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E72 - Dr. Suzy Pinnick Explores Pediatric Palliative Pot

Dr. Suzy Pinnick, a family physician specializing in palliative medicine and remote northern medicine, shares her cannabis story with Kirk. In this episode, the two health professionals sit in a casual masked conversation within the warmth of the NIC’s office of a northern nursing station during a deep Covid19 Canadian winter evening. She is quick to say she has very little knowledge of cannabis, yet believes it is important to learn. When she was asked by parents to prescribe cannabis for one of her pediatric palliative care patients, Dr. Pinnick quickly recognized how little she knew. Kirk brings the story to Trevor, how this experienced doctor is willing to learn as she practices; how she learns the art of medicine while applying the formal duties of a doctor.

Wednesday, 28 July 2021 13:25

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Episode Transcript

Trevor: Kirk, we're back. 

Kirk: Hey, how's it going? 

Trevor: I'm good. So we're going back in time a little bit to an interview you did up north in Little Grand Rapids. Let's talk a little bit about before we get into the cannabis part, just to kind of set the stage, tell people a little bit about Suzy Pinnick and what you have to do with her Little Grand Rapids. 

Kirk: Certainly, Dr. Suzy Pinnick. This is going back to two conversations that I had with her over January and February. Yeah, we were. Suzy Pinnick is a family doctor with a specialty in remote nursing stations and remote care. She's also got some skills in pain management and also palliative care. Now, I know her through work in the north and she was gracious enough to talk to us. We were sitting in an office, a nurse, nurse in charge office. As we're sitting and we're talking at one point in the conversation, I think you can hear someone come in. I think one of our colleagues came in and I think she's using the fax in the middle of a medevac or something to that effect. And of course, everything's in the nursing nurse in charge office. So she comes in and Suzy and I keep talking and I'm what I'd like to hear. You know, what I would like our listeners to hear is that I caught Dr. Pinnick when she's pretty tired now. I think we're probably midweek because she was she would be traveling the next day to another community. So I called in the evening before she would have been putting in about 16 hours a day reviewing charts and patient assessments, plus being on call all night. So, it was very gracious of her to talk to us. And as I'm listening to her and as we've been preparing for this to bring her voice from the shelf, I think this is almost a My Cannabis Story. So, in a sense, what we've got here, Trevor, is we've got a doctor or a doctor who has who has come to use cannabis in palliative care. I'm going to speak a little bit more about how this relates to other stories we've done, but that's what I'd like people to hear. I also have another story for you later in the episode. Another my cannabis story from a nurse that talks to me, talks to talks to us about her experience with cannabis as well. So, we've got two My Cannabis Stories in this episode. 

Trevor: I just want to set the stage a little bit because I think it's easy for you and I to forget not everybody listening are health care professionals. So, let let's just a couple definitions, because I forget people don't even know the some of the what we consider basic word. So, Dr. Pinnick started out being a family doctor in rural remote. Just what's a let's it sounds silly, but let's start with simple things. What's a family doctor?

Kirk: Well, that's the general practitioner, right? That's back in the day. The the in my day, the family doctor came in, the house calls. So, family doctors in small towns and I don't dwell on big cities. Family doctors don't often have hospital privileges. Right. They work from a clinic. 

Trevor: So this is like the doc that you go see that you probably you and your family go see in their office. 

Kirk: Yes. This is a family doctor. But Dr. Pinnick specialty is with remote care. So, Doctor Pinnick flies into these communities and helps and works in nursing stations and helps with chronic care programs, helps with immediate acute issues, nurses work in guidelines. When we work up north and there are things we can do, there are things we can't do and there's things that we need permission from a physician to do. So, Dr. Pinnick, is that is that individual that a nurse would call when we're in the north and we need to do something that nurses can do but we need doctor permission for. And if we don't if we can't, of course, then we medivac. And she would, the doctor would be involved with getting an accepting hospital to find our patient. 

Trevor: Another word that I think I forget that people don't hear every day. Kirk, what's palliative care? 

Kirk: End of life planning. So so as people enter palliative care programs and that is where you have defined yourself as end of life, you you have a disease process, an illness that has put you in a situation where you you're planning your death and how that death would be. 

Trevor: And just to be very clear, palliative care, it's not the same as assisted suicide or medical assistance in death.

Kirk: MAID. No, not at all. 

Trevor: That this is this is not, quote unquote, the people who kill you. This is the people who help you go out gracefully. 

Kirk: Wow, kill you? 

Trevor: Well, you know, because there's going to be some people who really didn't see the difference between medical assistance in dying and palliative care, so I thought I'd better just sort of throw that out there. 

Kirk: True. The palliative care program is where you and your family and your health care team come to an understanding that you are dying and you will have end date, you know. You haven't been hit by a bus and you're not in acute care; in an ICU. This is a disease that is slowly killing you. The MAID program is a whole different podcast and a whole different episode. We will have to get into cannabis use in the MAID program, which is medical aid in assisted death. 

Trevor: I know it sounds like I'm being picky, but, you know, I think we forget that there are some of the words we use aren't in common use everywhere else. 

Kirk: Yes. 

Trevor: I have asked enough questions at the beginning. Anything else we need to hear from about Dr. Pinnick before we let her talk? 

Kirk: No, let's go into it. I think that's it. I wanted people to understand that you're hearing a My Cannabis Story from a physician. She she says in the discussion, by no means is she cannabis knowledgeable. She is naive in cannabis and is learning so in many ways Trevor, what I'm bringing you is a story of how a doctor learning to use it and a nuance is what sparked my conversation with her is that she's had experience using it in pediatric palliative care. And the story ends and ends on that note from the second interview now in the middle, we're going to break in the middle. 

Trevor: I think I recognize your voice in the middle.

Kirk: OK. All right.

Kirk: And so, essentially, Dr. Pinnick, please introduce yourself and explain to my listeners what you do with cannabis in palliative care. 

Dr. Pinnick: So, as you said, I'm a physician with the WRHA Palliative Care Program and I work the adult side of the program, but I also work the pediatric side of the program. The pediatric side of the program is newer for me. I have a majority of the time I was just with the adult side, but an opportunity came up and they asked me what kind of help from that side. And so I have so much experience with cannabis is, I would say limited. And to be truthful, it's not something that I introduce right off the bat for patients. It's usually patient requested.  So from the adult perspective, there's a few that I have prescribed, you know, well, I should say CBD oil. 

Kirk: This is the palliative program. 

Dr. Pinnick: They are registered on the palliative care program. They are palliative patients. And so in that regard, I you know, I agree on one particular patient. I remember she had a particular cancer just to kind of keep things private for them, but wasn't getting her pain management wasn't being managed with our usual, you know, opioids. And so our family suggested cannabinoids. And so we tried the cannabis oil. And that seemed to work really well for her. I admit that I was a bit scared because it's, prescribing is so there's no real cookie cutter way to prescribe. Right. You get what I mean? 

Kirk: Oh, I know exactly what you mean. 

Dr. Pinnick: You know that if you start off with, like, say, a blood pressure medication, there's usually a starting dose and then you move up to the next dose and you go that way. It's not the same for marijuana or cannabis oil. Right. And things like that. So, you're kind of like, OK, so I felt this. All right, how do I understand how do I write out this request for this person? In all honesty, I think that's probably why I'm assuming that a lot of physicians don't right away kind of say, OK, let's try this, because there's nothing that there's no real protocol to doing it right. So, I think with this patient, when she came up with this request came up, it just kind of worked out that another oncologist from our team, another oncologist, he's an oncologist, but he also did some palliative care for our palliative team. We had a morning conference on marijuana. Right. And so, he gave suggestions on how to start prescribing, you know, cannabis oil and stuff. Right. And so that helped a lot. So, I looked at the form. I was like, OK, we'll start off with three, three works out to be about three grams a day. Right. And you use it as you see fit to right. 

Kirk: You're explaining to me that you have had a situation where pediatric palliative care that the family came to end of off camera. We were off camera for off mike. We were talking about some of the dilemmas that you were facing with using that. Could you give us a little bit of a history of the patient and the situation you found yourself in? 

Dr. Pinnick: So, this was a little this patient, this particular patient was only eight years old and had a brain tumor. And so, we had been he hadn't required much. But then one evening when I was on call, I had a request from the parents. Could they try Cannabis oil. 

Kirk: And this was CBD oil, again. 

Dr. Pinnick: CBD oil, and at first, I was like, I'm OK with it. So, you've just going to order it yourself right thinking and it was like. No, could you prescribe it for him? And so I guess what brought it on is they had a friend in the US who I guess works with oncologists, pediatric oncologists who prescribe cannabis fairly regularly for their patients, so I said, you know what, I said, it's not that I don't want to be just let me do a bit of research first, because I said I've never done this for a child and especially a child this young. Right. So, when. in my mind I thought this was simply going to be going and talking to some oncologists are talking to people saying, you know, what do you do? How much do you prescribe? How do you go about this.  To discover that no one was ever actually prescribed it? They were mostly OK with it, but no one had actually said, here, here's a script, get some CBD oil. And so, I tried to do some literature research again, lots more of his bent towards the adult side of things. And so, I realized very quickly that this was going to be me figuring this out. And so, what I decided first was to talk to the head of my program right.  On the pediatric side. And I said, hey, you know, if I prescribe this, are you guys going to be OK with this? Right. Because we are a team and I want to make sure that we're all on board were all OK with this. And he told me to go forth basically because he said truthfully, he said truthfully, Suzy, we have parents who do it anyways. 

Kirk: Right. And we're finding that out too. 

Dr. Pinnick: They're doing it anyways, whether we're prescribing it or not. So, he said and he says most of the specialists don't really have a problem with it. It's just that fear of prescribing it. And so, I spoke to one of the, kind of one of, the companies that had used on the adult site. And I spoke to one of the guys there and he was helpful. And even for him, it was a little bit trying to figure out, given his age and stuff like that, how much we would do. And so basically what I did was say, OK, I normally start adults off at this dose. I'm going to half this dose and then I'm just going to go a little bit further. And that's what I did for this patient. And so, I think I started off with a range of 0.5 - 1 gram or something like that

Kirk: a day 

Dr. Pinnick: a day.

Kirk: and who administrated it. Was it the nurses? Was it the family, 

Dr. Pinnick: the family.

Kirk: the family. So, this was this was a prescribed cannabis so it would have been on the chart. How did that how did that work? How was it with working with the nurses on the floor? 

Dr. Pinnick: Well, he was at home. 

Kirk: OK. It was a home program. 

Dr. Pinnick: It was a home program, but you do bring up a very important point is that the nurses don't usually give cannabis oil or, you know, we had one woman who actually just smoked the marijuana that don't have any involvement with that we have to know about and they have to know about it, but basically it's up to the patient. 

Kirk: So she would go outside with this, a palliative patient that would go outside to smoke. Was she smoking in her room? 

Dr. Pinnick: Her brother found her some kind of piece of equipment that she was able to smoke in in her room. 

Kirk: A vaporizer, she used the vaporizer. So no smoke. No, no. Yeah. And that was that allowed. 

Dr. Pinnick: At that time it was. 

Kirk: This was palliative.

Dr. Pinnick: Yes it was a palliative care was OK. And so she did it. And I think she would do that about three times a day. 

Kirk: OK. And did you notice a difference in that patient compared to another patient? Was she using the less opioids? Was she was she did you notice any difference in how she her palliative care was? 

Dr. Pinnick: To be honest I didn't know and this is what I think from my perspective, I really leave it up to patients, right? Because I know, like some of our older patients, at least in my experience, I find that if they've never really used marijuana or, yeah, if they've never used it, they tend to not really like it, don't find it really beneficial, but and they're more and the flip side is when we try something like Nabilone, although I find that it works a little bit better. On the flip flipside of that, if I have somebody who's had exposure to using marijuana, Nabilone, it's like spitting in the wind. It's not going to do anything. So, yeah, I really and I can say that I said, you know, I don't have a problem with it if it helps with nausea, if it's helping with your pain or if it's helping to relax you. But I'm all for it. Right. 

Kirk: So, so, so in the last couple of days, just talking and we're working together. Is it fair for me to say that you have little cannabis naive? 

Dr. Pinnick: Oh, no, it's totally fair. 

Kirk: OK. OK, so in your practice you've had a few patients that you've just prescribed for the peds patient and an adult and you've had an experience with one particular patient who was doing it on her own. From what you've observed in these patients, is cannabis something that interests you for the future or is it only is it only something that patients will bring to you? Is it something that has sparked you in your practice? Is that a fair question to ask? 

Dr. Pinnick: It's not an easy question. 

Kirk: Thank you. 

Dr. Pinnick: And I don't know if I have a kind of a straight answer for you and I think I'd be more open to if we're not coming to any kind of if we're trying medications and we're getting nowhere, right. And they're still having a lot of issues with, say, nausea or pain. Right. I think I'd be more open to trying it or prescribing it for my patients. You know, I am sorry, I'm going to kind of tell a little bit of a story on the side, but remember, this is working on the ward and we had this one elderly gentleman with some kind of cancer, and I believe his son was a botanist and his son said, well, let me make this CBD oil for my dad. 

Kirk: was it Rick Simpson oil something called Rick Simpson Oil, because this is something that the cannabis culture uses. I'm interrupting. I'm sorry. 

Dr. Pinnick No, no, no. You know, I'm learning from you, too, right? It could have been. He made it. And we would joke and say he made this with love, right? Yeah. Because this man needed nothing else. Like he needed nothing else. 

Kirk: And he was on palliative care. 

Dr. Pinnick: And he was on palliative care. Metastatic disease. 

Kirk: Does not trigger something in the back. 

Dr. Pinnick: Never. And so we thought maybe there's something different. This one is made with love.  It was different from even when we prescribe it and get it from a company. There is just something about what he had done. Yeah. That kept his dad very comfortable. 

Kirk: I believe it if I'm guessing it's probably something called a Rick Simpson oil. And if you look it up, there's a lot of claims to it that your doctor's mind is probably going to go ummm. But there's a lot of people using it in cancer care is Rick Simpson oil. 

Kirk: When you had that one patient, you see my inquisitive mind only because I'm involved with cannabis the way it. I wonder if you went back to the chart and compare that one patient who was using cannabis on her own and compare her opiate use compared to other patients. And the reason why I say that is that some of the research that we're doing, we're finding people and physicians prescribing cannabis instead of opioids and they're dropping the opiates as the cannabis goes up. Right. And as you as I'm sure you might know, that there are no there are no endocannabinoids receptors in the brainstem. No. So you can't overdose on cannabis. Right. Whereas you can. So so I guess I guess that's where my intrigue was. Did you check? You know, and but I mean, as a busy physician, you've got you've got your practice to worry about. 

Dr. Pinnick: Yeah. You know, I admit if it's working and it's like she was definitely on opioids, I remember that for sure. And she was on scheduled opioids and she would use breakthrough's because they came up. But to give you a definitive answer of whether it went down when she used, I don't I can't remember. And I am to be honest with you, I probably wasn't looking for it. So, I was more looking at her pain controlled. Right, with what she's currently on because including the smoking, the marijuana. 

Kirk: So when you're ordering when you're ordering pain relief in the chart, you're probably I'm assuming you're giving the nurses a range. Right. It's a range that the nurses can work in and the nurse decides to that range what to give. Yeah. Yeah. So, yeah, I get that. So. So once you've done that, you walk away and come in. If the pains managed and obviously the order was working. 

Dr. Pinnick: Exactly. Yeah. Yeah. 

Kirk: And so in in Winnipeg Palliative Care Program, do you know if cannabis is used by any of the other team members. It is a part of the care or is only when patients bring it to them. 

Dr. Pinnick: So, you know, when I think about my colleagues and again, I I'm going to make an assumption, but I believe with most of them and we're pretty good team with each other, like we get along pretty well. Most of them kind of have an attitude, kind of like me, like if it works for you and you want to use it, let's go forth, OK? And if you want me to prescribe it, I can. You know, I think like and I've heard this comment like say, oh, how much do I prescribe. What’s the dose? So, I know what I'm doing. But generally speaking, it's more like if it works than. Go ahead, go ahead.

Trevor: Kirk, you want to do your your middle bit. 

Kirk: Yeah. The middle bit is, is during the conversation I was talking to the Doctor Pinnick a little bit about how cannabis is used in the palliative care program, forgetting the nuance of the discussion. The nuance discussion is most of her palliative care is done at home. And I didn't get the nuance until we were deep into the conversation. And it makes sense to me. She's a family doc, so she's assisting with palliative care at home. So that was a nuance. But however, my question didn't get answered. So I went to an old friend of ours, the old palliative care nurse, Paul Martin, and he basically explained to me a little bit about how cannabis is administered in palliative care wards. And and you're familiar with those thinking maybe our listeners aren't in the sense that palliative care, hospitals have developed palliative care programs where there are special rooms set up for people and families so that they can have a comfortable death and in a controlled environment, because not all people, not all homes are situated for that. So when it happens in the hospital, what what what Paul was saying before legalization, a lot of it was up to family. So, as we discussed the nuances in both Dr. Daeninck's episode, Episode seventy and and other times in other episodes, people bring cannabis, are brought cannabis to the palliative care wing, and they administered it themselves. And sometimes what would happen is that, you know, they would give people vaporizers. And of course, then, of course, the smell of cannabis became an issue. So some people were allowed to go outside and consume their cannabis if they brought it in themselves. That progressed into a situation where and you will know this is a pharmacist with doctors write orders on patients' charts, nurses will transcribe those orders into documents that nurses then use to track the medication. The nurses, the bedside caregivers will then assist the patient. If it's oral, if it's suppository, if it's some, some nurses may actually roll the joint for the patient if they're if the patient's unable to do so. So, there's a lot of bedside care being done in these fields and the nurses and the guess it's done and I'm assuming it's also documented. So, there is a there is a process followed. And I guess like all things, it progressed with time. So so we can return now to Suzy's voice and and hear a little bit about the rest of her story.

Kirk: OK, what I'm hearing from you is it's so new that you're still learning to, but you're not you want to ensure your clients get access to it and then allow them to learn and use it as they see. 

Dr. Pinnick: Yeah, yeah, yeah. OK, you know, so far, the only time I've ever had to pull back and say to someone, you know, we got to pull back. And that was an older man and he was quite delirious. And and there were some other meds that I pulled back as well. But it was like a step by step process. It wasn't like I just did everything at once, but it was like, OK, let's pull this back and let's pull this back and see if that was OK. Let's pull this back. Right. And certainly when we did, he cleared up somewhat. So that's the only time I ever kind of said that's stop that. But generally speaking, OK. 

Kirk: So if they're if there is one thing you would like to share with our audience about using cannabis in palliative care, pediatric palliative care, what is that? What is the one thing? What is it you've learned? What is what is your sound bite, I guess? 

Dr. Pinnick: That's not an easy question because I'm still learning. I think what I'm learning is that with cannabis, is that allowing the parents to treat their child's symptom or work with their child using cannabis it gives them a certain level of autonomy and I don't know what the right word is, but kind of that parent control of kind of choosing what they feel is best for their child, right? Mm hmm. I may not know what all this cancer meds are doing. And we've tried this and we try that. But let me at least try this to try and giving them that ability to do that. I have no problem with it. And if it relieves the symptoms of their child's symptoms, why not? Yeah, more like why would you have a problem with that? 

Kirk: It must be emotionally challenging to work in palliative care, but pediatric palliative care must be just turned to 11, it must be that much more intense because children aren't supposed to die before their parents 

Dr. Pinnick: Exactly. Exactly. Exactly. And it is hard. Yeah, it is hard. I was just on last week and it was a busy week. And so, it's just seeing all the different reactions and how people have to adjust with the fact that their child is sick. Yeah, right. Whether it's prenatally or just shortly after birth, I think I feel really bad for the teenagers because there is an acknowledgment they know what death is. Right. They understand the finality of it. And so when I when I see certain kind of behaviors and I try to give him an opportunity to voice it. Well, of course, there's social workers who do a much better job than me, but I actually try to bring it up sometimes. I'm like, are you scared? Yeah. And they'll say, yes or no. Yeah. And so, it allows them to speak. You know, I am awake at night thinking about this. 

Kirk: often times, in my experience, and it's not great at all, but oftentimes they are more worried about their parents and their themselves. 

Dr. Pinnick: Yes, they are. Yeah. Huge. Yeah, huge. 

Kirk: We have that insight. 

Dr. Pinnick: And so yeah, I've heard that before. Mm hmm. I don't want my parents to be sad. Mm hmm. And I know that they will be sad.

Kirk: What do you take away, Trevor? 

Trevor: Well, let's start with non-cannabis stuff, palliative care and kids like I have some experience with palliative care in the community. So, you know, people are, quote unquote, go home to die. You know, we have people, they have palliative. They the way their medication gets covered changes.  Often, we're asked to compound unusual things. You know, maybe they can't take anything by mouth anymore. And we still have to get their Anti-nauseates into them. So, I have experience talking to and about and with people going through palliative care at home. I obviously I knew it was out there, but I never really gave much thought to palliative care and kids. And that's got to be hard, like especially, she especially sort of tugged at my heartstrings a little bit there when she talked about teenagers because many, many, many moons ago I had a friend in age 15 or so who died of cancer. So, you know, plucked a lot of heart strings there. So, I will just start with just kudo's to people who can do this for a living, because I don't think I could. 

Kirk: End of life. End of life. Nursing is a specialty. It's this one thing about the medical field. We have such opportunities to specialize in different areas and we all have our skill sets. And I've always appreciated the elder care people, the geriatric care and those people that do long term care and palliative care. These are these are some of the heaviest nursing bedside care positions. And kudos. Yeah, I agree. 

Trevor: But yeah, now and I don't mean this in a negative way at all, but Dr. Pinnick is kind of flying by the seat of your pants a little bit on cannabis and palliative. Now, I again, this is not maybe shocking a little bit to non-health care professionals, but you you've got to deliver that first baby. I'm never going to deliver first, baby. But if you are if you're a doc, at some point you've got to deliver the first baby. You've got to do the first surgery. You've got to deal with your first palliative, your first cannabis patient. And, you know, the first time it might seem like you don't know what you're doing because you don't know what you're doing. But I think it's still important that these patients are asking for it and she's trying and getting better. 

Kirk: Yes, but, you know, it's interesting. It's I wanted to we've had this story in the show for a few months, and I wanted to bring her story after we did Dr. Paul Daeninck. And and interesting enough going back to Episode 71, Paul Daeninck was a name that we had known for a while. You had known about him for twenty years. I heard about him, but you never thought about an interview. It took Suze to find the interview for us. And I think we add these two episodes together. You know, you see how a doctor like Dr. Pinnick would use a mentor like Dr. Daeninck to to learn her craft. And Dr. Pinnick has some serious skills. I mean, she's a pain management specialist. She's a rural family doc, which means that she sees more in a day than some specialist see, you know, from all ranges the medical field. But she's quite prepared to say to us, I don't know a lot about cannabis, but here's my story so that, yeah, I appreciated that side of it. Yeah. 

Trevor: No, I love the interview. Thank you, Dr. Pinnick. I really appreciate the time and your honesty and, you know, the beginning of what we hope is a long career using cannabis to help people feel better. 

Kirk: Yes. I'm hoping to stay in contact with Suzy. We've got some plans to do some programing in the future together. We'll see if it comes up. I have a second. My Cannabis Story. A little shorter. This one follows our one to two-minute thing. This is a nurse that I was working with up north. Of course, it's all things cannabis when you're with Kirk, right. I'm always finding a reason to bring cannabis into a discussion. Well, Maureen told me story about how she had an allergic reaction to it. So let's hear her story.

Trevor: Let's hear Maureen. 

Maureen: My name is Maureen. I am a nurse, I've been nursing for forty-three years. I feel strongly that cannabis is something that is very good for medical issues and stuff. But unfortunately, I cannot be anywhere near it as I am very highly allergic to it. My sister and I went to a concert and we there was no smoking of cannabis in the concert. After we left, there were several groups that weren't even close to us smoking and you could smell it very much. And by the time I got to the car, my hands and my face were very swollen. So, a lot of people don't believe you can be allergic to stuff, but you can be allergic to anything, people are allergic to the sun. They're allergic to like, you know, almost anything you can be allergic to. So, but I do feel that it's it can be very beneficial, 

Kirk: but not for you, 

Maureen: but not for me. 

Kirk: So now what's interesting about this story is as a sort of the voice recorder off, she looked and goes, oh, you know, you know the times I took the gummies, it was fine. And I went wow what, Why, didn't you mention that in the in the narrative you just did, she goes, oh, well, I didn't think about it until now. So it's interesting. I think what happened is that she had definitely a respiratory effect, a respiratory, something, maybe a terpene, maybe maybe a cannabinoid in the in the off smoke. What do you call it? 

Trevor: Secondhand smoke. 

Kirk: What do you call it. Secondhand smoke? So there's obviously something that triggered the respiratory effect that she had. But yet you can pop gummies and it's not there. So Curious.

Trevor: And well it is, again. Really appreciate it. She shared the story, but makes my mind spin a little bit. You know, I go all the way back to Dr. Daeninck and him talking about, you know, just obviously we're very canna-positive here. But just remember, that is still a medicine. It's not perfect for everybody, for every circumstance. And even Dr. Pinnick in this episode talking about, you know, she had one older guy where it was not going well and, you know, had to back off the dosage and then it got better. But it's just one of these as canna-positive as we are, it's good to remember it's not all things for all people all the time. Yeah, sure there are. There are potential problems. 

Kirk: Very true. No, I agree. I like hearing these stories. And I'd like to encourage other listeners to send us their Cannabis stories, because the stories it would bring is what brings education to us. I mean, most of the physicians and researchers we've talked to, they all speak about how their patients bring them the stories.  Brought them the first nugget of information. So we I mean, we are always encouraging people to speak to your doctor. I've got a future story coming that I'm working on for another Winnipeg story, another listener story. And it's going to be about someone with long-covid and how she's using cannabis. So that's coming in coming up in a couple of episodes. But again, we're learning how people use cannabis in their world. Right. And how. 

Trevor: Yeah, and maybe this is a good place for an ad break to. We haven't had a one to two minute My Cannabis Story in a while. And we miss them. People love hearing them. And like we just heard, it doesn't have to be about how cannabis is wonderful. We'll more than happy to take the I hate cannabis because we just we want to keep the conversation going about cannabis. Everybody out there, I guarantee everyone who listening and most of the people just out there have some experience, good or bad, with cannabis. And we want to hear about it. So the easiest thing to do, record one to two minutes, say, and we'll we can keep it perfectly anonymous. If you want record one or two minutes on the voice memo thing on your phone, email it to us all. The info is on our website and we'd be more than happy to put it up. And like I said, we can we can keep you completely anonymous if you want. But, yeah, I think the more people who tell their stories, the more the more education goes up there. 

Kirk: Exactly. And I guess that segues right into We are Reefer Medness - The Podcast. I'm Kirk - I'm the nurse. 

Trevor: And again, at end of the episode. I'm Trevor Shewfelt, I am the pharmacist. 

Kirk: So, thank you for listening. 

Rene: All right, guys, that was great. It's Rene back here in the studio. And Reefer Medness- The Podcast would like to recognize that the recording of Dr. Pinnick interview occurred on the traditional territory of Little Grand Rapids, which is part of the modern-day treaty five.  As well we'd like to note that Reefer Medness - The Podcast, is recorded within unseeded territory of Treaty Two of the Anishinabewaki. So now we move on to play a song as we typically do. Dr. Pinnick had mentioned a couple of songs that she thought would be nice to have in this episode. So I've chosen Dinah Washington. What a difference a day made.