The "No More Catching Butterflies" Effect by Dr. Michelle Weiner
As an identical twin, I have always valued a partnership with a healthy dose of motivation. As a young athlete, competing in team sports taught me the importance of synergy and finding that perfect balance. I chose to major in Nutritional sciences with a minor in health science education to gain knowledge about health and the human body. In an attempt to incorporate my passion for a functional and holistic approach to medicine, I became an Osteopathic Physician. While in medical school I pursued my master’s in Public health to properly learn how to evaluate the evidence as well as feel confident pursuing my own research in the future. Now, as an interventional pain management physician in private practice, I have treated disease relying on pharmaceuticals and injections; however, have I just been masking my patient’s pain?
As I started conducting my own IRB approved research through FIU using cannabis as a substitute for opioids in chronic pain patients, I have had the opportunity to establish relationships with my patients; to sit with them and understand their goals and what aspects of their life they want to improve. The Nova Southeastern medical students who shadow me in the office are fascinated with this approach. They are amazed by how satisfying my job is as they witness my patients thanking and hugging me with appreciation and not frustration.
Last Tuesday, as I walked into the patient’s room I saw a mother and daughter sitting next to each other. I asked the mother about 75 years old, the patient, so how are you feeling on your current cannabis regimen? The daughter replied, “thank you for giving us our mother back. She is no longer catching butterflies.” (demonstrate) meaning she used to sit and hallucinate in her own world reaching her hands up into the air swatting at objects that didn’t exist. By using cannabis, we had weaned her mother off of fentanyl, Percocet and Xanax. She was sleeping, active during the day and had significant less pain. Her daughter told me when she asked her mother’s pain dr, “would you give all of these meds to your own mother” his response was, I have a responsibility to treat the patient. How I interpret this without judgement is, I am limited by the tools in my tool box.
I sometimes wonder, am I, as the Physician, the placebo? The mind plays such a critical role on the body’s health and disease states. If I give my patient hope through new possible alternatives supported by science and evidence or if they have confidence in ME as a Practitioner, will they have a greater chance of a positive outcome? Is this rooted in the trickledown effect based on our physiology for example a positive thought causing an increase in oxytocin? If I ask a fibromyalgia patient, well, have any other fibro friends of yours improved with pharmaceuticals and then give them a prescription for a medication or increase their mgs of an existing medication that is not controlling their pain when I know as well as the patient, its most likely not going to help, will this negative thought lead to changes in their HypoPituataryAdrenal axis causing disruption in their stress hormones like cortisol, epinephrine, norepi levels creating a fight or flight response. When I educate my fibromyalgia or chronic fatigue patients about the endocannabinoid deficiency syndrome and explain that by supplementing with the cannabis plant they can normalize/increase their endogenous levels similar to treating a vitamin deficiency and I give countless examples of my personal patients who have decreased their opioids, antispasmodics, anti-inflammatories, antiepileptics and have gotten their lives back, I give them hope. Isn’t it interesting that the categories of pharmaceuticals start with Anti? Like anti-arrhythmics or anticoagulants, antihistamines?
Will identifying the root cause of a patient’s suffering lead to promoting the body’s innate ability to self-repair not just suppress symptoms? Can we stop using pharmaceuticals to counter side effects of other pharmaceuticals?
Promoting health or wholeness, practicing precision and preventative medicine also allows the patient to have control over his or her body and perhaps make more conscious deliberate and be accountable for their choices. Most educated people these days have lost faith in traditional institutions and western medicine. Instead of treating illness we need to promote wellness. Why do some people’s acute pain turn into chronic pain? Why do most burns heal on their own? At every level of organization starting at the cellular level below the mind we have an innate intrinsic resilient system to defend against toxins, microorganisms, pollution, etc. Does the pain medication we take acutely after surgery allow this hyperalgesic state to quiet down so that our body can continue to facilitate this natural process of tissue healing? Is that the purpose of and the right time to use conventional medicine?
Preventing illness does not require expensive or invasive technology. we need to evaluate if the latest fad trending in social media is effective. We have sophisticated tests that tell us if our micronutrient levels are depleted and if we have bacteria in our GI tract. we can treat these deficiencies with supplements and IV infusions. However, Precision medicine should start by spending more time taking a look at what is on our plate, how much we move, if we are resting enough. When we consciously engage with our mind and body we can reclaim our natural state of aliveness and stop overeating or using addictions to cope. We can now sequence genomic information but what can we do with this? We know mutations drive a patient’s cancer but what’s the treatment and will it be more effective especially if the physician gives you a designated length of time to live? We are lonelier than ever due to this disconnection driven by technology; intimacy only becomes a goal when the relationship is already suffering.
Anxiety feels more acute since the wired generation feels continuously bombarded with new alerts on their smart devices. A New York times article in Oct 2018 stated CBD went from being a fidget spinner alternative for stoners to a mainstream panacea. A show of hands, who has heard of CBD? CBD or Cannabidiol, one cannabinoid in cannabis can decrease inflammation, pain, anxiety, help with insomnia, depression, PTSD, spasms, seizures, tremors, decrease cravings, addictions to opioids, inhibit cancer growth and spread. how can this all natural non-psychotropic and widely available derivative of marijuana be a potential cure for the 21st century? It’s like we have discovered yoga, penicillin or even oxygen.
A cardiovascular surgeon said that the discovery of the Endocannabinoid System could save more lives than the sterile technique. In the 1990s, the discovery of cannabinoid receptors in the brain that respond to cannabis and the subsequent identification of endogenous cannabinoids in our own bodies that bind to these receptors has significantly advanced our understanding of human biology, health and disease. CB1, is found primarily in the brain and neurons in the spinal cord and central nervous system. CB1 receptors are thought to be responsible for the psychoactive effects of cannabis specifically from the THC cannabinoid and plays a role in signaling pathways responsible for cognition, neuronal growth, and the regulation of reward and mood systems. The CB2 receptors are primarily expressed by immune cells and may have evolved as a defense mechanism for the body since it is involved in suppressing inflammatory responses and in neuroprotective responses to brain injury.
The cannabis plant has more than 100 cannabinoids; THC and CBD have been studied most extensively. Most of us don’t realize that our bodies are making cannabinoids all the time on demand. These molecules function a lot like THC. Our cells produce and use cannabinoids in precise ways to respond to stress, illness, and injury, thus keeping us healthy and in balance. They are released from the postsynaptic neuron as a negative feedback loop to keep neurotransmitters and the other systems in the body in homeostasis or the same place. For example, it can prevent the release of glutamate, which is thought to be the mechanism behind the neuroprotective effects of cannabis against excitotoxicity for ex in seizures or neuropathic pain. CBD appears to activate other receptors including 5HT1A (serotonin) and TRPV1, both of which are involved in the anxiolytic and mitigating panic/fear responses to stress.
CBD is thought to inhibit the activity of fatty acid amide hydrolase (FAAH), the enzyme responsible for breaking down the endocannabinoid anandamide (bliss molecule). As a result, CBD can contribute to elevated levels of our endogenous cannabinoids. There’s evidence that some people’s endocannabinoid system (ECS) may not be functioning optimally; this can be addressed by adding the right dosage of Phyto or plant-based cannabinoids from cannabis.
Beyond cannabis, however, certain foods and activities can also help the ECS function optimally. Omega-3 fatty acids are needed to balance the omega-6 fats. These fatty acids are much harder to come by in our diet. Hemp seeds and oil, Flax seeds and oil, Chia seeds, Walnuts, Sardines and anchovies also optimize our ECS. Cacao powder contains three compounds that are structurally very similar to endocannabinoids.
While chronic stress can deplete your ECS, a highly tuned ECS can protect you from the detrimental effects of stress. Incorporating exercise into your daily routine will optimize your ECS, but only if you enjoy it! Animal studies teach us that if you force yourself to exercise, your ECS will interpret the activity as stress, but freely choosing and enjoying the same activity can have the opposite effect of stress and actually increase endocannabinoid levels. It’s been shown that Rats in social isolation produced less cannabinoid receptors, while social play and grooming behavior increased function of the ECS. It’s interesting to note that a balanced ECS appears to be pivotal to a healthy stress response and mitigating fear, anxiety, and panic that tend to accumulate with dysfunctional responses to stress. Through Social interaction Meditation Yoga Massage Acupuncture Breathing exercises we can manage not only our anxiety but help protect our other organ systems as we stay closer to homeostasis.
My 40 yo male mechanic patient with a 4 year old son no longer stops at the bar on the way home for a few beers because he uses his cbd vape after work to decompress. The 55 yo postmenopausal female uses cbd oil sublingual drops twice daily and her hot flashes are minimal and sleep pattern has returned to normal. Adding a small amount of THC to a healthy dose of CBD can elevate mode, minimize pain, insomnia, tremors. The secret about CBD is it is the only antidote to THC; it will mitigate the psychoactive effects of the THC so one can use this medicine and function optimally. The multitude of delivery methods from oral drops under the tongue to soft gels vapes topical creams allow one to treat immediate or chronic issues while focusing on prevention. Cannabis does not have to be smoked, one does not have to get high and should not wait until he or she is sick to think of this medication as an option!
My grandma used to say, Michi, sometimes people live too long. Why would she say this? Ninety two percent of seniors have at least one and 77% have at least two chronic diseases. Our bodies ability to maintain homeostasis as we age becomes more challenging especially when pharmaceuticals are added into the mix. The fact that as we age we produce less endogenous cannabinoids may be one cause of chronic disease. As we age, the neural stem cells and their progenitors exhibit reduced proliferation and neuron production, which is thought to contribute to age-related cognitive impairment and reduced plasticity. Cannabinoids can induce neurogenesis and increase endogenous cannabinoid levels while decreasing inflammation.
The term “inflammation” has become a bit of a buzzword lately, when talking about chronic health conditions. This is warranted because inflammation really can set up a chain reaction of dysfunction that can result in health problems in just about every system. Just like your brain, the inner mucosal lining of your gut has no pain fibers, but inflammation in your GI tract can wreak serious havoc on your mood and brain function. For example, 95% of your body’s serotonin, your “feel-good” hormone, is produced in your GI tract. In fact, the gut manages quite a few neurological functions.
To move toward an anti-inflammatory diet and anti-inflammatory foods, we primarily move away from the abundance of overly processed, unbalanced diets of the West and toward the ancient eating patterns of the Mediterranean, fruits, vegetables, no meat additives, omega 3. The Elimination diet clears the body of foods and chemicals that may be sensitive or allergic to improve the body’s ability to handle and dispose of those substances, support the microbiome and reduce inflammation while increasing phytonutrients. It has been found that fermented foods contain probiotics that have a protective effect against social anxiety. In 2017, UCLA found an association between gut microbiota and brain regions involved in processing sensory information. childhood traumas affect brain development and the gut microbiome composition.
Cannabis, or cannabinoids, have become the focus in developing new therapies, and the medical use of cannabis has become a target of public policy. The sad reality is only 17% of CBD products labels are accurate in terms of THC content and only 59% had detectable CBD based on a study done in California and Washington.
My desire to focus on health is different from other educated consumers who are just obsessed with the idea of wellness. I am frustrated when I am sent a cancer patient post chemo who now has neuropathy; perhaps the cannabis could have prevented the numbness and tingling the patient is now suffering from not to mention could helped with nausea, appetite, mood, sleep during her treatment. Why not give the patient the option to speak to me about cannabis or other alternatives and let them decide? My passion is to help others expand their minds and honor their bodies through diet and lifestyle choices. I want to educate others about the substantial evidence that exists in other healing aspects of medicine and make cannabis medicine a facet of integrative medicine. I know in acute situations conventional medicine is necessary but why not return to a simpler, cleaner life where we integrate the Art of medicine with the science by forming partnerships.