What's Hookah?

What's Hookah?? In the past few years, instead of asking my patients "Do you smoke?" I have learned to ask  "Do you smoke? (pregnant pause)...ANYTHING?" I found that asking in that manner greatly increases my yield. Couple that with Colorado's legalization of marijuana, and more people are freely sharing the full extent of their substance use with their doctors. Which left me asking the question, "what's hookah?" (I could add here that I was also asking "what's shisha" and "what's snus"?)

Hookahs are water pipes used to smoke flavored tobacco. The flavors are often sweet- chocolate, cherry, licorice or fruit flavored. The heat source is charcoal, and the vapor/smoke goes through a water basin before being inhaled. A common misperception is that this "purifies" the tobacco, so that the smoke is no longer harmful. Hookahs can have multiple tubes allowing several people to inhale at one time, or users can pass around the mouthpiece and take turns inhaling (obviously sharing germs as well as the hookah vapor).  Hookah bars seem to be multiplying across the United States, especially in college towns. Austin, Texas, is no exception. A 2013 study of 7 large universities showed that 1 in 10 college students used hookah.

Although hookahs has been around for centuries, we certainly do not have a plethora of double-blind, placebo-controlled meta-analysis studies to clarify exactly the specific health risks of long term use of hookah. What do we know?

• Hookah smoke is "at least as toxic as cigarette smoke" (CDC, 2013)
• Hookah tobacco and vapor contain the same poisons that cause mouth, lung and bladder cancer
• Hookah sessions are usually much longer than cigarette breaks- often up to an hour, increasing the toxin exposure up to ten times higher than traditional smoking
• The nicotine in hookah tobacco and vapor is very addictive (just as in cigarettes)
• Smoke from the heat source, charcoal, can cause carbon monoxide poisoning
• Gum disease is 5 times more common in hookah users than cigarette smokers

BOTTOM LINE: Hookah (water pipe) smoking is NOT a "safe" alternative to cigarette smoking- don't take up this habit! 

CVS Quits Smoking!

Congrats to CVS pharmacy for taking a stand for HEALTH and announcing that they will completely quit selling tobacco products by October 1st of this year! While, yes, consumers can choose to walk across the street and head into another store to purchase their cigarettes, I am hopeful that other major pharmacies and grocery stores will consider this same step. As people have heard me say repeatedly, there is NO amount of tobacco that we believe to be actually GOOD for your health.

Every single day in the United States, there are over 1300 deaths attributed to smoking. How can you picture what that means in terms of human tragedy? Imagine two enormous jumbo jets colliding- which would mean approximately 1200 people dying...and think about how many times we would see that ghastly image on our computers and televisions. I want young people starting to smoke to have THAT image printed on their brains, rather than associating smoking with fun, alcohol and parties.  Did you know that the vast majority of long-term smokers began the habit before the age of 21? I cannot tell you how many soccer moms my age, as well as professionals of all sorts, are still closet smokers- hating their addiction and wanting to quit. Many picked up "social smoking" in college fraternities and sororities, thinking it was no big deal...and that they would stop that habit after they graduated. Now it is ten or twenty years later, and they are hiding this addiction from their peers and especially their children. I believe it may be easier for people who smoke openly to quit, because at least they can enlist the support of their friends and family!

If you are still smoking, please talk to your family doctor about all the medical options to help you quit, and think about setting a quit date in 2014. Your habit didn't form over night, and the average serious smoker takes 7 tries to quit for good. Nicotine replacement medications (gum, patch, nasal sprays, inhalers and lozenges)  have been shown to increase your chance of successful smoking cessation by 50-70%. Other medications such as Chantix & Zyban double or triple the success rate as well.

BOTTOM LINE: Smoking doesn't "just" cause lung cancer (and many other cancers), it causes heart attacks, strokes, and really crummy quality of life with chronic bronchitis and COPD (Chronic Obstructive Pulmonary Disease). If you still smoke, please make an appointment to talk to your family doctor about quitting. You CAN do it!

Cigarettes- the Good News & the Bad News

Let's start off with the GOOD news- the CDC's anti-smoking TIPS campaign has turned out to be far more successful than they had dared to hope! Over 1.6 million smokers had a quitting attempt, and at least 200,000 smokers DID QUIT as a direct result of the shocking pictures and stories featured in this unique national program. The Lancet published a wonderful article this week summarizing all the findings: Effect of the First Federally Funded U.S. Antismoking National Media Campaign.

I have always maintained that stories are more powerful than statistics. Sure enough, this campaign is chock-full of stories from former smokers- people sharing extremely painful negative consequences from their nicotine addiction. Virtually every complication from smoking is shared: heart surgery scars, asthma, artificial limbs (from damage to blood vessels), artificial voice boxes (from throat cancer), COPD (chronic obstructive pulmonary disease) and of course, lung cancer, to name a few. Hearing from Terrie- a former cheerleader, points out the dangers of "social smoking" in college. Likewise with Michael, who smoked in the military. Click on the TIPS from Former Smokers 2013 to hear and see more...and share with any of your friends or family or co-workers who still smoke.

The campaign goals are to increase public awareness of both immediate and long term health risks of smoking- both first-hand, and from inhaling second-hand smoke. Note that for every person who dies from smoking, 20 more Americans are LIVING with a smoking-related illness. The CDC wants to encourage and support smokers who are ready to quit, as well as encourage them to limit other people's exposure to their second-hand smoke. 

So that was the good news...now the bad. Just last week, Notes from the Field: Electronic Cigarette Use Among Middle and High School Students- United States, 2011-2012 was published in the CDC's Morbidity and Mortality Weekly Report. E-cigarettes are not a new cell phone app, they are true electronic cigarettes that are battery powered and deliver nicotine and other byproducts via an aerosol. Worse yet, they can add sweet "childhood" flavors- fruit, mint or chocolate. Really??? Does the industry have NO conscience???? Not surprisingly, they are portrayed as "safe smoking" (anyone else reminded of "safe sex" campaigns?) and teens are jumping on board. E-cig use doubled in this time period, yielding nearly 2 million (1.78, lest I exaggerate) students trying out nicotine in this delivery system last year. Please note that although we do not yet have long-term studies on the "pure" damage of these e-cigarettes, we know that nicotine is damaging to adolescent brain development and, hello- nicotine is ADDICTIVE. If you get addicted via e-cigs vs. dipping vs. "regular" cigarettes- the outcome is the SAME. You are ADDICTED to NICOTINE.

BOTTOM LINE: There is still NO AMOUNT of smoking that is GOOD for you, so please, help encourage your friends who are already smoking to QUIT, and parents, please warn your kids that e-cigarettes are NOT SAFE. NICOTINE is ADDICTIVE in ANY FORM.

What Did You Give Up?

Lent came early this year- tough to have Valentine's Day the second day of this season if you gave up chocolates! While certainly not everyone practices Lenten observances, I think most people are familiar with the general concept of offering some sort of self-discipline as part of a religious practice, so this is a good opportunity for me to share a thought about the mix of religion and medicine.

As a physician- especially as a Catholic one- I really appreciate Lent. Just as New Year's resolutions for healthy changes are fading away, in comes Lent to save the day! All kidding aside, while many of us have wonderful intentions of limiting sweets, sodas, alcohol, nicotine, or you-name-it in the name of HEALTH, a good portion of us need that extra nudge of discipline that comes when these intentions are linked to a higher good. One way to do this is indeed the traditional practice of a "fast"from an earthly pleasure. If every time we start to reach for or simply crave our "off-limits item", we instead check ourselves and take a minute for prayer or reflection, how great is that? Not only are we not harming our body with an unnecessary substance or calorie load, but we gaining the peace and lower blood pressure that comes from meditation. Definitely a win-win! (Of course, if we gripe and grumble and feel extremely self-deprived every time, that's a whole different ballgame...)

Whether it is fasting, prayer, meditation, or acts of service for others, religious practices can be a wonderful asset to our health- both physical and mental. In my practice, I have seen tremendous success  when patients combine their spiritual and physical efforts in a very practical manner.

BOTTOM LINE: Harness the power of your religious strength to give you that extra push to stick to healthy life-style choices!

Texting Can Save Lives?

http://t.cdc.gov/ecards/message.aspx?cardid=573&category=157

Following up on yesterday's Great American Smokeout..., an interesting study was published this year looking at the effectiveness of TEXTING support to help people quit smoking. This was an analysis of several other studies, including over 9000 total participants. Text messages were used either exclusively or as a supplemental part of smoking cessation programs. Although the results were not fully consistent between the individual studies, ultimately the data is encouraging to support use of this ever-present appendage to aid people in quitting smoking.

In fact, the National Cancer Institute has a texting support program for smokers wanting to quit. Smokefree TXT is designed to be a 24/7 support system offering advice, encouragement and tips for tobacco users trying to kick their habit.

More and more, we are finding ways to use technology to help our health. This picture above is from the free e-card collection at the Center for Disease Control (CDC). Use the link above to check out the wide range of health reminders that you can share with your friends and family! Everything from flu shot reminders, to cancer screenings (think mammograms, pap tests and colonoscopies) to yes, quitting smoking.

BOTTOM LINE: Every bit of contact and support that we can give our friends to help them quit smoking is worthwhile- even texting!

Great American Smokeout!

TODAY, the third Thursday in November, is the annual GREAT AMERICAN SMOKEOUT sponsored by the American Cancer Society. Each year, smokers are encouraged to use this day as a QUIT date, or at least as a day to make a plan to quit. If you have a friend who still smokes, please reach out to them today and kindly encourage them with a reminder that today is a special day earmarked for their health. With this vice, there is NO amount that can be justified as being "good" for you.  Tobacco harms virtually every organ in the body. Everyone knows about the cause and effect of smoking and lung cancer, but cigarettes also greatly increase the risk of developing cancers of the bladder, kidney, pancreas, esophagus, throat, mouth, pancreas, stomach, ovaries, cervix and colon. Smoking directly increases your risk of heart disease- both heart attacks and strokes. Obviously it damages the lungs, causing chronic conditions with increasing shortness of breath and lack of energy.
Finally, appealing to your vanity (hey, whatever it takes!)- tobacco stains your teeth and gives you bad breath. And guys, smoking can lead to erectile dysfunction that evenViagra cannot "cure"...enough said.

Tobacco is one of the strongest addictions, and therefore often the most difficult to quit- if you are a smoker, I don't have to tell you that! The good news is that we have more ways to support you as you quit, and even if you have smoked for many years, quitting now still yields many benefits for your health! Blood pressure and carbon monoxide levels improve the first DAY you quit. In a couple months, both your circulation and lung function start to improve. In just one year after quitting, you will have cut in half your excess risk of heart disease compared to people still smoking. In a decade, your risk from dying of lung cancer falls to half that of a current smoker.

BOTTOM LINE: If you smoke- even "socially"- the SINGLE MOST IMPORTANT THING YOU CAN DO FOR YOUR HEALTH IS TO QUIT SMOKING!!! Talk to your doctor and make a plan TODAY.

Can't Swallow That?

Difficulty swallowing, known medically as "dysphagia", is a very common complaint. In fact, up to nearly a quarter of patients seen in primary care settings will suffer from this problem. Dysphagia is definitely more common in the older population, whether they are in nursing homes or living independently.

What causes dysphagia? The most common cause depends on the age. In small kids, there may be structural problems present from birth that may need surgical correction. In adults, however, the cause is often something that can be fixed more simply, with medications and/or behavior changes.

Smoking, excess alcohol, and obesity all tend to increase stomach acid refluxing back up into the esophagus, which can cause pain or difficulty in swallowing. Reflux, also known as GERD (Gastro Esophageal Reflux Disease) is a very common cause of dysphagia that is seen in otherwise healthy people. Quitting smoking, stopping excess alcohol and weight loss can all improve symptoms, as well as taking medications that reduce acid production.

Medications such as NSAIDS (like ibuprofen), potassium supplements, antibiotics and osteoporosis medications can all cause problems with swallowing, so both diagnosis and treatment of dysphagia in this case may involve stopping prescription medications.

• Let me take this opportunity to caution against "DRY SWALLOWING" pills. I cringe when I see people grab an ibuprofen and swallow it without a drink. Every time you take a pill or capsule, swallow it along with at least a half glass of liquid. Dry swallowing can essentially "scrape" or chemically irritate the lining of your esophagus. And please, let gravity help you get that pill all the way to your stomach- don't lie down for at least five or ten minutes after you take medications.

Less commonly, the more serious causes of dysphagia are to blame, including cancers, strokes, neurologic disorders such as Parkinson's Disease, advanced infections, or scarring from prior trauma or radiation.

BOTTOM LINE: Don't ignore trouble swallowing, especially if it persists or is getting worse. Schedule an appointment with your family doctor!

A WEIGHTy Issue- Quitting Smoking!

Why do people who quit smoking gain weight? Does it always happen, or can it be avoided? Do we really care that weight gain is really less detrimental to our health than smoking?
As a physician, I have found that women in particular choose to keep smoking because they simply do NOT want to gain weight. Period. I will confess that I will occasionally try to appeal to their vanity by discussing the yellow teeth or bad breath that tend to accompany cigarettes, but the reality is that what is important in this situation is helping patients understand why smokers gain weight with quitting, and how it can be avoided. So here are some things to remember:

1. Nicotine is an appetite suppressant, so obviously, when you initially take it away, your appetite is up.
2. Smoking KILLS taste buds, so just about the time the extra appetite from quitting is going away (around a week), suddenly food begins to TASTE better, because now you've actually got healthy taste buds!
3. Happily, ALL FOODS taste better, not only the high fat/high calorie ones.
4. Yes, oral gratification is a habit, so STOCK YOUR FRIDGE with some low calorie, crunchy and delicious snacks like carrot sticks with hummus, or apple slices, or ANY fruit or vegetable. Additionally, suck on sour hard candies the first week or two.
5. Don't forget EXERCISE! Getting and keeping your heart rate up for 30 minutes per day is equal to a low dose of an anti-depressant medicine, so exercise will not only balance extra calories consumed, but will make you HAPPY and less irritable!

BOTTOM LINE: As we approach New Years, move QUITTING SMOKING to the top of your list and know that weight gain is NOT inevitable.

SEVEN Ways to Leave Your Cigarettes

SEVEN seems to be the magic number for habits of successful people, right? SO...smokers, step on up to the SEVEN choices to help with QUITTING SMOKING! In alphabetical order, here they are:

1. Bupropion SR (Wellbutrin SR)- this is an antidepressant that works via unknown mechanisms to decrease your desire for smoking; you start it a week or two before your quit date, and it significantly shuts down that craving for a cigarette.
Common side effects- insomnia and dry mouth.
2. NIcotine gum- do NOT chomp it like regular gum! It's chew, chew, stash it.
3. Nicotine inhaler- used every hour or two during the day; may cause throat/mouth irritation and cough
4. Nicotine nasal spray- 2-4 sprays per waking hour as needed; may cause local irritation in nose and throat
5. Nicotine patch (now OTC, but ask your doctor which dose)- may cause skin irritation; remove at night so no sleep issues
6. Nicotine lozenge- may cause mouth soreness and nausea
7. Varenicline (Zyban)- blocks nicotinic receptors and sharply decreases cravings; Common side effects: very vivid dreams and nausea.

Are they expensive? Puh-lease! Are cigarettes expensive? YES! These aids are money well spent, and will pretty much equal what you are already spending on your habit.

BOTTOM LINE: If you think you've tried everything to quit, double check the list and head to your doctor for a new cessation aid!

Attention SMOKERS: Get Ready to QUIT!

If you found yourself anxiously scanning yesterday's blog about CT scans for lung cancer screening in smokers, hoping for reassurance that we now have means to detect lung cancer early enough that you'll have time to quit before it's too late, then read on...

If you are a smoker today, then the SINGLE MOST IMPORTANT THING you can do for your health is to QUIT. Period. While we are learning to detect and treat smoking-related cancers better each year, believe me, you don't want to count on a CURE. Often times the surgeries and chemo are devastating, though life-sparing.

I have met very few smokers who do not WANT to quit, though yes (my friend who shall remain nameless) there are some out there who simply enjoy smoking and hope they don't live long enough to end up suffering poor quality of life because of chronic bronchitis or emphysema. MOST SMOKERS WANT TO QUIT, but have not found either the right motivation, medical aid, or family/friend support to do so.

First of all, let me say that it takes the average serious smokers multiple attempts to quit. Have you quit for a month, a year, a pregnancy or two, only to restart? That is COMMON, and NOT a reason that you "can't" quit!

There are SEVEN different medical aids that your doctor can recommend or prescribe to help you from the pharmacy end of things! Have you really tried them ALL?
There are numerous behavioral changes YOU can make NOW that will help you quit, too! Stay tuned for more blogs this week with more details...


BOTTOM LINE: NO amount of nicotine IMPROVES your health, so make an appointment with your doctor to find out which method might work best for you!

Breaking News for SMOKERS

Last week we had an encouraging development for smokers- the National Cancer Institute prematurely stopped a study because they felt ethically obligated to let all the participants know that a low dose CT scan of the lungs as a screen for lung cancer was yielding a 20% decrease in mortality (as compared with screening chest xrays). What does this mean? Should every smoker get a lung CT scan?

Hold your horses- CT scans for all smokers is NOT the answer- though I wish it were that simple. What we know so far is that in this group of smokers, which was an older group that had a greater than 30 pack-year smoking history (smoking a pack per day for 30 or greater years), the CT scans apparently allowed earlier detection of lung cancers, enough that they had a significant (20%) decrease in deaths.

Over the years I have had many patients who smoke ask for annual screening chest xrays. I explain to them that this is NOT a good screening method, though often I have ended up ordering the xray, in the hopes that they might at least see some noncancerous damage from the smoking that might be enough to motivate them to QUIT. Now, however, we may be changing our recommendations, at least for the older smoker with an extensive smoking history.

Ultimately, though, the real answer is to never start smoking, and if you ARE smoking at ANY amount, find help asap to QUIT!
I'll spend more time this week discussing smoking cessation, but know that there are seven medical aids available through your physician that can help you quit for good.

BOTTOM LINE: Smokers with a greater than 30 pack-year history of smoking may indeed benefit from CT lung scans to detect early lung cancer- check with your doctor (and QUIT TODAY!!!)

Heartburn or Broken Bones?

Okay, I'm interrupting my summer tips with this "breaking" report. The FDA has issued a warning regarding proton-pump inhibitors (PPI's) which are medicines that stop acid production such as Prilosec, Nexium, Prevacid, etc. Six of seven studies showed that people, especially those over 50, who take these medications- whether they are the over the counter version or prescribed- for over a year or in high doses, have increased risk of fractures in their hips, spines, and/or wrists.

So what does this mean? Do you have to choose heartburn or broken bones?

Of course not. What it means is that these drugs, like every other class, have potential side effects. We need to use them judiciously, and not as a band-aid for a long term problem. GERD is typically caused by behaviors that can be modified: caffeine, alcohol, and nicotine are at the top of the list. Consider switching gradually to decaf, decreasing your alcohol intake, and quitting smoking instead of routinely grabbing your acid pill every day.

BOTTOM LINE: All medications have side effects; please review ALL of your medications with your doctor and see which, if any, can be reduced or eliminated if you are willing to make some behavioral changes.