Selected Podcast
Quitting Smoking for Good
Are you ready to quit smoking? Dr. Sidharth Bagga discusses how you can quit smoking for good, and how the Oroville Hospital's smoking cessation program can help you kick the habit once and for all.
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Learn more about Sidharth Bagga, MD
Sidharth Bagga, MD
Dr. Sidharth Bagga joined Oroville Hospital as a pulmonologist, internist and critical care specialist in 2012. He studied medicine at Saba University in the Dutch Caribbean and received residency training in internal medicine from Copper Medical Center in New Jersey. Fellowship training from Thomas Jefferson University in pulmonary and critical care furthered Dr. Bagga’s expertise in the physiology and reversibility of chronic lung diseases. Dr. Bagga treats patients for common conditions such as lung cancer, pneumonia, COPD and smoking. He has been instrumental in spearheading the hospital’s smoking cessation program for patients.Learn more about Sidharth Bagga, MD
Transcription:
Melanie Cole (Host): Every year millions of Americans quit smoking or try to quit smoking and maybe this year, you’ve decided to be one of them. You know that it’s going to be a tough journey, but we’ve got some answers for you here with my guest to help you begin this process. My guest is Dr. Sidharth Bagga. He’s a pulmonologist with Oroville Hospital. Dr. Bagga let’s talk about some of the harmful effects and the financial burden and really the economic impact that smoking has on the country today.
Sidharth Bagga, MD (Guest): Smoking is the most preventable cause of injury to the body in the country at this point and today’s date. Financially, it costs people a significant amount of their annual earnings to support this habit and in the process; it’s hurting their body in multiple ways from the lungs, the cardiac, the risk of cancer to joint pain and even difficulties with vascular approaches to their organs and ulcerations. So, the problem is not just a financial; it’s also a burden on the patient’s body and on the society as a whole because as people with smoking related lung disease or other organ diseases get worse; then that burden then either passes on to them in terms of the cost that they have to pay or back to the society and the society then foots the bill for the entirety of care for people who can’t afford to care for themselves. So, cigarette smoking is literally the most important healthcare problem that the United States faces at this point, in this stage.
Host: So, why is it so hard to quit? What’s the addictive property of smoking and Dr. Bagga what happens when somebody quits smoking?
Dr. Bagga: Cigarette smoking is – it creates a pathway in your brain that is very similar to the feedback that we get when we eat. You can imagine that everybody we meet is addicted to food. And what the cigarette provides you with is nicotine. Nicotine is best delivered through smoke. If there was a way to deliver nicotine as rapidly to your brain as smoke does; all the cigarette manufacturers would jump on it. Cigarettes are not a device to sell you smoke. It’s a device to sell you nicotine. And nicotine has the addictive properties. Nicotine is also essentially what gets released in your brain after eating. So, it’s just as hard to quit smoking as it is to quit eating. So, that is why when people attempt to quit smoking; they always feel the need to eat more to augment that in the missing enzymes is why they feel they are not as good, they are not feeling as good as they have before when they were smoking. So, people tend to gain weight.
Nicotine replacement products even though they are effective for getting the nicotine; they are not as quick as getting that nicotine to your brain, so it would never be able to associate that addiction that every puff makes me feel better right away rather than taking a lozenge or a nicotine gum which makes me feel better 20 minutes later. So, the problem is not so much – the addiction is not the smoke, the addiction is from the nicotine and quitting is just that difficult because it is one, widely available and used to be supported by society and two, it is as difficult to quit as it is to quit eating.
Host: So, what do you think is harder to quit, the behavioral portion because for some people it’s going out in the garage or the movement between their fingers or whatever the behavioral aspect of it is or the physiological, that addictive nicotine prospect? Which do you think is tougher? And while you are answering that question Dr. Bagga, start with the process. What’s the first thing you want people to think about when they are thinking about whether it’s behavioral or physiological and what you want them to do first.
Dr. Bagga: So, most people who are smoking nowadays started usually when they were younger. They were targeted heavily by cigarette company ads and even unfortunately physicians earlier in the years. So, it was societally the normal thing to do even the “cool” thing to do. That has stuck in a lot of people’s heads as that’s the norm. And to think that cigarette smoking advertisement has stopped would be a mistake. They still spend about 9 billion dollars a year in advertising even though they are not on TV, they are not on radio, they are not – they are just print ads. So, there’s a lot of effort still in convincing people that cigarette smoking is the right thing for them to do.
So, the behavioral aspect of it is you have a process that you are used to doing. There is some structure in your family, be it your friends, your car, your coffee in the morning that triggers that behavioral aspect and you want to do it and you can’t give that up because it’s the first thing you do and once you start for the day; you are not giving up. A lot of times I talk to my patients about realizing that there are multiple ways to quit smoking; but the first step is to admit to yourself that you are interested and a lot of times I ask patients are you interested in quitting smoking, and if they are not interested in quitting smoking; they are not going to succeed.
So, step one is always to identify am I ready to quit smoking. And if you are; then that’s excellent. There are multiple pathways including what we call “cold turkey” which is you just stop, and you give up and if you have the willpower and the mental capacity to do it; you do well, and you remain quit smoking. But most people end up using some kind of smoking cessation aid be it lozenges, gum, mediations or behavioral therapy including hypnotism or electronic cigarettes. Most people will find what works for them, mostly by trial and error methods, but the patches are probably the first step once the patient is ready to quit smoking or understands that they are ready and willing.
I tell them to develop a quit date, figure out their triggers, avoid those triggers and then act on it. And then hold themselves accountable. Have a family member hold them accountable. Make appointments with the physicians to check in every few weeks to make sure heh, I’m on track or do I need more support or am I doing well the way I am. That is the way I would typically approach most patients who are trying to quit smoking.
Host: If nicotine is so addictive, if someone goes on the patch or they are trying Chantix or any of these others; will they experience that nicotine withdrawal and what can they expect those first weeks to feel like?
Dr. Bagga: Nicotine is very addictive. It is the whole reason the industry is still surviving despite so many bad outcomes happening from the use of this product. So, there is no other product that causes cancer and is still available on the market on a routine basis. If you think that – so when you stop nicotine, people have a transient withdrawal syndrome where they feel like that they are missing a calming source in their body. Nicotine itself, raises your levels of stress in the body and then use of nicotine then brings it back down to a normal. So, when people notice that my stress level is increasing it is not because nicotine – the lack of nicotine is doing that; it is because the nicotine already raised it to a higher level and then just brought it back down to a normal. So, when people take up quitting smoking and they notice these withdrawal symptoms; use of patches to stabilize this withdrawal syndrome is the best way. Lozenges, gum also work well, but people don’t tend to associate that instantaneous effect that they get with cigarettes. So, it is a matter of grit and kind of persistence through the initial withdrawal phase and once that withdrawal phase goes away; most people are able to tolerate – don’t have any significant nicotine withdrawal as your brain rewires itself to not expect such a high level of nicotine.
Host: What about the worry of things like weight gain with quitting or going to social events when you feel like that’s been sort of a crutch or where people might be smoking and the advent of vaping, you know Jewels and these E-cigarettes that supposedly are “better for you.”
Dr. Bagga: The societal aspect of smoking has drastically improved over the last five, ten years. There are grading systems for states on providing places that are smoke-free, not allowing in public places, and almost every state is moving in that direction. So, the majority of the societal impacts that people notice with smoking are in their own houses. And as people realize more and more that smoking in and around their house is making their family members sicker, their kids develop asthma, them developing other health conditions; people are realizing that that is not what they want for their families. So, the societal impact I think is less and less in fact, I think it promotes the quitting of smoking.
As for the newer replacement products of cigarette industry, the Jewel products and the electronic cigarettes; those are a means of behavioral modification. If somebody is anxious and needs something in their hands or mouth or something along those lines to keep them occupied; it is a means of moving away from cigarettes; but by no means is it healthy for you. The electronic cigarettes have also been known to have carcinogens in them. Even though the initial products are deemed very safe; they are still found to have carcinogens. Not is as high a quantity as cigarettes but they are still there. It is the equivalent of saying I’m going to be eating a pound of butter because it’s better than eating a pound of some oil or something bad. So, it’s equivalent in the bad outcomes, but it’s newer so it’s more societally acceptable; but still is not good for you.
Host: And if you slip up, if you have got that willpower, maybe you went cold turkey, maybe you did the patch, or you did some medication assisted; you went to support and counseling; you did all of the things that are really good ways to quit smoking. Dr. Bagga what if you have a slip up? Then what? You get right back on the wagon? And also speak about your smoking cessation program and what it offers.
Dr. Bagga: So, I typically tell my patients that failing to quit smoking is not a failure. Failure to start quitting smoking is the complete failure. So, I have patients who start quitting smoking and they fail twice a week. They keep at it. The goal is to not quit on quitting. And as long as you keep trying, you will succeed. I have had patients try to quit smoking for two years and then eventually come to a point in their life either financially or health wise or mentally that this is just not the right thing for me and then the next day, they are done. So, because you have failed once or twice or three times, is not an indication to stop trying. So, there are multiple other avenues of trying to treat smoking so if you fail one, try the other, try the next and keep going. Your physician should be able to help with that.
In our community here, we have a smoking cessation program. It is a clinic visit that is based solely for the purpose of helping patients quit smoking. Most of the times when you go to your primary care out of the ten medical problems you have; one of those is quitting smoking and literally has very minimal amount of time spent on counseling provide or options discussed. In our clinic, we discuss only smoking cessation. We discuss the options, the avenues, the medications, the side effects, the risks, the benefits and the expectations. And patients seem to accept that more readily, understand that this is the focus and once they realize that this is the goal; they are able to act more decisively on that.
Host: Then wrap it up for us, because this is really a great topic and so important for our society Dr. Bagga. Give your best advice for people that love somebody who smokes or are considering quitting themselves and what you really want them to know about just the tough part, getting started, which seems to be everybody’s biggest fear.
Dr. Bagga: The biggest obstacle is ourselves, in trying to quit smoking. So, we have been brainwashed for the longest time by society, by media, by everybody around us who smokes that this is not bad enough, this is what helps, this is what you need. And we need to change that mindset. I typically talk to my patients and I discuss with them and I said – I tell them imagine if there was a medication that you would have to pay completely out of your pocket, no insurance coverage to calm your brain and in the process this medicine would cause you to have heart attacks, strokes and lung cancer. And I ask them the question, and ask them would you ever pay for a medicine out of your own pocket and the answer is a resounding no. And then I ask them what if that medicine was cigarettes? And they came in the form of a cigarette – the pill was a cigarette. Would you buy that cigarette? And the answer is absolutely not, and it changes a mindset. You see a light bulb go off in people’s head and they realize yeah, I’m doing this to myself at my own cost to hurt myself and that is the good start where you can realize I don’t need to do this. This is not in my best interest.
Host: Wow. What a great analogy because really the light bulb went off in my head too when you said that. It’s like wow and plus the cost of it is so expensive for smokers. Thank you so much for coming on today Dr. Bagga and explaining all of this and sharing your expertise and telling us about the smoking cessation program at Oroville Hospital because it’s so important that people take that first step. Thank you again for joining us. You’re listening to Growing Healthy Together, a podcast by Oroville Hospital. For more information please visit www.orovillehospital.com, that’s www.orovillehospital.com. This is Melanie Cole. Thanks so much for tuning in.
Melanie Cole (Host): Every year millions of Americans quit smoking or try to quit smoking and maybe this year, you’ve decided to be one of them. You know that it’s going to be a tough journey, but we’ve got some answers for you here with my guest to help you begin this process. My guest is Dr. Sidharth Bagga. He’s a pulmonologist with Oroville Hospital. Dr. Bagga let’s talk about some of the harmful effects and the financial burden and really the economic impact that smoking has on the country today.
Sidharth Bagga, MD (Guest): Smoking is the most preventable cause of injury to the body in the country at this point and today’s date. Financially, it costs people a significant amount of their annual earnings to support this habit and in the process; it’s hurting their body in multiple ways from the lungs, the cardiac, the risk of cancer to joint pain and even difficulties with vascular approaches to their organs and ulcerations. So, the problem is not just a financial; it’s also a burden on the patient’s body and on the society as a whole because as people with smoking related lung disease or other organ diseases get worse; then that burden then either passes on to them in terms of the cost that they have to pay or back to the society and the society then foots the bill for the entirety of care for people who can’t afford to care for themselves. So, cigarette smoking is literally the most important healthcare problem that the United States faces at this point, in this stage.
Host: So, why is it so hard to quit? What’s the addictive property of smoking and Dr. Bagga what happens when somebody quits smoking?
Dr. Bagga: Cigarette smoking is – it creates a pathway in your brain that is very similar to the feedback that we get when we eat. You can imagine that everybody we meet is addicted to food. And what the cigarette provides you with is nicotine. Nicotine is best delivered through smoke. If there was a way to deliver nicotine as rapidly to your brain as smoke does; all the cigarette manufacturers would jump on it. Cigarettes are not a device to sell you smoke. It’s a device to sell you nicotine. And nicotine has the addictive properties. Nicotine is also essentially what gets released in your brain after eating. So, it’s just as hard to quit smoking as it is to quit eating. So, that is why when people attempt to quit smoking; they always feel the need to eat more to augment that in the missing enzymes is why they feel they are not as good, they are not feeling as good as they have before when they were smoking. So, people tend to gain weight.
Nicotine replacement products even though they are effective for getting the nicotine; they are not as quick as getting that nicotine to your brain, so it would never be able to associate that addiction that every puff makes me feel better right away rather than taking a lozenge or a nicotine gum which makes me feel better 20 minutes later. So, the problem is not so much – the addiction is not the smoke, the addiction is from the nicotine and quitting is just that difficult because it is one, widely available and used to be supported by society and two, it is as difficult to quit as it is to quit eating.
Host: So, what do you think is harder to quit, the behavioral portion because for some people it’s going out in the garage or the movement between their fingers or whatever the behavioral aspect of it is or the physiological, that addictive nicotine prospect? Which do you think is tougher? And while you are answering that question Dr. Bagga, start with the process. What’s the first thing you want people to think about when they are thinking about whether it’s behavioral or physiological and what you want them to do first.
Dr. Bagga: So, most people who are smoking nowadays started usually when they were younger. They were targeted heavily by cigarette company ads and even unfortunately physicians earlier in the years. So, it was societally the normal thing to do even the “cool” thing to do. That has stuck in a lot of people’s heads as that’s the norm. And to think that cigarette smoking advertisement has stopped would be a mistake. They still spend about 9 billion dollars a year in advertising even though they are not on TV, they are not on radio, they are not – they are just print ads. So, there’s a lot of effort still in convincing people that cigarette smoking is the right thing for them to do.
So, the behavioral aspect of it is you have a process that you are used to doing. There is some structure in your family, be it your friends, your car, your coffee in the morning that triggers that behavioral aspect and you want to do it and you can’t give that up because it’s the first thing you do and once you start for the day; you are not giving up. A lot of times I talk to my patients about realizing that there are multiple ways to quit smoking; but the first step is to admit to yourself that you are interested and a lot of times I ask patients are you interested in quitting smoking, and if they are not interested in quitting smoking; they are not going to succeed.
So, step one is always to identify am I ready to quit smoking. And if you are; then that’s excellent. There are multiple pathways including what we call “cold turkey” which is you just stop, and you give up and if you have the willpower and the mental capacity to do it; you do well, and you remain quit smoking. But most people end up using some kind of smoking cessation aid be it lozenges, gum, mediations or behavioral therapy including hypnotism or electronic cigarettes. Most people will find what works for them, mostly by trial and error methods, but the patches are probably the first step once the patient is ready to quit smoking or understands that they are ready and willing.
I tell them to develop a quit date, figure out their triggers, avoid those triggers and then act on it. And then hold themselves accountable. Have a family member hold them accountable. Make appointments with the physicians to check in every few weeks to make sure heh, I’m on track or do I need more support or am I doing well the way I am. That is the way I would typically approach most patients who are trying to quit smoking.
Host: If nicotine is so addictive, if someone goes on the patch or they are trying Chantix or any of these others; will they experience that nicotine withdrawal and what can they expect those first weeks to feel like?
Dr. Bagga: Nicotine is very addictive. It is the whole reason the industry is still surviving despite so many bad outcomes happening from the use of this product. So, there is no other product that causes cancer and is still available on the market on a routine basis. If you think that – so when you stop nicotine, people have a transient withdrawal syndrome where they feel like that they are missing a calming source in their body. Nicotine itself, raises your levels of stress in the body and then use of nicotine then brings it back down to a normal. So, when people notice that my stress level is increasing it is not because nicotine – the lack of nicotine is doing that; it is because the nicotine already raised it to a higher level and then just brought it back down to a normal. So, when people take up quitting smoking and they notice these withdrawal symptoms; use of patches to stabilize this withdrawal syndrome is the best way. Lozenges, gum also work well, but people don’t tend to associate that instantaneous effect that they get with cigarettes. So, it is a matter of grit and kind of persistence through the initial withdrawal phase and once that withdrawal phase goes away; most people are able to tolerate – don’t have any significant nicotine withdrawal as your brain rewires itself to not expect such a high level of nicotine.
Host: What about the worry of things like weight gain with quitting or going to social events when you feel like that’s been sort of a crutch or where people might be smoking and the advent of vaping, you know Jewels and these E-cigarettes that supposedly are “better for you.”
Dr. Bagga: The societal aspect of smoking has drastically improved over the last five, ten years. There are grading systems for states on providing places that are smoke-free, not allowing in public places, and almost every state is moving in that direction. So, the majority of the societal impacts that people notice with smoking are in their own houses. And as people realize more and more that smoking in and around their house is making their family members sicker, their kids develop asthma, them developing other health conditions; people are realizing that that is not what they want for their families. So, the societal impact I think is less and less in fact, I think it promotes the quitting of smoking.
As for the newer replacement products of cigarette industry, the Jewel products and the electronic cigarettes; those are a means of behavioral modification. If somebody is anxious and needs something in their hands or mouth or something along those lines to keep them occupied; it is a means of moving away from cigarettes; but by no means is it healthy for you. The electronic cigarettes have also been known to have carcinogens in them. Even though the initial products are deemed very safe; they are still found to have carcinogens. Not is as high a quantity as cigarettes but they are still there. It is the equivalent of saying I’m going to be eating a pound of butter because it’s better than eating a pound of some oil or something bad. So, it’s equivalent in the bad outcomes, but it’s newer so it’s more societally acceptable; but still is not good for you.
Host: And if you slip up, if you have got that willpower, maybe you went cold turkey, maybe you did the patch, or you did some medication assisted; you went to support and counseling; you did all of the things that are really good ways to quit smoking. Dr. Bagga what if you have a slip up? Then what? You get right back on the wagon? And also speak about your smoking cessation program and what it offers.
Dr. Bagga: So, I typically tell my patients that failing to quit smoking is not a failure. Failure to start quitting smoking is the complete failure. So, I have patients who start quitting smoking and they fail twice a week. They keep at it. The goal is to not quit on quitting. And as long as you keep trying, you will succeed. I have had patients try to quit smoking for two years and then eventually come to a point in their life either financially or health wise or mentally that this is just not the right thing for me and then the next day, they are done. So, because you have failed once or twice or three times, is not an indication to stop trying. So, there are multiple other avenues of trying to treat smoking so if you fail one, try the other, try the next and keep going. Your physician should be able to help with that.
In our community here, we have a smoking cessation program. It is a clinic visit that is based solely for the purpose of helping patients quit smoking. Most of the times when you go to your primary care out of the ten medical problems you have; one of those is quitting smoking and literally has very minimal amount of time spent on counseling provide or options discussed. In our clinic, we discuss only smoking cessation. We discuss the options, the avenues, the medications, the side effects, the risks, the benefits and the expectations. And patients seem to accept that more readily, understand that this is the focus and once they realize that this is the goal; they are able to act more decisively on that.
Host: Then wrap it up for us, because this is really a great topic and so important for our society Dr. Bagga. Give your best advice for people that love somebody who smokes or are considering quitting themselves and what you really want them to know about just the tough part, getting started, which seems to be everybody’s biggest fear.
Dr. Bagga: The biggest obstacle is ourselves, in trying to quit smoking. So, we have been brainwashed for the longest time by society, by media, by everybody around us who smokes that this is not bad enough, this is what helps, this is what you need. And we need to change that mindset. I typically talk to my patients and I discuss with them and I said – I tell them imagine if there was a medication that you would have to pay completely out of your pocket, no insurance coverage to calm your brain and in the process this medicine would cause you to have heart attacks, strokes and lung cancer. And I ask them the question, and ask them would you ever pay for a medicine out of your own pocket and the answer is a resounding no. And then I ask them what if that medicine was cigarettes? And they came in the form of a cigarette – the pill was a cigarette. Would you buy that cigarette? And the answer is absolutely not, and it changes a mindset. You see a light bulb go off in people’s head and they realize yeah, I’m doing this to myself at my own cost to hurt myself and that is the good start where you can realize I don’t need to do this. This is not in my best interest.
Host: Wow. What a great analogy because really the light bulb went off in my head too when you said that. It’s like wow and plus the cost of it is so expensive for smokers. Thank you so much for coming on today Dr. Bagga and explaining all of this and sharing your expertise and telling us about the smoking cessation program at Oroville Hospital because it’s so important that people take that first step. Thank you again for joining us. You’re listening to Growing Healthy Together, a podcast by Oroville Hospital. For more information please visit www.orovillehospital.com, that’s www.orovillehospital.com. This is Melanie Cole. Thanks so much for tuning in.