Smoking Cessation: STOP smoking. Breathe easy.

Takes practice and time to quit smoking, but it can be done, and the benefits of stopping smoking are worth the effort. There are many ways to quit smoking - using either the "cold turkey" method or a system to gradually taper off smoking. Each person is unique, and different strategies work better for different people.

Smoking cessation medications

Smoking cessation medications include nicotine chewing pieces (gum), the nicotine patch, nicotine inhaler, nicotine lozenges, bupropion, and varenicline. Research shows that when used as directed, and combined with either support groups or counseling, these medications can increase your chance of success. Speak to your doctor of pharmacist about which medications may be appropriate for you.

Support groups and counseling

Group programs usually involve meeting small groups of people who are all trying to quit smoking. Group support programs have proven one of the most successful methods for quitting smoking. Qualified health professionals lead some group programs, and these tend to be more effective. Contact your local public health department to locate any smoking cessation groups active in your community.

Individual counseling programs range from brief advice and counseling offered by a health care professional to intensive individual counseling available through specialty clinics. These clinics are not available everywhere, but are especially helpful for certain smokers. Talk to your doctor about whether individual counseling is an appropriate option for you.

Tips for quitting

Quitting smoking may be hard, but it can be done! Here are some tips to help you quit:

• Develop an action plan to improve your chances of quitting. Writing the plan down will help you think more carefully about what you need to do and how you will approach it. Try the following:
  • Pick a day as your "quit date," which is the day you intend to stop smoking. Write this date down.
  • Make a list of the important benefits of quitting and read it over before and after you quit. Use this list while you are trying to quit to remind yourself of your reasons for quitting.
  • List the situations in which you smoke and the reasons why you smoke - this will help you identify what "triggers" you to light up.
  • List fun and healthy activities to replace smoking, and be ready to do these when you feel the urge to smoke.
• Avoid smoking triggers. Starting with your quit day, try to remove or avoid your smoking triggers. For example, if you associate coffee with smoking, try drinking tea or water instead. If you usually smoke at parties, find other ways to socialize with friends until you feel comfortable and confident about facing these situations.
• Don't carry matches, a lighter, or cigarettes.
• Each day, delay lighting your first cigarette by one hour. After the first cigarette, when you have your next craving to smoke, delay for another 15 minutes or half an hour. By delaying each cigarette, you take control.
• Familiarize yourself with possible withdrawal symptoms and how you plan to handle them.
• Get moving! Exercise is a great way to relax and feel good, instead of smoking. As you exercise, with each deep breath you take, you can start to repair some of the damage done to your body from smoking.
• Build your own support network. Enlist the help of a close friend or family member, your doctor, someone you know and respect who has recently quit, or someone who wants to quit smoking with you.

Acne Pimples · Zits

Acne is an inflammation of the skin that causes blackheads, whiteheads, and red spots usually called "pimples" or "zits." The most common type of acne is acne vulgaris (vulgaris means common). Doctors call a flare-up of acne pimples lesions. Acne appears most often on the face, but can also be a nuisance on your chest, back, and upper arms. Acne affects about 90% of adolescents as well as 20% to 30% of individuals aged 20 to 40 years. It accounts for more doctor visits than any other skin problem.

Acne isn't life threatening, but it can be upsetting and disfiguring and cause psychosocial problems. Acne can also lead to serious and permanent scarring.

Causes

Acne develops because your sebaceous glands are overactive. These glands normally produce small amounts of sebum, which is a thick mixture of oil and skin cells. When you have acne, these glands go into overproduction and the extra sebum can block your follicles and bacteria move in, particularly the species called Propionibacterium acnes.

Hormones can cause an outbreak of pimples, or increase the number you get. The hormones that are active during puberty also trigger your sebaceous glands to produce more sebum. The hormones with the greatest effect on the oil glands are the androgens, the male hormones. Both men and women have androgens, but men have more.

In women, these hormones can also cause acne during the menstrual cycle, and that's why women often find that acne continues into adulthood. Hormones found in many types of birth control pills can also cause flare-ups of acne.

Eating junk food and chocolate normally has nothing to do with acne. In a few cases, particular foods cause pimples, but this is rare. Greasy hair and skin also doesn't cause acne, but they're often a sign of overactive sebaceous glands, which can cause acne. Research suggests that stress may worsen acne.

A tendency to get acne can run in families. It's more common among Caucasians than Asians or people of African descent.

Things that irritate your skin can also cause acne. These include:

• rubbing or friction from your clothes
• contact with a dog's tongue (e.g., after a friendly lick)
• skin contact with certain sports equipment
• certain cosmetics
• skin exposure to extreme temperatures

Taking corticosteroid medications can also cause an acne-like condition.

Symptoms and Complications

Acne symptoms vary from person to person. They include:

• blackheads - black spots the size of a pinhead - are open right on the surface of your skin (superficial) and don't leave scars.
• whiteheads or pustules, the most common type of acne, are usually the first lesions people get. They don't turn black because they're not exposed to the air.
• deep pustules and cysts look irritated; they're usually red and swollen with visible pus.
• deep acne can be more severe: it's usually red, inflamed, filled with pus, and painful to touch. It often appears on the back and chest. It's often the most difficult type of acne to treat and may leave scarring. Deep acne includes pustules and cysts, both of which can appear on the skin's surface. Some, however, are deep in the layers of the skin. If they burst, the pus that's released will cause more lesions.

Deep acne can lead to scarring. Picking at or squeezing the pimples often leaves a pitted appearance that may or may not be permanent. Scarring is more common in men because deep acne affects more men than women - and because men don't seek a doctor's advice as often as women do.

Headaches: Make it stop!

When a headache strikes, it can feel like an eternity before it disappears. Don't stress out - if it's a tension headache, you'll just make it worse. Try these methods instead for quick relief:

• Take a warm shower (steam relieves sinus pain).
• Apply an ice pack for a maximum of 20 minutes at a time.
• Massage temples with your fingertips (better yet, get someone else to do it!).
• Place a cold, moist towel over your forehead while lying down.
• Take a walk (fresh air helps).
• Rest and take a nap.

Preventing headaches is better than treating them. We're often too quick to grab that bottle of painkillers. Here are some non-drug ways to avoid tension headaches:

• Avoid or eliminate the stressful situation.
• Get regular exercise.
• Get plenty of rest and sleep.
• Eat regular meals - skipping meals can cause headaches.
• Avoid excess caffeine and alcohol.
• Prevent eyestrain - don't work for long periods at the computer.
• Wear sunglasses - avoid squinting in the sun.

No matter what, if headaches get worse or become more frequent, see your doctor.

DIABETES: Nutrition and exercise to control

Controlling diabetes is closely linked to diet and lifestyle.

Healthy eating

• Smart food choices help keep blood sugar, weight, and cholesterol in better control. Focus on fewer calories, and eat less fat (especially saturated fat). Enjoy more fresh fruits, vegetables, lean meats, fish, and legumes instead.
• The amounts of fat, carbohydrate (fruits, vegetables, breads and grains) and protein (meat, fish, milk, nuts) you eat depend on your calorie needs and goals for weight control. A healthy diet usually includes 10-20% of daily calories from protein, 30% or less from fat, and the rest from carbohydrates.
• Always read the labels before trying "low fat," "light," or "no fat" foods. Some of these specially-labeled foods are "dietetic" because they're sugar free. Others are lower in calories. Some mention that they're good for people with diabetes. But many diet foods that use sugar substitutes are high in fat and calories. Words like "light" or "low" can be deceptive. Try to read the fine print!
• Just one alcoholic beverage on an empty stomach can lower your blood sugar drastically. Sip drinks slowly and always drink alcohol with food in your stomach. Limit yourself to no more that two drinks a day and avoid brandy, port, and liqueurs, which have high sugar content.
• Enjoy sweets in moderation: People with diabetes don't have to avoid sugar all together. You can still enjoy a cookie, a piece of cake, or chocolate every now and then. Talk to your health care professional about how to safely incorporate sweets into your diet.

Exercising

• Exercise usually lowers blood sugar. It can help insulin work more effectively and improve your health and energy.
• Ask your doctor about the right kind of exercise for you. Get a checkup if you're starting out, and avoid overdoing it. Gradually increasing your levels of physical activity helps prevent injuries while maintaining your enthusiasm to continue exercising.
• Check blood sugar levels before and after you exercise. This helps avoid low blood sugar. Monitoring your blood sugar can help determine how different types of activities affect sugar levels.
• Exercise one to three hours after a meal. If you take insulin, avoid exercising immediately after an injection or if you have not eaten for several hours.
• Try walking, swimming, and light weightlifting exercises for physical activity.

Diabetes: Managing Your Condition

Blood glucose meter is used to test blood glucose at home and determine whether blood glucose levels are in the target range.

In recent guidelines, the American Diabetes Association (ADA) suggests that all people with type 1 and type 2 diabetes should self-monitor their blood glucose levels. The ADA also recommends self-monitoring for most people using medications to control type 2 diabetes, and even for those who are managing their type 2 diabetes through diet and exercise alone.

A blood glucose meter is used to test blood glucose at home and determine whether blood glucose levels are in the target range. Meters can be purchased at most pharmacies. Testing glucose levels helps put the person with diabetes in control and be more active in managing their condition. Using blood glucose meters to determine the effects of certain foods on blood glucose levels can also help a person with diabetes to choose appropriate foods more carefully.

A person with diabetes should talk with their diabetes educator or pharmacist about which model of glucose meter is appropriate for them. Anyone using a glucose meter should receive proper training so that they can test their blood glucose levels properly.

Ask a diabetes educator about:

• the size of the drop of blood needed
• the type of blood glucose strips to use
• how to check if the meter is accurate (the meter should be checked at least once a year)
• how to code the meter
• how to clean the meter

If a person with diabetes experiences symptoms of hypoglycemia (i.e., low blood glucose), they should check their blood glucose immediately. If a meter is not immediately available, the symptoms should still be treated with the following guidelines:

1. Eat or drink a fast-acting carbohydrate (½ ounce):
• 3 to 5 glucose tablets (the exact amount will depend on the glucose content per tablet of the brand you have; check to make sure you are aware of this amount and take enough to make up 15 g of glucose)
• ¾ cup of orange juice
• 8 Life Savers^® OR 5 hard candies
• 1 tablespoon of honey
2. Wait 15 minutes, then check blood glucose again. If it is still low:
   • treat again
   • if the next meal is more than one hour away, or if the person is going to be active, they should eat a snack, such as a half-sandwich or cheese and unsalted crackers (something with ½ ounce of carbohydrate and a protein source)

Certain people at risk of hypoglycemia may be advised by their doctor to carry a pre-filled 1 mg glucagon injection and make it readily available for emergency situations. This medication is intended to increase blood glucose levels from 3.0 mmol/L to 12.0 mmol/L within an hour.

Do-it-yourself urine tests for ketones are useful during times of illness or for diabetes that occurs during pregnancy (gestational diabetes). Ketones are potentially dangerous acids that build up in your blood when you lack insulin. Ketone build-up is much more common if you have type 1 diabetes.

When performing a ketone test, collect a sample of your urine and place a test strip in the urine. Wait for the strip to change color, and then compare it to a color chart showing the amount of ketones. Medium or large amounts are a sign to call your doctor immediately. Small amounts may mean that a build-up is starting and you should test again in a few hours.

Eating Disorders Bulimia · ANOREXIA

Symptoms and Complications

People with anorexia nervosa may appear severely emaciated due to malnutrition, sometimes so severe their ribs can be seen through the skin. Other common symptoms of anorexia include:

• constipation
• dehydration
• depression
• dizziness
• dry, scaly skin
• faintness or weakness
• inability to concentrate
• intolerance to cold
• irritability
• loss of body fat
• low blood pressure
• missed, or absence of, menstrual periods
• psychological fears of obesity and weight gain
• slow heartbeat

While most people feel hungry and uncomfortable when their calorie intake is low or restricted, people with anorexia suppress this discomfort and usually lose the ability to appreciate normal hunger cues. As they begin to starve, they may experience a feeling of euphoria, similar to how a runner or jogger gets the well-known "runner's high."

If the onset of anorexia occurs before puberty, a girl's sexual development will stop and menstruation won't begin. Severe anorexia leads to chronic malnutrition, which has damaging effects on the body, especially the thyroid, heart, and digestive and reproductive systems. Anorexia can be fatal. Half of those who die with anorexia die of suicide and half die of medical complications.

Some people with bulimia may experience episodic weight loss, while others maintain a normal weight. In some cases, menstrual cycles may be affected and stop, but menstruation is usually preserved. Possible symptoms of bulimia include:

• dehydration (due to excess use of laxatives or frequent self-induced vomiting)
• tooth decay and erosion (due to the acids that are brought up from severe and constant vomiting)
• low blood pressure
• constipation
• swollen cheek glands (like mumps)
• abnormal hormone levels
• stomach problems
• irregular heartbeat

A variety of complications can result from the constant vomiting. For example, inflammation of the esophagus (called esophagitis) and severe dental problems can occur. At its worst, constant purging can lead to heart damage. People with bulimia may have a history of anorexia or obesity. They may also have psychiatric problems such as depression, anxiety disorders, social phobias, and panic disorder, as well as addictive behaviors like alcohol or drug abuse.

Making the Diagnosis

To diagnose eating disorders, doctors generally only need signs and symptoms based on a physical exam and a detailed medical or personal history. In the case of a person with anorexia, continued weight loss at a low or normal weight, obsessive exercise, progressive food restriction, falling grades at school or work productivity, and depression should raise suspicion. The diagnosis of anorexia nervosa is made medically when the person's weight has dropped to at least 15% below the minimum normal weight for their age and height due to a pathological fear of obesity. Blood tests reveal abnormalities in hormone levels that help confirm the diagnosis for both anorexia and bulimia. However, there is no test that is diagnostic and the diagnosis of anorexia is made by clinical assessment.

Treatment and Prevention

People with anorexia rarely seek or want treatment, since they usually don't acknowledge or admit they have a problem. It's often left to family members and friends to recognize the eating disorder and urge them to get treatment.

Anorexia doesn't get better without treatment - people with anorexia need medical and professional help to get better. The biggest obstacle to treating anorexia is the person's unwillingness to undergo treatment.

The primary goal of therapy is to get the person to eat again and gain weight. In general, people with anorexia don't consider their behavior to be abnormal or unhealthy, so it's very difficult to convince them that they have a serious problem and to get them to eat normally. If the condition is severe, to the point of emaciation, hospitalization is usually necessary.

Counseling, both individual and family, is commonly part of a treatment plan. This involves cognitive behavioral therapy, where patients are counseled about body image issues, weight management, normal eating habits, nutrition, and the effects of starvation. Drug therapy with medications such as antidepressants are only useful for associated problems such as depression, anxiety, or obsessive-compulsive disorder (OCD). About 70% of people who receive therapy in a timely manner will make a full recovery. But in some cases, anorexia becomes a lifelong problem and may require long-term and counseling and management.

People with bulimia usually want and seek treatment, since they recognize their eating disorder is abnormal and is harmful to their health and happiness.

People with bulimia rarely require hospitalization. They're usually treated with a combination of cognitive-behavioral therapy and medications. Antidepressants are often prescribed, which often reduce food craving and binge-eating episodes. Psychotherapy is used to create awareness and to educate about eating patterns and behaviors, as well as to deal with distorted thoughts about body image and weight. Group and family therapy are commonly used to manage bulimia, and are quite effective. As with anorexia, people with bulimia who get early and prompt treatment will have a full recovery and suffer minimal long-term ill effects.