The post Medical Cannabis first appeared on Wholistic Medical Centre.

The post Medical Cannabis appeared first on Wholistic Medical Centre.

Medical cannabis, or CBD oil, is not a first line treatment. As per the Royal Australian College of General Practitioners guidelines, “medicinal cannabis products should only be considered when all first line, conventional options have been tried.”

So, if you have a medical condition of more than 3 months duration and conventional medications have not proved effective for you or the side effects have outweighed the benefits or you wish to stop using ‘community acquired’ cannabis. Then it may be worth having a detailed discussion of the potential benefits and downside of medicinal cannabis with one of our doctors.

Who prescribes Cannabis at the Wholistic Medical Centre?

Cannabis (CBD) can only be prescribed by a Doctor through an individual application on your behalf to the Therapeutic Goods Authority – Special Access Scheme TGA SAS.

At the Wholistic Medical Centre, Dr Nick Bassal is registered with the Therapeutic Goods Authority – Special Access Scheme (TGA SAS) to prescribe Cannabis.

The Wholistic Medical Centre Difference

We differ from other clinics who prescribe cannabis, at the Wholistic Medical Centre we will consult with you from a holistic perspective. Cannabis is not just another drug, herb or magic bullet, we view it as an adjunct to holistic health care. So, where appropriate we can also discuss nutritional medicine, exercise, sleep and psychological support. It may also be useful to incorporate Chinese herbs relevant to your condition to improve outcomes. The above adjuncts will potentially have the effect of improving health outcomes, reducing the dose of cannabis you need and hence reduce the monthly cost and any potential side effects.

The Consultation Processes

For the initial appointment (which can be in person or via video) you will need to have relevant information such as medical history, letters from your GP or specialists. If Cannabis is indicated, the Wholistic Medical Centre doctor will make a formal online application to the TGA on your behalf. Note that your name is not revealed. We only need your initials and date of birth.

You will be notified once we receive the approval from the TGA.  You will be asked to make an appointment to discuss the specific medication and starting dose and things to look for. Your doctor will write a prescription and send/give that to you, along with the approval documentation. We will also endeavour to find a specific pharmacy near you that will provide you with the medication.

Follow up appointments are advised initially fortnightly to establish the correct dose and then monthly for the first 6 months to monitor progress and thereafter every 3-6 months as advised to obtain repeat scripts.

If you would like to discuss further, please make an appointment. Call 02 9211 3811 or make an online booking via our website.

What is the cost involved?

The fees below apply to Medical Cannabis consultations with  Dr Nicholas Bassal:

Initial consultation- You will not be out of pocket any more than $199 with Dr Nicholas Bassal. This is for the initial phone or video consultation (this includes the time taken for the Doctor to complete the TGA SAS application on your behalf).

The fee may be different if the consultation is in person, or on video, who you see and how long the consultation is, this is due to different Medicare item numbers that are charged. However, your out of pocket cost will remain at a maximum of $199.

Follow up consultations : $99 (out of pocket)

If you wish to gain from mindfulness-based psychotherapy, in addition to the cannabis, to assist in your holistic treatment, then a follow up consultation will be required with Dr Nicholas Bassal.

As Cannabis has been used in Traditional Chinese Medicine (TCM) for millennia, usually in conjunction with other herbs, TCM practitioners already know which Chinese herbs to use to boost the benefit of cannabis. Each case however needs to be individualised according to their TCM presentation. If that is of interest to you, then make a consultation with Tanya Newton our highly experienced TCM herbal practitioner.

In the unlikely event that your application is declined, unfortunately the initial consultation fee is not refundable

The cost of the medical Cannabis appropriate for you varies depending on the exact product recommended (CBD:THC ratio, supply company and pharmacy). The cost can vary between approximately $200-$400 monthly.

Note- Currently cannabis products are not on the PBS (Pharmaceutical Benefits Scheme), so there is no government subsidy. So, all the costs of the cannabis products as supplied by the pharmacy are privately paid for.

If you want to find out if cannabis might help you. Please call 02 9211 3811 for an appointment.

The Ancient History of Cannabis in Medicine

Cannabis is a form of herbal medicine and has been used for over 5,000 years in many parts of the world. The medical benefits of cannabis were documented by Emperor Shen-Nung in China in 2737BC. Cannabis has been considered one of the 50 fundamental herbs in Traditional Chinese Medicine and its use has been continually documented in Chinese medicine for ~1800 years. In the modern era the seeds, known in TCM as huomaren 火麻仁, are listed in the Chinese Medicine Pharmacopeia.

Read more on Cannabis in Chinese Medicine

The Ebers Papyrus (c. 1550 BCE) from Ancient Egypt describes medical cannabis.

Surviving texts from ancient India confirm that cannabis’ psychoactive properties were recognized, and doctors used it for treating a variety of illnesses and ailments, including insomnia, headaches, gastrointestinal disorders, and pain, including during childbirth.

The Ancient Greeks used cannabis to dress wounds and sores on their horses, and in humans.

In the medieval Islamic world, Arabic physicians made use of cannabis for its diuretic, antiemetic, antiepileptic, anti-inflammatory, analgesic and antipyretic properties from the 8th to 18th centuries.

Modern History of Cannabis

An Irish physician, William Brooke O’Shaughnessy, is credited with introducing cannabis to Western medicine. O’Shaughnessy discovered cannabis in the 1830s while living abroad in India, where he conducted numerous experiments investigating the drug’s medical utility (noting in particular its analgesic and anticonvulsant effects). He returned to England with a supply of cannabis in 1842, (Queen Victoria even used it for period pain) gradually its use spread through Europe and the United States. Cannabis was entered into the United States Pharmacopeia in 1850 and used legally until US prohibition in 1937

Cannabis began to attract renewed interest as medicine in the 1970s and 1980s, in particular due to its use by cancer and AIDS patients who reported relief the effects of chemotherapy and wasting syndrome. In 1996, California became the first U.S. state to legalize medical cannabis in defiance of federal law. In 2001, Canada became the first country to adopt a system regulating the medical use of cannabis.

Our Body’s Own Cannabis

In 1992 it was discovered that our body produces its own cannabis like neurotransmitters and has receptors for them. (similar to the discovery of our natural endorphins). So, it was named the endo cannabinoid system (ECS).

The ECS modulates different body systems to help achieve homeostasis. It is involved in many functions including inflammation, pain, sleep, appetite, digestion, metabolism, cardiovascular function, bone development, reproduction, immune function, mood, memory and cognitive processes.

The Endo-Cannabinoid System (ECS)

We have two natural endocannabinoids – anandamide (from the Sanskrit word, “ananda” meaning bliss; similar structure to THC) and 2- AG (similar structure to CBD) and it was also discovered that there were two types of cannabinoid receptors – CB1 and CB2.

Most of the receptors are CB1 receptors and located in the central nervous system (CNS) which includes the brain (cognitive functions, memory) – e.g. hypothalamus, amygdala, hippocampus, basal ganglia, cerebellum, cerebral cortex. And peripheral nervous system (PNS) all the nerves connected to our muscles and organs.

CB2 receptors are in the immune system and gut (immune function, pain and inflammation).

CBD and THC are chemically similar to our own naturally produced cannabinoids- hence they can interact with our CB1 and CB2 receptors.

Chemistry of Cannabis

Many people are familiar with two of the well-known chemicals found in medicinal cannabis- CBD (cannabidiol) and THC (delta 9 tetrahydrocannabinol).

Cannabinoids can be classified into three categories:

•      Endocannabinoids– natural produced in the body
•       Phyto cannabinoids– from plants
•       Synthetic cannabinoids– pharmaceutical products

The cannabis plant has over 500 chemicals which can be grouped as cannabinoids, terpenes and flavonoids.  There are approx. 140 cannabinoids of which CBD and THC are the most well-known and researched. However, the terpenes and flavonoids have their own beneficial actions and also work synergistically with the cannabinoids- this is known as the entourage effect. Which is why we prefer whole plant extract.  The main variety of the cannabis plant is Cannabis sativa. Hemp is a strain of Cannabis sativa and has been bred to have lower concentrations of THC and higher concentrations of cannabidiol (CBD), which decreases or eliminates its psychoactive effects.  Hemp has been used for centuries for its fibre for making cloth, paper and ropes. Marijuana the other strain of Cannabis sativa which has been bred to have higher concentrations of THC and is the strain commonly used recreationally.

Medicinal uses of CBD and THC

CBD – this is the non-psychoactive component that has many beneficial properties including:

•      anti-inflammatory
•       anti-epileptic
•       anxiolytic
•       analgesic
•       anti-emetic
•       anti-psychotic

CBD is thought to inhibit the enzyme that breaks down anandamide (one of the two natural cannabinoids in the body) and stimulates the production of 2-AG (the second naturally occurring cannabinoid).

THC – produces the psychoactive effects (“high”) that cannabis is known for. However, it also has many other benefits including:

•      analgesic
•       anti-spasmodic
•       improving appetite
•       anti-inflammatory
•       anti-emetic
•       anti-spasticity

THC binds to CB1 receptors in the central and peripheral nervous system whereas CBD binds very weakly to CB1. It has been found that when THC is combined with CBD, this helps to reduce the THC’s psychoactive side effects. Phyto cannabinoids can also bind to other receptor sites apart from CBD 1 and 2. e.g. CBD is an agonist (enhancer) for the serotonin receptor.

CBD and THC can be used alone on in various formulations depending on individual circumstances and medical conditions.

In Australia in November 2016, THC became a Schedule 8 classification (controlled drugs – like morphine) and CBD became a Schedule 4 classification (prescription only medicine – like antibiotics, strong painkillers) by the TGA (Therapeutic Goods Administration).

Which medical conditions is Medical Cannabis (CBD) useful for?

• Chronic non cancer pain (CNCP)
• Chemotherapy induced nausea and vomiting (CINV)
• Cancer pain
• Epilepsy
• Multiple Sclerosis
• Inflammatory bowel disease
• Autism
• Endometriosis
• Fibromyalgia
• Migraine
• Anxiety/Depression
• Chronic insomnia
• PTSD
• Parkinson’s disease
• Alzheimer’s disease
• Sleep disturbance associated with Obstructive sleep apnoea (OSA)

Who cannot use Cannabis (CBD)?

CBM is generally contraindicated in:

•      Unstable cardiopulmonary disease
•       Cardiovascular risk factors
•      Pregnancy and breast feeding.
•       Active mood disorder, a history of psychotic disorder, schizophrenia.
•       Hypersensitivity to cannabis products

Caution is required in:

•       Patients < 25 years old. Cannabis can be used with careful monitoring in children/young adults with certain conditions like epilepsy (e.g. Dravet syndrome- drug resistant epilepsy) or autism.
•       Kidney/liver impairment
•       History of substance abuse
•       Previous or family history of mental illness e.g. schizophrenia.
•       Patients with risk of fall e.g. frail elderly patients.

Drug interactions – caution if taking these medications

•       Blood thinning agents e.g. warfarin.
•       Drugs/herbs that are also metabolised by CP450.
•       Sedatives and analgesics- alcohol, benzodiazepines, anti-depressants, anti-epileptics

What are the side effects of Cannabis?

The most common side effects are dry mouth, dizziness, disorientation, confusion, drowsiness, fatigue and anxiety.

Less commonly, people may also experience increased heart rate, impaired reaction times, fatigue, nausea, diarrhoea, vomiting and depression.

These effects are dose related and completely reversable.

That’s why we use the principle of “start low and go slow”.  Each patient will be started at an low dose, with any dose changes done gradually and closely monitored especially in the initial phase. Once on a stable dose, the frequency of follow up visits can be less frequent. The aim is to be on a dose that provides maximum benefit with minimal side effects. Each patient will be different.

Forms of Medical Cannabis

The oil is the most commonly used method for administering medical cannabis. The whole plant extract is mixed with a food grade oil (e.g. olive, canola). A dropper is used to place the oil under the tongue, it is absorbed within a minute.

Taste is generally not an issue. Capsules containing the oil are also available.

There are other methods like using a vaporiser or inhalation and creams/patches, but these are not currently approved in Australia.

Absorption of Cannabis

When taken as an oil (most common form of medical cannabis) under the tongue, and not swallowed, Cannabis is absorbed directly into the blood stream and has medium bioavailability. The effects can be felt in 30min to 90min and last about 4-8 hrs.

When Cannabis (CBD) is ingested, (added to food) it goes through the digestive tract, has lower bioavailability and is slower to act. Effects can be felt in 30min to 2 hours and last 3-6 hours.

By contrast smoking ‘community acquired’ cannabis (not recommended) provides high bioavailability and acts within a few minutes with a duration of 3 to 4 hours. The dose delivered by smoking is highly variable depending on the strain, potency of the plant, how it has been grown and dried. Generally smoking can deliver a dose of about 250mg to 1000mg of THC this of course hinges on initial quantity and how many people are sharing.

Can I drive?

CBD is less likely to impair driving than THC; however, there can still be very small amounts of THC in a CBD only product. So, until Mobile Drug Testing legislation allows for minimal levels of medicinal THC (like alcohol), it is not advised to drive even though your driving may not impaired.

If you want to find out if cannabis might help you, please call 02 9211 3811 for an appointment with

Dr Nicholas Bassal

The post Cannabis and Medicine first appeared on Wholistic Medical Centre.

The post Cannabis and Medicine appeared first on Wholistic Medical Centre.

Many women feel exhausted & overwhelmed after the birth of their baby and their recovery is overshadowed by the desire to ‘bounce back’. In modern society women are praised and admired for how quickly they are up and at ‘em and looking great post the birth of their baby. This modern day phenomenon is contrary to many traditional cultures where it is common place for the new mother to do nothing more than rest, feed and bond with her baby. In traditional Chinese medicine this is known as the Golden Month and new mothers are given special care, food and support until they feel recovered. This month is seen as providing valuable health benefits and allowing a new mother to adjust to her new role regardless if this is her first or third child. As every child, pregnancy & childbirth will be different, the needs of every new mother will differ. This is a time to recuperate and it is important to promote a mothers physical & emotional wellbeing. This is an opportunity to address any health needs that the mother may experience in the recovery from childbirth and start the journey to motherhood supported and confident.

What assists a new mother in her recovery in the postpartum period can be simplified in four basic tips:

Rest

Every new mother is told to sleep when your baby sleeps. This is essential for recovery as newborn babies will breastfeed at all different hours and sleep when you don’t think they should. Lie down for a day sleep with your baby as this will not only encourage bonding but will provide you with some valuable rest.

Nutritious food

New mothers need good nutrition. A combination of carbohydrates, protein & good fats to encourage a good milk supply & provide the needed nutritional needs that are amplified while breastfeeding and recovering from childbirth.

Hydration

New mothers need at least 10 -12 glasses of water each day to satisfy their fluid requirements in the postpartum period. This is to promote lactation as well as assist the heart and kidneys to flush all that extra fluid and interstitial fluid that accumulates in the final weeks of the pregnancy.

Reach out to your tribe & accept help

It is so important to create a supportive circle of people. They can assist in providing nutritious meals during this time that can be easily frozen and eaten anytime, especially when cooking cannot be managed. This is essential for your physical and emotional recovery. Reach out to your mothers group & local breastfeeding support groups in your local early childhood centres as this can be a great source of support & connection with other local mothers. Remember you are not alone and don’t hesitate to ask for and access the help you need.

RECIPE FOR NONNA’S CHICKEN SOUP

This brings such memories from watching my grandmother skim the pot of her chicken broth & one that will bring you nourishment, warmth, health & happiness.

BRODO DI POLLO – ITALIAN CHICKEN SOUP

For stock and soup:

• 1 whole chicken

For stock:

• 2 carrots, peeled and halved
• 3 celery stalks, rinsed and trimmed with leaves removed, then quartered
• 1 fennel bulb, stalks removed, then quartered
• 1 garlic bulb, halved widthways
• Rind from a wedge of Parmigiano-Reggiano cheese *
• 2 bay leaves, fresh or dried
• 1 handful continental parsley and stalks
• 1 teaspoon peppercorns

For soup:

• 2 tablespoons extra virgin olive oil
• 1 medium brown onion, diced
• 1 garlic clove, minced
• 2 medium carrots, diced
• 2 celery ribs, diced
• 1/3 cup dried risoni pasta
• Salt and Pepper to taste (to serve)
• 1 handful fresh continental parsley (to serve)
• 1/4 cup grated Parmigiano-Reggiano cheese (to serve)

STOCK
Place chicken and vegetables in a large stockpot over medium heat. Top with cold water till just covered (don’t add too much water or the stock will be weak in flavour). Add remaining stock ingredients and let it slowly come to the boil. Lower the heat to a gentle simmer and cook for 1 hour, partially covered. While simmering, skim the surface of the liquid once or twice to remove any impurities that rise to the surface. Top with more water if required to keep the chicken just submerged.

Remove the chicken to a cutting board and allow to cool for a few minutes. When it has cooled, discard the skin and bones and shred the meat with a fork. Set aside in a covered container.

Strain the stock through a fine sieve into a large bowl to remove the vegetables and aromatics and set aside. Then, wash and dry your stockpot.

SOUP
Heat olive oil in the stock pot over medium high heat, then add the onion, garlic, carrot and celery and sauté till the onion is translucent but before the mirepoix browns. Lower the heat to medium-low and add the stock to the pot with the shredded chicken and the risoni. Simmer until the risoni is cooked (about 11 minutes, but follow the timing on the pasta packet).

Remove from heat, season to taste with salt and pepper and stir through the cheese and finely chopped parsley then divide between four bowls.

*I keep the rind from finished Parmigiano-Reggiano cheese segments in the freezer for whenever I need to add flavour to simmering soups.

https://chewtown.com/2014/07/brodo-di-pollo/

The post After the Birth. What now? Tips to help you through the Golden Month. first appeared on Wholistic Medical Centre.

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15- minute acute-care consultations are suitable for relief from mild ailments such as:

• Cold & Flu – Treatment and prevention
• General Immune Support
• Sleep Issues
• Stress & Productivity
• Hay-fever
• Warts
• Thrush
• Tummy upset, gastroenteritis
• Injury – pain & inflammation

Please note: acute-care is not suitable for:

• Hypertension
• Cancer
• Liver or Kidney Issues
• Pregnancy & Breastfeeding
• You have had the condition for over one month
• You are taking more than two medications
• You have severe allergies

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Depression in men – it takes courage to seek help

Picture the worst person you can imagine whispering the cruelest things in your ear. Now picture yourself believing every single word. To try and get away from that person, you start isolating yourself from everyone. But that person is actually thoughts inside your head and they follow you around and the pressure cooker of feelings continues to build and build.

You feel like you’ve got no way out and that it would be embarrassing to tell anyone.

That’s what depression feels like for many men.

It robs them of joy, of connection with loved ones, of their own self-worth and physical strength. Worst of all, some men don’t even know this is called depression.

Why don’t men talk about depression?

Sadness, loneliness, despair and helplessness are likely to be taboo words for most men. That’s because when men have any vulnerable feelings they are often hit with a huge tsunami of shame that follows closely behind. Shame is created by the messages men get directly or indirectly about which emotions are acceptable and not acceptable. These beliefs are borne within a family, relationship, community, religion, culture and society in general.

How do men discriminate against themselves?

Men’s stories about their negative feelings sound something like this:

“If I bottle it up, suck it up, just carry on, I’ll be right.”

“I am strong when I’m tough, independent and unemotional.”

“If I can’t tough it out alone, there is something wrong with me.”

These views form a centrepiece of self-stigma. It is how men add shame, embarrassment and humiliation to their emotional experiences. It acts as handcuffs for men, preventing them from reaching out for help and contributes to men not seeking support until their depression is very severe, if at all. It’s no wonder then that the biggest killer of men under 45 is suicide, that 1 in 4 men have thoughts about taking their own lives and that more than 40% suffer in silence, never telling anyone how they are thinking or feeling.

Meet Joel – the man behind the mask who had the courage to talk

Joel* was a 35 year old outwardly successful engineer who came to see me for help with his gambling and his daily marijuana use. His partner of 10 years had recently discovered his gambling and the loss of a sizeable amount of money. His relationship was now in crisis and they were considering separation. Joel was unable to open up and explain to his partner what was going on inside of him. Every time he went to look inwards he felt like a ‘cloud’ would come over him that left him confused, ashamed and at a loss for words.

Marijuana helped him relax in the evenings and gave him some relief from the negative self-talk that he was failure and that there was something deeply wrong with him for not being able to snap out of it. The more he hid and kept secrets, the more ashamed he grew of his behaviour as he knew he loved his partner and could see the impact of his actions but nevertheless, felt compelled towards these behaviours.

At the same time Joel was becoming increasingly withdrawn around his friends and partner, he also noticed he was getting more irritable over small things. When a stranger would brush past him on a crowded street, he became convinced that they were showing him disrespect deliberately and would become engulfed with anger and fantasise about ‘smashing them’. Joel began to feel that the world was acting against him.

So by the time Joel came to see me, the cracks in his mask were getting bigger and he was desperate to make a shift. This was Joel’s first ever attempt at talking about what was happening behind his mask with ANYONE – he had not spoken to any of his friends or even his partner about what was truly happening inside of him.

What does depression look like in men?

Depression looks different in men and women. In fact, in men who are deemed clinically depressed, some don’t even know they are depressed. All they know is that they have a stomach ache or headache that just won’t go away. They know that they hate their job and they have lost their mojo in the bedroom. Or they know that everyone keeps doing these little things to deliberately irritate them. Or they may know they have become obsessed with work or are turning to alcohol, drugs, gambling or sex to get some relief. Women at this point are more likely to say “I think I may be depressed”. Men, on the other hand are inclined to say “I am not depressed. I don’t want to talk about it. I’m just fine”.

What are the hidden symptoms of depression in men?

Angry and irritable – snapping at your kids, fighting with your partner, having road rage.

Work performance suffers – depression affects your ability to concentrate and your motivation.

Stress-related medical problems – headaches, back pain, irritable bowel syndrome, heartburn, recurrent viral infections, tired all the time, waking up in the early hours of the morning for no good reason, difficulty getting or maintaining an erection.

People feedback – people asking if you are all right, that they can sense something is wrong and that they are worried. Or they are telling you they can’t stand your snappiness.

Numb and shut down – you can’t feel your emotions, even when you want to feel. You don’t feel anything except maybe being annoyed all the time. Feeling empty and very disconnected from other people. For example, not being able to feel the joy celebrating big moments in your life, or not being able to snuggle up and feel close to loved ones.

Deep cover depression – these are the guys that look great on the outside – cheerful, got it together, successful, everybody likes them. But the outside doesn’t match the inside – you may feel miserable, broken or like a fraud.

Addictions/reckless behaviour – relying on alcohol, drugs, gambling, work or sex to take the edge off.

It takes courage to ask for help. You are not a hero if you suffer in silence.

Using a mindfulness exploration technique, Joel and I explored these feelings of shame, disgrace, humiliation; specifically how it felt in the body, what thoughts and beliefs were attached to them. Joel learnt to make room for these unfamiliar yet normal feelings and to give less oxygen to his shame by having them. He learnt to feel his feelings without reacting against them, and to give himself permission to express and communicate his emotions. He found that over time, his shame disappeared. He developed more tolerance, less judgment and more acceptance of himself. He began to see vulnerability as a great strength as it required him to have courage to face risk, uncertainty and emotional exposure. He found it took a lot more guts to be vulnerable than it was to stay hidden and embraced a new definition of what it meant to be “strong”.

Once enough shame had subsided, Joel was then able to learn how to stay and work with increasing amounts of discomfort rather than covering over, pushing away or distracting himself from it. By feeling his feelings in a mindful way, he discovered they were not so bad after all and he could manage them directly by attending to them kindly.

He was able to identify and examine unhelpful templates that he had downloaded from his own childhood and how they played out now in his adult life. From this mindful observer state, he became less reactive, less automatic with his reactions to the world and for the first time ever, he felt he had the choice to shape his reactions to life in the way he wanted them to be. In this way, Joel could re-write his own story.

After cultivating this self-compassion and way of seeing, Joel was able to see the underlying forces that drove him to marijuana and gambling and was able to deal with these feelings at the root source. His discovery of a new way of being in the world had a positive flow-on impact on his relationship with his partner as he now had the language and skills to describe his inner emotional landscape. He noticed he was able to self-regulate when he came across intensity or discomfort and could provide a much more positive presence for his partner that had never ever been there before. And as he liked himself more and more, other people also found it pleasant to be around him again.

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