Counseling – Other Topics
Smoking
 Smoking history
o how long, how many packets, type and brand
o Increasing/decreasing
o Pleasure, after work, when stress
o Tried quitting, what happened then
o Withdrawal symptoms
o Illness – cough, dyspnea, CVS
o FHx of smoking and illness
 Social Hx
o Married, children
o Who he stays with and lives with
o What are their opinion
 Benefits of quitting
o CVS, resp
o Breathe easier, taste sharper
o Financial
o Good for children and loved ones
o Many have been successful
 Fears and offer solution
o Withdrawal (restless, irritable and lack of sleep)
 nicotine replacement (gum, patches, inhalers) and bupropion
 These double the chance of successfully quitting
 NRT start on quit date (2 weeks supply initially); have locaolised
reation and may have mild sleep disturbance
 Bupropion start 1 week before quit date (3 weeks supply initially);
0.1% of seizures and 0.1% of severe hypersensitivity reaction; 3%
has rash/urticaria/pruritus and c/o dry mouth and insomnia
 Not for <18, breastfeeding or pregnant
o Weight gain – up to 5 to 10 pounds in the first few months is expected but
can exercise and have healthy snacks
 Any intention to quit, will to quit
o No – can meet up again; phone no, leaflets
o If yes, can refer to a NHS Stop Smoking Service
 If not keen, then offer advice on quit date and nicotine
replacemen/bupropion; anticipate likely failure triggers
 If keen, then make the referral!
Organ Transplant
 The new Human Tissue Act in UK comes into effect on 1/9/06
o If someone who wants to donate, ie on the NHS Donor register or Donor
Card carrier or expresses wishes to donate organs upon death, relatives
cannot object
o Unrelated Live Organ Donation
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Allowed from the 1/9/06
“paired” or “pooled” or “altruistic”
 Paired = 2 couples in which they are not compatible within
but compatible with the other couple
 Pooled = >2 couples
Alder Hey Scandal whereby organs of the dead were taken and stored without
consent of the deceased or relatives
In UK, it is an “Opt In” system
Hormone Replacement Therapy
 Informed decision
 Types
o Creams and gels (estrogen) which should not be used >3-6 months
because systemic absorption of estrogen
o Tablets, patches, implants, nasal spray (estrogen), Mirena(IUD with
progesterone), vaginal ring with estrogen only and for hysterectomised
patients and “bleed-free HRT”
o All women with uterus must have progesterone
 Uses
o For menopausal symptoms which normally lasts for 6 months to 2 years
which includes hot flushes, vaginal atrophy, frequency, urgency and
dyspareuina, night sweats and irritability
o For premature menopause up to age 50
o Osteoporosis
o Reduce risk of colorectal cancer
 Risk of
o CHD
o CVA
o PE/VTE
o Breast Cancer, ovarian cancer, uterine cancer
o Dementia
 Side effects
o Breast tender
o Vaginal discharge
o Nausea, weight gain, irregular bleeding, headaches
o Progesterone can cause premenstraul tension, depression, ankle swelling
and jaundice
o Increase size of gallstones
 Alternatives
o Homeopathic alternatives and use of phyto-estrogens
Compensation
 For asbestosis, silicosis, coal worker’s pneumoconiosis, byssinosis and
mesothelioma
 Get form B1; MO from Social Security visit; compensation backdated 3 months
except for mesothelioma; have up to 1 month to dispute degree of disability