I did not expect to see Madam Luo this time, as she had failed to turn up for the previous consultation and I thought she had given up on quitting smoking.
She is in her late 60s and had started smoking when she was just 14. She had tried repeatedly to kick the habit, but failed.
Her family physician had referred her to me eight months ago. She was suffering from chronic obstructive pulmonary disease, a severe lung condition that affects her breathing, and she desperately needed to stop smoking.
When she first entered my consultation room, she was barely able to complete a sentence without pausing, often taking time to steal a breath or two between words.
She had difficulty walking as well, panting as she hobbled from the waiting area of the clinic to my door, requiring assistance from health attendants along the way.
When she informed me that she had been smoking 40 cigarettes daily for most of her life - and up to 60 sticks at times - I thought the task ahead of her was herculean.
Often, it is easy to blame smokers for their poor decision to pick up the habit and the jeopardy in which they put others with the second-hand smoke. The knowledge that smoking causes cancer and lung diseases has become ubiquitous.
Yet, smokers continue to do so despite knowing the harm it does them and their families.
To comprehend why it is so difficult to quit smoking, it is worth looking at the highly potent ingredient found in cigarettes - nicotine.
Nicotine is a highly addictive chemical and, as a famous saying goes, "people smoke for the nicotine but die from the tar".
Nicotine is so addictive because it produces pleasurable effects that wear off quickly. The mechanism of the cigarette ensures the nicotine reaches the brain within seconds. Some experts have compared the addictiveness of nicotine to heroin and even cocaine.
Smokers addicted to nicotine need to maintain a certain level of it in their system. Otherwise, withdrawal effects will kick in.
To prevent nicotine levels in the bloodstream from dipping too much, a smoker needs to light up every 40 minutes or so to get the required level of the chemical. This works out to about 20 cigarettes a day.
Once an addiction to nicotine has developed, it becomes quite difficult to quit smoking, even if one has the knowledge of all the harm it causes.
It is at this stage that a smoker will often require help to stop, perhaps with medication, nicotine replacement therapy, counselling or a combination of the above.
Here, I want to bring up the issue of e-cigarettes, which have caused a vaping epidemic among youth in America, according to United States Surgeon-General Jerome Adams.
Vaping, the act of puffing on an e-cigarette, has been touted by its manufacturers to be less harmful than smoking.
E-cigarettes contain a nicotine liquid, which can be calibrated according to the user's preference and seems to have much less toxic chemicals than a traditional cigarette.
In the field of addictions, there is a theory called harm reduction through substitution, whereby you replace a more addictive substance with a less addictive one and subsequently wean the person off the less addictive substance.
Some experts have thus argued that vaping can help people quit smoking.
More importantly, though, the premise of e-cigarettes as a harm reduction agent is not entirely true. The cartridges in e-cigarettes sometimes contain more nicotine than that found in a cigarette.
Hence, despite breathing in less toxic chemicals compared with a traditional cigarette, you are just as likely - or even more likely - to become addicted to nicotine once you start vaping.
The e-cigarette then becomes your lifelong crutch. It is difficult to estimate at this point the type of harm that chronic use of e-cigarettes can inflict on your body.
As an addictions specialist, my opinion is this: Don't go there. E-cigarettes sustain an addiction to nicotine, not end it.
We are moving in the right direction of reducing smoking rates in Singapore through various policies of raising the legal smoking age, banning point-of-sale display and using plain, standardised packaging for tobacco products.
If you are serious about quitting smoking, there are professionals skilled in this area to assist you. If you have tried to quit multiple times, but failed, it does not mean you cannot succeed one day.
Perseverance, determination and the right support are the ingredients to beating an addiction. It is, after all, a relapsing and remitting illness, and there is no easy solution.
When I greeted Madam Luo, she smiled and said: "Sorry for being late. I finally managed to quit smoking and just wanted to tell you the good news."
This was a pleasant surprise for me as, just seven months ago, I had changed her treatment from an older medication to a newer one that more specifically targets nicotine receptors. She had seen no improvement with the first medication, so I made the switch.
After one month on the second medication, she had reduced her smoking to a pack a day and I had continued her on the medication for several more months.
She had been making steady reductions in her smoking before she defaulted on her last treatment visit, for which I had assumed the worst. I felt truly embarrassed.
After 50 years of heavy smoking, Madam Luo has finally stopped the habit. We just needed time to work out the right treatment for her.
It's never too late to try. You can stop smoking too, with the right support.
• Dr Lambert Low is a consultant at the National Addictions Management Service at the Institute of Mental Health.
Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.
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