Cessation using the Cold Turkey Method for Asthmatic patient

CTCS Tutorial #13 Case 2

 

On 15 September 2023, the 13th monthly tutorial session was conducted for Certified Tobacco Cessation Specialists. One of the two cases discussed a 38-year-old, chronic cigarette smoker, owner of a travel agency, referred for cessation by a pulmonologist. He had been smoking for the last 25 years, consuming around 40 cigarettes a day. He was married, had 2 children, and was accompanied by his mother to the cessation center. He gave a history of bronchial asthma for 3 years and diabetes, and blood pressure for 2 years, and was under medications for the same.

            He had been consuming 40 cigarettes in a day, with maximum consumption during morning hours, around 6-7 cigarettes reportedly before using the washroom. Apart from this, he had increased frequency while driving, meeting friends, after meals, and under stress. He stated that a few times when he could not smoke for 2-3 days, he felt extreme anger, stress, and restlessness. He reported sweating, thirst, constipation, and increased appetite during this phase. Presently, he was quite motivated to quit smoking due to health issues.

            He was explained the adverse effects of smoking and the benefits of quitting in the long run. A detailed treatment plan was made for him after counseling. He was guided for a Cold Turkey method of quitting smoking, replacing it using a 21-mg Nicotine patch to be used for three weeks and Nobacco gums (4 mg) to be used for severe craving episodes. He was allowed 2 puffs of smoking a day initially, which he stopped after 2 days. He complained of body cramps and worsening asthma in 2-3 days of withdrawal. He was supplemented with SleepNova, Lycoedge, Cbinan, ELC, and Mg tablets.  He was suggested to use the Acapella device for breathing exercises, which helps in clearing mucous in the throat. Mucolytics and anti-asthmatic drugs were also modified accordingly by the consulting pulmonologist. He was kept on a nebulizer, steam inhalation, and a modified diet plan and showed considerable improvement in asthma over 2 weeks.

The Nicotine replacement patch would be reduced to a 14-mg dose after 3 weeks, further to a 7-mg dose in 2 weeks, continuing, in addition with 1mg BD Varnitrip, over 3 months duration. He would be regularly monitored by a cessation specialist and pulmonologist over this period and the treatment plan would be modified accordingly.

ICanCaRe Academy Tutorial for Certified Tobacco Cessation Specialists (CTCS) is a monthly program on the 15th, from 9-10 PM. We welcome our CTCS to present complex cases on tobacco cessation for discussion and finding solutions for successful quitting. Please contact Dr. Mariya, Dr Siddhi, or Dr. Monalee for tutorial cases.

ICanCaRe Academy encourages you to take part in our monthly session and learn in-depth details about practical tobacco cessation through cases discussed here.

To be a Certified Tobacco Cessation Specialists go to www.icancare.in/academy/ctcs

#icancareacademy #tutorial #icancare #siddhi #pawangupta #CTCS #icancare #mariya #monalee #reenarkumar

Case presented by – Dr. Anshika Pandey, BDS, Certified Tobacco Cessation Specialist with MAX – ICanCaRe Centre.

Blog composed by  – Dr. Siddhi Hathiwala, MDS (Public Health Dentistry), CTCS(GU) – ICanCaRe. Assoc. Prof. & HoD, HDCH, Jabalpur)

Expert – Dr. Pawan Gupta M.Ch. Cancer Surgeon and Master Trainer Tobacco Cessation

Cessation using Plateau Therapy for chronic Smokeless Tobacco consumer

CTCS TUTORIAL #13 Case 1 ICanCaRe Academy

On 15 September 2023, the 13th monthly tutorial session was conducted for Certified Tobacco Cessation Specialists. One of the two cases discussed a 60-year-old retailer, chronic tobacco chewer. He had a history of consuming tobacco, 6-7 pouches in a day, for over 40 years, with added supari, chutney, and slaked lime. He consumed tobacco after breakfast, and had quid in his mouth the whole day, even while sleeping.

He had a known case of hypertension for 4 years, under medications including Aspirin, Telmisartan, and Rabeprazole. Also, he had a history of phobia of crossing roads and uneasiness and had been taking Escitalopram oxalate and Clonazepam for 5 months. He was self-motivated to quit tobacco and had come to the clinic with his wife. He had himself tried to quit earlier twice but failed within a week duration. He developed cold and cough, fever, and uneasiness during quit attempts. Presently, he has been gradually tapering his tobacco consumption for 1 month, 1 pouch per week following his behavioral motivation.

Our team has now suggested asking him to set a committed Quit Date for himself, within 14 days; while the specialist is handholding him to cope with withdrawal symptoms. He has to be kept on a gradual reduction of tobacco consumption while using nicotine patches continuously. Initially, apply a 7-mg patch for a week, reducing tobacco by 50%, then a 14-mg patch and complete stoppage of tobacco consumption in the next 7-10 days. He would then be continued with a 14-mg or 21-mg patch beyond the quit date. Also, Varenicline (1mg BD) would be added at this stage during the maintenance phase and reduced gradually over a 2-3 month period. Other supplements would include Nobacco pastilles or lozenges (only in the beginning to curb intense craving episodes) and oral supplementation with Aquazyl, Turmnova, or chia seeds. He would be prescribed multivitamins and minerals, Vit. C, Folic Acid, as needed. He would be kept on regular follow-ups every week for 3 months duration along with his medical assessment at regular intervals.

ICanCaRe Academy Tutorial for Certified Tobacco Cessation Specialists (CTCS) is a monthly program on the 15th, from 9-10 PM. We welcome our CTCS to present complex cases on tobacco cessation for discussion and finding solutions for successful quitting. Please contact Dr. Mariya, Dr Siddhi, or Dr. Monalee for tutorial cases.

ICanCaRe Academy encourages you to take part in our monthly session and learn in-depth details about practical tobacco cessation through cases discussed here.

To be a Certified Tobacco Cessation Specialists go to www.icancare.in/academy/ctcs

#icancareacademy #tutorial #icancare #siddhi #pawangupta #CTCS #icancare #mariya #monalee #reenarkumar

 Case presented by – Dr. Mariya, BDS, Certified Tobacco Cessation Specialist, Mumbai

Blog composed by  – Dr. Siddhi Hathiwala, MDS (Public Health Dentistry), CTCS(GU) – ICanCaRe. Assoc. Prof. & HoD, HDCH, Jabalpur)

Expert – Dr. Pawan Gupta M.Ch. Cancer Surgeon and Master Trainer Tobacco Cessation

Smoke Free from 40 to 0 in 15 days

ZUSTIN – SMOKE FREE FROM 40 to Zero in 15 days. ICanCaRe Tobacco Cessation Program at MAX Vaishali

ZUSTIN USE TO TAKE 40-50 Cigarettes per day for 15 years. Referred by Dr. Sharad Joshi, Pulmonologist to ORAL CARE & TOBACCO CESSATION CENTRE, at MAX Vaishali.

With ICanCaRe ‘ABCD’ of Tobacco Cessation Intervention he is completely Tobacco-free in 15 days. and continues to be free at 3 months. He is extremely happy and thanks the team at MAX – ICanCaRe ORAL CARE & TOBACCO CESSATION PROGRAM at MAX Vaishali for the excellent outcome.

ICanCaRe ‘ABCD’ TOBACCO CESSATION – HOW WE DO IT –

TOBACCO CESSATION IS EASY WHEN DONE MEDICALLY EVIDENCE-BASED ‘ABCD’ INTERVENTION –

A – ACTIVE MOTIVATION for TOBACCO CESSATION

B – BEHAVIOURAL INTERVENTION and COMMITMENT

C – COMORBIDITY MANAGEMENT – managing associated diseases

D – DRUGS and MEDICATIONS. Specific medications for tobacco Cessation intervention are individualized as per addiction level and willpower index.

YES, IT IS POSSIBLE TO QUIT TOBACCO

CONTACT –

ORAL CARE AND TOBACCO CESSATION CENTRE at MAX INSTITUTE OF CANCER CARE TOWER 2, 6th Floor MAX – VAISHALI

Dr. ANSHIKA PANDEY – 8383905605

Mr. ROHIT – 9773856663

Dr. Pawan Gupta – 9811290152

ICanCaRe Quitline – 011-43077695

ICanCaRe Tobacco Wellness APP – http://app.icancare.in

#icancare #quittingsmoking #quittobacco #icancareacademy