply blood to the brain leaves smokers at risk of a stroke. EYES SMOKING can lead to defective vision and even blindness. A condition called age-related macular degeneration (AMD) is the largest cause of blindness to people in the UK and is most common among smokers. Smoking damages the eyes because it reduces the levels of plasma antioxidant, a substance in the bloodstream which protects retinal cells. Smoking also causes the protective layer between the retina and blood vessels to wear away, resulting in poor circulation, irritation and scarring. Some scientists now also believe smoking could contribute to the incidence of cataracts. NOSE MANY smokers complain that their habit affects their sense of smell. This is because smoking irritates the delicate membranes of the respiratory tract, including those inside the nose. Another problem for smokers is that in a bid to get rid of noxious smoke fumes, the nose secretes more mucus than normal. This causes the nasal cells to swell, restricting breathing and possibly leading to chronic sinusitis. MOUTH USE of tobacco is connected to 90 per cent of oral cancers, including lip, tongue and palate. Many of the chemicals found in tobacco smoke are carcinogenic, and therefore when the tissues of the mouth are bathed in toxic substances, this can lead to oral cancer. Smoking also increases the risk of periodontal disease which affects the teeth and gums. Smokers tend to develop hard layers of plaque on the teeth called calculus (tartar). If not removed, it remains below the gum line, destroying tissue and causing gums to pull away from the teeth. This, in turn, creates deep pockets between the teeth and gums which allow in bacteria to destroy tissue and supporting bone. Eventually, teeth loosen and fall out. As smoking affects blood supply round the body, smokers bleed less easily so there will be no warning signs such as bleeding gums. SKIN ACCORDING to research, smoking is at least as damaging to the skin as the sun. Every inhalation creates thousands of wrinkle-forming free radicals which attack collagen, cell membranes and the skin's fatty layer. It is also thought that smoking impairs blood flow and lowers levels of vitamin A, which is vital for healthy skin growth, so producing a dull, dry complexion. Smoking can also lead to crow's feet as smokers unconsciously squint to avoid the smoke's irritating and drying effects on their eyes. THROAT MANY smokers develop a hoarse speaking voice caused by smoke drawing down over the larynx. The toxic content of smoke damages the delicate membranes of the larynx, making the smoker prone to laryngitis and in more severe cases, cancer of the larynx. Smokers who suffer chronic nasal congestion may also have a nasal drip which leaks down the throat and leads to pharyngitis, laryngitis, and bronchitis. LUNGS MOST people are aware of the connection between lung cancer and smoking. Around 90 per cent of people who develop the disease are or were smokers. Lungs are so vulnerable to damage because the tar that forms from burning tobacco settles in them, damaging the surfaces and clogging the cillia - tiny hairs that protect the lungs from dirt and infection. However, smoking can cause many other serious lung diseases. These include chronic bronchitis, which is caused when the air passages produce too much mucus. As the lungs become more damaged, the body cannot rid itself of the mucus which becomes infected. Eventually, the air passages are blocked causing permanent breathing difficulties. Emphysema is a lung disease which can follow on from chronic bronchitis and is caused by damage to the air sacs of the lungs. This reduces the lungs' ability to exchange the oxygen we breathe in with the carbon dioxide we breathe out and can be fatal. STOMACH SMOKING is harmful to all parts of the digestive system. Chronic cigarette smoke may increase the amount of acid secreted by the stomach causing peptic ulcers - lesions in the lining of the stomach. Smoking is also linked to Crohn's disease, an inflammation deep in the lining of the intestine. Doctors believe this may be because smoking could lower the intestine's defences against infection. Many smokers complain of heartburn, and this may be because smoking lessens the strength of a valve at the lower end of the oesophagus or gullet, which would normally stop stomach acid flowing back up the food pipe. HEART TOBACCO smoke produces carbon monoxide, a highly poisonous gas which combines with haemoglobin in the blood and makes breathing difficult. This reduces the body's ability to carry oxygen, putting the heart under strain. Smokers also have a higher risk of hardening and narrowing of the arteries, which can cause a wide range of cardiovascular problems. BONES FEMALE smokers face an increased risk of developing osteoporosis, a condition that reduces bone substance and results in fragile bones that are liable to fracture. This is because smoking makes the ovaries less effective at producing the hormone oestrogen which is vital for maintaining a healthy bone mass. SMOKERS COUNTDOWN TO A HEALTHIER LIFE
SMOKING CASE HISTORIES AND HELP IF YOU ARE HOOKED Janet Sackman, 63, Hicksville, New York I often wonder what my life would have been like if I hadn’t gone to the beach that afternoon when I was 14. I was walking along the sand in a gorgeous new bathing costume, relaxing after a swim, when a well-dressed man stopped me. “Excuse me, miss,” he said. “I think you could be a model.” And he handed me a business card. “Thanks!” I said. Later, I showed my mother the card. “He was joking,” she said. You’re wrong, I thought. I was already five foot nine and had long blonde hair, perfect teeth and a good figure. I sneaked out and rang the number on the card. It turned out to be a real modelling agency, and they hired me. Within three years I had hit the big time – nationwide television. Oh, was it exciting! I would wear a blue evening gown on Perry Como’s show Chesterfield Supper Club. The announcer would take a puff on his cigarette and then suavely declare, “Chesterfield leaves no unpleasant after-taste.” Then I’d kiss him and say in my smooth-as-silk voice, “You know he’s right!” I also became a Lucky Strike cover girl, smiling from a million magazines. There I was on a snowy mountain, holding ski sticks and a cigarette as the wind blew my golden hair, urging people to “smoke a Lucky to feel your level best”. Of course the mountain was just a painted backdrop, and I couldn’t ski. I didn’t even smoke. But during this same photo session, a tobacco executive drew me aside. “It would be good if you learned to smoke,” he said earnestly, “so you’ll know how to hold a cigarette and puff on it.” He didn’t pressure me but, at 17, I was eager to be a grown woman. It wasn’t long before I bought a packet. The first drag was awful – like sucking on a burning rope. But I was determined to master this proof of sophistication, and each time I tried I found it a little easier. What I didn’t understand was that I was creating an artificial need for nicotine in my body, so that when I smoked I felt a great relief – which I interpreted as pleasure. Soon I was smoking more than a packet a day. Eventually I gave up modelling to have a family. But I didn’t stop smoking. Every time I tried, I’d get jittery. So I’d say, “Well, maybe tomorrow.” In 1983, now 51 and the mother of four, I began to have terrible earache. Finally the doctors found the cause: throat cancer. “We might not have to remove the entire larynx,” they assured me. When I woke up after surgery, I was shivering and desperately in need of a blanket. I opened my mouth to call the nurse. No sound came out. My voice had gone. It took me a year to learn “oesophageal speech”. I draw air into my oesophagus and literally belch out the words. My new voice has no inflection. I laugh soundlessly, and when I cry I shed silent tears. I breathe differently too. I inhale and exhale through a stoma, a coin-sized hole in my throat. Sometimes it whistles. I thought I had paid an awful price for smoking, but at least I was alive – and completely off cigarettes. But in 1990 the doctors found cancer in my right lung. In hospital I wondered, why me? And I thought, maybe it’s punishment for the advertising. Think of how many people it persuaded to smoke. I vowed that if I survived, I would begin speaking out against smoking. The surgery was terribly painful. I still hurt most of the time. I try not to think about dying of cancer, but I know the odds. One night recently, I came upon three teenage girls waiting for a bus. Their cigarettes were glowing like fireflies. “Ladies,” I said, “let me introduce myself.” My croaking voice startled them. “I smoked at your age,” I said. “Maybe you don’t care what’s going to happen when you’re 40. I know I didn’t. I just wanted to be cool and glamorous, like the women in magazines. But those ads are only meant to manipulate you. I know – I used to make them.” I told them about my modelling career, and the cancer. Then I pushed back my collar and said, “Look, here’s my stoma where I breathe. See how glamorous I am now?” I left them saucer-eyed. I don’t know whether they understood or not. Young people have to make up their own minds. I just hope it doesn’t take them as long as it took me. Jack Fortenberry, 56, Calera, Alabama When I was a child my heroes were cowboys. I looked up to them in the same way that boys admire pop stars today. I wanted to be tough like them. They smoked, so I smoked – a couple of packets a day for 40 years. It made me feel like the Marlboro Man. My cigarettes never seemed to bother me. I went to the gym, stayed in shape. I made deliveries for a soft-drink company. I could carry three hundredweight of syrup tanks up two flights of stairs in a single trip. We had a nice life. I made good money. I loved Bernice and our two boys. Out biggest dream was to buy a motor home when I retired, and tour the West. One afternoon I was driving my van and felt a stab in the middle of my back. I pulled over and realized tears were rolling down my cheeks from the pain. The doctor said something in my right lung was pinching a nerve. He ordered X-rays. The next day, Bernice had to break the bad news. “You have lung cancer,” she said, sobbing. “They need to operate straight away.” Two days later I was wheeled into theatre. The tumour was inoperable, so they just sewed me up again. After a month or so I went to have radiation treatment – five days a week for seven weeks. It made me unbelievably tired. On the way home Bernice would have to pull over to the side so I could vomit. They gave me morphine for the pain of the surgery, and when I finally came off it, the nightmares started. I’d wake up scared out of my wits, shaking, sweating. Bernice had to change the bed eight or nine times a day. One of the first walks I took was out to the post-box. It’s only a hundred yards, but I had to sit down halfway. The birds were singing and the smell of honeysuckle filled the air. I thought: the world is such a beautiful place; why did I have to ruin it for myself by smoking? I had to give up work. Insurance didn’t pay for everything, and money is tight. There won’t be any travelling to the West. I’m angry with myself for smoking, but I’m also angry with the tobacco companies. I saw a couple of cigarette executives on television the other day, and they had the gall to say there’s no proof that smoking is bad for you. I’m proof. A few weeks after I came home from hospital, I felt a loose tooth. I stuck my finger in my mouth, and the tooth dropped in my lap. The cancer had caused a blood disorder that was making my teeth fall out. In just a few days, I had only three left. Today, when I look in the mirror I am shocked by what I see. A fellow with no teeth, a 15-inch scar from his chest round to his back, struggling to walk, face scrunched up in pain. And then I realize what I want to do. I want to have my picture blown up and plastered all over the world on giant hoardings. Because now, you see, I’m the real Marlboro Man.
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