Medical cannabis: insight into the patient's journey

BACKGROUND

To date, medical cannabis is legalized in the United States in 30 states, including:

Alaska, Arizona, Arkansas, California, Colorado, Connectiut, Delaware, DC, Florida, Hawaii, Illinois, Maine, Maryland, Massachusets, Michigan, Minnesota, Montana, Nevada, New Hamshire, New Jersey, New Mexico, New York, North Dakota , Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington and West Virgina.

Each of these states has its own rules and guidelines for use and qualifications.

Here in Florida, the marijuana legalization initiative, also called Amendment 2, was released on November 8, 2016. For qualified patients under the supervision of a qualified and licensed medical cannabis doctor. In addition, the amendment was adopted in total 6,518,919 (71.32%) YES votes and 2 621 845 (28.68%) NO votes.

The federal government has classified cannabis as a schedule 1 drug, which causes doctors to prescribe marijuana for their patients. Cannabis doctors may only recommend marijuana in accordance with state law, which may apply for up to 1 year. Patients cannot go to a pharmacy to fill out a medical marijuana prescription.

Pursuant to strict regulations, medical cannabis cannot be associated with any medical cannabis distributor or clinic.

Only some patients with "debilitating ailments" are protected under this amendment. Ailments classified according to its provisions include PTSD (post-traumatic stress disorder), Chronic Muscle Cramps, Multiple Sclerosis, Seizures, Glaucoma, Crohn's Disease, Crohn's Disease, Cancer, HIV / AIDS, ALS (Amyotrophic Lateral Sclerosis or Lou Gehrig & # 39; s Disease) and Parkinson & # 39; s Disease.

Although the above complaints have been identified as "primary debilitating conditions," in accordance with this provision, Amendment 2 also indicated: "or any other ailment / condition of similar severity / symptoms, according to the physician's opinion that the medical use of marijuana outweighs any potential risks for one's health ".

There are currently about 56 known and noted cannabis doctors in Florida.

More information and details on this topic can also be found on the Florida Department of Health website (http://www.floridahealth.gov) on how to become a medical marijuana patient in Florida. More detailed information on amendment 2 can also be found here.

PARKINSON'S DISEASE

A few months ago I came across a video on Facebook about a man with Parkinson's disease who was given an injection of medical marijuana. The movies before and after were impressive. Before the surgery you can see the significant tremor, stuttering and abnormal posture of this man. A later video showed a completely different person. His speech was understandable and heard. He didn't stutter, trembled and showed very controlled movements. This man was walking and speaking like an ordinary person. He also shared how he improved his quality of life.

As a physiotherapist with experience in different cultures, I personally have mixed feelings about medical cannabis. However, as a healthcare professional, observing one of my patient's significant changes in relation to marijuana use is a real revelation.

Mr. JL with Parkinson's disease

For over five years, Mr. JL has come to me with breaks for physical treatment because of problems associated with Parkinson's disease. Knowing the progressive nature of the disease, I watched this gentle soul deal with the effects of this debilitating ailment. His primary physician will refer him to treatment when he begins to develop weakness, stiffness, tremor, and above all, problems with balance when reporting falls at home.

We saw him every time for about six to eight weeks. We worked to improve his coordination, strength, flexibility and balance, mainly to ensure his safety and self-sufficiency at home when he lives alone. He is also to refrain from falling, which predisposes him to more serious injuries and complications.

Change

About a few weeks ago he came to the office to arrange physical therapy because he was referred again by his doctor. Working with this patient for years, I tried to find out what had changed in him. I watched and watched carefully when I made the initial assessment. Perhaps he noticed the curiosity that bothered me because he gave me a knowing smile. Not being able to stop my curiosity anymore, I asked him, "Mr. J., what have you been doing?" Mr. J just laughed and asked me why curiosity!

Well, I finally realized that Mr. J. barely had tremors on his right hand, where he used to show the typical tremor of this disease. His neck was even and not shifted to the right. What's more, his speech was clearer! Another thing that hit me was that he was going better. Not great, but he was able to turn around without shuffling, as I've seen for years.

He finally shared with me that he had started taking medical marijuana for over a month, as his neurologist recommended. His friend apparently mentioned a Facebook video about a man with severe Parkinson's disease. This man received a marijuana injection, and the change was visible after a few minutes. This apparently prompted him to consult his main doctor and then a neurologist.

The change I saw in Mr. J. after more than a month of taking marijuana is significant. His speech improved. His voice is deeper and more audible. He didn't stutter and had more control over his right hand after a nearly non-existent tremor. He also stands upright. His balance and coordination have improved, all the more thanks to the advanced balance training he is currently receiving.

During therapy sessions, Mr. J could bounce the ball faster on the floor with greater accuracy. We saw him throw and catch the ball in a standing position without being held by anyone. Once someone stood behind him and held him because he had slow reactions and feedback. His walking also improved. Just a few months ago, he pulled his right foot and walked very slowly. He would lose his balance at the slightest attempt to turn or raise his leg higher to stand on one leg.

These seemingly subtle changes in him for just over a month of using marijuana changed his life. He said he felt more relaxed and less afraid of falling. Able to do simple homework with greater confidence and is able to tolerate more advanced therapeutic exercises during physiotherapy sessions. He does not feel so tired and is able to perform more tasks during the day.

Mr. J is still on this journey and wanted to share this experience and tell me his story. Knowing him and his origin, he is not the type of person who would take marijuana uncritically for mere rest and indulgence.

About Mr. JL

Mr. J is from Central New York and moved to Florida. He was diagnosed with Parkinson's disease about seven (7) years ago. He was the designer of the very prestigious Chinese producer Syracuse, whose clients are the White House, 5-star hotels and prestigious restaurants. He was also a member of the Barber Shop Quartet as a tenor for SPEBSQSA (Society for the Preservation and Incourage of Barber Shop Quartet Singing in America) and was on several amateur programs on Broadway in New York. He was an art teacher for middle school students teaching drawing.

His life changed when he was called to serve at some point in 1986. He became involved in healing services, which he revealed mainly concerned people with tumors. He traveled abroad to expand his healing ministry. This attracted so much attention that even the media noticed and made several accounts about his ministry. He is now retired and lives in Palm Bay, Florida.

It's a privilege to meet this unique person who has done so much in his youth. He devoted so much time and commitment to helping others. I really appreciate the humanitarian service that J performed and how his service affected so many lives. I consider him to be another unknown hero of my time.

His willingness to share a fragment of his story is a privilege. What's more, the opportunity to work with him to further develop and see motivation and determination over the years is a very inspiring experience.

Mr. JL's personal battle with Parkinson's disease.

Mr. J, he shared, was officially diagnosed with Parkinson's disease about seven years ago. He was looked after by an internal medicine practitioner practicing in Palm Bay, Florida.

About Parkinson's disease

As described by Mayo clinic staff: "Parkinson's disease is a progressive disease of the nervous system that affects movement. It develops gradually, sometimes with barely noticeable shaking with only one hand. But although tremor can be a good … known symptom of Parkinson's disease, this disorder often causes stiffness or slow motion. "

Later effects of the disease include: an expressionless face, also known as facial masking or hypomime, and a decrease in speech quality, which can be blurred, soft and even stuttering. These are very common in patients I have worked with. It also affects the patient's walking ability. Loss of arm oscillation due to torso stiffness, stiffness and walking due to lack of coordination.

Unfortunately, this disease is progressing and current medications are aimed at improving symptoms, but not necessarily medicine.

A lot of treatment research is currently underway, including surgery to regulate certain areas of the brain and electrostimulation.

However, there is currently no standard cure treatment, according to the National Parkinson Foundation.

In addition, medication, lifestyle modification, exercise and rest are recommended.

Prescription Drugs

Currently prescribed drugs include: carbidopa-levodopa, carbidopa-levodopa infusion, dopamine agonists, MAO-B inhibitors, catechol-O-methyltransferase (COMT inhibitors), anticholinergic drugs and amantadine. Source: Mayo Clinic Organization

Parkinsons and Surgery

Deep Brain Stimulation (DBS) is a procedure involving the implantation of electrodes into specific areas of the brain using a generator implanted in the chest area near the collarbone, which sends impulses to the brain to reduce symptoms. However, this is not a medicine and it has many risks and side effects. Both the drug and DBS will not stop the disease from progressing.

Parkinson and physical therapy

Physiotherapists are beginning to work with this type of patients at various stages of the disease. This is primarily due to a functional decline resulting from a lack of coordination, dyskinesia (involuntary movements) and stiffness, which makes intentional and spontaneous movements very burdensome.

These problems can hinder even the most basic functions such as feeding, care and toilets. Walking becomes very uncertain. The shuffling gait is very common where it is difficult for them to take the first step (because of bradykinesia – very slow motion), but once they leave, it is also very difficult to stop. Many of these patients are at high risk of falling, and a large number in advanced stages become completely dependent on care.

With regard to physical therapy, patient education on appropriate exercises, movement strategies, task modifications, gait training and fall prevention strategies is part of the overall care plan and functional intervention. They are also often referred to as speech therapy for speech and feeding problems and occupational therapy to provide basic self-care and the function of the hands or upper limbs.

The battle of Mr. J

I first collaborated with Mr. J. about 5 years ago. Although at that time he was not at an advanced stage of the disease, he already manifested the main visible symptoms of the disease: trembling of the hands and neck, masked faces, stiffness and a significant lack of coordination. He walked very slowly, shuffled and even walked from room to room for a long time because he was unable to turn quickly. When he turns around, he tends to lose balance and fall. His reflexes were very slow. He could barely catch the ball or bounce it. His speech was blurred, barely audible, and he had stuttering. He had difficulty climbing in and out of straight curbs and stairs. He fell several times due to balance problems.

Mr. J persisted in the physical therapy program and was always very motivated. In each of the episodes, to which he was transmitted to us for years, he always showed improvement and always followed the specific exercise program that we rewritten. However, due to the progressive nature of the disease, he had a physical decline and we had to work with him again.

He told the story of the first time he noticed a change in him from Parkinson's. First of all, he mentioned it when he taught drawing junior high school students in his art class in New York. He said he gradually had difficulty drawing and using his right hand because he began to tremble. The rest occurred with a change in facial expression, stiffness and stiffness all the time. Over the years, the situation worsened, until his move to Florida.

Under the care of an internist, he was prescribed Sinemet and other medications that he had been taking for years.

The last time I saw him on treatment at the beginning of 2016, where he had significant tremors in his right hand and involuntary twitching in the neck. His masked faces advanced, his face almost fell, and he walked with so much shuffling and difficulty. He could barely move one foot in front of the other. He also reported falls due to worsening balance problems.

That is why, when I saw him in March this year, I saw in him a significant change that he attributed to medical marijuana.

Medical marijuana: capsules and jelly beans

Later he shared his story. Having learned about the potential benefits of marijuana in Parkinson's disease, he consulted his main doctor who referred him for further consultation with his neurologist. His neurologist recommended trying marijuana because of the progression of Parkinson's disease.

Mr. J then began medical hemp capsules, which, he said, contained about 30 pieces of 25 mg capsules. It cost about USD 80, including shipping costs. Along with his parcel, a trial pack of jelly beans was delivered in the version about 5 jelly beans in a packet. According to him, the capsules were bitter and he took one capsule a day.

He added that after taking the first capsule, he felt so relaxed and calm. He could move, get up and get out of bed easier, get in and out of the chair better. He also noticed that for the first time his tremors were much smaller.

Mr. J said he liked hemp jelly beans more because they tasted more like candies and were tastier than capsules. What's more, the effect of jelly beans seemed much faster than capsules and was much cheaper. Capsules per piece would cost around USD 3 each, and jelly beans would be around USD 1 each.

To mimic the action of jellies, Mr J said he was trying to melt the capsule under his tongue to remove the edge of his bitterness. He also chewed on ordinary gummy bear candies. It worked for him.

Until now, Mr. J is continuing physical therapy, in which we can see that he tolerates and performs high-level training tasks that he was unable to do before. His right hand has little or no tremor, no more tremors around his neck, and his reflexes have improved. I can see it thanks to his ability to take turns and not lose his balance. We do not need to hold it when it catches, throws or bounces the ball to improve its protective reflexes, which is necessary for it not to fall. it can raise feet higher when walking, and its shuffling is much smaller.

Still aware of the progressive nature of this disease, it is inspirational to see how this very gentle, kind, intelligent and talented person overcomes the simple everyday functional obstacles caused by this debilitating and irreversible disease.

For a population affected by devastating diseases, a daily victory in the ability to move and perform tasks that seem so trivial to most of us is a blessing.

Legalizing medical marijuana is and will continue to be a congressional struggle. We all have different positions and strong opinions on this subject. Research is ongoing into its pros and cons. I foresee greater awareness of its existence as an alternative treatment for various diseases that do not respond to conventional medicine and treatment.

However, as a medical specialist, it is a satisfaction to see functional changes in Mr. J., how he is able to remain independent and self-sufficient despite his disability.

I am currently working on finding a person who can also share the negative effects of medical marijuana with me. I would like to hear from you and be able to share my journey and experience anonymously.

Contact me if you have anything to share.

Greetings for a great day and until the next article!