Not many things can make physicians shuffle uncomfortably in their seats (we've seen it all) but weed?...It's not just the politicians and the public who harbor mixed feelings about this plant and the validity of its medicinal value.
What are all these hang-ups? Here are some of the questions we doctors and researchers have, and which are often shared by the general public:
Cannabis, THC, and CBD
The cannabis of medical marijuana has more than 100 active ingredients, and THC (tetrahydrocannabinol) is the one that causes the so-called “high” feeling that we've heard about. CBD (cannabidiol) however, results in no altered consciousness. Even without the high however, there is considerable anecdotal evidence reporting many benefits from CBD, such as relief from anxiety, insomnia, pain and seizures.
Cannabis also appears to ease a lot of neuropathic pain, including that from multiple sclerosis, which is great news because all the other options are little better than drinking cat's urine (which I am not recommending by the way). Being able to live a fully functional daily life is key for patients who are either disabled from lack of pain relief, or sedated from too much old-school pain relief. Cannabis to the rescue. There are reports of its usefulness in fibromyalgia, endometriosis, interstitial cystitis and other conditions that make most physicians groan and moan, myself included, when we see it on the patient's chart before we walk into the room. We groan because it's so difficult to treat and we feel almost powerless at being anything better than a kindly listener!
The number one use for cannabis is indeed pain control and, although it's not strong enough for the most severe pains (such as a fractured femur or neck, or recovering from major surgery), it has been found to be rather effective for a lot of chronic pain, especially with advancing age.
Cannabis is categorically safer than opiates and it's a good substitute for over-the-counter drugs like ibuprofen, if people can't take them due to ulcers or kidney problems. You can't overdose on cannabis and it's arguably far less, if at all, addictive, compared with many other drugs, legal or not.
Cannabis also appears to serve as an effective muscle relaxant as well as remedy for reducing tremors, such as in Parkinson's disease.
Being an appetite stimulant, nausea and chemo-related weight loss also seem to be qualifying conditions for cannabis.
Patients with PTSD also report dramatic improvements in their symptoms and this condition may be the biggest lobby for federal decriminalization which, in my opinion, is inevitable because elected officials seem to support things that will gain them votes, and the mental health of our veterans is important to the majority of people.
Muscle wasting in HIV and AIDS also seems to be helped by cannabis, as does IBS and Crohn's Disease.
The State of Missouri has declared other “chronic conditions as a qualifier for physician certification, which seems to be rather an interesting blanket description.
Given all the above reports and claims however, the real tests of effectiveness can only really be proven after a few years of well-controlled scientific studies, so my physician friends should behave more as clinicians rather than scientists. As you're aware, we were advising people to quit smoking tobacco long before the studies proved any harm. A clinician has that liberty to make recommendations, whereas a scientist does not, the latter waiting for compelling proof before he is willing to make any bold announcements. I do understand that some, if not most, doctors need measurable and substantial proofs before making any recommendations for treatment or management plan. However, it may behoove us to remember that many of our patients cannot wait years for this proof to finally appear.
Patients, Please Talk With Your Doctor. Doctors, Please Talk With Your Patients.
Reminiscent of when Viagra first came out, a lot of patients really want to know more about the medicinal uses of cannabis, but are afraid or embarrassed to raise the matter with their doctor. It may even be more taboo than erectile dysfunction was (I still remember the ads on the radio encouraging men to speak with their doctor about it). This won't happen with cannabis of course, until it's federally legal, because you can't advertise federally illegal drugs on TV.
Unfortunately, there are some in the medical community who are either in disagreement with the benefits of cannabis or consider it unscientific or unethical in some way without any scientifically-derived reason. One’s ethics will of course be dictated by which belief system one holds dear, if any.
Patients are afraid of being scolded, criticized, chided or judged, so there are some who won't even tell their doctors.
My approach is that honesty is the best policy. Don't hesitate to have the conversation with your doctor for fear of their reaction in knowing you are using cannabis, or that you’ve been wondering if it might be useful for your condition. They may surprise you and be extremely supportive. If you also tell them that quite frankly, you consider the use of cannabis as part of your medical regimen, and that at the very least, you expect your primary care physician to have studied it enough to discuss it and make a recommendation, I don't think you'll get much push-back if any.
My unsolicited words of advice for my fellow physicians is that, whether you like it, love it, hate it or just don't know enough about it, your patients are either using it already or they will soon. Get yourself educated on it, keep an open mind about it and don't judge your patients. They're trusting you to be an oracle of wisdom with regard to their health. If you judge or dismiss, you really are letting them down. If you are utterly against cannabis, tell your patient that you're not ready to prescribe it and that perhaps they should look for someone who is. Otherwise, it's just going to be awkward for both of you when they next visit.
Maintaining the trust from our patients requires us doctors to be honest with them, just as we expect them to be honest with us. The doctor-patient relationship is sacred and our patients' lives hinge on this relationship being very open and clear, without anyone having any problem discussing anything. If we consider it our professional duty to willingly discuss sexually transmitted disease, alcoholism and erectile dysfunction, and the various managements for those issues, then surely a condition that might benefit from cannabis, even just anecdotally, shouldn't be any different.
It is true that we don't [yet] have sufficient scientific evidence to recommend medical marijuana to our patients, but it is also true that we doctors should always be willing to discuss any issue with our patients.
My name is Dr. Sonny Saggar. I founded Downtown Urgent Care (DUC) in March 2009, and I have had the joy this year of celebrating 10 years of this fulfilling experiment. I have never earned an income from the creation of this facility. I got my pay from being an ER doctor or from a consulting gig here and there. If I had demanded a paycheck from DUC, it wouldn’t have survived more than a couple of years. I want to say something today in this post, about all the stuff I go on about. Why do I torment my readers with all this talk of doing what is right, with how DUC is one of the few facilities that accepts patients on Medicaid, who are among the poorest people in our society? Why do I think it’s a big deal that DUC is open 24 hours a day? It was not lost on me that I was shouting my soliloquies in an echo chamber, and only to those people who were also on social media. So I want to speak with you people.
I am going to assume that you people are probably more likely to have health insurance, and that you have a job and a car and a place to live. That you’re not homeless or otherwise impoverished. I have never been poor but I have met thousands of poor people since I started at medical school back in 1986. I’ve always been a bit of a loose cannon and a deliberate disruptor, but if there was any cause that captivated my imagination it was that of socioeconomic prejudice. That’s why I have asked people many times to show solidarity with those who are less fortunate.
If I can mobilize people who have never been on the downside of privilege, or who have never been anything close to being described as ‘poor’, to act on behalf of those who are poor, of those who have been turned away from a medical facility because they “didn’t have the right insurance”, or who’ve gone without a meal day after day, then I think it’s helping fix things.
Humans have a power known as empathy, which leads to collective action that gets people access to medical care and actually saves lives. You ‘comfortable people’ and I hope you will forgive me for calling you that, whose personal wellbeing and security is assured. You could join together in ever-increasing numbers to help those who you do not even know, but whom you walk past or drive past almost every day. You can help those people who, believe it or not, are also part of your community.
No, you’re not going to see them at that fundraiser, because they’re busy working 2 or 3 jobs, just get some food on the table. No, they’re definitely not ‘in your circle’, because, well, because they’re poor, or they’re less educated, or they didn’t go to the same school as you, or maybe they didn’t even go to school. But they’re still part of your community. They are poor and you are not. And if you can extend them a little help by only using medical facilities that do also help ‘those people’, then your small participation in this process could be one of the most humbling and inspiring experiences of your life.
Human beings can learn and understand [to a certain degree] without having experienced what it was like to be a certain way. Straight people can understand [to a certain degree] what it’s like to be gay. White people can understand [to a certain degree] what it’s like to be black. Men and women can even understand one another [to a certain degree]. Cis people can understand [to a certain degree] what it’s like to be trans. Wealthy people can understand [to a certain degree] what it’s like to be poor. Families with health insurance can understand [to a certain degree] what it’s like not to have health insurance for a family. People living in free countries can understand [to a certain degree] what it’s like to live in an oppressive regime. Some of us can understand [to a certain degree] what it’s like to be pregnant as a result of rape, without ever having to have suffered that.
All these people I have listed are all part of your community. They are your brothers and sisters, whether you accept them or not.
I say can understand, in that we have the capacity and ability to do it, but we all know that only some of us use that super-power. And many of us don’t use it.
Humans can think themselves into other peoples' places [to a certain degree].
So you can choose to remain comfortably within the bounds of your own experience never troubling to wonder how it would feel to be born other than what you are. You can refuse to listen and know what ‘those people’ are experiencing. You can close your minds and your heart to any suffering that may be going on. You have the right to switch off your empathy if you so wish, but be careful. The willfully unempathetic actually see more monsters than those with exercise their empathy.
More importantly, those who choose not to empathize, enable the monsters. They enable the medical facilities that turn people away, just because they have Medicaid. They enable the State legislators that call a woman a murderer if she chooses to have an abortion at 8 weeks gestation. They enable the law enforcement officer who shoots an unarmed motorist for ‘resisting arrest’. They enable the government that discriminates against people because of religion or nationality. The list is endless.
What we all achieve inwardly, will change our outer realities. We are all connected. We all touch one another just by existing.
You can use your status and your influence to raise your voice on behalf of those with no voice (or a quieter voice). If you are privileged or comfortable, you have the power to help those who are not. You just have to decide to do it. You have the power to not turn your back on them.
Even if you have only identified with the powerful, you can now start to also see that you can also identify with the powerLESS. They are your family too.
You have the ability to imagine yourself into the lives of those who do not have your advantages, and you can help change the reality of millions of people, or even just a few hundred people in your own town.
That’s all I wanted to say today.
Happy Memorial Day everyone!
If you earn more than the threshold requires you to qualify for Medicaid and still don't have enough funds to be able to afford private health insurance, then you are in what we call the "Healthcare Gap". We have developed a number of solutions which do not require insurance, Medicaid, or Medicare, which are easily and affordably accessed.
“In states that haven’t expanded Medicaid, the coverage gap prevents the [Affordable Care Act] from working as intended – and the burden is not felt just by impoverished, uninsured residents. It’s shared by hospitals, businesses, state budgets, and residents who have private insurance.” –healthinsurance.org
Even if you do have insurance but your copay or deductibles are too high, you qualify too!
Our centers never turn away those don't have Medicaid. Other clinics have both privately and publicly stated their reasons for turning away those using Medicaid with, "Medicaid doesn't pay enough" or "Medicaid doesn't pay quick enough" among other dubious “reasons”.
We don't buy those excuses. Let's follow the facts: If the clinic's staffing is a sunk cost, it shouldn't matter how low Medicaid pays. Plus, in our experience, Medicaid often pays faster than most commercial insurers. And even if they didn’t, it’s still about doing the right thing.
By voting with your dollars to facilities that believe in people before profit, facilities like 24/7 Healthcare, patients who can afford private insurance can feel good about supporting a clinic that accepts Medicaid.
My hopes are that we can share this information and persuade those Medicaid-rejecting clinics to see the error of their ways. Maybe it'll help the patients with commercial insurance who these clinics crave after, make a decision to only go to a place that treats all humans equally.
Moreover, why go to a clinic that attempts to extract every penny it can out of its patients when there are clinics that genuinely want to help people with the highest quality treatment and facilities? Regardless of your financial wealth, we want to see all out patients prosper.
Call any urgent care company you like and ask them a simple question, "Do you accept Medicaid?" That'll tell you all you need to know.
Let's stand together as a community, end the cherry-picking, and build a better experience for all.
We're committed to evaluating and managing patients with injuries and concussions using a comprehensive and time-tested approach.
Our sports clinic offers concussion and other sports injury evaluations and management through a collaborative team effort made up of primary care sports medicine physicians, neurologists, neurosurgeons, neuro-psychologists, certified athletic trainers, vestibular therapists, radiologists, neuro-ophthalmologists, and researchers, all dedicated to patient recovery. We are closely affiliated with specialists at Saint Louis University and SSM but we are fiercely independent and have excellent relationships with every hospital system in Saint Louis.
Our sports clinic teams accept appointments on the following days at our locations:
Use this patient checklist and refer to the additional resources, from the Cleveland Clinic.
Even "fender-benders" can cause hidden injuries that can develop into pain, headaches, and arthritis. Even worse, most people who have been involved in an auto accident may not even know that they've been hurt.
When someone's been hurt in an accident, they need to be examined before they may settle with the insurance company but often times, accident victims don’t notice their symptoms until days or weeks after the accident. Victims can sometimes find themselves settling cases with insurance companies too quickly.
If you have been hurt in an auto accident, even a minor injury, we recommend being examined and provided with treatment options including chiropractic services. Car accident victims are often left with spinal misalignment, pinched nerves, and muscle spasms. That is why it is so important to get examined after an accident. Don't go another day living in pain!
Did you know Missouri drivers now have only 14 days to seek medical attention after the accident has occurred in order to receive Personal Injury Protection medical benefits?
We have over [number] years of experience working with claims adjusters and insurance companies and completing their required reports and documentation. Come to us and we'll manage all the paperwork so that your claim is handled conveniently - and usually with no out-of-pocket expenses to you.
Please call us at 314.932.1213 for a free auto accident consultation.
Let us answer your questions regarding our services. The STL Accident & Personal Injury Centers in Saint Louis are here to help you in every step of the way so that you can focus on getting better.