Smoke Free Life

Dear Dr. B: I have been a chronic smoker. I have tried to quit but can never succeed. I have given up trying. Is there an easy way to quit smoking?

Answer: Well, you are not alone in this dilemma. It is well known that people give up trying because they find it so difficult to quit smoking. Old habits are hard to break. But with patience, perseverance and under proper guidance they can be broken.

Studies have shown that 70 per cent of smokers now want to quit smoking completely, 46 per cent try to quit each year and more than 70 per cent of smokers visit a health care setting each year. Good news is effective treatments now exist (JAMA, 2000;283:3244-3254).

U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/) says that there are five steps to quitting smoking. These five steps will help you quit and quit for good. You have the best chance of quitting if you use all five steps together:
1.Get Ready.
2.Get Support.
3.Learn new skills and behaviors.
4.Get medication and use it correctly.
5.Be prepared for relapse or difficult situations.

Most smokers fail to quit smoking because they try to quit on their own, without the benefit of highly effective treatments. You need help from yourself (have motivation and get ready), from your family and friends, from your physician (get medications and use it correctly), seek counseling and join a support group (to learn new skills and behaviours and be prepared for relapse or difficult situations).

Physicians have to treat smokers just like they treat patients with chronic diseases such as hypertension, diabetes and high cholesterol levels. After all smoking is a chronic disease.

A minority of smokers (about seven per cent) does achieve permanent abstinence in an initial attempt to quit, but the majority continues to smoke for many years and typically cycle through multiple periods of relapse and remission. So don’t feel bad if you are going through this phase. Don’t give up fighting and seeking more help as success rate can be increased to 15 to 30 per cent if you persevere with the guidelines and recommended treatment.

One way to do it is by enrolling in the Freedom from Smoking Program organized by AADAC and Palliser Health Region, in conjunction with the Students’ Association of the Medicine Hat College.

Gordon Wright, Health Promotion Marketing Coordinator, Palliser Health Region informs me that this is a free program for any smoker who wants to kick the habit. Monday, January 15, 2007 was orientation day. You can phone Rita Aman (Palliser Health) @ 502-8224 or Anne Joly (AADAC) @ 529-3582 to see if there is room to enroll in the program.

Good luck and keep trying. I know you will eventually succeed.

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ELMOSS for 2007 – Back to the Basics

“Never underestimate your power to change yourself……”

– H. Jackson Brown Jr.

Changing oneself is one of the scariest and most difficult things to do. It requires motivation, planning, dedication and discipline. But it can be done. What we need is to have a desire to change. The desire should come from within us. We should control our own destiny – hopefully for the better.

It has been six years since I first used the mnemonic ELMOSS. It was my column for the millennium edition of the Medicine Hat News where I said sticking to the basic principles of good health will sustain us for the next millennium. New technology will come and go but the basic principles will always remain the same. In fact the new technology should make it easy for us to stick to our basic principles of good health, that is ELMOSS.

ELMOSS stands for exercise, laughter, meditation, organic/healthy food, smoke-free and stress relief life. Briefly let us examine each segment and see how it can help us stay healthy.

Exercise: Regular moderate exercise or physical activity has tremendous benefits. It is an important strategy in the prevention of cardiovascular diseases and other chronic ailments including stress relief.

Walking improves cardio-vascular fitness, lowers cholesterol levels and blood pressure. Burns calories, improves muscle tone, relieves tension, improves digestion, and makes one feel good about one self. It also helps prevent osteoporosis.

Experts suggest we should do one hour of physical activity every day – it does not have to be all at one time.

Laughter: Here are some quotes which speak for themselves.

“Laughter is the closest thing to the grace of God,” says Karl Bath (1886-1968).

“Only three things in life are real: God, human stupidity, and laughter. But the first two pass our comprehension; we must do what we can with the third,” says Aubrey Menen in The Ramayana.

“I made the joyous discovery that ten minutes of genuine belly laughter had an anesthetic effect and would give me at least two hours of pain free sleep,” Norman Cousins.

Laughter brings happiness and happiness brings good health.

Meditation: “All man’s miseries derive from not being able to sit quietly in a room alone,” says Blaise Pascal (French philosopher, scientist, mathematician, and writer).

Meditation reduces stress, brings harmony in one’s mind, and increases focus. Reduces blood pressure and may boost your immune system to fight infection and cancer.

Organic healthy food: If you can find organic food then it is good. But it is not always easy to do that. What is important is to eat a low fat, high fiber diet with five to 10 servings of fruits and vegetables. There are definite benefits in terms of preventing heart disease and cancer.

Stress relief: Life without stress is not possible. So learn to manage stress. Be an optimist but have plan B ready. Never feel as if you are trapped in a situation. Learn to manage your time and people around you. Many people can help you – you just have to ask.

Smoking: Tobacco use is the leading preventable cause of death in Canada. It is responsible for one in five deaths. Half of regular smokers die prematurely of tobacco-related disease.

Nicotine causes tolerance and physical dependence. It literally takes over control of your life. If you do not smoke then do not start. If you smoke then immediately find help to quit smoking. Your life is in danger.

For 2007, remember – if you take care of ELMOSS then ELMOSS will take care of you. Have a great year.

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Looking Back at 2006

So, how do you feel today?

Do you feel healthier today than you were a year ago?

It’s Boxing Day and you are taking it easy. You had your Christmas dinner. You had your Christmas presents. Even if you do not formally celebrate Christmas you cannot escape the spirit of it. Especially the turkey dinner, the yummy chocolates (my favourite), the variety of nuts (my second favourite) and Christmas songs and carols. I don’t care too much about alcohol but I like the holiday part.

I have to be careful with chocolates and nuts. They are supposed to be good for your health but they are loaded with calories. With my heart condition I have to indulge in these “vices” carefully. Of course, I convince myself that by exercising more I will burn off some of the calories from my system. But it is not always that easy. I have to exercise a lot to burn off few calories. Here are some examples:

I can burn 12 calories a minute by swimming. I can burn 10 to 11 calories per minute by jogging 9.6 km. (six miles) an hour or go cross-country skiing, play squash, play handball or basketball. I can burn eight calories a minute by playing tennis or shoveling snow, downhill skiing or water-skiing.

I can burn seven calories a minute indulging in sexual activity, shoveling dirt, skating or bicycling 16 km. (10 miles) an hour. I can burn six calories a minute raking leaves, five calories a minute by doing housework, four calories a minute by walking 3.2 km. (two miles) an hour. If I am too lazy then I can burn two calories a minute just standing or sitting at one place.

Wonderful thing about exercise and burning calories is we have so many options to choose from. Just like yummy food which we never seem to be able resist. There is so much of good food. Packed in so many attractive packages. Tastes so good. Resisting good food is like inflicting cruelty to our ever expanding girth. But resist we must. That would be kindness to our fragile body. And that fragile body needs exercise to stay beautiful.

Eating never gets boring. We need food to give us energy and hopefully good health. Similarly, exercise should never get boring. We need exercise to give us stamina and keep our body nice and trim. We have so many options that we can change the type of exercise we do and have fun and burn some calories. I can combine aerobic exercise with resistance training and stretching. A perfect combination. Don’t you think it sounds pretty good?

So, have I been a good boy this year? Am I happy to look back and say I am lucky to be here writing this column at the end of the year? It is definitely yes. I started the year badly with ill health. Thanks to my luck, my doctors and modern technology, I have been well since then. At the time of writing this column (one can never take life for granted) I can say I have had a wonderful year. I am thankful for that.

What about you? Have you had time to reflect about your health, about your family and about your work and say that you are happier today than you were 12 months ago? If not then do so. Sit down in a quiet room and spend few minutes to reflect and meditate. It will help you plan your next year better. So do it today. The more you postpone it the less chance of you finding time to do it.

In the meantime enjoy the rest of the holiday season and have a happy, safe and wonderful new year. Enjoy those left over turkey sandwiches and see you next year.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!

Physician Health Matters

Yes, physician health matters because physicians are a valuable human resource.

Few days ago, I was in Ottawa attending 2006 International Conference on Physician Health. It was organized by the Canadian Medical Association (CMA) and the American Medical Association (AMA). The conference was attended by delegates from Canada, U.S.A., Europe, Australia, New Zealand and many other parts of the world.

This year’s conference was 18th in the series since its inception in 1975. This year’s theme was: Physician health matters: preserving a valuable human resource.

The delegates at the conference heard about the latest research on physician health, about new skills to survive and thrive in their career and learned about the progress that is being made around the world to protect the health of physicians.

The organizers of the conference say that by raising physician health issues at an international policy level, the conference seeks to promote a healthier culture of medicine and decrease the stigmata associated with the physician ill health, thereby decreasing barriers to physicians seeking timely personal care.

In 2003, a survey conducted by the CMA found that 46 per cent of Canadian physicians were in an advanced stage of burnout. Physicians feel they have to work harder and longer hours because there is a shortage of medical manpower. With the information overload there is a significant pressure on physicians to satisfy the public and there is constant political battle within our health care system to obtain fair share of resources to provide good patient care. All these factors do affect physicians’ personal and mental health and their capacity to deliver good patient care.

In order to help physicians understand the importance of looking after their own health, CMA set up a Centre for Physician Health and Well-being (cma.ca/well-being). Since then every province in Canada has established programs to help physicians and their families cope with stresses of work and encouraging healthy behaviours within the physician population as a whole.

At the conference, I was pleased to learn that every physician in Canada has access to a physician health program. In Alberta, it is called Alberta Physician and Family Support Program. The program has a toll-free number and a physician or a family member can call this number for help 24-hours-a-day.
As we know, prevention is better than cure. In the last few years, medical students, interns and residents have been in the driving seat promoting ideas on physician health and well-being. They are educating themselves at an early stage of their professional life to look after themselves and their families. They have learnt to reduce the hours they work, they have learnt to say “no” when they are tired and they have learnt to balance their lives.

I belong to a foolish generation of old doctors who took pride in working round the clock. Readers of my column and those who have read my book, A Doctor’s Journey, are well aware of my trials and tribulations with my own health. I learnt my lesson too late. In the last four years I have tried to change my practice and find a better balance in life.

It is hard to break old habits. After all work is a kind of addiction. It takes about one to two years to “detoxify” oneself. During this process one needs an understanding health-care administration, understanding colleagues, good friends, and a devoted family. Count yourself lucky if you get all four groups rooting for you during your down time.

Remember, as one door closes, another one always opens. So be brave doctor, do not forget to heal thyself first.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!