Medical Cannabis

Medical cannabis remains a controversial topic throughout the United States as many states are repealing associated restrictions. Both recreational and medicinal cannabis is now available in a handful of states.  Despite the growing research supporting cannabis as a pain management and rehabilitation tool, the federal government continues to classify cannabis as a Schedule 1 drug. This makes cannabis federally illegal, as well as limits medical studies that would better explore the benefits. 

Cannabis and cannabis derivatives are used to treat the symptoms of many ailments and illnesses, such as cancer, PTSD, AIDS, epilepsy, and more.  According to a 2017 study published in Cancer Chemotherapy and Pharmacology, pharmaceutical cannabis can decrease nausea caused by chemotherapy and almost eliminate vomiting. Cannabis has also been found to relieve the spasticity of the muscles that is sometimes associated with multiple sclerosis and can help treat appetite loss and “wasting” associated with conditions such as HIV/AIDS and certain types of cancers. One chemical compound of the cannabis plant, Cannabidiol (CBD), has been used to treat and reduce seizures in people with epilepsy (specifically Lennox-Gastaut syndrome and Dravet syndrome). Cannabis is used to treat chronic pain, and in some cases may be used instead of opioids for pain management. (Opioids are highly addictive and are typically not recommended for long-term use in treating chronic pain.)  Cannabis may also be beneficial in symptom management of some mental health conditions, such as PTSD.

While there are many benefits to using cannabis, there is still much we do not know about this plant and its long-term usage. For example, studies have shown that frequent use may seriously affect short-term memory, as well as impair cognitive ability. While there are many ways to ingest cannabis, smoking anything can seriously damage your lung tissue. Immediate side effects of cannabis use may include paranoia, elevated heart rate, anxiety, and impaired motor function.  Long-term effects may include mood swings, lung infections, panic attacks, and memory loss.  Signs of impairment may include red eyes, delayed reaction time, poor hand-eye coordination, lack of concentration, and decreased perception of time and distance.

Cannabis has been implicated in a high percentage of automobile crashes and workplace accidents. A review of the medical record and summary of care often provides insight into the extent and timing of cannabis use in relation to a mishap.  R&G is here to help with reviews of cases involving cannabis.  Please call 623-566-3333 or 1-888-486-2245 for more information about case reviews. 

The month of May is Celiac Awareness Month

There are over 200 symptoms that people with Celiac Disease may experience. You could be feeling fatigued, have a stuffy nose, get regular abdominal bloating, stomach pain, or even have an itchy skin rash.  These symptoms can be misdiagnosed for years as allergies or stomach issues, creating missed or delayed diagnosis.  Celiac Disease is an autoimmune disorder, not an allergy.  It can be treated with a gluten-free diet, but it can lead to colon cancer and other very serious medical conditions if not addressed.

The only way to be officially diagnosed with Celiac Disease is by a tissue sample taken endoscopically from your small intestine.  When someone with Celiac Disease ingests gluten (the protein found in wheat, barley, and rye) an autoimmune response is triggered in the small intestine. This response damages the villi that are responsible for absorbing nutrients. Many people are gluten intolerant, but please do not confuse this with someone who has Celiac Disease.  If you have a medical diagnosis, all food you consume must have less than 20 ppm (parts per million) of gluten.  To give you an example of this, a crumb of regular gluten bread is much higher than 20 ppm.  Cross-contamination of gluten products is the number one issue for people with this diagnosis.  Potatoes, as a rule, do not contain gluten- but slice them on a wooden cutting board that someone previously cut bread on makes this an unsafe food option.  Or frying potatoes in oil that gluten products like chicken tenders have fried make the food unsafe for someone with Celiac Disease.

All stages of life are affected once diagnosed. It is not easy to navigate at any age.  Soy and teriyaki sauce, spice blends, canned soup, some medications and supplements, imitation crab, licorice, and oats would appear gluten free, but they all contain hidden gluten products.  When you have a child, it will affect the formula you give them, the foods you introduce to them as toddlers, the preschool birthday parties you attend, and the lunches served at your elementary school.  A teenager will be limited to fast food stops after high school games and college parties you attend.  Once an adult, the potlucks at work and the dinner parties you get invited to will present other challenges as well.  People with Celiac develop a new social norm which is to always to be prepared, which means lots of planning ahead and preparing your own food for social gatherings. You always err on the side of caution because consuming gluten can affect you physically for days or weeks.

Hope is on the horizon.  Many trials have started to find a solution to the Celiac problem.  There is a biotech company that focuses on eradicating food allergies.  They are developing a safe substitute for gluten products so people at home can make bread, pasta, and pizza without the harmful gluten effects.  Time will tell if this is an option, but the trial stage has proved very promising.  Another company is currently in trials for a medication you take before eating your meals that eliminated cross contamination issues. This drug does not enable people to eat a regular gluten diet, but it would be used in conjunction with a gluten free diet to protect against unintended gluten consumption.  It would be a massive breakthrough for a Celiac diagnosis.  Eating French fries at a restaurant could be in your future!  For the most current information, please visit the Celiac Disease Foundation at Celiac.org. 

May is Mental Health Month

May is Mental Health Month.  According to the National Institute of Health, depressive disorder affects 17.3 million Americans.  There are varying levels of depression, some people require therapy and medication.  Others are able to abate symptoms through behavior modification.   Dealing with the stress of the pandemic has exacerbated depression symptoms for many.  Self-care and positive talk are often helpful in moving forward though the day.  

5 Tips for self-help include: 

Exercise – The reason exercise is helpful to treat depression is that the chemical endorphins are released with activity.  A short brisk walk several times a week may help. 

Avoiding sugar – Eating foods with folic acid and omega -3 fatty acids may ease symptoms.  Add some avocado to your salad for a boost.  

Set objectives daily – Consider things like making your bed, going for a walk or calling a friend in objective setting. 

Be kind to yourself – Positive self-talk can help.  Congratulate yourself on small victories.  For example, compliment yourself on completing a task that you were putting off.  

Mindfulness – Mindfulness is a form of meditation where you quiet your mind to focus on the present.  Take one day at a time.  

If you or a loved one is struggling with mental health reach out to the Crisis Text Line.  Text Hello to 741741.  The line services anyone in any type of crisis. 

April is Autism Acceptance Month

Autism is a developmental disability that may impact a person’s social skills, communication and ability to self-regulate.  It typically appears in during early childhood and the level of disability varies from person to person.  According to the Center for Disease Control and Prevention Autism has risen from 1 in 150 in 2000 to 1 in 59 in 2021. 

Since 1972, the Autism Society of America has worked diligently to promote acceptance and educate the general public about Autism.  The Autism Society has formally announced a shift from “Autism Awareness Month” to “Autism Acceptance Month”.  They are calling on the media to promote this change in their coverage in order to promote a higher level of acceptance and opportunities for those with Autism.  This year’s campaign, “Celebrate Differences” is observed throughout April. 

There are many ways to support those with Autism.  The Autism Society offers a free course, Autism 101 which takes about 30 minutes to complete.  https://www.autism-society.org/living-with-autism/how-the-autism-society-can-help/online-courses-and-tutorials/#autism101.  The offering is sure to increase knowledge around the subject matter.  The Ohio Center for Autism and Low Incidences offers free training modules on various Autism topics.  https://autisminternetmodules.org/help.php.  The Autism Society shares stories from family members and individuals on the spectrum.  Stories can be submitted to stories@autism-society.org.  Autism Matters is a free electronic newsletter.  Business can subscribe and post the information in public viewing places.  Joining the Autism Society can be completed online.  A household membership costs only $40.00 annually.  https://www.autism-society.org/get-involved/join/.  The benefits include access to information along with promotions and giveaways. 

Many businesses are now doing their part to promote acceptance.  AMC theaters, Home Depot, Ford, CVS, AMC, Walgreens and Microsoft have developed programs to hire and train those with disabilities to include Autism.  AMC has gone 1 step further and developed a program of monthly movie offerings for those with disabilities.  The lights remain up and the sound is turned down in order to decrease stimulation that many with Autism find bothersome.  Sesame Street at SeaWorld in Orlando provides specialized training for Associates to ensure they understand how to best interact with those with Autism.  They recently introduced Julia, a 4 year old with Autism, as a Sesame Street Character.  Quiet rooms are provided for the people with disabilities who may need a break.

Kit Albrecht author of 5 Guidelines for Autism Acceptance Month and Beyond (https://www.assistiveware.com/blog/5-guidelines-for-autism-acceptance-month) provides helpful suggestions to promote Autism acceptance.  Kit points out not all people with Autism like to be referred to as a person with Autism.  Some prefer no reference to it.  Afterall, people with Autism are people and pointing out the disability may not be necessary.  Living well, not becoming normal is another point made.  Focusing on reducing hypersensitivity, promoting education and employment should be the focus of support. 

In sum, awareness of support services and acceptance of those with Autism should be the focus of Autism Acceptance month.  Celebrating difference and encouraging inclusion for people throughout the year facilitates acceptance for those in need of greater understanding. 

Women’s History Month

March is Woman’s History Month, celebrating women and their contributions throughout the history of the United States.    This formal recognition of women came about in 1980 as the result of an initiative by Representative Barbara Mikulski, from the House of Representatives, and Senator Orrin Hatch.  Together they co-sponsored a Congressional Resolution for National Women’s History Week honoring the achievements of American woman.  President Jimmy Carter designated a week, March 2 -8, as National Woman’s History week.  By 1987, 14 states extended the celebration to a month-long period.   Congress followed their lead and officially declared March the month celebration of women.   

The role of woman in the United States has dramatically evolved. Women are leaders of large and small companies and woman serve at the highest levels of government.  Iconic women such as Eleanor Roosevelt and Susan B. Anthony changed society in dramatic ways in terms of being role models for advocacy for people.  Amelia Earhart, was a bestselling author, pilot and was instrumental in pioneering a role for woman in aviation.    

Women of present-day lead some of the largest companies in America.  Mary Barra, CEO, lead General Motors, lead the company efforts to make ventilators during Covid.  Carol Tome, CEO of UPS, lead the company the Covid pandemic.  UPS stoic shares doubled as of October 2020.   

The military is one are that women have excelled.  For example, in 1989, Captain Linda Bray led the 988th Military Police Company and was the first woman to command American troops in combat.  In 2012 Army General Ann Dundwoody became the first woman to reach the rank of 4 star General.   In 2015, Captain Kristen Griest and Lieutenant Shaye Haver were the first women to complete Army Ranger School.  Woman now serve in many previously closed areas of the military.  For example, combat roles such as infantry and certain aviation platform are now open to women.  

Woman have made strides in politics.  In 2005 Condoleezza Rice, became the first black woman to service as U.S. Secretary of State.  In 2019 Nevada became the first state to have woman hold the majority of state legislative seats.  A record number of women are serving in the 117th Congress and we now have a female Vice President.   

The future is bright and encouraging for women.  Opportunity exists in every faucet of the private and public sector.  The information age of the internet and social media provide a platform for growth to include resources, education, training as well as a voice to be heard.   

In the words of Helen Keller Alone we can do so little; together we can do so much”.

Disaster Preparedness

Disaster preparedness means knowing what type of disasters you might face and what to do in each situation. Living in Idaho? You probably don’t need to worry about hurricanes. California? Better be ready for an earthquake, but don’t overlook the chance of severe weather, fires or even an Ebola outbreak. Unfortunately, disaster can strike anywhere in the country. The American Red Cross has a list of possible disasters that may affect you at http://www.redcross.org/get-help/how-to-prepare-for-emergencies/types-of-emergencies
The following tips can help you prepare for whatever Mother Nature throws at you.

1. Learn your area’s evacuation routes and shelter locations.

While a hurricane is bearing down on your home or after a flash flood warning has been issued, is not the time to figure out where you will go. Evacuations are common and it will serve you well to know the details ahead of time. You should know all the escape routes from your home, including the more obscure ones, such as getting out of that ground-level window in your bathroom. If you have children, draw them a home fire escape plan and post it near their bedroom door. Plan a meeting spot for your family to regroup if you must evacuate your home. Pick one meeting location right outside your home and one outside the neighborhood in case you must leave the area. Decide ahead of time where you would go in case of an evacuation, whether it’s a friend or relative’s house or a Red Cross shelter.

2. Have an Emergency Go Kit and know how to use it.

You should have an Emergency Go Kit with some basic necessities. Necessities include food, water, basic first aid supplies, and other emergency equipment that you already have (such as flashlights, rope, lighter, knife and duct tape). The key is to have this kit assembled and ready to use in an easy-to-grab bag, not scattered all over your house. Make sure everything is in working order and items aren’t expired. Some kits are available for purchase pre-packed, but remember, if you don’t know how the items work, they could be useless. Don’t forget prescription medication and important documents, such as Social Security card, driver’s license, credit card, birth certificate, etc. Keep items near your kit so they are easy to grab. Ready.gov and RedCross.org have additional tips at the links below.

http://www.redcross.org/get-help/prepare-for-emergencies/be-red-cross-ready/get-a-kit

https://www.ready.gov/build-a-kit

3. Keep an updated USB flash drive loaded with a copy of your important digital documents and family photos in your “Emergency Go Kit”.

Chances are if you need to evacuate your home, you may not have the time or space to grab your computer. It is advised to keep any important digital copies of documents you may need, along with any family photos and files you do not want to risk losing, on a USB flash drive in your go kit. Another option is to keep them on a secure online cloud storage system, (Dropbox, Google Drive, etc…) that you can access from another computer at a different location if needed.

4. Know how you’ll reconnect with people who matter to you.

If cell networks aren’t working, you don’t just need to worry about how your Netflix stream will be affected. Consider how you will contact your family or friends to let them know you’re safe. Figuring this out ahead of time can make everything much easier in a difficult situation. According to the America Red Cross, use an out-of-area emergency contact to have family members check in with, since it may be easier to make long distance calls. Everyone should also have a list of emergency contacts and local emergency numbers.

5. Remember those who may need special preparation.

Children, infants, seniors and those with disabilities may need special consideration while planning for an emergency. In an evacuation, remember to take any needed medication or special equipment. Talk with your neighbors about how you can help one another and check on each other in case of a disaster.

6. Learn what to do if you’re caught away from home.

Obviously, you may not always be at home when disaster strikes. In the case of an unexpected emergency, you should be prepared to react from different locations, including your workplace or car. As mentioned before, know your evacuation routes, communication plan and how you’ll receive emergency notifications. Have a plan for reconnecting with your children, who may be at school, daycare or after-school activities. Talk to your children’s schools about how they will communicate with families in case of an emergency, if they have a shelter-in-place plan, and where they will go if they have to evacuate.

7. Prepare for your pet’s needs.

If you need to evacuate, you should never leave your pet behind. Try to evacuate to a friend or family member’s house, as pets may not be allowed inside public shelters. Keep a pet emergency kit on hand with food and other important items. The ASPCA recommends microchipping pets so they can be identified and returned to you even without tags (or you may want to invest in a GPS tracker so you can find them yourself). The ASPCA has an app that helps you keep track of animal records required to board pets at an emergency shelter and has other helpful tips for a variety of situations.

8. Sign up for emergency alerts and know how officials will communicate with you during a disaster.

You can get emergency alerts on your cell phone if you haven’t disabled them already. The blaring noise overtaking the silent mode on your phone can be annoying, but this is probably the best way to be informed about emergencies. The emergency alert system also broadcasts over radio and television. NOAA weather radio can alert you if severe weather is expected – 24 hours a day, seven days a week. Tune into social media as well, but don’t rely on it exclusively, as you may lose internet connection.

9. Learn emergency skills that can always come in handy.

Knowing little things can make a huge difference, such as how to use a fire extinguisher or perform basic first aid. Get trained in CPR or the even simpler hands-only CPR, which could help save someone’s life when you least expect it. Learn how to shut off utilities in your house in case of a disaster that may damage gas, water or electrical lines.

10. Find out how to help your community during a disaster

Want to help out even more? Learn how you can be a community leader during a disaster or teach others how to be prepared. Various volunteer positions with local emergency response agencies or nonprofits are always needed.

Disaster can strike at any time, but by planning ahead we give our families the best chance of getting to safety.

R&G Certified as Veteran-Owned Business

After completing a comprehensive vetting process conducted by the Center for Verification and Evaluation at the Department of Veterans Affairs, R&G is pleased to announce its certification as a Veteran-Owned Small Business.

Receipt of this designation enhances R&G’s ability to secure government contracts.  In addition, companies seeking to support Veterans through use of services provided by Veteran-owned businesses may be assured that R&G meets stringent government standards of Veteran ownership and management.

Veteran-Owned Small Business Certification
Veteran-Owned Small Business Certification

National CPR and AED Awareness Week

The Beat Goes On!

In December of 2007, Congress declared the first week of June each year as National CPR/AED Awareness Week in an effort to increase the number of people certified in cardiopulmonary resuscitation (CPR) and trained to use an Automatic External Defibrillator (AED). In today’s advanced technological world, the American Heart Association (AHA) has determined that in order to increase the survival rates for victims of sudden cardiac arrest, we need to go back to the basics of  CPR. This is not limited to healthcare workers but includes lay people as well. According to the AHA there is a 95 percent mortality rate for over 300,000 Americans who are victims of sudden cardiac arrest each year. It is also estimated that on average it takes 8 to 10 minutes for 9-1-1 to reach a victim. Survival rates for individuals with ventricular fibrillation treated by AEDs have been reported between 0% and 31%. Comparatively, the survival rates for performing CPR alone are reported between 0% and 6%.  More lives could be saved if members of the general public have training in the use of AEDs and CPR. .

Why is this important?

The reason that this is so important is after four minutes without oxygen going to the brain it will begin to die. After eight minutes it becomes the point of no return, irreversible brain death begins to occur. So even if the heart is restarted, the damage after eight minutes can never come back. This is why we need people to do CPR. In cases where CPR is performed immediately, this risk is cut in half. Victims’ chances of survival decrease by 7 to 10 percent each minute that they go untreated after their heart stops, so bystanders’ knowledge of CPR is a matter of life or death.

Why did they change CPR?

New CPR Rules: Pump First, and Save the Breaths for Later If you have ever been trained in CPR, we were all trained  A-B-C,  for “airway, breathing, compressions”. But the American Heart Association (AHA) recommends a different approach. The new mnemonic is C-A-B; we’re now supposed to start chest compressions right after calling 911; adjust the airway and leave the rescue breaths for last. The AHA wants to encourage people to be willing to administer CPR; so making the mouth-to-mouth breathing a less prominent part may make the procedure more palatable.  In recent years, the results of study after study have supported the fact that the victims who receive compressions alone from bystanders survive as well as those who received traditional CPR.  The guidelines apply to adults, children, and infants but exclude newborns.

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  • Establish responsiveness, if victim is not responsive, roll the person onto their back. Check for a pulse for no more than 10 seconds.
  • Call 911 or ask someone else to do so.
  • Start chest compressions. Place the heel of your hand on the center of the victim’s chest. Put your other hand on top of the first with your fingers interlaced.
  • Press down so you compress the chest at least 2 inches in adults and children and 1.5 inches in infants. “One hundred times a minute or even a little faster is optimal,” Sayre says. (That’s about the same rhythm as the beat of the Bee Gee’s song “Stayin’ Alive.”) Allow for a complete recoil of the chest after each compression. Give at least 30 compressions before you proceed to rescue breathing.
  • If you’re been trained in CPR, you can now open the airway with a head tilt and chin lift.
  • Pinch closed the nose of the victim. Take a normal breath, cover the victim’s mouth with yours to create an airtight seal, and then give two, one-second breaths as you watch for the chest to rise.
  • Continue compressions and breaths – 30 compressions, two breaths – until help arrives.

These guidelines apply to children and adults alike, since AHA officials did not want separate and potentially confusing advise for different groups of people. The change in CPR is part of a larger revision of its emergency heart care recommendations.

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AEDs are user-friendly devices that untrained bystanders can use to save the life of someone in cardiac arrest.

  • Before using an AED, check for puddles or water near the person who is unconscious. Move him or her to a dry area, and stay away from wetness when delivering shocks (water conducts electricity).
  • Turn on the AED’s power. The device will give you step-by-step instructions. You’ll hear voice prompts and see prompts on a screen.
  • Expose the person’s chest. If the person’s chest is wet, dry it. AEDs have sticky pads with sensors called electrodes.
    • Apply the pads to the person’s chest as pictured on the AED’s instructions.
    • Place one pad on the right center of the person’s chest above the nipple.
    • Place the other pad slightly below the other nipple and to the left of the ribcage.
  • Make sure the sticky pads have good connection with the skin. If the connection isn’t good, the machine may repeat the phrase “check electrodes.”
  • If the person has a lot of chest hair, you may have to trim it. (AEDs usually come with a kit that includes scissors and/or a razor.) If the person is wearing a medication patch that’s in the way, remove it and clean the medicine from the skin before applying the sticky pads.
  • Remove metal necklaces and underwire bras. The metal may conduct electricity and cause burns. You can cut the center of the bra and pull it away from the skin.
  • Check the person for implanted medical devices, such as a pacemaker or implantable cardioverter defibrillator. (The outline of these devices is visible under the skin on the chest or abdomen, and the person may be wearing a medical alert bracelet.) Also check for body piercings.
  • Move the defibrillator pads at least 1 inch away from implanted devices or piercings so the electric current can flow freely between the pads.
  • Check that the wires from the electrodes are connected to the AED. Make sure no one is touching the person, and then press the AED’s “analyze” button. Stay clear while the machine checks the person’s heart rhythm.
  • If a shock is needed, the AED will let you know when to deliver it. Stand clear of the person and make sure others are clear before you push the AED’s “shock” button.
  • Start or resume CPR until emergency medical help arrives or until the person begins to move. Stay with the person until medical help arrives, and report all of the information you know about what has happened.
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AED
AED Setup and Use

 

RESOURCES: American Heart Association. 2010 Guidelines for CPR and Emergency Cardiovascular Care, October 2010
http://www.cardiacscience.com/marking-national-cpr-and-aed-awareness-week/
http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/What-is-CPR_UCM_001120_SubHomePage.jsp
http://www.heart.org/HEARTORG/CPRAndECC/WhatisCPR/CPRFactsandStats/CPR-Statistics_UCM_307542_Article.jsp
http://www.heart.org/idc/groups/heart-public/@wcm/@ecc/documents/downloadable/ucm_317350.pdf
http://mycprcoach.com/hands-only-cpr/ Weisfeldt ML, Sitlani CM, Ornato JP, Rea T, Aufderheide TP, Davis D, et al. Survival after application of automatic external defibrillators before arrival of the emergency medical system: evaluation in the resuscitation outcomes consortium population of 21 million. J Am Coll Cardiol. Apr 20 2010;55(16):1713-20.
Automatic External Defibrillation Author: Joseph J Bocka, MD; Chief Editor: David FM Brown, MD http://emedicine.medscape.com/article/780533-overview
AED use: National Institute of Health – AED proceedures
Graphic and CPR Data: American Heart Association CPR Awareness Page