The endocannabinoid system: an explanation for cannabis enthusiasts

Here’s a treat for your brain.  Knowledge is power…learn up!

http://www.thecannabist.co/2017/05/02/endocannabinoid-system-cannabis/78767/

Paging Dr. Van Winkle

When was the last time you woke up and realized you’d been a drugged zombie for 17 years?

That happened to me.  This month: May, 2017, I went through what is, I hope, my last withdrawal from psychiatric drugs.  (I remain on lithium, which is killing my kidneys slowly, but I need it, at least for now.)

And now I’m me again.  But who the hell is “me,” and what am I supposed to do?  Having been disabled by my various chronic conditions, multiplied by the even more profound disability of the drugs that were supposed to help me function, yet enveloped me in such a cloud of grey fuzz that I was insulated from both my environment and myself, I awake to find a gulf spread out between myself now and myself in the past, with no way to possibly bridge it.  17 years.

If it had not been for the drugs themselves doing what drugs do (side effects and adverse reactions), I’d still be moving about in a sea of brain fuzz.  I had no notion of stopping them on my own.  The opposite!  I was convinced that it was only those drugs that prevented me from the inevitability of suicide.  But even before I began getting serious side effects that contraindicated the antipsychotics and antiepileptics, I had started to sow the seeds for what would serendipitously become the replacement for not just one, but seven, psychoactive drugs, plus a prescription antiinflammatory.

I started taking cannabinoids as pain medicine.  Following a protocol hybridized from several in use, I began a scheduled dosage of cannabidiol (CBD), along with microdoses of THC.   I started this in the fall of 2016, and the pain relief has been superior to anything else, with minimal negative side effects and a whole load of positive ones.

When my antipsychotics began to cause extreme muscle twitching and movement disorder, I thought for sure I was doomed, because I really had benefited from their help.   The combination of brain without quetiapine and brain in withdrawal from same really did haul me to the brink.  And that was before I ever thought of cannabis.

Fortunately I had plenty of benzos to blunt the crash, but I’ve always been very careful not to get hooked on the benzos….and actually didn’t, despite being on them nightly since 1989.  More about benzos shortly.

The next to go was my darling lamotrigine.  Now, modern neuroscience tells us that bipolar disorder shares features with seizure disorders: there is a type of “kindling” that begins as a misfiring somewhere in the brain, which can then spread to other parts and finally, if that process is not interrupted somehow, involves the entire brain, causing an acute episode.  Medication and other treatments can stop this from happening, or at least blunt the reaction (note: CBD is shaping up to be a very effective antiseizure medicine, as proven in study after study).  Since antiepileptics help in bipolar disorder, that adds weight to the hypothesis that bipolar shares features with epilepsy.  Clearly, I did not want to stop my lamotrigine; but I developed the most feared side effect: toxic epidermal necrolysis.  This causes the layers of one’s skin and mucous membranes to separate and slough off, like a second degree burn.  It is incredibly painful and can be life threatening.  Fortunately mine didn’t get that far, but it was terrifying.  Bye-bye, lamotrigine!

I waited for the backlash after quitting lamotrigine, but none came.  By that time I was slamming the CBD every four hours, for a nasty episode of spine arthritis pain.  Either I had suddenly stopped needing antiseizure meds, or…wait….I was taking them–just a different one, for which my body has actual receptors: CBD, which activates CB1 receptors in the brain.

The winter wore on, and I found it necessary to have my injured left wrist operated on for the 4th time.  Even though that’s not a huge surgery, there would be pain afterwards, and if I hoped to receive any opioid pain medication, the benzos might have to go.  I decided to taper over six weeks, which is very rapid for benzodiazepines.  These drugs, which have helped me and many others immensely, are very hard to get off of.  Our bodies love what they do.

I was also taking Zolpidem, a sleeping pill that works on similar receptors to benzos.  In effect, I was taking two different benzos!  That had to stop.  And if that weren’t enough, I had a third benzo that I took when my PTSD broke through: clonazepam.  Three different types of benzodiazepines.

It wasn’t as hard as I expected.  The CBD stepped right in behind the benzos, and now that’s what I use.  The benzos didn’t make me stop having PTSD.  They helped me sleep and function a bit better in everyday life.  CBD does that too, and I feel like I’ve walked out of a wall of fog.

Along the way I got rid of the gabapentin (prescribed for neuropathic pain: THC works much better), and the celecoxib, which is supposed to be for pain/inflammation, but CBD/THC combinations work worlds better and cost much less.

Yes, medical marijuana is costing me much less than the copays for my prescription drugs, which at one point were close to $500 a month– with Medicare!  My oils, tinctures, and herbs are now costing me less than $200/mo.  Soon I hope to grow my own, which will cost even less and I’ll be able to grow organically.  I’ve substituted one botanical for eight pharmaceuticals.  Hmm, no wonder Big Pharma is all about patenting those cannabinoid analog drugs and suppressing the medical marijuana movement!

I feel like someone who has been sucked up by a vacuum and plopped down somewhere entirely different.  I can see where I was at the beginning, and I see where I am now; but the ground I have traveled is invisible.  It is a chasm.  I am no longer who I was then, and no longer who I was along the journey.

Fine, you say.  Congratulations!  But it’s not so simple.

You see, I became disabled from working at any job whatsoever on 4/4/2000.  Since that day I have maintained my medical license and all its requirements.  I tried to go back to work a couple of years after my breakdown, only to find that the system has quirks in it that do not include doctors with bipolar disorder.  I was trapped being sick.

I did do a few miscellaneous things with my time, but between my physical illness and my brain and its special disabling brain-drugs, I was trapped into being a sick person.

I have always felt that the brain part was the limiting part, since people manage to continue to work with all manner of disabilities, up to the point where the body simply puts on the brakes– like, for instance, the years I have spent on the toilet.  Or the years without use of my hands, due to joints falling apart and needing surgery.  Or the vexing problem of not being able to look up, down, left, or right, due to neck arthritis.

With my head out of the fog, I’m looking into the future.  It looks awfully scary.  I used to not care about the future, because I was certain of dying from one thing or another before I got there.  Now I’m not so sure, given the salutary response to cannabinoid therapy, that I won’t have a shot at another decade or so.

Problem is, I won’t be able to afford to live.  I have private disability insurance that will (if they don’t find a way to screw me out of it) continue till age 65, which is another year and a half.  After that, it’s Social Security, if there still is such a thing by then.  And although I’ve saved aggressively, I don’t have enough to even remotely get by.  And, lamentably, I don’t think I will be magically all better by then.  My skeleton will still be a wreck, and my guts will likely still be a-bleedin’.  I won’t be able to work at Wal-Mart, unless they have a back office with a bathroom.  

It’s a great grief to look back over that 17 year chasm, back to myself doing my doctor thing, the life I loved.  Now I’m just an aging sick person, soon to be an aged sick person living in poverty.  This was not what I requisitioned.  I did not work three jobs to put myself through The University of Chicago, to end up as one of the underhoused/homeless seniors I meet on the road.  I did not work my way through medical school and graduate school so that I could live the rest of my life disabled.  I did not work 120+ hours/week for three years of residency, only to become a patient myself, with nothing to show for my passion.

It’s tempting to throw in the towel, seeing what a colossal waste my life has turned out to be.  But not yet: I have time.  There’s always death waiting.  I want to see what’s out there, at least until my next surgery.  A joint replacement, and I don’t mean that kind of joint!

At least maybe then I’ll be able to play my banjo.  That really was the last straw with the “god” thing: taking away my hands.  If that very god looked upon me as I played, clinging to that banjo for very life during the hard times–since the moment I first picked up a banjo at age 19, it has been my comfort, my solace, and my joy where there was none before.  And my prayer, my meditation, my chant.  So if then there was some god watching as I played, and it decided to afflict my hands and take my one direct line to joy away, then I say….shame!  For tormenting the tormented.  

At least if I get a new wrist and can make it work, then I can sit and play and people will throw money.  I’ll be grateful.

Article: Cannabis compound may halve seizures for patients with severe epilepsy

Cannabis compound may halve seizures for patients with severe epilepsy

http://flip.it/UjtIiI

Um, yeah.  

Ohio State University scientists have proven what those of us who have been using the herb medicinally have known for years: Cannabidiol, or CBD, is a powerful antiepileptic medicine.  The article mentions a few of the other conditions and illnesses that CBD is known to help.

And in the tradition of medications being used precisely because of their side effects (think belladonna [atropine] which dries up respiratory secretions), note that the only side effects to CBD mentioned are sedation and appetite loss.  Useful, those, in certain circumstances.

While this publication is great news for helping to refute idiot attorneys general who still think cannabis has no medical benefit, it’s also cause for caution: right now the biggest threat to unrestricted adult use is…Big Pharma!

Yes, Big Pharma knows good medicine when it smells the scent of Big Money.  And friends, cannabis is big money, no matter how you cut it.

Big Pharma would much rather see the money from cannabis medicine in its own pocket, and we all know that Big Pharma has lots of senators and other influential players in its own pockets.

One chilling example: Arizona’s 2016 ballot measure that would have legalized adult use was narrowly shot down, largely due to a fierce anti-cannabis campaign bankrolled by the drug giant Insys, which is quartered in Arizona.  Insys produces a large proportion of the synthetic opioid fentanyl that is produced in the U.S.  Fentanyl is used in anesthesia and various delivery systems for treating pain.  It’s also been the culprit in many of the recent opioid overdose deaths we hear so much about.

You may be thinking: oh, right, statistics show that in states with legal cannabis, opioid prescriptions decline by about one-third.  So of course an opioid manufacturer doesn’t want that!

It gets worse.

Seems that Insys was just on the point of rolling out its first synthetic cannabinoid, a THC analog that is pretty much redundant not only because there are already synthetic THC products on the market, but also because anyone with a medical marijuana card can get their THC straight from the source.  

But that’s “not good for business,” as Texas Senator Ted Cruz pointed out when I mentioned that rolling back clean air laws is not good for children.  So Insys spent half a million bucks a couple of weeks before the election on a rabid T.V. ad campaign, spreading fear among the uninformed, mouthing the old saws about how marijuana causes violence, crime, unemployment, blah blah blah, and it worked.

So on one hand, the more good science, the more knowledge, the less fear, the better the public can understand and accept cannabis as medicine.

On the other, the more science, the more Big Pharma sees opportunity, the more danger that our access to this amazing plant could be once again restricted, in its natural form, in favor of…pills.

Too Damned Hot Already!

95°F=35°C= too damned hot for the month of March, even in Southern Arizona.  But wait, “there’s no such thing as climate change.”  That must mean that it’s now normal to have temperatures >15 degrees above normal, in a sustained fashion, two years in a row.  OK, I’ll try to squeeze yet one more incongruity the size of Texas into my pea-sized brain.  

For reasons that are well explained by Ayurveda, my tongue got the word about the heat wave first:

That thing that looks like a small liver on the underside of my tongue is an aphthous ulcer.  It’s the classic “punched out” kind.  Makes me feel pretty damned punched out, let me tell you.

That was a few days ago.  The ulcer kind of propagated into the back of my mouth and throat.  I’ve been literally living on aloe vera juice and coconut water, which I leave in the freezer and sip on.

It occurred to me that this was rather more ulcer-ness than I’m used to.  I get them every few weeks or months.  A Crohn’s thing, you know: it’s a “mouth-to-anus” disease.  Meaning that, lesions can occur anywhere in there.  And do.  

My brain survives and at times even thrives, by continuously scanning for outliers.  That’s how the prey animal survives.  That ripple in the tall grass that wasn’t there earlier?  Lion.  That shadow in the water?  Crocodile.  

Those bizarre mouth ulcers?  Could be just the ol’ Crohn’s monsters.

And on the other hand…there’s lamotrigine (Lamictal®).

Ever since I landed in the hospital in 2001, and ever since the amateur psychiatrist who tried to kill me with every antidepressant under the sun nearly succeeded, and ever since she thankfully went on vacation and left her on-call beeper with the brilliant neuropsychiatrist who correctly identified my brain as bipolar, I have faithfully taken my “L&L cocktail” every day.  Lamictal in the morning, lithium at night.

It’s worked better than anything else.  It’s been my staple.

There’s a problem, though.  It’s been a theoretical problem, till now.

Lamotrigine has one major potential adverse reaction.  It doesn’t happen often, but when it does, it can be devastating.  It’s called Stevens-Johnson Syndrome.  (The linked article downplays what the syndrome really looks like….)  It’s a known and much-feared adverse event that’s associated with Lamictal.  That’s the reason for the very slow dose buildup, if you’ve ever taken it, and the huge black box warning that says if you ever get these nasty lesions, stop taking Lamictal immediately.

My tongue up and turned completely white, then started peeling.  I put my Lamictal away.  Increased the lithium dose by 25%, got out some high CBD cannabis to help with the transition.

If you take medicine for brain stuff, you just naturally deal with side effects.  How not?  Most of this shit we dump into our bodies, no one has any clue what they actually do, outside of the one thing they have to look at for the studies.  Beyond showing that this does or does not increase dopamine levels in the brain, for instance, researchers are not able to predict every single one of the thousands of other chemical interactions a medicine may set into motion all around the body.

Fortunately most side effects are merely unpleasant but not life-threatening.  Stevens-Johnson is extremely unpleasant and also life-threatening.  You just don’t want it!

Lithium has its bad side too: kidney failure holds down the position of real bad actor.  But lithium won’t kill you today.  It might take decades.

On the other hand, Lamictal’s dark side will put you in the burn unit…or the grave.  Right quick.

It’s a terrible choice to have to make: my sanity or my life!  There’s no percentage in trying to gamble with Lamictal, once these mucous membrane lesions appear.  There’s no guarantee that a break from the drug will fix the problem.  For me, this is the red line.  No more.

So what am I gonna do now?

Well, I’ve increased my lithium dose.  That means I have to be incredibly careful in this heat, because lithium can become toxic via dehydration.  And since lithium has a diuretic effect, that makes it even harder to stay hydrated.

I’m making plans to move to somewhere cooler after the end of the month, when I have my hand surgery recheck.  Oregon is sounding good to me….

And yes, my medical cannabis is once more doing yeoman’s duty.  I read an abstract of a study that looked at using CBD to treat psychosis.  Holy crap, the stuff holds up alongside conventional antipsychotics, with absolutely zero side effects!  I’m on that bus.

When Retirement Comes With a Daily Dose of Cannabis | Patients for Medical Cannabis

https://patients4medicalmarijuana.wordpress.com/2017/03/11/when-retirement-comes-with-a-daily-dose-of-cannabis/

That Big 420 In The Sky

Our dear friend Johnna has left this life.  We’re not exactly sure how or when.  More news soon, I hope.

In the meantime, I’m thinking of her fondly, wondering what she’s doing now.

What a dope!  I know what she’s doing!

In that Sweet Home in the Sky it’s always 4:20!

So as I light up, I’ll sing a little tune, and meditate on the Johnna quote for the day:

“I don’t care whether it’s Indica or Sativa. I care if it’s strong.”

Alice B. Toklas Rides Again…and again…and again…and….

Chocolate.  More chocolate!  Gluten free.  And….medicated!

Yes, I tried a piece hot out of the oven.  I need the medicine, and the chocolate doesn’t hurt. It’s medicinal, too, after all.

The wind is kicking up a ruckus outside with the kinds of cactus that blow around so they can stick in your dog’s feet the next day.  It contributes in a bad way to my current state of ultra-ultra-ultra rapid cycling, punctuated by a few episodes of the dreaded mixed state.

I used to take Seroquel for this.  I’m not sure it broke the cycle, but at least it knocked me out so I could get a break from it.  But I started getting very bad neurologic side effects from the Seroquel, and had to stop it.  Some of the nervous system damage has turned out to be permanent, so there’s no way I’m going to try any other drugs in that class (atypical antipsychotics).  So in a word, I’m fucked.

But there’s a Lone Ranger on the horizon…I hope.

I have been so remiss in writing here that I can’t remember what I’ve told you.  Here, I’ll recap:

Spine pain got bad, had lots of consults, results: spinal arthritis, many collapsed discs, moderate spinal stenosis, and…drumroll…five vertebrae are filled with a benign tumor.  It’s benign, because it doesn’t metastasize, but it’s locally destructive.  And I have it in my liver, and god knows where else.

There are other joints in this pity party.  None of them are smokeable.

Which brings us to The Point:

I began using medical cannabis over a year ago.  It takes my spine and joint pain from “all-encompassing, intrusive, consuming” all the way down to, “OK, I can definitely feel this, and I think I’ll do the laundry and walk the dog now.”

That’s the difference.  Of course, I use a special strain of cannabis (PennyWise) that is engineered to have analgesic, anti-inflammatory properties while not being overly psychoactive.  I can get things done, and I’m not constantly going, “Ouch!  Shit!  Fuck!  Damn!” and so on.  Like, right now my thorax is aching and so is my neck and shoulders, but I’m not paralyzed by it.  Nevertheless, I am going to stop writing all hunched up, and go light my Hanukkah menorah.  Sixth night.

Low-dose vaporized cannabis significantly improves neuropathic pain. – PubMed – NCBI

http://www.ncbi.nlm.nih.gov/pubmed/23237736

Read and think.

Rain On The Brain

It’s raining again in Grand Rapids, Michigan.  I left my precious Arizona, hot but at least high and dry, to trade in my trusty Jenny the Chevy camper for the 24 foot house on wheels that I ordered back in November. 

image

I’ve been sick ever since my arrival last Thursday.  Stress is a bitch!  And for me there is nothing more stressful than moving, even if it’s from one mobile dwelling to another.  I get completely disoriented with all my personal shit strewn around.  Disorder breeds more disorder. 

Speaking of disorder, my dear doggy is completely discombobulated.  All her two favorite hangout places in our previous van are gone.  Like moi, she’s having to adjust to this new space and new lifestyle, all of a sudden. There’s lots more room for her to stretch out in the aisle, but I’ve configured the bed in a way that is unacceptable to her, so she is sleeping in the driver’s seat in protest.

I’ve been in awful, unremitting pain ever since I left the lovely dry Southwest.  Humidity kills me.  My spine is screaming; likewise my shoulders, hands, and hips: all the arthritic places.  And wouldn’t you know it, I had a Crohn’s flare-up start the day I moved my stuff from Jenny into my new rig (whose name might be Betsy).  I finally got the blood stains out of my brand new plastic toilet this morning.  That’s one of the lovely things that come with a Crohn’s flare: shitting blood.  I’ve got a sore throat, headache, and spent last night alternately chilling and sweating.  Fucking immune system, where are you when I need you?  Either running hot or on vacation, and sometimes both at the same time.

My sweet doggie came to see me about dawn.  She must have been listening to me shifting uncomfortably around in the bed, trying unsuccessfully to find a pain-free position.  She tried to worm her way into bed with me, but she is still a puppy, albeit a large one; and in the process of her thrashing around trying to cuddle up with me, she accidentally slashed my throat with one of her claws, and razored me up pretty good. 

My sleep deprived, paining self overflowed and I began to wail.  Poor Atina fled to the driver’s seat, and required a great deal of comforting for the rest of the morning.  She feels terrible when she hurts me.  She knows I am fragile, and tries her best to take care of me. But she is large and ungainly.  Accidents are bound to happen.

After applying first aid to my gashed and bleeding throat, I sat down with my new vaporizer and medicated.  I felt better.  I started the day.

Yesterday it rained.  Today it rained.  I’ve grown accustomed to places that don’t steam all the time.  I intend to make my way back West, where I feel good.  A friend called me a little while ago, from Glacier National Park.  He is not a formally religious man, but he said that Glacier felt to him like knowing God.

God and I have been on the outs for some time, so I think I’ll head over to Glacier and see what my friend is talking about.  I wouldn’t mind having a God experience.  My mind needs a jump start.

image

This far corner of Montana is 1,713 miles from where I currently sit.  And that doesn’t take account of my planned side trip to Michigan’s Upper Peninsula.

image

The arrow is supposed to point to the Upper Peninsula.  The little blue dot at the bottom is where I am now. So the whole trip will be a big adventure with my new motorhome as I learn its ins and outs. 

I’m glad I temporarily have the ability to do this kind of gypsying.  I won’t always.  Finances and ill health will eventually clip my wings; but I’ll keep on as long as life lets me.  I’ll go as long and as hard as I can, and be gentle with myself too.

That’s my spiritual discipline now: giving myself permission not to do, but to be.  I get depressed.  I say, OK, I’m depressed.  It will pass.  I use cannabis as part of my medication regimen.  It works.  It helps me get through the depressions.  It helps me feel better.  Isn’t that the point of medication?

None of the meds we take for brain pain are “disease modifying.”  They don’t work unless we take them.  If we stop taking them, they stop working.

Cannabis will break me out of a suicidal depression.  It helps me engage with the world, with my environment.  I feel creative.  I can cook and clean up, take a shower, talk to people.  I don’t lie around crying all day.  I’m still depressed, but I’m more functional and less likely to hole up isolated.

Sometimes I’m just too sick though, like last night when I couldn’t even think well enough to pick up the vaporizer till my dog broke me out of it by slashing my throat.  Well, it was over the top, but it changed my state, so I guess it was all right.  Hope the wound heals.  The skin right there is awfully thin.

I hate it that I’m too disabled to work.  All I want to do is to be in my own office, healing the sick.  But I’m too sick to heal anyone, not even myself.  This mobile lifestyle helps me to not go crazy mourning my lost calling.  It’s a distraction, true, and that’s what I need.

It’s interesting to see how campgrounds are places of refuge for the mentally ill and physically disabled.  Of course no one you meet will say, “My name is Doris, and I’m mentally ill.”  Nope, she will say she has a bad knee, or something legit like that.  All the talk about getting rid of the stigma surrounding mental illness has done absolutely nothing compared to the speculation about the “mental health” of the various recent shooters.  Hell, if I were to tell some campground owner that I’m bipolar, you can bet they would be fresh out of campsites.  Mental cases not welcome anywhere…not openly, anyway.  But we’re here.  We are transient; we float from place to place.  We keep quiet and don’t cause trouble.  But we don’t disclose. 

When will the Mentally Ill Matter? 

Maybe never.  We’re the Invisible Minority.