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| What Should NPs and PAs know about Smoking? |
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by Bob Blumm, MA, PA-C, DFAAPA - July 1, 2011
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A few years ago, I read a magazine article about the “Marlboro Man.” One image demonstrated that young, energetic cowboy and the second was a frail old man on his death bed dying from lung cancer. Is there a correlation? It seems as if medical science has a definitive case against the tobacco industry, blaming it as the #1 satisfying killer in the Unites States. A common fact is that tobacco kills more Americans each year than alcohol, cocaine, crack, heroin, homicide, suicide, car accidents, fire and AIDS combined. This fact would have made it on the public enemy #1 page for me and I would have sent the SEALS after the payload but, then again, I am not the President of the United States nor am I the Surgeon General. Therefore, my hands are tied.
What are some of the common diseases caused by smoking that we can agree upon? I would venture to go out on a limb and start with lung cancer which keeps increasing and has an extremely poor prognosis. I am a surgical PA and have seen the open thoracic cavity on numerous occasions. Sometimes the lung is inflated, pink with speckles and looks quite healthy; sometimes, it is a shell of its former self: smaller, black and filled with tar and secretions that indicate that it is very sick. This is from an objective view before we carve out a mass and then remove a lobe or the entire lung. Before this product takes its trip into the lung, it starts in the mouth as a cigarette, cigar, tiparillo or even as chewing tobacco. It has the ability to cause cancer of the tongue, the lip, mouth, throat, and larynx. It then turns its attention to the bladder, pancreas, stomach, kidneys and the cervix. It looks as it has the same effect as a nuclear reactor that is melting down. Other diseases such as heart disease and stroke are also caused by this insidious mixture of nicotine and carbon monoxide. It does bring people to a party however, a pity party: when shopping, they see a victim of COPD, chronic bronchitis or emphysema who requires oxygen in the cart attached to a tube in the nose just to survive.
There are countless other problems that are inherited by smokers that affect their daily lifestyle, such as shortness of breath that prevents them from playing basketball with the kids or grandkids. These folks have a nice color to their gums, usually indurated or red and filled with pouches that are matched by teeth resembling corn on a stalk. They have greater difficulty in becoming pregnant and have a greater loss of life for the fetus as well as low weight births. For the gentlemen, smoking can cause the dreaded ED (erectile dysfunction) that can incapacitate our minds and send us to the health provider for Viagra or Cialis. The smoking habit affects everyone in our homes or restaurants or enclosed places including babies, asthmatics and the elderly. We are weakening the lungs of pediatric patients, causing asthmatics to use inhalers to stop struggling for breath and are playing Dr. Kevorkian with the elderly, as surely this will have the same effect although it will take longer.
Did you know that there are 4,000 chemicals in tobacco smoke? There exists our friend arsenic, carbon dioxide, menthol and methanol, acetic acid, butane, nicotine, histamine ammonia and just scores of others. Talk about the ingredients in a Big Mac: you could never repeat the number in this little stick of impending death. Can we in the medical and nursing professions help you to help yourselves and your families? Sure, that’s what we do best. We counsel, demonstrate concern, send you to hypnotists and programs, give you literature and, on a more practical level, give you inhalers to both help you breathe and also give you a quick start of nicotine for your addiction. As we progress, we can supply you with a prescription for a chewing gum as long as you don’t chew it after your cigarette. There is a nice drug called Zyban that is taken orally and has no nicotine, but works to decrease your craving for tobacco products. The patch is used as a delivery device for numerous diseases, among them nicotine addiction. It provides your body with a small dose and I would suggest that our patients have only one patch on at a time to decrease the confusion. There are nicotine sprays and lozenges that can help the dependent person; but the best motivator is looking into the eyes of your loved ones and making the life changing decision. My father stopped immediately after his first heart attack and placed the pack of KENT on a moulding between the living room and dining room as a constant reminder as he had a date transcribed across it.
The sad portion of this article is that there will be some that do not take heed of sound advice and they will have their names prematurely written across a brass plate or headstone in their final resting place. We all have decisions to make in life. For some, it is their mate, others an automobile or a home or location to move. Should I wear a red dress today or a blue one? Should I wear a tie and sport jacket or a nice pullover? Most decisions are thought-provoking, but do not create an inner turmoil. The decision to make smoking a part of history, our history, is a bit more difficult. We, as America’s health care team, wish you strength in your decision and a happy future.
Robert M. Blumm has received national recognition as a distinguished fellow of the American Academy of Physician Assistants (AAPA). He is the past president of the Association of Plastic Surgery Physician Assistants, and was past-president of the American Association of Surgical Physician Assistants, past president of the American College of Clinicians and NYSSPA, as well as Chairman of the Surgical Congress of the AAPA. In addition, Bob received the John Kirklin MD Award for Professional Excellence from the American Association of Surgical Physician Assistants. Along with his associate, Dr. Acker, Bob was the first recipient of the AAPA PAragon Physician-PA Partnership Award. He has been a contributing author of three textbooks, written 150 plus articles and is a sought out conference speaker throughout the United States.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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