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Cigarette
Smoke is More Than Skin Deep
by
Jeffrey S. Rosenthal, M.D.
A pregnant
woman waddles across the parking lot, balancing her
soon-to-be-born child while causally puffing on an extra long
cigarette. In an off moment my eyes wander outside. Two senior
citizens are making their way to their car. Each is supported by
a crutch or two. Their movements are labored yet both are able
to balance while lighting a cigarette. Handicapped sit in wheel
chairs bound by the unresponsiveness of their extremities but
unbridled by their passion to smoke. Parents put their young
children in car seats while exhaling a silver grey cloud over
them. Adolescents congregate outside of the local theatre
chatting and brandishing their tobacco weapons. Our patients
report chest pain, difficulty breathing, wounds that fail to
heal, sorrowful complexions, lines about their faces, breath
that is stagnant with teeth to match and yet are still
passionate about their tobacco brands.
We know intuitively that cigarette smoking imparts irreparable
damage. Toxins that spew out of the lit end promote death not
health. Oxygen no longer bathes the nascent human cell and,
worse yet, is replaced by carbon monoxide, the very antithesis
of well-being. Forget about the cigarettes: save money! Just
pucker up to your exhaust pipe. Each cigarette causes
vasoconstriction for up to 12 hours, diminishing blood flow,
life sustaining oxygen and nutrients, the very essence of what
we need to mend our wounds. These vital substances are replaced
by over 40 known carcinogens and toxins that most assuredly will
be the ruin of skillful surgery; yet we question the
responsibility of asking our patients to totally suspend
cigarette smoking.
A Plastic Surgeon’s, goal is to promote a salubrious lifestyle
through counseling and surgery. Why allow our patients to
continue smoking? For the past 16 years I have endeavored to
assist my patients in discontinuing cigarette smoking in the
perioperative period. This window of opportunity for a breeze of
clean air to fill their lungs is 2-4 weeks before and after
surgery. Rather than downsize an operation by offering less than
optimal maneuvers, surgery may be deferred or postponed for up
to six months, especially when dealing with a facelift or
similar procedure that would be potentially jeopardized. The
damage that cigarette smoking has reaped is permanent; however,
we can minimize the extraordinary risks of combining surgery and
smoking by unabashedly insisting on restraint.
There can be no financial incentive high enough to risk an
unwanted surgical outcome and the accompanying disgruntled
patient that must live with this untoward conclusion. Not to
mention the albatross that will swing from your neck until the
crisis is resolved to everyone’s satisfaction.
Difficult as it may appear to dissuade your patients from
smoking, it is the easiest and safest path to follow. Of course,
this does require additional time to inform your patients of the
harm that smoking will cause and carries the attendant risk of
losing these individuals to another physician who has comprised
standards of care. The misguided impression that even 1
cigarette is acceptable will transfigure the most adept sleight
of hand magic into a ghastly headstone memorial.
I have delighted in the knowledge that 70 % of my smoking
patients have permanently discontinued this habit. They are
thrilled with the prospect of breathing fresh air, tasting food
unsullied by tobacco while losing a dependence that, all to
frequently they wish to end. Our power to motivate these
individuals should not be dismissed lightly. We can offer them
the initial impetus through our guidance, concern and knowledge.
This not only informs them of the dangers of smoking but also
allows them to partake in the decision-making and healing
process. Some of your patients may bridle at the thought of
restricting their choice but most understand that optimal
results require a healthy individual.
If our first obligation is to practice exemplary medicine then
purveying this message is of the highest priority. I look
foreword to the day that signals the end of this scourge and the
beginning of a brighter and most assuredly healthier time.
Please address comments to Jeffrey S. Rosenthal, M.D., 75 Kings
Highway Cutoff, Fairfield, CT 06430.
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