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What is Rett Syndrome? | #OverpowerRett

Imagine the symptoms of autism, cerebral palsy, and epilepsy affecting one child who cannot speak. That is Rett syndrome.

Rett syndrome is a rare genetic neurological disorder that occurs almost exclusively in girls and leads to severe impairments, affecting nearly every aspect of the child’s life: their ability to speak, walk, eat, and even breathe easily. 

The hallmark of Rett syndrome is near constant repetitive hand movements. Rett syndrome is usually recognized in children between 6 to 18 months as they begin to miss developmental milestones or lose abilities they had gained.

What causes Rett Syndrome?

The clinical features of Rett syndrome were first described in 1966 by Dr. Andreas Rett. Patients with these clinical features were subsequently given the designation of Rett syndrome in 1983 in recognition of Dr. Rett’s original report. Rett syndrome is still considered a clinical diagnosis based on specific developmental history and clinical criteria. These clinical criteria were last revised in 2010.

Rett syndrome is caused by mutations on the X chromosome on a gene called MECP2. There are more than 900 different mutations found on the MECP2 gene. Most of these mutations are found in eight different “hot spots.”

Rett syndrome is not a degenerative disorder with individuals living to middle age or beyond. It is not inherited. Rett syndrome occurs worldwide in 1 of every 10,000 female births, and is even more rare in boys. 

Rett syndrome can present with a wide range of disability, ranging from mild to severe. The course and severity of Rett syndrome is defined by the location, type, and severity of the mutation and X-inactivation.

Symptoms

Symptoms for Rett Syndrome may not reveal themselves from six months until 18 months after an infant is born. One day your child is healthy and happy, grasping for things as babies do. The next day you notice they are experiencing:

  • Breathing difficulties
  • Cardiac Issues
  • Swallowing and digestive issues
  • Scoliosis
  • Seizures
  • Repetitive hand movements

These are just some of the symptoms of Rett Syndrome, a neurological disorder primarily affecting girls. Symptoms may be more severe in boys. 

A mutated gene may be the cause of this disorder that affects all racial and ethnic groups around the world. That’s why it’s essential to know about Rett Syndrome Awareness Month in October.

Males with Rett

In 1999 it was reported that mutations in the MECP2 gene, located on the X chromosome, were associated with the clinical presentation of Rett syndrome. Since the ability to test the MECP2 gene has been available, there have been over 60 males reported with mutations in the MECP2 gene. 

A few of these males had a clinical picture consistent with the clinical criteria for Rett syndrome; however, most of these males presented with a different clinical presentation. Most males with mutations in MECP2 gene present with an earlier onset of symptoms, typically with significant problems beginning at or shortly after birth.

The determination of Rett syndrome is still based on clinical criteria and the clinical presentation. Over 95% of females with classic Rett syndrome will have a mutation in the MECP2 gene. Mutations in the MECP2 gene by themselves are not sufficient to make a diagnosis of Rett syndrome. Patients with mutations in the MECP2 gene that do not meet the clinical criteria for Rett syndrome are given the designation of MECP2-related disorders.

How can you help?

Having a loved one with Rett Syndrome can be difficult. They often have behavioral problems and extreme levels of anxiety because they can hear and understand us, but cannot respond or move well on their own. Here are ways you can help someone you know who has Rett Syndrome: 

Socialize. Kids must spend time with their peers, but when they can’t talk, it makes things difficult. Try teaching them yes and no with the direction they move their eyes, or even giving them a choice board so they can point to their answers. Taking a trip to the movie theater with friends is also a good idea because speaking will be minimal from both ends.

Be active. Again, this is something that can be hard when a child has trouble moving on their own. But, if you can help them on a short walk, go for a swim, or even ride horses, it can help with both physical and mental strength. Plus, it’s something the whole family can enjoy together.

Keep learning and be mindful.  There is constant research happening with Rett Syndrome. Hopefully, someday, a cure or better treatment will be discovered. The more you learn and are aware of what is truly going on in your child’s mind and body, the better you can react in ways that will make them feel comfortable.

5 Things You Might Not Know About Rett Syndrome

  1. The mutation is random. One of the most frustrating things about studying the gene mutation is that it occurs with conception, and other family members may not experience it.
  2. Sufferers can outgrow it. Many live satisfying lives well past middle age and into their later years.
  3. Babies seem healthy until it appears. Unlike other kinds of disorders, Rett Syndrome babies seem entirely normal until symptoms appear between six and 18 months after a female child is born.
  4. Varied symptoms. Rett Syndrome symptoms can include scoliosis, irregular breathing during the day, and sleep disturbances at night.
  5. Love and support make a difference. People impacted by Rett Syndrome can improve immeasurably with the love, understanding, and support of their family and friends.

To learn more or donate to Rett Syndrome, visit these organizations:

World Stroke Day

If you or someone you know wants to make an appointment at the DENT Stroke Clinic, call 716-250-2000 or click here for more information.

World Stroke Day 2019 is October 29. The world stroke campaign’s goal is to raise awareness of stroke symptoms and the leading causes of strokes. 

One in four people will have a stroke in their lifetime. Most strokes are preventable with a few simple steps. Here are the top tips that help to reduce the risk of stroke.

Control high blood pressure

Half of all strokes are associated with hypertension. Knowing your blood pressure and controlling it with lifestyle changes or medication will reduce your risk of stroke.

Exercise 5 times per week

Over a third of all strokes happen to people who do not get enough exercise. 20-30 minutes of moderate exercise five times per week will reduce your stroke risk.

Eat a healthy balanced diet

Almost a quarter of all strokes are connected to poor nutrition. Eating a diet that is high in fresh fruits and vegetables, and reducing consumption of processed food will reduce your risk of stroke. 

Reduce your cholesterol

More than 1 in 4 strokes are linked to high levels of “bad” LDL cholesterol. Eating low saturated fats, avoiding processed food, and exercise will help to reduce your risk. If you are unable to maintain a healthy cholesterol level with lifestyle changes, your doctor may advise medication to help. 

Maintain a healthy weight

Being overweight or obese was found in almost 1 in 5 strokes. Maintaining a healthy Body Mass Index (BMI) or Hip to Waist Ratio will help you reduce your risk.

Stop smoking and avoid smoky environments

Almost 1 in 10 strokes were associated with smoking. Stopping smoking will reduce your risk of stroke and the risks of people who live around you. Getting help to quit increases your chances of success.

Reduce your alcohol intake

Over 1M strokes each year were linked to excessive alcohol consumption. If you drink, keep it a limit of 1-2 units of alcohol a day. 

Identify and treat atrial fibrillation

People with AP are 5x more likely to have a stroke than the general population. If you are over 50, talk to your doctor about AF screening. If you have AF, talk about treatments that will reduce your risk. 

Manage diabetes

If you have diabetes, you are at a higher risk of stroke. Diabetes and stroke also share several risk factors, including diet and exercise. If you have diabetes, talk to your doctor about how to reduce your stroke risk. 

Manage stress and depression

Almost 1 in 6 strokes are linked to mental well-being. Managing stress, depression, anger, and anxiety are all critical to reducing stroke risk. 

Recognize signs FAST

F.A.S.T. is a way to recognize signs of a stroke. 

FACE (has their mouth drooped?)

ARMS (can they lift both arms?)

SPEECH

TIME (time is critical!)

Why choose DENT?

There are about 1.5 Million strokes in the US each year. Nearly half of these are severe, requiring immediate hospitalization and often aggressive intervention. On the other hand, approximately 750,000 strokes occur with only passing symptoms. These mild strokes or Transient Ischemic Attacks (TIAs) are alarming, but often result in little or no deficit.

TIAs are critically vital warning signs of a potential devastating stroke. TIA symptoms must not be ignored. The Dent Mild Stroke/TIA clinic is run by experts in stroke neurology that have fine-tuned the diagnosis and treatment of this disease, resulting in a significantly reduction in the risk of a recurrent stroke. 

Learn more about our comprehensive stroke center here.

Find out more about stroke risk factors and prevention at www.WorldStrokeCampaign.org

Suicide Prevention and Mental Health Awareness

Mental Health Promotion and Suicide Prevention Livestream Recap with Dr. Horacio Capote, Director of the DENT Psychiatry Clinic.

Talking about Mental Health and Suicide Prevention is very important. A million people a year died by suicide. 

“There are a lot of myths to discuss and a lot of questions that you may have, so hopefully we will be able to cover a lot of these topics,” says Dr. Capote.

Myth: you can make someone suicidal by bringing up the topic

“This is completely false,” stats Dr. Capote. “In fact, many people are eager to discuss it, share it, and have an outlet.”

If you have suspicion that someone might have suicidal thoughts, it does not hurt to ask. You’re not going to do anybody any harm by asking. Instead, it shows that you are empathetic and that you care.

Myth: there is nothing you can do

“The data shows us that everyone is completely conflicted about suicide, all the way to the end,” explains Dr. Capote.

There are many places to intervene, and several things you can do. The first thing is to have curiosity to reach out and be willing to be part of the solution.

Recognize the warning signs:

Someone might show warning signs for suicide if they:

  • Suddenly are obsessed about death (talking about it, writing about it, etc.)
  • Have a change in personality
  • Have a change in behavior

“These are signs that something is going on that is worth identifying, and there are more major signs of trouble,” says Dr. Capote. 

These significant signs of trouble are:

  • A family history of suicide
  • If that individual has attempted suicide before
  • If that individual has a mental illness

“People with schizophrenia and many other mental illnesses have a much higher risk for suicide compared to the general population,” explains Dr. Capote. 

Treatment Options

“Sometimes, we tend to get a little pessimistic about treatment,” says Dr. Capote.

It is important to note that there are many many types of treatment, not just medication treatment. There are many forms of psychotherapy (psychodynamic psychotherapy, supportive psychotherapy), cognitive-behavioral therapy, dialectical behavioral therapy, and lifestyle management.

Lifestyle management include how you eat and exercise. Active people feel engaged and empowered. The Meditteranean diet is good for the brain. 

“The Meditteranean diet is probably just a fancy way of saying ‘eat colorful foods,'” Dr. Capote jokes. “If it is colorful, not bleached, and not processed, you know it has a lot of antioxidants that are helpful and protect your brain.”

Why choose DENT Neurologic Institute

There are a variety of treatments, and DENT Neurologic Institute, fortunately, has all of them available. 

“To my knowledge, DENT is perhaps one of the few places that may offer these various treatments in one location,” says Dr. Capote. “We are the only free-standing outpatient institute in the country that offers electroconvulsive therapy.”

If you or someone you know wants to become a patient at DENT, call us at 716-250-2000. Click here to learn more about our Psychiatry Center. 

If you are in crisis, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or contact the Crisis Text Line by texting TALK to 741741.

Spasticity Clinic Livestream Recap

On September 13th, we went Live ith Dr. Bennett Myers, Co-Director of DENT’s new Spasticity Clinic. Spasticity is, unfortunately, a prevalent problem that we see at DENT Neurologic Institute.

What is Spasticity?

In its broadest terms, spasticity refers to abnormal muscle contraction that is produced by an injury to the brain and spinal cord. Often, it can be confused with muscle spasm. 

All of us have had muscle spasms in our neck, back, or arms. Muscle spasm also refers to a kind of abnormal muscle contraction. It is fundamentally different than spasticity. 

The difference is not always evident to most people. 

“Neurologists who are skilled in diagnosis and assessing patients can usually pick [the differences] up quite readily,” explains Dr. Myers. “There needs to be some sort of injury to the brain or spinal cord to produce spasticity.”

Most Common Causes + Diagnosis

The most common causes of spasticity that we often see are diseases of the central nervous system, like Multiple Sclerosis, Cerebral Palsy, or brain tumors. Spasticity is not a disease in itself; it’s more of a symptom of a lot of different types of conditions.

Most patients who show up to the Spasticity Clinic already have a diagnosis for whatever is wrong with their central nervous system that is reducing the spasticity.

“Since most patients who come to the clinic already have a diagnosis, our focus at the DENT Spasticity Clinic is focusing on management of the spasticity,” explains Dr. Myers. 

Why do you need to manage spasticity? 

Not all spasticity needs management. 

“Some patients will have some weakness in their legs,” explains Dr. Myers, “and the spasticity is helpful to them. It helps keep them upright and enables them to walk.”

If you over treat the spasticity, you can take someone who can walk and treat the spasticity, and now their legs are weaker, and they are unable to walk. 

“We always have to be very clear as to what we are trying to accomplish when treating the spasticity,” says Dr. Myers. When treating someone with spasticity, the specialists at DENT first identify what the cause is. Next, they figure out if the spasticity is causing problems for the patient and what those problems are. 

 

What is the goal of treatment?

Spasticity can be quite painful. Relieving pain for patients could be a goal of treatment. Sometimes, spasticity is not helpful, and it can interfere, which is more common in the arms and the hands. 

“For example, people [who] have had strokes. Maybe they are not paralyzed. There is a weakness, but they have some movement. The muscles become very spastic from the injuries to the brain, and the spasticity interferes with function,” says Dr. Myers. “So, our goal of treatment in that individual may be to improve function.”

Those who have more severe spasticity, it is not only painful, but it can be hard for them to care for themselves. “If a patient has severe spasticity of their arm, so their arm is curled up very tight, you can imagine it is hard t get a shirt on and off,” says Dr. Myers. “A goal of treatment for that individual may be to relieve the spasticity to make it easier for the patient to get dressed.”

What is a contraction or contracture?

We often treat spasticity to prevent contracture formation, which is scarring at the joints. 

“An example of this is if I took my arm, put it in a sling, and leave it there for three months. Later, if I took the sling off, I might not be able to move my arm at all,” says Dr. Myers. “Why is that? Neurologically I am fine, but the problem here is that the joints have stiffened up so severely and scarred down that now they do not move anymore.”

Someone who has had the issue after any type of injury to the brain or spinal cord will eventually have their joints tighten up and scar. The mentioned injury can be a painful situation. Often, preventing contracture formation is a goal when treating spasticity.

Steps take to diminish spasticity 

We don’t treat spasticity for the sake of it. We want to relieve pain, improve function, prevent contracture formation, and make our patients’ lives better in some way.

The treatment plan depends on how much of the body is involved and how bad the spasticity is. 

“Let’s take someone who has mild to moderate degree of spasticity, for example. The first thing we try is physical therapy, occupational therapy, stretching, and regular exercise,” Dr. Myers explains. “We will see if we can get an adequate handle on the spasticity without resorting to any medication.”

The treatment suggestions mentioned by Dr. Myers do not have any side effects. Our first form of treatment is trying to manage spasticity without an invasive or medication approach. “When we can be successful in that rate, usually everybody is quite happy,” says Dr. Myers.

“Often, that is not enough, and we need to be more interventional,” Dr. Myers adds in.

Interventional Treatments

The next step will often be medication. There are several medications that we commonly use that relieve spasticity. These usually work best in people where the spasticity is relatively widespread, or is severe. 

Most medicines that help with spasticity have the same side effect: sleepiness. 

“If I am making them semi-comatose where they’re sleeping 20 hours as a side effect, I am not doing them any favors,” says Dr. Myers. “That is often our limitation to using medication. If it is a high enough dose, I can relieve an awful lot of spasticity. However, if someone is sleeping all the time, then I haven’t improved their quality of life, which is the whole goal of why I am treating the spasticity.”

Why choose DENT?

The DENT Neurologic Institute is among the largest, most comprehensive neurology practices in the United States. We are focused on providing superior clinical care, advanced diagnostic services, clinical research, and education.

The breadth and scope of our clinical expertise has allowed the creation of our specialty clinics. Every clinic has the same mission: to provide a disease-specific approach to treatment. This unique and integrated model has strengthened our standards of care, quality measurement, outcomes, and participation in clinical research.

To make an appointment, please call 716-250-2000. More information about our new Spasticity Clinic will be released soon. 

Reasons to see a Spine Specialist | DENT Spine Center

Spine Specialist in Buffalo, NY | Neck pain and back pain can range from being an irritation to being debilitating. No matter the pain level or the injuries and conditions you may have, the DENT Spine Center has more treatment options now than ever before. 

Dr. Thomas Pfiffner, DENT’s Spine Specialist, can diagnose the cause of your pain and counsel a wide range of remedies. Dr. Pfiffner brings over 20 years of experience as a chiropractor to DENT.

In this blog post, we will highlight why you should consider seeing our Spine Specialist.

 

#1 – Team Access

Our team specializes in spine disorders, neuroradiology, chronic pain management, physiatry, and physical medicine and rehabilitation. On top of that, the DENT Spine Center, UB Neuro and Buffalo Rehab group are all conveniently located in one spot. 

 

#2 – Non-surgical Treatment

Every back and neck pain patient is unique, and our team can help determine a diagnosis outside of surgery. Surgery may seem like the obvious and only option if your neck and back pain is severe enough. However, a spine specialist can ease your neck pain or back pain in non-surgical manners. 

 

#3 – Are You Suffering From Debilitating Pain?

It might be time to call a Spine Specialist if your neck and spine problems are causing you to miss work or day-to-day activities. Signs or symptoms to see a Spine Specialist may include back or neck pain that :

  • Does not get better, or worsens
  • Produces numbness, tingling or weakness
  • Makes fine motor skills and/or general movement hard

Having one or more of these conditions that affect your activities can sometimes make you feel hopeless. The DENT Spine Center is focused on getting the right treatment plan for you.

 

#4 – Learning about the cause

What is really causing the problem? Are there any changes I can make to improve the pain? What treatment options will lead to normalcy? A spine specialist can answer all of these questions, plus more.

 

Why choose DENT?

Specializing in the brain and spine, patient-centered care is our primary focus at the DENT Spine Center. With on-site collaboration between DENT, Buffalo Rehab, Bennett Rehab and University at Buffalo Neurosurgery, we provide unparalleled coordination and expertise to manage the most complex spine conditions. Our full-service imaging with onsite neuroimaging and general radiology experts are from DENT and Western New York Imaging. 

DENT provides ongoing research and development on the region’s most sophisticated MRI. This brings state of the art diagnostic capabilities to our patients, while simultaneously delivering an experience that elevates patient comfort.

 

Expanded Imaging Services

DENT has recently expanded our Imaging Services at the new Spine Center on George Karl Boulevard, near Wehrle and Transit. In addition to MRI and Ultrasound services, DENT is seeing the return of CT, and is venturing in X-Ray for the first time.

X-rays are available for pediatric and adult patients.

CT will be available from newborns to adults. Our new scanner has software to limit radiation exposure to our pediatric patients.

 

 

 

Our Spine Specialist and team is ready and excited to take care of you. To learn more, click here or call 716-250-2000 to make an appointment – help is one phone call away.

DENT congratulates Dr. Zhang on a successful ten years as Director of the DENT Dizziness, Balance and Tinnitus Center

In 2009, Dr. Zhang became the Director of the DENT Dizziness, Balance and Tinnitus Center. This week, Dr. Zhang celebrates 10 years in this role. Dr. Zhang has 12 years of extensive neuroscience research experience with almost 30 peer-reviewed publications in various neuroscience journals.

As one of the principal investigators, Dr. Zhang has been involved in multiple national clinical research projects in the areas of Restless Leg Syndrome, Neuropathic Pain, and Epilepsy. Currently, he is developing new research projects focusing on Meniere’s Disease, migraine-associated vertigo and imbalance/falls in elderly patients.

His patient focus is on balance disorders, dizziness/vertigo, sleep medicine and epilepsy as well as general neurology.

Dr. Zhang can provide comprehensive evaluation, diagnosis, and treatment all in one location. The treatment is mainly the combination of non-sedative dizziness preventive medications and vestibular therapy. The DENT Dizziness, Balance and Tinnitus Center offers Computerized Dynamic Posturography, a state-of-the-art technology, developed for NASA astronauts, to evaluate patients with unexplained falls or imbalanced conditions. This technology can also provide objective data to assess the ability for someone to return to a normal lifestyle following a sports concussion or work-related injury.  

Before the center opening, The Cleveland Clinic was one of the closest places Western New Yorkers would travel to for treatment.

Call 716-250-2000 to make an appointment and click here for more information on the Dizziness, Balance and Tinnitus Center.

 

 

DENT Neurologic Institute is officially recognized as a Partner in Multiple Sclerosis (MS) Care

Buffalo—DENT Neurologic Institute, a leading provider of care for people living with MS in Buffalo has been officially recognized as a Partner in MS Care, Center for Comprehensive MS Care through the National Multiple Sclerosis Society’s Partners in MS Care program. This formal recognition honors DENT Neurologic Institute’s commitment to providing exceptional, coordinated MS care; and a continuing partnership with the Society to address the challenges of people affected by MS.

Buffalo, NY is considered a world hot spot for the prevalence of patients diagnosed with MS.

The Society’s Partners in MS Care program recognizes committed providers, like DENT, whose practices support the Society’s initiative of affordable access to high quality MS healthcare for everyone living with MS – regardless of geography, disease progression, and other disparities.

DENT Neurologic Institute is the only recipient of this specific award in Upstate New York. DENT has been designated as the only Comprehensive Care Center in our region.

Partners in MS Care – Centers for Comprehensive Care are led by clinicians with demonstrated knowledge and experience in treating MS; offer and coordinate a full array of medical, nursing, mental health, rehabilitation and social services and have a strong collaborative relationship with the National MS Society. We have shown our level of dedication to the patients in our community by being one of the first centers in the country to offer new, novel therapies to the patients in our community. DENT is often a chosen site to participate in MS research opportunities. Our staff are also recognized nationally for the expertise on MS and the understanding of what it takes to run such an integrated practice.

“We are so proud to partner with DENT Neurologic Institute to enhance coordinated, comprehensive care for the people who live with MS in Buffalo,” said Stephani Kunes, of the National MS Society, Upstate New York. “In earning this recognition, DENT has demonstrated extraordinary leadership in MS care, making a tremendous impact on people affected by MS in our community,” Stephanie Kunes continued.

 

For more information, please visit www.nationalMSsociety.org/partnersinMScare or call 1-800-344-4867.

 

 

Cannabis: A Medical Update | Facebook Live Recap

During the Facebook Live we went over what is new in the Cannabis world. The Dent Cannabis Clinic sees about 115 Cannabis patients on a daily basis.  We have over 30 individuals seeing patients for various reasons for using Cannabis. When we talk about Cannabis, there are three types of Cannabis: recreational, Medical, and Hemp-based products. 

 

Type 1: Recreational Cannabis

 

Recreational Cannabis is what you hear about smoking and is legal in 10 states. 

“I don’t deal with that [recreational Cannabis],” Dr. Mechtler says. “It is hard for me to support recreational Cannabis when individuals have to smoke it. At the end of the day, I’m a Physician. For me to promote smoking, when I have been anti-smoking my whole career, would be very difficult.”

When Recreational and Medical Cannabis are compared, there is a huge difference. Recreational Cannabis is mostly high THC and low CBD. Naturally, the plant does not produce a lot of CBD. There are some exceptions to the rule, but the higher the CBD content, the higher the price of the product. 

 

Type 2: Medical Cannabis

 

Legal in 33 states, including New York State, Medical Cannabis allows the physician to change the THC to CBD ratio to help with specific medical disorders, many of which are neurological. This includes, but is not limited to: MS, ALS, Neuropathy, Spinal Cord Injury, Epilepsy and HIV. In New York State, they added Chronic Pain, Substance Abuse and Opioid Abuse.

“With these indications, we can now look at a patient at our Cannabis Clinic,” Dr. Mechtler explains. “Most of our patients come here because of Chronic Pain, but other disorders also happen. We see close to 10% of all patients in New York State.

 

Type 3: Hemp-Based CBD Products

 

 The Hemp Farm Act of 2018 that was signed in December 2018 has lead to hemp-based CBD products being sold nationally. It comes from the same plant. The difference between hemp and recreational cannabis is that in hemp, you have less than 0.3% THC. 

“That number is very important. Once it is above 0.3% THC, it is not legal to sell in stores,” says Dr. Mechtler. “It is very low THC and high CBD. People who are looking for CBD are looking for its health benefits. The are four main health benefits of CBD. The first is that It’s an anti-inflammatory, like ibuprofen but without the stomach problems. Second, it is a pain killer, but without the problems of Opioids, such as addiction. Third, it is an anxiety medication without the side effects. Lastly, it helps you sleep without the side effects of Ambien.”

CBD is natural with minimum side effects. This is something that can help anybody, and is a product you can find almost everywhere.

 

Be cautious of where you buy CBD

 

The problem with CBD right now is that it is not regulated. Arno Hazekamp did a study where  he bought 46 different CBD products online. These products were checked to see what exactly the CBD content was. The CBD content was 0 in 39% of these products. This tells us that there is a 39% chance that the product you have does not have any CBD. The other problem is that the THC level in the products were high. Some of them were 57% THC. Those products should not be legal, but it is not regulated. 

Products with CBD need to be regulated and third-party tested. What does that mean? This means that when you buy a CBD product, look for a QR code. The QR code, when scanned, will give you all the information about the product from a third party. It will tell you what is in the product you just bought. 

“There are two things you have to look for,” says Dr. Mechtler. “First, what is the actual CBD content and what is the THC content? That is very important. Second, you are looking for what we call contaminants. These products can have contaminants such as: heavy metals, insecticides, pesticides, and fungus.” 

Not all products have third party testing, as it could make the product more expensive. In addition, not all third party testing tests for contaminants. As a consumer you need to understand that what you are buying is not regulated by the government. 

At Dent, a full spectrum physician formulated CBD stored located on the first floor, called Mend. Mendis a retail hemp-based CBD store owned by Jushi, Inc as is a tenant within the Dent Tower building in Amherst. Dent is not affiliated with the store, however, our providers believe in the high quality products that it produces and feel strongly that our patients can benefit from utilizing their products.

The Mend products are third-party tested for CBD and THC amounts, as well as for contaminants. They offer soft gels, lotion, and tincture (eye drop in the mouth).  The formula is based on the research from Dent. 

 

The MORE Act 

 

New legislation waiting to be passed in New York, called the MORE Act,  states the change in federal law to take Cannabis off of the Controlled Substance Act, which is category one. This will allow researchers in Cannabis to see more patients and do research without the any issues with the federal government. The MORE Act is hoped to be passed by the end of this year.

 

Retrospective Cannabis Research in the Elderly Population

 

One of the unique things about Dent is the amount of patients we see. However, current legislation makes it difficult to do prospective research. A prospective study watches for outcomes, such as the development of a disease, during the study period and relates this to other factors such as suspected risk or protection factor(s). The study usually involves taking a cohort of subjects and watching them over a long period. 

What we are able to do is retrospective research. A retrospective study looks backwards and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study. It has been difficult to tell providers what to give patients because we do not have that data. The things that you typically have with a pharmaceutical medication, like dosage and safety, we don’t have yet with Cannabis.

“What we have been doing is creating a database and looking at different patient populations to see what works, what doesn’t work, what is safe and what is not safe,” explains Paul Hart, Research Assistant at Dent. 

This last year, the researchers at Dent looked closely at how the Elderly population reacted to Cannabis. What dosage can they receive while having the least amount of side effects? This research was presented at the  American Academy of Neurology (AAN), and it was selected for press release. That means that the AAN saw our research, thought that it was beneficial enough and helpful enough to be presented at their annual meeting. 

“Our research had the average population age of about 81 years. This population is probably on several different medications, and has different side effects from those medications,” explains Hart. “If they switch to Cannabis as an alternative, they should have fewer side effects. We found that only 30% of patients had side effects, and of that, half were resolved from changing.”

One of the focuses is to get patients off of Opioids to help ensure our patients do not form an addiction or have serious side effects. Although we have a long way to go, a solid foundation has been put into place from our funding.

 

Chronic Migraine and Cannabis

 

Chronic Migraine is a debilitating disease that affects millions of Americans. The Dent research team looked at 316 patients at Dent who incorporated Cannabis into their Chronic Migraine plan. 

“We looked at Quantitative data, numbers that we can find out from patients, but also Qualitative,” explained Vincent Bargnes, Research Assistant at Dent. “We took a look at what numbers we can pull from how Cannabis has been affecting these patients, but also the non-number things, see how it makes them feel.”

The research team at Dent saw an improvement in 88% of our patients. There was also a decrease in monthly headache days – from about 24 days to about 17. Additionally, we found that 56% of patients who were on Opioids reduce the amount of Opioids. Improvements in anxiety, mood and sleep were also found.  “It was very, very well tolerated with minimal side effects,” explains Bargnes. 

With excellent results, the Dent team has been trying to get these findings published. Unfortunately, the finding have been rejected by both organizations that Dent has submitted to. 

“This is the problem in cannabis research,” Dr. Mechtler explains. “Not only does the Federal Government give us a difficulty using cannabis in research on human beings even though it’s been used as 12,000 years. But also, the establishment of medicine is resistant to the science that we are producing here, which is very unfortunate. Now trust me, we are not giving up, we are moving forward and will find a journal that will publish our findings.”

 

The Cost of Cannabis

 

We see that the average cost of treatment is about $200 a month. The Dent Research team looked at underserved populations to get a better understanding of cost as a factor of their treatment plan.

The Dent Research team ran a study that looked at 1,200 people that are in the Cannabis Clinic and looked to see how they are doing with Medical Cannabis. “What we found is that 80% of all people that use Medical Cannabis had some positive outcome from using the treatment,” explains Chris Ralyea, Research Assistant at Dent. “We also saw that in the underserved populations, the ability to afford medical cannabis went down significantly. The retention rates in what we call normal populations at about 70%. In the underserved population, the retention rate was about 50%.” This means we are losing half the underserved population, visit after visit. 

What is the Opioid use? Are we able to reduce the amount of Opioids our patients are using? “We found that about 36% of all patients included in this study were able to reduce their use of Opioids by using Medical Cannabis, even if it was a lower dosage than what we recommend here in our clinic,” explains Ralyea. 

 

Geriatric Research

 

The geriatric research had patients from 75 to 102 years old. Age is not an issue. “Our publications showed that in that population, we don’t see significant side effects. So, it’s safe,” reports Dr. Mechtler. “We don’t see people getting high. Nobody comes to us because they want to abuse Medical Cannabis.”

 

Dr. Laszlo Mechter is also working with an insurance company in Western New York to do some research with Albany to see what happens when you pay for Medical Cannabis. “I can tell you right now, some initial research has shown that people who take Medical Cannabis save payers a significant amount of money on the use of other drugs,” explains Dr. Mechtler. “I have so many patients that throw away 4-5 medications since they have been on Medical Cannabis.”

 

 

The Dent Cannabis Clinic
 

One of the biggest complaints we have received is the wait time for an appointment at the Cannabis Clinic. “We have added more providers on, and are excited to say that our wait time is cut down,” says Amanda McFayden, DENT Cannabis Clinic Program Director. “Right now we are accepting referrals.”

To be seen at the Dent Cannabis Clinic, have your primary doctor fill out the Cannabis Clinic referral form. Once we receive that form, it will be reviewed and you will be put with the appropriate provider. We do not accept workers comp older than 2 years. We do not accept self-pay, we go through insurance. Feel free to call 716-250-2000 for any further questions.Click here for more information about the Dent Cannabis Clinic.

 

 

 

What is Nira? FAQ’s about the new physician formulated CBD store located in Dent Tower.

On Monday, June 3rd, Nira will be opening up in Dent Tower at 9 am. With CBD stores and products appearing everywhere, why choose Nira? Nira has one clear focus: a pure formula at an affordable price.

“Our research is based on clinical data from over 8,000 patients in our Dent Research Institute” – Dr. Mechtler, Dent Institute’s medical director and director of the cannabis clinic. Below are some FAQs related to this store opening.

 

What is CBD? Is there any THC?
 

Cannabidiol (CBD) is a non-psychoactive product that is from cannabis or hemp. It is different from marijuana, which has more THC (the psychoactive ingredient). Patients who have chronic pain and chronic inflammation as well as sleep trouble have had excellent results from CBD.

The cannabis plant contains hundreds of different phytochemicals including cannabinoids, terpenes, and other compounds. Full-spectrum CBD or hemp oil generally refers to products that not only contain CBD but contain the other plant molecules as well. This version of CBD oil is minimally refined, leaving most of the cannabinoids and terpenes intact and in the oil.

Full-spectrum, also called “whole plant,” means the full plant extract is included. Full-spectrum provides more of the plant’s molecules in ratios and amounts that nature intended.

There are indications that show cannabinoids and terpenes work together to influence each other. This synergistic effect is called the entourage effect and has seen CBD work with THC to reduce the effects of a high and CBD to influence one’s own cannabinoid receptors.

Nira is a full-spectrum CBD product store. There is less than 0.3% THC in CBD products. There is no risk for psychoactive effect with these products.

 

Who can buy products from Nira?
 

Nira is open to the public. You do not need to be a patient at Dent to buy the products; however, we encourage anyone who wants to establish a relationship with an experienced provider to discuss their medical condition and learn more about proper dosing and what would work best for them to call our office at 716-250-2000 to schedule a consultation. All Dent patients will get $5 off all products. 

CBD does not require a prescription. You do not need a medical marijuana card to buy products at this location, as these products are not part of the NYS Medical Marijuana Program.

If you are interested in becoming a patient in the NYS Medical Marijuana Program, please visit our website at www.dentinstitute.com and click on the cannabis clinic logo to print off a referral form for your provider to complete and submit to us.

 

What products will be sold?
 

The initial product line will consist of: Soft Gel Capsules, Lotions and Tinctures. Soon, a hemp derived CBD lozenge will be added to the product line. The prices for these products are:

Tincture: $50

Soft Gels: $60

Lotion: $65

Keep a lookout for new additions as they come along, the Nira line will continue to develop new and exciting products!

What are the ingredients in each product?

 

Nira Tincture: CBD, Medium Chain Triglyceride (MCT) oil

Nira Soft Gels: CBD, Medium Chain Triglyceride (MCT) oil, glycerin

Nira Lotion: CBD, Water (Aqua), Butylene Glycol, Glyceryl Stearate, Propylene Glycol Dicaprylate/Dicaprate, Glycerin, C12-15 Alkyl Benzoate, Cetyl Alcohol, Stearic Acid, Sodium Lauryl Sulfate, Phenoxyethanol, Triethanolamine, Polyacrylamide, C13-14 Isoparaffin, Laureth-7, Carbomer, Methylparaben, BHT, Propylparaben, Menthol, Camphor, Disodium Edta, Aloe Barbadensis Leaf Juice, Tocopheryl Acetate

*All products contain less than 0.3% THC. Store at room temperature, away from sunlight. 

 

Is there an option to purchase online?
 

The store will be opening June 3rd and online purchases will be soon to follow. The store will be cash only for the first couple weeks. *UPDATE: the store is now accepting credit cards!

 

Is Nira affiliated with Dent?

 

Nira is a retail hemp-based CBD store owned by Jushi, Inc as is a tenant within the DENT Tower building in Amherst. DENT is not affiliated with the store, however, our providers believe in the high quality products that it produces and feel strongly that our patients can benefit from utilizing their products.

 

Why buy from Nira?
 

  • Third party lab testing
  • Physician formulated
  • High quality product
  • Products come with recommendation on dosing and titration based upon years of research, specialized for each condition.

 

As of now, CBD is not regulated. We believe in top-quality, highly compliant products. We track everything and third-party test everything.

“Most products on the shelves might just be vegetable oil with a sprinkle of hemp extract. You want a product that’s standardized for CBD content. We look at the lab tests for heavy metals and toxins” – Steven Przybyla, Sounds Wellness LLC company president.

Dosage is not the only thing that is important….it’s the purity of the CBD. “Physician formulated means that it’s under our supervision, and going forward, we’ll continue to modify these products,” said Dr. Laszlo Mechtler.

 

The Nira Store is opening June 3rd at 9 am. Business hours will initially be from 9 am – 5 pm. It will be located at Dent Tower: 3980 Sheridan Drive, Amherst, NY 14226. You can contact the store by calling 716-466-MEND or emailing info@soundwellnessllc.com

Dr. Joshi Will Be Presenting in the 2019 Migraine World Summit

Buffalo, NY – Attending Neurologist and Headache Specialist at DENT, Dr. Shivang Joshi, will be presenting at the 2019 Migraine World Summit. 

According the Migraine World Summit’s website ,”The Migraine World Summit is a virtual event that brings together over 32 top experts including doctors and specialists, to share new treatments, research and strategies, for migraine and chronic headache.”

Dr. Joshi will be presenting on “Drug Interactions and Side Effects from Common Drugs.”

Registration is required to take part in this event, please visit the Migraine World Summit’s website for more details.