Smoking shisha; is the WHO right?

I have decided to write an article because I had once been asked to smoke shisha, being insisted that there were no health implications involved and shisha was essentially the perks of smoking without the drawbacks, such as the continuity of use being able to possibly cause lung cancer! My decision to write this article was also perhaps encouraged by the growing market of shisha, which to has seen roughly a 210% rise in the number of cafes offering in since the smoking ban was implemented in 1 July 2007, as reported by the Independent. Moreover, there were 179 shisha bars in 2007 but there were 556 in 2012. So I now will begin writing a little bit of what I know to do with this subject.

“An oriental tobacco pipe with a long, flexible tube that draws the smoke through water contained in a bowl” describes ‘hubble-bubble’, ‘hookah’, ‘waterpipe smoking’ and any other alias the infamous shisha tends to spread under. First discovered by Abul-Fath Gilani according to popular belief, the upcoming craze originated from the humble, and likewise, booming country that used to be Persia; India – though this is said to be a disputed merit.

Shisha, often written under as a safer alternative to cigarettes, is a ‘glass-bottomed waterpipe’ which emits radiant fruity smells of your desires. But, surprisingly, for such a simple task of smoking, shisha requires a rather sophisticated device, inclusive of many components from grommets to diffusers. Thus, there is already a physical distinction from its cigarette counterpart. However, it is from the water jar where, unsurprisingly, most of the common misconceptions about shisha arise.

So the misconceptions, which are often seen as a major contributor to why shisha has become increasingly popular since the noughties, become intriguing as a blur between fact and fiction becomes visible. The first main myth to this tobacco craze would be the bubbling water creates the illusion of the smoke being cleansed and purified thus apparently being made healthy. Although, in reality the water, bubbling it may be, does not filter out all the toxins and the fruity smell is only the guise for the smoke which contains the otherwise cancer causing chemicals. Dr Sellehudin Abu Bakr even goes as far as to call the water ‘filter’ a ‘gimmick’. Additionally, passive smoking can be dangerous as it can be the smoke and its composition which causes harm. In the smokes composition exist an addictive substance: nicotine, which can cause a dependence upon this social commodity which increasingly seems harmful. Unfortunately, this is not where the problems end, as sharing a mouthpiece increases the risk of infection with TB or hepatitis, both of which come with disastrous implications.

As a result of public unawareness, the World Health Organisation (WHO) had, from their research published as ‘Waterpipe Tobacco Smoking’ in 2005, which found that, contrary to ancient lore and popular belief, the smoke of shisha contained many toxicants which can cause lung cancer, heart disease and can have other detrimental effects to your body. The WHO also came to the conclusion that 1 hour of smoking shisha is equivalent to up to 200 cigarettes worth of smoke, and this isn’t particularly ‘good’ smoke as the heat sources for shisha are often cinders or charcoals. These are dangerous as they release carbon monoxide.

Additonally, shisha delivers nicotine which as many of you may know, is an addictive substance. Despite the water absorbing some of it, it still enters your body in substantial amounts, so much so, that it can cause addiction, like other tobacco products. The study also highlighted the dangers of second-hand shisha smoking. So by even entering a shisha bar where others are smoking, even by not smoking yourself, you can still be endangered. Also, another important note to focus on is that in this research, they had showed shisha, like cigarettes to contain the capacity to have an adverse effect on the unborn baby during pregnancy. So by smoking shisha, one can potentially harm their baby.

Therefore, one must ask the question on whether smoking shisha is really as harmless as others advocate. In light of the WHO research, it becomes increasingly clear that there are dangerous aspects to this craze, but the research isn’t conclusive enough, many seem to argue. Thus, in order to really clear the misconceptions surrounding shisha, more research needs to be carried out.

Accutane – Month 4, Day 107 , week 16

7:06:2010 – Returned to the hospital to see the dermatologist, who increased my dose from 30mg a day to 60mg, which I still take in one go.

The affect has been very quick all the acne is starting to diminish under this heightened dose. I no longer have any active acne on my arms or chest and my back is clearing up also. Obviously along with this my skin has become very very dry and almost flaky. Im now using two moisturizers on my face along with aloe vera gel, which was a really useful tip from “highonhealth.com”.

I am not getting many adverse side effects from the drug. I certainly dont feel suicidal or even depressed. At some points, whilst I was on the lower dose I had some moments of feeling very down, but these were when I was very tired. I think being on the drug made those moments worse, rather than actually causing them.

Recently I have given up caffeine and am sleeping much better as a result of this and have not had one of these moments for a while. <(-_-)>

Still have not had a single nosebleed since applying vaseline constantly twice a day. Again <(-_-)>

 And my skin is looking is looking the best its looked for a very long time. <(-_-)>

Isotretinoin – Month 3, week 10, Day 68

7th May 2010: Roaccutane is working very well. All the huge cysts have gone from my face now and I have only small pimples, which come and go within a few days.

My lips are extremely dry and even excessive use of lipsyls wasn`t working – also I don`t like using vasaline. However I have found that one works very well now – called aloe lips, making the whole experience a lot more comfortable. My skin was becoming very dry as Istopped using the “simple” mositurizer, because it had stearic acid (comedogenic) within it. However one trip to Boots produced a non-comedogenic moisturizer, which has fixed this.

I have only a couple of tiny marks left on my chest now, which I’m pleased about and all the acne on my arms and back is drying! Hah! However it seems to mark the skin on my arms really badly – much worse than it marks my face. However other marks that I have had here have faded over time – so I remain confident.

The nosebleeds have stopped completely – with the use of vaseline on the inside of my nose.

A couple of weeks ago I got a strange rash on my arm- it was a patch of extremely dry skin and it looked very like eczema, which I have never had in my life. Thankfully it has gone , with the use of moisturizer on the spot.

 My GCSEs are approaching and the “stress” doesnt seem to be causing any breakouts. YEY!

 I return to see the dermatoligist, probably to get my dose upped – in exactly one month – 7th June.

Isotretinoin – Day 37

The Initital breakout sucked…

Between weeks 2-4 I developed many pus filled cysts, especially on  my cheeks. Now at the beginning of week 6 they are all going down: “slowly but surely” is an idyllic, apt thrase for the improvement.

My lips are incredibly dry (no matter how much vaseline I apply) and without the use of an intense moisturizer my skin gets very dry also – but those side effects were not unexpected and are in some ways reassuring as they show it is working.

The acne on my arms, back and chest is all reseading also. I love not having to use the blue light for hours and applying Benzoyl Peroxide (such a fowl chemical) to my skin, but my acne is still improving: at the moment I love this drug.

 Side effects so far; Dry skin and lips, headaches (occasionally), nose bleeds (from time to time – must remember to apply vaseline to the inside of my nose everyday – dont want to have one of these whilst at school), very dry hair, less reistance to disease ( I’ve had a lot of colds, which I usually dont get!).

Isotretinoin – Day 8

8 March 2010: Have now taken 240mg of Isotretinoin in total and can definately feel it within me. My lips are now really dry and begin to crack, without the use of vaseline. My skin feels more fragile – when I apply moisturisier it stings a little (the way it used to when I first started using benzoyl peroxide) and I can see now why the dermatoligist wanted me to stop all other treatments.

 Last week I suffered from a few minor headaches. I think this may have been whilst I still had moderately high doses of tetracycline in me, which increases the risk of “idiopathic intracranial hypertension” – basically headaches. These have now ceased, which has pleased me since it suggests that it wasnt accutane alone causing them.

Positive: My acne has not broken out as badly as I expected. I expected that it would return, as it was before christmas – severe nodulocystic. However since starting accutane I haven’t had a single cyst develop (on my face anyway – I don’t look at my back). I have had a lot of new spots come, but they are small, come to a head and heal very quickly. Much quicker than I think they would if I was not taking isotretinoin.

Isotretinoin – Day 1

March 1st 2010:

Returned to the dermatoligist today, with healthy blood tests, and was finally put on a generic form of Hoffman Laroche`s (Ro)accutane. I weigh 63kg and was therefore started on 30mg daily ( 0.5mg/kg/day).

Picked up the tablets from hospital pharamacy the same day and then returned to school. I was in an ecstatic state all day. Have disposed (finally) with my tetracycline tablets and benzoyl peroxide creams – it was a very good feeling.

I plan to continue using the blue light therapy (less frequently) throughout the first months of accutane use, to help it along a bit. I am a little nervous about the drying affect of Isotretinoin, but am confident that it cannot be much worse than what benzoyl peroxide did to me when I first used it.

Am about to take the first capsules with dinner now – I am sure that in 4/5 months time I will be extremely glad of my decision to take this drug.

Roche Accutane (isotretinoin) – “magic cure” or ”dangerous drug”

This is a matter which has concerned me for a long time – is Ro-accutane safe?

I, as I’m sure have many, have read a huge amount of content both pro and anti Ro-accutane.

There are many accounts of its success, but also its potential side effects. Some websites even seem to imply that there is a liklihood that it will kill you – this worried me hugely. But after speaking to a professional consultant dermatologist I am far less worried. He told me that he has treated thousands of people with isotretinoin and most experience only dry skin and chapped lips, with some occasionally getting joint aches.

Therefore to me it seems that the side effects of this drug are completely over hyped. The worst culprits for this, I feel are companies trying to sell you “acne vitamens”. To me this implies that if they feel the need to discredit Ro-accutane, it is most likely because it achieves better results than their product does. 

Therefore I have personally come to the conclusion that only one who has never suffered from acne would argue that Ro-accutane is definately not worth consideration. However I do acknowledge the very real danger posed to pregnancies, of those on this drug.

Isotretinoin – my only option.

Although the skin on my face is 100 times better, my back, chest and now arms also, are terrible. I cannot treat it with BP, for I would use a whole tube each time I applied it and the blue lamp is so time consuming already just using it on my face, so I cant use that either.

Feb 2010: I went to see an NHS dermatoligist (we decided against private as my skin was improving with topical treatments), with the intention of asking to be put on Ro-accutane (isotretinoin) or one of its generics. When I asked, and with only my newly improved face to go on, he looked very sceptical as to whether I needed Ro-accutane. But after I showed him my back and arms (my chest is not really that bad) he agreed instantly.

Now, in the UK, the prescription procedure for R`tane is much quicker (no i-ipledge), all I had to do was have my blood test fine. I had my blood taken, at the GPs a few days after and expect them to be fine. I return to see the dermatoligist on the 1st march 2010 and presuming my blood tests have been fine, i will be prescribed it and begin the course the same day. I dont yet know how long im going to be put on it for and at what dose – that will be determined 1st march. At present I am a little concerned as to what will happen to my face when I drop all other treatments ( as you have to when taking R`tane). Isotretinoin is suppose to cause an initial breakout anyway – so I am certainly not looking forward to the first month on it. My derm did say that if it gets really I can come back and be prescribed “emergency” steroids to prevent the inflamatory response.

Photo therapy and its dramatic effect on me

December 2009: Whilst my mother was trying to get me a private derm, my father was also spending money to try and solve this for me. It was really damaging my self esteem and I had no motivation to do anything other than watch tv and escape reality through computer games, such as Runescape.

At the time I was also doing my GCSE mocks, which didn’t help by adding to my stress. Anyway my dad bought an acne lamp, which effectively is just a blue lamp. You hold this to your skin and it activates some chemical in the bateria causing them to fry themselves. I`ve heard that if you have this treatment done prefessionally it hurts quite a lot, but I personally have noticed no side effects.

Within about three weeks the skin on my face was looking so much better I no longer had huge cysts and nodules and had fewer pimples. The change was incredible. However it would be unfair to attribute all this improvement to the blue lamp. I was still taking Lymacycline (although this is clearly not the reason for the improvement since I still have sever acne on my back and chest) and I was still using benzoyl peroxide. Together it seems BP and the acne lamp have cleared up my face considerably, to the point were I have no more acne than most people in my year at school (Year 11) and I was so much happier with my life, come new year.

2010 had started on a positive.

Severe Acne vulgaris and its affect on teenage psychological health

November 2009: My acne had become severe, I would have described it as acne fulminaris. My dermatolical appointment was not until february 2010. I was desperate and began to search the internet. I came across the website acne.org, which heavily recommends benzoyl peroxide. I had heard that this was extremely irritating and dryed your skin out terribly.

However i really didn’t care anymore so went to the chemist and bought BP 10%. My face went bright bright red and flaky and I immediatly abandoned BP and returned to adapalene.

December 2010: Acne getting really severe, with huge nodules and cysts starting to join together – to form like a riverworks of acne. I am forced to re-try BP. This time 2.5% and with a good mositurizer. It doesnt have the severe affect as it did the first time. It seemed to be drying the spots out effectively but I had so many at this point that I could see no dramatic improvement. My acne was so bad my mother thought that I could have a secondary infection and retruned me to the GP to ask to see a private dermatoligist.

Erythromycin for Acne treatment

September 2009: My acne was beginning to become nodular and it was covering my back and chest. Therefore my mother insisted that we return to see the doctor, although i at the time was adamate that commercial products would eventually work. The doctor kept my on adapalene, which i had continued to use with commercial products. But changed my antibiotic prescription to erythromycin.

I was sceptical at the beginning, thinking that this would do nothing – how wrong I was. Within 2 weeks I was completely, and I mean completely clear. I was ecstatic, unfortunately the results were short lived. The bacteria became resistant very quickly – in about 2 weeks my acne was descending back into its prior severity and the erythromycin was starting to have its common side effect of making my skin ridiculously greasy. Moreover I begun to acquire strange rashes on my arms ( target shaped), which on examination of the leaflet proved to be a known side effect of erythromycin. My doctor removed my prescription immediately and returned me to lymacycline. He then refered me to an NHS dermatoligist for stronger treatments.

Commercial treatments – creams/scrubs/washes/gels – CLEARASIL

August 2009: However no good thing lasts forever and in the summer of 2009 my acne entered a stage, which one would dub: moderate. I, in my ignorance, presumed that the medication prescribed by my GP, didnt work properly. I prefered, foolishly I see now, to place my trust and reliance in the hands of the commercial products.

I tried loads of exfoliating scrubs, ( the one i found worked best was St Ives), antiseptic washes (boots, clearasil, clearasil ultra ect). I must have spent hundreds of pounds and hours upon hours in the bath and shower, but nothing worked. I found however that my condition did inprove after strong exposure to sun light but I would not advise this as a treatment, as it can have disatrous long term affects.

Developing Acne Vulgaris

December 2008: Soon my skin condition began to get worse. It started getting worse as winter came and I spent less of my time exposed to UV (which is known to effectively kill proporibacterium – but which is never used as a treatment due to its long term damage on the skin). Therefore I once again returned to the doctor for a new treatment.

He gave me an adapalene gel (Differin) and an antibiotic (Lymacycline/ tetracycline 300mg). The combination had a miraculous effect and cleared most of the acne, within a month. I continued to use the treament for about half a year and although it never had me completely clear, I had only a couple of small pimples, which was commonplace within school.

Mild Acne, at the age of 13.

Guest blogger saying hello 

I am currently 15 years of age (15 and  1/2 to be precise) and I have suffered from acne for around 2 years. Originally it was extremely mild and my GP prescribed me Zineryt, which was intended to kill the proporibacteria. I do not fully know the effectiveness of Zineryt, since at the time, the acne was so mild, I thought it not worth my time trying to fight it. Therefore I only occasionally bothered to apply and consequently it had very little affect.