Author: DENT Neurologic Institute

Ask the Expert: Medical Cannabis

Medical cannabis is an effective method for treating a variety of medical conditions. Legal in 30 states medical cannabis is approved for a number of qualifying indications. After its legalization in New York State in 2014, DENT quickly became the largest resource in Upstate New York for certifying and managing patients. With over 30 DENT providers qualified to certify patients, the DENT Cannabis Clinic oversees 6,000 medical marijuana patients and has become a tireless advocate for its acceptance and use by the medical community. We gathered commonly asked questions and gave them to Director of the DENT Cannabis Clinic, Dr. Laszlo Mechtler, who answered them on Facebook Live.  

Below is a summary of the presentation, keep scrolling to check out the entire Facebook Live!

1. How do I start the process? Do I speak with my primary care doctor to get a referral & appointment for your clinic?

At DENT, you must be referred to the Cannabis Clinic by a current treating physician. By beginning with this referral, our Cannabis Clinic providers can create a collaborative partnership with the patient and the referring provider, giving our providers the opportunity to learn the most we can about the patient’s current medical condition and previous medical history. This allows us to provide comprehensive care to the patient.

To begin the process, the patient (or referring provider) can download the referral form on the DENT website, give it to their physician to fill out, then have it sent back to DENT (fax number located on the top of the form). After receiving the referral along with office notes and diagnostic testing records, our medical director determines whether or not there is a qualifying indication based upon New York State (NYS) guidelines. From there, our Cannabis Clinic team will call the patient to schedule a consultation appointment. The chronic pain indication has a wait time of approximately 4 months upon receipt of the referral for an appointment.

Being seen by a provider does not guarantee the patient a certification. Further testing may be recommended or it may be found that the patient doesn’t qualify for the NYS program. If the patient does qualify they will receive their certification from the provider, at which point the patient has to go online and register themselves as a patient with New York State (instructions given to patient from our office staff). Once the patient has registered online and NYS has approved the account, the patient has the opportunity to print a temporary card off of their account that is valid for 30 days until their hard copy card arrives in the mail. The patient must have this card in hand along with the certification to enter a dispensary and obtain their medical cannabis product. Currently, there are 5 dispensaries in New York State (with multiple locations throughout the state). Locally, there are dispensaries located in Amherst and Williamsville (PharmaCannis, MedMen).

 

2.  What indications are approved in New York State?

• Amyotrophic Lateral Sclerosis (ALS/Lou Gehrig’s)

• Cancer

• Inflammatory Bowel Disease (IBD)

• Parkinson’s Disease

• Spinal Cord Injury with spasticity

• Epilepsy

• Neuropathies

• Huntington’s Disease

• Multiple Sclerosis

• HIV/AIDS

• Chronic Pain

•   PTSD

•   Opioid Replacement

Patients must also have one of the following associated or complicating conditions:

• Cachexia or wasting syndrome

• Severe or chronic pain

• Severe nausea

• Seizures

• Severe or persistent muscle spasms

• PTSD

• Opioid Use Disorder (must be in an Article 32 treatment program)

3. Is there any possibility of insurance companies working with patients to help with some of the cost?

“Unfortunately of the 6,000 patients in the DENT Cannabis Clinic, one third cannot afford medical marijuana,” said Dr. Mechtler.

That being said, DENT is working diligently to present evidence that proves to insurance companies medical cannabis works and is worth covering.

“We are doing this by extensively documenting our patient’s experiences with medical cannabis including efficacy, side effects and complications,” said Mechtler.

 

4. If you use medical cannabis will you fail a drug test for the company you work for?

Yes, most standard drug tests screen for THC and CBD, both of which you will test positive for if you use medical cannabis.

 

5. Can cannabis be used for chronic migraine?

Yes, medical cannabis can be used to treat chronic migraine.

“Chronic Migraine is defined as more than 15 headaches per month, of which 8 of those headaches have to be disabling migraines that last more than 4 hours a day,” said Dr. Mechtler.

“In 263 patients suffering from chronic migraine, of those treated with medical cannabis, 88.9 percent showed significant improvement,” said Mechtler.

 

6. What is the difference between CBD and THC?

A Cannabinoid plant has 3 major components, primarily made up of cannabinoids, flavonoids, and terpenes, it is also composed of THC and CBD.

THC is the part of the cannabinoid plant that has a psychoactive effect on the brain. This means that the THC affects CB1 receptors in the brain, giving people the feeling of being ‘high, and may produce side effects like anxiety and paranoia. However, THC also has positive medical effects and works well for nausea, anorexia, and pain management. 

CBD has no psychoactive effects and me “CBD is used more for treating the body, whereas THC is more for the mind,” said Dr. Mechtler.

Both have medical properties, however it has been found that depending on the patient, some patients need more THC while others may  need more CBD. Some patients may even require a combination of the two, known as the entourage effect. 

 

7. Is medical cannabis a good alternative to opiates?

Yes! Medical Marijuana is a great alternative to prescription pain medication because of its non-addictive properties. It has the potential to alleviate patients’ pain to the point that allows them to significantly reduce or discontinue their opiate medications.

 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

 

 

 

Back to School Sleep Tips

Summertime can take a toll on a child’s sleep routine. Sleepovers, vacations and fewer responsibilities make it easy for children to get out of a consistent sleep schedule, making the back to school transition that much more difficult.

We sat down with Attending Neurologist and Director of the DENT Sleep Center, Dr. Marc Frost, who explained how to ease your children back into a sleep routine, and why instilling healthy sleep habits in your children now will not only help them this school year, but can benefit them the rest of their lives. 

1.  What is the recommended amount of sleep for children and young adolescents?

“Depending on age, it could be as much as 8-9 or even 10 hours,” said Dr. Frost. “The best way to know that a child isn’t getting enough sleep is to note signs of tiredness throughout the day.”

Dr. Frost stated that signs of tiredness in children can manifest differently than in adults who will just feel tired and sleep.

“Children may sleep and nap, but may also just be inattentive. Children may even appear to be daydreaming, or show the opposite of what you might expect and be somewhat hyperactive.”

Dr. Frost added that mood and personality changes may also be observed.

 

2. What are some steps parents can take to get their children back on a regular sleep schedule?

“Taking steps to create a consistent routine should start the week prior to school,” said Dr. Frost. This routine can be created by putting children to bed and waking them up at the time you would normally for school. This will help ease children back into the school sleep routine.

“And as always, no electronics in the bed or bedroom and no caffeine in the evening,” added Dr. Frost.

 

3. Why is a consistent sleep schedule so important? Is it especially important for school-age children?

“We tend to be creatures of habit, so a regular schedule will promote regular sleep.” said Dr. Frost. “Instilling these habits in your children now will promote lifelong healthy sleep habits that will prevent sleep problems later in life.”

 

4. Is there evidence to suggest that children who have a consistent sleep schedule perform better in school?

“Tired children are inattentive and potentially hyperactive children,” said Dr. Frost. “This will clearly lead to poorer performance in school.”

Dr. Frost also added that poor sleep can lead to depression and anxiety, which will affect children both at school and at home. 

 

5. How can parents help their children practice healthy sleep habits?

Practicing the habits mentioned above can help children achieve a better quality of sleep, especially with school around the corner. 

“Parents also need to try and lead by example by maintaining good habits themselves,” said Dr. Frost. 

 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

 

Alzheimer’s vs. Dementia – Facebook Live Recap

According to the World Health Organization, there are approximately 47 million people around the world living with dementia, with that number expected to increase significantly in the next 30 years. Alzheimer’s disease is the most common form of dementia, with 5 million people in the United States diagnosed with the disease. Often, the terms Alzheimer’s and dementia are used interchangeably, however, there are distinct differences between the two and recognizing those differences is important in helping you and your care partner understand and manage your diagnosis.

What’s the difference?

Dementia is not a specific disease, but a general term that describes a group of symptoms that are associated with trouble with thinking.

Dementia is often thought of strictly as a memory problem, however it encompasses much more including, but not limited to:

  • Difficulty planning or solving problems
  • Confusion with time and place 
  • Changes in visual and spatial skills (depth perception, peripheral vision)
  • Forgetting or losing things often
  •  Problems finding words or using the correct words
  •  Changes in mood or personality
  •  Difficulty completing familiar tasks

There are many conditions that can cause dementia, Alzheimer’s is only one cause.

Alzheimer’s disease is a specific condition that causes dementia.

Alzheimer’s is the most prevalent form of dementia and accounts for about 70 percent of cases. The Alzheimer’s Association reports that every 65 seconds someone in the United States develops the disease. In Alzheimer’s amyloid and tau proteins clump and create plaques and tangles, causing brain cells to die. It takes a long time for enough damage to be noticeable, meaning the process can begin long before someone is symptomatic, this period is referred to as pre-clinical Alzheimer’s disease.

Alzheimer’s is categorized in three stages; mild, moderate and severe. The stages are based on the severity in which a person’s thinking problems has progressed. The progression of Alzheimer’s is different for every individual and it is important to note that stages can overlap and last different amounts of time for different people.

Alzheimer’s disease is marked most notably by short term memory issues. The short term memory loss occurs because Alzheimer’s impacts a person’s hippocampus, the area in the brain where new memories are created, making it harder for new information to stick.

Forgetting a date once in a while is not Alzheimer’s disease. However getting lost in a familiar place may be a sign that something more serious is going on. It is incredibly important to see a doctor if your memory loss begins to disrupt your daily life.

“The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice.  Readers should always consult with a licensed healthcare professional for diagnosis and treatment.”

 

Check out the entire Facebook Live here: 

Sarah Harlock, is the Program Director for the DENT Integrative Center for Memory. 

Concussion: Signs, Symptoms, and Treatments – Facebook Live Recap

Concussion is one of the most common injuries reported by athletes, with an estimated 3.8 million sports related concussions occurring in the United States every year. In high risk sports like football and soccer, an estimated 20 percent of players suffer a concussion, with 40 percent of those players returning to the sport before making a full recovery.

Dr. Jennifer McVige, Director of the DENT Concussion Center, attributes low diagnosis and recovery rates to a lack of knowledge surrounding concussions.

What is a concussion?

“A concussion is a direct or indirect, pathophysiological process that affects the brain, that is caused by a biomechanical force. This means that you don’t have to directly hit your head to be diagnosed with a concussion,” said Dr. McVige.  “In addition to hitting your head, you can actually have a significant whiplash injury, where your head goes backwards and forwards within your skull, causing a concussion.”

Dr. McVige likened concussions caused by whiplash to an egg. “If you shake an egg, the yolk within collides with the interior shell of the egg. The same idea can be applied to your brain. The brain is in cerebral fluid, and if the head is shaken hard enough your brain will hit the sides of your skull causing a concussion,” said McVige.

Symptoms:

Concussions are most commonly marked by the rapid onset of short-lived neurological impairment that resolves spontaneously.

This neurological impairment can manifest in a number of ways. You may feel as though you are in a fog, or notice that you are having a hard time retaining information or concentrating. You may have a headache or feel dizzy, these are all signs you may have a concussion. This altered neurological state occurs because the trauma caused to the brain is temporarily impairing its biological responses.

Dr. McVige focuses on what she refers to as the 5 modifiable factors of concussion, which she uses to diagnosis concussion

5 modifiable factors of concussion:

1.       Headache

2.       Sleep Disturbance

3.       Mood Issues

4.       Dizziness and Imbalance

5.       Attention and Concentration Impairment.

Dr. McVige also stressed the fact that you do not need to lose consciousness to be diagnosed with a concussion. In fact less than 10 percent of those diagnosed with concussion lost consciousness.  However, a loss of consciousness can signal a more challenging recovery.  

Imaging:

Imaging plays a large role in the accurate diagnosis of concussion. Medical imaging allows doctors to look inside the brain to ensure everything is functioning correctly and rule out serious complications.

“Typically, what we have seen with concussions is that standard CT Scans are not useful in telling us if everything is ok.  As doctors, we are only as good as our tools, in this case the quality of our imaging.” said McVige. “Often with a standard CT Scan, even when a brain has suffered a concussion the image will reflect a normal brain. The MRI is much better, especially for seeing small injuries.”

Dr. McVige also noted that a CT scan is most often used if there is suspicion of a bleed or fracture in the brain, or a person is an imminent danger and falling in and out of consciousness.

What happens to your brain during a concussion?

Any disruption to the brain, caused by either a front, backwards or rotational force, pulls on the brain parenchyma, or the functional tissue in the brain. This pulling can interrupt sensory nerves in the cortex, causing those nerves to pull and shear, creating an injury which resembles a rip or tear called a diffuse axonal injury.

This can happen in the cortex (the top of the brain) and the brain stem, which connects the brain and the spinal cord. Most individuals lose consciousness when the injury occurs in the brain stem.

When this disruption happens, whether by a direct or indirect force, it causes the neurons in the brain to swell. Neurons are the cells in our brain that allows us to communicate and do all the things we do on a daily basis.

Dr. McVige likens neurons to electric cords, you have two parts, the plug and the cord. The axon acts as the cord and the neuron is the plug. If the axon swells or gets inflamed by an injury, it disrupts communication between neurons. This disruption causes the symptoms that are associated with concussion, like slowed processing and difficulty retaining information.

The force, whether direct or indirect, that causes a concussion can also alter blood flow to the brain. Altered blood flow can cause a number of problems because it restricts the oxygen to the brain. That loss of oxygenation hinders the body’s regulatory processes. For example, if a runner attempts to return to running before they are fully recovered, this could cause them to be easily winded because self-regulation is altered. This dysregulation has been shown to last 6 – 18 months after a concussion, even though a person may feel fully recovered.

Pediatric Concussions:

In the brain there at 2 types of “cords” or neurons. These cords can be myelinated and non-myelinated. This is important because myelinated fibers are covered allowing them to go fast. Non-myelinated fibers move much slower, making them much more susceptible to damage. This distinction is especially important in children, because children’s brains are not done growing and all of their cords are non-myelinated. This is important because children are still developing critical thinking skills and fine motor skills and damage to their non-myelinated fibers could hinder those processes. Studies have shown that children 12 years of age and younger are especially vulnerable to long term damage.

Post-Concussion Syndrome:

Post-concussion syndrome refers to a condition where concussion symptoms persist beyond a certain period in time after the diagnosis of concussion.

Dr. McVige focuses on what she refers back to the 5 modifiable factors of concussion, which she uses to diagnosis post-concussion syndrome. In post-concussion syndrome any or all of these factors can last months.

5 modifiable factors of concussion:

1.       Headache

2.       Sleep Disturbance

3.       Mood Issues

4.       Dizziness and Imbalance

5.       Attention and Concentration Impairment

Treatment:  

Treatment for concussion depends on a number of factors, including what symptoms a person has, if they have any pre-existing conditions including depression, ADHD, even headaches. All of these are incorporated into a treatment plan.

“Treatment for concussion is very individualized,” said Dr. McVige. “Sometimes it just takes time to heal. I cater treatment to what symptoms people present with and what the patients’ concerns are.”

Exercise is a very important component to recovery. Dr. McVige noted that there is often a sweet spot to get back to exercise, starting with light walking and gradually returning to more intense exercise.

For contact sports, Dr. McVige’s general rule is that patients should not return to contact sports before they are 7 days symptom free without medication. Dr. McVige also advises a gradual return to play.

Check out the full Facebook Live Here: 

 

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

 

5 Tips for Brain Health

The brain is an incredible organ filled with 100 billion neurons that seamlessly communicate, allowing you to complete tasks from breathing to critical problem solving. Amazingly, it only takes the brain around 1/10,000th of a second to identify a need and respond with the appropriate action.

According to the National Institute on Aging, “Brain health refers to the ability to remember, learn, play, concentrate and maintain a clear, active mind. It’s being able to draw on the strengths of your brain—information management, logic, judgement, perspective and wisdom.”

Essentially, brain health is all about taking care of your brain so that it is able to function at its highest potential.Taking good care of your brain is also an important part of reducing some of the risks aging poses to cognitive health. 

We sat down with Attending Neurologist and Director of the DENT Concussion Center, Dr. Jennifer McVige, who shared her top tips for brain health.

1.Use it or Lose It

“Your brain, just like any other muscle needs to be exercised,” said Dr. McVige, “To keep your brain functioning at its highest potential, you must exercise your brain as you would exercise your body.”

You can keep your brain sharp by participating in activities that require mental stimulation, such as reading, solving puzzles, even learning a foreign language. The best way to keep your brain young is to never stop learning new information.

“Staying cognitively fit will keep you more alert as you get older,” added Dr. McVige.

2. Maintain a Healthy Diet

A well-balanced diet, makes for a well-balanced brain. 

“If you put junk food into your body your brain will not work as effectively. Stay away from high sugar, high fat processed foods,” said Dr. McVige, “Try to eat clean.”

Some ‘brain foods’ include blueberries, wild salmon, dark leafy greens like kale and spinach, and dark chocolate.

3.  Physical Exercise

What’s good for the body is good for the brain!

“Regular physical exercise helps your brain work better,” said McVige. “It helps increase blood flow to the entire body, allowing us to process information better.”

4. Sleep

 Sleep is a vital part of staying mentally and physically healthy.

“A proper sleep regimen is important for adequate brain health. Sleep deprivation can cause difficulty with concentrating, create mood issues, and even cause headaches.”

5.  Be Conscious of Brain Injuries

“When in doubt sit out,” said Dr. McVige. “Your brain is a beautiful, complex organ with amazing healing powers, but if more injuries are sustained before the brain is fully recovered the healing process gets interrupted.”

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

Tips for a Good Night’s Sleep

We sat down with Dr. Marc Frost, Attending Neurologist and Director of the DENT Sleep Center, who shared his tips for achieving and maintaining healthy sleep habits.

According to the Center for Disease Control, approximately 1 in 3 American adults aren’t getting enough sleep. The American Academy of Sleep Medicine and the Sleep Research Society recommend that adults 18–60 years of age, need at least 7 hours of sleep a night.

Why is sleep so important?

Getting a good night’s sleep is a vital part of staying physically and mentally healthy.

“Poor sleep can lead to an increased risk for multiple medical issues, in addition to feeling poorly the next day. Depending on the cause, poor sleep can increase your risk for heart attack, stroke and other medical issues, just as much as untreated high blood pressure, elevated cholesterol and cigarette smoking.” said Dr. Frost.

Poor sleep can also increase the risk for anxiety, depression and other mood related conditions.

Tips for Sleeping Well:

Regular Exercise

Exercising is an important part of sleeping well. Regular exercise is a great way to maintain a healthy sleep cycle and comes with a number of added benefits. However, try exercising earlier in the day, so that you aren’t working out too close to bedtime because it could leave you feeling too wired to fall asleep.

Consistent Sleep Schedule

Maintaining a consistent sleep schedule is imperative to achieving healthy sleep habits. Sleep hours should follow a routine from day to day, time to bed and time to wake should be consistent, even on weekends.

Be Careful of Over the Counter Sleep Aids

Over the counter sleeping pills, with the exception of melatonin, need to be used carefully. They are simply antihistamines, and should not be used for prolonged periods of time.

Myth vs. Fact:

MYTH: Drinking alcohol before bed will help you sleep better.

FACT: While it is true that alcohol may help you fall asleep faster, it is one of the most disruptive inhibitors to normal sleep. The sleep you get after drinking is very fragmented and unrefreshing. Alcohol use should be kept to at least several hours prior to bedtime.

Click here to learn more about our Sleep Center.

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

MS Fatigue and Tips for Management – Facebook Live Recap

Fatigue is a common symptom in Multiple Sclerosis patients, affecting around 80 percent of the patient population. There are three main types of MS Fatigue, ranging from basic tiredness and the feeling of needing sleep, to cognitive fatigue, which can affect thinking, to physical fatigue, which can manifest as a tiredness of the muscles.

“One way our team at DENT tries to combat fatigue is by recommending daily routine changes that may have a big impact,” said Katelyn McCormack, a Family Nurse Practitioner in the DENT Multiple Sclerosis Center. 

Lifestyle modifications can have a huge and positive impact on your Multiple Sclerosis fatigue. All the methods discussed can be used in helping to manage MS fatigue symptoms.

Physical or Occupational Therapy:

Different devices can be prescribed by your physician to help manage your physical fatigue by reducing the amount of energy it takes to complete certain tasks.

“Some patients may have weakness on one side, or trouble gripping, and we can prescribe different devices to help limit how much energy a task takes you,” said McCormack.

These methods can help to reduce the feeling of muscle tiredness that accompany physical fatigue.

Good Sleep Hygiene:

It’s very important to practice good sleep hygiene, which includes maintaining a consistent sleep schedule, for example going to bed and waking up at around the same time every day.

“Sleep improvement is a major way to combat fatigue,” said McCormack. “And it may not be that you’re not getting enough sleep, but that you’re not sleeping well. We use sleep studies to find the problem, or trying meditation to aid with sleep improvement. There are also vitamins available that can promote quality sleep.”

Sleep improvement can be achieved by minimizing poor sleep habits like staying up late and not keeping a consistent routine. It is also important to minimize artificial blue light exposure from electronic devices. Sleep is vastly underrated, and if quality of sleep isn’t there it can have serious negative ramifications and lead to worsening fatigue.

Exercise:

Exercise not only promotes healthy sleep hygiene, it also can also have a huge impact on managing your fatigue symptoms. There are many types of exercise you can try to find what works best for you. Alternative types of exercise include swimming, yoga, and water aerobics, all of which are great ways to get active.

“Stretching is a large component of managing fatigue. We advocate stretching in the morning and at night. Stretching can play a large role in relaxing your muscles and preparing your muscles for sleep and it plays a large role in minimizing spasms.” said Dr. Mazhari.

Another notable factor in managing fatigue is being aware of the role heat can play. Exposure to heat from either exercise of environmental factors can exacerbate fatigue symptoms. In order to reduce your exposure to heat your physician can prescribe cooling products, like cooling vests or scarves to aid in the cool down process. In addition, it is important to consider timing. For example it may be beneficial to take walks in the morning during the summer, rather than in the middle of the day when it is warmest out.

Vitamins:

“Data shows optimizing vitamins are so important.” said Dr. Mazhari. Vitamin D is often lacking in this area, so adding that to your vitamin regimen can have a large impact. Other vitamins like B12 and Biotin have been shown to make improvements as well.

Mood:

Depression can be a big part of MS. Some patients will notice that when their mood changes it can impact stamina, and what you feel like doing. Depression can be a hard topic to bring up, due in part to the stigma surrounding it, but it could be why you’re having fatigue. So don’t be afraid to mention those symptoms to your physicians.

Caffeine:

Over caffeinating can also be a contributing factor to an increase in fatigue. A cup of coffee in the morning is okay, but caffeine all day long can create issues. Our doctors recommend two cups of water of every cup of coffee.

Side Effects of Medicine:

Sometimes certain side effects of medicine can play a role in increasing your fatigue. However fixing this can be as simple as changing the time you take your medicine. It can also help to evaluate the current medicines you are taking to ensure that your medication is benefiting you and working cohesively to make you feel better.

The content of this post is intended for general educational and informational purposes only; it does not constitute medical advice. Readers should always consult with a licensed healthcare professional for diagnosis and treatment.

 

Check out the full Facebook Live Here:

2017; A Year in Review

As we celebrate the beginning of a New Year and look forward to new successes in 2018, it is also a special time to reminisce. Last year was extraordinary in many ways, as DENT professionals led the country in the introduction of breakthrough therapies for severe neurologic disorders such as amyotrophic lateral sclerosis (ALS), Multiple Sclerosis (MS), spinal muscular atrophy (SMA) and brain cancer, and received special recognition from numerous local and national authorities. Continue reading “2017; A Year in Review”