Member Questions and Answers from Joanne Lynn, MD Tobacco Cessation Joanne Lynn, MD serves on the Medical Advisory Board of The Transverse Myelitis Association.  If you have questions for Dr. Lynn regarding the Transverse Myelitis condition, please send those to Sandy Siegel; we will attempt to have your questions addressed in a future newsletter. The following information is offered as a general response to questions related to Transverse Myelitis and is not to be construed as a specific medical recommendation for any individual.  This response is based on the information provided in a brief question and is without the benefit of a complete history or an examination.  Any decisions regarding diagnosis or treatment should be made in consultation with your personal physician who is best suited to make appropriate medical recommendations for you. Q. Why should a person with TM consider quitting smoking and what suggestions might you offer to help them quit? Approximately 23% of US adults smoke cigarettes; tobacco use is the leading cause of preventable death in the US.  More than 2/3 of current smokers state that they wish to quit.  However, less than 10% of smokers who try to quit without treatment remain abstinent in the long term.  Smoking is a problem for many people with Transverse Myelitis.  There is little data about the effects of smoking on TM.  In one study on Multiple Sclerosis, there were minor deleterious effects reported on motor function; however, this is relatively insignificant compared to the multiple other health problems caused by smoking.  Some people with TM see their neurologist more frequently than they see their primary care provider, making it incumbent upon the neurologist to attempt to motivate patients to quit and to be familiar with potential treatments. Barriers to quitting include tolerance and physical dependence on nicotine and psychological factors related to tobacco use.  Two treatments have been shown to be helpful in smoking cessation: drug therapy and counseling.  An approach that employs both of these treatments is most effective of all.   Counseling Counseling for smoking cessation generally involves teaching about strategies to deal with stress and symptoms of nicotine withdrawal.  Smokers often learn to associate smoking with certain cues and times such as after meals, when relaxing, to unwind after an argument or other stressful event, during a work break, or with an alcoholic beverage.  Cognitive counseling helps to teach smokers to break the links between these cues and smoking. Drug Therapy Nicotine replacement therapy provides nicotine to relieve cravings and symptoms of withdrawal.  The use of nicotine replacement therapy is associated with significantly better rates of smoking cessation.  Nicotine replacement is available in various forms: a skin patch, chewing gum, nasal spray and a vapor inhaler. Other drugs besides nicotine are used in smoking cessation efforts.  Buproprion (Zyban) has been shown to be helpful in combination with supportive counseling.  Other medications which may be helpful include nortriptyline and clonidine. Other Treatments Hypnosis as a treatment for smoking cessation has been inadequately studied thus far.  Studies of the use of acupuncture have failed to show effectiveness. Approximately 50% of moderate or heavy smokers die prematurely due to illnesses related to tobacco abuse.  Even if initial attempts to stop smoking result in relapse, many smokers eventually achieve long term abstinence after multiple attempts to quit. Smoking cessation increases life expectancy and reduces the risk of tobacco-related illness leading to a better quality of life for people trying to live well with their TM.   Reference:  Rigotti N. Treatment of Tobacco Use and Dependence.  NEJM. 346(7), Feb. 14, 2002, pp. 506-512.

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