Questions posted in the The Addiction Forum have been answered by Steven Adelman, M.D. and by Richard C. Bozian M.D. F.A.C.P. of Harvard Vanguard Medical Group.

Subject: Re: WHAT'S UP WITH ME?????
Forum: The Addiction Medicine Forum

Topic Area: Smoking

Posted by SUE on August 12, 1999 at 10:01:19

DEAR DR. STEVE,
FIRST OF ALL LET ME THANK YOU FOR THIS WEB SITE. I JUST FOUND IT THE OTHER DAY AND FEEL THAT THIS IS WHAT I WAS SEARCHING FOR.I AM A 39YR.OLD FEMALE WITH HEART DISEASE. I HAD A QUADRUPLE BYPASS 5 YEARS AGO WHICH WENT WELL BUT UNFORUNATLEY I NEVER QUIT SMOKING. MY DOCTORS HAVE SAID THAT I HAVE VERY SMALL ARTERIES WHICH IS WHY I HAVE WHAT I HAVE SO YOUNG.NEEDLESS TO SAY I BEGAN HAVING ANGINA RECENTLY AND HAVE ALL THE TESTS WHICH SHOWED EITHER ANOTHER BLOCKAGE OR I HAD A HEART ATTACK.BECAUSE OF MY AGE AND SMALL ARTERIES THEY WANT TO TREAT ME WITH MEDICATION FOR AS LONG AS THEY CAN.I HAVE BEEN TOLD TO QUIT SMOKING TIME AND TIME AGAIN. I'VE DONE THE PATCH, GUM, HYPNOTISED,ZYBAN,COLD TURKEY,AND NOW I'M GOING TO A COUNCELOR FOR THE FIRST TIME IN MY LIFE TO FIGURE OUT WHY,UNFORTUNATLY THE COUNCELOR ISN'T TELLING ME ANYTHING I DON'T ALREADY KNOW ABOUT THE TRICKS OF QUITTING ETC. I DON'T WANT TO DIE AND I WANT TO QUIT SO DESPERATLEY BUT NOTHING SEEMS TO WORK FOR ME, I'VE GONE TO STOP SMOKING CESSATION WITHOUT ANY SUCCESS.WHAT IS WRONG WITH ME THAT I CANNOT QUIT,WHAT CAN I DO?
I HAVE GONE AS MUCH AS 6 WEEKS WITHOUT SMOKING WITH EITHER THE GUM OR THE PATCH, BUT THEN SOMETHING TRIGGERS ME TO SMOKE.JUST THE THOUGHT OF QUITTING AGAIN MAKES ME SO ANXIOUS INSIDE.I'VE BEEN PUT ON EFFEXOR FOR DEPRESSION,IS THERE ANYTHING OUT THERE FOR ME?THERE IS NOT A DAY THAT GOES BY THAT I DON'T THINK ABOUT NOT SMOKING AND I AM NOT IGNORANT ABOUT MY HEART PROBLEMS, SO...WHAT'S UP WITH ME?
SUE

Posted by SA, M.D. - HVMA on August 16, 1999 at 09:55:11

Dear Sue,

You should be working closely with an M.D. who is an expert in smoking cessation (along with the counseling - by the way, you should share your concerns about the counseling with your counselor, that often helps to improve the working relationship). In cases like yours, I believe in very intensive pharmacotherapy - sometimes I have combined the patch, inhaler, and Zyban. In cases like yours, when the intensive regimen helps a person like you to stop, I would maintain it for quite a while, and only recommend gradually decreasing the medication and nicotine replacement if and when you were feeling good and comfortable about doing so.

For much more on pharmacotherapy and smoking cessation, take a look at http://www.headdocs.com .

Good luck!

DrSteve

The information provided is for general medical education purposes only, and not a substitute for medical diagnosis and treatment provided by your physician.

keywords: nicotine, replacement, bupropion, smoking, cessation



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