Smoking is a difficult but important issue to address with those who suffer from repetitive strain injuries. As therapists, we do not want to "preach" but to provide information that helps people make decisions regarding their health and injury recovery.

Nicotine can have such an impact on healing, compromising circulation and blood flow that I have known physicians who insisted on a promise of smoking cessation prior to their performing surgery. If the patient did not quit, the doctor advised, there would be no point in performing the surgery because it was bound to fail.

The following describes the effect of nicotine on the body and the impact it has on impeding injury recovery.

Nicotine -

• Increases carbon monoxide levels in the body by 2-4 times reducing energy and increasing fatigue.
  
• Causes a fight-or-flight reaction.
  
  • Increases heart rate by 10-20 beats.
    
  • Increases blood pressure by 10-20 degrees.
    
  • Releases adrenaline and causes blood sugar to rise.
  
  
• Is a stimulant (after an initial, momentary chemical release that causes a sense of relaxation) that can increase muscle tension and anxiety.
  
• Constricts capillaries and blood vessels decreasing blood flow to the hands and feet.
  
• Interferes with the body's ability to store calcium.
  
  • Increases the risk of osteoporosis.
    
  • Delays healing of fractures.
    
  • Increases risk of musculoskeletal problems including disc degeneration.
  
  
• Impairs sleep patterns (initially after quitting, the ex-smoker may experience several nights of "twitching and jumping" until the body adjusts to the new deeper sleep pattern).

Source: Angela Jullings. Facts About Smoking. Last Packet. 2004. www.last-packet.com/facts_about_smoking.asp

The benefits from quitting smoking begin immediately.

Within 20 minutes:

• Blood pressure drops to normal.
  
• Pulse rate drops to normal.
  
• Body temperature of the hands will increase to normal.

After 8 hours:

• Carbon monoxide level in the blood drops to normal.
  
• Oxygen level in the blood increases to normal.

After 48 hours:

• Nerve endings begin re-growing.

After 2 weeks to 3 months:

• Circulation improves.
  
• Lung function increases up to 30 percent.
  
• Coughing, sinus congestion, fatigue, shortness of breath decreases.

After 1 year:

• Excess risk of coronary heart disease is decreased to half that of a smoker.

Long-Term Effects of Quitting Smoking (5-15 years):

• Stroke risk is reduced to that of people who have never smoking.
  
• Risk of lung cancer drops to as little as one-half that of continuing smokers.
  
• Risk of cancer of the mouth, throat, esophagus, bladder, kidney, and pancreas decreases.
  
• Risk of ulcer decreases.
  
• Risk of coronary heart disease is now similar to that of people who have never smoked.
  
• Risk of death returns to nearly the level of people who have never smoked.

Source: Quit Smoking. The American Lung Association. 2007. www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=33568

The American Lung Association offers these tips on preparing to quit :

• Identify your personal reasons for quitting.
  
• Set a quit date.
  
• Identify the issues that may keep you from quitting.
  
• Make specific plans ahead of time for dealing with temptations. Identify two or three coping strategies (such as taking a walk or calling a friend).
  
• Get cooperation and encouragement from family and friends.
  
• Seek information from your physician or pharmacist on nicotine medications that can help ease the cravings for a cigarette.

Source: Quit Smoking Action Plan. American Lung Association. 2007. www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=117062.asp

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The American Heart Association offers these tips to help smokers quit:

• Keep busy doing things that keep the hands busy and make it hard to smoke (like working in the yard, washing the dishes and being more active).
  
• Fight the urge by going to places where smoking isn't allowed and staying around people who don't smoke.
  
• Avoid situations that tempt you to smoke, like drinking coffee or alcohol.
  
• Find a substitute to reach for instead of a cigarette. Try a hard candy.
  
• Don't give up if you smoke a cigarette. Just resolve not to do it again.
  Remind yourself that you're likely to feel better if you stop smoking.
  
• Tell family members and friends that you need to quit smoking and need their support. If your husband, wife, son or daughter smokes, ask them to quit with you.

Source: The Effects of Smoking . American Heart Association. 2007. www.americanheart.org

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.