UNDERSTANDING NICOTINE/TOBACCO

Understanding and Coping With Nicotine Withdrawal

 

 

More people die from tobacco use than suicides and murders combined. So why do smokers continue to light up when statistics like these make it clear that they should quit? Nicotine addiction is powerful, which makes quitting difficult--but it is possible. There are now 45 million smokers, but 47 million successful quitters. By understanding nicotine addiction and withdrawal, you can be better prepared to crush out this destructive habit for good.

Understanding the Addiction

When you smoke, nicotine speeds to receptors that trigger the release of dopamine, your body's feel-good chemical. Nicotine causes dopamine to be released in several parts of the brain: the mesolimbic pathway, the corpus striatum, the nucleus accumbens and the frontal cortex . Over time, the receptors where nicotine can connect become desensitized. This means that they lose some of their ability to send signals that result in the release of dopamine, and other neurotransmitters. As a result, more nicotine receptor sites are created. The overall effect is that smokers who have developed additional receptors need more nicotine to avoid having withdrawal symptoms.

The longer you smoke, and the more you smoke each day, the more severe nicotine addiction becomes. The craving for nicotine intensifies and becomes more frequent. Ignoring the cravings brings on unpleasant withdrawal symptoms. And what alleviates those? Yes, more nicotine.

The Rewards of Nicotine

Let's face it: If there were no positive outcomes to smoking, no one would ever do it. "There are many motivations to smoke," says Michael D. Stein, M.D., Professor of Medicine and Community Health at Brown University and author of The Lonely Patient and The Addict. "The dominant one is physical dependence--that is, smokers who try to stop have withdrawal symptoms, and cigarettes relieve the symptoms. But nicotine can also improve attention and vigilance. Smokers smoke when they need to concentrate or focus. Smoking helps some people feel in a better mood, or they feel a high, a buzz. Some smokers enjoy the taste and smell of a cigarette. Finally, smoking serves as an appetite suppressant. People smoke to control their weight." While all medical experts agree that the health risks are not worth these beneficial aspects, many smokers have a real fear of losing the sense of control and other pleasurable sensations when they stop. So, how can quitters learn to conduct their daily routine smoke-free? Understanding what to expect and planning for withdrawal symptoms is a great place to start.

Managing Nicotine Withdrawal

The physical symptoms of nicotine withdrawal are rough stuff. The brain and body still crave nicotine's positive effects, so its absence causes quite an uproar. Quitters can experience any combination of irritability, anxiety, depression, sweating, headaches, insomnia, confusion, cramps and weight gain. Understanding what feelings and symptoms accompany nicotine withdrawal is important, because there are steps you can take to manage your symptoms.

1. Craving for nicotine If you aren't using a nicotine replacement treatment, you may have cravings. Cravings last only a few minutes, but will feel much longer at first. Stay busy, especially during the times when you used to smoke. Plan a small snack or distracting task during these times.

2. Irritability The frustration of leaving your desire for nicotine unfulfilled affects your mood. Know that your emotions will be intensified for the first few weeks after you quit. Talk about your mood, and the fact that you've quit smoking, to anyone in the line of fire. Going for a walk or other exercise can take the edge off.

3. Anxiety Smokers with pre-existing anxiety disorders have a harder time quitting. Other quitters may have new feelings of anxiety. Anticipating this frame of mind, and knowing that it's related to quitting is the first step. Try to wait it out, or take a break to talk to a friend who knows what you are going through.

4. Depression Some of the prescription drugs for smoke cessation treatment also treat depression. If you are quitting without those, realize that you may start to feel down. If you have planned a support system and engaging distractions for your transition to the non-smoking life, rely on them.

5. Sweating Metabolic changes and increased circulation after quitting smoking may bring on sweating. Dress to stay cool, and drink plenty of water.

6. Tingling in hands and feet Your circulatory system is making positive adjustments after you quit, which can create some new sensations. A tingle in the extremities is a good thing. Just wait it out.

7. Headache Could be a circulatory effect, or a result of tension and anxiety from craving. Take ibuprofen or acetaminophen if you usually do. Try deep breathing or meditation to relieve tension.

8. Cramps and nausea Smoking can cause peptic ulcers and other digestive ailments. As your digestive tract recovers from your time as a smoker, you can feel temporary discomfort. Avoid spicy, irritating foods as you wait for this phase to pass.

9. Insomnia Nicotine is a stimulant, so it has definitely affected your sleep-wake cycle. Treat yourself to extra soothing activities before bedtime: a warm bath, a massage, total quiet.

10. Mental confusion Nicotine gives smokers focus and clarity. Its absence can make you feel a bit foggy. When confusion takes over, stop. If you're in the middle of a task, take a break. Confusion gradually dissipates as you adjust to the absence of nicotine.

11. Weight gain Some smokers fear gaining weight so much they don't attempt to quit. Most quitters gain fewer than 10 pounds.  "Weight gain following smoking cessation is mostly due to decreased metabolic rate, increased food intake, and decreased physical activity" after quitting, says Michael D. Stein, M.D., Professor of Medicine and Community Health at Brown University. "Also, an enzyme called lipoprotein lipase (LPL), which affects fat cells' metabolism, becomes more active after you quit. And some appetite control agents, including leptin and neuropeptide Y, are influenced by nicotine." Dr. Stein notes that those who are concerned about gaining weight are more likely to relapse after quitting. Exercise would be a great substitute for smoking, if you're concerned about gaining weight.

Most of the nicotine withdrawal symptoms are short-lived, and symptoms pass in time, usually in less than a week. Withdrawal is the most uncomfortable part of quitting, but getting past this rough patch is the first real challenge in staying away from tobacco for good!

KNEE JOINT

Your knee joints are one of the unsung heroes of your body. If you're like the average Indian, you take just over 5,000 steps a day -- and each one of those steps places a force equal to three to six times your body weight on your knee joints. It's no wonder that by the time you reach age 60, chances are good you will have developed osteoarthritis of the knee, a sometimes-painful condition caused by wear and tear to the knee joint. More than 50 million Indians currently have this condition, and that number is expected to soar as high as 100 million during the next two decades as baby boomers age and become obese, a major risk factor for the disease, increases. While many people with knee osteoarthritis never have symptoms, others experience stiffness and dull pain, especially upon waking, or, in extreme cases, severe pain that limits their mobility.

What is osteoarthritis? In a healthy knee joint, a slippery tissue called cartilage fills the spaces between the bones and cushions the bones as they move. Osteoarthritis (OA) occurs when the cartilage wears away due to daily use -- or overuse. The ends of the bones begin to rub against each other and often develop spurs and cysts. In addition, the tissue that lines the joint may become inflamed and the ligaments and muscles that support the joint weaken.

Most people who develop knee OA are over 45. The disease is more common among women than men, and having osteoporosis or a previous knee injury increases your risk. While genetics plays a role in about 20 to 35 percent of cases, one of the biggest risk factors is something you can control -- your weight. Overweight women (defined as having a body mass index (BMI) of 25-28.9) have a four times greater risk of knee osteoarthritis, and overweight men (BMI 26-29.9) have five times the risk of normal-weight men.

Prevention and relief: There is no cure for osteoarthritis, but there are steps you can take to reduce your chances of developing the disease and to manage the symptoms if you already have it.

1. Control your weight. You can greatly reduce your chances of developing knee OA by maintaining a normal weight or shedding at least some of any excess weight. Losing even a few pounds can make a big difference in the load you place on your knees. Recent studies have found that when overweight people with knee arthritis lost just one pound, it resulted in anywhere from a twofold to fourfold reduction in the load placed on their knee joints. One report estimated that losing 10 pounds would take 48,000 pounds of weight off the knee joint for every mile walked. That, in turn, can reduce wear and tear on the cartilage and prevent osteoarthritis from developing. In fact, losing 11 pounds over a 10-year period decreases the chances of developing osteoarthritis of the knee by 50 percent, according to one recent study. Losing weight can also help reduce knee pain if you already have arthritis.

If you are overweight, talk to your doctor about a healthy weight loss program that includes eating lots of fresh vegetables and fruits, lean protein and whole grains.

2. Exercise. Regular, low-impact exercise will not only help you to lose weight, it can help prevent knee OA and manage symptoms in other ways. Often people who have arthritis of the knee cut back on their physical activity to avoid pain. But that's the worst thing you can do. It's critical to keep the knee joint mobile and flexible and to strengthen the muscles around it. You can do that by combining aerobic exercise with strengthening and flexibility exercises.

Aim for at least 30 minutes of low-impact aerobic exercise five days a week. Walking, biking and golfing are all good choices because they don't place stress on your knee joints. Exercising in water is also a great way to work out because the water supports your weight and gives your knees a break. Studies show that water exercise such as swimming or water aerobics can be especially helpful in reducing pain and improving function in those who already have knee OA.

Exercises that strengthen the muscles around the knee and the quadriceps (thigh) muscle can help protect your knee joints and may actually help prevent osteoarthritis. These exercises can also reduce pain and improve your mobility if you have arthritis. Try isometric exercises where you push or pull against resistance. Stretching exercises like yoga and tai chi can prevent and reduce stiffness in your knee joints.

Talk to your doctor before starting an exercise program -- especially if you have pain in your knees. You may need to begin by working with a physical therapist to learn how to strengthen the muscles around your knees in a safe way.

3. Protect your joints. An injury to your knee can alter the alignment in the joint and that can make the cartilage wear away. So take precautions to avoid injuries to your knees if possible, especially if you do a lot of sports. If you do injure your knee, get immediate treatment to reduce your risk of damaging the cartilage. Wearing a knee brace may help support your knee and reduce pain if you already have arthritis.

4. Pain relievers. Aspirin and other non-prescription pain relievers such as acetaminophen, ibuprofen and naproxen can reduce arthritis pain, but regular use can produce serious side effects. Talk to your doctor about the safe use of these pain relievers.

5. Other treatments. Glucosamine and chondroitin are two natural substances that are found in cartilage. Researchers have been studying whether or not they help relieve arthritis pain when taken as a dietary supplement. Recent studies suggest that they don't help any more than a placebo, but some doctors suggest taking them for three months to see if there is any benefit.

Some doctors prescribe anti-inflammatory gel to relieve pain or injections of hyaluronic acid to lubricate the joint and act like a shock absorber. In very severe cases where other treatments do not provide relief, your doctor may recommend surgery to replace the knee joint.

The best treatment of all is prevention, of course, and the best way to prevent osteoarthritis is to keep your weight down and get in the habit of regular exercise. If you do develop osteoarthritis, an early diagnosis can mean a better outcome -- so see your doctor right away if you notice pain or swelling in your knee.

FEW WORDS ABOUT ANGER

Anger is difficult to work with, but like many challenges, the rewards are great. Rage sweeps you away, and before you know what's happened you're already upset, and you don't notice what's been going on until hours later. To start with you may only be able to notice your anger when it begins to subside. This is okay. Any noticing is good. 

So as you practice mindfulness, notice anger, and name it. You can say "Angry Mind!" Look at your body and see where the anger is. It might be your stomach, or shoulders, the muscles in your neck. Breathe relaxation into that part of your body. With anger, you may notice it first in the body as tension -- a headache, or upset stomach -- or you may pick it up more easily in your mind. It doesn't matter. But do both parts of this exercise. Name the anger and breathe into the tense spot. 

 

You may be wondering about the moral ground of anger. Isn't it wrong to be angry? But by noticing you are not ignoring it. In fact you are giving it due honour. Usually people leap so quickly to act on anger, or to judge (What should I do? Am I right to be angry? Whose fault is it? Hers!) that often they forget to notice the simple fact that they are angry. Of course it's not good to lose your temper and shout, and mostly it's very counter-productive. There's war, violence, genocide, murder, child-abuse and bodily harm, all of them arising from anger and fear. Australia has law-courts, prisons, and armed forces. But putting this right can only happen when each person can address personal anger in their own hearts, and acknowledge silently to themselves, "I'm angry." Be very tender with yourself, just as you would be with a small child. 

. For self-protection our anger needs to be in good shape. If you are a quiet person coming off amphetamines (which raise self-confidence and self-assertiveness) you should check the health of your anger. To check the health of anger, start by noticing it. 

If you are angry a lot of the time, and taking it out on other people, this exercise will help. You should also talk to your counsellor about it. If you are not having counselling, then find a wise and sober friend. Name the problem to them, as honestly and openly as you can, including the good bits of the situation. Telling another person is a simple form of naming and acknowledgment. Yoga, dancing and swimming will help the anger in your body. 

As you collect anger, you are giving yourself a chance to allow your anger a place in your life, giving it a value. It starts to take its rightful place, to come forward appropriately. You gain a few seconds before you react. Those few seconds heal every war that was ever fought.