The Monterey Preventive Medical Clinic offers a program to help you stop smoking originally sponsored by the Stanford Heart Disease Prevention Centre and designed to help you to quit with minimal withdrawal. The program involves your participation in setting a "QUIT DATE", filling out certain questionnaires and reading pamphlets giving information on how to handle certain situations related to smoking: for example: "How to talk on the telephone without smoking"; "How to Relax without smoking;" "How to reward yourself without smoking" and "How to control your weight without smoking."

Step 1- The Basic Smoking Cessation Program plus Clonidine Patch

An initial interview with the doctor and discussion of the results of the "Smoking Quiz" help determine the best technique to use in stopping the use of tobacco. Nicotine chewing gum and Nicotine patches are available OTC when needed and the Clonidine patch (TTSreg.1-information follows) is provided as part of the program. Support systems are built in with daily phone calls to the office and weekly visits for three weeks, to insure that you are successful in kicking the addiction to tobacco. Remember, the biggest problem with successfully quitting cigarette smoking is not to start again. We are here to help you! Although Nicotine has many side effects, it appears to be the smoking and the tobacco, with its many additives including hydrocarbons and Radioactive Polonium, which causes cancer and not the nicotine. Nicotine however, is toxic and dangerous to the heart and circulation.

Tobacco Addictive and Toxic? Why Smoke?

In 1986 Tobacco smoke was finally declared as toxic to male and female reproductive organs. The scientific panel also said that the cancer threat for tobacco products extends to second-hand smoke inhaled by non-smokers.

The Surgeon General as of 1988 declared that nicotine is an addictive drug "just like cocaine, heroin and other drugs that people commonly accept as addicting."

For the first time a direct link between smoking and heart damage has also been established by researchers at the Medical College of Wisconsin, Milwaukee. It has long been known that smoking indirectly causes heart attacks by interfering with blood supply, but the researchers found that men under 55 who smoked were 2.8 times more likely to have cardiomyopathy - ( heart tissue damage). "Smoking also increases the risk of heart attacks in part by causing deposits occluding the arteries of the heart. Smoking may change certain components of the blood, making it more likely for a blood clot to form in the arteries," said Dr. Arthur Hartz. Smoking also tends to increase cholesterol deposits on bypass grafts and smokers comprise nearly 50% of the patients who need a second bypass operation. Recent evidence has also linked smoking to an increase in all types of cancer and acceleration of the aging process.

Cigarette Craving and Smoking Withdrawal

Clonidine, a blood pressure medication available in a skin patch (TTSreg. 1 or 2) has been tested against a Valium type-tranquilizer called Xanax in heavy smokers with withdrawal symptoms after abstaining from cigarettes. Clonidine suppressed anxiety, tension, irritability, and restlessness, cigarette craving better than Xanax. As a matter of fact, the ex-smokers preferred it to the tranquilizer but unfortunately, it is not a cure for smoking. Even among those smokers who have been successfully withdrawn from cigarettes, 60% will return to cigarettes within the next 6 months. However, Clonidine continues to be effective over several weeks and along with Nicorette gum provides a successful support technique for smoking cessation. Clonidine has also been studied in the the treatment of alcohol and opiate withdrawal and found successful. The Clonidine Patch is included at no additional charge in the regular smoking cessation program in this office.

We may also prescribe Zyban® for the treatment of smoking withdrawal symptoms. This is a relatively new methodology. Please call for further information.

Cost of the Program and Insurance Reimbursement

If you wish to have your insurance company reimburse you for visits related to quitting cigarettes, various diagnoses such as "increasing shortness of breath, R/O Chronic Obstructive Pulmonary Disease, Emphysema (which all smokers get eventually) and Tobacco Dependence" are used. These are reimbursable by most major medical insurance at about 70% to 80% and deductibles must have been met previously. Some insurance companies do not reimburse smoking cessation programs including Hypnosis.

We have a Spirometer at the office which enables the doctor to study your lung function and determine the degree of emphysema (obstruction) or asthmatic bronchitis (restriction) resulting from years of smoking. Remember that damage to these most vital organs is permanent. Cost is $85.00 for this test or it can be included in the extensive program with injections and hypnosis. This test is usually reimbursable by most major insurances.

Quitting smoking reduces your cancer risk substantially when compared to continuing smoking. Cessation of smoking definitely improves pulmonary function and decreases the prevalence of respiratory symptoms. Quitting also reduces the chance of premature death from chronic bronchitis and emphysema and does diminish an individual's risk of dying. Life expectancy is shortened by the number of years as a smoker and the amount smoked. A 30-35 year-old , 2 pack-a-day smoker has a life expectancy 8 to 9 years shorter than a nonsmoker the same age.

Aside from the financial outlay, {some smokers spend $10,000 over their 20 year smoking history to develop their smoking related illnesses}. How much further ahead you would be to invest that money, even with today's inflation. Male current smokers report a 33% excess of work days lost and female smokers a 45% excess of work days lost. Also, women who both smoke and use oral contraceptives have increased risk of strokes and blood clots and peptic ulcers.

With all these terrible facts, why do so many people smoke? Addiction is the answer. Nicotine is a highly addictive substance, as powerful as heroin and alcohol for some. Chewing tobacco is even more addictive and causes oral and throat cancers in young adults. Interestingly enough, ex-smokers who use the nicotine chewing gum do not seem to have problems withdrawing from it because the dose is so much less than they get as a "fix" when they smoke. Most users of the gum need at least three months of use to prevent returning to tobacco and success rates are as high as 75% for those who complete the program. Nicorette reg. and Nicotine patches - Nicoderm®, Habitrol®, and Prostepreg® are available over the counter and need not be prescribed by the doctor.

Step 2-Extensive Program plus Hypnosis and Injections:

A few heavily addicted smokers require the Acupuncture Injection Technique, originally developed in Singapore for opium addicts, to help stop their withdrawal. The injections have been used in France for many years and over 80,000 smokers have quit using this aid. Certain vitamins and Xylocaine or Procaine (Novocaine) are used in the injection. The effects last about three weeks which is the length of time it takes the brain to unlearn a habit. Four injections are given around the nose and ears. The Procaine helps reduce the discomfort and special acu-points are selected to prevent withdrawal.

In most cases, injections are given only if the smoking habit returns after Step 1 has been followe . Those who are evaluated as in need of the injections from the "smoking quiz" are told at the time of their first visit and go directly to the Step 2 program. Remember, the average ex-smoker has tried to quit 5 Times before he or she is successful. Sometimes certain medications such as anti-depressants which have been shown effective in withdrawal from cocaine or alcohol are also used to help decrease the cravings during withdrawal. These will be discussed on an individual basis with patients by Dr. Kryger and are not necessarily part of the program.

Medical hypnosis has broad applications in many conditions ranging from Headaches, Asthma, Pain Control, Anxiety, Phobias, Insomnia , Obesity and Psychosomatic Illness. In Smoking Cessation, it has been found to be up to 75% effective in conjunction with some of the other techniques mentioned earlier. The Step 2 program includes :

1. Spirometry for lung function studies plus
2. Four Acupuncture injections as mentioned above plus
3. Four hypnotic sessions with training for self-hypnosis. (optional)
4. Check-in phone and email sessions are an essential part of the program.

Please contact our office to set up a consultation if you have more specific questions. Payment is expected when the program is undertaken. A quit date must be selected and a contract signed as to the efforts to be made by the smoker to end his or her addiction to Nicotine. Insurance reimbursement is each individual's responsibility. We encourage your financial commitment in order to solidify your desire to quit. If you have any other questions, please contact the office manager.

This program may be undertaken in conjunction with Smoker's Anonymous or any other self-help program ongoing in the community. Smoking is a tough addiction to conquer and requires real commitment and the desire to stop smoking. We are here to help you, but we cannot do it for you.