View Full Version : smokers and imunosuppressents

10-15-2006, 01:32 AM
I have been on Paqunil since July for subcute Lupus. I was covered with Hives on my torso and had the rash on my face. My hair was falling out too. The hives on my chest, back, and arms all but went away. My face got a little better but was still a mess and my hair continued to fall out. I started steriod drops on my head, used creams, bought Nioxin and Mirracell. Nothing helped. I went back to the Rheum on Friday he says the Paquinil is not keeping my Lupus under control. My hives are starting to show up again. He said where most of my symptoms are derm based he will leave the choice of a med change to the derm, but mentioned imunosuppressents. The problem is that I am a smoker...I have smoked now this time for 17 years...and my chest xray shows chronic bronctis from smoking.....yeah yeah yeah I KNOW i have to quit...My weight has slowy crept up over the years and I could not face quitting and gaining another 30 pounds on top of what I already am....I started dieting and excersing in May and have lost 40 pounds and plan on quitting in Jan (I should be at goal weight then) .....does anyone smoke and take imunosuppressents?

10-16-2006, 06:47 PM
hi, I've smoked for 30 years, am on plaquenil,I quit for 5 mos, jan to june. Stupid I know, I didn't feel any better when I wasn't smoking except I wasn't as short of breath. I gave in and started again when the pain in my joints got worse, I know it's all in my head but I feel calmer when I smoke. My rheumy would prefer I didn't smoke, but hasn't mentioned any connection to the plaquenil. That said, I plan on quitting again for good. I have had pneumonia, bronchiitis, and bronchial asthma far to often, so smoking is just asking for trouble. Prednisone cleared my hives up quickly, and while I still get alot of rashes, I haven't had full blown hives in a long time. Good luck :)

10-17-2006, 08:25 AM
I went back to the Derm yesterday...he informed me that smoking diminishes the effect of the Paquinil and he wants me to try the Paquinil without smoking...easier said than done...I know smoking is not good for me...I am NOT stupid but I am sick and tired of it being the Patsy for Docs. So when I quit and the Paqunil STILL doesnt work....
I was over weight ...and decided this spring I needed to get a lot healthier...this was before I found out I even had Lupus. So I started on a diet and excersice plan and have lost almost 40 pounds. I do have a plan...finish losing the weight, quit smoking in Jan (when i get income tax money back and can afford to join a gym) ....My plans do NOT seem to impress the Docs who tell me "quit today" yet when I asked the Derm about perscription smoking cessasation options....he just brushed me off and told me to "call my regular doc" ....Telling me to "quit today" is like telling me "stop having Lupus"

10-17-2006, 10:05 AM
My older brother was a smoker and an alcoholic who had to give up both for health reasons, he often said that the cigarettes were much harder to give up than the alcohol.

I know this is hard for you, but the fact that you have been able to lose weight shows you are a strong person with a lot of discipline and determination - you will be able to do this.

If you really want some more motivation, figure out how much you spend on cigarettes in a day, then multiply by 365 to see how much money you spend on smoking in a year - think about all the things you could have done with that money instead of smoking. Think even more about the things you could do with the money you will save once you've stopped!

Many of the stop smoking products that contain nicotine are available over the counter - you don't need a prescription, but you should definitely talk to your doctor before using them. You can find a lot of information about these products at the American Lung Associationn website - www.lungusa.org - and the American Cancer Society - www.cancer.org. Zyban, and nicotine-replacement inhalers, require a doctor's prescription.

Many health plans and worksites provide free quit-smoking programs and some health plans cover the cost of medications to help you quit. Check with your insurance carrier or your employer for more information. You may also find programs or support groups sponsered by your local hospital, or the local health department, and many cities have branches of the American Cancer Society that also have programs. This ia a very hard thing to do, but there are a lot of resources available to help you!

10-17-2006, 10:37 AM
I know that there are OTC products but I would much rather pay a $15 co-pay for the patches than $60 (still cheaper than smokes I know) ....I have quit before (last time was 17 years ago and I quit for 3 years after watching my Mom die of Lung cancer)
I need to quit and I want to make it this time for good...but I really need to do it the right way...I have lost almost 40 pounds and I quit drinking in June as well. I know if I quit now and start putting the weight back on I will start smoking again. Losing the weight has not been easy and I will not go back to being fat. I want to reach my goal and join a gym...which I can't do until I get my income tax back. I did call my PCP and asked for her to call me in a perscription for patches ....but I am not at all happy to get pressured into disrupting my well laid plan. I think it is the best chance I have to succeed.

10-17-2006, 11:15 AM
Ultimately it has to be your decision for it to work - you know what works for you and what doesn't. The one thing I would caution you about - some doctors will drop you as a patient if they advise you to stop smoking and you don't. They have to give you thirty day's notice to find another doctor, It's still fairly unusual, but a lot more doctors are doing it, especially HMO or "capitated" doctors. Obviously, you know your doctors and I don't - this is just something I've seen happen to other patients.

10-17-2006, 11:38 AM
Legalized discrimination....I consume a legal substance....Until they make cigarettes illegal (which they won't because they make too much in taxes) then it is discrimination. I guess what made me the most upset was his flipant attitude of "just quit" and when I asked for some help (a script for patches) he blew me off.

10-17-2006, 12:56 PM
It doesn't seem fair, unfortunately, from the doctor's standpoint, it isn't discrimination - it's "failure to follow reasonable medical advice", which is a legitimate reason to terminate a doctor-patient relationship. In fact, doctors who attend seminars on malpractice claims prevention are routinely advised to "fire" patients who don't cooperate with medical advice - even though the AMA Code of Medical Ethics says that doctors should accept a patient's right to accept or refuse medical advice or treatment - it also recognizes the doctor's right to terminate the relationship as long as the patient is given notice and time to find other health care, unless the patient needs emergency care and there is an existing doctor-patient relationship,

This is going to become more of an issue as more patients become involved in managed care insurance plans like HMOs and PPOs instead of traditional fee for service plans. What many patients don't understand is that it often isn't the doctor's decision whether he will accept a particular insurance or health plan - it's the insurer's. It's called "red-lining" - whether or not a doctor (or medical practice) is admitted or retained in a particular health plan depends to a large part on how cheaply the doctor treats his patients. An insurer or health plan that feels a doctor's cost per patient is too high simply drops that doctor from its list of participating providers-- not only shedding an expensive doctor but eliminating the most costly patients too. So from the doctor's standpoint, there's both a legal and economic incentive to get rid of "problem" patients. It certainly isn't fair, but it is happening more and more.

There was a case in Kentucky just a few months ago where an OB/GYN dropped an overweight pregnant patient who wouldn't follow the diet he recommended and kept gaining weight - after she was dropped she couldn't find another OB to take her, and ended up having to get prenatal care from the local health department. She filed a grievance with the state medical board, but they upheld the doctor's action. So it isn't just smoking that's an issue, it's more the whole malpractice environment.

Sorry, didn't mean to digress so much here, this is just one of those issues that really bothers me.

10-17-2006, 01:36 PM
My PCP just called...she is calling in the prescription for Nicotine patches today.

10-17-2006, 01:52 PM
Well, I have stopped, but a bout in the hospital with pneumonia will do that for you. I haven't even missed it (yet) but I do know when I get home the temptation will be STRONG (it's about the only vice I have left, darn it!) I plan on having lots of gum and sugarless candies on hand, as well as cinnamon toothpicks...they helped me quit when I was pregnant.
We can be each other's support group if you like???? :)

10-17-2006, 02:10 PM
I need all the help I can get! It is very tough...I have done it in the past 3-4 times...but this time I have smoked for 17 years ...I cant afford it and hate it...I just really hope I dont blow up like a balloon. I have struggled so hard to lose the weight.

10-17-2006, 03:36 PM
You might want to talk to your doctor about a prescription for zyban - it is supposed to reduce nicotine cravings while also suppressing the appetite, so those who are quitting don't gain as much weight. Since it doesn't contain nicotine, you can continue to smoke while taking it and wean yourself off smoking at your own pace. It isn't safe for everyone, but might be worth discussing with your doctor. That way you might not feel so pressured into quitting right away.

Littlered, one thing to remember about sugar-free gums and candys - they may be better for your teeth but most have just as many calories as the full-sugar versions - and sugar-free products sweetened with zylitol, mannitol or sorbitol can cause diarrhea and stomach cramps if you use too much. Think about other things instead - carrot and celery sticks, frozen grapes instead of hard candy, fat-free pretzels. Clean out the fridge and cabinets of the junk food before you quit smoking and stock up on healthy snacks - it's a lot easier to resist temptation when the chocolate cake isn't sitting on the counter. At the times when you would normally smoke, like after meals, try doing something totally different like going for a walk, or put on some music and dance, or go outside and wash the car, anything to keep yourself distracted. Otherwise, if you snack when you would normally smoke, you're just substituting one bad habit for another.

And think about rewarding yourself with something special with the money you save by not smoking! Not to mention how much younger you will look and feel!