“Robert, you’ve had some second chances,” my cardiologist said, “You might be pushing things.” The conversation came near the end of my annual visit with my heart doctor. Two days prior to my visit, I had my quarterly lab and CT scan that are part of my high-risk cancer surveillance program. The CT scan came out as NED – “No findings to suggest local recurrence or metastatic disease in the chest, abdomen, or pelvis.” In the words of my oncologist, my scan and lab/blood work came out “great.” My heart doc went back over the results and noted specific areas that pertained to my heart. The only areas of concern were my two aneurysms - a thoracic aorta aneurysm which was stable and unchanged, and an abdominal aorta aneurysm in which there was a mild dilatation. Both will require stents at some future point, but, for now, they are not areas of concern. Other than that, my heart doc said my heart was in good shape with excellent results regarding my lipids and cholesterol. The conversation then turned to my high blood pressure problem. In my last three CT scans, my BP was high - 146/85 (1/21/19), 148/85 (10/16/18) and a whopping 151/80 (7/16/18). My BP that morning at the heart doctor was 106/72. Needless to say, I had my concerns. Although my heart and blood work was fine, I didn’t like the idea of being visited by a sudden stroke. “Do you still smoke?” he asked. “Yes,” I answered. “I smoke about 7-8 cigarettes a day.” It was no secret to my cancer team that I smoked. It was on my medical profile. At the time of my heart attack in November 2012, I was smoking nearly two packs a day. “Robert, you’ve had some second chances. You might be pushing things. Seven or eight cigarettes are still too much. Right now, you’re free of cancer. So, there’s that. And your blood pressure problem could be very well related to your smoking. It’s time you quit.” At this point, readers may wonder why in the world a cancer patient would smoke. You would think that two cancer surgeries and sixteen rounds of chemo would be enough to quit. Some people never get a second chance. So why double-down and flirt with The Beast? Smoking among cancer patients/survivors is one of those “inconvenient truths.” I observe that disturbing truth when I go for my appointments at the cancer hospital. Patients in their gowns, arms attached to IV stands, hunched over and smoking in designated areas outside the hospital. It doesn’t matter if it's raining, snowing, or cold. They are always out there. Walking contradictions lost in the plumes of smoke. And I was part of that inconvenient truth with my habit of 7-8 cigarettes a day. According to the Surgeon General’s report in 2014:
It’s estimated that about half of patients who smoked before their diagnosis continue to smoke following cancer treatment, and that many who quit relapse. “With the stress cancer patients are under, they tend to be at higher risk of relapsing for a longer period of time,” said Brian Hitsman, associate professor of preventive medicine at Northwestern University Feinberg School of Medicine. “Personally, I’m not surprised,” said lead researcher Robert Schnoll, a psychologist at University of Pennsylvania. “I’ve been working in nicotine dependence research for 20 years. The brain chemistry is affected by decades of exposure to nicotine. Some patients view [smoking] as critical to managing the stress in their lives.” Depression is another factor. Approximately 58% of cancer patients suffer from depression compared to 10% of the population. For me, aside from addiction, stress and anxiety are significant factors. It’s not easy being a cancer survivor. I don’t sit around and constantly think about a recurrence that will come back and kill me. But I think just living with cancer, despite bring NED, is in and of itself a stressor. It seems like I’m living from CT scan to CT scan and not knowing what the next one will bring. And the scanxiety is more acute on the day of the scan. And there’s the stress of everyday life of a survivor. Little aches and pains that become magnified and with it the thought - has it come back? In 2012, following my emergency angioplasty, I began using an electronic cigarette. That seemed to work although the strength of the nicotine was basically the same as a nicotine patch. The attraction of the e-cig was it was similar to a smoking cigarette - a long, thin object shaped like a cigarette that you placed in your mouth, inhaled, and exhaled smoke. Four months later, I was diagnosed with colon cancer. My oncologist gave me a prescription for nicotine patches and an inhaler. But those didn’t work and I began smoking 1-3 cigarettes a day. Eventually, I worked my way to my current level of 7-8 cigarettes a day. Of course, I’ve always felt guilt and shame by smoking. Cancer survivors, of all people, should know better than to smoke. And I think that those of us who do continue to smoke feel like pariahs in Cancerland. However, according to Dr. Alberg, Professor of Public Health Sciences and the Associate Director of the Hollings Cancer Center in South Carolina: “So, I think first and foremost, please recognize that smoking cigarettes is not a failing of you as an individual. If you are a smoker, it is not a personal failing. Most adult smokers tried cigarettes when they were young, in childhood or when they were a teenager, usually for social reasons, and from that experimentation, end up with a nicotine addiction that can be very difficult to overcome. So recognize that this is an addiction, that it's not easy to overcome, but can be overcome with effort and with the appropriate help.” Dr. Alberg’s words don’t give us the green light to smoke. Rather, his words help us understand that our addiction is deep-rooted and, perhaps more importantly, we’re not failures (or pariahs) because we continue to smoke. Looking back, I can say I had appropriate help. My oncologist, assistant oncologist and nurses encouraged me to quit. Nicotine patches were offered and brochures for QUITPLAN were given to me. My cancer team thought it was a bit of an achievement to go from two-packs a day to under a half pack. But they felt that I should take it a step further and quilt altogether. What was lacking was any real effort on my part. Smoking cessation products can help curb the need for nicotine, but cessation requires the will to quit. And having the will to quit is the most difficult part of cessation. It was my cardiologist who gave me the sternest lecture on the hazards of smoking. He wasn’t talking about the effect of smoking on my heart since my heart was in good shape. Rather, he emphasized the danger of contracting a secondary cancer. We decided on a prescription for Chantix. Oddly, I had never been offered such a prescription from my oncologist. Perhaps such a prescription had to come with my heart doctor’s approval since Chantix’s side effects could impact my heart. My heart doc said that Chantix wouldn't interfere with my current heart regimen of metoprolol, lisinopril, baby aspirin, and rosuvastatin. And because I was in good shape physically, including my heart, my heart doctor green-lighted the prescription for Chantix. Of course, I realize that all this time I’ve only been kidding myself. Seven to eight cigarettes may sound good compared to two packs. But that doesn’t make me immune from secondary cancers. And contracting secondary cancers runs high in survivors who smoke. And then there is my high-risk cancer surveillance program that is scheduled to run for over several years with periodic CT scans and lab/blood work. I admit that I’ve harbored the thought that if any recurrence or secondary cancers develop, the scans will catch it in time, so why worry about a few daily cigarettes? But do I really want to face the consequences of that route? Face the possibility of more surgery and chemo? Or what if The Beast metastasizes so quickly that it can’t be stopped? I had a dream about this the other night. I was holding a box of Chantix. I was looking at a pill. My finger was over the plastic bubble and slightly applying pressure against it to pop it out. In the shadows, The Beast gleefully lurked and encouraged me to stay my hand from popping out a pill. As of this writing, I have yet to begin my smoking cessation program. But the dream gave me an obvious choice of what I need to do. It isn’t just about quitting smoking. It’s more about preventing the deadly specter of The Beast back into my life. In Cancerland, The Beast (or whatever you chose to call it) is always the foe. That’s what the battle is all about. Second chances is about not relinquishing to the enemy. And second chances is about reaching and maintaining a quality of life in which one can achieve personal goals. Not everyone has the opportunity for second chances. I do. © 2019, Robert DesJarlait
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Robert Desjarlait
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