Need Help Quitting?

Have you been thinking about quitting smoking but weren't sure how to get started?
Have you tried quitting in the past and haven't found the method that quite works for you?

Pick a good time to quit. Don't try to quit near the holiday season or when you are under alot of
stress.
The quitting process is different for everybody. Talk to other former smokers for support, but don't
expect your experience to be the same.
Maintain some kind of physical activity by walking, playing basketball or swimming. Exercise can
boost your energy level and get your mind off of your goal of staying smoke-free.
Eat a healthy diet, drink lots of water and get enough sleep.
Ask for help from family and friends.

Who is at risk?
Smoking attracts over 3,000 young people each day and 1.7 million youths have smoked cigarettes by
their 18th birthday. A California survey* of college students reports that 20% of college student smoke
cigarettes. Men are slightly more likely than women to have smoked (21.9% of all men vs. 18.9% of all
women). Among students who smoke, 44% report trying to quit during the past six months. Quitting is
difficult because nicotine is a physically addictive drug.
Every 10 seconds, someone dies from tobacco use, says the World Health Organization.

What is the risk?

Scientific evidence exists linking death and disease to tobacco use. Health risks include cardiovascular
disease, chronic coughs, reduced lung function, emphysema and cancer. Short-term health risks include
smelly clothes, bad breath, clothing burns and loss of income spent on cigarettes. Tobacco smoke
contains about 4,000 chemicals, including 200 known poisons. Tobacco smoke is harmful to everybody's
health.

"We know -- and so do the tobacco companies -- that there are dozens of chemicals in
tobacco smoke that are carcinogens or reproductive toxicants"... Los Angeles City Attorney
James Hahn

Social Smoking
Social Smoking is smoking less than everyday. A social (or casual) smoker may smoke a few cigarettes
one night, then not smoke for days or weeks afterwards.

Reasons why people smoke socially:

Many people who smoke socially dont realize that occasional smoking can be harmful
They may not be aware of how easy it is to become addicted
If you are around people who smoke, you may be tempted to smoke too. It may seem like
smoking makes social situations easier.
Some people just have a cigarette when they go out with friends and were drinking.
Sometimes you find someone that may have been up all night studying and wanted a break or
something to help them stay awake, which resorts them to chain smoking through a cramming
session

Statistics: Social smokers make up the significant population that do not consider
themselves to be smokers, but are at risk of becoming addicted to nicotine.

About 60% of students are non-smokers, reporting never smoking cigarettes.

About 10% of students are smokers- using cigarettes every day or every other day.
This leaves us with about a 1/4 students- 30% who probably do not consider themselves smokers
but smoke a couple of times each week or month.
A high percentage of smokers- 85-90%- must smoke every day or they start to go through
withdrawal
In contrast- only about 10% to 15% of people who drink alcohol are problem drinkers; which puts
nicotine as probably the most addictive drugs.

Risks: Even if you are smoking every now and then you are still subject to physical
consequences.

You are still exposed to the 4000 chemicals such as arsenic, lead, and mercury.
Even after a cigarette or two, smokers will experience a spike in blood pressure
30 minutes of exposure to secondhand smoke can cause heart damage similar to that of an
everyday smoker.
Addiction could happen within 10 seconds of taking a puff of a cigarette, nicotine reaches the
brain and regulates the feeling of pleasure. The thing is within a few minutes the effects wear off,
which makes the person crave another cigarette.

Signs of Addiction:

You buy your own cigarettes because you feel guilty about bumming from friends so often
You start to smoke alone
You think about smoking when youre not
You crave cigarettes when you wake up
You dont feel the dizziness and headaches of a new smoker.

ETR Associates. (2003). FAQs Tobacco (274) [Social Smoking].

California: Ralph Cantor.

Hookah
HEALTH RISKS OF HOOKAH USER

Risks depend on the duration and frequency of use

Wide variation in the content of the different brands of hookah tobacco may increase risk

CONSTITUENTS OF HOOKAH SMOKE

Evidence shows that hookah smoking is not a safe alternative to cigarette smoking.
Hookah smoke has been found to contain high concentrations of carbon monoxide (CO), nicotine,
tar, and heavy metals
Commonly used heat sources like charcoal or wood cinders may increase health risks because
they produce such toxicants as CO, metals, and carcinogens
Risks may be increased by using quick-burning charcoal which likely emits more CO than the
charcoal traditionally used in the Middle East.

HEALTH EFFECTS

Health problems identified by researchers in the Middle East, China, and India include lung, oral
and bladder cancer, and cancer of the esophagus and stomach
Other health risks include nicotine dependence and infections like tuberculosis, herpes, and
hepatitis
Viral infections can be transmitted through the sharing of the same mouthpiece; a common
custom in many cultures

AWARENESS, ATTITUDES AND MISPERCEPTIONS

There is a widespread misperception that hookah smoking is safe.

Studies conducted in Egypt, Israel, and Syria have found that in general, people know little about
its health effects and believe that it is less harmful than cigarette smoking
Another common misperception among hookah users is that they will not suffer any adverse
consequences if they smoke occasionally rather than daily like most cigarette smokers
Yet even occasional users could be harmed because they probably inhale lot of smoke full of
toxic substances during smoking sessions that typically last for 45 minutes to over an hour (both
directly and through secondhand smoke)

Secondhand Smoke
What is Secondhand Smoke?

Secondhand smoke (also known as environmental tobacco smoke) is the sidestream smoke
(smoke from the burning end of a tobacco product) and mainstream smoke (the smoke exhaled
by the the smoker)
Secondhand smoke constitutes more than 4,000 chemicals, at least 250 are known to be harmful,
and 50 of these are carcinogens which include:
o arsenic (heavy metal toxin)
o benzene (chemical found in gasoline)
o beryllium (toxic metal)
o cadmium (metal used in batteries)
o chromium (metallic element)
o ethylene oxide (chemical used to sterilize medical devices)
o nickel (metallic element)
o polonium-210 (chemical element that is radio active)
o vinyl chloride (toxic substance used in plastic manufacture)

Is Secondhand Smoke Harmful?

There is no safe level of exposure to secondhand smoke as reported by the US Surgeon General
in 2006
There is scientific evidence that shows even low levels of secondhand smoke exposure can be
harmful
The only way to fully protect nonsmokers from secondhand smoke exposure is to completely
eliminate smoking in indoor spaces
Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot
completely eliminate secondhand smoke exposure

What are the Health Risks for Secondhand Smoke Exposure?

Secondhand smoke causes cancer in nonsmokers

Secondhand smoke is classified as a Class A carcinogen by the US Environmental Protection
Agency (EPA), the US National Toxicology Program (NTP), the US Surgeon General, and the
International Agency for Research on Cancer (IARC)
Approximately 3,000 lung cancer deaths occur each year among adult nonsmokers in the US as
a result of exposure to secondhand smoke
Secondhand samoke causes heart disease in adults and sudden infant death syndrome (SIDS),
ear infections, and asthma attacks in children

Information from the National Cancer Institute, 2009

http://www.healtheducation.uci.edu/tobacco/secondhandsmoke.aspx

Introduction

What is cholelithiasis?
Cholelithiasis is the medical name for hard deposits (gallstones) that may form in the gallbladder.
Cholelithiasis is common in the United States population. Six percent of adult men and 10% of adult
women are affected.

The cause of cholelithiasis is not completely understood, but it is thought to have multiple factors.
The gallbladder stores bile and releases it into the small intestine when it is needed for digestion.
Gallstones can develop if the bile contains too much cholesterol or too much bilirubin (one of the
components of bile), or if the gallbladder is dysfunctional and cannot release the bile.

Different types of gallstones form in cholelithiasis. The most common type, called a cholesterol
stone, results from the presence of too much cholesterol in the bile. Another type of stone, called a
pigment stone, is formed from excess bilirubin, a waste product created by the breakdown of the red
blood cells in the liver. The size and number of gallstones varies in cholelithiasis; the gallbladder can
form many small stones or one large stone.

The course of cholelithiasis varies among individuals. Most people with cholelithiasis have no
symptoms at all. A minority of patients with gallstones develop symptoms: severe abdominal pain,
nausea and vomiting, and complete blockage of the bile ducts that may pose the risk of infection.

Cholelithiasis can lead to cholecystitis, inflammation of the gallbladder. Acute gallstone attacks may
be managed with intravenous medications. Chronic (long-standing) cholelithiasis is treated by
surgical removal of the gallbladder.

Cholelithiasis involves the presence of gallstones, which are concretions that form in the biliary tract,
usually in the gallbladder. Choledocholithiasis refers to the presence of 1 or more gallstones in the
common bile duct (CBD). Treatment of gallstones depends on the stage of disease.

Signs and symptoms

Gallstone disease may be thought of as having the following 4 stages:
1.
2.
3.
4.

Lithogenic state, in which conditions favor gallstone formation

Asymptomatic gallstones
Symptomatic gallstones, characterized by episodes of biliary colic
Complicated cholelithiasis

Symptoms and complications result from effects occurring within the gallbladder or from stones that
escape the gallbladder to lodge in the CBD.
Characteristics of biliary colic include the following:

Sporadic and unpredictable episodes

Pain that is localized to the epigastrium or right upper quadrant, sometimes radiating to the right
scapular tip
Pain that begins postprandially, is often described as intense and dull, typically lasts 1-5 hours,
increases steadily over 10-20 minutes, and then gradually wanes
Pain that is constant; not relieved by emesis, antacids, defecation, flatus, or positional changes; and
sometimes accompanied by diaphoresis, nausea, and vomiting
Nonspecific symptoms (eg, indigestion, dyspepsia, belching, or bloating)
Patients with the lithogenic state or asymptomatic gallstones have no abnormal findings on physical
examination.
Distinguishing uncomplicated biliary colic from acute cholecystitis or other complications is important. Key
findings that may be noted include the following:

Uncomplicated biliary colic Pain that is poorly localized and visceral; an essentially benign abdominal
examination without rebound or guarding; absence of fever
Acute cholecystitis Well-localized pain in the right upper quadrant, usually with rebound and guarding;
positive Murphy sign (nonspecific); frequent presence of fever; absence of peritoneal signs; frequent
presence of tachycardia and diaphoresis; in severe cases, absent or hypoactive bowel sounds
The presence of fever, persistent tachycardia, hypotension, or jaundice necessitates a search for
complications, which may include the following:

Cholecystitis
Cholangitis
Pancreatitis
Other systemic causes
See Presentation for more detail.

Diagnosis
Patients with uncomplicated cholelithiasis or simple biliary colic typically have normal laboratory test
results; laboratory studies are generally not necessary unless complications are suspected. Blood tests,
when indicated, may include the following:

Complete blood count (CBC) with differential

Liver function panel
Amylase
Lipase
Imaging modalities that may be useful include the following:

Abdominal radiography (upright and supine) Used primarily to exclude other causes of abdominal pain
(eg, intestinal obstruction)
Ultrasonography The procedure of choice in suspected gallbladder or biliary disease
Endoscopic ultrasonography (EUS) An accurate and relatively noninvasive means of identifying
stones in the distal CBD
Laparoscopic ultrasonography Promising as a potential method for bile duct imaging during
laparoscopic cholecystectomy
Computed tomography (CT) More expensive and less sensitive than ultrasonography for detecting
gallbladder stones, but superior for demonstrating stones in the distal CBD
Magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP)
Usually reserved for cases in which choledocholithiasis is suspected
Scintigraphy Highly accurate for the diagnosis of cystic duct obstruction
Endoscopic retrograde cholangiopancreatography (ERCP)
Percutaneous transhepatic cholangiography (PTC)
See Workup for more detail.

Management
The treatment of gallstones depends upon the stage of disease, as follows:

Lithogenic state Interventions are currently limited to a few special circumstances

Asymptomatic gallstones Expectant management
Symptomatic gallstones Usually, definitive surgical intervention (eg, cholecystectomy), though medical
dissolution may be considered in some cases
Medical treatments, used individually or in combination, include the following:

Oral bile salt therapy (ursodeoxycholic acid)

Contact dissolution
Extracorporeal shockwave lithotripsy
Cholecystectomy for asymptomatic gallstones may be indicated in the following patients:

Those with large (>2 cm) gallstones

Those who have a nonfunctional or calcified (porcelain) gallbladder on imaging studies and who are at
high risk of gallbladder carcinoma
Those with spinal cord injuries or sensory neuropathies affecting the abdomen
Those with sickle cell anemia in whom the distinction between painful crisis and cholecystitis may be
difficult
Patients with the following risk factors for complications of gallstones may be offered elective
cholecystectomy, even if they have asymptomatic gallstones:

Cirrhosis
Portal hypertension
Children
Transplant candidates
Diabetes with minor symptoms
Surgical interventions to be considered include the following:
Cholecystectomy (open or laparoscopic)
Cholecystostomy
Endoscopic sphincterotomy

(Reuters Health) - People who have had a kidney stone seem to have a heightened
risk of gallstones -- and vice versa, according to a new study.

Researchers already know that obesity, diabetes and having a generally unhealthy
diet put people at risk for both types of stones. But even when those common risks
were taken into account, the link remained.
The report "raises our antenna to this shared relationship between these two
disorders," said Dr. Brian Matlaga, a urologist at the Johns Hopkins University
School of Medicine in Baltimore.
"From an anecdotal standpoint, certainly it's not an uncommon scenario that a
patient would have had both," Matlaga, who wasn't involved in the new research,
told Reuters Health. But, he continued, "I'm a little bit at a loss trying to define what
that relationship would be."

That's because stones in the kidney and gallbladder form differently, he said, and are
made of two different things -- kidney stones of calcium and gallstones of cholesterol,
most of the time.
Data for the current analysis came from three different long-term studies of nurses
and doctors who completed a health and lifestyle questionnaire, then reported any
new medical conditions every two years afterward. In total, more than 240,000
people were followed for between 14 and 24 years.
Over that time, there were about 5,100 new kidney stones diagnosed and close to
18,500 new cases of gallstones.
Depending on the population -- male or female, older or younger -- people with a
history of gallstones were between 26 and 32 percent more likely to get a kidney
stone than people who hadn't ever had gallstones.

And the link also went in the opposite direction. A past history of kidney stones
meant study participants were between 17 and 51 percent more likely to report a new
gallstone.
That was after factoring in the impact of age, diabetes, high blood pressure, weight
and certain aspects of diet on the risk of both kinds of stones.
Researchers led by Eric Taylor from the Maine Medical Center in Portland said it's
possible that a shift in the type of bacteria in the intestines might somehow
predispose people to both kidney stones and gallstones. But, Taylor said, "the fairest
thing is that we just don't know" why the two would be linked.
In their report in the Journal of Urology the researchers echoed Matlaga's call for
more detailed research into any explanations for a common cause -- which might
help doctors prevent or treat both kidney stones and gallstones, they added.
"They are really two different kinds of stones, so the relationship is not going to be
simple between the two conditions," Taylor told Reuters Health.

Matlaga said that for now, there are steps people can take to reduce their risk of both
gallstones and kidney stones, even if they've already had one condition.
"You'd like to try to minimize those common risk factors and work on things like
weight loss and cholesterol control," he said.
Taylor agreed that the findings "emphasize the importance of healthy diet and
healthy weight."
SOURCE: bit.ly/pMoRpk Journal of Urology, online Sep