Episode Transcript

Trevor: Kirk. We're back. 

Kirk: Hey, Trevor. How are you? 

Trevor: I am well. It looks like you're in your basement. 

Kirk: I am. I'm setting up my basement as my new office space. 

Trevor: Very nice. So I talked to Dr. Jennifer Anderson. 

Kirk: You did? I found it a fascinating story. I was out cutting my grass, and I was listening to your interview. And I kept saying to myself, this is really another My Cannabis Story. 

Trevor: It kind of is. And, you know, also one of those interesting how cannabis affected my life, but the person whose life was affected was a physician. So you can then ask her a whole bunch of other questions. 

Kirk: Yeah, it's I kept I kept listening to, you know, it's funny funny thing about pharmacists and nurses, our brains looks at things differently. Right. I kept looking for this to be a clinical question. When are you going to get into the clinical questions? Because right now you're exploring her experiences becoming a cannabis doctor. And that's what I found this to be, that this is My Cannabis Story of a doctor who learned to use cannabis because of one of her children, and in the in the journey, has become the person she was looking for at the beginning of her journey. 

Trevor: Yeah. And we'll get to more of that later. But yeah, listeners listen for now, remember, this did start a little bit before recreational legalization. But honestly, I don't think it's too much different today if you are trying to find a cannabis doctor. It's not always easy. So just, you know, listen to all the struggles she went through, you know, even after she's realized cannabis is good for her, good for her child, good for the situation, how many hoops she had to go through to get a physician to agree to help her with this? And she's a doctor who knows other doctors. This was it was not easy. 

Kirk: You know, it was interesting. She's talking to you and you ask you the question and you say, oh, the specialists, the pediatric specialist, seizure specialist is going to report you to the College. And my brain was going, no, no, no, Trevor, not the College. They're talking about Social Services. 

Trevor: Yes, that's exactly what she said. 

Kirk: Yeah, yeah, yeah. And I'm thinking to myself, because I'm thinking as a nurse, I'm thinking, no, no, no, man. They're going to report in Social Services because she's giving her own child cannabis without a prescription. She's in big trouble. This is what I'm thinking. So. So, yeah. Again, not giving anything away. There's a little bit of a there's a little bit of a cliffhanger. And I was thinking, oh, Trevor's its the wrong questions, she's going to be reported. And sure enough. No, it's Social Services. Yeah. So can you imagine, Trevor, how many? This is a family physician and the role of any family physician in today's medicine, when I when I first started nursing 40 years ago, the family physician that I was working with started in the thirties. And he was all encompassing, all knowledgeable, and everything he said was right. Today's family physicians are a little different. They their job is to sort of be the gatekeeper and help their patients to see some specialist. The information comes back and then they're supposed to manage the care. 

Trevor: Yeah. So I've heard it described as kind of like the quarterback of Team Health. 

Kirk: Yeah. Well in my practice when I was practicing up north, that's what the nursing stations did. We, it was part of our responsibility as nurses and primary care to sort of coordinate all that. But so in today's busy society, busy practices, doctors don't always get a chance to do this. And they I think they lose track. So here is a physician trying to maneuver through the system as a customer. And I say customer because I keep forgetting I think health care providers keep forgetting that we provide a service. So therefore, yes, we have patients, yes, we have clients, but ultimately they're our customers. They're here to get a service from us. So here is a family physician not getting any service, but yet she knows how to manipulate the system and she keeps going into blind alleys. It's fascinating story. 

Trevor: And you know what? Let's just let Dr. Anderson talk and will have a couple more comments at the end. Dr. Anderson, thank you very much for joining us. 

Dr. Jen Anderson: Thank you so much for having me. 

Trevor: The first time, well, probably not the first time I heard about you, we've talked to and about Dr. Shelly Turner for quite a while, so we'd sort of heard about you through her. But I think the first time I heard you talk was I was at a cannabis talk, but on by Spectrum Therapeutics, they put out a nice series of talks. And I heard about your story about how you became, it went from a skeptical family physician about cannabis to one who is quite pro. Can you kind of lead our listeners through what happened? 

Dr. Jen Anderson: Absolutely. Yes. I graduated in 2014 from family medicine, and at that time medical cannabis was legal. It has been since 2000, but Family Docs were not giving a whole lot of training on it. And I was taking over a practice for another physician and he had a few patients that were on cannabis, and at that time coming out of residency, I wasn't something I really wanted to delve into. I did have a brother that did really well with cannabis for pain, so it wasn't like I didn't believe in it. It was just a matter of it's not something I felt the need to touch on at that time. So I didn't take a few patients at that time and ended up having some complaints about that. So it kind of went from a doctor that wasn't really willing to go there. And then the year after that, well, a few years into my into my clinic, my son, who is a Donor Twin and the Twin Twin Transfusion Syndrome, and he has Cerebral Palsy, intractable epilepsy over the previous years his seizures had just started to escalate. So in 2016, we spent most of the year in the hospital and leading up to October of 2016, he was in the hospital all the time. In ICU, and we would just kind of get home for a day or two and then be calling ambulances because of his seizures. So at that time, I started to look into other options. We had a meeting with his neurologist and she basically asked me if I wanted him resuscitated. And I think at that point I just everything sort of hit me that, you know, I think you just keep going when you have a child that's in hospital and you're trying to work. But at that time, you know, I started to panic. I went and I quit my job because I didn't I just couldn't handle that. I couldn't even get to work at that time. So, you know, I went and I just started working emergency because I could literally go from the children's hospital in the morning; go to work and come back. And they were eight-hour shifts. I could move them around when I was done work, I didn't have anything else I had to do.

Trevor: You're were living at the hospital? 

Dr. Jen Anderson: Pretty much, yeah. Oh, yeah. Because I was going from one to the other. I would literally tell the nurses, I'll be right back as soon as I am done my shift, you know? And then I had a respite for a person that was helping me with the other twin. They were like three years old at the time. So and then my daughter, who was a few years older. So, you know, I just basically was living on nothing. And so I went online and I found the news report by Sanjay Gupta. CNN report on Charlotte Figi. You know, I started to look into that. I went to my neurologist and I said, what do you think about cannabis? You know, like there's really no other options. We had to take them off of Valproic acid because of his bone marrow suppression, and he was seizing multiple times an hour. A lot of times we couldn't even tell if he was in a seizure or out of a seizure. We just kind of guessing how many he was having each hour. And then at night he was up all the time seizing. So I would be up most of the night as well watching him. So, anyways I went to his neurologist and asked about it. She had actually trained, I think, in some of the centers in the states that were doing Epidiolex trials. And so she basically said to me, it could work, but I can't help you with it. And I said, okay, so what do I do? She said, You have to find a family doctor who's an expert in cannabis as well as epilepsy, and they can hopefully help you. And I said, Well, how do I do that? You know? And she goes, I can help you with that. 

Trevor: I'm just going to say it. That's not even common now, but a few years ago, that would have been really hard to find. 

Dr. Jen Anderson: Yes, this is 2016. So this is before recreational legalization as well. So, you know, I, had a blog on my Facebook just talking about our challenges with the twins in general since they were born. And I started just talking on there about how I wanted to try cannabis. And one of my friends who I'd grown up with actually had been trying Charlotte's Web with her son, who was autistic at the time. Still autistic, but she didn't find that it was helping. And she messaged me and she said, You know, Jen, I have I have this extra Charlotte's Web. Do you want to give it a try? And I was desperate. It was a Friday night. I remember I was exhausted. I went, I mean, I just and it was like $200 for this bottle. But, I mean, I didn't feel like I had any other options. So I brought it home. I gave them one drop and I put them to bed. I didn't know how much to give him. So anyways. And he slept the whole night and he hadn't slept the whole night forever. I was up all night watching him and in the morning I gave him another drop and he had seizures through the day and no real change. And I didn't really think anything of the first night. And then the second night I gave him another drop and he slept the whole night. And that continued. And on the Monday, the daycare basically said, like, he's a different kid. All of a sudden he was awake. It was like he woke up. He just had a different look. He was alert. He was paying attention to things around him. He was playing with kids. You know, he was just alert and came alive. So, you know, things just gradually improved. My respite person at the time, she said, you know, Nicholas is walking fine again because he had regressed and he was starting to crawl again. Now he was walking, you know, he was starting to do the things that he could do before and he just sort of regressed throughout that summer. So people around him started noticing. I had told Neurologist that, well, she had asked if I would tell her if we were going to start any type of cannabis because he was out of Clobazam and we need to pay attention to that. 

Trevor: Right.

Dr. Jen Anderson: And so I told her and the response was, who is helping you with that in terms of physician? And I said, Well, no, nobody is. She is like, No, you still need somebody, you know? And through talking to a few of the neurologists and, you know, the answer was, you need to go find someone within the next day or two, or we're going to have to report that you're using that you're giving your child cannabis. 

Trevor: Before you get to that, this is a fascinating bit. But just because you're not just a regular mom, you're a physician mom. Any chance and I'm sure you have mauled this all over your head. Any chance that the condition your son had could just sort of spontaneously go away, you know, that this was just a a coincidence. A placebo thing. Did you think was that ever a possibility that this was just getting better on its own? 

Dr. Jen Anderson: No. So, my son's brain developed completely abnormally due to the Twin Twin Transfusion Syndrome. So that's the source of his seizures. And we were basically just told, even when he was a baby, that he might not have anything but reflexes. We, I pushed him and we got him all of the help we could. And he's, you know, he's just behind his brother in terms of walking and that. But, you know, the seizures, we were told, were going to escalate. And once you start having seizures, you have more seizures, you create these circuits in the brain. And so our conversations with neurology were basically at the point of asking if we wanted him resuscitated because there was nothing else other than adding more medications. And as I learned more about seizures, you know, I learned that after two medications, you know, your chance of controlling seizures after two medications is really low. So, doesn't really you can just keep adding medications but you're really adding side effects. 

Trevor: No, fair enough. And I'm sorry. So your neurologist was threatening to call the College on you and. 

Dr. Jen Anderson: Yeah, I think it was more Child and Family Services that, you know, for, but obviously my license would have been on the line as well. And I think that shocked me because here I had a child who was completely different after a week and I was being told to stop the cannabis until I found someone that would help me with that. And I said, well, he could die because kids that have seizures have always a risk of sudden unexpected death and epilepsy. That's called SUDEP. And so if you're seizing multiple times an hour, your chance of dying is huge. And so I said, you know, he could die. And the response I got was, yeah, he might. But I felt, you know, that's a. 

Trevor: Terrible thing to hear as a parent. 

Dr. Jen Anderson: Yeah. I mean, I can still hear it in my head and it wasn't actually my neurologist. I'll make that clear because I really like our neurologist and I think she's done everything that she could do, having her hands tied by the department. But it was one of the other neurologists that was on call. And I remember that conversation and thinking, What is wrong with our system? This is crazy. You know, here I am a mom, but also a physician thinking how many other kids are out here like this, right. I mean, what happens when you don't have any options? Like at what point does someone say that's wrong to try? I mean, obviously, you're not going to give yourself something your kids, something that you know is going to hurt them. But, you know, I think that whole experience in my life has really helped me to understand other families. Like if I'm just jumping ahead a little bit, like, you know, I, I look at kids differently. I look at families differently. And I you know, it's just it's  helped to put things in perspective. But yeah. So at that time, I was told to stop it. Of course I didn't. And I went to the head of Peds Oncology, the head of Peds Palliative. I thought, if anyone's going to help me, it'll be the doctors that are in charge of all these kids with these horrible issues. Right. But nope.  One of them was, you know, I knew pretty closely and he just said Jen I can't help you. Not at this time anyways. And I mean I mean, it's a hard ask. So, I totally respect that decision. But it was so frustrating that there was nobody and I was basically supposed to go find a family doctor, like not even a specialist, a family doctor. And at that time, lots of them were operating on this on the corner and things like that. Right. And they basically gave you your authorization and no instruction. So, I just... It was so bizarre. So anyways, long story short, after being completely desperate, one of my family doc friends that worked emerg with me, she said Jen, I'll help you. And we sat down together. She'd never done it before. We wrote what we thought was an authorization, and I called the neurologist. Neurologist is like hey great. At least, basically, at least I could write down that you're getting it legally, so. And yeah, so that's how we started. And then from there it just got better and better and we drastically reduced our hospital stays the first year, I would say 50% each year. And so now we have not been in hospital for seizures since for four years. 

Trevor: For four years. Wow. That that was going to be my next question is how is he doing now? And seizure free for four years is amazing. 

Dr. Jen Anderson: So he's not seizure free. 

Trevor: Hospital free? 

Dr. Jen Anderson: Hospital free. Yes. So we do have ups and downs. He will have sometimes, he has episodes to that we're not sure if they're seizures. We had some ups and downs this year. We had a planned hospital stay to sort of watch him on a video EEG. So that was the only sort of hospitalization we've had. But, you know, some of his his seizures are so far in the brain that they don't actually show on any EEG. And what I've learned is actually your EEG only picks up seizures that are in the cortex.  Any deep brain seizures won't show. To my knowledge or to what I understand. You know, they're hard to detect on any EEG. So just because the child is not showing any seizure on an EEG doesn't mean they're not having one. So, you know, that was really interesting because Nicholas doesn't have the generalized tonic clonic seizures. He has vomiting seizures. He has lots of other seizures that were hard to recognize. He started off with having electrical status epilepsy in sleep. So basically every time he went to sleep, he was in status. That took forever to diagnose. He was up at like ten and three, 10 p.m. through 3 a.m. with these like shaking, vomiting episodes. And I'd be going to the neurologist and saying, I think these are seizures. I think these are seizures. And then I was in the E.R. just working, and I'd be like researching on medical sites, you know, what are these nighttime seizures? And I came back and I'm like, I think he's got, like ESES Electrical Status Epilepsy in Sleep like, no, no, he's never been diagnosed. His EEGs are fine. We were actually going to Florida. This is when he was like two. And I said, Can I please have some Lorazepam? I don't want to end up in the hospital. You know, I'm pretty sure these are seizures and the neurologist at that time, now retired, but she said, you know Jen, I've never diagnosed with epilepsy. You know, it's absolutely I'm not going to give you respite. I'm like, okay, fine. Like, what do I know? I'm just like a family doctor. So anyways, we went to Florida. He had episodes like crazy. I came back and I went to a neurologist and like, this is not right anyway. So then they did a five day home EEG and they called us back and said, Oh, by the way, he's seizing all night. So anyway, it's been a real journey learning about seizures. And that's my point.  Even neurologists sometimes do not pick up seizures. So. 

Trevor: It sounds like you've become sort of a what? I don't know what to call it, an amateur neurologist along the way. 

Dr. Jen Anderson: Not anywhere close. But I do understand, you know, the struggles that my parents go through. So yeah. 

Trevor: So let's talk a little bit about what you're doing in your practice now. So a lot of your practice revolves around cannabis now, right? 

Dr. Jen Anderson: It does. I still do work emergency, but on the side. So in 2017, I was actually working in Emerg, when someone from one of the cannabis clinics in the city came out to the ER to talk to me because they said we have all these families coming with these kids with epilepsy, wanting cannabis, but not even the cannabis doctors will touch them. And so I said, you know what? Absolutely not. I'm not going to be the pot doc for kids I said. Because I was still traumatized by my own experience. But after a few months and actually learning a lot more about cannabis, I made some colleagues in the field that really explain things. I thought, No, there's actually a method to this. And I started pulling the papers from Israel and looking at the studies and trying to figure out the dosing. And so I started seeing kids in the early 2017. Just kind of quietly, and I would actually write a letter back to their neurologist saying, Your patients came to me wanting to see about cannabis because they've failed this, this and this. I've agreed to see them. I'm just giving you a courtesy letter to let you know because there are some drug interactions and things like that. So that's kind of how it started. But after doing that for a while, I started actually getting consults. So, you know, it started with, you know, some family doctors, then some pediatricians, then it started different random specialists.  Rheumatologists and, you know, various specialists. But then also then in the last year or two, neurology has started to send their kids. So it's just exploded into a consult based practice since 2017. And we've just moved into a new space that's a medical clinic. And we're also doing a research center that we're just sort of doing ethics proposals and stuff for. So in the next six months, we should have all that up and running, and that will be based out of the Children's Research Center in Manitoba. And so, yeah, that's it's a lot of things on the go right now, but it's been amazing to work with other physicians and everybody as a team with these kids. 

Trevor: And I don't I don't want to run out of time, but I want to take a little bit of a left turn. There is a documentary out now, I believe it's a most about like you and your son and their journey. Do I have that right? 

Dr. Jen Anderson: Yeah. So the documentary is not quite out yet. We're still trying and figuring out where it's going to be showing. It's called Anything Can Happen. And it basically talks about my story as a physician and as a mom. And then it goes through three of my patients that I agreed to be on the documentary, two with autism and one with epilepsy and just what cannabis meant to them and how they see it working with their child. It's a really non-biased film. It's about 42 minutes and it really just gets people thinking. It's a platform for discussion. 

Trevor: Fantastic. Now, we had a little bit of time trouble because I sent weird emails too, but we had a little bit of trouble scheduling you for this because you've been all over North America lately, talking at various conferences.  Where have you been lately and what? What are people asking you to talk about? 

Dr. Jen Anderson: So I did go to two conferences in May that made the month a little bit crazy. I went to Lift and Co in Toronto and there I was on a panel talking about models of care for cannabis and like clinic models. And so there was a few of us on there just talking about what patients need, what we felt was important for patients in terms of their continuity of care. I had the opportunity just to talk about what we've done in Manitoba with kids. We're the only province really that has a consult based centre for these Kids. There are some of my colleagues in other provinces, but there's the structure of their practice a little bit different. 

Trevor: So maybe I should jump in because not everyone's going to know what that means. What does the consult based center mean?

Dr. Jen Anderson: So basically for any other specialty, a family doctor, for example, if you needed something cardiac or heart wise, your doctor would consult Cardiology about it.  And you would go see the Cardiologist and then you would come back to your family doctor. And your family doctor generally is the one that ties everything together. In terms of the patient's care. At least that's the way it's supposed to work. So with the consult based practice with, like this, I'm basically operating as a family doc that has a special interest in cannabis. I can get other doctors sending their patients to me that I sort of help them with that patient. So it's a really collaborative care approach. 

Trevor: Okay. So Lift and Co. sort of talking about, we'll call it how to set up patient care and how that care is differing across country. Where else were you in May? 

Dr. Jen Anderson: Then I went to the Cannabis Science Conference. I was asked to be part of a panel there as well with Bonnie Goldstein and Tracy Ryan and a few others talking about both physician and patient experiences with cannabis and kids. So, I got to talk a little bit about my journey as a mom, but also my journey from going from my mom to a physician who looks after all these kids and just a little bit of the advocacy that we've done to try to change policy, education and various things as we go along. 

Trevor: Very cool. So so let's swing back to your practice now. Most of the people you're seeing now, kids and kids with epilepsy, or is it kind of all over the map? 

Dr. Jen Anderson: So, I do see some adults, but it is getting to be more and more kids. I would say that the majority of the kids I see have epilepsy. I do have kids that have autism. And we try to see whether we can find a form of CBD that will be effective for different challenges. I do get a lot of kids from oncology now with various types of cancers, especially the palliative ones. So I, I liaise with the palliative team and the oncology team and we're always in really close communication, which is great. There's interactions with different drugs that there are, so we need to all be very close with these kids. Yeah. 

Trevor: No good. And obviously. Well, we'll start with the caveat. Don't do this at home. Don't do this without talking to your physician. But so when you giving cannabis to kids, I'm assuming this is all oral oils or am I wrong? What's how do you how do you get it into the children? 

Dr. Jen Anderson: And actually, that's a common question. I do still get asked if the kids smoke.  No, they don't. Yes, we do use oils. Usually they're easier to dose and we have to use products from Health Canada licensed producers legally. So we use oils, they go through a g-tube generally or they are taken orally. The kids I work with have various ways that they eat so. 

Trevor: And because I hear this complaint from adults, people don't generally like the taste of the cannabis oils. How are you? And tastes is a big deal for some kids anyway. How are you that kids who are not going through a tube who have to taste it on the way down. Have you found a tips and tricks for getting it into them? 

Dr. Jen Anderson: Absolutely. We have done lots of problem solving. So generally we start with putting it in something fatty. We do know that the oils get absorbed the best with something fatty. So peanut butter, yogurt, things like that. We also have gotten local pharmacies to compound it and add flavorings and try to change the taste, which is great. So those two things, you know, I am looking forward to and we have a few different options for products and fortunately some of the other products like the dissolvable strips and things like that, they are just way too expensive for these kids. You know, with the dosing of CBD, according to the studies that some of these kids are on 100 to 300 milligrams of CBD. So it's just they can't afford all the fancy stuff. 

Trevor: Okay. And I don't tell me who they are, so I don't want to get my pharmacy colleagues in trouble. But when we ask about things like compounding it, we were told by our College that as a Pharmacist in Manitoba thou shall not have any cannabis products in your pharmacy at all, you know, not even compounding with it. Any idea how they're getting around that? Just, you know, as a professional curiosity.  

Dr. Jen Anderson: I'm not a pharmacist. And, you know, I think that the patient brings the oil and then they do something. And I don't know exactly what they're doing. I just know that the families are reporting that the pharmacy is helping them. 

Trevor: So you've mentioned CBD a lot. Is that predominantly what you're using with your kids or are you using any THC or any other cannabinoids or, hey, this Terpene works well in autism or anything along those lines? 

Dr. Jen Anderson: Unfortunately, in Canada we are really tied with kids right now. There are no Health Canada Licensed Producers that are producing the minor cannabinoids, which is what we want. So we are using high CBD products. I have my favorites to go to, just that I know that have worked and it is because of Terpenes that I think there's a difference. I am looking forward to the day when we have more full spectrum products and minor cannabinoids that we can add to preparations in the Health Canada Licensed Producer side because that's what we have to have with kids. 

Trevor: So cool. What in your research, what do you think? Which minor cannabinoids do you think might be helpful for what? 

Dr. Jen Anderson: That's a good, I mean. 

Trevor: I know a whole different topic, but just a couple. 

Dr. Jen Anderson: That's a whole different topic, I would just say I wish I could have CBDA and THCA as well as maybe some CBG, CBN and I work with a lot of different ages, including adults. So those are those would be the ones on my list. 

Trevor: Okay. That was that's been really great. And you've been very generous with your time. And like we ask everybody, is there anything you wished I'd asked or any other sort of rabbit holes you wish we had gone down before we before we let you go?  

Dr. Jen Anderson: No, I think we covered quite a lot. You know, I I'm just really finding that I'm focusing more on educating other physicians and trying to educate just anyone, because I find once people understand more about cannabis and how it can be used and that there's actual research. People start to listen. And it doesn't matter if they're in the health care community or in politics or education, everyone has an interest and you kind of need everybody to change policy. 

Trevor: Okay. Kirk, again, I love that talk. I am so excited that Dr. Anderson gave us a little bit of her time. She is a busy woman. And just a quick aside, I swear after two years of this Zoom stuff, I should be getting better at this. But in addition, she has had all these conferences. It's hard to find a date, yada, yada. But apparently, in addition to everything else, I invited her to a Paxlovid talk.  Paxlovid for those who don't know is a drug to treat COVID 19 and I was going to a Paxlovid talk so instead of sending her the Zoom invite to talk to me, I sent her the Zoom invite to Paxlovid talk and she answered back, So you're doing a Paxlovid talk? No, no, no. I'm trying to learn about Paxlovid. So, yeah, two years into this, apparently I still can't send out Zoom invites. Right? But back to the actual story. So I wrote it down. A Twin Twin Donor Syndrome. So I read a little bit about it and something about sharing a placenta and some other stuff. So now we don't have can you tell a little bit about what it is? 

Kirk: Again, I had to do some research. So what a Twin to Twin Transfusion Syndrome. It has to do with it's a rare condition with twins or multiple twins. And it is, you're correct. It has to do with the twins sharing one placenta and a network of blood vessels and how that the blood is distributed between the two individuals; the twins. So, sometimes what happens is the vessels that connect the placenta are not evenly dispensed throughout. So there's an imbalance. One twin becomes the donor twin, which means that that twin is giving away more blood than it receives. And then one twin becomes the recipient twin. They receive too much blood. So it's a balance of blood. And because of that, morbidities and conditions can manifest from it. Without getting too deep in it with her, of course, it became this cerebral palsy and was and and the. 

Trevor: What she specifically said there were the brain didn't develop properly. I think we can leave it at that. Okay. 

Kirk: Sure. Yeah. So the brain doesn't mature properly. And therefore, what happened is the child now is left with chronic seizure syndrome. 

Trevor: Yeah. To the point that it sounded like on at least one occasion, but one in particular, they asked if basically you want to put a Do Not Resuscitate on your child, which is, you know, it's just in case you missed the whole DNR thing. That's what I mean. Do Not Resuscitate. This is the hey, if your kid goes into a really bad seizure and looks like they're going to die, you want to just let them die? Like, that's that's as that's just a kick in the gut as a parent. 

Kirk: Yeah, no kidding, man. And to be a family physician, to be a family physician, that to go through this. Astounding. So, yeah, I thought that was a really good My Cannabis Story with a little bit of clinical work in it.  I'd like to explore more the clinical side of children therapy using cannabis. And I think did you have anything more you wanted to say about Jen? Dr. Anderson.

Trevor: I just as a pharmacist, I just, you know, because some things jump out at me. One of her, the seizure medication or her child was on Valproic Acid. I dispense it all the time, just, you know, just to be reminded, you know, medications have side effects. I know, not as interested in everybody else, but her kid was actually getting bone marrow suppression from it. And the other one that just sort of jumped out at me because I have kids who are on multiple seizure medications, just the, if you're on two seizure medications, two or more, and it's not working, chances are another one's not going to work. I am like oh, that's just crappy, you know? And we've heard from other people, other places about the good things cannabis, you know, Epidiolex is CBD in trials in the States, but you know, just sort of hits home that there's a whole bunch of seizure stuff that we might not be treating as well as we could be. And you know, cannabis and CBD is obviously not the end all, be all, but it seems terrible that we're not maybe not using it more because there are certain patients that it seems to be doing wonders for.

Kirk: And clinically when we are dealing with Valproic Acid. I was involved with a few cases in the north and we were drawing levels to determination to see if the child was getting the medicine right because there was there was some issues about compliance. If the child was still having seizure activity and the nurses believed that there might have been a compliance issue with taking the meds. So we were drawing levels. And I understand like this again, my my practice is northern. So I think in acute care situations we do draw levels of medications when we're dealing with with seizure activity. So my question was to you and I sent the question to doctor, Dr. Anderson through LinkedIn about the therapeutic levels, biomarkers of cannabis when treating this. And her answer to me, her answer was, let's see if I can read this. "Thanks for your message. We currently don't track serum levels of cannabinoids. I'm not sure how helpful they would actually be. That is not a test that's available either. I'm not aware of any studies that show that levels of cannabinoids correlate with seizure frequencies. Most kids have different etiology of the seizures, which is probably why." So I fired it off to a couple other specialists. One name people might recognize who I've been trying to get on our podcast forever is Raphael Mechoulam and he is the Israeli scientists who discovered THC in cannabis CBD back in the sixties. And he he turned me to Natalya Kogan, a colleague of his in Israel. And I've sent a message out to her asking about biomarkers and drawing cannabinoid levels. I've also sent an email to Cadham Labs asking them about drawing cannabinoid levels because again, thinking as a clinician, I'm wondering somewhere someone must have been drawing levels because I can't see why they would not be. So I guess. 

Trevor: I don't know any more than you, but I'll, I'll throw in pharmacist hat and devil's advocate against the levels thing. So things like Phenytoin, we draw levels because if Phenytoin and other seizure medication because it has a narrow therapeutic index if we give them too much, we're causing harm. And if we give them too little, we're not helping the seizure. So, you know, it's important to know where that Phenytoin level is. I would argue with the CBD because we don't have any, we have no idea. You know, we can, you know, let's say a test existed and we can find out what your CBD level was. We have no idea if you know level of five in Kirk: if that's going to affect his seizures or not. And more importantly, even if a five consistently helps Kirk's seizures, five might not help Trevor's seizures at all. So I just don't think we have enough research out there to say this level helps seizures in this many people. And maybe just as importantly, again, I'm not as a not promoting overdosing people, but because CBD is so safe, the chance of overdose is so low that I think it clinically it makes perfect sense to just treat to effect. You know, use the lowest dose possible to keep the seizures as least as possible. And that's fine. Now it would be lovely over time if we can get some actual levels, but I think that's going to take a lot of years and a lot of research. But if somebody out there knows better than me, please let us know. 

Kirk: But there's the ultimate word that we keep coming to. There's not enough research to justify cannabis. It's all anecdotal or it's all observational. Well, okay, I agree. I agree. We are learning in plant medicine. We observe our patient, we give them medications, we observe, we individualize it. I get it. But there is research being done in in autism for cannabinoid levels. And I did find a paper on that. And what they what they basically said the conclusion of the paper was that "the results of the cannabinoid responsive biomarker shift towards a therapeutic dose means after medical cannabis treatment and can potentially quantify benefits at the metabolic level. These changes appear to be similar to the trend described in behavior surveys. Larger trials need to be happening." So what they're basically saying is what they have done in small, small cohorts is that the observations that we're making when they do check the levels, the levels and the observations measure, saying that at this level it works for this individual. So I guess if we're going to justify the use of cannabis, we need more studies. So saying that we're not doing we're so saying we're not doing it because there's no studies is a copout of researchers. I guess I'm calling them out. There's a lot of children who are being treated with cannabinoids for seizure activities. I mean, not I mean, not as many children being treated for other issues, but I mean, it's happening. So we should be we should be measuring it. We should be coming up with those quantified numbers so that we can say with some sort of assurance that your child best therapeutic dose of cannabis is this, you know. 

Trevor: So that I know and that's all important and I agree with all of that. But again, devil's advocate and sorry, folks, if we're getting too much into the weeds, but if we go over to a different disease like COVID, you can measure COVID antibodies and people go, oh, you've got COVID antibodies, you know, you're safe. You don't need this. This Paxloivd a little bit. You don't need this monoclonal antibody because you've got you generate your own. The problem with that in COVID is we have no idea how many COVID antibodies makes you protect it. So just because we can measure something doesn't make it useful. 

Kirk: Yeah. No. Well. 

Trevor: And I would love the researchers to tell me, you know, this level in this type of seizure gives you protection. I just, you know, but even when that test becomes available, we just have to be careful about using it properly. 

Kirk: Yeah, I guess. I guess that's apple and oranges in the sense that I understand immunizations because I mean, I was I was immunized for Typhoid Fever back in 1984. I got all my immunizations. I traveled the world, I went to Asia, and I got myself into a bad situation. And I caught typhoid. I spent I spent I caught typhoid in India. And I spent a week in an Italian hospital in 1985 with typhoid. And I was properly immunized and I had antibodies, but I was tired. I ate I may have eaten a salad that may have been rinsed in water that had fecal matter in it, which is probably how it happened. I drank some milk, which I shouldn't have done. I made some mistakes traveling the way I was. I got typhoid with immunization. I think the question I'm asking is a little different because I'm asking about blood levels of a medication being used for a specific problem. So like I said, I'm hoping that I can talk to Cadham Labs, talk to a lab expert. I don't even know if the province of Manitoba offers the service, but I think they do. I imagine in ERs, they're drawing they're drawing drug profiles in the E.R. and cannabinoids are one of them.  

Trevor: Almost I would almost guarantee they have a THC level because I guarantee somebody somewhere has been checked to see. 

Kirk: I've done it. 

Trevor:  Whether or not they're using cannabis. 

Kirk: When I've done it. I mean, in the north part of our opiate therapies is doctors request drug profiles from the patients. So we know what we know what they're doing and again, therapeutic levels of what we're given. So again, I'm looking at this purely as a clinician. I think we need to have I think that research needs to be happening. Right. So I guess if Dr. Anderson's listening to me, I guess the question I'm having is why not? And why can't we start it so that we can basically say that, yes, it's individualized and we got the paper right. So. Yeah. We're, spending a lot of time on it. 

Trevor: We're way, way, way into the weeds. So anything else you wanted to talk about?  

Kirk: Ya, I got lots of stuff I'm doing. Gee,  upcoming stories? Manitoba's or Canada's Southern Rock band Wreckin' So they have played in Dauphin in the past. Are fans of ours and I have I have an interview happening I think next Tuesday on this. And this has to do with Lyme disease. Cool. This is a gentleman that caught Lyme disease and is using cannabis as a therapeutic. So I'll be having that coming. I have another one. I am looking at cannabis and amnesty another word, I have trouble with amnesty. And again, how in Canada right now there is about 500,000 people that have criminal records of cannabis that need to be dealt with. I'm also been trying to figure out in Manitoba how to how to how to have a cannabis dinner, because we are pre-pandemic, we're going to have a cannabis dinner. So I went looking for permits. In the province of Manitoba you can drink alcohol in public places and get a permit, but cannabis there are no permits. Which leads me to another potential story at Dauphin's CountryFest, which is our big, big music festival in Dauphin. 10,000 people come to Dauphin and plug our town up. They're going to have a Delta9 mobile cannabis store. 

Trevor: That's ask them how that licensed that sounds like a good story. 

Kirk: That sounds like a fantastic story. So so what's the expectation of buying cannabis at a music festival? Because in Manitoba at a campsite and you've heard us say this before people. At a campsite, you can consume cannabis. If it's a registered campsite, can you consume cannabis in a public place? And so the Selo grounds, where Country Fest is held, is a public place. So. So will cannabis consumption be ignored or is it permitted? So it's it's again, it's another one of those. It's not me saying, hey, I'm going to get CountryFest in trouble. It's more how we keep pushing the laws. We keep pushing the laws. They get our politicians to wake up to the fact that, you know, cannabis is actually safer than alcohol, but yet we allow children ten years old to advertise cannabis. You know, I think the last time I was at a Countryfest, they're handing out fanny packs that said Bombay. So Bombay is some sort of sweet alcoholic rum drink. I don't know. I don't drink it, but it's it's but it comes in a can and we're and we're getting our children to advertise it for us. Alcohol. It's been in our society for so long, we allow children to advertise it. But cannabis. Oh, my God, let's keep cannabis away from the children. So yeah, I'm quite excited about it Trevor. I think it's, I think it's marvelous to see how we, how big business can push government, but the little guy like us who we're just trying to have a dinner get no. Well, I'm going to keep pushing and keep pushing. 

Trevor: Well, we'll find something. So, Kirk,  I don't think we've said who we are yet. So I'm Trevor: Shewfelt, I am the pharmacist. 

Kirk: And I'm Kirk: Nyquist. I'm the registered nurse and we're Reefer Medness - The Podcast and I ask people to go to our website www.reefermed.ca. And for all those millennials out there, let's just say reefermed.car. You don't even have to do. Did you hear? You don't even have to do that w w w anymore. 

Trevor: That that must have had something to do with the retirement of Internet Explorer and must in the system.  

Kirk: Yeah. Anyways, it was a good My Cannabis Story. Thank you, Dr. Anderson. I enjoyed listening to your journey. Thank you for going through it. So the rest of us can benefit. 

Trevor: Yes. Thank you very much. And have a good day. Everybody will talk to you next time.