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Fall - A Time for Fresh Starts

Posted by Dr.Hays Oct 11, 2017

As we enter the season of autumn – I always feel a sense of new beginnings, and a ‘fresh start’.


For, this time of year is full of new beginnings:

  • kids going back to school with newly-sharpened pencils and a   fresh box of crayons;
  • the possibility of new friendships;
  • and, young adults beginning their college careers.


Perhaps, I’m thinking about starting a regular exercise regime.

I could begin by:

  •  parking farther from the shopping mall; 
  •  looking into that yoga class I been interested in; 
  •  or, taking a relaxing walk after dinner rather than sitting down in from of the TV.


As humans we are constantly changing as we are shaped by our everyday experiences.

And these changes are processes – often slow and methodical, a little at a time.


So it is with quitting smoking, and as this time of year is full of  ‘fresh starts’, make this fall a fresh start for you – by making small steps towards quitting smoking.


But just what would be some small steps to achieving that goal?

  • write down your reasons for quitting – and how you hope your life will be different as a non-smoker;
  • talking with your friend about quitting smoking with you;
  • or, even making an appointment and talk with a tobacco treatment specialist, or your doctor, about some of the medications out there now to help you quit.


These seem like small steps, yet they are giant leaps in how you will feel about yourself, just knowing you have begun the process.


Just taking small steps toward your goal could make you feel surprisingly productive, and energize you toward achieving the goal in the end – a smoke-free life.

In June 2009 the Food and Drug Administration (FDA) was authorized to regulate cigarettes, roll-your-own tobacco, and smokeless tobacco products.  In June 2016 this authority was extended to all tobacco products.  The rule empowered the FDA to regulate marketing, strengthen warning labels, and take measures to reduce youth smoking.  The FDA was limited in its ability to recommend changes to cigarette design or elimination of harmful compounds in cigarette smoke.


The new FDA commissioner recently announced a new strategy. The agency is delaying a plan to regulate E-cigarettes and vape devices, and embarking upon a plan to reduce the nicotine content in cigarettes.  The idea is that, without nicotine, cigarettes will not be addicting.  While nicotine is not one of the many toxic compounds in cigarettes that causes the myriad of health problems, and hundreds of thousands of deaths each year; however, it is the chemical that causes the addiction to cigarettes.


Reducing nicotine in cigarettes, so that young people do not become addicted and smokers will not maintain their addiction, has been a strategy recommended by some public health researchers and advocates since 1988.  The real life effect has never been demonstrated in actual practice.   Tobacco stocks did drop after the announcement, which may be an indicator of the impact of nicotine reduction.


We would be interested in hearing your thoughts about this new FDA plan.


The Secrets of Addiction

Posted by Dr.Hays Sep 27, 2017

I would like to recommend a very informative article recently published in National Geographic Magazine titled “How Science is Unlocking the Secrets of Addiction”.  If you are interested, you can access the article online.


Our understanding of the complexity of addiction is improving considerably.  Research, using scanning technologies, is identifying more specifically the physical changes that occur in the brain as regular use of drugs gradually hijacks our natural reward mechanisms. 


As addiction develops, habits become hardwired and preoccupations to use a drug can override more rationale decision-making areas in the brain.  And, as recovery happens, healthy habits are relearned, the brain can ‘re-wire’ and a person can regain their ability to make healthy choices free from craving and preoccupation.


The article, illustrations, and video available at the National Geographic link do a wonderful job of summarizing a vast amount of research into addictions.  While the research is on a variety of drugs in addition to tobacco, it is all quite applicable to tobacco addiction.  I hope you find it useful in your recovery!


Let us know what you think in the comments.



Tobacco as a Coping Skill

Posted by Dr.Hays Sep 20, 2017

Using tobacco or any other drug for that matter offers some kind of reward, it may not be the healthiest option but we are inclined to do it.


Think of your brain as the muscle that it is, it gets exercised and formed into the brain it is now.  The beauty of our brain is it has the ability to mold and transform just like the muscles in the rest of your body, this is called neuroplasticity. In addition, the brain is reinforced by chemicals that are released (dopamine) when you interact with your environment or others make you feel good.


Take smoking or chewing for example; since the age you started using tobacco you have been pairing this substance with whatever the thing or situation may be. This in turn gets worked into that muscle memory of your brain and becomes hard wired to the point where maybe you do not even think about it, it’s more of an automatic thing that occurs.  Therefore, you are getting what we like to call a double sided reward. You are allowing the routine (avoiding discomfort of a new routine) and you are getting nicotine, which releases dopamine (a natural feel good chemical). This becomes the norm or habit if you will.


Now, go back to when you were a kid and remember your parents telling you “don’t worry, practice makes perfect.” They were right!  It takes time to rewire the brain circuits to choose the healthier learned behavior over the tobacco, whether it is nicotine replacements or a new found coping skill e.g. deep breathing, sucking on candy, going on a walk, etc. Keep the positive thoughts flowing and reinforcing the replacement behavior, it is hard, and you may slip up, which is okay!

There is an overlying myth that Cigars are less harmful as cigarettes or chewing tobacco. Here are the cold hard facts:

4 Deadly Facts about Cigar smoking

  1. Cigar smoking is harmful. It contains more than 60 cancer causing chemicals such as arsenic, cyanide, polonium 210, chromium IV, aromatic hydrocarbons and benzene.  Cigar smoking causes cancer of the lips, tongue, mouth, throat, voice box, and lungs.
  2. Cigar smoking in addicting. Even if you do not inhale the smoke, high levels of nicotine is still absorbed through the lining of the mouth.  A single cigar can have as much nicotine as an entire pack of cigarettes.
  3. Some people think that cigar smoke is safer because they don’t “inhale”. Even if not purposely inhaled, some gets down to the lungs and tissues.  The lips, mouth, tongue and throat are still exposed to the cancer causing chemicals.
  4. Research shows that smoking cigars may be even more harmful than cigarettes. Cigar smoke is denser, that is, it contains a higher number of cancer-causing substances, more tar and a higher level of toxins. In addition most cigars are bigger than cigarettes, and it can take longer to smoke cigars. This results in more exposure to toxic substances.



Remember that there is no safe tobacco product and no safe level of tobacco smoke exposure.

This past week I had the opportunity to be on a telephone “live chat” with members of the EX Community.  On the call were community members (Giulia, elvan dkr953, Showiestodin and Pops ) who have been tobacco free for many years, and others who were still early in their quitting journey, or trying to figure out how to start the journey again. All of these members, no matter their specific situation, expressed extraordinary commitment to becoming and staying tobacco free.


There is something very special about the strength that can be found in sharing our successes as well as our struggles and setbacks.   It was wonderful to hear during our call the special support that is freely offered to one another in the EX community.  Stopping smoking is vital to health, but it can be very difficult, especially if one feels alone with the struggle.  It is true that shared burdens are suddenly made lighter, and the sharing on the EX Community makes what can seem impossible, become a reality. This is a life saving community to which I am glad to be a contributor.


Dr. Hays

Nicotine withdrawal can be severe.   For many people withdrawal symptoms peak between 3-5 days, but they can last for many weeks.  Recognizing and alleviating withdrawal from nicotine can be extremely helpful in stopping smoking.


The most common withdrawal symptoms are irritability, anxiety, craving difficulty concentrating, depressed mood, insomnia and restlessness.  Symptoms can also include constipation, dizziness, nausea, sore throat, nightmares, tremors, rapid heart-beat, stomach irritation, anhedonia, and fatigue.  These unpleasant physical sensations, emotions, and cognitions can trigger an intense urge to smoke, however smoking in response to these symptoms is very reinforcing and strengthens the cigarette addiction and builds the ‘habitual’ component of smoking.


Nicotine replacement alleviates withdrawal and is a very safe alternative to smoking.  Nicotine medications don’t deliver the rapid and high doses of nicotine like a cigarette, and are not addictive like the cigarette.  More importantly the nicotine medications don’t contain the 1000’s of chemicals that are in cigarette smoke, and which cause the tremendous toll to health.


These days, there is no reason to suffer from nicotine withdrawal.

Sometimes people have concerns that health problems will occur as the result of stopping smoking.  On the contrary, for people who smoke there is no one thing that they can do that will provide more health benefit than stopping smoking.  Cigarette smoke contains thousands of chemicals, and smoking can damage nearly every organ in the body.  The benefits from stopping begin immediately and will accrue over time.  However the perception that stopping will bring about health problems is persistent.


I think there are a number of reasons for this. People sometimes stop smoking when they are feeling ill. An underlying health problem may emerge or be diagnosed coinciding with quitting, but not caused by the absence of cigarette smoke in the body.  Sometimes stories on the internet may describe studies of populations of smokers compared with non-smokers that can be misinterpreted as showing a comparative health benefit for those who smoke.  Another possible reason is that stopping smoking can cause withdrawal symptoms or other physical sensations that can be interpreted as unhealthy.


Don’t let any concern about health stall your efforts to stop stopping smoking.  Cigarette smoke is toxic.  Not ingesting the smoke allows your body to heal and grow healthier each and every day.


Chest pain

Posted by Dr.Hays Aug 16, 2017

Chest pain is a frightening symptom because it is so closely associated with heart attack; however most chest pain people experience is not from a heart attack, but due to other causes such as injury to the ribs, tendons, or muscles in the chest wall, or from the esophagus or stomach, often caused by acid indigestion. 


Warning signs that chest pain may be more than just indigestion include: pain lasting more than a few minutes; pain associated with shortness of breath or dizziness; pain that comes on with exertion and is relieved by rest; pain or pressure that radiates to the neck, shoulder, or back; or chest pain occurring in someone who has a history of heart disease, stroke, or peripheral vascular disease. Chest pain with these features or any chest pain that does not resolve on its own in several minutes should be checked out by a health professional.


Although chest pain is not more common among people who have recently quit smoking, it is true that among current or former smokers most chest pain should be taken seriously since people who smoke are at greater risk of heart disease, heart attack, and sudden death due to a cardiac event.  Stopping smoking can rapidly reduce the risk for heart attack, with the risk going down by one-half in the first year, and down to no increased risk level after 3 years of stopping smoking. 


Making a plan to stop smoking and sticking with it is the best way to a healthier heart.  Use Cardiovascular Disease information and other resources to support you.


Smoking and Hypertension

Posted by Dr.Hays Aug 9, 2017

People with hypertension (high blood pressure) who smoke are at serious risk for a number of health problems, in addition to the many illnesses to which all smokers are vulnerable.  When smoking is added to hypertension, and high cholesterol the risk of heart attack, stroke, and sudden death increases more and more.  Smoking also hastens the development of renal disease and other organ damage that can occur from chronic hypertension.  Still about 20% of people with hypertension in the United States continue to smoke.


Carbon monoxide, nitrogen oxide and a number of free radicals are some of the compounds in cigarette smoke that can damage the circulatory system and increase the health risks for people with hypertension. Like for all people who have tobacco dependence, a combination of medication and counseling or support is the most effective ways for stopping smoking.   However, some people might be concerned that medications could worsen blood pressure. 


Many studies have found that nicotine replacement seems to be quite safe for people with hypertension.   Nicotine can cause constriction of the blood vessels, and nicotine replacement can increase blood pressure for non-smokers, but studies with smokers have found that blood pressure does not increase when using nicotine replacement, probably because they have developed a tolerance for nicotine from smoking.  And nicotine replacement will make success in stopping more likely.


Bupropion and Chantix are two non-nicotine medications that are effective for stopping smoking.  Chantix has been found to have no effect on blood pressure, but bupropion can increase blood pressure in some people.  People who want to take bupropion for stopping smoking should have a discussion with their health care provider about this if hypertension is a concern.


If you have hypertension, you’ll be well served by stopping smoking., phone or in-person counseling options, and/or your health care provider can give you the support and expert advice that can help you quit for good.


Chantix vs. Wellbutrin

Posted by Dr.Hays Aug 2, 2017

Are you worried you will choose the wrong medication? How do you determine what is the best option for you?

There are two medication options that do not include Nicotine; these are Varenicline (Chantix) and Bupropion (Zyban or Wellbutrin). 


  • Varenicline (Chantix) was designed specifically to interact with the nicotine receptor in the brain. It was patterned after an old medication called cytosine. Cytosine was thought to block the nicotine receptor but cytosine did not have great results for smoking cessation.
  • Head-to-head tests of both Varenicline and Bupropion show that Varenicline results in higher smoking cessation rates.
  • The most common side effect due to Varenicline is mild nausea and for bupropion it is sleep disturbance.


  • Bupropion (Zyban or Wellbutrin) was initially developed and currently used as an antidepressant, and through the almost accidental observations of a psychiatrist at a California VA hospital, was found to reduce smoking in people who were taking it for depression.
  • Bupropion may reduce the weight gain often experienced by people after they quit smoking; and it may reduce the negative moods often experienced after smoking cessation. Varenicline does not appear to have these positive effects.
  • Bupropion may interact with other drugs that may require adjusting the dose of these medications. Varenicline has no important interactions with other drugs.

Both Varenicline and Bupropion:

  • One study showed that combining the two drugs resulted in higher smoking cessation rates for heavier smokers (over 20 cigarettes per day) when compared to taking Varenicline alone.
  • Either drug can be combined with Nicotine Replacement Therapies (NRT); this may boost the smoking cessation rates when compared with Varenicline or bupropion alone.


Choosing which medication may be right for any given person requires weighing the potential benefits and differences in the medication to find the best fit for a particular person. Your doctor should be able to help with this decision. All things being equal, Varenicline may be the best choice for many smokers since it is associated with the best smoking cessation rates.

Many folks are convinced they perform their best — at work, in artistic pursuits, in life — when they’re smoking. As a painter and writer one said, “Smoking makes me more creative.”


Does it really?




If you believe you do your best work while smoking, you’re giving cigarettes too much credit. A cigarette won't plant an idea in your mind that wasn’t already sprouting.


Smoking may seem like critical to your creative process, but in reality, it’s a distraction.


Every time your nicotine levels drop and the urge to smoke hits, you’re forced to interrupt your work — whether or not you’re on a roll. Your addiction always comes first!


In fact, you start becoming distracted even before the nicotine craving strikes. When your brain relies on the drug to keep you feeling “normal,” your concentration starts waning after about an hour. Soon enough, you’re thinking about your next cigarette — not the texture of your painting.


When you quit smoking, you might feel a bit “off” for a bit, but before long, you’ll get into a better, sharper, more productive groove.


That painter I mentioned? Much to his surprise, once he quit smoking, he became more prolific. “I actually have a portfolio,” he said, “rather than just wishing I had one.”


Do you fear that quitting smoking will compromise the quality of your work? Or that you just won’t feel like yourself when you quit?


Please share and experiences!

Many smokers fear that when they quit, withdrawal will never end. They’ll say, “What if I’m always miserable?”


That’s a natural concern. After all, nicotine cravings are real, and they’re not fun! But this doesn’t mean you’ll be plagued by cravings — or that they’ll be strong enough to drive you back to smoking.


Here are 3 ways to minimize how hard cravings hit and how long they last.


  • Use nicotine replacement therapy (NRT) with a strong enough nicotine dose. When smokers say, “The patch didn’t work” or “the gum didn’t help,” it’s often because they chose a patch with an inadequate nicotine dose or didn’t chew their gum on schedule. A trained tobacco specialist can help you use NRT correctly.
  • Don’t quit medication prematurely. Some newly quit smokers, emboldened by their success, ditch their medication when they’re still highly vulnerable to relapse. Remember: It’s smoking, not medication, that poses a danger!
  • Don’t expect medication to eliminate cravings. Even after nicotine has cleared your body, you can be tripped up by habit or emotional triggers. Be prepared! Learn alternative ways to occupy your hands, mouth, and mind, and work on replacing old routines with new ones.


You might hear former smokers say they still “crave” cigarettes years after quitting, but they’re not talking about “my chest is going to explode” feeling common in the first few weeks. They may occasionally think, “A cigarette would be nice right now,” but they quickly move on.


As one former smoker put it, “My fear of suffering was far greater than my actual suffering.”


Let us know: If you’ve relapsed recently, ? Next time around, what will you do differently to ease withdrawal?


If you’ve quit for good, how long did it take for your regular cravings to stop?

Have you ever stashed cigarettes in the closet or the freezer just before quitting?


Some smokers reason that a secret stash will give them “peace of mind” to focus on quitting, kind of like a security blanket. Others believe quitting in the face of temptation will only make them stronger.


This is faulty reasoning!


Keeping cigarettes around when you quit is not empowering; it’s sabotage.


If cigarettes are just a drawer pull away when a craving hits, you’re likely to act on impulse. You probably won’t stop and think: I’ve saved $350 this month not smoking or I’m really going to regret blowing my quit.


Nope, in the moment, when your chest is tightening or your mouth is watering, you’ll tell yourself: Eh, what’s one cigarette going to hurt?


Of course, “just one smoke” leads to another and another. . .


Sure, you can always head out to buy cigarettes, but unless you live next to a convenience store, making your purchase will take more than 5 minutes, which is how long a craving typically lasts. That 5-minute buffer is important. It gives you the time to think more clearly.


The problem with hiding cigarettes goes beyond temptation. It’s sending the wrong message to yourself. If you keep a pack hidden “just in case,” you’re conceding that you might smoke again.


You’re giving yourself an out — essentially preparing to slip up.


Instead, prepare to succeed by making a firm commitment to quit! Go full steam ahead, and destroy or give away every cigarette and ashtray you possess. Show yourself that you mean business — that you’re not just trying to quit. You are quitting.


What if you relapse? You’ll deal with it. Chances are, you’ve dealt with setbacks before. Most ex-smokers have blown a quit — or 20.


What’s important is committing 100% right now.


If you’re an ex-smoker, let us know: What did you do with your cigarettes right before you quit? What advice do you have for folks who are in the process of planning their quit?

Have you ever considered your cigarettes a friend? Does the prospect of giving up cigarettes make you feel sad or lonely?


These feelings are common among longtime smokers, and they won’t last forever, but it’s important to acknowledge and address them, so you can put 100% effort into quitting.


Our community is a great place to explore sadness or ambivalence about quitting — feelings that people who’ve never smoked may not understand or may even dismiss outright.


Some smokers don’t recognize their bond with cigarettes until they get serious about quitting. That’s when — in search of reasons not to quit — they start thinking: Cigarettes don’t pass judgment me. They don’t argue with me. They’ve always been there for me, through thick and thin. They are my loyal companion.


True enough! But let’s explore this notion further. If cigarettes are your friend, just what kind of friend are they?


In truth, they’re a “friend” that spends your hard-earned money, compromises your health and your pet’s, sucks up your time, invites dirty looks,  and exiles you from restaurants!


The reality is, cigarettes control you, demanding your time and attention throughout the day from when you wake up to when you go to bed.


Leaving an unhealthy relationship is never easy, but we’re all capable of it. Here are three approaches many smokers have used with success:


  • Write a “Dear John” letter to your cigarettes. For instance: “Dear cigarettes: You are stealing my money, my singing voice, and my stamina, and you make my car smell! I cannot be your friend anymore. Goodbye.”


  • Come up with a mantra to repeat whenever you feel the urge to smoke. For example: “You are not my friend; you are my enemy.”


  • Focus on the ways cigarettes have hurt your actual friends and loved ones. As one smoker put it: “You killed my grandfather and strapped my father to an oxygen tank. You are not going to do that to me. You are not my friend.”


Which, if any, of these strategies resonate with you? How will you break off your “friendship” with cigarettes?

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