Episode Transcript

Audio Transcript

Trevor: Kirk, we're back for part two of Genester Wilson King.

Kirk: Hey Trevor, how's it going? It's like I just saw you about five minutes ago.

Trevor: It is weird how that works. Yeah, time travel is amazing.

Kirk: Yeah, so this was a very long, I discussed in part one, this was very long conversation with a lady in Florida. If you haven't listened to part one please do. If you have listened to the episode on endometriosis, go back. She's been a very gracious lady to our podcast. Knowledgeable, wellness, this is a female wellness episode, we do talk about prenatal, we do talked about breastfeeding. We talk about how the endocannabinoid system is a huge part, a huge of the reproductive system. Yeah, is there anything you want people to watch out for in this episode?

Trevor: Yes, as we mentioned in part one, she throws a statement, I'll say about two-thirds of the way through this part where, and I'm not saying a bad statement, but both of our jaws are pretty sure hit the floor at the same time, so listen for that. We'll talk about it a little bit on the way out. But no, other than that, I could just listen to Genester Wilson King talk all day, So how about we go do that?

Kirk: Yeah, let's do that. Let's just move into the conversation and we'll come out. So in your practice, Dr. Wilson-King, in your in your practice, how do you recommend a route administration, an individual recognizes individual care. But how what are your recommendations for route administration of

Dr. Genester Wilson-King: What I do with my patients is I go through the routes of administration and explain them to the patient. We talk about inhalation. Inhalation can consist of smoking, vaping, vaporizing. Smoking involves combustion, the production of carcinogens, et cetera, even though we know lung cancer is not a significant adverse outcome to smoking cannabis. Whereas it is for smoking cigarettes. But still the combustions with smoking cannabis can cause a chronic cough, can lead to bronchitis. So there are some, there is still respiratory impact. Then you have the vape pens, which contain oil and the oil is heated by a filament. To what temperature? We don't know. And that causes... Is we were hoping it causes a vapor so that the patient can inhale it. But we don't know if they're burning inhaled cannabis particles or is the filament from which the heat emanates is that shedding at all? We haven't I don't I haven't seen those studies yet. So then there's vaporizing and there's either a portable vaporizer or the vaporizer that's tabletop. And I believe that's the volcano still. And that's been since the sixties. No, I didn't see it in the sixties. I wasn't around. But I have seen them since. The vaporizer is a very clean way. It doesn't heat the flour to high temperatures. It heats the flour so that there's a steam coming off the flour through which you can inhale. And like I said, it's a cleaner way to inhale the cannabis. I prefer that if you need to inhale. Then you have the tinctures. The tinctures are oils alcohol-based or oil-based liquids, I should say, that are in a bottle with a dropper, and you can dose yourself from one drop to 10 drops, whatever, or a half of an ml, half of a dropper, things like that, whatever dose works. And with those, I generally recommend you start with the lowest dose and slowly titrate up, and then you can find that sweet spot. Say if you're trying to sleep. You wanna find the dose that allows you to sleep through the night, but wake up feeling refreshed, not drugged or Groggy. And so patients learn to titrate their dosing to that. And that's a, I like tinctures because you can start off at a really low dose. And sometimes with some of the products you have to start at five milligrams or higher. And that may be too high for some people. Then you have, these are basic. Then you the edibles, the products that you eat, you chew and swallow, et cetera. They take, no, I didn't say the duration of action. Inhalation lasts, the onset of effect is one to three minutes. It may last one to the three hours. The tinctures, the sublingual products, products that go under the tongue will... Onset of action is about 45 minutes to an hour and can last four or five hours. And then the edibles, which can take up to two hours for onset and can last for six to eight hours. So that's why a lot of people use edibles for sleep. But you'll find a lot of smokers who have difficulty adjusting to the edibles. Because with using inhalation, you get immediate response. Using the edibles, it takes some time. And people are not used to taking that kind of time. These days, we have the time it takes to read the article. At the top of the article, then you can determine whether or not you're going to read it. I mean, this is all part of the AI world and the world of the internet and whatnot. So, hey, you gotta go with it. So and then there's topicals. Topicals, when people discover topical, they are amazed because they really are effective and they really do work. So those four basic types. Route of Administration can be used by the patient. And I really encourage the patient to use what they feel most comfortable with. There are hundreds of products from which to choose. There's even drinks of powder. You can put in any kind of juice that you have and drink your medicine. There's all sorts of ways to medicate. And I think that's fantastic that you different ways of it of ingesting your, taking your medicine. Medicating is the word.

Kirk: In your practice and getting back to your prenatal patient, from the point of view of law and medical legal, are there considerations that you have to take into when you are working on an individual's care plan? And it includes cannabis. So what are some of the things you would consider for that client if you were recommending cannabis? And I don't know, you can make a patient up when- Give me an atypical patient where you might recommend cannabis for them during pregnancy.

Dr. Genester Wilson-King: Certainly a pregnant patient who had a history of hyperemesis with her first pregnancy, hyperemesis gravidarum occurs in about 0.3 to 1.3% of pregnant women. And it's a severe nausea and vomiting of pregnancy, but not the typical morning sickness. This lasts all day, every day. And patients can get dehydrated. Even say in days past, those patients might be hospitalized and put on IV nutrition because of the persistent nausea and vomiting. Now we have our routine anti-nausea medications including like Zofran and Compazine and things like that, but those aren't things that are routinely, well first of all composition and others weren't routinely used in pregnancy and really weren't even cleared for pregnancy. Most drugs, unless they're specifically tested in pregnancy, have not been tested in pregnancy. When we started using, when I say we, I'm saying the physician population, started using Zofran for morning sickness, it had never been tested before. It was just another use for the drug that we thought, oh, This might work since it's safe in other places. Have since been a few studies, and it seems safe enough, but it just doesn't always work.

Kirk: But that's called using it off label, right?

Dr. Genester Wilson-King: Exactly, it's called using it off label.

Kirk: And cannabis, we don't use cannabis because we don t have enough research. So how is it physicians can justify using a drug off label or medication off label, but they won't use cannabis? I guess that's another episode.

Dr. Genester Wilson-King: Thats just the hypocrisy of it all. However, there have been some adverse outcomes with cannabis, primarily in the preclinical population, not humans, but you just can't totally ignore that. You know, we can accept all the good findings in the preclinical world and clinical world, but we got to accept the negative too and recognize the negative, be aware of it. Carry it in your repertoire when you're counseling patients, you have to share the negative with the positive. One of the things, and I kind of use this as an example, I don't listen to or read the reviews, the Google reviews and all that sort of thing. My staff pays attention to that. I do not. Because I say, if I pay attention to the good reviews, then I'm gonna have to pay attention to the bad reviews. And I don' wanna do that. So. They can do that for me if they want. And if there's something, of course, that someone said that we need to correct, we will do that. But it's just too much. It takes up too much time. But at any rate, so if none of the other medicines work, and this is say it's a patient with a twin pregnancy, no less, or like I said, had a history of hyperemesis, and this woman wants to terminate her pregnancy, is that's how hysterical she is and how fearful about going through that again, she would rather not. So I used my counseling session as harm reduction and we talked about using cannabis to help her get through. Now, many of the studies show, the studies that looked at light use of cannabis, moderate use of cannabis, and heavy use of cannabis. Defined as one or two joints a week for the light, three or four joints a week for moderate, heavy use, more than five joints a week or more than five joints a day. That's heavy use. So the ones with the light and some of the moderate, light and moderate use. If they stop after a certain period of time, and usually it's the first trimester, don't seem to have any adverse outcomes. So what I did with this patient is I had her do two tokes of a vaporizer twice a week. If she didn't need to use it, she didn't feel any nausea or anything, don't use it. But two tokes twice a weak and we got her through 16 weeks gestation and then weaned her down and she did fantastic. She did fabulous. Had a full-term birth without any problems. That's the kind of thing you can do, its not necessarily...

Kirk: I'd like to go on with that harm reduction. I think that's a good flow. So when you're consulting clients, patients that are pregnant, there are other over-the-counter drugs that we also have to be aware of. And I guess harm reduction, when you look at people's availability of, I guess, you know, I'm gonna preface this question by saying, first of all, the best pregnancy is good air, good activity, good diet, good sleep, no drugs, no alcohol, right? Best case scenario. But when we look at harm reduction in the real world we live in, and you were talking about anxiety, and cannabis is so good for anxieties, when you say you look at a harm reduction, where does cannabis just fit in all that? I mean, Ibuprofen, I mean people sometimes swallow that stuff. And those points in pregnancy, your ibuprofen is not recommended. Tylenol is consumed like candy sometimes. Where does cannabis fit into all that within your practice?

Dr. Genester Wilson-King: Well, overall, cannabis is the safest known substance known to man at this point. It really is. It will not kill you. It does not. It's not toxic to the liver.

Kirk: Bold statement. That's a bold statement, but I completely agree with you. Sorry, I'll shut up.

Dr. Genester Wilson-King: Okay, the law judge from the first case to reschedule cannabis was Judge Francis, Law Administrative Judge Francis Young. And that was his statement at the end. When he recommended that cannabis be rescheduled, this is back in probably 1980s, when he recommended the cannabis be, cannabis be re-scheduled, he made this statement, It is the safest known substance. Known to man. So, and I would agree with that, because as far as toxicity, etc., it won't kill you. It is just safe. Safer probably than sugar. Sugar can have adverse outcomes. I mean, people take in a lot of sugar. So it is safe. So I don't necessarily have a problem using it. We just don't know if it's totally safe for the baby. That information is inconclusive. Now, with all the people using cannabis all these years, we haven't had a epidemic of the same problem relating to cannabis use. It's like we're always, we're thinking there's one and then when we really look at it, nah, that's not it, roll that back in. Let's go with this one. So there've been several. And like I said, there are articles that show harm from these things and there are articles that shows no harm. So, what do you do? It's very, very difficult. So what I would say is, do not even consider using cannabis unless it's something you feel you need to do. And then if you want to do it, you do it under the guidance of one who understands your condition and can understand you and how you need, need to use it. I individualize, have the patient in, do the counseling, get a good, good history from them. And then we, and the consultation is a good hour, a solid hour, sometimes longer. And I get to know the patient. And then I can, I'll make my recommendation.

Kirk: Let's go back to that patient that has seizure activity. She's pregnant, she's been using cannabis through her pregnancy. Now she's breastfeeding. How does cannabis get into the breast milk? We know it's very fatty, it loves fat. Is there a concern at all going into the breasts milk? So we're now moving this client, this patient into postnatal care.

Dr. Genester Wilson-King: Right, the other issue about postnatal care, though, is 80% of women in postnatally care, who are postpartum, rather, there's lots of stress, there's lot of anxiety, there's a lot of sleep issues, there's all sorts of things going on. So they're more likely,  just as likely to use cannabis as well. Cannabis will get into the breast milk and will kind of hang out in the breastmilk for a while. I'm trying to also speak things in terms of. Non-medical people can understand what I'm saying as well. So cannabis as in THC, CBD, and we know there are some other cannabinoids that can cross into breast milk as well because breast milk is very lipophilic and breast milk. And lipophilia, meaning life's fat, are the cannabanoids. So they will get into the breast milk and they will hang out. Now, studies have shown that they can be found in there up to 17 weeks later. So that means what people used to do is like if they smoked an hour or so before nursing, what they will do is remove the breast milk, remove a cup or so and throw that out thinking they're getting rid of most of the cannabinoids that might be in the breastmilk and then they can continue to breastfeed with lower amounts of breast milk, but we've realized from our studies that that doesn't work. So what that means is if you're going to breast feed during pregnancy, then you shouldn't inhale your cannabis because that's where you get the most absorption of the cannabinoids into the fat. So use something. Use an oral form of the cannabis if you must use it in the postpartum period while breastfeeding because the metabolic products of the oral meds are more water soluble and won't get into the breast milk nearly as much. So that's what I generally recommend for people who want to breastfeed and used their cannabis in the postpartum period.

Kirk: Fantastic. I guess we have come up to our time. Is there anything you'd like to say at the end?

Dr. Genester Wilson-King: I guess the main thing is ask someone. If you don't know ask a cannabis expert. We're all out here and we are really willing to help. And some people maybe charge more than you would like. If you need to find someone who charges a little less, do that, but we are willing to health. And there are plenty of people I know who will adjust the fee to your ability to pay. So we are all people and we are all out here really trying to help everyone use cannabis in a responsible manner. And that's what we want. So I would say the biggest thing is particularly for pregnant women is please get some help. I do consultations all over the country. We do it by video if you're not anywhere near Florida. Get the help, get some direction and guidance, and you'll know what to do. You really will. And if we don't know what do, we will find out for you and get back to you with some guidance for sure.

Kirk: That's a good place to end. Thanks you

Trevor: Kirk? So how safe do you think that their cannabis is?

Kirk: You know, Trevor, we talk to people, we've been doing this podcast for seven years, we've had doctors make bold statements. That was a bold statement. It's the safest drug she knows, the safest medication she knows. And it's so controversial for her to say that when cannabis is not recognized as a true drug with a DIN. We've talked about this, a Drug Identification Number. Because the pharmaceutical companies... The government? Who assigns D-I-N?

Trevor: The government. You can go down the conspiracy hole if you want, and many people do, but the Drug Identification Number system, it's not really designed for natural products. And so because there are so many different things going on in cannabis and so many sort potential active ingredients in there. I am not surprised that it doesn't have one assigned, and then the conspiracy-ish part, and getting a DIN number costs a lot of money. So the system isn't really set up for natural products and... Nobody's going to make a ton of money off a patent on cannabis. So there's less money behind it. So it's not ya.  It's not a drug. I'm not going to say it's never going to be a drug, but it's, uh, being, I'm, not quite sure how it's going to go.

Kirk: Well, and isn't that interesting? Because of the way our system works, a medication is identified as a medication when it has a DIN, a Drug Identification Number, which is odd, right? But that's, but we've discussed Big Pharma, we discussed one molecule to one issue.  What do you guys, pharmacists call it one one drug for one? What's it called?

Trevor: One indication.

Kirk: One indication, but yes, whereas cannabis is a multi, what's the word she used in the first interview?

Trevor: I think multi-molecular or multi or multi-pharmaceutical or multi pharmacological

Kirk: It's multi-molecular, so there's so many components to cannabis that you can't call it a medication, because medications are very specific. So therefore, in our culture, as healthcare professionals, we have to be very careful when we talk about plant medicine, alternative medicine, whatever you want to call it, but yet there she says. I mean, she came out and said it's the safest drug, and we've discussed this. I mean, this is. For her to say it is bold because, wow, thank you for saying that, because we talked to so many advocates. And I just posted today, I just post our video of Owen Smith, and I made the comment that no matter how many advocates we talk to, we're all of like-minded people. We think cannabis helps people. But yet all of us are always still surprised by the stigma of cannabis. So anyways, we are talking a lot about that, that was a bold statement.

Trevor: I yeah, let's go back to pregnancy because she did hit some interesting points. Kirk do you have way more experience with this than me.  Hype Hyper-emesis of pregnancy. She had another Latin word, but I know what it's hyper emesis of a pregnancy. Just Quickly, what is that? And how dangerous can it be?

Kirk: Well, it's an overwhelming, overwhelming... Babies are parasites, right?

Trevor: Yes.

Kirk: Ultimately, they're parasites.

Trevor: pre-and post natal I have two kids, I love them dearly.

Kirk: Yes, yes.

Trevor: Yes, they are.

Kirk: But so they feed off your body and it creates hormonal shifts, it creates electrolyte shifts, and nausea and vomiting can be a huge component of early pregnancy as bodies adjust.

Trevor: But this hyper-emesis is not just vomiting.

Kirk: No, this is uncontrollable evacuation of bodily fluids, right? So you're losing electrolytes, you're loosing hydration. I think we've discussed this, it's like if you're vomiting for three days or more, go get them help. If you've got diarrhea for three or more days, go get some help because you're loosing fluids. So for her for her to say that cannabis if when all else fails, let's bring in cannabis

Trevor: I just want to put in one more, just to put a pin in how serious this is, we're not being overly dramatic when we say hyperemesis of pregnancy can kill the patient.

Kirk: One of her case studies was how she read a paper of a lady that was denied any sort of treatment and denied the cannabis and she died of nausea vomiting. That shouldn't be happening, right? So if all else fails, if pharmaceuticals cannot help, cannabis can be an option. Right? Look how cautious we are, right? Look how conscious we are.

Trevor: no no and you know what? It's OK to be that cautious because we are talking about we are cautious about everything around pregnancy and rightfully so.

Kirk: So essentially, you get into a situation where somebody is severely vomiting, it's life-threatening, it requires hospitalization, it requires IV fluids, it require an adjustment of electrolytes, it can happen in pregnancy. We've discussed this before, two men talking about women's health, right? In my career, I've delivered babies, in my career I've done prenatal visits, in career. I've done women's health. I was certified at one time for women's health so I get it, but I'm not a woman. But I've been involved with prenatal care and also helping women to latch with breastfeeding. I found it interesting talking about the breastfeeding and how ingestion versus inhalation changes for the cases.

Trevor: Hadn't even I hadn't again make sense but never occurred to me and weirdly if you'd asked me ahead of time I would have guessed that ingested like a gummy a drink oil would have I just don't know why but in my brain okay well that will go more into the breast milk that was just my my intuition but no it's the the inhaled and if I'm understanding what she was saying properly it's because it stays more in the fatty, lipophilic way of being and so that'll go into the breast tissue into the breast milk all fatty and into the baby more than the oral which will be metabolized into a more we call hydrophilic or a less fat soluble form and that will go into the baby less. Does it matter not that's a whole other different thing but just the pharmacology was interesting

Kirk: Yeah, that's the thing. That's why I like this episode. She gets into the whole endocannabinoid system with the reproductive system. She get's in that if you are going to use cannabis during pregnancy, get help, talk to somebody knowledgeable about cannabis, find a coach that knows about cannabis. Find a prescriber that knows a lot about cannabis find somebody that understands cannabis. Just don't do it. Now, but if you aren't just going to go do it, consider harm reduction, that maybe when you nauseated, you know, a vape pen. In the first episode she talked about using a vape pen with whole flower.

Trevor: No, she mentioned it here too. And she was stressing her if you were going to inhale, she said her preference actually medically is to use oral like oral liquid is just easier to titrate and that stuff. But for a while, I think we're getting our terminology a little mixed up. But what she I my understanding of what she was trying to say is though, if you put a whole flower in in something that heats it up and we have a term for it in the tobacco world we call it "heat not burn" but the idea being you can heat up the cannabis bud and just get the cannabinoids and some terpenoids and stuff off of it without actually burning the plant material because we think it's those products of combustion that are bad and by bad we mean carcinogenic maybe. So she liked the heat not burn vape.

Kirk: Yeah, I have one of those vaporizers. They're very good. You can adjust the temperature and by adjusting the temperature, different cannabinoids burn hotter and differently. So you can actually, as a medical user, if you are inhaling cannabis, having a whole-flower vaporizer is the way to go. Because you can tie in by heat the terpenes you want and the cannabinoids you want. So that's kind of cool. You know, this has been two very long episodes. There's so much I want to talk about in regards to this conversation, that they'd learn more about the Melanie Dreher. You know? Yeah. You must remember me discussing that when we first started this podcast.

Trevor: Yeah, no, absolutely. You have mentioned her quite a bit over the years and I'm losing track now whether we did that in the first episode of this one or the second, but I liked how she went into some of the detail about the Melanie Dreher thing and how because it's always really hard in the real world to tell what exactly a person is consuming. Like, unless you take, that's why in drug trials, we literally take the person and we put them in, you know, the equivalent of a hotel or a warehouse. And in addition to getting the drug or not, we completely control what they eat, what they drink, you know whether they can smoke, whether they could have coffee. All those things are just so that the control group and the treatment group are identical. But in the real world you can't control all that stuff. So I thought it was really interesting her going over the, well Dreher did not a bad job on picking this group of Rastafarians who just kind of by definition weren't consuming a lot of other stuff. In my mind, I know it's not right, but in my mind as you know around here it'd be like the Hutterites you know just because of their chosen cultural things you know they're not consuming, you know a bunch of coffee and alcohol and and and just because of that how they choose to live. So I thought it was interesting the Rastafarians were specifically not having a lot of other tobacco and coffee and and so it was easier to easier to tell if if what cannabis may or may not be doing to the kids

Kirk: Yeah, but you know what, once again, you stumble into a conversation with somebody about how often pharmaceuticals are used off-label.

Trevor: Yeah, for me, again, it was the Zofran and ondansetron. So that leapt out at me both times we talked to her because, and for those of you who aren't pharmacists, this is a really powerful anti-nausea medication that it's not dangerous, but we specifically use it for cancer. That's sort of where it came up for us. You know, cancer chemotherapy, we give it there, so it... Kind of blew my mind that a they're using it in pregnant women because you know we should all still be terrified of thalidomide and the bad things that that happened when we used it off label in pregnancy so we used a really potent thing off label. Thank god it has been proven now to be actually safe in pregnancy but we're using an off-label in pregnancy beforehand and that's bonkers.

Kirk: But yet, the safest drug we know, is still considered alternative medicine. Yeah, yeah. It was, it was another good one. I really enjoyed talking to Genester Wilson-King Esther I mean, I truly hope once again to meet her. And we are talking about future projects. She has a couple of future stories for us that I hope to cultivate from her. So. This has been a very interesting journey to get this episode, these two episodes. So I hope people enjoy them. And please, feedback would be wonderful. You know, we haven't done this. I'm gonna move on, Trevor. Is there anything else you wanna talk about?

Trevor: Yep, yep. No, no. No. She was great. She was great thanks for talking to us, Dr. Wilson-King.

Kirk: No, so, but we haven't asked for this in a while, you know. You know, people, we're looking for some help from you. Social media, it's very difficult for us to get our message out on Meta. Because cannabis is not respected on Meta. So we're using LinkedIn a lot and we're also using YouTube now.

Trevor: Feedback is great.

Kirk: Yeah, yeah, good feedback. But that's where I was going to go with this. So feedback on YouTube, if you interact with us on YouTube you can watch the videos. We're doing videos now on YouTube All of these episodes, I think about 70% of our shows going forward are going to be videotaped and put on YouTube. And please, if you like us on Instagram, talk to us, share our stuff on Meta, like tell your friends about us on Metas so that we can get the message out. Visit us on LinkedIn. I spend a lot of time on LinkedIn and on YouTube, and if you're on iTunes or Spotify, rank us. Give us a hello. Give us a, hey these guys are great, you know. Let's get Reefer Medness out there. We've got seven years of this. We've a huge library. There's a lot of information. Tell a friend.

Trevor: Tell a friend.

Kirk: I'm Kirk Nyquist. I'm the registered nurse.

Trevor: And I'm Trevor Shewfelt. I'm the pharmacist. We didn't mention that at the end of the the first half because we're too excited to get to the second half, but we really are still here and we really do have names.

Kirk: Interact with us and talk to you later.