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!

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.

Quitting Smoking...a WEIGHTY Issue

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: Be proactive with your available food choices and exercise, and you will NOT pack on a bunch of weight when you quit smoking.