S agreed to share her story with us. Here is her stop smoking journey, in the words of her stop-smoking advisor...
S was referred to the service by a junior doctor on the Acute Medical Unit at Barnsley Hospital on 16.01.18. She had been admitted that day with a collapsed lung.
She was in a side room and her husband L was with her.
S was struggling to breathe so the assessment had to be short. I was able to ascertain that this was the third time that her lung had collapsed.
She was smoking 20 – 30 rolls ups per day and had a fagerstrom score of 8.
S had tried to stop smoking many times but had always returned to it. She said that she knew that she must do it this time as she now had so many problems with her lungs. We discussed nicotine replacement and I was able to get her doctor to prescribe the 21mg patch and 15mg Inhalator (not ideal for someone with breathing problems but no other oral product is stocked by the hospital pharmacy and she was a heavy smoker in need of plenty of nicotine).
We also talked about the behaviour changes that might help her stay smoke-free on discharge from the hospital. These were identifying when she was getting repeated thoughts about smoking (triggers) and pro-actively planning things to do at these times, using distractions to take her thoughts away from smoking and working out how much money she will save.
During the conversation with S, I became aware that her husband L was staring at me in a strange way with a facial expression that I can only describe as a quizzical scowl!
I asked him what he was thinking. He said that he wanted to stop smoking too but thought I was talking rubbish (or words to that effect though slightly less polite).
I decided that I needed to engage him around this and asked him to tell me why. He said that the products were rubbish and didn’t work and they had tried them all before. I let him know that there were lots of products including Champix that were available by a voucher scheme through our service and that he was 4 times more likely to quit with the right products and professional support.
This led to a conversation about where he might attend appointments as he worked away from home. I informed him that telephone support was available. At this point, he said that he wanted to try and that he needed to support his wife by quitting with her. He even cried as he said this. I was pleased as it was apparent that he was now on side. This raised the mood in the room and both became much more receptive. I agreed to call him the following day so that I could put his details on the system and booked him an appointment with the telephone support service. I later did this and he sounded very positive and motivated about getting started. He also apologised for being rude to me! Result!
I agreed to contact S on her discharge from hospital to plan her support as it was not clear how mobile she would be at that point.
S remained in hospital from 16.01.18 to 22.01.18 and managed to remain smoke-free on going home. Although, initially, she attended appointments at the hospital office (as the family live very near to the hospital), she was in a lot of pain and very breathless. However, I think that this motivated her to stay quit as she said that she knew that if she relapsed that she would feel much worse and that her lungs would suffer and the healing time would be extended.
S talked about never having been so positive about quitting or so sure that she would never smoke again. She was also pleased that L had stopped smoking and this was helping her a great deal as there were no cigarettes in the house and he was encouraging and supporting her.
In the early weeks S found the nicotine patches helpful but struggled to find an oral product that suited her and she tried the Inhalator and Mouth Spray before settling on the 2mg Chewing Gum. At week 3 she attended her appointment and was struggling to walk as she was in so much pain and so breathless. We both knew that she should not be feeling like this and I urged her to go back to her GP. Despite this, S said that she was “buzzing with it” about her quit and feeling really good that she had managed to stay quit without feeling the effects of nicotine withdrawal or feeling stressed and grumpy as she had in the past. She had never managed to quit for this long before.
S missed her appointment at week 4 as she was still feeling unwell and had gone to stay with her Mum. We talked on the phone instead. She talked emotionally about how she had seen the consultant and he had told her that she had emphysema and as a result part of her lung needed to be removed. However, she remained quit and was at least feeling very positive about this and glad that she had quit as we had earlier discussed the benefits of quitting in relation to surgery, namely, less anaesthesia needed, faster recovery from anaesthetic, faster wound healing and less chance of post-operative infection.
We agreed to continue support by telephone as she was waiting to be admitted to the Northern General Hospital in Sheffield for the surgery. I think her level of motivation is demonstrated by the fact that despite feeling ill she attended the office to complete her 4 week follow up Carbon Monoxide test before being admitted as she was keen to know the result.
I continued to speak to S by phone while she was in the hospital and following her subsequent discharge. She stopped using the patches but was keeping the lozenges to hand to use if she needed them but she had not had any for some time. On return home, there were some complications as the lung was not inflating as it should and she had a chest drain in place which caused a lot of pain. When this was removed she texted to let me know how much better she was feeling now and that she was able to reduce her gabapentin. She also reported that her husband was still quit too and was doing really well.
Amazingly, by week 7 of her quit she went back to college for a few hours a week and had completely stopped all medication. We continued to speak on the phone with our last conversation being at around week 9. By this time she said that she knew that she would never smoke again.
Some further reading around the theory of teachable moment.