Just tell him the truth, your Dr. is supposed to be your confidant in matters of health, yeah you may get an ear full from him but at least he knows your history and if there is ever a medical emergency he has all the facts not just some of them. My Dr. knows that I smoke, and in the beginning he told me you know you should quit and etc. etc. etc. I explained to him that I enjoy smoking and I know the risks, since then he does not mention it anymore and we have a great relationship and he takes very good care of me. I guess it depends on your Dr. if you trust him, he is your primary Dr. and how often do you visit him. I have the misfortune that I must see mine every 4 months or so, but it also is a blessing in hopes that any situations will be caught early. Now with regards to my pipe he told me on several occasions to keep smoking it because it relaxes me and with the migranes I get its a good thing.