Friday, August 10, 2007

Dear Chantix Prescribers

Dear Chantix Prescribers,

I'll preface this by saying that I am not a doctor or pharmacist. I also have no other title that makes me in any way qualified to speak to any possible undesirable medical or pharmacological ramifications of what I'm about to propose (though I'd be surprised if there were any).

I am, however, a very attentive observer, and I do think that by just saying a few specific things while you write out the Rx for Chantix, you could help your patients have a realistic expectation of the role Chantix will and won't play as they embark on this monumental journey of changing their lives by quitting smoking. And it is, indeed, monumental and daunting at the start - your patients are trying to not do something they have been doing approximately every hour of their waking lives (give or take) for the last X number of years. It's that big of a deal.

If you are a doctor who is already listening to your patients about what it's really like to be on Chantix and understand how different each person's experience can be and that the 8th day is not necessarily the best quit date for everyone, and if are advising your new Chantix patients of this instead of prescribing just "as is," then you are one of those great examples I wish other doctors would follow. Thankfully, the person who told me about Chantix had a doctor that did explain it to him, so when my friend passed the information along to me, I was able to set a reasonable quit date for myself of Chantix Day 15, but I quit sooner, on Day 13.

If you are not already one of those doctors, please read on.

First and foremost, please tell your patients that a vast number of Chantix users are simply not ready to quit smoking on Chantix Day 8 and that, realistically, your patient may want to aim for something closer to two weeks out (maybe even longer in some cases) once the first full dose of Chantix has actually been taken and has had some time to take effect. Almost everyone agrees that having a quit date is often very helpful no matter what method of quitting smoking is used, but it should be a realistic date, and what is realistic will vary from person to person because of an individual's combination of physical as well as mental factors. Some people feel the effects of Chantix early on and begin noticing such a very reduced desire to smoke that Day 8 does look reasonable, and that reduced desire just bolsters the mental gearing up that they have been doing. For a whole lot of your other patients, it will just take a little longer before they find themselves smoking so very much less to the point that they can begin to see that they really will be able to quit without complete suffering.

Of course I believe you should also advise your patients that even with Chantix, their cooperation and willingness will be required in the process of quitting smoking. In fact, I believe that you *must* explain that so they are not surprised to find out that it's not the "magic miracle wonder pill" that sometimes people call it (though it is the closest thing yet!).

Can you imagine the sense of heartbreak and failure that many of your patients must feel to white knuckle it through to late in the day on Chantix Day 8 only to succumb to this powerful addiction, wondering just what it was that Chantix was supposed to do for them that it didn't and why it is they they have "failed" yet again? I can, and, frankly, it breaks my heart every time I read about it because Day 8 is simply not realistic for many serious smokers.

And yet, thankfully, so many of your patients will be tenacious enough to keep going: keep smoking but also keep taking the Chantix, keep waiting for that newly chosen and far more reasonable quit date to approach... and then quit even before that last final date because the Chantix did what you prescribed it to do for them - it helped them quit smoking.

Please tell your patients what's realistic, and save them unnecessary discouragement. Not all of them are as blessed as many of us sharing our experiences online and learning from others, so they are counting on YOU as their doctor to arm them with good information to help them take this big step into what is hopefully their final battle with smoking.

Sincerely,
Maggie, a grateful non-smoker on Chantix Day 65 and Smoke-free Day 53

24 comments:

  1. O yea, Maggie... I think that's a pretty right-on sort of post.

    You are correct. My doctor instructed me to take the pills for a week before I stopped smoking + the first week was DAMN tough.

    That's actually why I started blogging about it. I didn't start blogging it until the third day of the quit, and, that's because I was flipping out.

    I wasn't planning on doing a Chantix blog; but, as I was going bonkers I just didn't know what to do, but, I did want to quit, and i thought blogging it would make it easier.

    It did.

    I think that everybody who's quitting should start a blog or journal........... it helps....

    You are right though that I don't think a one-size-fits-all prescription advice is the best approach.

    John

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  2. Yeah blogging about my quit was a HUGE help for me, I contribute a large part of my success to my blog actually (and of course the support I got from people reading it). A combination of blogs (mine and reading others), Chantix, Water, little straws and the desire to not die is pretty much how I managed to make it through the first weeks of not smoking.

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  3. John and Lakasha, yep, blogging and reading other blogs should almost be on the label along with the other instructions ;)

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  4. I completely disagree.

    The day 8 quit day is not a requirement but a suggestion. I think it plays a huge psychological role. In the end, everyone will quit when they do, depending on how ready they are.

    But I think if you don't really give that optimal quit date, people (and I can just see how addiction demon voice would just completely take over at this point) would keep smoking forever and ever. You know how people are - you tell someone who constantly comes in late to come at 8:45 when you know that person will end up showing up at 9:00.

    So I think there's more behind the day 8 quit suggestion than it may seem.

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  5. Stan, I do agree that a quit date is a very, very extremely good idea for the exact reason you said. In fact, it's pretty close to almost (not quite) mandatory in my book, and it helps to get the mind geared up as well. I do love quit dates!

    But I also think that doctors need to talk to their patients about what's realistic. Day 8 is simply not a reasonable date for lots of people to the degree that if the Chantix hasn't "kicked in" for some people yet, it's barely better than trying to go cold turkey during the first handful of the toughest days - except with the added cost of the doctor's visit and the Rx plus some dashed hopes that the Chantix was really going to do more to help by that point.

    I'm eternally grateful that enough doctors out there are saying to give it a couple of weeks so that I was told in a round about way to plan accordingly because I would have been one of the discouraged on Day 8. I was ready to fight with help, but I was simply not ready to do the same level of battle as I'd done countless times in the past going cold turkey - that's why I asked my doctor about Chantix ;)

    For some people Chantix does seem to kick in earlier, and I think you were very fortunate to be one of those who could quit even before the Day 8 mark. That was really incredible and showed some serious determination and readiness! For others Day 8 is just about perfect, and all goes swimmingly as prescribed. For yet others, more time is needed. The problem is that if those not ready on Day 8 are not reading about other people's experiences (plenty are not online or reading blogs, etc.), it can seem like they "failed" somehow not knowing that they are very much not alone at all and that it's reasonable for many to take just a bit more time. If the doctor doesn't tell them, and if they do not read blogs, how do they know? My doctor told me nothing about Chantix. At all. I asked him for it, he condescended me and then sent me to the "smoker program" to get it set up.

    My point is just that like John put it, a one-size-fits-all prescription for Chantix isn't necessarily the best approach considering how very differently people will react to Chantix, and doctors still need to discuss prescriptions with patients, but to do so, they need also to know what real people are experiencing so that they have realistic information to share with patients.

    After that, they can recommend Day 8 as a starting point for a quitting date if it seems appropriate for that particular patient.

    Opposing views make for good things to consider and for good conversation, so I am glad you spoke up, and I do agree in principle with some of what you are saying, even if not all of it ;)

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  6. To Maggie, yes it was Baryshnikov and I blew it!

    To everyone else, too: I set a quit date on day 8 and failed. But the instructions said to set another, so I did. I almost made it on day 16 and then smoked a cigarette at the end of that 24 hour period. I was so annoyed with myself. That was the deciding factor, I wouldn't smoke the very next day. Why should I? I made almost 24 hours with no major problems except stupidity. How many times had I tried before Chantix? Setting a quit date and failing over and over again. What's the adage? If at first you don't succeed, try it once more? We need to get past the small failures. We need to support each other, whether it's on a blog or email, phone call or face to face. I applaud each of you for quitting. I pat myself on the back for making it this far. And tomorrow morning I'll get up and decide "I'm not smoking a cigarette today".

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  7. Excellent advice, Sherri! Both to keep trying and to take it a day at a time.

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  8. I have to agree with Maggie on this one, based on my experience. I was absolutely NOT ready for Day 8. I don't think I was physically ready with the drug build-up, nor was I psychologically/emotionally ready. Day 8 was WRETCHED for me. On the other hand, yesterday wasn't all that bad. Neither was today. I also agree with Maggie, that you MUST have a concrete quit date. I just don't think Day 8 is realistic for everyone.

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  9. Tasina, I am just so glad you did not give up and got to see how not entirely miserable even the first quit smoking day can be with Chantix, and I'm glad that you are having some "not so bad" days because that's awesome!

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  10. I LOVE IT!!! I love it so much that I am going to take it, print it, and give it to my PCP on Saturday morning when I go see her. I have one of those *AWESOME* doctors that really does listen to me when I talk about things...I mean...everything. She would so love to see this...

    That is, if it's OK with you??!! :D

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  11. Jaime, thank you, and by all means, share all you'd like. I think it's a worthwhile topic for doctors to consider. I think it's wonderful that you do have a doctor that you like and are so comfortable with because I think that's how it should be. I had one, but she's not under my insurance...

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  12. This post darned near made me cry. I'm seeing my doctor again on the 28th, and I plan to print this out and take it with me. Thanks for saying what I couldn't express, Maggie!!

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  13. Oook, the majority is the majority. :) I'm really glad we have a chance to discuss a lot of things, Chantix related or not.

    I think the key would be the balance. Doctors should talk more about that proposed day 8 quit date, but not to the point as to give enough room for quitters to feel like they can go on smoking forever. Because ultimately, it is the mental addiction that we overcome on that quit date with Chantix, since the drug takes care of the physical aspect of it rather well.

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  14. Aw, Bay, thank you. I had already been wound up about this topic while talking to my friend J last night, since he was the one who told me what his doctor told him - expect roughly 2 weeks or so, maybe sooner. Shortly after that chat with him, I read your post, and I was again so glad that someone had told me to expect a little longer so that I didn't have to experience quite that kind of struggle. Glad you are sticking with this and hoping your next day one will be more like Tasina's experience.

    Stan, I still love you ;) And I do think that you hit the nail on the head with balance. Heck, I literally got zero information from my doc, so *any* would have been good. I think physically I was a few days behind some folks, but after the first full dose, I started catching up! I agree completely that the "indefinitely plan" is probably not the best approach since getting geared up was such a huge component for me.

    Really, thank you for keeping the conversation lively! Half the time I feel like I'm talking to myself, and tonight it's more like a conversation ;)

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  15. Maggie....well put and I think everyone has beat me to saying that day 8 is not on the mark for all. I was determined no matter how hard I was done on day 8. I laid em down the night of day 7 and have been done since. But I can see others not doing so. It was hard so hard in fact I didn't think I could do it. But determination made me. I am hoping to be able to get this printed off to give to Dr Warden when I see him next month.
    Did I mention he called me the other day? Not his office personell but him personally he wanted to know how things were going for me and if I had quit yet. He let out a woot woot when I told him that I quit on day 8. He told me to keep it up and to seek help if I need it. I was really surprised he cared enough to call himself.
    well keep bloggin I love readin!!!!

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  16. As the Chantix Failure (copyrighted), I must agree that Day 8 was not the day for me. And my failure to make it through that full day, which didn't start out tough, led to my eventually chucking the whole quit and giving up not too long after.

    But I've always been the perfectionist type and that's my cross to bear. (As in, if I can't quit perfectly, I just won't quit. Brilliant!)

    I truly believe that I will give this another go in the future and I'm willing to give Chantix another shot to help me.

    Knowing that my physical addiction was handcuffed and tossed in the closet by Chantix did make trying to quit easier. I just desperately need a substitute mental addiction... that is neither alcohol, drugs nor sex. Nor candy... I packed on 3 pounds in 2 days by choosing candy as my replacement. BAD IDEA.

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  17. Tabatha, how wonderful that you doctor is taking such an interest! I kind of forced information on mine when I was asking about tapering. Hopefully he'll at least be aware of my experience.

    Danielle, you will quit again, and I bet you'll make it once you get geared up and ready to go for it. When you do, keep this in mind when picking your quit date - it doesn't have to be quite as rugged as you had it. I love that you are still reading along.

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  18. I was a lot like Tabatha... I quit on Day 8 through sheer determination and a whole whole lot of smoking the night of Day 7. I was afraid that if I went past the "suggested" quit date my evil addict brain would convince me to just not bother trying. I just went back and read my blog from those first few days. Those first few days were so frickin hard.

    My Doctor didn't really know much about Chantix but asked me that I let her know how it was going and she has called me a couple times to check in on me. My pharmacist talked to me quite a bit about it and told me how many people he has seen quit on it. The times I have been back in the store and he has seen me he always asks how it is going and when I told him I had been quit for over a month and was off the Chantix he called all of the pharmacy aids over to meet me and asked me to tell them a bit more about it. I guess I was the first person he had talked to who was already off the Chantix.

    Course I think he may have a bit of a "thing" for me so that could be why he is so interested in my experience.

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  19. Wow, Lakasha. It's great to hear how interested your doctor and pharmacy folks are (whatever the reason!). I do think the for some Day 8 really is just the right and most reasonable date even if it's not for others. That first day is going to be one of the harder ones no matter what. How awesome that you are still going strong even off the Chantix. I'm looking forward to that day for me ;)

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  20. Danielle, one failure is just that, one failure. This shouldn't be about making it on the date specified. It should be about making it, period. A friend gave me a cinnamon stick to hold between my fingers (some will chew and eat them, yuck). I still have the same one, it stays in my purse and I twirl it while driving. I keep those mini Altoids and Dum Dums handy. Nothing chocked full of calories, but something to put in my mouth. Darned oral fixation! Hang in there and let us know if you try this again. We are all here for you.

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  21. I agree, Sherri, it's all about quitting smoking in the end, regardless of day. Wow, a cinnamon stick - I hadn't thought of that, but it does sound perfect!

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  22. Graet post - thank you for pointing it out!

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  23. Thanks, Chris. I was a bit on fire that day.

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