OBGYN.net
Conference Coverage
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http://www.obgyn.net/avtranscripts/nesbitt_carter_stopsmoke.htm |
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| Barbara
Nesbitt: "You
all know who I am, I'm Barbara Nesbitt, the Editor of the world's largest
site for obstetrics and gynecology for women. You all know I've had breast
cancer, and that I'm doing wonderful three years out. I had a little
depression but now I'm going to tell you the big secret - I smoke, and I
am sick of it. I have run out of excuses, the dead husband excuse is over,
that's over three years ago, and everything else is over. I have just run
into Dr. Carter, who you're all familiar with, and he has some marvelous
things that he does - he has a smoking cessation clinic, and he's going to
help me kick the habit." Dr. James Carter: "Barbara, first thing - your presentation is what we hear. Smoking just doesn't come out of nowhere, sometimes there's a long history of it but frequently it intensifies in a crisis situation. It gets worse when a person is depressed. There are habits that are then built up, but then the nicotine takes over, and when the nicotine reaction takes over - we have moved what is a habit into what can become an addiction. It's that transition that then makes it so difficult, no matter how much one says - "My will is there, my desire is there." This becomes a major life issue. Let me explain how I approach this, first if we look at our total life, our genetics or our "DNA" as we call it - it gives us 128 years. We know that's what's in the DNA, and that's what's programmed. We go from that to some of the genetic changes in our own heredity - what was generated down our line - and sometimes they'll be a tendency towards high cholesterol, problems with insulin, or problems with diabetes for instance. Some of these inherited conditions, and that's where physicians come in, clinicians can help us diagnose those problems and use modern medicine to blunt their effects. Then we have our bones, muscles, and our sinews - how do we keep them healthy? We know we have to exercise, we know we should be checked and see if we have good enough bones and if we're candidates for developing osteoporosis. Calcium is important; our diet becomes important - so let's go to number four. So we have exercise, we have protecting the bones, and we have our diet and what we take in - our nutrition. So we have those four factors and we bring them together - our given life span with genetic influences from our heredity, our exercise and our diet - but what is all this for? What all this is for is leading a productive useful life, working with our community, having our friendships - and those are the parts that lead us then to these decisions to give up some of the things that we truly like. And people smoke because it does feel good." Barbara Nesbitt: "That's true." Dr. James Carter: "So how can you get someone to give up something that feels good, they have to have something that's of value. What is the value? The value is to keep you around so the rest of us can enjoy you. We value you, and that's the first thing I try to communicate is the value of that person - not today, not with that cigarette, but five years from now when we want them still here working with us, still healthy, not with emphysema, not with lung disease, not with cancer of the lung, but healthy. So where do we start? We start with that decision that you just made - I'm stopping - and then where do we go? It's an addiction - we need some help. There are two things that I have found very helpful in terms of medicines. One is any form of the nicotine substitutes because you can put on a patch, give yourself a low dose of nicotine so that it helps with that craving, and that's important. But remember none of these will give you the level. One puff of one cigarette gives such a high level directly into the brain of nicotine, and you can never replace that. So what do we need second? Let me tell a little story, and I'll tell you what we use. These older gentlemen in these homes that are run by the government for retired military, they all smoked. A lot of them were depressed, and they were given medication to help them with their depression. They started using the medicine, and lo and behold, after a few months half of them weren't smoking - they had stopped. Now the medicine had another interesting effect that is something that I help my patients with, and that is - it actually increased their libido. These older gentlemen were suddenly interested again, they got interested in life, and they stopped smoking. Now why is that important? What we found was that with a simple medicine that's called "Wellbutrin," that's the trade name, that medicine is very effective for depression. By the way, it can be added to medicines like Zoloft or antidepressants - what we call the SSRI's. It doesn't compete with them, it works in a different method." Barbara Nesbitt: "That's good." Dr. James Carter: "That medicine helps people loose the craving for smoking. It was then re-introduced after it went through the FDA for clearance as a medicine called "Zyban." That medication given to people twice a day, one pill in the morning, one about two in the afternoon - decreases their craving, their desire. When you just use it alone, you get excellent response over a period of a year, up to 50%-60% stop smoking. If you add that then to the nicotine substitutes, you even can increase that up to 60%-70%, which is a wonderful impact. Today we now have something we didn't have before - a way people can actually stop smoking. It helps add to their will power, it reduces their desire, and those people then can find themselves with an ability to stop. Now I've found a third thing that does help, and we call it "biofeedback." Barbara Nesbitt: "Yes, you were talking about that. It's new to me." Dr. James Carter: "You know Barbara here at this Pelvic Pain Congress in Connecticut at the International Pelvic Pain Society - we're helping her to stop smoking which is probably the most important thing that's going to come out of this Congress because then she's going to be communicating with us so much about our futures. Biofeedback has a place in pelvic pain. We teach people how to relax their muscles, how to reduce the tension in those muscles using techniques of a sensor that's placed so that they can see how the muscles work, and then by the feedback of seeing on a computer screen what those muscles are doing - the individual is able to relax that muscle. In reverse, we use biofeedback to strengthen the muscles to treat incontinence. I use biofeedback extensively in my office for patients with incontinence. I have a very large incontinence practice. Women who lose urine, if they catch it right away - "Doctor, I just lost a little" - that's when they need to get at it. Don't wait until you're losing it everyday with a cough. If you lose it once in three months, go in and talk to your physician, and sign up for some biofeedback training. Get control of those muscles so that instead of the incontinence becoming a controller of your life, you control the muscles - then incontinence isn't your problem. Because if you wait too long until that's really a serious problem, it's now everyday - then surgery may be the only option. But early on with biofeedback - training those muscles, we call them the old Kegel exercises that's been refined with the year 2000, really the millenium technique of using the computer to give you feedback of what those muscles are doing so that you can then get control of those muscles and prevent incontinence. Where does biofeedback fit in with smoking? It's very similar, what we're trying to do is teach people - and psychologists who are trained in biofeedback are excellent at this - that when they feel the craving, and we talked about diaphragms remember - diaphragms are diaphragms, so here we are…" Barbara Nesbitt: "Yes." Dr. James Carter: "Proper diaphragmatic breathing - released properly. It's a tai chi exercise. My wife as you know is Chinese, she's Asian. I've learned a lot about the Asian approaches to these things. Each morning eight to ten tai chi-type deep breaths - diaphragmatic meditation. You know who knows how to do these breaths - singers. You go to your local singing teacher, and they will teach you diaphragmatic breathing. Now what does doing that diaphragmatic breathing help with - it clears, it relaxes. The diaphragm is a big muscle; you use it properly for excursion and relaxation. You fill the lungs properly, you breathe, and you will relax so that rather than reaching for a cigarette when you feel that urge because even with the Wellbutrin or the patch - you'll find yourself with the desire." Barbara Nesbitt: "Yes, the phone rings and you always grab a cigarette when the phone rings. So it's a mind thing that you've been doing." Dr. James Carter: "So now when that phone rings, and it's a mind thing, and there's that connection to a habit, before you let that habit, use Dr. Andrew Weil's book. He has written a tremendous number of books on this issue of good health. One of his works is Eight Weeks to Health - it's one that I follow, and he has a newsletter in which one of the issues just simply talked about breathing. When that phone rings, one of the things Dr. Weil would teach us to do - if you have a stimulus that's going to lead to a response, and you want to break that response then put in a new response in the way - and that's how you break the habit. The phone rings - you would normally reach over for a cigarette. Now the phone rings and before you answer it, take that relaxing cleansing breath. Now you won't have that desire, you can pick up the phone, and you'll be calmer. You can then relate, put it down, and search something else in between that stimulus and that response so you can break the response. And for everyone that's listening to this and watching, this is so important - stimulus and response - what you brought up. Learn your triggers, write them down - when do I smoke? I smoke when the phone rings. I smoke when I think about my financial situation and get nervous - write all those down. Now when those occur, put in that other response, which is that deep breath to take away that automatic built in response - so you can lose that habit. You're not breaking the habit, you're losing the habit - just let go of it You can't break habits, you lose them, and you replace them with new better habits. That's what I try and teach, and it's a very successful approach especially for someone who's committed like you." Barbara Nesbitt: "I am, I'm tired of smelling terrible, I'm tired of hiding out, I'm tired of running around Austin looking for a restaurant that lets you smoke - outside if you're lucky. I really am tired of it all but I'm hooked. I have to say - I've gone beyond, I'm where you said in the beginning - I am now addicted to that nicotine." Dr. James Carter: "And that's the first step - admitting. It's one of the twelve steps, and admission is the first step. Really you don't need twelve, you can fit it in to about four steps. Admitting there's the problem with the commitment to change is the first. Getting the assistance with the medication, adding in the exercise to replace the stimulus response, and then the turn around is becoming a missionary of health which you already are with this website. You're a true missionary of health to those out there who need this because everyone slips. Everyone slips a little bit but the slippage doesn't mean that it's back to the old habit. Sure, maybe you take a deep breath once in a while for some second hand smoke, that doesn't mean you're a smoker again. It's all around us, and then you can help others through the same crisis that they have." Barbara Nesbitt: "We'll have a little follow-up on this in about a month?" Dr. James Carter: "Maybe in a day." Barbara Nesbitt: "In a day maybe." Dr. James Carter: "We'll work on it day by day." Barbara Nesbitt: "Thank you very much, James Carter." Dr. James Carter: "Thank you, Barbara, it's such a pleasure." |
