Q: I know that smoking is bad for me, but quitting is hard. Is it OK to just cut down if I can't quit?
A: As you suggest, smoking is associated with a variety of health problems, including lung cancer, heart and vascular disease, and lung disease. Fortunately, the use of cigarettes in the U.S. has fallen substantially. In the middle of the past century, more than four out of 10 adult Americans smoked, while now the rate is down to about one in six.
Here in North Dakota, we've been a little higher than the national average over time, but not as bad as some states (especially those in the Deep South). We are still behind Utah, the leader in the nation, where fewer than one in 10 adults smoke. The health benefits of stopping cigarette smoking are clear and unequivocal.
Some people - like you - assume that smoking only a cigarette or two per day is associated with little or no risk. But some recent data suggest that this may not be true. A just-reported study found that smoking only one cigarette each day was associated with one-third to one-half of the risk associated with smoking a pack a day.
For example, in this study a man who smoked a pack of cigarettes a day doubled his risk for coronary heart disease and stroke. But smoking only a single cigarette a day still increased his risk by 50 percent.
So the bottom line is clear - while cutting down has some benefit, to really reduce your risk of complications associated with cigarette smoking, you need to stop completely.
Q: A few years ago I had my right knee replaced and following the surgery I developed a blood clot that lodged in my lungs. I'm now scheduled to have my other knee replaced and I'm concerned about the blood clot issue.
A: Although usually very successful and safe, total hip and total knee replacements may be associated with a variety of complications, including infections and especially the formation of blood clots that can break off and then travel to the lungs (called pulmonary emboli or PE), just as happened to you.
Because physicians are aware of the risk of such clots forming, patients undergoing these procedures typically are given one of several types of blood thinners to try to prevent the clots from forming in the first place.
Although practices vary, a common approach is to use what we call an anticoagulant to thin the blood for several weeks following surgery, especially for people like you (with a prior episode of PE) who are at higher risk of clotting.
But an important new study may soon change that practice for many patients (but maybe not for you and people like you who are high-risk for clots). The study compared the use of a blood thinner with low-dose aspirin (following an initial five-day period where all patients received the blood thinner). The study found that aspirin was just as good as the blood thinner-and a lot cheaper.
So for many people, the best clot prevention may be as simple as taking a baby aspirin. That said, anticoagulation choices are complex. Be sure to have a conversation with your doctor about what is the best anticoagulant choice for you.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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