Archive for the Addictions Category

What does each pack of cigarettes REALLY cost?

Posted in Addictions with tags , on March 17, 2008 by Dr. CJ

NY Times article

Interesting, very interesting.   I’m not sure what they mean by “discount rates”, since the link to the actual paper is broken.  That’s obviously a population average.  Try pulling the numbers on someone who dies of secondhand smoke, though.

Dark chocolate

Posted in Addictions with tags on March 5, 2008 by Dr. CJ

Thank goodness for dark chocolate!  Ever since I’ve cleaned up my diet, I’ve had major cravings for sweets, particularly chocolate.  Maybe because it always seems to be available, I don’t quite know, because I used to not get too excited about it before this new way of eating.  At least there is some health benefit of small amounts of chocolate, has to be dark chocolate, but that’s okay with me. 

The Vasculopath

Posted in Addictions, Heart Disease with tags , , , on January 30, 2008 by Dr. CJ

I had an incredibly frustrating patient encounter yesterday – a 60-something gentleman who was recently in the hospital for an ischemic stroke. When I admitted him (late at night – curse this job), I mustered enough good charm to suggestively congratulate him on his first day of having quit smoking (I knew he wouldn’t). Super pleasant guy, with a supportive family all huddled around him in the ICU, but I just knew he couldn’t be reached on the smoking thing, even though he’d just dodged a major bullet by reversing all of his stroke symptoms after receiving the “clot-buster” medication just hours before.

Problem was, this guy is the ultimate “Vasculopath”. What is a “vasculopath”? It’s a rather informal term I apply to an individual with significant vascular disease, of which there are many risk factors and many manifestations. This guy had them all: high cholesterol, smoker, high blood pressure, family history of heart disease, age (>55), male sex, obesity, Diabetes Mellitus, and worst of all – personal history of heart disease, having had an MI (myocardial infarction) in the past. His regular physician had done marvelous work on him: normal blood pressure, controlled diabetes, normal cholesterol, had him taking aspirin – all the right things, but he refused to give up his cigarettes. As the saying goes: You can lead a horse to water, but you can’t make him drink.

Anyway, he convinced everyone at his bedside (at my less-than-gentle prodding) that he would quit smoking as a result of his stroke. I saw him back in clinic today and inquired about his 9 days since being admitted for a stroke – of course he’s right back to smoking with no intention to quit. [Deep breaths . . . count to ten] As I mentioned before, you choose your own death, in a sense. He’s basically playing a form of Russian Roulette – one of these days he’ll have “the big one”. My suggestion to clean up his diet and learn how to incorporate some physical activity into his daily routine fell on deaf ears, but he reluctantly agreed to try Chantix (a wonderful new addition to our smoking cessation arsenal) for the sake of his wife. [Mr. Passive-Aggressive, himself]

I can only hope that he sees the folly of his ways before it’s too late. A patient like this reminds me that I can do only so much as a physician – it’s times like this I just feel like a glorified advice-giver. It feels like a waste of my time, but maybe one of these times I’ll get through to him.

Free from Dew for a year

Posted in Addictions with tags , , , on January 17, 2008 by Dr. CJ

Today marks my 1-year anniversary of quitting Mountain Dew. I used to be a religious one-can-daily “user”, tapered down from a ridiculous amount of Dew in college and med school. I now keep the can you see below in the fridge as a little reminder of my victory. I almost want to celebrate this 1-year anniversary by drinking it, but that sounds inappropriate to me for some reason. Cutting out soda was a major step for me – I would get caffeine withdrawal headaches whenever I tried to quit. This time, I went 1 day without a Dew, had a miserable headache, then for the next 2 days, I drank only half a can, then stopped without any further withdrawal headaches.

Haven’t so much as sipped a regular Mountain Dew since [sorry PepsiCo]. At 170 calories a pop, imagine what quitting your regular soda habit will do for your weight. If nothing else, start with just transitioning to diet soda – caffeine without the calories is better than the sugar bomb.