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Weight gain and prostate cancerOne of the hormone therapies involves increasing the production of LH-RH. Luteinizing Hormone-Releasing Hormone (LH-RH) is a hormone which is produced by your body. This lessens the production of testosterone. The drug given induces the generation of this hormone. One of the side effects of this therapy is weight gain. Along with this, breast pain, hot flashes, nausea, and growth of male breast tissue might occur. Apart from hormone therapy side effects, the presence of fatigue can also stop a patient from regularly exercising, thus, resulting in gaining weight. However, it is important that this weight gain is averted as the chance of cancer returning is a possibility. You can keep your weight in check by following these tips: Ask your doctor if your hormone therapy can lead to weight gain. If you receive an affirmative answer, then ask for a diet chart to be followed. You can also keep a food and activity journal to get an idea of how your body is reacting to the treatment. Inculcate physical activity in your schedule. This will not only help to reduce fatigue, but also keep at bay the chances of becoming constipated or feeling nauseous. Medical studies have shown that cancer patients must have at least 2-1/2 hours of moderate physical exercise per week. Have about 2.5 cups of fruits and vegetables every day. Also, shift to whole grain food items. You should also consume at least a cup of legumes, for example, beans, to keep up your protein levels. It is best to opt for lean protein snacks like yogurt and chicken. You must stay adequately hydrated during your treatment. Drink about 10 to 12 glasses of water everyday. Do not consume excessive amount of sweetened beverages like coffee and cola. Have a small portion of nut and nut seeds. If you feel distressed due to the therapy, go for a massage. These have been proved to reduce anxiety and stress caused during the treatment of cancer. Most importantly, keep up with your appointments with the doctor and convey the bodily changes that you may notice. Have an optimistic outlook towards the treatment and do not repress any emotional disturbance. Weight gain in men who had been previously healthy often leads to depression regarding weight issues. Being proactive and focusing on keeping your weight under check is the key here. You could also approach a psychologist if you have been feeling low. The LH-RH therapy is also known as Androgen Deprivation Therapy (ADT). This therapy leads to a weight gain of around 9 pounds within a year of starting treatment. You can make sure that your weight is controlled by altering your lifestyle and getting adequate physical exercise everyday.
Are you the proud owner of this beer belly?While you must have earned a lot of 'brownie pints', a beer gut is not quite something one can be awfully proud of, as it is positively dangerous for your health. Well for one this condition seems to be a common affliction amongst men more than women (though it isn't entirely unknown for women to guzzle beer). A beer gut is normally found in middle aged men as a token for services rendered to a sedentary lifestyle and hours spent accumulating empty calories. How is a beer belly formed? A protruding mid-section in men is generally formed when they consume more than they burn off. So given a busy lifestyle with very little exercise and discretion one generally can end up consuming lot many calories than one is willing to toss out. According to Dr Michael Jensen MD, endocrine and obesity expert at the Mayo clinic, the liver burns calories earned from alcohol instead of the existing fat. So say, if an average beer is around 150 calories plus all the tiny appetizers one has along with the beer (Pizzas, cuts, chips etc.) one can easily understand how these go about accumulating around the belly area in to a paunch. And because the liver was all too busy burning the calories guzzled from the beer, the rest finds a cozy place to settle around the tummy. This is exactly what gives majority of men and some women the infamous paunch or beer gut! GIVE YOUR PAUNCH A PUNCH IN THE FACE Well for starters be a giver and not a taker. Which means give more time to exercise like running, cycling, swimming, skipping, dancing or aerobics which should take care of visceral fat (which is easiest to shake off, by the way). As one ages their calorie needs go down, but then so do their physical activity levels and this is where the fat creeps in. Stick to light beer if you must but do not miss your exercise regimen for anything in the world.  
Marrying late in lifeConventionally, the marriage age is determined according to the linear formula of happiness that we have constructed and believe to be true. The formula being: getting married by 24 --> having children by 27 --> working (optional) --> becoming a grandparent (that too, real soon!). However, time and again, men and women wandering in their 40s-50s have woken up from the deep disturbed slumber to realize that maybe- just maybe, they had walked into things too fast. They had been unable to know who they are and to become a self-conscious human being before being ready to fuse their lives with another. The prime point of being single and marrying later in life is not to go on some form of egoistic joy-trip but to be able to know oneself and become ready to be the right person for the other. By marrying late, you give yourself time to experience freely what you like and dislike. You get to explore the world at your own terms- travel whenever you want and involve yourself in festivals and activities that manifest who you are. Marrying early doesn't allow for time to explore one's being, as marriage generally immediately follows the time you finish your studies or begin working. One of the most important aspects of adulthood today is travelling. However, every individual has unique wants of travelling and being a single adult will allow you to experience the world fully. You will also get in touch with yourself, exploring how you would like to live. The decision will arise from a ground of experiences which would clearly tell you what repels and what appeals to you. Such experiences are rarely findable once you begin living with another, as you would have to schedule your days and basically, your routine around the other's life as well. Financially, you have reached a point where you know how to take care and manage finances, allowing you to plan your wedding pragmatically. Marrying at a later point in your life allows you to be clear about when you would like to be a parent. Your experiences also ready you to be a considerate and understanding parent who can guide a child. As you grow older, you tend to become more tolerant and the propensity towards differences turning into unnecessary fights is lowered. As our ways of looking at the world change, every person as an individual has the need to learn to see the world as a home. This feeling of being at home is created only through series of experiences one has to go through as a responsible adult. In the face of inexperience, two individuals coming together often find themselves incapable of being happy with one another. Marrying later allows you to have grown into a wiser person yourself before sharing your life with another.
Fitness mantras during pregnancyYou must be wondering how Shilpa Shetty maintained her fitness even after bearing a child. The simple answer is that she never gave up exercising. Exercising during and after pregnancy is the best way to stay in shape and ensure your mental and physical healthiness. It also helps you in preparing for labour pain and delivery, and quick recovery postpartum. However, there are some things you need to keep in mind while exercising during pregnancy: Measure your fitness You need to determine how fit you are. This will help in determining the type and duration of exercising during pregnancy and post pregnancy. Also, before you continue your old exercise routine or begin a new one, you should talk to your doctor about exercising while you're pregnant. Pregnancy is a balancing act After the fourth month of pregnancy, it's likely you will lose balance while you exercise. Though your baby is well protected with amniotic sac, it is better to be safe than sorry. Safe exercises Activities such as swimming, walking, yoga, pilates, and low-impact aerobics are good choices. Pregnancy is not the right time to start any new intensive exercise, but it is safe to continue with most types of exercise if you're used to them. The things you should avoid Avoid exercises where you are likely to lose your balance or could make you fall or slip. Vigorous or extreme activities such as horse riding, skiing, mountain climbing are out of the question. They carry too high a risk of injury to your tummy. Avoid exercises such as: Sit-ups Standing on one leg Separating your legs widely You should also avoid most contact sports, such as football, basketball and so on. Finally, give racket sports a miss if you're not a regular player as they can be tough on your knees and ankles. Check with your doctor Consult the doctor before starting with any new or unusual exercise. Check for any complications or unusual conditions. Also, discuss for any concern such as: Pregnancy-induced high blood pressure Early contractions Vaginal bleeding Premature rupture of your membranes, also known as waters (the fluid in the amniotic sac around the fetus) breaking early The best outfit for exercise Clothes should be comfortable and loose fitting while exercising. Wear a supportive bra which protects the breasts and is also relaxing. If your shoe size has changed because of mild swelling, you may want to buy a new one. Duration of the exercise Exercising three to four times a week is necessary. This reduces stress, fights fatigue, and stabilizes emotions in early pregnancy. Start gradually, may be with only five minutes a day, if you were totally inactive before. Add five minutes each day till you reach 30 minutes. Also keep in mind to avoid exercise on an empty stomach. Eat a snack 30 minutes before exercise. Never over do Listen to your body when it says 'stop'. Over exercising causes overheating. Raising your core temperature too much can affect the baby adversely. Always sip water before, during and after exercising. Listening to your body when something hurts or doesn't feel right - that means stop. Drink a lot of water Try to drink about two glasses of water two hours before you begin exercising. Take a sports bottle of water with you when you exercise and take frequent sips from it. It's important you don't get dehydrated. This may raise your body temperature, which may not be good for you or your baby.  Keeping these points in mind, exercise to stay healthy and fit. We hope you soon give birth to a healthy kid.  
Stress - Even kids cannot escape!Often when we feel overwhelmed with stress, we go back in the past and reflect. We miss our golden days of childhood.We think of those days with fondness, miss the free and carefree times. We feel like becoming kids again. But the truth is that at no age are we free of stress and worries. It is just that with time, we move on to newer situations and every new stressor seems worse than the previous one. Children stress out too, some more than the others. Stressors Simple things like a test in school, a Physical Training class or poem recital could mean a lot of stress for the little ones. The desire to meet the expectations of parents or teachers also creates tremendous pressure on the children. They are eager to do well at all the times and the smallest failures can upset these kids immensely. Peer groups are difficult to manage. In childhood, the social maturity is not sufficiently developed to handle day-to-day conflicts. Trivial fights or comments from classmates and friends can lead to a long-lasting impact on the vulnerable minds. They get easily influenced by their friends. Elder siblings also play a major role. Some act as mentors, some as bullies. Some cause damage unknowingly, some are plain indifferent. Life is full of new things and childhood is a fast-track learning lesson. Every other day, there is something new a child has to do. Meet a new kid, learn a new subject, try to dodge a ball differently or ride a bicycle without side wheels; there is too much to learn. These cause anxiety and may make the child nervous. Performance pressures, technology, precocity, media influences, etc. are some of the other factors that add to the stress in childhood. Signs Watch out for subtle changes in moods and behaviour. With adults, it is easier to identify the stress and hence rectify it. But with children, it is quite a challenge. Most of the children are themselves unaware of the stress they are facing, they don't understand why they are feeling sad or angry or fearful. They are just not at ease. Inordinate crying or screaming is a common sign. Being withdrawn, aloof and quiet is another way by which kids express their tensions. Physical signs can be seen in basic physiological changes - in sleep patterns (oversleeping or inability to sleep), eating habits (not eating or eating too much), frequent aches and pains, especially digestion disturbances and headaches, etc. Managing childhood stress Pay attention to your child. Listen to what he/she is saying, but also try to listen to what he/she is not saying in words, although only in action. Help the kids open up to you, spend quality time with them and talk to them about everything under the sun. Be well connected with their school teachers and parents of their closest friends. If the need be, please don't hesitate to reach out and seek professional help from psychologists and child counsellors. "One of the luckiest things that can happen to you in life is, I think, to have a happy childhood." - Agatha Christie  
Get the couch potato out to playKids in the modern day are increasingly getting lazier and unfit. Watching TV, playing games on consoles and smartphones, and spending time on social networks is eating into time which would otherwise be spent playing outdoors.The lack of exercise comes with a host of problems, which can affect kids in childhood or later on in life. Therefore, parents must encourage kids to exercise by being an example. However, do keep in mind that there is nothing that will bore a kid than treadmills or lifting weights. Playing sports is often the better way to go. Give aerobics a try Aerobic exercises can help kids to stay fit and also can be fun at the same time. The common perception is that aerobics involve dancing a set pattern. However, aerobics is any exercise that increases your oxygen intake. Outdoor activities can include basketball, cycling, soccer, swimming, tennis, walking or running Along with aerobics, children should also do stretching exercises, which help in improving flexibility, allowing muscles and joints to bend and move easily through their full range of motion. Getting your kids excited It is important, however, to communicate with your child the need to exercise. You could encourage them to take part in outdoor games at school as well as in the locality where you stay. You should regulate the number of hours your kid can spend in front of the TV or PC. This way she will look for means to play outside the house. You can also play with them yourself. It will be fun for the both of you, as well as helps you bond with your child. Exercising for at least an hour a day is ideal, and it broken down into chunks of 15 minutes at a time.  
Afraid of the dark? understand your fear and cure it!Scotophobia, more commonly known as Nycotophobia, is a psychological illness, where the patient is afraid of the dark. Children are more prone to this fear, though it does affect quite a few adults as well. The dark often represents insecurity and uncertainty to children, and it symbolizes their entrance into an unknown territory. If the children are alone during their first few encounters with darkness, the absence of parents (who exemplify safety), tends to amplify this crippling fear. While most of us do actually possess this fear in relatively small amounts, as we grow up the fear diminishes. However, there are those of us who might carry this fear of the dark into their adulthood and in such cases, the fear is usually accompanied by quite a few intricate issues. People often tend to externalize a set of conflicting feelings about a certain situation, towards something else. For instance, you might be worried about your children; but your mind may externalize this fear, via your inefficiency at work. This process is called externalization. So, when it comes to the root of your fear of darkness, it is possible that at some point in your past, you experienced something untoward, which through externalization, inculcated this fear of darkness, deep into your psyche. Evolutionary Ties to Darkness: Many scientists have pointed out that this phobia might be linked to the process of evolution. Since predators hunt for their prey at night, we might have inherited this fear of darkness from our ancestors, who believed that darkness was a space where they could be attacked by wild animals. However, recent studies have shown that  Scotophobia begins at approximately the age of two in children, and thus, it cannot be said to be innate to us. In a study done by Ryerson University involving over 90 students, it was found that people who are afraid of the dark, are more likely to be poor sleepers, than those who are not afraid of it. More interestingly, it was discovered that any kind of noise made while the people with this phobia were asleep, frightened them the most.. Symptoms of Scotophobia: The first symptoms of this fear are the resistance to visit dark places and the yearning for company when such situations arise. However, many a times adults who are suffering from this fear, do not reveal it due to the added fear of embarrassment and this, sometimes, results in outbursts of rage when they are forced to go out for an event at night, or to confront the dark under any such circumstances. A person battling this fear may experience panic attacks, sweating and trembling prior to, or while staying in the dark. The blood pressure also rises, accompanied by chest pain and lastly, a difficulty in breathing. Diagnosis of Scotophobia: In children, this fear can be easily verified by their behaviour. However, adults might require further assistance, due to their natural resistance to openly admit to such a fear. Scotophobia can be diagnosed through a comprehensive psychiatric evaluation. Following this, your psychologist would be able to give you an idea of the source of your fear as well. Pursue a course of treatment immediately after the discovery of the phobia, which will ensure a faster and more effective recovery. Treatment of Scotophobia: The process of 'desensitization' is most commonly used to help with such a phobia. In this form of treatment, the patient is slowly exposed to the object of fear, in a situation where she/he will not feel vulnerable. This is done by asking the patient to confront the dark along with another individual who symbolizes safety for him/her. This could be a parent or a friend. Night lights can also be installed to gradually reduce the fear. You may try certain breathing exercises, which will reduce the panic attacks that accompany this fear. Hypnosis has also been said to be very effective in dealing with this phobia. If your psychologist sees fit, you might be also prescribed some medicines; antidepressants are given in some cases. Joining a self-help group is also a good option, in addition to your psychological treatment.  
How to remember everyone you meet?Now that would be quite a feat, would it not? To be able to recall the name and occupation of every person we ever encountered right down to the minutiae of how, where, and why we were introduced to them to begin with! Sometimes we raise the bar of forgetfulness to the extent of forgetting just who it was who introduced us to "Mr. what's-his-face!" If only there were ways to remember the modest and average people who leave virtually no impression on us, wouldn't that save us great embarrassment? Plus it will help us do away with those sheepish looks when it dawns upon the other person that you haven't the foggiest of notions as to who he is. Stranger: Hi! You remember me? How are you doing, Frankie? Frank: Umm! I am well (this guy's face looks mighty familiar, but for the life of me, I cannot recall ever having cast my eyes on him). Stranger: So, how was your annual bridge completion? Manage to beat the Swiss pairs this time? Frank: Atta boy! Got it! This guy happened to be kibitzing at the weekend bridge club at Aldermere. Whew! Stranger: You gave me quite a start there. You looked right through me and I was quite not pleased at the fact that just last week I happened to congratulate you. Frank: Well Martin, be tough to not remember you, of course I do! Just didn't think of bumping into you here. Martin: Well, I am Walther and I can now see that you don't remember me at all! How many times has the above scenario happened to us? While it is well-nigh impossible to remember every name or face that we come across, it would be  a good habit to at least attempt our 'mental name book' to avoid an occasion for future embarrassment! Now, how in the world does one do that? Simplest way would be to carry a small notebook with a pen to make note of someone that you have just been introduced to, at a meeting or a social do. Our friends often introduce us to people and chances are that if there is no occasion to remember that person, then the brain fades it out of its memory list, as it will only use up space on the brain's 'hard disk.' Human memory might be jogged to remember trivia from 25 years ago in great detail, but ask a simple question - remember what you had for lunch last Tuesday?  - and that would be very difficult to answer, especially if last Tuesday was just an ordinary day with no special reference points around lunchtime to help you remember. Maybe if something momentous had occurred on Tuesday last, like pretty Meg from next door, sharing lunch with you rather unexpectedly, then you can bet your bottom dollar you will remember what you had on the day in question. So create reference points! When you are introduced to someone, first and foremost, reference it with who introduced you and then try and make a reference of at least one unique distinguishing feature in that person. Now you don't really require the eye of a physiognomist, and it would be mighty impolite to stare hard for the "distinguishing feature" coin to drop. So a quick look and you got 'long nose Mary Gomez' all referenced and ready for recall at the next chance meeting. Make the reference phrases funny so that you won't have any problem whatsoever in recalling the name behind the funny phrase when you most require it. Alternatively, try associating a picture with the name if you aren't very good with phrase reminders. These techniques are called mnemonics, which is pronounced ni-mon-nics, and funnily enough the very curious spelling - Mnemonics makes you want to have a picture card memory association for the right pronunciation. A mnemonic for this could be 'knee-moan- knicks". Easy enough, i.e., if you remember the sequence right. You could also try memory exercises with names picked off from the telephone directory at random. Pick an A-lister say - 'Anderson' and then flick through to D and pick 'Dougherty' and so on until you have picked at least 10 names of a different alphabet. Now, try and write down the numbers that you must have undoubtedly memorized until now. You can consider yourself blessed even if you are able to memorize the number of the third person by the time you reach person number 10. This will give you a memory for names and numbers at least. Or, go through any university web sites and look at the photo galleries of past alumni. Give yourself 1 minute to quickly glance at all the names on the page. Then try and recall the name by applying the memory picture association or develop your own technique. With regular practice, you could well be in the employ of the local police to help identify criminals off a line up. If that's too dangerous for you, then at least that will  keep your brain alert and active with this brain gym and help avoid any boo-boos in the future.
High heels can walk you to the hospital bedHigh heels make a fashion statement which makes us look tall, elegant and good but they cause injuries on a regular basis. High heel shoes have been luxury item once upon a time; today high heels have made themselves a part of every girl's life thanks to supermodels and stars. You will not find any health warning on shoes but they ought to, as they seriously put you at a high risk of numerous health problems. How are high heels and low back painrelated? High heels significantly affect your natural posture and your spine. The natural arch of spine becomes acute when walking in high heels. This poses high risk to the spine getting injured. This not only wears  and tears intervertebral cushions called discs but cause injury to the nerves too.  High heels put strain on muscles of lower back causing pain after a long day of wearing high heels. Nerve trapping, nerve pain and radiculopathy can result from wearing high heels for a long period. This is exhibited     as tingling, numbnessand pain. Arthritis, nerve pain, hammer toes, ingrown toenails and bunions are all common problems due to high heels. Calf muscle shortens and tightens after prolonged use. Jogging, playing, running with high-heeled shoes can tear and rupture calf muscles. What can you do to prevent damage? Firstly ensure your body is in top shape before you start. There is a much less chance of developing low back pain if you are strong and fit. So do activities like swimming, pilates, circuit class, box-exercise and whatever else thatmakes you feel good. Focus on activities that make the abdominal area strong includingyour deep core muscles. Secondly a regular regime of stretching will prevent a lot of problems occurring. Either get involved in a yoga class or make sure you do 10-15 minutes of stretching every day. Stretch your back, your calves and hamstrings especially. Thirdly get sports massage at leastonce-a-month. This will loosen the tightened structures, realign the spine and lengthen the hamstrings, calves and Achillestendon
Some tips to prevent night blindnessHere are some foods and eating tips, which will help improve vision and prevent night blindness: Eat dark green leafy vegetables like spinach and collards. These contain high amount of lutein and zeaxanthin, the nutrients for healthy eyes. Do not smoke. A glass of red wine daily is fine but drinking is not. Stay away from hydrogenated oils, refined carbohydrates and sugars in excess. Always wear sunglasses while going out in bright light to avoid potential sun damage to eyes.  Amber and grey-coloured lenses are effective against ultraviolet rays. See an eye specialist and get prescription glasses for driving at night, if required. Do not ride in dim light at night and see if you can postpone the work until next day. Even good lighting conditions at night even in a big city, can be troublesome to someone with night blindness. Vitamin A rich foods like spinach, carrot, papaya, broccoli, and mangoes should be added to your daily diet. Fish oil is a great source of vitamin A. Cod-liver oil is used as medicine too. Some wild plants are said to be rich in vitamin Abut they are seasonal, available in small quantities and there isn't much known about them. Beans are another fairly common source of vitamin A. These are consumed especially during autumn. Eggs are a good source of vitamin A. Eat eggs daily. People with high cholesterol should, however, limit their egg intake. Hot pepper is contains vitamin A too, but the preservation method, sun-drying, decreases the vitamin A content. Carrots are another good source. They are high in vitamin A and arenot expensive as well.
Psychological impotenceSex is not just physical but just as equally mentally involved. Mental stimulation and response are responsible for arousal and overall enjoyment; and therefore any sort of psychological disturbance or mental issues like stress, tension, or anxiety can lead to psychological impotence. Stress or exhaustion are most possible explanations for psychological impotence. Depression and post-traumatic stress disorder also may result in impotence. A mental trauma of sexual or physical abuse, guilt due to sexual relationship, problems amongst partners contribute too. Confusion over one's sexual identity is also a major cause for impotence. Impotence results from underlying physical disorders, especially if the people choose to stay unaware of it. Absence of knowledge of this disorder leads to anxiety and stress building up over a period of time.  So when determining factors rule out physical causes first and then go for identifying mental causes. Psychological impotence can be sometimes situational or only with a particular partner and the treatment approach differs with the cause. Counseling works wonders in the case of psychological impotence. For example, depression or anxiety may require treatment to improve condition. Post-traumatic stress disorder or abuse needs therapy on coping skills. Sometimes simply explaining underlying cause of physical condition resulting in impotence and comfort and reassurance are sufficient. So don't hold back, share to get your mojo back!!
The link between oral sex and cancerSymptoms of oral cancer: The common symptoms of oral cancer include: Red and white spots on the tongue or the lining of the mouth, inflammation of the mouth which continues well over two weeks, mouth ulcers which take over three weeks to heal, discomfort and pain during swallowing food, and lastly, sensation that something is stuck in the throat. HPV types and their nature: There are over 100 different types of HPV. Out of these, 15 have been found to cause cancer. These 15 types of HPV are called high-risk HPV. The HPV types which are found in the mouth are sexually communicable and the primary means for its transference is considered to be oral sex. It could also be carried through anal and vaginal sex, causing laryngeal cancer, anal cancer, cervical cancer, tonsil cancer, vulval and vaginal cancer, and penile cancer. Some of the HPV types get passed through skin contact. These cause warts, especially in the genital region. These types of HPV which cause the warts are less likely to escalate and cause cancer. Though there is no determinate answer as to how common the HPV mouth infection is. Advanced studies during the 21st century have put forward the role of HPV16 in new types of cancer. This was done using DNA testing. Through a medical study, it was found that the most vulnerable groups are: People in the age group of 30 to 34 and 60 to 64 years old. People who have had over 20 sexual partners in their lifetime, around 20% suffer from HPV oral infection HPV leads to cancer?: HPV does not directly cause cancer. It stimulates modifications in the cells which it has infected, like those in the mouth or cervix and due to the modifications the cell becomes cancerous. In only 10% of the cases where the patient suffers from HPV infection does cancer develop. The infection generally treats itself and is removed naturally within 2 years by the body. The chances of progression of the HPV infection into cancer is increased by smoking and drinking. Smoking injures the immune surveillance cells. Due to this injury, they are not able to fight the virus and the virus continues to persist over 2 years, leading to cancer. Vaccinations: In the United Kingdom, girls (aged 12 and 13 years old) are vaccinated against HPV. This vaccination protects the women against cervical, vulval, and vaginal cancers. Men and boys also take vaccinations against HPV, though it is not pursued as strongly as in the case of women. This leaves men who have sex with other men at a greater risk of getting oral and anal cancer. Even though the link between oral sex and cancer is not completely proven, what we do know is that oral sex causes many other infections like gonorrhea, herpes, syphilis, and chlamydia. Did you know that a very low percentage of people (only 10%) who are infected with HPV virus develop cancer? In 90% of the cases, the infection is naturally cleared by the body within two years. The natural process is, however, obstructed in those who smoke and drink.    
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