Medical Marijuana: An insight into a patient's journey. (Part 2)

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On Part 1 of this topic, I tackled the basic background on Florida's Amendment 2: the Medical Marijuana Legalization Initiative which passed November 8, 2016.

I also touched briefly and introduced Mr. J.L., a patient who is battling Parkinson's disease and how he was introduced to medical cannabis use. 

Mr. J.L.'s personal battle with Parkinson's Disease.

Mr. J as he shared, was officially diagnosed with Parkinson's Disease some seven years ago. He has been under the care of Dr. Joven T. Garcia, a doctor of Internal Medicine practicing in Palm Bay, Florida under MAB, the Medical Associates of Brevard group.

About Parkinson's Disease

As described by the Mayo Clinic staff: "Parkinson's Disease is a Progressive disease of the nervous system that affects movement. It develops gradually, sometimes with a barely noticeable tremor in just one hand. But while tremor may be the well-known sign of Parkinson's disease, the disorder also commonly causes stiffness or slowing of movement."

Subsequent effects of the disease include the following: expressionless face also known as masked facies or hypomimia and decline in speech quality that can be slurred, soft, even stuttering. These are very common to patients I have worked with. Furthermore, a patient's walking ability is affected. There is loss of arm swing from trunk rigidity, stiffness and shuffling steps from resulting incoordination.

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

There are currently many ongoing researches for cure including surgery to regulate certain regions of the brain and electrostimulation.

Still, there is no standard treatment for cure at this time, as per the National Parkinson Foundation.

Additionally, medication, lifestyle modification, exercise and rest are recommended. 

Medications Prescribed

Current medications prescribed include the following: Carbidopa-Levodopa, Carbidopa-Levodopa infusion, Dopamine Agonists, MAO-B inhibitors, Catechol-O-Methyltransferase (COMT Inhibitors), Anticholinergics and Amantadine. -Source: The Mayo Clinic Organization

Parkinsons and Surgery

Deep Brain Stimulation (DBS) ia procedure where electrodes are implanted in specific areas of the brain with a generator implanted in the chest area near the collarbone which sends out impulses to the brain aimed at reducing the symptoms. It is not a cure however and there are many risks and side effects involved. Both the medication and DBS will not halt the progression of the disease.

Parkinson's and Physical Therapy

Physical Therapists get to work with these type of patients during the different stages of the disease. This is primarily because of the functional decline resulting from incoordination, dyskinesias (involuntary movements) and rigidity which makes purposeful and spontaneous movements very tedious.

These problems can make even the most basic functions as feeding, grooming and toileting very difficult. It also makes walking very unsteady. Shuffling gait is very common where it is difficult for them to make the first step (because of bradykinesia - very slow movement) but once they go, it is also very difficult to stop. Many of these patients are at a high risk for falling and a large number during the advanced stages become fully dependent for care.

When referred to Physical Therapy, patient education regarding appropriate exercises, movement strategies, task modification, gait training and fall prevention strategies are a part of the overall plan of care and functional intervention. They are also often referred to Speech Therapy for speech and feeding problems, and to Occupational Therapy for basic self care and hand or upper extremity functions.

Mr. J's Battle

I first worked with Mr. J about 5 years ago. Although he was not on the advanced stages of the disease at that time, he already manifested the primary visible symptoms of the disease: Hand and neck tremors, masked facies, rigidity and significant incoordination. He walked very slow, was shuffling and took a long time walking even from room to room as he was unable to make quick turns. When he does turn, he tends to lose his balance and fall. His reflexes were very slow. He could hardly catch a ball or bounce it. His speech was slurred, barely audible and he had a stutter. He had difficulty getting up and down simple curbs and stairs. He had fallen many times from balance issues.

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Mr. J persevered with the physical therapy program and was always very motivated. For each of the episodes that he was referred to us through the years, he always showed improvement and always followed through with the specific exercise program we prescribed. Due to the progressive nature of the disease however, he would have a physical decline and we had to work with him again.

He shared the story of how he first noticed the change in him from Parkinson's. Foremost he mentioned was when he was teaching drawing to middle school students in his art class in New York. He said that he was progressively having difficulty drawing and using his right hand as he had developed tremors. The rest followed including a change in his facial expresison, the rigidity and feeling stiff all the time.This became progressively worse through the years until his move to Florida.

Once under the care of an internist, he was prescribed Sinemet and other medications which he had taken through the years.

The last time I saw him for treatment was in early 2016 where he had significant tremors on his right hand and an involuntary twitching in his neck. His masked facies had progressed, his face almost droopy and he was walking with so much shuffling and difficulty, barely able to move one foot in front of the other. He also reported of several falls because of worsening balance problems. 

This was why when I saw him in March of this year, I saw the significant change in him which he attributed to medical cannabis.

Medical Cannabis: Capsules and Gummies

He further shared his story. Upon hearing about the potential benefits of medical cannabis for Parkinson's disease, he consulted with his primary physician who directed him for further consult with his neurologist. His neurologist recommended trying medical cannabis due to the advancing nature of his Parkinson's disease.

Mr. J then got started on medical cannabis capsules where he said it contained about 30 pieces of 25 mg capsules. This costed him about $80 or so including shipping. With his shipment came a sample pack of the gummies version of about 5 gummies in a pack. The capsules were bitter, according to him and he took 1 capsule daily.

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

With the sample gummies, he stated that he liked it better as it tasted much like candy and was tastier than the capsules. Even more so, the effect of the gummies seemed much faster than that of the capsules and was much cheaper. The capsules per piece costed about $3 each and the gummies would amount to about $1 a piece he added.

So as to mimic the effect of the gummies, Mr. J said he tried melting the capsule under his tongue and to take off the edge of its bitterness, he also chewed regular gummy bear candy. This worked for him.

To date, Mr. J continues with physical therapy where we see him better able to tolerate and execute high level balance training tasks that he was unable to do so before. He has very little to no tremor on his right hand, he no longer exhibits the twitching on his neck, and his reflexes improved. I see this by his ability to make a turn and not lose his balance. We do not have to hold him while he catches, throws or bounces a ball to improve his protective righting reflexes necessary for him not to fall. he can lift his feet higher when walking and his shuffling is so much lesser.

Still aware of the progressive nature of this disease, it is just inspiring to see this very soft-spoken, kind-hearted, intelligent and talented individual overcome simple daily functional obstacles brought about by this debilitating and irreversible disease.

Legalized medical cannabis seems destined to stay. Ongoing researches of its benefits are inevitable and for sure we will be discovering more pros and cons about its use. But for the population afflicted with debilitating diseases, a day to day victory of being able to move about and perform tasks that seem so trivial to most of us, is a blessing.

Although I am also very much a digital entrepeneur, I will always be a healthcare advocate at heart.

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