027: From Pain Relief to Better Sleep: How Medical Cannabis Can Benefit Seniors – Susan Feldmeth

Marty Stevens-Heebner:
Are you confused by what you've been hearing about cannabis and all its medical uses? Or marijuana, as we called it in my teenage years. There are so many varieties and different uses for the cannabis plant, and it can be very confusing. Fortunately, our guest today is here to demystify things for us, and so if you're curious, keep listening.
Moving your mom or your dad or yourself isn't just about moving things from one place to another. It is much more complicated than that, as are so many things having to do with later life. How to Move Your Mom (and Still be on Speaking Terms Afterward) provides in-depth conversations with professionals, older adults, and their family members who share their stories with warmth, understanding, and humor.
I'm your host, Marty Stevens-Heebner, and here, you'll find answers to many of your questions, as well as different perspectives that I hope will inform and inspire you.
Sue Feldmeth, thank you so much for joining me.

Susan Feldmeth:
Thanks for having me, Marty. I'm happy to join you today.

Marty Stevens-Heebner:
Here's a bit about Sue Feldmeth, who has 30 years experience as a nurse and is the founder of MC Wellness Consulting, where she's dedicated to safely guiding people through the often confusing world of medical cannabis.
Sue's concerns about her own aging mother's severe arthritis pain and her use of opioids sparked Sue's interest in cannabis. Sue also works as a cannabis consultant at the Kensington Assisted Living and Memory Care Community in Sierra Madre, California, and she is the clinical supervisor for About Senior Solutions, a geriatric care company.
So here's the question I always start out with, Sue. What's your favorite memory of your grandparents?

Susan Feldmeth:
My grandfather lived with my parents from before I was born until he passed away. He lived to be a hundred and was the epitome of health. Looking back, I can see all the things he did well. My sister and I were very picky eaters and did not like to eat our vegetables, so every day, he would walk to the grocery store, buy fresh fruits and vegetables, and juice them. Juicing is so big now, but he was doing it way back in the '70s. So every day, we had a fresh glass of juice that had beets and spinach, but carrots and apples, which would make it good. That way, he was rest assured that we got our vegetables one way or another.

Marty Stevens-Heebner:
Your grandpa was years ahead of his time then.

Susan Feldmeth:
Yeah, all the things he did, I see, are very trendy right now. We didn't appreciate it at the time. Like with a lot of things when you're young, you don't appreciate the wisdom of our elders.

Marty Stevens-Heebner:
So true. Now, let's just get straight to it. What are the different types of cannabis and how can they help us?

Susan Feldmeth:
We'll talk about the two big categories of cannabis. Because we hear marijuana, which is a slang term for the recreational type of cannabis that is usually a short, bushy plant. Lots of flowers. Tends to have high amounts of THC. THC stands for tetrahydrocannabinol. That's the component that makes you high. And then there's hemp, which is a cousin. It's still in the cannabis family, but it has a tall, thick stalk, fewer flowers, and has many thousand industrial uses for hemp. And it primarily has CBD, cannabidiol. It can have, in this country, a third of 1% can be THC, but not more than that. We see a lot of CBD products from hemp because they don't have the same restrictions as a product that's from the marijuana plant.
And I hate saying marijuana because it's a slang term and the plant is called cannabis. Cannabis is a plant, so it has a lot in common with other plants. And if you think about tomatoes, there's beefsteak tomatoes, cherry tomatoes, zebra tomatoes that are green and stripy. There are so many different variations of tomatoes. They're all tomatoes, but they taste a little different, they look a little different, and that's how it is with the cannabis plant as well.

Marty Stevens-Heebner:
That's so many different kinds.

Susan Feldmeth:
There's multiple strains. A lot of times in a dispensary, you'll hear the terms indica and sativa. They'll say indica tends to be more sedating, and sativa is more uplifting.
What tells you about the plant is the concentration of cannabinoids. Cannabinoids is a new term probably for a lot of people. CBD and THC are both cannabinoids. That's a family of compounds found in the cannabis plant. These cannabinoids have lots of different benefits and act on different receptors in our body.

Marty Stevens-Heebner:
How did you come to start using cannabis to help your mom?

Susan Feldmeth:
The story of my mom is interesting because there's so many parts to it. She was on Norco, which is an opioid, for her pain, taking three or four capsules a day, and she was still in pain and miserable and wanted to die and said it many times a day. She also had the beginnings of dementia at the time.
Her pain management doctor is the one who suggested, "You might want to look into medical marijuana, because I can't go up on her dose anymore. It's not safe." My thought was, "This guy's a quack. How can he recommend medical marijuana for my mom?" All I knew is I'd learned my whole life that it was something bad. And I initially said, "We're not going to do that." And then I thought, "Well, let me learn about it and understand what I'm actually saying no to and why would he recommend it.
That's when I had listened to a podcast about the science of it and was blown away and had to learn more. And I was very skeptical the whole time. Can this be real? It sounds too good to be true. Because the information sometimes you find on the internet are from sources that seem dubious and don't seem to have a medical background, and I just didn't believe it.

Marty Stevens-Heebner:
What changed your mind?

Susan Feldmeth:
That's when I found the American Cannabis Nurses Association. So in my mind, it seemed a little bit more legitimate if nurses were looking at it. And the nurses had their educational modules in a way that I understood, kind of boring, scientific approach, which made sense to me, talking about our endocannabinoid system, which all humans have.
It's a system that was discovered in the 1990s by an Israeli scientist, and he discovered a whole new set of receptors that had never been identified before, primarily concentrated in your brain and central nervous system and on the cells of your immune system, and they're found on multiple organs, tissue types, bone. Everywhere that has a cannabinoid receptor is going to interact with the cannabinoids in cannabis.
The next question was why would our body have receptors to a plant? We have receptors because our body makes cannabinoid-like compounds. So our body produces these chemicals only as needed, on demand. And the whole purpose of the endocannabinoid system is to maintain homeostasis, to maintain the body in balance. So when something happens to throw us out of whack, like for my mom, it would be lots of inflammation due to her arthritis, causing a lot of pain.

Marty Stevens-Heebner:
What triggers that system into action, and how frequently does it go to work for us?

Susan Feldmeth:
For us, on a daily basis. It could be walking down the street, a car swerves, almost hits you, and you have to jump out of the way. So your heart rate goes up, your blood pressure goes up, you have a surge of adrenaline. But once the danger passes, you have to come back down to baseline. So that's when your endocannabinoid system kicks in. The chemicals are released and it says, "Okay, danger's over, and everything come back to normal." So that's what this system does. It's working in the background.
As we age or have some kind of a disease process, our endocannabinoid system can get out of balance. As we age, we don't make as many of these endocannabinoids, and so supplementing with plant cannabinoids seems to be pretty effective.
As we get older or as we watch our parents get older, they tend to be more anxious about things that they could have handled in the past, and you're like, "What's the big deal? So you have two doctor's appointments on one day." That's too much and they freak out. But I think a natural function of aging, just the way we don't make hormones like we used to when we were younger, we don't synthesize vitamin D as well as we did when we were younger, I think we don't synthesize and make these endocannabinoids that help stabilize our mood and anxiety response as well as we did when we were younger. So I think they're just not as capable to rein those feelings in. We don't make as much melatonin, so we don't sleep as well sometimes as we get older, which is natural.

Marty Stevens-Heebner:
When did you first start using cannabis with your mom?

Susan Feldmeth:
Well, my first trip to a dispensary was 2016, and it's not the way it is today. You needed a letter of recommendation from a doctor to go to a medical dispensary. I'd assume it would be like a pharmacy. I foolishly asked if I should bring my mom, if they would want to monitor her after she had her first dose, and the doctor laughed and said, "No, it's not that kind of place." I purchased some CBD gummies, some chocolates, and we gave the first dose to my mom. It was probably five milligrams of CBD.

Marty Stevens-Heebner:
I'm just going to interject here that you and I live in California.

Susan Feldmeth:
Yes.

Marty Stevens-Heebner:
Where now we can go buy it on our own. There are a lot of states that are like that now, but back then, it wasn't legal to go do that. Now it is in many states.

Susan Feldmeth:
I think there are 38 states where cannabis is medically legal. CBD from hemp is legal in all 50 states. Back then, there were a few more hoops to jump through, and in certain states, people might still have to go to a doctor to get a letter of recommendation. Cannabis is not prescribable, so you can't go to a doctor to get a prescription.

Marty Stevens-Heebner:
Nothing approved by the FDA, in other words, at this point.

Susan Feldmeth:
Nothing approved by the FDA. THC is still a federally illegal substance. That's why it's difficult to research in this country. So each states are coming up with their own laws, and in California, it's a lot easier and we have products readily available.
I would really stress to go to a licensed dispensary. It's more expensive because you are charged lots of taxes, sales tax, the state cannabis tax, and then there's usually a local tax, but you're insured that every product is lab tested, so there are no contaminants. What it says on the label of the product is what's in the product. A lab tested product is crucial.

Marty Stevens-Heebner:
You don't want to just go to some dealer who could lace it with who knows what.

Susan Feldmeth:
No.

Marty Stevens-Heebner:
Go to a licensed dispensary.

Susan Feldmeth:
And especially now in the era of fentanyl and fake pills, that's extremely dangerous to do. So going to a legal dispensary and purchasing a product avoids a lot of that, because if you buy from a reputable CBD company, you Google the US Hemp Authority and see what their recommended companies are, it has to jump through lots of hoops to qualify and get that seal.

Marty Stevens-Heebner:
That's very important. That's great to know.

Susan Feldmeth:
So it's good to do a little bit of homework. So little by little, we were able to wean my mom off of her opioids. Actually, quicker than I expected. A few months that she'd been on a regular CBD dosing schedule, she was home from the assisted living facility with me and my family for the weekend, and I heard her laughing. That's when I realized it had been about three years since I heard my mom laugh. She had been very negative for the last few years with her arthritis pain. Very pessimistic, just not herself. So little by little, I felt like her old self was coming back. She didn't have the constipation issues she did while she was on the opioids. So-

Marty Stevens-Heebner:
Talk about unpleasant. Yeah.

Susan Feldmeth:
It makes you miserable. The opioids changed her personality. So it was nice to see that coming back. We did have to add some THC to her routine at nighttime, because for some people, CBD can be stimulating and it makes them awake and alert. For other people, it can be really relaxing and almost make them drowsy, and you just have to gauge how it makes you feel. I take CBD, a small dose every day. I don't feel either of those. I just feel regular.

Marty Stevens-Heebner:
I'm sure it depends on the plant itself, because you talked about all the varieties, the way the product is manufactured, and then our body chemistries are so different. So our CBD system that's built into us can be very intricate and will respond differently.

Susan Feldmeth:
That's why there's no one dose fits all, even for each condition. So everybody has a personalized CBD or cannabis program, and you just have to see how they respond.
We use some CBD products at the Kensington, which is an assisted living and memory care facility in Sierra Madre, California. Our approach is the same for everybody. We start with a low dose. But it's amazing to me how nine milligrams once or twice a day has transformed a person from being anxious to just going with the flow or participating more, sleeping better. So we start at this low dose and go up as needed, based on the response of the person.
There was one point where my mom needed a hundred milligrams in the morning of CBD, a hundred milligrams in the afternoon of CBD, and 15 milligrams of THC at bedtime. Now, for you and I, 15 milligrams of THC, you'd have to peel us off the ceiling, I think.

Marty Stevens-Heebner:
Wow.

Susan Feldmeth:
We slowly went up to that. And they do find that for some reason, older women have a higher tolerance for THC. I don't know why.

Marty Stevens-Heebner:
We have a higher tolerance for everything.

Susan Feldmeth:
So that's when she was at her height of her arthritis, her anxiety, everything. And then over time, I was able to decrease her down. When she was doing well, I said, "Well, let's see if she can tolerate less." You really have to listen to your body and sometimes go up on the dose, and sometimes you can go down on the dose and just see if you're getting the same effect.

Marty Stevens-Heebner:
Body chemistries do change over time. You mentioned the tolerance situation. And your mom was very fortunate to have a daughter who's a registered nurse. So it's not only if you're able to express what you're feeling, but also, if somebody has dementia, to be very observant of their movement and how they're reacting.

Susan Feldmeth:
As a nurse, you would think I come with a tool bag of all this knowledge, but it was hard for me to get the information I was seeking, to get the dosage guidance that I needed. I really had to wing it and figure it out on my own, and so that's why I ended up starting my company to share what I've learned, because it was a long journey, and I'm still always learning, and share this in an easy way to help guide people. As a nurse, I can't prescribe or tell people what to do. I give them the education and steer them towards products that I feel are reputable.

Marty Stevens-Heebner:
And as you mentioned, it can't be prescribed anyway.

Susan Feldmeth:
A lot of times, doctors, they would just shut a person down who wanted to try it and discourage them. But now, at least with CBD, I think they're confident that it's not harmful if you get a good product. They can't give you much guidance, but they'll say, "Yeah, I think you can try it and have some success with that."

Marty Stevens-Heebner:
Here's when I really discovered especially pain relieving benefits. I was on vacation at this place and I got a massage there, and they would use the CBD oils on you. And I've been having the knee, the back, the this, the that, and it was cold. I did that treatment. I got up, put my jacket on. As I'm walking down the stairs outside, I'm not feeling any pain. I turned around, went back in and said, "What products did she use?" They had the products in their store. I bought them, and they're wonderful.

Susan Feldmeth:
Using topical products like that is a real good way for people to start who are nervous about using a cannabis product. A lot of times people will say, "For pain, what's the best way to do it? To ingest it, to use it topically?" And there's not one best way. For my mom, my plan was to attack her inflammation from all sides. CBD is very anti-inflammatory. She was taking something internally, the oil, the capsules, the chocolate, the gummies.

Marty Stevens-Heebner:
You told me that you had this ingenious way of creating one dose for your mom so that if someone else was giving it to her, it wouldn't mess things up.

Susan Feldmeth:
When she was at the assisted living facility, I would buy the cannabis oil, and I knew what dose I wanted her to have, so I started making little chocolates. I bought these molds and each chocolate would have her dose or close to it. Another time, I would pre-fill a bunch of syringes, and one syringe was a dose. So she would get a syringe in the morning, a syringe in the evening.
For a long time, I thought, "Let's avoid THC. That's the bad one. CBD is the good one," but that's not the right way to look at it. THC has a lot of beneficial properties, you just have to be more careful because it's intoxicating at a certain level. I didn't want them to accidentally give my mom too much THC and give her a bad experience or lower her blood pressure too much or whatever, so that's why I pre-measured syringes, I prefilled capsules. I went through lots of different iterations. Because not only did I want to help my mom get better, I found this so fascinating. I just wanted to learn more and she trusted me completely.

Marty Stevens-Heebner:
You're a registered nurse. Of course.

Susan Feldmeth:
And her daughter and the one who always has taken care of her when she's needed something. But we also used topical products on her knees and her shoulders. You have something.

Marty Stevens-Heebner:
I have my little thing. It's calming for a little stress. A friend introduced it to me. It's topical. I just put it on and it smells nice and I don't feel high or anything like that.

Susan Feldmeth:
No, that's a great thing to use. So for pain, when you apply something topically, you're attacking the inflammation and the pain from the outside in. It doesn't work for every kind of pain. Like my mom had hip arthritis, and I think that was too deep in her body for it to penetrate. But knees are bony, right at the surface. Neck, hands, feet. All those little bony joints that are closer to the surface are easier. And I would say to do it twice a day if your pain is every day, and then you can apply more as needed.
We even taught my mom how to use a vaporizer. It looked like a little electric cigarette that was formulated specifically for pain. It had two parts THC, one part CBD. Each dose was measured. When you inhale it, the little plastic cigarette would vibrate and that told you the dose was delivered. We found that where she'd been sitting for a long time and if she had to get up to go to the bathroom, she had to go quickly, but the pain was sometimes too much at that moment. If we gave her one little inhalation, it worked very quickly. It didn't take all her pain away, but it took the edge off enough that now she can get up and go to the restroom. So it's not necessarily which product do I use. I think it was nice to have different types of products on hand.

Marty Stevens-Heebner:
Think about over-the-counter medications. Each of us knows which one works best for us. I've had people talk about a certain brand, like the T for the flu, and there's the M brand. The M brand actually works for me, but the T brand doesn't.

Susan Feldmeth:
Body chemistry is different. And I find that the people who don't give up right away are the ones who generally find success, because there are so many different products out there. It took us a while to realize we needed to add a little bit of THC to my mom's program to get better results. And just listening to your body. It's fascinating, each person becomes an expert on themselves and what works for themselves.

Marty Stevens-Heebner:
You had mentioned earlier that your mom came to rely much less on the opioids. Is cannabis good for helping to ease what could become an addiction to opioids? Because as we know, that is rampant.

Susan Feldmeth:
Yeah, they have shown that CBD is helpful in any kind of addiction. A lot of times it helps to deal with the withdrawal side effects of coming off of either alcohol, drugs, opioids, which is one of the reasons why people don't want to stop using it is because they can't tolerate the effects of not using it. And if it's helping the pain that the opioids were helping, you need less of the opioids because your pain is getting addressed, that's another way it can help. But it also helps with the cravings that were reward-seeking behavior. CBD tends to help regulate that as well. THC, marijuana was always talked about as a gateway drug when I was in school and as a kid.

Marty Stevens-Heebner:
I remember.

Susan Feldmeth:
But some addiction specialists are using it as a exit drug. It's easier if you add cannabis to a person who's already addicted to something, and you shift their reliance on whatever hard drug they were on. It's much easier to then get them off of the marijuana than it was to just cold turkey get them off of cocaine or heroin or whatever they're on. So it's been interesting to see that it can be used kind of the opposite of the way we were told.
I really didn't believe when I saw the list of things that people used CBD to treat, because how can it possibly treat alcoholism, Alzheimer's, cancer, arthritis pain, all these different things? Once I understood how our endocannabinoid system works and we have receptors throughout our body, these cannabinoids from the plant interact with the receptors in our body, different organ systems, I do understand how cannabis can have an effect on all those very different conditions.

Marty Stevens-Heebner:
Sue, what do you wish people knew about what you do, but they generally don't know?

Susan Feldmeth:
I wish they would know not to be fearful of this plant and to ask the right questions. To talk to their doctors about it, to find answers from a health professional. There aren't a lot of cannabis nurses out there, but there are some.
People think I sell products, but I don't. I just share information and give dosing and product guidance. I'm not a doctor, but I do share the information and the education for a person to advocate on their own.
I want people to advocate for their own health, and if they really think CBD or THC is something that can benefit them, keep at it and give it a try and you'll see for yourself. Chances are you're not going to get the results quickly, because it's not that kind of product. It's not like a pharmaceutical that sometimes hits you hard and fast. It's gentle.
There's documentation and evidence of at least 10,000 years of cannabis plants being used medicinally, but the plants back then were not as potent with such high levels of THC as they are now. Nowadays in a dispensary, you can get a product that's maybe 20, 30% THC and naturally occurring in the plant. The way nature intended was maybe 3% to 5% THC or less. So yes, the plants of today are the Frankenstein version of the more naturally occurring.
So it all goes to dose, and a little goes a long way, especially with THC. THC dosing tends to be very low. Maybe one milligram, maybe two milligrams. I wouldn't start at five milligrams. I think that's probably too much to start with. CBD dosing is much more generous, anywhere from 10 milligrams to there's kids with severe epilepsy who are taking 1,500 milligrams.

Marty Stevens-Heebner:
Wow, and I just want to reiterate, what you're talking about is made from hemp, which is legal in all 50 states.

Susan Feldmeth:
Yes. There's good hemp products and there's good cannabis products. So not to say one is necessarily better than the other, it depends on what each individual person needs. I like to start with hemp products, just because it's less expensive.
And to find a good quality product. Do a little bit of research. A reputable company will send you or let you access the certificate of analysis, the test results that there are no pesticides, heavy metals, contaminants in the product, that the milligrams are what's stated on the label, with a little bit of variation because it is a natural plant.

Marty Stevens-Heebner:
That's Mother Nature for you.

Susan Feldmeth:
That's right.

Marty Stevens-Heebner:
This is just a wealth of information, very important information, and I'm so grateful to you for being on this episode.

Susan Feldmeth:
Thank you. I was so happy to be here and enjoyed talking with you.

Marty Stevens-Heebner:
Thank you so much for listening to How to Move Your Mom (and Still be on Speaking Terms Afterward). Please visit howtomoveyourmom.com for more information about this episode and for additional podcast episodes featuring other extraordinary guests and conversations. Until next time, this is your very grateful host, Marty Stevens-Heebner.