CNB Medical News: The Winter Blues

(NAPSI)—You may have heard the terms—winter blues, Seasonal Affective Disorder (SAD), Depressive Disorder with a Seasonal Pattern. No matter what you call it, with approximately 17.3 million adults in the U.S. experiencing seasonal depression, according to the National Institute of Mental Health, feeling gloomy this time of year isn’t uncommon—but it can be overcome.

The Problem

Depressive Disorder with a Seasonal Pattern (formerly called SAD) can affect anyone of any age. Whether you’re a student returning to class, a busy working professional who’s always playing catchup, or even newly retired with found time on your hands, the excitement of the holidays is long over and wintry dark days are here. While January and February are the typical peak months for the disorder, symptoms can persist through April, according to Mental Health America.

Doctor’s Advice

When that feeling of sadness persists for several weeks, it’s time to take action, according to Dr. Desreen Dudley, a licensed Clinical Psychologist and Behavioral Health Provider of Therapeutic Services for Teladoc Health. But, she points out, often the toughest thing for many is how to discern whether what they feel is temporary or something more serious.

“If someone has a few days of feeling low, that’s normal and typically nothing to worry about. It’s when the feeling lingers for weeks and people lose interest in daily activities and suffer persistent negative thoughts, that lend a stronger basis for Depressive Disorder with a Seasonal Affective Pattern diagnosis,” she says.

What To Watch For

Other symptoms she warns about are:

•Change in appetite

•Change in sleep pattern

•Decreased energy

•Decreased concentration

•Feelings of worthlessness or guilt

•An inability to think, concentrate, or finish tasks at work or school

•Thinking about suicide, self-harm, or death

Dr. Dudley contends individuals already struggling with depressive disorders are susceptible to SAD patterns. For older Americans, a Vitamin D deficiency can exacerbate low moods. On the other end of the spectrum, she has worked with newly independent college students who find SAD a heavy burden and say their new responsibilities of classes, exams and jobs can compound their depression. For some, not rising as early for classes as they did in high school means sleeping in more and further limiting their exposure to sunlight.

What To Do

In addition to considering therapy, such as virtual care, which is available on your terms and from any location you choose, Dr. Dudley recommends:

•Avoiding or cutting back on alcohol and other addictive substances

•Eating healthfully—more lean proteins, fruits and vegetables, and eliminating sugar

•Daily exercise at least 30 minute a day (walking counts)

•Yoga or meditation

•Learning about and trying light therapy

•Regularly surrounding yourself with those you enjoy being around.

When To Seek Help

According to a recent global study conducted by Ipsos MORI for Teladoc Health, individuals often recognize when they’re struggling, but even so, over a third of the respondents who have had one mental health episode admitted to not seeking professional help. The reason? For many, it’s often the difficulty in finding mental health care.

“Thankfully, virtual care is becoming increasingly available as a source of convenient mental health care,” Dr. Dudley says. “It eliminates the traditional obstacles of in-person visits and has opened up access for anyone with a busy schedule, individuals who may have difficulty getting out of the house and students who may fear the stigma of walking into the campus mental health clinic.”

Learn More

For further information, visit

www.Teladoc.com/therapy

Tips for keeping your car insurance low

Gloucestercitynews.net (February 17, 2020)–Auto insurance is a tailor-made product, and your policy is very much your own based on factors that are exclusive to you. It is not a fixed cost and could cost you some good money. Still, you can lower it through better bargaining with the insurance company to get better

insurance quotes

only when asked for. Having adequate coverage does a lot of good when you face adverse situations that damage the car or injure others and damage property. The insurance policy protects you financially as the insurance company pays out for the damage when you lodge a claim.

It does not require that you cut down driving, which can help to lower the premium because there are many other

ways to obtain other discounts

which, when added together, considerably lower the premium.

Focus on safe driving

Since insurance rates depend upon the risk assessed by the insurance company, the more you prove that you are a safer driver, the lower would be the insurance rate. On the other hand, if you are accident prone and used to frequent traffic violations, be ready to pay higher insurance. To ensure safe driving, drive at moderate speed, and stay alert and agile so that you have better control over the vehicle and avoid accidents. Maintaining the smallest list of traffic violations is the way to keep insurance costs low.

Buy an insurance friendly car

The car is a major factor that determines the insurance rate, and when you buy a car, check if there are better models from the insurance perspective. The cost of the car and its fancy features are reasons for a higher premium, and it is better to choose a car that is more need-oriented than an object of vanity. The value of the vehicle has a direct relation to the collision coverage, and it is inherent in some car models to attract higher insurance. If you buy a sports car or something that one can interpret to be a sports car, then you must be ready to pay higher insurance as you must for other luxury cars.

Avail behavior-based discounts

Insurance companies reward well-behaved and disciplined drivers with favorable insurance rates by offering discounts. Having a clean driving history underlines the safe driving habits and lowers the risk which the insurance company acknowledges by charging a lower premium. The more control you have on your driving behavior, the better it is because you can claim better rates from insurance companies.

Focus on care safety features

Choose a car that matches your budget and has adequate safety features. Avoid buying a car that might cost less because of fewer safety features because insurance companies rely on better safety features that can minimize vehicle damage after accidents and lower the claim amount. Striking a balance between the cost of the car and its safety features, which must be something more than the minimum, will lead to a lower premium.

If you can reduce the average driven distance in a year, the insurance will be lower.

NY State’s $4 Billion Medicaid Gap Fueled by Highest-in-Nation “Excess Diabetes Costs”

Newswise — NEW YORK, February, 2020

— As Governor Andrew M. Cuomo’s new Medicaid Redesign Team meets for the first time today, a new report,

Wasted Billions, Wasted Health

examines the state’s out-of-control diabetes costs as a major driver of its budget crisis and offers up a number of evidence-based, patient-centered education programs as a solution to the state’s $4 billion Medicaid gap.

The report from Health People, a leading disease prevention community group, calculates that New York’s excess diabetes costs have reached an unprecedented $13.4 billion a year. It also calculates the potentially enormous savings that diabetes patient-centered education programs could have to bring down those costs and close the budget gap.

The Centers for Disease Control and Prevention defines “excess diabetes costs” as the extra amount of money a state annually spends on Medicaid patients with diabetes, compared to those without diabetes. New York’s $15,366 a year extra cost per Medicaid patient with diabetes is the highest in the nation — and double that of any other state. Some 14 percent New York Medicaid patients are known to have diabetes.

According to the report, 18 percent of

all

Medicaid costs in New York are excess diabetes costs, which are substantially driven by complications and poor outcomes, such as diabetes-related blindness, kidney disease and amputations. In fact, the state’s diabetes-related lower limb amputation rate alone has soared 48 percent in the past decade.

These excess diabetes costs and complications, says the report, are significantly preventable through better clinical care and, especially, with well-evaluated patient self-care education. Yet,

Wasted Billions, Wasted Health

underscores that even while effective patient education is proven to help people with diabetes control their blood sugar, bettering their health and slashing costs, New York has the lowest diabetes patient education rate in the nation.

“New York is in a situation where it cannot lower Medicaid costs in a way that meaningfully improves health as long as the New York State Department of Health refuses to address diabetes –our most widespread epidemic,” said Chris Norwood, Executive Director of Health People and the report’s author.

“Diabetes presents the single greatest opportunity of any major disease to substantially save Medicaid money and significantly improve health outcomes for patients,”

Wasted Billions, Wasted Health

emphasizes. “This is because diabetes is prevented or much better controlled by ‘lifestyle’ changes people can readily learn.”

The report cites two best-practice, data-driven diabetes education programs – the CDC-endorsed National Diabetes Prevention Program (NDPP) and the Diabetes Self-Management Program (DSMP) — as among those that have successfully reversed diabetes among patients and reduced diabetes-related costs. For example, in a recent large-scale evaluation, the DSMP was show to save an average $2,200 in medical costs per diabetes patient in just the first year.

In terms of the potential savings, the report says “providing well-evaluated self-care for just 20 percent of state Medicaid diabetics and 10 percent pre-diabetics would potentially save the state a minimum of $306 million a year and up to $612 million in just the first year. Because patients’ improved ‘lifestyle’ lowers their costs for years, investment in education provides savings that continue on for years, while creating the implementation funding to keep expanding cost-saving strategies.”

The report also underscores that the state does not support any evidence-based strategies, including plant-based nutrition, which have been shown to help reverse diabetes and enable diabetics to cease taking or substantially reduce their medication.

NYS Department of Health Fails to Confront Diabetes

“Still, the New York State Department of Health has stubbornly refused to confront the diabetes epidemic and reduce its impact in any real way,” said report author Norwood, adding it has “even declined to make reducing diabetes- related lower limb amputations—which can easily cost $250,000 in just the first year— a goal of the state’s official “Prevention Agenda.”

Nor has New York’s health department supported effective patient self-care and education. Rather, it has essentially blocked it. In 2019 when the state legislature mandated that New York include the NDPP as a Medicaid benefit, the health department followed up by announcing a reimbursement “formula” that only paid for half the costs of providing the multi-session education for pre-diabetics. That, despite the fact that the NDPP has been shown to cut by 60 percent the risk that pre-diabetics will proceed to develop diabetes.

Since many of the nonprofit community-based organizations that deliver the NDPP to patients lack the funding to pay for the remaining costs, the state’s “penny-wise and pound-foolish” approach to the NDPP is leaving huge Medicaid pre-diabetic populations without an effective way to avoid diabetes.

“The state’s inaction is especially confounding since patient education for diabetes prevention and self-care is so relatively inexpensive to implement and so clearly pays for itself in reduced patient costs,” states the report. “To start a statewide program, New York need only provide an initial investment for organization and training in order to realize that investment within the first year of operation. Following that substantial year-by-year savings would accrue from prevention participants not developing diabetes and self-care diabetic participants having significantly lower risks of developing severe complications and other costly outcomes.”

“The state’s failure to use proven strategies to make the progress for diabetes we have seen for other epidemics is as baffling as it is unacceptable,” said Robert Morrow, MD, Associate Professor, Department of Family and Social Medicine, Albert Einstein College of Medicine. “As a doctor in the Bronx, which has the worst rates of diabetes complications, I am outraged that the state doesn’t support the serious and effective patient education which everyone knows is a key to controlling this ever-worsening epidemic.”

Failure to Confront Leads to Skyrocketing Medicaid Costs

As a result of this inaction, excess diabetes costs paid by the state are actually rising twice as fast as the overall Medicaid deficit. With a projected 14%, or 896,000 of the state’s 6.4 million Medicaid patients having diabetes, the mean extra annual cost of $15,366 for each patient has brought New York’s spending for excess diabetes costs to $13.4 billion a year out of total projected Medicaid spending for 2019-2020 of $74.5 billion.

With the state responsible for paying 33% of Medicaid expenditures,

its $4.5 billion obligation for excess diabetes costs in one year is more than double the overall $4 billion Medicaid combined deficit for the two fiscal years of shortfalls.

“It’s incomprehensible watching billions wasted this way,” said Reverend John Williams, President of New Creation Community Health Empowerment, a Brooklyn faith-based health organization. “We have people trained and ready to provide the Diabetes Self-Management Program in Central Brooklyn – one of the worst hit areas by the diabetes epidemic. Yet, the state provides nothing to groups like ours – not even the educational materials needed. We have to ask what it means when a Health Department seems have just accepted the terrible level of disabilities and injured lives from this epidemic.”

For a copy of the report, visit Health People’s Newswise newsroom at:

https://www.newswise.com/institutions/newsroom/19933

– # # # –

About Health People

Health People is a groundbreaking peer education, prevention and support organization in the South Bronx whose mission is to train and empower residents of communities overwhelmed by chronic disease and AIDS to become leaders and educators in effectively preventing ill health, hospitalization and unnecessary death.

Established in 1990 as a women’s AIDS prevention and support program, Health People has grown, using its peer-education model, to provide a full range of HIV/AIDS services for men, women and families. It also has conducted community asthma programs, New York’s first diabetes peer-educators program, and a community smoking cessation program. Health People’s Junior Peer program, Kids-Helping-Kids includes teens who are mentors for younger children with sick or missing parents.

For more information, please visit www.healthpeople.org.

New Jersey Allows Residents To Choose What Gender They Want To Be

TRENTON – New Jersey Motor Vehicle Commission Chief Administrator Sue Fulton today announced that customers may now change the M/F gender designation on their New Jersey driver license or non-driver identification card without a doctor’s note.

The “Declaration of Gender Designation Change for New Jersey Motor Vehicle Commission Driver License or Non-Driver Identification Card” form is available at NJMVC Agencies and can be downloaded from the NJMVC website,

njmvc.gov

, and no longer requires the signature of a health care practitioner.

Customers who choose to change their M/F gender designation must surrender their current driver license or identification card and obtain a duplicate for the standard fee of $11.00.

“We are proud to serve one of the most diverse states in the nation, and it is a bedrock principle for us at the NJMVC that we represent and treat every individual with respect and dignity,” said Chief Fulton. “Allowing customers to change their gender designation to reflect their gender identity is deeply important for showing that all New Jerseyans are valued equally. We are proud to stand with our LGBTQ community.”

The ability to change gender designation by self-attestation follows the passage of the “Babs Siperstein Law,” named after the noted transgender activist, which was signed into law by Governor Phil Murphy on July 3, 2018.

Later this year, the New Jersey Motor Vehicle Commission will offer an \”X\” gender option on New Jersey driver licenses and non-driver identification cards for non-binary New Jersey residents.

EPA Says: No Need To ‘Warm Up’ Modern Vehicles In Cold Weather

CAR CARE COUNCIL BE CAR CARE AWARE

(NAPSI)—When the weather is cold, many motorists wonder if they need to let their vehicle “warm up” or idle before driving. In fact, today’s modern cars are ready to drive in cold temperatures without

You may have to bundle up before you drive in cold weather but your modern car is ready to go, with no need to idle a while

excessive idling.

The idea of idling before driving dates back to when cars were built with carburetors. With new fuel-injection technology, complex computer systems and thinner synthetic oils, drivers don’t need to warm up their cars before hitting the road.

According to the Environmental Protection Agency (EPA), “When a car idles for more than 30 seconds, it has several negative effects, such as increasing air pollution unnecessarily, wasting fuel and money and causing excessive wear or even damaging a car’s engine components, including cylinders, spark plugs and the exhaust system. Contrary to popular belief, idling isn’t an effective way to warm up most car engines.”

“Unless you are trying to defrost the windshield or warm the interior of your car, idling is not required for today’s vehicles,” said Rich White, executive director, Car Care Council. “In most cases, idling longer than 30 seconds is unnecessary, even on the coldest days. The best way to warm up your car’s engine is to drive gently at the start. Remember, a vehicle gets zero miles per gallon when idling and the result is lower fuel economy and wasted money.”

The Car Care Council has a free 80-page Car Care Guide for motorists that features several pages of fuel economy and environmental awareness tips. Available in English and Spanish, the popular guide uses easy-to-understand, everyday language rather than technical automotive jargon and fits easily in a glove box.

The non-profit Car Care Council is the source of information for the “Be Car Care Aware” consumer education campaign promoting the benefits of regular vehicle care, maintenance and repair to consumers.

To order a free copy of the popular Car Care Guide, visit the council’s consumer education website at

www.carcare.org

Jefferson Health Patient Engagement Scheduling Center Opens in Cherry Hill, NJ

Cherry Hill, NJ

, February 13, 2020 –

A ribbon-cutting ceremony was held this week for the new 35,000-square-foot Jefferson Health Patient Engagement Scheduling Center in Cherry Hill. This new call center is designed to increase efficiency and ensure a seamless patient experience. It combines several existing call centers in southern New Jersey and Philadelphia, and will handle everything from ‪1-800-JEFF NOW calls to appointments for Medical Imaging studies, and Jefferson Primary & Specialty Care practices. A second new Jefferson Health Patient Engagement Scheduling Center is slated to open this spring in Fort Washington, Pa.

Shown, from left, are

: John Ekarius, EVP and Chief of Staff, Jefferson Health; Joseph W. Devine, President, Jefferson Health (NJ) and Chief Experience Officer; Kasandrah Garnes, Vice President, Seamless Access; Stephanie Conners, Chief Operating Officer, Jefferson Health; Albert E. Smith, Jefferson Health New Jersey Board Trustee; Lisa Griffin, Senior Vice President, Seamless Access; Camden County Freeholder Jonathan L. Young, Sr.; Miosoti Guash-Astacio, Patient Access Representative; Edwin Boogaard, Senior Director, Seamless Access; and Stefani Stephens, Patient Access Representative.

Kratom for Pain Relief

Gloucestercitynews.net (February 13, 2020)–It is unfortunate that some of us have encountered accidents at some point in our lives. In some cases, we are blessed enough for the accident to not inflict any major injury. Sometimes, the injury is incessant enough to linger for longer than anyone would want it to be. Medications, too, seem to cease to

credit unsplash.com

provide any evident relief.

One feels utterly hopeless when even medical science has nothing to offer for a problem so troublesome. But, nature has a remedy for every crisis mankind faces. Its vast storehouse of herbs and shrubs are the answer to possibly every physical malady human faces. One such herb is Kratom. Kratom, or Mitragyna Speciosa, as it is called in the scientific community, is a native plant predominant in Thailand. It has been used for its medical applications since the nineteenth century. Kratom works very efficiently for pain relief. A study conducted on 10,000 Americans concluded that a staggering 68% of them used Kratom for self-treatment of pain. Here, we explain the pain-relieving properties and a bit about the

best Kratom for pain relief

. Read on!

The high concentration of Alkaloids

Humans experience pain due to the presence of pain receptors that travel to the brain. Kratom has a naturally high concentration of alkaloids. These alkaloids dull the pain receptors which results in an evident decrease in the pain a person is experiencing. Thus, no matter how old the pain is, kratom shows its effectiveness by attacking the very base of origin of pain. Maeng Da Kratom literally translates to \’pimp grade\’ kratom, which is suggestive of its very strong reserve of alkaloids.

Promotes the production of Serotonin and Dopamine

One of the curious effects of kratom is the enhanced production of Serotonin and Dopamine in the body. The initial of these neurotransmitters regulate a person\’s mood while the following elevates the feeling of happiness. This helps a great deal in chronic pain as it is often accompanied by persistent depression and anxiety. This also helps in coping with long lingering pain. Besides, it is always a good idea to be a bit more cheerful and happy.

Richness in Mitragynine

Kratom is known to be very rich in Mitragynine. Mitragynine is an alkaloid that has excellent anti-inflammatory properties. This is very effective in muscle stiffness, and therefore, is a terrific pain reliever. This is additionally effective in diseases such as fibromyalgia, arthritis and rheumatism, etc. Mitragynine is also known to produce euphoric and stimulating effects on the human body.

Helpful in managing Diabetic neuropathic pain

A lesser-known impact of kratom is its ability to control blood sugar levels. Pain is one of the leading consequences of diabetic neuropathy. Controlling blood sugar levels can be a bit tricky for a person who cherishes food. An unstable diet can result in blood sugar spikes which can be dangerous in several cases. Research has proven that alkaloids in kratom help in regulating insulin production and thus, control the amount of glucose in the blood. This helps in preventing sudden rises or troughs that diabetics face.

Non-harmful pain-relieving perks of opioids

There are multiple medical conditions where opiates are used to counter pain afflicted in the body. But, there are multiple side effects of opiates such as addiction, dependence, respiratory dependence, etc. Kratom can be used to derive all the positive pain-relieving perks of opioids while ruling out the potential negative effects it can impart in a human. Kratom can be used without the suspicion of unaccounted ill effects.

Increases energy levels

Excessive pain can reduce the circulation of blood and energy levels as well. Kratom optimizes specific metabolic processes and rebuilds energy levels and increases circulation, fighting the sensation of pain. This is exceptionally useful for the physically active workers as the grievance of low circulation and energy levels is commonly heard from them.

Conclusion

Kratom has been traditionally used for assistance with pain and distress. It comes loaded with natural antioxidants. Whether it is acute or chronic pain, it can help in managing both of them. While using chemical painkillers may introduce a number of side effects, such as nausea, dependence, etc, kratom is a safe and effective way of confronting pain. Tried and tested, Kratom is one of the best alternatives at your disposal to counter and cope with any kind of pain or discomfort you wish to get rid of.

STUDY: Kratom May Have Therapeutic Effects And Relatively Low Potential For Abuse Or Harm

(

John Hopkins Medicine)

(February 2020)–Using results of a survey of more than 2,700 self-reported users of the herbal supplement kratom, sold online and in smoke shops around the U.S., Johns Hopkins Medicine researchers conclude that the psychoactive compound somewhat similar to opioids likely has a lower rate of harm than prescription opioids for treating pain, anxiety, depression and addiction.

Kratom Leaves (left) Young kratom trees in Indonesia (right) Credit: American Kratom Association

In a report on the findings, published in the Feb. 3 issue of

Drug and Alcohol Dependence,

the researchers caution that while self-reporting surveys aren’t always entirely reliable, they confirmed that kratom is not regulated or approved by the U.S. Food and Drug Administration (FDA), and that scientific studies have not been done to formally establish safety and benefits. They say that U.S. drug agencies should seek to study and regulate rather than ban kratom sales outright because of its seemingly safe therapeutic potential, and as a possible alternative to opioid use.

The American Kratom Association (AKA), a consumer advocacy group, estimates that 10-16 million people in the U.S. regularly use kratom by either eating its ground leaves in food or brewing them in tea. Kratom is a tropical plant related to coffee trees, and grown mainly in Southeast Asia. It contains a chemical called mitragynine, an alkaloid that acts on the brain opiate receptors and alters mood. In Asia, where use has long been widespread, people use it in small doses as an energy and mood booster, similar to coffee use in the West. They use larger amounts for pain, or recreationally like beer and wine.

Kratom products are unregulated and nonstandardized, and reports — although sparse — have linked its use to hallucinations, seizures and liver damage, when combined with alcohol or other drugs. In 2016, the U.S. Drug Enforcement Agency (DEA) proposed banning commercial sale and use, and the FDA has advised categorizing it as a Schedule I drug, meaning it has no proven medical application and has a high risk of abuse. These agencies were met with public and supplement industry pushback, and no action was taken. A salmonella contamination outbreak in 2018 among users increased concerns.

However, says

Albert Garcia-Romeu, Ph.D.

, instructor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, the new survey findings “suggest that kratom doesn’t belong in the category of a Schedule I drug, because there seems to be relatively low rate of abuse potential, and there may be medical applications to explore, including as a possible treatment for pain and opioid use disorder.”

“There has been a bit of fearmongering,” he adds, “because kratom is opioidlike, and because of the toll of our current opioid epidemic.”

A 2015 study in Thailand that reported that people in Asia have been using kratom successfully to treat opioid addiction for decades renewed interest among researchers in the U.S.

For the current survey, Garcia-Romeu says, he and his team enrolled 2,798 people to complete an online survey on their use of kratom. They recruited participants online and through social media, as well as through the AKA. Overall, users were mostly white, educated and middle-aged. Some 61% of users were women, and 90% were white. About 6% reported being multiracial, 1.5% reported being Native American or Hawaiian, 0.5% reported being Asian and 0.4% said they were African American. Participants were an average age of 40. About 84% of participants reported having at least some college education.

Of these participants, 91% reported taking kratom to alleviate pain on average a couple times a day for back, shoulder and knee pain, 67% for anxiety and 65% for depression. About 41% of survey responders said they took kratom to treat opioid withdrawal, and of those people who took it for opioid withdrawal, 35% reported going more than a year without taking prescription opioids or heroin.

As part of the survey, participants completed a Substance Use Disorder Symptom checklist to assess whether their use qualified as a substance use disorder according to the American Psychiatric Association

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

guidelines. Fewer than 3% of responses met the criteria for moderate or severe substance use disorder for abusing kratom, but about 13% met some criteria for kratom-related substance use disorder. This is comparable to about 8%–12% of people prescribed opioid medications who became dependent, according to statistics from the U.S. National Institute for Drug Abuse (NIDA).

“Both prescription and illicit opioids carry the risk of lethal overdose as evidenced by the more than 47,000 opioid overdose deaths in the U.S. in 2017,” says Garcia-Romeu. “Notably there’s been fewer than 100 kratom-related deaths reported in a comparable period, and most of these involved mixing with other drugs or in combination with preexisting health conditions.”

A third of the survey participants reported having mild unpleasant side effects from kratom, such as constipation, upset stomach or lethargy, which mostly resolved within a day. Only 1.9% reported that side effects were severe enough for them to seek medical treatment, such as feeling withdrawal symptoms such as anxiety, irritability, depression or insomnia when the kratom wore off. Fewer than 10% of participants reported notable kratom-related withdrawal symptoms.

“Although our findings show kratom to be relatively safe according to these self-reports, unregulated medicinal supplements raise concerns with respect to contamination or higher doses of the active chemicals, which could increase negative side effects and harmful responses,” says Garcia-Romeu. “This is why we advocate for the FDA to regulate kratom, which would require testing for impurities and maintaining safe levels of the active chemicals. Otherwise, unregulated products run the risk of unsafe additives and dosing problems, which could be like getting a shot of grain alcohol when you were trying to order a beer.”

Garcia-Romeu adds that data is scant on whether one can overdose on kratom alone, or how it interacts with alcohol or other drugs. The researchers also say rigorous clinical research needs to be done to test kratom for its potential therapeutic benefits, for behavioral intoxication effects and adverse side effects to further help inform government policy and regulation. They also suggest that people err on the side of caution and not mix kratom with any other drugs or medications, and to always talk with their health care provider before taking any supplement.

Aside from Garcia-Romeu, authors on the study include David Cox, Kelly Dunn and Roland Griffiths of Johns Hopkins and Kirsten Smith of NIDA.

Support for this study was provided in part by grants from NIDA (R01DA003889 and R01DA035246).

Dunn has consulted for Grünenthal.

CNB Business: How to Choose Quality Cannabis

CBD OILS

or marijuana

(CNBNewsnet)(February 17, 2018)–On January 23, 2018, New Jersey

Governor Murphy issued Executive Order #6

, which calls on the Department of Health to “undertake a review of all aspects of New Jersey’s medical marijuana program, with a focus on ways to expand access to marijuana for medical purposes” and to reduce barriers that patients face when they are seeking access to medical

marijuana

. It will also include a review of regulations.

Additionally,

the recommendations issued by the Medicinal Marijuana Review Panel

concerning the addition of debilitating medical conditions that qualify for the medical marijuana program are also under review. The State of New Jersey\’s medical marijuana law was passed in 2010. Presently there are 15,000 residents enrolled in the program, over 5,000 of those individuals signed on in the past year.

Nearby Pennsylvania began its medical marijuana program on February 15, 2018. According to the Pennsylvania Health Department when fully implemented, the Medical Marijuana Program will provide access to medical marijuana for patients with a serious medical condition through a safe and effective method of delivery that balances the patient need for access to the latest treatments with patient care and safety.

Many of those enrolled in these programs have no idea about the different marijuana strains. In the hope of clearing up this problem

cannaporium.ca/

released the following information.

So, perhaps you have learned the visual differences between marijuana strains and how to properly store your weed, but you still fail to tell the visual differences between poor and top-notch marijuana? At our website, we constantly receive many questions from our puffing community on choosing quality cannabis-based only on photos or the strain’s appearance alone. And while there is not and cannot be an exact study for selecting potent cannabis (most of the deal seems to come down to personal opinion), there is still quite a number of visual cues you can and MUST search for when scanning the proposed buds at the dispensary and figuring out if the stuff is good quality cannabis or just Nah.

How to choose the best marijuana: Low-Quality Buds

Low-quality weed is usually transported in the form of compact bricks, which in its turn results in a whole mass of shaken, heapy, and compressed herbs. Typically, such products can only be found on the black market or from unscrupulous suppliers. Concerning the color, such trashy stuff appears to be less colorful than the medium-quality marijuana, often having more brown than green color (thus it was given a nickname Bobby Brown). Its aroma is quite dry and earthy with a taste that can be both harsh and spicy as opposed to the sweeter and more like floral notes of the high-grade pot.

When the product is not compacted into the brick crap, those low-quality buds turn out to be light, leafy, and really thin. Logically, the concentration of cannabinoids in such stuff is likely to be extremely low due to poor environmental conditions, like, for instance, high temperatures and some other variables.

Finally, the effects from low-quality weed when consumed tend to be quite mellow, relaxing even lazy, and intensively sleep-inducing (because of the CBN). It is not so uncommon for a user to experience strong headaches and a range of other side effects from poorly cultivated and cared-for marijuana.

How to choose the best cannabis: Medium-Quality Buds

Now medium-quality kush is exactly where the bigger deal of domestically-grown cannabis strains lie. Mediocre cannabis might be identified by its spectrum of green hues and the obvious presence of bright pistils. Such product showcases purple tone, moderate flavor qualities and sugary aftertaste. Experiencing a smoking session with medium-quality cannabis may definitely vary, but oftentimes if the genetics are pretty strong, the effects turn out to be potent enough and enjoyable.

How to choose quality cannabis: High-Quality Buds

Well, we’ve finally got to some good quality weed! Every provider claims to possess only high-grade products in stock, yet how can you confirm it yourself? First of all, the most essential thing you certainly need to know is that top-shelf marijuana will stand out in its sea of green. Apart from the diverse range of colors that premier genetics tend to show, truly awesome quality and sophisticated flavors of really dank weed will be screaming “choose me!” Moreover, you need to understand that truly outstanding weed has no price cap – you can probably come across some luxury items like old French wine and, thus, prices may reach extreme levels. The high-quality herb should be quite sticky still without being moisturized or anyhow wet. When grounded, the buds must break apart without turning into a pile of dust and if burnt, those should leave white ash behind.

Source:

https://cannaporium.ca/

Is Recreational Cannabis Coming to New Jersey?

CNB Business News

Research Scientists Wish They Had More Brains

Mysteries of the Mind Part 1, Wanted: Your Brain

Jeff Stoffer

DEC 17, 2019

American Legion Magazine

Research scientists in Boston wish they had more brains.

One they can expect is that of a former Harvard University football player who wants to know,

preferably before he dies, exactly what happened inside his skull after he was kicked in the head during a professional wrestling match in 2003.

A brain the researchers have already examined came from a Navy Special Warfare veteran who lost his battle with head injuries in September 2018, to suicide.

The scientists, the former athlete and the surviving wife of the 25-year retired Navy chief are making the same uneasy ask. They want anyone who is willing to donate that most complex and mysterious of organs, regardless of its condition or how it functioned during life, so more can be learned to prevent and treat brain injury and disease. While their primary targets are former football players and military veterans, they

will take –

and need

– all the brains they can get because the more they have, the more can be learned to improve chances to save lives in the future.

“It’s not like a normal organ donation, which doesn’t include the brain,” says Nicole Condrey of Middletown, Ohio, who endured her husband’s downward churn through a three-year storm of traumatic brain injury issues – depression, anger, impulsiveness, withdrawal, suicidality – until he shot himself in the chest while holding her hand, in their RV, their service dog nearby, a week before they were supposed to close on their first home together.

Hours after his death, Nicole got a call from former Navy SEAL and author Jason Redman, who asked, on behalf of the Concussion Legacy Foundation (CLF), if she would donate her husband’s brain. “I said, ‘Absolutely. We need to get his brain in.’

“The (CLF) is working to raise awareness that you can pledge to donate your brain separately through

projectenlist.org

. They don’t just need veterans’ brains. They don’t just need athletes’ brains, because in science you need a baseline. They need anybody’s brain. I have pledged to donate my brain to science when I die. You have to tell your family and your loved ones. Ultimately, the next of kin are the ones who have to make that decision … I do know that they do not collect early.”

The CLF was co-founded in 2007 by Chris Nowinski, who played football in high school and four years at Harvard as a defensive tackle before he entered the WWE arena as “Chris Harvard,” a chiseled 270-pound, 6-foot-5 competitor who typically wore an H letter jacket as part of his shtick. Three years of training, heavy travel and regular blows to the head ended his career on the circuit a few weeks after a kick from “Bubba Ray Dudley” put him on his back in Hartford, Conn. “Something was wrong with my vision,” he later wrote of that moment. “I didn’t know where I was, what was happening around me, or why I was staring up at fuzzy-looking lights on the distant ceiling of a gigantic arena – I only knew that something was terribly wrong.”

He wrestled a few more times following that, battling painfully through whatever was suddenly wrong with his head, until it was obvious he could not continue. At that point, he set his rewired mind to a better understanding of concussions and their effects. His 2006 book “Head Games” is now in its third edition and was the subject of a documentary that explored the effects of concussions among football players, which made headlines in

The New York Times

, led to congressional hearings and influenced changes in the game.

“I was fearless,” says Nowinski, who now has a Ph.D. in behavioral neuroscience. “When I give lectures on neuroscience, I show how crazy I was with my own brain. I let people hit me in the head with chairs and objects. The head butt was my move in football. I have two bad shoulders, so I hit you with my head. I did things that I regret.”

He regrets them now but had no idea at the time that multiple blows to the head had probably damaged his tau – a protein that holds certain brain cells together so they can deliver messages that affect executive functions, mood, vision, sleep and other operations among a mind-boggling list of tau-assisted responsibilities. He had no idea then, nor is he sure now, that he was confronting the degenerative brain disease chronic traumatic encephalopathy (CTE), which cannot yet be detected among the living. Its presence can only be confirmed through laboratory examination of a sufferer’s brain tissue.

Identification of CTE before death is one goal of the Concussion Legacy Foundation and pioneering neuropathologist Ann McKee of VA and Boston University, who runs the VA-BU-CLF Brain Bank at the Jamaica Plain campus of the VA Boston Healthcare System. The bank opened 25 years ago as a two-person lab at the Edith Nourse Rogers Memorial Veterans Hospital – the Bedford, Mass., VA medical center – and studied donated brains to seek answers about such conditions as Alzheimer’s disease and dementia.

Over the past decade, largely due to Nowinski’s persistence, the brain bank has evolved, grown and captured national attention. The brains of former National Football League (NFL) players who suffered severe and often deadly effects of post-concussive syndrome following their careers have been examined, one after another, by McKee and her team. The program has grown to four neuropathologists, four technicians and 20 other staff members, supported by VA. They now have more than 1,100 donated brains in the bank, which are studied for multiple conditions.

In most cases, especially early, the growing number of football player brains came after Nowinski cold-called families to make the uneasy ask. As NFL families agreed to have their loved ones’ brains studied, evidence mounted. Four of the first four had CTE. Now, out of 111 former NFL players’ brains studied by McKee, CTE has been identified in 110. Among them was the high-profile case of former New England Patriots star tight end Aaron Hernandez, who in 2017 died by suicide in a jail cell at 27 following a highly publicized murder conviction and a string of irrational acts. “I was stunned that Aaron Hernandez had so much disease,” McKee said. “For some reason, you think it’s not going to happen. And then it does.”

Traumatic brain injury and post-traumatic stress disorder have been called the “signature wounds” among post-9/11 veterans. Blasts from improvised explosive devices, crashes, falls and other blows to the head have come with the territory of training and fighting in Iraq and Afghanistan. Ron Condrey did not have any one major head injury, his wife explains, but he sustained multiple concussive events over the years, perhaps 20 in all.

“He had a motorcycle accident during his Navy training,” Nicole says. “I think that was the start to a lot of things. After that, he fell down a mountain in Afghanistan on some mission. He had a Humvee roll over. He had a helicopter crash. As an EOD (explosive ordnance disposal) tech, you’re around explosives. Repeatedly, over and over throughout his career. Big ones. Small ones. You have one (concussion) and then the next one compounds itself, and then the next one and the next one. Individually, he might have been OK had he only had one.”

A Notre Dame-educated electrical engineer, Nicole had been a civilian IED countermeasures analyst for the U.S. Army in Afghanistan. Ron, who had been committed to the Navy since 17, was a beloved combat leader and highly trained paratrooper. Their paths never crossed in theater, but they found each other in 2013 when she was trying to get her initial skydiving license in Suffolk, Va. He was an experienced trainer, and they soon discovered they had more than jumping out of airplanes as a common interest. “We both kind of dealt with IEDs in different ways, but we never met each other until later. When we did, we had a lot of similar connections.”

Ron had been jumping for more than 15 years, and pushed Nicole to keep training and working to become a master skydiver. “I was his apprentice, you might say,” she says.

They loved extreme outdoor recreation, and each other. By the time they married July 30, 2015, however, Ron had already shown signs of brain injury, including a suicide attempt earlier that year. “It was a pretty bad one. His buddies came and said, ‘Hey, we need to get him help.’ I’d been trying to get them to understand for a while that there was something going on with his brain. It took a suicide attempt. He was still in the Navy at the time. They said, ‘Yeah, we should intervene.’”

He enrolled in DoD treatment programs in Portsmouth, Va., and Bethesda, Md. Nicole accompanied him to appointments in the early months of their marriage. Soon, it was clear he needed to get out of the Navy, perhaps with a medical discharge, but he had enough years to retire in May 2017.

By that time, she explained, his condition was plummeting. “It was like a roller coaster. I’m sure anyone who has been a caregiver, or a spouse or a loved one – someone going through this – could tell you the same story. One day, he could be doing really great and the next day just in the dumps. Or one hour doing great and the next hour not.”

That’s when they were given Via, a trained service dog. “Ron really liked a lot of the Latin words that are used in the military,” Nicole says of her name. “Via directly translates to ‘road’ or ‘street.’ But it can also have the meaning of journey or path. So we picked that name because she was an important part of Ron’s journey.”

Initially diagnosed with major depressive disorder, “which stems directly from the traumatic brain injuries and the post-traumatic stress,” she explains, Ron’s condition was later characterized by VA as PTSD with some TBI, and he was given a 100 percent disability rating. “Lots of different meds,” she recalls. “And the meds make you gain weight. For a warrior to gain weight, it’s a sign of weakness. He felt even worse, and his view of himself went down the tube even more.”

She says he tried prolonged exposure treatment, but that wasn’t effective because Ron had no single triggering event. “The idea is that there is an event that is really haunting you or bothering you on a regular basis. For Ron, he was a warrior. He expected to see everything he saw. There wasn’t one event. But they really wanted to help him with his post-traumatic stress. Prolonged exposure was the key, or so they said. He got worse. There wasn’t

event for Ron. There were events, but they happened to his brain, concussively, not his psychological state.”

By that time, Nowinski, McKee and the VA-BU-CLF Brain Bank were advancing scientific understanding of the links between concussions and psychological behavior. More and more brains were coming in, particularly from former athletes, and a growing number from veterans who had been diagnosed with TBI and PTSD, which are studied together and separately for the presence, or not, of CTE.

“Traumatic brain injury can be an acute injury – a blow to the head, a subdural or epidural (bleed) – and it can be a major injury with loss of consciousness, amnesia, neurological deficits,” McKee says. “Or it can be a mild injury. There are all types of severities – mild, moderate and severe. Mild TBI is what I am primarily concerned with. You don’t see a bruise. There is no blood on their scalp or anything. It’s a subtle injury, but it can have long-term consequences. What we know from our research now is that if you sustain these mild TBIs – enough of them over a long period of time – it dramatically increases your risk for … CTE. It’s like the brain gradually breaks down, bit by bit.

“A TBI is like a car accident. A car accident can be a big accident. It can be a small accident. A mild TBI, or a concussion, is more like you’ve got a car on a really bumpy road, and you just keep driving on it, and your car slowly breaks down. It’s a long-term consequence – subtle damage that occurs over years.

“PTSD is a complex set of symptoms. They can be sleep difficulties, anxiety, all sorts of things. And it is usually related to trauma. The trauma doesn’t have to be physical. It doesn’t have to be a TBI. It can be psychological trauma. It can be sexual trauma. What we have found is that individuals exposed to trauma – psychological or even physical trauma – develop PTSD, which is this well-defined but complex set of symptoms. So, how does this fit in with TBI and CTE? How can you compartmentalize those? It’s not easy, and we are still working on it. There are people with PTSD and no trauma, PTSD and no CTE, and we also know – because we have a big brain bank here for PTSD – that some of those cases have CTE.”

“For them to stamp PTSD on his medical record, it was all they knew how to diagnose,” Nicole says of her husband’s situation. “The problem is, how do you really diagnose it? The symptoms are so similar.”

One therapy that seemed to work was skydiving. “It was something physical he could repeatedly do,” Nicole says. “In theory, it was supposed to help his brain recover and heal.”

Moreover, she adds, “He was really good at skydiving. He loved it, and he loved giving back.” He had more than 5,000 recorded jumps over his career. He’d also been booked to do demonstration jumps at various venues, including Soldier Field in Chicago – 10 of which he did with Via. “She doesn’t like the plane much,” Nicole says of their skydiving service dog. “But the second she gets out of the plane, it’s like any dog putting its head out the car window.”

The stars were thus aligned for the Condreys to pack up and move to Middletown, home of Team Fastrax, which teaches skydiving, performs demonstration jumps at big events – typically involving huge U.S. flags – and competes against other skydiving teams around the world. It was something they could do together, especially after they saw the team’s annual Warrior Weekend to Remember event where Gold Star Families and disabled veterans gather for a weekend of skydiving and camaraderie.

“If you’re a combat-disabled veteran, you jump for free,” Nicole says. “We were in it to inspire people and be a part of the community, and get people to get outside their comfort zones and do great things.”

Ron’s condition, however, worsened as his neurons continued to misfire. “Ron was in a really bad state the last six months. He actually got to the point where he stopped jumping. He didn’t enjoy anything about it anymore. And this is something you see in people who can be depressed. They don’t enjoy the things they loved to do before. He was a recluse. He didn’t go out at all. He would push everyone away, including me and his service dog … and we were keeping him alive at the time.”

In late August 2018, he checked into a private-sector retreat for veterans. He came home with a sudden appreciation for everything around him. “He was a totally different man. I was euphoric, but I had this feeling in my gut that I couldn’t pinpoint.”

A few days later, the euphoria was gone. The roller coaster descended, fast. As for the retreat, “I think Ron got there too late. He had gotten so far into that hole without getting back up, it just took one more bad place, one more bad moment, for him to not see his way out of it. His brain wasn’t thinking logically at that time.”

It was about 4 in the afternoon when he pulled the trigger. “I can’t tell you why that day,” she says. She called 911 and then the Team Fastrax hangar. “They were here for me. I have an extended family that has been through a lot with me.”

The decision to donate his brain to the bank came without hesitation. “Ron wanted to give back to veterans in every way he could, so it was just a clear fit, something that could last.”

“It’s terrible to lose these guys,” Nowinski says. “If we can do anything to stem the tide … so many people are committed to suicide-prevention campaigns, but it still happens. We need to understand how we can do more to help.

“We have learned more about our brains in the last decade than we have in all of human history,” he adds. “The brain is the last great frontier. It’s so complex. We are only beginning to understand its complexity. So sometimes the only way to really appreciate it, since it’s hidden inside of our skull, is to actually look at it under a microscope after somebody has passed away. What’s been amazing, doing this work for a decade now with the most amazing researchers in the world at VA and Boston University, is that we make breakthroughs every year, because this work hasn’t been done before.”

New rules about helmet-to-helmet hits, player suspensions for multiple such penalties, warning posters in locker rooms, research and development of safer helmets, and regulations about returning players to the field after concussions are among the steps football has taken since the CLF was established. “Football is dramatically safer today than when I played it,” Nowinski says. “We are not doing all the stupid things we did back then. (But) the reality is, we are still creating CTE in people’s brains.” He says raising the age limit for tackle football can help by reducing the number of years a player is exposed to repeated blows to the head.

“Football is not the problem,” he says. “It’s too much football. I think the future of football is non-tackle versions until high school.” Adult athletes – as with firefighters, police officers and military personnel who risk head injury but understand the risks, Nowinski says – are different from children who often start cracking heads with one another on the gridiron as young as 5.

The route between head injuries and CTE is different for military personnel, McKee says, but they commonly lead to the same destination. “What I can say about military veterans who have been exposed to either blast or concussive trauma is that it’s not as predictable as football. Football tends to be a relatively stereotyped exposure. They tend to do relatively the same things every time they go out and play. But a military person, a veteran – it’s pretty random. Are they in combat? Are they not? Where are they in combat? What are their exposures? Were they driving down the road where there was a blast? Where were they standing or where were they sitting in relationship to the exposure? There are so many variables. It’s much more complex.”

Scanning and imaging technology can only go so far to detect and understand brain disease, McKee says. More is learned by cutting into brains and carefully studying their conditions after death.

“I could never have seen (CTE) using an imaging technique. You can only find, in imaging, what you are looking for. You have to know what you are looking for, target it and find it. There is exploration and discovery in neuropathology that is not possible with neuroimaging.”

The research, Nicole says, can provide guidance for the military before assignments that may include exposure to head trauma. “Right now, the military is not doing neuro-psych evals on entry for EOD techs,” she says. “We have to have a baseline … when they first get into the military, into sports, whatever it might be. All of our brains are different. Then, throughout someone’s career, if they have had an injury to the brain, they need to be tested again. Regularly. If we were able to do it regularly, we could stop it earlier. Ultimately, the goal is keeping people from getting long-lasting TBI symptoms. The research and the data are extremely important, the end goal being that we don’t get people in that state.”

Nowinski adds, “If we change how we play sports and how we conduct military training, we can create better outcomes.”

Treatment of CTE’s effects depends on seeing it in the first place, McKee says. “The basic cornerstone of treatment is detection … during life. If we can do that – if we have a biomarker, something in the blood or saliva or spinal fluid, or if we have an imaging technique that can pick up CTE – then we can treat it. We would have lots of ideas how to treat it. We have anti-tau therapeutics. There are anti-inflammatory therapeutics. There’s a gamut of possibilities.”

To get there, it’s going to take donated brains, she says. “It’s very important to have the brains. That informs us how to do the detection.”

“I think (the brain) is more powerful than we have any idea about,” Nicole explains. “It’s also susceptible. It’s fragile. We can do great things with our brains, but if we don’t protect it, if we have a concussive incident, we need to be sure to take a timeout and step away from that activity before we go back into it again.

“If we do something else again right away and get another concussion, our brain is going to have a much harder time healing. Learning more about our brains and what can happen to them is extremely important, so we can be those fully functioning warriors.”

“We are now honestly addressing the issue,” Nowinski says. “We have a tremendous opportunity to prevent this problem going forward by changing what we’re doing. But also, there are generations of people dealing with this disease, whether they are athletes or veterans, and we don’t have an answer for them. We need to invest in research so we can create better answers.”

To that end, Nicole says she is driven to help CLF make the uneasy ask. “I am taking Ron’s spirit with me in all of this,” she says. “I would call it a passion because I loved him so much.”

Adding military, veteran and control brains to the bank will “help us solve this problem,” Nowinski says. “Go to

projectenlist.org

and sign up to pledge your brain. Follow the instructions. Hopefully, we won’t get your brain for a very long time, but you will be part of an important mission going forward to cure this.”

There is no cost, he adds, and every family gets a full report of the findings. “We treat every family like our own.

“I now look back and realize I was very lucky to get kicked in the head by Bubba Ray Dudley in that wrestling match in 2003. It has allowed me to do work that I am passionate about. And this work is helping people.”

Jeff Stoffer is editor of

The American Legion Magazine