subspecialty in whole area or long health sue has been teaching and counseling on smoking cessation for fifteen plus years and so my prayer for those that are in attendance here today is that  diabetes arthritis sudden infant death syndrome are all in the smoking are all over the factors for those diseases too but for that let's talk about quitting because that's the most important thing the most important thing about quitting is you want to tap in from worked as a well you're hitting the physical part pretty strong that's but that's just one part of quitting truly quit successfully you need to hit all three legs not only the physical part but you also need a plan to deal with the habit and the changes in the habit and the changes in routine that come with quitting you also need a plan to deal with the psychological effects of quitting because most of us and i have found over the years i think particularly women have a very strong emotional attachment to the cigarette is a friend it's a body it's there are bad and it's there in a good day doesn't question me it's just it just makes me feel good when i need to feel good so that for most people tends to be the part that really is the most difficult to overcome so very often people say i really want to quit smoking enjoy it so much and it's really does but i really want to quit but i enjoy it i really want to quit but i have too much stress and really want to quit but i'm worried about my family just does but that we have to take care of because those predictable things we do every day being in the car after meals computer first thing in the morning break time coffee without the all those are pretty much very common times that most people will have a cigarette with these particular activities plus you know there's been many more and everybody has individual habits but when you're thinking about your habit you want to rethink it do i really need to do it do i really need to do this what i'm doing now to maybe to do it this way can i reinvent it can i do it differently can i drive to work differently reinvent how you do something or replace it do i really need that coffee maybe i can have hot chocolate maybe i have coffee in the car instead of at the table where you always have my cigarette and most important thing is when you're getting ready to confront the different habits of changing up your habits when you quit smoking before you actually quit you want to rehearse those habits in your new format so if you're going to change up your teen at the maury or drive a different way to work or have something different for breakfast instead of coffee you want to take a few days and rehearse doing those new habits without the cigarette so for at least once before you quit your brain's been able to experience that activity or that habit with the cigarette so it's a little bit  familiar to the brain and the brain understands what you're doing is just not a total jolt so when her saying is very poor and rehearsing those habits this new habit you're going to be doing before you quit this is helpful usually only last anywhere from a few days to the end of the first week it can be very disconcerting when you first quit smoking that you feel a little little light headed a little woozy it's like glass bubble that you can't think straight you can't concentrate actually that comes from the fact that when you quit your oxygen is flooded with new oxygen and the brain literally gets a little bit of an oxygen high and because of that the brain you know you kind of have that the brain is adjusting to those higher levels of oxygen which in the long run is very good thing for the brain but for few days after you first quit it's a little disconcerting for you but that is one thing that goes away fairly quickly things i e that your ability and the tea that can go on for a few weeks it can usually peak around the third week and then by the fourth fifth we can starting to get better but usually by the third week people i am done with this i can't take this anymore i'm done i just don't have a cigarette that's why those these two reasons that i just explained is why most people will relapse or go back to some of the counter a few days or that so many times within the first week and a lot of times people say oh i only made it a few weeks i only made it a month so those are the two big relapse points we worry about during that first week basically helpful to quitting extra sleep really really important your body is going through very a lot physically going through a lot and mentally going through a lot so you don't get tired it's a part of quitting so get some extra sleep but on the other hand you want to exercise because again that activity is good for a couple reasons there's nothing more beneficial than the walking and nothing that you will get a bigger bang for your buck than the walking because the walking will help you deal with stress one of th cry and deep breathing deep breathing in itself is walking around and around with a little bit higher blood sugars and you should sit in the wall and when you quit your blood sugars kind of go down which is why you're hungry all the time and also preaches cravings so cinnamon will kind of help regulate that blood sugar a little bit and hel eliminate cravings and also appetite stuff eating breakfast is important for that reason because your blood sugar level is dropping you need to give birth in the morning most smokers will have a cup of coffee in a cigarette that cigarette does increase your blood sugar level and doesn't reach your metabolism and gives you that get up and go in the morning and you miss that in the morning and then if you just have your coffee your sleeping your coffee your drag and that's not a comfortable feeling on especially if you have to go to work you have a job so even breakfast will do the same thing that the cigarette did it will get your metabolism going it will get your bush blood sugar up it'll increase your heart rate and blood pressure so kind of give you that will get up and go that the cigarette  did i would be it without poisons carcinogens and all that other stuff so we always recommend when you quitting smoking is to eat breakfast and the other thing that will help with your energy levels in the morning is just  and do a couple deep breaths get that oxygen flowing and get the blood flowing that is going to help tremendously although that energy level they need in the morning and also the only multi vitamin because it's a lot of work physically and mentally to quit smoking it does your immune system does take a hit and a lot of times usually within the first couple weeks of putting a lot of people want a cold getting a cold or feeling sick and alive it's because your immune system just took that hit  little bit more vulnerable to getting sick so take a multivitamin keep your immune system boosted which by the way walking also helps the immune system so again you get a lot of bang for your bu these but probably the biggest thing i can tell you for cravings for stress this is kind of an all planned in the state plan and because when you're feeling stressed we all get a craving when you're having a sick craving for a cigarette you're going to get stressed they go hand in hand so whenever you're having a craving or having stress you want to incorporate your escape plan we sometimes call this the five decent it's a little bit on  line here in a minute but with those escape plan the first part is delay you want to have five or ten playing to the grain in the restaurants because if you think about it that cigarettes going to take about five or ten minutes to smoke so five or ten minute plan to do something else other than smoke a cigarette second the fourth d is to do something else so you want to eat you want to walk away from that person place or thing that's making you stressed that's causing you a craving and guess what learning to cope with stress i mean walking away when you are stressed is a very good way to cope if you want to walk away from a person place or thing that's making you feel stressed i'll talk about why you can sometimes walk away that moment and what we do then but walk in the way you know because you know i just can't do when i'm at work sometimes i just outside of an office and walk inside the hall as i'm going to the gift shop and look around sometimes i'll call somebody sometimes i'll just do something else for a few minutes to get my mind off of it sometimes i'll go complain to my boss  but you know for a few minutes i get away from it and that is a good way to cope so that's something that you want to plan for how can one get away to other then that cigarette can i go for go outside but instead of stopping for a cigarette just walk a little bit and i do some deep breathing go in the bathroom and wash my hands wash my face brush my teeth and i pick up a book or a magazine and i just close my eyes and daydream for a few minutes but whatever it is you need to look scape if you can made that promise to ourselves i blame our parents because if your parents ever told you no dessert you eat your vegetables no t v to do your homework can't play outside to clean up your room we're used to getting their reward when we do something we don't want to do but when we're done with it we get something so we give ourselves something we wanted that to be something else to be not  something else other than a cigarette i know i'll sit at work and i'll say thinking i'm here on that you know bad day can't wait to get i hear i'm going to stop and do this i'm going to do that when i get home you know i promised myself something that i can look forward to and we all need that something to look forward to if we don't give ourselves something to look forward to when putting we feel deprived that we build a private say i don't deserve this i don't care anymore and i just got so the rewards are very very important and yes well people reward is quitting smoking i'll be healthy and i think that's great that's wonderful you're going to be healthier but you're not going to that's not going to do it you need those tangible rewards that you can give yourself or family members i always say need that can always blam is tell your spouse your family member and say you know what the person the hospital said that i need a reward so please do this do that for me so i can quit smoking  these are the psychological barriers and i spoke a little bit to these before you know i want to quit smoking but i enjoy i worry about being way too much stress i might fail these are going to go away we can't magically you can't magically tell your brain i don't enjoy smoking anymore or i don't want to smoke because your brain is going to be smarter that the brain knows you do it so you kind of have this is where the mental part comes in and so i really want to put some money but enjoy it so much but i'll enjoy health more and the joy my kids more i'm going to you know think of other things that perhaps you also enjoy in life if you're worried about gaining weight it's ok if i gain a few pounds this is more important you have to kind of a list but i'm things you kind of pump yourself up past it so you can face those things and again can't really eliminate them but accept them deal with them cope with them whatever it takes the next five things i'm going to do over this are the steps to the put plan i do have handouts in the other room you're welcome to take those and those handouts do go over these five steps that i am about to give you the first one is to get ready and what we suggest to setting a quit date a lot of people will wake up or go to bed when i say up tomorrow morning i'm not going to smoke i quit tomorrow morning without any preparation and invariably by the end of the next day they are smoking and a lot of times i'm having their quit planned in a single lifetime spend their quit plans to increase the ability of you to be successful at quitting because you're planning on planning for those habits you're planning for the physical part of what you're going to do you're planning for the psychological barriers the emotions because you're planning for those and you ready to face them you're ready to deal with them you know how you're going to handle that eventually or successful so set quit date make a list of the reasons you want to quit and not to quit and this is important because the reasons why you want to quit is what motivates you to quit but it doesn't keep you quit the reasons why i don't want to quit are the reasons why you may relax and go back to smoking so this was all motivate you but unless you confront once on this list which are really your psychological barriers in life you confront and have a plan to deal with what's not to go on the not to quit list it's going to hard to be successful change your environment and review past experiences was past experiences are never ever failures they are part of the process they're part of the process of learning that takes place when you quit i've seen reports saying that look smokers these days have to quit twenty twenty five times before they're successful but you know what it's really hard it's real hard to pour your heart and soul your money your effort time into trying something and not make it and the hardest part of putting is getting up and putting again so you know look at those they are not failures they're opportunities to learn their opportunities to move forward take what works get rid of what didn't add to the mix and go for it anticipate the challenges and plan ahead of those i'm talking about and it surviv kit you know how weeks i can't take this anymore he grab the cigarettes and you walk out well instead of grabbing your cigarettes have a little bag of maybe some gum some water weights a book or magazine a cd of your favorite music so instead of grabbing the cigarette little bit out see go out and do something support is instrumental sometimes family and friends are not always the best support basically that support needs to be on full thrusters for a good thirty days because it takes a good thirty days to kind of get through the initial phase of quitting  you know a lot of folks i know will you know say oh aren't you in a week or two don't quit and yet so quitting quitting takes months and the first thirty days is the big rollercoaster ride where you need the most support and the support of ask and honestly i've been a lifelong nonsmoker and when my mom was quitting smoking i did all the wrong things and what you really need to do is ask the person that's quitting what do you need me to do what can i help you with are going to be there or automatically i would say because she did quit but she quit when i moved out of the house and i asked her i asked her mother why did you know why didn't you quit while i was still living at home i was there for you i loved you i was helping you i was supporting children restraining i other thing too that's very helpful in dealing with the cravings associated with quitting and the stress of just everyday stress even don't wait until that moment really like what you want to do is every couple of hours take a five minute break whether it's just a walk down the hall or a walk to the restroom and you washing your hands or getting a cup of drink a water a cup of coffee or just leaning back and stretching and breathing wherever you are at the moment if you can take makes it easier to cope with all the other crap that might come up during the day so a lack of a better word excuse my language but planning for just taking those little rock relaxation breaks during the day are very important quit plan medications talk to your health care provider there's not everybody is i will tell you that i have had to take care of people with every medication that's been out there and what one person  great on another person does terrible on they could be one thing and then they try something else and that works better it's different every eighteen years i've been doing this and many many many i probably thousand i don't know but the people that i work with as are quitting smoking i can honestly say no two people are the same everybody finds a little something a little bit different everybody finds what works for them that's why i often eat those repetitive those repeated attempts defining what works for you even more importantly why don't we and i will say that the current practice guidelines who are treating tobacco use does strongly recommend the use of medications but again it's not for everybody i have had people that have quit without medications and that's fine but they do take into account one of those other things i talked about that you can do for the physical side but if a patient can reduce withdrawal symptoms it doesn't live in and that reinforcing a fact because remember that big release of  it gives you time and this is what's really important medication maybe physically more comfortable giving you time to comfortably great to have it and the psychological dependency it's very hard to break that habit or psychological dependency when you're having a lot of the physical effects of quitting so that's what medication can often do for people just makes you comfortable so you can deal with this and this and that it is very addictive it is as addictive as prescription patches over the counter you know twenty one fourteen and seven milligram if you are if you are half a pack or more days store i'm twenty one if you're anywhere between anywhere under half a papist are fourteen we generally don't recommend starting on the south you can wear it at night sometimes people get wild and crazy dreams a lot of people describe it back in the sixty seven dollars some people like them some people don't so i'm removing it you can remove it and i there's pros and cons to that nicotine the most important thing about the nicotine gum is that it's not to look like regular gum you'll get in your mouth and both of them and that was it you can take that on when you first quitting you can take that on a regular basis like every about every one to two hours has is one of those medications that was developed it is a pill it's prescription it was developed just to help people quit smoking i've had people that have taken sharon tests and it's like wow i never smoke again it's like some something you know flip t switch off in their brain other people who been taking it taking it nothing absolutely nothing new about that but other people who have had very severe some minor side effects i've had people have had very severe side  your behavior particularly with what we're all here for today you know there's been an increase in suicidal thoughts and even suicide with chantix so is anybody you want to have people looking out on to you to anything changes in your really no scientific proof there's a few studies and say it does has a few studies that say it out so we really don't know at this point there's no targeted studies telling us i think exactly what to do with the cigarette so it can help you quit smoking most don't really know anything we do know that there is a list in regards to quitting but we do know that the nicotine in the cigarettes is addictive and can keep you addictive because the chemicals they put in those areas also cause the nicotine to hit the brain really quick giving that type feeling that keeps the addiction going we don't know all the health effects of they've been but we do know there are chemicals in them and those are ways and there are percentages there are fine metal made so if you you know after a while and then you start to degrade my husband's in engineering i was talking about metallurgy and you know engines engine parts you know that we have to replace the engines because the metal actually becomes very fragile can even start like off and that's what happens with the east cigarettes over time they're not regulated they are not well actually they are not regulated but they are they just pass the rules and they are going to start regulating and i don't think those regulations are all  toxic chemicals and they do take lithium batteries and we know the story of lithium batteries that can catch fire and explode we particularly worry about children again a lot because of those harmful particles of the spine metal bell particles that are in poison and can cause you to stop breathing and there have been a couple cases of toddlers dying after drinking so the child picks up a cigarette butt and put it in their mouth it's like his back they throw away they pick up the parent planning ahead always recognize your dangerous situations and then bill in coping skills this is what you're planning is this is what you rehearsed in his these are a lot of things that we've discussed we've talked a lot about the physical how to manage the physical effects of quitting everything up here we're talking this is just a quick review to put everything together for you so these are some of the things that we've discussed to man help you manage the physical effects of quitting these are some of the things that we talked about the rethinking the reinvention replacing distraction all those things and talked about i do think that visualization is very important you know kind of thinking you know if you're going to a party or a car out  so again it's always that planning ahead making sure you have enough things in your basket or the things in place that you can use to keep you from not smoking so that pretty much smokers in the house eat a healthy diet stay happy and use multiple resources counseling support and then occasion that combination gives you the best results there are some very good resources to help you  quit the pretty quick line it's a free phone call for a quick coach they have free packages available so if you do the program with them is a wonderful way to get support counseling and medication all three pieces that you need to be successful you can get through the quit line if you don't want to actually talk to a person there's also that program is also available online so that is a good program we of course have free programs at the hospital and  resources through throughout allegheny county the last thing i can leave you with the last thing i can leave you with in this is the most important thing that i can tell you as you're going through the journey of quitting is never quit quit you don't do it the first time try the second time third time keep going at it and to your able to do it for good i know it can be discouraging i know it takes a lot out of you every time you put your  you know they would be able to give you that number and if all else what you can do is just google a state west virginia or quit line kansas quit line michigan quit line and see what comes up most a student now have quit lines on the lot of his paid for by the money denver from national jewish out there which is an internationally renowned hospital hospital for pulmonary breathing problems and you know if i was going to get anybody to do it it would be national jewish center that  years even if the mission i gave twenty twenty five years ago i would say oh the cigarettes that you need to hit your brain seven seconds sounds like two or three seconds so you know it's become much more efficient delivery devices over the years and when  psychological issues i do like the combination will be you sure and the patch together that is one combination you can use to get where it's going between in the past that does seem to work very well but again i would advise you to talk with your physician