We all have our vices; mine is chocolate cake. I cannot walk by a chocolate cake and not eat some of it. How can I get on someone for smoking? Surely, this is their vice and are we not allowed one at least? I think about this all the time as I counsel my patients to stop smoking prior to a surgery. I assure you, I am an equal opportunity abuser: I equally counsel my obese patients’ km weight loss prior to their surgery or the diabetic on better glycemic control. But what is it about smoking that makes it so bad for you?

Smoking affects so many aspects of the human body: the lungs, heart, blood vessels and on and on. The blood vessel effect is probably the most problematic for what I do as a surgeon. We rely on blood supply to organs to allow them heal after cutting out a part. The blood vessels bring life saving nutrients and oxygen to the area of healing. Without this, there will be limited, or no healing and things can leak or just not heal. This can cause life threatening effects including death. 

The heart is critical to life as it pumps blood through the body. As with other critical organs, blood needs to supply the heart. This sounds so counterintuitive as the heart is full of blood all the time – surely it does not need more blood. The heart is a muscle and the blood vessels to the heart itself (called coronary vessels) can be affected by smoking. Blockages in these vessels can lead to heart attacks and death. This can be a major issue during the stress of surgery. 

We look at those who smoke as higher risk for surgery in general. 

There are so many types of smoke exposure. Those that smoke cigarettes have first-hand smoke exposure. Those that live with smokers have secondhand smoke exposure that can be very harmful. We sometimes see a patient that does not smoke have lung issues attributed to those that smoke. This is from second-hand smoke from being in a household with someone that smokes. Please do not underestimate the risk that second-hand smoke may give. 

Vaping has become a big issue, especially in the younger population. This has become a trendy thing to do. The reasons for this increase in use amongst the younger population is manifold; vaping is thought to be safer than cigarettes. This is not correct. Most gaping fluids contain high levels of nicotine and this can be more harmful than lower-level exposure in cigarettes. Most agree that the lack of smoke in vape is safer on the lungs than smoke in cigarettes. However, homemade vaping fluids are especially dangerous as they may contain high levels of harmful agents. This has been recently shown in the vitamin E containing vaping fluids that have caused lung injury. Some vaping fluids are mixed with THC and other substances that are thought to aid in the ‘experience’ of vaping. This mixing can be dangerous and could cause lung injury and even death. 

The preservatives in vape fluid as well as the flavours can be harmful when inhaled. The smell of vape fluids that are flavored with many ‘fruity’ additives make these especially attractive to younger users. The lack of regulation of vape fluids can make this practice very dangerous as many additives that have unknown effects can be present.

So why stop smoking?

• It is bad for you
• It is hard to quit
• It causes proven damage to your vital organs

I see it everyday. I see patients who have had to have their leg cut off because of poor circulation. 
Please tell someone you love to stop smoking. You never know if you could be the one who changes their life..
(The writer is Chair, Department of Surgery, TCU and UNTHSC School of Medicine, Director HPB/AGI Fellowships, Director GI Surgical Services Associate Programme Director,  General Surgery Residency, Methodist Richardson Medical Centre, Dallas, Texas, USA)