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
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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