Last summer I wrote about Acomplia (rimonabant), the weight-loss pill that is also supposed to help smokers kick the habit.

I’ve eagerly awaited the availability of Acomplia in the U.S. since I first read about it several years ago. Alas, even though the drug is approved in the EU, our FDA has delayed approval here for more than a year. The agency did not approve Acomplia as a smoking cessation aid–they went so far as to make that call.

April 26

Finally, the FDA has set the date–their decision on Acomplia should be announced April 26. I take this as a very good sign–because April 26 is Jeff’s birthday. Not that I’m superstitious.

Some studies also have shown that Acomplia reduces blood sugar levels, improves cholesterol levels and reduces that most hazardous weight–the spare tire. And…smokers were twice as successful at quitting, with less weight gained in the process, than smokers who received a placebo.

Acomplia works differently than other drugs used as tobacco cessation aids. It blocks activation of cannabinoid receptors that stimulate your appetite for food–and nicotine. (Does the word cannabinoid sound familiar? It’s your body’s natural version of cannabis, the substance in marijuana that gives people the munchies.)

Acomplia also…

may just help people ditch other addictions, such as drug and alcohol dependencies. Acomplia is so promising that NIDA, the U.S. Institute of Drug Abuse is teaming up with Federsed, the Italian Federation Services for Drugs and Other Addictions to establish protocols for clinical studies of Acomplia as tool to fight other addictions.

Side Effects

Acomplia was tolerated fairly well in most of the studies completed thus far. The most common side effects have been transient dizziness and nausea. A small number of people have experienced depression and anxiety when taking the drug.

I’ve been around the block enough times to know the bulk of the work of quitting smoking and losing weight is personal effort. But a little help sure doesn’t hurt.

Unlike certain politicians, I have no problem admitting that I’ve made many…many mistakes in my life. There definitely are a few I prefer not to share. That still leaves a lot of doozies that I’ll own up to. I consider smoking a big one, as is the following incident that I’ve never lived down.

Cheap Date

“I guess I’m just a cheap date,” I announced on my radio program many years ago. It was a Friday morning and my guest didn’t show, so I invited my friend and program director, Frank Dawson, to join me in the studio for a show on cheap thrills–inexpensive activities for weekend fun.

At one point, I mentioned that to me a great evening activity was popping a big bowl of popcorn and playing a cutthroat game of Monopoly. With a shrug in my voice I added, “I guess I’m just a cheap date.”

Frank’s mouth made like a railroad tunnel and he crumbled into an impossibly small ball for such a lanky guy. Maintaining that position, he rolled onto the studio floor and howled silently.

I looked up and saw staff from the am and fm stations showing way too many teeth at the studio window.

Good thing it was nearly the end of the show and we were able to struggle along until it could cut the mic and ask what the heck had happened.

Well, I was given a definition of cheap date that I wasn’t aware of. (Loosely, well, it was like a woman of easy morals.)

Up in Smoke

Yep, I’ll admit to a lot of stupid mistakes. But I’m not sure any are of the caliber of the screwup made by a patient of Methodist Dallas Medical Center last summer.

The poor fellow was supine on his hospital bed with a non-removable mask shooting oxygen into his damaged lungs. Things must have been a bit dull and that old cigarette lust kicked in.

So, the patient lit up.

So did the hospital room. Fortunately, a sprinkler system helped confine the fire to the one room and its fortune of medical devices. As a precaution, 100 patients were evacuated, just to make sure that butt wasn’t smoldering somewhere.

The fellow who lit up? He was moved to the burn unit at another Dallas hospital for treatment of severe burns.

DON’T SMOKE!

ESPECIALLY, DON’T SMOKE WHEN WEARING AN OXYGEN MASK.

Hot off the presses: People who have injuries to their insula–part of the brain tucked under the frontal lobes that’s about the size of a chicken gizzard–forget they want to smoke! It seems the insula is involved when we have urges.

This finding was stumbled on when neurologists stopped having to write passes to the smoking area for brain-injured patients who had been smokers. Researchers have since verified the insula/smoking urge connection in clinical studies. Now they’re going to try and find a way to apply this knowledge to real-world smokers.

When Mother had the cerebral hemorrhage that revealed her brain tumor (glioblastoma multiforme), her longing for a cigarette was gone. Just gone. Knowing a little about her tumor, it could well have stretched its evil tentacles into her insula. Not the way to quit smoking, believe me.

Now, I was all ready to head over to Mendota State for a lobotomy that would do away with that problem insula that made me have bad urges. Then I read a little further and learned that, for some reason, the insula has no impact on my urge for chocolate. Such a pity!

I only smoke one cigarette a day. I know I can go without that cigarette–but I don’t. I’m still addicted to nicotine.

With this lousy flu bug, smoking really doesn’t sound appealing. But, by golly, it sure hasn’t stopped me from smoking my daily cigarette. (I don’t know about you, but I’ve always felt pretty stupid smoking when I’m sick.)

There are three motivators at play when we smoke:

1. Physical desire or addiction
2. Mental or emotional need
3. Habit

Before I first quit (all two months of being smoke-free), I’d kept track of which of the three smoking motivators matched cigarettes I smoked throughout the day. I knew the physical desire cigarettes were going to be the toughest to avoid.
(Downloadable Smoking Journal or Trump the Trigger forms are on this blog and can be used for this purpose. You’ll find them by going to the list on the right column of the home page.)

From this experience, I can tell you that my cravings these days come nearly completely from my mind.

Another Quitter

Our dear friend, Owen, has been cigarette-free for several weeks. Last weekend, he told me he’s been so ornery in the process that he’s feeling like bowling down people when he’s driving.

I asked him, “Do you want to take them out or just maim them?”

“I don’t really care,” was his response.

I’m normally the lucky one who gets a mild version of the latest bug going around, but this time I got socked but good. Given the progression of my symptoms, I’d say it’s definitely some kind of flu rather than a cold. I have to tell you–I’ve been sick since Sunday, but I have no wheezing whatsoever.

In the past, almost any ailment I acquired eventually ended up in my lungs or bronchial tubes. Then I’d get the familiar crud cough that won’t go away–you know how that is.

My family has always tended to take a Spartan approach to routine illness, only relenting and going to the doctor when people hound us. Because of this trait, I was really miserably sick when I gave in and went to the doctor with an ugly cough some years ago.

Examining me, the doctor announced that I had asthma and bronchitis. She asked if I smoked (yes, I was very tempted to lie) and when I told her I did she asked, “Do you have a death wish?!”

That wasn’t enough to get me to consider quitting. Still in my 30s at the time, I was more concerned about staying thin. And I still had some of the denial/attitude that cancer or emphysema just wouldn’t happen to me–I had plenty of time to quit. Duh!

What’s good?

The flu bug didn’t travel to my lungs.

What’s bad?
I’m still smoking one cigarette a day.

A tip:

Talking to one of our staff pharmacists a year ago, he mentioned that saline nasal irrigation is an incredibly effective, drug-free remedy for congestion. I went to Walgreen’s and bought the little Aladdin’s lantern-like device and tried it out. It works! (A number of clinical studies back this up.)

If you haven’t done nasal irrigation, it can sound pretty gross and uncomfortable. It’s not. I’m thinking about trying the full sinus irrigation–if I can still stand on my head.

Like groomsmen slipping a little gin into the punchbowl at the reception, it seems those silly folks at the major tobacco companies have been slowly adding to the nicotine content of the cigarettes we smoke.

The gin in the punchbowl may have caused a few headaches the next morning. The nicotine? Well, it’s a highly effective way of building customer loyalty. And it’s killing people.

According to a study conducted at the Harvard School of Public Health, big tobacco boosted the nicotine content of cigarettes we smoke by approximately 11 percent between the years of 1998 and 2008.

Harvard professor, Dr. Gregory Connolly, says the nicotine increases were deliberate and are found in all major U.S. brands.

“We know from our data that there are intentional design changes that result in more nicotine in smoke that increases the capacity for the cigarette to cause and maintain addiction,” Dr. Connolly says.

The simple addition of nicotine also contributed to the increases.

Despite tobacco cessation efforts across the country and our increasing awareness of the harm caused by tobacco, 900,000 Americans become addicted to tobacco every year.

And that’s just the way big tobacco likes it.

It was good to get a detailed update from my friend, Debra, on her tobacco-free status. I think she may have found the magic bullet that can “cure” all tobacco fiends of the nasty nicotine habit–chocolate! I think there’s a fortune to be made substituting small nibbles of healthful dark chocolate for nicotine!

Of course, Debra balances the rich, chocolaty calories with exercise and looks fabulous. If she’s gained any weight after quitting, it sure doesn’t show.

Coincidentally, just this morning I asked myself whether I’d rather be as thin as I was at 40 and smoking–or as I am now. I haven’t decided how to answer that yet.

Hi Sue,

I love the idea of laughing gas parties, oh well I should have married a dentist, but then I wouldn’t be happily incompatibly married to Mike.

I replaced the nicotine urge with one really good chocolate and that really seems to work for my after dinner craving. Otherwise I pretty much resort to a piece of nicorette gum or get on the treadmill – which also works for increasing dopamine levels. I’m running more every day and that endorphin rush seems to stay with me a long time and I know if I start smoking again I’ll be coughing and straining my lungs to get through my workout.

So that was my crutch, chocolate and running. I am now 110 days and counting and my urges are seriously gone and I have zero interest in ever picking up a cigarette again. But, I also tried quitting approximately 4 times in the last 3 years and I was pretty successful, but I always cracked at around 6 weeks. So in this case, practice makes perfect, and I really do feel better and I’m also glad that the smoking ban is in place throughout the entire Madison area, the less temptation the better.

I love reading your blog and if you really just simply “quit”, we wouldn’t get to read about your struggles. I always looked at it as a work in progress and it’s really hard to break a habit that makes you feel good and is also your friend. So, don’t be so hard on yourself about the 1 or ½ cig a day. Keep doing what you are doing and try quitting completely at some point in the future, maybe on your anniversary date of quitting in July?

Dr. Jesse Haven of Naples Florida believes inhaling laughing gas instead of tobacco smoke on their Quit Day helps people find success in their cessation journey.

In a small study he presented before the American Academy of Family Physicians, Dr. Haven reported that 40 percent of quitters who had the laughing gas were able to avoid smoking completely for the first three days of their quit effort. More than 90 percent of those who had laughing gas said their cravings were substantially reduced.

Dr. Haven’s theory is that laughing gas (nitrous oxide), the stuff you can get in the chairs of kind dentists, boosts dopamine levels that normally are depleted during withdrawal from nicotine.

In the years before the Civil War, people used to host laughing gas parties. Is it possible that I remember my mother saying they gave her laughing gas when she was in labor with me? Well, that might explain a lot.

I only had half cigarette yesterday–actually just a few puffs. It helped that we had Arctic temperatures and blowing snow that I didn’t want to stand in, even for a cigarette. Plus, I got my feet wet walking to the office from the parking lot yesterday morning. That always does it for me–I shivered the rest of the day, long after my feet had dried. I’ve never gotten acclimated to Madison’s weather.

One snowy Sunday afternoon, shortly after I moved to Madison, I took a drive downtown to see the sites and find my way around. Now, Madison is truly a gorgeous small city. We have lakes, parks, the university and a thriving, if small, arts scene. It’s quite a progressive town, which suits us just fine.

On that afternoon drive, however, I stumbled across a sight that sent me into a state of shock. Right in the middle of town was a field full of shacks. I mean sorry-looking shacks, perched on the snow. My God! I had no idea that Madison had that level of poverty. It looked like the hills outside Tijuana, Mexico. I questioned whether the move to Madison had been smart for us.

I happened to mention this experience to a new acquaintance. He asked me where this shanty town was and I gave him the general location. Suddenly he clutched his stomach, turned purple and started howling.

It seems the shacks I’d spotted were really ice-fishing shanties on snow- and ice-covered Monona Bay.

In July, 2005, Madison’s stiff smoking ordinance went into effect, banning smoking in all workplaces. The purpose of the ordinance was to protect workers from secondhand smoke, including workers in restaurants and taverns, just about the only workplace left where a person could have a smoke.

The Taverns

Naturally, local taverns were afraid of losing business–especially from the regulars who belly up to the bar to sip and puff the hours away. Some did lose business. A few even closed, though the cause may have been normal attrition.

One of the most militant ban-the-ban businesses has been Antler’s Tavern, a establishment that’s been in the family of Homer Simpson (real name) elder and Homer Simpson the younger for 63 years.

Antler’s Tavern is a log-walled, shake-roofed male bastion on Madison’s south side. It’s like so many Wisconsin taverns– a big bar and probably a grill where you can get a basic burger or brat. At one time, Antler’s was a great spot to stop for a beer after fishing, but the city’s grown around it and the old gang’s mostly gone.

Establishments like Antler’s on the fringes of the city have been hardest hit by the ban. Their customers don’t have far to go to find a bar outside town that welcomes smokers.

Signs of Discontent

Well, the situation got Homer’s dander up. He started spending his spare time crafting a series of signs that he set up like a long row of dominoes on the grounds of the tavern. The signs were right next to what used to be the main drag into Madison before they dug into the marsh and built the beltline. People who want to avoid the beltline traffic still take the old route, where you couldn’t miss Homer’s signs.

They said things like: “Welcome to Madison, Anti-Small Business,” “Ban the Ban,” “The Ban’s Bad for Business,” leaving little doubt about where Homer stood on the issue.

Sign Up

The signs had been up for several weeks when I drove by one day and saw the giant billboard that rose up out of Homer’s sea of small signs. The anti-smokers had rented the billboard and it said something along the lines of, “Go ahead and smoke. Who cares if your breath smells like a sewer.”

Homer’s signs disappeared about the same time the billboard was changed to an ad for Volkswagens.