Patient Profile: Al Graham

[This article was originally published in Cannabis Health Journal in April 2006]

HBK11RenderOntario resident Al Graham isn’t the stereotypical image one envisions when hearing the phrase “medical marijuana user.” Neither a pothead nor a rebel, this Crohn’s sufferer is more likely to be found at a 4 x 4 tough truck competition than a hempfest. But like millions of others, Graham knows one thing that permeates all cultures: His pain and suffering are diminished through the use of medical cannabis.

Graham, a 44-year-old father of three, began experiencing the symptoms of Crohn’s disease in December 2002. Since that time, his daily routine has been turned upside down. Fear, painful and sometimes humiliating symptoms, and a barrage of intimidating treatments have disrupted his life for the past three years.

The Onset

Crohn’s disease is a disorder afflicting nearly a million people in North America. It features chronic inflammation of one or more sections of the gastrointestinal tract, typically the intestines. Although it’s cause is unknown, one theory stipulates that Crohn’s is caused by abnormalities in the immune system’s response to the contents of the bowels. Symptoms include abdominal pain, diarrhea, and bleeding. Complications encompass bowel obstructions and perforations, cancer of the bowel, and inflammation of the joints, spine, eyes, and liver.

During the six-month period between the onset of Crohn’s symptoms and his official diagnosis in the summer of 2003, Graham’s life changed significantly. He suffered such significant and rapid weight loss that his illness was virtually impossible to hide. “I thought, oh, great, I’m losing weight. And then, all of a sudden, it got real bad,” he said during an interview at an Ontario smoking café, explaining how he lost 60 pounds in only six months.

A busy Type A prior to his diagnosis, Graham has experienced difficulty with the fact that Crohn’s has forced him to slow his daily pace. Hospital stays characterized by sheets full of blood while his lavatory became a jar beside his bed have served as a shocking and pronounced reminder that his life may never be “normal” again.

Al_Graham

It would have been understandable if Graham’s medical use of cannabis was limited to simply getting high to dull his pain and forget his worries. Instead, he told me he felt an obligation to get educated. “As soon as I got sick, I went looking for information,” he said. “I wanted to find out how [cannabis] was going to benefit me and look for strains that would help—instead of just relying on any ol’ bag of weed.”

Strain efficacy is a topic close to Graham’s heart. When queried, he mentioned Williams Wonder and Juicy Fruit as especially helpful. “Juice Fruit makes me hungry and gives me the munchies,” he said. Not a trivial thing for a patient who lost 10 pounds per month for half a year and is fighting to maintain a healthy weight.

Graham’s favorite forms of cannabis are edibles and vapor. “Edibles have reduced my trips to the bathroom. They slow the process,” he said. He explained that he prefers smoking for help with sleep, stress, appetite, and pain. Edibles, however, provide him with more of a gastrointestinal benefit than smoking, striking at the heart of his ailment.

The Education

While his doctors were able to educate him regarding Crohn’s disease, it was Graham who had to educate some of his doctors about how cannabis could help not only his symptoms, but also the negative side effects of his pharmaceutical treatments. He said his research wasn’t just to educate himself, but also to educate those around him. “It’s not just me and my wife, but I have to educate all of my close family,” he said.

Not an easy task for a man whose 16-year-old daughter completed the D.A.R.E. program in her public school. After admitting his use of medical cannabis to her, she cried and told him it would lead to harder drugs and harm his health—sincerely believing that it could even kill him. While Graham has countered much of her taxpayer-supported brainwashing with the facts, his own daughter still asks him not to medicate in her presence.

His wife—always supportive of his choice to use cannabis to treat his disease—was at first skeptical of its efficacy. “Then the doctor came out and didn’t have any question [regarding its efficacy],” said Graham, adding, “She was quite surprised.”

This humble Canadian has been a trailblazer in the career of his family physician, who had never before filled a prescription for marijuana. “So I brought the paperwork to his office. We talked about the facts,” he said. When his doctor raised concerns that cannabis might act as a gateway to hard drugs, Graham reacted calmly but sternly. “I said, hey, I’m 44, I have three kids. Have I ever missed a doctor’s appointment?” His physician had to admit that Graham, since his diagnosis, had been fully cooperative, accepting all recommended treatments for his condition.

“When they wanted to stick a needle in my rib cage and take a piece of my liver out, I did it,” he said. “When they wanted to stick a six foot hose…heh, yeah,” he said, stopping himself and bearing a painful smile. A smile earned through years of enduring treatments that, while helping to sustain his life, have threatened to dehumanize him, stripping away his hope of regaining normalcy within his life. Graham, however, remains optimistic.

The Treatment

If the direct symptoms of Crohn’s aren’t enough to frighten you, consider the side effects of some of the pharmaceutical medications commonly prescribed. In strong enough doses, they are all seemingly designed to kill either the disease or the patient in a modern wild western medicine metaphor of “this body ain’t big enough for the two of us.”

Graham’s lifestyle hasn’t been altered merely by the necessity of taking dozens of pills every day to treat his Crohn’s symptoms. “You’re always getting stabbed or they’re sucking twelve tubes of blood out of you,” he said, only half joking.

His family has had to learn to shop for groceries differently, carefully reading labels. “It’s no fun looking at food and wondering what it’s going to do to me,” he said. “Can I eat it? Am I going to be in deep pain? Fears of what you can and cannot eat get to you. Marijuana helped me want to eat,” he said gratefully.

pill container

At one point, Graham was consuming 33 pills each day. He described how pharmaceuticals affected his life. “You go into the drug store and you’re looking for a container so you can organize your pills, one that has separate containers for Monday through Sunday,” he said. “But the whole container doesn’t have enough room to hold one day worth of pills,” he exclaimed.

One nasty drug commonly given to Crohn’s patients is Prednisone. During our interview, Graham elaborated on the negative side effects of this anti-inflammatory steroid commonly administered for a wide variety of ailments. Among its more pleasant side effects are bloating, nervousness, and increased joint pain.

Several other strong pharmaceuticals, each with its own set of sometimes significant side effects, entered the picture. “My doctor put me on Methotrexate,” he said. “It’s used for treating chemo patients with cancer.” Also known as Biotrexate and Neotrexate, among Methotrexate’s listed potential side effects are nausea, vomiting, diarrhea, and–death. While more gastrointestinal and stomach problems isn’t exactly what a Crohn’s patient needs, death isn’t on anybody’s gift list.

It’s easy to say, with distant objectivity, that Graham’s symptoms and negative side effects are “bad things.” But consider injecting yourself once a week in the stomach with a drug that warns, in large capital letters, METHOTREXATE IS A POTENT AND POTENTIALLY FATAL DRUG. “It’s not the kind of thing you wanna read, eh?” he said, sporting a nervous laugh.

Methotexate also often causes decreased bone marrow activity, further complicating the fact that Prednisone carries the potential side effect of diminished bone density. “I was on Prednisone so long and so many different times that both of my doctors told me they were going to send me for bone density tests,” he said.

Graham detailed his Methotrexate routine. “It’s an injection that I have to take once a week, in my stomach,” he continued. He explained how he had never before given himself an injection. Thus, he went to his family doctor and requested that the nurse perform his first injection to show him the ropes.

Smacking of legal policies that serve mostly to alienate and dehumanize patients, Graham described how the nurse donned a mask, gown, gloves, and protective glasses in preparation for the injection. “I asked her what she was doing and she said she had to in order to give me the drug. I asked, ‘If you’re afraid of getting a bit of this medicine on your hands, what do you want me to do?’” he said incredulously. “Allow this to be put into my bloodstream?”

A full account of Graham’s treatments can be both intimidating and depressing. In addition to the daily pill regimen and weekly Methotrexate injections, he must undergo infusions of a drug called Remicade every six weeks. A solution targeted at Crohn’s patients with moderate to severe symptoms who have “tried other therapies without success,” Remicade’s goal is to reduce flare-ups, inducing and maintaining remission.

When asked if he gets high before such unpleasant treatments to better cope, Graham said no. “I wait ‘til after. I just prefer to do that,” he said. “Afterward, when we get out of town with my wife driving, down comes the window.”

The Side Effects

Graham says he often suffers from the negative side effects of his pharmaceutical drugs. “I feel like an old man, like an 80-year-old with a cane. My joints, my muscles…and it’s from the medications,” he said.

prescription-drug-abuse1

Graham is quick to point out that cannabis helps not only the symptoms of his Crohn’s disease, but also the side effects of the pharmaceutical drugs he must take. “I’m currently on two of the hardest drugs my doctor can prescribe to me,” he said, referring to Mexothrexate and Remicade. “There’s no other drug that he can give me.”

Remicade carries possible side effects of blood and nervous system disorders. Both it and Methotexate are last resorts on the doctor’s list of escalated treatment therapies. And both sometimes seem as bad or worse than the disease they treat, giving patients like Graham twice as much to worry about.

Graham isn’t without a sense of humour regarding the negative side effects of his pharmaceutical treatments. “At one point I was on so many different medications that I made a long list of all the potential side effects,” he said. “I just took the data from the information packets and listed it on the computer. I had about seven eighths of those side effects,” he said. “It was just brutal.”

After describing the irony of the pharmaceutical drugs that keep him alive while simultaneously torturing him, Graham smiled while talking about the efficacy provided by cannabis. “It has allowed me to keep my sanity,” he said. “Being sick and taking pharmaceutical drugs often leads to bouts of depression,” he said soberly, describing tearful sleepless nights and paralyzed body parts. Sadly, he was describing pharmaceutical drug side effects, not symptoms of Crohn’s. “Marijuana helps put a smile on my face and lifts my spirits while I wait to have some tube or needle stuck in places that people just don’t talk about,” he said.

Graham was brave enough to be starkly honest about the personal impact of the side effects of his treatments. “I’m going through periods that I find myself having a shortness of breath, dizzy spells, and numbness in my hands and face,” he told me. “It gets me to a point that it makes me cry. I just hurt all over,” he confessed. “Cannabis helps me deal with what I’m going through, without all the severe side effects.”

The Finances

When a disease like Crohn’s strikes, it affects more than just the patient. After 21 years of employment and working his way from entry level yard assistant to plant supervisor, Graham was forced to leave his job with a local hydro power company. “They knew I was sick,” he said. “It was obvious.”

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Currently on long-term disability, Graham says he is actually fortunate. “I was lucky. I had a benefits package that included long-term disability. They give you [a percentage] of your wage,” he said. He and his family, however, are now deprived of the bonus money he used to earn on his job, costing them $10,000 a year. “All of the sudden you’re down to making next to nothing on your unemployment and it doesn’t even cover a mortgage and a loan payment,” he said.

Graham’s bi-monthly Remicade infusion carries a cost of $3,500. While he receives financial assistance for this expense from the Trillium Foundation, a provincial patient assistance organization serving Ontario, this still has a significant impact on his finances.

“I had an infusion about three months ago. That’s $3,500 that goes out the door to the pharmacy. I haven’t received the cheque yet,” he said. Until he actually receives a reimbursement payment, he can’t repay the pharmacy. “So I’m paying interest on that credit, plus I have to pay my deductible,” he lamented. “By the time I’m done, it costs me about $500,” he said. That’s five hundred dollars, every six weeks, that the Graham household cannot recoup—in addition to lost income, other significant health-related financial burdens, and the $10,000 in lost bonuses from the job he can no longer hold.

The Glass Half Full

Fortunately, Graham has noted some benefit from his current situation. When asked if his disease and the resulting hardships have strained his relationships with his wife and children, he  told me, “It’s actually brought us closer together.”

Possibly most remarkable is the fact that, despite his pain and suffering, Al Graham isn’t a bitter man. In fact, he’s frequently expressing his thanks to those who have helped him in one way or another since his condition began. “Every time I needed something done, my doctors, my wife and family, and my friends were always right there to do it,” he said sincerely.

His reliance on cannabis, preferably in the form of vapor or edibles, has decreased his capsule consumption from 33 to four pills a day. Sympathetic doctors, new coping skills, the responsible use of cannabis, and a supportive, caring family are slowly giving Al Graham his life back.

While he breaks many of the traditional stereotypes, Graham’s story is nearly identical to that of any patient who takes refuge in medical cannabis. Regardless of their other commonalities—or lack thereof—these are people who use cannabis to alleviate the symptoms of a deadly disease for which a treatment better than mother nature’s seemingly can’t be conjured. Not even by a species that has walked on the moon and developed weapons of mass destruction.


HBK11RenderGooey Rabinski is a counterculture writer who has contributed dozens of feature articles to magazines such as High Times, Skunk, Heads, Weed World, Cannabis Health Journal, Green Thumb, and Treating Yourself. He is the author of Understanding Medical Marijuana (2015 Edition), available on Amazon Kindle.

His marijuana-related freelance photos, spanning back more than a decade, are available on Instagram and Flickr. He tweets from @GooeyRabinski.

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