Understanding Dementia

The National Institute of Aging defines dementia as a blanket term to cover a variety of mental afflictions and it “…is the loss of cognitive functioning — thinking, remembering, and reasoning — to such an extent that it interferes with a person's daily life and activities. Some people with dementia cannot control their emotions, and their personalities may change.” 

Up close and personal, dementia is scary and heart wrenching all at the same time. The person that you knew and loved is past the point of no return and there isn’t anything a damn person can do about it. 

The Power of Connection

Every now and then it feels like nothing short of divine intervention when a consultant is paired up with a patient. As if the cannabis confused stranger in front of you was meant just for you. Sometimes it’s because you both share the same medical condition, a life experience or it could be as insignificant as commiserating over your local sports teams. 

This last one in my 3 part storytelling series, is how an 80-something year old man taught me how to go beyond my initial reactions and left a mark on my heart.

Meeting Stu

“Hi loser”, said Stu with a crooked smile. 

Oh boy, I thought, am I really starting my day with degradation? I replied with a level tone, “Now how would you know such a thing when we just met?” 

Stu leaned in a little closer, as my co-workers within ear shot stopped what they were doing to see if I was going to make this a teachable moment or if I forgot to pack my patience that morning. “Your shirt. I can see you are a fan of our loser baseball team. That makes you a loser too.” 

I couldn’t help but smile at this gentleman’s attempt to be charming. 

Testing our communication boundaries I said, “Well, are you one of those diehards that have been dedicated to our football team since the beginning of time? Because if you are, that makes you an even bigger loser than me.” 

With a shared chuckle, and the staff returning to their tasks disappointed that I didn’t snap, we both agreed that our teams were the worst and moved on to matters at hand.

Exploring Cannabis as an Alternative

Stu’s bride, as he lovingly referred to her, was stuck in the nightmare that is dementia. Even though she was becoming more and more violent every day, the family released her from the hospital whose method of treatment was to strap her to a bed and feed her the highest concentrations of sedatives known to man. 

With tears in his eyes, he was bordering on begging for something, anything to help her. Her pain levels weren’t the issue, in fact she didn’t take any painkillers at all, but solid sleep was. The less his wife rested the more likely she was to beat and batter the family in the home. 

Gently, I asked Stu if she had a sweet tooth, as this would help me to know if tinctures (which sounded like it would be a nightmare to administer) or sugary edibles would be better. “Sometimes I think that she loves chocolate more than she loves me”, said Stu having regained his composure. 

Not really trusting that any intake recommendations would make it back to the family unchanged, I wrote down the instructions for him to take home. With a “see ya loser”, Stu left the shop with a spring in his shuffle.

Not three hours later Stu had returned with his daughter and son-in-law, who were pretty combative about my recommendations and Stu’s purchases. It wouldn’t be the first time I had been blamed for “taking advantage” of an elderly patient for pushing them into buying the wrong thing. It’s almost always by family members who wanted pop-pop or gam-gam to bring home super high milligram stuff for them.

They explained the family’s situation again and were adamant that the milligrams I advised Stu to start with weren’t even close to what they wanted for her. “She needs to be drugged. She needs to be sedated at all times”, urged Stu’s daughter who was bruised from yesterday’s battle with her mom. 

And there it was.  I was automatically protective of both Stu, his bride, and my recommendation. 

Are these people actually asking me to recommend something that will render this poor woman immobile? Oh hell no. “Cannabis is about quality of life. It is not meant to induce zombie-like reactions. I mean, isn't that the whole reason you discharged her from the hospital?” I clapped back. 

After a very heavy and long pause, Stu’s daughter Lynne, revealed herself to be a nurse. A nurse that had seen traditional medicine fail her family, and much like her father hours earlier, was just about begging for an alternative solution. 

It instantly fit that the woman in front of me would be in a position of taking care of others. It also made me feel a bit better knowing that her mother was discharged from the hospital and released into her care. Lynne had a very old soul. She was one of those formidable females that demanded respect and attention just for being in the room.  There was zero doubt that this woman was the matriarch of her family. I betcha she got it from her mama.

And now it was my turn to beg.

I pleaded with them to try the initial purchase, and with Lynne being a nurse and ever mindful of drug interactions, she could adjust different ratios and milligram amounts. I expressed my hope that they would land on the right combination of cannabinoids to calm her mother, but not knock her out. 

Moments of Clarity and Relapses

About a week later Stu returned with his now endearing greeting of “hi loser” and his freshly scratched and days-old bruise covered daughter. Lynne reported that they tried a few different combinations without any change in the violent attacks and therefore gave her half of the chocolate bar in one sitting.

I froze. 

“You’re kidding?” came out of my mouth before I could stop it. It didn’t help that I still had it stuck in the back of my mind that these folks just wanted her completely comatose. But before I could scold her for being so reckless, she said with a shrug of her shoulder “it didn’t faze her.”

 Unable to find another statement, I said again, “You’ve got to be kidding me.” Both Stu and Lynne confirmed that while she didn’t move around the house as much during the intoxication period, her verbal abuse continued and they still couldn’t get close, as Lynne’s scratches attested to. But they both agreed that it was better than before and wanted to continue using cannabis as treatment. 

The Surprising Tolerance Levels in Dementia Patients

I immediately became uncomfortable with the conversation, as I knew what the next question was going to be. “Do you have anything stronger?” asked Stu with that hope in his eyes again.

I generally don’t recommend RSO to those without cancer or very specific directions from their doctor, but outside of offering that the woman eat several candy bars a day, RSO was the strongest product in the place.

I explained why the whole plant concentrate may work better (and differently) than the distillate infused candy and repeated the dosage and a stern warning to be overly cautious when it came to the amber colored syringe. I also offered the advice of only buying one, because all of this trial and error can get expensive. They both agreed and left with one RSO syringe and another chocolate bar as a “treat” for her.

Another couple of weeks had passed before I saw the father and daughter duo in the lobby again. My first thought was that the RSO was just way too much for her and tried to stuff away my “I told you so” speech. But it happened that I returned to my simply shocked “are you kidding me” response when they told me that they made a “sandwich” out of the RSO and candy bar. “Kinda like a smore. She always loved smores.” Stu said with a touch of nostalgia in his voice. 

At this point I am trying to do both the math on how many milligrams she took and find any words at all for the situation.

Now I’ve seen ridiculous tolerances for cannabis in those that consistently over-partake and in those that take high doses of painkillers for decades, but this lady took the cake. 

I was rendered speechless.

Finding the Perfect Serving

They started out by giving her a couple of pieces of chocolate periodically during the day as a reward for good behavior or a bribe for better behavior. They then took what was left of the chocolate and literally squished a quarter gram of RSO between the pieces right before bed. 

According to Amy, for the first couple of days it was touch and go. Sometimes the candy worked in curbing her violent attacks and sometimes she wanted nothing to do with her “treats” and would just rage on. True to her calling, Lynne had been keeping a journal of all of her mom’s vitals with the different dosages, ratios, and products up to this point.

Stu jumped in on the storytelling by saying that once it became routine, she began lashing out less. Her mean-spirited outbursts were shorter and at times almost mumbled like she really didn’t want to say them in the first place. 

Still floored by the amount of cannabis this woman can take in a sitting, I returned to consultant mode by remembering that there actually was a smores-like chocolate bar and offered to substitute it for the original one. 

For my efforts I got a warm “thank you for paying attention” smile from Lynne and a wink and a “thanks loser” from Stu.

Loss and Legacy

We stayed in contact and sometimes I would even visit Stu at the curb when his wife made the trip with them. Every so often she would have a morning or an afternoon where she was manageable in public or mentally present enough to enjoy a Sunday car ride like the old days when their love was new. 

I also got a few more minutes to talk smack with Stu about our cursed sports teams. One such visit even included my promise to attend a ball game with Stu if one of our teams managed to make the playoffs. Since both of our teams were traditionally terrible, I figured it was a safe bet to make an old guy happy. 

Then one day it was only Lynne in the lobby. She wasn’t there for smores or RSO. She was there to tell me that her mother had passed, and that her father had followed his bride a very short time after. 

She gave me the kind of hug that would break your heart if you held on too long. 

She thanked me for helping her family and allowing Stu to be the only person that could get away with calling me a loser. With both of us laughing and crying, I made another promise, but this one to his daughter, that I would go to his funeral as requested. 

I had been working with medical marijuana patients for over ten years and Stu’s funeral still has been the only one I have attended. But, if having me at the funeral aided them in any way, I would be honored to help the family one last time. 

To date, neither of our teams have made the playoffs since my promise to Stu. But when that day comes, I know it will be because Stu is pulling some strings upstairs for all us losers.