Wherein I Tumble Into the Weeds Yet Again…

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Well, I didn’t really think I’d be returning to this topic—certainly not so soon—but I’ve learned some things since the first post appeared that I feel are worth sharing.

As I noted previously, despite my ambivalence concerning legalization, I’ve been assuming that it will eventually happen. I still do. A number of you have pointed out the analogy to Prohibition, and we all know how that effort to oppose the public will turned out.

But a New York Times report on the collapse of an effort to legalize marijuana in New Jersey, which was a campaign promise made by the state’s governor, Phil Murphy, and had both his strong backing and statewide public support, points to some opposing arguments that legislators made. (I promise if you stay with me through this, you’ll see that I conclude my findings on a high note. Oops, there I go again with the bad puns.)

From the Times:

“Some lawmakers were unsure about how to tax marijuana sales. Others feared legalization would flood the state’s congested streets and highways with impaired drivers. Some would not be deterred from believing that marijuana was a dangerous menace to public health.”

The Times pointed out that New Jersey lawmakers, and those in the neighboring states of New York and Connecticut, have tried to avoid problems that have occurred in states that have already legalized cannabis. 

Colorado, for example, according to a state-sponsored study published in the March 26, 2019, issue of Annals of Internal Medicine, has seen three times as many cases of people presenting to the emergency room for visits attributable to pot since legalization in 2012. 

The greater number of visits was attributed to edibles—“tales of tourists needing emergency care after gobbling too many marijuana gummies”—leading to vomiting, racing hearts, and psychotic episodes. But the worst problems at a Denver hospital were caused by inhaled marijuana. The study was also prompted by three deaths in Colorado related to edible marijuana products. 

An Associated Press report in the Times observed:

“The analysis confirmed edibles are trouble. Statewide, they made up less than 1 percent of total cannabis sales, measured by THC content [the ingredient that creates the “high”]. Yet 11 percent of ER visits were triggered by edibles.”

There’s no information on safe dosing of these edibles, according to Andre Monte, MD, lead author of the Annals study. An accompanying editorial by Dr. Nora Volkow, the director of the National Institute on Drug Abuse, stressed the need for additional research about marijuana’s benefits and harms and called increased oversight of marijuana manufacturing and labeling an “urgent need.”

Some of the legislative concerns have been financial: in California and Massachusetts, tax revenues from marijuana sales have been disappointing.  My biggest worry, about how to protect teenagers from the drug, has also evoked serious discussions.

I’m going to digress slightly here because a dear friend who’s a long-time mental health professional observed after reading my first post that discussing marijuana is not sufficient without also talking about vaping, which she knows from experiences among acquaintances has led to psychotic breaks in some adolescents. 

If you know any young people who are tempted by or are engaged in this activity, this fact sheet for teens contains information about the dangers of vaping both e-cigarettes and marijuana. Many brands particularly target youth, prompting one report to ask:

“How can a tween, teen, or 20-something looking for inclusion, status, or the next cool thing resist? Given that vaping among high school students in grades 9-12 increased approximately 1286% between 2011 and 2018, it appears they are willing to give vaping a try.”

Some people have suggested to me that if pot were legal, teenagers might be less likely to find it attractive. A 1286% increase in 7 years? If that statistic is even half right, it offers little support for the “if it’s no longer illegal, it loses its allure” argument.

Another important issue in states that have legalized marijuana, notes the Times article,  involves “a burgeoning industry dominated by white corporate interests even as advocates in Hispanic and black communities say their neighborhoods have been most negatively affected by the drug.”

As I noted in my previous post, I am deeply concerned that the social aspect of marijuana legalization be addressed. While I touched on that issue, it clearly needs more exploration. (I mentioned that the records for marijuana arrests in areas where it’s legal continue to show racial disparities, and there’s agreement that better police training is needed.)  If legalization is to take place, it had better be done in a way that rights the wrongs that have been inflicted by the criminal justice system for years.

In this regard, the bill that was voted on in the New Jersey legislature last week was exceptionally strong. According to the ACLU:

“The bill before the Legislature is truly historic. It includes forward-thinking measures to reverse the injustices wrought by the failed drug war.”

  • expedited expungements for cannabis-related criminal records;
  • ability for people to vacate current sentences;
  • non-discrimination for cannabis use;
  • opportunities in the industry for people with criminal records;
  • social justice representatives on the cannabis regulatory board;
  • meaningful provisions for diversity in the industry.

No other state has leaned into the social justice elements of marijuana legalization the way New Jersey is poised to.”

Let’s hope that any future legalization legislation is equally forward-looking and just.

So the concerns I expressed in that first post—about the need for sensible regulation, careful monitoring, greater awareness of potency, focus on teenagers, and emphasis on criminal justice reform—remain intact, even heightened somewhat by the Colorado study. I guess this is a societal experiment in which we’ll bumble along and, I hope, with good sense and good luck, get better at doing things right with time.

Here’s where I end this unplanned revisit on a high note:

A friend alerted me to an article in Scientific American with the optimistic title: “Marijuana May Boost, Rather Than Dull, the Elderly Brain.” (The original study appeared in Nature Medicine; here’s the abstract.)

Before anyone gets too excited, the senior citizens in question were of the genus Mus—specifically, mice. According to Scientific American, 

“…the drug might affect older users very differently than young ones—at least in mice. Instead of impairing learning and memory, as it does in young people, the drug appears to reverse age-related declines in the cognitive performance of elderly mice.”

Scientists not involved in the study who found it intriguing cautioned, of course, that additional research is needed before assuming the findings would be relevant to aging humans. But those who did the study noticed that in the treated elderly mice, the neurons in the hippocampus (the part of the brain essential for memory and learning) had developed more of what’s called synaptic spines, by which neurons communicate with each other. 

The Scientific American author pointed out that the researchers were even more struck by the dramatic difference in the hippocampus of the THC-treated mice as compared with the elderly, untreated mice. Andreas Zimmer from University of Bonn, Germany, the lead researcher, stated:

 ‘That is something we absolutely did not expect: the old animals [that received] THC looked most similar to the young untreated control mice.” 

The hypothesis is that the THC and possibly other components in cannabinoids act similarly to the brain’s naturally occurring endocannabinoids, which are directly associated with the brain’s neural activity and appear to decline with age. Thus, externally introduced cannabinoids could, theoretically, reverse that process. 

One clinical researcher who wasn’t associated with the study, Mark Ware at McGill University, observed:

“To anyone who studies the endocannabinoid system, the findings are not necessarily surprising, because the system has homeostatic properties everywhere we look.” In other words, it adjusts to changes in order to maintain internal stability.

That can explain the variations we see, points out the Scientific American author. 

“For example, a little marijuana may alleviate anxiety, but too much can bring on paranoid delusions. Likewise, cannabis can spark an appetite in cancer patients but in other people may produce nausea. Thus, the detrimental effects seen in young brains, in which cannabinoids are already plentiful, may turn out to be beneficial in older brains that have a dearth of them.”

Of course, this is just one study, but it’s quite fascinating, isn’t it? While I’m still worrying about teenage abuse of the substance, and irresponsible drivers, and lack of information about potency that’s sending people to the ER for glomming down too many gummies (I wonder how many gummies it took…), I find myself eagerly awaiting further research on the effects of cannabis on the aging brain.

I received several new clearly weed-related followers after my first post on this topic, and I wondered why they found me a kindred spirit when I was so filled with skepticism and concerns.  Then a friend reminded me of my reverie about cherry tomatoes after my one-and-only experience with pot decades ago.

Another friend had commented that he had been pro-legalization, but my first post made him rethink his position. But I told him about this study. After hearing about it, I now have images of happy elderly folk in all sorts of places, reveling in their carefully regulated dosages of brownies, gummy bears, and the like—followed by a chaser of cherry tomatoes unlike any they’ve ever experienced before.

And in my fantasy view of memory nirvana, all who so engage will be able to promptly retrieve the first and last names of everyone they’ve ever met; the actors, titles, and stories of all those wonderful movies; the plays, players, and scores of sports events they viewed with pleasure decades ago; and…well, you get the picture.

…And Mr. Google will simply have to find another line of work.

As always, I welcome your thoughts, opinions, and stories in the comment box below—as well as your feedback in the form of stars (from the one on the left for “awful” to the one on the right for “excellent”) and the “likes” from WordPress folks.  Thanks so much.

Annie

Then, a 20% Chance; Now…

“The purpose of life is to live it, to taste experience to the utmost, to reach out eagerly and without fear for newer and richer experience.”

   ——–Eleanor Roosevelt

A mini-celebratory brunch is in order: the doctor reported both heart and aorta are sound.

“We’ll take you out,” we say.

“You’ll come here,” she insists. “The best bagels, fresh eggs, delicious fruit, plus quiet and lots of room.”

We relent.

Four years ago, the collapse—after a symphony hall concert.

She attended concerts often—multiple subscriptions, with friends and alone. And the art galleries, the library lectures, the thrice-weekly swims, the scheduled trip to Macchu Picchu…

That evening, she was alone. 

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Ambulance rides to three separate hospitals. Number one: ill-prepared for such an emergency. Number two: heart attack—quick; give her blood thinner. But then the correct diagnosis: a ruptured aorta, meaning the blood thinner was a clearly awful decision. “Won’t operate,” said the head doc. “Too old; too risky.”

But three’s the charm. “Bring her here,” said the vibrant young female surgeon, expert in repairing damaged hearts and valves, at a larger affiliated hospital.

Afternoon next day: We—in-laws and daughters—met with the surgeon, a tall, slender, soft-spoken woman whose brown eyes were at once warm and riveting. She minced no words.

“Without surgery, she will soon die.

“With it, a 50% chance she’ll die during surgery or within the next three days.

“A 30% chance she’ll survive the surgery but then suffer a stroke or other event that would seriously impair her functioning and quality of life.

“There’s a 20% chance she’ll walk out of the hospital and resume her life.”

What would you do?

“What do you think?” we asked the surgeon, who also happened to be kind and empathetic.

“She’s come through all this time, and two moves by ambulance, and her color’s still good,” the surgeon said. “She’s been leading an active life until now—I think it’s worth a try.”

When asked about the prior surgeon’s reluctance to operate, she said: “The patient is 81, with a ruptured aorta—clearly in extremis. It was not surprising he [the surgeon] wanted to head for the hills. But the family members come in and say she swims 3 times a week, is very independent, very functional. That sways away from ‘let the poor old lady go…’”

Shortly after 9 pm, nearly a full day after the collapse, the surgeon came to see us, her lovely face looking tired but illuminated. “It went very well,” she said. “We repaired the aorta, the aortic valve, and the mitral valve.”  The patient, she said, “is a picture: most people after surgery are pale and puffy. She looks like herself.”

Later, she acknowledged: “I had major doubts, but one of the great benefits of a large hospital system like this was that I spoke with my chairman and another specialist in aneurism repair. I said, ‘I know what you’re going to say, but…’ Both felt it was reasonable to operate.”

Three days after surgery, when the patient was speaking and demonstrating an understanding of commands, the surgeon pronounced her, in highly technical terms, “a miracle.”

When we first saw her, she greeted us with a big smile. But when the nurse told her she was about to swab her mouth and make her more comfortable, the former school principal uncharacteristically replied: “Bull s—t!” The surgeon expressed delight: “Profanity and criticizing breakfast are two excellent prognostications,” she said wryly.

“This was a Type A dissection,” she explained to me. “The pipe has burst. You sew in a piece of material, being careful not to leave gaps and not to miss a stitch. It’s like sewing a sleeve into a jacket. It’s not difficult, but you have to be meticulous. If you miss one stitch, you spend a lot of time regretting.”

As the patient prepared to leave for a rehab center at the end of her hospital stay, the surgeon said she expected her to resume her life and live for a number of years more. The surgeon has already been proven right. 

That brings us to today’s brunch, served on china—no paper plates. images-17A nicely arranged platter of cut-up fruit sprinkled with almonds forms an edible centerpiece. After brunch, I have to fight her to let me do the dishes.

She tells us about the concert she’d been to the night before, and the gallery visit the day before that. Her eyes are bright, her face unlined and attractive without a touch of makeup. Her mind totally sharp—despite a stroke some months after her surgery, which minimally damaged her vision in one eye.

She explains—without complaint—that she needs to rest a lot more than she once did. And she’s more concerned about walking about the city in the winter, fearing a fall that might hurt her fragile back (she’s had several fractured vertebrae). “I feel somewhat isolated,” she says.

She can’t keep up with the group of women nearby who meet daily to pursue one cultural event after another. One, in her 90s, lives on the 13th floor of her building, and walks up and down the stairs twice a day in addition to her other activities. I am exhausted just hearing about her.

She talks about my blog, describing the posts she most enjoys. She asks me how I feel about it. “I love it,” I tell her. “It’s so freeing to be able to write about anything I choose, and I enjoy the dialogue with my readers. It’s a source of great satisfaction for me.”

“That’s the way I feel about this,” she says. And she points out her new response to that sense of isolation. Once an art teacher, she has painted and sculpted—both before moving to special ed, then becoming the principal of two schools for autistic children—and since retiring. But those art forms require space and effort expended to clean up. Now, in her 86th year, she has found the ideal medium for her present circumstances: paper collages. 

She points to her “studio”: a corner of her dining area holding scissors, Elmer’s glue, pieces of cardboard and styrofoam for backing.

Suddenly, we see the works, positioned throughout her apartment. Each one is a visual delight—demonstrating a keen esthetic sense and a creative mind channeling itself in a wholly new direction. 

A large one features Eleanor Roosevelt, the Statue of Liberty—its torch the highest point on the collage—and other images and references to that era: Social Security, the UN, the WPA.

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Another—also large—is a replica of her favorite concert hall, pieced together from performance programs and advertisements. One depicting penguins and divers in the ocean is a work in progress. And on and on.

Her sources of inspiration? She combs through discarded magazines and the detritus of junk mail, finding things that strike her just the right way. That sea bird that hovers over one work? “He just caught my eye and spoke to me,” she says.

And so she meticulously pieces together from multiple sources all kinds of stuff, building new and larger stories than the ones she’s extracted—at the same time enlarging her world and, as we look at these works from all angles—ours as well.

I am in awe of this remarkable woman, who spends almost no time complaining and a great deal of time creating. How many of us will move beyond our limitations and find new ways to reach within ourselves for personal satisfaction and growth—regardless of our ages?

As I think about the doctor who refused to operate on her four years ago because she was “too old” and it was “too risky,” I find myself pondering those nearly impossible decisions about how much to do when an older person is “in extremis.” 

A 20% chance didn’t seem like much, but we in the family are forever grateful to the wise surgeon who felt it was worth the risk, guided us accordingly, and then used her brilliant skills to make that decision the best one.

 

As always, I welcome your thoughts, experiences, stories, and in this case, philosophy about how to confront these difficult decisions.

Annie

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