Question Title: Suspected Nicotine Overdose Please Help

I am 35 and had been smoking for about 20 years. I had decided to quit 4 months ago, so I went on the patch. It was very successful I had not touched a cigarette nor had an urge for two weeks. I was home with the flu and was bored so I dug up an old stale cigar and proceeded to smoke it. Within about 1/2 hour I started to have horrible symptoms, tightness in the chest, (felt like someone was sitting on my chest) difficulty breathing and severe anxiety, and heart palpitations to the piont of burning around the heart.
I took off the patch and went to a clinic, they suggested I go to emergency. I waited for several hours then went home. The anxiety lasted a couple of days. And I basically slept. Since I did not see a physician at the time I did not make the connection between the patch and smoking. I continued to feel very weak, so I thought I cannot fight two battles, needless to say I started smoking again. The anxiety soon returned, I have subsequently developed digestive problems, hyperacidity, motitliy problems and a tightness around the stomach (usually attributed to stress, however in my case caused by the nicotine). Generally the symptoms are worse after the first cigarette in the morning, tightening of muscles in the throat and chest. Burning anxiety or nervous feeling in the stomach, disconected (drugged feeling) and weekness, and sweating with very little physical exsertion.
All of these things are foriegn to me so I was getting quite concerned. So I came to the conclusion that since I have felt this way since my incident with the patch It may have caused a sensititivy or an intolerance to nicotine. So I quit cold turkey and was off for 3 days but the insomnia from the withdrawal was too much. I have noticed that when I am off the cigarettes I have energy and most of the symptoms disappear, the anxiety is still there but I attribute that to the withdrawals.
I would like to know if I am on the right track, and what I can do to make quitting less stressful, and how long it should take before I notice an improvement. ( have tried zyban bit it gives me a very disconnected drugged feeling, another side effect from my ordeal, I cannot handle drugs like antihystamines, or gravol, I get extremely groggy for hours after I wake.)

Thank you

Dear Andy,

The episode you described with the cigar may have been a panic attack, although the "crushing" chest pain is definitely something you need to review, sooner rather than later, with your personal physician (if you do not have one, you should get one).

The panic episode may have been triggered by too much nicotine. Because that episode was highly uncomfortable and difficult to forget, you may be re-experiencing the panic feelings now whenever you experience a feeling or sensation that is even remotely reminiscent of what you felt that day you smoked the stale cigar.

It is difficult to stop smoking when one is contending with an untreated anxiety disorder (in your case, it's a very treatable condition called panic disorder), so it probably makes the most sense (after you get checked out thoroughly by an internist or cardiologist) for you to get treated for you anxiety disorder, both to feel better and to increase the likelihood that you will succeed in stopping smoking. You could check out the web site of the Anxiety Disorders Association of America (I believe it is http://www.adaa.org) to learn more about anxiety disorders, and to identify a competent mental health practicioner in your area. As soon as the anxiety has subsided, get going again with stopping smoking - don't put it off - that never helps, it just makes it harder to quit when you eventually decide to go ahead and do so.

For more information about smoking and smoking cessation, check out my Ask DrSteve web site ( http://www.drsteve.org ).

Good Luck!

DrSteve

Keywords: panic, anxiety, nicotine, smoking