Tue, May 09, 2023 4:51PM • 1:47:20
SUMMARY KEYWORDS
cannabis, cbd, patient, thc, product, phyto cannabinoids, milligrams, plant, dose, trophy, week, pain, study, delta, reported, based, talk, form, administration, anxiety
SPEAKERS
Bill Clearfield
00:00
First
01:06
Jason come back and get the good one
01:13
my brain is my Swiss cheese brain
03:06
You want the coffee pot left on?
04:07
Honey Bee
04:09
hey John Bell
04:10
oh you know me I’m having the title of my life.
04:13
Yeah, man. How are you doing?
04:16
I’m doing excellent. I’m being mostly amazed by all the company I’m keeping. It seems that our new school people are just like us.
04:29
misfits.
04:32
They’re the old timey osteopath. They’re carrying on osteopathic biodynamics, which is the what is that? The subtle stuff you’re not supposed to talk about because it sounds too much like God
04:48
was talking to ritualize one now he’s uh, he’s pretty. He’s got he’s got a lot more knowledge about that than I did.
04:55
The subtle cranial people they just keep going through phases. And it’s just osteopathy, you know for 100 years but then they give it new names. But
05:07
yeah. Well, I would have to disagree a little bit with this study with Jim jealous his program for seven years. Oh, yeah. I also stay with Feijoa Fryman bonnet full for twice that out in Oregon. And so I mean, I really have chase down this for some period of time in my practice. And actually I’m, I’m in the process of writing a book. But I will say that it was really it does depend on people’s point of view, but I felt it under my hands. Ah, it took me years to feel anything and many, many courses in cranial and different people have different opinions, and different people have different thoughts. It does all direct though. Back to still, and will Sutherland but
06:16
it’s,
06:18
I don’t know. What’s it like, you know, that old saying about the elephant? You know that if you feel the detail, it’s one thing. So in some cases, one could say it’s the same, the breath of life that they talk about. That does go back to still in his in his readings and writings, I mean, but I have been fascinated about this, along with integrative medicine for many years. And like I say, I studied this and the interesting thing and I’m not going to go on beyond this, but my interesting thing was, I was interested in in the cranial idea, osteopathy from get go in med school, but and then I was in practice. And then somebody comes to me from running Pennsylvania and wants me to do the stuff that you read about in inter walls book spontaneous healing, second chapter devoted to Bob Fulford right in my own backyard. And and I thought Who is this man? Who’s a osteopath that Andrew Wilde knows and I’ve never heard of. So I went out and took two courses from him in Oregon. And that influenced me. Then I went down to Washington DC, that we’re setting up and had for a few years, this university of integrative holistic medicine, I forget exactly what it was called. And I went there for a weekend and they were talking about lots of stuff that people talk about in integrative medicine. I was very fascinated. And at lunch, I started talking to three dentists, and told him about my interest and they said, Well, you need to go study with Jim jealous dentist. So it’s ironic that two of my major influences came to me, not from other osteopathic physicians, but from one group of dentists and Andrew Weil. So this is something we could talk about in another time, but it’s but I just don’t think it’s the same stuff. But it took years and years. To feel and an awful lot of work. Where does it go with? And that’s what I’m trying to put partly in the my book. Anyway, that’s spoken off. I’m gonna go because this is somebody else’s dollar here.
08:58
We’ll talk much more than I’m very interested and we can all share and I know what you’re saying and I agree.
09:04
Okay. All right. Hey, can’t we can’t Hey, guys.
09:15
I hope I’m gonna be able to get through this without coughing too much.
09:22
Hi. All right. Do the best you can. And if you can’t,
09:30
I’m sure Dr. Dr. Burgess can pick up the slack right.
09:36
Now I’m a slacker
09:39
when this lunch is just hanging on. You know, it’s got it from I don’t know where we got it. I didn’t see anyone sick out there. Bill. When we went to AMG.
09:54
The airplane probably. Die was
10:00
I was stuck in the air in the Dallas airport for 10 hours.
10:03
Oh, yeah, your story’s way worse than mine. I was only complaining about a couple hours and then losing the entire planes. Luggage. They lost the entire planes luggage at LAX. Took them 25 minutes to find where it went. No, well,
10:25
you know only 25 minutes that’s that’s nothing
10:29
I was after we waited 30 minutes all right, well
Bill Clearfield 10:35
do the best you can and if you can’t, can’t get through it. You know, we’ll get through it. We we always we always have some backup stuff. So so we have some new new faces tonight and a couple of old faces Dr. Block it’s good to see you again. It’s been a long time. And Dr. Robin is contacted me this week and she’s a functional medicine doctor in Oregon who’s doing some interesting things. And Ryan Braswell is a name I haven’t recognized before and everybody else. Pretty much regulars. Dr. Patel, good to see you again. So Ken Crowley is are one of our resident cannabis experts. And he’s a little under the weather. We were in Miami last week and traveling back wasn’t wasn’t a whole lot of fun. So I’m gonna let him introduce himself. And I’ll I’ll let folks in and let me because last week, unfortunately, I forgot to return on the recording. So here we go. Okay,
11:48
looking correct on your end. Yeah.
11:51
It looks like you have the it’s not the whole slide. It looks like you have the next slide.
11:58
Shoot. How much work the right way.
12:02
I’m not sure. Okay, that
12:06
do that and do slideshow.
12:12
Over here, slideshow,
12:15
slideshow. Right? They’re
12:17
still playing then from start play from start right there.
12:21
They want to do view to it because you had presenters view up there.
12:26
That’s what I want to see. But how do I get it to show you just this? Now they’re gonna
12:31
see what you see on the on your screen.
12:36
Well, you could do it that way
12:37
too. If you go back out and do it do either this slide or beginners view. That’s how that’s how we do it. Yeah, there you go.
12:47
There you go. Perfect. Okay,
12:50
that’s I can’t see my notes.
12:55
You should be able to see it.
12:57
I can’t. That’s why I don’t know how to set this up. Right.
13:03
Well then do it, do it. Do it the way you had it. Then do the Presenter View and just make it bigger. So the way you think that just hit here you go.
13:14
Can you guys see the Yeah, we can see. All right, well, I do need to disclose that my primary employment is in the cannabis space. So I do derive revenue from it. The learning objectives you should be able to list three medical conditions that cannabis has successfully helped or treated. Describe the importance that formulation and route of administration has on the onset and duration of action of cannabis in humans and lists three routes of cannabis administration. Really tough objectives. The goal of this presentation is just get you familiar with basic cannabis terminology. Discuss general considerations when you’re considering a cannabis product or recommending a treatment. I’m going to list some of the most common real world medicinal uses of cannabis and then present some published out in case reports supporting a few of those indications. So this is the cannabis leaf on the right. And an example of the finished product called the bud which is the cured and trimmed final consumable form of the cannabis plant. today. It’s really hard to recognize the difference between hemp and marijuana. Hemp being on the right and a marijuana cultivar or being on the left. So both plants are Cannabis sativa L which describes the species of marijuana and how to regulate the terms or regulatory terms based on the THC content. Marijuana having greater than point three milligrams per gram of THC and the dry weight of the plant and it’s still as of this day of federally schedule one drug which by definition, has no recognized medicinal value and as a highly addictive and him having point three milligrams per gram or less of THC in the driveway that the plant Congress amended the farm bill in October of 2018 and defined hemp and all of its components and extracts a agricultural commodity and legal in states that have approved USDA or equivalent programs and by default federally legal based on those state approved programs. Bacteria and fungi have strains, but plants do not a strain is the laypersons term for cultivar or describing a phenotypically different plant typically named by the grower based on smell, appearance and physiologic effects. common terms used describe sativa as a taller, more slender plant. It generates more of an energetic effect in because being a short or squatty plant and generally provide a more of a relaxing effect but greater than 95% of the flower market today are hybrids which are a mixture of the two varieties. Names for those above three, respectively are Jack horaire blueberry or Cannatonic keema var. is a is a term used to describe the actual profile of the plant and hopefully chemo var will be used as we move cannabis into a more acceptable and reproducible form in medicine. The most clinical studies of cannabis in the past focused on the contents of two major cannabinoids THC and CBD. Regardless that now we’ve found over 150 phyto cannabinoids in this heat map from David Mary’s lab in Israel. On the x axis, it’s got the it’s really hard to see but it’s got 36 cultivars, and down on the y axis, it’s listing a whole bunch of phyto cannabinoids. Now, typical testing in the US today, just two years ago was nine to 13 Now some of the cannabis labs are testing as many as 23 phyto cannabinoids partly because there isn’t a lot of standard references, but that is changing rapidly. Probably next year. We’ll have a bunch more that are available but the challenges you’ve got 10 different types of THC 10 different types of CBD and so on. All of these phyto cannabinoids are active they have some physiologic effect and in certain combinations can really generate a beneficial or not so beneficial outcome in in any individual. Now as of this publication in 2020, there have been over 27,000 published studies since 2020 in peer reviewed literature. I like this slide because it just describes some of the components of the cannabis plant. It’s got some good references. So this is looking at a diagram of the phyto cannabinoid acids and their metabolism in the plant. The plant produces phyto cannabinoids in the acid form. The mother of all is CBG a
20:09
and looking at
20:13
the two dominant phyto cannabinoids THC on the left and CBD on the right. Following harvest decarboxylation is generally performed in some form of an extraction by by using an extraction method, but light or heat can change these forms even in the plant it’s remarkable that all of these phyto there’s so much activity with phyto cannabinoids and even a terpene beta carry awful and is an agonist at the CB two receptor. Now there’s general terms that can be can be used to describe extracts full spectrum broad and isolates. The full spectrum is attempting to maintain the full profile of the cannabis plant that was processed broad spectrum is trying to attempt the same thing without any measurable THC that’s detectable and isolates our extracts they’re generally greater than 99% of a single cannabinoid.
21:55
The extraction method
21:58
will determine what components of the plant are able to be removed, and that content vary significantly. co2 is probably the most common marijuana extraction that’s used in the cannabis space in the US followed by light hydrocarbon. But alcohol and different fatty acid solutions are are used as well as some of the old forms which are water, ice and steam. And these produce from the same material. A very different sometimes very different amount and content of phyto cannabinoids and terpenes in the commercial, big farming platform, petroleum hydrocarbons are generally used in in the commercial space for him. Those are the main methods of extraction. So these are some of the common types of routes of administration that are used. And you can pretty much find cannabis in every pharmaceutical dosage form that exist except injectable inhalation uses both combustion and vaporization ingestion. There’s a term use edible, which I like to try and focus as food, Candy drinks, etc. But they’re both being consumed orally, whether it’s a pharmaceutical dosage form like a tablet or capsule. sublingual and buccal means placement in the mouth both looking for oral mucosal absorption and then you have topicals transdermal patches, suppositories, bath bombs, you name it. Many of these routes of administration will avoid first pass metabolism which is pretty significant and can have a significant impact on the users experience. So some general guidelines that we can use looking at the route of administration inhalation usually has an onset of less than a minute, and a duration of one to three hours. Looking at the research or the literature. The CPE Max is generally around five minutes. You don’t get as much of an anti inflammatory effect as with any of the other routes of administration, but it’s probably still well above 70% of the form that is consumed in by US citizens.
25:26
using cannabis today,
25:30
edibles and orals generally have a 45 to four hour onset of action and the duration is four to 24 hours. It’s really dependent on what’s in the stomach at the time of administration. And this is where it’s, it has such an unpredictable onset and duration for most people. This is where people get to have had a gummy or a cookie or a brownie and they didn’t get any effect and they take another one an hour later and they still didn’t get an effect and four hours later they’ve had four or five servings and then they get so high they wish they were
26:18
not high.
26:20
sublingual tinctures or fatty acid solutions they use all forms of fatty acid solutions today usually have an onset of action from 15 to 45 minutes but it depends on how long they hold it in the mouth before swallowing and the solvent used if it’s a true tincture. Ethanol is about 85% and the onset of action is much quicker than something in a fatty acid solution. The other problem is most of the instructions on the packages today follow some other Pharmacopoeia not the USP. They miss brand tinctures which are not ethanol based solutions. And the confusion comes when people describe their effect the onset and they’re using the term tincture and it’s just not all the same. buccal absorption is placement between cheek lip and GM. dosage forms include a Trosky a film and an oral dissolving tablet and OD T. They they have pouches have a number of different delivery systems, but generally placement in the mouth. You can get the least amount of saliva production which allows for more oral mucosal absorption and less going down the hatch. And turning into an oral route of administration. onset of action is typically three minutes to 15 minutes and again it’s variable based on the formulation, but the duration up to eight hours. Challenges facing patient order their practitioner when recommending or out of the administration is that products in any category can be very different in formulation and content. So this makes already a complicated product, delivering medication. Even harder to guess out unless you really understand the formulation and the actives and whether they have been mechanically or chemically modified, which currently many of the active forms in the market now can have chemical or or
29:21
mechanical
29:23
modification which will change their bioavailability substantially. You know a typical oral dose of an oil filled CBD 25 milligram capsule will be around 16% But you can increase that bioavailability changing it chemically or mechanically by making it a nano particle size to greater than 90%. onset of action is nonlinear for cannabis. It’s biphasic and it’s dose dependent. So it’s a real challenge unless you follow some of the rules that we’ll talk about in a second. The genomics of the individual have an impact. We talked a little bit about route of administration. And then what are the major API’s the act of product ingredients or pharmaceutical ingredients that are in that particular recipe because multiple phyto cannabinoids can have an influence on all of the phyto cannabinoids in that that mixture. And so it’s important not to categorize clinical outcomes based on route of administration and that particular formulation. So this is an example of how much we don’t know. This is a 30 year old having eight seizures per day on four different medications. He went to a dispensary and was recommended a three to one ratio CBD to THC. So that would be 30 milligrams of CBD 10 milligrams of THC,
31:30
no terpenes
31:32
in MCT oil and the cultivar was diamond dou G this patient became seizure free and around 24 hours and stayed seizure free until his next refill when he went back and asked for Can I get a three to one sublingual solution 40 milligrams per mil. Well the dispensary bud tender gave him the same looking product. If we look down at the phyto cannabinoids down here, most common things that are listed are CBD, THC. Maybe the acidic forms of both of those but typically CBN.
32:23
Just three,
32:25
and if you look at these, they’re almost identical. But that particular extraction product from Lemon Haze allowed or did not control his seizures. And again, it came from two different cultivars. The dispensary the bud tender that was in the dispensary also knew that because he was an extraction one of the extractors that they had changed their cult DEVAR and he was able to re extract more diamond OG and get this individual back into control from the same material. I don’t know if the patient was able to continue to maintain that because the cultivars of batches tend to change
33:23
based on where they are produced.
33:30
So you wonder how an adaptogenic herb can have an effect on so many conditions and this is only a partial list. I’ve highlighted the conditions starred them based on the conditions we see most frequently in our Huntington Beach clinic. Most states that have a medical marijuana program will have a list of qualifying conditions and allow a practitioner to recommend cannabis therapy and have regulations in place to protect their license. States with recreational programs do not require a qualifying condition for cannabis act access. So if you’ve done any reading in the cannabis space, the National Academies of Science and Engineering and Medicine published their first report in 1996 on the medical evidence of cannabis following California voter approval of prop 215 allowing the medical use of cannabis in January of 2017 18 years later, they did an extensive review of the literature and focused only on human literature and did not include other basic research. They looked at over 10,000 research articles and broke down the levels of evidence based on conclusive and substantial and so forth. What they found is that there was substantial evidence for the clinical efficacy in chronic pain in adults as antiemetics in the treatment of chemotherapy induced nausea and vomiting and improving patient reported multiple sclerosis and spasticity. Now, one October of 2022 the first study of its kind in the United States was published. It was a multi brand IRB approved randomized controlled trial to evaluate the effectiveness of non prescription CVD products currently on the US market. If you hold your phone up, you can get a picture of this QR code in the upper right hand corner and it will take you to the URL of the actual article if you’d like to take a look at it.
36:26
So
36:27
the ACEs study, or advancing cannabis education in science was a four week open label randomized with a waitlist control arm of 20 820 participants aged 21 and older with prior symptoms of anxiety, sleep disturbance or chronic and or chronic pain. 20 704 of them were randomized across 13 CBD products currently available on the market. And 296 were randomized to a waitlist control. primary objective was to document a change in wellbeing from baseline compared to the control and secondary is to document a change in pain, sleep disturbance and or feelings of anxiety from baseline compared to the weightless control. patient reported outcome measures were collected at the end of each week for four weeks using validated surveys addressing quality life, anxiety, sleep, pain in adverse events using these validated measures. Here’s a picture of the products that were utilized in the study. I am particularly fond of trophy but I loved that it was up against Charlotte’s Web.
38:13
You can see here,
38:16
the spectrum type broad versus full versus isolette and the different formulations that were used by the different companies that were included. This is a list of 13 products that were used their dosage form and the API’s and relative absorption. There was eight that used ingestion for that were sublingual, and one that was buccal as well as the CVD as well as a couple other minor cannabinoids and if there was any THC at all measured. Remember that from this slide, full spectrum there were several products five, in fact, but there was only one of the five that actually showed a measurable amount of THC. So just because it says full spectrum doesn’t mean that it’s going to contain a measurable amount of THC so looking at the impact on wellbeing and anxiety. Taking any CBD product in this study led to significant improvements across all health outcomes relative to the waitlist control at each week. So on the left we’re looking at wellbeing score. Here’s our weightless control and here’s the improvement. Mean anxiety score weightless control and improvement. Looking at sleep and pain, similar there was improvements across all health come all health outcomes relative to weightless control.
40:21
Excuse me be
40:26
looking at the results largest improvements occurred in the first week of use. Participants experiences 71% improvement and well being on average. I don’t know why my computer’s deciding to change things for me. And then 63% with anxiety, noticed a claiming clinically meaningful improvement 61% was sleep difficulties and 47% with pain and realize that these formulations were really not designed specifically for sleep or anxiety or pain. They were general CBD product. adverse events reported and approximately 10% of the participants in this list that frequency and number are the type of adverse event and the number on the right of each one of these columns. So let’s look at pain in older adults. Up to 50% of community dwelling and 80% of nursing home read residents complain of pain. Pain affects 80% of patients greater than 85 years old. The common causes of pain we’re all familiar with pain leads to decreased functional status, increased falls depression, anxiety, agitation interrupted sleep and poor quality of life. Typical adverse events of the typical pain medications that we use, can cause falls can cause sedation, confusion, constipation, incontinence, retention, many drug drug interactions there’s addiction or tolerance in the list goes on. The CDC reported the 12 month period ending in April of 2021 that there was 100 over 100,000 fatalities from an opiate related overdose
43:01
so this is
43:02
Israeli study was using Tinkham olam products they utilize bud or inhalation routes of administration very commonly in Israel and this prospective study of 20 736 patients greater than 65 or equal to using cannabis between this period of time. They the indications were pain in cancer results after six months of inhaled cannabis, which was over over 1000 subjects 93.7% reported improvement in their condition within with a drop of their NHS score from eight to four which is pretty typical in the published literature about a 50% reduction in pain. The number of reported Falls was significantly reduced. Most common adverse effect was dizziness and dry mouth and after six months of cannabis use 18.1% decreased or stopped opiate use cannabis use in neuropathic pain meta analysis by mu key looked at 16 studies with 17 150 participants, some using commercially available products and the big smalls is the generic word or term for Sativex, which is a approximately one to one oromucosal solution that is approved in over 25 Other countries still has not been approved in the US now alone Dronabinol Dronabinol are both commercial products scheduled to in three available in the US today, but concluded that cannabis based medicine may increase the number of people achieving greater than a 50% 50% or greater pain relief compared to placebo. And cannabis based medicines have probably increased the number of people achieving pain relief of 30% or greater. And a study that we did out of our clinic published in frontiers and 2018 It was an observational longitudinal study over 12 weeks with 49 subjects with a primary diagnosis of chronic non cancer pain which is the buckle route of administration for standardized cannabis extracts. We call it a trophy the onset of analgesia was reported between five and 40 minutes with an average reduction in the pain intensity numeric ratings score of roughly
46:37
five
46:40
there were 31 subjects using opiates 26 of which reduced or discontinued their use without any reported symptoms of withdraw one of the subjects being or using only CBD and 100% reported feeling an improvement in the globe in the a global rating
47:04
scale. In a
47:11
group of rheumatoid arthritis patients, they did a randomized double blind placebo controlled five weeks study using Sativex the one to one oromucosal Spray produced by GW Pharma and showed a significant improvement in pain on movement pain at rest and sleep. Using those two measures, there was no effect on morning stiffness but baseline scores were low. adverse events were mild or moderate to no patients withdrew
47:56
mean
47:57
and 21 published a patient reported outcome in those consuming medical cannabis in a prospective longitudinal observational study of chronic pain patients in Canada.
48:16
His results
48:19
showed the cannabis users reported using opiates decreased by half from baseline at 12 months and pain intensity, pain related interference scores were reduced quality of life in general health symptom scores are improved compared to baselines and that was also historically significant. So cannabis can have drug interactions and the main interactions are surrounding phase one elimination. The more than 60% of prescription medications today are metabolized by the CYP 450 system. And all phyto cannabinoids can inhibit certain families within that system. I’ve listed the most common as this is the two c two D and 3/8 families. CBD is a strongest inhibitor of all the phyto cannabinoids studied today. But they can also be a mild promoter. They don’t inhibit and. And so most the the main important thing is a lot of the data has been done using
49:58
concentrations or
50:00
doses in vitro that are 10 to 400 fold higher than supratherapeutic concentrations, then what’s actually clinically used. So, most references now are including because Epidiolex a CBD product is now FDA approved. They’ve started including both THC and CBD in the drug interactions. I particularly like how faxing them parisons Alexa comm has done a good job of that. Project cbd.org is a great reference for health care providers as well as patients. And I recommend you take a look at this and the science behind what you know adverse reactions can and drug drug interactions can involve based on real products that are out there and fairly good studies. There’s more and more that are coming out the most recent one that I saw on I’ve seen involved digoxin actually in inhibiting its metabolism and getting an elevated level from THC. So, general rules of starting dose, it’s always good to start low and go slow because at some point there is a lower dose that’s going to get a patient a beneficial effect before that changes and you lose that benefit and then at a much higher dose possibly you’ll again get a benefit. In our clinic, any patient that’s cannabis naive always starts with CBD, a minimum of one to three days. And we see whether that patient has any benefit whether they’re using it for anxiety or pain. You don’t tell him to change any of the medications that they’re on. You just say add it and let’s see what happens. And then once CBD is on board then you can add THC if you need to generally hit low doses starting between one and 2.5 milligrams. Remember that the acidic forms of THC generally do not cause intoxication, only the neutral forms and the route of administration will also have an impact based on whether there’s first pass metabolism or not. For instance, in elation, you’ll only get about 10 to 20% of a given dose of the THC component, converting to the first metabolite 11 hydroxy THC, which is typically three to six times more potent in its intoxicating effect. When you take something orally you can get 100% of that THC being converted to 11 hydroxy. And so, depending on the route of administration, you can have huge differences using the same product. Cannabis has a biphasic action like I talked about, so there’s always a response of a lower dose. Remember that CBD is an antidote to THC. intoxication. And that’s one of the reasons why we always start someone on CBD before they will try THC in any combination. The certificate of analysis this particular one is from the trophy product that was in the ACEs study. And this is a sea of A and A provides these details what’s the cannabinoid profile is there Miko? Is there microbiological contamination like mycotoxins, is there? residual solvents, what is the terpene profile? Is there any pesticides or heavy metals? These are the things that are important to know about any product that you’re considering. Either recommending or patient ever buying if there isn’t a sea of a accessible from that product for that batch. Then that’s a product that you should never buy or or take. The purpose of the CMA is to make sure that what is on the label is there. It’s safe and it’s contamination free. These are organizations that provide great information society cannabis clinicians is probably one of the longest ones. But all of these organizations these are the current links that you can get are a great resource for continuing education. Many have modules that you can go through and now I think the society cannabis clinicians has been has a certification program that’s relatively simple to go through in in obtain to give yourself a good comfort level. When you step into the space of answering all your patients questions, which they just keep coming. Seems like everyone’s going to have to engage in this space if you really want to help your patients. And that’s it. Thanks so much. And I survived without coughing too much. You’re good, good.
57:00
Good, good. Good.
57:04
So we have some things in the in the chat. Some questions do they have rectal suppositories? Is that a good way? To use it?
57:15
I find that they’re fabulous. When but then I’m using a you know a pharmaceutical base I use PCC as MBK base if any of you Doc’s work with a compounding pharmacist, MB MBK.
57:40
I think
57:43
does a very good job of delivering the phyto cannabinoids rectally and one of the nice things about it is there’s in any given a equivalent THC dose, say 100 milligrams of THC. If you took it orally, they would get a certain effect if you take it rectally. They’re going to get about 30% of the intoxicating effect of that dose. So that’s kind of a an average number. You can use. I use suppositories. CBD suppositories I make for a company, and they use them for female issues. They’re delivered vaginally. NBK base can be vaginal erectile PMS, endometriosis pain associated with that. They work fabulous
58:59
okay,
59:00
I’m not able to oh, there we
59:02
- You can’t see it. Okay. Here in Pennsylvania. The MD is a qualifying provider but the script is written by the form d.
59:12
There isn’t a script written wait and Pa pharmacist are involved.
59:22
Right. Okay, what is the question?
59:29
I’m not really sure. Mary, is it? Dr. Southern? That’s that’s your question.
59:36
No, there wasn’t a question. It was just in reference to you know, the qualifying provider doesn’t really recommend the dose. It’s the farm D that recommends the dose, which is basically I think a lot of states.
59:51
Well, there’s not many states that still are or allow a pharmacist to get involved. There’s still states that the Board of Pharmacy we’ll attack a pharmacy and pharmacists if they put CBD in their pharmacy today. So what was it Connecticut? Maybe Dr. Block can chime in but the East Coast got or kept the physician patient connection or at least health care provider. Being able to touch the patient with guidance rather than, you know, California, which tried to do everything possible to prevent a prescriber from guiding a patient using cannabis. So it really depends on the state.
1:00:52
Right.
1:00:54
I wouldn’t go east coast there can’t that say that Florida, from its inception actually mandated that a physician was there to certify again just as a point it’s not really a moot point. Cannabis can’t be legally prescribed. And that’s a key word anywhere in the country be scheduled one DEA designation. So in Florida, the physician is central to a patient access through what are called certifications the initial visit done in the same room and then you get telemedicine especially during COVID. That sort of adjusted the way patients are seen in all aspects of medicine. So let’s just say that I think the point Ken’s bringing up is that Florida still values the importance of a physician to be the the can’t say the facilitator here but the the determined of a medicine being treated as a pharmaceutical were those states that are either going recreational or even issues now with gray market things like delta eight which he didn’t get too much into that’s intoxicating. That’s all something that hopefully a legal medical market in a state keeps physicians central to it. And MDS Indios by the way, in Florida are the only two. Doc’s recognized for that. And naturopaths who bring a lot of talent to the space because of it being a plant are not recognized in their full capacity like they are on the West Coast states. And up in Canada. So here if a naturopath comes here very often they’re doing a dietician type roles, hospital based things nutrition based things but are not an eligible physician to see patients and in comparison to that. Last I looked in Arizona 80% Of all the certifications there for patients were done by naturopaths. So every state’s doing its own experiment.
1:02:48
Thanks so much for that. There’s a question what’s the best product to use? For Lower Back Pain with ridic ridiculous. Like severe sciatica it really depends on the individual. I can’t stress this enough. I would approach this patient first with hemp based products, getting them not changing any of the medication that they’re on. That’s a key start adding product I can tell you that for instance, a trophy which is a Buckley administered unit dose form of hemp CBD. You could use 20 milligrams three or four times a day. Broccoli, and you would see how that helped. If that wasn’t adequate, then you would have them consider adding THC if they were in a state that allowed them to have access to it. Starting with you know, a two and a half to five milligram dose of THC as long as their CBD on board. Two and a half to five milligrams will get a non naive patient possibly inebriated. And so dosing is always if you’re adding THC always start dosing in the evening or some time point that they can take it and not risk needing to drive and if that was too uncomfortable, making sure that they had CBD to rescue them. There is nothing that THC is just like a panic attack. People with a panic attack feel like they’re going to die. Well, you can take enough THC to cause that same type of an effect. And that effect is not going to harm the patient. It’s only going to last for as long as you know, that particular dose, their elimination system, you know, they’ll get through it without any sequelae and you just need to make sure that if you’re starting someone on THC, they understand that there’s no reason to call the ER. It’s going to pass just drink plenty of fluids and in relax
1:05:56
any interaction between cannabis and opioids, opioids?
1:06:00
Well cannabis doesn’t suppress the respiratory center in the brain. So there is an interaction in what’s beautiful is it generally will give a better quality of life, better pain control, and in my experience, lessen the likelihood of escalation or tolerance with opiates. Generally we get about a 50% reduction in patients that are chronic pain patients and we start incorporating cannabis. If if CBD doesn’t work full spectrum CBD doesn’t make it then many need to go in and and get this true, you know a one to one ratio of something with THC in it so some people do really well on CBD and some people don’t. Some people need a lot of THC in order for it to work in you know, it’s just their genomics.
1:07:14
Like anything else, right? Yeah,
1:07:17
pretty much.
1:07:19
Give the products you use for some of the most common issues a family practice will face
1:07:32
again, you know, I’m I’m the I’m the inventor of the trophy delivery system, a patented buckled delivery system. And for a hemp based product. It’s absolutely remarkable at a 10 to 20 milligram dose, how you can get benefits in a patient with anxiety. Panic attack, I’ve taken people off the ceiling in under seven minutes with a 20 milligram dose of CBD in the you know, in the buccal route. There was a study done in in South America recently that I probably could find and share with you. I have a whole section on talking about fibromyalgia and some of the literature’s surrounding cannabis in its benefit. There’s the you know, very simple, very low doses that were used in a particular study I’m trying to remember that were used in a sublingual oil based solution. And they got remarkable results in the in the surveys that they used in fi in these fibromyalgia patients. You’ll find many times that a patient that is not sleeping well and has anxiety if you use CBD and it helps with the anxiety, they get better sleep. We probably have around 40 to 60% of our patients that use CBD alone for sleep. So you don’t need to have something else added to it can interact with supplements I guess it could if you’re taking big enough doses you know some of the dosing for some of the childhood
1:09:59
seizure disorders
1:10:03
you know, get up above 20 milligrams per kilo. I mean I’ve heard people going as high as 50 milligrams per kilo, which is just a massive dose. Typically word dosing in the in the real world not dealing with those genetic disorders. You know him that well under 100 milligrams is a single dose and many times in the in the five to 25 milligram dosage range. It’s you know, it’s we use a lot lower dosing than a lot of the studies are using.
1:10:55
So,
1:10:56
that again, you you look at how the products are metabolized. You know, we know that Clobazam definitely because of its active metabolite, you’re going to have to lower the Clobazam dose on a patient substantially. But all this stuff is in the in the literature so all it takes is a quick look.
1:11:25
And can I add something about those things second, because I you talk we use the very familiar phrase that’s popular about start low and go slow. Most of the evidence based data is based on studies that came from the first 40 of the last 50 years of studying cannabis and THC and not surprisingly, there weren’t as many concentrated chemo VARs as there are now so most of that evidence based data is a little bit skewed to say that yes, in low doses it works for certain things. I doses seem to be more not just acceptable but more efficient for neuropathic pain and cancer pain. And if you’re getting into other stress disorders, true PTSD, not a diagnosis of convenience, but true PTSD is determined usually by a trained psychiatrist. So with the exception of those things, most everything else about that start low go slow, has a sensibility about what is the optimal dose goal, and that goal is to ensure that both a cannabis naive or a tablet, a cannabis tolerant, savvy patient achieves the same safe and effective outcome where the benefit clearly exceeds risk and that you’re not just trading off one problem for another. But then there’s the optimal outcome goal, which is a little different. And that actually is to ensure that cannabis is impact on the endogenous receptor system stays consistent with what the system’s purposes, which is to maintain the physiologic balance, and that’s why it’s there in the first place. So if you go off the deep end, you can actually disrupt balances by pushing cannabinoids where they probably aren’t naturally meant to go. And so staying within what the purpose of the endogenous system is, therefore, in the first place, I think is an understanding that a lot of physicians haven’t quite grasped yet into their dosing regimens. And that’s just my own little editorial comment. Start low go slow was the brilliant phrase you use. Thanks again.
1:13:30
Yeah, that’s always tough. The CBD slow reflexes. A THC is definitely documented, again in the neutral form, but CBD typically doesn’t unless you’re one of the really sensitive people that can feel like they’ve gotten 50 milligrams of Benadryl and and some patients are extremely sensitive to CBD. Even I’ve had one with very low doses of CBD show, clinically significant orthostatic hypotension. So they’re all out there. There’s outliers, but the majority will not show CBDs close your reflexes.
1:14:27
Does cannabis in general, affect driving?
1:14:33
Say that over again.
1:14:34
Does cannabis affect driving
1:14:39
hemp based products I would say generally if they’ve been properly labeled, and the and they meet at the hemp diagnose definition. They shouldn’t
1:14:54
but
1:14:56
those extreme there are clinicians, my colleagues that are looking for ways to help patients in skilled nursing facilities that have cognitive decline, including Alzheimer’s and we’re trying to come up with dosage forms that will be able to deliver to that patient, at least two milligrams of THC. So it has to be kept below point 3% In order to fall under the guideline. So we are doing some manipulation in two milligrams with you know, eight milligrams of CBD or CBD that may be sedating for someone and could affect their ability to drive so you got to know about which products you’re talking about.
1:16:02
Okay, thank you.
1:16:05
Cannabis intoxicating Delta nine THC can add sedation. Oh, that’s Dr. Block. Okay. You already talked about that. Mainly CBD is known to impact Cytochrome P 450. potentially impacting the half life of anticoagulants. Right? In particular warfarin. Can you od unspin CBD on CBD Oh D meaning
1:16:39
overdose.
1:16:42
Now again phyto cannabinoids don’t impact the respiratory center. You can take enough to possibly cause severe diarrhea and some of the others adverse events that are listed on on the on the the typical adverse you know list of what cannabis can cause but no. For driving blood levels do not necessarily correlate with the good with the degree of impairment that’s for sure. Cannabis does not impact driving Studies at the University of Iowa. driving simulation lab show drivers perform with extra caution by often driving slower than normal and showing an inability to stay within a lane. Cannabis does impact driving. Right. So again, THC is going to impact driving CBD is not
1:17:54
for most people.
1:17:59
Are there any books on the subject? There are a number of them. And I will get that list and provide it to you guys. I can do that for you, Bill. I’ll send you a list.
1:18:17
Please do. We’ll send it out the news, you know on one of our weekly letters. Dr. Richwine here
1:18:28
is a question by W R. I’m a PA provider. Each medical dispensary has either a pharmacist or a physician to consult patients MD or do certify that a patient has an approved indication got it.
1:18:55
Em in
1:18:56
the doc certifies based on condition the doses done in dispensaries here by the farm D that’s how it should be in it’s unfortunate that most of the states don’t have this relationship. It’s just a shame. Can CBD be used just for health maintenance?
1:19:18
Absolutely. Keeping
1:19:22
your endocannabinoid system in good shape is you know just as good as you know I I compare it to using the good
1:19:35
fish oil.
1:19:39
If we want to use CBD to help with sleep, how many hours should it be taken before asleep? It really depends on the individual. If it depends on the components of what’s keeping them asleep, is it pain? Is it anxiety? Is it a combo of both? You know good sleep hygiene requires you know go to bed. That isn’t the place where you watch television until you pass out. You know, things like that. But on in general we have a sleep product with melatonin in it and we will tell a patient take 30 minutes before you go to bed. Some will be ready to go to sleep in 15 minutes. Others won’t be ready to sleep for a couple hours. It just depends on the individual what is the delta eight strain that is being sold commercially? Well, Delta eight is a phyto cannabinoid that’s been extracted and concentrated. And you know, it’s just delta H THC. So that is that’s really you know, there’s several even delta delta 10 there’s companies out there doing things that just you know, aren’t right. And that’s one of the products that some states are trying to prevent access from on the you know, base side.
1:21:34
Can Can I give a little comment on delta at the moment because delta eight occurs in incredibly tiny little amounts in the natural plant. Yep. But But what happened? And this is political and it’s actually an interesting process. The 2018 farm bill you mentioned was what made marijuana get redefined so that hemp would contain a strict definition that it would have less than that 0.3 amount of Delta nine THC, which is the plants really only practical, intoxicating molecule. Well, this other relatively rare cannabinoids, it’s also intoxicating, Delta eight is not practical to try to farm so much hemp that you can extract it right from the plant. So what’s happened is that with the 2018 Farm Bill, all of the states now are farming him, but they’re not farming it for the traditional textile. They’re farming it for CBD or cannabidiol, which two and three years ago looked like it would be the new wonder drug. So as a result, the price has come way down and there is a national glut of CBD. Well, I’ll tell you, I’m a chemistry major from memory before medical school, and it’s not hard to know when you expose it to certain acids. Now this being CBD that is chemically processed with an acid process. It can be turned into delta eight THC synthetically and that’s how come because of the glut of legal through hemp CBD. Now it essentially is take this for what it is. I know the chemistry. It’s a designer drug. Now that has declared itself through a gray not black market but a gray market. And that it’s being sold to anybody and everybody including 11 year olds in gas stations around the country. That’s not good. And I’ll tell you why. We know a lot about the other common intoxicating chemical that’s Delta nine that’s in marijuana. But the hemp field through an unintended consequence of that farm bill now has found a way to sell something that people want something that’s intoxicating. The difference is we’ve got zero evidence based data or information on what happens to people when they consume Delta eight other than they get high. in similar ways it appears to to what THC does, but it’s relatively more concentrated because it’s coming from a processed oil and staying one. It’s coming from CBD and made into delta eight. And it also then is put into things that are taken not necessarily sublingually like your trophies, but are ingested through gummies in the sword, which then your liver the same week converts into hydroxy 11 THC which is roughly three and four times stronger and last three or four times longer than delta nine THC. So a little old lady taking it could be out for the count when she doesn’t realize what she’s taking because it’s usually not packaged. And labeled responsibly in a gray market economy. So that’s my little editorial comment about how it’s really not derived directly from the plant at all, but synthetically constituted as being something else. That is intoxicating. Thank you.
1:24:51
Absolutely. Yep,
1:24:54
you can make THC, all of the different isomers using CBD.
1:25:04
I want to talk
1:25:06
Hey, thanks dr. Block for sharing.
1:25:09
Thank you for being here.
1:25:10
I see a hand up
1:25:12
Michael. Wait, oh, you’re on mute. When can I talk?
1:25:22
Move your cursor around and click the
1:25:27
can you let them off? Phil? I’m not sure.
1:25:32
Oh, I can ask him to unmute himself. I’m not sure if I can do it so
1:25:44
the bottom left Mike very bottom left there. It says he’s
1:25:49
it looks like you’re unmuted. Here you go.
1:25:53
You’re good. Can we hear you now you’re good. To go
1:26:01
go ahead and talk Michael
1:26:07
yes is talking so no, I
1:26:15
don’t hear you
1:26:22
says he’s unmuted so sorry.
1:26:26
We’re getting while we’re getting Michael on I just want to make a comment about the trophy products and the patented delivery systems that have been developed by Kent Crowley. They’re pretty incredible. I run a pain clinic in West Virginia for about 40 years. Nearly all of my patients we recommend some type of cannabis like CBD usually CBG is you know, becoming more of a factor. But when you talk about delivery systems, it’s the Goldilocks things. It can be too fast it could be too slow or it can be just right. If you’re doing the inhalation vapors, whatever you’re taking, say you get it fast within three minutes. They can become habitual and dependent upon it and that’s not always too good, especially if you’re blowing hot smoke in your lungs. And the other way of if you’re in real discomfort, either anxiety or pain, and you have to wait 45 minutes to get a result that can be a long time and with the truck is with the beautiful absorption. It’s so consistent and quick and easy that it seems to be just right, the Goldilocks just right stuff. So in 10 to 12 minutes you can usually resolve definitely the anxiety issues and the pain issues. So anyway, I just wanted to put a plug in for that because I recommend the turkey products to all of my patients. And usually once a patient starts to use it, they don’t find anything better. It’s something that works well.
1:28:03
So thanks. Thanks, Doctor. You’re now Michael. Still no,
1:28:13
he may not have a speaker attached to his computer.
1:28:17
Well, because it says he’s unmuted so okay,
1:28:21
maybe if you can type in, type in your question.
1:28:25
I mean your question your question, Dr. Gerber. While he’s doing
1:28:32
that kid, I wanted to find out what you think is the regular administration just for health with your regular trophy and then the trophy with melatonin? What’s the level of an administration that how much do you think people should do for insomnia? Depending on insomnia
1:28:51
it really depends on the individual insomnia can be all over the board. I have some people that take you know three four servings and which are 10 milligram in that particular product. That’s the bar form which is being comm which is being moved to the to the unit dose form, which
1:29:22
I happen
1:29:25
to have a box here that I could open and show you
1:29:31
this is the the new Oh wow. Okay, those four so it
1:29:44
as individual, okay, those trophies you can pop out you can take half for one, they’re 20 milligram dosing. But for most people is what I would recommend, I mean if you’re exercising, doing it, and you’re doing heavy exercise and you want to recover quicker 20 Taking 10 Or taking 10 mil 10 milligrams of a trophy an hour before and right after workout you. We’ve shown in a double blind crossover trial, at least four of the nine subjects that completed the study that were you know, elite level CrossFit
1:30:43
practitioners.
1:30:46
They showed measurable improvement in recovery and in energy production.
1:30:56
What about expiration date? How long does your faith your old trophies go past expiration date
1:31:02
all. We have three years stability in the old form, and we’re currently doing a three year accelerated study in the unit dose foreign which we expect to be three years as well at least. Okay, thank you. The nice thing about this because their temperature sensitive, has now it can melt reform. You just lay it on the counter and it will solidify it’s still uniform in its composition. So it is now eliminated the problem of delivering trophies to Phoenix when it’s 120 degrees.
1:31:51
You have some other forms though can’t write you have a patch and and you do have some pills right?
1:31:58
We have we have a capsule that’s nano using nanotechnology. That’s an oral capsule and we have a patch. We haven’t remanufactured the patch yet because the FDA is coming down on any company that is using
1:32:24
a a product
1:32:27
like lidocaine which we have in ours, lidocaine and menthol that has a monograph associated with CBD. They’re sending them warning letters, so we haven’t been able to figure out how we can put that on the market again without getting an FDA warning letter. really sucks is the best patch on the market. People beg for that patch.
1:32:58
Yeah. We use
1:32:59
a lot of them so and we don’t know how to how to avoid the FDA attack. I mean, this is really sad. They’re supposed to be protecting, you know, patients, all they’re doing is preventing access. I don’t know if this
1:33:18
may help, but there’s a lot of legalities into private membership associations, but a lot of people are going that route to avoid stuff like the FDA. Have you and your company checked into that.
1:33:33
What do you mean, you basically sell
1:33:35
a subscription. And that way you can get patches to your patients because they’re part of a private membership.
1:33:46
I didn’t know you could do that. But I definitely will look into it. Thank you. So so much for that Joel.
1:33:53
Definitely. PMA.
1:33:58
That’s wonderful. Thank you.
1:34:01
That all right.
1:34:01
I mean, we’ve had to go through almost a year of retooling the entire website because of the the requirements that you can’t make any claim and we have studies for with trophy and and we’re if we use one of the trigger words insomnia, right I mean, you know, I can’t even use oromucosal
1:34:34
Yeah, yeah. Yeah. Paul salad was one of the one of the first people like 20 years ago in farming that started to go full blown organic with his farms and the they were coming after him hard. And so he started the PMA and that way he can get his organic pigs or his organic beef out to his membership people. And that was the way he took on the government. It’s pretty powerful.
1:35:04
Awesome, because we’re, you know, we’ve we’ve focused on prescribers now, because Trowbridge does a great job, when it’s prescriber directed therapy. And, and so we’re closing you know, the way that you can access but that membership thing may be a real winner for us to get around the challenge. Thank you so much, Joel.
1:35:32
Definitely. Will keep in contact and I’ll send you some more information. Cool. Okay,
1:35:42
anybody else have any other comments or questions? Michael? Not sure why we can’t get get in touch with you. But send me a text message and I’ll I’ll try to relay
1:35:58
so okay. Anyway,
Bill Clearfield 1:36:03
thank you all for being with us. Dr. Block. Good seeing you again. It’s been a while. Thanks for your input. Can’t made it through. He’s good. You did fine. He did a great job. Thank you for your for everything that you do. Thank you. For what for what you do for us. And next week, we’re going to have David Kahn Juan David. What does he do? He does EMF some sort of EMF equipment right.
1:36:30
So he P EMF and I think he’s a chiropractor? Yeah.
1:36:35
Kyle, electromagnetic field therapy.
1:36:39
Yeah, I know. He’s got like beds and pillows and all sorts of great stuff. So future. Yeah, you know, you know me I’m too I’m too left. Fast to know what that stuff is.
1:36:54
That stuff’s old technology. It’s been around for 50 years. There’s a lot of
1:36:59
you know, so I gave a talk last night for Dr. Lawson’s group on methylene blue and you know, that’s old technology too, but
Bill Clearfield 1:37:09
got the I tried to put it in perspective, though. So I gave this is what it does. And this is what you use it for Bing bing, bing, and it didn’t go well. They they took over after an hour. And then they were talking about all sorts of things. So like, as they usually do so. So that’s next week. We have Dr. John Casey the week after that, and Dr. Carolyn Macon who’s frequency specific microcurrent and she’s going to talk about Ehlers Danlos Syndrome. Then on May 30,
1:37:39
maybe we can get Dr. Block to give a talk. He’s an author now of three textbooks, or at least portions thereof. In ones is someone becoming or being released here shortly, Jeff?
1:37:56
Yeah, and actually the third one this year also. And there was somebody who in the chat asked about are there textbooks in this? There’s a lot of magazines there’s a lot of spirit of industry sponsored rags, but not really many textbooks. So in 2020, I did a chapter on cannabinoid receptors and medical cannabis that was in a book called advanced therapeutics in pain medicine. It’s a it’s a real book, there’s 24 chapters. It’s the integrative approach to treating pain and it’s usually chronic pain in that respect. Then another two weeks or so or other week from now, the first total book actually this one involving cannabis is cannabis. Chemistry and Biology fundamentals. The editor is Mahmoud el Solio, who runs the federal government’s farms and the University of Mississippi at Oxford, so he’s technically the Feds grower for the last 40 years about a kid in Colorado. And the third book is a pharmacy textbook called Brody’s human pharmacology. It’s it’s seventh edition. I’ve rewritten actually two chapters, the first one on cannabis therapeutics, but I looked over the book and I told them I do the cannabis therapeutics chapter if they will let me also rewrite where cannabis is also mentioned in their chapter on drugs of illicit use and abuse. Otherwise, you can come across as being too much of an advocate if you don’t approach it from the fair and balanced way. So those are three different textbooks, two of which are coming out in the remainder of this year. So thanks for the plug. Can’t I make no royalties?
1:39:33
Yeah, there’s the advances in advanced therapeutics and pain medicine. And then Goldstein Bonnie, if you don’t know her, with a Ethan Russo forward, this is cannabis revisited revealed excuse me, and that’s another recent publication that goes over a lot of stuff.
1:40:01
Where can we get your work? Can we get those books from Jeff?
1:40:08
What is it so the first book is CRC Press. That’s the Taylor and Francis group. That’s a fairly solid second tier medical publisher. And while neither is the Harvard press or Lancet, the other one coming out in a week or two is do Grauer the publisher is a German publisher again, in health care. That’s again, cannabis chemistry and biology fundamentals. The third book I’m gonna mispronounce it. Eval seer is the publisher of Brody’s human pharmacology that has not been released yet, or it doesn’t have the release date, but it’s supposed to be sometime later in 2023. So I think all of those if you pulled up Amazon, you could pull up the individual books. I know the one Kant was just showing with the black cover, you know, that’s certainly available that way. And I think most of them are all available also as ebooks, so doesn’t have to be that expensive.
1:41:11
Great. Okay. Don’t be a stranger. Hey, thank you guys.
1:41:17
Thanks so much. I’m gonna go.
1:41:19
We try. We try to try to have each other’s back. John, you got anything for us?
1:41:25
Everything’s beautiful. Thank you what’s happening in the medical school world? 100% Positive times 10. It’s outrageous. We got some wonderful, very, very advanced thinking people at the medical school. And they’re in line with everything we speak of and everything we do. So they’re brave people as well. And they’re probably going to pull it off. In other words are going to incorporate nutrition research and all of us are for nutrition and research. And they go way beyond that. They’re really osteopath.
1:42:00
You know the name of the school yet have they have they named the school?
1:42:03
This school will be Meritus osteopathic medical school. Maryland is run by a medical system like Blue Cross in places you have Meritus operating system in Maryland and they are in such need of qualified physicians, that they have decided to start a medical school and train them as they think would be appropriate. And they just have really high quality people in the whole thing. The Academic Dean, Chief resonance family practice LMT they’re way beyond anything I was expecting.
1:42:42
All right, keep us informed. Yeah. Okay.
1:42:47
Anybody else have anything to comments, questions?
1:42:54
Okay, thank you. So
1:42:56
always bill for keeping this thing running.
1:42:59
Yeah, yeah. Yeah,
1:43:01
we’re, you know, we’re not stopping. So I’ve actually had a couple of folks making inquiries about maybe doing a hands on workshop kind of program. And I may actually have a couple of folks coming here to Reno, the end of June beginning of July, if anybody’s interested and we would do
Bill Clearfield 1:43:25
some aesthetic stuff. Probably how to do how to do pellets, things, things, things of that nature. So if anybody’s interested, let me know. And we’ll we’ll put it together. I think we’re getting we’re getting ready to Yeah.
1:43:44
Dr. Robin chimed in.
1:43:48
You’re, you’re muted. You’re muted. Dr. Rob. All right.
1:43:52
I just want to say thank you. I didn’t know about this group. I ran into you guys, I think at an omad conference in San Diego, and it was very surreal because I didn’t know that they allowed that kind of thing at omit and I was bleeding. Do you want me to I don’t want to get anybody started because I I’ve heard I’ve heard a little bit but I’ll hear it sometime but I just want to you know that was my that was where I hung out the whole time. I was there just to take an exam and and it was like, Oh my gosh, my people are here and then then I lost you again. So rented to Bill somewhere in the last couple of days on LinkedIn or something like that. So I just want to thank you guys for for holding the torch. Sounds like you’ve been doing a really beautiful job and I’m really like, happy to meet you and hope to be part of this. Yeah.
1:44:54
Thanks, Lisa. Thank you for being here.
1:44:56
Yeah. Oh,
Bill Clearfield 1:44:58
I did have one once they just one little thing at AMG. A do came up to me and she actually apologized to me and said he was in the I know you don’t want to hear John. He was he was at that meeting. And he apologized for not standing up standing with us. So I won’t mention any names. But so I guess I felt good. I don’t know. Let’s just play. So that’s it. That’s all you’re gonna hear.
1:45:25
All right, guys.
Bill Clearfield 1:45:26
We’re moving on. And I think John will talk to Sylvia I think it’s time to maybe start looking at looking to get recertified again, as integrative medicine, so, okay. We’ve let it sit for a year. I think it’s time time to time to get moving.
1:45:50
I would actually I would actually be interested in being a part of that conversation if you needed more strength
1:45:59
or Hey, Laura, why
1:46:01
don’t you be the committee chairman and do this?
1:46:05
Just you’re just volunteer. I vote
1:46:11
Wait, what did we say? Oh, we’re getting low and going slow, right?
Bill Clearfield 1:46:19
Yeah. We’ve been going slow. So. All right. So all right. I’ll be in touch with everybody else we will be here next week, same time, same station, and anybody has anything that they want to present, please let me know. And we’ll take it from there. Okay. So let’s see you and I do apologize about last week. I don’t know what happened but the video didn’t didn’t record and so so we missed that one. But we got this one. So, aos rd.org That’s where everything is. And I’ll try and get in touch with Dr. Gerber and see what he had what he wanted to say and sort of see what see what, what kind of questions and answers we can get. for him. Okay. Okay with that everybody have a great night. Thank you for being here. And and just take care. Okay. Rock