Episode Transcript

Trevor: Kirk, we're back.

Kirk: Hey, Trevor. How's it going?

Trevor: Good. If you hear any annoyed, yelling, slash scratching, slash batting. Doris and I have a new puppy. Her name is Rosie. She is very cute and at the moment, very annoyed that she's locked in the kitchen. So we'll see how many times I get interrupted by Rose because Doris is out bowling right now. So normally that'd be a great time to, you know, do some pod cast reporting. But Rosie also thinks this should be time for us to be playing. So a little annoyed she's in the kitchen. We will see how she punishes me for that later.

Kirk: Well, it's not the first time the podcast has been stopped by dogs.

Trevor: No, This is true.

Kirk: So we're back down in Florida again. You brought another guest that you met in Florida.

Trevor: Yeah, I really, really enjoyed meeting Dr. Wilson-King and her talk in Florida was great. And she's, you know, a wonderful person to talk to. But I was most excited by the content because endometriosis has come up a few times in our podcast. In our reading, you know, Episode 84, we talked about suppositories and endometriosis. It's come up is Doctor Russo when sort of he was using it as an example of a condition that could be considered a endocannabinoid deficiency syndrome. And Dr. Wilson-King goes into that. She's actually, not surprisingly, a big fan of Doctor Russo. But just endometriosis, it's probably a condition, we talk about not enough, that affects just the life of a lot of people. And there they suffer in silence without a lot of remedy. It came up in the pharmacy today one of my female pharmacy colleagues, and her sister, she's got two sisters, but I think she's talking to the nursing sister, who just happened to be talking about endometriosis and the fact that treatments aren't great. Like, you know, you do the medical treat when you give someone birth control pills, etc., you know, might help 40% of the people. You do actual surgery like remove the uterus, a hysterectomy, might help 50% of people. Like it's really, yeah I have family members who have been affected by endometriosis. It's a it's kind of a hidden problem out there that we don't talk about enough a lot and really messes with some people's lives.

Kirk: Well, if you go to our web page, reefermed.ca and search for endometriosis, we've discussed it about seven episodes. But I know that in S3E3 with Canna Curious, we got into endometriosis studies. We got into it with Episode 34 with Keiley Beaudry, with Sex and Pharmacy. And you're right.

Trevor: Episode 84 is a Assuage suppositories Sarah Roberts

Kirk: You took it right out of my, took it right out of that. Yep. There it is. Endometriosis. It's also what I get a kick out of it is how Dr. Winston King discusses how it's men diagnosed it back in the 50s and 60s. And basically it's men once again diagnosing a female ailment and basically saying it's all in the mind or the demographic was "white women that worked" was another one. I also I do remember endometriosis in the 80s when I was practicing. I was working as an O.R. nurse in those days and women with endometriosis were always getting D and C. And again, what I found interesting.

Trevor: There tell, tell, tell people what? What's the &?

Kirk: Dilating and Curettage. Essentially, they dilate the cervix and go in and peel off the inner lining the endometrium of the uterus. And they believe that would recharge and have the uterus regrow the endometrium. And again, looking back and having this discussion, you know, 35 years ago, we may not have been on side with that. But what I found interesting is that she's saying that it's actually tissue that grows outside the uterus and can be found in the brain. I thought that was wondrous.

Trevor: I got the whole, I'm sure in pharmacy school we talked about, you know, it being. Endometrial lining, growing places it wasn't supposed to. So in my either I was told or in my mind I was picturing growing up the fallopian tube into maybe growing over an ovary, but in the general area of the uterus. Okay. Well, that makes sense. But yeah, in the lung, in the brain, you know, all these people finding incidental endometrial tissues, other places during random surgeries that I just had no idea.

Kirk: Yeah. I also I also there is a whole bunch of statistics she threw out, like the one about trans men, I'm not going to say it here, but that we discussed that she discussed trans men and how trans men tend to have more and endometriosis than just cis women. But let's like that's stuff we can talk about when we come out of it. What I like to do is just talk about this individual. And as I was listening to her speak, I kept thinking, this is a wellness doctor. This is this is a traditional Western doctor that specialized in women's health. OB GYN, she got into more of the wellness side. And she has her own clinic and her own her clinic is a Victory Rejuvenation Center.

Trevor: She treats a spirit that has a soul that lives in a body.

Kirk: Yeah, yeah. And she also, when she goes into her testing, as a nurse, I recognize some of the things she's hitting is social determinants of health, how people live their lives. It's not just it's not just you come in with, you know, a problem. She assesses your entire life and prescribes wellness, wellness therapy, as well as medicine. And hey, one of the medicines happens to be cannabis. But she's also she's a plant based medical doctor focusing on integrated health. You know, she uses nutrition supplements, cannabis and hormone balance. So she works on being, she works on the wellness of the client. And I am, I'm excited about that. I think I'm quoted often saying that wellness is a better model to live than the sickness model and the Canadian health care system would be better off if it focused on a wellness model. Of course, the problem with the wellness model, it takes 25 years to measure. It takes a generation to measure. And we live in a three-year political cycle so we don't get a chance to work on wellness. It's all about getting the new MRI in your small community. But I digress. So, is there any more we want to talk about the about this, this, this lady or do you want to get into it and talk about her talk afterwards?

Trevor: I want to just highlight what she'll do better than I. But just listen again, I mentioned it once, but just listen again how she talks about, you know, Doctor Ethan Russo's idea. She really liked it and she thought and endometriosis really fits into this clinical Endocannabinoid Deficiency Syndrome and sort of the criteria for for why it does because it really made. I've read that before, but it really made sense to me when she sort of plugged a condition into this Endocannabinoid Deficiency Syndrome. You can sort of see how it and other things fit into that Endocannabinoid Deficiency. So let's listen for that. She goes over that well.

Kirk: Also, we should talk a little bit about the terminology down there. Down there in America that we don't use up here and that's type one, type two, type three. You want just briefly.

Trevor: We do that quite often.

Kirk: Yeah.

Trevor: Yeah. You know, absolutely. Because lots of people in Florida at CANNMED use this. And at first I had no idea what they're talking about. So Type One means a THC dominant strain or mixture. You know, it's a tincture or whatever, but whatever using is THC dominant.  Type Two is more balanced, and it doesn't have to be exactly 1 to 1 THC to CBD, but more balanced and Type Three is CBD dominant.

Kirk: Right. Okay. Sure. Let's get into it.

Trevor: All right. Introducing Doctor Genester Wilson-King. Okay.

Dr. Genester Wilson-King: Yes, I am Dr. Genester Wilson-King, Medical Director of Victory Rejuvenation Center in Lake Mary, Florida. I'm a board certified obstetrician gynecologist. I've been practicing for many years. I had actually had the largest Ob-Gyn practice in my area for several years until I realized I really need to sleep a little bit more at night. So I stopped doing obstetrics and focused mainly on Gyn and that's what led me to the practice I'm in today, which is the same practice, but it's morphed into more of a wellness practice, and it's a practice in which I assess where people are on the wellness spectrum. Health and wellness spectrum, and then help them get to where they want to be. We use several different modalities, testing first and then several different modalities where we assess lifestyle, including what you're eating, what you're doing with your body. We approach the management of our patients from the perspective of, we are a spirit who has a soul that lives in a body and you need to nourish and nurture all three. Not every day, of course, but certainly nourish and nurture all three. If you can every day that's great. But in order to be well, not just not have disease but be well, you need to nourish and nurture all three of those. So we do discuss ways to do that. You nourish your body, what you eat, you care about what you put in it. You learn that you need to use it, you need to exercise it more. As far as the mind or the soul goes, stimulation is necessary there. And then the spirit.  Have some sort of spiritual practice. I don't promote any religion or anything like that, but it's a matter of a spiritual practice, whether it's walking in nature or listening to nice music and kind of allowing it to take you away. Things like that are good to do on a regular basis as well. So I mainly treat women because I'm an Ob Gyn. But what happens is the my patients, when they get help, then they want me to help their husbands improve because their husbands can't keep up with them any longer. So I have, I do have some men in my practice.

Trevor: That is excellent. So the place we learned about you was at CANNMED and I listen to an excellent talk you gave on endometriosis. So I think that segways nicely into tell us because it's something that's a condition that affects many, many people. But honestly, outside the medical community you probably don't hear about it very much. So let's start with what is endometriosis and how does it affect people.

Dr. Genester Wilson-King: Sure. People outside of the medical field will know about it if they have a family member that has it. Believe me, it does impact the whole family. Endometriosis is defined as the presence of endometrial tissue outside of the uterus. Now, when I say endometrial tissue, the inner lining of the uterus is called the endometrium. And the tissue that lines the inside of the uterus is called is called endometrial tissue. So when this tissue is anywhere other than its normal location, within the uterus, it's known as endometriosis. The fact that it is out of place causes a chronic inflammatory reaction that becomes systemic inflammation. We used to actually think of endometriosis as, well, I will say we used to.  Years ago up until the 80s and the endometriosis was viewed by gynecologists as a disease of white women who chose career over having children.

Trevor: Really?

Dr. Genester Wilson-King: Exactly how it was described in the textbooks. And that's how it was described during residency and whatnot. But of course, we know that that is not true. And that endometriosis can occur in many different people. Many different people. There's adolescents. Adolescents can have endometriosis. They found that women, Actually there was a registry of about 4000 adult women who had endometriosis, and two thirds of them reported that their first pelvic symptoms were prior to the age of 20. And 1 in 5 of them had pain before the age of 15. And what was found is that 40 about, it's a wide range of adolescents who don't respond to conventional medical therapy or the treatment of menstrual cramps or pelvic pain, had endometriosis, anywhere from 49 to 70, 50 to 79, 75% had, will have endometriosis. The endometriosis also seems to affect about 25 to 35% of adolescents who have chronic pelvic pain. So two primary things don't respond to conventional treatment or cramps, etc., and have chronic pelvic pain. Then endometriosis can also be seen in post-menopausal people. It's the first reported case was in 1942 and it's well documented. We don't know if it's a recurrence of previous endometriosis or whether it's a new occurs because sometimes it is found in women who never knew they had endometriosis.  Then there's also people of color. It's just it's not just a disease of white women. And we found that because of, oftentimes women with or people with endometriosis have fertility issues, so they go for an infertility evaluation and endometriosis was found in the black patients being evaluated for infertility or fertility issues. As well as Asian, Latin. All kinds of people were found to have endometriosis. And then there's a new category. I don't know whether, transgender males are having endometriosis. Probably of about, there was a 2020 study that looked at the transgender men who presented for hysterectomy. 50% of them reported pelvic pain and one in 3 of them had with. 1 in 3 of those with pelvic pain had findings of endometriosis. And then finally, there's a lot of undiagnosed patients who are asymptomatic. Of course, we don't know about those but we find them is that their endometriosis is an incidental finding when they're having surgery for other reasons, like uterine fibroids, ovarian cysts or masses, things like that. But the recognition of endometriosis, the time range to diagnosis, is anywhere from 4 to 11 years, with about 65% of them being initially misdiagnosed. And that's pretty, pretty striking. Yeah.

Trevor: It is. Now, I eventually want to get to cannabinoids. So for those of you who are listening for the cannabis part, but just because I know there's going to be some people who this is all new. So what? And we touched on some of them, pelvic pain, cramping. But what are some of the symptoms someone who has endometriosis might experience?

Dr. Genester Wilson-King: Sure. Dysmenorrhea or menstrual cramps is probably the most common symptom. But this type of dysmenorrhea is more progressive than worsen dysmenorrhea and they can occur at non menstrual times of the month. That's the key factor here. Infertility can occur in up to about 40% of them. So infertility is one of the signs. Endobelly. Chronic gastrointestinal symptoms, meaning your stomach always, always has some issues. Despite changing your diet, medications, etc., you have bloating, constipation, diarrhea. And it just can be quite disruptive. And the one big thing about the endometriosis is that it significantly affects patients mental and psychological health. Many patients are on anti-depressants, anti-anxiety and even anti-psychotic meds. When you go for years with complaints and nobody finds what's wrong, you start to think that maybe there's something mentally wrong with yourself and unfortunately health care providers start looking at you like that too, and you end up with some of these mental health illness medications, such as medications such as anti-depressants, anti-anxiety and even antipsychotic meds. And this is where it really affects the family members, the partners and those who care for people with endometriosis. It can be quite disruptive to the family.  They can't participate in activities. They don't want to go places do that. It really is a disease that is all consuming for everyone involved. So, yeah.

Trevor: So now we'll jump into the endocannabinoid system and endometriosis. How do we think, what do we think the relationship is there? Do we know what's going on?

Dr. Genester Wilson-King: Well, let's start with this first. If we look at the Endocannabinoid system in and of itself, which Dr. Russo calls the master regulator of the body. But I'm talking about specifically the theory of clinical Endocannabinoid Deficiency, which Dr. Russo proposed in 2008 and then wrote a paper called the Clinical Endocannabinoid Deficiency Reconsidered in 2016. And it's a theory. Okay. Not any kind of definitive measurement, but it's a theory. But it fits. Its a theory that suggests, well, it has four tenants to conditions and that they have in order to qualify as a Clinical Endocrine Deficiency. And first, what that means is that the body doesn't produce enough endocannabinoids or enough receptors for the endocannabinoid system to function properly. That's where the endocannabinoid system fits in there. And then there's four tenants to the conditions that can qualify as a Clinical Endocannabinoid Deficiency condition. The first is the increased sensitivity to pain or hyperalgesia. The second is there's no finite definitive finding, lab finding, or test that is diagnostic for any disease can be considered a Clinical Endocannabinoid Deficiency. And endometriosis does not have any patho-mnemonic signs and symptoms that are specific for the disease. Instead, the disease has symptoms that are common to many other gynecological and non gynecological problems. The third tenet is that this disease is associated with or a Clinical Endocrinology Deficiency condition has a higher incidence of anxiety and depression. And endometriosis has that. And the final is that it overlaps with a lot of other conditions PTSD, M.S., autism, musculoskeletal disorders, all those disorders that can be considered Clinical Endocannabinoid Deficiency diseases. So it fits in that theory endometriosis appears to be associated with a downregulation of CB1 and CB2 receptors and then upregulation of TRPV1 receptors. Now that sounds really foreign people I know, but CB1 and Cb2 receptors are part of the Endocannabinoid System. So endometriosis, it seems that these receptors are decreased in numbers and amounts. And TRVP1, which are pain receptors, modulators of pain, are upregulated. So there's more pain and less cannabinoid receptors to help. When you use cannabinoid agonists, it can actually potentially inhibit endometriotic cell growth. So there's a couple of studies that show that. So I'll leave it there. There's one other.

Trevor: Well, go ahead.

Dr. Genester Wilson-King: One other thing. Okay. So THC and Beta-caryophyllene were it seemed to be effective in treating and the major doses. They did a study in which there was a mouse model that mimicked some of the conditions of human endometriosis. And these growths were implanted endometriosis growths outside the uterus and female mice. Those poor mice. But at any rate, the implants grew and the mice developed some of the common symptoms that patients have with endometriosis. Like anxiety and hypersensitivity to pain. Well, the mice were treated with THC for 28 days. It was given subcutaneously, which is not how we ingest THC. But this is this was the way we could give it to the mice. And there was a before and after picture that showed how the THC decreased the size of the endometrial implants. And this was only over a 28 day period. And then another study and I'll finish up looked at Beta-caryophyllene, which is one of the terpenes. They looked at Beta-caryophyllene and again, it was another mouse model that endometriosis was created in them. They measured the growth of the implants over a four week period, and then they treated the mice with Beta-caryophyllene. 10mg/kg and 30mg/kg for 21 days. And then they measured the growth of the implants again.  The ten milligrams per kilo Beta-caryophyllene suppress the growth of the endometrial implants by about 52.5% compared to controls. And it also caused cell death of the endometrium implants. The 30mg/kg dose did not do as well. And that illustrates the point that with cannabis, sometimes less is more. And that's an important concept. It's also a concept that is very difficult for us Americans to catch on to. We think of something worse, more must be better, so let's do more. But that's not always the case with cannabis. And the final point in the Beta-caryophyllene study is that the Beta-caryophyllene did not interfere with fertility because they used the mice that were treated with Beta-caryophyllene and measured their fertility and there was no effect on their fertility. They were able to reproduce without difficulty. So that's just some of the studies, like I said, clinical some of the preclinical and clinical studies that that suggests that cannabis may be uniquely suited for the treatment of endometriosis.

Trevor: Okay. And since I've got you here with all your expertise, how would we normally or what's our standard of care for treating endometriosis now, and how might cannabinoids fit into that?

Dr. Genester Wilson-King: Sure. The many factors to consider when treating someone with endometriosis is is one, how severe are their signs and symptoms and the other is whether or not you hope to become pregnant because that does tend to manage the treatment. There's medical and there's conventional.  Medical treatment, and they're both probably about the same effect as far as recurrence. They're both mediocre at treating and endometriosis. Medical would be something like some people on birth control pills. Do something to suppress the fluctuation of hormone levels, whether you do it via the brain or via the ovary. Its similar and then the another is surgical, which can involve removing various organs all the way from just an ovary to a simple, to a total hysterectomy and removal of the ovaries. And both of them, like I said, are mediocre. The recurrence of pain with surgery was 53% and the recurrence of pain with medicine was 44%. So our current treatment is mediocre. So the best treatment for endometriosis is going to be something that relieves the pain and can treat the other symptoms. I mentioned the mental health symptoms with anxiety and hyperalgesia, for the sensitivity to pain. And so we want to treat the pain. We want to treat the other symptoms, and we don't want to adversely affect fertility. And that's where cannabis can be far superior to what we have now.

Trevor: And so it's obviously not me because but if a patient like me. We'll take a 52 year old female with endometriosis comes in moderately severe symptoms. Are you talking about suppositories or. We're talking about oral oils, Are we inhaling? Do you have any sort of preferences where you start?

Dr. Genester Wilson-King: You know what, it's whatever works. Whatever method of ingestion the patient is most comfortable with is what we'll use. Of course, it's silly to smoke your medicine, but that's how most people that's how many people prefer to ingest their cannabis. So we will use inhalation. The way I like to do it and actually I'm a 52 year old woman's treatment, or I should say person's treatment is different than a 44 year old.

Trevor: Sure.

Dr. Genester Wilson-King: If the 52 year old comes in and has endometriotic pain, we first have to determine, okay, are you taking hormones? Because that's what stimulates the endometrium implants, mainly estrogen and makes them cause pain. So, in menopause or if you're post-menopausal, you're not making estrogen. So the endometrial implants will be quiescent or sometimes they call them senescent.  But a 44 year old very live in action the endometrial implants and their hormone levels are made within the body. So their hormone levels in that age range is, they're fluctuating wildly, and that makes the, that really can influence the pain and inflammation with endometriosis. So a 44 year old, I would check the hormone levels and try to balance the hormone levels with progesterone. Generally, 44 year olds are in the perimenopausal phase and they are estrogen dominant. So estrogen stimulates the endometrial implant. So we need to do something to balance out the effects of the progesterone and giving, balance out the effects of estrogen.  Giving progesterone can do that. And that works a lot of the time. But progesterone there are probably about one third of patients with endometriosis that are progesterone resistant. We don't know why, but that just happens and that leads to elevated estrogen and worsening, facilitating growth and worsening of the symptoms. So we'll start off with progesterone in a 44 year old and look at the 52 year old who may be just taking estrogen not progesterone and give her progesterone and see if that will help. Although no woman who's on estrogen should ever be on estrogen without taking progesterone as well, with or without a uterus. And that's a topic for probably another talk. And we want to stay focused on cannabis.

Trevor: Yeah, but back in the day, we did a lot of bioidentical hormones. So that was a like we used to make them in the pharmacy and that that was a tough sell with the older doctors. Is someone without a uterus still using progesterone. But you're right. To go back to the cannabis, okay, that's make me pre-menopausal again instead of post-menopausal. So I like the 44 year old because there's going to be a lot of those listening. So I'm 44 and still producing some hormones, but I'm pre-menopausal perimenopausal. I've got some of those wonderful symptoms, but I do have I do have endometriosis. So you've sort of leveled up my hormones, got me on some progesterone cream, say if I say or if you or I think that cannabis might be something else, What? How would you do the something else for me?

Dr. Genester Wilson-King: Okay. Sure. I do want to add a little caveat. I believe that cannabis works best from a holistic perspective. So yes, the hormones are important, but we also do nutritional assessments and we also recommend exercise programs and there's reasons for all of that. But we don't have time to go into that. So let's start with the cannabis. What I do is just talk to the patient, first of all, about cannabis. It depends if they're cannabis naive or cannabis experienced. I generally will start with a 1 to 1, Type 2 that's a mixed ratio type of cannabis. And it can either be tinctures or capsules or inhalation, if that's the way you want to ingest your cannabis. Tinctures I fine work best because it's easy to adjust the dose as needed. So anyway tincture will titrate to the dose that seems to keep things under control. If there is breakthrough pain, then inhalation is great for that. It's quick and works well, and if that happens frequently, we may have to adjust what the chronic dose that they're using, the dose that they're taking consistently. Then if there is pelvic pain or if they're having difficulty with intercourse, a vaginal suppository is perfect for that. It's inserted at night. It can be a Type One or a Type Two.  I generally like the Type Two.

Trevor: But I'm going to jump in real quick. In Canada, we don't, it was interesting when I was in Florida, we don't talk about Type One and Type Two. But just so just remind us what you mean by Type One and Type Two.

Dr. Genester Wilson-King: Sure. Type One is THC dominant meaning primarily THC product.

Trevor: Okay.

Dr. Genester Wilson-King: Type Two is a mixed ratio. THC and CBD in anywhere from 1 to 5 ratio amounts. Their equal. That's Type One Types Two, Type Three, just to be complete, there's actually a four and a five, but I won't go into all that. But the Type Three is a CBD dominant product, which is meaning mostly CBD, but it still has THC, just like the THC dominant still has CBD. So those and thank you for interjecting that because you're right, the terminology has not been standardized or made universal in many respects. So thank you for that.

Trevor: So I know I have to be cognizant of your time and we are getting close to the half an hour. I promise to not keep you for too long. And I really could talk to you for hours because like I said, we used to do a lot of bioidentical hormones and, well, that's not this podcast. And I know Kirk might harass you later, you know, next few months because he's got a resounding interest in cannabis and pregnancy and I know you that's another thing that you like talking about but we've at least scratched the surface on endometriosis. But I want to ask, is there is there anything the audience should know, anything I missed Endometriosis in general or cannabis and endometriosis anything I should have asked that you really think everybody should know about?

Dr. Genester Wilson-King: Well, let me just say this then. The vaginal suppository are quite effective. And it should be known that if THC is in there, you will experience the effects of THC through the vagina. It's pretty known, I think, that throughout the industry that rectal suppositories sometimes don't give people the effects of THC. Although they are locally, they can be actually helpful. But natural suppositories and those both the rectum and the vagina have two different circulatory systems. They drain the rectal area, especially the upper part of the rectum drains into the liver, and that's part of the issue. But for the vaginal circulatory system, it goes systemic immediately. So you can get effects from THC. So you must be careful if you're making your own suppositories. And be careful of the amount of THC that you use because you will feel those effects. With some of about endometriosis it's a very complex disease. And we do know that it is a disease that causes systemic inflammation, I mean, inflammation throughout the body. And so I've seen patients with endometriosis implants in the lung. In the liver.

Trevor: Wow.

Dr. Genester Wilson-King: And some have actually had them in the brain. So endometriosis can be anywhere. It's not localized to the pelvis, as was initially thought back in ancient times of the before 80s. The 80s. I don't like to call it ancient, but it seems ancient from now. So there's a lot more to this disease that we need to find out. Even your gut microbiome can influence. We don't know if it's the result of endometriosis or part of the ideology of endometriosis but the gut microbiome can influence endometriosis.

Trevor: Dr. Wilson-King this was fantastic. Again, I like I said, I wish we had all day. And, you know, maybe if we're going to keep you on our Rolodex, because I'm sure there's a few more questions we have for you down the road. But this was great. We really appreciate your time.

Dr. Genester Wilson-King: Thank you for the invitation and thank you for being patient with me about getting this set up too. It was a pleasure talking to you. And yeah, I kind of we could have talked for quite a while.

Trevor: I think so. Maybe. Maybe next time. All right. Thank you again.

Dr. Genester Wilson-King: You're welcome.

Trevor: So I just I'm going to go over the Endocannabinoid Deficiency Syndrome is, again, Dr. Ethan Russo's idea,  but I liked how she saw fit endometriosis into it as a great example. So. The four criteria she was talking about, you get hyperalgesia. Meaning, so we think of analgesia pre-surgery deadening or getting rid of pain. Hyperalgesia means things that should normally not cause you pain do cause you pain. You feel pain more. It's also as a condition that doesn't have a lab test to prove you have it. You know, it's a condition of, a diagnosis of exclusion. You rule out everything else and I guess you must have endometriosis. And she talked about, you know, I think she said 4 to 11 years on average between when someone has symptoms and when they're diagnosed because there's no lab test that goes Bing, Endometriosis.  Three, it's associated, and we hear this so much and it's just fascinating, I'm not saying good, but fascinating, it keeps coming up. It's associated with more anxiety and depression than then it should be. You know, anxiety and depression seem to go hand in hand with it to the point that she even said, you know, a burden of disease of endometriosis is the number of anti-depressants, anti-anxiety and even a psychoactive like a schizophrenia type drugs people end up on. And the fact it overlaps with some other conditions like M.S., PTSD and other musculoskeletal disorders. So like she said, this is sort of Dr. Russo's idea. Dr. Russo's framework. But interesting that how well endometriosis falls into those four categories.

Kirk: Yeah. No, it's it was a great discussion, good introduction to endometriosis. I also liked how she remind us that more is less with cannabis and how cannabis works as a medicine. And I think we've often talked to experts that have told us that when you're using cannabis as medicine, you're not trying to get high, you're using it to balance whatever you're balancing. And what I like about this is that it's research in the endocannabinoid system and how now we're slowly starting to get the research that matches, matches people's unbalance or the lack of homeostasis and how often when somebody is off their balance, when their life and their, you know, I guess body and spirit and mind aren't balanced that often, I guess we're kind of kind of cannabis centric here, but often it just relates to the endocannabinoid system and we're finding these stories that are just proving that the endocannabinoid system has a purpose in our balance, in our wellness. And what better way to be a doctor than to include cannabis in your wellness? I think that's imaging.

Trevor: I geeked out a little bit, though, when you're talking about the less is more part. That one was what she talked about several interesting studies. But that one, they had specifically taken a mouse giving them endometriosis, like giving them an implant of endometrial tissue someplace that shouldn't be. And then they gave them their Beta-caryophyllene.  I have trouble with that one which isn't actually a cannabinoid it's a Terpene and in this case it was, it was the terpene Beta-caryophyllene that the number of cells number and size of the cells had shrunk. So you know it did some good stuff but like she said the they had sort of two treatment arms, a high dose and a low dose. The high dose didn't do so well. The low dose actually did better. So like you said, it's not always about whacking it with a bigger hammer.

Kirk: No, no. The other thing that I found fabulous here and I and I have an underline in my notes, is that the patient is in control with the dosing and the method of consumption. And yes, it is odd that someone would inhale their medicine, but if that's how the medicine gets into you and it works, well, so be it. And I guess as a wellness doctor, she wants to probably work with the ingestible or even or suppositories. That was fascinating. I was wondering how you.

Trevor: I do try to work suppositories and every conversation I have with people.

Kirk: Yes, yes, yes, you do. So I was I was waiting for you to make that introduction in the front of the in the front of the episode. And you didn't do it.

Trevor: I didn't have to she went there. And again, sorry to geek out a little bit more. I loved her explanation because we've touched on it before of the blood supply for a vaginal suppository versus rectal suppository. Sorry, people yes I seem to have a bit of a fascination. But the vaginal blood supply doesn't go directly to the liver, where it's about two thirds, one third for the for the rectal suppository, which means, like she said, the THC goes directly into your bloodstream. It doesn't get it doesn't get broken down, changed at all. So basically, she's saying, you know, careful, if you have too much THC, you might get higher than you want. That was my interpretation of what she would say.

Kirk: Well, yes, And I do remember I think it was in Episode 34 with Kieley Beaudry when she mentioned the fact that if you are using virginal suppositories and your partner is is doing cunalingus there might be more sharing going on in regards to the experience, than not.

I think Kieley even mentioned, you know, telling your partner that a condom might not be the worst idea that night came up to. But, you know, as long as everybody is understanding what's going on and I guess we you know.

Kirk: And consensual, it's always go to the consensual.

Trevor: Exactly. So I really, really enjoyed the conversation with Dr. Wilson-King. She was great. I hope we get a chance to interview her again. I sort of hinted at it there. You know, maybe we could get to.

Kirk: Yeah. Yeah.

Trevor: Have you talked to her about pregnancy? But I really hope she does let us keep following her because she is a a wealth of knowledge and really, really nice and easy to talk to. You know, she's one of those, you know, when you talk to someone, you go, yeah, I wish she was my doctor, she, she really has it. I wish she was my doctor kind of vibe.

Kirk: Yeah, I've LinkedIn with her and I plan to, once she accepts my request, I plan to contact her and do another episode on pregnancy because I did do some reading of the papers that she has on her website and you'll be able to get to her website via our website reefermed.ca. We'll put up the links for her and I remember you talking about her a few months back and I was focused on other things a few months back doing other stuff around town in the city. And I didn't think about the podcast for about three weeks Trevor.  Took a little bit of a break and.

Trevor: It happens.

Kirk: And I will get to that.

Trevor: She did give us a song request. Earth, Wind and Fire Fantasy.

Kirk: good song.

Trevor: We forwarded that onto Rene.

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

Trevor: I am Trevor Shewfelt I am the Pharmacist.

Kirk: Okay.

Trevor: All right. So everyone later was another good one.

Kirk: Talk to you later.