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Brandon's Missing Legs:
Smoking and Buerger's Disease

According to the Centers for Disease Control, 31 year-old Brandon Carmichael started smoking in his mid-teens. By age 18, he was diagnosed with Buerger's disease, a disorder linked to tobacco use that causes blood vessels in the hands and feet to become blocked and can result in infection or gangrene.

In the above video Brandon recalls, "After losing my big left toe ... obviously, I was able to stop smoking. But sometime over the next few months I ended up smoking four or five cigarettes."

"In a matter of three and a half weeks, my left foot went from a normal looking foot to a foot that had to be amputated," recalls Brandon. "A third of my foot was missing its skin, so you could see the red, fleshy meat. Where my big toe used to be I had a huge ulcer, so big as to when I cleaned it out, besides gagging on myself from the smell, I could see the bones inside of my foot."

Despite knowing what causes Buerger's disease -- smoking -- Brandon continued a cycle of quitting and relapsing. "Both of my index fingers are shorter. The tips turned black, the black tissue fell off. I had bones sticking out of one of my index fingers. And then the other finger, the tip turned black and then the doctor actually pulled that off."

"The addiction is so overwhelming that after losing my body parts, I am still outside smoking," recalls Brandon.

"I was young. I didn't believe it. I was going to prove the doctors wrong," says Brandon. "Ultimately, it took 9 years and the amputation of both my legs and several fingertips for me to quit smoking."

Smoke-free for 4 years now, Brandon hasn't had any more amputations, but he still must manage the consequences of being a double amputee.

What Is Buerger's Disease?

Buerger's disease affects blood vessels in the arms and legs. Blood vessels swell, which can prevent blood flow, causing clots to form. This can lead to pain, tissue damage, and even gangrene (the death or decay of body tissues). In some cases, amputation may be required.

According to the CDC, the most common symptoms of Buerger's disease are:

How Is Smoking Related to Buerger's Disease?

According to the CDC, almost everyone with Buerger's disease smokes cigarettes. However, Buerger's disease can occur in people who use other forms of tobacco, like chewing tobacco. People who smoke 1½ packs a day or more are most likely to develop Buerger's disease.

Researchers are working to understand how tobacco increases the risk for Buerger's disease, notes the CDC. One idea is that chemicals in tobacco irritate the lining of the blood vessels and cause them to swell.

Photo of Brandon Carmichael

No Rationalizing Buerger's Disease Away

"If a smoker gets lung cancer, the person and other people can sometimes think, 'well non-smokers sometimes get lung cancer too, maybe cigarettes didn't cause it.' Same thing with heart attacks or strokes, non-smokers get them too, smokers just get them much more often," notes Joel Spitzer, WhyQuit's education director and a 40-years full-time cessation educator. "A certain level of denial can be exhibited and there is no way to conclusively prove that cigarettes did it."

"But Buerger's Disease, having no other known cause and basically never happening in non-smokers does not lend itself to such denials. When a doctor determines he or she is dealing with a Buerger's Disease patient, a basic ultimatum is going to be delivered - quit smoking or lose your limb - your choice! If we were dealing with simply a "bad habit," how many people given such an ultimatum and knowing it is true would continue doing the particular behavior given such consequences?" asks Joel.

"I didn't need for a house to fall on me"

"While Buerger's Disease is much more common in men, I have personally had two women who were Buerger's Disease patients in my clinics," shares Joel. "My first actual encounter with a Buerger's Disease patient was with a woman who was 38 year old when I met her, which was about 24 years ago. Three years before I met her, at the age of 35 she was diagnosed with Buerger's Disease."

"This is actually relatively late to first be diagnosed," notes Joel. "Her doctor had told her she had to quit smoking, but she did not comply and within a few months she had her right leg amputated. The circulation in her left leg was also badly affected, and after the hospitalization from the amputation she did quit smoking and had no further circulatory complications for the next three years."

"Then one night at a party, a friend offered her a cigarette. She figured that since she had been off cigarettes for so long, she now had control over her dependency. If she liked the cigarette, she would smoke one or two a day. If she didn't like the cigarette, she just wouldn't smoke anymore."

"Well, she took the cigarette," says Joel. "She didn't particularly like the cigarette, but the next day she was up to her old level of consumption. Four days later she lost circulation in her left leg. She knew the reason. After three years with no problem and only four days after going back to smoking her circulation was affected. Her doctor told her that if she did not quit immediately, she would probably lose her other leg."

"This is when I met her," recalls Joel. "She enrolled in a smoking clinic that week and quit smoking. Almost immediately her circulation improved. The doctor took her off anti-coagulant drugs and vasodilators he had put her on a few weeks earlier to try to slow up the process even though they were highly ineffective at stopping the likelihood of gangrene and amputation. But once she quit smoking she no longer needed them. Soon, her circulation was back to normal.

"Nine months later, I called to ask her to serve on a panel," says Joel. "At that time, she sluggishly replied, 'I can't come. I have been in the hospital the last two months.' When I asked what had happened, she hesitantly replied, 'I had my toes amputated.'"

According to Joel, she had gone back to smoking. She tried one because she just couldn't believe she would get hooked again. She was wrong. She lost circulation, had her toes removed and eventually had her leg amputated.

"I have had other clinic participants with similar experiences, being told to quit smoking or lose limbs who did not quit smoking," recalls Joel. "The reason I talk about this particular woman again and again is about a year after she had the second amputation, she came back into a clinic I was conducting and told me she had quit again and was now off about 9 months. I told her I was surprised, I thought she had permanently lost control. After all, she had her leg removed, the toes from her other foot, and eventually her second leg."

When Joel confronted her with that information she replied, "The doctor finally convinced me. He said, 'You might as well keep on smoking, I'll just take your arms off next.'"

According to Joel, that scared her into quitting. Her next comment to him was unbelievable. She looked Joel straight in the face, dead seriously, and said, I didn't need a house to fall on me to tell me to quit smoking."

Already likely unable to run hard for 1 mile, why wait for the damage being done to become impossible to ignore? Knowledge isn't just power but a quitting method. We invite you to continue to explore www.WhyQuit.com until far smarter than your addiction is strong.

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Created April 3, 2014 and last revised on 12/27/2018 by John R. Polito