I quit smoking and use a vape device.  That’s good, right?  Right?

What’s good about a vape device?

Nothing really - let me explain.  As a doctor you find out that conversation is the primary key to making a diagnosis.  In the medical world we may call it the history, but I call it good conversation with a focus on the primary reason the patient has come to your office.  “How are you?  How can I help?  Tell what you do for a living?  What do you do for fun?”  Inherent in that conversation is a discussion about social activities to include alcohol intake, recreational drug use and smoking.  Many patients are very literal about the smoking question.  A good doc is going to go one step further; do you chew tobacco or use a Vape Device?  Why?  It’s all about the nicotine.

What's not good about vape devices - nicotine

Nicotine has a number of lower extremity health consequences.  One cigarette has enough nicotine to decrease the blood flow to the foot by 30% for up to 1 hour.  What about a vape device?  It’s the same.  Switching to a vape device may eliminate tar in your lungs, but you’re still going to have the same detrimental lower extremity problems that affect your circulation.  And dipping?  Just the same.  Nicotine is nicotine, regardless of how you ingest it.

How does nicotine affect the outcomes of foot and ankle surgery?

The majority of my podiatry practice is wound care and reconstructive surgery.  Diabetes and tobacco abuse are the two biggest issues that affect my ability to heal a wound or mend a broken bone.  If I need to use a bone graft in surgery in a smoker, will it heal?  Probably not.  Honestly, in many cases it’s just not even worth trying to place the graft in patients who are chronic nicotine users.

The pattern of arterial occlusion seen in nicotine users in the lower extremity arterial tree is distal to proximal.  Distal to proximal means that usually we’ll see more arterial damage in the toes.  The problem  with this distribution is that the arterial occlusion is very difficult to treat surgically and more often results in loss of limb.

Many patients ask, "Will marijuana cause the same problems with healing?"  The answer is no.  Even though smoking marijuana deposits tar in your lungs, marijuana has no nicotine.  So in terms of lower extremity health and what we've discussed with bone healing and wound healing, marijuana is OK to smoke.

So have you done a good thing by quitting smoking?  Sure, that’s a good start.  But focus on ditching the nicotine, OK?. 

Jeff

Jeffrey A. Oster, DPM

Medical Advisor
Myfootshop.com

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