Quit smoking, spend more time in the poker room

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This column first appeared in Ante Up Magazine in February 2010.

When you “set mine,” you try to see a flop cheaply with a medium or small pair. If you hit your set, you then try to get maximum value from your disguised monster. In a recent game, a mid-position player raised and I was in the small blind with 6-6. If I called, maybe the big blind would come along, too, maybe not. I knew the odds of flopping a set were about 8-to-1 against. That’s about a 12 percent chance of success, which isn’t great. Clearly there’s not enough in the pot right now to justify a call. Are my implied odds large enough to make this play worthwhile? What critical piece of information have I left out? More on this hand later.

I’m going to make a serious confession: I used to smoke. I haven’t used tobacco products in many years, but I know deep within the center of my brain that if I lit up today, I’d enjoy it.

When I started smoking in the late ’60s, no one talked about the dangers. Heck, doctors, professional golfers, even Santa Claus smoked. My father smoked. Even JFK smoked! In my high school, the smoking area behind the gym was where parties were planned, where the cheerleaders hung out, where the major social interaction of our school took place. And if you didn’t light up while you were out there, you stood out like a geek at a football game.
It took me years to decide to quit and years more to succeed. I truly understand first-hand the allure, the psychological pleasures and the biochemical cravings of nicotine addiction. I understand the crackle of the cellophane as you open a new pack, the click-whoosh of a hefty Zippo and the little surge of calm enjoyment that comes when the nicotine receptors in the brain’s pleasure-center release tiny packets of dopamine.

I understand it, but I also hate it. I hate that smokers use the streets as their ashtray. I hate that my grandfather died from lung cancer, that my father could hardly breath during his last years on earth, that my stepfather-in-law is getting radiation treatments on his tongue. I also hate the smell. I hate it on the clothes of an asthmatic child who rode to the E.R. in a car with a smoker, or in the hair of a cougher who can’t understand why his bronchitis won’t go away. Or on my fellow players who rush outside for a quick smoke during every break.

I really don’t make any value judgments about smokers. I understand no one ever quits without the will to do so and the success rate of quitting is not an issue of will power alone. It’s an issue of biochemistry, of overcoming a constant barrage of psychological and biochemical messages that reinforce the feeling that lighting up is comfortable; it relieves stress; it’s pleasurable. Smoking may be the most difficult addiction of all to conquer.
The success rate of trying to quit without some sort of medication is pretty abysmal, in some studies as bad as 8 percent. Nicotine replacement (patches and gum) help a little.

Zyban, which calms the nerves and reduces the cravings, is a little better but still not great.
Chantix by Pfizer blocks and, at the same time, stimulates nicotine receptors. That means the pleasure-producing effects of nicotine are blocked (that puff doesn’t feel quite as good), yet Chantix also stimulates the receptors a little so that a small amount of dopamine is still released. For some, that small amount is just enough to reduce the nicotine cravings that cause so many to fail.

Time now for full disclosure: I’ve owned a small amount of Pfizer stock for decades. They never have sent me on a junket, bought me dinner or even given me a coffee cup with their logo on it. The stock has dropped like a rock. I wish I never had bought it.

Chantix is not magic. There are side effects such as nausea and sleep disturbance, and some big risks including suicidal thoughts. So if you’re considering trying it, you should discuss the risks in detail with your doctor. The success rate using Chantix is about 22-44 percent depending upon the study, which is better than trying on your own or using gum, patches or Zyban. If those numbers seem low, consider the payoff. If you’ve tried to quit before and failed, it just might be the trick to help you succeed.

Now back to the poker hand. You can’t estimate implied pot odds without knowing how much you might win and the stack sizes. The stacks at my table were too short to justify a 12 percent chance of flopping another six. The implied pot odds were low, so I folded.

With Chantix, your chances of success are at least double what my chance was of hitting my set. And the implied pot odds are enormous: decreased risk of cancer, stroke and heart disease, and more money in your pocket to play poker. Plus you’ll smell better at the table. It’s a bet you should consider very seriously.

— An avid poker player, Frank Toscano, M.D. is a board-certified emergency physician with more than 28 years of front-line experience. He’s medical director for Red Bamboo Medi Spa in Clearwater, Fla. Email your poker-health questions to ftoscano@redbamboomedispa.com