Why Rehabilitation & Recovery Go Better Once You've Quit

You've heard it a million times before -- "You need to quit smoking," -- from your friends and loved ones, even your doctors. It's not like you haven't thought about quitting. Maybe you've even tried to quit before. But for whatever reason, you're smoking again.

So now you're facing elective surgery.   While you're in the hospital, you'll be in a smoke-free environment. You've decided to have the surgery -- why not decide to quit smoking at the same time? Doctors, nurses, and other health care professionals will be there to give you the support and help you need as you take the first step.

Here Are A Few Steps To Help You Quit

• Set your quit date around the time of your surgery and let your doctor know.

• Ask for help from doctors, nurses, and attending hospital staff. While you are in the hospital, they can start you on nicotine replacement therapy (nicotine patch, gum, or nasal spray) to help control your cravings, and increase your chance of quitting for good.

• Enroll in a support class or program to help you over the rough spots. Programs offer tips on coping with difficult situations that can trigger the urge to smoke.

• Keep your doctor in the loop. Many smokers who have tried to quit, even with the best of intentions, have relapsed. Relapse doesn't mean you've failed. The key is to learn from it. Studies show that the more times you try to quit, the greater your chance of success is with each new try. Your doctor is prepared for this and can help you get back on track.

It can be tough "unlearning" something that is so familiar. There is no magic solution -- but you have the power to stop smoking. The right attitude, drive, commitment, and your willingness to get help from your health care professional will help you along the way.

If You Stop Smoking, Did You Know:

• You'll heal and recover faster, especially in the incision area or if your operation or injury involves any bones.

• You'll lower your chance of having a second heart attack if you have had a history of heart problems.

• You'll reduce your risk for a second cancer to occur, especially if your lung, head, or neck cancer has been successfully treated.

More Information

An electronic version of the consumer guideline, "You Can Quit Smoking," is available from the Agency for Health Care Policy and Research Web site at http://www.ahcpr.gov/consumer/ch_quits.htm. You may also obtain a printed copy by calling toll free 1-800-358-9295 or writing to: Agency for Health Care Policy and Research, Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907.

Source: "Smokers Facing Surgery," Factsheet, Agency for Health Care Policy and Research.

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Smoking Before Surgery a Dangerous Decision

Although most of us understand the risks of smoking, there are certain situations in which smoking can be even more dangerous than usual. One of these situations is smoking before surgery.

Harvey Woehlck, MD, Professor of Anesthesiology at the Medical College of Wisconsin, recently led a study regarding people who smoked within 24 hours of having surgery. The study found that people who considered themselves smokers, and who smoked within 24 hours of surgery, had more markers of restricted blood flow to the heart than those who considered themselves nonsmokers, prior smokers, or chronic smokers, who did not smoke before their surgery.

Patients who received general anesthesia had a higher occurrence of EKG abnormalities usually associated with restricted blood flow to the heart than did those who did not smoke prior to surgery. In this case, the study could not distinguish between actual changes in blood flow, or the additional combined effect of carbon monoxide and cyanide absorption from cigarette smoke.

Can Damage Heart if Untreated
"General anesthesia and surgery cause stress," says Dr. Woehlck. "There is the possibility of pain, changes in blood pressure, loss of blood, and other events that occur during surgery; it is like running a race." Fortunately, the episodes in patients who were included in the study lasted only a few minutes because they were being closely observed. "We were able to reduce cardiac workload with medications and avoid problems in these patients," said Dr. Woehlck. "If this goes untreated for 20 to 30 minutes it can begin to damage the heart muscle, similar to the damage that occurs during a heart attack."

Dr. Woehlck and the researchers in this study observed 740 patients under age 65 who were undergoing non-emergency, non-cardiac, and non-major vascular surgery. The patients in the study had no previous symptoms of ischemic heart disease, a condition in which blood flow to the heart is restricted. Of those studied, 274 were smokers, and 67 of the smokers had smoked before surgery, despite the order to refrain from smoking prior to their surgery.

Dr. Woehlck explains, "We measured carbon monoxide concentrations in the breathing circuits of patients undergoing anesthesia, and we monitored the EKG (electrocardiogram)." The carbon monoxide concentrations gave researchers information regarding the patient's recent smoking occurrences.

Dr. Woehlck says that people are increasingly choosing to have outpatient surgery, instead of hospitalization, and therefore have access to cigarettes before their surgery. This can lead to bad decisions; despite warnings against it, it is evident that some patients do smoke shortly before their procedure takes place.

The obvious warning, says Dr. Woehlck, is "Don't smoke before surgery." He notes that while smoking is an unhealthy habit to begin with, when combined with the stress of surgery, it can be doubly hazardous. "You can do one thing wrong and maybe get away with it. If you do two things wrong at the same time, it will catch up with you," he cautions.

Quitting
Cigarette smoking remains the leading preventable cause of death in the United States, accounting for approximately 1 of every 5 deaths (440,000 people) each year. Coronary heart disease and stroke-the primary types of cardiovascular disease caused by smoking-are the first and third leading causes of death in the United States. For those who are anticipating surgery, or who just want to quit smoking, here are some helpful tips:

1. Get Ready
Set a quit date. Change your environment. Get rid of all the cigarettes and ashtrays in your home, car, and place of work. Don't let people smoke in your home. Review your past attempts to quit. Think about what worked and what did not. Once you quit, don't smoke - not even a puff.

2. Get Support and Encouragement
Studies have shown that you have a better chance of being successful if you have help. You can get support in many ways:

• Tell your family, friends, and co-workers that you are going to quit and want their support. Ask them not to smoke around you or leave cigarettes out.
• Talk to your health care provider (for example, doctor, dentist, nurse, pharmacist, psychologist, or smoking counselor).
• Get individual, group, or telephone counseling. The more counseling you have, the better your chances are of quitting. Programs are given at local hospitals and health centers. Call your local health department for information about programs in your area.

3. Learn New Skills and Behaviors
Try to distract yourself from urges to smoke. Talk to someone, go for a walk, or get busy with a task. When you first try to quit, change your routine. Use a different route to work. Drink tea instead of coffee. Eat breakfast in a different place. Do something to reduce your stress. Take a hot bath, exercise, or read a book. Plan something enjoyable to do every day. Drink a lot of water and other fluids.

4. Get Medication and Use It Correctly
Medications can help you stop smoking and lessen the urge to smoke. Ask your health care provider for advice and carefully read the information on the package. All of these medications will more or less double your chances of quitting and quitting for good. Everyone who is trying to quit may benefit from using a medication.

5. Be Prepared for Relapse or Difficult Situations
Most relapses occur within the first 3 months after quitting. Don't be discouraged if you start smoking again. Remember, most people try several times before they finally quit. Here are some difficult situations to watch for:

• Avoid drinking alcohol. It lowers your chances of success.
• Stay away when others are smoking - it can make you want to smoke.
• Many smokers will gain weight when they quit, usually less than 10 pounds. Don't let weight gain distract you from your main goal-quitting smoking. Eat a healthy diet and stay active. Some quit-smoking medications may help delay weight gain.
• Using bad mood or depression as an excuse to start smoking. There are a lot of ways to improve your mood other than smoking.

And remember, you can always speak to your health care provider for more advice. He or she can help you quit smoking and develop a healthier lifestyle.

P. J. Early
HealthLink Contributing Writer