Health Matters: N.D. resources for tobacco cessation
Q. I know that I need to quit smoking cigarettes, but it sure is hard! My doctor tells me that I need to quit cold turkey, but when I've done that, I soon restart puffing away. I think I can stop by gradually reducing my smoking. What do you thin...
Q. I know that I need to quit smoking cigarettes, but it sure is hard! My doctor tells me that I need to quit cold turkey, but when I've done that, I soon restart puffing away. I think I can stop by gradually reducing my smoking. What do you think?
A. Although many might favor abruptly discontinuing cigarettes as the preferred strategy (similar to what often is recommended for abusers of alcohol), the available evidence actually suggests that the gradual route may not be significantly inferior to abrupt cessation. Some patients I've worked with have stopped smoking completely by setting targets -- and then meeting them. So, for example, a patient might be smoking half a pack per day (10 cigarettes) and cut down by one cigarette/day every week.
Thus, in less than three months, the patient can be free of tobacco use. The key to the gradual option is to hold to the preselected targets -- otherwise the patient will end up right back where she started. One very helpful resource in North Dakota is NDQuits, a free telephone-based service available to smokers and smokeless tobacco users. People using NDQuits have about a 10-fold higher chance of staying off of cigarettes after one year than those choosing to go cold turkey on their own. Give them a call at (800) QUITNOW or (800) 784-8669. And please call them soon!
Q. My 39-year-old brother has high blood pressure, but his pressures are still elevated despite medication that is prescribed by his nurse practitioner. Is this problem common, and what can be done to treat his hypertension?
A. Sad to say, the first thing we think about when blood pressure remains high despite medication is that the patient is not taking his pills! Noncompliance with medications is a huge problem overall and especially for high blood pressure patients. It has been estimated that a third to half of all adults in the United States who are on chronic medications are not adhering to their medical programs. There are many reasons why patients aren't fully compliant with medications: fear of side effects, including impotence in men with certain blood pressure pills; expense; and lack of understanding of the benefits. By trying to identify why a patient is nonadherent, we have a better chance of improving compliance in the future.
So if your brother isn't taking a medicine because of concern about side effects, switching to another medicine might just do the trick. It turns out that most hypertensive patients require several medicines to adequately control their blood pressure, and finding the right combination is crucial to improving compliance.
If your brother is in fact compliant with his program, he may simply need more or different medications. We can usually find a combination of ingredients that adequately controls the pressure. When we can't, we need to look for uncommon but treatable secondary causes, including kidney diseases, narrowing of certain blood vessels (like the aorta or kidney arteries), the sleep apnea syndrome, and certain benign tumors. The younger the patient, the more likely that he has one of these uncommon but often correctable causes. So it's back to the nurse practitioner for your brother!
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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