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20 nurse focus cannabis patient care | vol. 2 no. 3 cannapatientcare.com K RISTIN L. WOHLSCHLAGEL is a registered nurse. She identifies herself as a nurse who understands that we need conventional treatments, standard of care treat- ments, and that cannabis has a place for symptom con- trol and potentially as a therapeutic. She strongly believes can- nabis should be researched and studied. There should be lots of support for patients to educate themselves in at least the ba- sics of medical cannabis—and so, Wohlschlagel took matters into her own hands and started seeking out researchers in other coun- tries to understand what the current research was revealing about medical cannabis and then she started compiling data from pa- tients she was working with. Here, Wohlschlagel shares her journey to understand medical cannabis, how it translates to breast cancer patients, and her plans to continue educating herself and others. Spotting "Bigfoot" Kristin L. Wohlschlagel has been an RN for 16 years, becoming an oncology nurse in rural Hawaii right after graduation. She explained that the first year of her oncology nurse work was very hard so she soon transferred to be an ER nurse where she remained for 6 years. After that, Wohlschlagel went on to hospice and oncology supportive care nursing for patients that needed care at home. In 2016, she started hearing more about medical cannabis from some of her patients, who reported that it helped with nausea and sleep—her stance was always that it was fine as long as their doctors were aware. There was one patient in particular that changed Wohlschlagel's perspective quite dramatically. She explained that this patient was in hospice and there would be meetings for the group of nurses on the care team. "We would discuss patients that were struggling to get their symptoms controlled," she said. "We were giving this particular patient more and more medicine to control symptoms and it got scary, so much so that we were having to deliver the medicines every day because the pharmacist and doctor were afraid the patient would just overdose in desper- ation to find relief." Then something remarkable happened. "The nursing team noted that the patient wasn't using as many of the pills. They were being left in the box, so the nurses asked what was being used and were shown a little bottle of homemade cannabis oil. The patient said it helped more than the other things that were brought," she said. "A couple of months later, it was noticed that the patient's abdomen that had been swollen with cancer had begun to shrink. And the next thing I knew the patient was gone from hospice care. I never heard more about that patient again, but I made a note of what kind of cancer it was." This particular case was a form of neuroendocrine cancer. Wohlschlagel is always careful to point out that not all neuroen- docrine tumors shrink on THC. But this experience opened her mind to the possibilities of cannabis medicine. Shortly after that experience, she had to take time off work for a back surgery. "I had begun to look online for information about the use of can- nabis. First, I was worried about drug interactions because this patient was swallowing this oil, not smoking it. And I knew that when you swallow chemicals, you increase the risk of drug in- teractions through the liver because a lot happens in the liver. I was looking online for resources. I couldn't find anybody telling me what were safe doses or when drug interactions would hap- pen," said Wohlschlagel. Next, she started digging into the scientific articles discuss- ing the interaction potential. "I noted that some of these arti- cles I was reading were written by scientists in Spain, Israel, or other countries. They were studying the potential for antican- cer use of cannabinoids. Well, I felt a chill go up my spine be- cause I had witnessed something that I felt was like seeing Big- foot. You are afraid to talk about it, and question if you believe you really saw what you saw, but once you see it, you can't un- see it," she said. Wohlschlagel reached out to those scientists and told them what happened with that patient. The scientists explained that there was a little bit of research on that type of cellular cancer in a different setting—prostate cancer. "The fact that they could point me to research showing that THC or a similar chemical that binds to the same receptors in the same ways was able to push back on that neuroendocrine differentiation of cancer cells in prostate cancer studies in the lab—it really hinted that what I saw with that patient might be scientifically explained if they all paid attention. So, with that, I didn't assume that cannabis was the cure for all cancers, but I realized that this was worthy of my study," said Wohlschlagel. Taking Matters into Her Own Hands: A Nurse's Journey to Self-Educate on Medical Cannabis Benefits and Risks B Y M E G A N L' H E U R E U X