|Los Angeles Marijuana Doctors
|4344 Eagle Rock Blvd
Los Angeles CA 90041
Open 7 Days a Week
Joseph Michelson, a physician, is the author of 5 medical texts, over 50 professional articles, 2 paperback novels, and has had his non-fiction published in San Diego Magazine, the Los Angeles Times, the Orange County Register, and the “J”. Dr. Michelson wrote a history column for a Los Angeles weekly on-line paper and has been on the faculty at both Stanford and Harvard Medical Schools.
Dr. Michelson serves as medical director of the Medical Marijuana Evaluation Center, Eagle Rock, Los Angeles California and as a consultant to the San Bernardino Medical Clinic, San Bernardino, California.
Articles by Joseph Michelson, MD.
Migraine and Medical Marijuana
My wife, Kate, suffers migraine. To call it "headache," is understating its force. Migraine sufferers will tell you of its potent impairment: devastating head pain (like someone is shot in one side of the head with a hot bullet), accompanying nausea, perhaps vomiting, even a seizure in rare situations. An incessant array of lights, sparkles, colored invaders attack the vision; one's sensitivity cannot tolerate any light once the barrage of pain and perceptions begin. The usual migraine sufferer must retreat to a dark room for several hours.
Thirty million Americans between ages 15 to 55, approximately 6 percent of men and 18 percent of women, suffer migraine. MCT Illustration
Many of the great icons of Western civilization have suffered migraine: Julius Caesar, Charles Darwin, Sigmund Freud, Albert Einstein, Thomas Jefferson and many others. Even while great, enduring truths have emerged from the minds of these imposing figures, they were brought to their knees with disabling head pain by migraine.
Migraine is caused by a spasm of a blood vessel in the brain. Classic medications facilitate vasodilation in order to reduce the spasm. Yet, in spite of the caffeinated drugs and vasodilators available to treat the acute headache; medical marijuana does wonders for migraine. It not only relieves the headache pain, but it also calms the patient who is often agitated with head agony.
Marijuana is available now as a pill (tetrahydrocannabinol) called Marinol. But our patients will readily tell you that the pill does not work as well as "straight" marijuana. The marijuana should not be smoked – since the very smoking can trigger a migraine. Rather, it should be consumed as one of the very many edible forms of marijuana available, i.e. as a cookie, brownie, candy, soft drink, etc.
Why has the established medical authority not embraced this very useful drug, when the American Indians used marijuana as medicine for arthritis, childbirth, and nausea and vomiting for at least 500 years before we even arrived here?
Why has the federal government still not approved medical marijuana? Are they afraid that by approving marijuana as medicine (under a physician's direction) it will aid or abet the illicit drug trade? Firstly, in California, medical marijuana is grown with a grower's license similar to the patient's user license, and the supply of the medication is very amply available legally to the dispensaries.
Are they just intimidated by the "bad wrap" that the FDA gave marijuana in the 1930s, when it was classified as a class1 drug – like morphine and codeine? In response: medical authorities will assert that marijuana is not addictive. Furthermore, the federal government doesn't seem to mind that we physicians administer narcotic so freely (Vicodin, Norco, Soma, Tylenol 3&4, etc.) to minimize pain, when, in fact, for chronic pain – we render these helpless and hapless patients into narcotic addicts. Marijuana has never killed anyone; narcotics have killed thousands, perhaps millions.
In America, today, with our elder population living longer and healthier than ever, we are unfortunately hunted down by the frightening specter of Diabetes—which now strikes one in three of our elderly over 65 years of age.
While we can control diabetes better than ever, nevertheless, certain diabetic complications strike horror into the minds and bodies of our neighbors: the devastating damage from circulatory and nerve impairment. Diabetic neuropathy renders—the feet especially— numb, senseless, blue, cold and prone to gangrene. Diabetes is, by far, the leading reason for amputation surgery in the U.S. (greater than 60% of patients!). Worse yet, these numb and senseless appendages, may unpredictably scream out from a phantom pain that should not normally affect numb and bloodless tissue, deprived of regular circulation.
Ms.Anne S-D, age 42, relates “I used to suffer so terribly…
I couldn’t walk—even getting out of bed, to trample into the bathroom hurt with each step. I was a prisoner to my bed and couch… …I would just sit home each day and cry… Now, I still have pain, but much less. I can move about—I’m here, see—and my pain is not so overwhelming… …I’m calm with it…”
Mrs. S-D has suffered from diabetes for the last ten years. Like 10% of all her fellow Americans. Worse yet, she has peripheral neuropathy in her feet ( greater than 60% of diabetics suffer some neuropathy—mild to severe). While we non-Diabetics do not even think about our feet as we ambulate about all day, a diabetic develops neuropathy (“faulty nerves”) in the feet. This is a constant, nagging reminder that their feet hang from the legs like two limp attachments which lack feeling… …and yet these numb feet can be startled into pain in an unpredicted moment. Worse, there are many diabetics whose neuropathic feet are extremely sensitive signals for any touch—and then they ring out in pain. Even the gentlest touch can arouse searing pain from the feet into the legs.
These folks are miserable. They even sleep with their legs enclosed by a “tent” of blankets at night, with those blankets arched high enough away so as not to touch and ignite a fire of pain in those otherwise numb but paradoxically super-sensitive feet.
It is ironic that two numb feet, which may seemingly not register sensation to examination when examined by a doctor or nurse with mild pin-pricks, can be so exquisitely sensitive to the mildest touch and set off a stream of pain—as if attacked by a monster.
Diabetics must be very vigilant about their feet. If they suffer both retinopathy (eyes) and neuropathy (nerves) together in time, which often happens—these folks can neither see nor feel ulcers which develop on the souls of their feet. Since diabetics heal poorly, they are especially prone to these eroding ulcers. Diabetics head the curve for amputations in America: which often starts in the toes and works its way upward, in a cruel unrelenting fashion, without any available treatment except surgery. First the toes, then the the feet, then…
What about Ms. Anne, who started this story? How has she gained relief, when her medications failed her, and worse, nothing is available to halt the progression of this cruel, taunting disease ?
She avails herself of medical marijuana.
While the marijuana does not halt the progression of nerve and blood vessel damage, it does give her relief from the ever-present, ever-threatening touch of some insignificant tease just waiting to unleash its torment upon her. And it puts her at ease, perhaps most importantly, so she is not on edge all day, ever-vigilant, fearfully awaiting the next jolt of pain. While most sufferers also experience tingling, and other noxious sensations from their neuropathy—nothing matches the affliction of the attacks of searing pain coming from almost nothing. These patients have special shoes, sandals, socks, etc., and try to prepare for these unpredictable events.
What about standard pain meds? Of course they do nothing to avert the damage to nerve and circulation before it occurs; nor are they preventative in nature. While they should lessen pain when it occurs—the torment of neuropathy, as the patients will tell you, is so unusual in presentation and feeling, that while the narcotics avert normal pain—they do little during the onslaught of neuropathy attacks.
But most of these patients are satisfied with the results of medical marijuana. They are relaxed and the pain is either greatly lessened or taken away completely. Medical marijuana seems to further contain a special effect for these tortured folks, that our standard meds do not possess. It confers an inherent calming effect upon them—it “mellows” them out. And marijuana is not addictive, as are our standard narcotic pain meds.
Anne is fine, and happy. “I am a new woman,” she states. And luckily, she is a California woman, since marijuana is medically legal here.
Another patient Ms L.I.J., has suffered neuropathy almost 20 years, with wracking pain. Until she discovered medical marijuana, and relief, almost five years ago, she had resolutely informed her physician that she was “ready, and prepared, to check out.” She is now a well adjusted California lady, who can live with her disease, fortified by her medical marijuana. She has zest for life once again.
Mr. M.W., only 20 years of age has Diabetes type 1, is insulin dependent, and formerly had trouble just walking. Now, medicated with his marijuana, can exercise to a limited degree, and is free from the pain which used to hold his feet hostage.
Sixteen states, and D.C. have legalized medical marijuana. The sufferers of diabetic neuropathy, in the other 33 states, have nowhere to turn since the federal government persists in a vigilant patrol of medical marijuana which outlaws its use. By federal standards: marijuana is classed as a level 1 addictive drug, along with heroin and cocaine—even though medical authorities will loudly proclaim that it is not addictive, and very valuable as a medicine: not just for diabetic neuropathy, but for our cancer patients, our migraine patients, our chronic pain patients, and all of our patients out of patience with our intolerant, uncaring federal government.
What are our neighbors in intolerant states to do?
Karen R., a victim of ovarian cancer, age 35, is aware of her prognosis. Dying, like birth, and every other stage of living, is difficult, she often ponders. Her chemotherapy, which offers a partial or perhaps full redemption, is arduous at best: she suffers violent nausea and vomiting during her very necessary phases of chemo: connected ("chained") to an IV, her repose on the gurney is interrupted, quite quickly, by her urgent anxiety, pulling her IV alongside, to the rest room to vomit her guts out.
Lately, however, Karen avails herself of a candy bar, in between the "bag" changes on her IV pole. Her nausea interruptions are much less frequent and urgent, and she is calmer, and happier with herself... ...the necessary torments of scheduled chemotherapy are so much easier to take now. "What has made the difference?" asks her anxious, but very curious fellow chemo. victim on the next gurney.
"My candy bar... ...would you like to try one?"
"Why? What is it?"
"Medical marijuana, " Karen smiles. "It makes the whole ordeal easier..."
She hands her chemo-bed-fellow her bar. "Here, take a bite. It's chocolate ..."
We live in the enlightened times of approval of medical marijuana. California, and 16 other states have approved the use of Cannabis (marijuana) for chronic disease, authorized by a physician, and it is especially of help to cancer patients and chemotherapy recipients. It cannot be "smoked" in the atmosphere of the chemotherapy clinics, since the ambient smoke might prove offensive to those with asthma and C.O.P.D. (emphysema). But it can be ingested in a variety of forms: pills, soda-pop, brownies, cookies, candy, etc.
Marijuana has a long history of use as a drug or agent of euphoria. It is documented in Chinese medical compendia from as early as 2730 B.C.E., from where it spread to India, then North Africa, which stimulated its travel by traders to Europe by 500 A.D. It was listed in various pamphlets and books of the U.S. pharmacopeia from 1840-1972 for use in "labor pains, nausea, and rheumatism." It was then considered unlawful by the government. In the 1930s the U.S.Federal Bureau of Narcotics considered marijuana dangerous and addictive. By the 1970s, the U.S. Government classified marijuana, along with heroin and LSD as class 1 drugs: having the relatively highest abuse potential and no accepted medical use.
This judgment follows on the hundreds of years acceptance and use of marijuana, peyote, and other plants of medicinal and ritual (religious) use by Native Americans.
In spite of this confused and confusing history, marijuana is currently made into a drug: marinol (dronabinol). It is legal in the Netherlands, Canada, Spain and Austria as a medicine for the amelioration of nausea and vomiting in various medical conditions, the stimulation of hunger in patients on chemotherapy regimens and with A.I.D.s who suffer "wasting" syndromes, it lowers eye pressure in patients who suffer glaucoma, and it works wonders as an analgesic -- pain reliever -- in many situations. It has also been shown to be of benefit in neurological disorders such as multiple sclerosis and Tourette's Syndrome. Unfortunately, marinol does not demonstrate as much effectiveness as other medications (with more major side effects) as "unrefined" marijuana. So the unorthodox means of administration of marijuana—smoking, eating, drinking: appear to be more effective than the accepted medicinal form of a simple pill. Perhaps there are elements in marijuana, over and above the simple tetra hydro cannabinol (THC) that contribute to its medicinal effects.
Whatever, there should be no resistance to the use of marijuana as a medication -- especially for cancer patients. An argument arises that physicians would be making these patients marijuana addicts. But they are already addicted to narcotics, and use of marijuana is also used to reduce patients' dependence on narcotics. We needn't discuss and weigh the alternatives of cocaine addiction, narcotic addiction, even alcohol addiction in terms of society costs (altercations, deaths, DUI's, etc.) vs. whatever minimal "costs" are attributed to marijuana.
What is needed now is for the government to recognize what our medical care-givers already recognize: the powerful, medical use of marijuana.
What is needed more is for the government to sanction and oversee the medical distribution of marijuana so that its dosage and administration is uniform. What do I mean? If I tell a patient to take an aspirin, say 300 mg. of salisylic acid, they are able to obtain 300 mg. How do we administer marijuana? Please smoke a reefer after chemo, or enjoy a candy bar during chemo?
It is time for the federal government to step up to the plate.