A new patient. In a wheelchair, gaunt. Cigarette smoke smell so bad it stunk up the waiting room. Beautiful, toothless smile with a gleam in her eye. 72 years old, looks 90. In a wheelchair. Daughter in law brought her - I'd say early 40s, overweight, smokes has pharyngitis. Patient smokes 2 PPD "I'm not going to lie to you, she smiles". She didn't like the doctors she got assigned to after her old doctor retired. She fell (loss of conciousness - never documented), went to ER "worked up" and sent home. A few days later fell again, had a seizure and a stroke. Left hemi-body, due to fall and "missed" subdural hematoma. Neursurgery, evacuate clot. Rehab. Home to live with the kids. On several blood pressure meds. No lipid meds. 2 PPD. Has document Carotid disease, amount unknown. Has seen a vascular surgeon who says no, and yet another who says go for it.
I tell her I would be surprised if any vascualr surgeon would take her with current active Emphysema. "What emphysema" she asks, while rolling around mucous in her lungs in a sort of cough.?
She is a sweetheart. Born in a nearby town, lived and smoked nearby and never went anywhere, did anything. Seems warm, and has a good sense of humor. O2 sats on room air are between 96 and 97 and her BP and pulse are fine.
I make a plan. Stay on current meds. Get copies of old records. She agrees. I suggest, while smilling, that she think about doling out 10 or less cigarettes I day. Okay, she says, I'll try. No you won't. I laugh back. She looks up gleaming and says I'm right. I feel that we've bonded, and I'll see her soon.
2 comments:
Have you tried Chantix on any patient's? I ask because I am a patient and recently 4 weeks ago started Chantix. I also smoked 2ppd. You smoke for the first week while this stuff gets built up in your system and then you quit on the 8th day of treatment.
If she would bulk at the price you could remind her that 120.00 month for this medication is alot cheaper than what she was paying for a 2PPD habit. At 4.00 per pack she is spending about 230.00 each month on cigs.
I have only one time since I stopped, smoked one cigarette. Well I tried anyway and it taste terrible and make my stomach upset. I have not had any of the withdrawal symptoms that I had suffered when I would try to quit on my own. Maybe she would do this also?
Our success with Chantix so far has been mixed. I believe that "cold turkey" (as the literature suggests) is still the best, because it assumes you've made a decision not to smoke. Nonetheless, it is SO important to quit that we're willing to offer whatever step a patient may need to try. Good luck and just don't light up.
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