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04/20/18 09:17 PM

#3045

David Mitchell

Sounds like there may be another book in our group Jim. The world is a strange and interesting place.

04/20/18 09:44 PM

#3046

David Mitchell

I would have posted this sooner but I was out all day. Didn't want anyone to miss this point;

Back on my "Mariachi Post" (#3045) - - if you look real close, I'm pretty sure that's John Jackson in the back row playing his tin whistle.

Oh, BTW - John informs me there are no Mariachi bands in Doolin, nor anywhere in County Clare for that matter. So maybe we could book the Chieftains at a club in Puerto Vallarta instead. Janie could fly us all down there for our 55th - or maybe it would have to be the 60th. I guess we're already booked for Donna's in Barcelona for 55 aren't we? I've already got my toothbrush and sleeping bag packed.

Then for the 65th, I say we serve cheese sandwiches out on the terrrace at St. Joseph's Cemetary chapel. (soft cheese that is - and with the crust cut off). And John could bring his tin whistle - if he can still get up enough breath to blow on it. Damn, I'm lookin' forward to that!

04/22/18 09:59 PM

#3047

James Hamilton, M. D.

It has been two days since the last entry on this Forum - very unusual! So, I'll add something here that does not necessarily involve anything specific to Appalachia.

A while ago we were discussing cannabis and periodically, that topic recurs. From a medical standpoint I had said that some components of marijuana were undergoing research for certain conditions such as intractable (mainly pediatric) seizure syndromes. This past week the FDA approved cannabadiol, a non-psychoactive phytocannabinoid, under the brand name Epidiolex, for such disorders.

After such approval there will be a number of post-marketing studies to see if it is as efficacious as the pre-marketing trials indicated. Also what the long term side effects may be. Hopefully, it will be a good drug. It is definitely not a cure but seems to significantly reduce the number of daily seizures that occur in these children.

Stay tuned...

Jim

04/23/18 11:10 AM

#3048

Michael McLeod

It's interesting to me that marijuana has been percieved as a danger for so long in our culture, though that view is finally changing.

And opiods, which have been responsible for tremendous tragedies that are still ongoing, were accepted by the medical mainstream and made drug companies -- one in particular -- millions of dollars.

As you know, pot is palliative and has been used, with or without a prescription, by people who were in pain, including cancer patients. I find myself wondering if the opiod epidemic could have been avoided had we been more accepting of pot, had it been legalized and incorporated into medical practice sooner.

I see this as a cultural blindspot. I also see it as an issue in which making money took precedence over the welfare of patients. There have been, as you probably know, stories about the rush to sell medications that turned out to be addictive and helped to create the opiod epidemic.

Something tells me you may have a different view. I am wondering what your view might be. Do you, as a doctor, have any thoughts, suspicious, judgements about the dangers of "Big Pharm"? And my little theory about what might have been if we hadn't been so quick to judge pot?

04/23/18 11:17 AM

#3049

Frank Ganley

Jim, thank you for the update on cannabis and its many uses. Let us also remember that the Lord gave us this plant and its primary use is in its natural state without any add-ins, add-ons or processing it in many ways. There has been a huge push for its passage of medical marijuana and there are many cases here in Florida that have documented the use in treatment for children with all kinds of seizures and this as Dr. Jim says,"it's not a cure but it sure helps those suffering from these seizures. Once the excuse the pun, drug companies start their research it will prove to contain many compounds as medicines. Dupont, Eli Lilly et all are chomping at the bit for discoveries. Though the cotton industry is nervous as the hemp plant makes longer lasting, stronger fibers than any cotton strain, even the cotton grown in Beauford SC. Civil War fun fact about Beauford my wife and I learned while staying in the Cuthbert House and taking the worst ghost tour in the world but the greatest history tour you could take. Marijuana is no longer only used by stoners but a preferred pain medicine over opiate by us old folks who have long preached about its gifts to the world. For those of you who do not smoke , try an edible when in a state that its legal. You may give up drinking

04/23/18 12:41 PM

#3050

John Maxwell

I may be wrong, it has happened, but pot is on the list of class one dangerous narcotics, as it is a line item in the NATO, AOS and SEATO treaties. It is subject to all those international rules, laws, statutes etc. Til the laws are changed by all the signatories, then the U.S. Govt. is obliged to regard pot as a most ruinous and dangerous drug. Getting NATO, et al to change this law might relax the status in this country. However there is a significant portion of our population who drank the "pot bad" koolaid who have sway over the federal laws. In the streets I've seen it's becomes a matter of personnel judgement and not the law, at least until the laws changes. In the meantime Jefferson Beauregard Sessions is coming for you pot smokers. I'm not one to promote sedition, but I for one, am kinda tired of living on the peaks and valleys of political whims and a money driven judicial system.

04/23/18 02:18 PM

#3051

Timothy Lavelle

This morning on the Today show they did a quick story about an ex-NFL guy taking a comic photo holding a gun while standing between his daughter and her Prom date. This humor is as old as fatherhood but in our tense country people are upset, calling it insensitive. A viewer e-mailed the show to say "This is not worth getting upset over" ...a point of view I agree strongly with. I only bring this to your attn because the viewer's name was shown as Mike Mcleod! Total truth.

Medicinal pot will become a worldwide tool depending largley on its efficacy in each case. It will surely take a long time.

Pot "for fun" will always remain subjective because of its frightening ability to make normal people think very paranoid thoughts. That, and the normal fear any parent has for a child experimenting with anything from fast cars to fast women. But as long as some people get born with any sense of daring, or a willingness to experiment, we will have marijuana to deal with. Thankfully!

04/23/18 03:14 PM

#3052

David Mitchell

Frank,

Beaufort SC? The Cuthbert Inn?

It would appear that you are openly admitting your contact with a pair of citiznes of this Confederate town. I won't expose them by last name but they may be a particlular couple who go by the names of Mary Ann and Jeff. This is actually a pair of Yankees appearing to be Southerners. They have been formerly Innkeeprs who welcomed any and all visitors - even with such suspicious names as Tom Berenger, Andi MacDowell, and various local dignitaries. And furthermore, they have actually been known to go to such extremes as to take an aging Vietnam "Loach" pilot to a (wondeful) local trendy restaurant. Their hospitality seems to have no shame.

As for Ghost Tours. Doesn't every Southern city have one? I think American toursists will buy anything if you package it right. The ones in nearby Savannah and Charleston do millions o f dollars every year.

___________

We here in Beaufort County have a very highly respected Conservative Republican State Representative who is actively pushing (against heavy odds) to get medical marijauna legalized, and he cites some pretty compelling scientific eveidnece for his arguement.

That much I would agree with. But I am still not a believer in "recreational'. I have experienced a case of one (believe it or not) "Loach" pilot in my platoon in Vinh Long who was a flying accident waiting to happen until he admitted his habit and was removed from flight status. The slowing down of reflexes seems to be quite similar to alcohol - or is that just my percepetion? And isn't there a noticeable drop in a person's motivation? That is something I believe I have witnessed in the case of several friends. They beame so "mellow" that they could no longer show up for work.

And I would argue with anyone about the "gateway drug" argument. That is an issue of simple human physicology - with many different variations of effects on many different people's bodies. For some it is not the case at all. But for some it clearly is. As I mentioned earlier, my older cousin Jim ran a drug crisis center just north of OSU camus years ago and he said a majority (not all) of the more serious drug addictions started with pot.

* (befoe you jump on this please read what I said - "MANY - NOT ALL"). It all acts differently in each indivudual body - as with many chemical reactions). That simple scientific fact was made crystal clear to me by my Dad in his medical practice.

I also am sadly aware of the effects of driving while under the influence - something that no roadside test seems to be able to detect - as is the case with alcohol. I knew a lady from a Colorado town who's father was a pillar of the community, but is now a parpalegic, after being broadsided by a car driven by a young girl who moved to Grand Junction, Colorado specifically so she could smoke "legally".

But I guess we stiil don't have any laws against stupidity in this country - duh!

04/23/18 03:25 PM

#3053

James Hamilton, M. D.

Marijuana has been used for many different ailments including glaucoma, all kinds of pain syndromes, seizures and chemotherapy induced nausea and vomiting (CINV). Even though there have been several good studies and meta-analysis the data of it's efficacy is slim at best and mostly confusing.

There are >400 individual chemical compounds in MJ of which >60 are psychoactive agents (THC being the most psychoactive one). The THC content of "today's" pot is much, much higher than that of the 1960's.

Plants have always been a source of finding chemicals that have medicinal value and I do expect that science will find some useful ones in cannabis species over time. Epidiolex is an example.

There are, of course, many testamonials and anecdotal reports of the benefits of marijuana, but those are not scientific studies. What the current good research studies have shown is that pot itself (with all of it's 400 chemicals) does not seem to help glaucoma, has conflicting but perhaps minimal efficacy for CINV and chronic neuropathic (nerve malfunction and nerve compression) pain and probably no effect on nociceptive (arthritis etc.) pain. We really need more and better studies on the individual components of cannabis, done with various potentially therapeutic doses, compared with placebo and currently accepted therapies in double blinded trials.

As for "Big Parma",I have mixed views. I despise the fact that for many drugs they charge way too much even after their research and development costs have been recovered. It is my feeling that patents should be longer than 7 years, perhaps 15, so that initial R&D expenses could be spread out and recovered slower. The strides that Big Pharmaceutical companies have made in developing not only new drugs, but also new categories of drugs to combat diseases that were essentially untreatable just a few years ago is amazing. Biologicals, anti-virus agents, monoclonal antibodies, various kinase inhibitors and now gene altering therapies (some of which may present ethical issues) are changing rapidly how medicine is practiced but at astronomical costs.

The FDA is also an agency with which I have likes and dislikes. We certainly need protection from placing drugs for widespread use on the market that are untested for both efficacy and safety. But is the process too lengthy? That depends on your viewpoint. If you or a loved one is suffering from a painful or terminal illness, a possibly helpful treatment can't be approved fast enough. On the other hand, we don't want another thalidomide disaster like America avoided in the 1940's.

As a health care professional I always wanted to help my patients and not do them any harm. Sometimes that required me to say no to some of their requests and demands. That became more difficult when computers and the internet arrived on the scene. It has often been said that a little knowledge is a dangerous thing. Unfortunately, the press and some websites sometimes offer a little knowledge. For many headlines that I read in the newspapers there are 8 page articles in medical journals that say the opposite.

I don't want to compare opioids to cannabis as I look at the two as totally different in their medical uses. But, for one thing, an opiate is usually composed of one chemical, not hundreds, and we know a lot about that chemical. Where medicine and pharmaceuticals have erred, in my opinion, is in creating long acting narcotic products. Short acting narcotics, such as morphine, are invaluable tools for pain control and are probably underused. As doctors we should have had better training on the proper use of such agents but now I believe that is changing. At least I hope so.

I think we all need to keep open minds about the potential benefits - and harms - of cannabis as well as opioids.

Jim

04/23/18 03:26 PM

#3054

David Mitchell

Is it just me? Or are we getting boring again?

I see a trend. It's all guys again since Janie's Birthday. I think we are suffering from what has been called "Man Answer Syndrome". We guys have an answer for everything - even when there is no question being asked.

Clare, maybe could you expound on the "Casting Ponds" just a bit more for us?

04/23/18 05:24 PM

#3055

Janie Albright (Blank)

Thanks for all your birthday greetings, especially all of you Mariachi band members who practiced so hard for my big day!

Some of you have already tried on 70 for size and you gave me the confidence to give it a try. So far so good! When it’s your turn go for it!

Colleen and I have been amigas since Peter Pan Playhouse days (Do any of you remember it? About Weisheimer and High in Beechwold?) Co is Godmother to my oldest daughter, Nancy and a member of our family. She actually brought the birthday cake from a fabulous and famous bakery in Cincinnati, Bonbonerie.

Co and Gabe and my great niece.

04/23/18 06:20 PM

#3056

Michael McLeod

I was never any good with the girls. You're the ladies' man, Dave. I hold you responsible.

04/23/18 07:55 PM

#3057

Timothy Lavelle

I sure wish we could expand our group too.

Hey, maybe we could could hear from some of the black kids in our group. They could give us their definitive view on what it means to be white and entitled.

No, no...way better. Let's get some in depth marriage advice from a priest since they've never been confused on the issue or confronted with any of the true difficulties of that relationship, having zero actual experience.

Or better, let me just shut up and let two guys who have never smoked weed tell us all about what is wrong with it.

Jim, as a decent guy you may never have given thought to the fact that because you are a doctor, you can sound off about anything and people immediately give it resonance...just because you have a title. You ask for definitive analysis of dope but then cut the legs out from under weed's help for glaucoma and such. Let's just imagine that on any given day, the number of dope smokers in the US helps reduce our overall tension quotient in this country...wouldn't that be a good thing in general? If one person has less pain isn't that a good thing?

Maybe you guys could talk about the medicinal wonders of single malt scotch?

04/23/18 09:09 PM

#3058

James Hamilton, M. D.

Tim

I think this Forum is proof positive that my comments on medical topics are not always met with blind acceptance! That can also be said about a significant portion of my patient population over the years.

I do not claim, nor does medical science, to have all the answers. Science is based on tests, results and percentages. Recently, there has been a trend for certain illnesses, mainly cancers, to pursue "Personalized Medicine". This involves looking at certain genetic variations in the tumor cells (which differ from patient to patient) and treating that patient with a specific medicine to target those cells. This is a paradigm shift from the old way where certain cancer drugs were used for all comers with the same diagnosis. I can see in the future that approach being used for many other disorders including pain management. Perhaps some of those 400 components of pot will be isolated, purified and concentrated for such purposes. That is what I referred to as keeping an open mind.

The main goal of glaucoma treatment is to control intraocular pressure (IOP) in order to prevent damage to the optic nerve and preserve vision. There are many medicines, mainly topical drops, that do this quite well. These have long enough half-lives to be administered once or twice daily. Marijuana smoke does lower IOP but the duration is very short lived, about 2 hours. That would require smoking pot at such doses over a 24 hour period to cause extreme intoxication and mental impairment. Now, if science could isolate the substance in MJ that helps lower IOP and make a slow release eye drop formulation of it that works, then we could add that to our treatment options. Maybe this also would be a good area for Personalized Medicine.

In regard to single malt scotch: I believe whisky was the "drug of choice" for anesthesia and antisepsis in the past particularly after those gunfights in the old west.

Of course, feel free to not agree with what I have just written! 😡

Jim

04/23/18 10:15 PM

#3059

David Mitchell

We interrupt this debate for the following public service announcement:

Today is Roy Orbison's Birthday!

I was hearing a radio show about his life - hosted by his two sons and did not know how closely related (as musicians, co-song writers, and friends) he was to Carl Perkins, Ricky Nelson, and my all time favorites, the Everly Brothers. And you can throw in a little influence from Johnny Cash. I did not hear the entire program. Can't help wondering if Buddy Holly, Chuck Berry, or even the "King" might have figured into the story also.

Man, I loved all those guys. That whole "Rockabilly" sound was so sweet. Just think - "Pretty Woman", "Blue Suede Shoes", "Travelin' Man", and "All I Have To Do Is Dream" -- my vote for the best Rock & Roll song of all time. (The "B" side was my unoffcial theme song in about 5th grade - "Kathy's {Shannahan's} Clown")

04/23/18 10:35 PM

#3060

David Mitchell

Yeah, You're right. I better honor Roy with one too. Happy Birthday to one of the greats. This is one of his best!

04/23/18 10:41 PM

#3061

David Mitchell

Isn't that Bruce Sprinsteen sitting in a chair and playing guitar on the far right?

Check it out at 0:53 seconds into the video.

04/23/18 11:24 PM

#3062

Janie Albright (Blank)

Good eye, Dave!

https://en.m.wikipedia.org/wiki/Roy_Orbison_and_Friends:_A_Black_and_White_Night

04/23/18 11:25 PM

#3063

David Mitchell

Or is that John Jackson again?

And serously - just realized that is K.D. Lang standing with the three ladies at the microphone in back. Feels like I saw this on TV some years back - like a tribute to Roy or something like that. Might be some others in the group?

(Elvis Costello beside Bruce - to our left - of Bruce - maybe ???)

04/24/18 12:22 AM

#3064

Frank Ganley

Dave, if you watch the entire concert, how i wish i was there as i would have snatched one of those idle guitars on stage and really have a ball but i digress . Springsteen, elvis costello were playing guitars. emily lou harris and bonnie riatt were back up singers thats how strong the band was.all playing roy songs. Tim easy on the non smoking brothers because as the Lord so aptly put “ forgive them father for they know not what they say. Dr jim you are right on my of those points you made. Recently i have been dianosed with macular degeneration.. the Dr said it was the bad one , wet , whatever that means . Help on that jim lol. never be it said that i don’t have a comment on just about everything, oh thats ok doc i already smoke my medicine. And just as miracle max said in princess bride” oh you who know so much!” He stated without a smile, to my disappointment, you would have to smoke about a pound of pot a day. I told him i couldn’t smoke that much. To those who are under the opinion that smoking pot makes one listless similar to alcohol . No if you drink till you can’t move is nothing like the high from pot. On al k hall with that much you can’t drive. Those who do smoke would say the same. A completely buzz. Lets address opiates as i had a long time need and long time use. For those who don’t know my medical history it does not have anything to do with health but all orthopedic proceedures. Starting with a fusion on c-4-5, followed a year later with a laminectomy on the same area. Knee surgery followed but it only required a little trim up. Next came bi-lateral tarsal tunnel release. Almost list my right foot as it bacame infected with e-coli. Next came a complete left hip replacement. I have a stryker hip, everybody go wow as i was told its the best lol. The next i broke that little pointy bone on the inside of the wrist. My next surgery was a right mid foot fussion followed immediately with a fussion on that little bone again along with a bone graph and two screws. You ask what was the cause, 50 years of hitting golf ball after golf ball. The constant wear and tear on the body. I really don’t know how tour players move after all there time on the range.So for all of that time from age 42 till about 58 i took big daddy oxicontin, pham heroine, neither i nor my doctor who i have had for almost 35 years, so mike knows me well and i have no secrets from him, i was one of his first patients,neither of us knew that i would become addicted as i only took one every three or four days. When the pain became unbearable. It was only when a driving range i was teaching at sold to land developers that i became aware of addiction. Since i was sending out resumes and not hitting balls i didnt take a pill for about 4 days or so. Then i got the flu so bad i was living in the bathroom. After taking everything under the sun for the flu i asked my wife for an oxi so i could fall asleep. BOOM about a minute and i was perfect again. Next day with dr he cried as he didnt know he was doing that to me. I told him , we didn’t know but we do now. I stopped then and there and just do the pain with pot. I don’t know how or why it works nor do i care as i know it helps me. I also smoke it recreationally also a puff or two ah nice euphoric little buzz. Also i can smoke and drive. Please if ever comes to a vote in your state please vote yes for all who need it, or just want an alternative to booze or like me do both and smile.

04/24/18 04:27 AM

#3065

James Hamilton, M. D.

Frank,

You are correct that the wet form of macula degeneration is more threatening to vision than the dry form. However, it is also the more treatable form. I assume that your ophthalmologist or retinal specialist has discussed with you the various therapies available, the two most commonly used ones being Vascular Endothelial Growth Factor (VEGF) inhibitors which are injected into the eye and Photodynamic Therapy (PDT) which is laser therapy. As with all treatments for anything, there are potential side effects which your doctors would discuss with you.

I know of no studies that look at cannabis in treating macular degeneration. At least with the dry form smoking tobacco has been shown to worsen and hasten the loss of vision. Since certain vitamins and supplemental minerals are helpful in treating both the wet and dry forms and some of those vitamins are contraindicated in smokers, smoking may limit the use of those in the wet form.

I have a very strong family history of glaucoma as well as macular degeneration. My father suffered from both glaucoma and dry macular edema. In his later years it was his major limiting factor to enjoying life. I had often wished he had had the wet form as these treatments were just coming on the market back then. Needless to say I faithfully get my eye examinations.

Jim

04/24/18 01:34 PM

#3066

Kathleen Wintering (Nagy)

Great picture of Janie and Colleen! ! Kathy W.

04/24/18 02:16 PM

#3067

Joseph D. McCarthy

First, Happy 70th Janie; It's about time you joined the crowd.

Next, for my 2 1/2 cents. regarding MJ. If my foggy recollection is right the United States was the biggest dispersant of MJ during WWII. It had the idea that sowing the seeds along railroad tracks would aid in keeping fires from spreading. Also, as once again my recollection goes, the Government licensed the growing and study of MJ over the years. One of the largest RESEARCHERS was an outfit headquartered in Columbus known as Batelle Memorial Institute (BMI). They supposedly published scientific articles on the subject. Don't know if any are still available through BMI or if they now repose only with Chemical Abstracts (another Columbus facility).

And last, yes Dave I'm finishing, scans of typical Coal Company Scrip used by the Captive Workers.

04/24/18 04:00 PM

#3068

Frank Ganley

Jim i get an injection in each eye once a month but it has been working as i now am every 6 weeks plus i take that medicine talked about on tv

04/24/18 05:23 PM

#3069

James Hamilton, M. D.

Frank,

Good treatment! The injectable one is most likely one of the VEGF inhibitors. There are about 4 of them on the market and are all about the same.

Do you know the name of the one advertised on TV, the other one you take?

Jim

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