Quit Smoking Tip of The Week: Keep The Weight Off! Part 1

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Post cessation weight gain can cause a lot of stress for most people. You don’t want to put on 10-15 extra pounds, especially if that will put you in the overweight or obese category. That’s completely understandable, and there are small changes you can make in order to achieve and maintain a healthy weight but most importantly a healthy and active lifestyle.

First, I do want to address the fear of gaining weight while quitting smoking. If you are concerned about the health implications of gaining weight, know that putting on a temporary 10-15 pounds is far healthier than continuing to smoke or use tobacco. This is something I touch on with my clients who bring up weight as a major concern or trigger in their reduction/quit journey. I also like to let clients know that the upside to quitting is that even when you do gain a few pounds, your body is continuing to detox and rebuild its cellular processes post smoking cessation. This means that you will be able to more efficiently burn fat and put on healthy amounts of muscle because you are no longer doing continuous damage to your organs (which must function optimally to lose the RIGHT kind of weight).

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With my background in nutrition and weight loss coaching, I understand that this can feel like an uphill battle oftentimes, but rest assured that all you need is patience and dedication and there is no reason that you won’t be able to prevent or remedy weight gain after quitting. The best thing you are doing for your physical health and appearance is quitting smoking. Let’s face it, it’s hard to be fit and also a smoker- something to keep in mind.

Okay, so HOW exactly do you manage your weight?

Now let’s get into the details: how do you lose weight or even prevent the weight gain altogether? This is going to be a multi-part blog series, because there is no one magic secret that is going to do the trick. Tons of things factor into weight and how you gain and lose it, and it takes a long time for both to happen. In America especially, we get so caught up in the “immediate results, immediate gratification” mindset that we don’t step back and take a look at the whole picture.

Two Major Components: Exercise and Nutrition

These are the most well-known components to a healthy weight and lifestyle, yet most people are still not eating the right types of foods and either not exercising enough or exercising too much.

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A healthy diet includes a diet consisting of healthy fats, proteins and vegetables and a moderate amount of complex carbohydrates, such as the Mediterranean diet. The Mayo Clinic offers a great, easy to follow guide here.  One of the most important things that you can do for yourself regarding weight loss or maintaining a healthy weight is to eliminate as much processed food from your diet as possible. This includes chips, donuts, cereal, etc. This doesn’t mean that you can never eat these types of foods, but it’s encouraged to limit these to a “once in a blue moon” snack and not a daily (or even weekly) item to have.

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Now it’s time to touch on physical activity. You should strive to get 20-30 minutes of exercise each day at minimum. These guidelines are from the American Heart Association. This includes walking, so don’t let yourself get discouraged if you don’t have time (or the strength) to hit the weights every day. If you work, try to get up every hour or so to do a lap around your building. Take the long way to the restroom. Even park farther away (or, if you utilize public transportation and live in a safe area, try walking to your destinations as much as possible). Walking and more intense forms of cardio can be wonderful for jump starting a weight loss journey. But if you stick to JUST cardio, it will be just that and only that: weight loss. Not fat loss. Excessive cardio eats away your muscle, so you want to be careful to not overdo it. Muscle is what you want to keep, and build, in order to actually loose fat. The more muscle you have on your body, the higher your resting metabolism. It’s important to mix up your routine if you’re looking to lose fat rather than maintain your weight. Work on building strength, and the weight will come off (as long as you stick to a healthy diet—trust me, I have personal experience from years of learning that you can never out train a bad diet! Fat loss starts in the kitchen). Next week, we will go a little deeper in proper exercise and nutrition as well as touch on another important, but often neglected factor in healthy weight and lifestyle.

The Connection – Smoking and Anxiety

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Many people are under the false assumption that smoking helps relieve anxiety OR they know intellectually that it doesn’t help, but they don’t actually know why or how the brain tricks you into still craving that cigarette as the “only” thing that will take away the panic, the racing thoughts, etc. The association between cigarettes and anxiety can be confusing when you don’t know the whole story of how they affect each other.

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Clients with anxiety, depression, or who have beat other addictions are the ones who will benefit the most from quitting! Most of the time, one drug has a learned association with another that is being used. Think about coffee. If you’re a coffee drinker and a smoker, you probably associate the two together. Same with alcohol and other drugs. So staying abstinent from all drugs, including nicotine, is a good way to stick to your sobriety.

It is backed by science and many studies that quitting smoking only has a positive effect on mental health and to continue to smoke is to continue to agitate the symptoms of anxiety as well as speed up the progression to HIV stage 3 (AIDS).

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How smoking increases anxiety and why your brain still tricks you into thinking that smoking helps relieve anxiety and stress

Nicotine is a stimulant. When it enters the bloodstream and makes its way to the brain (within 7-10 seconds) it increases the heart rate, increasing your cortisol, as well as your alertness. These are symptoms of physical stress, and for people with anxiety or a predisposition for anxiety, these stress catalysts can make anxiety even worse.

Persons with a predisposition to anxiety also may experience more anxious thoughts as they enter nicotine withdrawal, which happens many times during the day for cigarette smokers. On the graph below, you can see that after the first cigarette, throughout the rest of the day there are continues spikes going up and down. The spike up is the initial pleasure response (release of dopamine) from smoking. The down spikes are the withdrawal cues that tell your brain to smoke again- manifesting themselves in excessive worry, irritability, tiredness, etc. This cycle of smoking to relieve withdrawal symptoms is very taxing on the body and can cause unnecessary stress on the body’s nervous system as you are constantly trying to find equilibrium yet being stuck in a cat and mouse game of highs and lows from nicotine.

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Acute tolerance is what tricks the body into thinking that smoking that cigarette is the magic stress reliever/ anxiety killer. But, acute tolerance is actually your body trying to protect itself from the effects of smoking. What happens is, as soon as you light up your cigarette when you’re feeling anxious, your body knows that your heart rate will increase rapidly, and you will get a short burst of energy. To defend against this, your body slows its heart rate down before you inhale. The cigarette did not relieve your stress or anxiety symptoms. Your body did (right before you smoked) as a response to what it knew was going to happen. Once you light up and smoke that cigarette, your body gets a wave of anxiety-causing symptoms again from the increased heart rate and raised alertness, yet thanks to acute tolerance, you would never even know!

One of the best things that you can do for your mental health is to reduce or quit your tobacco use and trade in your cigarettes for healthier, effective coping strategies for anxiety and stress. Reach out to a tobacco treatment specialist (TTS) at UNIFIED- HIV Health and Beyond now to see how we can work with you to reduce your stress and anxiety without cigarettes! To contact the TTS at our Detroit office, call (313)446-9817 to speak with Amber Jager, and for our Ypsilanti/Jackson area office, call (734)572-9355 to speak with Erin Suprunuk.

Tobacco Reduction Program Services

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Happy New Year, everyone! As we enter 2019, most of us have goals of renewing ourselves and refocusing on our health- whether that’s mental or physical. Along with those goals may be a big one: quitting tobacco or continuing to reduce your tobacco use as we enter the New Year. Whether you have never quit before, or have been quitting for the past year, the Tobacco Treatment Specialists at UNIFIED want to help you quit and stay tobacco free- whatever that looks like in your life!

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You may be wondering “Do I qualify for these FREE services, and if so, what exactly do these services provide?” To qualify for the Tobacco Reduction Program at UNIFIED you need to be an individual living with HIV/AIDS, qualify as low-income and live in either the Detroit, Ypsilanti or Jackson area. If you have never received case management services with UNIFIED before but fit the above qualifications, you still qualify for these FREE tobacco cessation services!

So what does a tobacco reduction counseling session consist of, anyways? The short of it, is that it is different for everyone and up to you what you want your reduction and quit plan looks like. We, as tobacco cessation counselors, are here to offer proven-strategies, non-judgmental support and accurate information to help guide your journey to a successful smoke-free life.

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When I meet with my clients, I think of it as them driving the car and me simply navigating the route for them. Most smokers know what they need to do to quit, but need a little guidance to create an individual and effective game plan to get there. That’s where Tobacco Treatment Specialists come in!

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Not ready to quit or reduce, but a little concerned about the health, social or personal implications of tobacco use? Come talk to a cessation counselor! We respect the boundaries of our clients and don’t push when an individual is not ready to make this big change. What we will do is offer information when appropriate, have open conversations about the pros and cons of smoking, and help you decide if it is the right time in your life to quit and give real feedback on what tools (mental coping strategies) you will need when you decide you’re ready to work towards reducing or setting a quit date. There’s nothing to lose by speaking with a tobacco cessation counselor, except maybe a pack of cigarettes or two!

Give us a call today! For our Detroit location, reach Amber Jager at (313)446-9817 and for our Ypsilanti and Jackson location, reach Erin Suprunuk at (734)572-9355.

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Quit Smoking Tip of The Week: Fight Post-Cessation Depression!

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Quitting smoking can momentarily bring on a more depressed mood as your body adjusts its hormone balance and the nicotine receptors slowly start to decrease back to a normal level. Think of it this way- when you smoke a cigarette, nicotine attaches to naturally occurring receptors in your brain. When this happens, you get a flood of dopamine (the feel good hormone). As time goes on and your smoking becomes a habit, your brain develops even more receptors allowing more nicotine to bind to receptors, resulting in a huge flood of dopamine. Well, your brain is not used to having this much dopamine readily available and down regulates this amount. Think of it as you listening to uncomfortably loud music and putting earplugs in to lessen what you can hear (Sleight, VJ. (2016, September 18) A craving is just your brain screaming, “WHERE’S MY NICOTINE?” Retrieved from https://www.linkedin.com/pulse/craving-just-your-brain-screaming-wheres-my-nicotine-vj/). This is what your brain does with dopamine.

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Once you stop smoking, your brain will take a while (a few weeks usually) to adjust to the lessened amount of dopamine that is being produced. Your brain is still down regulating the amount of dopamine being produced, leading to even less dopamine being processed in your brain than before you started smoking. So, you’ve turned the music down but you haven’t taken the earplugs out yet (Sleight, VJ.). The time it takes is different for everyone’s brain to adjust to the normal hormone levels now being produced (some only days, some up to a few weeks) and this could by why some people experience depressed symptoms after quitting tobacco use and some do not. It could also be the reason for increased agitation and feelings of anxiety as part of the withdrawals.

Also, as we dive into the winter season in Michigan we need to be aware that seasonal depression is among us. Up to 10% of adults will experience SAD, Seasonal Affective Disorder (Mental Health America, http://www.mentalhealthamerica.net/conditions/sad).

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Here are a few things that you can do consistently throughout the week to help fight the onset of depression or to just increase your happiness in general: 

  • Keep a Gratitude Journal
  • Savor the moment. This could be any moment- having dinner with a friend, talking with a loved one, walking outside, etc. Savor it by being completely present in this moment- no thoughts of the past or future, electronics put away, thoughts on what you feel, see and hear in that moment.
  • Be kind to someone. This could be someone that you know, or a complete stranger. But the idea is to act with kindness without expecting anything in return. Open the door for someone, smile at a stranger, give someone a compliment.
  • Spend less money on things and more on experiences (but free experiences are an added bonus). We get used to and bored with things. Experiences are encoded as memories that we can cherish forever, and they foster personal growth.
  • Make a new social connection or strengthen a friendship that you currently have. Say hi to a stranger, call a friend that you haven’t spoken to in a while, check-in on your neighbor.

These are just a few! I encourage you to do some of your own research, try out new things and see what works for you to lessen the seasonal blues. I strongly believe in taking care of your mental health and reaching the highest potential as possible regarding your happiness– we all deserve it! If you would like to work on more specific coping mechanisms with a smoking cessation counselor one on one to develop an individualized approach with tangible resources to help you quit with less distress, reach out to Amber Jager at (313)446-9817 for persons living in the Detroit area, and Erin Suprunk at (734)961-1077 for persons living in the Ypsilanti and Jackson area to see if you qualify for FREE smoking cessation services!

Please take into consideration that the combination of these activities are meant to be a part of lifestyle changes in order to help increase general happiness and fight off mild feelings of depression, but are in no means meant to treat Major Depressive Disorder or other extreme conditions that need to be treated by a physician. If you are experiencing suicidal thoughts or experiencing extreme or worsening depression, call the National Suicide Prevention Hotline at 1-800-273-8255. The Lifeline provides 24/7, free and confidential support for people in distress, and prevention and crisis resources for you or your loved ones.

National Suicide Lifeline

Quit Smoking Tip of the Week: Stay prepared with supplies!

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Find a place (your backpack, purse, home, car, etc.) where you can easily access a supply of gum, mints, toothpicks, fidget toys, and whatever else can keep your hands and mouth busy to distract you from the urge to smoke as well as fulfill the hand-to-mouth routine that your body has become used to from months to years of smoking. If you are interested in quitting or reducing your tobacco use, call (313)446-9817 to schedule an appointment with Amber Jager, Tobacco Treatment Reduction Program Specialist at the Detroit location, or (734)961-1077 to schedule an appointment with Erin Suprunuk, Tobacco Treatment Reduction Program Specialist at the Ypsilanti office. During your visit you can create a quit plan that includes individual tobacco counseling sessions with one of our specialists, or you can just stop by to pick up a quit kit that includes a variety of the above supplies listed to help you reduce and cope with smoking cravings! Below I have outlined a few more helpful things to keep with you for withdrawal symptoms and the quit-smoking-journey.

Your Quitting Tool-Kit

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The Power of Cinnamon Sticks: You can purchase whole cinnamon sticks and literally replace them with your cigarettes. Of course you won’t light these up, but you can use cinnamon sticks to mimic the motion of how you use a cigarette: inhale with the cinnamon stick when you feel a craving, until this feeling subsides. This helps by adding the deep breathing that your body gets when smoking a cigarette and the motion can even help trick your body into thinking that you are smoking and calm the urge a bit. This does not work for everyone, but is worth a shot. An added bonus is that even just using cinnamon mints or cinnamon containing gums, oils, etc. help to drastically reduce sugar cravings! So if you’re concerned about weight gain and the craving for unhealthy food, try some cinnamon to combat this.

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Journal The Process: Keeping a journal on you can be very beneficial for you in order to understand your habits and help prevent relapse in the future. It can also be helpful to prevent boredom when used as a creative outlet. Something that I have most of my clients do, depending on their stage in the quitting process, is fill out a Pack Wrap. A Pack Wrap is where you record the feelings/triggers/actions that are occurring during the times when you smoke. The goal is for you and myself to understand what the most triggering situations/feelings are, and create an individualized and successful quit plan with the help of this information. How you do it: this is to be done before you actually quit smoking. Over the course of a few days to a week (I encourage recording a couple days during the week and one day on the weekend to get a full view of your habits) keep your journal on you throughout the entire day. Right before you smoke a cigarette, record the time of day, what you just did/are about to do, and what feelings you have. Even as adults, it can be hard to identify what exactly you are feeling, and this list of 57 different emotions can come in handy to give a name to what you feel.

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Stay Hydrated: The first 3-4 days are the most important when it comes to helping your body detox from nicotine and the many other substances that your body has absorbed from smoking. Try to drink half your body weight in ounces each days (if you weigh 150lbs, then you should be drinking about 75 ounces of water daily). Keeping a water bottle handy at all times, though, will help you with hunger cravings (a lot of the time we think we are hungry when we are just dehydrated), tiredness, headaches and coughing that all can occur at increased rates during the withdrawal stage.

What Does This Worse-Than-Normal Flu Season Mean for PLHIV?

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Sad woman with tissue and medicines lying on bedI found myself unable to sleep the other night because I was so worried about this year’s severe flu, and if I, a person living with HIV (PLHIV), am more susceptible to acquiring it. The stress of outbreaks is already heightened given the recently increased rates of Hep A. My paranoia isn’t unfounded; after all, HIV is a virus that weakens the immune system. And most of us Positive folks have received a stern warning from a doctor or nurse regarding the vulnerabilities of our weakened immune systems. In response to my concern, I looked into why this year’s flu is so bad and if PLHIV are more susceptible to flu in any given year.

Thankfully, the Washington Post read my mind and reported today on this flu season and why it is the most widespread (see map below) on record. The Post’s article explains that more than 8,900 people have been hospitalized since Oct. 1, the beginning of the flu season, and has lead to a higher than normal number of deaths of children.

The Center for Disease Control and Prevention (CDC) further explains that part of the problem this year is that this strain, H3N2, is one of the “nastiest” to confront our modern population. It is good at working around our immune systems’ defenses and current vaccinations are less effective at blocking it. They also state that the season was predicted to peak the first week of January, but rates have continued to rise. So we, as a general population, are up against a powerful influenza virus without knowing when it will end.

But what about us Positive folks? Are we even more at risk of catching this year’s scary flu? I read a December 2015 interview with Christina Schofield, M.D., from The Body Pro, a go-to site for many HIV health professionals. Dr. Schofield says, “There’s probably a little bit of physician bias, and a bit more cautious treatment toward patients that are HIV positive, despite the fact that our patient population is a very healthy HIV-positive population.” She continues, “I would say that, just because somebody’s got HIV doesn’t mean they’re going to have more severe disease.”

But us PLHIV know that not all of our HIV experiences are the same. If you are one who has an immune system already damaged by HIV, then your doctor may suggest flu-fighting medications sooner than they would to someone who was able to fight against their HIV earlier on.

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With that said, it remains important to take steps to protect yourself against this year’s flu, just as your HIV-negative friends and family ought to do. The CDC continues to recommend a flu shot even though it has been less effective this year. They recommend it is because states where H3N2 has been prominent have also seen high rates of more common strains against which the current flu shot is more effective. They caution that there is still a long time to go in this flu season and, like stated above, it is very difficult to predict when it will end.

Beside the flu shot, there are many ways to protect yourself and we hear them every year: wash your hands with soap for at least 20 seconds; cover your mouth and nose when sneezing and dispose of tissues right away; avoid touching your nose, eyes, and mouth; and avoid contact with sick people. I’ve also seen it suggested that you keep your toothbrush away from others’, clean surfaces with anti-bacterial products, and frequently launder your bedding.

A note on adherence: It can be difficult to maintain your HIV-medication regimen when you are sick with the flu or otherwise. Heck, it can be hard to remain adherent even when you feel great. Remember: it’s just as important to take your antiretroviral therapy when you are sick as when you are not.

HIV Doesn’t Celebrate Holidays

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By: Jonathon Arntson

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No matter how much I teach and preach about HIV and taking control of it instead of letting it control you, I still have my own ongoing struggles. One of them is with adherence. It’s not because I question the medications or their importance. It’s because I have a tendency to let life get away from me. This shows up in a deeper depression, heavier drinking, lower funds, and less fresh, stable eating. I pamper myself with gifts, food, and décor. I also live across the state from my family and getting back to visit during the holidays can take a large bite of my wallet.

Sometimes, it gets really real like this week when I cancelled an infectious disease appointment because I wasn’t sure if I would have enough for the copay. I recently rented a car as an indulgence to visit family for Thanksgiving, but unfortunately I had to do the same the following week for a funeral in the same city across state. While giving me better options as far as schedule, this unexpectedly set back my wallet, and on top of that, I need to reschedule my appointment.

I’m not upset about not having money; I am upset about losing control over my treatment. I am undetectable, but I cannot continue proclaim so if I do not have the labs to prove it. My last labs are from July of 2017. Now I am at the mercy of Henry Ford’s appointment openings and running the risk of getting off my ID-appt-every-six months schedule. At least I have medication refills to last another couple months. I think. But I do not wish to make that yet another thing to have to handle and remember. Once those things start adding up, I tend to fail on all accounts. It’s happened before.

For more HIV and the holidays reads, check out Being Positive and Beating the Holiday Blues or this reminder from 1992 of how far we’ve come: Holidays and the Bad Tidings of H.I.V.

So, how could I have handled this better? For one, I could have looked before this past weekend to see when my appt was scheduled to take place. This would have reminded me to set aside the copay. Instead, I squandered it on a rental car (and Starbucks, to be honest) when I very well could have saved with Greyhound (and… Speedway?).

Perhaps that would have worked, but perhaps another angle to consider is the mental health benefit I had by renting a car. I used Turo, a site that connects you to vehicles listed by their owners. I had a 2016 Chrysler 200c. It was a sweet ride, and since I rely on bus and Uber here in Detroit, it felt awesome to speed down the freeway with music blasting. It was an expensive feeling, but I did a lot of thinking along the way and had numerous moments of clarity re: life.

Either way, I packed my travel pill case with a few Genvoya even though I knew I’d only need one. I managed to maintain my eating times so that I could take my medication at 7pm without suffering an upset stomach.

When I was home, I answered my family’s questions like, “How are you doing with… everything?” Y’know, everything being the menacing little virus that’s suppressed into some dark corner of my body (apparently the stomach and lymph node areas). Those moments make me yearn for the days when I could handle and sustain a stronger buzz. Now I have to face reality as it happens. But it’s all in the name of remaining adherent. Undetectable. Untransmittable.

Since my tolerance is diminished, I am also working to lessen the amount of alcohol I consume. I find this is connected to my medication–this has affected my adherence in the past. I take my medication between 7pm and 9pm. This is so I will have eaten dinner because my meds hurt my stomach if it is empty. However, if I drink around the same time as, or even hours after, taking my meds, I will certainly feel queasy and uneasy. Many times I wake up the next morning feeling like back in the day when I could have more than a bottle of wine and be okay the next day. But again, it’s reality-facing time and all that.

While we get to celebrate the holidays and hopefully have some time off with friends and family, we positive folks know the virus is always there waiting for an opportunity. As I move into Part 2 of the holidays, I seek to do a better job preparing for financial hiccups, upset stomachs, and several days of being away from my home without a maintained buzz. But hey! There are many more ways to make it through and even enjoy the time.

Enjoy your holidays!

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