My last gasp of childhood took place at my Uncle Ron (Mother’s brother) and Aunt Thelma’s house in the country in Indiana’s beautiful, lush, hilly Brown County.

I was 13, working hard at being a teenager, and had been invited to spend the late-summer weekend in the country. It was a good deal for me because this aunt and uncle had four boys, so I always got special treatment.

The oldest of the boys was my cousin Tom who was a year younger than me. When I was very young and we lived not too far away, Tom and I had been good pals.

Tom had white-blond hair and a slow southern Hoosier drawl. He was infamous for not being able to resist any dare. (I knew this because my cousin Rhonda and I had tested him thoroughly–daring him to jump out of trees, walk across the narrow, high rail of the bridge over the creek by our grandparent’s house and hurtle himself down the rocky “cliff” that was a frequent play area.)

I always thought Tom and his brothers were more at home in the woods and fields than their own house. So, as to be expected, when I arrived for the weekend we immediately headed out back to the creek and woods.

We waded along the creek until we came to what looked like a great swimming hole. Best of all, some limbs of a tree on the south bank were exposed, one curving out over the water. We fooled around for quite a while, trying to attach a “diving board” onto the root and swimming in the creek.

Next we decided to build a primitive raft to float down the creek. When we couldn’t gather enough fallen logs, Tom ran back to the house and snuck back a small axe. We hacked down a few little trees in the woods to round out our stock.

(Later we found out they were young oaks. Tom caught the devil from Uncle Ron but I got off the hook because I wasn’t from the country and didn’t know they were valuable oaks–and because I was such an “innocent” girl.)

Bound with rope, our raft bobbed and dipped down the creek–a trail of tree trunks and branches in its wake.

That night, after a meal at the house, we headed back to the creek and built a bonfire on a sand bar to cook our dinner. Tom climbed into the house via a window and came back with purloined butter and hot dogs. We dug potatoes and picked sweet corn in the garden. Tom had read that the Native Americans cooked potatoes in mud, so we packed mud from the creek on the potatoes and stuck them in the hot coals. We cooked the corn in their husks and hot dogs on switches over the flame.

In my dim memory, I remember that meal as one of the best I’ve ever eaten. We told stories around the fire and Tom and I talked about smoking.

It seems Tom had been caught with a partial pack of cigarettes. Uncle Ron made him sit down and smoke every one of them–one right after the other–until the pack was empty and Tom was green. That made Tom swear off cigarettes–but not smoking. He said he’d become fond of smoking grape vine bark.

Last winter I talked with Tom on the phone for the first time in years. He has struggled with terrible asthma all his life and shares the risk of esophageal cancer that is in our family. I asked him if he’d been able to kick his smoking habit.

“I know I need to and I’ve sure tried. But I just can’t seem to do it,” he said.

After the questions about managing depression and smoking cessation, I asked for advice from WEA Trust colleague, Ken Robbins, M.D., who is board certified in both internal medicine and psychiatry. Following is his reply:

“It (depression) is definitely an issue for a number of reasons. One is that antidepressant levels can change when someone stops smoking (generally they increase); another is the withdrawal from nicotine (can be managed with nicorette, etc); another is the loss of an activity that brought comfort. To decrease the risk of depression during the time this person stops smoking I would suggest the following:

1. Increase the frequency of visits to his/her psychiatrist, to be sure they are being followed closely, and adjustments are made to the antidepressant dose, if necessary;
2. Increase exercise. That will reinforce the improved lung function, and provide another way to increase dopamine, and help with anxiety during the withdrawal period;
3. Look for other ways to find comfort. Meditation might help, spending more time with friends or family, or with hobbies he or she enjoys.”

Very helpful!

Deadly Habit

When you’re doing hand-to-hand combat with a smoking habit, you can’t be reminded too often of the deadly health consequences of smoking.

Having witnessed cancer battles–and cancer deaths–I have a healthy fear of the disease. I’m not alone; the National Institutes of Cancer says Americans fear cancer more than any other disease.

Take a look at the types of cancer smoking causes.

Source: U.S. Department of Health and Human Services

A reader responded to my last post by expressing concern that quitting smoking might trigger a recurrence of his/her major depression.

Man…can I ever relate to this fear. In fact, I spoke with a mental health professional well before I quit. She encouraged me to quit anyway–citing the long list of deadly medical conditions caused by smoking.

Chicken or Egg?

Tobacco and depression have a weird pushmepullyou relationship. People who are depressed are more likely to be smokers. Smokers who quit are at risk of becoming clinically depressed, particularly if they have a history of depression.

Is it possible that smoking has contributed to the reader’s depression?

Consult the Pros

Of course, since I never attended medical school, the best course of action would start with a conversation with the mental health professional who you’re working with to treat the depression. I’ll confess that during an incredibly rocky time in my life my therapist said, “Whatever you do, don’t quit smoking now!” Given the relationship between depression and the inability to quit, it makes sense that addressing the depression would be important to the cessation effort.

Zyban and Therapy

I take two medications for my depression–one is Wellbutrin, which is the same drug as Zyban, and is widely used as a smoking cessation aid. I don’t know if it helped me quit, but it seemed to diminish my urge to smoke when it was first prescribed for me a few years ago.

Reading I’ve done suggests that taking Zyban for smoking cessation, in addition to the antidepressant you already take, can be helpful in alleviating depression. And some studies show that cognitive therapy, often used to treat depression, can be successful in helping people–including those with no history of depression–quit smoking.

Although I’m struggling with these issues now too, I’ll have to say that quitting has given me a real sense of success and control–following several years of being extremely frustrated (even angry with myself) because I hadn’t quit. It feels darned good that I’ve done something so positive for my health.

I smoked a cigarette Saturday. The day was rainy and gloomy, daylight was waning and the winter months loom. I was so low you’d need a shovel to scrape me off the floor. I didn’t care about how hard I’ve worked to quit or if I disappointed anyone.

I’ve mentioned before that, for many years, I’ve had major depression. Unfortunately, significant efforts to treat the disorder have been only moderately successful–at times. I knew well before my quit date that depression was going to pose a major obstacle to my efforts to kick the habit.

Nicotine in Action
Smoking and depression are strangely interrelated. Following are a few interesting facts:

• Nicotine stimulates the brain’s reward system and triggers the release of dopamine, a feel-good neurotransmitter. Thus, smokers may use nicotine to self-treat depression.
• In a study of major depression at Columbia University, 60 percent of the participants were smokers. Only 18 percent of the general population smokes.
• Smokers who’ve had at least one episode of major depression are less likely to quit successfully and more likely to relapse.
• Several studies have shown the people who’ve never experienced major depression are twice as likely to develop depression after they start smoking.
• In people who’ve experienced major depression, kicking the habit can trigger severe depression.
• A study at Children’s Hospital Medical Center in Cincinnati found that smoking teens are four times more likely to become clinically depressed than nonsmoking teens.

I’ll be very honest in saying I’m not sure how to manage this situation now that we’re heading toward winter, a sure-fire depression trigger for me.

TIME
1972

PLACE
Sunny Hills High School, Fullerton, California (Anywhere outside Southern California an institution named, “Sunny Hills” would be a nursing home.)

PLAYERS
Me (During this phase I ofter signed my name “su.” Grief!)
Doug, my boyfriend, one year older than me

MY STORY
I thought Doug was so cool. He had a bit of a “bad boy” reputation, but when you got to know him well, you found out it was pretty much a facade.

Because of his reputation, my group of close friends–the “arty” bunch– didn’t approve of Doug. I thought he looked like a young Clark Gable. (After all, I spent two years fantasizing that I was Scarlett O’Hara when I was younger.) And he had very long hair, which I knew would bug the heck out of my parents. When it didn’t, I was darned upset.

Like me, Doug wore jeans and t-shirts with beads around our necks. But Doug had pockets on his t-shirts–a box of Marlboro reds poking out of them.

Doug and I became inseparable. Because he had graduated the year before, Doug wasn’t allowed on school grounds during hours school was in session. That, of course, made it all the more fun to meet on the fringes of school grounds at the end of the day, smoking our Marlboros and tempting trouble. This was the point when I became a serious smoker.

Yep, we were pretty darned cool. Puffing away. Totally devoted–until Doug’s parents announced they were moving to the Mississippi coast. Being of age, he had the option of staying in California. Not being quite as cool and independent as his image, he decided to go with them. So much for devotion.

Then they told him he’d have to get his hair cut or risk problems in conservative Mississippi. I was shocked when he agreed to this.

On the evening of the haircut, his older sister (think the older sister in “Ferris Bueller’s Day Off”) was assigned to drive us to the barber to ensure the correct cut was given.

Oh…those mounds of long, dark hair! We embraced. We wept.

We promised to write. He wrote several times. I wrote once.

Then I met another Doug.

I kept the smoking habit for years.

I’ve run out of nicotine lozenges. So far, peppermint candies seem to be an effective substitute. Although I only indulge in about two candies a day, I should probably look for a sugar-free option.

I always suspected the nicotine lozenges, which take about 20 minutes to dissolve in your mouth, worked for me, in part, because they kept my mouth busy.

There are several new options in tobacco-cessation aids–both in the pipeline or recently introduced.

Chantix

Chantix hit the market with a splash this summer. It’s a new kind of cessation aid– easing withdrawal symptoms and reducing the pleasure of nicotine for people who relapse. (I’d like to find a pill that would reduce the pleasure I find in chocolate.)

Chantix is a medication–but not an antidepressant like Zyban. Clinical trials with this new option have been very promising.

Nicotine Vaccines

Several nicotine vaccines are being tested after being placed on fast-track status by the FDA for their potential to benefit the 38-million U.S. smokers who wrestle with quitting.

These vaccines prod your immune system to make antibodies that prevent nicotine from entering your brain. (A wee bit of nicotine escapes the antibodies–just enough to ease withdrawal symptoms.)

There’s no word yet on when the new vaccines will receive FDA approval and hit the market.

Acomplia -Zimulti

A pill that helps you quit the nicotine habit–and lose weight?!

This is no hoax. Developed by pharmaceutical giant, Sanofi-Aventis, Acomplia works on the brain’s endocannaboid system which regulates our appetite for food and nicotine. (Yes! It would work for my nicotine and chocolate addictions!)

I’ve been following the progress of Acomplia eagerly since I first read about it a couple of years ago. Although it has been approved in European Union states, FDA approval is pending.

It’s likely that Acomplia will be called Zimulti if and when it is marketed in the U.S. For reasons understood only by the FDA, Accomplia will not be approved as a nicotine-cessation aid in the U.S.

Slim and smoke-free, all I’ll need is a pill for aging.

Because I smoked a few cigarettes in Europe, do I have to start counting my smoke-free days from day one again? Am I still a nonsmoker? I haven’t had a cigarette since last Thursday morning. I really feel guilty.

Leaving work yesterday, I passed by a couple of smokers outside the building. They kindly held their cigarettes back, but oh…the smoke smelled so good.

People tell me cigarettes stop smelling and tasting good. (The smokes I had in Europe tasted great–just a little strong.) And I sure do smell tobacco smoke now that I’ve quit.

Full of Hot Air

We did a fair amount of hiking and hill or stair climbing when we were in Europe. The first test was the nearly 400-step climb, plus uphill ground, we hauled ourselves up to reach the castle above Heidelberg Germany. Although I’m out-of-shape and have lousy knees (heck, yes…arthritis), I ended the trek in far better condition than many others I saw stalled on the stairs and gasping for air. I wasn’t winded at all!

We also climbed all around Germany’s tallest waterfall on a mountainside deep in the Black Forest. I did fine with that too. The only thing that drove me cuckoo was the drive up the mountain–breathtaking beauty and hairpin turns. Jeff drove and I nearly punched a hole through the floor of the car, braking reflexively. I found it helps to unfold a map and wrap it totally around your head.

My success with climbing in Europe is encouraging me to think more about getting in shape–which I vowed to work on after the vacation. After all that “swine and spaetzle,” it’s a darn good idea.

We’re home and trying to get over jet lag and into the swing after our vacation. We saw remarkable things, enjoyed interesting conversations and ate fabulous food in Germany and France.

We saw France’s magnificent 12th century Haut-Koenigsbourg Castle lighting the nighttime sky. Twinkling lights along the canals of Colmar made for a romantic night-time stroll. Timber-framed 15th century buildings in Rothenburg, Germany were lit to post-card perfection. And Susan lit up.

I was worried about maintaining my non-smoking record in Europe. I’ll even confess that, in the back of my mind, I thought I might have a cigarette with a glass of wine at a sidewalk cafe–not every day, just a couple of times.

Arriving in Frankfurt

We were already frazzled when we got on the plane at O’Hare. I’d been in the emergency room the day before (more to follow) and our original flight had been canceled. When we arrived at Frankfurt, Germany after our long, long flight, we walked through the airport, past a large number of crowded smoking stations. I did fine.

But when we met my sister at the airport hotel and she pushed a pack of cigarettes and a lighter to me, I was in trouble.

Back Home Again

I didn’t smoke a lot in Europe, but I’m not happy that I smoked at all. That said, I have not smoked since last Thursday morning when we arrived at Frankfurt Airport for our trip home.

I don’t believe I smoked enough to trigger nicotine withdrawal symptoms.

Emergency Room

I intended to write to you the day before we left for Europe but ended up in the emergency room instead. It’s a bit of a story…

Being rather tall, I had been vain about my long legs since my teen years. For the last 10 or 12 years, however, I’ve kept my legs covered with pants or opaque black stockings.

You see, I inherited a tendency for varicose and spider veins. Even though I was quite thin until middle age, I did have four babies, which hastened development of unsightly veins in my legs. And smoking damages the walls of the veins, adding to the problem. In my case, given my many years of puffing away, the condition has progressed to Superficial Thrombophlebitis –inflammation and clotting of superficial veins in my legs.

Frankly, my legs–particularly my ankles–are pretty unsightly. So, when I was painting my toenails and taking care of all the grooming one does before a vacation, I noticed what I thought was a blood blister on my ankle. Afraid it might be a problem if I bumped it on the plane, I decided to do a little self surgery.

It wasn’t a blood blister. As I was spewing like a geyser, my daughter drove me to the emergency room. I do not recommend self surgery.

I’ve thanked my colleague, Ben, for updating you after my departure. Ben, a heck of a great guy, makes this blog happen. I hope he remembers that I have a single daughter of marriageable age.

Dear Faithful Readers:

Susan is currently traveling in Europe with family and friends. Assuming airport security let her take her nicotine gum with her, she is probably chewing furiously, fighting the urge to smoke as she winds her way among ancient castles and hip cafés.

Smoking rates are significantly higher in Europe than the United States. Additionally, there are fewer restrictions on smoking in restaurants, bars, and public accomodations. In some parts of Europe, asking someone to put out their cigarette will be met with indifference or potentially a hostile stare.

Wish Susan luck as she avoids the daily temptation to smoke.

-Ben, Susan’s colleague and guest blogger