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DEAR DR. ROACH: I have a question that I’d love to see answered in your column sometime. My husband recently had major surgery. Before the surgery, they asked if he has ever smoked. (Husband is 77.) He answered that when he was 9, he smoked a cigarette. He is now in the computer as an ex-smoker, and the nurse told us she is “required by law” to provide him with information on quitting.
When physicians ask, “Have you ever smoked?” do they really want to hear about one cigarette, smoked almost 70 years ago? Is this meaningful information, in medical terms? – S.S.
ANSWER: There are very important reasons to know a person’s smoking history, especially when someone is about to undergo surgery. Current smokers should know that quitting well before surgery can reduce risks of surgical complications.
The anesthesiologist can be extra-vigilant for breathing issues. Some of these points are valid for ex-smokers who have recently quit or who were very heavy smokers.
Of course, one cigarette at age 9 is meaningless, and anytime I hear “required by law” I wonder if it’s really true. In this case, I doubt it: Why give ex-smokers information on quitting? It makes no sense.
Primary care providers like me ask about smoking because a significant history of smoking increases heart disease risk, so I might be more likely to recommend treatment to reduce that risk (for example, in a person with elevated blood pressure or cholesterol who otherwise doesn’t quite meet criteria for drug treatment). Also, people who smoked more than 1 pack per day for 30 years, or the equivalent, should have a discussion about whether screening for lung cancer is appropriate.
Finally, it’s easier to answer if you have never been a smoker. Some people who smoke socially don’t consider themselves smokers but would still benefit from advice to stop.
DEAR DR. ROACH: I took a sleep study and slept on my back all night because I was wired up and couldn’t sleep on my side. After a couple of hours, I was told that I have moderate sleep apnea. I snore when I’m on my back, but not when I’m on my side. Do you think I really have sleep apnea? – T.M.
ANSWER: Obstructive sleep apnea very often goes unrecognized. It is caused by the soft tissue in the neck obstructing the airway; the muscles relax while you are asleep, closing the airway. This is indeed much more likely to happen when lying on the back (we use the anatomical term “supine”), and generations of spouses have learned that turning a snorer on the side is a good way to get him or her to quit snoring. Snoring is caused by the very same process that leads to sleep apnea; in fact, snoring is a significant risk factor, with up to a third of snorers having the condition.
I believe the sleep study. While I am sure you would have demonstrated less obstruction if you could sleep on your side, you still are likely to have some obstruction during the night, especially since we frequently change position while sleeping without knowing it. However, there are many different treatments for sleep apnea, and you should talk with your doctor about which is right for you. You need not jump to the most aggressive treatments.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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