MyMedExpert Health Articles

What health problems are caused by smoking? 
Smoking harms nearly every organ of the body and diminishes a person’s overall health. Smoking is a leading cause of cancer and of death from cancer. It causes cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia .

Smoking also causes heart disease, stroke, lung disease (chronic bronchitis and emphysema), hip fractures, and cataracts. Smokers are at higher risk of developing pneumonia and other airway infections .

A pregnant smoker is at higher risk of having her baby born too early and with an abnormally low weight. A woman who smokes during or after pregnancy increases her infant’s risk of death from Sudden Infant Death Syndrome (SIDS) .

Millions of Americans have health problems caused by smoking. Cigarette smoking and exposure to tobacco smoke cause an estimated average of 438,000 premature deaths each year in the United States. Of these premature deaths, about 40 percent are from cancer, 35 percent are from heart disease and stroke, and 25 percent are from lung disease . Smoking is the leading cause of premature, preventable death in this country.

Regardless of their age, smokers can substantially reduce their risk of disease, including cancer, by quitting.

Does tobacco smoke contain harmful chemicals?
Yes. Tobacco smoke contains chemicals that are harmful to both smokers and nonsmokers. Breathing even a little tobacco smoke can be harmful (. Of the 4,000 chemicals in tobacco smoke, at least 250 are known to be harmful . The toxic chemicals found in smoke include hydrogen cyanide (used in chemical weapons), carbon monoxide (found in car exhaust), formaldehyde (used as an embalming fluid), ammonia (used in household cleaners), and toluene (found in paint thinners).

Of the 250 known harmful chemicals in tobacco smoke, more than 50 have been found to cause cancer. These chemicals include :

arsenic (a heavy metal toxin)
benzene (a chemical found in gasoline)
beryllium (a toxic metal)
cadmium (a metal used in batteries)
chromium (a metallic element)
ethylene oxide (a chemical used to sterilize medical devices)
nickel (a metallic element)
polonium-210 (a chemical element that gives off radiation)
vinyl chloride (a toxic substance used in plastics manufacture)

What are the immediate benefits of quitting smoking?
The immediate health benefits of quitting smoking are substantial. Heart rate and blood pressure, which were abnormally high while smoking, begin to return to normal. Within a few hours, the level of carbon monoxide in the blood begins to decline. (Carbon monoxide, a colorless, odorless gas found in cigarette smoke, reduces the blood’s ability to carry oxygen.) Within a few weeks, people who quit smoking have improved circulation, don’t produce as much phlegm, and don’t cough or wheeze as often. Within several months of quitting, people can expect significant improvements in lung function .

What are the long-term benefits of quitting smoking?
Quitting smoking reduces the risk of cancer and other diseases, such as heart disease and lung disease, caused by smoking. People who quit smoking, regardless of their age, are less likely than those who continue to smoke to die from smoking-related illness. Studies have shown that quitting at about age 30 reduces the chance of dying from smoking-related diseases by more than 90 percent . People who quit at about age 50 reduce their risk of dying prematurely by 50 percent compared with those who continue to smoke . Even people who quit at about age 60 or older live longer than those who continue to smoke .

Does quitting smoking lower the risk of cancer?
Quitting smoking substantially reduces the risk of developing and dying from cancer, and this benefit increases the longer a person remains smoke free. However, even after many years of not smoking, the risk of lung cancer in former smokers remains higher than in people who have never smoked .

The risk of premature death and the chance of developing cancer due to cigarettes depend on the number of years of smoking, the number of cigarettes smoked per day, the age at which smoking began, and the presence or absence of illness at the time of quitting. For people who have already developed cancer, quitting smoking reduces the risk of developing a second cancer.
Should someone already diagnosed with cancer bother to quit smoking?
Yes. There are many reasons that people diagnosed with cancer should quit smoking. For those having surgery or other treatments, quitting smoking helps improve the body’s ability to heal and respond to the cancer treatment, and it lowers the risk of pneumonia and respiratory failure . Also, quitting smoking may lower the risk of the cancer returning or a second cancer forming .

What are some of the challenges associated with quitting smoking?
Quitting smoking may cause short-term problems, especially for those who have smoked a large number of cigarettes for a long period of time:

Feeling sad or anxious: People who quit smoking are likely to feel depressed, anxious, irritable, and restless, and may have difficulty sleeping or concentrating.
Gaining weight: Increased appetite is a common withdrawal symptom after quitting smoking, and studies show that people who quit smoking increase their food intake . Although most smokers gain less than 10 pounds, for some people the weight gain can be troublesome . Regular physical activity can help people maintain a healthy weight.
Depression, anxiety, restlessness, weight gain, and other problems are symptoms of nicotine withdrawal . Many people find that nicotine replacement products and other medicines may relieve these problems (see Questions 10 and 11). However, even without medication, withdrawal symptoms and other problems do subside over time. It helps to keep in mind that people who kick the smoking habit have the opportunity for a healthier future.

Can a doctor, dentist, or pharmacist help a person quit smoking?
Doctors, dentists, and pharmacists can be good sources of information about the health risks of smoking and the benefits of quitting. They can describe the proper use and potential side effects of nicotine replacement therapy (see Question 10) and other medicines (see Question 11), and they can help people find local quit smoking resources.
How can I help someone I know quit smoking?
It’s understandable to be concerned about someone you know who currently smokes.  It’s important to find out if this person wants to quit smoking.  Most smokers say they want to quit.  If they don’t want to quit, try to find out why. 

Here are some things you can do to help:

Express things in terms of your own concern about the smoker’s health (”I’m worried about…”).
Acknowledge that the smoker may get something out of smoking and may find it difficult to quit.
Be encouraging and express your faith that the smoker can quit for good.
Suggest a specific action, such as calling a smoking quitline, for help in quitting smoking.   
Ask the smoker for ways you can provide support.
Here are two things you should not do:

Don’t send quit smoking materials to smokers unless they ask for them.
Don’t criticize, nag, or remind the smoker about past failures.

What are nicotine replacement products?
Nicotine is the substance in cigarettes and other forms of tobacco that causes addiction. Nicotine replacement products deliver small, measured doses of nicotine into the body, which helps to relieve the cravings and withdrawal symptoms often felt by people trying to quit smoking. Strong and consistent evidence shows that nicotine replacement products can help people quit smoking (13).

It’s far less harmful for a person to get nicotine from a nicotine replacement product than from cigarettes because tobacco smoke contains many toxic and cancer-causing substances. Long-term use of nicotine replacement products is not known to be associated with any serious harmful effects (14).

All nicotine replacement products, which are approved by the U.S. Food and Drug Administration (FDA) and available in the following five forms, appear to be equally effective:

The nicotine patch is available over the counter (without a prescription). A new patch is worn on the skin each day, supplying a small but steady amount of nicotine to the body. The nicotine patch is sold in varying strengths as an 8-week quit smoking treatment. Nicotine doses are gradually lowered as the treatment progresses. The nicotine patch may not be a good choice for people with skin problems or allergies to adhesive tape. Also, people who experience the side effect of vivid dreams may opt to wear the patch only during the daytime.
Nicotine gum is available over the counter in 2- and 4-mg strengths. When a person chews nicotine gum and then places the chewed product between the cheek and gum tissue, nicotine is released into the bloodstream through the lining of the mouth. To keep a steady amount of nicotine in the body, a new piece of gum can be chewed every 1 or 2 hours. The 4-mg dose appears to be more effective among highly dependent smokers (those who smoke 20 or more cigarettes per day) (14, 15). Nicotine gum might not be appropriate for people with temporomandibular joint (TMJ) disease or for those with dentures or other dental work such as bridges. The gum releases nicotine more effectively when coffee, juice, and other acidic beverages are not consumed at the same time.
The nicotine lozenge is also available over the counter in 2- and 4-mg strengths. The use of the lozenge is similar to that of nicotine gum; it is placed between the cheek and gum tissue and allowed to dissolve. Nicotine is released into the bloodstream through the lining of the mouth. The lozenge works best when used every 1 or 2 hours and when coffee, juice, and other acidic beverages are not consumed at the same time.
Nicotine nasal spray is available by prescription only. The spray comes in a pump bottle containing nicotine that tobacco users can inhale when they have an urge to smoke. Absorption of nicotine via the spray is faster than that achieved with any of the other types of nicotine replacement. This product is not recommended for people with nasal or sinus conditions, allergies, or asthma, nor is it recommended for young tobacco users. Side effects from the spray include sneezing, coughing, and watering eyes, but these problems usually go away with continued use of the spray.
A nicotine inhaler, also available only by prescription, delivers a vaporized form of nicotine to the mouth through a mouthpiece attached to a plastic cartridge. Even though it is called an inhaler, the device does not deliver nicotine to the lungs the way a cigarette does. Most of the nicotine only travels to the mouth and throat, where it is absorbed through the mucous membranes. Common side effects include throat and mouth irritation and coughing. Anyone with a bronchial problem such as asthma should use it with caution.
Experts recommend combining nicotine replacement therapy with advice or counseling from a doctor, dentist, pharmacist, or other health care provider. Also, experts suggest that smokers quit using tobacco products before they start using nicotine replacement products . Too much nicotine can cause nausea, vomiting, dizziness, diarrhea, weakness, or rapid heartbeat.
Are there products to help people quit smoking that do not contain nicotine?
Bupropion, a prescription antidepressant marketed as Zyban®, was approved by the FDA in 1997 to treat nicotine addiction. This drug can help to reduce nicotine withdrawal symptoms and the urge to smoke , and can be used safely with nicotine replacement products . Some common side effects of bupropion are dry mouth, difficulty sleeping, headache, dizziness, and skin rash. People should not use this drug if they have a seizure condition such as epilepsy or an eating disorder such as anorexia nervosa or bulimia, or if they are taking other medicines that contain bupropion hydrochloride. Also, people should avoid using alcohol while taking buproprion because alcohol consumption increases the risk of having a seizure.

Varenicline, a prescription medicine marketed as Chantix™, was approved by the FDA in 2006 to help cigarette smokers stop smoking. This drug may help those who wish to quit by easing their withdrawal symptoms and by blocking the effects of nicotine from cigarettes if they resume smoking. Some common side effects of varenicline are nausea, changes in dreaming, constipation, gas, and vomiting. People should not use this drug if they have kidney problems, and women should not use this drug if they are pregnant, plan to become pregnant, or are breastfeeding .

Although nortriptyline and clonidine are not currently approved by the FDA for the treatment of nicotine addiction, doctors sometimes prescribe these drugs to help people quit smoking .

What about combining medications?
Some health care providers suggest that combining the nicotine patch with nicotine gum or nicotine nasal spray may work better than using a single type of nicotine replacement therapy . Nicotine gum in combination with nicotine patch therapy may also reduce withdrawal symptoms better than either medication alone. The patch provides a base level of nicotine, and the additional products can deliver extra nicotine when cravings or withdrawal symptoms occur . Another option is the combination of bupropion and nicotine patch therapy . People who think they may benefit from combining medications should consult with their health care provider before making a decision.

Are there alternative methods to help people quit smoking?
Some people claim that alternative approaches such as hypnosis, acupuncture, acupressure, laser therapy, or electrostimulation may help reduce the symptoms associated with nicotine withdrawal. However, clinical studies have not shown that these alternative approaches help people quit smoking .

What if a person smokes again after quitting?
Many smokers find it difficult to quit. People commonly quit smoking and then find themselves smoking again, especially in the first few weeks or months after quitting. People who smoke after quitting should try again to quit. Most people find that they need to persist in their attempts to quit smoking before they quit for good. It may take four or more attempts before smokers are able to quit for good (15). People who stop smoking for 3 months or longer have an excellent chance of remaining cigarette free for the rest of their lives .

Source: National Cancer Institute (www.cancer.gov), National Institutes of Health

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What is GERD?

Gastroesophageal reflux disease (GERD) is a more serious form of gastroesophageal reflux (GER), which is common. GER occurs when the lower esophageal sphincter (LES) opens spontaneously, for varying periods of time, or does not close properly and stomach contents rise up into the esophagus. GER is also called acid reflux or acid regurgitation, because digestive juices—called acids—rise up with the food. The esophagus is the tube that carries food from the mouth to the stomach. The LES is a ring of muscle at the bottom of the esophagus that acts like a valve between the esophagus and stomach.
When acid reflux occurs, food or fluid can be tasted in the back of the mouth. When refluxed stomach acid touches the lining of the esophagus it may cause a burning sensation in the chest or throat called heartburn or acid indigestion. Occasional GER is common and does not necessarily mean one has GERD. Persistent reflux that occurs more than twice a week is considered GERD, and it can eventually lead to more serious health problems. People of all ages can have GERD.

What are the symptoms of GERD?
The main symptom of GERD in adults is frequent heartburn, also called acid indigestion—burning-type pain in the lower part of the mid-chest, behind the breast bone, and in the mid-abdomen. Most children under 12 years with GERD, and some adults, have GERD without heartburn. Instead, they may experience a dry cough, asthma symptoms, or trouble swallowing.

What causes GERD?
The reason some people develop GERD is still unclear. However, research shows that in people with GERD, the LES relaxes while the rest of the esophagus is working. Anatomical abnormalities such as a hiatal hernia may also contribute to GERD. A hiatal hernia occurs when the upper part of the stomach and the LES move above the diaphragm, the muscle wall that separates the stomach from the chest. Normally, the diaphragm helps the LES keep acid from rising up into the esophagus. When a hiatal hernia is present, acid reflux can occur more easily. A hiatal hernia can occur in people of any age and is most often a normal finding in otherwise healthy people over age 50. Most of the time, a hiatal hernia produces no symptoms.

Other factors that may contribute to GERD include
• obesity
• pregnancy
• smoking
Common foods that can worsen reflux symptoms include
• citrus fruits
• chocolate
• drinks with caffeine or alcohol
• fatty and fried foods
• garlic and onions
• mint flavorings
• spicy foods
• tomato-based foods, like spaghetti sauce, salsa, chili, and pizza

What is GERD in children?
Distinguishing between normal, physiologic reflux and GERD in children is important. Most infants with GER are happy and healthy even if they frequently spit up or vomit, and babies usually outgrow GER by their first birthday. Reflux that continues past 1 year of age may be GERD. Studies show GERD is common and may be overlooked in infants and children. For example, GERD can present as repeated regurgitation, nausea, heartburn, coughing, laryngitis, or respiratory problems like wheezing, asthma, or pneumonia. Infants and young children may demonstrate irritability or arching of the back, often during or immediately after feedings. Infants with GERD may refuse to feed and experience poor growth.
Talk with your child�s health care provider if reflux-related symptoms occur regularly and cause your child discomfort. Your health care provider may recommend simple strategies for avoiding reflux, such as burping the infant several times during feeding or keeping the infant in an upright position for 30 minutes after feeding. If your child is older, your health care provider may recommend that your child eat small, frequent meals and avoid the following foods:
• sodas that contain caffeine
• chocolate
• peppermint
• spicy foods
• acidic foods like oranges, tomatoes, and pizza
• fried and fatty foods

Avoiding food 2 to 3 hours before bed may also help. Your health care provider may recommend raising the head of your child�s bed with wood blocks secured under the bedposts. Just using extra pillows will not help. If these changes do not work, your health care provider may prescribe medicine for your child. In rare cases, a child may need surgery.

How is GERD treated?
See your health care provider if you have had symptoms of GERD and have been using antacids or other over-the-counter reflux medications for more than 2 weeks. Your health care provider may refer you to a gastroenterologist, a doctor who treats diseases of the stomach and intestines. Depending on the severity of your GERD, treatment may involve one or more of the following lifestyle changes, medications, or surgery.

Lifestyle Changes
• If you smoke, s.
• Avoid foods and beverages that worsen symptoms.
• Lose weight if needed.
• Eat small, frequent meals.
• Wear loose-fitting clothes.
• Avoid lying down for 3 hours after a meal.
• Raise the head of your bed 6 to 8 inches by securing wood blocks under the bedposts. Just using extra pillows will not help.

Medications
Your health care provider may recommend over-the-counter antacids or medications that s acid production or help the muscles that empty your stomach. You can buy many of these medications without a prescription. However, see your health care provider before starting or adding a medication.
Antacids, such as Alka-Seltzer, Maalox, Mylanta, Rolaids, and Riopan, are usually the first drugs recommended to relieve heartburn and other mild GERD symptoms. Many brands on the market use different combinations of three basic salts—magnesium, calcium, and aluminum—with hydroxide or bicarbonate ions to neutralize the acid in your stomach. Antacids, however, can have side effects. Magnesium salt can lead to diarrhea, and aluminum salt may cause constipation. Aluminum and magnesium salts are often combined in a single product to balance these effects.
Calcium carbonate antacids, such as Tums, Titralac, and Alka-2, can also be a supplemental source of calcium. They can cause constipation as well.
Foaming agents, such as Gaviscon, work by covering your stomach contents with foam to prevent reflux.
H2 blockers, such as cimetidine (Tagamet HB), famotidine (Pepcid AC), nizatidine (Axid AR), and ranitidine (Zantac 75), decrease acid production. They are available in prescription strength and over-the-counter strength. These drugs provide short-term relief and are effective for about half of those who have GERD symptoms.
Proton pump inhibitors include omeprazole (Prilosec, Zegerid), lansoprazole (Prevacid), panrazole (Protonix), rabeprazole (Aciphex), and esomeprazole (Nexium), which are available by prescription. Prilosec is also available in over-the-counter strength. Proton pump inhibitors are more effective than H2 blockers and can relieve symptoms and heal the esophageal lining in almost everyone who has GERD.
Prokinetics help strengthen the LES and make the stomach empty faster. This group includes bethanechol (Urecholine) and metoclopramide (Reglan). Metoclopramide also improves muscle action in the digestive tract. Prokinetics have frequent side effects that limit their usefulness—fatigue, sleepiness, depression, anxiety, and problems with physical movement.
Because drugs work in different ways, combinations of medications may help control symptoms. People who get heartburn after eating may take both antacids and H2 blockers. The antacids work first to neutralize the acid in the stomach, and then the H2 blockers act on acid production. By the time the antacid ss working, the H2 blocker will have sped acid production. Your health care provider is the best source of information about how to use medications for GERD.

What if GERD symptoms persist?
If your symptoms do not improve with lifestyle changes or medications, you may need additional tests.
• Barium swallow radiograph uses x rays to help spot abnormalities such as a hiatal hernia and other structural or anatomical problems of the esophagus. With this test, you drink a solution and then x rays are taken. The test will not detect mild irritation, although strictures�narrowing of the esophagus�and ulcers can be observed.
• Upper endoscopy is more accurate than a barium swallow radiograph and may be performed in a hospital or a doctor�s office. The doctor may spray your throat to numb it and then, after lightly sedating you, will slide a thin, flexible plastic tube with a light and lens on the end called an endoscope down your throat. Acting as a tiny camera, the endoscope allows the doctor to see the surface of the esophagus and search for abnormalities. If you have had moderate to severe symptoms and this procedure reveals injury to the esophagus, usually no other tests are needed to confirm GERD.
The doctor also may perform a biopsy. Tiny tweezers, called forceps, are passed through the endoscope and allow the doctor to remove small pieces of tissue from your esophagus. The tissue is then viewed with a microscope to look for damage caused by acid reflux and to rule out other problems if infection or abnormal growths are not found.
• pH monitoring examination involves the doctor either inserting a small tube into the esophagus or clipping a tiny device to the esophagus that will stay there for 24 to 48 hours. While you go about your normal activities, the device measures when and how much acid comes up into your esophagus. This test can be useful if combined with a carefully completed diary—recording when, what, and amounts the person eats—which allows the doctor to see correlations between symptoms and reflux episodes. The procedure is sometimes helpful in detecting whether respiratory symptoms, including wheezing and coughing, are triggered by reflux.
A completely accurate diagnostic test for GERD does not exist, and tests have not consistently shown that acid exposure to the lower esophagus directly correlates with damage to the lining.

Surgery
Surgery is an option when medicine and lifestyle changes do not help to manage GERD symptoms. Surgery may also be a reasonable alternative to a lifetime of drugs and discomfort.
Fundoplication is the standard surgical treatment for GERD. Usually a specific type of this procedure, called Nissen fundoplication, is performed. During the Nissen fundoplication, the upper part of the stomach is wrapped around the LES to strengthen the sphincter, prevent acid reflux, and repair a hiatal hernia.
The Nissen fundoplication may be performed using a laparoscope, an instrument that is inserted through tiny incisions in the abdomen. The doctor then uses small instruments that hold a camera to look at the abdomen and pelvis. When performed by experienced surgeons, laparoscopic fundoplication is safe and effective in people of all ages, including infants. The procedure is reported to have the same results as the standard fundoplication, and people can leave the hospital in 1 to 3 days and return to work in 2 to 3 weeks.
Endoscopic techniques used to treat chronic heartburn include the Bard EndoCinch system, NDO Plicator, and the Stretta system. These techniques require the use of an endoscope to perform the anti-reflux operation. The EndoCinch and NDO Plicator systems involve putting stitches in the LES to create pleats that help strengthen the muscle. The Stretta system uses electrodes to create tiny burns on the LES. When the burns heal, the scar tissue helps toughen the muscle. The longterm effects of these three procedures are unknown.

What are the long-term complications of GERD?
Chronic GERD that is untreated can cause serious complications. Inflammation of the esophagus from refluxed stomach acid can damage the lining and cause bleeding or ulcers—also called esophagitis. Scars from tissue damage can lead to strictures—narrowing of the esophagus—that make swallowing difficult. Some people develop Barrett�s esophagus, in which cells in the esophageal lining take on an abnormal shape and color. Over time, the cells can lead to esophageal cancer, which is often fatal. Persons with GERD and its complications should be monitored closely by a physician.
Studies have shown that GERD may worsen or contribute to asthma, chronic cough, and pulmonary fibrosis.

Points to Remember
• Frequent heartburn, also called acid indigestion, is the most common symptom of GERD in adults. Anyone experiencing heartburn twice a week or more may have GERD.
• You can have GERD without having heartburn. Your symptoms could include a dry cough, asthma symptoms, or trouble swallowing.
• If you have been using antacids for more than 2 weeks, it is time to see your health care provider. Most doctors can treat GERD. Your health care provider may refer you to a gastroenterologist, a doctor who treats diseases of the stomach and intestines.
• Health care providers usually recommend lifestyle and dietary changes to relieve symptoms of GERD. Many people with GERD also need medication. Surgery may be considered as a treatment option.
• Most infants with GER are healthy even though they may frequently spit up or vomit. Most infants outgrow GER by their first birthday. Reflux that continues past 1 year of age may be GERD.
• The persistence of GER along with other symptoms�arching and irritability in infants, or abdominal and chest pain in older children�is GERD. GERD is the outcome of frequent and persistent GER in infants and children and may cause repeated vomiting, coughing, and respiratory problems.

Source: National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health

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Sneezing, a scratchy throat, a stuffy nose, coughing – everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people in the United States suffer 1 billion colds.

You can get a cold by touching your eyes or nose after you touch surfaces with cold germs on them. You can also inhale the germs. Symptoms usually begin 2 or 3 days after infection and last 2 to 14 days. Washing your hands and staying away from people with colds will help you avoid colds.

There is no cure for the common cold. For relief, try

• Getting plenty of rest
• Drinking fluids
• Gargling with warm salt water
• Using cough drops or throat sprays
• Taking over-the-counter pain or cold medicines - but not aspirin for children

Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health

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