my PCP rx'd a box of those nicotrol inhalors after i first saw dr. ahn and he dx'd TOS on the spot. not only did he advise me that i needed the rib resection (for mine is a case of true neuro TOS and all the PT in the world wasn't going to help me, he said), but this very knowledgeable fellow very patiently explained to me that my smoking was actually adding to my TOS sx; namely, the ischemia...

ischemia, i thought to myself! sounds more like a communist plot to me--

and a hell of a time to have to give up cancer sticks, too! right before a major and risky surgery, which can be um, a little nervous-making to put it mildly... (the buddhist didn't seem to care)

but dr. ahn is the man who gave me the best reason i'd ever heard of to finally kick the habit, beth.

the inhalors got me used to not smoking cigs in a fairly painless manner. so i looked like an idiot with a pacifier dangling from my mouth for a few weeks, OK months, whatever... who cares, it worked! this was before the rx you mentioned had become available, so ask your doc about using the device in tandem with that med, though.

there are some wonderful programs on-line which i also found very informative, supportive and useful. freedomfromsmokingonline.com is sponsored by the american lung association. quitsmokingonline.com is good, too. whyquit.com is another one, and there are others as well.

not gonna tell you it's easy. but definitely one of the best things i've ever done for myself. i wish you every success and do let us know how that new med works out for you, beth. it sounds very promising in the field of addiction... and make no mistake - that is what we are dealing with here.

since the scalenes are respiratory muscles, though, there is a definite EXTRA payoff for TOS'ers who quit, in that it will eventually really help with diaphragmatic breathing (plus that ischemic aspect) and, therefore with pain management technique... on top of all the myriad of reasons to quit the american lung association and any reformed smoker will be only too happy to tell you all about ad infinitum and on and on and on. snore zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz

lucky for you i don't have a medical background and can't answer your other question, so i'll stop here having given my usual too much unsolicited advice for the day thang--

alison