Cannabis Patient Care - November 2021

Cannabis Patient Care November Issue

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27 patient & nurse focus october/november 2021 | cannabis patient care one of Nurse Heather's sessions, Pichette was mesmerized by her knowledge of the endocannabinoid system, the canna- bis plant, and her style of storytelling and healing. As a nurse, Pichette had never learned about this bodily system. With all of this education on cannabis and the endocan- nabinoid system, Pichette now assists other breast cancer patients along their journey but doesn't help them through a nursing approach. Instead, Pichette talks with them from a patient perspective of how her journey with cannabis was during her breast cancer diagnosis. An important and often forgotten aspect of breast cancer is mental health. Pichette explained that people often focus on the cancer and not about how such a scary diagnosis can affect the mind and spirit. Cannabis helped Pichette realize that she was much more than her breast cancer diagnosis, even after losing one of her breasts. These are some of the topics she discusses with fellow patients. Through surviving her double breast cancer diagnoses, Pichette is still a cannabis user today, more so to support her mental health. It is unknown if cannabis is helping her stay in remission, but the medicinal plant has done wonders for her mental health. Now, she is not taking any pharmaceuticals, except for her asthma. Cannabis has assisted in allowing her to live her life in a more peaceful, positive mindset. Finding Her Own Treatment Plan While receiving her medical treatment at Dana-Farber Cancer Institute in Boston, Massachusetts, medical cannabis was still considered taboo, so doctors were not interested in recom- mending it's use in her treatment plans. Harvard University is connected with the institute. Dana-Farber had a volunteer program that was similar to a buddy system, connecting newly diagnosed breast cancer patients and helping them with things new patients are faced with. Due to her cannabis use, Pichette was denied involvement in the program. Pichette's journey with cannabis wasn't an easy one. The negative effects of cannabis aren't often discussed out in the open. Pichette suffers from a high sensitivity to THC and would experience paranoia at times. To begin use, she was micro-dos- ing 2.5 milligrams of THC a day. In 2013–2014, Pichette said she wasn't getting information on micro-dosing from her dispensa- ry. Soon Pichette began working with Nurse Heather, whose Na- ture Nurse product helped significantly with micro-dosing her endocannabinoid system. Pichette kept a log of which products were working and which weren't. It was a lot of trial and error, trying to figure out her medical cannabis treatment plan. Now, she is able to micro-dose her way into wellness by using the right products. When Pichette goes to a dispensary, she has to keep note of the percentage of THC. Another cannabinoid she needs to look into percentages is cannabidiol (CBD) or else she would have negative side effects. Luckily for Pichette, acquiring medical cannabis wasn't a dif- ficult task like the trials and errors of product testing. She has lived in Rhode Island, Massachusetts, and California, which are all states where breast cancer is a qualifying condition. Each state has their own guidelines though so now being in Rho- de Island, Pichette is unable to access to the THC part of Na- ture Nurse products. Unless she visits California, she is not able to receive the products that work best for her. Even while trav- elling, Pichette has the hurdle of crossing state lines with can- nabis products, which depending on where you are going may become a challenging issue. There are other products that are available, but the Nature Nurse product line suits Pichette's needs best. "Everybody has their own desired medication just like pharmaceuticals. And that's the hard part is if you find a strain, if you find a product, and then that strain is no longer available or that product is no longer available. Now, you have to go through all of those hoops again trying to find where you're at, what state you're in, and what's available to you," said Pichette. "Then you have to start all over again because each product is different. At least for me, that's what I found." An important thing to note with cannabis is that it may not be suited for use while a patient is on other medications. Al- though it is a safe plant in which you cannot overdose through its use, cannabis may interact negatively with certain types of pharmaceuticals and bodily functions. Pichette mentioned that cannabis has the possibility to increase your heart rate or low- er your blood pressure. "I know one of the big things is if you're on an anticoagulant, if you have any blood clotting factors, it can change your prothrombin time/international normalized ratio (PT/INR). That way, you might need less anticoagulation. There are different medications that would have to be titrated whether up or down," she said. Due to the possibility of unfavorable pharmaceutical reac- tions, Pichette always instructs patients to work with a medical professional and also someone who had a medical background in cannabinoid therapeutics and the endocannabinoid system. Addressing Stigma Due to the stigma of cannabis and its' federal substance ruling, many breast cancer patients may not be aware of the medicinal health benefits it can offer. Pichette is still actively working as a nurse in a psychiatric unit. When she was the acute psychiatric hospital night supervisor for a year and a half, she kept seeing the erroneous diagnosis of Cannabis Use Disorder and this led to her research study at Salve Regina University, in which she hopes to graduate with her Doctorate in Nursing Practice in May 2022. Being surrounded by nurses and doctors day-to-day, she witnesses the stigma surrounding cannabis and says it is still significantly high. A lot of breast cancer patients might have little to no education of canna- bis's effects on the body because of the lack of knowledge on

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