Hepatitis C affects approximately 4 million Americans.   It is a virus transmitted via blood to blood (mostly IV drug users and sexual intercourse) and quickly infects the liver.   The major problem with hepatitis C is that 10-20% of patients will develop cirrhosis and the risk for liver cancer (hepatocellular carcinoma) increases 70 fold.

The most common treatment for patients with HCV is to give weekly injections of a drug called Interferon- alpha-2a or 2b plus ribaviron.   Treatment course and dose depends on a few variables (mostly the specific genotype of the HCV) but it typically is either 24 or 48 weeks.  The problem with this treatment is that side effects can be debilitating.

Interferon is a medication that triggers cells to activate the immune system to fight the virus.   Unfortunately, like any acute illness, you WILL get side effects as if you are fighting an infection.

50-60% of patients will develop typical flu-like symptoms (muscle aches, body aches, joint pain, fever, fatigue). In addition patients develop: Abdominal Pain, nausea, poor appetite, diarrhea.  Depression, anxiety, anger. Headache.  Hair loss, itching, photosensitivity and rah.    These are the most common side effects.

Over the past few years I have had dozens of patients with hepatitis C who come in during interferon therapy because they can not tolerate the side effects.  Medical marijuana is an excellent treatment to combat the nausea, increase appetite and reduce joint and muscle pain.  It can also reduce anxiety, elevate the patients mood and decrease anger outbursts.   It also is a great choice for headaches.

I do not have any data on the change in percentage of patients who remain on interferon by using medical marijuana but in my experience patients are more likely to continue the entire treatment course.

There was an article published in the Gastroenterology journal that said daily marijuana use increase the chances that a patient with HCV will develop fibrosis of the liver.   That is the first I have read of this and have not been able to speak to any hepatologists about this study.   However I would imagine that discontinuing therapy would be much worse as far as patient outcomes then using medical marijuana and continuing treatment.  Again this is an educated guess and I can not find a study that looks at these two head to head.   My intuition tells me staying on therapy and using marijuana is better overall for stoping progression of the disease.   One note in the article is that it did not say how or why marijuana use affects the liver.   No other studies have shown liver toxicity with marijuana use.

I will continue to recommend medical marijuana in these cases where patients want to quit interferon therapy.  In the meantime I will continue to speak to the experts and provide more data and information as it comes in.

Thanks for visiting this blog.

be blessed.

He came to me because for the last 2 months he has been using medical marijuana and says it has helped tremendously.   He feels he is sleeping better and his days are not spent worrying (as much) about his mortality.     READ ON….

What is CLL?  It is simply a cancer that affects the white blood cells in the body.  White blood cells fight infection and regulate the inflammatory response in the body.   Cancer means that cells grow out of control, unchecked.   Normally cells grow, function and then die off.  They do not just keep proliferating.   So in this case we see a rapid growth of white blood cells in the body.  What happens is that these cells grow unchecked in the bone marrow (where blood cells are formed) and take over.    The bone marrow becomes overwhelmed and can not properly produce blood cells.

This patient noticed this when he started feeling fatigued more than usual.  This was most likely because he wasn’t producing enough red blood cells (which carry oxygen to the cells of the body).   He also noticed that he had reoccurring mouth infections (result of abnormal white blood cells).   When his doctor checked his blood counts it was clear something was wrong.

A diagnosis of cancer is a very life altering event.   It instantly changes patients priorities and immediately forces them to consider their mortality.   Fo my patient is threw him into a severe depression with underlying anxiety.  (interestingly the survival rates for CLL are pretty good)   He had a real difficult time knowing his days were numbered… even though every one reading this, including me, is “on the clock.”  The difference is that we don not think about often.  Cancer patients do all the time.

Cannabis (marijuana) can be a great alternative for patients that do not respond to traditional medications or have to stop them due to side effects.   Typically one or two doses of a medical grade strain will suffice.   This will allow patients to still function as far as their day to day responsibilities yet get the benefits of the medicine.

He told me he used many different medications and they all worked to a certain extent.  However the side effects he was experiencing made the risks outweigh the benefits.    It wasn’t until he tried cannabis that he felt some relief without worrying about any side effects.    He simply has been using it in the afternoons and at night to help him sleep.   He uses a vaporizer to avoid having to smoke it and prefers an indica strain because of its sedating affects.

UCSD’s Center for Cannabis Research recently completed a study looking at vaporization vs smoking and this is what they found: READ ON TO SEE THE RESULTS…

RESULTS:

The full results of this study have been published in the journal Clinical Pharmacology & Therapeutics. Below is a brief summary of these results.

The purpose of this study was to evaluate the use of a vaporization system (the Volcano; VAPORMED® Inhalatoren) as a “smokeless” delivery system for inhaled marijuana. The study looked at heating marijuana to form a vapor and then comparing drug levels in the blood to those obtained from smoking an identical amount of marijuana from a cigarette. In addition, we compared the tolerability of the two methods and measured expired carbon dioxide to evaluate whether the vaporizer reduces exposure to respiratory toxins.

Eighteen healthy subjects were recruited and admitted to the inpatient ward of the General Clinical Research Center (GCRC) at San Francisco General Hospital to investigate the delivery of marijuana by vaporization compared to marijuana smoked in a standard cigarette. One dose (1.7, 3.4, or 6.8% tetrahydrocannabinol) and delivery system (smoked marijuana cigarette or vaporization system) was randomly assigned for each of the six study days. The analysis suggests that the blood levels of vaporized marijuana are similar to those of smoked marijuana. However, blood concentrations at 30 minutes after drug administration and beyond were significantly higher in vaporized marijuana as compared to smoked marijuana. In addition, the carbon monoxide levels were significantly reduced with vaporization compared with smoked marijuana. Fourteen participants preferred vaporization, 2 smoking, and 2 reported no preference. No adverse events were observed.

In this study, vaporization of marijuana was found to be a safe mode of delivery. Participants had a clear preference for vaporization over smoking as a delivery system for the marijuana used in this trial.

I want to stress the two points that are highlighted above:

1. Blood concentrations are higher.   When you smoke marijuana and burn it you only get between 15-50% of the THC due to the high heat.   Put in other terms, you are wasting your money when you smoke it.   Because blood concentrations are higher you will use less marijuana over time which puts money back in your pocket.

2. Carbon Monoxide (CO) is produced when you burn anything.   CO has a 240x greater affinity for red blood cells (RBC’s) than oxygen.  What happens when you inhale CO is that it binds to your RBC’s (which carry oxygen to your cells) and prevents oxygen from binding and feeding your cells.  The result is a period of low oxygen (hypoxia) and damage to the cells throughout your body.  It is not just your lungs that are affected.

One of the main risk factors for Erectile Dysfunction in men is smoking. Why?  Because smoke damages blood vessels and CO robs the penis from oxygen it does not work as effectively.

SO STOP SMOKING AND START VAPORIZING?

]]> http://www.mcsocal.com/blog/vaporizing-medical-marijuana-safer-an-alternative-to-smoke-ucsd-study/feed 2 http://www.mcsocal.com/blog/medical-marijuana-doctors-quacks-says-nj-governor-chris-christy http://www.mcsocal.com/blog/medical-marijuana-doctors-quacks-says-nj-governor-chris-christy#comments Tue, 18 Jan 2011 06:48:02 +0000 Dr. Sean Breen http://mcsocal.com/blog/?p=722 As New Jersey tries to implement it’s medical marijuana program, the governor has made it clear what he really feels about it.  Read this quote from the newly elected governor…Christie had said there are flaws with laws in some other jurisdictions, leading to situations where there is “”a head shop in every town and quack doctors writing prescriptions for people with headaches to get marijuana.‘   A find it pretty unbelievable that he label a physician who has the courage to recommend cannabis to a headache sufferer as a “quack”… especially since he has NO CLUE what he is talking about.  READ ON…

It is times like these that I wish there truly was “karma”.   If that were the case Governor Christy would develop severe migraines, his wife would develop breast cancer and his son would develop an opiate addiction secondary to taking oxycontin for pain.   I would then wonder if he would try to derail New Jersey’s medical marijuana law.  Would he still want to limit the concentration of cannabinoids and hence its potency?  Would he outlaw the ability for collectives to deliver medicine to a terminally ill patients home?  Would he try and limit the ability to grow it to one or 2 locations in the state?  I HIGHLY doubt it.

To the contrary, medical marijuana would  be accessible to every patient in need… probably yesterday.   He would be searching the most potent strain he could find and for the cheapest price.   His family would have the largest personal grow in the State.

But like most politicians, he is a pussy.   He is too afraid of what his constituents are going to say out of fear of losing re-election… and in turn is being dishonest.

I PROMISE you that is the Governor had a migraine that was not effective treated with Imitrex, Maxalt, Tylenol, Motrin,, Vicodin etc… he would be the first appointment in my office tomorrow morning.  And he would be begging for relief so that he can actually function.

So I guess I take some offense to being called a “quack” for recommending cannabis to headache patients.     It is just frustrating professionally because I get to hear from hundreds of patients every month about how their lives have been changed for the better because of this plant.

Governor Christy you suck.   New Jersey will go backwards under your “leadership”.

I’m probably much easier to reach than you are.  Feel free to give me a call at 877-721-0047 and I would happy to enlighten you.

Moving forward, the state of California needs to strengthen its medical marijuana laws to insure that patients always have safe access to medicine.  In my mind four things need to happen.

1. They need to allow collectives and dispensaries to operate FOR profit.  The current guidelines state that medical marijuana can not be sold for profit.   This is s huge mistake.   The traditional medical model is profit driven.  Patients see a doctor and pay for that service.  They pick up their medicine from CVS and pay for them.  CVS gets paid, the pharmacist get paid as does the drug company who supplied the medicine.   If we are going to treat cannabis as medicine then it should fall under the same business model as any other medicine.

If you allow a collective to show profit, they will do so AND pay their taxes.   If you tell them they can’t make a profit then guess what, they are not going to show a profit.    These folks have dedicated their time, resources and energy into starting a business and creating jobs.  WHY WOULD THE STATE WITH 12.5% UNEMPLOYMENT TRY TO PREVENT THAT? There is a huge opportunity for the growth of small business in California in the medical marijuana business.

2. The State needs to allow growers to grow legally and offer protection from federal interference.    Just like a farmer would grow apples and sell them to the supermarket, people who grow medical marijuana (medicine) should be able to grow and supply collectives.  Currently there is very little to no regulation of people who are growing medical cannabis.   Are they using pesticides?  Are their crops full of molds or spider mites?  No one knows because there is no one regulating that grow.   That needs to change.

3. EVERY city needs to be mandated to come up with a medical marijuana ordinance.   They need to let collectives know where they can legally set up and take care of patients.   The law of the State should be just that.   It shouldn’t be the law of the State, but illegal in Orange County.     Cities need to listen to the medical community and come up a solid plan to implement safe, regulated collectives that generate revenue and pay taxes

4. I believe that State medical board needs to look into some of the practices that medical marijuana doctors clinics are implementing.   They were pretty clear in setting the standard of care for qualifying patients.  A complete history with medical documentation, good faith exam and informed consent.   This is not happening in many of the clinics.  This is allowing the recreational user to proliferate under the guise of medical marijuana.     Hopefully the law that governor just passed making possession of an ounce a ticket versus having to go to court will reduce the recreational abuse of the medical system.

Studies have shown that HIV+ patients are 30% more likely to stay on their medication regimen if using cannabis concomitantly.   Atripla is one pill that contains three different HIV medications; Efavirenz + Emtricitabine + Tenofovir   They work by disrupting the virus’ ability to multiple in the body and attack the immune cells.    They are extremely effective but have a lot of common side effects:

1. Nausea, lack of appetite, vomiting, bloating, abdominal pain

2. Dizziness and Drowsiness

3. Headache

4. Difficulty Sleeping/ Vivid Dreams

In addition there are more serious side effects but these are common.  Of the three patients I took care of in the past week all were using them for it GI SIDE EFFECTS.   They stated that when using marijuana their appetite improves, their nausea subsides and they can gain weight.  ”I feel like eating again!” one patient excitedly told me.

Two of them had tried the prescription Marinol which is synthetic THC but it made them too drowsy and it didn’t work as well as the whole plant.    So they are sticking to VAPORIZING the plant so they do not have to smoke it.   HIV+ patients especially do not want to inhale smoke because it weakens the immune system making them more susceptible to infection.

If you are someone you know is taking medications to fight HIV please spread the word about using medical marijuana.  IT TRULY WORKS!

To make an appointment to come in and speak with me simply call 877-721-0047 or through our website at www.mcsocal.com

Until next time.  Be blessed!

Dr. Breen

Selective Serotonin Reuptake Inhibitors (SSRI’s- i.e Prozac, Paxil, Zoloft, Lexapro etc) are drugs commonly used to treat depression and anxiety.  They work by increasing the amounts of serotonin that build up and concentrate around nerve cells in the brain which in turn elevates patients moods.   They are THE most common drug to treat depression and anxiety.

One of the downsides to using these medications is that they can reduce a patients libido and also make orgasm very difficult.

My first patient was a 27 year old women who had been taking Lexapro for the past 12 months for her Social Anxiety.    She went on to tell me that she is engaged to her boyfriend of 7 years.  Over the past year her sex drive has been “non-existent” which has made her relationship very challenging.   Even though her fiance has been extremely supportive she told me she feels “inadequate”  because of this.   Her boyfriend decided to search out alternative therapies when he came upon my website and read about previous patients in similar situations.

SHE TOLD ME THAT FOR THE PAST MONTH SHE HAS BEEN MEDICATING WITH CANNABIS AND HER SEX LIFE HAS BEEN GREAT. In addition to having sex more she stated that she was less inhibited which even enhanced her sexual experience with her fiance.   Her plan is to continue to use the Lexapro and use cannabis to stimulate her sex life.

My second patient was a 44 year old women who came in with her husband of 13 years.  She had a very similar story although she had been taking lexapro for depression which she had “as long as I can remember.”   They also had two autistic sons ages 10 and 8 which made time for romance very difficult.    Although she initially felt apprehensive about using marijuana as a medicine those feeling quickly subsided as her sex life started to improve.   Her husband was definitely supportive as he said there marriage is “in a place that it hasn’t been in… in a long time.”

I tell every patient that comes into my office that there are benefits and risks to using every medication.  Cannabis is no different.   In these two examples both women had to weigh the benefits they were receiving from using Lexapro from the risks… which in this case were a decline in their sex life—-> leading to stress in their relationships.

The plan was simple.  If cannabis improved the quality of their lives and relationships then they would use it… if not no harm done.  Cannabis is relatively benign if used responsibly.

OK here it is.  The brain is considered our central nervous system.  The spinal cord and the nerves that exit the spinal cord that project to all of the organs, muscles, vessels and skin are considered the peripheral nervous system (there is also an autonomic nervous system but ignore that for now)   Think of nerves like the electrical wiring that runs throughout the house.   To keep this simple let’s take the bones and tissues of the knees (a common complaint I see is arthritis of the knee)  If you have pain in the knee it is because the nerves (wires) that originate at the knee are in a very excited state.  They get activated and send the signal through the nerve (headed to the brain ultimately) which makes it first connection in the spinal cord.

Once at the spinal cord that nerve typically connects and communicates (via neurotransmitters… chemicals that allow one nerve to communicate with another) with a new nerve in the spinal cord which runs all the way up the spinal cord and terminates in the brain.

Once in the brain that signal is processed and it sends it back down a new set of nerves (originating in the brain) which run back down through the spinal cord.   So thus far we have knee—–>Spinal Cord—–>Brain—–>Back down spinal Cord—–> lastly a nerve leaves the spinal cord and ends back at the knee where ultimately the patient feels pain.

They way marijuana works (that we know of thus far) is that it specifically binds to a receptor on the nerves themselves and blocks or slows down the transmission of pain up and down the spinal cord to the brain. The electrical wiring (nervous system) in our body has what we call receptors on it along the way (Think of receptors as door locks).   Each of these locks has a specific key that opens it and causes it to have a specific function.   When you inhale cannabis you inhale specific “keys” that go and search out these specific locks on the nerves.   When they find them they bind to them and cause the nerve to be less excitable which ultimately slows the transmission of pain throughout the nervous system.

Now, in my effort to keep things simple and stupid I know that there are scientists out there who will read this and say… “yeah but thats not exactly how it works.”  However, in a more general sense this is how marijuana reduces pain in the body.

If you are a person that wants to get into the nitty-gritty science behind this you can read plenty of studies which discuss the physiology of CB1 and CB2 receptors.   The CMCR at UCSD has published a study on cannabinoid analgesia and it is accessible online.

If you suffer from pain and would like to discuss using cannabis to improve the quality of your life please feel free to make and appointment to come in and see me at my Irvine or Long Beach CA office.   Simply call 877-721-0047 or pre-qualify for FREE at www.mcsocal.com

Be blessed,

Dr. Breen

Behcet’s syndrome is very rare in the United States.  It mostly affects men and women who live in the middle east and asia.  It is a disease that causes inflammation of the blood vessels.   It is characterized by painful ulcers in the oral mucosa (mouth, gums and tongue) and genital region.   They look like your typical “canker sore”.  Patients also can suffer from visual changes as a result of inflammation of the blood vessels in the eye.   Two thirds of patients suffer from arthritis in the knees and ankles (most commonly).  Less commonly patients can have lesions in the brain that affect patients balance and coordination.  Also some patients can form clots in their veins.

The reason why patients with Behcet’s syndrome can experience relief using cannabis is because the plant has over 60 cannabinoids which influence the immune cells and reduce inflammation.   It also binds to the nerves directly and reduces the amount of pain that patients experience.

My patient reported using cannabis on 3 occasions in the past month and on each occasion experienced a significant reduction in the pain in her knees.   Even though she felt “anxious” about coming in to see me she could not deny the benefits she experienced.  After speaking with her and going over both the risks and benefits of using cannabis she felt relieved that she will finally get regular relief.  I expect that she will do very well and cannabis will become a routine part of her treatment plan.

If you suffer from Behcet’s Syndrome or pain for any reason and would like a professional medical evaluation to see if cannabis can improve the quality of your life simply make an appointment to come in.  My staff will be able to answer many of your questions and schedule an appointment.  877-721-0047

Be blessed,

Dr. Sean Breen

Medical Cannabis of Southern California is the most respected clinic for providing patients with medical marijuana recommendations.  Our offices are located in Irvine and Long Beach California.

The study examined the risk of heart attack and stroke in over 1 million patients who averaged 39 years of age and had no significant health problems (high blood pressure, heart disease, diabetes etc) over an 8 year period.    They found that patients who regularly used NSAID’s to treat chronic pain were 29% more likely to have a heart attack or stroke.   This is significant because how many people do you know (you included) head to the local CVS and pick up a bunch of Motrin for that chronic pain or ache without considering the side effects??  They estimate that 20% of the population has been PRESCRIBED (not including those who get it over the counter) NSAIDS at one time or another for pain.

We are beginning to understand in medicine that many treatments that we used to believe were safe are actually significantly dangerous to patients (for example hormone replacement therapy in post-menopausal women).   NSAIDS can cause significant gastro-intestinal bleeding and now we find out increase the risk of heart attack and stroke significantly.

One thing the study did find is that if you really need to use an NSAID for pain the safest one in the study was Naprosyn, commonly known as Aleve.

You may not know that there are over 60 cannabinoids in the cannabis (marijuana) plant that exert their effects on the body.  Many of them specifically decrease the inflammatory response and thus reduce pain.   Cannabis has very few unwanted side effects.  You can not overdose from it!   It does not effect your kidneys or liver.  It is not addictive.  It does not cause ulcers or bleeding.  It is one of natures best remedies for pain and inflammation.

I can not tell you how many older patients I see everyday that want to stop taking their “pain pills” for chronic pain.   The stories I hear about how cannabis has improved the quality of their life are truly remarkable.  They love being able to vaporize it as opposed to having to smoke it.

I HIGHLY recommend that if you are suffering from chronic pain (for any reason) that you come into my office and we can discuss the benefits and risks of using marijuana to treat your symptoms.   Simply call 877-721-0047 or pre-qualify for free online and one of my staff will contact you shortly.

Dr. Breen, Medical Director, Medical Cannabis of Southern California