Up in Smoke

 Bumming cigarettes doesn't make you any less of a smoker. Quitting does.

More and more I hear gay men and women say they're cutting back on cigarettes like they're cutting back on calories. But when it comes to quitting smoking, you can't apply dieting logic. True, smoking less does reduce your exposure to harmful carcinogens, and it's better than smoking more . However, even while cutting back you continue to inhale fumes that damage your lungs' alveoli, where your circulating blood absorbs oxygen and releases carbon dioxide. Alveoli don't grow back, so if you destroy them, they're ruined forever. The good news is that there are viable medical treatments to help you quit, like Zyban and Chantix. The better news is that after one year off cigarettes, your risk of heart disease is reduced by half; after 15 years off, there's no more risk of heart disease than if you've never smoked at all.

Doctor, I'm Dancing as Fast as I Can
Adult attention deficit disorder is quickly becoming the new gay "wastebasket," or faddish diagnosis some doctors and patients are clinging to in an effort to keep up with our 24-7 culture. Hardly a week goes by without my hearing of some gay man or woman who has taken extreme measures to get an ADD diagnosis in an effort to keep up with the false perception that gays are sharper, more alert, and less fatigued than everyone else. ADD assessment begins with a review of symptoms (unable to stay focused or complete tasks, trouble maintaining relationships), but a physician must first rule out thyroid disease, anxiety, depression, and menopause. I recommend my patients see a psychiatrist for confirmation of ADD before I begin treatment. Beware of doctors who dole out amphetamine-based medication without legitimate evidence to warrant its use. Prolonged exposure is associated with mood swings and increases in heart rate and blood pressure, none of which is worth going through just to get to the end of your to-do list.

Oral Sex and HIV

There was a fascinating study that came out of Sweden recently. Researchers there looked at 25 HIV-negative men in serodiscordant relationships and found that after repeated unprotected oral sex with their HIV-positive partners, 13 of the men had developed neutralizing antibodies in their saliva, protecting them from contracting the disease orally. If such antibodies develop in the saliva, they could provide a first-line host defense against infection. And if repeated exposure has the potential to strengthen the immune response, this might explain why the rate of HIV transmission through oral sex is low, even in serodiscordant couples. This doesn't, however, negate the fact that HIV can be contracted through unprotected oral sex.