The status of using CBD for SD cancer patients

578184Recently I have had discussions with people who were under the impression that cannabidiol (CBD) has been legalized in South Dakota. That isn’t quite true. It is true that in 2017 the SD legislature passed a bill with a narrowly focused move forward towards legalization. But overall CBD oil is not truly legalized, especially not for cancer patients.

In 2017 the South Dakota legislature passed SB 95 and Governor Daugaard signed it into law. This bill as signed into law did a couple of important things:

  1. Section 1 of the bill made the following change to the definition of marijuana in SDCL 34-20B-1. The parts striken through are what the bill removed from the law. The parts underlined is what the bill added to the law.

    (12)    “Marijuana,” all parts of any plant of the genus cannabis, whether growing or not; the seeds thereof; and every compound, manufacture, salt, derivative, mixture, or preparation of such plant or its seeds; but. The term does not include fiber produced from the mature stalks of such the plant, or oil or cake made from the seeds of such the plant, or the resin when extracted from any part of such the plant or cannabidiol, a drug product approved by the United States Food and Drug Administration;

    This part of the bill removed cannabidiol (CBD) from the definition of marijuana. This is important because it potentially dramatically decreases the penalty for those caught with CBD oil.

  2. Section 2 of the bill adds Cannabidiol to the list of Schedule 4 drugs for South Dakota. The law listing the Schedule drugs can be found in SDCL 34-20B-25. Originally the bill listed had it worded as “Cannabidiol, a drug product approved by the United States Food and Drug Administration.” This was amended during the committee process to remove the reference to the FDA. But, from what I understand any Schedule 4 drug in South Dakota already needs FDA approval and needs to be prescribed by a doctor. So adding Cannabidiol to the list of Schedule 4 drugs does not open up CBD for use in SD. It is only allowed for cannabidiol products specifically approved by the FDA.

To summarize the above sections, this bill does as passed into law does three important things:

  1. SB 95 removed CBD from the definition of marijuana.
  2. SB 95 added cannabidiol to the list of Schedule 4 drugs in South Dakota.
  3. Schedule 4 drugs have to be approved by the FDA, prescribed by a doctor, and the prescription filled by a licensed pharmacist. That means any CBD not fitting the preceding metrics are NOT legal in SD.

Right now it appears that Epidiolex, a CBD manufactured by GW Pharmacies and used to treat some forms of epilepsies, is the only CBD product approved by FDA. Actually during testimony of the drug GW Pharmacies tried to get the bill even narrower in scope to ensure their drug Epidiolex was definitely the only CBD drug that would be approved in SD.

The main thing to remember is that the claims made by CBD oil companies that cannabidiol products are completely legal in all 50 states are false. Some of those companies will still ship to you in SD, but it not legal for SD residents to use these products. Only CBD products specifically approved by the FDA, then prescribed by a doctor, and the prescription filled by a pharmacist is approved in SD. Currently that makes Epidolex the only product actually legal in SD. Hopefully this will change in the future because in my research there have been some cancer patients who responded positively to CBD.

R-CHOP, the chemo regiment I’m on

21746916A follower of this blog noticed I’ve mentioned R-CHOP often as being the chemotherapy regiment I’m on. She asked if I could briefly explain what this means as she is about to start R-CHOP chemo herself. The doctor did give her information about R-CHOP, but it was basically just a sheet explaining the many side-effects which are possible. In this post I will try to briefly explain what R-CHOP is.

What is R-CHOP

R-CHOP is a chemotherapy used specifically to treat non-Hodgkin lymphoma. R-CHOP actually is actually an acronym for the five drugs that are used together to best battle the lymphoma. Combinations of drugs are often used in chemo. The five drugs which make up R-CHOP are as follows:

  • Rituximab
  • Cyclophosphamide
  • Doxorubicin (Hydroxydaunomycin)
  • Vincristine (Oncovin)
  • Prednisone

Explanation of each drug in R-CHOP

Only three of these drugs are actually chemo therapies. One is a targeted therapy drug and another is a steroid. Here is a further breakdown of these five drugs.

Rituximab

Rituximab is not actually considered a chemo drug. Instead it is a type of targeted therapy drug known as a monoclonal antibody. Here is what cancer research UK has to say about this drug:

Monoclonal antibodies target proteins on the surface of cells. Rituximab targets a protein known as CD20. CD20 is found on white blood cells called B cells. It is the B cells that are cancerous in the most common type of non-Hodgkin lymphoma.

Rituximab attaches itself to the B cells and marks them. The cells of the immune system recognize the marked cells and kill them.

It is a pretty cool idea to use the body’s own immune system to fight cancer. Rituximab is given via IV just like the chemo drugs. It is also the drug that makes the first round of chemo last seemingly forever. This drug has a lot of potentially nasty side-effects and the first IV has to be done very slowly to determine if the drug can be safely used for a patient.

Cyclophosphamide

Cyclophosphamide is one of the three chemo drugs. It is classified as a “cytotoxic agent” due to it being toxic to both bad and good cells. This drug is given through the IV.

Doxorubicin (Hydroxydaunomycin)

Doxorubicin is also a chemo drug. This may be prescribed as Adriamycin. It is given through an IV. Cancer patents often know this drug as the “red devil”. I have to agree with this name. The drug is deep red. It looks like a poison to me, but I’ve heard other say it looks very cool. It is also very dangerous if it leaks on the skin or out of a vein. But it is also a very effective chemo drug, so I find the risk worth it.

Vincristine (Oncovin)

Vincristine is the third and final chemo drug in the R-CHOP regiment. It is also given through an IV.

Prednisone

This is actually a steroid, and not a chemo drug at all. Some patients have Prednisolone instead of Prednisone during their R-CHOP treatment. This is taken as a pill instead of through the IV. In fact I take this the day of chemo, and the four days following. While prednisone has anti-inflammatory properties, it is used in this chemo regiment because it can “stimulate programmed cell deaths“.

How often is R-CHOP given

R-CHOP is typically given every three weeks. Each three-week period is called a cycle. I’ve read about two-week cycles, but honestly I can’t imagine being so aggressive with R-CHOP unless it was absolutely necessary. R-CHOP can last up to 8 cycles. In my case I was told I would likely be on R-CHOP for 6 to 8 cycles. As I write this post I am actually preparing for my fourth cycle. Today I should either be half way done or two-thirds of the way done with my chemo treatment. The results of my PET scan will help determine that.

Other thoughts on R-CHOP

I’ve heard of R-CHOP being referred to as a “shotgun approach” due to the mixture of drugs. I don’t think this is an unfair assessment of R-CHOP as a treatment. One of the problems with certain blood cancers, such as some types of non-Hodgkin lymphoma (NHL), is that they are not curable and can only be pushed into remission. NHL patients often have to wait for their symptoms to be bad enough for treatment. When they finally get that treatment they want it to be as potent as possible to help prevent the need for further treatments any time soon. Personally I am thankful R-CHOP treatment exists. At the same time though I hope new treatment options are created in the future which aren’t so hard on the body. And yes, R-CHOP is very hard on the body.

Fall allergies while on chemo

Cleaning up Yard during AutumnEarlier this week I noted there wouldn’t be any real post that day due to not feeling very well and my brain fog being too thick. For the last few days it has been hard to put thoughts together and breathing has been very hard. Luckily today I seem to be back to normal and believe it was in fact fall allergies which took me down for the last few days.

One thing I love about our home is that we have a lot of old trees surrounding the house. Of course that also means a lot of leaves. Sunday of this week was a very nice day. It was slightly cool, but there was no wind at all. This was perfect for one last time to clean the leaves in the yard. I spent a few hours in the afternoon with my leaf-blower and hauled a full pickup load of leaves to the dump site. Not only did I feel that something was accomplished by removing all the leaves, I also got some good exercise in.

It didn’t occur to me at the time to worry about my fall allergies. I am already taking Claritin every day. I partially take Claritin to combat fall allergies; and partially to combat the side-effects of certain drugs I am taking; more specifically Claritin helps battle the side-effects of Neulasta and Xgeva. Even though Claritin does a fine job of keeping fall allergies at bay, it does have its limits. I apparently found those limits by using a leaf blower to shoot a lot of allergens into the air.

I didn’t exactly have my normal fall allergy symptoms. Typically during fall I get a runny nose, my sinuses feel plugged, and my head feels like it is going to explode. This time I had a little bit of a runny nose, but I don’t believe my sinuses were clogged at all. My head didn’t feel like it was going to explode either. Instead I had a harder time breathing and I just felt “off”. Additionally my brain fog seemed to really get thick. I just couldn’t put any thoughts together at all. Finally today, four days later, I feel almost back to normal (well the new normal for me being on chemo).

This morning I was in contact with another cancer patient going through chemo. She has a similar experience when doing yard work. To combat this she has to take a shower immediately after doing any yard work and ensure she doesn’t come in contact with the clothes she was wearing again until after they have been washed. Additionally if she has done something like raking she will put the blue mask on. That day I did not take a shower until the evening. Now I know to do that right away.

Now that there is a light layer of snow on the ground hopefully fall allergies won’t be an issue. Furthermore, if my treatments go right I hopefully won’t be on chemo come spring when I have to worry about allergies again. Either way I now know my body definitely reacts differently to fall allergies than it used to. I guess it’s just one more thing to watch out for while on chemo.

Got my bone shot today

20815350Every four weeks I have to get a shot to rebuild my bones. This is due to the fact my cancer has spread from my lymphatic system and into my bones, known as bone metastasis. The drug I take is called xgeva, also known as denosumab. In this post I will briefly blog about what xgeva does.

Xgeva (denosumab) is a drug often used to treat osteoporosis and hypercalcemia. Recently it has also been used to treat bones which have been weakened by cancer. Since my cancer has spread heavily to my bones I am at risk for bone-related injuries. Actually I probably already broke or fractured a pinky finger last month. My pinky is mostly healed now, although I am still waiting to lose the nail. Hopefully this xgeva shot will help prevent any further bone injuries and reduce the bone pain I am experiencing.

How Xgeva works is pretty cool. There are cells in our body that continuously break down our bones and other cells that continuously rebuild those same bones. The balance between these cells doing their work allows bones to be healthy. Certain conditions such as cancer in the bone marrow throws this whole system out of balance and bones can become too broken down. Xgeva is basically an antibody which interrupts the proteins that break down the bones. The benefit of this is the bones are allowed to be rebuilt and be strengthened.

I had my first xgeva shot on my second round of chemo, which was exactly four weeks ago. Every four weeks I will continue to have xgeva shots. So far I haven’t had any noticeable side-effects from xgena. I believe the pain I feel in my back has been going down, possibly due to my xgena injections. Hopefully this round of xgeva will bring my bone pain down even further.

How I keep track of meds

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My Pill Case

In yesterdays post I noted that I almost took my morning meds twice during my first cycle of chemo. That would have been bad. To prevent brain fog from causing issues when taking my medications I implemented a couple of changes to ensure I would keep on track. In this post I will briefly share those changes taken and recommend the phone app I use to track meds.

When I first started chemo I was simply taking my pills straight out of the bottles. At that time I only had to take a few pills in the morning and one in the evening. That seemed easy enough. After missing one evening pill and then almost taking my morning pills a second time, I decided it was time to take action.

Well, actually first my wife decided to take action. She went to the pharmacy and bought me a pill case which could handle a full weeks worth of pills. It also has multiple compartments for each day. The case she bought is pictured in this post. I really should have gotten a case like this right away, but I had resisted because I thought it made me seem old.

Having this case helped quite a bit to ensure I didn’t take the same pills twice each day. But it did nothing to help me actually remember to take the pills. After missing my kidney pill a second evening, I spent a lot of time on the internet researching various pill reminder phone apps. There are actually quite a few pill reminder apps out there. Some are good, and some are pure crap. Maybe someday I’ll do a few a full review of the various apps I tested out. But that goes beyond the scope of this post.

The app I ended up using is called Medisafe. This app is available for Androids and Iphones. I won’t do a full review in this post. Instead I will just list a few bullet points about why I like this app:

  • It is easy to enter my pills and schedule them.
  • The app is quite persistent to remind me about taking my pills. I get so annoyed at having to snooze the app that I am forced to take my pills no matter what I’m doing.
  • The app has information links about most of the pills I take. There is even a video for a few of them.
  • I can track my kids medications with their own profiles. To have more than one kid in the app I did have to pay for the full version. But it was worth it to ensure they are also taking their daily meds.
  • I can easily track when I take extra meds, such as painkillers or stools softeners.

For anyone with a smart phone I would definitely recommend the Medisafe app. Anyone without a smart phone has options as well. I’ve seen pill dispenser which include alarms on them. The main thing is make sure there is an alert of some type as a reminder it is time to take meds.

I’ll end this post here. This post was probably more of a review than anything. I will say that since I got the pill case and phone app I have not missed my meds once. The peace of mind that comes from not worrying about pills is well worth having yet another app on the phone alerting me.