By Keith Roach, M.D.
Q. My husband and I have been together for 27 years. He has smoked cigarettes daily for 30 to 35 years. Recently, he had an attack in which he couldn’t breathe. We took him to the clinic, where they did a breathing test. My 15-year-old son and I watched as my husband agonized to get through the test. The doctors gave him an albuterol machine, prescribed Advair and sent him on his way. My husband quit smoking about two years ago using Chantix. But he started again. His father also smoked for many years and now is on oxygen for COPD. He is miserable. I don’t want to watch my husband suffer like his father. I don’t understand how he sees what his father is going through and still continues down that road. I know it is not too late for him to stop, even though I am pretty sure he has already done serious damage to his body. How can I help him?
A. Quitting smoking is perhaps the most difficult recommendation to follow. There are some definite red flags in your husband’s case as you have described it, but some reason to hope as well.
On one hand, the fact that your husband can see the effects of smoking on his father but has not successfully quit is worrisome. On the other hand, quitting now will greatly slow down damage to his lungs. Similarly, although he restarted quickly after quitting, he was able to quit.
He needs to know that most people who quit successfully have tried several times to quit and went back.
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It’s worth trying again.
Varenicline (Chantix), bupropion (Zyban and Wellbutrin) and nicotine-replacement therapies definitely are helpful for most people. I am sure his doctor will be happy to partner with you, his family, in helping him quit. The American Lung Association, Centers for Disease Control and Prevention, Health Canada and the American Heart Association all have helpful information for people trying to quit as well.
Q. At age 45, I was diagnosed with bipolar II disorder. I am now 60 and have diligently taken medication. I have never experienced the manic/depression swings associated with bipolar disease. I rarely hear anything about bipolar II. What can you tell me about it?
A. Bipolar disorder is a complex spectrum of diseases that have in common drastic changes in mood and behavior. Depression is the most common initial mood disorder in bipolar disorder.
Bipolar I disorder is diagnosed when there are manic episodes. A manic episode is defined medically as an abnormal, persistently elevated mood with increased activity or energy, lasting at least a week. Feelings of increased self-esteem, decreased need for sleep, being unusually talkative, having racing ideas and distractibility are common. Spending sprees, sexual indiscretions and foolish investments sometimes occur during episodes.
In bipolar II, true manic episodes are not present. Depression always is, as is at least one episode of hypomania, which is similar to manic episodes but less severe or long-lasting. Bipolar II is probably underdiagnosed, partly because hypomania can be hard to recognize.
It is important to make the diagnosis, since treatment is different, and it is worth reconsidering the diagnosis if treatment is ineffective.
Q. What can be done to slow down glaucoma? Mine went from bad to worse.
A. Glaucoma is an eye disease caused by damage to the optic nerve, usually due to elevated pressure inside the eye. There are several types of glaucoma, but the most common in older adults is open-angle glaucoma, where the pressure inside the eye is high, probably due to increased fluid production combined with decreased outflow. Acute closed-angle glaucoma is a surgical emergency.
Open-angle glaucoma can and should be treated in order to prevent progressive loss of vision. Reducing the pressure inside the eye reduces the risk of vision loss. This can be accomplished through medication, usually such drops as prostaglandins, which increase fluid outflow, or other drops like beta blockers, which reduce fluid production. Some drops, like alpha blockers, do both, but those tend to have more side effects.
Glaucoma also may be treated with laser therapy or surgery. Surgery is not usually the initial treatment due to a higher risk of complications, but laser treatment is sometimes first-line.
No matter what treatment is used, people with glaucoma need careful follow-up with the ophthalmologist. Primary-care doctors should make sure patients are using drops (if appropriate) regularly and seeing an ophthalmologist, since there can be problems with compliance.
Email questions ToYourGood Health@med.cornell.edu.