Category: News

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. For more information, click here.

 

 

 

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

On Monday, June 3rd, Mend will be opening up in Dent Tower at 9am. With CBD stores and products appearing everywhere, why choose Mend? Mend 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 FAQ’s 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.

Mend 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 Mend?
 

Mend 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 look out for new additions as they come along, the Mend line will continue to develop new and exciting products!

What are the ingredients in each product?

 

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

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

Mend 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 Mend affiliated with Dent?

 

MEND 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 Mend?
 

  • 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 Mend Store is opening June 3rd at 9am. Business hours will initially be from 9am – 5pm. 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. 

DENT Study Finds Medical Cannabis May Alleviate Symptoms of Chronic Disease in the Elderly

Buffalo, NY – A recent study conducted by the DENT Cannabis Clinic finds that medical cannabis may alleviate symptoms associated with chronic conditions in the elderly.

The study, led by Dr. Laszlo Mechtler, focused on the effects of medical marijuana in seniors with chronic conditions. Of the 204 patients in the study, ranging in age from 75 to 102, 70 percent reported a significant increase in their quality of life and more than 30 percent were able to stop taking their opioid pain killers. 

The study found that a 1:1 ratio of THC to CBD, proved to wield the best results with the least amount of side effects. Dr. Mechtler and his team will be presenting their findings at the American Academy of Neurology Annual Meeting in Philadelphia this May. 

“Our findings are promising and can help fuel further research into medical marijuana as an additional option for this group of people who often have chronic conditions,” said Dr. Laszlo Mechtler, director of the DENT Cannabis Clinic.

Check out additional coverage of the study below. 

American Academy of Neurology – “Could Medical Marijuana Help Grandma and Grandpa with Their Ailments?”

WGRZ – DENT Studies Effects of Medical Marijuana on Seniors

 

Making the Most of Your Healthcare Visits – Facebook Live Recap

Preparing for healthcare appointments can seem daunting for both caregivers and patients. There are questions you want to ask and updates you want to give, but you may find that preparing for an appointment is an overwhelming task.

“Sometimes we have patients or family members who don’t necessarily understand the process, and it makes them feel like they don’t get the most out of their healthcare visit,” said Program Director for the DENT Integrative Center for Memory, Sarah Harlock. “However, there are steps that patients, family members and care partners can take to get the most out of appointments.”

Booking and Scheduling

After a dementia diagnosis, it can feel like there are appointments every other week. One day you may have an appointment with your physician, the next week you may need to get additional testing or imaging done. The frequency of appointments and testing can seem overwhelming at first. However, those initial tests are an important part of confirming your diagnosis and creating an appropriate treatment plan.

“Once a treatment plan has been made appointments will become less frequent. Some patients come once every three months, others every six. Depending upon your diagnosis and your needs, you and your physician will create an appointment schedule that works for you,” said Harlock.

Appointment Preparation

Reminders

The way patients diagnosed with memory disorders respond to appointment reminders is very individualized. Some patients enjoy keeping track of their appointments and want to be reminded in advance. Other patients may become very anxious or nervous when reminded. If as a care partner you notice that the person you’re caring for has increased anxiety leading up to an appointment, it’s okay to be sparing with reminders.

Time of day

Caregivers, try to schedule appointments that are at the patient’s best time of day.

“If person the person in your care is generally more confused and agitated in the afternoons, schedule a morning appointment,” said Harlock. “At appointments we will do in-office assessments and we want patients to feel relaxed and able to perform at their best.”

Allot enough time to get ready

“It is important that a patient is fully prepared for their appointment, so try to be mindful of that when scheduling,” said Harlock. “As a caregiver, if you know your loved takes 2 hours to get ready in the morning, maybe an 8 am appointment doesn’t make sense.”

“At each appointment, we want to make sure the patient is in the best frame of mind. Rushing them out the door to the appointment, creating stress is not a good way to achieve that optimal frame of mind,” added Harlock.

Caregivers, it is also important to be mindful of how much help your loved one needs. Is a telephone reminder enough, or has it become necessary to have someone helping them get ready for the appointment?

Preparing for the Healthcare Visit

There are many things you can do as a care partner to make the most of your loved ones healthcare visit.

Make sure the patient has their glasses, hearing aid, etc.,

“One major part of being prepared is making sure the patient has remembered their glasses or hearing aid, or anything vital to their communication. It is very difficult to assess patient if we cannot properly communicate with them,” said Harlock.

Bring an updated list of current medication

Another important piece of being prepared is having a current medication list. This list should include over the counter medicine and supplements. “

This is important, so that we know exactly what the patient is taking,” added Harlock. “The other piece to this is that caregivers are knowledgeable about how well the patient is taking their medication and there are ways to be respectful about this.”

One way you can respectfully check in with your loved one to measure how well they are taking their medicine is to say something along the lines of I’m sure you’re doing this right but just so I can answer the doctor, I need to know you are taking your mediation the way it is prescribed.’

“We have seen many patients whose family member thought they were taking their medication properly, then something happens as a result, and they realize they weren’t.” said Harlock.

Document any changes since last visit

The day before the appointment take a few moments to think about or write down the changes that have happened since the last visit. 

Documenting changes in a patient’s willingness to take shower, ability to handle finances or take medication, is vital information for a provider to be continually updated on.

“Mood is also an important thing to be taking notice of. If there is a big change in mood we would like to know about that,” added Harlock. “Additionally, if there is something you cannot say, or don’t feel comfortable saying in front of the patient, write us a note. Slip the note to the medical assistant or nurse and they will get the questions to the provider who will then make sure it is addressed during the visit.”

At the Appointment

Have your list of questions ready

It is easy to be distracted by rushing to the appointment, or hearing something the provider said. This list will help you focus and on the appointment and get your questions answered.

“Be knowledgeable and honest about what the patient is capable of. If you are the caregiver for a loved on it can be difficult to share, however it is important to be honest and accurate,” added Harlock.  

Take notes during the appointment so you can be mindful of what to keep an eye out for and what to mention in your next appointment.

“It is also helpful for caregivers to ask if there are any red flags to be watching for, especially with medication changes.”

Additional Tips

For caregivers

Caregivers, you are part of the healthcare team! Your insight is vital in maintaining and adjusting treatment plans.

In addition, please do not wait for the next appointment to tell us about a medication side effect, or that the patient is struggling with or has stopped taking a medication,” added Harlock.

For patients

Consider bringing someone to your appointment with you who knows you. Due to the changes that are happening in your brain, even at an early stage, your perspective may not be the same as your families or friend’s. You may not be an accurately communicating or understanding what your treating provider is saying. This is not meant to be an insult, but the reality of the a cognitive impairment diagnosis.

View the entire presentation below!

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.

 

Care Partner Resolutions: Staying Healthy – Facebook Live Recap

According to the Alzheimer’s Association, more than 16 million Americans provide unpaid care for people with Alzheimer’s disease or other forms of dementia.  This care ranges from assistance with activities like bathing and dressing, to financial assistance, to coordinating care or providing emotional support. 

Different care responsibilities are important to note because although traditionally we may think of “hands on care,” as the primary role of a caregiver, there are many ways to be involved in managing a loved one’s diagnosis. 

“Many people are long-distance caregivers or care partners.  Adult children living out of the area often help by assisting with paying bills or helping coordinate care. Those responsibilities make you a care partner too,” said Sarah Harlock, program director for the DENT Integrative Center for Memory.

“I encourage caregivers and care partners to think of their own health and consider steps to put into play to ensure they are taking care of themselves,” said Harlock.

Importance of Prioritizing Your Health

“As the care partner to someone with Alzheimer’s or dementia, you yourself are at increased risk for higher levels of stress, depression, anxiety, negative physical health changes, or complications to existing health problems,” added Harlock. “Study after study shows that care partners have increased stress and depression scores over the general public.”

Often, with all the added responsibilities, caregivers will begin to neglect their own self-care. Many caregivers feel like they can’t find time to exercise or are too tired to prepare healthy meals for themselves. It is also common for caregivers to put off their own healthcare appointments or treatments.

An Analogy for Caregiver Health

Harlock likens the rules of maintaining caregiver health to the instructions given when flying on an airplane.

“I recently had the opportunity to travel by airplane and the safety instructions they provide haven’t changed much. They tell you to be cautious moving about the cabin, to keep your seatbelt on even when sitting, to put your own oxygen mask first before assisting others and so on,” said Harlock. “And I found it’s a pretty good analogy for caregiving.”

1. “Be mindful when moving around the cabin”

Be aware of your overall health. This includes your physical, mental and spiritual health. Being a caregiver to an individual with dementia can have a negative impact on your health.  Paying attention to changes in your own physical and mental health will keep you and the loved one in your care in healthier.

2. “Keep your seatbelt fastened, even when seated”

Memory disorders can bring a lot of change and you want to be prepared for when that change happens. As professionals, we can’t tell you exactly what changes you will see next or when you’re going to see them.  Gathering information and staying prepared can help you be prepared for when changes do arrive. Generally speaking people feel more at ease, more confident and less anxious when they have done some preparation.

3. “Be careful opening the overhead bins as contents may have shifted”

Be mindful that things are going to change. It’s important that you know what kinds of community resources are available to you. This informed and prepared approach will help increase confidence, decrease depression and decrease anxiety.

 4.  “Know where your emergency exits are”

Know how to give yourself a break. Know who you can call, for instance the neighbor who offers to stay with the person with dementia when needed, or know where you can turn to when you need assistance with your care partner roles. This plan could include some social programs that provide care partners some respite, or volunteers to come and visit, so you can take a break.

5.  “If there is a change in cabin pressure and the oxygen mask drops in front of you, put your mask on first before assisting others”

If you are not in good health it’s hard to give your all to the person you are caring for.  It is not selfish to care for yourself while you are providing care to others. You owe it to yourself AND the person you are caring for to care for yourself.

Questions to Ask Yourself

Try to look at each part of your health. First, look at your physical health. What is your doctor saying? Are you noticing any negative changes in your physical health? 

Also make sure to check in with your mental and emotional health.  Are you in a good mood most of the time or are people commenting that you don’t smile or laugh much anymore? Do you find yourself short tempered (more than before). Do you have healthy coping skills like exercise or coffee with friends? 

It is also important to be aware of your spiritual health. What brings you peace? Are you doing the things that being you peace or is there something else you can do that gives you that feeling?

After checking in with yourself act accordingly to work on any part that may be out of sync. 

With everything else going on, how do I make time?

“I think it’s important to set goals, then break those goals down into small manageable steps. Create an action plan,” said Harlock. “There is a great program out there called Powerful Tools for Caregivers which has its participants develop action plans.”

Sarah provided the following action plan as an example. 

“Let’s set the goal as wanting to lose 20 pounds.  Rather than looking at all 20 pounds at one time and all of the activities you have to accomplish to do that, break it down into manageable steps,” said Harlock. 

 Start by making the statement I will __________ fill in the blank with the healthy activity, on __________ fill-in the days of the week you will perform this action at __________ give a time.

The statement might read, “I will walk for 10 minutes Monday, Thursday and Friday at 4:30 pm.”

Look at the statement and decide how confident you are that you will be able to achieve this small step. On a scale of 1-10 (1 being not confident at all and 10 be extremely confident). If your confidence is lower than a seven you need to rethink this step.

For instance maybe three days a week that is not realistic, 4:30 may not be the best time to achieve that goal.  If at 4:30 pm your care recipient is typically engaged in an activity like a nap, then it might be the perfect time. However, if your loved one starts to get anxious, restless or more confused in the late afternoon, you may need to rethink the time. Adjust this statement until you feel confident you can accomplish it. 

“The point is you build on the success!  This week you may walk 10 minutes on Wednesday at 2:30 pm because you know that your husband will be having coffee with the guys. You see that you were able to do it and maybe next week you walk twice for 10 minutes. Now,  walking 10 minutes once a week is not going  to make you lose 20 pounds, but gradually those small steps will help you accomplish that larger goal of losing the 20 pounds and you keep building on your success. 

“The concept applies to other goals such as being a happier caregiver, feeling less stressed. You break it down into reasonable and manageable steps and you build on your success. If you don’t accomplish the task one week, look at why, adjust and try again,” said Harlock. 

Care partner well-being is so important to you and to the person you are caring for!

To view the entire presentation, check out the video below. 

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.

DENT Welcomes Dr. Thomas Pfiffner

DENT Neurologic Institute is excited to announce that Dr. Thomas Pfiffner has joined DENT as director of the DENT Spine Center. Dr. Pfiffner brings a unique multidisciplinary approach to spine care. At the DENT Spine Center your initial evaluation will be conducted by Dr. Pffifner, who will then collaborate with experts across a number of specialties to create a comprehensive and effective treatment plan. Dr. Pfiffner has truly unique academic background, his board certifications include chiropractic medicine, chiropractic radiology, neurology, neuroimaging and neuro-oncology, and he is also certified in medical cannabis. 

At DENT, Dr.  Pfiffner will be focusing on spinal disorders, including, but not limited to:

  • Radiculopathy 
  • Disc Disease
  • Spinal Stenosis
     
  • Post Traumatic Spine Injuries
  • Spinal Tumors
  • Neuroimaging Evaluation of Spinal Disorders

Dr. Pfiffner completed his neurology residency at the University of Minnesota. He is Fellowship trained at DENT Neurologic Institute and Roswell Park Cancer Institute. Dr. Pfiffner has published and contributed to multiple articles focused on spinal pathology. He will be key in the development of a new multidisciplinary spine center partnering with UB Neurosurgery.

Dr. Pfiffner is looking forward to his return to western New York and using his extensive experience to help those with spinal injuries.  

Dementia and Communication – Facebook Live Recap

Dementia is an umbrella term used to describe a group of symptoms. Those symptoms can arise as any negative change related to thinking, including; difficulty with memory, language, reasoning or problem solving. Those symptoms, commonly referred to as cognitive changes, may affect the way a person communicates. 

Program Director for the DENT Integrative Center for Memory, Sarah Harlock, explained over Facebook Live why these communication breakdowns happen and techniques you can use to improve communication between you and the person in your care. 

Importance of Communication:

It is important to note that there are many types of dementia, including but not limited to; Alzheimer’s disease, Lewy Body dementia, and Frontotemporal dementia. That being said, it is important to understand that communicating with someone with Alzheimer’s disease may be different than communicating with someone with frontotemporal or vascular dementia. Approaches in communication may need to vary from person to person, dementia diagnosis to dementia diagnosis.  

“It’s helpful to think of dementia communication as a continuum. The person you’re caring for with Alzheimer’s may not be able to communicate the same way as the person sitting next to them who also has Alzheimer’s,” said Sarah Harlock, program director for the DENT Integrative Center for Memory.

“Communication, at its core, is about connecting with another person,” said Harlock. “Although, sometimes communication may be about giving an instruction or direction, try to remember that communication is about making emotional connections and that is what the person with dementia is trying to do.”

In the later stages, dementia can be accompanied by changes that may impact a person’s ability to communicate. 

 

Vision Changes:

Vision changes are a large part of a late stage dementia diagnosis. A person with late stage dementia may experience significantly diminished peripheral vision.

“For example, if you put a cup of coffee on the side of their place-mat and they keep asking ‘where’s my coffee,’ you, as a care partner may be frustrated and keep saying ‘it’s right there, it’s right there’. It’s important to remember that they are not asking to annoy you, or be difficult, the loss of peripheral vision has made it so they really can’t see it,” added Harlock.  

Depth perception and the ability to discriminate colors can also diminish as a dementia diagnosis progresses.

 

Hearing/Auditory Changes:

As dementia progresses, hearing changes can occur making it difficult for a person with dementia to hear certain pitches, particularly higher pitches.

In addition, as the disease progresses it can be hard for a person to distinguish between background noise and foreground noise.

“Whereas our brains can tune out background nose and focus on the conversation at hand, that can become increasingly difficult for a person with dementia, making it hard for them to follow a conversation,” added Harlock.

Creating a quiet and calm environment can be helpful when trying to communicate with a person in that stage.

 

Sensory Perception:

The importance of sensory perception can often be overlooked. However, sensory perception can be very important for people with dementia. Often they can become too hot or cold, and even the feeling of clothing can be uncomfortable for the person, so try to be mindful of that.

 

Processing Time:

When having a conversation with someone we expect them to respond back in a timely manner or give us non-verbal clues that they are thinking about their answer. This processing time can change significantly for a person with dementia.

“Processing time for someone with moderate to late stage dementia can take up to 90 seconds,” said Harlock. “In that case, repeating what you said louder again and again won’t help, it will only frustrate the person. Slow it down and give them a chance to process the information,” said Harlock.  

 

Language:

“Many times, in the late stages,  a person with dementia may revert back to their primary language. For instance, if a person’s first language was Spanish, and they learned English later in life, it is not uncommon for a person to begin solely speaking Spanish,” added Harlock.

 

Emotion:

Emotion can play a large part in communication for someone with a memory or mood disorder.  For example, if a person is anxious it causes them to be distracted, which can affect their ability to retain information.

“It is important to recognize that a person’s emotional state will impact their ability to communicate,” said Harlock. 

 

Verbal vs. Non-Verbal Communication:

 

There are many things you can do as a care partner to make communication easier for you and the person you’re caring for, both verbally and non-verbally.

 

Verbal Communication:

 

Word Choice:

When speaking, avoid slang or jargon. Remember to slow it down, including both talking slower and allowing for a longer processing period.

 

Tone of Voice:

“If you want someone to do something, make sure you are saying it in a way that makes them want to cooperate with you. If you are gruff, unfriendly, or you’re stressed out, the person will pick up on that and be less likely to do what you are asking of them,” said Harlock. 

 

Non-Verbal Communication:

 

“Most communication that happens is non-verbal. Body language, facial expressions and eye contact, all play a big role in communication,” said Harlock.

 

Facial Expression:

Facial expression can play a huge role in communication with a person who has dementia. “If you looking for someone to do something, make sure you are making the correct facial expression that will get you the cooperation you need, “ said Harlock.

 

Body Language:

“If you are acting aggressive or assertive a person with dementia will pick up on that and think ‘Whatever he/she wants me to do doesn’t look like fun, so I’m not going to do that.’ So make sure your body language is really calming.” added Harlock.

 

Gestures:

“If understanding language has become very difficult, we can use gestures to get our point across,” said Harlock

 

Eye Contact:

“Due to the vision loss, make sure you are in their line of sight and engage them in conversation,” said Harlock.

 

Effective Techniques will vary from person to person and type of dementia to type of dementia, however generally these tips can be very useful for creating meaning and effective communication.

 

1.     Speak slowly and calmly

2.     One question or instruction at a time, keep it clear and simple.

3.     Allow time for a response. *remember it can take up to 90 seconds to process the information and respond

4.     Tell the person what you want them to do, not what you don’t want them to do.

5.     Be more positive in your communication. Avoid using the word no (unless safety is at risk, then use the words you need to

6.     Simplify questions, don’t make them too long, keep them clear and concise

 

Techniques:

 

There are a few additional techniques that can help have more positive and productive communication with the person in your care.

 

Validation:

Validation is a way of opening up communication lines.

If the person you are caring for keeps saying ‘I want to go home now’ rather than saying something terse, like ‘you are home’ over and over,  try a different approach like, ‘tell me about your home or what home are you thinking about.’

This method will open the door and allowing for meaningful and productive communication.

 

Therapeutic Fibbing:

Described as a detour from the truth, this technique can be very helpful and very kind for the person with dementia. This technique is best used when telling the truth will be more hurtful than helpful.

“I once worked with a woman who had dementia and would get very upset that her mother didn’t know where she was. She would become agitated wanting to get in touch with her mother. Unfortunately, the woman’s mother had died many years ago, however, instead of saying ‘your mother passed away’ only creating further agitation. we would use therapeutic fibbing to say something like “Your mother called, she wants you to stay for dinner,” and immediately the woman would calm down and be so relieved that her mother was no longer worried,” said Harlock.

 

Watch the full presentation below:

 

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.

What is TMS Therapy?

Transcranial Magnetic Stimulation or TMS therapy, is an FDA approved treatment for depression that utilizes energy to stimulate the brain and facilitate improvements in depressive symptoms. The treatment utilizes short pulses of a focused magnetic field to stimulate nerve cells in the area of the brain thought to control mood. This brief and painless treatment is performed in a quiet, comfortable setting under the supervision of a psychiatrist and is administered while the patient is awake and alert.  

We sat down with Physician Assistant in the DENT Psychiatry Center, Michael Asbach, who explained how TMS works to treat depression. 

1. How does it work? 

“A 3 Tesla magnet, which is the same strength magnet used in an MRI, is placed over the area of the brain known as the dorsolateral prefrontal cortex. The powerful magnet sends pulses through the skull and causes depolarization of the neurons in the superficial cortex of the brain. Through neural pathways, the local stimulation causes functional changes in other brain regions and leads to improved cell communication and improvements in depressive symptoms,” said Asbach. “The electromagnetic coil is placed against the scalp and delivers pulses of magnetic field in 30 second intervals involving 40 pulses in a 4 second period with 26 seconds of rest. The magnetic pulses are not painful and feel/sound like a light tapping on the scalp.”

“I often describe the sensation to my patients as if someone were to lightly flick your head 4000 times in a 20 minute period. It may not be comfortable but it is not painful for most.”

2. How long does the treatment take? When can patients expect to see results? 

“The first TMS treatment is called a mapping. At this appointment a medical practitioner and TMS technician will use a computer algorithm to identify the best location on the scalp for treatment. As a result of the mapping, your first treatment session usually lasts about an hour. Subsequent treatments are quicker and last anywhere from 20-30 minutes,” said Asbach.

“Patients receive treatments 5 days a week for 6 weeks or a total of 30 sessions. Patients commonly will start to see improvements in their symptoms about half way through the sessions, however sometimes improvements are not observed until later in the treatment process. The reason being that TMS is causing changes in neuron functioning and communication through the repetitive and sustained exposure to magnetic impulses which stimulate the cells and “wake them up.” This does not occur in just one session and requires continued exposure to the magnetic pulses,” Asbach continued.  

3. What patient population does this therapy work best for?

The FDA has approved TMS for patients with treatment resistant depression. Treatment resistant depression is defined by the failure of two or more antidepressant therapies with adequate trial of dose and duration.

“TMS treatment of depression is covered by most insurance companies although some insurers require further medication failures and/or an adequate trial of counseling. TMS is not recommended for the treatment of depression within the context of Bipolar illness. Additionally, patients with a history of seizures are recommended to consult with their neurologist as TMS treatment has been reported in rare instances to increase the risk of seizure (in normal clinical use the estimated risk of seizure is 0.03% of treatments),” added Asbach. 
 

4. What are some common misconceptions surrounding TMS that may hold people back from trying it?

A common misconceptions surrounding TMS is that it is an invasive procedure. Patients think that anesthesia is required or drastic alterations to their medication regimen. However, TMS is a non-invasive treatment that is done in the office. Patients are able to drive to and from their TMS treatments and often come to the office to receive their TMS treatment on their lunch break or on their way to work. 

“If patients suffer from depression and have tried 2 or more medications without success, they may be good candidates to receive this innovative treatment,” said Asbach.

 

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.

What is Epilepsy?

Epilepsy is the fourth most common neurological disorder. According to the Epilepsy Foundation, epilepsy affects 3.4 million people in the United States and 1 in 26 people in the U.S. will develop the condition at some point in their lifetime. 

We sat down with Director of the DENT Epilepsy Center, Dr. Marc Frost, who cleared up common misconceptions surrounding the disorder. 

1. What is epilepsy?

“Epilepsy means that a person has recurrent seizures,” said Dr. Frost. “The type of epilepsy depends on the type of seizures the person has.”

The terms grand mal and petit mal are often misused to describe types of epilepsy. Those terms are simply a description of the seizure. A grand mal seizure occurs when a  person convulses or shakes. A petit mal describes a seizure where the person does not convulse.

2. What is a seizure?

“A seizure is the physical response to an abnormal electrical discharge in the brain,” said Dr. Frost

3. Are there different types of seizures?

“The type of seizure depends on where in the brain the abnormal discharge occurs,” said Dr. Frost. “If it happens where movement comes, the person will have abnormal movements in that part of their body, or a motor seizure. If it happens where sensation comes from, the person will have an usual sensation in that part of the body, also known as a sensory seizure. If the discharge stays in that spot, a person may just have a partial seizure. If that discharge spreads, a person may get confused and act strangely, known as a complex partial seizure. If it spreads to the rest of the brain, the person may have a full body convulsion, or secondary generalization.”

4. Who can be affected by epilepsy?

“Anyone at any age can have seizures and the causes of the seizures may be different at different ages. About 10% of adults will have single seizure. About 10% of those people (1% of the population) will go on to have recurrent seizures, or epilepsy,” said Dr. Frost. 

5. Is epilepsy genetic?

“There are some types of epilepsy that run in families and have a genetic component to them. However, the majority of epilepsy does not run in families,” said Dr. Frost.

6. What should you do if you see someone having a seizure?

“Let the seizure happen,” said Dr. Frost.  “Do not restrain the person or try to hold them down, they are more likely to be injured that way. Try to get the person on the ground and in a safe location. Lose any tight clothing and move any heavy objects away from them. Make sure to turn them on their side, they may vomit and you don’t want them to inhale or they will choke.”

Dr. Frost also stressed to remember to NEVER put anything in someone’s mouth during a seizure. “It is not possible to swallow your tongue, it’s attached to the bottom of your mouth. The person may bite their tongue, but that will heal. Objects put into someone’s mouth can break teeth, be swallowed or choked on, and fingers that are put on someone’s mouth can be bitten off.”

“People may hold their breath or stop breathing during seizure even to the point they start to turn blue. This does not mean that you must do CPR on them. They will start breathing once the seizure is over, so just watch them closely to make sure they do. When the person starts waking up, they will be confused and may get angry or agitated, talk softly to calm them down and guide them to a safe place. Do not try to restrain them, or they may just get more confused.”

“Always, always call 911,” added 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.