I want the magic pill too, but…

I want to say this gently, because I’m going to be talking about acts of kindness by people who love us or at least care about us. We live in a culture of fixers. We like to fix things and that’s hard to do when the problem is complex and not something you can wrap your hands around. In those cases we give advice, lots of advice.

We all have bodies and they fail at one time or another. Sometimes they downright betray us. It’s hard to watch this happen to someone you care about. It’s hard to feel helpless. Almost from the time we met Garry heard me complain about the goofy things people say to you in a crisis. I would always tell him “you can’t go wrong with a hug and saying I’m sorry”. So, when my dad died I got a lot of hugs and whispers of “I’m sorry”. I think he was scared to say or do anything else. I regretted painting him into a corner when it came to addressing my loss. He was one of the few people who probably could have said anything and it would have been right, because I know his mind and his heart.

At risk of painting people into a new corner I want to talk about the advice we give when someone is sick. I’m not talking about the compulsion we have to God-splain suffering to those who suffer (that’s another post for another day). I’m talking about the tangibles. The dietary recommendations, the supplements, and the exciting new world of legalized marijuana. I will probably get under some people’s skin, because there is a weird tendency to get down right evangelical about your diet, supplements and THC/CBD. I can appreciate this, when you feel something has improved your life you want to share it. I’ve been a pusher of acupuncture and essential oils for the same reasons. I’m not judging anyone. I forfeit that right a long time ago. I’m simply introducing some considerations and guidelines for recommending complementary treatments to the ill.  

Because words matter I’m going to introduce some definitions to keep us all on the same page.

Cancer: We think of this as one disease, and it’s not. It’s a multitude of diseases. The type, stage, location and genetics of the cancer have their own complexities and greatly affect treatments and outcomes.

Cure: to destroy the illness completely to the point of no return. It’s gone. Over. Dunzo.

Hypercoagulation: Forms clots faster and more often than one should in locations you don’t want clots, like within the blood vessels and organs of your body. It can kill you.

Palliation: to ease suffering or manage symptoms. Not a cure.

Poly pharmaceutical: heaping wads of prescription drugs.

Let’s start with supplements. I feel I should disclose that I have a fairly adversarial relationship with supplements. I do take supplements, but back up their use with either physician recommendation, peer reviewed studies or professional journal articles. I believe the supplement industry is the modern day version of the traveling snake oil salesman. Of all U.S. industries, it is the ripest for grifters, frauds, charlatans and swindlers. The industry is very nearly unregulated, they make too good to be true promises, and have an impressive retail markup.  Yet the industry is booming. The placebo effect and magical thinking are also very much alive and well. Almost every study in recent history finds that supplements either do nothing or cause harm. I’m not saying they don’t have their place and there aren’t some good players out there. I’m saying eat a balanced diet, be active, and get a little sunshine without the burn every now and then. It will save you money and you’ll have better results.

My greatest concern when it comes to supplements and the chronically ill is drug interactions. Here’s the thing, supplements can and will affect important functions like clotting and hormone production. People think they are either a miracle drug or relatively benign, but when mixed with some pharmaceuticals or disease processes they can be dangerous. There are also limitations on studies of supplements and drug interactions. There is a lot we don’t know. If you have a chronic illness you are likely on poly pharmaceuticals. Starting a supplement regime in addition to your prescriptions could adversely affect you, and/or counteract the care plan of your medical doctor. I know an 18 year old employee at a health food store can sound impressive, but did you give good advice when you were 18??? Why are you listening to the 18 year old in an apron? Listen to your MD! They may recommend some adjunctive supplements but please don’t go crazy on your own without consulting them.

We have a very well meaning family member who is also what I refer to as a supplement abuser. She has brought me supplements that increase the risk of miscarriages when I was pregnant, and recommended supplements for clotting disorders that are actually contraindicated and lead to an increase in stroke for patients that hypercoagulate. If you have a regime that you swear by, I kindly ask that unless you’re a physician or pharmacist, try not to recommend them to your friends and family when you don’t know their health history or current medications and treatments.  Above all else when you Google or Bing or whatever please add “study” or “professional journal article” to the end of your search terms. There is so much anecdotal bullshit out there you can get lost in it. Also, never trust the articles in the free magazine at the entryway of your health food store. Just don’t.

You are what you eat, and I’m fried, crispy, salty, and juicy sweet. But seriously, I find diet is a hugely important player when it comes to decreasing your symptom burden in chronic and acute illness. The diet you should be on can vary dramatically depending on the disease. When Garry was diagnosed with cancer he had been Paleo for five years. Five long horribly boring to the pallet years. The Paleo and Keto diets have been well studied and we actually know a great deal about the way they affect a person’s body, or rodents body (according to the literature there are massive amounts of keto rodents living in labs). The keto diet is known to decrease inflammation, can starve cancer tumors and even assist in tumor regression with the exception of two cancers. The Keto diet leads to an increase in breast cancer recurrence because of its high fat content, and it actually causes tumor growth in melanoma tumors. The mechanism of the tumor growth is continuing to be studied, but they think it has some genetic component. For breast cancer and melanoma they recommend the Mediterranean diet with low fat and healthy grains.

Like I said in my definitions, cancer is not one disease. Cancer is Legion. Each disease responds differently to its environment. Yes, cancer loves sugar, but not all rules can apply to all cancers. Depriving cancer of sugar may slow it down, but it is resilient and adaptable. It will eventually find another food source. Most oncology, diabetic, and cardiac clinics provide dietary counseling. If you are ever in need of any of these services please also meet with a dietician. There is a lot of wonderful research out there with very exciting results that not only improve quantity of life, but improve quality. Let someone qualified lead you to the right choices for you. Anything that universally reports to cure or fight cancer should be suspect, because no two cancers are the same, and no diet or drug can make a universal claim like that.

The legalization of marijuana is exciting to me as a clinician. I have never personally been a user either for recreational or medical reasons. Well, that is not entirely true, I did use a cosmetic night cream that had CBD in it, and I thought it was great. My experience with all things marijuana is mostly laughing at the bone-headed things potheads say, and being amazed by the comfort and relief it has brought my hospice patients over the years. I’ve had patients who utilized marijuana to manage their end of life symptoms long before it was legal. I’ve seen it relieve nausea, increase appetite, decrease anxiety and ease pain. At the time there was very little data to support what I saw, because it wasn’t entirely legal to study outside of a handful of cohort studies. So, my experience was just more anecdotal bullshit.

Today the data is rolling in hot and fast and generally supports all the anecdotal bullshit of my early career. We all have cannabinoid receptors in our bodies. We are designed to receive and process cannabinoids just like we are with opioids. The main difference between the two is where the receptors live. Unlike opioid receptors you do not have cannabinoid receptors in the part of your brain that can make you stop breathing and die. This is an obvious benefit to cannabinoids over opioids, however nothing is without its risks and those risks should always be weighed against the benefit.

CBD and THC are the two components of marijuana most often manufactured and marketed. THC is the psychoactive component and CBD is non-psychoactive. In other words THC will get you high and CBD won’t. In fact, in some studies CBD actually balances the psychoactive traits of THC. There are multiple other chemical components found in marijuana that have not been studied independently and we may find other benefits in the future. On the whole, if you were my patient and were not concerned about THC I would recommend straight up smoking marijuana the old fashioned way. If my anecdotal bullshit experience means anything, I have found that patients have greater relief when they smoke. Theoretically the plant works best as a whole. What we do know is that smoking bypasses the stomach and the user has a rapid feedback method to more safely adjust dosing. Although a large dose of marijuana won’t depress your respiratory system, it does have adverse effects. Police officers and emergency department employees can tell you all about them. When using the edibles you won’t feel the effects as rapidly, and sometimes people keep taking more because they think its not working, only to go bat-shit crazy when it finally peaks in their bloodstream.  Keep in mind, my patients were hospice patients, and the risk benefit model is different in those cases. If you are or intend to use medical marijuana talk to your physician, I am not a physician, and I have no idea what your medical history or needs are.

Cannabinoids provide a type of neuro protection that makes them ideal for affecting conditions of the nervous system such as anxiety, sleep deprivation, pain, and even seizures and some types of brain tumors. We’ve all heard the stories about children with seizure disorders finding relief through medical marijuana. The evidence supports that this is not a placebo or crazy hippy parent thing. However, the utilization of medical marijuana for pediatric seizures has not been embraced by pediatric medical societies because of marijuana’s adverse effects on brain development. I have never met a physician who recommended marijuana use until after the age of 26 when your brain is fully developed. Before we go all judgy-parent on those who use marijuana on children let’s consider the fact that seizures aren’t good for brain development either. Plus if you have ever watched anyone have a seizure it’s about the most helpless feeling you can have. I can’t imaging watching my child go through that once let alone on a daily basis.

Cannabinoids can stabilize or even decrease the growth of some cancer tumors such as neurologic cancers, but they tend to increase growth in others specifically cancers of the male sex organs. I have found absolutely no evidence that cannabinoids have cured any cancer. Inhibiting growth is not a cure. It may prolong life and improve quality, but it’s not a cure.  In fact, it remains illegal to market cannabinoids as a cure for cancer, because they’re not, and although they may inhibit one type of cancer, they may also promote another, and the average consumer does not know the difference. Please don’t perpetuate the claim that they cure cancer. It’s dangerous and irresponsible.

Cannabinoids are wonderful in the palliation of cancer symptoms. They work both as a pain reliever and an anti inflammatory. They can increase appetite which can prolong life and add quality, because food is part of quality life. Anxiety and nausea are worse than pain in my mind. Cannabinoids are shown to decrease both of these symptoms. Another debilitating symptom is sleeplessness. I am a sleeper. I can sleep through anything especially stress, but I am aware that I am often sleeping soundly next to a guy that is wide awake and probably resenting my slumber. Cannabinoids can help adjust sleep cycles which will decrease stress, increase coping, and all the other wonderful things that go with a good night’s sleep. Including not hating the person sleeping next to you because they are sleeping.

My primary concern with promoting marijuana in cancer and cardiac patients is that CBD can potentiate the action of blood thinners. So, if you are already on coumadin or xarelto or even taking aspirin or ibuprofen, CBD can increase the thinness of your blood. Thinner blood means a decreased ability to clot and an increased risk of stroke. I’m not a giant fan of having my husband beat cancer only to have a stroke or internal bleeding or any other such tragic end.

As unpopular as it is, I am a giant fan of big pharma. I know they have been very bad lately. Very very bad, and they should be punished. The price of insulin is a dick move. There’s no two ways about it. It’s a dick move. However, there needs to be some shared accountability for that. For one thing the fuck-nuts we’ve elected have some political responsibility to sort this mess of a medical system, and stop benefiting from it. But please don’t throw the baby out with the bath water. Big pharma and the fuck-nuts also brought us some amazing miracles. I sleep next to one every night. Good dads don’t grow on trees, and my kid has one. Big pharma let us keep him. If it weren’t for big pharma Fathers Day would suck around here. So at the end of the day, I appreciate all the advice. I know it comes from a kind and hopeful place, but if we don’t do the thing that you believe will save us, it’s probably because we trust the science behind big pharma and the fuck-nuts more than you…. But (for what it’s worth) we are grateful you put yourself out there and took the time to speak up with care. We love you and hope you have a great fathers day! We will be enjoying the gift of another year with our big pharma miracle.

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