Mental Health Cannabis for dystonia

In the process of walkin to try and get outta bed someone next me woken up..
What's dystonia? Serious I don't know what it means
 
A neurological movment disorder, like a circle of muscle spasm in your body, which hurts. I'm currently on diazepam and lergigan for it.
 
Going very lightly through the literature, it looks like cannabidiol helps some people. It looks like certain synthetic cannabinoids(spice, etc) may exacerbate or induce extrapyramidal symptoms of dystonia in people who do not usually suffer it, but this is not well documented and is somewhat speculative. So...who knows?
 
Cannabis may have medicinal uses in a variety of diseases. The neural mechanisms underlying dystonia involve abnormalities within the basal ganglia—in particular, overactivity of the lateral globus pallidus (GPl). Cannabinoid receptors are located presynaptically on GABA terminals within the GPi, where their activation reduces GABA reuptake. Cannabinoid receptor stimulation may thus reduce overactivity of the GPl and thereby reduce dystonia. A double-blind, randomised, placebo-controlled, crossover study using the synthetic cannabinoid receptor agonist nabilone in patients with generalised and segmental primary dystonia showed no significant reduction in dystonia following treatment with nabilone.
DOI: 10.1002

This is out of a review from April 2014 and it cites the only randomised, double-blind, placebo-controlled trial that has been performed on a cannabinoid's efficacy in the treatment of dystonia. They concluded that their results presented insufficient data to either refute or confirm the efficacy of dronabinol. Apparently a few sources are claiming cannabinoids would help, but this study from 2002 is the only randomised, double-blind, placebo-controlled one.

If you are desperate or down with pot anyway you could try it. If you are very afraid it might make it worse, best stay away. Ideally, I'd see what your neurologist has to say about this.
I can give you both those studies as pdf, but I doubt you'd gain much insight there. Also, keep in mind the only such study has been performed with dronabinol with doesn't have that much in common with some fine bud as you will be well aware of.

Now there have apparently been some other studies, but they don't fulfill the criteria to be of any scientific value, since they were not randomized, double-blind and placebo controlled. It has definitely been indicated that cannabis would help, but there is currently no proof.
Your best bet would be meeting other patients suffering of dystonia who have tried this or directly asking your doctor who might have talked about this to other patients. Sometimes a few anecdotes could be enough to convince you and legitimately so imho. The problem with listening to those who use cannabis as medication is that they might well only use these claims as justification for their (ab)use of said substance which ofc doesn't mean it's helping them treat whatever it is they have, but you still get a shitload of false positives, so treat whatever you hear with a grain of salt. The brain can be amazingly self deceiving when it comes to substance abuse.

Out of curiosity: Have you tried it and what were your results?
 
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Going very lightly through the literature, it looks like cannabidiol helps some people. It looks like certain synthetic cannabinoids(spice, etc) may exacerbate or induce extrapyramidal symptoms of dystonia in people who do not usually suffer it, but this is not well documented and is somewhat speculative. So...who knows?

Sounds logical to me, I've experienced similar reactions to the synthetic cannabinoids.
 
This is out of a review from April 2014 and it cites the only randomised, double-blind, placebo-controlled trial that has been performed on a cannabinoid's efficacy in the treatment of dystonia. They concluded that their results presented insufficient data to either refute or confirm the efficacy of dronabinol. Apparently a few sources are claiming cannabinoids would help, but this study from 2002 is the only randomised, double-blind, placebo-controlled one.

If you are desperate or down with pot anyway you could try it. If you are very afraid it might make it worse, best stay away. Ideally, I'd see what your neurologist has to say about this.
I can give you both those studies as pdf, but I doubt you'd gain much insight there. Also, keep in mind the only such study has been performed with dronabinol with doesn't have that much in common with some fine bud as you will be well aware of.

Now there have apparently been some other studies, but they don't fulfill the criteria to be of any scientific value, since they were not randomized, double-blind and placebo controlled. It has definitely been indicated that cannabis would help, but there is currently no proof.
Your best bet would be meeting other patients suffering of dystonia who have tried this or directly asking your doctor who might have talked about this to other patients. Sometimes a few anecdotes could be enough to convince you and legitimately so imho. The problem with listening to those who use cannabis as medication is that they might well only use these claims as justification for their (ab)use of said substance which ofc doesn't mean it's helping them treat whatever it is they have, but you still get a shitload of false positives, so treat whatever you hear with a grain of salt. The brain can be amazingly self deceiving when it comes to substance abuse.

Out of curiosity: Have you tried it and what were your results?

I've been trying some bad hasch for it once. It took most symptoms away. I will try it again. My conclusion is if diazepam and lergigan helps, weed would do too. Weed have more medical properties.

Dystonia is like your muscle is uncontrollable moving at 10 hz rate. I can comeback and report my result, when I've been trying it again.
 
Well if it helps you, then it would seem reasonable to keep taking it and see if you can lower your diazepam and promethazine doses, especially the former. Talk about all of this to your doctor before first! Afaik, if you left your dystonia untreated (regarding the two classes of medication you are taking) it would not not mean a more severe course of illness, but I am not sure. Again, make sure your doctor is informed and see what he thinks about it.

Once you go down this road, anotehr issue would be getting a large supply of the same strain (sort of standardized). If you want to treat cannabis as a medication, I would advice you to use the smallest amount that will improve your symptoms and preparing your daily dosages long in advance with an accurate scale, but most importantly using a strain that suits you and having a very steady supply of it.

If you keep changing dosages and the ratios between the various active ingredients around, this might introduce other problems. E.g. you could be much more prone to develope a large tolerance; you could experience more severe symptoms upon switching strains while maintaining the same dosage but more undesired side effects at the same time or more undesired sides after being forced to up the dosage with a new strain. There are ways to guarantee a steady dosage of whichever active ingredients cause you relief, but it's not really possible without a steady supply of the same strain.
 
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Well if it helps you, then it would seem reasonable to keep taking it and see if you can lower your diazepam and promethazine doses, especially the former. Talk about all of this to your doctor before first! Afaik, if you left your dystonia untreated (regarding the two classes of medication you are taking) it would not not mean a more severe course of illness, but I am not sure. Again, make sure your doctor is informed and see what he thinks about it.

Once you go down this road, anotehr issue would be getting a large supply of the same strain (sort of standardized). If you want to treat cannabis as a medication, I would advice you to use the smallest amount that will improve your symptoms and preparing your daily dosages long in advance with an accurate scale, but most importantly using a strain that suits you and having a very steady supply of it.

If you keep changing dosages and the ratios between the various active ingredients around, this might introduce other problems. E.g. you could be much more prone to develope a large tolerance; you could experience more severe symptoms upon switching strains while maintaining the same dosage but more undesired side effects at the same time or more undesired sides after being forced to up the dosage with a new strain. There are ways to guarantee a steady dosage of whichever active ingredients cause you relief, but it's not really possible without a steady supply of the same strain.

Good inputs, that's what I was thinking. A heavy indica for it. I've been trying out White Widow long time before I got Dystonia, it's contain 90% indica and 10% sativa. It really knocks you to the floor, like no other strain.
But since time and environment changes, I can't get ahold of the same strain anymore. So I will try out some new, as you said. Not too much sativa since it gets into your head. In my experience.

I've been on Diazepam for a long time, and I noticed when I smoked, I could lower the dosage. Now I'm on a heavy dose on Diazepam. It really lower my self esteem, since I want to stop use it for good.

Getting advice for a doctor is impossible unfortunately. Since it's very restrict laws here about cannabis. And second I don't trust them at all. In a way of looking at it. It was them who gave me Dystonia in the first place. They prescribed Zyprexa for anxiety and sleeping problems. Which that medicine isn't at all used for.

So I have to experiment on my own. But I think a good indica will really help me. Problem is just get a hold of it atm. I can report back early in next week.
 
Good inputs, that's what I was thinking. A heavy indica for it. I've been trying out White Widow long time before I got Dystonia, it's contain 90% indica and 10% sativa. It really knocks you to the floor, like no other strain.
But since time and environment changes, I can't get ahold of the same strain anymore. So I will try out some new, as you said. Not too much sativa since it gets into your head. In my experience.

I've been on Diazepam for a long time, and I noticed when I smoked, I could lower the dosage. Now I'm on a heavy dose on Diazepam. It really lower my self esteem, since I want to stop use it for good.

Getting advice for a doctor is impossible unfortunately. Since it's very restrict laws here about cannabis. And second I don't trust them at all. In a way of looking at it. It was them who gave me Dystonia in the first place. They prescribed Zyprexa for anxiety and sleeping problems. Which that medicine isn't at all used for.

So I have to experiment on my own. But I think a good indica will really help me. Problem is just get a hold of it atm. I can report back early in next week.
I'm all about indica strains myself, but unfortunately I have to take what I can get. The kids over here usually want crazy shit like Amnesia Haze and other mostly sativa strains these days it seems, strains I simply cannot smoke because either they will not knock me out at night or when I dose higher they will cause a rather uncomfortable high and massive depression on the next day. I'm extremely sensitive to this sort of this. Simply Afghan strains used to be my favourites, I even love the way they smell and taste. Nobody will grow these anymore. So I just get like 100g of a strain that is not too far on the sativa side and make it last very long, by avoiding to let the dosage fluctuate because I want to get blasted. I only used like 0.1-0.2g pot per day over the past year lol. I got so sensitive throughout the last 15 years.

I think you have doctors that are worth anything at all, they will not pass judgement for your questions about cannabis. Pot is also completely illegal where I live, yet if the situation called for it I've told every single one of my doctors that I use cannabis or even abuse other drugs. I never got the feeling of being judged. In fact most will value honesty a lot. They are bound to medical confidentiality and I'm very certain that no doctor in your country (whichever that is) has ever contacted authorities about a patient using drugs.

However I guess talking to your doctor would probably not get you too far anyway, since there is no data about cannabis in dystonia.
 
I'm all about indica strains myself, but unfortunately I have to take what I can get. The kids over here usually want crazy shit like Amnesia Haze and other mostly sativa strains these days it seems, strains I simply cannot smoke because either they will not knock me out at night or when I dose higher they will cause a rather uncomfortable high and massive depression on the next day. I'm extremely sensitive to this sort of this. Simply Afghan strains used to be my favourites, I even love the way they smell and taste. Nobody will grow these anymore. So I just get like 100g of a strain that is not too far on the sativa side and make it last very long, by avoiding to let the dosage fluctuate because I want to get blasted. I only used like 0.1-0.2g pot per day over the past year lol. I got so sensitive throughout the last 15 years.

I think you have doctors that are worth anything at all, they will not pass judgement for your questions about cannabis. Pot is also completely illegal where I live, yet if the situation called for it I've told every single one of my doctors that I use cannabis or even abuse other drugs. I never got the feeling of being judged. In fact most will value honesty a lot. They are bound to medical confidentiality and I'm very certain that no doctor in your country (whichever that is) has ever contacted authorities about a patient using drugs.

However I guess talking to your doctor would probably not get you too far anyway, since there is no data about cannabis in dystonia.

So true about the kids smoking sativa kind of situation. Here it's always about that "great brown" hasch. Which I found out not to be so good. Always like a high amount of THC and taste like shit. It's like they want to smack their heads out of the reality.
I'm all about the green, always checking up which strain it is, and are careful and inspectate a lot. I also like like you Afghan. Not that Afghan which this little kids says to all the brown haschish. But the real Black afghan, which you really recognize instantly from the smell.

Sure, maybe it's worth telling the doctors about it. I've an telephone appointment set up next week. A follow up on a medicine I asked for, for my Dystonia - Akinetone. It can cause psychosis though. So I'm better of with the cannabis, since I've tried it. Always seems to be the situation, better of with cannabis. Lol. Would be funny hearing her reaction to it. I always comming from a honest view. That gets you the best treatment.

I got my Exodus Cheese next week. 60% Sativa and 40% Indica, not too bad ratio although, he said it was more like a indica high. "will cradle you gently to sleep as if you were a newborn baby". And if that bad hashich I got 1 month ago, I felt really relaxed in my body, although left my head spinning. So will be interesting what the Cheese strain will bring.

Can't wait. And I have theory about Dystonia, since the Zyprexa messes with your signalsubstances, Dystonia is like you have a high sensibility towards Dopamine. Since I have trouble moving my arms. I look like a mental retard sometimes. Constantly dropping things. Cooking food is fucking a impossible mission sometimes. I've been trying lergigan off and on, and it really has made me calmer.

So I can't wait to see what it will bring to me. I'm very optimistic about a constant cure.
 
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But the real Black afghan, which you really recognize instantly from the smell.
I was referring to pot, strains that are really close to Afghan strains, like Afghan skunk. Most of these which I've seen never really were labelled, but I'd recognize it anytime. Very firm, small buds that are very dark green in color and smell like pine trees.
I like a lot of hash, but not a big fan of black afghan or what's sold as such in the netherlands today. Hash is simply too strong for me, but it's great for the occasional blast and excellent for cooking purposes. Purely recreational for me and even when I last had a bunch I ended up giving it all away because it's simply too strong.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498787/
There are lots of articles on this. Olanzapine is known to cause dystonia.
I'm sorry man, I've suffered some adverse effects from neuroleptics myself and now one of my eyes is fucked. They were necessary for me though. Neuroleptics should only be prescribed when they are needed. Prescribing them off label is fucking crazy when there are alternatives that are indicated and have not even been tried.

For how long were you taking olanzapine (can you give us a timeline, out of interest)? Who prescribed it? A psychiatrist? A general practicioner? Does he actually SEE you? Phone appointments are non existant where I live. What exactly was the diagnosis it was prescribed for (you can ask him again or ask your health insurance), anxiety or insomnia? Are you sure you weren't psychotic back then, but complaining about anxiety and insomnia? He might have very well diagnosed you with something other than what you told him your problems were.
Generally speaking, you can't do anything if olanzapine was indicated for the diagnosis, it's simply a case of bad luck, BUT if he prescribed it off-label then you pretty much have him by the balls. If that is the case, first establish with him that you suffered a severe neurological disorder because of his decision, then give him a chance to explain his decision. If he's an ignorant knuckle-headed fuck though, like some doctors unfortunately are, I'd find a lawyer and see if you can squeeze some money out of his insurance. You might actually get enough money for a nice supply of pot out of that. ;)

Good luck with all this and again, I'm sorry to hear you got this off your medication. Neuroleptics save lives, but they do have severe side effects sometimes.
 
I was referring to pot, strains that are really close to Afghan strains, like Afghan skunk. Most of these which I've seen never really were labelled, but I'd recognize it anytime. Very firm, small buds that are very dark green in color and smell like pine trees.
I like a lot of hash, but not a big fan of black afghan or what's sold as such in the netherlands today. Hash is simply too strong for me, but it's great for the occasional blast and excellent for cooking purposes. Purely recreational for me and even when I last had a bunch I ended up giving it all away because it's simply too strong.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3498787/
There are lots of articles on this. Olanzapine is known to cause dystonia.
I'm sorry man, I've suffered some adverse effects from neuroleptics myself and now one of my eyes is fucked. They were necessary for me though. Neuroleptics should only be prescribed when they are needed. Prescribing them off label is fucking crazy when there are alternatives that are indicated and have not even been tried.

For how long were you taking olanzapine (can you give us a timeline, out of interest)? Who prescribed it? A psychiatrist? A general practicioner? Does he actually SEE you? Phone appointments are non existant where I live. What exactly was the diagnosis it was prescribed for (you can ask him again or ask your health insurance), anxiety or insomnia? Are you sure you weren't psychotic back then, but complaining about anxiety and insomnia? He might have very well diagnosed you with something other than what you told him your problems were.
Generally speaking, you can't do anything if olanzapine was indicated for the diagnosis, it's simply a case of bad luck, BUT if he prescribed it off-label then you pretty much have him by the balls. If that is the case, first establish with him that you suffered a severe neurological disorder because of his decision, then give him a chance to explain his decision. If he's an ignorant knuckle-headed fuck though, like some doctors unfortunately are, I'd find a lawyer and see if you can squeeze some money out of his insurance. You might actually get enough money for a nice supply of pot out of that. ;)

Good luck with all this and again, I'm sorry to hear you got this off your medication. Neuroleptics save lives, but they do have severe side effects sometimes.


Black Afghan I used for special occasions sometimes, it gave me a nice euphoria and a good feeling in body. I don't know about the other afghan strains, worth looking up. It just bugs me out how the doctors is operating.

Suprisingly enough, I've been using promethazine, a 15 mg tablet, for 1 week, on and off. And my tremors and twitching in my chest/legs/neck is dissapearing. It's like when I'm taking a tablet, it makes you twitching more, but in a different kind of way. And now I've been off it, and feeling kind of stable. Less twitching, and less dropping of things, and better muscle coordination. Which makes me thinks it all about signalsubstances, since promethazine is working on dopamine receptor. Funny how it can reverse the symptom.

I've been on and off for three years. I had non stop crying, bad panick attacks, and all that horrible things by the Zyprexa. Diazepam helped me through it though. It made all effects of Olanzapine slowly dissapear. Since I got better and felt more stable, I wanted to educate me further, I felt I needed some stable medicine in the background incase of something will happen. But they wouldn't prescribe me anything but Celexa or Zyprexa. Which I knew from instinct that it was shit, and wouldn't work on me. But I played long with their cards. My biggest misstake. Got hospitalized 8 times in 3 months. Lastly Zyprexa made me cramp all over the floor in the beginning of this year, I had an odd feeling before that something wasn't right in my head. A kind of fainting feeling.

So they gave me a medicine called Akinetone, injected IM. To prevent the Dystonia attacks. I really thought I was going to die. Like all your muscle masses just cramped up. Then the Akinetone made you feeling like a flat wall. So it kind of resolved it. Some symptoms is still lasting, which I fight with.

But one thing for sure. No more Zyprexa, and no more Celexa. And trust your insticts more than just some doctor, who working a hardass schedule to get you out asap. It was a regular doctor at the psychiatry. They couldn't give me anything for my sleep or anxiety cause I've been honest about my drug experient earlier. So I got placed in a "tray" That's why they prompt on giving me the fucked up stuff instead. That's just fucking bullshit. They bounced me around, and no one wanted to take on the responsibility it seems. More afraid of losing their license, than listening to a patient. It's life sadly.

I was diagnosed with moderate PTSD also. Sure some doctors were okey atleast and gave me some sleeping aid. Zopiclone 5 mg. But what I needed was that anxiety dampening medicine. The cortisol eated up my head.

Now in finally rid of the PTSD for good. But had it's toll of experimenting of Norspan patches (Suboxone), Diazepam, MDMA & Cannabis. I would say that the Celexa would never helped me. I would be eaten alive by my own stressed brain and body. I'm off all the morphine now though. Just a miracle. My habitual state is back to normal. No stress. No panick attacks. Just these little tremors and Dystonia symptoms. Which I will get rid of.


How long did you go on Olanzapine? And which dosage? It's a nightmare these sideeffects, but remember your body is good at healing.
 
Also I think it was the rapid onset on and off of the drug that caused the sideeffects. Now when I'm reflecting on it. And I've read somewhere, can't remember the source, that it isn't the best suitiable thing to do with Olanzapine.

Forgot to add, I've been almost crippled to speak too. Really zombielike. That was half a year after regularly taking it.
 
I really think you are attributing too many of your symptoms to the olanzapine. I've never heard of it causing panic attacks or crying. That would be very unusual, it also does help against anxiety to some degree and should knock you out pretty hard. I've been on it for 4 or 5 months and I am very grateful that stuff exists, it was a lifesaver for me. After that I was on quetiapine for the remaining part of 13 months. I'm quite a big fan of both meds, even with the permanent side effects I got, I actually came into hospital gladly expecting to receive olanzapine.
 
Woa! Ur right, I put it wrong, anxiety wasn't from the Zyprexa. I'm sure I got excessive non-stop crying of it though. I've been talking to someone else medicated with it, and he got the similar reaction as me. I found something here on this forum also about it. Try: "zyprexa withdrawl" here.

I needed it too at first, but not for that long extended preiod. My main dose was 10mg/day. It sure helped me through the very bad psychosis linked to my PTSD in the start. And in the end when I got some mystic "rebound action"? My head fall into one little working piece again.
This happned when I was outside for a walk. If you can see the "white rings" there. Hard to explain, so better with a picture, if you minimaze it. http://sv.wikipedia.org/wiki/Dissociation_(psykologi)#mediaviewer/Fil:Worried_People_2.jpg . Then my cognitive abilities in my head started working better, language, speaking, habiutal state. I stopped react to when someone just opens a door from nowhere. Before I could freeze, because linked to PTSD.

All right. Just be careful man. What is your dosage by the way? I think my biggest misstake was to start and stop with it more than one time. So my head couldn't adapt. They also said it in there at psychiatry that it wasn't the best thing to do, to go on and off. I got myself advice from 20 different doctors over three years. Some of them were smart about it. So I had different methods to do. Some of them really "off labeled" it at very high doses. Like 20mg/day. Weird enough, the cheif doctor at that department, recommended "take when needed". So different opinions at least. Summit: it's not for anxiety though.
 
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Woa! Ur right, I put it wrong, anxiety wasn't from the Zyprexa. I'm sure I got excessive non-stop crying of it though. I've been talking to someone else medicated with it, and he got the similar reaction as me. I found something here on this forum also about it. Try: "zyprexa withdrawl" here.

I needed it too at first, but not for that long extended preiod. My main dose was 10mg/day. It sure helped me through the very bad psychosis linked to my PTSD in the start. And in the end when I got some mystic "rebound action"? My head fall into one little working piece again.
This happned when I was outside for a walk. If you can see the "white rings" there. Hard to explain, so better with a picture, if you minimaze it. http://sv.wikipedia.org/wiki/Dissociation_(psykologi)#mediaviewer/Fil:Worried_People_2.jpg . Then my cognitive abilities in my head started working better, language, speaking, habiutal state. I stopped react to when someone just opens a door from nowhere. Before I could freeze, because linked to PTSD.

All right. Just be careful man. What is your dosage by the way? I think my biggest misstake was to start and stop with it more than one time. So my head couldn't adapt. They also said it in there at psychiatry that it wasn't the best thing to do, to go on and off. I got myself advice from 20 different doctors over three years. Some of them were smart about it. So I had different methods to do. Some of them really "off labeled" it at very high doses. Like 20mg/day. Weird enough, the cheif doctor at that department, recommended "take when needed". So different opinions at least. Summit: it's not for anxiety though.
Ok it all makes a lot more sense now. Generally, it is advised to stay on antipsychotics for 1 year because that can significantly reduce the risk for another psychotic episode. Often it would make sense to switch from a heavily sedating antipsychotic like olanzapine to a less sedating one. I also agree that often patients are kept on antipsychotics for much too long. A lot of doctors are scared to take a patient off or simply don't care very much ('never touch a running system' I guess lol). So the crying appeared during withdrawal? That makes more sense. :D Definitely taper off this stuff and don't just discontinue. A few psychiatrists I've talked to really aren't aware of the symptoms after discontinuation, except for the possibility of a rebound psychosis. Not everyone experiences them, but it's definitely a very real phenomenom for many. After all, your dopamine receptors will be upregulated due to prolonged treatment, it shouldn't strike anyone as the least bit surprising that shit like this happens (e.g. the crying).

Shit I gotta go fast. :D
 
Ok it all makes a lot more sense now. Generally, it is advised to stay on antipsychotics for 1 year because that can significantly reduce the risk for another psychotic episode. Often it would make sense to switch from a heavily sedating antipsychotic like olanzapine to a less sedating one. I also agree that often patients are kept on antipsychotics for much too long. A lot of doctors are scared to take a patient off or simply don't care very much ('never touch a running system' I guess lol). So the crying appeared during withdrawal? That makes more sense. :D Definitely taper off this stuff and don't just discontinue. A few psychiatrists I've talked to really aren't aware of the symptoms after discontinuation, except for the possibility of a rebound psychosis. Not everyone experiences them, but it's definitely a very real phenomenom for many. After all, your dopamine receptors will be upregulated due to prolonged treatment, it shouldn't strike anyone as the least bit surprising that shit like this happens (e.g. the crying).

Shit I gotta go fast. :D

Yes, you're right about switching to a less sedating antipsychotic after a while. Irritating as it is, the doctors don't want them how to be told to do their work.
I did tapper off carefully, but I guess it happend because too much switching. Also the doctors should really be more informative about the medicine they prescribe, especially antipsychotics.

Now all dystonia symptoms have gone away. Strangely enough. Maybe it was a lot induced because of stress. Weird. I took some Zopiclone for the sleep, and it faded away after a couple of days. Also I went for Bubba Kush instead of Exodus Cheese. And I found he had Afghan Kush, one of the same straintree you prefered. It is really hugh black/purple crystalized nuggets. And "medical AAAA" Not just three A :D.

So I will try it this weekend.
 
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