Issue link: https://www.e-digitaleditions.com/i/1442004
27 cannapatientcare.com december 2021 | cannabis patient care nurse focus meditating and praying?' We talked about nutrition, and about movement and using cannabis as a bridge towards health." Joe started using a 3:1 tincture every day. "We're able to sort of balance out GABA/Glutamate (5), which is the excitatory in- hibitory." Glutamate is the excitatory, and GABA is the inhib- itory neurotransmitter in the mammalian cortex. "Glutamate may cause excessive firing, causing the tremors. So, we started working on reducing the tremors first." In her follow up calls four weeks later with Joe, she asked him about how he was sleeping, and about his level of anxiety. "I then asked him if he felt like he was able to better socialize. We started to work through all these different layers, because when you're working in cannabis therapeutics, it's almost as if you're peeling back an onion or a clove of garlic. You see all the other things that you get to deal with. And one by one, you start bringing those to the awareness of the patient." Mack said that a lot of people don't realize any of the men- tal health issues they may have. "Joe was on medicine for de- pression and anxiety, taking benzodiazepines and Prozac, and his goal actually was to come off the Prozac due to side effects," Mack said. "We got him down to 10 milligrams a day from 40. We created more awareness and a sense of calm, and now that anxi- ety and depression could be aided by cannabinoids," Mack said. Then she added the idea of a 1-to-1 vape, Mack said. "These (cannabis) products can be stacked into the treatment plan, each doing something a little different. We teach the patient how and when to use each of them, and how best to person- alize this medicine. Somebody struggling with PTSD and other physical conditions needs to understand that they can get be- hind the wheel. They develop agency, saying 'You know, I can tune into my own body and determine some cause and effect. So, when I take this 1:1 vape, I can use that to stay calm and say to my wife, yes, I can have that dinner party on Friday, I'll take a puff.' Over time, Joe started to become empowered, and didn't need to shut himself off anymore," Mack said. "I do believe that cannabinoids were game changers, giv- ing him that momentary release of anxiety—as well calming his nervous system. Over time, you start changing those behaviors so that their life can become full again." Mack recalled another patient, a woman with severe depres- sion, stuck in a traumatized living situation. She felt trapped. She was in bed 20 hours a day. "It was social anxiety and depression," Mack said. "And over time, she was able to wean down the drugs she was on, such as benzodiazepines and Lamictal (6), an anti- convulsant medication used alone or with other medications to treat seizures, and used to stabilize mood in adults with bipo- lar disorder (manic depression). I think that drug kept her in bed with fatigue, and was not treating her panic," Mack said. Mack took that patient on a six-month journey through can- nabis therapy. "We used some really good CBD oil, a 10:1 ratio, or 10 parts CBD to one part THC. She needed some THC to real- ly work with the fight or flight in the amygdala and hippocam- pus. But she was able to wean down the Lamictal and improve her quality of life, and eventually stopped the benzodiazepines as well. So now she's literally just on cannabis oils." Now that patient is volunteering again at the church. She's happy, and only sleeping eight hours a day The Body-Mind-Spirit Training When Mack trains either patients or clinicians, she said, she talks about body-mind-spirit (7). "When you are taking these cannabi- noids, it is not just a single molecule pharmaceutical that's activat- ing a receptor to cause a specific effect in the body. Cannabinoids don't only activate one receptor. We're not targeting one function in the body. We're targeting many things at once—it is pleiotropic." With Joe, for example, balancing out GABA and glutamate to help him feel better and have less tremors also helped his brain. "We have a lot of neuro inflammation, which causes Nurses are the ones that can take this and become that bridge between healthcare and cannabis in a way that I think is going to give to them something that they've not known before: autonomy. – E L I S A B E T H M A C K Elisabeth Mack, RN, MBA