Tobacco Cessation Resources on campus

At the University of Denver Health & Counseling Center, we offer several resources to help you quit and stay quit. Our treatment plans are individualized and tailored to meet your needs and desires as you nix nicotine.

We offer free tobacco cessation counseling for all students who pay the Health & Counseling Fee. This service is offered by a staff member trained as a Tobacco Treatment Specialist with special training and experience to help you overcome tobacco.

Our services include:

• Customized treatment plans
• One-on-one counseling
• Group counseling
• Medical consultations for prescriptions
• Resources & information tailored to help you quit tobacco, including a guide to medications.

We believe in a non-judgmental & supportive approach using evidence-based practices proven to work. When you’re ready to quit, the right treatment can make quitting easier than you’d expect.

Why Quit?

Smoking is the largest cause of preventable death in the country. More than 5,000 Americans start smoking cigarettes each day. And that’s despite the fact that they know the damaging effects it has on the human body. One in five deaths in the United States is related to tobacco use. And every ten seconds, someone dies from a disease related to smoking.

Effects on the Body

Heart
When you smoke, your pulse quickens, causing your heart to beat an extra 10-25 times per minute… or as many as 36,000 additional times a day. This forces the heart to work harder and can contribute to the risk of a heart attack. Cigarette smoking is directly responsible for at least 20% of all deaths from heart disease; it lowers “good” cholesterol levels, causes deterioration of elastic properties in the aorta and increases the risk for blood clots.

Lungs
Cigarette smoke attacks the lungs’ natural defenses and can completely paralyze the natural cleansing process. Excess mucus in the lungs will make you more susceptible to colds, flu, bronchitis and other respiratory infections. Continued exposure can lead to lung cancer and lung diseases, including pneumonia and emphysema.

Cancer
Lung cancer is just one of the serious health risks caused by smoking. Smokers and chewers are also susceptible to cancers of the larynx, mouth, esophagus, bladder, pancreas, kidney and stomach.

Eyes
Smokers have a much higher risk of developing two major sight-threatening conditions. Macular degeneration can occur when the macula, the central part of the retina at the back of your eye, becomes scarred, robbing the person of central vision. Research has shown that smokers are about 3 times more likely to develop cataracts, a gradual thickening that develops in the lens of the eye. Smoke can also cause serious irritation for those who wear soft contact lenses.

Nose & Throat

Irritating gases in cigarette smoke, such as formaldehyde, ammonia, hydrogen sulfide and others, can cause serious irritation to the sensitive membranes in the nose and throat. The results: a runny nose and the proverbial smoker’s cough. Continued exposure can produce abnormal thickening in the throat lining, a condition, when accompanied with cellular changes, that has been linked to throat cancer.

Mouth
Stained yellow teeth, bad breath and an acute loss in your sense of taste are just some of the less serious consequences of smoking. Smoking as well as the use of spit tobacco or “chew” can also contribute to cancer of the lips, gums and throat.

Skin
Smoker’s have what is called a “smoker’s face.” Characterized by a grayish appearance of the skin and deep lines around the corners of the eyes and mouth, smoker’s face is caused by a lack of oxygen to the skin. These conditions occur because smoking constricts the blood vessels in the skin, making it more susceptible to wrinkling.

Male Reproductive System
The negative effects of smoking on the blood vessels leading to the male reproductive organs may mean men can experience erectile dysfunction or even impotency. Smoking can also affect fertility by decreasing sperm count and mobility.

Female Reproductive System
Smoking can result in fewer reproductive years and a sharp decline in fertility for women. Female smokers are three times more likely to be infertile and reach menopause one and three-quarter years earlier than nonsmokers.

Breast Cancer
Research is finding a connection between the risk of developing breast cancer and smoking.

Bones
Smokers have a higher risk of developing osteoporosis, a condition that involves bone thinning. The loss of bone tissue, more prevalent among women, can result in an increase of bone fractures.

Blood
The carbon monoxide inhaled with each drag on a cigarette can stay in the bloodstream for up to six hours. Once in the bloodstream, it begins attacking the red blood cells, virtually replacing the oxygen your body needs to function. The process means less oxygen reaches the brain and other vital organs.

Digestive System
Smokers are at greater risk of developing peptic ulcers, Crohn’s disease and gallstones and can experience chronic heartburn. Smoking also affects the way the liver operates, particularly in terms of how it processes alcohol.

Lifestyle Effects

Habit
Smoking or chewing often quickly becomes a deeply-rooted habit for many daily users. You smoke/chew when you’re tired, when you’re anxious, when you’re drinking, when you’re driving, when you’re happy, sad, stressed, nervous, or celebrating. When smoking becomes linked with several daily occurrences, it becomes a habit as much as it is an addiction to nicotine. Cigarettes and smokeless tobacco become a crutch. You may feel naked without it. You’ll suddenly alter your day in order to get it. Using tobacco can seriously alter your daily routine & lifestyle. Do you sometimes wish you didn’t have to worry about having cigarettes or smokeless tobacco?

Image of a Smoker/Chewer
Most (91%) DU students say that they would prefer to date a non-smoker (TUAS, 2005). Tobacco users may deter relationships due to their potential partner’s lack of tobacco use. Smoking also can cause premature aging, yellowing of the teeth, increased coughing, sickness, & the smell of smoke that lingers on the skin, in the hair, and on clothes. How do you want to be identified? As a smoker or a non-smoker?

Second-Hand Smoke
Most people know the damaging effects that second hand smoke can have on others. But did you think about the influence you have on children, peers, & co-workers? May people choose to quit because they want to be a good role model for their children, siblings, nieces, nephews, parents, and co-workers. Is your influence & reputation related to smoking/chewing important to you?

Cost
It’s certainly not getting any cheaper to use tobacco. With the rising cost due to taxes on tobacco products — it may be important to you to look at how much you’re spending on cigarettes or snuff. Take a look at what you spend daily, weekly, & monthly on tobacco products. In addition to these tangible costs, there are often health consequences which may add to health care costs — increased sickness & dental complications alone can really add up. Can you afford to smoke or chew? Check out the smoking calculator to find out how much tobacco is costing you.

Tips for Quitting & Staying Quit

While quitting tobacco can seem like a daunting thing, everyday people successfully quit. Nicotine is highly addictive; however, with a variety of tools and support you can make quitting a reality for you.

Setting a Quit Date and Making a Quit Plan

Once a person has decided to quit, it’s time to pick the all-important Quit Date. Make sure it’s pretty soon — like maybe in the next month. Choosing one too far in the future will make it easier to rationalize a way out of it. But there also needs to be enough time to get prepared. Then it’s time to come up with a solid plan. Here are some steps to help you get prepared.

• Pick the date and mark it on a calendar.
• Tell friends and family of the quit date and ask for their support.
• Stock up on sugarless gum, cinnamon sticks, toothpicks, carrot sticks and hard candy.
• Decide on a plan. What options does the Health & Counseling Center offer for cessation? Are there community resources or on-line support services that best match your personal needs?
• Is nicotine replacement therapy (i.e., the patch or gum) or other medications the way to go? Medications have been proven to increase the success of quitting. Investigate your options and decide what will work best for you. If you decide on medication, you may need to start using it before your quit date.
• Attending a smoking cessation class or calling a quit line also can help you to stay smoke-free.
• Set up a support system. Tell others of your plan and ask for their support. Ask a friend to quit with you. You can talk with a friend who has successfully quit and is willing to help.
• Get rid of all cigarettes, lighters, ashtrays, etc.
• Identify your triggers, the things that tempt you to smoke. Think about the times or rituals during the day when you normally smoke, such as with a cup of coffee in the morning, between classes, while studying or at the bar. Figure out what you will do instead of smoking, such as skipping the coffee, going for a walk, chomping on carrot sticks or lollipops and even avoiding the bar. These temptations will become less and less strong the longer you are smoke-free.
• If weight gain is a concern, know that exercise can decrease your chances of gaining weight while you quit and can make quitting easier.

What to Do When the Quit Day Comes

• Do not smoke. Stop smoking the night before and when you wake up the next morning, you will have an 8-hour head start to being smoke-free!
• Keep active — try walking, exercising or doing other activities or hobbies.
• Drink lots of water and juices.
• Start nicotine replacement therapy (if chosen).
• Continue attending a smoking cessation class, following a self-help plan and using computer resources. Call your support system or the Quitline (1-800-QUIT-NOW) when you’re tempted.
• Avoid high-risk situations where the urge to smoke is strong. Sit in non-smoking sections when you go out to eat or frequent smoke-free establishments.
• Reduce or avoid alcohol and caffeine. Why? Alcohol clouds judgment and can make it easier to slip and smoke. Plus, alcohol may be linked to smoking for some people and it’s important to break this connection.
• Use the four “A’s”
  • Avoid. Certain people and places can tempt you to smoke. Stay away for now. Later on, you’ll be able to cope.
  • Alter. Switch to soft drinks or water instead of coffee or alcohol. Take a different route to school or work. Take a walk when you used to take a smoke break!
  • Alternatives. Use oral substitutions like sugarless gum, hard candy or sunflower seeds.
  • Activities. Exercise or hobbies that keep your hands busy (video games, needlework, woodworking, etc.) can help distract the urge to smoke.

Dealing with Withdrawal

Everybody knows that withdrawal comes with the territory of quitting but that doesn’t make it any easier. It can be hard and even frustrating for the person quitting to deal with withdrawal and for those around the person. But understanding what’s going on, physically and psychologically, can help and can assist you in helping a friend quit.

• When smokers quit, they begin to go through some changes, some physical, some emotional. The physical symptoms, while annoying and difficult, are not life threatening. Nicotine replacement products such as the patch or gum can help reduce many of these physical symptoms. For most smokers, the bigger challenge is the psychological part of quitting.
• This psychological part of smoking is really hard to beat because smoking becomes linked to so many things — things like waking up in the morning, eating, reading, watching TV, drinking coffee, etc. It’s like a ritual. Your body becomes used to having a cigarette with certain activities and will miss this link when you first become smoke-free.
• It will take time to “un-link” smoking from these activities. Unfortunately, the patch or gum can’t relieve the psychological need to smoke. That’s why it’s so important for the smoker to create a plan to deal with situations that trigger their urge to smoke. Smokers can also ask friends and family for support with simple things like walking around the building before class instead of having a cigarette.

Withdrawal Symptoms

If and when a smoker goes through withdrawal, they need to keep this in mind. Even though they may not act like themselves, and they may feel rotten, these feelings will pass. After 30 days or so, and after they’ve quit smoking, all this will be behind them. In the meantime, here are some of the withdrawal symptoms smokers may experience and what they can do about them.

• Craving. This is the body’s physical addiction saying, “I need nicotine now!” Each craving will last for only a couple of minutes and will eventually stop happening altogether in about seven days. Smokers should use nicotine replacement products to help reduce cravings. If the smoker still feels the urge, they can admit out loud to themselves or someone else that they are having a craving. Then they should count to one hundred and let the feeling pass — and it will, usually within a couple minutes.
• Difficulty Concentrating. “Help, I quit smoking and I can’t concentrate!” Some people say nicotine helps focus their attention. When they quit smoking, the increased blood flow and oxygen can lead to a feeling of mental fogginess. If this happens, they should try making lists and daily schedules to keep organized, then set aside some total relaxation time when they don’t have to concentrate on anything!
• Fatigue/Sleeping Problems. Trouble sleeping and fatigue are common symptoms of withdrawal. Because nicotine increases one’s metabolism to an abnormally high rate, when people stop smoking their metabolism drops back to normal, making them feel like their energy level has dropped. So what can they do? They need to get their body used to the new metabolic rate by getting plenty of sleep, whenever possible. Although sleep patterns may be interrupted at first, this is normal and temporary.
• Irritability. If you have snapped at someone or had a new non-smoker snap at you, you know what we are talking about. Irritability is caused by the body trying to adjust to the sudden disappearance of all those chemicals it’s been used to. The best way to handle this is for smokers to simply be honest with those around them that they are trying to quit and they do not feel like themselves.

Staying Quit (Maintenance)

Staying quit is the final, and most important, stage of the process. Many of the same methods can be used to stay quit as were used to help get through withdrawal. A smoker should think ahead to those times when they may feel the urge to smoke and plan on how they will use alternatives and activities to deal with it.

Here are some things a smoker can do if they feel tempted to start smoking again:

• Wait: Cravings are natural and they will pass. Don’t think about not being able to smoke for the rest your life, think about not smoking for the next 10 minutes.
• Remember the reasons for wanting to quit: You only have to go through this once and then you’ll be a non-smoker for the rest of your life.
• Seek support: Call someone. Tell them you are thinking about smoking and ask them to help you through it. Talk to friends who have successfully quit or friends quitting with you.
• Replace the craving with something healthy: Drink water, make yourself a snack, take a walk, exercise, see a movie. Do something to pass the time.
• Reduce stress: Is something happening in your life that is causing stress? Try to let it go, talk to a counselor, take a shower, go work out, schedule a massage… do whatever it takes to de-stress!

What Happens When You Quit?

Many smokers have heard the negative effects of smoking and know that quitting can lower chances of getting related cancers. However, the benefits of quitting begin with the first 20 minutes and can continue as long as one stays quit.

After smoking the last cigarette:

20 minutes

• Blood pressure and pulse drop to normal
• Body temperature of hands and feet increases to normal

8 Hours

• Carbon monoxide levels in blood drop to normal
• Oxygen levels in blood increase to normal

24 Hours

• Chance of heart attack decreases

48 Hours

• Nerve endings start to re-grow
• Smell and taste abilities are enhanced

2 Weeks to 3 Months

• Circulation improves
• Walking becomes easier
• Lung function increases by up to 30%

1 to 9 Months

• Coughing, fatigue, shortness of breath and sinus congestion decrease
• Cilia re-grow in lungs, increasing the lungs’ ability to clean itself, handle mucus and reduce infection

1 Year

• Excess risk of coronary heart disease is half that of a smoker

5 Years

• Lung cancer death rate decreases by almost half, for average (1 pack a day) former smoker
• Stroke risk reduced to that of a non-smoker
• Risk of cancer of the mouth, throat and esophagus is half that of a smoker

10 Years

• Lung cancer death is similar to that of a non-smoker
• Precancerous cells are replaced
• Risk of cancer of mouth, throat, esophagus, bladder, kidney, cervix and pancreas decreases

15 Years

• Risk of coronary heart disease is that of a non-smoker

Why protect your skin from sun?

The vast majority of skin cancers are due to unprotected ultraviolet radiation exposure. Most of this radiation comes from sunlight, but some may come from artificial sources, such as tanning booths. The amount of UV exposure depends on the strength of the light, the length of exposure, and whether the skin is protected.

What happens with overexposure to UV rays?

The short term results are sunburn and tanning. The long-term results are prematurely aged skin, wrinkles, loss of elasticity, dark patches, and skin cancer.

Besides skin cancer, UV radiation also increases the risk of cataracts and certain eye problems, and can supporess the immune systems.

Are any UV rays safe?

UVB radiation is well known to cause damage to the DNA of skin cells. Skin cancers develop when this damage affects the DNA of genes that control growth and division of skin cells. Recent research has found that UVA also contributes to skin cancer formation. Scientists now believe that both UVA and UVB rays contribute to skin damage, including skin cancer. There are NO safe UV rays.

You need to be especially careful in the sun if you:
* have lots of moles, irregular moles or large moles
* were previously treated for skin cancer
* work indoors all week and then get tan on weekends
* live or vacation in tropical or subtropical climates
* have freckles or burn before tanning
* have fair skin; or blond, red or light brown hair
* have a family history of skin cancer, especially melanoma
* live or vacation at high altitutdes
* spend a lot of time outdoors
* that medications that reduce immunity

How do I protect myself from UV?

It is impossible to completely avoid sunlight and it would be unwise to reduce your level of activity because you don’t want to be outdoors. But there are precautions that you can take.
* Limit direct sun exposure during midday
* Cover up: Wear clothing to protect as much skin as possible.
* Wear a hat
* Use a sunscreen with SPF of 15 or higher
* Wear sunglasses that block UV rays
* Avoid sunlamps and tanning booths
* Check your skin regularly for abnormal changes

The ABCD Rule for Early Detection of Melanoma:

* A:
Asymmetry—One-half of a mole or birthmark does not match the
other.
* B:
Border—The edges are irregular, ragged, notched, or blurred.
* C:
Color—The color is not the same all over, but may have differing
shades of brown or black, sometimes with patches of red, white, or
blue.
* D:
Diameter—The area is larger than 6 mm or is growing
larger.

Suicide Warning Signs

• Talk of death, suicide, or harming oneself
• Chronic panic or anxiety
• Constant insomnia
• Altered personality or appearance
• Changes in sleeping or eating habits
• Dropping grades
• Giving away treasured possessions
• Becoming isolated – pulling away from normal social activities
• Talk of depression, life is not worth living

Signs of Depression

• Loss of interest in formerly pleasurable activities
• Dissatisfaction with life
• Withdrawal from social activities
• Loss of energy
• Feeling useless or hopeless
• Irritability
• Great concern with health problems
• Sadness or crying
• Worry and/or self-criticism
• Difficulty concentrating and/or making decisions
• Loss of appetite and weight
• Insomnia or hypersomnia (sleeping too little or too much)
• Psychomotor agitation or retardation (lethargy or excessive restlessness)
• Recurrent thoughts of death

Listen to the “cry for help”

• Express your concern
• Describe counseling services available
• Call the Counseling and Behavioral Health Center (303.871.2205) if you would like consultation regarding how to deal with someone who may be suicidal

What is binge drinking?

• Binge drinking is defined as having five or more (four or more for females) drinks in a row or on one occasion.
• Signs that drinking is a problem: blacking out, missing classes, fighting with others, drunk driving, not doing school work, engaging in unplanned sexual activities, damaged property, gotten in trouble with the law, others mention it is a problem, you think it MAY be a problem

What are the symptoms of substance abuse/chemical dependence?

The following are the most common behaviors that indicate an individual is having a problem with substance abuse. However, each individual may experience symptoms differently. Symptoms may include:

• getting high on drugs or getting intoxicated (drunk) on a regular basis
• lying, especially about how much they are using or drinking
• avoiding friends and family members
• giving up activities they used to enjoy such as sports or spending time with non-using friends
• talking a lot about using drugs or alcohol
• believing they need to use or drink in order to have fun
• pressuring others to use or drink
• getting in trouble with the law
• taking risks, such as sexual risks or driving under the influence of a substance
• work performance suffers due to substance abuse before, after, or during working or business hours
• missing work due to substance use
• depressed, hopeless, or suicidal feelings

  The symptoms of substance abuse may resemble other medical problems or psychiatric conditions. Always consult your physician for a diagnosis.

Treatment for substance abuse/chemical dependence:

Specific treatment for substance abuse/chemical dependence will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the symptoms
• extent of the dependence
• type of substance abused
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

  A variety of treatment programs for substance abuse are available on an inpatient or outpatient basis. Programs considered are usually based on the type of substance abused. Detoxification (if needed, based on the substance abused) and long-term follow-up management are important features of successful treatment. Long-term follow-up management usually includes formalized group meetings and developmentally age-appropriate psychosocial support systems, as well as continued medical supervision. Individual and family psychotherapy are often recommended to address the developmental, psychosocial, and family issues that may have contributed to and resulted from the development of a substance abuse disorder.

Who Gets Stress And Tension Headaches?

Women are slightly more likely to be affected by tension headaches than men. Adults between 20 and 40 years of age are most affected.

The Headache Event

The headache usually occurs on both sides of the head or may be confined to specific areas of the head:

• front (frontal)
• sides (temporal)
• lower back (occipital)

They usually start gradually, taking hours or days to occur. The headache is described as aching, tightness, or a pressure. If not treated, the headache may last for several days or even up to several months or years.

What Triggers The Headache?

There are many triggers that may lead to a stress or tension headache. These factors can include such things as:

• poor posture with prolonged bending of the neck
• depression
• fatigue
• emotional distress.

Also an injury that causes the bones of the neck, back, and shoulders to be out of alignment may cause undue stress or tension on the neck and back muscles. This could result in headaches. A thorough medical and physical exam should help determine if this is the trigger for the headaches.

Therapies for Stress and Tension

Since many of these headaches are caused by tight muscles or muscle spasms along the base of the skull and along the top of the shoulders, therapies that help relax the tensed muscles may be very useful (such as massage). Chiropractic therapy may be helpful if the headache is due to the bones and muscles being out of alignment.

Medications will provide only temporary relief and are generally not the best long-term therapy for stress and tension headaches. Some of the most effective therapies for these headaches involve some type of behavior modification. Aerobic exercise, such as running, brisk walking, bicycling, or swimming may be helpful. Exercising for 20 to 30 minutes 3 times a week has been found to prevent headaches by reducing stress and producing endorphins. (These are the body’s natural pain relievers.) Additional activities useful in reducing stress include biofeedback, yoga, meditation, visualization, guided imagery, and hypnosis.

What Do You Do?

If you suffer from stress or tension headaches, it is time to take a good look at your life. Try to determine the triggers that lead to your headaches. Once you know the triggers, then you can try to find a therapy or therapies that fit into your lifestyle and are most likely to help prevent your headaches. Check with your health care provider if your headaches are persistent or other symptoms are present.

What is stress?

Stress is what you feel when you react to pressure, either from the outside world or from inside yourself (wanting to do well in school, wanting to fit in). Stress is a normal reaction for people of all ages. It’s caused by your body’s instinct to protect itself from emotional or physical pressure or, in extreme situations, from danger.

Is stress always bad?

No. In fact, a little bit of stress is good. Most of us couldn’t push ourselves to do well at things–sports, music, dance, work, school without feeling the pressure of competition. Without the stress of deadlines, most of us also wouldn’t be able to finish projects or get to work or school on time.

If stress is so normal, why do I feel so bad?

With all the things that happen at your age, it’s easy to feel overwhelmed. Things that you can’t control are often the most frustrating. Maybe your parents are fighting, or your social life is a mess. You can also feel bad when you put pressure on yourself, like pressure to get good grades. A common reaction to stress is to criticize yourself. You may even get so upset that things don’t seem fun anymore and life looks pretty grim. When this happens, it’s easy to think there’s nothing you can do to change things.

Signs that you’re stressed out

* Feeling depressed, edgy, guilty, tired
* Having headaches, stomachache, trouble sleeping
* Laughing or crying for no reason
* Blaming other people for bad things that happen to you
* Only seeing the down side of a situation
* Feeling like things that you are used to enjoy aren’t fun or are a burden
* Resenting other people or your responsibilities

Things that fight stress

* Eating well-balanced meals on a regular basis
* Drinking less caffeine
* Getting enough sleep
* Exercising

How can I deal with stress?

Although you can’t always control the things that are stressing you out, you can control how you react to them. The way you feel about things results from the way you think about things. If you change how you think, you can change the way you feel. Try some of these tips to cope with your stress:

* Make a list of the things that are contributing to your stress. Think about your friends, family, school and other activities. Accept that you can’t control everything on your list.
* Take control of what you can. For example, if you’re working too many hours and you don’t have time to study enough, ask your boss if you can cut back.
* Give yourself a break. Remember that you can’t make everyone in your life happy all the time. And it’s okay to make mistakes now and then.
* Don’t commit yourself to things you can’t do or don’t want to do. If you’re already too busy, don’t promise to decorate for the school dance. If you’re tired and don’t want to go out, tell your friends you’ll go another night.
* Find someone to talk to. Talking to your friends or family can help because it gives you a chance to express your feelings. However, problems in your social life or family can be the hardest to talk about. If you feel like you can’t talk to your family or a friend, talk to someone outside the situation. This could be a counselor or your doctor.

Things that don’t help you deal with stress

There are safe and unsafe ways to deal with stress. It is dangerous to try to escape your problems by using drugs and alcohol. Both can be very tempting, and your friends may offer them to you. Drugs and alcohol may seem like easy answers, but they’re not. Using drugs and alcohol to deal with stress just adds new problems, like addiction, or family and health problems.

What are they?

Sprain: Refers to an abnormal stretching or tearing of a ligament. Ligaments are the tough pieces of tissue that hold your bones together. Often, in an athletic event or accident, the ligament between two bones gets stretched in a direction it is not designed to go, or it gets stretched too far. The result is a tear of the tissue itself. These tears can be minor and require only minimal care and time to recover to normal function, or they can be severe and tear the ligament completely in two often requiring surgery to repair.

Strain: Refers to an abnormal stretching or tearing of a muscle or tendon (a piece of tissue that attaches the muscle to the bones). Generally, these hurt a great deal but heal in time and do not require extensive therapy. On occasion, a tendon may rupture or tear completely in two. Sometimes this requires surgery to repair.

What causes them?

Because we are active people, injuries to our ligaments occur frequently doing even just routine daily activities. A common ankle sprain can come able just from stepping wrong or slipping. Knee sprains are fairly common in skiers and other athletes who stop and pivot or who participate in contact sports like football and rugby. Strains of our muscles and tendons happen commonly when we have not warmed up even more before participating in any strenuous activity.

What should you do about them?

1. Initial treatment of sprains and strains is essentially the same and is relatively simple. Because these injuries cause disruption of tissue there is usually bleeding and swelling under the skin. Trying to prevent this swelling is the major objective of initial therapy. Ice is the mainstay of early swelling prevention.
2. For the first 48 hours, ice should be applied to the area affected by the injury. A plastic bag may be filled with ice, wrapped in a dry towel, and placed over the injury. The ice should be left on the injured area for 15 minutes. These 15 minute periods can be alternated for several hours and then repeated later. After 48 hours, ice is probably not helpful.
3. Elevation of the affected body part is also helpful. The elevation should be high enough to get the affected limb above the level of you heart. This may require that you lie flat and put the injured part up on a pillow or two.

Human Immunodeficiency Virus (HIV)

HIV infections weaken the body’s ability to fight infection and can cause acquired immune deficiency syndrome (AIDS) — the most advanced stage of HIV disease. HIV is the most dangerous sexually transmitted infection, and it affects people of all ages. It is now the fifth leading cause of death for American women and men between 25 and 44 years old.

It is believed that at least 40,000 Americans become infected each year. There have already been more than 700,000 cases reported in the U.S. Like many other viruses, HIV remains in the body for life.

Common symptoms

* constant or rapid, unexplained weight loss, diarrhea, lack of appetite
* fatigue, persistent fevers, night sweats, dry cough
* lightheadedness, headaches, mental disorders
* a thick, whitish coating of yeast on the tongue or mouth — “thrush”
* severe or recurring vaginal yeast infections
* chronic PID
* purplish growths on the skin

There may be no symptoms for 10 years or more. In one 20-year-long study, about five percent of men with HIV had not yet developed symptoms.

How HIV is spread: in blood, semen, vaginal fluids, and breast milk by

* anal and vaginal intercourse — less commonly transmitted through oral sex
* sharing contaminated needles for injecting IV drugs
* transfusion of contaminated blood products
* childbirth
* breast-feeding
* accidental pricks with contaminated needles in the course of health care

Diagnosis

There are blood, urine, and saliva tests to detect HIV antibodies. Diagnosis of AIDS is based on the presence of one or more of a variety of conditions and “opportunistic” infections related to HIV infection.

Treatment

No cure or vaccine. HIV infection and many AIDS-related conditions —such as various pneumonias, cancers, and infections that take advantage of weakened immune systems—can be managed to some extent with different treatments. However, at this time, no one has recovered from AIDS. Although people with AIDS are living longer, it is still considered fatal.

Protection

Condoms offer good protection against infection with HIV.

What is chlamydia?

Chlamydia is a sexually transmitted bacterium. It can cause sterility in women and men. In women, it infects the cervix and can spread to the urethra, fallopian tubes, and ovaries. It can cause bladder infections and serious pelvic inflammatory disease, ectopic pregnancy, and sterility. In men, chlamydia infects the urethra and may spread to the testicles, causing epididymitis, which can cause sterility.

Chlamydia can also lead to reactive arthritis — especially in young men. One in three men who develop reactive arthritis become permanently disabled. In infants, chlamydia can cause pneumonia, eye infections, and blindness. Chlamydia is the most common and most invisible sexually transmitted bacterial infection in America. At least three million American men and women become infected every year.

Common symptoms

* discharge from the penis or vagina
* pain or burning while urinating, frequent urination
* excessive vaginal bleeding
* painful intercourse for women
* spotting between periods or after intercourse
* abdominal pain, nausea, fever
* inflammation of the rectum or cervix
* swelling or pain in the testicles

Symptoms appear in seven to 21 days — if they appear. If your partner is a man, and he has a urinary tract infection, you may have chlamydia.

Seventy-five percent of women and 50 percent of men with chlamydia have no symptoms. Many women discover they have chlamydia only because their partners are found to be infected. Other women discover that they must have had it for some time when they are treated for the infertility that it can cause.

How chlamydia is spread

* vaginal and anal intercourse
* from the birth canal to the fetus
* rarely, from the hand to the eye
* rarely, during oral sex

Diagnosis

Can be confused with gonorrhea and other conditions. Examination of tissue samples or urine is necessary for correct diagnosis.

Treatment

Both partners can be treated successfully with antibiotics. Follow-up testing may be suggested three to four months after treatment.

Protection

Condoms reduce the risk of infection with chlamydia

Genital Herpes

There are two forms of genital herpes — herpes simplex virus-1 and herpes simplex virus-2. Although herpes-1 is most often associated with cold sores and fever blisters, both forms of herpes may be sexually transmitted. In fact, most adults have herpes simplex virus (HSV), either type 1 or type 2, or both.

During pregnancy, herpes may cause miscarriage or stillbirth. If active herpes infections are present during childbirth, newborn infants may suffer
serious health damage, including developmental disabilities and, rarely,
death. Transmission to a newborn is more common during the first episode
of the herpes infection and less common during recurrent herpes outbreaks.

More than 45 million Americans have been diagnosed with genital herpes.
At least one million new cases are diagnosed every year. Like many other
viruses, the HSV remains in the body for life.

Common symptoms

* a recurring rash with clusters of itchy or painful blistery sores
appearing on the vagina, cervix, penis, mouth, anus, buttocks,
or elsewhere on the body
* painful ulcerations that occur when blisters break open
* The first outbreak may cause pain and discomfort around the infected
area, itching, burning sensations during urination, swollen glands
in the groin, fever, headache, and a general run-down feeling.

Symptoms usually appear from two-20 days after infection — but it
may be years before an outbreak occurs.

Recurrences are sometimes related to emotional, physical, or health stresses.
During recurrences, it is important to observe strict rules of day-to-day
hygiene. Wash hands frequently and do not touch the sores. If the sores
are touched inadvertently, wash hands immediately. Be particularly careful
when handling contact lenses and touching the eyes.

How HSV is spread

* touching, sexual intimacy — including kissing
* vaginal, anal, and oral intercourse

HSV may be passed from one partner to another, or from one part of the body to another, whenever contact is made with an active herpes virus. Oral sex play can pass herpes from the mouth to the genitals or from the genitals to the mouth.

HSV is most contagious from the time the sores are present until they are completely healed and the scabs have fallen off. Some people may be contagious at various times when they have no symptoms. Mucous membranes of the mouth, anus, vagina, penis, and the eyes are especially susceptible to infection.

Diagnosis

Can be confused with syphilis, chancroid, and other sexually transmitted infections. Definitive diagnosis is possible by laboratory culturing of fluid samples taken from the sores or by blood test.

Treatment

No cure. Symptoms can be relieved and the number of recurrences reduced with the drugs valacyclovir, acyclovir, and famciclovir.

Protection

Partners should refrain from sexual intimacy from the time they know the blisters are going to recur until after the scabs have completely fallen off the healed sores. Condoms reduce the risk of transmitting the virus between outbreaks.

Molluscum Contagiosum

Hundreds of thousands of cases of the virus, molluscum contagiosum, are diagnosed every year. It is often transmitted by nonsexual, intimate contact.

Common symptoms

Small, pinkish-white, waxy, round, polyp-like growths in the genital area or on the thighs. There is often a tiny depression in the middle of the growth. Symptoms usually appear between two and 12 weeks after infection — but it can take years.

How molluscum contagiosum is spread

Vaginal, anal, and oral intercourse, as well as other intimate contact. For example, children may become infected through casual contact. In such cases, growths may appear on other parts of the body, especially the abdomen.

Diagnosis

microscopic examination of tissue taken from the sore

Treatment

Growths may be removed with chemicals, electrical current, or freezing.

Protection

Condoms reduce the risk of molluscum contagiosum, but the virus may “shed” beyond the area protected by condoms.

Hepatitis B

Hepatitis B virus (HBV) is a common sexually transmitted infection that can be prevented with vaccination.

About 78,000 Americans get HBV every year because they have not been vaccinated. Sexual transmission of the hepatitis A virus (HAV) is less common. Unlike most sexually transmitted infections, a person with HAV also develops immunity against reinfection. Sex play has a limited role in the transmission of hepatitis C virus (HCV).

Although 90-95 percent of adults with HBV recover completely about five to ten percent of people who get HBV as adults will be “carriers” and have chronic (long-term) infection with HBV. Chronic HBV infection can cause severe liver disease and death. Unless they are treated at birth, 90 percent of the infants born to women with HBV will carry the virus.

Common symptoms

* extreme fatigue, headache, fever, hives
* lack of appetite, nausea, vomiting, tenderness in the lower abdomen

Later symptoms

More abdominal pain, dark urine, clay-colored stool, yellowing of the skin and white of the eye — jaundice

Hepatitis may be invisible during its most contagious phases.

How HBV is spread

In semen, saliva, blood, and urine by:

* intimate and sexual contact, from kissing to vaginal, anal, and oral intercourse
* use of unclean needles to inject drugs
* accidental pricks with contaminated needles in the course of health care
* sharing personal hygiene utensils such as toothbrushes and razors

How HAV is spread

Oral contact with fecal matter through:

* oral/anal sex play
* other kinds of sex play
* sharing needles with intravenous drug use

Hepatitis A and B are very contagious. However, HAV infection is contagious for only a short period of time.

Diagnosis

Blood test

Treatment

In most cases the infection clears within four to eight weeks. Some people, however, remain infected and contagious for the rest of their lives. There are three drugs that can help treat chronic HBV — adefovir dipivoxil, alpha interferon, and lamivudine.

Protection

Condoms may offer limited protection against hepatitis during vaginal, anal, and oral intercourse. Latex or plastic barriers can be used during oral/anal or oral/vulvar contact. But the virus can be passed through kissing and other intimate touching. Children and adults who do not have HBV can get permanent protection with a series of HBV vaccinations. There is also a vaccine for HAV that is recommended for people who may be at risk of infection.

What is the purpose of Occupational Therapy?

The purpose of Occupational Therapy is to help people increase their functional independence in daily life while preventing or minimizing disability. Often Occupational Therapy is combined with other treatments including Physical Therapy.

These programs are very structured, goal-oriented, and customized to meet the patient’s needs. Occupational Therapy strives to promote emotional well-being, independence, and an enhanced quality of life. It could be said Occupational Therapy teaches life skills.

Occupational Therapy can help a person with activities of daily living (ADLs), which include dressing, bathing, food preparation, and return to work or school following injury or illness.

What is an Occupational Therapist?

Prior to becoming an occupational therapist, students must obtain a Bachelor’s, Master’s, or Doctoral degree in Occupational Therapy and pass a national licensing examination.

Their education includes (but is not limited to) anatomy, human growth and development, the physiological and emotional effects of illness or injury, and supervised clinical internships in different health care settings (e.g. hospital, rehab center).

Occupational Therapy Assistants are required to complete a two-year Associates Degree in Occupational Therapy. Both Occupational Therapists and PTAs work in hospitals, outpatient clinics, rehabilitation centers, home health agencies (homebound patients), and private practice.

What does an Occupational Therapist do?

Usually the attending physician prescribes a course of Occupational Therapy. The occupational therapist assesses the patient’s general health, past medical history, and functional abilities to determine areas of weakness or lost function. The therapist may visit the patient’s home or place of work to evaluate the environment.

The therapist can then address those weaknesses to help the patient be more productive in all areas of their life. Occupational Therapy may include therapeutic activities, exercise, simulated work tasks, and special devices designed to help the patient such as a walking aid (e.g. walker, cane).

Adaptations to the home or work environment may include handrails, ergonomically designed furniture, foot rest, stairlift, or items that make opening jars easier. The list of creative solutions is practically endless!

Who benefits from Occupational Therapy?

Patients of any age with low back problems, rheumatoid arthritis, spinal cord injury, fractures, learning difficulties, stroke, an injury sustained during a fall, and many other problems.

Winston Salem Health Occupational Therapy Information Source: Dana L. Davis, MPT and Spine Universe

Two categories of stalking behavior:

“Love Obsession Stalkers” (20 – 25%) – develop love fixation on another person w/whom they have never had any personal relationship. May stalk celebrities or regular, ordinary people.

“Simple Obsession Stalkers” (70 – 80%) – have had a personal or romantic relationship w/their victims before the stalking behavior began. Victim usually has become the stalker’s sole source of self-esteem. When victim tries to break off the relationship, perpetrator’s thinking evolves from “If I can just prove how much I love you” to “I can make you love me” to “If I can’t have you, nobody else will.” Stalking cases which developed from domestic violence patterns are the most common and potentially lethal.

Stalking is a crime in all fifty states. It is essential to document every stalking incident very thoroughly. Victims may seek to obtain a restraining order from the local court. Nevertheless, restraining orders are not foolproof and may create a false sense of security. Victims may also use the law when they determine that the perpetrator has broken the law by entering the victim’s residence w/out permission, by stealing or destroying property, or by physically assaulting the victim.

Stages of stalking

• Mental Obsession: Stalker preoccupied w/intrusive thoughts regarding the victim. Stalker unable to stop thinking about the victim. This type of obsession often occurs at the beginning of a relationship during the infatuation stage, or at the end of a relationship when the stalker feels rejected.

• Surveillance: The stalker follows the victim to collect information. Surveillance allows stalker to watch victim in natural habitat. Info about the victim collected from various sources &mdahs; observation, coworkers, friends, family, and unsuspecting others. Direct approaches range from reading victim’s mail to going through victim’s trash.

• Harassment: During harassment, the stalker attempts to either seduce or intimidate the victim into compliance. The stalker crosses the line from observation of to interaction w/the victim. In the beginning, the stalker may attempt to be attentive, charming, or even romantic. The stalker remains congenial as long as the victim responds favorably. However, if the victim rebuffs or ignores the stalker’s attempts at courtship or control, a more negative campaign of harassment may result.

• Extermination: This is a lethal phase of stalking because the perpetrator has now realized no possibility exists for any relationship with the victim. The stalker may not see any alternative but to kill the victim and frequently him or herself.

While the progression of these levels is common, no stalking case is completely predictable.

Recommendations

(From the National Victims Center) — presented in order of escalating danger from preventive measures to responding to imminent danger:

1. Notify the stalker to stop. You or your attorney can send a registered letter to the
   stalker requesting that the behavior cease. Treat all threats as serious and notify law enforcement immediately.
2. Tell everyone you know what is going on. Give residence hall directors, campus security, friends, coworkers, relatives, and neighbors a description or picture of the stalker and vehicles, and have them document everything they see. Warn them not to give the stalker any information about you. Have coworkers or family members screen visitors and calls. Give your address and phone number to as few people as possible.
3. Document everything carefully. Take pictures of destroyed property, injuries inflicted on the victim, or other evidence. Save all letters or notes written by the stalker. Save answering machine messages. Log dates and times of all unwanted contact.
4. Secure the residence. Change locks and secure spare keys. Install solid doors w/deadbolt locks. Post a “no trespassing” sign on the edge of your property. Improve lighting and visibility around your house. Change your phone number to unlisted. Obtain a post office box.
5. Vary your behavior. Don’t follow the same routine every day. Change your driving routes and times when you usually do things. Limit or eliminate walking or jogging alone. Try to stay in public places.
6. If you move don’t leave a “paper trail” by having mail forwarded to your new address. Take all records (medical, financial, school) with you.
7. Take care of yourself. Join a support group or consider therapy to help you deal w/stress. Develop your support system.
8. Develop a safety plan:
   • Or have quick access to important phone numbers including:
     Law enforcement
     Safe places (friends, shelters, etc.)

     Attorneys
     Trusted people to help you when safety is secured (child care, pet care, etcd.)

   • Be ready for a quick departure:
     Pack a small suitcase for yourself (and children)
     Have reserve money stashed
     Gather critical documents (birth certificates, prescriptions, social security information, passports, creditors’ numbers)
   • Alert critical people of your situation:
     Family and friends
     Law enforcement/security

     Employers/coworkers

9. Victims in Imminent Danger: Attempt to locate a safe place:
   • Police stations
   • Residences of family or friends
   • Shelters or local churches
   • Public areas (stalker may be less likely to create a public disturbance)
10. Call 911 or other emergency number

Note: The above information is not intended to be a strict set of guidelines, but rather to give victims options. Unfortunately, there is no guarantee that if you follow any or all of these suggestions that you will be safe.