Posts Tagged ‘bladder cancer’

Bladder Cancer Treatment With TB Vaccine

April 22, 2017

Andrew Siegel MD  4/22/17

The use of tuberculosis vaccine (a.k.a. bacillus Calmette-Guerin or BCG) to treat bladder cancer is one of the great success stories in the history of using the immune system to combat cancer. For 40 years, BCG has been recognized as the standard of care for high-grade, superficial bladder cancer and carcinoma-in-situ (CIS), a flat but high-grade bladder cancer. The use of BCG is responsible for significantly reducing bladder cancer progression and recurrence.

IMG_2097

Image above: BCG in powdered form that needs to be reconstituted

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Image above: Typical appearance of a superficial bladder cancer

 

Bladder cancer has a strong tendency to recur, despite cystoscopy-guided complete removal of visible tumors (using a “telescope” placed within the bladder via the urethra). This approach can only treat obvious and visible tumors, with the real possibility that there are additional tumors present that are not yet visible (microscopic), since bladder cancer is a “field” disease—capable of occurring anywhere within the bladder lining. One of the rationales for using a medication like BCG is that it is a liquid formulation that is instilled in the bladder and will bathe all inner surfaces of the bladder. I often use the analogy of plucking out dandelions in your lawn individually as opposed to using a weed spray with respect to the difference between bladder tumor resection (cystoscopic surgical removal) and using a BCG-like medication.

A Brief History of BCG

BCG is a unique strain of “weakened” mycobacterium bovis (cow tuberculosis bacterium) developed by Albert Calmette and Camille Guerin at the Pasteur Institute in Lille, France in 1921 as a tuberculosis vaccine. At the time of its development, there was a growing recognition of the relationship between the immune system and cancer. In 1929, it was discovered that BCG might also have a role in the treatment of cancer when autopsy findings in TB patients were correlated with a reduced prevalence of cancers. Early investigators found that mice given BCG were protected against cancers that were implanted. In 1975, Dr. Jean deKernion at UCLA reported a melanoma that had spread to the bladder that was eliminated by direct injection of BCG into the melanoma. In 1976, Alvaro Morales successfully instilled BCG inside the bladder to treat bladder cancer and after clinical trials it was FDA approved for use within the bladder in 1990…The rest is history.

How It Works

BCG activates the immune system and triggers an inflammatory response that destroys bladder cancer cells. A good response to BCG immunotherapy requires a patient with an immune system capable of mounting a cellular immune response. It is accomplished by infusing a sufficient quantity of BCG so that it has direct contact with cancer cells.

How It Is Used

BCG is instilled directly within the urinary bladder.  One cycle is a once per week treatment for 6 weeks.  A full course is two cycles, followed by maintenance therapy. Typically the BCG treatment is initiated two weeks or so following the bladder tumor resection to allow the bladder time to heal. BCG is placed inside the urinary bladder using a narrow catheter. Retaining it for two hours is ideal and rotating body position is important so that all areas of the bladder are adequately bathed with the BCG.

Side Effects of BCG

Low-grade fever, urinary urgency, frequency, burning and blood in the urine are typical symptoms, often indicative of the immune response being mounted.   Occasionally, flu-like symptoms may occur, including fever, chills, cough, muscle and joint aches. When severe symptoms occur, BCG concentration can be reduced to 1/3, 1/10, 1/30, or even 1/100th of a dose to prevent escalating side effects.

 Tips For Patients Receiving BCG

  • Avoid drinking any fluids for at least 2 hours and avoid caffeine-containing products for at least 4 hours prior to bladder instillation in order to be able to retain the BCG for a full 2 hours after the instillation and to avoid diluting the concentration of the BCG.
  • Rotate your body in order to bathe all surface areas of the bladder with the BCG (supine, left, right, prone).
  • Care should be used when urinating after the BCG is instilled to avoid contaminating one’s hands or genitals with the BCG. Men should sit to urinate to reduce the likelihood of self-contamination. Hands and genitals should be thoroughly washed afterwards, and household bleach should be added to the toilet immediately after urination. The bleach should stand for 15 minutes before flushing to deactivate the BCG.

Wishing you the best of health,

2014-04-23 20:16:29

http://www.AndrewSiegelMD.com

A new blog is posted every week. To receive the blogs in the in box of your email go to the following link and click on “email subscription”:  www.HealthDoc13.WordPress.com

Dr. Andrew Siegel is a practicing physician and urological surgeon board-certified in urology as well as in female pelvic medicine and reconstructive surgery.  Dr. Siegel serves as Assistant Clinical Professor of Surgery at the Rutgers-New Jersey Medical School and is a Castle Connolly Top Doctor New York Metro Area, Inside Jersey Top Doctor and Inside Jersey Top Doctor for Women’s Health. His mission is to “bridge the gap” between the public and the medical community that is in such dire need of bridging.

Author of MALE PELVIC FITNESS: Optimizing Sexual & Urinary Health http://www.MalePelvicFitness.com

Author of THE KEGEL FIX: Recharging Female Pelvic, Sexual and Urinary Health  http://www.TheKegelFix.com

YouTube site: http://www.YouTube.com/incontinencedoc

Vidscrip site (for short educational videos): http://www.Vidscrip.com/andrewsiegel

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Of Nighttime Urination, Sleep Disruption and Promiscuous Eating

March 29, 2013

Andrew Siegel, M.D.  Blog #100

Nocturia is a condition in which one awakens from sleep to urinate. Arising once or so to empty one’s bladder during sleep hours is considered normal; however, when it happens multiple times, it can be not only annoying but also sleep-disruptive. It is common in both men and women and increases in prevalence as we age.  It is primarily a kidney-driven urine production problem, as opposed to a bladder-driven urine storage issue.

As with many matters, nocturia is more complicated than it appears and is often multi-factorial.  That stated, it is important to reiterate that the most common underlying cause of nocturia is nocturnal overproduction of urine.  Although most associate the occurrence of nighttime urination with lower urinary tract conditions, in many cases the problem is actually due to the kidneys (upper urinary tract) and not the bladder and prostate (lower urinary tract).  Nighttime urine overproduction, a.k.a. nocturnal polyuria, may result from kidney issues, but also from cardiac or lung conditions. Nocturnal overproduction of urine at night has been implicated as a causal factor in over 80% of cases of nighttime urination.

Nocturia can certainly occur on the basis of lower urinary tract conditions, particularly with benign prostate enlargement or overactive bladder. Under these circumstances, the nocturnal urinary frequency is often on the basis of decreased bladder capacity (in which the bladder is incapable of storing normal volumes) or sometimes because of failure to empty the bladder (in which the bladder is always left partially full).  Additionally, any source of bladder irritation such as an infection, stone, cancer, etc., can irritate the lining of the bladder and cause nighttime urination.   Nocturia can be induced by extrinsic pressure on the bladder, seen with fibroids of the uterus and rectal fullness due to either gas or constipation, although it can be caused by the presence of any pelvic mass. Nocturia can also occur on a neurological basis since neurological diseases such as stroke, spinal cord injury, multiple sclerosis, Parkinson’s disease, etc., can affect urinary frequency during sleep. Even when nocturia is caused primarily by prostate enlargement, overactive bladder, bladder irritation or a neurological issue, etc., nocturnal overproduction can contribute to the process.

Why does nocturnal overproduction of urine occur?  It can result from a number of factors such as the mobilization of excess fluid stored in the lower extremities in people who have peripheral edema. Edema refers to fluid within the tissues–typically the ankles–that tends to accumulate with gravity over the course of the day. Upon assuming the lying-down position when sleeping, the legs are relatively elevated as opposed to standing and this tissue fluid returns into circulation, causing the kidneys to increase urine production.  In general, those with peripheral edema go to sleep with ankles (and perhaps legs) engorged with edema fluid and wake up with thinner legs, as the return of some of the fluid to the circulation and the subsequent increased urination rids them of this. Another underlying cause is excessive production of atrial natriuretic peptide due to sleep apnea or congestive heart failure.  Yet another possibility is an abnormality in the nocturnal secretion of anti-diuretic hormone.  This pituitary hormone functions to cause the kidneys to retain fluid; nocturia may occur because of an age associated decline in its secretion while sleeping. Other factors include excess fluid intake in the evening, especially caffeine-containing beverages, and the use of medications such as diuretics.   Systemic diseases such as diabetes mellitus, diabetes insipidus, and kidney insufficiency, can all cause nocturnal polyuria.

Sometimes nighttime urination occurs not because of any systemic illness or bladder, prostate, kidney or overproduction issue, but simply because of poor sleep. When sleeping poorly, one often gets up to urinate because the wakeful state makes one more conscious of their bladder being full, or alternatively, for an activity to occupy time during the insomnia. Any sleep disorder—insomnia, obstructive sleep apnea, restless leg syndrome, etc.—can result in poor quality sleep and often nocturia. The bladder is a convenient outlet for anxiety, which can induce urinary frequency.

The principal diagnostic tool for assessing nocturia is a voiding diary in which the time and the volume of urination are recorded for a 24-hour period.  There are 4 major findings that may occur: reduced bladder capacity; global polyuria; nocturnal polyuria; or a mixed pattern.  Typical bladder capacity is 10–12 ounces with 4–6 urinations per day. Reduced bladder capacity is a condition in which frequent urination occurs with low bladder capacities, for example, 3–4 ounces per void. Global polyuria is a condition in which bladder volumes are full and appropriate and the frequency occurs both daytime and nighttime. Nocturnal polyuria is nocturnal urinary frequency with full and appropriate volumes, with daytime voiding patterns being normal. A mixed pattern can be a more complex picture involving elements of the other patterns.

If fluid intake is found to be excessive, simple moderation of intake will be helpful, particularly with respect to caffeinated beverages and high fluid content foods such as melons and other fruits. Restricting liquid intake after dinner is often advisable. Minimizing high salt content foods and table salt can help prevent fluid retention. If edema is the issue, compression stockings worn during the day as well as elevating the legs during the day can be of value in getting some of the interstitial fluid out of the system. Diuretics taken during the late afternoon may decrease fluid accumulation.

Medications may be helpful, depending upon the cause of the nocturia.   Synthetic  antidiuretic hormone, aka DDAVP which is useful for childhood bedwetting, can be useful for adults with nocturia associated with nocturnal polyuria. Bladder relaxing medications as well as behavioral techniques and pelvic floor exercises can be beneficial for overactive bladder. Prostate relaxing and shrinking medications or surgical treatment can be helpful if an enlarged prostate is the cause.

Nighttime urination is one of the most annoying and bothersome of urinary symptoms given how sleep-disruptive it often proves to be.  Chronically disturbed sleep can negatively affect one’s quality of life and health.  It can result in daytime fatigue, increased risk of traffic accidents, increased incidents of fall-related nighttime injuries, and weight gain because of altered eating patterns. Insufficient sleep alters our internal biochemical environment and can profoundly disrupt our eating drives leading to patterns of “promiscuous eating.” Clearly, there appears to be a physiological basis for this fatigue-driven eating. Sleep deprivation or the need for sleep results in decreased levels of leptin, our chemical appetite suppressant, and increased levels of ghrelin, our appetite stimulant, in addition to increased levels of cortisol, one of the stress hormones. This sleep-deprived change of our internal chemical milieu can drive our eating. Therein lies the link between urology and nutrition/health/wellness that I am so fond of establishing.

Bottom Line: Nocturnal urinary frequency should be investigated to determine its cause, which may in fact be related to conditions other than urinary tract issues.  Nighttime urination is not only bothersome, but may also pose real health risks. Chronically disturbed sleep can lead to a host of collateral wellness issues.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

Blog subscription: A new blog is posted every week.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts in your inbox.  Please avail yourself of these educational materials and share them with your friends and family.

Bladder Cancer

February 2, 2013

Bladder Cancer

Andrew Siegel, MD  Blog #92

 

Bladder cancer is such a common public health problem that I thought it would be worthy of an educational blog.  Few people realize that its occurrence is more highly linked to tobacco than is lung cancer.

In the USA, the incidence of bladder cancer has increased greatly over the last few decades, with more than 60,000 new cases diagnosed each year.  It is the fourth most common cancer in men and the eighth in women. With the exception of skin cancers, bladder cancers are the most frequently recurring cancer, with up to 70% of patients experiencing recurrence.  The occurrence of bladder cancer increases with age and is three times more common in men than women.  80% of newly diagnosed individuals are 60 years of age or older.  At present, about 20% of patients die each year, but when the disease is diagnosed and treated in the early stages, the chances of survival are excellent, highlighting the importance of a timely and accurate diagnosis.  More than 90% of newly diagnosed bladder cancers are urothelial cell carcinomas  (cancers originating from the unique lining of the urinary tract).

The majority of patients with newly diagnosed bladder cancer have superficial cancer that involves the very inner layers of the bladder wall.  About 20% have invasive disease that involves the deeper layers of the bladder wall.  The remaining 5% present with metastatic disease, defined as spread beyond the confines of the bladder.

The highest prevalence of bladder cancer is in industrialized nations.  Cancer-causing agents (carcinogens) are most often responsible for bladder cancer.   Bladder cancer is highly associated with tobacco smoking—even if one stopped smoking years ago, the risk is related to the quantity of tobacco smoked over the years.  The carcinogens that are present in tobacco are absorbed through the lungs into the bloodstream and are filtered through the kidneys directly into the bladder, where their prolonged contact time with the lining of the bladder leads to cancerous changes.   Certain occupations are at higher risk for bladder cancer because of exposure to chemicals—these include: hairdressers, painters, machinists, printers, and those who work with dyes, textiles, rubber, leather, and petrochemicals.

Bladder cancer most commonly manifests with blood in the urine, either visible or microscopic (seen only under microscopic magnification).  It may also cause irritative lower urinary tract symptoms including urgency, frequency, discomfort with urinating, and urinary leakage.

The evaluation for blood in the urine includes imaging, cytology, and cystoscopy.  Imaging tests are means of visualizing the anatomy of the urinary tract, typically through ultrasound, computerized tomography (CT), or magnetic resonance imaging (MRI).  Cytology is a microscopic inspection of a urine sample by a pathologist for the presence of abnormal or cancerous cells that slough off the lining of the bladder, similar to a Pap smear done to screen for cervical cancer.  Cystoscopy is a visual inspection of the entire lower urinary tract (bladder and urethra) using a tiny, flexible, lighted instrument attached to a camera and monitor.

When a bladder tumor is identified on cystoscopy, attention is directed to the number of tumors present, their size, location within the bladder, and physical appearance.  A papillary appearance consists of fronds (finger-like projections floating in the bladder) with a narrow attachment to the bladder lining versus a sessile appearance, in which the tumor appears solid and is widely attached to the bladder lining.

Once a bladder tumor is recognized, it needs to be removed and sent for pathological evaluation.  This is performed under general or spinal anesthesia via cystoscopy, using an electric loop which is used to remove the area of concern as well as cauterize (use electricity to coagulate tissue) the underlying and adjacent tissue, both to stop bleeding and further destroy tumor cells.

The biopsed tissue is carefully examined by a pathologist, who will provide valuable information regarding malignancy vs. benignity, the type of tumor, depth of tumor, and grade of tumor.   Again, the vast majority of bladder tumors are urothelial cancers, referring to the cells that line the bladder.  A minority of bladder tumors are squamous cell cancers or adenocarcinomas.   Depth refers to the degree that the cancer is growing into the bladder wall.  Bladder cancers are broadly categorized into superficial and deep.  Superficial tumors are largely confined to the bladder lining and superficial layers and do not penetrate the muscle layer of the bladder, whereas deep tumors have “roots” that penetrate the muscular wall of the bladder.  Tumor grade refers to how much the microscopic appearance of the cancer deviates from the microscopic appearance of healthy bladder cells.  Low-grade cancers are similar in cellular appearance to normal bladder cells and generally behave in an indolent (slow) fashion versus high-grade cancers that can often behave aggressively.  Other factors of prognostic importance are the number of tumors present, the size of the tumors, and their physical characteristics.

In general, the best prognosis is for a solitary, small, superficial, low-grade papillary tumor and the worst prognosis is for multi-focal (originating from many different areas of the bladder), large, invasive (deep), sessile, high-grade tumors.

The biopsy information will enable the staging of the bladder cancer, a means of classifying the cancer.  It is extraordinarily unlikely for a superficial cancer to cause lymph node or distant spread, these events occurring with much greater likelihood with more deeply invasive cancers.

Staging of bladder cancer is as follows:

  • Ta: Superficial cancer is found only in polyps (papillary) on the surface of the inner lining of the bladder.
  • Tis: Carcinoma-in-situ. Tumor is found only in flat lesions on the surface of the inner lining of the bladder.
  • T1: Tumor is found in the connective tissue below the lining of the bladder but has not spread to the bladder muscle.
  • T2: Tumor has spread to the muscle layer deep to the lining of the bladder.
  • T3a: Tumor has spread through the muscular wall of the bladder into the fatty tissue layer as identified under microscopic examination.
  • T3b: Tumor has spread through the muscular wall of the bladder into the fatty tissue layer and is capable of being identified without a microscope.
  • T4: Tumor has spread to the prostate in men and to the uterus or vagina in women, or to the pelvic or abdominal wall in either gender.

Superficial cancers are usually managed with cystoscopy, with regular “surveillance” due to the high predilection for recurrence.  It is imperative to have frequent check-ups (every 3 months for the first year after initial diagnosis), consisting of periodic urinalysis, urine cytology, imaging, and cystoscopy.  If surveillance does not demonstrate any recurrences, the interval between follow up can gradually be increased (to every 6 months in the 2nd year; if there are no recurrences, to an annual check-up).  If a recurrence is found, treatment must be repeated and the surveillance frequency then starts anew with the every 3-month cycle.

To help prevent recurrence, under certain circumstances it is beneficial to use a medication that is instilled in the bladder on a weekly basis—this is especially useful when many tumors are present, in the presence of a high-grade tumor, or cancers that have recurred.   It is particularly useful for carcinoma-in-situ (CIS), a variant of bladder cancer that is very superficial, flat, yet of a high-grade pathological nature.  The medication of choice is tuberculosis vaccine—BCG (bacillus Calmette Guerin), which is a live, attenuated (weakened) form of tuberculosis bacteria!

Muscle-invasive cancers most often need to be treated with a major surgical procedure involving either partial or complete removal of the urinary bladder.  In the circumstance that the entire bladder needs to be removed, the ureters (tubes that conduct the urine from the kidneys to the bladder) need to be diverted to a piece of intestine that is either attached to the skin to a collection bag (ileal conduit) or attached to the urethra (neo-bladder or “reconstructed” bladder).  At times, in lieu of surgery, chemo-radiation can be utilized (a combination of radiation therapy provided by the radiation oncologist and chemotherapy provided by the medical oncologist).

Bladder cancer often behaves as two separate types of diseases—one that typically presents as multiple, superficial papillary tumors that have a tendency to recur but are not lethal (similar to many skin cancers), versus another, more deadly form characterized by high-grade, non-papillary, muscle-invasive tumors that have a tendency to metastasize.  Fortunately, the vast majority of bladder cancers are the superficial type.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com

Available on Amazon in paperback or Kindle edition

For an educational video on bladder cancer that I have done, please go to the following link: http://www.youtube.com/watch?v=WvEOcCzw2gQ

Blog subscription: A new blog is posted every Saturday morning.   On the lower right margin you can enter your email address to subscribe to the blog and receive notifications of new posts by email. Please avail yourself of these educational materials and share them with your friends and family.

Tobacco Keeps Me Way Too Busy As A Urologist

February 25, 2012

 

 

 

Blog # 47       Andrew Siegel, M.D.

To paraphrase Dr. David Katz—the master levers of our medical destiny are our fingers, forks and feet: fingers that may or may not bring cigarettes to our lips; forks that may or may not bring healthy food to our mouths; feet that may or may not participate in exercise and fitness pursuits.  The negligent use of our fingers, forks and feet is the leading causes of premature death and conversely, the appropriate use of them is capable of preventing 90% of diabetes, 80% of cardiovascular disease and 60% of cancers.

Bottom line:  Most everyone is knowledgeable about the role of tobacco in contributing to cardiovascular disease, stroke, lung cancer and emphysema.  However, the complications of tobacco abuse go way beyond the heart and the lungs; physicians in every medical and surgical specialty bear witness to the havoc that tobacco wreaks on every system in our body.  As a urologist, I am on the front lines of the deleterious and deadly effects of tobacco. Tobacco has clearly been linked to several urological cancers as well as numerous other non-malignant conditions. Tobacco is a major factor in the occurrence of bladder cancer, kidney cancer, sexual dysfunction, and infertility in both men and women.  Smoking cessation can help reverse these serious issues.

Bladder cancer is an incredibly prevalent cancer.  It is the 4th most common cancer in men and the 8th most common cancer in females.  It is highly correlated—hugely so—with the use of tobacco.  Cigarette smoking is the number one environmental cause and greatest risk factor for bladder cancer.  Cancer-causing chemicals known as carcinogens get inhaled into the smoker’s lungs, are absorbed into the bloodstream and are filtered by the kidneys, from where they pass into the urinary bladder.  In the bladder, these carcinogens have prolonged, direct contact time with the bladder lining, where they induce changes that ultimately can become malignant.  There is a many-year “latency period” from the time of exposure of the carcinogens to the actual occurrence of cancer—often several decades.  So the smoking that you did in your teens and twenties can come back to haunt you in your forties and fifties.

Continuing to smoke leads to worse bladder cancer outcomes compared to patients who discontinue tobacco use. Ongoing smoking after the diagnosis of bladder cancer greatly increases the risk of morbidity and mortality, treatment-related complications, recurrence of the cancer and the development of a second malignancy.  Smoking cessation will diminish all of the aforementioned consequences.  It is estimated that elimination of smoking could decrease the overall incidence of bladder cancer by 50%.

Prostate cancer is the most prevalent cancer in men and keeps our office bustling with patients.  Although smoking does not increase the risk of being diagnosed with prostate cancer, men who smoke at the time of prostate cancer diagnosis have an increased risk of recurrence and death from prostate cancer and also face an increased overall mortality from cardiovascular disease. Conversely, those who quit smoking at least a decade before the diagnosis of prostate cancer was made have mortality similar to those who never smoked.

Smoking is also strongly correlated with both male and female sexual dysfunction.  Anything that compromises blood flow to the genitals is going to interfere with sexual function, and the chemicals in tobacco do a marvelous job at constricting blood flow.  Approximately 40% of men with erectile dysfunction are smokers.  There is a direct relationship between the quantity of smoking and the extent of sexual dysfunction. Smoking cessation will help restore lost function, but tobacco takes its toll as former smokers have been shown to be at an increased risk of developing sexual dysfunction later in life.

Smoking adversely affects the reproductive system in both sexes.  As compared to non-smokers, the semen of smokers demonstrates poorer parameters, particularly sperm motility. Thus, sperm from smokers has reduced potential for fertilizing an egg.   Females who smoke have a higher prevalence of fertility issues including an increased risk of ectopic pregnancy and fare poorer than non-smokers when assisted reproductive techniques are needed.  Women who smoke during pregnancy increase their risk for bearing male children born with undescended testicles. Smoking has also been associated with increased risk of acquiring HIV infection, HPV infection, invasive cervical cancer, and pelvic inflammatory disease.

An estimated six trillion cigarettes are smoked worldwide every year.   It is not only the smokers who suffer the ill effects of tobacco use.  The health of individuals exposed to smokers is also at risk due to second-hand smoke. Second-hand smoke is a mixture of the smoke given off by a cigarette, pipe or cigar and the smoke exhaled into the air we breathe from the lungs of smokers.   Second-hand smoke is involuntarily inhaled by non-smokers and can linger in the air for hours after tobacco products have been extinguished.  There is no safe level of second-hand smoke, and even brief exposure can be harmful. Second-hand smoke clearly is associated with serious diseases and is responsible for shortening life spans. Second-hand smoke has been classified by the Environmental Protection Agency as a cause of cancer in human beings, causing approximately 3,000 lung cancer deaths and about 50,000 cardiac deaths in non-smokers in the United States annually.  Second-hand smoke is particularly harmful to young children, being responsible for hundreds of thousands of respiratory tract infections in those under 18 months of age.

There at least 43 carcinogens and more than 300 polycyclic aromatic hydrocarbons in second-hand smoke, as well as many other toxins including arsenic, carbon monoxide, lead, cyanide, DDT, formaldehyde and polonium 210. Polonium 210—a highly toxic radioactive poison that was brought to the attention of the public because of its use in the poisoning of a former KGB agent—is inhaled along with the tar, nicotine, cyanide, and other chemicals.

Smoking is a vile, incredibly harmful, self-destructive and miserable habit and addiction.  It is the single greatest cause of illness and premature death in modern society.  Every cigarette that is smoked can be thought of as another nail in one’s coffin.

Years ago, smoking was an excusable habit simply because we didn’t know any better.  It was thought of as a sophisticated, glamorous and sexually alluring and was so glorified on television, in magazines, and in Hollywood on the silver screen.   Magazine advertisements depicted physicians smoking and one slogan went so far as to state: “More doctors smoke Camels than any other cigarette.”   Even my father, a physician, smoked; however, as soon as he caught wind of the fact that smoking was dangerous to his health, he stopped immediately.

The greatest irony is that there are many smokers who have a pervasive fear of terrorism and potentially pandemic bacterial and viral illnesses such as avian bird flu, mad cow disease, SARS, anthrax, West Nile virus, etc.  What they fail to realize is that the cocktail of carcinogenic chemicals entering their lungs and bloodstream via smoking and being delivered to every single cell in their body can be thought of as little terroristssuicide bombers if you will, that can and certainly will ultimately wreak havoc on their health and their lives.  Smoking really is just a form of slow, voluntary suicide.  While we do not have a great deal of control over terrorist acts or deadly pandemics, we certainly have the ability to live a smart lifestyle that avoids self-destructive behavior such as smoking.

What truly is a source of amazement to me are the smoking lounges in the airports.  Glassed in like fish in an aquarium, these ridiculous-appearing humans are puffing away in unison, garnering not only the ill benefits of first-hand smoke, but also second-hand, third-hand, and every other permutation imaginable!  A motley group of men and women collectively inhaling and exhaling, hacking and choking within this absurd observatory, with plumes of smoke floating around like clouds—this glass menagerie is a showcase for the folly of humankind.

This folly is certainly aided and abetted by Big Tobacco. In 2006, a federal judge named Gladys Kessler ordered strict new limitations on tobacco marketing, sticking it to the cigarette manufacturing companies for their disingenuous behavior and forcing them to stop labeling cigarettes with deceptive descriptors including “low tar,” “light,” or “natural.”  The tobacco industry was shown to have “marketed their lethal product with zeal, with deception, with a single-minded focus on their financial success and without regard for the human tragedy or social costs that success exacted.”  She further stated that “cigarette makers profit from selling a highly addictive product that causes diseases leading to a staggering number of deaths per year, an immeasurable amount of human suffering and economic loss, and a profound burden on our national health care system.”

The WHO (World Health Organization) estimates that by the year 2020, cigarettes will be responsible for the deaths of 10 million people annually.   Cigarettes killed 100 million people in the period between 1900 and 2000, and we’re on track for nearly a billion tobacco-related deaths for the 21st century.  About half of all smokers will die of smoking-related diseases. Habitual smoking decreases general life expectancy by an average of 8-12 years. Many smoking-related deathsare not pleasant and quick deaths, but are often protracted and associated with significant suffering.

There is a magic pill—inexpensive, readily available, free of side effects and safe for all ages—that taken daily will reduce the risk of getting any major chronic disease by 80% or so. This pill is called healthy lifestyle, and if you don’t have it in your medicine cabinet yet, it would make all the sense in the world to acquire it.

 

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food

 Now available on Amazon Kindle

www.PromiscuousEating.com

 

For my educational video on bladder cancer:

http://www.youtube.com/watch?v=WvEOcCzw2gQ