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Medical marijuana: an insight into the patient’s journey

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BACKGROUND

To date, medical marijuana has been legalized in the United States in 30 states, including the following:

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 Virginia.

Each of these states has its own regulations and guidelines on use and qualifications.

Here in Florida, the Medical Marijuana Legalization Initiative, also known as Amendment 2, was adopted on November 8, 2016 for eligible patients under the supervision of a qualified and licensed marijuana physician. Furthermore, this amendment was adopted with a total of 6,518,919 (71.32%) YES votes and 2,621,845 (28.68%) NO.

The federal government has classified marijuana as a List 1 drug, which doctors illegally prescribe marijuana to their patients. These marijuana doctors can make recommendations for medical cannabis under state law that can be valid for up to one year. Patients cannot go to the pharmacy to fill out a prescription for medical marijuana.

Under strict regulations, marijuana doctors are prohibited from associating with any medical cannabis distributors or dispensaries.

Only certain patients who have “attenuated diseases” have legal protection under this amendment. Diseases classified in its provision include PTSD (post-traumatic stress disorder), chronic muscle cramps, multiple sclerosis, seizures, epilepsy, glaucoma, Crohn’s disease, cancer, HIV / AIDS, ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease) and Parkinson’s .

Although the above ailments are referred to as “primary debilitating conditions,” in this provision, Amendment 2 also indicated: “or any other disease / condition of similar severity / symptom, determined by medical opinion that medical use of marijuana will outweigh any potential health risks.” .

There are currently about 56 known and enumerated marijuana doctors in Florida.

More information and specifics related to this topic can also be obtained from the Florida Health Department 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 Facebook video about a man with Parkinson’s disease who was given a shot of medical cannabis. The before and after videos were pretty impressive. Before treatment, you may see significant shivering, stuttering, and abnormal posture of this man. A very different person is shown after the video. His speech was intelligible and audible. He had no stuttering, shivering, and showed very controlled movements. This man walked and talked as any normal person would. He also shared how it improved his quality of life.

As a physical therapist with exposure to different cultures, I personally have mixed feelings about medical cannabis. However, as a healthcare professional it is quite an epiphany to witness one significant change in my patient with the use of medical cannabis.

G. J. L. with Parkinson’s disease

Mr. J.L. he has been coming to me for more than five years for physical therapy for problems caused by his Parkinson’s disease. Knowing the progressive nature of the disease, I observed how this gentle soul copes with the effects of this exhausting trouble. His primary care physician would refer him for treatment when he began to develop weakness, stiffness, shivering, and most of all balance problems where he reported falling at home.

We would see him each time for about six to eight weeks. We worked to improve his coordination, strength, flexibility and balance, with the primary purpose of making him safe and self-effacing at home, because he lives alone. It is also to keep from falling which predisposes him to more serious injuries and complications.

Change

About a few weeks ago, he came to the office to schedule physical therapy because he was referred again by his doctor. Working with this patient over the years, I have been trying to figure out what has changed in him. I looked and watched carefully as I performed my initial assessment. Maybe he noticed the curiosity that bothered me because he was giving me a smile. I could no longer restrain my curiosity, I asked him, “Mr. J, what were your intentions?” Mr. J just laughed and asked me why curiosity!

Well, it finally occurred to me that Mr. J. almost had a shiver on his right arm where he manifested the typical shiver of this disease. His neck was straight and not moved to the right. Furthermore, his speech was clearer! Another thing that struck me was that he walked better. It’s not great, but he managed to turn around without having to mix what I’ve seen for years.

He finally shared with me that he had started taking medical cannabis for over a month as recommended by his neurologist. His friend apparently mentioned to him a Facebook video about a man with severe Parkinson’s disease. That man received a shot of medical cannabis, and the change was visible after only a few minutes. This apparently prompted him to consult a primary care physician and then a neurologist.

The change I saw with Mr. J after just over a month of consuming medical cannabis is significant. His speech improved. His voice is deeper and more sonorous. He didn’t stutter and controlled his right arm more than the almost non-existent shiver. And he stands straight. His balance and coordination have improved, even more so with the advanced retraining of balance he is currently receiving.

During his therapy sessions, Mr. J was able to bounce the ball on the floor faster with better precision. We saw him catch and catch the ball standing without anyone holding him. We used to stand behind someone and hold him back because he had slow reactions and reflexive reactions. His gait also improved. Just a few months ago, he would have pulled his right leg and walked with a very short stir. He would lose his balance with the slightest attempt to turn or raise his leg to stand on one leg.

These seemingly subtle changes in him in just over a month of using medical cannabis brought significance to his life. He shared that he feels more relaxed and is less worried about the fall. He can perform simple household chores with more confidence and is able to withstand more advanced therapeutic exercises during his physical therapies. She does not feel tired and is able to do multiple tasks during the day.

Mr. J is still on that journey and he wanted to share that experience and for me to tell his story. Knowing him and his background, he is not the type of person who would take marijuana indiscriminately for mere recreation and self-indulgence.

About Mr. J.L.

Mr. J is originally from New York and has moved to Florida. He was diagnosed with Parkinson’s disease approximately seven (7) years ago. He used to be the designer of the very prestigious Chinese manufacturer Syracuse, whose customers include the White House, 5-star hotels and prestigious restaurants. He was also a member of the Barber Shop Quartet as a tenor of SPEBSQSA (Society for the Preservation and Encouragement of Singing Barber Quartet in America), and participated in several amateur Broadway shows in New York City. He was an art teacher to high school students who taught drawing.

His life changed when he was called up for service sometime in 1986. He connected with a healing service that he found to be mostly with people who have tumors. He traveled abroad to expand his healing ministry. This attracted so much attention that even the media noticed and leaked some information about his ministry. He is now retired and lives in Palm Bay, Florida.

It is a privilege to know this special person who has done so much during his younger days. He devoted so much time and dedication to helping others. I deeply appreciate the humanitarian service provided by Mr. J and how his ministry has touched so many lives. I consider him another unconvinced hero of his time.

His willingness to share me is a clip of his story of privilege. Moreover, being able to work with him to improve his progress and see his motivation and determination over the years is a very inspiring experience.

Mr. J. L.’s personal battle with Parkinson’s disease.

Mr. J, he shared, was officially diagnosed with Parkinson’s disease some seven years ago. He was under the care of an internal medicine doctor who practices 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 tremor in just one hand. But while tremor may be a well-known sign of Parkinson’s disease, the disorder also it often causes stiffness or slowing of movement. “

Subsequent effects of the disease include the following: a faceless expression also called masked facies or hypomimia, and a decline in speech quality that may be condensed, soft, and even stuttering. These are very common in the patients I have worked with. It also affects the patient’s ability to walk. There is a loss of arm swing due to trunk stiffness, stiffness and ring change strokes resulting from misalignment.

Unfortunately, this disease is progressive and current medications aim to improve symptoms, but not necessarily the cure.

There is currently a lot of research in progress, including surgery to regulate certain areas of the brain and electrostimulation.

However, there is currently no standard treatment, as noted in the National Parkinson’s Foundation.

In addition, medications, lifestyle modifications, exercise, and rest are recommended.

Prescribed medications

Currently prescribed medications include the following: Carbidopa-Levodopa, Carbidopa-Levodopa Infusion, Dopamine Agonists, MAO-B Inhibitors, Catechol-O-Methyltransferase (COMT Inhibitors), Anticholinergics, and Amantadine. Source: Mayo Clinical Organization

Parkinson’s and surgery

Deep brain stimulation procedure (DBS) in a procedure in which electrodes are implanted in certain parts of the brain with a generator implanted in the chest area near the collarbone, which sends impulses to the brain aimed at reducing symptoms. However, it is not a cure and there are many risks and side effects. Both drugs and DBS will not stop the progression of the disease.

Parkinson’s and physical therapy

Physical therapists can work with this type of patient during different stages of the disease. This is primarily due to the functional decline resulting from incoordination, dyskinesia (involuntary movements) and rigidity which makes intentional and spontaneous movements very tiring.

These problems can make even the most basic functions such as feeding, grooming and toileting difficult. Walking becomes very unstable. Promoting walking is very common where it is difficult for them to take the first step (due to bradykinesia – very slow movement), but once they start, it is also very difficult to stop. Many of these patients are at high risk of falling and a large number during the advanced stages become completely dependent on care.

When it comes to physical therapy, educating patients about appropriate exercises, movement strategies, task modification, step training, and fall prevention is part of an overall care plan and functional intervention. They are often referred to as speech therapy for speech and feeding problems, and occupational therapy for basic self-preservation and hand or upper extremity functions.

Mr. J Battle

I first worked with Mr. J about 5 years ago. Although he was not in an advanced stage of the disease at the time, he manifested the primary visible symptoms of the disease: trembling of the hands and neck, masked facies, rigidity, and significant incoordination. He walked very slowly, moved and walked for a long time even from room to room because he was not able to make fast turns. When he turns, he tends to lose his balance and fall. His reflexes were very slow. He barely managed to catch the ball or bounce it. His speech was thick, barely audible, and he had stuttering. He had difficulty ascending and descending simple sidewalks and stairs. He fell from balance problems several times.

Mr. J persevered in the physical therapy program and was always very motivated. For each episode that was referred to us over the years, it was always improved and always followed the specific exercise program we prescribed for it. But due to the progressive nature of the disease, he would have a physical decline and we had to work with him again.

He shared the story of how he first noticed a change in him since Parkinson’s. What he mentioned earlier was when he taught drawing to high school students in his art class in New York. He said it was progressively difficult for him to draw and use his right hand because he developed tremors. The rest followed, including a change in facial expression, stiffness, and a feeling of stiffness all the time. This became progressively worse over the years until his move to Florida.

Once under the care of an internist, he was prescribed Sinemet and other medications he had been taking over the years.

The last time I saw him in treatment was in early 2016 where he had significant shivering in his right arm and involuntary twitching in his neck. His masked facies progressed, his face was almost bearable, and he walked with so much rolling and difficulty. He barely managed to move one leg in front of the other. He also reported falls due to worsening balance problems.

That’s why, in March of this year, I saw him in the significant changes he attributed to medical cannabis.

Medical cannabis: capsules and gums

He further shared his story. Hearing about the potential benefits of medical cannabis for Parkinson’s disease, he consulted with his primary care physician who referred him for further consultation with his neurologist. His neurologist recommended trying medical cannabis because of the advanced nature of his Parkinson’s disease.

Mr. J then started with medical cannabis capsules, where he said it contained about 30 pieces of 25 mg capsules. It cost him about $ 80, including shipping. Along with his shipment came a sample package of rubber versions of about 5 tires in a package. According to him, the capsules were bitter, and he took 1 capsule a day.

He added that after taking the first capsule he had ever felt so relaxed and calm. He could move more easily, get into bed easier, get in better and lean back from the chair. He also noticed that his tremors were much less than the first time.

Mr. J stated that he prefers cannabis gum because it tastes like candy and is tastier than capsules. Moreover, the rubber effect looked much faster than the capsule effect and was much cheaper. Capsules per piece cost about $ 3, and erasers would cost about $ 1 per piece.

To mimic the effect of the erasers, Mr. J said he tried to melt the capsule under his tongue to remove the edge of the bitterness. He also chewed plain bear gum candies. This worked for him.

To this day, Mr. J continues with physical therapy, where we see that he better tolerates and performs high-level balance training tasks that he was not capable of before. He has very little tremor on his right arm, he no longer shows twitching in his neck, and his reflexes have improved. I see it in his ability to make a turn and not lose his balance. We don’t have to hold him as he catches, throws or bounces the ball to improve his protective reflective reflexes that he needs to keep from falling. he can raise his legs more while walking and his mixing is so much less.

Still aware of the progressive nature of this disease, it is only inspiring to see how this very soft, cordial, intelligent and talented individual overcomes the simple everyday functional barriers brought about by this debilitating and irreversible disease.

For a population afflicted with debilitated diseases, the blessing of daily victory in the ability to move and perform tasks that seem trivial to most.

Legalization of medical marijuana is currently and will be in battle in Congress. We all have different views and strong opinions on this issue. Research on its advantages and disadvantages is ongoing. I envision a greater awareness of its existence as an alternative treatment to various diseases that do not respond to conventional medicine and treatment.

However, as a medical professional he fulfills the opportunity to witness functional changes in Mr. J., as he is able to remain independent and self-sufficient despite his disability.

I am currently working on finding an individual who can share with me the negative effects of medical marijuana as well. I would like to contact you and be able to share my journey and experience, of course, anonymously.

Please contact me if you have anything to share.

Greetings for a wonderful day and see you next article!

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