Case Reports Directory

Case Report

Medical Condition:Gastrointestinal disorders

Description

Cannabidiol alleviates eosinophilic esophagitis
Medical Condition
Gastrointestinal disorders
Symptoms
Food gets stuck in throat
Gastrointestinal Disorders
Heartburn and reflux disease
Pain Scale: Before Cannabis Use
6
Pain Scale: After Cannabis Use
2
Abstract
This 31-year-old white male with heartburn and dysphagia unresponsive to antacids was diagnosed with eosinophilic esophagitis. He finds relief of his symptoms by using cannabidiol rich concentrates.
Patient information
Gender
Male
Age
25-34
Brief history and target symptomatology
This 31-year-old computer security specialist developed heartburn around age 15, which did not respond to usual antacid treatment. 6 years later he developed severe dysphagia and was diagnosed with eosinophilic esophagitis upon esophagoscopy and biopsy. Recently he required bougienage for esophageal stricture. Cannabidiol rich concentrates relieve his dysphagia, without the need for additional medication.
Previous and current conventional therapies
Standard antacid therapy (Protonix, Nexium) did not relieve heartburn. He undergoes annual esophagoscopy and esophageal biopsy and recently required esophageal dilatation for stricture. He is currently in remission, for which he credits cannabidiol.
Clinical response to Cannabis
Relief of heartburn and dysphagia.
Additional Comments
Esophageal eosinophilia is increasingly recognized as a separate disease, with an incidence of one in 10,000 per year. Unlike GERD, it does not respond to antacids. It manifests with progressive dysphagia and may progress to esophageal stricture. It is usually associated with food allergies, however it may occur in antibody deficient patients. It is treated with dietary restrictions and topical corticosteroids, such as Flonase. The role of medical marijuana has not been investigated.

Reference: http://www.aaaai.org/conditions-and-treatments

Here is a description of patient's method of using medical marijuana: “I do not use medical marijuana throughout the day, just at night, usually sometimes just before dinner to before bed, but almost never more than once in a day. I have used it twice after food has become lodged (and subsequently dislodged) to try to limit the additional swelling that usually occurs after such an event. With the use of medical marijuana, I have been able to return to, and finish my meal. My tolerance is quite low, so I have tried both vaporized plant and concentrate, and smoked plant, and low-dose lozenges and sprays. I cannot say for certain that one is any better than the other; all seem to help.”
Cannabis
Usual method of Cannabis administration
Vaporized
Frequency of Usage: Time Per Day
3
Frequency of Usage: Days per Week
3

Case Report

Medical Condition:Adverse effects

Description

Retinitis Pigmentosa progression may be slowed by cannabis
Medical Condition
Adverse effects
Symptoms
Vision loss, headaches, depression
Abstract
A 37 y/o PhD university research associate with retinitis pigmentosa found relief of associated symptoms with cannabis and subjective slowdown in progression of vision loss.
Patient information
Gender
Male
Age
35-44
Brief history and target symptomatology
This 37 y/o PhD university research associate was diagnosed with retinitis pigmentosa (RP) at age 14. He experiences progressive vision loss, headaches, depression and insomnia.
Previous and current conventional therapies
Supplementation with antioxidant vitamins was ineffective. Serial electroretinopathies (ERG) were discontinued in the belief that the flashes of light used further damage his retina and "ophthalmologists only want photographs for their own collection". His eyeglass prescription is reviewed annually to compensate for his increasing tunnel vision. He has not found significant improvement in his mood with psychotherapy.
Clinical response to Cannabis
Stress, mood, headaches and insomnia have all improved with cannabis use.
Additional Comments
RP is a genetic disease found in 1 in 4000 people in the US. In patient's case, it was traced to mutations in both parents' X chromosome. There is no known cure; valproic acid, gene therapy and retinal transplantation are currently in the research stage. Administration of a THC analog to rats with chemically induced RP has shown reduction in the rate of degeneration of retinal photoreceptors. .
Reference: Experimental Eye Research (2014), 120:175-185
Cannabis
Usual method of Cannabis administration
Smoked
Frequency of Usage: Time Per Day
3
Frequency of Usage: Days per Week
7

Case Report

Medical Condition:Glaucoma

Description

Congenital cataracts
Medical Condition
Glaucoma
Symptoms
Vision loss, eye pain, tearing.
Abstract
This 58-year-old patient was born with bilateral cataracts. He had surgery on one eye at age 3. Eventually he developed near blindness in that eye and severe vision loss in the other. He suffers from constant eye discomfort, frequent headaches and tearing. He uses edible marijuana for prolonged mydriasis, which improves his vision and relieves his other symptoms.
Patient information
Gender
Male
Age
55-64
Brief history and target symptomatology
This 58 years old man was born with bilateral cataracts. At age 3 he underwent surgery on his left eye, suffered postoperative complications and progressive loss of vision; he developed retinal detachment, then glaucoma and became legally blind in this eye around age 35. His right eye was not operated on but also suffered progressive loss of vision with a visual acuity of 20/80 currently.
The patient was a software programmer for several years however his deteriorating vision forced him to switch from actual programming to a consulting role. He uses on occasion the common mydriatic agent Cyclogyl to maximally dilate his pupils, allowing him his best possible vision but prefers edible marijuana because its effect is longer-lasting. Marijuana also relieves a constant discomfort associated with his vision, which he calls "eyestrain" and which may progress to frank headache.
Previous and current conventional therapies
Surgery. Mydriasis with Cyclogyl (generic name: cyclopentate HCl).
Clinical response to Cannabis
Improved vision. Relief of associated "eyestrain" and headaches.
Additional Comments
Congenital lenticular opacities (cataracts) are rare, estimated at 5 per 10,000 in the US. Most are idiopathic, many are familial, some are due to intrauterine infections or metabolic and genetic disorders. Visually significant cataracts are in the center of the visual axis and greater than 3 mm in diameter. For these, surgery is the treatment of choice; outcomes have improved over the years with the development of new techniques and new intraocular lenses (although use of the latter in infants remains controversial). To ensure minimal or no visual deprivation, surgery should be performed when patients are younger than 4 months. Even with aggressive surgical and optical treatment, visual deficits are common: amblyopia ("lazy eye"), nystagmus and strabismus in childhood, and glaucoma and retinal detachment years after surgery.

References:
Bashour M. Congenital Cataract. Medscape 2014; Retrieved at http://emedicine.medscape.com/article/1210837
Yorston,D. Surgery for Congenital Cataract. Community Eye Health 2004; 17: 23–25.
Cannabis
Usual method of Cannabis administration
Ingested
Frequency of Usage: Time Per Day
4
Frequency of Usage: Days per Week
7

Case Report

Medical Condition:Adverse effects

Description

Marijuana Is Helpful in Xerostomia
Medical Condition
Cancer chemotherapy
Symptoms
Hyposalivation
Abstract
A 39-year-old retired cab driver treated with radiation and chemotherapy for tonsillar cancer 4 years ago finds medical marijuana helpful in reducing oral mucosal dryness and the need for special dental hygiene.
Patient information
Gender
Male
Age
35-44
Brief history and target symptomatology
The patient drove a cab for 39 years and retired 2 years ago. He has suffered from psoriasis for 16 years and currently takes IV Orencia w. maltose ( generic: Abatacept) for severe hand pain due to psoriatic arthritis. He was a longtime tobacco smoker until 2010 when he was diagnosed with right tonsillar cancer and treated with radiation and long-term chemotherapy. He now suffers from dry mouth and decreased appetite. He spends a long time flossing and brushing his teeth after every meal to decrease his risk of dental caries. He does not suffer from xerostomia and does not have Sjogren's syndrome to his knowledge.
Previous and current conventional therapies
Cough lozenges were not effective.
Clinical response to Cannabis
Marijuana subjectively decreases the unpleasant feeling of dry mouth and subjectively increases his production of saliva. It also "definitely" improves his appetite.
Additional Comments
Alterations in whole saliva flow rate induced by fractionated radiotherapy
WB Wescott, JG Mira, EN Starcke, IL Shannon and JI Thornby
American Journal of Roentgenology. 1978;130: 145-149.

Read More: http://www.ajronline.org/doi/abs/10.2214/ajr.130.1.145
Cannabis
Usual method of Cannabis administration
Smoked
Frequency of Usage: Time Per Day
3
Frequency of Usage: Days per Week
7

Case Report

Medical Condition:Gastrointestinal disorders

Description

Rectal spasms (Levator ani syndrome, proctalgia fugax)
Medical Condition
Gastrointestinal disorders
Symptoms
Recurrent anal sphincter pain, constipation, anxiety
Gastrointestinal Disorders
IBS
Pain Scale: Before Cannabis Use
10
Pain Scale: After Cannabis Use
2
Abstract
Proctalgia fugax is a recurrent episodic form of a more prolonged and severe condition called levator ani syndrome. It is associated with often excruciating rectal pain and great difficulty defecating. It involves the internal anal sphincter and may represent neuralgia of the pudendal nerves. It has no known cure.
Patient information
Gender
Male
Age
25-34
Brief history and target symptomatology
The patient is a 26-year-old experienced computer specialist, fully and stressfully employed as a customer assistant in a retail electronics store. His rectal pain may occur at night or during the day, when it causes significant social anxiety.
Previous and current conventional therapies
Warm baths (if the pain lasts long enough to draw a bath), warm enemas, relaxation techniques. (Botulinum toxin, inhaled Albuterol and low dose diazepam at bedtime have been mentioned in the literature as occasionally helpful but the patient has not tried these.)
Clinical response to Cannabis
Inhaled marijuana brings immediate relief of the acute symptoms. Regular marijuana use somewhat decreases the frequency of pain attacks.
Additional Comments
Good review article, with references, in Wikipedia.
Cannabis
Usual method of Cannabis administration
Smoked
Frequency of Usage: Time Per Day
5
Frequency of Usage: Days per Week
7

Case Report

Medical Condition:Cancer

Description

Cancer – Childhood neuroblastoma complete remission
Medical Condition
Cancer
Symptoms
pain, anorexia, nausea, vomiting
Cancer
Neuroblastoma, endocrine
Abstract
Neuroblastoma, a childhood cancer was treated with cannabis after failure of conventional therapy. Cancer disappeared after 4 years of regular cannabis use.
Patient information
Gender
Male
Age
Under 18
Brief history and target symptomatology
This child was diagnosed at 6 years of age with neuroblastoma. He was having pain, nausea, and vomiting at the onset of the disease.
Previous and current conventional therapies
Chemotherapy, Surgical de-bulking tumor resections, Radiation therapy, Intra-operative radiation therapy.
Clinical response to Cannabis
Gastrostomy tube feedings followed by intravenous hyperalimentation feedings were utilized to support nutritional status. Parents consulted Dr. Mikuriya for a cannabis approval when child was dying at age 9. Pain control and control of nausea and vomiting followed onset of regular cannabis use. Cannabis use was typically smoked for rapid onset and ease of dosage control. Frequency of use was symptom dependent and variable, though typically once or more daily
Additional Comments
After 4 years of regular cannabis use and no further conventional therapies from the University based treatment program, there was no longer any evidence of the neuroblastoma tumors. He continued to use cannabis on a daily basis for control of pain, nausea, and anorexia until he was 16 years of age. Sadly, he died at age 16 with peritonitis/sepsis from a perforated bowel.
Cannabis
Usual method of Cannabis administration
Smoked
Cannabis strain (if known)
Unknown
Frequency of Usage: Time Per Day
3
Frequency of Usage: Days per Week
7

Case Report

Medical Condition:Cancer

Description

Anxiety Associated with Dying
Medical Condition
Cancer
Symptoms
Anxiety, Insomnia
Cancer
Breast, female
Abstract
54 year old woman dying of metastatic breast cancer, restless and anxious and confused – requiring regular doses of Ativan for minimal relief but not able to communicate with family due to side effects of the benzodiazepine.
Patient information
Gender
Female
Age
45-54
Brief history and target symptomatology
Four year h/o metastatic breast cancer, in liver failure and within 4 days of dying. Had a history of anxiety disorder well managed by occasional benzodiazepines. Was not a cannabis user previous to chemotherapy; resistant to using during chemotherapy. Did not like the ‘wooziness’ side effects. Agitated, restless, and anxious about the rapidity of her demise.
Previous and current conventional therapies
Ativan (lorazepam), liquid morphine.
Tried THC cannabis and did not like side effects during chemo.
Tried CBD-Rich cannabis and reported rapid and complete relief from chemotherapy side effects (nausea, dizziness, GI pain and anxiety).
Clinical response to Cannabis
Given CBD-Rich cannabis in honey-butter edible mode of administration. After first dose of CBD butter did not require any more lorazepam. Was able to communicate her needs and rest without side effects.
Additional Comments
She ran out of the CBD butter and her caregivers attempted to give her THC butter. After a single dose she refused any more, saying that it made her woozy. CBD was obtained and was sufficient until she died.
Cannabis
Usual method of Cannabis administration
Ingested
Cannabis strain (if known)
Harlequin
Frequency of Usage: Time Per Day
3
Frequency of Usage: Days per Week
3