Transcript
WEBVTT
00:00:00.000 --> 00:00:08.609
Can we help prevent that really terrible down hill slope of memory loss?
00:00:03.149 --> 00:00:42.420
I don't know the answer to that yet. But I can tell you as it relates to other nerve related diseases like neuropathic pain, the one that I first came into cannabis with neuropathic pain where the burning sensation in the feet and hands, the tingling sensation, that part we're seeing 20 years worth of scientific studies that show that it is helpful for that type of pain. And we're seeing study after study come out that show all these other cannabinoids, those other other chemicals in campus, those other cannabinoids as being neuro protective.
00:00:45.600 --> 00:01:04.140
Hello, and welcome to dementia discussions, the podcast for and about caregivers. If you'd like to share your caregiving story with me, I'd love to hear it. Please call me at 310-362-8232 or email me at dementia discussions.net.
00:01:06.750 --> 00:01:25.769
Today, my guest is Dr. Sherry of Hi, Dr. yify is a board certified emergency medicine physician. And she's also a cannabis, clinician and educator and the founder of the relief Institute. Dr. Yu fi. It's great to have you here. Thank you so much for being on the show.
00:01:23.969 --> 00:01:25.769
Thank
00:01:25.769 --> 00:01:32.609
you so much for having me this morning. This is such a wonderful program that you've put together and then so honored to be on it.
00:01:33.180 --> 00:01:45.329
Oh, well. Thank you. So you have an interesting job. Should I say? I'm so curious about it. How did you get into being a cannabis clinician?
00:01:45.689 --> 00:02:34.590
Yeah, that's a great question. I came about it in a very roundabout way. When I first started in emergency medicine way back in the early 2000s. I really loved my job. It was a really wonderful job. And I thought I knew almost everything about everything, which is what the way I like to do things. But over a period of time. In 2010, when I first started hearing things from patients about cannabis and marijuana, I'll never forget my very first patient I heard talk about marijuana in a very easy, Happy Go away. She was an 80 year old woman with some arthritic pains, and she'd come in because she'd taken the hall.
00:02:31.379 --> 00:03:34.139
And I was going through medication list with her. And she mentioned notice there was nothing on her medication list for pain, which seemed a bit unusual given the amount of apprenticeship. So I asked her, I said, do you take anything for pain? And she said, Oh yes, I take a piece of a chocolate chip cookie. And I was like, I eat chips so coy. I don't know what I get out of chocolate chip cookies. And I was I was befuddled I didn't understand at all. And she was really wonderful. She sat and explained it to me. She said, Oh no, this is a piece of a marijuana cookie. I take a little bit and I'm I'm having pain that makes the pain go away. And now it can scratch my head. I went home to my grandmother at the time, who's roughly 90. And I said, Have you ever heard of such a thing? And she like looked at me. She's an older Middle Eastern woman who led her country for religious persecution. And she's like, What are you talking about?
00:03:30.840 --> 00:06:29.490
Don't ever bring up drugs in this household? You know, what that idea and thoughts away? And I was like, Okay, fine. And it was for the next couple of years that I would hear these little things here and there. A patient's talking about cannabis use for pain management, nausea, management, you know, it cancer treatments. Again, here, there, it just couldn't be sprinkled along the way. And I didn't really think much more of it until about 2016 When my a family member was diagnosed with breast cancer. And around the same time another family member was diagnosed with stomach cancer. And it it came up in discussions with their oncologist and they bring it back to me asked me about it and they said, Well, my oncologist is telling me to smoke pot. I was like, Okay, well, I don't know what to say that. They didn't talk to me about this in medical school, or residency for that matter. And I thought, well, I don't know what to say what what did the oncologist tell you to say? And then with that missing a beat said they told me just Google it. And I thought that's seems a bit irresponsible of us as clinicians to tell our very, very sick and ill patients to Google something that we think is valuable as a medicine, but I kind of went along with it. And we googled it and we went through this kind of by gone backwards, you know, hillbilly kind of way of getting to medicine. And we showed up to somebody's office who's wearing a Hawaiian shirt and stains all over the funds, you know, barely looked at us was eating during the conversation, I think we did, did like a max three to four minute interview and walked out the door with some type of medical marijuana recommendation. And then we walked into the dispensary. And the dispensary was not much better. It was filled with smoke at the time. Remember, this is still back in the free recreational era? And, gosh, who are these people who are helping us out what surely one person forgot what we were asking for when they had walked to one side and stormed back and completely forgotten about what we were talking about? And was just kind of in a haze? That's good. And so it seems really unprofessional to me, first of all. Second of all, it seems like well, this doesn't seem like real medicine. We don't think of this type of thing as real medicine. And I started getting really confused and curious, all the same time. So I decided to take it upon myself and kind of do the research, right? Look through the articles, read through these things and take a look and see what am I actually dealing with, right? Like, is this really all witchcraft? Because that's felt like it felt like witchcraft.
00:06:29.850 --> 00:06:44.610
And I was floored, I was absolutely floored with the amount of research that has been done, the sheer quantity of research and the breadth of it.
00:06:39.509 --> 00:07:18.089
And then the more I read into it, the more I got interested, and this was around 2017, I decided to take on a patient and see how I could be helpful or see how this would even work, you know, if I was going to actually take on clients this way, or patients this way, how this would work. And I took on a friend of mine, her father in law, and they took him on as a patient and he was miserable. 60 some odd year old gentleman who was having severe pain in his face, that was poorly managed.
00:07:12.720 --> 00:07:21.389
She'd seen four specialists and tried oodles of different medications, none of which work.
00:07:22.319 --> 00:08:03.120
It's called post herpetic neuralgia. So sometimes after shingles, you can get this residual pain, that is just kind of god awful. It's even referenced as being the silent suicide type diagnosis because people just are suffering to intense amounts of pain that you cannot manage very well. He at this point, was living in Palm Springs and would go golfing in the mornings. And by the end of the day, he was just wracked with pain. And so he would take and he was on tequila at this point. So it was taking like a couple shots of tequila at night just to get himself to be able to sleep at night. This was not a man who was a drinker at all.
00:07:59.370 --> 00:08:14.910
But it was kind of found this to be the only solution. So we started working together. And he was a former engineer. So it made my work much easier. He was very methodical, very precise, gave me really nice feedback.
00:08:15.269 --> 00:09:05.820
And what we were able to do in six weeks was take him off all the alcohol, reduce the pain, get him back to his life, get him back to sleeping, and actually reduce some blood pressure medication as well, because we've found that as his pain was better control, his blood pressure became no surprise, I think either better controlled, and so he didn't need as high doses of the blood pressure medication. And then he came up with some of the other kind of pain management supplements as well. And so this became my segue into cannabis medicine. So very long story, I apologize. But it was a very long process, because it wasn't something that I inherently know. Now, I know a lot of individuals in their teens in their 20s will experiment and try some of this. I never did.
00:09:06.029 --> 00:09:16.830
And so I never had that personal experience or personal foray into this. And it was a it was to me a very methodical process.
00:09:16.860 --> 00:09:28.409
And so pivoting out of emergency medicine into cannabis medicine was also the same kind of really conscientious stepwise process.
00:09:29.340 --> 00:09:29.909
Yeah, I
00:09:29.909 --> 00:09:37.259
have that and not traditional right? Yes, suddenly, you're going into an untraditional line of work.
00:09:37.710 --> 00:09:42.330
Yeah, I would imagine. Maybe people frowned upon it. Or I always
00:09:42.330 --> 00:09:50.039
say I was in the closet for a long time while I was pivoting, and I came out of the closet to my colleagues.
00:09:50.460 --> 00:10:01.679
It took a few years for me to be very upfront with my colleagues about what I was doing and now and very forthcoming about it, it rolls off the tongue happens to them when they first start.
00:10:02.009 --> 00:10:17.309
So funny that you should say that because I find in support groups, people are not, you know, they're not forthcoming about using cannabis with their spouses. So these are care partners of people taking care of someone with dementia.
00:10:17.700 --> 00:10:58.350
And oftentimes, they don't talk about giving their loved one, you know, some form of cannabis, but I think a lot of people do use it. Right? So maybe talk about that a little bit because it still is, you know, kind of like, little Hush, hush. When someone says that in grip, other people then kind of come out and say, yeah, oh, yeah, we've done that, too. But it's not really a first line treatment advice. I mean, tell me if I'm wrong, but I think a lot of people have sort of been through Seroquel and the other sort of mainstream ways of trading, anxiety and agitation. So what's your experience?
00:10:58.889 --> 00:11:54.330
So there's two parts to what you were just saying. One is the kind of fear of openly discussing or, you know, uncomfort, discomfort of openly discussing cannabis and marijuana use with our peers or the people that we're asking for support from? And the second part is, why is it still second line treatment? And what is it even treatment for some people, first time might not even understand what we're talking about. And here in the know, cannabis? Let me start by saying yes, here in the state of California, especially locally here in Los Angeles, we are kind of the forefront still, I would say what we think of as not just recreational and medical, but really this kind of new in between, which is, it may have started as an experimentation, but it has now been brought on really as a medical treatment.
00:11:50.190 --> 00:11:54.330
And that kind of middle ground.
00:11:55.049 --> 00:13:10.740
Partly, the reason why we're seeing it not being completely accepted as easily is I always joke about Viagra. It's not easily as accepted as something as Viagra, which is I think of as truly a recreational medication, right? Yes, there is a medical perspective of it. But really, it's right that the resulting aspect is a recreation, right, the tremor equation for pleasure. And why is it that something like cannabis, which is truly a medical, right for our dementia patients, and others is being viewed as a recreational and the perspective is prescribes or recommends it and why you're doing this as a mess. And that's the difference I think between something we think of as recreational, I get a weed or pot or vape pen from a friend at a party that's recreational or I should not be so forthcoming about it, versus something I get from my physician is medicine, right? So if I get Viagra from my doctor's office, then that needs the medicine. But if I get cannabis from a friend, who's also going through something that I'm going through, then it seems more like a recreational or drug pace, you know, hot. So that's kind of one perspective.
00:13:10.860 --> 00:13:39.330
So really encouraged. The reason why we've gotten so much headway cannabis and marijuana, you'll see me interchange those words, just for you know, the person who's listening at home. The reason we've gotten so much headway is because patients have really brought it forward to the physician. This is how I was first introduced to it. This is how a number of my colleagues were first introduced. This is how we've made headway in research, because individuals are bring it to our attention.
00:13:39.870 --> 00:14:26.279
The way medicine usually works as a pharmaceutical company decides that it's going to make a medicine and then pushes it into our offices and into our schoolbooks and into our residency programs. Because there's no one pharmaceutical company pushing this as a medicine, we're seeing that education pathway go backwards, right from the patient to the physician. So it's real. To me, it's actually more valuable as a medicine because it was so long illegal, and yet still people found so much benefit to that they were willing to withstand that potential illegality, and still bring it to their doctor's office and say, hey, you need to look at that, to me is what made it really valuable, actually, and really potent as medicine.
00:14:26.940 --> 00:15:25.259
Because I'll tell you, I don't see people pushing Gabapentin on one another. They're not like, Hey, we're out. So you should come take it too. Right. It's an okay, medicine. Right. But that's the difference between Gabapentin and something like cannabis. People are finding such a profound result that they're willing to bypass that discomfort that they feel about talking about, because they've had such good results. And so for those of you who are worried about talking about it, I get it. I was in your shoes was at one point, but I will tell you, the more you feel comfortable with talking about it, and the more you can find benefit from it, you can help somebody else who can also get benefit from it. And at the end of the day, push your physician to recognize it more and more as a medicine, and less and less as a recreational drug. So that's kind of that uncomfortable part.
00:15:22.320 --> 00:15:25.259
And it's
00:15:25.259 --> 00:15:39.720
a really good point. So when you go to your regular doctor, you should bring up that you're, you're utilizing cannabis as part of the evening medication or with the before bed or whatever, whenever you're right. You may even tell people
00:15:39.720 --> 00:15:55.740
don't just leave it at cannabis. You that chocolate chip cookie patient who explained it to me, right, ie that person who takes the time says, Hey, by the way, I take the same consistent dose every night, I buy the same consistent medicine all the time. And this is how I dose it.
00:15:55.740 --> 00:16:15.090
And this is how I take it. And this is how I use it. Because that's I think, a much better frame of reference. And I think what a lot of physicians are thinking of is, you know, you don't know what you're doing or you're just kind of going on a whim all the time, which is not what we know our patients, they're not going on a whim.
00:16:11.399 --> 00:16:15.090
They're pretty darn consistent.
00:16:15.450 --> 00:16:39.029
And again, the difference between what makes medicine medicine versus a recreational drug. And then let's get to the second bar, which I think is almost the more interesting part is cannabis as medicine for dementia patients. It's such a wonderful medicine that we're seeing utilized so frequently now for anxiety that goes hand in hand with dementia.
00:16:39.179 --> 00:17:41.910
sundowning is a specific kind of subtype of anxiety, pain management that doesn't constipate and we'll repeat that or are typical painkillers will constipate over and over again and create more problems than they are worth resulting in trips to the ER with constipation, resulting in severe bowel impaction resulting in daily enema use resulting in daily you know, two or three other pills to get as a laxative to get you to. So really think twice about taking an opiate with dementia. No, we're not talking about a broken bone, we're talking about a chronic long standing pain modification issue. And then sleep. Those are the three big aspects of dementia that we're seeing really wonderful value with, with cannabis use. So for example, I'll give you individual examples of each of these for sleep. This is to me really a THC, you have to talk about the individual chemicals.
00:17:41.910 --> 00:17:50.430
Yeah, but to me THC is that really, it's the most notorious part of the cannabis plant. It is it gets a bit of a bad rap.
00:17:50.880 --> 00:18:18.630
It is so wonderfully, let me say that, again, so wonderfully helpful for sleep. And it is not something that has to get them high, it is not something that has to get them feeling funny, which also can be interpreted as feeling good. It doesn't have to be that if that's not what you want it to be, we can really dose this now in a way where we get the best of both worlds meaning that we get them to sleep well through the night.
00:18:19.259 --> 00:18:26.759
And also get them to feel better when they wake up in the morning without getting them high.
00:18:23.309 --> 00:18:54.690
Because I know that's a big fear for a lot of individuals. One patient I saw recently was only getting an hour and a half or two hours of sleep at a time and was getting up to pee every two hours. While we couldn't fix the getting up to pee every two hours because he's a patient has to drink a lot of water. He has a lot of kidney issues, etc. We were able to get him to fall back to sleep very quickly after she woke up time. So the quality of his sleep actually improved.
00:18:55.019 --> 00:19:19.410
Even though we couldn't fix that kind of the root problem of not being able to stop peeing, right? We wanted him to keep peeing overnight. That was a really important aspect sleep for him because I'll tell you the other aspect of this that I see in the clinical world, which is oh, by the way, I'm also taking Benadryl and melatonin.
00:19:13.410 --> 00:21:24.630
Yeah, that and Sanada an Ambien and you know, we can keep adding to this list, and what what I really try and do is is remember that we can fully eliminate some, if not all of those sleep aids and it depends on the individual, of course, but if they're not sleeping well and they're taking all these medications, can we do it better? Because the other aspect of dementia is, hey, Ambien, Lunesta, and Sonata probably are not good for your memory. There has been a research study linking them to early onset Alzheimer's and early onset dementia. Can we use something that could be more helpful to your brain? Then you is really, I call them hardcore Hypno sedatives and most people think of them as candy. That's how we're seeing and dispense the tyrosine utilized. And it's really important to remember that they do cause your brain to black out, THC is now being shown to have some neuro protective features. And I say this not lightly, because I think for a long time, and you were told this is your brain, this is your brain on drugs and showed that a breaking in the skillet, right? I think that from the 80s and 90s. That was our perspective on what THC will do to your brain. And now we have about 20 years worth of research saying, No, that's not what THC is going to do to your brain is that research showing that with MRIs that show improved, actually, I should say, new change in the MRI after 20 years of hardcore THC. We're not even talking about her or THC use. We thought studies that show with CBD leads that improved blood flow to the hippocampus, the brain membrane current brain, right? That's a really important functional part of Alzheimer's and dementia. So can we use CBD during the daytime specially to help preserve memory? Can we help preserve memory that's such an important aspect to dementia?
00:21:25.200 --> 00:22:10.950
Can we help prevent that really terrible down hill slope of memory loss? I don't know the answer to that yet. But I can tell you as it relates to other nerve related diseases like neuropathic pain, the one that I first came into cannabis with neuropathic pain where the burning sensation in the feet and and the tingling sensation, that part we're seeing 20 years worth of scientific studies that show that it is helpful for that tape. And we're seeing study after study come out that show all these other cannabinoids, those with other parts, other chemicals in cannabis, those other cannabinoids as being neuro protective, protecting the nerve protecting the brain.
00:22:11.279 --> 00:22:22.259
These are the first phenomenons that we're hearing about cannabis being actually protective for the nerve cells of the brain. And that's really where we're seeing this kind of pathway. Good.
00:22:22.890 --> 00:22:40.619
So going back to that for one quick second, when most people take Remus seniors, people in our world take medicines for sleep. were worried about them falling. So are you worried about your dosing THC for sleep? Are you worried but is there a potential for
00:22:40.619 --> 00:22:43.019
false?
00:22:40.619 --> 00:23:13.109
Absolutely, anytime you talk about anything that can be the least bit sedating? Yes, you have to consider it, you have to be mindful of it, we got to be mindful of the dose that we give people for that purpose. So usually, when I see people in the office, one of the things that we'll talk about is all risks and if they are a fall risk if they're not a fall risk, where the bathroom is located, if they need a urinal, etc. But fortunately, in my career, the number of falls I have seen with cannabis use Gleave is just one.
00:23:13.589 --> 00:23:49.109
And that was from a accidental overdose. So she accidentally took twice the concentration, because the company changed. Now it was out of no fault around the company changed their product line and doubled up their dosing strategy. So she was unaware. And that wasn't even a dementia patient. So with my dementia patients, I have not had false. So it is, fortunately I not seeing that as a very high level of increase. In the emergency department I used to call the bathroom the most dangerous place in the house.
00:23:45.059 --> 00:24:00.450
Inevitably, where people pass out and hit their heads and all when they're urinating or when they're having a bowel movement, or on their way to the back. So it's absolutely something that we want to discuss and be mindful as well.
00:24:00.930 --> 00:24:09.029
Okay, so go ahead. I took you up on that fall tangent, but go ahead. So you're talking about sleep, and then he wants to go on to I think anxiety. Yeah,
00:24:09.059 --> 00:24:52.619
Heidi and daytime kind of sundowning. And one of the things that I think when we talk about cannabis where we've been so nonspecific, when we talk about it in groups, and when we talk about it here and there. We talked about just cannabis as a whole. In my office. One of the things I like to do very specifically is talk about the specific chemical compounds that we're using. Just like we would if we were talking about a painkiller, right we talked about acetaminophen or Tylenol, ibuprofen Motrin. We talked about oxycodone, Percocet, being a mixture of oxycodone and Tylenol. We talked about these things in kind of the dualities of formats. And this is nothing new to medicine is to mix two things together.
00:24:52.980 --> 00:27:17.460
And so the the second kind of in command here that we're going to talk about a CBD, and with CBD, one of the things that We see is this really nice, really lovely, very easy chemical, much akin to I like to think of it like Tylenol, Motrin, so CBD to me is very mild, but very potent, which is really quite a lovely combination. So people oftentimes will say, Well, what will I feel if I take CBD, and you shouldn't feel anything, really, unless you make a point of thinking about it. So I will sometimes even have people patients will put on a timer after they take their first dose of CBD. And I will make them put the timer on about an hour and a half later. And I will actually have them think about the amount of pain for example, or anxiety that they're having when they take the medicine. And then an hour and a half later, I want them to re evaluate how much pain or anxiety. And the beauty of this, I think is that comes down about two to three notches, or more, depending on the individual very easily. So if we can measure, I always tell people, it's your own personal scale, I don't care what the number 10 means to you. But if we're talking about anxiety, you get to measure what your anxiety level is, and say it's a fill in the blank is eight out of 10 my anxieties in AR 10 Right now, I'm gonna take my CBD dose, and then an hour and a half later, I'm gonna measure it. And my goal is have that anxiety be less than a six or five. And that's about it. And it's really quiet acting is to how it affects, which is, again, really where we want our medicine to be right, we don't want to go from on to off, we don't want to go from up to down, we want it to be really a quiet background acting medicine. So with CBD, that's a really lovely potential for it. We also use THC for these types of treatment strategies, it really depends on the individual, I'm gonna take it into the office firm. So when a patient comes to see me it is all remote at this point. So it's all telehealth it's all zoom based evaluations. Because I do see patients from basically Southern California all the way up to northern California, the advantage of the pandemic was pushing us into this kind of newer reality where we can do medicine over a zoom type class.
00:27:12.539 --> 00:27:49.200
And the other advantage being that I don't make these diagnoses or I don't diagnose patients with dementia, they have to come into my office with that pre existing diagnosis through their neurologists office. And so what we can really focus in on and work on is honing cannabis type medicines into your routine and your regimen for a day to day treatment. We can work on adjusting your other painkillers, we can adjust on your other sleep medications, we can work on adjusting your other anxiety medication in order to bring cannabis into the fold.
00:27:49.829 --> 00:28:48.450
One of the things that historically in medicine we do is just add medicine on top of medicine. I tease my colleagues about it like you're depressed and we add an antidepressant on and then we add a secondary antidepressant on or for pain, we add one pain medicine on and your savvy pain will add more pain medicine on we will reevaluate or set up a time to say hey, in six months, we want you off of this medicine. It's a newer thought process. Because I think inherently in medicine too. We don't do a very good job of saying, hey, we want you back in the office not to put you on more medicine, but to bring you off of the meds. That's a newer frame of thought, right? Because back in the day, we used to say, well, you stopped taking it when you're not having pain. But that was also when we didn't have very addictive medicines on board. So yeah, it's hard to tell people to stop taking a medicine when that medicine is making you feel like you need to take them. So I digress.
00:28:49.470 --> 00:28:55.289
It's okay. It's okay. I mean, that is a good question. Are these medications you brought up addiction? Are they addicting?
00:28:55.859 --> 00:28:59.700
Like any medicine? This can be addicting?
00:28:59.700 --> 00:29:52.559
Yes. I don't shy away from that it is by the NIH standards. It's 9% Addiction rate. To give you a comparison alcohol 18% Addiction rate, opiates you go up to the 20s. So yes, it is addicting but it is by far and away much less addicting and to be even more granular and more specific. It's really cheap. See that is addicting. CBD has zero addictive properties to it. It's been researched Dr. Yasmin Hurd out of New York, did a really lovely study on CBD and continues to do studies on CBD and has shown that it is not addicting at all, much more akin to sired medicine or blood pressure medicine in terms of addiction, which is again non existent. When we have our physicians reevaluate medicine.
00:29:47.759 --> 00:30:29.490
We tend not to reevaluate you still need to be on this medicine. I have another patient who's on Cymbalta for pain. It didn't work, but A year later, he's still on it. It didn't help his pain at all. But we haven't really talked about taking it off yet. So one of the things I try and do in this, so it's a pretty long evaluation, I think by standard medical terms. It's about 45 minutes over zoom, this initial consultation that we go through, and we'll talk about what medications are working, what medications are not working. Why are we still on some of these medications and how we can simplify or regimen.
00:30:25.680 --> 00:32:16.170
One of the other things about dementia I find is that a lot of patients are probably no 10 pills a day, be the supplements, be the prescribed medications be divided, whatever it is, they're taking a boatload of pills a day. And for a lot of individuals are up to date, when we hit that age or dementia status, our appetite shrinks, and we don't want to eat as much. So when you're filling up and precious real estate of your stomach with pills, even if there's supplements or vitamins, it takes up space. So you want to know that each pill they're taking is worthwhile, right? It is important to be taking that pill. Sometimes we'll even talk about changing a supplement, which is still important to three times a week just to help free up some space met stomach for the health benefits of actual foods, right in your food items, right really healthy food items. So those are the discussion points that we want to bring up in that initial evaluation. And then as we discuss it, we'll come up with a really specialized personalized plan of which cannabinoids we want to utilize. And again, it's going to be a combination of CBD THC. We're introducing things like CBG, CBD, a THC A, and then I call it the alphabet soup of cannabis. So there's a lot of initials that go on in this discussion, that can be really overwhelming. But the beauty is that oftentimes, these come in an oil tincture format, so that it gets absorbed partly in your mouth and partly in your stomach, it doesn't have to take up space like the pills do. It doesn't have to take up our precious resources, it really absorbs in a much nicer way than a lot of our pills do.
00:32:16.650 --> 00:32:26.460
So that's a really good point. So before you're talking about your first patient with the cookies, so it can be all sorts of different forms. And it's
00:32:26.579 --> 00:33:29.880
I think it's nice when I think the beauty of having this as a medicine around for 1000s of years and having the individual really play around with it is that we get the imagination of 1000s of people millions, as opposed to more chemists in a basement, laboratory and technical company really, truly, they've made so many wonderful different pathways for this. Two of my favorites as a as needed basis would be honey, they mix THC and CBD into honey. And you can dose based honey sticks. And also in tea formats. Right remember, this is a flower just like other flowers that we get tea and herbal supplements from so they've made that into a tea supplement to again really lovely ways to get your medicine without making you feel like oh, if I have to take another 10 pills with lunch at the gram, I forgot her four pills at dinner time to get this in her now she's full. She's not feeling well. Having to get this into her is really challenging.
00:33:30.390 --> 00:33:40.319
So why better way then like a couple of bars of chocolate. So talk about the dosing a little bit. I guess it's actual milligrams. Yeah, so talk about that a little bit.
00:33:40.740 --> 00:34:00.869
I had one patient who came off of Xanax she was in her 90s. And she did such a lovely job. She's since passed, but she was my patient for a number of years. And she loved she was a chocoholic. And she was just over the moon when she heard she could take a little piece of chocolate at night to help her get to sleep instead of taking some Xanax.
00:34:01.079 --> 00:35:48.030
And she'd been on Xanax for decades. So it took us a really long time to wean her off that she was sleeping so much better and she was more pleasant with her caregivers when she felt this chocolate now in California comes pretty standard as five milligrams per rectangle chocolate is THC, you have to have to read the individual ingredients in each bar of chocolate. This is not something that is being run through a pharmacist. You are your own pharmacist when it comes to this or if you talk with a clinician such as myself. We will help guide you in reading those ingredient pathways. I do not recommend dementia patients start with five milligrams of chocolate because that can be way over the top. Again, depending on your size or weight, how many other medications and supplements you're taking. So you have to be really mindful the dosing strategy in this that five milligram chocolate rectangle was designed for a 20 year old to use for recreational Purpose, okay, so just bear that in mind when you start your loved ones or you think that this is a pathway to take, I don't recommend that dementia patients start this without a care provider without a physician or somebody who is helping you on this pathway. Because it can be something where if you take too much, you're not sure like how it makes you feel right off the bat. And then we fall into this pattern where people don't want to take any more, because they didn't like the way it made them feel that first. So you really want to start with the philosophy and cannabis is start low and go slow. Start with a really small dose, start with a piece of a chocolate as opposed to a whole bunch and see how you deal with it before you go trying to use bait or dosages.
00:35:48.480 --> 00:36:03.840
That's another really good point is people do order this stuff over the internet or go to the local dispensary? We probably should all be insulting someone like you, instead of doing something like that. Yes.
00:36:03.960 --> 00:36:06.059
So what to do?
00:36:03.960 --> 00:36:06.059
How do we know what to do?
00:36:06.090 --> 00:36:25.079
Exactly. Okay, so I'm going to encourage a couple of different things here from all your listeners. Number one, you have to have to start encouraging your physicians to bring on someone who specializes in cannabis or encourage them to get hit with cannabis. Right?
00:36:21.449 --> 00:36:59.820
Encourage them to start understanding dosages, and how to encourage that in your physician. Another way to do that is to and this is where I'm going to plug a little donation, I apologize here in advance. If you are interested in all in advancing the research here, Pacific Neuroscience Institute, he and I Pacific nurse Science Institute at St. John's Hospital, is working on bringing in myself as a cannabis clinician to work with their dementia patients really specifically, so that we can advance this for their health.
00:36:56.519 --> 00:37:35.670
Part of the reason why we need donations to get this started is because of the insurance coverage for all of this. So what we don't understand, really and what we don't know how to pursue is how insurance is going to cover this. Because as of right now, this has been really, as we talked about, in the beginning, it's been really hidden and under the covers and not really discussed. And now that we're seeing the legalities move forward. We have 23 states that are currently recreational use, which means that it's over 21 You can use this in 23 states, and the majority of all other states have medical use.
00:37:32.219 --> 00:38:13.619
There's only two states that have this, frankly, completely illegal. So what we're seeing is really on a national level, this is really being brought up as a both medical as well as recreational use. So what we're looking to do with p&i Pacific Neuroscience Institute, is bring on a cannabis clinician so that we can help patients on an individual basis because we know and understand that we do need to have some individual dialogue in order to make sure patients are using this appropriately and getting the best of all outcomes, right. That's really the best way to use medicines to get good outcomes. So if you're interested in all the research, myself, Dr. Bonnie Goldstein, Dr. Jeff Hagen, rather and Dr.
00:38:13.619 --> 00:40:51.420
Laurie voelen, where all four of us are cannabis clinicians here in the state of California, only Dr. Goldstein doesn't see dementia patients, I believe all three of us Hurtgen rather, and voelen also see dementia patients and will consult with any dementia patients to help them on this pathway. We all four of us together got a half a million dollar grant from the state of California last year, in order to bring up and discuss what patients were seeing use cannabis for medicine. As our discussions have moved forward in this research project, we've come to realize that probably about a third of our patients are dementia patients. So it's really quite impressive how many patients we're seeing in the world of dementia using this as a medicine. So the more we can help support this as an on a donation basis, the more that the universities the hospitals will see this as something they need to start implementing and they need to bring into the hospital setting in the clinical setting as a medicine so I really urge people if they have any desire to see that more in their clinical workspace to really bring those donations forward because as we know, money talks. The other way to get to know about this if you have more questions, cannabis clinicians.org That is the website for society of cannabis clinicians where I sit on the board, we have a fine to your local cannabis doctor. So you can just this is free for everybody. You can go into the find your local cannabis doctor on that website and you can find somebody in your local area. All you have to do is type in your zip code and it will pull up your radius of where you want to look for cannabis position. All those we are looking to implement one of the changes we're trying to make as anybody who recommends cannabis in the state of California, we're encouraging the State Medical Board to start implementing CME requirements. That means they need to be educated in this right? And to require that of somebody who's writing those recommendations or prescriptions for you. So these are the important aspects of somebody who's talking about cannabis with you. You want them to be educated, right? You want them to know what this means you want them to know the difference between THC CBD CBN, all of these different cannabinoids. So those are two easy ways to get to know about cannabis. Of course, please reach out to me and for any clinical questions, if you would like to schedule a consult, again, that initial consult is 45 minutes over zoom.
00:40:47.610 --> 00:41:22.050
So it's easily accessible to anybody. I encourage caregivers to be on board with those appointments. It is not for the patient alone, it is for everybody who has any interaction with the patient. So it is important that everybody is on board and understands where we can utilize this to get better results. And you can reach me at Sherry at MD relief.com. It'll be in the show notes as well. And D relief or the relief Institute is my website and relief spelled with a leaf on a tree L EA.
00:41:22.289 --> 00:41:25.980
And so you have to be in California to see you is that right?
00:41:26.190 --> 00:41:57.809
I see California patients if you need a recommendation for specifics here in California. So that means that I will help navigate you through the process here in California, and provide you with legal recommendations for it. If you are outside of the state of California. And you need a second opinion on what you're dosing, you've already got access to medicine, you've already got a medical recommendation to your own individual state. And you want better understanding on dosing strategies and the different cannabinoids that are available.
00:41:53.820 --> 00:42:43.889
I will also do those as a kind of Second Opinion for folks that are out of California because we are available more and more like I said everywhere. The products are different state by state, not always, but they tend to be a little bit different state by state. The challenge is not the products. The challenge is the dose and the ratio and the tunap Annoyed, right. So it's like saying here in the state of California, we have Tylenol Kroger brand, acetaminophen, that is Kroger brand versus acetaminophen, that is I don't know, Costco brand in a different state. Right? The brands may be different. But the dosing at the end of the day is the same. The Harmony across the states is going to be the dosing strategies. And that's what we want to remember. And hopefully,
00:42:43.889 --> 00:42:50.670
if you get on cannabis clinicians.org, the website that you mentioned, you can find someone in your state.
00:42:50.940 --> 00:42:51.179
And
00:42:51.179 --> 00:43:08.789
that organization actually isn't is not just nationwide, it is worldwide. So you can find anywhere in the world that is local to you. So if you are in other countries listening to this podcast, hopefully, you can also find somebody local to you in your country that knows your rules and regulations.
00:43:09.059 --> 00:43:32.429
That's great. So I guess main takeaway is don't go to the local dispensary. If your loved one has dementia, and it has anxiety, sundowning major agitation and sleep disturbance, call a physician, all cannabis clinician that really knows the dosing. Don't take it on yourself to zip down to the local corner.
00:43:32.699 --> 00:43:54.869
Call me that and see how it best fits for your loved one. Because really, if anything we're learning about medicine is the more personalized we can get with medicine, the better that long term outcome is going to be and the short term out, please don't hesitate to reach out it is one of my favorite things to do is to hear people doing better after eight weeks on this
00:43:55.139 --> 00:43:57.960
body of fight.
00:43:55.139 --> 00:44:17.789
Thank you so much for being here today. I really appreciate your coming up and talking to us about this. So it feels like so little is Nam and you have such a breadth of expertise. So thank you if there's any other developments in the world of cannabis and dementia, I'd love to have you back. So thank you so much.
00:44:18.300 --> 00:44:20.280
My pleasure.
00:44:18.300 --> 00:44:20.280
Thank you for having me again.
00:44:22.110 --> 00:44:45.929
Remember that you can follow dementia discussions on Apple podcasts, Spotify, Google podcasts, and many more. If you listen on Apple podcasts, that would mean a lot if you would leave me a review. For any other information about this podcast please visit me at dementia discussions.net and please share this podcast with someone you know if you think it may help.
00:44:42.239 --> 00:44:48.960
Thanks again for listening and I'll see you here again next time on dementia discussions.
