Cannabis and the Immune System

Dr. Sasha Noe

• Publisher: Purposely Created Publishing Group
• Year: 2018
• ISBN:
  9781644840375
• Edition: 1
• Topic: Médecine
• Subtopic: Théorie, pratique et référence de la médecine

Gain insight into some of the earliest years in cannabinoid research from the only known physician in the US who holds a PhD in molecular and cellular cannabinoid research. The journey began in 1994 when she became fascinated with the question: When someone uses cannabis, how is their immune system affected?

Years were spent investigating the role of cannabinoid receptor 1 in the immune system of a mouse model and that then evolved into research that explored the role of cannabinoids in HIV infection and replication. This book highlights the one of a kind doctoral dissertation works of the author as well as it’s application from ‘the bench to the bedside'.

Also included in this book is a BONUS SECTION of case studies with treatment pearls and best practices for several common medical conditions that are being safely and effectively treated with medical cannabis. Enjoy!

MEDICAL CANNABIS CASE STUDIES

DIAGNOSIS OF CHRONIC PAIN

Case Study: 69 year old female with Chronic Back Pain:

History of present illness:

• A 69 year-old Hispanic female presents for lower back pain and radicular neuropathy. Onset over 10 years ago and progressed gradually. There was no known injury. Patient describes pain as severe, achy and spasming constant with a waxing and waning nature. Pain increases with standing, walking, and prolonged sitting and is relieved with lying down. She also has an abnormal gait, as she is unable to ambulate without pain. Patient has been under the care of multiple specialists including rheumatology, neurology and interventional pain management.

• Patient takes Hydrocodone-APAP 10 mg-325 mg three to four times a day, and only achieves relief of her pain from 8/10 to 6/10. She has had 4 injections for her back pain in the past with no improvement and is vehemently opposed to surgical intervention.

• MRI shows L3-L4 posterior disc protrusion with severe spinal canal stenosis, L4-L5 severe spinal canal stenosis secondary to broad posterior disc protrusion and anteriolisthesis of L4 4-5 mm.

Review of Systems:

• Positive for mild numbness and tingling down left side, joint pain, joint stiffness, Î and muscle stiffness in the bilateral lower extremities.

Past Medical History:

• Hypertension, mixed hyperlipidemia, polyneuropathy, opioid dependence without complications for 10 years, rheumatoid arthritis, systolic heart murmur, peripheral vascular disease, varicose veins of bilateral lower extremities, allergic rhinitis, and trace edema of the lower extremities.

Surgical history:

• Cataract extraction from right eye.

Family history:

• Father is deceased from unknown causes; mother is alive with hypercholesterolemia Î and hypertension; brother with diabetes mellitus

Social history:

• Never smoked, no history of alcohol or illicit drug use, G3P3.

Medications:

• Simvastatin 10 mg once daily, Gabapentin 300 mg 2 tablets twice a day, Clonidine 0.2 mg once daily, Vitamin D3 5000 IU daily, Hydrocodone-APAP 10mg-325 mg four times a day as needed.

Allergies:

• No known drug allergies.

Pertinent Physical Exam:

• Musculoskeletal: spasms down entire spine. Thoracic and lumbar spine rotated right. 4/5 strength. Range of motion decreased due to pain and spasticity.

• Neuro: hyper-reflexive deep tendon reflexes in the bilateral lower extremity. Decreased discrimination to sharp and dull stimuli in lower extremities. Numbness and tingling in all extremities.

Medical Cannabis Treatment Recommendation and Outcome:

• During the initial visit the patient was recommended to use low-THC medical cannabis 20-30 mg tincture in the morning and the treatment could be increased to three times daily as needed and tolerated providing no adverse side effects.

• At the first follow up the patient 2 weeks into treatment, the patient found oil that the medical cannabis treatment helped with her pain for up to eight hours. It helped her exercise and increased her range of motion in her back. She has decreased her narcotic use from four times daily to twice daily. The patient’s muscle spasms are relieved. With narcotic use, the patient still had pain, however, with the Low-THC tincture her lower back pain was reduced to 0/10.

Case Study: 65 year old female with Chronic Back Pain:

History of present illness:

• A 65 year-old Caucasian female presents for neck and back pain. She was diagnosed with scoliosis at age 11. Patient reports chronic sciatica radiating down her left leg to mid thigh as well pain in her left trunk and flank. The neck pain is worsened with looking up and rotating her head from side to side. Thoracic back pain is worsened with driving, movement of her arms, and exercise. Patient has been under the care of multiple specialists including neurology and pain management.

• Previous treatments include bilateral cervical facet injections at C4- C5, C5-C6, and C6-C7 in the last 5 years. Pain was relieved for about 6 months. Additional treatments included narcotics, oral and topical anti-inflammatory medications, C3-C6 medial branch nerve ablations bilaterally, SI joint injection and various forms of physical therapy.

Review of Systems:

• Positive for chronic headaches and joint pain.

Imaging:

• Cervical x-ray: Multilevel degenerative disc disease with mild kyphosis.

• Thoracic X-ray: levoconvex scoliosis at thoracolumbar junction, dextraconvex scoliosis in mid-thoracic spine.

• Lumbar L-Spine with multi-degenerative changes, and disc bulges without nerve root impingement.

• MRI T-spine indicated scoliosis with convexity to right of mid-thoracic spine, central disc protrusions at T6-T7 and T7-T8, severe stenosis at T10-T11 secondary to scoliotic curvature and facet hypertrophy.

Past Medical History:

• Breast cancer status post bilateral mastectomies, hypertension, hyperlipidemia, gallbladder disease, scoliosis, GERD, generalized anxiety, edema, and COPD.

Surgical history:

• Bilateral mastectomies and cholecystectomy.

Family history:

• Mother is deceased (medical history unknown) and father is deceased from heart disease and stroke.

Social history:

• Smokes a half-pack of cigarettes daily, and drinks 1 glass of alcohol daily, G2P2.

Medications:

• Nortriptyline 25 mg once daily, propranolol 20 mg once daily, simvastatin 20 mg Î once daily, Mobic 15 mg once daily, Baclofen 10 mg one tablet three times daily, and tramadol 50 mg one tablet four times daily.

Allergies:

• No known drug allergies.

Pertinent Physical Exam:

• Musculoskeletal: muscle spasming and tenderness to palpation along cervical, thoracic, and lumbar paraspinal regions. Scoliosis observed and palpated and in thoracic region. Range of motion limited by pain and structural abnormalities. Strength 5/5 in the bilateral upper and lower extremities.

Medical Cannabis Treatment Recommendation and Outcome:

• During the initial visit the patient was recommended to use CBD with Low-THC at 20 mg tincture sublingually up to three times daily.

• At follow up after 2 weeks on treatment the patient stopped taking Mobic for a few days prior to the office visit and is still taking tamadol 50 mg nightly up to three times daily some days. Pain is still at a 7/10 with the treatment compared to a 10/10 prior to the medical cannabis treatment. As an aside, the patient states her vision had greatly improved, noting that “color is sharper”ใ The determination was made to recommend treatment with a higher level of THC and an order was placed consisting of THC 5 mg sublingually twice daily.

• Patient is using high-THC treatment at night and states her pain is still at a 3-5/10 at times. The higher THC product is only being used at night as the patient states that using high-dose THC twice daily “makes her spacey”. The patient is unable to discontinue Mobic due to her persistent pain. The patients’ treatment was adjusted to 50mg SL Low-THC CBD twice daily and was advised to continue use of the higher THC product at the night time until the next office visit.

DIAGNOSIS OF PARKINSON’S DISEASE

Case Study: 59 year old male with Parkinson’s Disease:

History of present illness:

• A 59 year-old Caucasian male presents with Parkinson’s induced tremor and weakness. The patient had previously tried hemp oil CBD (without THC) with no symptom improvement. Patient has been under the care of multiple specialists including a neurologist who specializes in movement disorders.

Review of Systems:

• Positive for weakness, fatigue, muscle cramps, muscle stiffness, joint stiffness, memory loss, nervousness, tremors, insomnia, constipation, urinary frequency, and urinary urgency.

Past Medical History:

• Parkinson’s disease, autoimmune hypothyroidism, history of prostate cancer, and history of a thoracic compression fracture, concussion secondary to motor vehicle accident over 30 years ago

Surgical history:

• Small bowel resection and repair of open pelvis fracture over 30 years ago.

Family history:

• Mother is deceased from Colon cancer and father is deceased from Colon cancer.

Social history:

• Drinks beer socially and infrequently. No history of illicit drug use.

Medications:

• Isaradipine 5 mg, one tablet twice daily; memantine 5 mg, one tablet twice daily; pramipexole 0.5 mg, two tablets daily; amanatadine 100 mg, one tablet twice daily; finasteride 5 mg, one tablet daily; vitamin D3 5000 IU; Nature-Throid 32.5 mg, two tablets in morning and two in afternoon; Mirapex 0.5 mg, 2 tablets...

Table of contents

• Title page
• FOREWORD
• TABLE OF CONTENTS
• MEDICAL CANNABIS CASE STUDIES
• LIST OF TABLES
• LIST OF FIGURES
• LIST OF ABBREVIATIONS
• ABSTRACT
• INTRODUCTION
• OBJECTIVES
• MATERIALS AND METHODS
• RESULTS
• DISCUSSION
• REFERENCES
• ABOUT THE AUTHOR
• BIOGRAPHY FOR SASHA NOE, DO, PHD