Winter Health Tips
Smoking: Steps to Help You Break the Habit
Why does it seem so hard to stop smoking?
Smoking causes changes in your body and in the way you act. The changes in your body are caused by addiction to nicotine. The changes in the way you act developed over time as you bought cigarettes, lit them and smoked them. These changes have become your smoking habit.
When you have a smoking habit, many things seem to go along with having a cigarette. These might include having a cup of coffee or an alcoholic drink, being stressed or worried, talking on the phone, driving, socializing with friends or wanting something to do with your hands.
How can I stop smoking?
You'll have the best chance of stopping if you do the following:
- Get ready.
- Get support and encouragement.
- Learn how to handle stress and the urge to smoke.
- Get medication and use it correctly.
- Be prepared for relapse.
How should I get ready to stop smoking?
Set a stop date 2 to 4 weeks from now so you’ll have time to get ready. Write down your personal reasons for stopping. Be specific. Keep your list with you so you can look at it when you feel the urge to smoke.
To help you understand your smoking habit, keep a diary of when and why you smoke. Using information from this diary, you and your doctor can make a plan to deal with the things that make you want to smoke.
Just before your stop date, get rid of all of your cigarettes, matches, lighters and ashtrays.
How can I get support and encouragement?
Tell your family and friends what kind of help you need. Their support will make it easier for you to stop smoking. Also, ask your family doctor to help you develop a plan for stopping smoking. He or she can give you information on telephone hotlines or self-help materials that can be very helpful. Your doctor can also recommend a stop-smoking program. These programs are often held at local hospitals or health centers.
Give yourself rewards for stopping smoking. For example, with the money you save by not smoking, buy yourself something special.
What about stress and my urges to smoke?
You may have a habit of using cigarettes to relax during stressful times. Luckily, there are good ways to manage stress without smoking. Relax by taking a hot bath, going for a walk, or breathing slowly and deeply. Think of changes in your daily routine that will help you resist the urge to smoke. For example, if you used to smoke when you drank coffee, drink hot tea instead.
What will happen when I stop smoking?
How you feel when you stop depends on how much you smoked, how addicted your body is to nicotine and how well you get ready to stop smoking. You may crave a cigarette or feel hungrier than usual. You may feel edgy and have trouble concentrating. You also may cough more at first and you may have headaches.
These things happen because your body is used to nicotine. They are called nicotine withdrawal symptoms. The symptoms are strongest during the first few days after you stop smoking, but most go away within a few weeks.
What about nicotine replacement or medicine to help me stop smoking?
Nicotine replacement products are ways to take in nicotine without smoking. These products come in several forms: gum, patch, nasal spray, inhaler and lozenge. You can buy the nicotine gum, patch and lozenge without a prescription from your doctor. Nicotine replacement works by lessening your body’s craving for nicotine and reducing withdrawal symptoms. This lets you focus on the changes you need to make in your habits and environment. Once you feel more confident as a nonsmoker, dealing with your nicotine addiction is easier.
A prescription medicine called bupropion SR (brand names: Zyban, Wellbutrin SR) helps some people stop smoking. It is taken as a pill. Bupropion SR does not contain nicotine, but it helps you resist your urges to smoke.
Talk to your doctor about which of these products is likely to give you the best chance of success. For any of these products to work, you must carefully follow the directions on the package. It's very important that you don't smoke while using nicotine replacement products.
Will I gain weight when I stop smoking?
Most people gain a few pounds after they stop smoking. Remember that any weight gain is a minor health risk compared to the risks of smoking. Dieting while you’re trying to stop smoking will cause unnecessary stress. Instead, limit your weight gain by having healthy, low-fat snacks on hand and exercising on a regular basis.
What if I smoke again?
Don’t feel like a failure. Think about why you smoked and what you can do to keep from smoking again. Set a new stop date. Many ex-smokers did not succeed at first, but they kept trying.
The first few days after stopping will probably be the hardest. Just remember that even one puff on a cigarette can cause a relapse, so don’t risk it.
Copyright © American Academy of Family Physicians 2004
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Seasonal Affective Disorder
What is seasonal affective disorder?
Seasonal affective disorder (also called SAD) is a type of depression that follows the seasons. The most common type of SAD is called winter depression. It usually begins in late fall or early winter and goes away by summer. A less common type of SAD, known as summer depression, usually begins in the late spring or early summer. It goes away by winter. SAD may be related to changes in the amount of daylight during different times of the year.
How common is SAD?
As many as 6 of every 100 people in the United States may have winter depression. Another 10% to 20% may experience mild SAD. SAD is more common in women than in men. Although some children and teenagers get SAD, it usually doesn't start in people younger than 20 years of age. For adults, the risk of SAD decreases as they get older. SAD is more common in northern geographic regions.
How does my doctor know I have SAD?
Although your symptoms are clues to the diagnosis, not everyone with SAD has the same symptoms. Common symptoms of winter depression include the following:
- A change in appetite, especially a craving for sweet or starchy foods
- Weight gain
- A heavy feeling in the arms or legs
- A drop in energy level
- Fatigue
- A tendency to oversleep
- Difficulty concentrating
- Irritability
- Increased sensitivity to social rejection
- Avoidance of social situations
Symptoms of summer depression include poor appetite, weight loss and insomnia. Either type of SAD may also include some of the symptoms that are present in other forms of depression. These symptoms include feelings of guilt, a loss of interest or pleasure in activities you used to enjoy, ongoing feelings of hopelessness, and physical problems, such as headaches.
Symptoms of SAD keep coming back year after year, and they tend to come and go at about the same time every year. The changes in mood are not necessarily related to obvious things that would make a certain season stressful (like regularly being unemployed during the winter).
Is there a treatment for SAD?
Yes. Winter depression is probably caused by your body's reaction to a lack of sunlight. Light therapy is one option for treating winter depression.
If your doctor suggests you try light therapy, you may use a specially made light box, or a light visor that you wear on your head like a cap. You will sit in front of the light box or wear the light visor for a certain length of time each day. Generally, light therapy takes about 30 minutes each day throughout the fall and winter, when you're most likely to be depressed. If light therapy helps you, you'll continue using it until enough sunlight is available, typically in the springtime. Stopping light therapy too soon can allow the symptoms to come back.
When used properly, light therapy seems to have very few side effects. Side effects may include eyestrain, headache, fatigue, irritability and inability to sleep (if light therapy is used too late in the day). For people who have manic depressive disorders, skin that is sensitive to light, or medical conditions that make their eyes vulnerable to light damage, light therapy should be used with caution.
Tanning beds shouldn't be used to treat SAD. The light sources in tanning beds are high in ultraviolet (UV) rays, which harm both your eyes and your skin.
Your doctor may also want you to try a medicine or behavior therapy to treat your SAD. If light therapy or medicine alone doesn't work, your doctor may want you to use them together.
Copyright © American Academy of Family Physicians 2004
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Television: Reducing the Negative Impact
Television has a tremendous influence on how children view our world. Youngsters spend more hours watching TV from birth to age 18 than they spend in the classroom. A positive aspect of TV viewing is the opportunity to see different life-styles and cultures. Children today are entering school more knowledgeable than children before the era of TV. In addition, TV has great entertainment value. While TV can be a good teacher, many children watch TV excessively and experience some of the negative consequences described below.
What are the harmful aspects of TV ?
- TV displaces active types of recreation. It decreases time spent playing with peers. A child has less time for self-directed daydreaming and thinking. It takes away time for participating in sports, music, art, or other activities that require practice to achieve competence.
- TV interferes with conversation and discussion time. It reduces social interactions with family and friends.
- TV discourages reading. Reading requires much more thinking than television. Reading improves a youngster's vocabulary. A decrease in reading scores may be related to too much time in front of the TV.
- Heavy TV viewing (more than 4 hours a day) definitely reduces school performance. This much TV interferes with study, reading, and thinking time. If children do not get enough sleep because they are watching TV, they will not be alert enough to learn well on the following day.
- TV discourages exercise. An inactive life-style leads to poor physical fitness. If accompanied by frequent snacking, watching TV may contribute to weight problems.
- TV advertising encourages a demand for material possessions. Young children will pressure their parents to buy the toys they see advertised. TV portrays materialism as the "American way."
- TV violence can affect how a child feels toward life and other people. Viewing excessive violence may cause a child to be overly fearful about personal safety and the future. TV violence may numb the sympathy a child normally feels toward victims of human suffering. Young children may be more aggressive in their play after seeing violent television shows. While TV violence does not increase aggressive behavior toward people in most children, it may do so in disturbed or impulsive children.
How do I prevent TV addiction?
- Encourage active recreation. Help your child become interested in sports, games, hobbies, and music. Occasionally turn off the television and take a walk or play a game with your child.
- Read to your children. Begin reading to your child by 1 year of age and encourage him to read on his own as he becomes older. Some parents help children earn TV or video game time by equivalent reading time. Help him improve his conversational skills by spending more of your time talking with him.
- Limit TV time to 2 hours a day or less. An alternative is to limit TV to 1 hour on school nights and 2 or 3 hours a day on weekends. Occasionally you may want to allow extra viewing time for special educational programs.
- Don't use TV as a distraction or a baby-sitter for preschool children. Preschooler's viewing should be limited to special TV shows and videotapes that are produced for young children. Because the difference between fantasy and reality is not clear for this age group, regular TV shows may cause fears.
- If your child is doing poorly in school, limit TV time to 1 half hour each day. Make a rule that your child must finish homework and chores before watching television. If your child's favorite show is on before the work can be done, consider recording the show for later viewing.
- Set a bedtime for your child that is not altered by TV shows that interest your child. Children who are allowed to stay up late to watch television are usually too tired the following day to remember what they were taught in school. By all means, don't permit your child to have a TV set in her bedroom because this eliminates your control over TV viewing.
- Turn off the TV set during meals. Family time is too precious to be squandered on TV shows. In addition, don't have the television always on as a background sound in your house. If you don't like a quiet house, try to listen to music without lyrics.
- Teach critical viewing. Turn the TV on for specific programs only. Don't turn it on at random and scan for something interesting. Teach your child to look first in the TV program guide.
- Teach your child to turn off the TV set at the end of a show. If the TV stays on, your child will probably become interested in the following show and then it will be more difficult for your child to stop watching TV.
- Encourage your child to watch some shows that are educational or teach human values. Encourage watching documentaries, or real-life dramas. Use programs about love, sex, family disputes, drinking, and drugs as a way to begin family discussions on these difficult topics.
- Forbid violent TV shows. This means you have to know what your child is watching and turn off the TV set when you don't approve of the program. This may even include news programs. Develop separate lists of programs that are OK for older children and for younger kids to watch. Make your older children responsible for keeping the younger ones out of the TV room when they are watching programs not allowed for the younger children. If they don't keep them out, the show must be turned off. The availability of cable television, videos, and DVDs means that any child of any age has access to the uncut versions of R-rated films. Many children under the age of 13 years develop daytime fears and nightmares because they have been allowed to watch these movies. Most television programs are now rated. The TV ratings are:
- Y (made for all children)
- Y-7 (made for children 7+)
- Y-7-FV (made for children 7+, includes fantasy violence)
- G (general audience, appropriate for all ages)
- PG (parental guidance suggested, may be inappropriate for young children)
- TV-14 (parents strongly cautioned, may be inappropriate for children under 14)
- TV-MA (mature audience only, may be unsuitable for children under 17)
Most newer television sets include a V-Chip so that you can block out TV shows with certain ratings. But remember, ratings are just guidelines. They cannot replace your good judgment. An educational animal show may have the same rating as a violent cartoon.
- Discuss the consequences of violence if you allow your older child to watch violent shows. Point out how violence hurts both the victim and the victim's family. Be sure to discuss any program that upsets your child.
- Discuss commercials with your children. Help your children identify high-pressure selling and exaggerated claims. If your child wants a toy that is a look-alike version of a TV character, ask how he or she would use the toy at home. The response will probably convince you that the toy will be added to a collection rather than become a catalyst for active play.
- Discuss the differences between reality and make-believe. This type of clarification can help your child enjoy a show and yet realize that what is happening may not happen in real life.
- Set a good example. If you watch a lot of TV, you can be sure your child will also. In addition, the types of programs you watch send a clear message to your child.
Published by McKesson Provider Technologies.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright © 2005 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
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Exercise - Winter Tips
What are the goals of exercise?
Everyone's goal for a long and healthy life should include a healthy diet, a regular exercise program, and a normal weight. Although most evidence on the benefits of exercise focus on heart protection, studies now are reporting that fitness has a stronger benefit on mortality rates than even some heart risk factors. (The more fit the individual, the lower the risk.)
Some research is suggesting, in fact, that our genes were designed for exercise. In other words, during prehistoric times, if a person couldn't move quickly and wasn't strong, he or she died. Those who were fit survived to reproduce and pass on these "fitter" genes. Some researchers believe that with the current sedentary culture, these genes have become maladaptive and their effects produce a number of adverse effects, leading possibly to many chronic illnesses.
The goals of exercise are the following:
- Improve oxygen delivery and metabolic processes.
- Build strength and endurance.
- Decrease body fat.
- Improvement movement in joints and muscles.
- Improve sense of well being.
No one is too young or too old to exercise. The US Surgeon General recommends at least 30 minutes of moderate exercise, such as brisk walking, nearly every day. However, strenuous exercise has risks that people should discuss with a physician. The American Heart Association recommends that people over 45 who have not had a physical exam in two years or longer, people with serious or chronic medical conditions or who are at risk for heart disease, and people on medication should consult a physician before embarking on a serious exercise program.
Fifty percent of all people who begin a vigorous training regime drop out within a year, so the key to attaining and maintaining physical fitness is to find activities that are exciting, challenging, and satisfying.
Frostbite and Hypothermia
Precautions need to be taken in cold weather. When exercising in winter, dress in layers, including gloves and socks, which create insulated air pockets that trap heat. In cold weather, wear shoes with less ventilation than those worn in the summer. Fingers, toes, ears, and nose are most susceptible to frostbite. From stinging or aching, frostbite progresses to numbness. Fingers and toes may become white. Soaking the extremities in warm water can help, but only once there is no risk of refreezing, since a second bout of frostbite after thawing can accelerate tissue damage. Hypothermia can be life threatening and can occur even after prolonged exposure to temperatures that are above freezing. The condition is characterized by extreme fatigue, mental confusion, apathy, and lack of coordination. The victim should be warmed as soon as possbile with blankets, body heat, and warm fluids.
How can a person be motivated to exercise?
In a 2002 poll, only 19% of women and 24% of men over 50 years old reported that they engaged in vigorous exercise (three or more times a week). Among younger adults, 30% of women and 35% of men exercises. On the positive side, more than half of men and women reported moderate exercise. Even small efforts can boost fitness levels and lay the groundwork for a healthy lifestyle. Some motivational tips are as follows:
- Think of exercise as a "menu" rather than a "diet." Choose a number of different physical activities that are personally enjoyable, such as sports, dancing, or biking. Note, that although experts advocate 30 minutes of aerobic exercises at least five times a week, those times can be divided into shorter periods -- such as 10 minute sessions. In addition, people can achieve health benefits from other exercise programs, including weight training, yoga, or tai chi.
- Stick to a prepared schedule and record progress.
- Develop an interest or hobby that requires physical fitness.
- Adopt simple routines, like climbing the stairs instead of taking the elevator, walking instead of driving to the local newsstand, or canoeing instead of zooming along in a powerboat.
- Try cross training (regularly switching from one type of exercise to another). Studies suggest it is more beneficial than focusing only on one form of exercise.
- Exercise with friends.
- Join a gym or take classes. Many affordable programs are available.
- For those who can afford them, personal trainers can be very helpful and are available in many gyms and exercise clubs. Personal trainers without any connection to a well-reputed gym or fitness club should be certified by a major fitness organization, such as the Aerobics and Fitness Association of America (AFAA) or the American Council on Exercise.
- Exercise videos may also be helpful, but people should be sure they are suited to individual age and health needs and bear the seal of the AFAA.
Motivating Children and Adolescents
Obesity is increasing in children and adolescents, with 15% now being overweight -- up from 5% in the early 1970s. Along with this trend is an increase in type 2 diabetes in young people. A 2002 study suggested that only high levels of physical activity -- not just using up energy -- helped prevent obesity in young people. Since 1991, government surveys have reported lower-than-recommended activity levels in this group. Girls exercise less than boys, and children in minority groups exercise less than Caucasians. Experts state that children should be vigorously active for at least 20 to 60 minutes three to five days a week. Many children used to walk to school, but fear of crime and traffic dangers have significantly reduced this activity. Parents and schools must be imaginative and rigorous in encouraging children to exercise.
Role of Parents
A 2002 study on teenagers reported that, on average, adolescents spend three hours a day watching television. Increasingly, sedentary activities, which also include computers and videogames, are dominating young people's time. Parents must make conscious efforts (including reducing their own TV watching!) to limit such activities and to encourage physical ones, not only for their children, but themselves. Even children who aren't interersted in joining a Little League team may enjoy a round of catch with their parents, walking in the park, or swimming in a local lake.
Role of Schools
Early school physical education programs can make a significant difference and the earlier these routines are learned, the more likely they will be carried forth into a healthy adulthood. Schools should emphasize team cooperation or individual improvement and self-mastery. Studies have shown that people tend to give up more quickly and feel less competent if their perceptions of success are based only in comparison to their peers. Unfortunately, many school officals equate physical health only with athletic success. And, even athletically gifted youngsters often fail to continue training after graduation once they lose the encouragement of coaches and fans, their only gauge of self-worth.
People mature at different rates, and there seems to be a genetic component to coordination, strength, speed, and one's response to resistance exercise. Nonetheless, everyone should strive to be as fit as they possibly can, given their strengths and limitations.
Stages for Adopting Healthy Behavior
For a person to successfully adopt a more healthy behavior -- whether it's to exercise more, lose weight, or stop smoking -- it's not as simple as just deciding to do it. Behavior change expert James Prochaska and his colleagues outlined a theory, which has been supported by numerous studies, showing that people cycle through a variety of stages before a new behavior is successfully adopted over the long term. It may help you to understand how this works. As you read the description of each stage -- specifically as it relates to exercise -- you may find yourself nodding and saying to yourself, "Yes, that's me!"
Stage 1: Pre-Contemplation.
People at this stage have no plans or desire to exercise. They aren't even considering exercising. People at this stage are generally unaware of the specific benefits that exercise can bring -- exercise may seem more like a hassle than something worth doing. Or, they may simply have "failed" in the past and have given up. There's no point in talking about how to start an exercise program if you are at this stage. Instead, it is important to think about why exercise might be good for you personally -- by helping you to lose weight, feel better, have more confidence, live longer, sleep better, or have less stress. The benefits must be identified before a person will consider exercise. If you are at this stage, a good activity is to ask four friends or family members why they exercise. That may unveil real-life benefits and inspire enough interest to compel you to take the next step.
Stage 2: Contemplation.
A person at this stage is thinking, "I think I should probably exercise, but I need help getting started." People at this stage know that exercise is good for them, but it seems like a daunting task or they don't think they can pull it off. Some may have tried and "failed" in the past, but they are still receptive to another go-round. It's important for people at this stage to consider some of the truths and falsehoods of exercise. For example, it is helpful to know that there are many forms of physical activity to select from, and that you can do your exercising in small chunks. It is not true that exercise has to be painful, or that you either succeed or fail. There is no such thing as "failure" -- people become more or less active at different stages of their lives, and it is never too late to get moving again. And people at this stage should find assurance that an exercise plan can be very simple. If you are at this stage, a good activity is write down (brainstorm) all your potential roadblocks -- the things that you believe make exercise difficult -- and to learn strategies for overcoming or side-stepping those hurdles. There are many ideas available on the internet. People at this stage might benefit from making a pledge, contract, or other commitment that they are going to get more active in the near future. Prochaska and his colleagues write that people in this stage are "aware of the pros of changing but are also acutely aware of the cons. This balance between the costs and benefits of changing can produce profound ambivalence that can keep people stuck in this stage for long periods of time. We often characterize this phenomenon as chronic contemplation or behavioral procrastination." Thus, the goal is to get un-stuck by identifying the roadblocks, ways to overcome these hurdles, and making a commitment.
Stage 3: Preparation.
These folks are primed and motivated. They are ready to give exercise a try. The goal of this stage is to create a specific action plan that takes all factors into account, so that the "launch" is successful. People at this stage need to know how much they should be exercising, their target heart rate, and the types of exercises. They should explore the different kinds of exercises and decide on which ones to try. At this stage, they'll evaluate exercise machines and health plans, if that interests them, pick the proper clothing or accessories, and consult a physician if necessary. And they need to think about how they are going to fit their exercise plans into their daily and weekly schedule. If you are at this stage, you should also consider some backup plans -- what to do if it rains, or if you don't feel like exercising. That way you are prepared to overcome that hurdle when it happens. And you should be aware of what to realistically anticipate at the beginning (e.g., weight loss takes time, but health benefits begin immediately).
Stage 4: Action!
People at this stage have just started exercising. This stage is where the most behavior change occurs - these folks have started to exercise but it is not yet a long-term, ingrained habit. Prochaska notes that this stage requires significant commitment and energy. If you are at this stage, keep talking to friends and family for inspiration. Review your backup plans. Reward yourself for small achievements. And give yourself notes and reminders to exercise. If you can find a friend to exercise with, that can be a huge support as you get through this stage. You want to build and maintain momentum, because it gets easier once it is a habit!
Stage 5: Maintenance.
The folks at this stage have been exercising at least 6 months. At this point, exercising has started to become a habit. The goal here is to prevent relapse. If you are at this stage, identify ways that you can fine-tune your program. Continue to identify roadblocks and improve your backup plans. Think about what you have found most enjoyable about exercising. What benefits have you gained? Keep reminding yourself of these perks. If giving yourself a challenge was part of your initial motivation, set new goals and give yourself new challenges. If you risk getting bored with your routine, find ways to vary it. Or maybe you have found a comfortable routine that you enjoy -- if it's working, great! Then no need to change it. You might want to read or learn more about your method of exercising and develop a deeper level of understanding about it. Soon you'll be a pro!
One point about this theory is that people do not proceed from one stage to another in a simple, step-by-step fashion. They actually cycle or spiral back and forth, so that they may move from stage 1 to 2 to 3, and then back to 2 again. They may stay in maintenance mode for years and then fall back to stage 2. Remember that this is normal -- if you tried exercising in the past and didn't stick with it, don't consider yourself a failure. Just know that it's time to try again!
WHERE ELSE CAN INFORMATION BE OBTAINED ON EXERCISE?
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity: www.cdc.gov/nccdphp/dnpao/index.html. Call (888) CDC-4NRG.
Aerobics and Fitness Association of America: www.afaa.com. Call (800) BE-FIT86 or (800) YOUR BODY.
American Council on Exercise: www.acefitness.org. Call (800) 825-3636.
Nicholas Institute of Sports Medicine and Athletic Trauma: www.nismat.org. Call (212) 434-2700.
Shape Up America! www.shapeup.org/sua
www.ivillage.com/diet/experts/fitfriday/archive
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Review Date: 3/31/2003
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Well-Connected reports; Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2003 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Copyright © Nidus Information Services 2004
A.D.A.M., Inc.
Copyright © 2005 Elsevier Inc. All rights reserved. www.mdconsult.com
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