Journal: blogging and catharsis

From the Washington Post:

Nearly half of bloggers consider it a form of therapy, according to a recent survey sponsored by America Online Inc. And although some psychologists question the use of the Internet for therapy, one hospital in High Point, N.C., started devoting space to patients' blogs on its Web site, a practice Inova Fairfax Hospital is also considering.

The rest of the article goes on to talk about the risks posed by taking one's personal information to the internets, how you should worry about identity theft, potential employers checking out your blogs, etc. What I think is so interesting is that in addition to what you might think is the most natural fodder for the blogosphere--politics--there is this huge chunk of the blogosphere that is about something much more personal, something not borne of conviction, but of ambivalence: illness blogs. Like this one.

To me, this means there is a large group of people, myself included, who are having trouble decoding the modern experience of illness using the traditional tools (medical professionals, family, faith, friends, etc.). I don't think it's just about catharsis, really. After all, I can write about the silver-dollar-sized purple blob that showed up on my penis the morning after the last time I gave myself an injection of papaverine (for those of us who flunked Viagra), and that's sorta cathartic, I guess, but there's more to it than just the catharsis I feel after talking about the ridiculous lengths to which I must go to deal with my MS-related erectile dysfunction. It's also about trying to help fill in some of the gaps in means available for decoding MS, and catharsis alone isn't going to fill those gaps. It's part cathartic performance but the essential ingredient is some kind of community, even if it's sometimes silent.

Cyber-Catharsis: Bloggers Use Web Sites as Therapy

In today's NYT: The impenetrable mystery of medical billing

Today, another article in the NYT's series on being a patient, this time on medical billing. Snip:

The paperwork nightmare started for Ms. Mayer when her oncologist switched hospitals. Everything suddenly seemed to need a justification, or a new piece of paper with an authorization. The stacks of papers, folders and Post-It notes related to Ms. Mayer's treatment have started to take over her house. They fill manila envelopes, boxes and files, which fill closets. They spill from the dining room table onto chairs.

"You can't just be sick," she said. "You have to be sick and be drowning in paperwork." So overwhelming has the paperwork grown that Ms. Mayer has considered giving up and ceasing all treatment because of the bureaucratic hassle that accompanies it. "It's comical, it's unbelievable," she said. "And I think to myself, 'What if I was an elderly person, or a single person? What if I wasn't healthy enough to handle it?' "

Link to article in NYT (free reg req'd)
technorati tag: multiple sclerosis

Study: Beta interferons linked to low birth weight, miscarriages

From an article about the Toronto-based study:

The study involved 64 pregnancies in 46 women. Some of these women were taking beta interferon during pregnancy, others had stopped drug treatment one month prior to conception and a third group comprised healthy women not on drug therapy.

"The women who received the beta interferon had more miscarriages," Koren says. "And the babies that were born were substantially smaller."

Only 55 per cent of pregnancies in the beta interferon group resulted in live births, compared with 81 per cent in the group that had stopped drug therapy before conception, and 90 per cent in the healthy group.

Link to article at Macleans.com.
technorati tag: multiple sclerosis

Journal: weekend self-medicating

This weekend, some old friends came up to visit, including a guy who's a regular pot-smoker. Over the weekend, we all enjoyed some good-natured substance abuse, a recurring theme in our collective friendships.

I'd been kind of a pot-head for several years since I finished school, not because I thought I was helping my MS any, but because it felt good to get really high. I'd eased off in recent years, though. I'd noticed I was having some lapses in short-term memory, but more importantly, I noticed that when I was high and nobody else was, I was a crashing bore.

Over the course of the last several months I'd been having increasing trouble with neuropathic pain, a dull, burning, pain in the backs of my legs that made it a real chore to sit at my desk at work in the afternoons. I'd also started getting the burning pain in the soles of my feet. I was curious how pot would affect me and the pain.

I was disappointed. Initially, I just felt plain old high, and the euphoria either replaces the pain sensation, or it just wasn't registering. That was nice. After a bit, I noticed that instead of the burning in my legs, I felt an intense numbness, almost like a vibration. But then a couple hours out, when I went to bed, the high sorta wore off and the numbness in my legs turned into an uncomfortable sensation of heat, which kept me awake for a while.

So it's totally unscientific, and my experience could have been colored by extreme fatigue, by forgetting to take sufficient Neurontin during the day, or by the large quantities of ice cream I ingested before going to bed. But I was hoping to drift off into a sound sleep and wake up refreshed and slightly loopy, the way I remembered it. Maybe if I'd remembered to fire up the lava lamp...

technorati tag: multiple sclerosis

MS and identity: dual citizenship, but without a country?

In Illness As A Metaphor, Susan Sontag wrote:

Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

I sometimes feel as though I switch passports so often that I don't know where I really live, that I don't feel at home in either kingdom. Thursday, I parked in a disabled parking space before heading to my full-time job. Yesterday, I called in sick because I had a bad head cold. Today, I'm sitting at home while my wife and friends stroll about at the farmer's market downtown.

Today, in The Guardian, there's a piece by Hilary Freeman, a 34-year-old woman with a fairly mild case of MS, that touches on these themes:

Just as someone with anorexia sees a fat person when they look into the mirror, so I see a healthy one. My self-image has never quite caught up with the knowledge of my condition. I have mild MS symptoms — fatigue, tingling, blurred vision, a thumb that sometimes shoots out of its own accord — but nothing that has stopped me, now aged 34, from living a normal life. Yet I find it nigh impossible to get insurance or to pass a medical. So who am I, a sick person or a well person? Disabled or able-bodied? The truth is, I don’t know. And neither, it appears, does anyone else.

Link.
technorati tag: multiple sclerosis

Factors related to employment status changes in individuals with multiple sclerosis.

In a sample of 50 individuals with multiple sclerosis (MS), participants able to work full-time ('W'), those who reduced their hours ('CB') and those who were unemployed ('NW') were compared on demographic and disease variables and symptoms that the participants identified as being responsible for their work status change. The NW group had significantly greater physical disability than the other two groups and significantly more fatigue than the W group. The CB group had significantly more years of education and higher occupational prestige ratings than the NW group. The W group reported significantly greater mood disturbance compared with the NW group. Employment status was unrelated to age, gender, full scale IQ estimate, disease duration, diagnosis duration or cognitive functioning. Ninety per cent of the CB group reported that fatigue was a primary symptom responsible for their work status change, whereas 86% of the NW group reported that broad physical/neurological symptoms were responsible for their change in work status.


Entrez PubMed

Gimpy ethics: Using my parking tag for good, not evil?

I've had a disabled parking permit for several months now. Initially, I asked my doctor about getting one because I'd had some trouble with distant parking spaces at places like the supermarket and Target. Getting to the store wasn't usually any trouble, but getting back to the car was: after wandering around the grocery store for an hour and a half trying to find where they hide the rice cakes, I'd be plenty tuckered out, especially in the summer months.

I made increasing use of my cripple tags (can I call them that? please? the phrase really just rolls off the tongue) over the summer. I also started making occasional use of a cane. Well, actually, it's just a 3-foot length of dowel my father-in-law had used to prop up the tail gate on his old minivan after it stopped staying up on its own. At first, I was pretty shy about it, but I've gotten a little more comfortable with it.

Up until recently, I'd been paying $100 a month to park in the parking ramp under the building where my office is located. I work downtown, and parking is awful; everyone who works downtown has to pay for a parking space (unless their employer pays for one, which mine does not). The ramp is pretty convenient, and although it has precious few designated spaces for the disabled, it was never very difficult to get a space that was within 100 feet of an elevator to the main floor.

There are a number of metered parking spaces conveniently located in front of my building. Where I live, if you've got a cripple tag (please?), you can park free in a metered spot for as long as you want (as long as it's more than a 30-minute meter). This past month, I gave up my paid parking space, and started parking out front with my cripple tag. By doing so, I've effectively given myself a raise of about $1,000 a year.

Am I a bad person? Consider:
1. I can afford $1,000 a year for parking, though it's definitely not chump change to me (hey, I'm a guy who washes and reuses ziplock bags).
2. The city, in compliance with state law, is essentially subsidizing my parking.
3. I notice that I'm not the only person who uses the metered spaces out front in this way.
4. If I could park in the ramp for free, I would (it's warm and dry), so it's not that I really prefer parking at the meter, I prefer parking at the meter for free.
5. I've been carrying the cane every time I park with the cripple tags, not because I always need to use the cane, but because I feel like it authenticates my entitlement to park with the cripple tags. If I was parking in the ramp, I probably wouldn't carry the cane to work every day. Incidentally, I don't use the cane in the office, just getting into and out of it, and I mostly need it at the end of the day when I'm at my wobbliest.
technorati tag: multiple sclerosis

Journal: Can a professional with MS have a vacation?

It sure seems like I can't. I took a nice 4-day weekend to celebrate my birthday and to generally decompress after some stressful weeks at work. It was lovely- went up North and spend some time sitting in a row bow aimlessly holding a fishing pole. But like a lot of other people, my work is my work; nobody else is going to dig in and do my work while I'm gone. Taking a vacation just means shifting work to a different time. You can either try and get ahead of things before you leave, and risk getting so pooped out you can't enjoy a vacation, or you can accept the fact that you'll return to a desk/inbox/voice mail account that's jammed with work, meaning you'll have to work that much harder when you come back.

This isn't unique to MS, but my ability to successfully shift work around to accommodate a vacation is lessened. I'm just not capable of productive 12-hour days. It means I'm more likely to end up working on weekends to catch up, which, of course, leaves me feeling like I could really use a goddamn vacation.

technorati tag: multiple sclerosis

Republican legislator in Wisconsin authors medical marijuana bill

The bill would legalize the possession and use a limited quantity of marijuana, with the approval of a physician. This press release cites 75% public approval of the measure, which apparently has not yet been formally introduced (contrary to the press release).

What isn't being touted, however, is any mechanism in the bill for qualifying patients to obtain pot. Seems like patients who would be allowed to use and possess pot would still be left to get the stuff by illegal means. Isn't that kind of a problem? Or are we implicitly acknowledging the prevalence of cultivation and sale for illegal, recreational use: Jeez, everybody knows somebody who knows somebody who could score some weed, right? Which is maybe why, despite the overwhelming public support, this bill probably won't go anywhere in a state legislature that's controlled by social conservatives, but a bill banning human cloning is treated with great urgency.

Study: Sativex effective in reducing neuropathic central pain (which is what's kicking my ass)

I found a press release pointing to the forthcoming publication in the journal Neurology of a UK study of Sativex involving 66 patients. The manufacturer obviously thinks it's good news, but I'm interested in what the science-types have to say:

This randomised, controlled trial demonstrates that Sativex® was significantly superior to placebo in reducing the mean intensity of pain (p=0.005) and sleep disturbance (p=0.003) amongst people with MS. The study was conducted in 66 patients, 65% of whom required support to walk or were wheelchair bound and were suffering from moderate to severe central neuropathic pain which had not been alleviated by currently available medications. Patients continued to take their existing medication throughout the trial. Sativex® was administered as an oromucosal spray allowing flexible dosing which is ideally suited to the variable nature of MS. Sativex® was generally well tolerated in the study, although more patients on Sativex® than placebo reported dizziness, dry mouth and somnolence. Cognitive side effects were limited to long-term memory storage.

Here's the cite:
D.J.Rog, T.J.Nurmikko, T.Friede, and C.A Young. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 2005;65:812

I wonder if they had problems with "unmasking" in this one...
Link to press release.

technorati tags: multiple sclerosis, medical marijuana

When can your doctor fire you?

I suppose it's more accurate to say that a doctor is quitting your employ, rather than firing you, but it's an interesting topic. A piece in today's NYT raises the issue from the professional ethics standpoint. According to AMA guidelines,

a doctor may withdraw from a case only if the doctor notifies a patient, the patient's relatives or responsible friends with enough advance notice for the patient to secure another physician. A physician, under the guidelines, can decline to treat a patient who requests a treatment that is known to be scientifically invalid or that is incompatible with the physician's personal, religious or moral beliefs.

Ethics, though, aren't the whole story. The law has something to say on the issue as well. In particular, states are considering laws that allow doctors, pharmacists, and other health professionals to refuse to perform certain procedures, dispense certain drugs, or otherwise participate in activities to which they have a moral or religious objection. The AMA's guidelines recognize that physicians may have religious objections to certain treatments, but AMA guidelines don't dictate the legal consequences of acting on such an objection. In Wisconsin, the state Senate is considering a bill that provides exemptions from civil liability, professional discipline, and adverse employment consequences to health care professionals and health care facilities that refuse to participate in abortions, sterilizations, and a half-dozen other activities. Link to a story about the bill in the UW-Madison Daily Cardinal.

Journal: Next, please.

So long, Cymbalta, and don't let the door hit you in the butt on the way out. Hello, Zonegran.

A few months back, I saw a neurologist at the pain clinic. My regular neurologist had suggested the pain clinic might have more success in dealing with the burning pain in my legs. After a really good visit with the pain clinic neuro, I started on Cymbalta, which is an antidepressant that works on both serotonin and norepinephrine. Almost immediately, I started having increased bladder trouble: harder to go during the daytime, then either having to pee or having to change the bed pad like half a dozen times every nite. (This is kind of odd because Cymbalta is sometimes used off-label to treat stress urinary incontinence.) After a while I noticed an improvement in the pain and in my mood, but I started to feel pretty sleep deprived.

Eventually, it became clear that on balance Cymbalta was not helping me. I called the pain clinic to let them know that I wanted to stop. The message I got back on a Friday was OK, fine, but you should probably taper off rather than quit cold turkey, to avoid withdrawal. Tapering required picking up some low-strength pills at the pharmacy, but I didn't bother to pick them up until Monday, by which time I'd realized that, yes, one should not quit Cymbalta cold turkey. Suffice it to say that Cymbalta withdrawal makes one a real asshole. Taking the low-strength pill on Monday morning restored me to my usual self.

Now, I'm starting an anti-seizure drug called Zonegran. This is on top of the 3000 daily mgs of Neurontin that I'm already taking. Zonegran's got side effects similar to those of Neurontin (makes me a bit sleeeeeepy, slightly stooooopid), so we'll see what happens. I'm tapering up to a full dose of 200 mg by ramping up 25 mg per week, meaning I won't be at full dose for a couple months. Wish I didn't have to wait that long. And I remain concerned that effective pain treatment will leave me too dopey to keep doing my geeky, thought-intensive job.

technorati tag: multiple sclerosis

Jet Fakes Emergency for Gambia Soccer Game - Yahoo! News

Pilots of a chartered jet carrying 289 Gambian soccer fans faked the need for an emergency landing in Peru so passengers could watch their nation's team play a key match, officials said Wednesday. The plane, claiming to be low on fuel, landed Tuesday in Peru's northern coast city of Piura, where Gambia played Qatar in the FIFA Under-17 World Championships later that night. Emergency crews were scrambled ahead of the Lockhead L1011 Tri-Star's unscheduled landing. It was to have landed in the capital, Lima.

How important is soccer? Really important, especially if you're not an American. Incidentally, I spent the first half of my junior year in high school as an exchange student in the city where the plane made its "emergency landing," Piura. I'd love to go back some day, but I think it might just be too damn hot there.

Link to AP story at Yahoo news.

Journal: What if my sclerosis was amyotrophic lateral instead of multiple, or What happened to my letter to Darcy Wakefield?

The other day on NPR, I heard a commentary written by a woman named Darcy Wakefield. A couple years ago, when she was 33 (about my age), she developed ALS (a.k.a. Lou Gehrig's disease). At the time, Darcy Wakefield was an English professor, an avid runner, and, it seems, just an all-around dynamic person. The piece on NPR was about loss: how she's lost the ability to turn herself over in bed and how terrifying this is, how it feels to confront the accumulating losses (oxymoron?) the disease has dealt her, how she longs for an escape from those losses. The piece was read by her sister, suggesting she's also losing or has lost her ability to speak.

After I heard the piece, I starting thinking about what Darcy and I have in common, and what's different about us. For me, MS has also been a story about loss: slowly losing some physical abilities, and then, as a consequence, losing activities and experiences, losing relationships, losing confidence and other bits of my identity. But while ALS deals out many of the same neurological damage that MS does, it's a very different animal. ALS viciously attacks only the motor neurons, leaving the patient paralyzed, but leaves the patient's mind intact. Eventually, patients can't breathe on their own. The average life expectancy of an ALS patient is two to five years. (Get the basics from the ALS Association here).

In her commentary, Darcy remarks on how 'slowly' her losses have unfolded, how they were almost unnoticable while they developed. But to me, a two-year progression like Darcy's seems unmercifully quick-- whatever disabilities I've got have taken 13 years to accumulate.

After hearing her story, I wanted to write to Darcy, to tell her about my experience, to ask her to tell me more about her life. God help me, I started writing and got a couple paragraphs down before I realized what a stupid idea it was. Here's why its a stupid idea.

For one thing, Darcy's published a collection of essays about her experiences so for called I Remember Running: The Year I Got Everything I Ever Wanted-and ALS. No need to bug her. But the other reason is more complicated.

I have a tendency to see people living through awful things as a potential source of insights that are unavailable elsewhere. I suspect I'm not unique here. I first became painfully aware of this tendency in myself a couple years ago when a good friend was diagnosed with really aggressive lymphoma. It had spread around her heart, or something like that. It was really grim. She decided to go back to her home town for her treatment. After chemo failed, she decided to undergo two consecutive autologous stem cell transplants. Shortly before the transplants were to start, she and her affable boyfriend paid a surprise visit for a weekend.

She was really skinny, with a couple inches of hair starting to grow back. She looked tough, and, I thought, wise. She's a scientist, and she tended to talk about her illness in what seemed like a detached way; cell counts and timetables and structure and process. We visited some favorite places, and over dinner, I tried to get her to talk about her illness in something less than medical terms, without success. In subtle and not-so-subtle ways, she'd change the subject, turn a question around; she didn't want to go there.

The weekend ended quickly, and when she and her boyfriend drove away, I thought to myself: I'm worried about her, she's not emotionally processing what's happening. Later, though, when talking about the visit with my wife, I started to think, well, um, maybe she's processing just fine. Maybe she's doing all kinds of work inside and she's just got her game face on. Maybe you're a jerk for expecting that she would at some point light up and spout some mystical wisdom for the benefit of those who were not sick, that they might live more meaningful lives. Maybe you're really just hoping she'll offer something to help your own damn processing, which has been going on for 13 years and has not transformed you into some kind of incontinent Buddha figure the way you thought it might.

So I'm not going to try to be Darcy Wakefield's pen pal. I'm going to read her book, and do some more of my own processing. It's going okay, actually.

Link to NPR site with audio clip of Darcy's sister reading Darcy's commentary.
And by the way, how hard would that be, to be Darcy's sister, to give voice to Darcy's words?

Neurorehabilitation and MS

Here's the deal: if you're like me, your MS treatment has two components: 1) disease-modifying drugs (interferons, Copaxone) and 2) symptom management. My symptom-management component is aimed at 6 issues:
1. pain (Neurontin)
2. bladder (Flomax, Oxytrol)
3. fatigue (Provigil)
4. spasticity (Baclofen)
5. depression (nefazodone)
6. um, "intimacy" (papavirin)

For me, symptom management has basically meant a new drug for each new symptom, with plenty of adjustments for the side-effects that tag along with each new symptom. Granted, I also try to do stuff like exercise, stretch, yoga, meditate, and whatnot, some of it at a doc's recommmendation. But there's a growing body of evidence that supports individualized non-drug rehabilitative approaches to managing MS symptoms. A new Lancet article is on-point:

[S]ymptomatic therapies have benefits, [but] their use is limited by possible side-effects. Moreover, many common disabling symptoms, such as weakness, are not amenable to drug treatment. However, neurorehabilitation has been shown to ease the burden of these symptoms by improving self-performance and independence. Second, we discuss comprehensive multidisciplinary rehabilitation and specific treatment options. Even though rehabilitation has no direct influence on disease progression, studies to date have shown that this type of intervention improves personal activities and ability to participate in social activities, thereby improving quality of life. Treatment should be adapted depending on: the individual patient's needs, demands of their surrounding environment, type and degree of disability, and treatment goals. Improvement commonly persists for several months beyond the treatment period, mostly as a result of reconditioning and adaptation and appropriate use of medical and social support at home. These findings suggest that quality of life is determined by disability and handicap more than by functional deficits and disease progression.

Link to the abstract at Pub Med.
technorati tag: multiple sclerosis

Is MS one disease or many?

A few years ago, a former neurologist of mine said he thought that some day, we'd learn that the disease we call 'multiple sclerosis" was actually a bunch of different diseases. I was reminded of this by a couple abstracts in this morning's query of Pub Med:

Two forthcoming studies will investigate the long-term effects of early treatment with interferon beta-1b (IFNbeta) on the course of MS. The BENEFIT study will incorporate pharmacogenetic and pharmacogenomic analyses to determine the genetic elements controlling treatment response. BEST-PGx is an exploratory 2-year study that will investigate the value of RNA expression profiling and pharmacogenetics in predicting treatment response to IFNbeta in patients with early relapsing MS. The main goal of BEST-PGx is the identification of differences in gene expression profiles of patients showing differential treatment responses. In addition, this study may reveal new information relevant to the mechanism of action of interferon treatment in MS and also to differences in the underlying pathology of the immune system. These data may help us approach the goal of a really "individualised therapy" with increased efficacy, reduced adverse drug reactions and more efficient use of healthcare resources.

Link to the abstract.

Treatment of MS has advanced dramatically in recent years, with the introduction of beta-interferons, glatiramer acetate and mitoxantrone. However, not all MS patients respond well to treatment with these drugs, and this may be a consequence of disease heterogeneity. Although immunomodulatory therapy has been clinically proven to be effective in patients with relapsing-remitting MS, studies in secondary-progressive MS patients have only demonstrated a positive therapeutic effect with interferon beta-1b. The pathology and pathogenesis of lesions suggest the need for a subtype-specific treatment, which may be possible when observations from pathology can be acted upon in the living MS patient.

Link to abstract.

technorati tag: multiple sclerosis

Nature: Women on the pill cut short-term MS risk in half

New research indicates that taking the pill may delay the onset of MS, though it won't prevent MS. Apparently, some doctors currently warn women with a family history of multiple sclerosis not to take the pill.

Women who take the contraceptive pill cut their short-term risk of developing multiple sclerosis by nearly half, according to a survey. The study suggests that the pill could help delay onset of the debilitating neurodegenerative disease.

Link to article at nature.com (free reg req'd?)
technorati tag: multiple sclerosis

Journal: What is the opposite of an Ironman?

It's still pretty early in the day, but just trying to get some stuff done around the house has me completely tuckered out. It's an indoor day today, hot like a furnace outside, so I've got a little list of odd jobs I meant to get through: hang a picture, make up a batch of hummus, tidy up the kitchen, etc. Now it's 2:30 pm, and I'm slumped in my chair. My legs are positively humming with that electric-charge, overheated feeling, and a trip to the bathroom--god, again already--means heaving myself up and lurching down the hallway like a drunk.

Monday is bearing down on me already. For the last couple months, I've been struggling to find the motivation or energy or panic-induced adrenaline to buckle down and get stuff done. This next week is looking like it could be really difficult even if I do finally get religion and get to work.

Even as I sit here stewing, our town is hosting a real live Ironman triathalon event. This morning, a bunch of people decided it would be a good idea to swim 2.4 miles around the lake, bicycle 112 miles, and then run a marathon. The newspaper ran a story about a woman diagnosed with MS in 1998 who will be competing:

As MS took a toll on her legs and vision, Carey Stillman found herself going through an intense psychological process. First came grief and denial. Then came anger. Then came enlightenment.

"I think a lot of people get this diagnosis and curl up in a ball," she said. "They let it take control of them, when they should take control of it."

If I was a more determined person, if I'd been less of a pessimist, if I had eaten more Wheaties and drank less beer, could I have been running marathons today? Could I have, by force of will, transformed myself and my life into an inspiring story of one man's refusal to give in to a crippling illess, a story ripe for a TV docudrama in which I am portrayed by Anthony Edwards (not a bad match, but maybe someone with a little more sex appeal)?

After medical pot is legalized, few Dutch patients buy from pharmacies

Pharmacoepidemiol Drug Saf. 2005 Sep 8; [Epub ahead of print]
Limited use of medicinal cannabis but for labeled indications after legalization.

Erkens JA, Janse AF, Herings RM.

PHARMO Institute, Utrecht, The Netherlands.

Since September 2003, cannabis is available for medicinal purposes in Dutch pharmacies to. It was anticipated that the medicinal cannabis use via illegal ways would decrease. The objective of this study was to get insight in the use of medicinal cannabis in daily practise as dispensed by community pharmacies and to characterize the users as well as the symptoms and conditions cannabis is prescribed for.A prospective follow-up study among 200 patients who filled a prescription for medicinal cannabis was performed in the period between September 2003 and January 2004. The patients filled out a structured questionnaire concerning symptoms and conditions and their experience with cannabis. Of all patients, 42% suffered from multiple sclerosis, 11% suffered from rheumatic diseases, and 60% of respondents already used cannabis before the legalization. Cannabis was mainly used for chronic pain and muscle cramp/stiffness.The indication of medicinal cannabis use was in accordance with the labeled indications. However, more than 80% of the patients still obtained cannabis for medicinal purpose from the illegal circuit. Because of the higher prices in pharmacies, ongoing debate on the unproven effectiveness of the drug and the hesitation by physicians to prescribe cannabis. Copyright (c) 2005 John Wiley & Sons, Ltd.

Link to abstract.
technorati tags: multiple sclerosis, medical marijuana

Woman with MS gets 3 years for 33 pounds of pot

An ailing West Virginia woman was sentenced to three to five years in state prison by a Cumberland County judge yesterday for transporting 33 pounds of marijuana in her Jeep. The question is whether Sharon Glaser, 52, who has multiple sclerosis, will serve a day of that sentence.

Link to story in Penn. Patriot News.
technorati tags: multiple sclerosis, medical marijuana