March 13, 2019 • 42 mins
Joel T Nowak from Cancer ABCs along with oncology nurse Fran Fanning (co-owner of Heavenly Hash) participated in a prostate cancer patient conference sponsored by Prostate Cancer International. The conference was held in Ft. Meyers Florida in March of 2019.
They offered a live presentation that described how hormone therapy worked, how it is achieved, its side effects as well as some "grassroots" methods used by men to control the side effects caused by ADT (hormone therapy). Fran's presentation included information and a discussion about the role of CBD and THC (marijuana) in cancer care.
Both Fran and Joel also answered many questions that were asked by the men and their support givers who were in attendance at the conference. Although most of the questions were about ADT, they also fielded other related questions about prostate cancer treatments as well as Cancer Thrivership.
Voice over introduction by Amber Bloom.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:15):
Welcome to this cancer ABC's podcast.
This podcast was recorded onMarch 2nd, 2019 in Fort Myers,
Florida.
It is alive, edited recording ofa presentation given by Jolty
know, ACC and Fran fanning onhormone therapy side effects for
prostate cancer.
The presentation was given as apart of a patient conference
(00:36):
presented by prostate cancerinternational cancer.
ABC's makes no representationabout the legal use of either
CBD or THC.
The laws vary state by state, socheck carefully with your own
state and municipality beforeobtaining or using any of these
substances.
If you obtain or use any of thesubstances are products
mentioned in this podcast, youdo so at your own risk.
(00:59):
The opinions expressed in thepresentation are solely that of
the presenters and not that ofcancer.
Abcs onto the podcast.
Speaker 2 (01:07):
Welcome everybody to our hope here is to answer your
questions about hormone therapy.
What I'm going to do is inviteanybody if you have questions as
we go along to raise your handand depending upon the flow,
Fran arrived, they recognize youat that point or not.
We also have a couple of naturalbreaks, so we have the slides
(01:29):
that we'll say any questions,but if something is burning and
you're afraid you're going toforget, stop us.
We're here.
And what if to help you learnmore about hormone therapy.
My goal in my presentation isfirst to describe hormone
therapy, how hormone therapy ispracticed, and some of what I
referred to as the grass rootsmethods that people have devised
(01:50):
in order to help remediate orminimize as much as possible.
The side effects, how do we dohormone therapy and why do we do
hormone therapy?
We're trying to aim for walkyour body's production of
testosterone and the other andbudgets.
And the second question, hormoneon therapy is to block the
(02:13):
ability of the cancer cell toutilize whatever hormones are
still made by your body.
We have basically two lines,hormone therapy, Gary's, what
we've heard too, or I referredto as crime area.
It's strokes, like we'll try oneof the common ones.
And then we also have drugs likeby glutemide.
Lou prime stops the productionof testosterone from the testes,
(02:37):
and that's about 90% of thehormones that a man's body will
produce.
We're still producing hormones,so we also use drugs that block
the ability of the cancer cellto use it.
Then on the surface of thecancer cell, you have these
receptors and think of them asif their locks and keys.
This is the simple way to it.
(02:59):
The testosterone will flow byand fit into that key into the
receptor, which then takes thetestosterone in and allows it to
get to the nucleus where it willhelp the cancer cell growth.
We have the drugs that stop theproduction from the testes and
then we have the drugs.
Cassa decks, also known as buyCaluda might fit that key on the
(03:21):
surface of the cell so that whentestosterone that is being
produced flows by.
You can't get in because it'salready you key in the lock, but
we have different ways toactually do hormone therapy.
The first way that it was everdone was to orchiectomy.
We still use orchiectomy or heectomy is not as common in the
United States.
It's used a lot of other placesin the world.
(03:43):
Basically it's the surgicalremoval of the testicles.
If you don't have testicles, youcan't produce testicular
androgen.
You can have prosthetictesticles installed.
That restores the test is to anormal thing, so you're not
necessarily facing looking sodifferent.
We also use what's called Lhrhagonists.
(04:04):
The examples being Lupron,Elegua Bar, those are the ones
that stopped the testicularandrogens.
There's a relatively new onecalled dagger, Dell X, also
known as Firmagon.
It has a different mode ofaction.
It's a shot that's every 30days.
The Lupron and the yellow.
You can get a one month, twomonth, three a month in a six
month option.
(04:24):
Firmagon obsessively every 30days.
You have to be obsessive aboutit.
Estrogens, the first chemicalway of creating castration.
Estrogens have some advantagesand some disadvantages.
The biggest disadvantage in theUnited States is there.
Not a lot of doctors use it andthey don't know what they're
doing with it.
It's very difficult to get agood balance of estrogen, the
(04:47):
best way to use it as do patchesand if you do decide to go that
route, you want to make surethat you're the doctor has some
experience in helping you tobalance out the levels because
these patches from one brand toanother not consistent and how
much the body absorbs them hadbeen originally some concern
that giving estrogen to menbecause we use thing whole des
(05:08):
they cause all sorts of birthdefects and it also causes a lot
of stomach issues and so forth,but if you use it to attach, you
avoid that whole way ofabsorption.
Best Way to do it if you'regoing to go that route.
Haven't experienced doctor workwith you and use patches.
We also, as I mentioned, havethe Anti Androgens.
Those are the drugs that fitinto the key holes.
(05:30):
There's also now newer drugs orhormone therapy and most people
don't realize this, but drugslike at standing enzalutamide
and Abiraterone, I was, it gotthere actually hormone therapies
also, but I think of them asbeing hormone therapies on
steroids.
What they do is not only blockthe testicular androgens but
(05:52):
they also block the testosteronethat is also being created by
the adrenal glands and also bythe cancer cells themselves and
also probably by fat tissue inyour body.
It's a more complete blockade.
These are the new drugs and area lot more expensive and as you
become castrate resistant, whichwe'll talk about, usually you
(06:13):
move on from through prime, thenadd those drugs later on.
Two common ways that androgentherapy or ADT or hormone
therapy or delivered ondifferent schedules.
Sometimes they're deliveringcontinuously from the moment you
start it, you stay on it untilyou died.
If she get hit by in New YorkCity, but that's my goal in my,
by the way, he wouldn't answer.
(06:34):
I want to dine out of cancer andmy died to get hit by a New York
City to us.
Some of us will take it forever.
There is a move and I do this ascalled intervention.
I go on and off the therapy.
There is some controversy as tohow effective it is in the sense
of how long you survive.
There's a lot of data that showsthat men who do intermittent
(06:55):
means you go on for a period oftime, you'd get that PSA down,
you hopefully see regression inyour scans, you in reality
improve the quality of your lifeand then when your PSA gets to a
certain point or your scans doneto a certain point in
consultation with your doctor,people that got there is some
issue as to whether or notyou're sacrificing survival for
(07:15):
that.
The numbers are index.
There's some great big studiesthat show that there's really no
difference in survival andthere's some studies that show
there are very personal choice.
Why do I do it?
I'm prepared to give up a coupleof years of my life to have a
much better quality and I havehad a better quality, but if you
have aggressive disease, Gleasoneight nine a lot of disease
(07:37):
decision you need to make invery careful consultation with
your doctor and get a secondopinion on it.
Second opinions on everything isvital.
There is also some controversyas to whether hormone therapy on
its intermittent.
First Kenny was whether youbecome castrate resistant
sooner, so there's some peoplethat believe that if you stay on
hormone therapy continuously,you may develop resistance more
(07:59):
quickly.
It was a good break time.
Any questions or comments?
Speaker 3 (08:02):
Long Story Short, I had testicular cancer in my
twenties I had the orchiectomy Ihad at the time what was normal
radiation.
They radiated me from my chestto just above my knee.
I am now paying the price forthat over radiation.
Two years ago, two and a halfyears ago, I was diagnosed with
(08:25):
prostate cancer, went toMoffitt.
Dr Pals Sang, said that I am nota candidate for radiation
therapy because I'm been overradiate.
It sent me down here for aprostatectomy, perineal
prostatectomy, and just recentlymy PSA has quadrupled in the
last year or so.
Two days ago I went to a medicaloncologist and she was very
(08:47):
loved London without survivalrate.
This is the only option.
I responded every single time.
Somebody said, well, you gotthis, do this, do this.
I don't want to take her wordthat that is my only option.
Corn on therapy would, should Ido?
Can I wait and see if there wassomething else six months down
(09:07):
the line?
Speaker 2 (09:08):
I am a voracious proponent for second and third
opinions and I would never makean important medical decision
without being very comfortablewith the decision.
One way that I becomecomfortable with the decision
besides doing research, I alsowould need to speak to a second
and the third doctor, maybe evena fourth doctor.
(09:29):
I will share a brief story.
I have a pen to seal cancer,which is a rare cancer.
There was only seven people inthe United States that have ever
treated it.
When I was diagnosed, I saw fiveof the seven and I spoke to the
other two on the phone and Ithink I made the right decision
and that helped me make adecision and I ended up doing
something that none of themreally had suggested.
I kind of merged stuff.
(09:50):
I think I'm going to urge you toget at least a second opinion.
Insurance companies will pay forsecond opinions.
I've never had them.
Even though I had five opinionsand I got billed for, I never
had a peep from my insurancecompany.
That doesn't mean you're notgoing to, but they will
definitely pay for secondopinions and you should always
take advantage of that.
Yes.
The hormone therapy, should youaccept the word of the
(10:15):
radiologists that you're dealingwith the oncologist or should we
seek a hormone related?
Doctor Hormone therapy isusually, and the most
experienced, our medicaloncologists particularly who
specialize in prostate cancer,he has, there are urologists who
also will use it.
What I think is important whenyou pick a doctor, a little bit
off topic, but I think I'm gonnarespond to it.
(10:37):
What's important when you takeyour doctors, get a doctor who's
very experienced, the moreexperienced your doctor is, the
better the cancer control andthe better the outcomes and the
side effect profiles.
It's been demonstrated time and,and again I think it was
reflected in the opening sessionwhere are presented and talked
about things getting better.
(10:57):
Part of that he referred to withthe technology, but when he
didn't say it was also theexperience of the person who's
performing the procedure.
I think Mike touched on thatvery briefly when he asked him,
well, how many of these have youdone?
That's a really importantquestion.
How many of these procedureshave you done?
The data is clear.
The more experience, the betterthe outcome, and you as a
(11:19):
patient should always ask thedoctor, how many of these
procedures have you done?
It's important.
Never be afraid to ask yourdoctor a question.
What's a doctor?
The doctor was a really welleducated contractor and that's
the way I approached my doctor.
I have a lot of respect fortheir experience and their
education, but I'm the one who'sgoing to go home with the
(11:41):
result.
If not, then they're going offto the next patient or whenever
I'm going home with the results.
So I have to be responsible asan oncology nurse and number 30
years.
It is extremely important onceall the saying.
Um,
Speaker 4 (11:54):
and you need to be comfortable with what that
doctor's telling you, that theywill listen to you, that they
will listen to your ideas thatyou bring to them.
If not, they may not be theright position for you.
And it's 100% oak pay to getthat second, that third opinion,
depending on their training,depending how long they've been
practicing, depending on theirbeliefs, they may not coincide
(12:17):
with yours.
So important to do just that.
Thank you.
Yup.
Speaker 2 (12:24):
One footnote to, I'm very familiar with prednisone
and I'm going to tell you thatis a
Speaker 4 (12:28):
horrible, horrible, horrible drug and hormone,
whatever you want to call it,work.
Okay.
How long of a period of time doyou see in the statistics from
the hormone deprivation therapyto the castration resistance?
Speaker 2 (12:47):
Excellent question.
And the answer is nobody knows.
First of all, it's verydifferent.
So if you read the literature,my understanding of the
literature is that one willnormally be on hormone therapy
for approximately 18 months.
I'm on 13 years.
And so you know what,
Speaker 4 (13:04):
that's a bullshit statistic.
Speaker 2 (13:07):
So I think it's very individual.
The vast majority of men that Ideal with, and again I talked
about the numbers go much longerthan 18 months.
There are some guys who Iunfortunately never have a
positive effect coming out ofthe starting gates.
A lot of it depends upon twocancer.
You have and Mike referred thismorning of the fact that we know
if there are 30 differentcancers, I suspect there's a
(13:29):
whole lot more.
We just haven't been able toidentify that.
Yes it is two years considered along time and so you went
continuous.
You are an intermittent orcontinuous continuous means
you're on forever and then threemore days after.
Speaker 4 (13:47):
I don't, did I answer your question though?
Speaker 5 (13:50):
If you want to do intermittent, no, go on and off
in consultation.
I need to really continue sayingthey didn't consultation with
your doctor.
You decide how long you want tostay on and how do you make that
decision in consultation, howyour PSA response, what was your
Gleason score if you were atGleason nine I personally am not
a doctor.
I personally don't singintermittent therapies and
(14:12):
terribly grand idea, so you'vegot to look at your Gleason
score.
For me, I had a Gleason seven Iwas a four plus three but I had
a PSA of four when I wasdiagnosed, I did surgery.
I went five years, no PSA, andthen it came back my first on
session I stayed on for about 14months.
My other sessions that cut itback to about nine months and
(14:32):
then they go off and I get goodlong periods, but that's my
cancer.
Your cancer may be different.
We don't have trigger points.
There's no research that saysyou go back on when your TSA
gets to here and you go off andget PSA is here.
It's not that scientific.
Speaker 2 (14:47):
Some of the side effects that men have complained
about, I only put some in redonly because I'm going to
briefly touch on those facts.
Flashes the most common loss ofmuscle mass, cognitive effects,
insulin resistance.
I think the important takeawayon this is that bottom
statement, not everyone sideeffects will be the same.
Not everyone's side effects willbe of the same intensity and
(15:11):
because the list is up here, itdoesn't mean you're going to get
it.
Don't get depressed by thislisting.
You're not destined to have is.
There are some guys that havehormone therapy and they say he
was the same and there wereother guys that are lose on the
floor.
We're in the range in themiddle.
What I have found from my ownexperience that when you're on
(15:32):
intermittence, the side effectsare not the same.
Each time I go on, I experienceddifferent side effects and I
experienced differentintensities so I can't even
predict it because it's upthere.
It doesn't mean you're going tohave it.
Speaker 6 (15:43):
In fact,
Speaker 2 (15:44):
remediation that I had been told about by other
patients at work or I playedwith it myself, a hot flashes,
cooling pillows and mattresses,net cooling wraps.
Some people think that wearingsocks to bed helps at night.
I don't know that it has for mepersonal fans.
I walk around, I'm back ontherapy and I walk around with
this and you'll see me sittinghere like this.
(16:04):
By the way, just I don't usuallyendorse products and I'm not
getting feedback, but this isthe best handheld fan I've ever
come to called old polar, o.
P.
O.
L.
A.
R.
It's rechargeable batteries.
It's got three speeds and it'sreally strong.
I get no money back from them.
I got it online.
I went to Amazon and I read allthe reviews and that was the one
that reviewed the best that Iactually like it and Amazon
(16:26):
doesn't give me a kickbackeither.
Although if you go to cancer,ABC is is your charity and trust
and I get 5.5% back.
I do admit that these are otherthings that I had cotton
handkerchief just I've got morecotton handkerchiefs shifts, I
carry my, you'll go anywherethat makes sure it's cotton and
polyester, polyester.
It just does not work.
That can try.
(16:47):
CDC got a nice pretty one,right?
They're layered clothing, deepbreathing and some men will use
estrogen patches.
The big thing, Wassup musclemass and physical strength.
We will have muscle wasting.
You have to do whatever you canto try to lose as little as you
can.
That's exercise and that'sweightbearing exercise for
muscle mass.
(17:08):
Go to the gym.
If you can find a trainer, finda trainer.
Ideally, if you find a trainerwho's dealt with people who have
cancer, that's always the best.
Can't always do that, but get atrainer.
Don't go into the gym byyourself and get help and
putting together a routine andalso will help motivate you.
Weight gain is another one.
My first round of hormonetherapy, I gained 45 pounds.
(17:29):
I was fat.
I started heavy, I've came fat,I did chemotherapy for another
cancer.
I lost most of that weight.
Stayed stable for two years onback on hormone therapy and four
months I'm up eight pounds.
That's too much and it all comesright here in the middle and we
know that fat in the middle isbad for the heart.
Hormone therapy is not good forthe heart.
(17:50):
There are cardiovascular issue,so we really want to be careful.
Watched how much we eat,exercise my family when I do
fuse to walk and move.
When they bought me a dog andthey came, here's your door.
We're not walking it.
He's actually now my bestfriend.
I want to talk briefly aboutemotional response being told,
(18:13):
you have cancer is tough.
We get depressed and then wetake these drugs and these drugs
including hormone therapy tendto add to depression.
It is normal.
It does not mean you're crazy oryou're sick.
What it means, perhaps findsomeone to talk to.
I recommend if you're feelingdepressed, go to a psychologist
(18:34):
or a social worker and find away to talk and also the
consider.
If you need to go to apsychiatrist for low dose
antidepressant.
I don't like the idea of anoncologist prescribing psych
drugs.
They're not experienced.
Go to someone knows what they'redoing.
There's nothing raw.
It's common.
We all suffer it.
(18:55):
We suffer depression because welive our life, but we set more
depression because we havecancer.
It's normal.
That doesn't have any meaning.
You're a person.
You're a human being expected,not a big deal.
It's really common.
Cognitive effects, pride, theconcentrate.
You got to work through it asmuch as you can, but if you do
feel this way, don't worry.
(19:16):
It's not you.
It's the drugs weight gain.
We talked about it.
Breast growth, very common.
There are some ways if it reallybothers you, oh you can before
you start the hormone therapy,you can't have your breasts
radiated.
Personally, I don't like itbecause you're exposing yourself
to radiation.
Radiation can cause secondarycancers, but it is something
(19:37):
that you can do.
Also, I'm going to back justbriefly met for, I mean on
weight gain, a med form.
It is a really good drug.
There's some evidence that madeform and actually will help
treating the prostate cancer.
It's a cheap drug.
It will keep your blood glucoselevels down and we'll help on
weight gain.
I'm on Metformin and insulinresistance.
The metformin hopefully willhelp stave off the development
(19:59):
of diabetes.
Bone density.
Again, exercise is so important.
There are some drugs that youcan take.
Certainly we should all betaking calcium and vitamin D.
You can take these other drugs.
I wouldn't do them.
I don't like the idea of peopledoing them until our hormone
resistant and then you got to doit carefully because long
exposure to these drugs quest,terrible fractures of the femur
(20:20):
so you gotta be careful.
Don't go lightly.
Speaker 6 (20:23):
And the cardiovascular events, it says
agonist versus antagonist.
The firm again is from a guy hasless cardiovascular or I believe
Speaker 2 (20:33):
that it has less.
Okay.
But it has other side effects.
You got an injection on thebelly and make sure you don't
get to get it on the belt line.
Make sure the nurse or thedoctor who's giving it to you
has given many more because ofthe injection is not given
correctly.
It will hurt
Speaker 3 (20:48):
for a long time.
We've been there, done that.
Okay.
Is it common to have the hormonetherapy and then Rudy?
That's an excellent question.
Speaker 2 (20:58):
There is a lot of good evidence that shows that
hormone therapy given truck herprior to the use of radiation
will enhance the radiation, willmake the radiation more
effective and good radiationdelivery lead.
You should involve at least adiscussion with your doctor
without preceding before I'm ontherapy.
There's a lot of good evidenceabout that because that's good
(21:18):
practice.
Should you pretreat with
Speaker 3 (21:20):
hormone therapy and continue on after radiation?
Depends upon your situation.
Could you comment on out lessalcohol?
That's kind of few less spicyfoods.
Speaker 2 (21:29):
Yeah.
Caffeine, alcohol, spicy foodstend to kick high flashes.
I know that.
I love spicy food.
I find for instance, I had somespicy food about a week ago and
I just waited like a pig.
Alcohol also can do that and socan caffeine.
Caffeine for me it doesn't, butalcohol and spicy food does.
It's individual.
If they basically kick hotflashes, you can see it.
(21:52):
If that's what it does for you,then you want to find a way to
avoid it or kind of down and ifit doesn't.
Joints.
Speaker 3 (21:59):
Question about other approaches.
Uh, you mentioned that form andthen I read about the possible
contribution there, butsomething I read about within
the last six months, it was asmall, just a small article and
I haven't heard it mentionedsince by anybody is talking
about the lock and key thingwith testosterone and the
(22:22):
Castleberry.
What I read was a cancer gets toa point where it gets around
supposedly as well.
I'm just telling you what I getsaround testosterone and moves
to, it's either cholesterol orsome derivative of it and it
picks up where the loss of thetestosterone left off.
(22:43):
And I've read where I thinkthere may be even a clinical
trial, I think it was inPennsylvania where they're using
a stat that was prescribed formorbidly obese people that is
supposed to target that.
Do you know anything?
Speaker 2 (22:59):
My understanding and I would qualify the amount of
any, any by any means an expert.
My understanding is thatcholesterol can break down and
create androgens that can thenfeed the cancer.
So it's actually not thecholesterol, but a byproduct of
it is my understanding.
And yes, there are men who dotake status with the idea of
controlling their prostatecancer.
(23:21):
A lot of people think of statusas being benign.
They're not necessarily benign,so you need to discuss that with
your doctor.
So the answer is yeah, there maywell be in effect, last question
we
Speaker 3 (23:32):
want for for the boom when it looks that would
mentioned there, you know weshould have for some action, you
know the recent risk fornecrosis of the Joe.
Yes.
From then and I read that of theoptions to prevent the breakdown
of the bone Boniva what do youthink of?
(23:54):
Well how are you,
Speaker 2 (23:55):
I don't know enough about the different drugs and
there are some differences and Ican't really speak to them but I
think what's really important,you know and that's something
you need to have a conversationwith your doctor.
But I think what's reallyimportant to start understand
that these drugs are not benign.
How'd you talked about the jarproblems though in j and then
also the femur fractures.
I'm glad you raised that.
Thank you.
Speaker 3 (24:16):
Now I'm going to ask ran if she would give her
presentation.
Speaker 7 (24:24):
Okay,
Speaker 4 (24:25):
so we're just going to do a continuation on managing
the side effects.
To answer your question, therewas actually a talk this
afternoon about chemotherapyside effects and we do talk
heavily.
It's with a medical oncologistand myself as well about Lnj.
So it will be in that.
Speaker 3 (24:41):
What did they do?
I backwards.
Sorry about that guy quoted usseparately.
You may be honest.
I don't know.
That's what I look at it andtastic I have my thumb drive.
Sorry about that guys.
So why we're friends working atany other questions or issues
people want to raise.
(25:01):
You haven't said anything.
Right?
Good.
Then.
Yeah.
Now you're on.
What about diet?
No one has said anything aboutdiets.
Yeah, no.
Well actually I said that youneed to control what you eat.
I think diet is a whole areathat you really need to talk to.
A nutritionist.
I would recommend that.
I think that you use anything.
I, again, I'm far from an experton diet.
I don't eat very well.
(25:22):
Uh, my wife will attest to that.
I think there are a lot ofpeople who really feel that
becoming Vegan or vegetarian candefinitely support anticancer
action.
Certainly lowering your fat,lowering carbohydrates will help
on weight.
Kind of frank, can you?
Yes.
You're better about diet.
So watching
Speaker 4 (25:40):
your sugars is, is a big part of it, especially when
you're talking about the sideeffects and as well as the Diet.
You know, there's a lot of mythsout there about cancer feeds off
of sugars, things like that.
More so it's managing andsymptoms and the side effects
and the things of that nature.
Sugars are actually going toincrease your immune system.
It's going to stimulategastritis.
So if you have underlyingconditions as well as helping
(26:03):
manage your diarrhea,constipation, things of that
nature, uh, muscle wasting.
Again, very, very importantbecause if you start to lose
muscle in general, you're goingto end up with problems being
able to ambulate, walk, set,things like that.
So it's really important thatwe're maintaining our muscle
mass.
Speaker 3 (26:21):
Any other questions in the meantime?
You having to ask for anythingyet?
Yeah, prospect, insert going.
Uh, I think cancer in general,including prostate cancer comes
from two different places isgermline genetics.
In other words, the geneticsthat you're born with, good
evidence that there's a 10 to20% of prostate cancers,
Speaker 5 (26:44):
probably germline.
Other the words you have it inyour family.
And it gets passed on.
I'm a great germline prostatecancer guy because my father had
prostate cancer.
His brother who is only siblingdied of prostate cancer.
His only son was treated.
My grandfather had prostatecancer and breast cancer and my
great grandfather, according tohis death certificate, I had
(27:06):
died of prostate prompts.
So I'm a really, although I havean older brother by the way, his
PSA is undetectable, so you doesjust because you have the
germline doesn't, you know, orthey have other members of your
family.
It doesn't mean your destinywith, and then I think the rest
of the cancers probably comefrom exposures that we have in
the environments.
And I think we're seeing moreprostate cancer today and more
(27:29):
serious prostate cancer.
Of course, we're exposingourselves to so many terrible,
terrible things in ourenvironment, drive our cars and
we breathed the air and thecities and farmers are working
with pesticides in the fields.
I mean, I think for veterans, weknow that they can significantly
damaged by their militaryexperience.
If you were in Vietnam, youprobably had some sort of level
(27:52):
of disclosure to agent orange.
We see today the guys thatfought in Afghanistan and Iraq
because of the burning oil wellsand they would walk through and
breathe this stuff that probablyis contributing to which
depleted uranium in artilleryshells.
You had a shell of blue up hereand then you walk by it, you're
exposed to depleted uranium, sothere environmental factors, so
(28:14):
there's germline, what you'reborn with and then your other
exposures with homophones or atleast what might be a typical
regimental continuous,continuous, continuous.
That's my opinion.
I personally, and again, I canonly talk to you about what I
would do.
Okay.
I'm not making a recommendation.
(28:35):
If I were a Gleason nine if Ihad multiple nines, I would be
continuous.
That's an aggressive cancer.
If I can knock my PSA down andknock my scans down, I
personally would not becomfortable allowing it an
opportunity to go back and grabhold again.
So you wouldn't wait until thePSA starts rising again.
I would say on a continuous likenever go off it.
(29:01):
That's a balance and that'ssomething that you really need
to speak to a couple ofdifferent doctors have af and
you're going to have to cause amagic trick here.
You're going to have to get youroncologist to talk to your
cardiologist.
If you can do that, please letme know how you did it and I
want to share it with otherpeople.
Well, you know, one of thethings that I look at is looking
at which ways to go.
(29:22):
It's probably the morecomfortable they are.
I don't know.
I sorted other hand.
Yes.
So the recommendation on calciumand vitamin D two assistants,
are there any specific levelsthat we shouldn't look for?
Is this something I would talk anutritionist and your
Speaker 3 (29:42):
oncologist.
Very easy.
Vitamin D three classes, a bloodtest.
It's inexpensive.
It's not a bad idea to do withthe Monitor.
Speaker 8 (29:49):
Sure.
Speaker 3 (29:52):
I was diagnosed stage four if the chemo they'll face
today.
Sorry, Tega just failed that.
Starting a new standing, Iguess.
What snacks?
You're asking me a question.
I'll just because you're feelingas though your size of birth or
that you get from being incollege.
Just that says here's thestandard of care order we do
(30:14):
things I don't like seeing that.
I'd like to see I oncologist whohas a lot of experience who will
look at you, look at yourdisease and be able to
understand what the guidelinesare, but figure out what's best
for you.
I think treating prostatecancer, seeing any cancer really
needs to be a very individualthing and that's fine.
You are comorbidities.
(30:35):
What else?
Issues you have if you haveillness or nothing.
Second Cancer, your cancer sideand we're still to a great
extent in the learning phase ofabout what prostate cancer is
and and I'm going to bemoderating a conversation later
on with a doctor Ellie.
Then Allen, that genomicapproach.
Mike referred this morning aboutthere being 30 different
(30:58):
prostate cancers and I saidthere's probably more and what
he's referring to is weidentified, I understand he's
can't just be different based onthe genomics, the underlying
genes, the genes, your cancer.
But are there other treatmentsafter Chemo and challenging
again yes and and so forinstance some of the options I
(31:22):
would look, how'd you sell,sequenced and find that if you
have a one of the Bracamutations or an ATM because then
you have potential of a PARPinhibitor.
Me, none of which are approvedbut you can get them.
Insurance companies are payingfor them.
I think that there are a coupleof other drugs, Saturday three
trials that are looking good.
You have a flexible doctor.
(31:43):
I would raise the issue oflooking at some of the
treatments that a littledifferent than ours in the in
that exact proof space that youget your insurance pay for it.
So does he drive that recently agroup called Apple glutemide
also know lead up early I e r le a d a apple glutemide is the
generic name you disapprove ornon metastatic castrate men.
(32:05):
But I have a guy who's taking itwho is burned through a number
of treatments including atSandy, Andy Sandy was some
changes in the molecularstructure.
Just a couple of little groups.
He has gotten the best PSA andscan response and tackling
anything.
His PSA is negligible.
He went from 800 to almostnothing.
So I think that's where theskill and the experience of your
(32:27):
oncologist is so important.
You want to go to a doctor, thisis what they do.
So they understand and know whatthe options are.
That's what I recommend.
But there are options also agood doctor will perhaps look at
some other the cancer treatmentsand say, cause I do know one guy
who took the chemo is reps andwelcoming and this was back
(32:50):
right, here's the go.
So we didn't have a lot of thesedrugs when I came up.
The options for follow up thereat the and though she patched
with chemotherapy.
Right.
And that was 1213 years ago.
Now we have a place I hearpeople use the word with or I
don't think so.
We have a lot worse and we havea lot of drugs that are in
development.
So I think we have every reasonto certainly feel optimistic.
Speaker 4 (33:14):
I apologize guys were having issues with being able to
download it but you don't havethe slides on here.
So basically what we're going totalk about is managing some of
the side effects especially.
Yeah, especially the symptomsand the side effects from
hormone therapy with CBD andunderstanding the difference
between CBD and the use of CBDversus what everybody knows as
(33:36):
marijuana.
And there is a huge differenceout there.
You look on your handout, wesolidify the differences between
hemp based CBD or cannabis thathas THC in it.
What everybody knows asmarijuana, it comes from two
different plants.
So basically how contains canavid oils or CVD now can have a
(33:56):
dials are part of ourendoccanabinoid system.
What does that mean to you?
It is something that is actuallynaturally found in our body as
mammals.
Yet them from a lot of the foodswe eat, I'll use one of the most
common that actually have[inaudible] and it's chocolate.
Why do we feel good when we eatchocolate?
Because the cow plant, we'rechocolates come from actually
(34:17):
have can the dials on it.
Mango was another thing thatactually has cadabra dials in
it.
So what's the difference betweenmarijuana and half?
Half was basically Rowan andused for textiles, for papers,
for fibers.
They grow very, very long.
They almost look like a bamboo.
They don't look like thoselittle tight plants at a
marijuana actually is.
(34:39):
They're used for the oil andhave them just benefit to the
oils.
They are non psychotropic saidthat means you're not going to
get high off of using a pure CBDoil.
Plants are extremely tall.
As I said, they can grow up to10 to 20 feet legal.
So CBD, in order for it to beillegal and you're not meeting a
marijuana card or a medicalmarijuana license on it must
(35:00):
contain less than 0.3% of THC init.
Most of them have 0.3% which isbasically zero.
Then there's some other levelsand there that have the THC, but
that's going to require amedical marijuana card.
Cannabis, again, we'll commonlyknown as marijuana.
It's actually grown for thebuds.
It's highly concentrated.
(35:21):
The high concentration of Thc,again is that six to 30%?
It is illegal all than thosestates that it is found that it
is, um, allowed or it has amedical indication.
So they talk about the greencards and the state of Florida.
It is legal for medicinal use.
Buy A, you will get thatpsychotropic effect from the
marijuana, so it's going to giveyou that a high.
(35:42):
And then the plants, like Isaid, do you not really have an
industrial application right nowso they're not used for their
fibers are not used for astrapping their oil.
It's not a thought, aremediation or the use of CBD to
help reduce some of those sideeffects from cancer treatments.
There's multiple uses out there.
They may be beneficial inhelping to reduce some of those
side effects.
So Kane, if it actually, whatCBD works on is in the
(36:06):
inflammatory system in our body,so they bind to what we call
canal receptors in our brains.
A CBD basically works directlyon the immune system so it can
reduce inflammation.
It can help decrease that nauseaand vomiting that sometimes you
can get from our medications,stimulate your appetite, not in
a way that you're going to haveit with Thc, but CBD can
(36:28):
actually help to stimulate theappetite or is very strong on
the GI system decreasinganxiety.
Joel talked a lot about that.
Depression.
CBD is very helpful in thatcalming effect in decreasing
anxiety and decreasing someeffects of depression.
Clashes just talked about thehot flashes because we're
working on decreasing theinflammatory system, decreasing
(36:50):
inflammation.
You're now going to also work ondecreasing hot flashes.
So again, hormonal therapies aresome of the things that we're
putting on, but even withprostate cancer that may not be
an option for you on may not beworking enough.
A lot of practitioners and a lotof patients that found that CBD
oil is very, very helpful forthat.
Decreasing fatigue and boostingenergy.
(37:11):
Again, it could help tostimulate and decrease some of
that overall fatigue that wefeel and then it has
antibacterial effects as well.
Again, these are just some ofthe ways that it helped
irritated skin.
They actually find that for alot of radiation burns that
using it topically it can help.
I'm down some of that rednessand some of that dryness that
they feel as well.
(37:31):
Speaking to your physician,making sure that it's not going
to interfere with your treatmentand how it may fit into you is
very, very important as well.
CVD applications and forms andavailability comes in a variety
of forms.
It can be topical, it can be anoil.
There's a lot of pure oils thatyou can add to your foods, put
underneath your tongue fornausea and vomiting and even see
(37:52):
sickness.
You can actually put it behindyour ear as well.
They can come in multiple foods.
I actually co represent themoncology nurse, but I also work
with another oncology nurse.
We have actually created acompany called heavily Hash
creamery.
We actually have CBD infused icecream and it comes in two
different ways.
One just to help get thebenefits of CBD, but we talked
(38:14):
about the[inaudible] and themuscle wasting.
We have a high protein ice creamformulation to help those
patients because who doesn'tlike ice cream?
I actually have a patient thatbenefits from it and actually
put some drops of it and one ofour air diffusers finds that the
kids who are very, very calmingeffect.
We have had patients thatutilize CVD.
They're able to come off withsome of their pain, so again,
(38:36):
it's important to talk to yourphysician, find out if it's
right for you or talk to yourclinician about it.
Speaker 6 (38:40):
That is kind of the quick,
Speaker 4 (38:42):
that's what I have.
Do you guys have any questions?
If the CBD is not marijuana, youdon't need a pursuit, you know
you do not need a prescriptionfor have me CBD, which is legal
in the state of Florida legaland all of the states.
If it has the marijuana, the THClevels, then you require a
Florida green card, but just CBDitself is 100% legal and you do
(39:05):
not need a prescription for it.
Are there different kinds of oilfor different things?
There's different, there'sdifferent milligrams stripes is
usually what there are.
There's so many companies outthere so everybody will have a
different oil.
Really what you want to makesure is that the oil is a pure
half based CBD oil.
I'm looking at the amount that'sin it and what it's going to be
(39:25):
useful.
Again, there's multipledifferent reasons and use the
sport and again, the milligramsrice, so it would be good for
hot flash.
What would you again, usuallyanything that we're going to be
taking internal and it's goingto help me because it's helping
you systematically.
So again, something like ananimal or an oil that you can
even add to your coffees, it'susually going to help.
Speaker 6 (39:47):
I just wanted to add to that.
Speaker 4 (39:49):
There's a lot you see CVD everywhere.
Please know.
Ask him about the testing behindshit.
Yes.
Don't take something that youdon't know where it's pretty
strong.
Right.
You want the seat to getincreased in United States as
they should have the testingparts behind it.
Right on, right on the wall.
Speaker 6 (40:08):
Yeah.
Oh Man.
That's kind of a trick question.
Speaker 4 (40:13):
Finding out that it's been produced in the United
States, it's going to be, it'snot FDA governed so much, so
what you're going to have isit's falls under what they call
generally regarded as safe work.
Ras, FDA approval, especiallyone of the
Speaker 6 (40:28):
animal.
Speaker 4 (40:29):
Ron in a paper lead it.
I also take CBD and I havevirtually no hot flashes.
There you go.
I love hearing testimonies.
It is an absolute wonderfulanxiety.
Hot flashes.
That definitely helps.
What way is it antiinflammatories?
How have they shown you couldset rates?
Yes.
So, um, if you go into thescientific studies and there are
lots of them out there, CBD hempderived CBD second avenue oil
(40:54):
from pure hemp, actual reason atworks on the cannabinoid
receptor to THC works oncannabinoid receptors, one in
our body and cannabinoidreceptor to actually work on the
immune system.
So that's how it works into theanti inflammatory properties and
how it was working in the immunesystem, how it works on our
hormone levels by decreasing ourhormone levels.
(41:16):
It actually, and again we'retalking about hemp derived CBD,
it actually can work to lowerblood sugars as well.
And there was lots ofstatistical data, um, in
scientific data out there on howit works and where it's working,
what inflammatory markers orthey have.
Yes.
And again, I don't have those infront of me, but I can give you
plenty of websites that you cango and you can see it.
(41:38):
There's testing being done atsome of the largest academic
institutions all over the worldin Europe.
They're far more advanced thanwe are when it comes to this and
the uses that they have beendoing to show its properties is
just, again, everybody isdifferent.
It depends on your body size aspawns in your body weight and
(41:59):
where you're coming from.
Most people, 20 to 40 milligramsis enough, but again, it depends
on what you're utilizing it for.
Natural Lane, we always tellpeople start low and slow and
kind of gradually go updepending on other medications
you're on or your symptoms thatyou have, but 2040 and 60
milligrams tend to be thatcommon.
Yeah.
Speaker 6 (42:17):
Yeah.
Any other questions?
That's it.
Great.
Thank you.
Welcome to this cancer ABC's podcast.
This podcast was recorded onMarch 2nd, 2019 in Fort Myers,
Florida.
It is alive, edited recording ofa presentation given by Jolty
know, ACC and Fran fanning onhormone therapy side effects for
prostate cancer.
The presentation was given as apart of a patient conference
(00:36):
presented by prostate cancerinternational cancer.
ABC's makes no representationabout the legal use of either
CBD or THC.
The laws vary state by state, socheck carefully with your own
state and municipality beforeobtaining or using any of these
substances.
If you obtain or use any of thesubstances are products
mentioned in this podcast, youdo so at your own risk.
(00:59):
The opinions expressed in thepresentation are solely that of
the presenters and not that ofcancer.
Abcs onto the podcast.
Speaker 2 (01:07):
Welcome everybody to our hope here is to answer your
questions about hormone therapy.
What I'm going to do is inviteanybody if you have questions as
we go along to raise your handand depending upon the flow,
Fran arrived, they recognize youat that point or not.
We also have a couple of naturalbreaks, so we have the slides
(01:29):
that we'll say any questions,but if something is burning and
you're afraid you're going toforget, stop us.
We're here.
And what if to help you learnmore about hormone therapy.
My goal in my presentation isfirst to describe hormone
therapy, how hormone therapy ispracticed, and some of what I
referred to as the grass rootsmethods that people have devised
(01:50):
in order to help remediate orminimize as much as possible.
The side effects, how do we dohormone therapy and why do we do
hormone therapy?
We're trying to aim for walkyour body's production of
testosterone and the other andbudgets.
And the second question, hormoneon therapy is to block the
(02:13):
ability of the cancer cell toutilize whatever hormones are
still made by your body.
We have basically two lines,hormone therapy, Gary's, what
we've heard too, or I referredto as crime area.
It's strokes, like we'll try oneof the common ones.
And then we also have drugs likeby glutemide.
Lou prime stops the productionof testosterone from the testes,
(02:37):
and that's about 90% of thehormones that a man's body will
produce.
We're still producing hormones,so we also use drugs that block
the ability of the cancer cellto use it.
Then on the surface of thecancer cell, you have these
receptors and think of them asif their locks and keys.
This is the simple way to it.
(02:59):
The testosterone will flow byand fit into that key into the
receptor, which then takes thetestosterone in and allows it to
get to the nucleus where it willhelp the cancer cell growth.
We have the drugs that stop theproduction from the testes and
then we have the drugs.
Cassa decks, also known as buyCaluda might fit that key on the
(03:21):
surface of the cell so that whentestosterone that is being
produced flows by.
You can't get in because it'salready you key in the lock, but
we have different ways toactually do hormone therapy.
The first way that it was everdone was to orchiectomy.
We still use orchiectomy or heectomy is not as common in the
United States.
It's used a lot of other placesin the world.
(03:43):
Basically it's the surgicalremoval of the testicles.
If you don't have testicles, youcan't produce testicular
androgen.
You can have prosthetictesticles installed.
That restores the test is to anormal thing, so you're not
necessarily facing looking sodifferent.
We also use what's called Lhrhagonists.
(04:04):
The examples being Lupron,Elegua Bar, those are the ones
that stopped the testicularandrogens.
There's a relatively new onecalled dagger, Dell X, also
known as Firmagon.
It has a different mode ofaction.
It's a shot that's every 30days.
The Lupron and the yellow.
You can get a one month, twomonth, three a month in a six
month option.
(04:24):
Firmagon obsessively every 30days.
You have to be obsessive aboutit.
Estrogens, the first chemicalway of creating castration.
Estrogens have some advantagesand some disadvantages.
The biggest disadvantage in theUnited States is there.
Not a lot of doctors use it andthey don't know what they're
doing with it.
It's very difficult to get agood balance of estrogen, the
(04:47):
best way to use it as do patchesand if you do decide to go that
route, you want to make surethat you're the doctor has some
experience in helping you tobalance out the levels because
these patches from one brand toanother not consistent and how
much the body absorbs them hadbeen originally some concern
that giving estrogen to menbecause we use thing whole des
(05:08):
they cause all sorts of birthdefects and it also causes a lot
of stomach issues and so forth,but if you use it to attach, you
avoid that whole way ofabsorption.
Best Way to do it if you'regoing to go that route.
Haven't experienced doctor workwith you and use patches.
We also, as I mentioned, havethe Anti Androgens.
Those are the drugs that fitinto the key holes.
(05:30):
There's also now newer drugs orhormone therapy and most people
don't realize this, but drugslike at standing enzalutamide
and Abiraterone, I was, it gotthere actually hormone therapies
also, but I think of them asbeing hormone therapies on
steroids.
What they do is not only blockthe testicular androgens but
(05:52):
they also block the testosteronethat is also being created by
the adrenal glands and also bythe cancer cells themselves and
also probably by fat tissue inyour body.
It's a more complete blockade.
These are the new drugs and area lot more expensive and as you
become castrate resistant, whichwe'll talk about, usually you
(06:13):
move on from through prime, thenadd those drugs later on.
Two common ways that androgentherapy or ADT or hormone
therapy or delivered ondifferent schedules.
Sometimes they're deliveringcontinuously from the moment you
start it, you stay on it untilyou died.
If she get hit by in New YorkCity, but that's my goal in my,
by the way, he wouldn't answer.
(06:34):
I want to dine out of cancer andmy died to get hit by a New York
City to us.
Some of us will take it forever.
There is a move and I do this ascalled intervention.
I go on and off the therapy.
There is some controversy as tohow effective it is in the sense
of how long you survive.
There's a lot of data that showsthat men who do intermittent
(06:55):
means you go on for a period oftime, you'd get that PSA down,
you hopefully see regression inyour scans, you in reality
improve the quality of your lifeand then when your PSA gets to a
certain point or your scans doneto a certain point in
consultation with your doctor,people that got there is some
issue as to whether or notyou're sacrificing survival for
(07:15):
that.
The numbers are index.
There's some great big studiesthat show that there's really no
difference in survival andthere's some studies that show
there are very personal choice.
Why do I do it?
I'm prepared to give up a coupleof years of my life to have a
much better quality and I havehad a better quality, but if you
have aggressive disease, Gleasoneight nine a lot of disease
(07:37):
decision you need to make invery careful consultation with
your doctor and get a secondopinion on it.
Second opinions on everything isvital.
There is also some controversyas to whether hormone therapy on
its intermittent.
First Kenny was whether youbecome castrate resistant
sooner, so there's some peoplethat believe that if you stay on
hormone therapy continuously,you may develop resistance more
(07:59):
quickly.
It was a good break time.
Any questions or comments?
Speaker 3 (08:02):
Long Story Short, I had testicular cancer in my
twenties I had the orchiectomy Ihad at the time what was normal
radiation.
They radiated me from my chestto just above my knee.
I am now paying the price forthat over radiation.
Two years ago, two and a halfyears ago, I was diagnosed with
(08:25):
prostate cancer, went toMoffitt.
Dr Pals Sang, said that I am nota candidate for radiation
therapy because I'm been overradiate.
It sent me down here for aprostatectomy, perineal
prostatectomy, and just recentlymy PSA has quadrupled in the
last year or so.
Two days ago I went to a medicaloncologist and she was very
(08:47):
loved London without survivalrate.
This is the only option.
I responded every single time.
Somebody said, well, you gotthis, do this, do this.
I don't want to take her wordthat that is my only option.
Corn on therapy would, should Ido?
Can I wait and see if there wassomething else six months down
(09:07):
the line?
Speaker 2 (09:08):
I am a voracious proponent for second and third
opinions and I would never makean important medical decision
without being very comfortablewith the decision.
One way that I becomecomfortable with the decision
besides doing research, I alsowould need to speak to a second
and the third doctor, maybe evena fourth doctor.
(09:29):
I will share a brief story.
I have a pen to seal cancer,which is a rare cancer.
There was only seven people inthe United States that have ever
treated it.
When I was diagnosed, I saw fiveof the seven and I spoke to the
other two on the phone and Ithink I made the right decision
and that helped me make adecision and I ended up doing
something that none of themreally had suggested.
I kind of merged stuff.
(09:50):
I think I'm going to urge you toget at least a second opinion.
Insurance companies will pay forsecond opinions.
I've never had them.
Even though I had five opinionsand I got billed for, I never
had a peep from my insurancecompany.
That doesn't mean you're notgoing to, but they will
definitely pay for secondopinions and you should always
take advantage of that.
Yes.
The hormone therapy, should youaccept the word of the
(10:15):
radiologists that you're dealingwith the oncologist or should we
seek a hormone related?
Doctor Hormone therapy isusually, and the most
experienced, our medicaloncologists particularly who
specialize in prostate cancer,he has, there are urologists who
also will use it.
What I think is important whenyou pick a doctor, a little bit
off topic, but I think I'm gonnarespond to it.
(10:37):
What's important when you takeyour doctors, get a doctor who's
very experienced, the moreexperienced your doctor is, the
better the cancer control andthe better the outcomes and the
side effect profiles.
It's been demonstrated time and,and again I think it was
reflected in the opening sessionwhere are presented and talked
about things getting better.
(10:57):
Part of that he referred to withthe technology, but when he
didn't say it was also theexperience of the person who's
performing the procedure.
I think Mike touched on thatvery briefly when he asked him,
well, how many of these have youdone?
That's a really importantquestion.
How many of these procedureshave you done?
The data is clear.
The more experience, the betterthe outcome, and you as a
(11:19):
patient should always ask thedoctor, how many of these
procedures have you done?
It's important.
Never be afraid to ask yourdoctor a question.
What's a doctor?
The doctor was a really welleducated contractor and that's
the way I approached my doctor.
I have a lot of respect fortheir experience and their
education, but I'm the one who'sgoing to go home with the
(11:41):
result.
If not, then they're going offto the next patient or whenever
I'm going home with the results.
So I have to be responsible asan oncology nurse and number 30
years.
It is extremely important onceall the saying.
Um,
Speaker 4 (11:54):
and you need to be comfortable with what that
doctor's telling you, that theywill listen to you, that they
will listen to your ideas thatyou bring to them.
If not, they may not be theright position for you.
And it's 100% oak pay to getthat second, that third opinion,
depending on their training,depending how long they've been
practicing, depending on theirbeliefs, they may not coincide
(12:17):
with yours.
So important to do just that.
Thank you.
Yup.
Speaker 2 (12:24):
One footnote to, I'm very familiar with prednisone
and I'm going to tell you thatis a
Speaker 4 (12:28):
horrible, horrible, horrible drug and hormone,
whatever you want to call it,work.
Okay.
How long of a period of time doyou see in the statistics from
the hormone deprivation therapyto the castration resistance?
Speaker 2 (12:47):
Excellent question.
And the answer is nobody knows.
First of all, it's verydifferent.
So if you read the literature,my understanding of the
literature is that one willnormally be on hormone therapy
for approximately 18 months.
I'm on 13 years.
And so you know what,
Speaker 4 (13:04):
that's a bullshit statistic.
Speaker 2 (13:07):
So I think it's very individual.
The vast majority of men that Ideal with, and again I talked
about the numbers go much longerthan 18 months.
There are some guys who Iunfortunately never have a
positive effect coming out ofthe starting gates.
A lot of it depends upon twocancer.
You have and Mike referred thismorning of the fact that we know
if there are 30 differentcancers, I suspect there's a
(13:29):
whole lot more.
We just haven't been able toidentify that.
Yes it is two years considered along time and so you went
continuous.
You are an intermittent orcontinuous continuous means
you're on forever and then threemore days after.
Speaker 4 (13:47):
I don't, did I answer your question though?
Speaker 5 (13:50):
If you want to do intermittent, no, go on and off
in consultation.
I need to really continue sayingthey didn't consultation with
your doctor.
You decide how long you want tostay on and how do you make that
decision in consultation, howyour PSA response, what was your
Gleason score if you were atGleason nine I personally am not
a doctor.
I personally don't singintermittent therapies and
(14:12):
terribly grand idea, so you'vegot to look at your Gleason
score.
For me, I had a Gleason seven Iwas a four plus three but I had
a PSA of four when I wasdiagnosed, I did surgery.
I went five years, no PSA, andthen it came back my first on
session I stayed on for about 14months.
My other sessions that cut itback to about nine months and
(14:32):
then they go off and I get goodlong periods, but that's my
cancer.
Your cancer may be different.
We don't have trigger points.
There's no research that saysyou go back on when your TSA
gets to here and you go off andget PSA is here.
It's not that scientific.
Speaker 2 (14:47):
Some of the side effects that men have complained
about, I only put some in redonly because I'm going to
briefly touch on those facts.
Flashes the most common loss ofmuscle mass, cognitive effects,
insulin resistance.
I think the important takeawayon this is that bottom
statement, not everyone sideeffects will be the same.
Not everyone's side effects willbe of the same intensity and
(15:11):
because the list is up here, itdoesn't mean you're going to get
it.
Don't get depressed by thislisting.
You're not destined to have is.
There are some guys that havehormone therapy and they say he
was the same and there wereother guys that are lose on the
floor.
We're in the range in themiddle.
What I have found from my ownexperience that when you're on
(15:32):
intermittence, the side effectsare not the same.
Each time I go on, I experienceddifferent side effects and I
experienced differentintensities so I can't even
predict it because it's upthere.
It doesn't mean you're going tohave it.
Speaker 6 (15:43):
In fact,
Speaker 2 (15:44):
remediation that I had been told about by other
patients at work or I playedwith it myself, a hot flashes,
cooling pillows and mattresses,net cooling wraps.
Some people think that wearingsocks to bed helps at night.
I don't know that it has for mepersonal fans.
I walk around, I'm back ontherapy and I walk around with
this and you'll see me sittinghere like this.
(16:04):
By the way, just I don't usuallyendorse products and I'm not
getting feedback, but this isthe best handheld fan I've ever
come to called old polar, o.
P.
O.
L.
A.
R.
It's rechargeable batteries.
It's got three speeds and it'sreally strong.
I get no money back from them.
I got it online.
I went to Amazon and I read allthe reviews and that was the one
that reviewed the best that Iactually like it and Amazon
(16:26):
doesn't give me a kickbackeither.
Although if you go to cancer,ABC is is your charity and trust
and I get 5.5% back.
I do admit that these are otherthings that I had cotton
handkerchief just I've got morecotton handkerchiefs shifts, I
carry my, you'll go anywherethat makes sure it's cotton and
polyester, polyester.
It just does not work.
That can try.
(16:47):
CDC got a nice pretty one,right?
They're layered clothing, deepbreathing and some men will use
estrogen patches.
The big thing, Wassup musclemass and physical strength.
We will have muscle wasting.
You have to do whatever you canto try to lose as little as you
can.
That's exercise and that'sweightbearing exercise for
muscle mass.
(17:08):
Go to the gym.
If you can find a trainer, finda trainer.
Ideally, if you find a trainerwho's dealt with people who have
cancer, that's always the best.
Can't always do that, but get atrainer.
Don't go into the gym byyourself and get help and
putting together a routine andalso will help motivate you.
Weight gain is another one.
My first round of hormonetherapy, I gained 45 pounds.
(17:29):
I was fat.
I started heavy, I've came fat,I did chemotherapy for another
cancer.
I lost most of that weight.
Stayed stable for two years onback on hormone therapy and four
months I'm up eight pounds.
That's too much and it all comesright here in the middle and we
know that fat in the middle isbad for the heart.
Hormone therapy is not good forthe heart.
(17:50):
There are cardiovascular issue,so we really want to be careful.
Watched how much we eat,exercise my family when I do
fuse to walk and move.
When they bought me a dog andthey came, here's your door.
We're not walking it.
He's actually now my bestfriend.
I want to talk briefly aboutemotional response being told,
(18:13):
you have cancer is tough.
We get depressed and then wetake these drugs and these drugs
including hormone therapy tendto add to depression.
It is normal.
It does not mean you're crazy oryou're sick.
What it means, perhaps findsomeone to talk to.
I recommend if you're feelingdepressed, go to a psychologist
(18:34):
or a social worker and find away to talk and also the
consider.
If you need to go to apsychiatrist for low dose
antidepressant.
I don't like the idea of anoncologist prescribing psych
drugs.
They're not experienced.
Go to someone knows what they'redoing.
There's nothing raw.
It's common.
We all suffer it.
(18:55):
We suffer depression because welive our life, but we set more
depression because we havecancer.
It's normal.
That doesn't have any meaning.
You're a person.
You're a human being expected,not a big deal.
It's really common.
Cognitive effects, pride, theconcentrate.
You got to work through it asmuch as you can, but if you do
feel this way, don't worry.
(19:16):
It's not you.
It's the drugs weight gain.
We talked about it.
Breast growth, very common.
There are some ways if it reallybothers you, oh you can before
you start the hormone therapy,you can't have your breasts
radiated.
Personally, I don't like itbecause you're exposing yourself
to radiation.
Radiation can cause secondarycancers, but it is something
(19:37):
that you can do.
Also, I'm going to back justbriefly met for, I mean on
weight gain, a med form.
It is a really good drug.
There's some evidence that madeform and actually will help
treating the prostate cancer.
It's a cheap drug.
It will keep your blood glucoselevels down and we'll help on
weight gain.
I'm on Metformin and insulinresistance.
The metformin hopefully willhelp stave off the development
(19:59):
of diabetes.
Bone density.
Again, exercise is so important.
There are some drugs that youcan take.
Certainly we should all betaking calcium and vitamin D.
You can take these other drugs.
I wouldn't do them.
I don't like the idea of peopledoing them until our hormone
resistant and then you got to doit carefully because long
exposure to these drugs quest,terrible fractures of the femur
(20:20):
so you gotta be careful.
Don't go lightly.
Speaker 6 (20:23):
And the cardiovascular events, it says
agonist versus antagonist.
The firm again is from a guy hasless cardiovascular or I believe
Speaker 2 (20:33):
that it has less.
Okay.
But it has other side effects.
You got an injection on thebelly and make sure you don't
get to get it on the belt line.
Make sure the nurse or thedoctor who's giving it to you
has given many more because ofthe injection is not given
correctly.
It will hurt
Speaker 3 (20:48):
for a long time.
We've been there, done that.
Okay.
Is it common to have the hormonetherapy and then Rudy?
That's an excellent question.
Speaker 2 (20:58):
There is a lot of good evidence that shows that
hormone therapy given truck herprior to the use of radiation
will enhance the radiation, willmake the radiation more
effective and good radiationdelivery lead.
You should involve at least adiscussion with your doctor
without preceding before I'm ontherapy.
There's a lot of good evidenceabout that because that's good
(21:18):
practice.
Should you pretreat with
Speaker 3 (21:20):
hormone therapy and continue on after radiation?
Depends upon your situation.
Could you comment on out lessalcohol?
That's kind of few less spicyfoods.
Speaker 2 (21:29):
Yeah.
Caffeine, alcohol, spicy foodstend to kick high flashes.
I know that.
I love spicy food.
I find for instance, I had somespicy food about a week ago and
I just waited like a pig.
Alcohol also can do that and socan caffeine.
Caffeine for me it doesn't, butalcohol and spicy food does.
It's individual.
If they basically kick hotflashes, you can see it.
(21:52):
If that's what it does for you,then you want to find a way to
avoid it or kind of down and ifit doesn't.
Joints.
Speaker 3 (21:59):
Question about other approaches.
Uh, you mentioned that form andthen I read about the possible
contribution there, butsomething I read about within
the last six months, it was asmall, just a small article and
I haven't heard it mentionedsince by anybody is talking
about the lock and key thingwith testosterone and the
(22:22):
Castleberry.
What I read was a cancer gets toa point where it gets around
supposedly as well.
I'm just telling you what I getsaround testosterone and moves
to, it's either cholesterol orsome derivative of it and it
picks up where the loss of thetestosterone left off.
(22:43):
And I've read where I thinkthere may be even a clinical
trial, I think it was inPennsylvania where they're using
a stat that was prescribed formorbidly obese people that is
supposed to target that.
Do you know anything?
Speaker 2 (22:59):
My understanding and I would qualify the amount of
any, any by any means an expert.
My understanding is thatcholesterol can break down and
create androgens that can thenfeed the cancer.
So it's actually not thecholesterol, but a byproduct of
it is my understanding.
And yes, there are men who dotake status with the idea of
controlling their prostatecancer.
(23:21):
A lot of people think of statusas being benign.
They're not necessarily benign,so you need to discuss that with
your doctor.
So the answer is yeah, there maywell be in effect, last question
we
Speaker 3 (23:32):
want for for the boom when it looks that would
mentioned there, you know weshould have for some action, you
know the recent risk fornecrosis of the Joe.
Yes.
From then and I read that of theoptions to prevent the breakdown
of the bone Boniva what do youthink of?
(23:54):
Well how are you,
Speaker 2 (23:55):
I don't know enough about the different drugs and
there are some differences and Ican't really speak to them but I
think what's really important,you know and that's something
you need to have a conversationwith your doctor.
But I think what's reallyimportant to start understand
that these drugs are not benign.
How'd you talked about the jarproblems though in j and then
also the femur fractures.
I'm glad you raised that.
Thank you.
Speaker 3 (24:16):
Now I'm going to ask ran if she would give her
presentation.
Speaker 7 (24:24):
Okay,
Speaker 4 (24:25):
so we're just going to do a continuation on managing
the side effects.
To answer your question, therewas actually a talk this
afternoon about chemotherapyside effects and we do talk
heavily.
It's with a medical oncologistand myself as well about Lnj.
So it will be in that.
Speaker 3 (24:41):
What did they do?
I backwards.
Sorry about that guy quoted usseparately.
You may be honest.
I don't know.
That's what I look at it andtastic I have my thumb drive.
Sorry about that guys.
So why we're friends working atany other questions or issues
people want to raise.
(25:01):
You haven't said anything.
Right?
Good.
Then.
Yeah.
Now you're on.
What about diet?
No one has said anything aboutdiets.
Yeah, no.
Well actually I said that youneed to control what you eat.
I think diet is a whole areathat you really need to talk to.
A nutritionist.
I would recommend that.
I think that you use anything.
I, again, I'm far from an experton diet.
I don't eat very well.
(25:22):
Uh, my wife will attest to that.
I think there are a lot ofpeople who really feel that
becoming Vegan or vegetarian candefinitely support anticancer
action.
Certainly lowering your fat,lowering carbohydrates will help
on weight.
Kind of frank, can you?
Yes.
You're better about diet.
So watching
Speaker 4 (25:40):
your sugars is, is a big part of it, especially when
you're talking about the sideeffects and as well as the Diet.
You know, there's a lot of mythsout there about cancer feeds off
of sugars, things like that.
More so it's managing andsymptoms and the side effects
and the things of that nature.
Sugars are actually going toincrease your immune system.
It's going to stimulategastritis.
So if you have underlyingconditions as well as helping
(26:03):
manage your diarrhea,constipation, things of that
nature, uh, muscle wasting.
Again, very, very importantbecause if you start to lose
muscle in general, you're goingto end up with problems being
able to ambulate, walk, set,things like that.
So it's really important thatwe're maintaining our muscle
mass.
Speaker 3 (26:21):
Any other questions in the meantime?
You having to ask for anythingyet?
Yeah, prospect, insert going.
Uh, I think cancer in general,including prostate cancer comes
from two different places isgermline genetics.
In other words, the geneticsthat you're born with, good
evidence that there's a 10 to20% of prostate cancers,
Speaker 5 (26:44):
probably germline.
Other the words you have it inyour family.
And it gets passed on.
I'm a great germline prostatecancer guy because my father had
prostate cancer.
His brother who is only siblingdied of prostate cancer.
His only son was treated.
My grandfather had prostatecancer and breast cancer and my
great grandfather, according tohis death certificate, I had
(27:06):
died of prostate prompts.
So I'm a really, although I havean older brother by the way, his
PSA is undetectable, so you doesjust because you have the
germline doesn't, you know, orthey have other members of your
family.
It doesn't mean your destinywith, and then I think the rest
of the cancers probably comefrom exposures that we have in
the environments.
And I think we're seeing moreprostate cancer today and more
(27:29):
serious prostate cancer.
Of course, we're exposingourselves to so many terrible,
terrible things in ourenvironment, drive our cars and
we breathed the air and thecities and farmers are working
with pesticides in the fields.
I mean, I think for veterans, weknow that they can significantly
damaged by their militaryexperience.
If you were in Vietnam, youprobably had some sort of level
(27:52):
of disclosure to agent orange.
We see today the guys thatfought in Afghanistan and Iraq
because of the burning oil wellsand they would walk through and
breathe this stuff that probablyis contributing to which
depleted uranium in artilleryshells.
You had a shell of blue up hereand then you walk by it, you're
exposed to depleted uranium, sothere environmental factors, so
(28:14):
there's germline, what you'reborn with and then your other
exposures with homophones or atleast what might be a typical
regimental continuous,continuous, continuous.
That's my opinion.
I personally, and again, I canonly talk to you about what I
would do.
Okay.
I'm not making a recommendation.
(28:35):
If I were a Gleason nine if Ihad multiple nines, I would be
continuous.
That's an aggressive cancer.
If I can knock my PSA down andknock my scans down, I
personally would not becomfortable allowing it an
opportunity to go back and grabhold again.
So you wouldn't wait until thePSA starts rising again.
I would say on a continuous likenever go off it.
(29:01):
That's a balance and that'ssomething that you really need
to speak to a couple ofdifferent doctors have af and
you're going to have to cause amagic trick here.
You're going to have to get youroncologist to talk to your
cardiologist.
If you can do that, please letme know how you did it and I
want to share it with otherpeople.
Well, you know, one of thethings that I look at is looking
at which ways to go.
(29:22):
It's probably the morecomfortable they are.
I don't know.
I sorted other hand.
Yes.
So the recommendation on calciumand vitamin D two assistants,
are there any specific levelsthat we shouldn't look for?
Is this something I would talk anutritionist and your
Speaker 3 (29:42):
oncologist.
Very easy.
Vitamin D three classes, a bloodtest.
It's inexpensive.
It's not a bad idea to do withthe Monitor.
Speaker 8 (29:49):
Sure.
Speaker 3 (29:52):
I was diagnosed stage four if the chemo they'll face
today.
Sorry, Tega just failed that.
Starting a new standing, Iguess.
What snacks?
You're asking me a question.
I'll just because you're feelingas though your size of birth or
that you get from being incollege.
Just that says here's thestandard of care order we do
(30:14):
things I don't like seeing that.
I'd like to see I oncologist whohas a lot of experience who will
look at you, look at yourdisease and be able to
understand what the guidelinesare, but figure out what's best
for you.
I think treating prostatecancer, seeing any cancer really
needs to be a very individualthing and that's fine.
You are comorbidities.
(30:35):
What else?
Issues you have if you haveillness or nothing.
Second Cancer, your cancer sideand we're still to a great
extent in the learning phase ofabout what prostate cancer is
and and I'm going to bemoderating a conversation later
on with a doctor Ellie.
Then Allen, that genomicapproach.
Mike referred this morning aboutthere being 30 different
(30:58):
prostate cancers and I saidthere's probably more and what
he's referring to is weidentified, I understand he's
can't just be different based onthe genomics, the underlying
genes, the genes, your cancer.
But are there other treatmentsafter Chemo and challenging
again yes and and so forinstance some of the options I
(31:22):
would look, how'd you sell,sequenced and find that if you
have a one of the Bracamutations or an ATM because then
you have potential of a PARPinhibitor.
Me, none of which are approvedbut you can get them.
Insurance companies are payingfor them.
I think that there are a coupleof other drugs, Saturday three
trials that are looking good.
You have a flexible doctor.
(31:43):
I would raise the issue oflooking at some of the
treatments that a littledifferent than ours in the in
that exact proof space that youget your insurance pay for it.
So does he drive that recently agroup called Apple glutemide
also know lead up early I e r le a d a apple glutemide is the
generic name you disapprove ornon metastatic castrate men.
(32:05):
But I have a guy who's taking itwho is burned through a number
of treatments including atSandy, Andy Sandy was some
changes in the molecularstructure.
Just a couple of little groups.
He has gotten the best PSA andscan response and tackling
anything.
His PSA is negligible.
He went from 800 to almostnothing.
So I think that's where theskill and the experience of your
(32:27):
oncologist is so important.
You want to go to a doctor, thisis what they do.
So they understand and know whatthe options are.
That's what I recommend.
But there are options also agood doctor will perhaps look at
some other the cancer treatmentsand say, cause I do know one guy
who took the chemo is reps andwelcoming and this was back
(32:50):
right, here's the go.
So we didn't have a lot of thesedrugs when I came up.
The options for follow up thereat the and though she patched
with chemotherapy.
Right.
And that was 1213 years ago.
Now we have a place I hearpeople use the word with or I
don't think so.
We have a lot worse and we havea lot of drugs that are in
development.
So I think we have every reasonto certainly feel optimistic.
Speaker 4 (33:14):
I apologize guys were having issues with being able to
download it but you don't havethe slides on here.
So basically what we're going totalk about is managing some of
the side effects especially.
Yeah, especially the symptomsand the side effects from
hormone therapy with CBD andunderstanding the difference
between CBD and the use of CBDversus what everybody knows as
(33:36):
marijuana.
And there is a huge differenceout there.
You look on your handout, wesolidify the differences between
hemp based CBD or cannabis thathas THC in it.
What everybody knows asmarijuana, it comes from two
different plants.
So basically how contains canavid oils or CVD now can have a
(33:56):
dials are part of ourendoccanabinoid system.
What does that mean to you?
It is something that is actuallynaturally found in our body as
mammals.
Yet them from a lot of the foodswe eat, I'll use one of the most
common that actually have[inaudible] and it's chocolate.
Why do we feel good when we eatchocolate?
Because the cow plant, we'rechocolates come from actually
(34:17):
have can the dials on it.
Mango was another thing thatactually has cadabra dials in
it.
So what's the difference betweenmarijuana and half?
Half was basically Rowan andused for textiles, for papers,
for fibers.
They grow very, very long.
They almost look like a bamboo.
They don't look like thoselittle tight plants at a
marijuana actually is.
(34:39):
They're used for the oil andhave them just benefit to the
oils.
They are non psychotropic saidthat means you're not going to
get high off of using a pure CBDoil.
Plants are extremely tall.
As I said, they can grow up to10 to 20 feet legal.
So CBD, in order for it to beillegal and you're not meeting a
marijuana card or a medicalmarijuana license on it must
(35:00):
contain less than 0.3% of THC init.
Most of them have 0.3% which isbasically zero.
Then there's some other levelsand there that have the THC, but
that's going to require amedical marijuana card.
Cannabis, again, we'll commonlyknown as marijuana.
It's actually grown for thebuds.
It's highly concentrated.
(35:21):
The high concentration of Thc,again is that six to 30%?
It is illegal all than thosestates that it is found that it
is, um, allowed or it has amedical indication.
So they talk about the greencards and the state of Florida.
It is legal for medicinal use.
Buy A, you will get thatpsychotropic effect from the
marijuana, so it's going to giveyou that a high.
(35:42):
And then the plants, like Isaid, do you not really have an
industrial application right nowso they're not used for their
fibers are not used for astrapping their oil.
It's not a thought, aremediation or the use of CBD to
help reduce some of those sideeffects from cancer treatments.
There's multiple uses out there.
They may be beneficial inhelping to reduce some of those
side effects.
So Kane, if it actually, whatCBD works on is in the
(36:06):
inflammatory system in our body,so they bind to what we call
canal receptors in our brains.
A CBD basically works directlyon the immune system so it can
reduce inflammation.
It can help decrease that nauseaand vomiting that sometimes you
can get from our medications,stimulate your appetite, not in
a way that you're going to haveit with Thc, but CBD can
(36:28):
actually help to stimulate theappetite or is very strong on
the GI system decreasinganxiety.
Joel talked a lot about that.
Depression.
CBD is very helpful in thatcalming effect in decreasing
anxiety and decreasing someeffects of depression.
Clashes just talked about thehot flashes because we're
working on decreasing theinflammatory system, decreasing
(36:50):
inflammation.
You're now going to also work ondecreasing hot flashes.
So again, hormonal therapies aresome of the things that we're
putting on, but even withprostate cancer that may not be
an option for you on may not beworking enough.
A lot of practitioners and a lotof patients that found that CBD
oil is very, very helpful forthat.
Decreasing fatigue and boostingenergy.
(37:11):
Again, it could help tostimulate and decrease some of
that overall fatigue that wefeel and then it has
antibacterial effects as well.
Again, these are just some ofthe ways that it helped
irritated skin.
They actually find that for alot of radiation burns that
using it topically it can help.
I'm down some of that rednessand some of that dryness that
they feel as well.
(37:31):
Speaking to your physician,making sure that it's not going
to interfere with your treatmentand how it may fit into you is
very, very important as well.
CVD applications and forms andavailability comes in a variety
of forms.
It can be topical, it can be anoil.
There's a lot of pure oils thatyou can add to your foods, put
underneath your tongue fornausea and vomiting and even see
(37:52):
sickness.
You can actually put it behindyour ear as well.
They can come in multiple foods.
I actually co represent themoncology nurse, but I also work
with another oncology nurse.
We have actually created acompany called heavily Hash
creamery.
We actually have CBD infused icecream and it comes in two
different ways.
One just to help get thebenefits of CBD, but we talked
(38:14):
about the[inaudible] and themuscle wasting.
We have a high protein ice creamformulation to help those
patients because who doesn'tlike ice cream?
I actually have a patient thatbenefits from it and actually
put some drops of it and one ofour air diffusers finds that the
kids who are very, very calmingeffect.
We have had patients thatutilize CVD.
They're able to come off withsome of their pain, so again,
(38:36):
it's important to talk to yourphysician, find out if it's
right for you or talk to yourclinician about it.
Speaker 6 (38:40):
That is kind of the quick,
Speaker 4 (38:42):
that's what I have.
Do you guys have any questions?
If the CBD is not marijuana, youdon't need a pursuit, you know
you do not need a prescriptionfor have me CBD, which is legal
in the state of Florida legaland all of the states.
If it has the marijuana, the THClevels, then you require a
Florida green card, but just CBDitself is 100% legal and you do
(39:05):
not need a prescription for it.
Are there different kinds of oilfor different things?
There's different, there'sdifferent milligrams stripes is
usually what there are.
There's so many companies outthere so everybody will have a
different oil.
Really what you want to makesure is that the oil is a pure
half based CBD oil.
I'm looking at the amount that'sin it and what it's going to be
(39:25):
useful.
Again, there's multipledifferent reasons and use the
sport and again, the milligramsrice, so it would be good for
hot flash.
What would you again, usuallyanything that we're going to be
taking internal and it's goingto help me because it's helping
you systematically.
So again, something like ananimal or an oil that you can
even add to your coffees, it'susually going to help.
Speaker 6 (39:47):
I just wanted to add to that.
Speaker 4 (39:49):
There's a lot you see CVD everywhere.
Please know.
Ask him about the testing behindshit.
Yes.
Don't take something that youdon't know where it's pretty
strong.
Right.
You want the seat to getincreased in United States as
they should have the testingparts behind it.
Right on, right on the wall.
Speaker 6 (40:08):
Yeah.
Oh Man.
That's kind of a trick question.
Speaker 4 (40:13):
Finding out that it's been produced in the United
States, it's going to be, it'snot FDA governed so much, so
what you're going to have isit's falls under what they call
generally regarded as safe work.
Ras, FDA approval, especiallyone of the
Speaker 6 (40:28):
animal.
Speaker 4 (40:29):
Ron in a paper lead it.
I also take CBD and I havevirtually no hot flashes.
There you go.
I love hearing testimonies.
It is an absolute wonderfulanxiety.
Hot flashes.
That definitely helps.
What way is it antiinflammatories?
How have they shown you couldset rates?
Yes.
So, um, if you go into thescientific studies and there are
lots of them out there, CBD hempderived CBD second avenue oil
(40:54):
from pure hemp, actual reason atworks on the cannabinoid
receptor to THC works oncannabinoid receptors, one in
our body and cannabinoidreceptor to actually work on the
immune system.
So that's how it works into theanti inflammatory properties and
how it was working in the immunesystem, how it works on our
hormone levels by decreasing ourhormone levels.
(41:16):
It actually, and again we'retalking about hemp derived CBD,
it actually can work to lowerblood sugars as well.
And there was lots ofstatistical data, um, in
scientific data out there on howit works and where it's working,
what inflammatory markers orthey have.
Yes.
And again, I don't have those infront of me, but I can give you
plenty of websites that you cango and you can see it.
(41:38):
There's testing being done atsome of the largest academic
institutions all over the worldin Europe.
They're far more advanced thanwe are when it comes to this and
the uses that they have beendoing to show its properties is
just, again, everybody isdifferent.
It depends on your body size aspawns in your body weight and
(41:59):
where you're coming from.
Most people, 20 to 40 milligramsis enough, but again, it depends
on what you're utilizing it for.
Natural Lane, we always tellpeople start low and slow and
kind of gradually go updepending on other medications
you're on or your symptoms thatyou have, but 2040 and 60
milligrams tend to be thatcommon.
Yeah.
Speaker 6 (42:17):
Yeah.
Any other questions?
That's it.
Great.
Thank you.
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