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Nicotine dose - patch or gum - for ex smoker

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Ulcerative Colitis
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Dropkick_Steve
New Member
Joined : Nov 2019
Posts : 8
Posted 11/18/2019 8:23 AM (GMT -7)
Hello everyone
I was diagnosed with uc in July '17. Symptoms appeared in June, 3 months after quitting smoking. I am currently on 3g mesalazine/day. My flares are moderate but really stubborn in duration. Except for the blood in my stool I don't have any major physical symptoms. No pain, no cramping, no diarrhea. But I am experiencing bouts of depressed mood and anxiety. For 6 months I was stupid enough to quit my medication, and gradually these mental issues progressed and I was left wondering what on earth was going on. Since my physical symptoms were not debilitating, my depressed mood was not originating from thoughts about having the illness, and my quality of life was at the best it had ever been. But still my whole way of thinking was turning negative, I was feeling anhedonic and getting rushes of anxiety even when I was not thinking about anything in particular.
There is ongoing research that suggests that chronic inflammation might cause mental problems like depression and anxiety. For me it really feels like that is the case, because while in remission I had never suffered from mental health problems.
Taking up smoking is not an option for me since the potential hazards of smoking by far outweigh the benefit of keeping me in remission, but I have started with 3 pieces of 4mg gum a day. From what I read approx. half is absorbed into the bloodstream. It has been 2 weeks and I haven't seen any results. I think the dose is small and I should probably increase it a bit. I have not tried the nicotine patch but I will consider it if I see no progress with the gum. I don't like the idea of vaping because I am afraid I will relapse into smoking.
Any insights from ex smokers who have tried the patch or / and gum would be much appreciated. Did any of these nicotine sources work for you and at what dose?
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Michelejc
Forum Moderator
Joined : Jan 2011
Posts : 2572
Posted 11/18/2019 8:56 AM (GMT -7)
I took Chantax and stopped smoking for over 6 years. Unfortunately, I started again. The patch didn't work for me. The gum didn't either.
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 6235
Posted 11/18/2019 9:14 AM (GMT -7)
I started smoking again after 9 years quit and it threw me into a huge flare. I know I am not the norm though because I got UC as a smoker and my symptoms got better each time I quit. Are you seeing a gastroenterologist? Have you been scoped recently to see if you even have inflammation?
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Dropkick_Steve
New Member
Joined : Nov 2019
Posts : 8
Posted 11/18/2019 10:32 AM (GMT -7)
Yes I am seeing a gastroenterologist and at some point he said that my blood tests at the time were not consistent with inflammation. However I was passing blood with my stool, so where would the blood be originating if not from my inflamed colon? He said it could be due to internal hemorrhoids but then wouldn't those show up in a colonoscopy? Since I have been diagnosed with UC, when I see blood in my stool I assume it is from a flare up.
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 6235
Posted 11/18/2019 10:56 AM (GMT -7)
Other possible causes of blood are anal fissures or hemmorhoids. I would assume the same as you if I saw blood, but you have no other symptoms (well, other than anxiety and depression which I have never heard of being linked to IBD inflammation with no symptoms). I personally would want to make sure it was my UC before making myself addicted to nicotine again. You could request a calprotectin stool test to see if you have inflammation. Good luck with whatever you decide to do.
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Dropkick_Steve
New Member
Joined : Nov 2019
Posts : 8
Posted 11/18/2019 11:29 AM (GMT -7)
Hello Sara thank you for your input. I was very sceptical before starting the gum that I might crave cigarettes if my system were to be getting nicotine again but chewing the gum bears no resemblance whatsoever to smoking. So I am happy because I do not crave cigarettes, I even have to actively remind myself to chew another gum because I don't crave it either. As for the link between inflammation and depression/anxiety it is true that the research is at an early stage and it also need not apply to everyone. There is an interesting article by a prominent neuropsychiatrist:
https://elemental.medium.com/the-link-between-inflammation-and-depression-a6e0d5c98639
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iPoop
Forum Moderator
Joined : Aug 2012
Posts : 16177
Posted 11/18/2019 11:48 AM (GMT -7)
What I've heard over the years is this: If you were a former smoker who quit and then got a UC diagnosis, then there is a chance reintroducing nicotine in some form might help a little bit with your symptoms. Of course, you gotta weigh the downsides of nicotine an addictive substance, and other risks when smoked that are well known and I will not say more about those here. Over the years, people have tried patches, gums, vaping, and cigs with varied results. The majority reintroduced cigs.

In my opinion, you are better off using UC meds, even stronger ones like remicade if needed.
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 6235
Posted 11/18/2019 12:54 PM (GMT -7)
I will take a look at that link, Steve. Thank you. I agree with iPoop regarding being better off using UC meds. Best of luck to you!

P.S. There is a really kind anxiety forum here on HealingWell if you ever want to post there. Some super nice folks.
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AndyRoark
Regular Member
Joined : Aug 2019
Posts : 37
Posted 11/18/2019 6:01 PM (GMT -7)
Former smoker (quit at 24), diagnosed with UC after battling GI problems for years in my early 30s.

Had a GI doc that wasn't worth anything for a couple of years and finally went into a major flare that he couldn't or wouldn't touch. Got a new GI guy. In the week before that appointment, my UC went hyper crazy and I started bleeding so hard I couldn't leave the house. By that point I knew about the reintroduction of nicotine theory and was desperate so I went out and bought a pack. And it worked. The bleeding stopped. By no means did it stop the flare but it allowed me to manage the symptoms. Which I did for the next five years.

I am not advocating smoking, but I am telling you it worked for me. During the five years I quit smoking many times when my symptoms were better, and also tried all of the nicotine replacement systems. Patches, gum, lozenges. None of them seemed to do anything for me. I tried vaping a couple of years ago and actually believe it made things worse. Didn't really study it as hard but I ended up with some funky symptoms that went away when I quit vaping.

But smoking always helped me. Pure, simple cigarettes. Nothing else.

Now that I've said that, I will strongly agree with iPoop. The stronger UC meds are a better choice. I quit smoking for the last time at my colectomy surgery and do not miss it a single bit. Smoking sucks.

But there is something there and I honestly wish the medical establishment would get over their aversion to all things smoking to figure out that there might be a key to understanding this disease in those nasty, publicly unpopular little boxes. I challenged my doctor on it one time. In my career, if something offered a clue on how to figure something out I would rip the walls down until I understood it. They seem totally disinterested in it because... cigarettes.
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Dropkick_Steve
New Member
Joined : Nov 2019
Posts : 8
Posted 11/19/2019 1:56 AM (GMT -7)
Hey Andy & iPoop and thanks for sharing your story. Yes I have read accounts of people that did not have their symptoms alleviated by the nicotine replacements. Could it be the route of administration that is the key factor, who knows. Some even suggest it could be other compounds present in tobacco smoke that induce remission or maybe it is a combination of compounds. This last time I quit smoking, the withdrawal symptoms were so nasty that they still serve as a reminder to never go back. I will do trials with the gum and maybe patches for a few months to monitor the situation and if things get worse in the future there are also the stronger meds as you say. This disease is so elusive in the way it unfolds, the triggers seem totally random, I have to this day identified no patterns whatsoever. This makes it even more frustrating and is something we can all relate to.
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