Breast cancer is the most frequent cancer among women, impacting 2.1 million women each year, and also causes the greatest number of cancer-related deaths among women.
My patient, Jessica found her first breast lump on a self-exam. She was 32 years old. 

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Here is her story :

I considered myself a “Super Mom”. I could do everything by myself without asking for help. I am a successful attorney, entrepreneur with my own law firm, married, have a two-year-old, and I manage to juggle it all. I knew there was something wrong. I felt a pull; a tightness in my chest muscles and underarm while carrying my toddler. When I first felt the lump in my breast, my heart sank. I thought that the disease was a sign. A wake-up call. An opportunity for me to re-examine my life. "I have cancer". The words engulfed me like a dark abysmal sea. My partner and I curled up together in the early mornings and wept quietly so our children would not hear. Grief and despair smothered our house. 


The most challenging thing for me to accept is that I can not control everything. At some point, the shock faded, and the routines of scheduled chemotherapy, daily radiation, surgery recovery, and physical therapy gave me a sense of calm. I had several months of fertility treatments followed by an egg retrieval procedure, eight rounds of chemotherapy, a bilateral mastectomy, and several reconstructive surgeries over four years. 


Out of the grief, an amazingly strong will grew inside me to win the battle of healing my body and my soul. I fought to be healthy for myself and my family. Even though I was receiving intense chemo treatments, I dramatically changed my nutrition, focusing on eating healthy food while exercising every day. Even if it was a ten-minute walk down the street, I did everything I could to keep my body moving.


I did well with the initial surgery and chemotherapy and used the opiate pain medication and anti-nausea medication my oncologist prescribed. However, when I got through my fourth round of chemo, things began to shift. I started losing my appetite, my pain level increased dramatically. I was also having trouble sleeping through the night, as the chemo's side effect included insomnia. 


I was being treated for breast cancer at a top cancer hospital in New York City. What the doctors do not talk about is an integrative and holistic treatment. What about my diet? Nutritional supplements? What about natural ways of healing and managing my pain? I read so much about CBD for pain, inflammation, nausea, and appetite. When I asked my oncology team, no one was able to give me concrete answers. I decided to educate myself, so I read dozens of books, articles, and websites dealing with this terrible disease. As an attorney and a mom, I didn't want to take anything high in THC.


Here is how I used CBD to help me with chemo, radiation, and reconstructive surgery.

Daytime: 
I took 50 mg of CBD divided into two doses. I took 25 mg with breakfast and 25 mg with lunch.

Nighttime:

I took a CBD & CBN formula. Chemotherapy and all the additional prescription medications make me feel like I drank 10 cups of coffee. CBD & CBN helped my body and mind get through the stress and trauma of fighting cancer. It helped me relax for bed and stopped my racing thoughts at night.

Throughout the day I used a CBD salve.

I massaged the balm around my breasts, underarms, neck and shoulder blades. This helped me heal after the mastectomies and expanders. Expanders are temporary implants. There are small port tubes placed inside your body. A needle is placed in the tube to inflate the expanders. The goal is to stretch the skin and help your muscles adjust for the implant, placed under the muscles. I am a woman of color. My skin tends to scar and keloid. The CBD salve helped me decrease the inflammation, scarring, ease the nerve pain, soften the tissue around my implants.


Taking CBD and changing my nutrition made me feel better physically and gave me a sense of control. Today, at age 39, the chart in my oncologist's office reads N.E.D., the three most beautiful letters in the English alphabet. N.E.D. stands for No Evidence of Disease! 
I am in remission. I am grateful.

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Cannabis is the only anti-nausea medicine that also increases appetite, aids with sleep. It elevates mood, something that is not easy to do when someone is facing a chronic and life-threatening illness. While doctors often write five different prescription medications—painkiller, anti-nausea, anti-anxiety, appetite stimulant, and a sedative—that may or may not interact with one another, they could recommend trying one plant medicine first, cannabis, and address all five symptoms at once. 
Since CBD is also an antibacterial, it can help the healing process and decrease the chances of infection around incisions. Researchers are exploring CBD skin formulations to increase the activity of the skin's ECS to treat inflammatory and immune-related disorders of the skin. The anti-inflammatory properties of cannabinoids are also showing promise in the treatment of chronic wounds. Dr. Vincent Maida, a palliative medicine specialist at the University of Toronto, is finding topical CBD with an extraordinary 90% success rate in healing chronic wounds. Chronic inflammation is the root cause of a non-healing wound.
Cannabis is not a cure-all or silver bullet for everything that ails you. Still, more and more research shows that it effectively addresses chronic health conditions by relieving symptoms and addressing and modulating your body's internal systems. By getting to the root of many disorders—an out-of-balance, poorly nourished endocannabinoid system—cannabis can offer more profound, more lasting relief. 
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Stress, anxiety, and even PTSD are common among cancer patients. The COVID-19 pandemic has affected patients' mental health with cancer and has increased the level of stress and anxiety. Evidence is lacking that stress alone will affect cancer treatments, but it can cause behaviors that may interfere with a patient's health.

According to my colleague, Dr. Elizabeth Comen, an oncologist at Memorial Sloan Cancer Center. 

"It's very common to experience some level of anxiety or stress when dealing with a cancer diagnosis. These are normal feelings that you don't need to hide. Post-traumatic stress disorder (PTSD), an anxiety disorder that often occurs after experiencing a very distressful or life-threatening event, is one type of anxiety you might feel. Add in the additional stress associated with a global pandemic to someone already dealing with cancer in their life, and it could overwhelm you. That is almost a volcano that is just so much for any cancer patient to bear." 

Stressed patients may develop behaviors that can, in turn, affect their outcomes. "If stress causes patients to be less compliant with their medications, to be fearful of leaving their house, or to eat poorly, or exercise less–those factors really can affect outcomes," says Dr. Comen.

Many people dealing with pain and other side effects of cancer have already tried more traditional methods before they decide to give medical cannabis a try. When you take plant-based cannabis, you're decreasing inflammation, and you're relieving pain simultaneously. 
But how can pot do this, and why? 
Humans have a natural cannabis system, or an endocannabinoid system, that our bodies create. When a person is in chronic pain, though, these natural pain relievers aren't enough. When we utilize phytocannabinoids from the cannabis plant, we are replenishing our body’s endocannabinoid system. By doing so, it helps us deal with pain and inflammation much more effectively.

Medical cannabis, if you think about it, is the only botanical medicine that can help nausea, increase appetite, decrease pain, and elevate mood. A lot of people who are undergoing chemotherapy as part of their cancer treatment and live in a state where medical cannabis is available are using it for relief. People come to me seeking relief for all types of chemo-related ailments, such as nausea, decreased appetite, pain, insomnia, or depression.

Some physicians will prescribe Marinol, or synthetic cannabis, to treat these side effects. Clinically speaking, I have seen that using phytocannabinoids is simply more helpful and much more effective in increasing appetite and decreasing pain for my cancer patients.

Daniela is an ER nurse who worked on the frontlines in New York City during the peak of the COVID-19 pandemic. Nearly three months later, she has been unable to shake the memories of the overwhelming deaths and demands of the emergency room's emotional and physical tolls. 
Daniela has the most trouble at bedtime. When she closes her eyes to sleep, she relives the trauma of treating and losing patients to COVID-19 over and over again. When she’s lucky and her sleep medication works, she can drift off, but few hours later she wakes up choking -- as if she were in a war zone. Daniela lies in bed in a cold sweat, out of breath, clenching her chest. During the day, she has trouble concentrating. She still works in the ER and feels anxious, stressed, and lives in fear of spreading the disease to family members.
Daniela was diagnosed with PTSD and began seeing a therapist every week. Her psychiatrist prescribed an antidepressant, a benzodiazepine, and a sleep aid. After six months of trial and error, the combination of medications helped with her daily jitteriness and debilitating panic attacks. However, she still felt fear, exhaustion, and isolation. 
Daniela's therapist suggested she try CBD to help ease anxiety and forget the painful memories. But as an ER nurse she treats patients with drug overdose and substance abuse daily. So when she walked into my clinic, her first words were, "I don't want to smoke it, I don't want to get high, and I don't want to sit on the couch with the munchies." 

Cannabidiol (CBD) and tetrahydrocannabinol (THC) are the two most abundant natural compounds found in both cannabis and hemp. Cannabis has a higher concentration of THC while hemp has a higher concentration of CBD. Legal hemp must contain 0.3 percent THC or less. Both CBD and THC are sold as gels, gummies, oils, supplements, extracts, vape cartridges, flower, and more. THC is the primary psychoactive compound in cannabis that produces the high; CBD doesn't cause any mind altering euphoria. CBD comes in different formats and I suggested a broad spectrum product which contains terpenes and cannabinoids but zero THC so she could relieve her stress without the high and won’t have to worry about failing a drug test at the hospital. I also worked closely with Daniela's psychiatrist and psychotherapist to monitor her progress.  

“ Statistics show that women suffer twice as much PTSD as men but this goes underreported...””



Although Daniela didn’t want THC two recent studies indicate she might have benefited from it. According to researchers at New York University and Vanderbilt University, PTSD patients have been shown to have lower levels of the "bliss molecule," anandamide, compared to people without PTSD. 
If you read this blog regularly you’ll know that our brains make their own cannabis molecules (endogenous cannabinoids). Anandamide (named after the Sanskrit word for bliss, ananda) helps temper stress and balance the nervous system, so we do not spiral out of control on high sympathetic overdrive. The endocannabinoid system, or ECS, is a system of receptors that modulates and interfaces with all of the other systems throughout the body. It regulates physical functions, such as movement, pain sensation, and immune responses, and cognitive or mental capacities, like perception, mood, and memory. Anandamide clear painful memories and reduce our stress levels. 
How Cannabinoids Enable Forgetting (Not The Same Thing as Memory Loss)



Take, for example, forgetting. Forgetting is a crucial aspect of treating anxiety, stress, and PTSD. Trauma survivors have been found to have problems with neurotransmitter signaling of serotonin and glutamate. Excessive glutamate signaling will lock in painful fear-related memories. Both THC and CBD can help release these painful memories by facilitating memory extinction and help survivors switch off those traumatic memories. 
Here's how it happens chemically. Cannabinoids mediate the neurotransmitter GABA, which signals to our body that we are safe and directs the body to relax. GABA also helps to reduce anxiety, foster sleep, and relax the muscles. CBD and THC tell the brain to increase the flow GABA, which creates the calming effect. My patients report it taking the edge off, turning down the volume on anxiety and stress. Once their racing thoughts and the "fight or flight" response tail off, patients say they feel better or "more comfortable in their skin." They can often quell racing thoughts that paralyze them at work or cause them to lie awake at night.
Women More Prone to PTSD



Not only do women and men respond to cannabis differently, but they also react differently to PTSD. Statistics show that women suffer twice as much PTSD as men, but because most trauma research focuses on male combat veterans, this fact is overlooked. According to the National Center for PTSD, around 10% of women have PTSD some time in their lives compared to 4% of men.
Recent neuroscience has also shown that certain lucky people have a genetic variation in the brain that makes them inherently less anxious and more able to forget unpleasant experiences. These "more carefree" folks also have brains that produce higher levels of anandamide, the body's own THC. Normal endocannabinoid system functioning helps people's nervous systems reset and recalibrate more quickly after stress exposure. Researchers and clinicians agree that vulnerability to PTSD and stress resilience results from an interaction between ECS, genes, and the environment.

More backing came from researchers from University College London who showed that a single CBD dose helped increase blood flow to the hippocampus. When vessels that supply blood to the brain are clogged or damaged, the result is a decline in cognitive function, memory loss, and difficulty making executive decisions. Mobility and balance get impaired, too. Increasing blood flow to areas of the brain helps maintain cognitive faculties as we age and perhaps increase memory in patients with Alzheimer's. (The mechanism of action for increased cerebral blood flow on the brain is unclear, and while this study is promising, more research is needed).


According to the UCL researchers, the hippocampus is like a "flash drive," meaning it aids in storing and retrieving memories. People who have experienced damage to their hippocampus may have difficulties storing and recalling information. This brain structure (along with the amygdala and prefrontal cortex) also plays a role in the ability to overcome fear responses. Traumatic stress can be associated with lasting changes in these brain areas. 

It's important to mention that many people with PTSD, anxiety, and Alzheimer's might be on prescription medication or antidepressants. If you supplement with cannabinoids be sure to discuss with your doctor as they can interact with these meds and amplify their effects. Be sure not to over-consuming one or the other. If the doctor increases your Zoloft, that doesn't mean you should up your cannabis intake.
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As for Daniela...after the first month of CBD supplementation her therapist reported that she seemed less anxious, more clear-headed, and their sessions were more productive. She also noticed an improvement in the quality of her sleep and mood. She’s on the road to recovery.

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Can CBD improve gut health?

Michael is a 15 year old high school student who came to my office with his parents. When he was just four Michael had a "nervous tummy." For years doctors thought he was lactose and gluten intolerant. He was fatigued and his body ached constantly. He was embarrassed because his constant diarrhea and constipation forced him to plan his life around the restroom. After batteries of endoscopies and colonoscopies he was finally diagnosed with Colitis. In the next few years Michael tried every medication; anti-inflammatory, steroids, anti-diarrhea, pain meds and antibiotics. 


Nothing stopped his deep, penetrating stomach cramps and bleeding colon. After all conventional therapies failed, his gastroenterologist recommended a bowel resection — removal of his colon. Michael was so frustrated; he began searching online for help. He came across thousands of websites where patients talked about how they cured Colitis or managed their symptoms by smoking pot. Some of these patients had detailed instructions on growing marijuana, lists of recommended varieties and dispensaries or recipes for pot- brownies. The sources of information and mis-information were endless. 


Three months ago Michael admitted to his parents that smoking cannabis helped him tremendously with the pain and cramping. Before cannabis, he would wake up five times a night, sitting on the toilet with searing cramps, trying not to wake his parents in the room next door. After only a month of cannabis use he started sleeping through the night and he noticed that the blood and mucus in his stools lessened significantly. His parents realized that Michael was going to use cannabis with or without their consent, which is when they appeared in my office in search of medical guidance.


I see a lot of Michaels in my practice. According to a cross-sectional study presented at Digestive Disease Week, approximately one-third of patients with inflammatory bowel disease report actively using cannabis, and 45% report using cannabis for the management of their IBD (Irritable Bowel Disorder) related symptoms. Many others anecdotally report that medical cannabis helps in managing stomach pain, bloating, nausea, and appetite. Unfortunately, due to US federal laws that block medical cannabis research, large studies for the efficacy of cannabis and IBD are lacking. But early studies have shown that cannabis can indeed help people with digestive diseases and few patients with these symptoms have the time or patience to wait for large clinical trials.

The Cannabinoid Connection

Have you ever wondered why you have butterflies in your stomach when you are stressed? Why do you run to the bathroom before speaking in front of an audience? These are clear examples of how your gut responds to stress. There is a gut-brain connection that links the nervous system to the gastrointestinal system.

There are two competing components to your nervous system: the sympathetic and parasympathetic system. The sympathetic system is the fight or flight response. This system kicks into gear when you have to perform public speaking, meet a deadline, or when you're exercising. The sympathetic system causes your pupils to dilate, heart rate increases, blood pressure rise, and sweat. The parasympathetic system helps you digest your food, sleep, dream, relax. These days, many of us stressed out people are living in a perpetual state of a fight or flight. We are overworked, overtired, anxious about the future. This constant stress results in digestive issues such as bloating, irregular bowel movements, reflux, and rapid weight gain/loss. Stress may cause a decrease in blood flow and oxygen to the stomach, which could lead to cramping, inflammation, or an imbalance of gut bacteria.


CBD, IBS and COVID 


This past April, Michael’s father caught and survived COVID. His father is a healthy, active 57 year old with no history of any heart or lung disease. However, he does have IBS. His GI disorder is not serious as his son’s. As an IBS sufferer, he does have to be mindful of what he eats and he knows that stress exacerbates inflammation in his gut that lasts for months. 


Luckily, his COVID symptoms were mild and he did not require hospitalization. He quarantined in a spare bedroom and was able to manage the mild fever, fatigue and body aches with rest and hydration. The majority of his complications were not lung related, but gut related. His IBS got considerably worse -- diarrhea, abdominal cramping and bloating. His symptoms are under reported but not uncommon. According to the American Journal of Gastroenterology, half of patients hospitalized for COVID-19 have digestive symptoms and develop gastric problems. In fact, many patients complain about nausea, diarrhea and stomach pain before they complain about the coughing, shortness of breath and COVID fever. 


NOTE: Coronavirus can be detected in the stool. This makes hand washing crucial to prevent fecal/oral transmission. Scrub your hands for at least 20 seconds.


Michael’s father is now fully recovered from COVID, but his digestive system has not returned to normal, even 3 months later. He is managing his IBS with a mix of CBD, probiotics, prebiotics, meditation and a low FODmap diet that eliminates certain carbohydrates from wheat and beans. 


From my vantage point, there is a connection between CBD, IBD and COVID that deeper research would certainly shine some light on. CBD (cannabidiol) is a potent anti-inflammatory and pain reliever and it may potentially be useful in the treatment of IBD and related gastrointestinal conditions. It appears to reduce inflammation in the digestive tract and help relieve the anxiety and stress linked to GI disorders. CBD and hemp oil (which is not the same thing as CBD but which is a rich source of omega fatty acids) are two good ways to reduce inflammation and help an unhappy gut. If you are thinking about integrating CBD for digestive issues, do not stop taking your prescribed medications, talk to your healthcare provider and try the LowFODmap diet. 

Aiden is 7 years old. He has special needs and uncontrolled epilepsy. For the last several years, I have been part of the team of health practitioners caring for Aiden. Aiden’s parents, Osiris and Nina found relief for their child with cannabis medicine. 

Check out Osiris & Nina's podcast " Love & Cannabis".
Aiden's parents fight to raise awareness, educate the public, and share their journey with raising a son with epilepsy.
 Treatment of Seizures with Cannabis Medicine
Documented cannabis use for the treatment of seizures dates back centuries and can be found in Sumerian texts. In the U.S. epilepsy is at an all-time high. During the past decade, we have seen a lot of developments in epilepsy therapy from new devices and new medications and the advancement of dietary therapies, yet despite all of those advances, we still have approximately 30% of people, both children, and adults with epilepsy, whose seizures cannot be fully controlled despite available therapies. 

Epilepsies have an extraordinary impact on a patient’s quality of life. Not only does it affect cognitive and behavioral functions, but if uncontrolled, it can lead to permanent disability.  Patients lose the ability to work and earn a living. There are two major constituents in medical cannabis, CBD (Cannabidiol) and THC. Cannabidiol is the major, non-psychoactive ingredient or compound. CBD as a treatment option for seizures represents a challenge and a unique opportunity.

In my medical practice patients come to seek my advice after they have exhausted all pharmaceutical options (anti-seizure medications), and even very aggressive treatments – brain surgery, special restrictive diets (ketogenic/paleo-type diets). Patients who come to me have usually tried over a dozen medications that have failed them.


On June 25, 2018,  Epidiolex became the first cannabis-derived pharmaceutical approved by the FDA in the U.S. Made from CBD extract, the drug is not psychoactive and has been approved for two rare forms of epilepsy: Lennox-Gastaut syndrome and Dravet syndrome. Dr. Orrin Devinsky, the principal investigator of the study behind Epidiolex, stated that “the CBD binds with a novel receptor in the brain and thereby dampens down too much electrical activity. CBD seems to be a relatively unique mechanism of action that’s not shared by any of the existing seizure medications.”  CBD  is thought to act on specific brain receptors and likely modulates calcium activity in neurons.

For the last 15 years, I have been treating children and adults who have treatment-resistant epilepsy. I work as a team with their neurologists to help integrate medical cannabis safely. Over 50% of my patients have a reduction in seizures after a trial of various CBD extracts. Many patients report decreased frequency, severity, and duration of the seizures. And interestingly, they report back that where the patient had a seizure before and it would take all day to get over that groggy and “hungover” feeling, the patient feels they can recover faster and feel like themselves again.


CBD can interact with prescription medications, especially current anti-epilepsy medications as well as increase liver enzymes. It is best to consult your specialist and a physician who is experienced in integrative cannabis medicine before you try CBD for seizures. To assess safety and efficacy patients should be continually monitored and re-assessed to develop a personalized care plan tailored to their needs.

Sleep and Seizures: A Complex Interplay

Research shows that there is a significant relationship between sleep and people with epilepsy.  Sleep is especially important if you have epilepsy. Most types of seizures are affected by sleep. 


If you have epilepsy, lack of good, restorative, sleep makes most people more likely to have seizures. It can even increase the intensity and length of seizures. Some forms of epilepsy are especially prone to sleep problems. Children and young adults with epilepsy require more sleep than adults.


Sleep is crucial to our physical and mental functioning. The most recent research indicates that sleep is essential to all of the body's repair and restore functions. When we are at rest, the body learns what's wrong and physically "relearns" how to contend with the complexities and stressors of everyday life. Restful sleep has been proven to improve memory recall, regulate metabolism, and reduce mental fatigue. 

During sleep, the brain reorganizes and recharges itself, and the body removes waste byproducts that have accumulated throughout the day. It's almost as if our dream life represents our struggle to get back to balance.


When people are sleep deprived, they suffer. Their cognitive abilities decline, their behavior, and their judgment becomes erratic. Fatigue makes us more emotional, anxious; more strung out, more on edge.

Anxiety, stress, and chronic sleep deprivation all inhibit GABA, a naturally occurring brain chemical that directs neurons to slow down or stop firing. This neurotransmitter also helps to induce sleep, relax muscles, and calm down. In essence, GABA directs the body to chill out.

Medical cannabis is not a silver bullet. Patients and the medical community need objective and unbiased data on safety and efficacy to endorse cannabis to treat epilepsy. Patients are looking for reliable information, but have few trusted healthcare-provided resources.

Wishing you all the best in health.
Dr. June Chin