The Great Escape: Breaking Free from Nicotine Addiction

Start the new year with a plan to quit smoking, vaping or dipping and see significant health benefits. The good news is that you don't have to do it alone. Sara Tello, a Texas Tech Physicians nurse practitioner specializing in smoking cessation, explains how she helps smokers quit. Tello emphasizes the importance of a personalized approach to quitting using medications and nicotine replacement therapies. This compassionate, non-judgmental approach to helping smokers quit offers them a chance to significantly improve overall health. 

Transcript

Melissa Whitfield  00:09

Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers. The start of a new year often means an opportunity to improve or change a part of our lives for the better. Perhaps you or someone you know smokes and has considered quitting but don't know how to start, or you need reasons to quit. Quitting smoking improves your health and reduces your risk of heart disease, cancer, lung disease and other smoking related illnesses. Sarah Tello, a nurse practitioner specializing in smoking cessation with Texas Tech physicians, is our guest for this episode. She explains the process and dispels misconceptions about what happens when you begin that journey to quitting. Whether it's smoking, vaping or dipping. 

Melissa Whitfield  01:09

Hello and welcome to our podcast. 

Sarah Tello, FNP-C  01:12

Thank you for having me. 

Melissa Whitfield  01:13

Can you tell us a little bit about yourself, your expertise of what you do here at the Health Sciences Center? 

Sarah Tello, FNP-C  01:19

My name is Sarah Tello. I'm a nurse practitioner, and I have a passion for treating tobacco dependency. So here at Texas Tech, I have clinic, and I help smokers, vapors and dippers quit. 

Melissa Whitfield  01:34

Well, that's the topic for this episode, is smoking cessation. I say smoking, but you also mentioned vaping and dipping. So if I say smoking, I also mean vaping and dipping. So it's the new year and somebody may be thinking about resolutions and say, "Okay, I have to quit this habit." What makes smoking, vaping and dipping so addictive and hard to quit?

Sarah Tello, FNP-C  01:58

The tobacco companies chemically alter their tobacco with 7000 chemicals, 70 cancer causing agents to be as or more addictive than heroin or cocaine. And it's wrong. Any way that you look at it, it's wrong. And I do not quite understand why we allow this, but we do. Personally, I do not believe that this addiction is the patient's fault. But in addition to the addiction, it's also a patient's best friend, stress relief, boredom relief and a part of their daily routine. My patients can tell me, I wake up, I have a cigarette, have coffee, have a cigarette, walk the dog, I have a cigarette. It's very attached and it's very complicated. So we use the medications to address the addiction, until we get their smoking down to manageable numbers. And then together, the patient I we start talking about life and what the nicotine tobacco is, is attached to. And one by one, whether it takes two weeks or two years, together, we get there. Is it is the most beautiful thing, in my opinion, to have my patients say to me, "I cannot believe I am no longer a smoker."

Melissa Whitfield  03:11

How does smoking impact our physical health?

Sarah Tello, FNP-C  03:16

There is not one body system that it does not impact. I mean, of course we know heart disease, lung disease, cancer, but macular degeneration, strokes, skin, hair, diabetes. We're finding out more and more and more it impacts everything. The best thing you can do for your health is to get help and quit smoking, vaping or dipping.

Melissa Whitfield  03:42

Some people might try to do this themselves, and they might start with an e-cigarette. Is that a safe alternative? 

Sarah Tello, FNP-C  03:48

No, the only thing safe to breathe in is clear air. I mean, we're doing more research, so I'm not allowed to specifically say about vaping or e-cigarettes, but you're changing one bad habit for another. If it's used as a tool, I mean, that may be different. But where we stand now, patients tend to replace the cigarettes, and it's not good.

Melissa Whitfield  04:17

Can you describe or tell us some therapies and strategies to quit smoking. So somebody decides they want to quit smoking, and they go to your office, do they quit cold turkey?

Sarah Tello, FNP-C  04:27

Oh gosh, no. Let's say a primary care physician. Patient comes in says, I want to quit smoking. Physician puts them on anything, pick something, a patch. Typically, patients not going to get any education about that patch. They're going to go home, put the patch on. In a couple days, they're still smoking, and they're going to say, this does not work, and they're done. They come to me, I explain all the options, medications, nicotine replacement. They will know why, how, when to use all these medications and together. I stay by their side. There's so many different variables. Nicotine and tobacco means different things for so many people. It's just every patient is different, and it's just a journey we take together. It's so beautiful.

Melissa Whitfield  05:22

What happens to the body when someone stops smoking? I know you said that it's not autom- that that they don't quit immediately, but once they start decreasing or and they finally get to stop smoking, what happens to the body?

Sarah Tello, FNP-C  05:37

Well, immediately the body starts to make changes. Heart rate improves, blood pressure improves, then their statistics about one to 12 months. Coughing and shortened breath decreases. One to two years, risk of heart attack drops sharply. Three to six years added risk of heart disease drops by half and on and on and on. About at 20 years, the risk of cancers dramatically decrease. So the benefits are ongoing. The longer that you refrain from smoking. The patients immediately say, just by even cutting down by half, oh my gosh, I breathe better, I see better, I concentrate better, and I have so much more energy. It is just amazing. It has changed my patients lives. Really has. From staying home, older patients staying home, smoking two packs a day, to going to pulmonary rehab, making friends, going to the gym every day, loving life, it's a total transformation, and they're not alone, whereas in the past, they've tried to do it by themselves. Research shows success rate of a patient doing this on their own is 5.9% that's five out of 100. With a specialist, success rate is 50%. I tell my patients, I'm stubborn. If you don't give up, I won't give up, and we will get you there, no matter how long it takes.

Melissa Whitfield  07:08

What happens if someone relapses?

Sarah Tello, FNP-C  07:10

Well, quite often it depends on what approach, what medicines we've used to get them to cessation. Chantix can be magic. You don't even have to try to quit smoking. Take a pill, prescribe it in a six month course. Typically they quit about 3, 4, 5 months. Once they quit, we take keep taking Chantix for an additional six months. There's also Wellbutrin. But then what I find most important is that the patient knows how to stack nicotine. What I mean by that, the patch is slow and steady. Once we find the correct dose, decreases their smoking by half in one to two weeks, just by putting on a patch and being a little patient. And then I teach them how to use fast acting nicotine, which is gum lozenge and Gengesil spray. This is what insurance might cover. They're going to understand that they're going to use that to try to not need that cigarette. We can use it in many different ways. And we strategize. We, it- it's just amazing, but, but there's not a one size fits all. Every patient, it's trial and error that really honestly. And we just figure it out together.

Melissa Whitfield  08:24

My husband smoked, and then he had, he was diagnosed with cancer, so he, that, he just quit cold turkey, and 10 years later, he picked it up again, but he was hiding it from us. So I didn't know how to help them without saying I know you're smoking without sounding like an accusation. So how can we help loved ones who are trying to quit smoking?

Sarah Tello, FNP-C  08:48

Let me tell you a story. I was 11, roller skating in the garage. My mom came and told me that her throat biopsy came back precancerous, and that if she did not quit smoking, one day, it would be cancer. In 10 years, she died of small cell lung cancer. But in those eight years leading up to the diagnosis, I watched my mother try everything available or within her power to try to quit smoking and she was not successful. So in my developing years, every time my mom would smoke that cigarette, I would watch her pull it to her mouth, and I would think my mom's going to die. During my mom's cancer treatment, I was awful. I gave her hell, I told her things I wish I had never said to her because I didn't know. Smokers are ostracized, they're ashamed, they're helpless, and they don't know how to quit. They're all alone. As medical professionals, it's so important for us to think about that person that's a mother and a brother and a sister, and show them some respect and most importantly, love. So when I have family members sitting next to me, to the patient, when they come to see me, I tell them, Sarah said, and I wag my finger and I say, all I want you to say to this person is, I love you and I support you whether you smoke or not, because it is absolutely the truth. And by you giving them a hard time, you're just making them smoke more and making them ashamed. They hide, they sneak it. It's out of their control. Personally, I believe this is not the patient's fault, and we need to be better as medical professionals. We need to approach it with love and kindness and understanding. We can do better. As providers, as caregivers, let's don't just bypass the question, do you smoke, vape or dip? Let's talk to them about it. Tell them there is help. Explain all the options. Tell them, let's go see Sarah. I had a resident tell me that he tells his patients, Sarah is just going to love you and hug you until you quit smoking. There are things that you can do to help the patient and if those don't work, then have them come see me and I'll help them reach cessation.

Melissa Whitfield  11:46

Thank you so much for coming on our podcast and giving us all this great information and definitely giving us a new way to think about people who smoke.

Sarah Tello, FNP-C  11:55

Thank you. Thank you for having me.

Melissa Whitfield  11:58

Thanks for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center I'm produced by TR Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams and me, Melissa Whitfield.