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"A time to be born, and a time to die." Ecc 3:2Researchers at the Colorado Institute of Grief offerus this helpful four-stage path to recovery. Stageone - Shock. Our initial response is one of denialand disbelief. "I can't believe this is happening.it'snot real!" There is a numbing of our senses, a God-designed natural "anesthesia" that buffers the earlyblow and allows us time to gather our copingmechanisms. Stage two - Protest. We feel angerand resentment against God, yet we feel guilty forblaming Him. We may blame ourselves, the doctors,the patient, and question God's love andfaithfulness-even bargaining with Him. "If You willjust do a miracle and bring them back, I will..." Stagethree - Disorganization. Everything comes apart atthe seams. The lifestyle we knew and lovedunravels. The dreams we cherished evaporate. Wefeel hopeless, powerless, lost in a strange, emptyuniverse. Secondary losses may loom: financialinsecurity, social dislocation, depression, loss ofconcentration, etc. We're convinced that life willnever be normal again. We survive moment tomoment, afraid to anticipate the road ahead. Stagefour - Reorganization. Unrelenting grief gives wayto waves of sadness varying in frequency andintensity. We begin to accept and accommodate ourloss. The energy we expended on grief workbecomes available again, enabling us to adjust tothe demands and opportunities of our new lifestyle.Slowly we reemerge and take hold of the reinsagain. The process will take many months, and fullrecovery even years. But God promises it will come!There will be "a time to heal...build up..laugh...dance...gain!" (Ecc 3:3-4, 6 NKJV).Support the show
Erica Hawkes is a Canadian landscape artist passionate about creating fine art from gorgeous captured moments in nature. She loves everything about the creation process, from taking photographs for future works to sketching new ideas and laying paint onto a canvas. Erica's work is carried in several fantastic galleries across the country, and her work can be best understood through the confluence of two styles. Nouveau 7 This style is inspired by various works of The Seven, a renowned group of Canadian artists, coupled with the beautiful flowing lines of the Art Nouveau movement at the turn of the 19th century. She discovered mixing elements borrowed from those who have inspired her the most creates something entirely new. Born and raised in beautiful BC, she studied at the Colorado Institute of Art in Denver before returning home to Vancouver to finish her degree in design. She has worked with countless mediums throughout the years, including graphite, acrylic, watercolor, india Ink, and oil. I've had the privilege to work as an illustrator, portrait artist, teacher and photographer, but my truest love is painting beautiful landscapes that bring a little joy to every home they find themselves in. Erica's website: https://hawkesfineart.com/ Erica's Instagram: @hawkesfineart This episode is brought to you by the Keep Climbing Mindset Journal, a companion journal to Age is Your Edge. A Self-Help Journal to Help you navigate the Adventures of Midlife and Cultivate a Positive, Resilient Mindset. It would be awesome if you grabbed a copy on Amazon
Michael Fields, President of Advance Colorado Institute spells out exactly why Colorado taxpayers are getting refund checks under the rules of TABOR, and that Governor Jared Polis - while taking credit for it to help boost his campaign - has absolutely nothing to do with it. Kristi Burton-Brown is filling in for Dan.
https://quangho.com Quang Ho was born on April 30, 1963, in Hue, Vietnam. He Immigrated to the United States in 1975. His artistic interest began at the early age of three and continued through grade school, high school, and art school and led him to an exciting and successful painting profession. In 1980, at the age of 16, Quang held his first solo show at Tomorrow's Masters Gallery in Denver, Colorado. The exhibit was a big success for the high school sophomore. In 1982, Quang's mother was killed in a tragic auto accident, leaving him the responsibility of raising four younger brothers and a six-year-old sister. That same year, Quang attended the Colorado Institute of Art on a National Scholastics Art Awards Scholarship. At CIA, Quang studied painting under Rene Bruhin, whom Quang credits with developing the foundation for his artistic understanding. Ho graduated from CIA in 1985 with Best Portfolio Award for the graduating class. He is a much sought-after teacher and lecturer on art and has won numerous prestigious awards nationally from the Artists of America to the Oil Painters of America exhibits. He has held a retrospective exhibit at the Steamboat Springs Museum of Art and has held shows at the Woolaroc Museum as well as the Booth Museum of Western Art. Quang enjoys reading philosophy and science, playing guitar and golf, and he finds time to hunt for fossils and forage for mushrooms.
https://quangho.com Quang Ho was born on April 30, 1963, in Hue, Vietnam. He Immigrated to the United States in 1975. His artistic interest began at the early age of three and continued through grade school, high school, and art school and led him to an exciting and successful painting profession. In 1980, at the age of 16, Quang held his first solo show at Tomorrow's Masters Gallery in Denver, Colorado. The exhibit was a big success for the high school sophomore. In 1982, Quang's mother was killed in a tragic auto accident, leaving him the responsibility of raising four younger brothers and a six-year-old sister. That same year, Quang attended the Colorado Institute of Art on a National Scholastics Art Awards Scholarship. At CIA, Quang studied painting under Rene Bruhin, whom Quang credits with developing the foundation for his artistic understanding. Ho graduated from CIA in 1985 with Best Portfolio Award for the graduating class. He is a much sought-after teacher and lecturer on art and has won numerous prestigious awards nationally from the Artists of America to the Oil Painters of America exhibits. He has held a retrospective exhibit at the Steamboat Springs Museum of Art and has held shows at the Woolaroc Museum as well as the Booth Museum of Western Art. Quang enjoys reading philosophy and science, playing guitar and golf, and he finds time to hunt for fossils and forage for mushrooms.
Jonathan is CEO and Executive Director of the Better Business Bureau of Southern Colorado and the Colorado Institute for Social Impact, BBB's recently restructured Foundation.
How do you talk to patients about medicinal cannabis? Dr. Ashley Glode (University of Colorado) moderates a discussion on effectiveness and safety, misconceptions and more. Featuring Drs. Ilana Braun (Dana-Farber Cancer Institute), Daniel Bowles (University of Colorado), and Kent Hutchison (University of Colorado). Subscribe: Apple Podcasts, Google Podcasts | Additional resources: education.asco.org | Contact Us Air Date: 1/19/22 TRANSCRIPT ASHLEY GLODE: Hello, and welcome to ASCO Education's podcast on medical cannabis, also referred to as medical marijuana. My name is Ashley Glode, and I am an associate professor with the University of Colorado School of Pharmacy. It's my pleasure to introduce our three guest speakers Dr. Ilana Braun is chief of the division of adult psychosocial oncology at Dana-Farber Cancer Institute, and an assistant professor of psychiatry at Harvard Medical School. Dr. Daniel Bowles is an associate professor of Medical Oncology at the University of Colorado. We're also joined by Dr. Kent Hutchison, a professor of psychology and neuroscience at the University of Colorado Institute of Cognitive Science. Let's start with a simple but fundamental question. What is medical cannabis or medical marijuana? ILANA BRAUN: So Ashley, I think that's such a great first question. I think of medicinal cannabis as herbal nonpharmaceutical cannabis products that patients use for medicinal purposes. And typically they're recommended by a physician in compliance with state law. DANIEL BOWLES: Dr. Braun makes a really good point. And I think it's important to know when patients are referring to medical cannabis, there's a wide variety of different things they could be referring to. Sometimes they would be referring to smoked herbal products, but there are also edibles, tinctures, ointments, creams, all sorts of herbal-based products that people use and call medical cannabis. And then there are also the components that make up medical cannabis-- largely, the cannabinoids. And I think the big ones people think about are THC and CBD. And sometimes those are used in their own special way. So I think that it's important for us as providers to be able to ask our patients, what is it that you mean when you say, I'm using medical cannabis? ILANA BRAUN: I think that's such a great point. And I will add I think it's also important to remember that when you offer a medicinal cannabis card to a patient, you're giving them license in most states to access any number of products. It's not an insurmountable challenge, but it's a whole new world for traditional prescribers who are used to writing a prescription and defining what is the active ingredient, how often a patient will take the medicine, by what means. DANIEL BOWLES: I think the other thing we need to be very aware of, as hopefully people are listening to this across the country and elsewhere, is the laws vary wildly from jurisdiction to jurisdiction about what consists of medical cannabis, who is allowed to use it, and in what quantities. So I think it's really important that as we learn about these and we think about these, we think about how they apply to any of our specific situations in which we live in practice. KENT HUTCHISON: So it's interesting-- just follow up on what Dr. Braun and Dr. Bowles, what they're saying, those two words-- right-- medical and cannabis. I think the medical part is somewhat easier because it can refer to the reason the person is using. Are they using for medical reasons are they using for recreational reasons, even though that's a blur? But the cannabis part I think is what's really complicated. And this is what Dan was getting at. All the different products, all the different cannabinoids, I mean all the different bioactive terpenes and everything else in the material, all different forms of administration. That is where it gets super complicated to really define what that is. And then of course, there's so little research we don't really know what all those constituents do. ASHLEY GLODE: Now that we kind of have a little bit of familiarity with medical cannabis, can you comment on adult use cannabis and what that might mean for a patient? ILANA BRAUN: Ashley, I think it's a really good question. And in some of the early research I did to try to understand where medicinal ended and adult use began, or adult use ended and medicinal began, I began to discover a theme that emerged, which is they sort of blend into each other often. In other words, some of the oncologists that I spoke to believed that it was not such a bad thing for a patient with serious illness, and pain, and many other symptoms to have a sense of high or well-being. And conversely, when I spoke to patients using cannabis, sometimes a cancer patient used medicinal cannabis for enjoyment, and sometimes they used it for symptom management, and sometimes they used it for both. And so I think it is somewhat of a slippery slope between the two. Would you agree? DANIEL BOWLES: I think there are definitely blurred lines between the two. I think that the advantages of what most states would recognize as medicinal cannabis is usually they're less expensive, patients can use them in larger quantities. There are certain advantages. But there's also paperwork that goes along with medicinal cannabis that some patients don't feel comfortable with. Or particularly I think when you have a patient who's interested in trying cannabis or a cannabinoid for the first time, they might not want to go through all the extra steps required getting that medical marijuana card, whereas adult use, I think people feel more comfortable, at least in my state, sometimes walking into a dispensary to discuss the options with people who work at the dispensary and then get it from more of an adult use or recreational cannabis initially. And then if that's something that they find helpful for their symptom management, to then take those extra steps and try to get a medicinal card. ILANA BRAUN: I agree with Dr. Bowles that the target symptoms or the target effect is often similar and access can differ. KENT HUTCHISON: Yeah. Just to chime in, I agree. I agree also. It's definitely-- the lines get blurred. The recreational user might also appreciate-- for example, college students, I hear them say a lot of times that they appreciate some of the anxiety-reducing aspects-- right-- even though they're not necessarily a person who has an anxiety disorder. And then of course, patients appreciate a slight increase in euphoria or positive affect, and what does that mean? Is I mean they're also using for recreational reasons? Or is that completely, I guess, legitimate? On the other hand, there are sometimes I feel like when-- especially on the recreational side-- when people are using for the more psychological effects, the sort of psychotropic effects, I know sometimes the medical patients refer to that as being a little bit loopy as a side effect. So I feel like there's definitely some blurred lines. And maybe there are some places where we can think about in perhaps in a less blurred kind of way. ASHLEY GLODE: How often do you guys have a patient ask you about medical cannabis? And what are the most common questions they might have for you? ILANA BRAUN: In my psycho-oncology practice, patients frequently tell me they're using cannabis, often with good effect and minimal side effects for polysymptom management-- for instance to address nausea, or pain, or poor appetite, or sleep, or mood, or quality of life. But they don't ask me a lot of questions. For instance, one of my longest-standing patients. A man with metastatic cancer and gastroparesis. Vaporizes cannabis before meals to keep his weight up. And many of my patients also use cannabis as cancer-directed therapy. And for these patients, side effects can sometimes be more pronounced. For instance, I have a lovely patient with metastatic cancer who follows a Rick Simpson protocol. So what is that? That's an online recipe marketed with an antineoplastic claim. And so this patient targets hundreds milligrams of cannabinoids daily. And with such high cannabinoid doses, she sometimes feels spicy, or out of it, as she describes it. And then I had another patient who targeted high daily doses and developed a debilitating nausea and vomiting that was initially diagnosed as chemotherapy-induced nausea vomiting because it was so hard to tease out in the setting of so many medicinal agents, what was what. But the symptoms resolved completely within weeks of the cannabinoids being halted. And so as I mentioned, what's notable about all three of these patients, and many of the others I see, is that they are quite open with their oncology teams and me about their medicinal cannabis use. But they don't seem to rely me or other members of their oncology team for their therapeutic advice . We insert ourselves when we see potential harm, but much of the decision-making seems to be made-- I don't know in the naturopath's office, at the dispensary counter, or by trial and error. And this anecdotal experience in my practice is borne out in my research findings as well. Patients are just not getting the bulk of their cannabis therapeutics information from their medical teams. DANIEL BOWLES: In my clinical practice, I am asked about cannabis or cannabinoids a fair, amount often in the context that Dr. Braun is describing, where a patient is coming in and they're already using a cannabinoid or they are planning on doing it and they just want my opinion. And I think unlike talking about more conventional cancer-directed therapies where they really rely, I think, on their medical team for information and guidance, we are often more a supplement I think in terms of information. In terms of the patients who come to ask me about cannabis or let me know that they're using cannabis, it's a very wide selection of people. I see young people, old people talking about it, men, women, a variety of different malignancies. So there really is a lot of usage or are thought about usage of cannabis or cannabinoids amongst our cancer patients. I think if you look at the studies, they'll tell us that depending on where we're working, anywhere between 20% to 60% of patients have used cannabis in the last year to help manage some sort of cancer-related symptoms. And I think the other thing that is notable is you'll find people asking about cannabis or cannabinoids who I think we might not have otherwise expected. So for instance, Just this past week, I had a patient with anaplastic thyroid cancer in his 70s, and his daughter was wondering whether he could try CBD to help with his sleep and anxiety. She wanted to make sure that it wasn't going to interact with this cancer therapies. And I appreciated her bringing it up, and we could have a frank discussion about the pluses and minuses of it, just like we might any other therapeutic intervention. So I think that particularly as the laws have changed across the country, more and more people are willing to tell us that they're trying cannabinoids and cannabis than maybe would have even 10 or 15 years ago. KENT HUTCHISON: I think in an ideal world, patients would be talking a lot more with their physicians about this topic. And I think unfortunately that a lot of people do get their information from dispensaries. From the media, from social media, from their kids, and from whoever. And I think that's something that I hope will change in the future. DANIEL BOWLES: In terms of questions that I'm often asked, I'll be asked if it's going to interact with their cancer treatments, in terms of making their medications more or less effective. I do get questions about how I think their cannabis use might affect some of their symptoms. I get questions about other drug-drug interactions-- let's say, interactions with opiates, or benzodiazepines, or some of these other medications that a lot of our patients are on. ASHLEY GLODE: In a recent survey 80% of medical oncologists who discussed medical cannabis with their patients, 50% recommended it in the past year, but only 30% felt knowledgeable enough to make recommendations. What do you guys think needs to be done to address this knowledge gap? And what resources do clinicians have to get and stay informed? DANIEL BOWLES: So I'm a big fan of the NCI's PDQ as a great resource. It has a fairly objective information about cannabis and cancer specifically. So I think that's a nice reference for people who are interested in getting an initial overview on the topic. I think there are also a number of different educational programs. I know the University of Colorado, for instance, has a Cannabis Science Master's and also a certificate program. So there are courses available for people who want to educate themselves more on this topic. ILANA BRAUN: Yeah. I guess when I think about what needs to be done, I think that cannabis needs to become a routine part of medical training curricula and CME programs. I think that a federal funding for high-quality clinical trials and a loosening of federal restrictions on accessing study drug were to occur, that would be really a big boon for the medical community. And my colleagues on this podcast I know are doing some very creative pragmatic clinical trials naturalistic studying what is happening in the field. And I am doing clinical trials using an FDA-approved version of cannabinoids. But it's still very hard to study whole-plant cannabis in a form that is sort of a standardized trial drug in a cancer patient. And then when I think about where I would begin to read, I don't think there is a single source, unfortunately. But a great place to start reading is actually a project that Dr. Hutchinson was a part of, which was an expert panel that was assembled by the National Institute of Science Engineering and Medicine in 2017. And they produced a monograph on the health effects of cannabis and cannabinoids. And it's several hundred pages long, including sections devoted just to oncology. So in other words, there is scientific evidence to evaluate, and it's sizable. DANIEL BOWLES: The Austrian Center for Cannabinoid Clinical and Research Excellence also is a helpful resource. One of the nice things about that is they actually give some dosing suggestions or ideas for people who really don't quite know where to start. Right now, there aren't a lot of people in that position to say, here's how it should be done. Here's how it gets dosed. Here are the data to support those decisions. And so the folks in the next level of training don't learn it in the same way that we have learned how to prescribe other medications. And they can't then lay it down. So because the data are scant, in some respects, and particularly for herbal products that So. Many of our patients are using, I think it falls outside the medical model that we've all become so used to using to learn how to take care of patients. And I think that's one reason that so many oncology providers feel interested in learning more about this topic, but don't feel comfortable giving patients guidance on how to use them. KENT HUTCHISON: So both Dr. Braun and Dr. Bowles identified some of the key resources out there. And certainly the training issues that Dr. Bowles just talked about are important. And I do want to emphasize the one thing that Dr. Braun mentioned, which is basically that we do-- we lack research and we lack data on some key important issues, like dosing, for example. What dose is effective? So cannabidiol has been out there for a long time, but what dose is effective for what? We don't know, right? So we definitely lack research. And there are definitely obstacles to doing that research. ASHLEY GLODE: So you guys brought up some good points about there being a lack of data, but also there is some evidence. So what is the current research and evidence on the efficacy of medical cannabis for management of cancer symptoms and cancer pain, specifically? DANIEL BOWLES: So there was a really nice review article that just came out in the BMJ looking at cannabis and cannabinoids, not specific to cancer pain, but including cancer pain. And what they found-- they looked at different preparations from herbal products-- smoked herbal products, oral agents-- cannabinoids, more specifically. They found there is a modest, but a real improvement in pain in patients or research subjects treated with cannabinoids versus those usually typically treated with placebo. In particular, the data are supported in neuropathic pain, I'd say more so than the other pains. I think the data are less compelling with regards to many of the other symptoms that people often use cannabinoids for, such as sleep, anxiety, appetite, things along those lines. ILANA BRAUN: So I'll tell you a little bit about how I think about the evidence base in oncology for cannabis use. So I'll preface this with two points. The first is that, as I mentioned, cannabis products tend not to be one active ingredient, but hundreds of active ingredients-- cannabinoids, phenols, terpenes, they all have bioactivity. And they don't work individually, they work through complicated synergistic and inhibitory interactions that have been termed entourage effects. So I don't think one can easily extrapolate from clinical trials of, say, purified THC, to understand whole-plant cannabis' activity in the body and how it might perform in humans. And then the other point I'll make is that when I think about the types of clinical evidence that we as clinicians hold dearest, it's clinical trials of our agent of interest in our population of interest. So cancer patients using whole-plant full-spectrum cannabis that they would access at a dispensary or grow in their own home. With this in mind, I believe the strongest evidence, randomized double-blind placebo controlled trials of whole-plant cannabis and oncology populations begins to support its utility for chemotherapy-induced nausea and vomiting. So there have been a few studies that have looked at this. But just in 2020, the most recent is a study by Grimison, et al. It was a multicenter randomized double-blind placebo controlled crossover trial comparing cannabis extract. And I think the extract they use was a 1 to 1 THC to CBD ratio versus a placebo in patients with refractory chemotherapy-induced nausea and vomiting. And what they found was that with active drug, there was a complete response in 25% of participants versus only 14% with the placebo. And although a third of participants experienced additional side effects with the active drug-- so remember, this was a crossover trial, so they saw both arms-- 80% preferred cannabis to the placebo medication. So that's clinical trials of cannabis and cancer. But if we expand the base of the pyramid of acceptable evidence to include high-quality clinical trials for health conditions other than cancer and extrapolate back, then I agree fully with Dr. Bowles that there's a growing body of evidence that cannabis may be beneficial in pain management. And there have been many clinical trials done in this arena, and they span myriad pain syndromes, including diabetic neuropathy, post-surgical pain, MS pain, sickle cell pain. And so it does seem like cannabis works for pain management in several other illness models, so we could extrapolate back and hope that it works in cancer pain. And then there is a small body of evidence with nabiximols, which is a pharmaceutical that has a 1 to 1 THC to CBD ratio. And it's a sublingual metered dose spray. And it has been trialed for opioid-resistant cancer pain. And this is not as a single agent, but as an adjuvant to opioids. In early trials, two times as many participants in the active arm as compared to the placebo arm demonstrated a 30% pain reduction. And for the pain specialists who are listening, they will know that is a substantial pain reduction. But then, additional studies fail to meet primary endpoints. I think there were three clinical trials that followed. Nabiximols was found to be safe and effective by some secondary measures, but the FDA opted not to approve nabiximols for cancer pain. So I think there's some suggestion of effect, but there's some smoke, but no fire-- no pun intended. DANIEL BOWLES: I think many of the studies that have been done looking at cannabis-- or cannabinoids-- have been compared to placebo or they've been crossover. And I would say fairly consistently, there is some improvement in pain scores with the cannabis products versus placebo kind of across a wide variety of disease spectrums with regards to pain. I think one of the other questions that a lot of people have asked is, can you decrease people's opiate usage using cannabis? As we know, there's a huge epidemic of opiate misuse in the United States of America right now. And I think many people are looking for ways to decrease opiate usage. There was a nice study done from Minnesota in conjunction with the Minnesota dispensaries-- or state marijuana program-- where some researchers randomized people to starting kind of herbal cannabis products early in their study or three months into their study. So it was kind of a built-in control. And they looked at opiate usage rates, pain scores, quality of life scores, et cetera. What they found is there, again, was some improvement in pain control overall in the cannabis users. However, it did not equate to a decrease in opiate usage. So I think that it's an open question that I think a lot of people want to know the answers to before they start recommending or incorporating cannabis or cannabinoids more widely into their practice. KENT HUTCHISON: It's certainly a complicated issue, in some ways, right? Because the research which is summarized very nicely by both Dr. Braun and Dr. Bowles, it is suggested, but not overwhelming, by any stretch, right? It's not clear-cut. And I think that one of the big issues here we talked about the very beginning is how complicated this cannabis thing is. and Dr. Braun alluded to this also, that there are obviously many different formulations, many potentially active constituents in cannabis. And so what has mostly been studied so far is either synthetic versions of THC or nabiximols, which is probably the closest thing to what some people are using. So I think the jury's still out, for sure. And I think hopefully at some point, what will happen is that some of the products that are actually being used by people-- because most people aren't using nabiximols, most people are not using THC only, hopefully there'll be some trials of the things that people are actually using out there in the real world that will tell us something more about whether it's effective or not. And maybe even more specifically, which constituents-- which parts, together are most effective with respect to pain. DANIEL BOWLES: I think one of the other topics that some of my colleagues have alluded to already is not just cannabis' role in symptom management. I think pain is often what people think of, and people are using it for chemo-induced nausea and vomiting, anxiety, sleep, appetite, but a fair number of patients are also using cannabis or cannabinoids with the hopes that it is going to treat their cancer like a chemotherapy or an immunotherapy may. And oftentimes, patients will point to preclinical studies looking at oftentimes very high doses of THC or CBD that might show tumor cell death or tumor reduction in test tubes. And I spent a fair amount of time-- and I know some of my colleagues spent a fair amount of time-- talking with patients about how it's a big step between cannabis or cannabinoids working to slow cancer growth in a test tube, to working in an animal system, to working in people. ASHLEY GLODE: So what are the most important considerations clinicians should keep in mind before recommending medical cannabis to patients with cancer? DANIEL BOWLES: We should be asking why they want to use cannabinoids. I think just like we might any other medication that people are thinking about trying-- or herbal product that people are thinking about trying-- I think we need to ask why they're interested in using these products. So is it for symptom management? Is it for some of the ancillary side effects of cannabinoids or cannabis? Why are they wanting to use it? And I think trying to incorporate that more than into the medical model, I ask my patients, hey, if you're using this particular product, do you feel like it's doing what you intended it for it to do? If it is and it's legal in your state, great. Do it as you feel fit. If it's not meeting your goals, if it's not helping with the pain, or if it's not helping with the anxiety, or it's not helping with the nausea and vomiting, maybe we should rethink whether we would use it. Just as if I was prescribing more conventional anti-nausea medication and you didn't think it was working, we wouldn't keep using it. So I think that's a really important thing to keep in mind. I think the other thing to know from a safety standpoint is, who else is in the household? We have a psychiatrist on the call with us today. I think there is an ample amount of data that cannabis is not safe for young people. It's not safe for growing brains. And I think we need to make sure, just as we would want people's opiates to be secured, that their cannabinoids and cannabis products are secured as well, from those who do not want to use them. ILANA BRAUN: And the thing I would keep in mind is that in most states, giving patients a medicinal cannabis card is allowing them to access any number of products with different ratios of active ingredients, delivery mechanisms, onset of action, potencies. And if you don't discuss all of these issues with your patients, these are things that they will decide at the dispensary counter, or by discussing with friends and family, or by trial and error. And I think it's really important that we clinicians guide this narrative. ASHLEY GLODE: So what kinds of patients are not good candidates for medical cannabis? DANIEL BOWLES: I would not recommend medical cannabis for people who can't meet some of the criteria we already discussed. So people who can't keep it safe in their households or have concerns about diversion in their own households. Those are people who I think would not be great candidates for medicinal cannabis or cannabinoids. ILANA BRAUN: As the psychiatrist on the call, I would add that I worry for people with a strong history of psychosis, or currently psychotic, or with a strong family history of psychosis. And perhaps those severely immunocompromised, since there is evidence of fungal and mold contamination in some cannabis products. DANIEL BOWLES: The other group of people I discussed this with are patients on immunotherapies. One of the ways that cannabis may be effective in some of the symptoms we discussed is it's an anti-inflammatory agent. One of the ways it could be detrimental for patients on immunotherapies is that it's an anti-inflammatory agent. There is one small study that suggested that patients might have worse responses to immunotherapy who are cannabis users versus those who are not. So that is a conversation I like to have, just so patients feel like they can be informed. I think lastly, cannabis even for people with medical cards, is not free. So there can be a financial burden for people who are using it. So that's something that I'll often bring up with people as well. KENT HUTCHISON: One thing I would add to this would be history of a substance use disorder might also be a consideration here as well. Mainly because you don't know what the person is going to get, and it could be something that lends itself to relapse or encourages a problem. So I would add that to list. ILANA BRAUN: And I would second what Dr. Bowles said about the financial challenges of using cannabis regularly medicinally. It's not something that's covered by insurance, either. So these are out-of-pocket expenses, and they can add up fast, particularly for patients in the oncology space using it for antineoplastic therapy. ASHLEY GLODE: So is there a concern about drug-drug interactions for patients currently undergoing active cancer treatment? DANIEL BOWLES: There are some data that there can be drug-drug interactions with cannabis and certain agents. In particular, cannabidiol, or CBD, is a CYP3A4 inhibitor. And there are a lot of drugs that are metabolized through that particular system. So I think that that's the clinical relevance of those interactions, I think, is sometimes unknown. But that is another topic that I do think we need to make sure we bring up with our patients. ASHLEY GLODE: Thank you. Yeah. So a lot of what we'll do is from a drug interaction perspective, use the FDA-approved products that we have available to run through a drug interaction checker, like Dr. Bowles mentioned. So we'll use dronabinol as the THC-based product and epidiolex as the CBD-based product. There's also some resources, such as natural Medicines Database. And some of the pharmacy programs that we use, you can actually put in marijuana or cannabis as a drug and run drug interaction checks. So there's multiple potential interactions, like he mentioned, through the immune system. But through the cytochrome P450 pathway, cannabis has been shown in some instances to be an inhibitor, sometimes an inducer of certain enzymes, as well as a substrate. So it's really important to work with your pharmacy colleagues to run through different potential interactions that may be present. ILANA BRAUN: I'll just add one thing, just in case that's helpful. I mentioned earlier in the episode that I had a patient who used cannabis as an antineoplastic drug, and targeted very high doses and developed a terrible nausea and vomiting. And when she stopped, so did the nausea and vomiting, even though her chemotherapeutic continued. And I, to this day, don't know if that was a cyclic nausea and vomiting syndrome, which has been known to plague some heavy cannabis users, or whether drug-drug interactions led to her high-dose cannabis triggering high blood concentrations of her cancer-directed therapy at the time. And so I think that drug-drug interactions do need to be carefully weighed. ASHLEY GLODE: So wrapping up, has the medical community stance on medical marijuana shifted in recent years with legalization in many states? ILANA BRAUN: I don't think we know the answer to this, about how sentiment has shifted because there aren't longitudinal studies that I know of examining this question. But we need some. And one could imagine that as medicinal cannabis becomes are commonplace, providers are increasingly confronted with questions about how to guide care and the desire for high-quality clinical trials and in-depth cannabis therapeutics trainings increases-- and as one piece of evidence for this, at the end of 2020 the National Cancer Institute held a first-in-kind four-day conference at the intersection of cannabis and cancer. And so I'm hopeful that grant opportunities will follow from that. DANIEL BOWLES: I think overall there has been more willingness to discuss cannabis in the context of patient care in the last decade. A couple of ways that I see this is I much more frequently see cannabis use described not necessarily in the drug history, or in the social history, but in the medical history, or in their medications, if they're using it for medical or therapeutic purposes. I think the other place that I've noticed cannabis usage become a bit more mainstream is in the clinical trial setting-- not in clinical trials of cannabis, but one of the things that many of us do is clinical trials of new drugs. And very frequently, 10 years ago we ran into trouble trying to get our patients who were using cannabis products for cancer symptom control onto these clinical trials because of potential drug-drug interactions, or just the fear of the unknown. And I feel like we run into that less commonly now. KENT HUTCHISON: I think it's also worth pointing out that there have been more and more podcasts like this one, right? So to the credit of this organization, I think we are seeing some change. I just wanted to highlight that. And I compliment everyone here for putting us together and putting it out there. ASHLEY GLODE: All right. Well, thank you. That is all we have for today. And thank you very much Drs. Braun, Bowles, and Hutchison for a delightful conversation. Thank you so much to all the listeners tuning into this episode of the ASCO Education Podcast. [MUSIC PLAYING] SPEAKER: Thank you for listening to this week's episode to make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit elearning.asco.org. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care, and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
Her Many Voices Foundation is delighted to present Tommy Nahulu for our Native American Heritage month Lunch and Learn on Nov 16, 12PM Mountain Time. Tommy will present on sustainability, then and now, through the lens of his Hawaiian culture. Tommy will touch on farming, community, and global impact to enrich our understanding of this important, yet often not presented, cultural heritage. The newest member of the Her Many Voices Foundation Board, Tommy has been an active supporter of their mission and work for years. His varied career and volunteer efforts are an expression of his love for people and community. Whether it is his restaurant service background, music business management or mural work, it is rooted in his deep connection to his heritage as a Hawaiian and his passion for art. A nationally celebrated muralist, Tommy has been painting murals since graduating from Denver East High School. After studying at the Colorado Institute of Art, he has painted murals in Hawaii, California, Colorado, Tennessee, and Florida. A professional artist, he also teaches art, as well. In addition to working in restaurants for over 30+ years, he has been heavily involved in the Colorado music scene. Tommy's involvement in the Colorado music scene began as a music lover, attending countless shows in clubs throughout Denver and Boulder. In 1994, Tommy was asked to help manage the popular Denver band Western Vogue. It was then that he became intimately involved in Colorado's music scene. He then worked with singer-songwriters Nina Storey and Liz Clark. He also helped on the Entertainment Committee for the CHUN Capitol Hill People's Fair for a few years, until he started and ran the Fair's Streetside Mural Project. He also served on the Colorado Music Association board for a few years, with one as President.Tommy is a hemp activist, with years growing hemp, harvesting hemp, and promoting hemp products. Currently he is an artist for the Colorado Hemp Company at all their NoCo Hemp Expo's and helped start and operate Serenity Remedies CBD as a manager of the hemp they grew for CBD production.Tommy helps feed and care for homeless, supports women's rights, and those choosing sober lifestyles. Tommy is a dedicated family man and creates a sense of welcome and connection with seeming ease in the communities he inhabits.This conversation will be led by Myrna James. James is a publisher, journalist, and interpreter of high tech. Her publication Apogeo Spatial illuminates how data from space is used to study the earth for the sake of humanity. See acast.com/privacy for privacy and opt-out information.
A recent independent study conducted by the Colorado Institute for Social Impact found that for every $1 Mt. Carmel Veterans Service Center receives, $2 of impact goes back into the community. Hear from community leaders why this Social Return on Investment recognition solidifies Mt. Carmel Veterans Service Center's impact on local military, veterans and their families.
In this episode, we have the final chapter of Dr. Barry Weinhold and Patricia Raskin's talk to Rafa Flores about how he has transcended suffering. This episode was brought to you by the Colorado Institute for Conflict Resolution and Creative Leadership. Find out more about these resources at weinholds.org Dr. Weinhold is Professor Emeritus at The University of Colorado at Colorado Springs, where he founded and directed the M.A. Program in Counseling and Human Development. He is a licensed psychologist and the author or co-author of 75 books in psychology. His latest book, GET REAL: The Hazards of Living Out of Your False Self is available now on Amazon, Barnes & Noble, and more! For more info on Dr. Weinhold visit www.weinholds.org Patricia Raskin can also be found as the host of The Patricia Raskin Positive Living Show on VoiceAmerica.com, apple podcasts, spotify and more. Patrica is a nationally recognized multimedia radio talk show and podcast host. She is an award winning producer, spearer, trainer, and author. For over three decades Patricia has been a pioneer and trailblazer for positive media messaging and has given voice through the airwaves to help people turn obstacles into opportunities, and challenges into solutions. Her programs have been featured on PBS, NPR, & Cumulus broadcast affiliates. Find more at www.PatriciaRaskin.com
BIO: Marty Two Bulls Sr. is a member of the Oglala Lakota from the Pine Ridge Indian Reservation in South Dakota. He spent his childhood in Rapid City, S.D. It was at the Rapid City Central High School’s student newspaper the Pine Needle, that Two Bulls first started drawing editorial cartoons. Marty studied commercial art at the Colorado Institute of Art. Two Bulls worked television, commercial printing, and newspapers. He would become the graphics editor at the Rapid City Journal and later The Sioux Falls Argus Leader. Leaving newspapers he returned to college to finish his BFA degree at the Institute of American Indian Art in Santa Fe, N.M. His work focuses on issues of political interest to Native American peoples who have been historically persecuted and marginalized by the dominant culture, which has reduced them to a minority in their own lands. Two Bulls embraced a growing readership of non-Natives cultivated through social media, in the hope that one Lakota man’s point of view will bring a better understanding and support for issues that affect Native American Indians. Marty currently works as a freelance artist, graphic designer and political cartoonist. m2bulls.com https://www.patreon.com/m2bulls https://www.facebook.com/martytwobulls https://www.gocomics.com/m2bulls https://www.instagram.com/m2bullz https://twitter.com/m2bulls
Photographer, Bobbi Jane, brings you photographs from the West. "I have been surrounded by both photography and the western life since childhood. I was born in Kansas but raised in the rural part of Tucson, Arizona. I grew up when kids played outside and all our games were made from our imaginations! I loved taking photos as a kid making “pretend” film with paper and putting in my Mom’s Kodak camera when there wasn’t any film. My dogs were my models. My junior year in high school, I dropped out of Algebra II to take Photography. And the rest is truly western history! After high school, I attended Colorado Institute of Art majoring in Photography. Those were still the “film” days and finding a job in a photography related field was slim. Nearly 20 years later after a career path in sales and marketing, I launched my own photography business, Way Out West Photography (Est. 2000) I consider my photography style to be “photojournalism” capturing the moment, subject and light as is.I currently live in Prescott, Arizona. I have been photographing weddings, people, businesses and events in Prescott since 2008. In the past couple years, it's been very competitive for weddings and events. I now focus on family storytelling portraits and senior portraits. I'm very flexible and funny and that helps to make every shoot stress free and relaxed. I do not shoot "gallery style" photos that are posed and professionally lit. I take photos of people in real life with natural light and showing emotions that make you want to smile. Family Storytelling sessions are about capturing genuine, emotional images of families through meaningful documentary-style portraits that will show your family’s love, emotions and laughs. I am still the kid with a camera! Photography is my passion and part of who I am. I know have a Nikon that doesn't need film. Crazy how the times change but really stay the same."Bobbi Jane Tucker www.WayOutWestPhotography.com Facebook @WayOutWestPhotographyInstagram @WayOutWestPhotos BobbiJane@WayOutWestPhotos.com928-910-5814
Host Gail Ferguson Jones talks with Clinical Psychologist Barry Weinhold, who has coined the phrase "counter-dependence," which he describes as living a false self that keeps one from establishing intimate relationships. Weinhold is the author of more than 75 books, the latest of which is titled "Get Real. The Hazard of Living Out of Your False Self." He and his wife, Janae, are co-directors of the Colorado Institute for Conflict Resolution and Creative Leadership. In this episode, Weinhold discusses how counter-dependence, also described as radical self-reliance, is the inability to establish healthy relationships and, if untreated, leads to addiction, isolation and depression. To learn more about Barry Weinhold, his work and books, go to: https://weinholds.org/ Gail Ferguson Jones is an award-winning journalist, speaker, podcaster and recovery coach, who helps families reclaim their peace of mind and freedom from the dysfunction of a loved one's addiction. Her Buttrfly Effect program offers peer-to-peer coaching specializing in recovery from codependency. To learn more or to subscribe to her newsletter, go to http://www.buttrflyeffect.com/ or contact me at http://www.buttrflyeffect.com/contact/ Music for The Buttrfly Effect Podcast, "Inspire Me," by Mixaund at https://www.mixaundbandcamp.com.
SROI? Social Enterprise? Non-Profit? Business For Social Impact? No matter how you phrase it, there are a growing number of individuals & companies who are interested in using their business to make a difference in the world. On today's episode, we talk with Jonathan Liebert & Stacey Burns from the Colorado Institute For Social Impact. With over 40 years of combined experience, their organization is on the front lines of helping for-profit & non-profit businesses share their Social Return On Investment to help people talk about their impact & how to convert that number to an actual dollar amount. Head to https://www.ci4si.org/ to find out more! Feast Over Famine does not provide legal, tax, accounting or other professional advice. You should consult professional advisors concerning the legal, tax, or accounting consequences of your activities. Feast Over Famine does not consult, advise, or assist with (i) the offer or sale of securities in any capital-raising transaction, or (ii) the direct or indirect promotion or maintenance of a market for any securities. Feast Over Famine does not engage in any activities for which an investment advisor's registration or license is required under the U.S. Investment Advisors Act of 1940, or under any other applicable federal or state law; or for which a “broker's” or “dealer's” registration or license is required under the U.S. Securities Exchange Act of 1934, or under any other applicable federal or state law.
Karen welcomes Jim Thomas to the show for part two of their conversation on using attachment theory when working with couples. Jim obtained his Bachelor’s Degree in psychology from the Ohio State University. He studied alternative approaches to psychotherapy for two years at Boulder College, and earned his Master’s Degree in Clinical Psychology from the University of Colorado at Denver. He is a Licensed Marriage and Family Therapist, EFT Therapist, and an AAMFT, Clinical Fellow and an AAMFT Approved Supervisor as well as an ICEEFT EFT Supervisor. In 1990, Jim joined the Colorado Institute for Marriage and the Family for Post-Graduate Training in couples and family therapy. His mentors there, Jan Raynak, MD, and Suzanne Pope, Ph.D., taught him the importance of co-creating meaningful experiences for clients in the therapy session, going beyond appearances to the heart of a relationship. From 1998 to 2002, Jim served as President-Elect, President, and Past-President of the Colorado Association for Marriage and Family Therapy (CAMFT). His peers elected Jim Chair of the Council of Division Presidents for the American Association for Marriage and Family Therapy (AAMFT). He served on the national board of directors for AAMFT. He presented workshops or facilitated strategic planning for the Alaska, Michigan, South Dakota, and Washington Associations for Marriage and Family Therapy. He also teaches EFT at Denver Family Institute. Jim left agency work to start the Institute for Change, P.C., and Engaging Trainings. His consulting work includes Shining Mountain High School in Boulder. He has consulted with Aurora Mental Health Center, Mental Health Corporation of Denver, Shiloh House, Community Reach Center, Dignity Program for Girls, Shepherd Valley School, and Emerson Street School.
Karen welcomes Jim Thomas to the show for part one of their conversation on using attachment theory when working with couples. Part two of this discussion will be released on Tuesday, September 1. Jim obtained his Bachelor’s Degree in psychology from the Ohio State University. He studied alternative approaches to psychotherapy for two years at Boulder College, and earned his Master’s Degree in Clinical Psychology from the University of Colorado at Denver. He is a Licensed Marriage and Family Therapist, EFT Therapist, and an AAMFT, Clinical Fellow and an AAMFT Approved Supervisor as well as an ICEEFT EFT Supervisor. In 1990, Jim joined the Colorado Institute for Marriage and the Family for Post-Graduate Training in couples and family therapy. His mentors there, Jan Raynak, MD, and Suzanne Pope, Ph.D., taught him the importance of co-creating meaningful experiences for clients in the therapy session, going beyond appearances to the heart of a relationship. From 1998 to 2002, Jim served as President-Elect, President, and Past-President of the Colorado Association for Marriage and Family Therapy (CAMFT). His peers elected Jim Chair of the Council of Division Presidents for the American Association for Marriage and Family Therapy (AAMFT). He served on the national board of directors for AAMFT. He presented workshops or facilitated strategic planning for the Alaska, Michigan, South Dakota, and Washington Associations for Marriage and Family Therapy. He also teaches EFT at Denver Family Institute. Jim left agency work to start the Institute for Change, P.C., and Engaging Trainings. His consulting work includes Shining Mountain High School in Boulder. He has consulted with Aurora Mental Health Center, Mental Health Corporation of Denver, Shiloh House, Community Reach Center, Dignity Program for Girls, Shepherd Valley School, and Emerson Street School.
Shelley Hofberg is a Clairvoyant, Psychic Medium, Tarot Reader, Pet Psychic and Healer. Her multi-faceted gifts are reflected in her multi-faceted psychic career. Shelley has appeared on NBC television, the Discover Channel and is included in feature articles of newspapers such as the Hollywood Independent and Ventura Star. As a staff member of the West Coast Well Being metaphysical publication, Shelley was responsible for writing a pet psychic column and as a pet psychic, was mentioned in Lisa Barretta’s published book, ‘The Street Smart Psychic Guide to Getting a Good Reading.’http://www.psychichorizon.comSpecial Guest: Dean PriceDean has been studying, practicing, and teaching astrology, numerology, sacred geometry, and hands-on healing for almost 40 years. In the 70’s, he developed the astrological keyword system that formed the basis of the best-selling astrological workbook ‘Astrology for Yourself’ by Douglas Bloch. In the 80’s, he founded the Colorado Institute of Energywork, where he discovered that our own energy centers (chakras) perfectly mirror the function of the planets and asteroids, following their same physical order and astrological meaning. From this, he developed Spirit Touch, an individually-tailored hands-on process to release, clear, and re-program astrological stress points and unconscious karmic patterns, using hands-on polarity techniques on corresponding pairs of Planet/Chakra points.http://spirittouch.org
Welcome friends to the Someone Gets Me podcast. I am your host Dianne Allen and I am delighted you are here. This podcast was created because I believe there is a visionary leader inside each one of us who is waiting to be seen. In each episode of Someone Gets Me you will hear useful tips from successful Visionaries who will share their stories about how being seen allowed them to take their Vision into Action. In this episode, I interview Autumn Romano, a native of the Pikes Peak region and can be found playing in the Rocky Mountains with her family every moment she can. She is a deeply curious. She completed the iLS Safe and Sound Protocol and Focus System training. Topics we discuss include: Autum’s connection to her calling Neurodiversity Self-care Porges and the SSP technology Polyvagal Theory My personal experience with the SSP Co-regulation Depression LINKS MENTIONED Join our Facebook Group Someone Gets Me Follow our Dianne’s Facebook Page: Dianne A. Allen, Visionary Leadership Mentor Email contact: dianne@someonegetsme.com Dianne’s Mentoring Services: someonegetsme.com/services To learn more about Dianne’s books and events: visionsapplied.com Contact Autum: www.autumromano.com https://www.instagram.com/autumromano/ https://www.facebook.com/autum.romano Be sure to take a second and subscribe to the show and share with anyone you think will benefit. Until next time, remember the world needs your special gift, so let your light shine! More about Autum: Autumn Romano is a native of the Pikes Peak region and can be found playing in the Rocky Mountains with her family every moment she can. She graduated from the Colorado Institute of Massage Therapy in 1997 and has logged over 17,000 massages. She is a deeply curious individual and has taken dozens of additional courses over the years. She completed the iLS Safe and Sound Protocol and Focus System training in 2019. She lives in the Old North End of Colorado Springs with husband Daniel Romano and son, Foster. She is delighted and honored to assist you in your quest for greater health.
Mike's interview with Derek Keenan, an artist based in Denver, Colorado. Recorded in Mike's home in Boulder, Colorado on March 31, 2019. Topics discussed include: Growing up in Arvada (Colorado), ’57 Chevys, learning from older siblings, organized sports, skateboarding, BMX bikes, Yellow Designs, DIY entrepreneurship, art education, Colorado Institute of Art, industrial design, marker rendering, internships in footwear business, working as a technical aviation illustrator, working as a picture framer, The Peace Corps, The Gambia, village life, Toubobs, African Mahogany charcoal, cultural differences, meditative awakenings, International Jazz Festival of Senegal, weed/psychedelics in Africa, Palm hooch, gender-based experience, Malik Njie, inside jokes/local knowledge, Not Self, hair in a bird’s nest, construction work, work options for felons, Fuzzy, toking on the job, street photography, recycling skateboards, craft fairs, earring hustle, Mukee, $15,000 laser, AT-AT, touring, support from the ladies, viral moment, booth design/fabrication, street-level business development, the stoney teepee, rubbing elbows, Etsy. mukee.etsy.com @derekkeenan @mukeedesign
Stacey Burns is the VP of Business Innovation of the Better Business Bureau of Southern Colorado & Colorado Institute of Social Impact. Her background in psychology has given her an in depth view on business and leadership. Check out this episode for more insight on social impact, early career advice, and how to be a leader even if you're an introvert.
Episode 007 with guest Micki Cockrille. Micki is a Digital Marketing and Event Specialist with the Colorado Institute of Social Impact and Better Business Bureau of Southern Colorado. He is also a founding member of the Aspiring Change Makers young professional group of Colorado Springs. Check out this episode for some advice on being a leader and serving the community in a way the compliments your natural talents and abilities!
Writer/Director Bradley King and Writer/Producer BP Cooper join me again in Episode 9 for Part 2 of a discussion about their break out feature film, TIME LAPSE. A really fun chat! Bradley King – Writer/Director Hailing from Los Alamos, New Mexico, Bradley studied animation at the Colorado Institute of Art and then attended the … The post 9 – Time Lapse with Bradley King and BP Cooper: Part 2 appeared first on ben phelps.
Writer/Director, Bradley King, and Writer/Producer, BP Cooper, join me in Episode 8 for Part 1 of a discussion about their break out feature film, TIME LAPSE. Bradley King – Writer/Director Hailing from Los Alamos, New Mexico, Bradley studied animation at the Colorado Institute of Art and then attended the Colorado Film School where he won … The post 8 – Time Lapse with Bradley King and BP Cooper: Part 1 appeared first on ben phelps.