Cessation and Prevention Prescription Tobacco Theory 11/20/14 Theory of Tobacco Addiction with the Biomedical and Chemical Equations for smoking cessation. Written by Doctor Theory For those who Want to quit or Continue to Smoke “Tobacco Theory” Video - Smoking Cessation Presentation: https://www.youtube.com/watch?v=GnW7tCxpt9M Science Entertainment Enterprises 1 Tobacco Theory Chapters 1.00 BRAIN DOMAIN 1.01Electricity Harmony 1.02 Reward Path 1.03 Synapse Gap 1.04 Brain Drain 1.05 Dope to Cope 2.00TEST QUEST 2.01 Smoked the Lungs 2.02Get Smart 2.03Scan the Plan 2.04 In-SPECT the Brain 2.05PET the Brain 2.06 Hard Knocks 2.07 Spaceship Earth 2.08Prophetic Genetics 2.09PISS and POOP 3.00 CANCEROUS CORPORATIONS 3.01 Cancerous Empire Objectives 3.02 Additive Chemistry Experiment 3.03 Corporate Genetics 4.00 DISEASES Of ADDICTION 4.01 Cancer 4.02 Lung Diseases 4.03 COPD 4.04 You’re Sick 4.05Bug Wars 4.06 Consultations and Medications 4.07Treating the SOB 4.08 Artery Diseases 4.09Cause and Effects 4.10 Data 5.00PRESCRIPTIONS for ADDICTION 5.01 Tobacco Cessation Medications 5.02 More the Merrier 5.03Obesity Theory 6.00 STREET DRUG THEORY 6.01 Gangs Of Dealers 6.02Pot or Not 6.03Medical Marijuana 6.04Crack the Ice 6.05Head Case 6.06Smokin’ Data 6.07 ReSPECT ADHD 6.08Medication Consideration 7.00 SMOKE BRAKE 7.01 Medication Consultation 7.02 Know Your ABCs 7.03All Together Now 7.04 EDucation Brain Domain (1.00) Identifies the chemical reactions, of the brain in action Test Quest (2.00) Presents the situations, which justify further investigations. Cancerous Corporation (3.00) Informs us how the corporate empire, increases our smoking desire. Diseases Of Addiction (4.00) Provides defensive medicine to ease, the tobacco-connected disease. Prescriptions for Addiction (5.00) Describes available medication, for tobacco termination. Street Drug Theory (6.00) Offers some hope, to stop the illegal dope. Smoke Brake (7.00) The final act, to help with the craving attack. 2 Dedicated to the school teachers of planet Earth, the most underpaid district in the Galaxy! Cover the Patient’s and My Gluteal Deal The contents of “Tobacco Theory,” including the text, graphics, and illustrations, as well as the material provided by others for this venture are for informational (instructional) purposes only. “TobaccoTheory”isNOTintendedasanalternativeforprofessionalmedicaladviceand consultation,orfordiagnosis,ortreatment.AlwaysseektheadviceofyourPrimaryCare Provider(PCP)suchasyourphysician,nursepractitioner,physicianassistant,psychologist, socialworker,orotherqualifiedhealthprofessionalwithanyquestionsordifficultiesyoumay have concerning your medical condition. Mostofthewrittenmaterialin“TobaccoTheory”ismyowncreationtobeofferedaspubic domain, a community service venture.Some of the written material and pictures are from other sources (see references) and thus require authorization for reproduction or use.This material is for health education and is freely available to assure the best opportunity for distribution for all those seeking to be drug free.In my perspective, drug addiction is an insidious disease, as well asbio-chemicalwarfareinfectingEarthandmaterial(ammunition)toconquerthispandemic should be freely available for all. Iamnotarealdoctor,althoughIhaveplayedoneonTV.Ihavetaughtonstageandon televisionwiththethemeofhealthandsciences.Presently,Iamanactivedutycommissioned officer with the U.S. PHS (Public Health Service-PHS) and this material is NOT affiliated with or created by U.S. PHS, or any governmental agency.In the real world I hold a master’s degree asaPhysicianAssistant,havebeeninpracticedforover20years,andhavespecializedin tobacco cessation.Biography of Doctor Theory is in “The Ends” chapter. Hopefully, I have covered everybody’s gluteus. 3 Welcometothe“TobaccoTheory”–chemicalequationsfortobaccocessationto inspireinhabitantsofEarthtobesmokingfree.Thisincludesunderstandingthe brain’schemicalactivityofaddictionandthemedicationsavailableforsmoking cessation. Many are not able to be free from tobacco/drug addiction and will smoke till death dotheydepart.Therefore,forthosewhohavenoplantoquit,alongwiththose whoalreadyhavechronicdiseasesfromsmoking,thismaterialofferspearlsof preventative medical wisdom for protection from the disabling diseases so one may live smokin’ ever after - a little longer and healthier.It is important to understand the diseases caused by smoking, as well as the medications that guard one from the earlyonsetofaheartattackorstrokeandparticulartreatmentplansforlung infections and diseases to protect every last breath of fresh air. “TobaccoTheory”includesasegmentdedicatedforthosesuckedintosmoking streetdrugs,suchasmethamphetamine,crackcocaine,andmarijuana,witha differentperspectivetodealwiththeobjective–tobeornottobedrugfree. One must capture the concepts in the chapters prior to this “Street Drug Theory” for the big picture to come into focus. By far the most popular and potentially dangerous chemical substance in the world, especially when laced with lethal additives and smoked, is TOBACCO. 4 Traditionally, Native Americans used tobacco for medicinal and ceremonial purposes.(49) (Curtis Zunigha, former Chief of the Delaware Tribe of Indians in Oklahoma and the Executive Producer “Smoke Brake” – IHS, Claremore Indian Hospital’s DVD Presentation) Mosttobaccoproductsarecontaminatedwithchemicaladditivesthatcause cancer,acravingtosmokemore,andanaddictiontoaparticularbrand.Aswe know,tobaccoisnotvitaminenrichedforyourhealth.Inthisplanetarydomain, onemustbeeducatedaboutthetobaccocompaniesthatsaturatetheirproducts withaddictivechemicaladditives.Itisimperativetobeawareofthechemical warfare played on one’s life.So be advised, my dear smokers and dippers, it is in yourbestinteresttostopthesebrandsoftobaccothatarelacedwithvicious additives. Forthosewhoarenotsmoking,thismaterialwillbroadenyourviewtoempathize withfamilyandfriendswhoareaddictedtotobaccoand/orstreetdrugsand perhaps be more understanding and supportive. We must investigate what is going on inside the brain, what drives the frustrating cycleformanytosmoke,drink,andcuss,andliveincaptivityofaddiction.Once wehaveaninsightintothesynapticsofthebrain,beingabletoseewhatis screwedupinside,thenwecanfixthebrain,oratleastgetitrunningalittle better. 5 1.00 BRAIN DOMAIN Tosecuresmokingcessationsuccessweneedtorecognizewhatissuesmayhave shuffled the deck of life such as biological and/or sociological events. Fromabiology pointofview,justassomeareborn,conceived,withthegenetics for having alcoholism, colon cancer, or diabetes, it appears drug addiction may run in the family as well (1, 2). New research offers several equations for addiction treatment.As we understand thegeneticprogramsinthebrainthatcausethisaddictionprocess,thenitisa matter of turning off the DNA program.Dr. Eric J. Nestler states, "Our research suggeststhattestingchemicalcompoundsthatreversechromatinremodelingisa promisingapproach toseekingtreatmentsfordrugabuse.Thisisalreadyamajor strategy for cancer therapy development" (3). The National Institute on Drug Abuse (NIDA) – Gene Model Geneexperimentationconfirmsapossiblecocainegeneticinteraction.Withthis finding,wearegettingclosertofindingthecode,apassword,toopenupthe secrets of addiction.To KISS it (Keep It Short and Simple) we may have found a “genetic addiction switch” and now we are searching to find out how to turn it off. Itwouldbeidealifwecouldjustfindacure(repair)forthegeneticpartof addiction and fix it. 6 So some are born with addiction and the other part of addiction in continued drug abuseislikeahideouscomputervirusthatre-programsthechemicalequationsin thebrain,causingonetobecomemoredeeplyaddictedandpossiblydevelop psychiatric illness (4).The earlier in life one begins chemical abuse, be it nicotine or methamphetamine, the more control it claims and difficulty to reframe. Sociological issues for drug abuse may have been encouraged by the pusher, be it the tobacco companies or street drug dealers, who have lured multitudes into using or selling drugs, some recruited into the industry before puberty. Thestreetisnotsweet,andworkingintheFederalBureauOfPrisons(BOP) providing medical care for the nation’s most notorious violent and drug trafficking villains, I have seen this glamorous road of crime and drug dealing lead into a dead end collision of harsh reality, death, and loss of fame.Some choose to live in the storm while others are able to reform. (50) Manyofushavelotsofissues,alifetimesubscription,playinggamesonthemind and have been hit hard with dysfunctional families, divorce, incarceration, death of friendsandfamily,andphysicaland/ormentalabuseandlivewiththesehaunting memoriesfromthewombtothetomb.Whenconfrontedwiththesetraumatic events,thebrainshortcircuitsintosurvivalmodeandstartsreprogrammingthe synaptic chemistry, implanting new subroutines (5). Thisself-preservationcodeisdesignedtoprotecthumansfromthesestressful environments–survivalofthefittest.Inreturn,thesociologicalandbiological changes for protection may alter one’s character, which may not fit well in Earth’s “civilized” society, yet work ideally on the battlefield or on the street.Many of us recover well, while others continue to live in hell. 7 1.01 Electricity in Harmony Justaselectricalpowerisdistributedthroughoutacity,soaretheneural pathways(neuronsandaxons)transmittingmessagesthroughoutthebrain.A lightning storm may cause a power outage and black out an entire city; likewise part of the brain may malfunction following the storms of life. Consider planet Earth from space at night, looking down at the city lights from the USA.Now imagine how it would look when we short circuit part of the country, the state of Tennessee, with a power outage.Now we cannot see Tennessee. Justasapowershortagewouldbeseenfromspaceshowingwhichareasareout, we have the technology to see parts of the brain in action, or not working at all.If the USA lost the resources from Tennessee - the music dies.Similar in thought, our brain would lose its memory for country music.Now let us get a picture of the brain from inside the skull, to see if the brain is working or not working at all. 8 !"#$ &'()*+ ,)-. For a visual of the brain in action we would have to secure a specimen, a volunteer. I have opened, dissected many a male volunteer skulls before my smoking cessation classescalled“SmokeBrake”onlytolearnitisnottheplacedudesstoretheir brains, and I am not going down wherever to search for gray matter.Say I found a brain and split it open (half) for illustration. The following picture “A” shows how different parts of the brain have special jobs toperformsuchasprovidinginformationaboutpain,accesstomemory,and transforming light into vision. Tounderstandthechemicalorchestrathattakesplace,thefollowingmodels“B” show the effects on the brain during nicotine stimulation.To KISS it, take note to therewardpathwayasseenintheyellowandblue-circledarea.Thisisthe location of the brain’s drug craving and addiction (9).Observe the smoker’s reward pathwaythatexhibitsmoreelectricalactivity(enlargedcircledarea)after smoking – a reward response. A)B) These are exaggerated (KISS) illustrations, as the areas of the brain presented are not exact or does the areas get larger in size. Oneofthemainchemicalsthatturnontherewardpathwayiscalleddopamine. Simply speaking, a dopamine surge is the rush in the brain that drives drug-seeking behavior.When smokers receive their dosage of dopamine, they feel balanced or supercharged.This is just one of several chemicals in the brain that humans may have a desire for or shortage of. Not having the correct harmony of chemicals in the brain is called a chemical imbalance – where one is not receiving his/her fair share. 9 !"#/ 012)34' 5)3 Tounderstandchemicalimbalance,letuslookdeepintothebrain,a“Fantastic Voyage” into the synapse of a tobacco abuser/user.To get a visual of a chemical imbalanceinactionwewillnowmagnify therewardareaofthebrain,closerand closermicroscopically,tolookdeepintothecells.Followthroughthese magnificationstoseetheneurons(nervecells)oftherewardpathway.These neurons have a special connection (gap) called the synapse. (47) Withanormallevelofdopamineinthisgap,thesynapsekeepsonebalanced- smoothsailing.Theneuronsinthebrainneedtherightamountofchemicalsto work properly. Someofthechemicalsofimportanceareserotonin,norepinephrine,dopamine, and endorphins (7). 10 Within seconds of inhaling cigarette smoke or chewing tobacco, a rush of nicotine along with a cigarette butt-load of others chemicals travels into the brain and increases chemical activity.This activity releases the norepinephrine and serotonin into the synapse (the gap).Together, they enhance memory and concentration and decrease anxiety.Also dopamine is released, which causes a pleasurable sensation and calms down the craving (8) – “I feel good” or “I feel normal.“ 1.04 Brain Drain If there are not enough chemicals (such as serotonin, norepinephrine, or dopamine) inthesynapse,thenthatpartofthebraindoesnotworkcorrectly,justlikean electrical outage.This is a chemical imbalance. Just as an engine requires: Oil to “lubricate,” gasoline to “run,” and water to “cool” the engine, The brain requires: Serotonin to "lubricate," norepinephrine to "run," and dopamine to "cool" the mind. Thecarengineoilwarninglightletsusknowwhentheengineislowonoil.When the light goes on one must immediately turn off the engine prior to burning it up. Ifyoudonotshuttheenginedown,itwillturnoffforyouandcostacoupleof thousanddollarstoturnbackon(toreplacetheengine).Inthesameway,the brain has a warning light when low on serotonin, with the response of depression or anxiety.In return some develop social isolation or anger issues.Untreated it may costmorethananengine;youmaylosetheentirecarfollowingthedivorce settlement. Inakitchensink,thefaucetregulateshowmuchwaterentersandthedrain determines how much water stays in.To wash the dishes in the sink we need the rightamountofwatertogetthejobdone,notoverflowingordry.Likewiseour brains require the right amount of chemicals in the synapse (gap) to work correctly - not overflowing or dry. Sochemicalstravelacrossthesynapsewheretheycanattachtoareceptor site (like a catcher’s mitt) to cause a signal to travel through the brain.Then that part of the brain gets the message to walk, talk, smell, cry, smoke, or laugh. 11 Balanced Brain (Synapse) For a balanced synapse there is a correct amount of Serotonin (S), Norepinephrine (N), and Dopamine (D): SND SND SND SND SND SND SND SND The above brain shows balanced chemistry with an equal amount of SND… Brain is Low on Serotonin If a brain is low on S for Serotonin and a normal amount of N and D (Norepinephrine and Dopamine) then there is an imbalance. NDNDND SNDNDND SND This brain is low on Serotonin, which may lead to problems with depression, anxiety, social phobia, or compulsive behavior. ToincreasetheserotonininthesynapseweusethedrugscalledSelective SerotoninReuptakeInhibitors(SSRIs).ThesedrugswillInhibit(stop)the reuptake (the draining away) of the Serotonin.When we plug up the drain then the Serotonin fills up the synapse in the brain.This is the KISS it version of chemical imbalance. One of the first popular drug plugs that accomplished this is called fluoxetine (Prozac - a.k.a. Vitamin P). 12 "#$%& %' ()* )& +)#,-%&,-.#%&, $&/ 0)-$1%&, SSND SSSSNDSS Hereonemayexperiencedepressionand/ordrugaddiction.Whenlowon norepinephrine one may feel lazy and less alert.Normal levels in the synapses mayincreaseenergyandalertness.Whenlowondopamineonemayhave problems with attention, motivation, pleasure, and/or reward activity. Medicationcanchemicallyincreasethenorepinephrineanddopamineinthe synapses of the nicotine addicted species. Thedrugofchoicemaybebupropion(Wellbutrin,Zyban)-allthesame medication, just different names. Thereareseveralothermedicationsthatmayreturnbalancetothesynapse, depending on the chemical imbalance. Justassomehaveaproblemwiththeirpancreas(anorganthatregulatesthe sugarlevelinthebody)causingdiabetesmellitus,somemaynothavethecorrect balanceofthesechemicals,causingdepression,bi-polardisorder,angerissues,or drug seeking behavior (9, 10).It depends on what part of the brain is affected, as well as the chemicals involved for that part of the brain. Forexample,achemicalimbalancemayenergizepartsofthebrainthatcauses inappropriate social behavior leading to criminal acts - in other words, some dudes may just have some bad-ass protoplasm (genes).Or it may be an injured organ of the body, the brain, just taking care of oneself with survival tools of violence.So donotkickyourselforothers,justseekouttheconsultationormedicationfor treatment.Depending on one’s ailment, it may take imprisonment to keep one from committing repetitive harmful acts to others and this may be a good thing. 13 Aninmatepatientofminewasinforhischroniccareclinictohavehisblood pressure medications renewed.This was one big mean, not so lean dude.This man was angry at the world, which in turn, promoted him up the food chain of respect behind the bars.He wore a deep burden on his shoulder; a history most would not wanttohear.Ifonelookedclosely,onhisfaceandthebodylanguage,youcould see it was depression, not anger that had been etched into his expression.After themedicalexamandwork-upforhishypertensionwascompleted,Iasked outright how long he had been depressed. He was surprised and inquisitive of what was to come.I briefly explained that just as his “blood pressure” medication calmed down his high blood pressure, perhaps we should try an “anti-depressant” medication to see if it would calm down some of the anger and depression issues.He agreed and thankfully our psychiatrist jumped all over it and asked for this patient to be sent directly to his office and sure enough hestartedhimonanantidepressant–socool.Threeweekslaterthisinmate approachedmewithasmilethatovershadowedhisscars,sharinghowhefeels great.The best part was when he told me even his mother noticed, over the phone, her boy was happy again.Three months later he returns for his follow-up visit and haslostover30pounds,runsregularly,andischeerful,withplanstogetoutto start life over – as a barber.Now that’s corrections! Soifonehasproblemswithaparticulardisease,beitdiabetesorhighblood pressure,itisbesttogetthecorrectmedication,education,orconsultationto solvethesituation.Justasonecannotjuststoptheirdiabetesfromhappening, drug addiction may require outside support to help those suffering to move on with life.Some situations require medical intervention to calm down the disease(s). 14 I have met many angered patients who have found the ideal medications that have calmeddowntheirhostilesynapticstorms–theyjustneededtherightdopeto cope. 1.05 Dope to Cope Somepeoplearemissingtheneurochemistryforpeaceofmind.Thischemical imbalance may be restored with the right medication.Some pharmaceutical drugs work better than others.It does not depend on the price of the drug as much as itbeingagoodmatch.Weneedachemical“plug”or“pacifier”foraparticular person’s brain. Somedrugsaremixturesoftheserotonin,norepinephrine,anddopamineandthis may be a better match to stop up the drain(s) and provide chemical balance – the more may be merrier. Ifonehastoomuchdopamineinthesynapses,thismaycausepsychosis,giving symptomsofhallucinations(seeingandhearingthingsnothereinreality), delusions,disturbedthinking,bizarrebehavior,andagitation.Thispsychosisis seenwithapersonwhohasthechemicalimbalancecausingthedisease schizophrenia.Similarly, when taking excessive controlled prescription medication (narcotics) or street drugs, dopamine invades the synapses, which may present one ashavingaSubstance-InducedPsychoticDisorder(gonemental).Inthatcaseit may be ideal to let time heal or use prescribed medications designed to lower the dopamine level and calm down the psychosis. Manyhavenevertakenstreetdrugsandthroughtheprobabilityofnature,or perhaps the corporate chemical contaminants, and/or genetic anomalies, escape the realworldanddevelopschizophrenia.Someofthenewatypicalantipsychotic medicinesmayhelp,suchasabilify(Aripiprazole),clozaril(Clozapine),geodon (Ziprasidone),risperdal(Risperidone),andzyprexa(Olanzapine).Theolder, inexpensivemedicationsarehaldol(Haloperidol)andthorazine(Chlorpromazine). These older medications may exhibit more undesirable side effects, yet are not as deadly as some of the street drugs and the bullets dodged to secure them.Some need medications for their personality to return to reality. For some individuals, it is not their fault they were short-changed on dopamine or have too much dopamine saturating the brain.Some have a balanced synapse full of dope, while others seek to find drugs to repair this chemical disparity. 15 Considera20-year-oldmalesmoking2packsperdaywillstatisticallyliveonly40 more years (death at about 60 years old).If this same dude were not to smoke he wouldliveover50moreyears(averagelifeexpectancyover70yearsold).Why would he smoke even though he may lose over 10 years of life and suffer from the tobacco related diseases? Considerwhatitwouldbelikeifwelivedinanotherworld,aparalleluniverse, where it is ass-backward and Mother Nature made it safe to smoke tobacco and dangeroustotakeantidepressantpills(over10yearsoflostlifefromtaking prescription medications). Now,askonetoSTOPhis/herantidepressant(suchasfluoxetine),whichis improving the quality of life. What would be a normal, acceptable response? “I would rather be happy for 40 years than depressed for 50.” Some people seek out drugs to calm the mental and psychological pain.Some need to restore this chemical imbalance and have not found the right formula. Science Experiment: 20 subjects (volunteers) were tested, not knowing what they are about to receive (placebo or the real drug) 10 received intravenous (IV) normal saline (placebo - plain salt water) and the other 10 received IV cocaine (Dope). Results - The 10 who received the IV normal saline had no effect, of course. Of the 10 who received the IV cocaine: -Half enjoyed the cocaine, wanting more (lots) and offered to return for more testing. -The other half did NOT like the cocaine, did not like the feeling and wanted to pull out the IV. 16 Some people have enough dopamine and do not want any more, while others need and seek to find their dope to cope. Research Data: Which state has the LOWEST TOBACCO usage per capita in the country? Utah (46) – They do not smoke or drink as much as those in other states, since the most popular religion in that part of the country discourages these activities. Which state has the HIGHEST ANTI-DEPRESSANT prescriptions written (such as fluoxetine) per capita in the country? Yep – Utah (11); Wonder why? The moral of the story is, “We will get our dope to cope!” Or serotonin for copin’. Yearsago,apatientcametoourclinicrequestinganantidepressantthatwasnot availablethroughourformularycalledcitalopram(Celexa),sohermedicationwas changed to a similar antidepressant, fluoxetine, which was freely available through our pharmacy.Citalopram is a SSRI, which is a serotonin type of medication just asfluoxetine.Inthistransitionthecitalopramwasstoppedandthefluoxetine started the next day.The problem was, when changing these medicines, that have particulardifferences,therewasnooverlapfromonedrugtothenextandthe Prozac takes a while to kick in, so she was out of antidepressant for 2 weeks.An overlap would require continuing the citalopram for about 2 weeks while taking the fluoxetine.On our visit following this transition, she informed me of troubles that were encountered during this transition.She was not depressed or agitated; yet, foraboutoneweekshewasreadyto“check-out”fromplanetEarthwiththe thought and plan to end her life.After the fluoxetine kicked in she realized how outofhermotherlypersonalitythiswas.Herbeingofftheserotoninwasnotin balancewithhernatureandalmostcostherandfamilygreatly–sheneedsher serotonin to keep on going. Tobaccoisanamazingdrug!Withthisantidepressantyoudonothavetowaitat thepharmacy;youcangetitanywhere,anytime,andyoudonotneedtoseea doctor for a prescription.On the other hand, this most popular drug in the world claimsmoredeaththanalltheotherdrugsofabusecombined.Itmaybea chemicalcatalystthatmaycauseachainreactionofeventsforonetoseekout new drugs of abuse (12). 17 Inreview,nicotinestimulatesthebrain,activatingthechemicalsSerotonin, Norepinephrine, Dopamine, and Endorphins, among others. ThechemicalSerotoninisfoundintheclassofantidepressantmedicationscalled Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine. Norepinephrine and Dopamine are found in the aminoketone class of antidepressant medicationcalledbupropion.Thisprescriptionmedicationisoneoftheoriginal tobacco cessation pills. When consuming tobacco, it is similar to taking anti-depressants such as fluoxetine or bupropion. So to wrap it up, “Stop practicing neuro-pharmacology; stop rolling and smoking your anti-depressants and get on the pill!" Doctor Theory rolling up bupropion pills. 18 2.00 TEST QUEST Sometimes the path to be smokin’ free is simple, with just consultation, medication, meditation,andalotofdetermination.Othertimes,especiallywhensmoking chemicalsoffthestreet,wemusttakeittothenextlevelwithextensive consultation,psychiatricevaluation,multipletrialsofmedications,andlaboratory and radiological investigation to get a visual of what is broke and needs fixing. Sometimes your Primary Care Provider (PCP) will want to get some tests done, such aslaboratorybloodwork,specialx-rays,andlungfunctiontestingtoseeifa disease is creeping in or has already claimed its territory.Depending on one’s drug of choice, special testing may be needed depending on what organs may be damaged such as the lungs or brain.Smoking tobacco sucks the life from one’s lungs as well ascloggingofthearteries.Dependingonthepackyearsonesmokestheriskis increased.Pack years are calculated by taking the number of years smoked times theportionofpackssmokedperday.Forexampleaone-halfPackPerDay(PPD) user smokes for 40 years (1/2 PPD X 40 years) is a 20 Pack Year Smoker. Street drugshavethetendencytocauseinjurysuchasshort-circuitingthebrain instigatingmentalillness.Thereisnomeansofmeasuringthequantityofdrug abusesuchaswithPackYearsbecauseausercoulddevastateanddebilitatethe brain for life from a one time high and be stuck in mental disability for life. Testsmayrevealthedeteriorationofthebrain,lungs,orkidneysorhormonal imbalanceandperhapsprovidevitaldatathatcanbeusedtoimprovethequality and quantity of life. 2.01 Smoked the Lungs The three common and important tests for smokers are the Chest X-rays (CXR), the Pulmonary Function Test (PFT), and the Pulse Oximetry. RadiologicaltestssuchasaChestX-Ray(CXR)maybehelpfultofinddiseases such as pneumonia or cancer.It is not good practice to get a CXR for all smokers justtoseeifthereiscancer.AnormalCXRdoesnotmeanyouarecancerfree. YourprovidermayorderaCXRifthereareproblemssuchasacoughforweeks, fever, shortness of breath, or chest pain.When cancer grows large enough in size it may show up on a CXR of the lungs.If one has cancer it can spread throughout the body (become metastatic).It would be ideal to catch cancer early, or better yettakestepstolowerthechancesofgettingitinthefirstplace,whichwillbe covered in detail in the following chapter. 19 TheAmericanCancerSocietystudiedtheNationalLungScreeningTrialand developednewguidelinesthatrecommendproviderstodiscusslungcancer screening with those who are at high risk such as 55 to 74 years, smoker for over 30PackYears,andcurrentlysmokeorhavequitinthelast15years.The recommended test is a Low Dose Computed Tomography (CT) scan and found those with the CT scan had a 20% lower chance of dying from lung cancer than those who just got a CXR.The screening should continue yearly thereafter till 74 years old (56). The above Chest X-Ray of the lungs shows pneumonia.The cloudy area is where the infection is. The name of the infection that invaded this patient’s lungs is called Streptococcus pneumoniae (13). APFTevaluatestheworkingabilityofthelungsbymeasuringhowfastandhow much the air flows in and out of the lungs.For example, the readings from a PFT may show a 50-year-old smoking patient may have the same lungs of a 90-year-old non-smoker.This test gives a reading of the type of lung disease one has, such as asthma or COPD (Chronic Obstructive Pulmonary Disease), which helps the provider decided the best of medication to help with the SOB (Shortness Of Breath).Also, it is a good baseline (starting point) for one to see improvement on their PFT after they stop smoking for six months.This may be encouraging news that can help one alongthepathofrecoverywhentheyarebreathingbetterandseeingthePFT shows that their lungs improved from a 90 to a 70-year olds’ lung. 2&3,45,/ 6#,$ 20 Doctor Theory with Celebrity The late Dr. Thomas Petty (world renowned pulmonologist) demonstrating a handheld PFT machine (Picture from the Tulsa World) APulseOximetry(PulseOx)devicepresentstheoxygensaturationlevelinthe bloodfromthefingertip.Itprovidesinformationifoneisnotgettingenough oxygenthroughthelungsandintotheblood,whichcanhappenwithpneumoniaor lung disease caused by smoking.Good oxygenation is in the range from 95 to 100 percent, although some smokers may have readings down to 90%, which may be ok. The following picture shows the Pulse Ox on the tip of the finger, which is reading a Saturation of Peripheral Oxygen (SpO2) of 97%. 2.02 Get Smart Thegoalofpsychiatryistoidentifytheneurologicalconfinementsonemaybe subjectto,andthenoptimizebrainfunctionthroughmodernmedicaltechnology andmedication.ToKISSit,theshrink’sjobistousemodern-daytoolstocrack openthebraintofigureoutwhat’scookingandputthefireout.Tounderstand thediseasesofaddictionandtreatmentsavailableitisimportanttobefamiliar with the special procedures available and the genetics of what is to come. 21 With these tools our complicated cases may be able to get a visual of why they are notabletoeasilybedrugfree.Itisbesttoinvestigate(test)allpossible situationsthatmaycausementalturbulence,tofindoutwhatelsecouldbegoing wrong–eitherbiologicallyorsociologically.Onoccasionsitmaybebesttofix othermentalissuesbeforeattemptingtostartsomeoneontobaccocessation medications.TheVeteransAdministration(VA)hasbeenalerttothisby identifying other conditions, such as a Post Traumatic Stress Disorder (PTSD) that many of our veterans are experiencing from the theatrics of war.While assisting theseveteranstostopnicotine,VAfounditbeneficialtoevaluateandfixthe other problems.The concern is that some tobacco cessation medications are not a good match for some psychiatric illnesses.Also, tobacco is an antidepressant and stopping this sort of drug could escalate PTSD. One'smedications(suchashormones)maybehelpingorcausingturbulenceand mustbeidentifiedandresolved.Mostcomingofftheirfemalehormonaltherapy (estrogenandprogesterone)dogreat,whileothersdevelopsymptomsofhot flashes,depression,anxiety,anger,insomnia(problemssleeping),andagitation.I have had several patients tell me their thyroid medication is off (too much or not enough)andtheyfeeltiredordepressed.Offtothelabandsureenoughtheir thyroidtest(TSH)isoutofboundsandtheadjustmentoftheirmedication restores chemical balance.A patient requested her expired estrogen prescription be renewed, as she was experiencing depression being out for several months.It wasdiscontinued,asthisistherecommendationfollowingrecentresearchand otherriskfactorsshepresented.Sheexpressedthatafterherhormoneswere stoppeddepressionwashoveringabout.Somewomenintheir40sstarttonotice theworldischangingaboutthem.Thisisagoodtimetofollow-upwiththeir provider to get labs to evaluate the hormonal levels that correspond to menopause or a trial on hormones. Iwasseeingapatientforflusymptoms(cough,fever,chills,bodyaches, headache)whenIbecamesidetrackedbyhisblatantmentaldysfunction,which wasmemoryproblemsandbizarrebehavior.Ilearnedthathewaspursuing disability compensation for severe memory problems and some undiagnosed mental illnessthatlefthimnon-functionalinaworkingenvironment.Iwasconcerned about an undiagnosed neurological or biological disorder being missed.His inability tocommunicateandfollowinstructionswassodevastatingthatIjusthadtorun himthroughthelabtoseeifIcouldfindsomethingontheotherside.Iwas relieved to find that the cause of his dysfunctional character was indeed chemical innatureandwasfixable.Allhislabssuchaschemistry,bloodcount,thyroid function,minerals,andvitaminlevelswerewithinnormallimitsexcepthisdrug screen was positive for methamphetamines, benzodiazepines, and marijuana. 22 Now put that in your pipe and smoke it and see if you have memory problems.Well notthebenzos–don’tgetanyideas.Inthiscasethestreetdrugswerecausing the mental disorder.Once the patient is off these drugs, then we can get down to finding the root of the problem(s).I believe this time it was a sociological event, a questtobepaidtoparty–notonmywatchandnotonmytaxes.Thereareso manytalentedpeoplewhoareluredintothedisabilitysocietyanddonotbelong there.It is true however that some who come off the methamphetamines do have permanent memory problems. 2.03 Scan the Plan In modern automotive mechanics, when the engine is running poorly and the trouble lightison,youtakeyourcartotheautomotivetechniciantofindtheproblem. Thencomputerdiagnostictestingisperformedonacarinsteadofjustreplacing expensive parts to try and fix the problem (as I do). Likewise,manyshouldgetadiagnosticevaluationofthebrain.Justaswehave regularx-raymachinestoshowusifonehasabrokenbone,wehavespecial radiologicalmachines(cameras)thatcangiveusbetterpicturesofthebonesor other organs like the brain. These machines are as follows: SPECT (Single Photon Emission Computed Tomography) PET (Positron Emission Tomography) fMRI (functional Magnetic Resonance Imagining) CAT scan (Computerized Axial Tomography or CT scan) CT ScannerPET Scanner(48) 23 The SPECT, PET, and fMRI can give us unique pictures of the brain activity, which isthebloodflowormetabolismorenergyofthesebraincells(15).Thesetests differ from the CAT scan that shows a still (snap-shot) picture of the brain versus the brain “in action” as with the SPECT, PET, or fMRI. In most situations the scans of the brain should be performed when all drugs are filteredfromthebody,ascertaindrugsinterferewiththeactivityofthebrain and may not provide a good baseline of the brain.These tests may provide us with the brain’s ability or disability. Ifsomeoneisunabletomoveonesideoftheirbody(armandleg)orhaslost speechoreyesight,itiscriticallyimportanttogototheEmergencyDepartment for a CT scan of the brain - STAT (from the Latin stattim: meaning immediately). A CT scan is a powerful tool, which takes many x-ray pictures (slices) of the organ orbonesforabettervisualof“what’sup.”Forthissituationitisimportantto determine what kind of Cerebral Vascular Accident (CVA) took place.This CVA is commonly called a “stroke” or “brain attack” and may be a life threatening or cause permanentinjurytothebrain.Itisimportanttofindoutifanartery(blood vessel)inthebrainisbleedingorcloggedup.A“brainattack”islikea“heart attack” – a medical emergency. OnetypeofCVAisfromanarteryinthebrainthat“ruptured”andrequires emergencysurgerytostopthebleeding.Thistypeofbleedingiscommonlyseen with methamphetamine use (16).Meth raises the blood pressure and/or causes the artery to spasm (cramp up) in the brain, which then explodes.When one burst an arteryitislikeblowingafuseinyourhomeandthepowerisouttothatpartof the house (brain).Some brain injuries can be reset while other types the fuse is burnt out for life and there is no way to turn that part of the brain back on. TheotherkindofCVAthatmayhappeniswhenanarteryis“cloggedup”from plaque.Thisplaqueishardeningfattystuffthatisstucktothewallsofthe arteries in the brain.This condition worsens from nicotine, causing fat to attach to the walls of the arteries.When one’s artery becomes completely closed off it is an emergency and requires a special medicine to be injected into the blood stream to possibly unclog it - chemical rotor-rooter of the arteries.This is why there is a campaigntorusha“brainattack”patienttotheEmergencyDepartmentwithin three hours of the stroke for the medication to work. 24 After three hours it will be too late for the medication to restore activity to the part of the brain that was blocked off.If the blood flows again then there may be return of speech or eyesight or muscle movement that was injured by the stroke. Ihaveheardofsituationsinwhichfamilyand/orpatients,knowingtheyaretoo late, will lie to the physician that the time was shorter than three hours hoping to getthemedicationsanyway.Ifthemedicationisgivenafterthethreehours,it could cause worse problems than the stroke.Research has revealed that there is morepossibilityofbleedingproblemsfromthedrugthantheproblemsfromthe stroke. (48) The arrows are zooming in microscopically to the part of the brain where the vessel is clogged up. So just as a CT scan is used to determine what is appropriate for treatment, such assurgeryormedication,soareotherspecialproceduresneededtodetermine what is wrong with the brain that may be causing psychological problems. 25 Psychiatristandrevisionistthinker,Dr.DanielG.Amen,believesthat, "Psychiatristsaretheonlymedicalspecialistswhorarelylookattheorganthey treat.The odds are that if a patient is having serious problems with feelings (e.g., depression),thoughts(e.g.,schizophrenia),orbehavior(e.g.,violence),the psychiatristwillneverorderabrainscan.Heorshewillprescribemedication, psychotherapy,electroconvulsivetherapy,orahostofothertreatmentsthatwill changebrainfunction-butwillnotknowwhichareasofthepatient'sbrainwork well,whichareasareoverworked,andwhichdonotworkhardenough.Inmy opinion,thelackofbrainimaginghaskeptpsychiatrybehindmedicine'sother specialties,reducingoureffectivenesswithpatientsandhinderingoureffortsto reduce stigma and improve compliance (17)." These special tests are a small price to pay to find a problem that may cause a life longdisasterofdrugabuse,mentalillness,incarceration,poorproductivity, divorce, and remorse.It is always best to test the brain as one may have a fixable problem.Alsothesetestsmaygiveusabaselinetocheckforimprovement following the treatment of certain medications.A before and after scan may help us see if the prescribed drug is working or not. 2.04 In-SPECT the Brain For an inside visual of the brain in action we have the radiological procedure called Single Photon Emission Computed Tomography (SPECT).To be a useful tool, these scans require one experienced in reading the test results. Dr.DanielAmen(psychiatrist)istheworld'sleadingspecialistinreadingSPECT images.HeisapsychiatristandownerofAmenClinic,whoprovidestheSPECT imagesandanelaboratework-up(history,laboratory,andphysicalexam).The procedure is coordinated with one's local physician for follow-up medication to be prescribed per Dr. Amen's recommendations from reading the SPECT images. Amen Clinic performed SPECT studies to look at the brain’s effect by street drug abuse compared to drug free brains.All of the drug abusers show problems in the parts of the brain interfering with judgment (prefrontal cortex) and also learning and memory (temporal lobes). Theseareasofthebrainareimportantinthedecision-makingprocessesoflife. Oneimportantdecisionistostopabusingdrugs.Sothedrugaddictioncycle begins as one takes the drugs, then loses the decision making process to not take the drugs, so they forgot to stop.Then the drug trap has been set, over and over, again and again. 26 To see an illustration of a SPECT scan in action, take note of the following images of the brain.These pictures show the top of the brain looking down from above as if the top of the skull was taken off.It is just like opening the hood of a car and looking down onto the engine.When the hood is up then we can work on finding the problem by checking for loose wires, low oil, or burnt spark plugs. Thesmooth“healthy”(drugfree)brainisatthetopoftheposteranditis compared to the other images that show injured brains caused by drug abuse – now we can see where the problem is. 27 2.05 PET the Brain PET (Positron Emission Tomography)scansareverypopularinevaluatingthe presenceofcancerinthebody.Withtheseimagesaspecialistscanaccurately diagnoseandfindthediseasedareaofthebodythenfine-tunethetreatment. TheNationalCancerInstitutepresentssomeexcellentPETpicturesofapatient withactivecanceroussites(15).WithPETimagestheoncologist(cancerdoctor) seeingwheretheremainingcancerishidingisabletofocusthetherapyinthat area to finish the treatment. PET images of the brain are motion pictures that show which parts of the brain are not working normally.They help in the investigation of brain tumors, brain damage, and/or drug injury.An experienced doctor in psychiatry who reads these tests can look at the problem areas of the brain and “fine-tune the medication” in an attempt to restore these areas of concern. 2.06 Hard Knocks Whentheheadisclobbered(traumatized),thebrainmaybedamagedatthe impactedsiteandbysharppartsoftheskullthatholdsthebraininposition. Whenaparticularpartofthebrainisinjured,thisconcussioncouldleadoneto have the condition called Post-traumatic Thalamic Syndrome. Thisheadinjurymayrendertheuserwithangerissues,irritability,violence,and abusive behavior – and this may be a good thing. Throughout history when attacked and injured, if those souls lived, they learned from their mistakes.It is a survival ofthefittestfeatureofthecreatures.Thankfully,Naturehasdevelopeda splendidwayforanimals,andhumans,toprotectthemselvesfromdangerous situationsbyhavingthembecomeferociousandlosingparticularmorals.Asa result,an“ass-whipping”mayhelponebecomemoredevelopedasawarrior- criticalforsurvival.Thisoncewhippedandnowwickedcharacterismentally groomedto“kick-ass”withhistoolsofrageandanger,protectinghimself,or his/her people, tribe, or platoon. Throughtheschoolof“hardknocks”thesedudesarere-programmedtoberude andrulewithoneoftheessentialsurvivaltraitsthathasperseveredhumanity throughouthistory.Nowadays,violentbehaviorhaslimitedoutlets.Sothese comrades who won our wars and secured tribal survival are locked up in jails, roam the ghettos, become politicians, and rage the Los Angeles highways.The evidence ofheadinjury/concussionscausinglonglastingirreversibleneurological complicationsisonairintheworldofsports.Thankfully,themedical/sports industryhasintervenewiththe“HeadsUp”fourstepactionplantoidentifyan athlete that has had a concussion and to initiate treatment for the brain to heal. 28 During my employment with the local jail and active duty tour with the Bureau Of Prisons(BOP),Ihavemetmanycombatants.Inthe70’sthejailrockscenewas longhair,todayKojaktakesthestandwiththeheadshaveddowntothebone. Interestingly, while conducting hundreds of physical exams, I noticed so many head injuries, skull indentations and “scars” - everyone’s got a story. As Dr. Daniel Amen explains on his web site: “The impact of head trauma is often overlooked in psychiatry.Even minor head injuries to vulnerable parts of the brain can cause problems for years to come.SPECT is one of the best tools in evaluating functionaldeficitsfromheadtraumathatareoftennotseenbyotherstudies, leading to better understanding and effective treatments for patients.” One of his examples is a 15-year-old student whose case sheds light on this school ofthought.Thisdudefromearlychildhooddisplayedsevereconductproblems, hadbeenarrestedforshoplifting,frequentlycutschool,wasdefiant,ragedwith anger,andwasabusive.Hedidnotgetalongwithothersatschool.Hesmoked tobacco and pot, and used cocaine regularly.And now for the rest of the story… HisbrainSPECTstudyshowedseveredamagetohisleftprefrontalcortexas presented by the arrow. Brain injury to the prefrontal cortex Causing problems with behavior. Whenhewas18monthsoldhefelldownaflightofstairs.Hismothersaid afterwards he had a drastic change in his personality – he was never the same. Think about it.If a person's judgment, behavior, morals, learning, and memory are damaged,howcanthatindividualchangewhenthatpartofthebrainisnot functioning well?For this situation specific medications were found to calm down the squall of anger. 29 As many are led to self-medicate (take street drugs) for one reason or another, we mayneedtosecurescansofthebraintogiveusinsightonhowtotreat psychologicalproblemswiththerightmedication,aswellasconsultation.Ideally, followupimagesaftertreatmentgiveusaclearpictureofthesuccessofthe medication and may further aid in the prescription adjustment.This is just like a PET scan is ordered to see if cancer is in remission (cleared).The concern is just assomecancerisnottreatablelikewisenotalltraumaticanddruginducedbrain injuries are mendable. 2.07 Spaceship Earth NASA - Jet Propulsion Laboratory Earth Scientists Reflect on Earth day ConsiderplanetEarthasalivingorganismwiththerockprovidingthestructure, justlikeourbonesdo,withthenutrientsandmineralsneededforlife.The atmosphereandmagneticfieldaretheskinforthisorbitingbodysecuring protection.Theplantsandanimals,riversandoceansaretheorgansandblood vesselsessentialtomaintainthebiologicaldynamicsoflife.Whenanysortof catastrophe occurs, such as a chemical spill, a war, or natural disaster, it disturbs the balance of nature and could in turn cause a devastating rippling effect across the entire planet, interfering with others here for the ride. 30 Mindfully we must all strive to keep the planet “Green” and our mind “Clean.”Drug abuse,beitnicotineormethamphetamines,causestheuserandotherstosuffer (family,friends,andvictims).ThisDrugWorldWarofAddictionparallels deploymentofaWeaponofMassDestructionandaviralpandemicandrequires intervention before it becomes contagiously metastatic infecting generations. Apatientofminewasinhishighschoolsenioryear,awrestlerandcollegebond when introduced to methamphetamines.He experienced a drug-induced psychotic episode.Bytheendoftwoweeksofbeingtotallyspacedoutonmethhehadno ideawhathappeneduntilhewokeupinjail.Heisnowdoinglifeinexchangefor the life he took during an armed robbery. 2.08 Prophetic Genetics Inthefuturewewillholdthecrystalballofgeneticstoidentifydiseasesand providetreatmentbeforeitcausesproblems.Tounderstandgeneticsandhowit willchangetheentireworldofmedicine,letusstartwiththebasicsof DeoxyriboNucleicAcid(DNA).Thesearethemoleculesthathangoutinthe nucleus (control center) of the cells.During fetal development the DNA transmits architecturalinformation,specialprogramsforwhatthecellistobecome.This programtellsthecellwhattobeandwheretobewhenitgrowsuplikethehair, skin,brain,orlungs.TheDNAalsokeepscellsofthebodyworkingproperly throughout the course of life.DNA programs or traits, are the "who, when, where, how,andwhy"wearewhatweare.Itisallinthegenes;everythingrunsinthe genes … even diarrhea runs in the jeans (down the pant leg).Moving it right along… DNA determines your physical makeup and may influence your sociological destiny. The above illustration is provided by the Human Genome Project coordinated by the U.S. Department of Energy and the National Institutes of Health, U.S. PHS (18).This molecular machine is the foundation of life and controls the living organism’s characteristics. 31 Someofthegenesmalfunction,causingvariousphysicalandmentalproblemsand diseases.These genetic expressions, such as breast and colon cancer, the color of hair,anddiabetesmellitusarepasseddownthroughgenerations.Thatiswhy PrimaryCareProviders(PCPs),suchasphysicians,nursepractitioners,physician assistants, psychologists, social workers, among others, are so interested in getting afamilyhistory.Wearetryingtogetagenetic(family)historyofeventsto foresee if history might be repeating itself.Just as one may have a family history of colon or breast cancer, also one may have the genetics for drug addiction.The NationalInstituteonDrugAbuse(NIDA),MolecularNeurobiologicalBranchhas recentdatashowingevidencethatthereisagenetictraitforhumanaddictive disorders (1) – vulnerability to drug abuse and addiction. 2.08 PISS and POOP Someofthesegenes(cells)donotdevelopwell,causingproblemsanddiseases. These developmental problems may originate from family DNA, but may also be the outcomeofgeneticderangementfromthePoisonousIndustrialSeepageand Sewage(PISS)inourenvironmentfoundincontaminatedwater,pollutedair, chemically processed foods, and cigarettes laced with additives.In fact, research maybeshowingPersistenceOfOrganicPollutants(POOP),thesesynthetic chemicals in the food chain may be triggering the increase in diabetes mellitus type 2 (19) as well as causing other problems such as obesity and cancerous and genetic malformations. There is evidence of gene sites that correspond to particular psychiatric illnesses. Somedaywewillhavethetechnologytouseasampleofone’sDNAtofindthe exact gene that has caused one's brain to dysfunction.For example, research is on the way to find ways to manipulate a particular gene, the “CYP2A6” to help in the preventionandtreatmentoftobaccoabuse,thusloweringtheriskfortobacco related cancers (20). Once the problem genes are identified we will be able to design the drugs to match a patient's particular genetic conflict.Better yet, in time we will be able to test oneforparticulardiseasesandbeginthetreatmentbeforetheproblemsetsin. Thiswilltransformtheentiremedicalindustryfroma“practice”toascientific adventure. 32 3.0 CANCEROUS CORPORATIONS TobaccocompanieshireEvilMadScientiststodesignthemostaddictiveproduct onthisplanet-turningthecigarettesintoTrojanHorses.Inadditiontothe nicotinefoundinpuretobacco,thesecash-suckingvampiresadddangerous addictivechemicals,makingtheircancerousmaliciousproductmoreirresistible than methamphetamines, heroin, cocaine, and alcohol. 3.01 Cancerous Empire Objectives Guys, think of tobacco as the alluring fragrance of perfume on some hot babe.One maydecidetojustflirtwiththehottie,haveadrink,andgohome.Lifesucks whenthemalesubjectisdruggedupandthenwakesupinahotelroomwithhis kidneymissing–nowthatwouldreallybeabitch,especiallyiftheydecideto harvestafewotherorgans.Nicotineisaddictiveenoughwithoutspicingitup. Infectingtobaccowithadditives,luringonetoconsumemoreofthesedangerous chemicals, will take more than your kidney in the years to come.Are these tobacco companies subjecting you to unknown dangerous chemicals, manipulating your neural chemistryandthuspracticinggeneticengineeringonyourbrain,withoutyour consent?Yes!Thisischemicalwarfare!Inthe1988reportoftheSurgeon General(21)wewereinformedthat"Nicotineisthedrugintobaccothatcauses addiction" and also "The pharmacological and behavioral processes that determine tobaccoaddictionaresimilartothosethatdetermineaddictiontodrugssuchas heroin and cocaine."These reports set off a course of legal events, during which several of these tobacco executives perjured (lied) before the U.S. Congress that nicotinewasnotaddictive,notanymorethaneatingTwinkies!Whoknowswhat else is going on behind CEO corporate closed doors? Intheoffice,Ineveradvisemypatientstostopsmoking.Idoaskforthemto stopsmokingtheadditivetobaccoandswitchtoanon-additivebrandandsignup for my “Smoke Brake” program – to put the brakes on tobacco addiction.The goal is for my patients to first go through the withdrawals from the additives laced in thetobacco.Theninabouttwoweeksitistimefor“SmokeBrake”athree-hour entertainmenttobaccocessationpresentations(witha10-minutesmokebreak). Moststoptheadditive-lacedtobacco,whichjustsohappenstobethemore popularexpensivebrands.Hum,wonderwhytheybecamesopopular?The Chemicals!Thesamebusinessplanusedtosellstreetdrugsisbeingusedonthe smoker.Theylureyouinandreaptheharvest.Thatsucks-tosecretlylacein your cigarettes chemicals to make you want to smoke more of their brand.I have heard over a hundred times of my students/smokers reducing from a pack per day (PPD)toone-halfPPDjustfromgettingofftheadditives.Somehavequitall together just by getting of the laced brands.Put that in your pipe and smoke it. 33 By the way, do not give up when experiencing the additive withdrawal side effects of headaches, anxiety, irritability, nausea, and/or fatigue.Also, one may develop a coughandharshtastefromsmokingthenon-additivetobacco.Yourlungswill adjusttocomingoffthesoothingchemicalsmakingitsoeasytoinhale.Thatis why new smokers start the most popular brand, as it is chemically tuned to make it easy on the lungs.The following list is just a few chemicals of concern. Chemical Additives: Methanol: Rocket fuel used to calm down the burning irritation of smoke traveling to the lungs Arsenic: Wicked pesticide important in growing process to keep the insects from eating profits Coumarin: Spice similar to rat poison and a lung specific carcinogen that can causes cancer (57) Ammonia: Toilet cleaner and rises the absorption of nicotine into the blood, thus addiction (58) Toluene: Industrial degreaser with a sweet taste and caustic to humans and the environment Polonium: Soil condition and fertilizers - makes tobacco radioactive, which poisons the lungs (59) Formaldehyde: Industrial chemical, bacterial and fungal disinfectant, good for embalming organs Cadmium: Battery power not to be disposed in the trash, yet added to tobacco and smoke Butane: Lighter fluid–helps keeps the cigarette lite and ensures complete and fast consumption Methane: Natural gas, the flammable part of a fart.“Put that in your pipe and smoke it!” Tobacco companies hold back crucial information.Note the script from 60 Minutes News(22)orwatchthemovie"TheInsider,"whichtellsthestoryofthe60 Minutes News producer portrayed by Al Pacino covering a story of a whistleblower onthetobaccoindustry.RussellCroweplayedthetobaccocompanyscientistDr. JefferyWigandwhoexposedthetobaccoadditiveindustry.Dr.Wigand,whowas notevil,informedthetobaccocompanyCEO,hisboss,thatoneoftheadditives they created and laced into their product was a lung specific carcinogen (coumarin). Hewasconcernedandwantedthisadditiveout(22).Thecompanyrefusedto remove this chemical that enhances addiction, as it would "impact sales!"In other words, they would lose customers because their product would not be as addictive. Itdoesnotentertheirequationthattherewouldbelesscancer,suffering,and death.What is more important? Tobacco companies do not care about losing customers to death - that part is not important, except in the calculations of lost years of life that equates to lost years of a good customer.In other words, they probably do calculate the increased sales fromtheadditivescomparedtothecustomer’searlydeathtofindagoodprofit margin.So the chemical additives stay. The bottom line of the financial equation is “sales,” not death and suffering!This ismaliciousandmustnotbeallowed–itislikeignoringafactorythatisdumping poisonouscarcinogenic(cancercausing)chemicalsintothecommunity’swater source,thuscausingcancerandbirthdefectsinthenearbycommunity.Asthis would not be tolerated, why is lacing of chemicals into tobacco allowed? 34 The Tobacco Empire is in the science of creating additives to enhance the nicotine deliverysystemtomakesmokingmoreaddictiveandrequiringmorequantityto quench the thirst, no matter the cost of life or health.I suspect that it does not stopthere,sincetheyareinthebusinessofwithholdinginformationandmaking money.It would be interesting to see the secret recipes of these corporations, as wellastheby-productsofthechemicalreactionsthattakeplacewhenthe cigaretteburnsseveralchemicalstogether.HiddenCEOgameswerefoundwith theadvertisingscamof‘Light”and“LowTar”thatsoappearedtobesaferthan “Regular”cigarettes.Thescientificevidencerevealsthatchangingtolightfrom regular is not any safer and does not decrease the health risks of smoking (60). WhenIwasinelementaryschool,Ialwayswonderedwhyitwassoeasyformy friend Randy and I to steal cigarettes. Then one of my patients told me when she workedinaconvenientstorebackinthe60sandthetobaccocompanies encouragedthecashierstoletthekidsstealthecigarettesandthecompanies would provide cartons in compensation.They wanted kids to get addicted, then pay for life.Randy was at 3 packs/day smoker for decades but had to stop this year asheneedsoxygentherapysecondarytosevereCOPD–thetobaccocompanies made a good investment (assholes). Randy and Me [Oh My; I was just getting ready to call Randy to ask permission to included the picture of us when Inoticedhisneck(throat).AsIwaspastingthephotointothisdocument,Izoomedontothe pictureandnotedtherightsideofhisthroatandthatthereisamass.Heassuredmehewould make an appointment to see his provider this week to consider an ultrasound of the neck/thyroid.] 35 Studythetechnologytocreatesuchadditives.Doyouthinkthesechemical recipes could be designed to make one more addicted to tobacco only?That would berelativelytechnicallycomplicated.Theseadditiveswouldbeprogrammedto alteryourbrainchemistrytogiveyouoveralladdictivecharacteristics.Thus tobacco may be a "Gateway Drug" to poly-substance abuse.And of course, if they created something like this by mistake, we know these villains would not take this additive out, as it would “Impact $ales!” 3.02 Additive Chemistry Experiment Years ago, I asked for a cigarette from one of our patients waiting in the hospital lobby.ThenIaskedforourlaboratorytechniciantomixthetobacco(andthe paper)intosomewater,andthenpouritintoaurinedrugscreentestingdevise. We found a light positive for opiates – an addictive drug.No, I am not telling you the brand of cigarette; it may be a false positive test, but it makes you wonder. Justimaginewhatnewdrugsareinventedwhenthesedifferentchemicalsmixed intotobaccoarecookedduringsmoking.So,whatarethehiddenaddictiveand cancerouscompoundscreatedduringthiscombustionandthenabsorbedintothe lungs?This should be public information – just like a label on food containers or a medication package insert. Inthesixties,onecompanywasthesmallestofAmerica'ssixleadingcigarette companies, which ruled the market.By the mid seventies there had been a seismic shift;thiscompanyemergedtothetopandistheworld'sbestsellingcigarette with a smokin’ one out of five of all cigarettes sold.Also over half of smokers who arebelow17yearsoldarechemicallyseducedbythisbrand.Yawonderhow? PerhapstheCEOshaveanACEuptheirsleevewithtobaccothatischemically engineered (laced) with seductive additives. Oneofmypatients,withasignificantsubstanceabusehistory,duringmymost entertaining“SmokeBrake”seminarindicatedthatwhenhesmokesaparticular brandhecanfeelasimilarmentalchemicalreaction,asynapses,astothatof smokingaformaldehydedippedcigarette(extremelydangerousstreetdrug/high thatcausesseverebraindamage)–justathought.Consideralsowhatother popular event took place in the sixties – the birth of the street drug era. Holdthisthought,thattheadditives,alongwithnicotine,maycausethebrainto change and lead to drug abuse as we look at the other side of the coin - genetics. 36 3.03 Corporate Genetics ScientistshaveconfirmedthatifonehastheDRD2gene(aparticulargenetic program)andsmokes,thatpersoncanplanongettinglungcancer(23).Consider thepossibility,atheory,ofanothergene;letuscallitthePM88genethatsome peoplemayhave.Whenexposedtoacommonadditivesuchasformaldehydeor ammoniathisgenetraitmaybeactivatedandsetoffacascadeofpsychiatric illnessesand/oraddictionbeyondnicotine,andintometh,heroin,marijuana,or alcohol. This PM88 gene trait, when exposed to certain chemicals, may be causing the rise inthementalillnessand/orthedrugaddictionthathasrampagedournationand world.Thissoundslikegeneticengineeringbeingpracticedonsmokerswithout theirknowledgeorpermissionwithaneuralmanipulatingmarketingscheme (brainwashing) that surpasses them all, legally - the drug sells itself!Think about itnow,nowonderitissohardtoquittobacco,withthenicotine,additives,and possibly genetics playing a powerful role in reprogramming the brain. Myguessisthatthetobaccocompaniesdonotcareifitweretobecausingthe drugabusecrises,psychiatricillness,cancer,anddeatharoundtheworld…just sales. Anothertheory:whatifthehormones,insecticides,andotherchemicaladditives usedinthefoodindustrytoacceleratethegrowthandpreservativeprocessof cattle and chickens where found to cause obesity?Would the food industry take out these additives? ThankfullytheU.S.Governmentrecentlysignedlegislationintolawthatwillallow theU.S.FoodandDrugAdministration(FDA)regulatoryinfluenceoverthe manufacture of tobacco products.Most importantly is the “ingredient disclosure” where tobacco companies will be required to list out all of the ingredients in their products.Then“ingredientcontrol”willrequiretobaccocompaniestoremoveor reduceharmfulingredientsintobaccoproducts.Thistechnicalitybattle(pissing contest) will take some time before the smoke clears and the “ingredient control” kicks in. U.S.legislationdoestakeintoaccount“importersoftobaccoproducts”yetwhat concerns me is there are no legal restraints to keep these U.S. and foreign tobacco companies from continuing their chemical warfare outside the USA - worldwide. 37 Tobacco companies’ chemical additives make you become THEIR: Addicted smoker to their brand of cigarette (with their secrete recipes of additives) Smoker of more cigarettes than you would without the additives (the more chemicals added the more you want to smoke) Sick with Cancer from the chemicals they put in the tobacco (it is the chemicals they add to their cigarettes that causes cancer) Or another way of putting it, you become THEIR: Biochemically Infected Tobacco Consuming Human! Thebottomlineisthattheseviciouscartelswillkeepthecancerousadditivesin theirproductsjusttoholdtheircustomerscaptiveeventhoughtheywillsuffer and die sooner.Their profits are more important than your life and health. Tobacco companies involved in lacing their product with chemicals and lying before theU.S.Congressstatingthatnicotine(theirproduct)wasnotaddictive,notany more that eating Twinkies, is genuine horseshit. And that be my Smokin’ Theory! 38 4.0 DISEASES Of ADDICTION In 2004 the U.S. PHS Surgeon General's Report (www.SurgeonGeneral.gov) states that nearly all the organs of the body are affected by tobacco abuse and the list growsevenlonger.ThethreeleadingcausesoftheseDiseasesOfAddiction (DOA) are from problems with the Cancer, Lung Diseases, and Artery Diseases. The objective of this section is for smokers and dippers to be prepared for what is to come.I do not deploy “scare tactics” of deranged blood and guts to divert my patientsintoquittingbutIfinditcrucialtoequiponewithpreventivemedical measurestopreservelife.Thisisbestaccomplishedbyassuringoneknowsthe basicsiftheyarereceivingthebestofmedicalcarewhendiagnosedwith pneumonia, heart attack, stroke, or cancer.Or better yet, know how to take a few preventative measures to prevent some of these DOAs and catch it before it is too late. Weknowtobackupourworkfromthecomputer–notfor“if”yourharddrive fails,butfor“when”itfails.Justthesame,whenitcomestomedicalcare,be prepared.Donotbecaughtwithyourpantsdown–unlessitisforcancer screening (colonoscopy, prostate exam, or pap exam). 4.01 Cancer As discussed, genetic traits may be passed down through generations.If one has theDRD2gene(program),thenlungcancerislikelytohappen.DNAdetermines yourdestiny:Somecansmokefora100yearsandnevergetlungcancer(they don’t have the DRD2 gene); On the other hand, gentlemen, you may end up with, or come“down”with,someothersideeffect,suchasimpotence(Erectile Dysfunction).It is all in the genes. Mostpopularbrandsoftobaccoarelacedwithadditives(chemicals).Whenone inhales,snorts,orchewstobaccotheseadditivesinfiltratetheblood,thentravel throughout the body – particularly to the brain.Some of the tobacco additives are carcinogens (cause cancer).These chemical additives may enter the cell’s nucleus anddamagetheDNAprogram.WhentheDNAisdamaged,thecellmaybecome cancerous and reproduce more damaged cells. 39 Thelistgoesonofthechemicalsthatareaddedtotobaccoforthepursuitof seducingoneintoaddictionandconsumingmoreoftheproduct.Additivesalso cause other devastating cellular changes that disable or destroy life. For a listing of 599 additives permitted into the United Kingdom take note to the Tobacco Additives listing following the References in “The Ends” chapter.Several tobacco companies have presented listings of tobacco ingredients used, which was submitted to the U.S. Department of Health and Human Services.They comment ontheirlistthatseveraloftheingredientsareFDAapprovedfoodadditives. TheseFDAchemicalsareapprovedforindigestionatparticularamountsnot smoked at whatever concentration.It is the chemical additives in tobacco that are primarily causing cancer, not the nicotine (23). Our intestines are capable of taking on industrial strength foods, such as the junk and fast food we consume; keep in mind the obesity problem is catching up to the tobacco death rate.My suspicion/theory is that the food additives and processed fast foods are not healthy and our bodies identifies these additive-laced foods as notnutritional,thusourbodiesarepreparingforafamine,triggeringobesityfor survival. 4.02 Lung Diseases YearsofsmokingtobaccocommonlycausesCOPD(ChronicObstructedPulmonary Disease).COPDisaconditionthatincludesShortnessOfBreath(SOB)and multiplelunginfections.Justasonelearnshowtodrive,trafficlaws,andthe basicsofenginemaintenance,sothesmokermustbeeducatedonCOPDtoknow how to stay out of the hospital and above ground.All smokers must know when to seeahealthcareprovider-ASAP,withoutdelay.SignssuchasincreasedSOB, wheezing (whistling sounds from the lungs), fever or chills, or cough (worsening of a cough) are red flags. 4.03 COPD COPD is the combination of chronic bronchitis and emphysema. Chronic Bronchitis is a productive (mucus) cough for over three months caused by lung pollution (such as smoking tobacco).Plugged-up bronchioles (tubes) cause poor oxygen flow into the air sacs.This decreases the oxygen exchange into the blood. This condition may improve with time when the pollutant is removed. Emphysemaisthepoorairexchangefromthenarrowedbronchiolesandthe enlargedairsacsthathavelostelasticity(expandability).Thislossinelasticity causespoorairexchange,andthusadecreaseinoxygenflow.Emphysemais permanent and causes Shortness Of Breath. 40 COPD is insidious; it creeps up on you without you knowing it.I asked many of my smoking patients if they are having a little SOB (I leaned quickly to stop asking the pregnant one this question); many just say no.Then I offer an albuterol inhaler to seeifitmakesadifferenceandsooftentheyhadnoideaoftheirbreathing issues were so bad.It is best to get a Pulmonary Function Test (PFT) to evaluate theconditionofthelungs–yourbreathingability.Thetestisbestdonebefore andafteraninhaler(breathingmedication)totestforimprovement.ThisPFT tellsyourprovidertheextentofinjuryandthetypeoftreatmentthatmaybe helpful.Alsoitprovidesonewithabaselinetoseetheimprovementprovidedby the medications and after smoking cessation. There is a light at the end of the tunnel; there is room for healing and stretching the timeline of life even though one is disabled from COPD (on multiple breathing medications, pills, and oxygen).Research shows that if lung disease is to the point of disability and if one stops smoking, life will continue on for about 5 more years IF one stops smoking.The lungs do not restore to the normal capacity, but they do become stable and you may be able to catch a breath of fresh air once again.You may notice an improvement of up to 30% of breathing capacity return in 6 months of smoking cessation. I am deeply frustrated when our lung cancer patients are “still” smoking with their lastbreath.Myconcernisnotbecausethesepatientsarestillsmoking.It agitatesmetonotethepatient’smedicationlistandseethatnoonehaswritten this patient a prescription for any smoking cessation medications.It is especially importanttoplaceoneonthemedicinesthatarealsoantidepressants(suchas bupropion or nortriptyline) for their treatment regiment. Think about it, if you were knocking on heaven’s door, gasping for every breath, and inpain,youtoowouldbesuckingupalltheantidepressantsandanti-anxiety chemicals possible.Thus, I get frustrated with the Primary Care Providers (PCPs) whohavenotstartedappropriatemedications.Here,smokingisnotasmuchan addiction now as it is a continuation of an antidepressant (tobacco) to help one face disability/death.It is ironic that often one is smoking the brand that is laced with a chemical that caused the cancer in the first place and they do not even know it. 4.04 You’re Sick Pneumoniacanbeabacterialorviralorfungalinfectionofthelungs,wherethe alveoli(air-filledsacsinthelungs)orthebronchialtubesareinflamed,irritated, andpluggedupwithinfectiousfluid.Thiscouldbedevastatingtoone’shealth, especially if suffering from COPD. 41 ThosewithCOPDhaveanincreasednumberoflunginfectionsbecausethereis poormucociliaryclearance(housekeepingisonabreak)causingtheairwaysto become cluttered with mucus.Also the airways are inflamed (the air conditioning isout)whichcausespoorairexchangeandagoodenvironmentforbadthingsto grow.Finally,whentheimmunesystemiscompromised(thesecurityguardsare sleeping on the job) bacterial and viral infections are invited over for the party. Viralinfectionsarethekindofillnessesthatwillhityoufromalldifferent directions with a headache, fever, chills, body aches, sore throat, cough, and being exhausted.All the antibiotics in the world will not change this condition, although ifthisinfectioniscaughtearly(firstorsecondday)somevirusescanbecalmed downwithantiviralmedicationsthatdecreasethedurationoftheinfection.If thesmokerishavingalittleSOBthenitmaybeidealtostartonanalbuterol inhaler and a steroid inhaler to prevent worsening of the emphysema. Mostviralinfectionslastlessthanoneweek,dependingonthetypeofvirusand the body’s ability to fight off the infection.Many seek antibiotics before the viral infectionclearsuponitsownorwhentheinfectionjuststarts.Theproblemis thatsomanyproviderswriteprescriptionsforantibioticsthatmaynotbe indicated.In the long run, giving out antibiotics inappropriately may cause further complicationsbycreatingresistantbacteria(streetwisebugs).Oftennoeffort wasmadetoloaduponfluidsandtrysomeoftheOverTheCounter(OTC) medicationslikeexpectorants,decongestants,andantihistamines.Ontheother hand, for those who are not medically stable, having uncontrolled diabetes or AIDS orCOPD,antibioticsandaninhalermaypreventtheviralinfectionfromgoing bacterial.Itisbesttosecureannualflushotsandforsomepneumonia vaccinations. Bacterialinfectionshitonelocation(throatorlungsorbladder)andwitha vengeance.If you have a sore throat it is important to secure a “quick strep test” toconfirmabacterialinfection(streptococcuspharyngitis–strepthroat)and then treat it with antibiotics. This time antibiotics will help.Most sore throats are viralinfectionsorjustpostnasaldripwhichisdrainage(snot)runningdownthe throat causing irritation and also a cough.Lung infections, such as bronchitis, may presentwithonlyaclearproductivecough(whitecoloredsputum).Ifthiscough continues for over a week, the sputum becomes colored, fever sets in, and/or the patientstartstohavedifficultybreathing,thenantibioticsmaybeneededalong with a bronchial inhaler (such as albuterol) and a steroid inhaler and if suspicious a Chest X-Ray. 42 A provider is the one who calls the shots on whether or not one should be started on antibiotics.Usually with COPD patients, 80% of the time there is an infection brewing.Over half are bacterial.Providers are more aggressive in the treatment (antibioticsandsteroids)ofapatientwithCOPD,asalunginfectionmaybecome disabling or fatal. Justasasoldierknowshisenemyandpreparesforbattlewiththeproper weaponry, a smoker must be educated on the basics to assure protection.As for thenon-smoker,theystaycoolandarearmedanddangerouswiththeir housekeepers and security guards on duty. Protectionfrominfectionstartswithprevention.Vaccinationsagainstinfluenza (flu)andpneumonia(pneumococcus)shouldbetakenasrecommended.Asmost smokerswithCOPDareinharm’swayandaremorelikelytocatchthese preventableinfections,itisbesttoteachyourbodytoprotectitselfwith vaccines.Vaccines for the flu and pneumococcal are ideal to prepare your body for possible invasion.It is just like finding out secret information about the kinds of weaponsandhowyourenemyplanstousethemonyousoacounterattackis preparedfordefense.Thisisveryimportantforoureldersmokersastheyare short on defenses and may not be able to afford another attack. 4.05 Bug Wars Whenantibioticsareindicated,theprovidersometimeswritesaprescriptionfor thesmokerthatisthewrongtypeofantibioticsfortreatingtheirlunginfection (bronchitis or pneumonia).This may be because the provider is not experienced in taking care of smokers who often may have difficult infections and/or the patient callsbackfromthepharmacycomplainingtheycannotaffordtheexpensive antibioticswritten,sothedoccallsinalesspowerful(andlesseffective) prescription.Be ready to fork out the big bucks for the new bazooka antibiotics to blow those bugs out of the water. Asfarasthedurabilityofbacteria,theytakeonthecharacteristicsof cockroaches.Usingwrongkindsofantibioticsforbacterialinfectionsislike shootingroacheswithapeashooter–theyeatthepeasandgethealthierand smarter.When the roaches are fired upon by a more powerful weapon, a BB gun (a strongerantibiotic)andsurvive,theygetreallysmart.Ifthewrongantibioticis given or the prescription is not finished, the roaches get “street-wise” and go out and buy leather jackets for protection.Next time a round of antibiotics is given to knock off the roaches (bacteria), the BBs bounce off their leather jackets and the roaches eat the antibiotics for breakfast. 43 The roaches secured the protection from “lessons learned” from the last attack or something grandpa Oliver Roach taught them well during War Stories.Know your enemiesandletyourproviderpickyourbattles-whentostartandthetypeof antibiotics.Youmaysuggestsomeofthefollowingantibioticsdependingonthe typeofinfectionsuspected.Theseantibioticmedications(infectionammunition) might change from year to year just as the different wars that infect our planet requireweaponryup-gradesornewpeacetreaties.Someofthemorecommon bacterial infections - “bug wars” are as follows: Streptococcuspneumoniae:Thisisthemostcommonpneumoniaanditis mostlyseeninpatientsover50yearsoldandinthewintermonths.Peoplewho have this infection may have a sudden onset of shaking chills, rusty colored sputum, have pneumonia (seen on the CXR), and higher than normal White Blood Cell (WBC) count.Theseroachesare“street-wise”suchaspenicillin-resistant.Research shows if you have COPD these little roaches may kick your ass even though you are ontheantibioticthatshouldbeworking,soyoumayrequireanotherroundof antibiotics.Forthesecharacterstheammunitionofchoiceiserythromycin, clarithromycin(Biaxin),levofloxacin(Levaquin),amoxicillin/clavulanatepotassium (Augmentin), or doxycycline.A vaccine is available called Pneumovax and will most likely prevent this infection from happening. Mycoplasmapneumoniae:Thisisthemostcommonbuginadultslessthan50 yearsoldandamongstudents.Itcommonlypresentswithadrycoughand wheezing, occurs in the autumn, and causes ear infections.The munitions for this battleareclarithromycin,erythromycin,ormyfavorite,doxycycline.Itmaybe necessary, to take this medication longer than the ten days usually prescribed. HemophilusInfluenza(HFlu)andMoraxellacatarrhalis:Thesetwoaremost commonlyseeninfectingsmokerswithCOPD.Herethestreet-wiseroaches becomeevenwiser,astheymayeatthefirstchoiceofantibioticsforbreakfast suchasamoxicillin/clavulanatepotassium,erythromycin,orclarithromycinleaving uswithlevofloxacin(whichsomedaymaybecomebreakfast).Theseroachesput away their leather jackets and secured Kevlar vests. 4.06 Medication Consultation Depending on how sick one becomes, like having a fever or problems with breathing, wemayneedtogetabloodtesttoseeiftheWBC(WhiteBloodCellCount)is elevated.TheWBCtellsushowstressedoutyourbodyisfromfightingthe infection, sort of a measurement of how many rounds of ammo your body shot off tofightthebattle.TheWBCwillalsogiveusanideaofwhatkindofbattleis going on, be it viral or bacterial. 44 Also a Pulmonary Function Test (PFT) will give us an idea of your breathing ability. A Pulse Oximetry is a light wave contraption that is placed over the finger or ear lobe and can detect how much oxygen is in the blood. Whenhealthcareproviderslistentoyourlungswithastethoscope,theyare checkingforabnormalbreathsoundslikecracklesorwheezing,whichisapartial closure of the airways.If there are no breath sounds at all this may be from the infected lungs being filled up with fluid, a condition known as pneumonia. Dependingonalltheabovetests,alongwithyourpocketbookorinsurance coverage, we may order a Chest X-Ray (CXR), showing us if you have pneumonia.If theCXRshowspneumoniathenitisbesttogetaSputumCultureandSensitivity (C&S), so the results will be back by the time the recheck CXR is planned (in seven days).AC&Sisatestthatfindsoutwhatkindofbacteriaisgrowingoutof control in your body like in a skin, intestine, or lung infection.The stuff you cough upinacupisplacedinspecialgrowingtray-sortoflikeplacingseedsina flowerpot to see what kind of plants grows.The Culture tells us what kind (name) ofbacteriaiscausingtheinfectionandtheSensitivitygivesusalistingofthe antibiotics that should work.In 7 days if the CXR shows no improvement then this wouldbethetimetochangeoraddanotherantibioticandiftheC&Swasnot orderedthenthisshouldbeconsidered.Afterrecovery,itmaybeidealto rechecktheCXRofthelungstoseeifthepneumoniaisclearingorthereis something else cooking/hiding. We must kill these wicked bacteria with prescription medications.For most types ofpneumoniatheantibioticAugmentinisagoodfirst-lineofdefense(ifthereis no allergy to penicillin) or levofloxacin.For a simple cough (bronchitis) doxycycline is ideal as it is inexpensive and is easier on the stomach than erythromycin, which worksgreattoo.Irecommendallmedicationsbetakenwithaliter(quart)of water to help calm down the nausea they can cause.This will also assure that fluid replacement is secured. Itmaybenecessarytosecureaprescriptionforanalbuterolinhaler(ora combinationofalbuterolandipratropium)andasteroidinhalertohelpbreathing and reduce the cough.It is important to calm down the cough at night to get some sleep; yet during the day it is best to cough it up and out.It is not a good idea to be coughing excessively to the point of chest wall pain, broken ribs, and exhaustion. 45 Guaifenesinwillloosenupthethickmucusandmaydecreasethecoughaswell. OTCmedicationslikedextromethorphanmaybehelpfulifusedwithinthe recommendeddosing–overdoseofthismedicationmaycausepermanentbrain damage. Aprescriptionmedicationgoodforacoughis(benzonatate)Tessalon.Itis inexpensive,doesnotcausedrowsiness,andisnotacontrolledsubstance(not addictive – such as codeine can be). Codeineworkswelltocalmdownthemoreseverecoughsnotcontrolledbythe othercoughmedicationsandhelpswiththechestpainfromcoughing.Thedraw back is it may cause drowsiness and is addicting, which is a concern with those who haveasubstanceabuse/addictionhistory.RarelyIwritethis–Icombinethe abovefirstandstartonsteroidstoreducethecough.Steroidpillsand/ora steroidinhalerdecreasetheinflammation,calmdownthecough,andareidealin regainingyourbreathingabilityduringandaftertheinfection.Recentresearch foundthatsteroidtreatmentforthosewithCOPD(asthmaoremphysema) protects the patient’s lungs from declining. Increasing water intake is essential in recovery. 4.07 Treating the SOB It is ideal to start on an inhaler(s) to help the Shortness Of Breath (SOB).As for medications,wegenerallystartwithinhaledbronchioledilatorslikealbuterol(a beta-agonist)oripatropium(ananticholinergic).Acombinationofthesetwois calledCombiventandisidealforCOPDpatients.Greatfor“AsNeeded”typeof treatmentonlyafewtimesperweek.Anymore,thenoneneedstoupgradeto daily long-acting type of inhalers. DependingonthePFTandtheproblemsoneishaving(suchasCOPDorasthma), another medication may be added, such as the long-acting bronchodilators.These includesalmeterolorformoterol,(long-actingbeta-agonists),tiotropium,(long- acting anticholinergic).We may add inhaled steroids or salmeterol (Advair), which contains an inhaled steroid and a long-acting bronchodilator. Also sustained-release theophylline, is an “old workhorse” that may be of value. For those who are really on the edge of life (like Randy) we may also add oxygen, butthisshouldbereservedforpatientsinrespiratoryfailure(closetodying). ThelaststrawisLungTransplantationthatentailsreplacingadamagedlungor lungswithhealthydonorlungs – notalwaysthe best solution as there is a risk of rejection and infections and one may continue to smoke, destroying the new lung. 46 4.08 Artery Diseases Nicotineconstricts(narrows)thearteries.Overtimethisdangerouslyreduces the blood flow to all the organs, extremities, and skin.Nicotine also causes plaque (cholesterol or plaque crap) to collect on the walls of the arteries.If one already has cholesterol problems it could get worse. Over time the arteries become more and more closed off as the plaque builds up, closing more of the artery. When the artery clogs up, it is like a rusty corroded water pipe that does not allow water to flow through. Side view of rusty corroded water pipeInside view looking through the rusted clogged pipe Side view of a clogged artery Inside view of dangerous fatty deposits in an artery A heart attack is when an artery that supplies blood flow to the heart is blocked off by blood clot and the heart muscle starts to get injured.If the blood flow is notrestoredtheheartbeginstodie.Wheneverthebloodflowtotheheartis compromised it will let the rest of the body know with symptoms such as chest pain and/or neck, jaw, or back pain and possibly shortness of breath or sweating or just collapsing.Some may just feel tired/fatigued. 47 Somecouldhaveaheartattackandnotevenknowithashappenedwhileothers suddenlycollapseanddie.Ifyouarethecollapsingtypeofcharacterthenhope and pray there is someone nearby who knows CPR to start chest compressions.It is best to have your spouse or friends be CPR certified if you are one at risk.If you have a heart that gives you time to let the rest of the body know – great. If one is having the following symptoms then call you PCP or get to the ER – STAT. Heart Attack Warning Signs from the National Institute of Health: Chest discomfort: Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. Discomfort in other areas of the upper body: Canincludepainordiscomfortinoneor both arms, the back, neck, jaw, or stomach. Shortnessofbreath: Oftencomesalongwithchestdiscomfort.Butitalsocanoccur before chest discomfort. Other: May include breaking out in a cold sweat, nausea, or light-headedness A Cerebral Vascular Accident (CVA) as discussed in detail in Chapter 2.3, is when anarteryinthebrainisblockedofforbustsopen,thenthatpartofthebrain stopsworking.Ifso–go,go,gototheEmergencyDepartment,STATbecause every minute millions of brain cells die. TheAmericanStrokeAssociationwantsyoutolearnthewarningsignsofstroke such as sudden onset of numbness or weakness of the face, arm or leg, especially ononesideofthebody,confusion,troublespeakingorunderstanding,trouble seeing in one or both eyes, hearing loss, trouble walking, dizziness, loss of balance or coordination, or severe headache with no known cause. To decrease the arteries from being clogged up, all smokers must consider taking cholesterolmedicationsifyourcholesterolisevenslightlyelevated.Withthe statin cholesterol medications, as most, assure your labs are checked regularly and ifyoustarttohavemuscleachesthencontactyourPCPtoseeifitmaybe secondary to the medications.Every smoker should take an 81 mg Aspirin per day tokeepthebloodclotsaway.Donottakeaspirinifyouhaveanactivebleeding stomachulcerorhaveahistoryofulcersthathavenotbeencompletelytreated. Donottakeaspirinifhavingsignsofastrokebecauseifyouarehavingthe bleedingtypeofcerebralvascularaccident–notgood.ThisiswhentheCTwill determine if it is the bleeding type of stroke or clotting of the arteries. 48 4.09 Causes and Effects Users beware of the multiple side effects or adverse reactions of tobacco abuse. Tobacco(nicotinelacedwiththeadditives)causesoristhoughttocausethe following diseases, adverse reactions, and side effects: Cancerofthelung,mouth,throat,bladder,kidney,stomach,pancreas,cervix,prostate, colon,andrectum.Italsocauses:COPD,halitosis(badbreath),deterioratingasthma, respiratoryinfections,chestpain,enlargedheart,heartattack,irregularheartbeat, enlarged/clogged artery, peripheral vascular disease, wrinkling of the skin, psoriasis, post- surgicalinfections,delayedwoundhealing,poorfracturehealing,discdegeneration, decreasedspinalfusion(healing),osteoporosis(lowbonemass),osteoarthritis(joint destruction),complicationsofGraves’Disease(thyroiddisorder),worsenedMultiple Sclerosis(brainandspinalcorddisease),Crohns’disease(inflamedbowels),ulcerative colitis (inflamed colon and rectum), is somebody actually reading this, peptic ulcer disease (stomachulcer),worseningofGIreflux(foodcomingbackuptheesophagus),middleear infections,earliermenopause,impotence(dudes,youdonotwantthislamesideeffect), infertility, decreased sperm count, TIA (mini-strokes), CVA(stroke), depression, anxiety, snoring,cataracts,hearingloss,gumdisease,opticneuropathy,maculardegeneration, blood-sugarabnormalities,impairedimmunity,burninjuriesfromfires,intellectual impairment, stillbirth, and premature birth (24). Often I hear patients did not take their smoking cessation medicines because they were concerned about the list of side effects from the package insert.I remind them that the above adverse reactions and side effects are much, much worse and are more likely to happen.One must compare and be aware. 4.10 Data Over 20 per cent of Americans are tobacco users and in some places in the world over50percentusetobacco.OutsideoftheUnitedStatestheseAmerican tobacco companies heavily market to young children – that’s sick. American Statistics (25): Normal life expectancy (26) Males:74 years old Females: 80 years old Average life lost from tobacco abuse is 13 years (27) Adjusted life expectancy from smoking Males:61 years old Females: 67 years old 49 Americanslostfromcombatdeathsin200yearsofwars/conflictsisover 623,000.Americanslostfrom2yearsoftobaccorelateddiseasesisover 880,000.Over 1,000 Americans are lost per day (27). One out of six who died in the year 2,000 expired from a smoking related disease (28). We lost over 47,000 in combat deaths in Vietnam from 1964 to 1975. We lose over 50,000 Americans a year just from second-hand smoke (29)! As for our children, the Nicotine Villain claims the following (30): Miscarriage - over 50,000/year, Sudden Infant Death Syndrome – over 2,000/year, and Fetal growth retardation – over 50,000/year. Is there a world pandemic?Globally, Earth loses over 4,000,000 humans per year to smoking related diseases.10,000 deaths per day! ThatisequivalenttothreeWorldTradeCenterdisasterseveryday(31). Surprisingly we do not hear about this in the news! 50 5.00 PRESCRIPTIONS for ADDICTION TheUnitedStatesPublicHealthService’s(U.S.PHS)Recommendationsfor TreatingTobaccoUseAndDependenceisavailableasaClinicalPracticeGuideline BookandontheInternet.Itprovidesanelaborateinformationpackageabout tobacco addiction, other sources for support, and different medication along with side effects and new alerts and warnings being issued (such as with varenicline). When taking any prescription medications always seek advice from your physician, (your PCP) and “Know your ABCs” (covered in the “Smoke Brake” chapter to follow). The objective of this chapter is to provide a few comments about the medications usingtheshortcourseversion,asitwouldtakeseveralyearstoprepareoneto practice the pharmacology of medicine.Also, if one has a preexisting or emerging psychiatric illness – tell your PCP. 5.01 Tobacco Cessation Medications (32): U.S.PHSFirst-linenon-addictingprescriptionmedicationsthatareapprovedby theFoodandDrugAdministration(FDA)arebupropionSRandNicotine Replacement Therapy. Bupropion SR (Zyban or Wellbutrin SR/XL) Bupropion SR is an antidepressant pill with a tobacco cessation rate of about 30% (32).Theactiveingredientsarenorepinephrine,whichhelpscalmdownthe withdrawal and dopamine, which feeds the craving for nicotine.Together they help in smoking cessation and treating depression (33). This non-controlled, non-addicting medication must not be used if there is a history of a seizure disorder, head injury, or other conditions that may have disturbed the brain'schemistry,suchaseatingdisorderslikebulimiaoranorexianervosa(34). Aswithanymedication,theremaybesideeffectssuchasproblemssleeping, nervousness, and constipation – that rock hard sensation. Nicotine Replacement Therapy(NRT) This regiment includes a non-additive nicotine delivery system at a decreasing dose viathegum,lozenges,inhaler,nasalspray,andpatches.Weoffernicotine medicationsviathemouth,thenose,andtheskin;thereisonlyoneopening (orifice) left and FDA is not going up that way.The cessation rate of NTR varies with different research parameters, but is between 10 and 30%. 51 Aswithallmedications,keepNRToutofthereachofchildren.Theoldpatches need to be disposed of safely.If it falls off the skin get creative, consider taping it on or place under your sock next to your leg.If the skin gets irritated consider placing OTC steroid cream in those areas of concern. One starts at an equivalent amount of nicotine consumed per day and tapers down overmonths.Ihavehadmanypatientsdowellonthenicotinegumregimentto stop smoking, yet it seems as though they left the tapering part out and continued to consume nicotine. Oneofmypatientswithsignificantheartdiseasewouldnotgiveuphisnicotine gum.This guy had a built in heart defibrillator onboard that would send a shock to hishearttokeephimalive.He was also a diabetic and was on his last leg of life (many legs ago).Many times friends and nurses would tell me he is still on nicotine gumandshouldstopitbecauseofhisfragilecondition.Iknewthisguywell(he was one of the best drug counselors I have ever met) and I figured that after all thedrugshehasbeenon,andnowisoffof–weshouldjustlethimbe.Iwas happyhestoppedsmoking,whichimprovedhishealthconsiderably,andfigured nicotine gum was his last battle and it may not be one to win.The following year he was involved in a fatal motorcycle accident – his last leg. WiththecombinationtherapyofNRTandbupropionthereisanincreaseinthe success rate. Clonidineandnortriptyline(32)aretheSecond-linemedicationsavailableifthe First-lineisnotworkingorthereareproblemswithsideeffectsorperhapsifa low budget prescription is needed. Clonidine(Catapres)isabloodpressureloweringmedicationwithanabstinence rateofabout26%.Thismedicationcomesinapillandalsoapatchformandis dirt-cheap.Some may experience one of the possible side effects of drowsiness, sowhenstartingthismedicationtryyourfirstdoseonadayoffofworkorat night. Many like the calming down feature this prescription offers.Some become drowsy atfirst,andthengetusedtothemedicationafteraweekortwo.Ifoneis already on blood pressure medications, consult your provider about cutting back on it and adding clonidine.I have seen great results with this inexpensive medication. Someprovidersarenotfamiliarwiththis“oldworkhorse”andareuncomfortable usingitbecauseofthesideeffectsofcausingdrowsinessoradropinblood pressure. 52 ClonidineisaCDCrecommendedmedicationandisFDAapproved.Astheside effects of tobacco are much worse, it may be a good idea to put it to work.This medicationisnotaddictive,yetmayhavewithdrawalsymptoms,suchasrebound hypertension,whichmeansthebloodpressuremaygoupveryhighafterstopping clonidine.So one should taper off of it slowly.Clonidine is not for anyone who can getpregnant(fertile),orwithababyonboard(pregnant),andalsoitshouldbe used with caution with the elderly.Just a thought - have you ever notice there are not that many elderly smokers? Nortriptyline (Pamelor) is an antidepressant medication with an abstinence rate of about 30 per cent.This medication I would choose over the clonidine if my patient isdepressedorbecomesdepressedfromsmokingcessationoriftheblood pressure may already be too low.Also if depression is a concern and bupropion is not a good match this is a good option.It is not as expensive as some of the other cessation medications and should not be used if one is pregnant. Varenicline(Chantix)wasapprovedbytheU.S.FoodandDrugAdministration (FDA) for distribution in 2006.Success rate is about 44% at 3 months and comes down to 30% at 6 months. Wegettwoforthepriceofonewithvarenicline.Itstimulatesthereleaseof dopamine(increasesthedopeinthesynapse)andblockstherewardpathway(do not get the fix).The drug turns on the faucet to the sink and plugs up the drain. This prescription medication works by giving the brain some of the special features of nicotine that ease the withdrawal symptoms.It has just about the same effect whensmokingwithouttheantidepressantfeatures.So,ifoneissmokingforthe antidepressantoranti-anxietyservices,becarefulaboutstoppingyour antidepressant (nicotine). Nicotine(smoking,dipping,orpatches)cannotbeusedwithvareniclinefor combination therapy, as it causes nausea.On the other hand, medications such as clonidine may be ideal if one has high blood pressure in need of treatment.There is no current research on combination therapy. The Varenicline Start Pak begins with a lower dose, then is increased in 7 days. Theinitialsideeffectprofileincludesnausea,constipation,headache,vomiting, flatulence(gas),insomnia,abnormaldreams,drowsiness,andchangeintaste perception. 53 Vareniclineappearstobeasafedrug,althoughsomewarningsfromtheFDAare starting to emerge as follows: Reportsofsuicidalthoughtsandaggressiveanderraticbehavior,drowsinessthat affectedtheirabilitytodriveoroperatemachinery,new-onsetofdepressedmood, suicidalideation,andchangesinemotionandbehaviorwithindaystoweeksof initiatingVareniclinetreatment.Ithasalsobeenassociatedwiththeexacerbation of underlying psychiatric illness. The FDA warns about cardiovascular problems, though these are infrequent. Certain events,suchasanginapectoris,nonfatalmyocardialinfarction,needforcoronary revascularization, and new diagnosis of peripheral vascular disease or admission for a procedureforthetreatmentofperipheralvasculardiseasewerereportedmore frequently in patients treated with varenicline (35). So to KISS it – while taking this drug you may go mental, do not take other drugs oralcoholwhileonthismedication(nobrainer),andifyouhaveheartproblems make certain you have fresh nitroglycerin onboard. Know your ABCs in the Chapter: “Smoke Brake.” 5.02 More the Merrier Ifonehashighbloodpressureitisnotuncommontobeonseveraldifferent medicationstocontrolthepressureaswellaspreventfutureheartproblems. Diabeticsareplacedononetypeofhypertensionmedication(eveniftheirblood pressureisnormal)calledanaceinhibitortoprotectthekidneys.Forsome bacterial infections a PCP may place his patient on two types of antibiotics to cover all the bases to prevent a dangerous infection from spreading. It is recommended to combine some smoking cessation medication with the patches (except if taking Varenicline).Consider taking bupropion with the nicotine patches and if so then check your blood pressure regularly, one to two times per week.It should read somewhere from 100/60 to 140/90.If the blood pressure is elevated, greaterthan140/90(thetoporbottomnumber),consideraddingtheblood pressure medication clonidine that has good smoking cessation results. Clonidine could cause drowsiness, so start with a low dose and at night – some will not have any problems at all and have stopped smoking on this medication alone. Nortriptyline(Pamelor),anothertobaccocessationmedicationsmaybeidealfor one having troubles with insomnia where as the bupropion may keep one up at night. Once again, it is a great achievement to just get off the addictive additive tobacco that in turn will reduce the amount smoked and collateral bodily damage. 54 5.03 Obesity Theory This is my theory of the obesity crises (my next project).I would like to share a brief two-course menu of my point of view, which will cultivate the idea of mixing medications for combined situations. The new drug in the news is Contrave. First is the concern of the drop of quality (caliper) of food (vegetables and meats), thus one not receiving the needed nutrition and the body having to compensate with quantity (volume) of food by overeating.For example, for several reasons such as the genetic modification and drop in soil quality, it takes ONE orange from the 1950s to equal EIGHT oranges of this era. (61)So the body sees this as a famine and will conserve body fat for survival. Secondly, are the chemical additives and synthetic hormones that have infiltrated our foods designed to promoted higher volume of meat, causing human obesity too? While they have been deemed safe, is it possible even though these chemicals are at a low concentration and have not shown compromise to human health, there may be a chemical or genetic adverse reaction (especially with other additives in the industry) that may be causing some sort of anomaly under the FDA’s radar?(62) It appears that the new era of chickens are not the same caliper as their ancestors - certainty not the survival of the fittest. My theory is that some humans are genetically sensitive such that when they eat these chemically and genetically infected foods they become obese too.Also, some may need to eat more to compensate for low quality foods, to keep up with their nutritional needs and expanding anatomy. (63) 55 For some who are burdened with obesity and tobacco/drug abuse the drug of choice may be Contrave (Bupropion/Naltrexone) which is two drugs working together for helping one with weight loss – food craving.By themselves they both have shown some help in weight loss.Together they have shown that combined with diet and exercise, patients have lost more weight than patients taking a placebo (sugar pill) and following the same diet and exercise program. (53) Bupropion, (Wellbutrin, Zyban) as discussed, is a dopamine and norepinephrine reuptake inhibitor (fill the sink by closing off the drain).Thus, they stimulate the pro-opiomelanocortin (POMC) neurons in the part of the brain called the hypothalamus.This causes a synaptic chain reaction in the brain that decreases the appetite and increases the energy output.This combination to decrease the appetite and added physical activity help work it to lose weight.POMC is regulated by endogenous opioids via opioid-mediated inhibitory feedback.(54) So bupropion provides an ideal tobacco cessation medication that can help with the obesity situation. Naltrexone is an opioid receptor antagonist (keeps the opioid drug from attaching to the brain).This drug helps one not have the desire for alcohol and opioid drugs. Opioid are the painkillers like morphine, methadone, Buprenorphine, hydrocodone, and oxycodone, and the street drug heroin.This particular drug suppresses the POMC inhibition, thus causing the reduction of the seduction of narcotics. (54) Bupropion and Naltrexone together work to calm down the part of the central nervous system that promotes the desire to eat, drink, and be obese. (55) As the bupropion offers tobacco cessation services, this medication is an ideal prescription for the obese tobacco addiction situation. 56 6.00 STREET DRUG THEORY TheothernameIhadinmindforthisbookis“Smokin’Theory”–tocoverthe themeofsmokingdrugs.Iftobaccoluresoneintostreetdrugs,thenjustabit about street drug addiction would be in line.One of the objectives of this chapter will be to let you know, before starting street drugs, about the side effect profile, asthePusherdoesnotmakethisavailablenordothesedrugsprovidepackage inserts.It is important to secure this knowledge before starting these drugs, to makeacleardecisionnow,becauseoncestarted,mostaddictslosetheirability (thatpartofthebrain)tomakethedecisiontostoptakingdrugs.Forthose already sucked into drugs, there is hope with medications and consultation to trim downtheseductionofaddictionandallowhealingofthemind.Thentosecure completefreedomonehastoescapefromthegangs/friendswhohaveyouin shackles.Sowheninfiltratingthebrainwithtoxicchemicalsoneshouldatleast understandquittingisnoteasywhenthatpartofthebrain,whichmakesthe decision to stop drugs, is scorched from smoking. The objective of this chapter is to also address the smokin’ issues that compromise health.For some it is easy to ignore the air pollution blanketing the city until it is too late.There are several types of environmental contaminates; some can be just as destructive to the lungs as smoking a pack per day.Pollutants, such as tobacco, areinsidiousindestroyingthelungs,causingacausalsuffocationovertheyears. Street drugs, on the other hand, are hideous and could instantly cost you decades oflossoflife,causepermanentmentaldisability,timebehindbars,orsixfeet under. 6.01Gang Of Dealers ItistheDrugPusherwhopromotesandprovidesthestreamofservicetofulfill theirclient'saddictionandcraving,aswellassatisfytheirownaddiction(beit power, drugs, money, fame, and/or sex).For some users to afford this expensive habit they must buy the product and sell it to those in line, thus the institution of the “pyramid” marketing plan.Just as one becomes addicted to drugs, one can also become addicted to the Pusher lifestyle of having it all. The Drug Pusher, through a cannibal-promotional plan, becomes even more evil when the plan is channeled through children to initiate this vicious drug cycle.Some of thesestreetdrugsarethemostvolatilesubstancesofallthedrugsandare brought to you by your local kitchen pharmacist (meth manufacture).These street pharmacistsarenotinthebusinessforyourhealthnorhavethedegreeorFDA approval to make drugs.Many of us are aware of the industrial strength cleaners and battery acid used in the cooking process of these street drugs. 57 Behind bars, in the pen, if one is locked up for child molestation, there is a “code of ethics” that disciplines these people, as so many recall their life being screwed-up after being sexually or physically abused.There are those in the dealing industry whoseeusingchildrentotrafficdrugsorbeinginthetransactionprocess(asa human shield) as child abuse.One of my inmate patients ended up in prison because hebecameangryandseveredatransactioninactioncausingittogobadwhena parent brought their child into this physically and mentally dangerous environment. Inthemovies,television,andnotsosurprisinglyinreallife,thesedrug cartels/pushersareouttomurderallthoseinthewayoftheirbusinessandwe (most of us - the good guys) despise these villains and look forward to seeing them gettheirshareofkick-assKarma.Thedrugpusherswhocommitviciousacts deserve justice - preferably a scan and corresponding medication for treatment to makethemproductivecitizens,sincetheprisonsystemshavenotquitemastered rehabilitation.Strangely enough, the leading drug industry that kills more than all theprescriptionoverdoses,alcoholicdiseases,andstreetdrugrelateddeaths combinedisbeingadvertisedinthemouthoftheseHollywoodactionheroeswho just killed all the bad guys.The tobacco empire is functioning at the same ethical levelasthesedrugpushers,andlegallyclaimingover400,000livesperyearand the drug pusher from overdose, diseases, and murder take about 40,000 per year. Sadly, this evil empire focuses their advertising campaigns towards children (very heavily in third world countries). Gangshaveinvadedourneighborhoodsandhaveinfectedourstreetsandprisons. I have talked to several inmates, big time famous gang leaders and followers, and I have been left with the following thought. When placed in the front lines of a war zone one has to put on a uniform and fight and kill or be killed.One of my patients, an inmate, decided while in prison not to be in uniform (a gang) and his face is battered with scars for his decision – a price he was happy to pay and lived to enjoy.Eventually he earned respect and was left tobe.Gangsandwarshavebeenaroundforthousandsofyears;theyjusthave differentnames,products,andaturftoprotect.Itseemslikeitmaterswhich side of the tracks you were born on and more importantly who your friends are and ifyoudecidetomakeenemies.Forsomeitistimetojumpthetracksandset yourself free. Asforthepushers,Iwouldsay–retire,disappear,takethemoneyandrun,get out, and move on before you lose your life or freedom (plan your escape from the freedom side of the bars). 58 I have discussed with several inmates, soon to be released, and after lots of time to think, their plan, when released to bury the past and start life over.I met one inmate whose plan was making as much money as possible from dealing until he got caught, then do his time, and live off the retirement he saved.He never used the drugs knowing that it would alter the odds against him for survival – sad thing is his careergoalshethreatenthelivesofothers.Perhapsstreetdrugsshouldbe legalized,requiremonitoredofthemanufacturing,keptfromchildren/developing minds, and taxed to the extreme. 6.02Pot or Not Cannabinoids (delta-9-TetraHydroCannabinol - THC) is available as marijuana and hashish.Marijuana comes in the form of a dried, cured leaf and is also known as pot, reefer, weed, grass, herb, joints, blunt, dope, Mary Jane, dubie, sinsemilla, skunk, and ganja.Hashish oil is a dense resin substance of cannabinoids obtained from the plant by solvent extraction into a harden form or an oil.It is also called honey oil, wax, dabs, or budder and it can be the most potent of the main cannabis products because of its high level of psychoactive compound per its volume. Marijuanaistheworld'smostcommonlyusedillegalsubstancethatisnow transitioning into the market as medicinal.It is a written prescription for multiple medical diseases/illness.As a prescribed medication for certain aliments there is hopeandgoodsuccess.Thereissideeffectsandadversereactionsprofile(the shit happens list) that all should know about before starting this controlled drug. Primarily it is smoked in the cigarette version (without the filter), or in a pipe, or in abong(apipewithasuperchargeronit–ramair),ordigestedintheformof “brownies.”Intoxicationbeginswiththepossiblesymptomsoffeelingcalm,cool, andlifeisgoodorfeelingreallybadwithanxiety(panicattacks),psychosis,or social withdrawal. Withlongtermuse/abuseofTHCtheremaybedamagingsideeffectssuchas problemswithshort-termmemory,problemswithshort-termmemory, complicationsperformingcomplexjobs,poorjudgment,problemswithperception ofthesenses,impairedbodyperformance(allextremities,gentlemen)and sedation.Theexperiencemayalsoincludehallucinationsordistortedhearing, seeing,orfeelingthings.Regularusersfindthemselvesexhaustedbothmentally andphysically,andone-thirdexperiencemildformsofanxiety,irritability,and depression, (36) while others just love it. 59 With research findings of loss in IQ of 8 points for those using pot early in life, it is of upmost concern for youth to abstain till development of the brain is fulfilled. Afteroneisintheir20sandolder,thenthelossinIQ(beingstupid)isonly temporary. (56) Many use it as a social event and it does not consume their life.However, I have seensocialusecostgreatlyfromgrosserrorsatworkandfaileddrugscreens, bothcostingemploymentstatus.Asfarasontheroad,marijuanadriversare probably more inclined to be hit from behind, by the drunks, for going too slow. This is a drug that causes euphoria and can diminish anxiety as life's problems are blown away.Some have no dependency or withdrawal symptoms when continual use ofmarijuanaisabruptlystopped.Others,afterthreedaysfollowingwithdrawal, maydevelopsymptomsofheadaches,cravings,restlessness,depression, irritability,andlossofappetite.Thesesymptomsmaylastuptotwotothree weeks.Also keep in mind, initial problems with depression, nervousness, anger, and sleepmayreturn.Thesemaybetheunderliningproblemsinthefirstplacethat mayhavedirectedonetouse.Theseproblemsarebesttreatedlegallyandwith professional consultation and prescription medication or just meditation. Somemaybedoingjustfineforyearsonmarijuana,thenoutofnowhere experiencea"badtrip"(beenthere,donethat,andsmokedtheT-shirt).There aremultiplefindingsofsevereparanoidepisodesthatincorporatedelusions, depersonalizations(partyisover),problemswithreality,andbrokenfamiliesand friendships from the "cranium up the rectum syndrome." Other problems I have seen with THC is the loss of memory and function to move on in life, laced with illusions of grandeur, when s/he thinks they are intellectually superior in wisdom and philosophy yet unable to finish high school.Looking at the SPEC exams, we see poor activity (metabolism) in the part of the brain where one learnsfromlifeeventsandmistakes.Ifthatpartofthebrainisnotfunctional, thenonemayhaveproblemswithmaturityandcuttingtheumbilicalcordfrom home and parents.Thus, with long-term abuse we may have the 40-year-old going on 14 and still living with mom. Dealershavebeenknowntoplayinthechemicaladditivegame(tomakethe productmoreaddictiveandhaveasynaptickick)bylacingmarijuanawithother chemicals that may dangerously compromise one's mental and physical health.And comingsoon,toatreatmentcenternearyou,wewillbeseeingmarijuana-induced cancer.The latest findings include cancer-causing additives found in marijuana. 60 Asamatteroffact,marijuanahasmoreofthelungcancer-causingagentcalled benzopyrenethantobacco(37).Twoofmypatientsintheirthirtieswhowere heavyusers,onesmokingonlypot,developedcancerofthebladder.Marijuanais alsoknowntocausetesticularatrophy,thatbeingsmalltesticlesinafull-grown adult - a big dude with child size balls.The children turn out ok, as far as we know, it just may be that the child will have bigger balls than pops.Bladder cancer is a simple cancer to fix as the surgeon just cuts out the bladder and attaches a tube to it that penetrates out the abdominal cavity, just below the belly button, into a pee bag.The cancer is easy to contain and keep from spreading.When the cancer hits the lungs, options for survival are limited. Over time with regular marijuana usage (with only one time per week) gum disease iscommon,whichcausesjawbonedeteriorationandlossofteeth.Itisthetoxin inhaled which causes this oral dilemma.So floss and brush your teeth. Street drugs and alcohol have been associated with the development of psychosis andschizophrenia.Consequentlythesesubjectsmayexperiencehallucinations (seeingandhearingthingsnothereinreality),delusions,disturbedthinking, bizarrebehavior,andagitation.Researchanddatarevealthat“Cannabis, Marijuana(andotherstreetdrugs)havebeenlinkedtosignificantincreasesina person's risk for schizophrenia” - up to 10 times higher risk with cannabis use (38). There has been over 30 scientific studies (mostly in Europe) and a most impressive one that interviewed 50,000 members of the Swedish Army that included a follow- up years later in the life of the users.The heavy users of cannabis at age 18 were 600% more likely to be diagnosed with schizophrenia before 30 years old.Other research findings presented a 700% increased risk of this disease.For those who usepotbefore15yearsold,thechancesofdevelopingschizophreniaarethree times more than those starting at 18 years old. Manyresearchscientistsbelievethatusingthedrugwhilethebrainisstill developing(under18yearsold)booststhelevelofthechemicaldopamineinthe brain,whichcausesschizophrenia.Alsothereisagenethatoneoutoffour humans inherit named COMT.If one has it, and smokes pot in their teens, it is like playing Russian Runlet.One out of six kids smoking pot with this COMT trait will enduppsychoticandtheother5maybehitwithothersideeffects.Inclosing, forthosesmokingmarijuana,thereisafourtimesincreasedriskofsuicidein malesandfivetimesforfemales.THCshouldnottobeusedforthoseunder18 yearsold,asthereisaconcernoflifelongmentaldisabilityandlossof intelligence. 61 6.03 Medicinal Marijuana For a current listing of the medical research and the potential of this medication, I would like to refer to Wikipedia, as follows (39): Medicalcannabishasseveralpotentialbeneficialeffects.Cannabinoidscanserve asappetitestimulants,antiemetics,antispasmodics,andhavesomeanalgesic effects, may be helpful treating chronic non-cancerous pain, or vomiting and nausea causedbychemotherapy.ThedrugmayalsoaidintreatingsymptomsofAIDS patients.Cannabis appears to be somewhat effective for the treatment of chronic pain, including pain caused by neuropathy and possibly also that due to fibromyalgia andrheumatoidarthritis.Inpalliativecaretheuseappearssaferthanthatof opioids. THC is not for developing minds and testicles. 6.04 Crack the Ice All right, I will quit picking on the potheads and hit on those who have been sucked into smokin’ chemicals.The statistics are not as readily available for chemicals as the research on marijuana. It is hard to find thousands of drug addicts taking and sellingillegaldrugsavailableforinterviewandtesting.Thereisoverwhelming evidence that methamphetamines (especially during the early years of life) lead to schizophrenia,depression,anxiety,andsuicideandthoseinthisdrugbracketare most likely to end up as BOP tenants - locked up (a bad trip lasting 10 to 30 years). Cocaine(cocainehydrochloride)isknownundervariousnamessuchasblow,bump, C, candy, Charlie, coke, crack, flake, rock, snow, toot.The smoked form is called “crack” and is the low budget version of cocaine. Methamphetamine(Desoxyn)isalsosmokedandcarriesseveralnamessuchas chalk,crank,crystal,fire,glass,speed,go-fast,ice,andmeth.Iceiscrystal, clearinappearance,lookslikerockcandyorrocksalt.Itisalsocommonlycalled crystal or glass and is very addictive. The use of this drug results in a longer, more powerfulhigh,fasteronset,andlessnegativeeffectsthantheotherformsof methamphetamine. Cocaine is the rich man (woman’s) drug of choice as it is clean and more socially and legallyacceptedanditgoesupthenoseorfindsitswayIV(IntraVenous). Crack/meth is the poor man/women’s curse. 62 The following are most of the side effects (adverse reactions) one may experience from these drugs.If some of these problems arise seek help quickly. Cardiovascular (heart and vessels): Tachycardia (fast heart beat) Hypertension (high blood pressure) Arrhythmias (irregular heart beats) Myocardial ischemia (poor blood flow to the heart that could lead to death) Cardiomyopathy (enlarged heart) from the hypertension Accelerated atherosclerosis (clogging of the arteries) Metabolic acidosis (the blood becomes too acidic) Arteries(bloodvessels)havespontaneouslyrupturedcausingorgandamageinthe brain,kidney,liver,pancreas,andsmallbowelofmethamphetaminedrugabusers. Alsowithanyintravenousdrug,bacterialorfungalendocarditis(heartinfection) can destroy the heart valves and the vessels that provide blood flow to the heart, leading to a heart attack. Central Nervous System (CNS-brain): Seizures (epileptic fit such as the body radically jerking about) Psychosis (seeing, smelling, hearing, or tasting things that are not there) Choreoathetoid (chaotic involuntary muscle movements) Stoke (hemorrhage or artery spasm blocking off blood flow to the brain) Cerebral edema (brain swelling) Cerebral vasculitis (brain vessel irritation) Respiratory (lungs): Pneumothorax (air becomes entrapped in the lungs) Acute noncardiogenic pulmonary edema (fluid builds up in the lungs) Pulmonary hypertension (high blood pressure in the vessels in the lungs) Renal and hepatic (kidney and liver): Renal failure (may require dialysis - kidney machine that filters the blood) Hepatocellular (liver) damage has been reported with just using a few times and this is especially of concern for those who have Hepatitis C Other: GI ulcers (bleeding stomach ulcers), Ischemic colitis (blood flow to part of the intestines is damaged), Spontaneous abortion (could be fatal to the mother) Teratogenesis (monstrously deformed baby) birth of a freaky looking baby, Self- induced skin picking and burns, Extreme tooth decay is common (tooth decay is probably caused by a combination of drug-induced psychological and physiological changes resulting in dry mouth and extended periods of poor oral hygiene, frequent consumption of high calorie, carbonated beverages and tooth grinding) 63 WiththerecentOklahomalegislationremovingephedrine(pseudoephedrine) medicationsfromoverthecountersales,healthprofessionalsareseeingan increase in hospital admissions that appear to be due to new substitute recipes for meth.The poisoning effects include uncontrollable rage, with delusional, paranoid thoughts, aggressiveness, and combative behavior. Most users were angry with the state government for imposing this law instead of beingangrywiththeirsuppliers.Thesemethkitchenpharmacistwerecreating new, cheaper, more dangerous recipes that are killing their clients - just to save a buck or two. An inmate who had a master’s degree in chemistry, bragged about his technique to makemeththatcostover$10,000inequipment,andwasmuchmoretime consumingandcomplextoprocess,thusyieldingacleanerandsaferproduct.He hadachosenfewwhomhesuppliedfor,mostlytruckers,thatwereparticular about their fuel supply to keep them on the road all hours of the day and night.I recommend caffeine, versus methamphetamines, as one will never financially break even speeding on meth. As mentioned above, one may just be seeking treatment for a chemical imbalance, thus prescription medications are much cleaner and safer (FDA approved). 64 6.05Head Case For those smoking meth, jus a heads up:Say you are at a party and the host falls tothefloorandcomplainsofnotbeingabletomovetherightsideofhisbody. You ask about his drug use and find that he has been hitting the meth.With your pearls of medical wisdom, you suspect he just had a CVA (stroke) and so you clear out the party and call the ambulance, STAT! Later that night you swing by the ER to visit your friend and you see the CT scan of his brain on the X-Ray box: This is a scan of your friend looking from on top (opening up the hood).The bleed is on the left side of his brain as seen by the large white “bust” figure that just so happens to have the jaw line of Jay Leno.Smoking just about anything out there is hazardous to your health.So if you can’t “Just say No”, then at best - don’t inhale. Sadly, this is one way to be drug free, being paralyzed in a nursing home (for life). This patient above was a meth addict and ended up in our ER with the above issues and abnormal CT scan. 65 6.06 Smokin’ Data US Recreational Drugs Deaths - Illegal:19,102/year. We know that substance abuse is involved in 50 percent of all highway deaths and over 50 percent of domestic violence cases (40).Recreational drugs have been the cause of countless fatal motor vehicle accidents – a new meaning to a "bad trip!" 6.07 ReSPECT ADHD If diagnosed with ADHD - get a PET or SPECT scan before and after medication to seeiftheprescriptionistrulyworking.Dr.Amen'sworkonADHDpatients actually demonstrates an improvement of brain activity after medication. He identified the different subtypes of Attention Deficit Disorder (ADD).Brain imaging is not necessary to make the diagnosis of ADD.On the other hand, it will confirm that the medicine is working and is helpful for complicated cases. Dr.Amenhasmappedoutthebrainpicturestomatchupwiththesubtypesof ADD.Let us look at some images of a patient who is at rest, when concentrating, and after treatment, to see the brain in living color. ThefollowingscanspresentapatientthathasAD/HDCombinedtype-both symptoms of inattention (cannot concentrate) and hyperactivity-impulsivity (cannot stand still). BrainSPECTimagingusuallyshowsdecreasedactivityinthefrontpartofthe brain,calledthebasalgangliaandprefrontalcortexwhenconcentrating.This subtypeofADDtypicallyrespondsbesttopsycho-stimulantmedicationsuchas Adderall or Dexedrine. 66 789:; 802