theZoomer Season 7, Ep. 22: Arthritis

theZoomer Season 7, Ep. 22: Arthritis


[intense orchestral music] [typing] [intense orchestral music] [typing] [intense orchestral music] [typing] – So I’m gonna talk about
what is mental health, about aging in mental health, about arthritis pain
and mental health. – The face of my
patients have changed, primarily to 55 plus
because people are seeking medical Cannabis to
help manage their pain. – There’s also a grieving
process that takes place as we see a decline
in our physical health as we’re dealing
with chronic illness. – From the ZoomerPlex in historic Liberty Village, The Zoomer, with Libby Znaimer. – Welcome to The Zoomer,
I’m Libby Znaimer. Millions of Canadians
suffer from arthritis and it takes toll emotionally,
as well as physically. We held a special event called, “Arthritis Talks:
Age with Optimism” and since so many
Zoomer’s are affected we wanted to share
this campaign with you. We’ll highlight the
key note addresses delivered by two
respected doctors in the fields of
arthritis and chronic pain as well as geriatric psychiatry. But before we dive in,
let’s T up the topic. – Over 4.6 million
Canadians have arthritis. By 2031, this will
grow to seven million. More than 10% of Canadian
adults have osteoarthritis, the ordinary degradation
of the joints associated with aging. Osteoarthritis
accounts for more than 80% of hip replacements and over 90% of knee
replacements in Canada. Another one million Canadians live with inflammatory
arthritis, including rheumatoid arthritis. While modern
pharmaceutical treatments from biologics to
immunosuppressant drugs are often a first choice
in treating arthritis, increasingly many are
turning to CBD cream, wondering if it could be
their joint pain Magic Bullet. [intense orchestral music] In the meantime, it’s
costing the Canadian economy an estimated 33
billion dollars a year. [intense orchestral music] If left unchecked, that
figure could more than double to 67 billion a year by 2031. [intense orchestral music] – In addition to the
physical limitations, arthritis takes a toll
on your mental state. But there are strategies to
help you cope with this disease. Dr. David Conn is the Vice
President of Education and the inaugural director
of the Center for Education and Knowledge Exchange in
Aging at Bay crest in Toronto. He’s also a professor in
the department of psychiatry at the University of Toronto. [applause] – So I’m gonna talk about
what is mental health, about aging and mental health, about arthritis pain
and mental health, and some ideas about
coping with pain. And we’ll talk about prevention
and health promotion. The pattern, this is
interesting, if you look at, on average, if you look
at happiness through life different ages, you’ll
see the ages there, different decades at the bottom, it looks like the bottom
is actually in the 40’s and then happiness seems
to increase in later life. How many of you are
surprised by that? Not that many of this
group, interesting. I’m always struck by
this statistic actually, it’s very interesting. Why are the 40’s so difficult? There was a fascinating
study done in San Diego on successful aging. So they looked
actually at individuals between the ages of 21 and 100 doing phone interviews,
mailing surveys, and so on. It was a complex study, but
if you look at this finding so physical health
declines through life. That’s no surprise,
aging is difficult. But sense of well
being seems to increase all the way through life. Now isn’t that remarkable and maybe a little
hard to explain? But that’s what the data showed. There are descriptions
of course about how to be more optimistic, how to
develop a positive attitude, and some of these simple
ideas actually can be helpful so, you know, actually looking
at the bright side of life. Or you know, when you smile the
whole world smiles with you. Having faith in yourself and
the power of the universe which, you know, raises the
whole issue of spirituality and the benefits of
that potentially. Associating with
positive people, and that does seem
like a good idea. It doesn’t mean getting
rid of all your friends who might be going through
a hard time, of course. But read inspiring stories, repeat affirmations that
inspire and motivate, visualizing the things
that you want to happen, and learning to master
your thoughts, meditation. So Sasson describes
all of these as steps you can actually take to have
a more positive attitude. There was an interesting
study a number of years ago out of Yale that divided
middle aged people up into two groups. One group had a more
negative view of aging, and the other group had a
more positive view of aging. And they studied these
people for several decades and the remarkable
finding was that the group that had a more
positive view of aging lived on average for more
than seven years longer than the group that had
a more negative view. Now you can sort of argue about what was the cause
and effect there, but it was a fascinating study. So how do we treat someone
who’s got a serious depression. The first thing that
you might think of are antidepressant medications, and we have a whole range
of different antidepressants that certainly help some people. And, you know, if you
compare the effects of an antidepressant
to a placebo, in most studies the
antidepressants are better than an inactive placebo. Although surprisingly enough, placebo is quite a
good drug as well. The inactive substance that
a person gets in a pill that has really nothing in it, actually works quite
remarkably well. And we always wonder about why? Does that make any sense? We think it’s because people, when they’re
enrolled in a study, actually get really
looked after, they’re seen regularly,
they’re evaluated, they have a lovely
research nurse who speaks to them and
gives them a cup of tea. That’s a social event, so a
placebo is not just a placebo. Then we come to psychotherapies
or talk therapies, which surprisingly,
it might surprise you, but psychotherapies are
remarkably effective in helping people
with depression. The one that’s talked
about a lot is CBT or cognitive behavior therapy. We’ll talk a bit
about that later. There are also
other interventions, various forms of
electrical stimulation, neurostimulation, transcranial
magnetic stimulation is a new one on the block
that seems very interesting, it’s a very benign
kind of treatment. Exercise, believe it
or not, exercise alone can be a very effective
intervention for
major depression. Light therapy for people who get more depressed in the winter. So let’s talk a bit about pain. So there are different ways of understanding pain,
different models. The Biomedical
model is that simply pain is the result of
an underlying disease. So you have an arthritic
joint, it hurts, that’s it, that’s
a simple model. The gate control
theory is that pain is actually influenced
by higher brain centers responsible for
cognition’s and emotions. So I have a quote
here from Dr. Turk from the University of
Washington who says that, “The reign of pain falls
mainly in the brain.” Which means, if we
didn’t have a brain, we wouldn’t actually
feel much pain. And that’s why what I’m
gonna say next is that emotions, depression, stress, can all affect our
perception of pain. And the cognitive
behavioral model includes these various factors in
contemplating why we have pain. Now this comes from the
Arthritis Society website, this is the most important
slide I’m talking about today. So it basically says that
yes, you have a disease, it creates pain, but there
are all sorts of factors then that contribute to that
as I was just saying. A fair amount has
been written about the psychological
approaches to understanding and treating arthritis pain,
and this particular paper the discussion focuses
on actually training in pain coping strategies. And there are a whole
variety of these that really revolve around actually a
cognitive behavioral approach. And some of these
are really basic, like learning
relaxation techniques. Mindfulness has
become very popular, positive visual imagery,
pacing one’s activity, taking a problem
solving approach, where you actually define
what is the problem you’re struggling with and
try to come up with solutions. And cognitive restructuring,
which sounds really fancy, but what that really
means is trying to think more deliberately
and positively. Because if you’re
depressed and in pain there’s a natural tendency
to think negatively. We think negatively
about ourselves, about the people around us, about the future,
about the world. So the cognitive behavior
approach actually challenges us and says, “Okay, let’s write
down what we’re thinking and how it makes us feel.” A lot of homework involved,
you gotta keep writing it down, but the goal is to either
work with a therapist, or on your own to actually
challenge those thoughts and realize that perhaps
you’re thinking too negatively. And a lot of studies suggest
those kind of changes really can make a difference. – When we come back,
Dr. David Conn discusses preventative measures
to stay healthy longer. Stay tuned. – You actually increase
your brain gray matter to the equivalency of
about a half a year younger then otherwise, so
lot’s of good evidence. [intense orchestral music] [intense orchestral music] – Welcome back, we know how
important our mental health is to our overall well being. So we continue this special
episode of The Zoomer with Dr. David Conn, as he
discusses preventive measures to maintain our mental health. – So, “An ounce of prevention is worth a pound of cure.”
as Ben Franklin said. So we’re all concerned as
we age, about our memory, about the possibility that we
could have cognitive decline, or even develop dementia. And a paper in the Lancet,
that’s the British Journal, two years ago suggested that there are modifiable risk
factors for dementia, so things we can do
to reduce our risk. They even went as
far as to say that if all of these thing
listed on the screen there were actually carried out, we could potentially
delay or prevent a third of all dementia cases which would be a dramatic
change in our society and in the healthcare costs. There are many
lifestyle approaches that can improve brain
and mental health. And, you know, I don’t
really think of mental health and brain health as being
difficult or different, it’s all integrated. So all of the things listed
here are both good for your mood but also good for your
memory and cognition. So there are reasons
to make a change. So exercising never gets old. You’ll reduce your
risk of dementia, you’ll lower your risk of
chronic illness and disability, you improve your mood,
better sleep quality, maintaining function
and independence, decrease risk of falls,
and increase longevity. Social activity
also very important and the health risks
associated with loneliness are of a similar risk magnitude
to smoking and obesity. Isolation is an
independent risk factor for developing dementia. Secure relationships, the
single most predictive variable in well being in later life. Challenging one’s brain, so
yes, doing all sorts of things that can keep the brain active. So there’s no question
that, you know, the more education you
have throughout your life, the lower your risk of dementia. Complex, novel
activities help the most, changing routines can help,
playing games, bridge, reading. You know, watching television and we’re in the
Zoomer’s studios here, some television
shows are wonderful and keep your brain active, but we have to be careful
not to become couch potatoes. So what about diet? Now we know diet is important and it doesn’t take
a genius to realize which of these two
groups of food, foods are better for you
and increase benefits. With a mediterranean diet or
clear cut and seem to help us, certainly in terms of our
brain function and mood. It’s very hard to change
one’s behavior for all of us, and there are many excuses. The common excuses are, “I am
too busy, stressed, old, sick to do anything or
to change anything.” Or, “This isn’t
really relevant for me or my medical situation.” Or, “It’s too late for this
to make a difference for me.” Or, “If I try this, and
it doesn’t work out, I’ll fail, let people down.” Or, “This goal is
too small to matter.” And these are all myths. So the Fountain of
Health actually creates behavior changing
tools, very simple ones. They’re available to clinicians,
to health professionals, to use with their
patients, their clients, to help their patients
make simple changes. Three simple steps, so
first set a base line, then set a smart goal, and then track your
progress, and then repeat. So, what is a smart goal? A smart goal is something
that is specific, measurable, action-oriented, realistic,
and time-limited. So here are some examples. So physical activity,
walk to the mailbox three times a day for one week or get up during the ads
during the 6 o’clock news four times a week. Social activity, call a friend or family member once a week, set up a coffee date once
in the next four weeks. Under brain challenge, read
the paper three mornings a week or listen to a radio
program twice a week. And there are other things we
can do for our mental health like attend a yoga class
once a week for four weeks, write a gratitude journal, or meditation even for
short periods of time. Because it takes, you have
to learn how to meditate, you can’t just do it. And then tracking
one’s progress. There are different
ways of doing it, either using online materials
or simply writing it down. But what we find is that
if people set a goal, and actually write it
down, and then track it, and you can either
do that on your own or maybe with your physician
or another health professional. We’ve studied this and
so many people report that yes, they are at least
partially meeting their goal, which is really exciting. – When we come back, Dr.
Shelley Turner discusses CBD and arthritis, that’s next. – We always look at
the risk versus benefit of all the medicines
we prescribe and Cannabis being one of those. Clinical research
is hugely important in innovation and improving
care for patients. [intense orchestral music] [intense orchestral music] – Welcome back, Dr. Shelley
Turner is being hailed as a trailblazer in the
medical Cannabis community, specializing in
Cannabinoid therapies for addictions, sleep and mood
disorders, and chronic pain. She discusses CBD and arthritis as this special episode
of The Zoomer continues. [applause] – Thank you very much. What a great pleasure it is to be here in The
Zoomer’s studios. I am actually a Zoomer, so
it’s kind of fun to be here with some Boomers
I think as well. So welcome, I’m gonna
talk a little bit about medical Cannabis, edibles,
topicals and oils. Oh my, right? There’s a lot of
information there. So much information so that
actually as of today’s date there are over 360
thousand people that have accessed medical
Cannabis in Canada. 360 thousand have applied
for a medical document. So very exciting times in
terms of research in this area. I am a student of Cannabis. I learned from my
patients that as well, as the sheer volume of
patients that I do see. My background is really actually in addiction and mental health. I’ve kind of fallen
into the track of prescribing medical
Cannabis to my patients and I’ve done this for
about, just over six years. So from addiction
to mental health, the face of my
patients have changed primarily to 55 plus
because people are seeking medical Cannabis to
help manage their pain. What I do believe
is that addiction is
not a moral failure. I believe that stigma
is a barrier to care, not only for people
living with addiction, but also for people trying to seek care for
medical Cannabis. I’m wondering from a number of
you here and online audience may have had difficulty
accessing Cannabis through their physicians
not really understanding or not knowing how to prescribe. We always look at the
risk versus benefit of all the medicines
we prescribe and Cannabis being one of those. And then always clinical
research is hugely important in innovation and
improving care for patients and this is something that
I’m very interested in. So this is a very
brief diagram here on really the time line
of medical Cannabis. This is not a new drug. Would you agree? This is not a new drug, this
has been around for millennia. And quoting Dr. Zack Walsh, who is the
psychologist out in BC who works a lot with
substance use, PTSD. He calls this an ancient
and gentle medication. So when we start to
look at the history, we can look back to 1000 BC, where there was pharmacopeia on the list of
different types of, different ways of
using medical Cannabis. Over 100 written recipes for
before particular ailments. We look at a Chinese physician
who operated on his patients using Cannabis and wine. Now we call that a
Saturday night in Gimli, but no we don’t. But it’s really, I’m very
thankful for research and anesthesia in
this 21st century. But we fast forward to 1964,
where Dr. Raphael Mechoulam, who is still practicing
as a bench scientist, he discovered that actually
there was a molecule called THC and then fast
forward to the 90’s where we discovered
that we actually have receptors in our
body for Cannabis. And we make our own
endo-cannabinoids. So the basics, as
I’ve alluded to, the endo-cannabinoid
system is within us all, we are a born with a system
that helps us maintain balance. Balance as we modulate
pain, mood, sleep, as well as our immune system. So when we look at the
receptors in our body, CB1 receptors are for THC. Those are primarily
in our nervous system. CB2 receptors are pretty
much everywhere else but heavily involved
within our immune system. So I always say, “The
dose is the poison.” When legalization happened, how many people’s
hair started on fire? Oh my god, legal Cannabis,
what are we gonna do? People are gonna be
running down the streets intoxicated, well that
hasn’t really happened. Actually when we start
to look at the stats and I actually just
pulled them up today. Each groups that we were
really concerned about, youth actually has
gone down in numbers. The numbers have not changed
to our 18 to 25 year, so but who’s using
more Cannabis? Us guys with gray hair, right? So when we talk about the
THC, it is intoxicating, but again the dose
is the poison. Generally most of my patients are using less than
20 milligrams a day
in a 24 hour period. Dependent on what they’re,
what I see them for. In my patients that are trying
to de-prescribe from Opioids, we have the ability to use
Cannabis as a substitution. It’s not, it doesn’t
work 100% for everybody, but again, I always say my
patients fall into a bell curve. The people in the middle,
generally are doing well, we de-prescribe all kinds of
medications over the counter. But it’s the tails, it’s
the people that may be too sensitive to THC
or the people that it doesn’t really
work very well. So those are the people
that I’m very interested in. And then of course,
CBD, so Cannabidiol, which is the non-intoxicating
form of Cannabis. I don’t say it’s not
psychoactive in the sense that it doesn’t make you high. It does work in your brain, but it doesn’t
cause intoxication. And it activates many systems,
especially our immune system. So most of medical
patients that I see are generally Cannabis
naive and we educate them. They generally are consuming
medicine, Cannabis, to help them reduce
harmful medicines or medicines that
they’re really, that they’re taking too much of, primarily around Opioids
and benzodiazepines. And as Dr. Conn was alluding to, we worry about our elder
population using benzodiazepines and I’ve had a lot of success
actually, tapering people off. So most patients that
are using medically are over the age of 50. The challenge with
many patients, my oldest patient
is 98 years old. Her 72 year old friend brought
her to my health center. Rolled her in, in her wheelchair and she was very excited
to try this new medicine. – When we come back, more
from Dr. Shelley Turner. That’s next. – So high CBD is generally
my rule of thumb. I generally go from 20
to 60 milligrams a day for patients to start them
and then add in THC as needed. [intense orchestral music] [intense orchestral music] – Welcome back, we continue
with this special episode of The Zoomer, featuring the
Arthritis Society’s campaign, “Arthritis Talks:
Age with Optimism” Dr. Shelley Turner is an
expert in medical Cannabis and it’s uses for chronic
pain, take a look. – So for topicals, anybody recognize those
chubby fingers there? Ouch, hey? So topicals work very
nicely for patients. We know that we’ve got this skin and we’ve got three layers
that we need to get through. [coughs] Pardon me. So we have to have a
good understanding of what type of topical will
actually permeate the skin. This is a model of inflammation. [coughs] Pardon me. So this is a very complex
diagram of inflammation and how our endo-cannabinoid
system works to help reduce
that inflammation. It works in a very
complex matter, initially that
inflammation is acute, but as you go forward
with that inflammation, if it’s not arrested
at that point it develops into a chronic
inflammatory process. So we worry about
people developing chronic inflammatory issues
especially with skin rashes as it relates to people living
with psoriatic arthritis. Any of the autoimmune arthritis, we don’t wanna get into
a chronic situation. And I’ve had very good
success with topicals for patients living
with psoriasis. So allergies with topicals. So out in the market,
in the legal market, there’s various
forms of topicals and they are just starting
to come out in the market. But I have many
patients that come in with some very nasty
smelling tubs of stuff that they’ve made themselves. And there could be an active
component of Cannabis, this is a topical Cannabis
that’s not been cooked or activated and
that is the rash. So it’s always good
to do a test site when you’re using topicals. So as I said, the
absorption rate, it does not cross the
blood-brain barrier so you’re not gonna get
high if you apply a topical. Using caution with open area,
especially if there’s THC, it takes about 30 to 60
minutes for that to take affect and it can last anywhere
from four to 12 hours. I have many patients that
will use this on joints, on their back, and have
had very good success. So these aren’t your
Kokum’s brownies. So if you’re a granny, okay? I don’t know how many times
I’ve had patients come in and talk about somebody
made them an edible and then they had
a bad experience. I actually had one
patient go to the hospital emergency department because
he had taken an edible somebody had made
and he thought, “Oh, this isn’t working.” Right? So he was like 45
minutes, it’s not working. So he takes another one
and then at about an hour, yeah, he was on that ride
for about eight hours and didn’t, couldn’t
get off, right? So you have to be very careful. But again, the
formulations are endless. Oil based generally is the go
to in terms of Cannabis oils. They come in many formulations, high THC, THC and CBD,
and primarily CBD. There’s different ratios, so you have to really
watch the dosing. The dosing I think
will be anywhere from one to 10 milligrams of THC, and there will be many
formulations with CBD. If ever you’re in a
recreational situation and you’re thinking
about using Cannabis, please use both together,
always have CBD with it, because that quite often
will help push the THC off the receptors so
you’re not getting as much of an effect. So again with
absorption and ingestion as I kind of alluded to,
please wait, please wait. If you haven’t had any
effect after 90 minutes then of course, by all means
go ahead and try another dose but it can affect dosing,
especially in patients living with perhaps diabetes, that may have a really
slow gut or gastroparesis, it can take somewhere
from two to four hours. My friends that are on the
She Can Facebook website, they’re a group of women that
are supporting each other I think there’s four
thousand of them out there. They always talk about
having a small fatty snack. So Cannabis likes fat, it
works best in our bodies. If patients are having
difficulty and they’re saying, “It’s really not working.” I would say have a
little, have something like a small fatty snack to
help that absorb faster for you. So this is just an overview, this is a table that
I give all my patients and it’s just an overview of
what, how you can use Cannabis. What I’m actually
missing on this one, and we’re not gonna
talk about that today, is suppositories for
patients that are not able to take anything by mouth,
that don’t wanna smoke, and especially for patients
living with GI problems, so ulcerative colitis,
Crohn’s disease, women living with endometriosis
can use that as well. But really this is
just an overview of what I’ve just spoken about. And then dosing, so high CBD
is generally my rule of thumb. I generally go from 20
to 60 milligrams a day for patients to start them
and then add in THC as needed. It is really dose
dependent on affordability and for all of you that are on, whoever is on medical Cannabis, we have to really look at
the price point for patients. A lot of patients say, “Oh my gosh, I wish
I could take more.” but they can’t afford it. Cannabis naive
patients on Opioids, can speak to my particular case, two gentleman that
I’m caring for now. One is on, both are
on high dose Opioids. This gentleman was on, I think
120 equivalence of Morphine and in six weeks he’s
come off all of that using medical Cannabis,
and so high CBD, 200 milligrams a day, plus
about 40 milligrams of THC. And I think within the next, so he’s still having
withdrawal from that, but he said, he can’t believe it because he actually
doesn’t have pain. He was really going
through withdrawals, so he’s done really well, and he has degenerative
disk disease and arthritis in his back. So again, looking at
anxiety versus depression. I have a lot of patients
that will come in and say, “Oh my gosh, I’m so anxious and I’m smoking
so much Cannabis.” they’re taking way too much THC. THC can actually be,
it’s counterintuitive. Too much THC can actually
make your anxiety worse, so I generally will
encourage those patients to use high CBD and
low percentage THC. As well, in depression
patients we’ll have a little bit more
THC for activation. And always with anybody that
you’re considering Cannabis or trying it even
recreationally, please
go low and slow. If you take anything from
today, low, low, low. And increase your dose
every one to three days. – When we come back,
we held a special question and answer session
for the audience, that’s next. [intense orchestral music] – Most that use
THC during the day are taking such small amounts with such a good CBD
buffer that they’re fine. [intense orchestral music] [intense orchestral music] – We’ve been showcasing
a special webinar held by the Arthritis
Society that focused on this ailment and
ways to live with it. During this event, we held a
question and answer session with both Dr. David Conn, a specialist in
aging and psychiatry, and Dr. Shelley Turner, a medical Cannabis and
chronic pain expert. As we mentioned, we’ve been
getting some questions in online so we’ll start with those. I’ll have to get my
glasses on to read them. So first question, what are
the ways to stay positive when you’re dealing
with chronic pain? – Yeah so, I think that there
are a whole variety of things as I’d mentioned
throughout the talk that can help a person
be more positive and for each person those
kinds of things are different. Different, but I would
say first of all, it helps if you have
other people in your life that can assist and that
can help you to be positive and as Sasson said, “It’s good to associate
with positive people.” And hopefully, either a
friend or a family member, someone who can be a
bit of a cheerleader, that can be really important. I think realizing and reflecting
on one’s own thoughts. So realizing that you
might be depressed, and that’s not unusual, and
it’s really understandable when you’re dealing
with chronic pain. So many of the
strategies I talked about sort of throughout the talk,
I think can be employed. But I think actually
writing down one’s thoughts and then one’s feelings and trying to see if there’s
a link between the two. There’s a very good book
called, “Mind over Mood” by Greenburger, that’s
designed for individuals to help them look at their
thoughts and feelings and how they interact
and that approach. I mean there are other
best selling books as well that can be really helpful
in looking at the connection between emotions and thoughts. – Okay, next question is how
to cope with grieving the loss of things I could
do before arthritis? – Yeah, so actually as it says on the Arthritis
Society website, when we think of
grief, or grieving, we think about the
loss of a loved one. But there’s also a grieving
process that takes place as we see a decline in
our physical health, when dealing with
chronic illness. And it’s important to realize
that and reflect on that, there are all sorts of
very normal emotions that one goes through when
one is dealing with grief and so again, reflecting
on those emotions. Not so much as being, as being
very negative or unusual, but actually it’s
a normal process as we adjust to our new
selves, all of us as we age have to cope with a
lot of these changes. – Can antidepressants help
with osteoarthritis pain? – Yeah so, antidepressants
of course are good for mood, and they’re also good
for anxiety, actually. So if you have a lot of
very serious anxiety, antidepressants are actually
the medications of choice, if you need medications. But there’s some evidence
that certain antidepressants seem to actually be
helpful for pain as well. There’s one called
duloxetine or Cymbalta, that, where there’s some
pretty good evidence that, that it can help both
depression and pain. So physicians will
often prescribe that kind of antidepressant. It’s called the dual
acting antidepressant, it works on two different
brain chemicals. – Okay, let’s open it up
to the studio audience. Does anybody have a question? Why don’t you tell us
your name first, please? – Yes, my first
name is Marianne. And I’m wondering why you
hadn’t mentioned surgery. I had excruciating
osteoarthritis
about 14 years ago, medication didn’t cut it. And so I was recommended
to have surgery and I postponed
it for three years and I could not walk
a block by that time. So if I hadn’t had the
bilateral hip replacements, I would probably be in psych
unit now in a wheelchair. So I just wondered why
you hadn’t mentioned surgery as an alternative. – That is no question that there’s a very
interesting pyramid design produced by Health
Quality Ontario. And the bottom on the pyramid are the largest group of people and the top of the pyramid
are smaller numbers of people. And when it comes to arthritis, there’s a huge number
of people at the bottom who have milder forms
of arthritis who can
manage, you know, with a little medication,
with exercise, with physiotherapy and so on. Then as you climb the pyramid, there are smaller
numbers of people with more severe arthritis
and on the top group, and they actually said
it was 4% of all people with arthritis who
really need surgery and can truly
benefit from surgery. So it’s the people
who have, you know, obviously if there’s no
cartilage left in your knee, you can’t walk very well
without excruciating pain. And a knee replacement
can be a miracle. Obviously you have to have
the courage to go forward and do that, but you’re
absolutely right. You know, with severe arthritis,
surgery can be miraculous. – Dr. Conn, thank you so much. – Thank you Libby,
pleased to meet you. [applause] – Okay, we have some
online questions and I think you’ve actually
touched on some things that people want to know. – Sure. – More about, so
the first question. Can CBD cause liver problems? Is it safe to take
with methotrexate? – Hm, okay. So you have to really
look at the pathway. So we talk about pathways
that go through our liver, we have many of them. Methotrexate generally
has been safe, but we always want to follow
that patient obviously closely. We talk about, there’s
been just a paper released on the possibility that CBD
may cause liver toxicity. It really, some people will
have elevated liver enzymes, but the people that I’ve seen,
I haven’t seen that happen. So it may be something
that is a one off, but that’s not something that
I’ve seen in my practice. – Okay, here’s something
you did touch on. Cannabis is so expensive, are
there more affordable ways to access medical Cannabis? – Well, I don’t want
you to go to jail. So that would be
stealing it, so no. [laughter] No, I think it’s so
challenging for many patients. There is the ability
to grow Cannabis under the medical regimen,
but I always kind of say, “You know, there’s challenges
with that in itself because patients aren’t able
to test their Cannabis.” For me as a physician, I really wanna know
what they’re taking. The license holders will
have certificate of analysis and so we look at that
certificate and we can say, “Is this working for you?” We can look at the
terpene profile, the
cannabinoid profile. Whereas in the growing
market, we don’t see that. So until our insurance
companies get on board, until we decide that we’re
not gonna tax this medicine, we’re kinda stuck
with what we have. – Okay, we can now open it
up to our studio audience. And what’s your name please? – My name’s Brenda. I’m wondering, for
example, like I’m assuming you shouldn’t drive if
you’re taking this stuff? And I’m assuming what if you’re
looking after grandchildren, I’m talking about taking
it for a medical reason. Like are you going to
be okay with doing that and looking after grandchildren? – Well Brenda, it depends
on what you’re taking. Right? So if you’re using high
CBD, no intoxication. If you’re adding, so I have
patients that will take 60 milligrams of CBD and add
in maybe two milligrams of THC. – Well that’s what
I heard you say, adding in that little bit. – Right, and so that is, the CBD is really buffering the
intoxicating effects of the THC. You’re still getting the Opioid
sparing ability from the THC but no intoxication. So can you drive? If you’re not intoxicated. The rule of thumb is, and again
the low risk use guidelines are available as well. But if you feel
intoxicated, don’t drive. If you’re taking THC and
CBD at night for sleep, generally you should
feel fine in the morning. Unless you’ve taken too much, and then you need
to check yourself. – So if you’re taking
these medications, say at night so when
you’re sleeping, does it have the affect
in the daytime of no pain or you have to be taking
it to have the no pain? – So mostly patients are
taking CBD during the day. – During the day, okay. – Most of my
patients are retired, so they’re not having to worry
about THC during the day. But most that use
THC during the day are taking such small amounts with such a good CBD
buffer that they’re fine. – Okay, thank you. – Okay, thank you so much. – Thank you very much. [applause] There’s more after
the break, stay tuned. [intense orchestral music] – Don’t forget, for
free tickets to the show go to www.Universe.com
and search “ZoomerMedia” and log on to
www.thezoomertv.com for full episodes and more. [intense orchestral music] – Welcome back to the Zoomer, we’ve been featuring
the Arthritis
Society’s new campaign, “Arthritis Talks:
Age with Optimism” arthritis is painful
and it can take a toll on your mental health as well. You should be open
with your physician and be open to learning
more about treatments you may not have considered. We wanna thank Dr. David
Conn and Dr. Shelley Turner as well as the
Arthritis Society. For more information, you
can visit arthritis.ca. Thank you for being with
us, we’ll see you soon. It’s time to zoom out. [orchestral music] [orchestral music] [orchestral music] [orchestral music]

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