Tag: quit chewing

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

Dilemma of a Doctor – Advise to Quit or Not?

Dilemma of a doctor – A 44 year old tobacco chewer with advance stage of cancer – should he be asked to quit tobacco???

Author – Dr. Monalee Prasad, BDS(2007), PGD in Aesthetic Dentistry (2009),TII -IDA(2020) ,OCTC (2021), CTCS (2021).

This is a case of a 44 year-old male patient suffering from Stage IV recurrent oral cancer with extensive neck and systemic metastasis. He was being treated somewhere in Uttarakhand. He attended OPD for treatment. He has been a chronic chewer and smoker for years and he continues to do so even after being diagnosed with advanced cancer with a short life expectancy. Besides the palliative treatment, the big question is about his tobacco – Should we ask him to quit? Or should we not ask him to quit?

How should we plan his treatment with regards to tobacco cessation?

The case was put for discussion during the tutorial for Certified Tobacco Cessation Specialists were – different difficult cases that we come across in Tobacco Cessation practice and their treatment are planned. It was a mixed opinion with more suggesting  that the patient should be told to quit tobacco.

The same question was put in the group who are actively working for tobacco control and the majority said that the above patient needs to quit so that the treatment will be helpful and the organs will respond better to treatment.

Now opinion from group of oncologists was seeked, unanimously they said there is no need for him to quit tobacco.

The argument put forth by was that with Stage IV cancer there is no hope of his long survival and it will not be of much help at this juncture to force him to quit. Also the handling of withdrawal symptoms is more difficult in this case along with the Palliative care that has to be provided. It will not improve the quality of life of this already dying patient.

Hence, it wouldn’t matter whether we advise him to quit or not. It would be his wish.

Also, in case we are able to convince him to quit; there are two case scenarios which were discussed and how we can use it as a positive messaging for the next generation.

One scenario is where he is able to quit completely and then the message that can be conveyed through him that even though he suffered from taking tobacco and has reached the last stage of his life, he could quit his habit with the help of our esteemed doctors. And if he can do it, anyone at any stage can do it and the sooner one quits, the better it is for health.

Second case scenario is when he is unable to quit despite all the efforts by the doctors and himself and he continues to smoke till his last breath. The message that we can pass on in this situation is that Tobacco is a deadly disease and really addictive one. Message is clear for the youngsters and family members – never to start such a habit and quit as early as possible. BE SMART DO NOT START and if you have then please QUIT.

So, an important learning was shared via this case by Dr. Pawan as to how to choose the messaging we need to convey to the society at large and always choose the treatment keeping the patient’s overall benefit in mind.

Medical treatment is available to quit tobacco and treatment from the cessation specialists should be seeked.

Do share your thoughts on this in the comments below? What would be your choice of treatment?

*Best Diwali Wishes I GOT TODAY! I feel elated!*

This Diwali is extremely satisfying, as I have now a good number of patients saved from getting cancer! The #SAVEtheyouth campaign with its components #knowtobacco & #chotadaana is off-course when a person gets cancer we can still save them, but it would be associated with morbidity, and compromised quality of life.

1. From a Lady Doctor, whose husband was a smoker for the last 22 years. They were celebrating their first No Cigarette Diwali. It had been a frustrating journey for her since her marriage, cajoling, persuading, quarreling, and nagging her husband to quit cigarettes. Not that her husband had not tried, he had but failed multiple times, and lost confidence that he would ever be cigarette free. In one of the meetings, she met me, and with difficulty we got her husband enrolled in the ICanCaRe Tobacco Cessation program. In the first intervention, he reduced the intake but could not sustain it and had a relapse. But the second intervention cycle was successful with intensive sequential therapy and regular motivation. Now it is going to be 4 months and he had not smoked a single cigarette. Feels stronger than before, less stressed, more stamina, more docile, and happier!

2. Second was from Mr. Satyabhan, 42 years old, a security guard, whom I had met at Qutub Minar around 2 years back. During the conversation, I found that he was chewing tobacco. And as a routine, I told him about tobacco and related cancers. Unexpectantly, he was convinced and he came over to the unit at MAX, Vaishali. On check-up, he was found to have a small cancer lesion on the lip, Submucous fibrosis, and dental lesions. He was treated in OPD. Excision of the lesion was done and medicines started. Today, he called me to wish me a happy Diwali, more than that, he was blessing me for saving him and his family.

When people call me back for what I might have done as my routine process, is the greatest gift for me. Their wishes and blessings motivate me to continue to do good for society. My SAVE the youth campaign is saving life, family, and money. I am happy many families will light happy diyas today!

*Dr. Pawan Gupta M.Ch.* Cancer Surgeon.

*Director, MAX* – PATPARGANJ, VAISHALI, NOIDA

Founder – ICanCaRe – TOBACCO #SaveTheYouth

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For Quitting Tobacco – Call 011-43077695

#icancare #winovertobacco #pawangupta #QuitTobacco #quitsmokingtoday #knowtobacco