DrJimenezConsentForm

Please read, initial, sign, and date the following informed consent and bring to the medical marijuana evaluation INFORMED CONSENT TREATMENT PLAN AND OBJECTIVES Edited by Foxit Reader Copyright(C) by Foxit Software Company,2005-2007 For Evaluation Only. Fletcher, Gary Name (Last, First, MI): _________________________________________________________________________ 11/08/1955 Date of Birth: __________________________ N3706281 ID No. (Dr. Lic#./State ID/Passport): _________________________________________ Based upon our face to face history and good faith examination on _____________ you have met the criteria for the medicinal use* of cannabis for the following qualifying medical diagnosis(es). If questioned about your medical condition, you have the legal right to refuse to disclose or explain your medical diagnosis(es) to anyone (including your employer or law enforcement). No one belongs in jail for marijuana. Dr. Jimenez will empower you by educating you on the California Medical Marijuana Laws -the Compassionate Use Act (Prop. 215, 1996) and the Medical Marijuana Implementation Act (SB 420, 2004). These Laws are in full force in the California courts, and must be upheld by all state and local law enforcement agencies. There is an ever-increasing understanding that marijuana is indeed a benign, valuable, medicinal herb that has been miss-scheduled and misunderstood. American Association for the Advancement of Science (AAAS) publication, and Dr. Jimenez concluded that the federal Department of Health and Human Services (HHS) are violating the Data Quality Act (DQA). The DQA is a mechanism to ensure that regulatory agencies base policy decisions on sound science. HHS made false statements in its publications and its Web site. There is a DQA lawsuit is currently pending before U.S. District Court Judge William Alsup. The government’s response to ASA’s complaint is due May 25, 2007, and the court is likely to hear oral arguments in July or August. “We’re confident that science will ultimately prevail over politics,” said ASA Chief Counsel Joe Elford. “The DQA is the vehicle to compel the federal government to recognize the truth about medical marijuana and validate the experiences of patients and doctors who have had success using it to alleviate suffering.” Historically, an orally administered cannabis preparation was introduced into Europe from India in 1842 as a remedy to relieve pain, muscle spasm, convulsions of tetanus, rabies, rheumatism, and epilepsy. It became widely adopted into various pharmacopoeias and formularies. A century ago, Queen Victoria’s personal physician wrote, “Indian hemp (Cannabis indica) is one of the most valuable medicines we possess,” and William Osler gave the opinion that cannabis was “...probably the most satisfactory remedy” for migraine. It was introduced into the United States Dispensatory by 1854 and effectively disappeared from American medicine with the introduction of the Marijuana Tax Act in 1937, corresponding to concerns over its recreational use. International treaties have precluded cannabis use, except for scientific and medical research. Qualifying Diagnosis(es)/ ICD 9 code(s): 1). _______________________________________________________________ 2).________________________________________________________________ 3).________________________________________________________________ 4).________________________________________________________________ You have informed me or are interested in finding that cannabis is providing/may provide relief for related symptoms of the above-referenced diagnosis(es). You have informed me that the above-referenced diagnosis(es) affects your activities of daily living, affects relationships, mood, workplace and sleep, or, if not alleviated, may cause serious harm to your safety or physical or mental health. You have tried multiple drug and medical regimens or have been offered multiple drug and medical regimens, but agree or assume that there will be either a poor or unfavorable response or both__________ (initials). Please provide Dr. Jimenez records now, or within six months, from one or all the following provider(s): Primary Care Provider (PCP), Orthopedist/ Physical Therapist/Psychiatrist/ Occupational Provider, Neurologist/ Neurosurgeon, Chronic Pain Specialist, Hematologist/ Oncologist, Aids Clinic, Ophthalmologist/ Optometrist, Psychiatrist/ Psychologist, Doctor of Chiropractics, Doctor of Naturopathy, Acupuncturist or other professional you deem as your primary care provider___________. It is important to understand that Dr. Jimenez acts as a Consultant (A Cannabis Specialist/Qualified Medical Marijuana Examiner) only - he is not your Primary Care Provider-Note a Cannabis specialist or Qualified Medical Marijuana Examiner has become a specialty because of the medical-legal complexities surrounding the issuing of a Medical Marijuana Recommendation. This recommendation is all that is needed to possess, use, and cultivate marijuana legally in state of California. This medical marijuana recommendation must be upheld by all state and local law enforcement agencies due to the Medical Marijuana Laws. Dr. Jimenez states; “It can be expected that a physician who recommends medical marijuana will get numerous calls from law enforcement, dispensaries and or Co-ops validating a medical marijuana recommendation (We offer a 24 hr ONLINE verifications and verbal verifications from 11:30 to 7 pm Mon. through Sat. (Sat till 4 pm) closed on Sundays and Holidays by calling our verification Getting a call from law enforcement, and getting numerous calls from multiple dispensaries and Coops can be intimating for most doctors, and, in addition they may not be prepared on properly handling of this calls. (However, Dr. Jimenez has recommended Medical Marijuana for over 5000 voice line at 808.689.4414 or go online www.1888215herb.com)”. patients over the years and has been an expect witness in court room for a number years .Dr. Jimenez has gained a thorough knowledge to insure that the process of possessing, using and cultivating medical marijuana works for his patients ). In addition, the refusal of HMO’s and Providers (MD, DO) to recommend medical marijuana due to its medical-legal or belief complexities contributed to the birth of the Cannabis Specialist. Proof or validation of your medical or psychological diagnosis(es) is required from a licensed provider (Name of your validating Provider____________). If you have not provided records during this visit, Dr. Jimenez will ask for physical proof or validation of your qualifying diagnosis(es) prior to your six month follow up, i.e., Letter head, Rx form, or other properly documented medical or psychological or legal report. After receiving your medical records and re-evaluation you will be renewed or approved for the medicinal use of cannabis for one year __________ (initials). If you haven’t seen a provider related to the above-referenced diagnosis(es), it was because you informed Dr. Jimenez that you don’t have medical insurance or adequate medical insurance, or because of financial difficulties, or because of past medical or psychological dissatisfaction from the AMA or AOA. But you have agreed to see a licensed provider per the request of Dr. Jimenez prior to your six month visit __________ (initials). You understand California defines ‘medicinal use’* as the acquisition, possession (allowable weight is up to 8oz of usable marijuana [only dried mature processed female flowers from the plant called cannabis ‘buds’-leaves and stalks not counted]), cultivation, use, distribution, or transportation within the state of California relating to the administration of cannabis to alleviate the symptoms or effects of a qualifying patient’s debilitating medical or psychological condition. The term distribution is restricted to the transfer of medical cannabis from the primary caregiver to the qualifying patient. It is illegal to transport medical cannabis across state or country lines, by airplane, train, or cruise ship, and it is also illegal to mail it or receive it in the mail. It is illegal to sell, traffic or transfer medical marijuana to friends, family or strangers, or for use of medical marijuana by a qualifying patient for purposes other than medicinal purposes__________ (initials). You understand it is illegal to purchase medical marijuana. The State of California does not provide any method for a qualifying patients or primary caregivers to receive medical marijuana. There is no place in the State of California to legally purchase cannabis, but Dr. Jimenez (drjimenez@drjimenez.org), Bruce Margolin, Esq. (www.1800420laws.com) , CAnorml (www.canorml.org), and Americans for Safe Access (www.safeaccessnow.org) strongly believe you should not purchase medical marijuana from a “Drug Dealer” or from the “Black Market” for your safety. We believe the burden should be placed on the State of California to allow for collective and cooperative operations or dispensaries to acquire medical marijuana __________ (initials) Note: The regulation of marijuana sales within the state continues, despite opposition by the federal government, drug police and local officials in some counties. Several dispensaries have functioned within the state since before Prop 215. However, the big surge has been since the passage of SB 420, which allows patients to work collectively and creates limited immunity from sections of the law that otherwise ban cultivation, sales and having a place where cannabis is sold (http://www.dhs.ca.gov/hisp/ochs/MMP/County_Programs_&_Business_Hours/CoProgBusHrs.pdf). “This new law represents a dramatic change in the prohibitions on the use, distribution, and cultivation of marijuana for persons who are qualified patients or primary caregivers,” according to the 2005 Urziceanu Appellate Court ruling. Since its provisions went into effect, twenty four counties have adopted ordinances to regulate over-the-counter access to marijuana by qualified persons, ranging from Los Angeles to Oakland to Placerville and its growing - more counties and cities are adopting ordinances to regulate dispensaries and Co-ops almost every month. But it should be made absolutely clear that the doctor, staff and representatives of this practice are neither providing cannabis, nor are they encouraging any illegal activity in obtaining cannabis __________ (initials). Remember, the Medical Marijuana Laws protect the Qualifying Patient, Care giver and Physician - not necessary Dispensaries and Co-ops. You understand that medical cannabis is currently classified by the Federal Government as a Schedule I drug, meaning that it cannot be ‘prescribed’ by any health care professional. State law allows licensed California doctors to ‘recommend or approve’ medical cannabis for certain medical conditions (California Health and Safely code 11362.5) _______ (initials). You understand that the medical marijuana shall be grown indoors only at the following locations: (1) your home address; (2) your primary care giver’s home address; (3) or a location owned or controlled by you or your primary caregiver. You understand that the marijuana authorized for medical use that you may jointly possess with your primary caregiver shall not exceed that total of mature marijuana plants, immature plants, and weight of usable marijuana that is determined by the county you reside in, e.g. 12 total plants, 6 mature and not exceeding weight 8oz of dried mature processed flowers of female cannabis plants or usable growing cannabis (only ‘buds’ are counted, leaves and stalks are not counted) at any one time per patient__________ (initials). (Note: In all cities and counties statewide, the quantity approved by a physician takes precedence over any local guidelines. There is a national medical marijuana prescription standard established by the National Institute on Drug Abuse in their Compassionate Investigational New Drug Program: About ½ lb/month or 2 oz/week, or 6 lbs/yr.) You understand the authorization for the medicinal use of cannabis shall not apply when it endangers the health or well-being of another person, in a school bus, public bus, or any moving vehicle, in the workplace of one’s employment, on any school grounds, any public park, public beach, public recreation center, recreation or youth center, correctional facility or other state monitored facility or other place open or accessible to the public. You have been informed that medical marijuana can affect judgment and reaction time, and not to use it with alcohol or other substances or medications which could result in excessive sedation or loss of consciousness. You agree to assume full responsibility for any harm resulting to you and/or other individuals as a result of your use of cannabis__________ (initials). Dr. Jimenez has discussed the medical benefits and risks and side effects (two versions of side effects have been offered and readily available on the websites) of cannabis use as a treatment for your condition(s), as well as recommended dosage, type of cannabis recommended and other interventions. In addition, you have been informed that the medical use of cannabis authorizes the possession and use of medical marijuana for medical purposes under State law only and you further understand that it is restricted under federal law__________ (initials). Dr. Jimenez recommends and encourages you to maintain continuity of care with your primary care provider/ consultant(s)/ Alternative therapy practitioner(s). Please inform your provider that you have been placed on medicinal use of cannabis for the above reference diagnosis(es). Dr. Jimenez believes if you cannot discuss or disclose ‘All your medicines’ to your provider then ‘You should seriously consider changing your health insurance and or your Provider immediately’. WESTERN MEDICINE IS NOT THE AUTHORITY WHEN DEALING WITH CHRONIC PAIN, MOOD/ BEHAVIOR/IMPULSE DISORDER(S), COPING WITH A CHRONIC ILLNESS(S) AND CHRONIC INSOMNIA. When dealing with chronic pain, mood/behavior/impulse disorder(s), or coping with chronic illnesses or insomnia, don’t look to Western Medicine as the authority. Instead seek alternative medical regimens in treating your aliment. According to the Center of Disease Control chronic pain and mental illness continue to be ranked in the top 10 reasons Americans are granted permanent disability. I encourage a ‘Cocktail’ approach with different approaches to your condition. For example, “Cocktail approach to your condition” may require Behavior Modification, Biofeedback, Chiropractic or Osteopathic Manipulation, Physical Therapy, Regular Exercise and Stretching, Prescription or Over the Counter Drugs, Vitamins, Herbs (i.e., Cannabis), Minerals and Diet. It is recommended that one redirects his/her thoughts in creating music, art, writing or other creative outlet. I encourage one to explore and get involved with Yoga, Meditation, Acupuncture, Chiropractic, Homeopathy, Naturopathy and other safe but effective methods in treating your condition. Dr. Jimenez states “During my long journey to becoming a doctor it became clear that “Health is Wealth” and I noticed a pattern that is essential to maintain health for all vital organs” The following six important proactive lifestyle requirements are needed to Prevent and Maintain Mental and Physical Health: 1. Sleep Sleep deprivation is a serious problem in USA, and it is recommended that you get at least 6 to 8 hours of sleep everyday. Sticking to a routine or circadian rhythm (i.e., falling asleep and a waking up at the same times everyday including weekends, holidays without using alarms) is recommended. Persistent or chronic insomnia can lead to serious mental and physical problems. Dr. Jimenez uses the following extreme analogyWhen someone presents with a severe head trauma in the ER the brain will shut down or go into coma (‘deep sleep’) and go into repair mode. It is well known that when the brain is asleep, that new cells are being produced and current cells are being repaired. 2. Fluids/Balance diet KISS (keep it simple stupid) drink plenty of water. Avoid harmful fluids like alcohol, (alcohol destroys brain cells) and carbonated sweeten drinks. It’s true -’You are what you eat’. It is recommended you eat a well balanced diet (i.e., Mediterranean Diet - pasta, lean meats and vegetables). Keep in mind to eat and drink everything in moderation. Watch what you eat, and buy Kosher Foods (http://en.wikipedia.org/wiki/Kosher_foods). Dr. Jimenez reports “How meats are slaughtered and are prepared is very important. The object is to minimize the pain and suffering of the animal inflicted. If the animal suffers during the slaughter a surge of harmful ‘flight or fight’ hormones are release into the bloodstream, and body. These hormones will cause an increase in heart rate, blood pressure, and cause anxious feelings and insomnia.” 3. Exercise and stretching Keep moving. Get plenty of aerobic exercise. If you are not in a Yoga class then it is highly recommend you join one. (http://www.layogamagazine.com). 4. Meditation “One of the most important tools for a longer, healthier life is a deeper, slower breathing practice through meditation.” - Andrew Weil, M.D. Achieve a new level of well being that reduces stress and promotes better relationships, better sleep, and more balanced and healthy lifestyle (www.wilddivine.com). 5. Protect your brain from harmful visual stimuli “Your eyes are windows to your mind”. Dr. Jimenez recommends you to refrain from watching TV programs that encourage or influence your mood -i.e., anxiety or fear. 6. Relationships One important variable is finding the right partner. This will have the most impact on your quest for a satisfying and happy relationship. I think, finding a partner with passion, integrity and brains is probably a good place to start on your quest. Remember, it is easy to convince yourself that people may change, but that really doesn’t happen. 10 Rules For a Strong Relationship 1. Communicate Always speak positively and act confident about yourself and your partner creating a positive force. Keep all lines of communication open especially for those of you who travel for business. Talk to each other everyday: this stimulates and reinforces memory cells that are associated with this relationship. 2. Trust Each Other Treat Jealously like cancer: do whatever it takes to prevent it and or get rid of it. Always be 100% loyal to your partner and never let him/her forget that you always have their best interest at heart. 3. Share The Same Goals In All Major Decisions Always portray where you are going in life, not where you came from. Dare to dream and create the life you want to live. Know what you want, know where you are headed and ask for help. Give everything you have to accomplish your goals. Stay disciplined and focused, but offer some degree of flexibility, because it’s not going to go your way all the time. 4. Be Professional Treat each other with respect, attention to personal detail. Treat each other as individuals and understand each other’s personal needs. Be fair to each other. This provides the relationship legitimacy projecting a successful image. 5. Keep Family Your Number One Priority Keep your eye on the ball. If self sacrifice is not one of your virtues you will mostly fail. 6. Bring Order Into Your Relationship This creates a stable home life. 7. Confront Issues Head On And Quickly Together Issues will not go away. They will only get worse if you are not willing to deal with them. Learn from your failures as well as your successes. 8. Agree On How To Parent a Child Start with Love and Tolerance. 9. Healthy Body, Healthy Mind A healthy life equals a healthy relationship. Commit to maintaining a positive, well balance life style. 10. Be Compatible Share life goals and respect each other’s hearts, passion, and outlook on life. They maybe the most important elements in finding happiness and peace. Don’t be afraid to challenge the status quo. CHRONIC PAIN/NEURALGIA/ MYALGIA / ARTHRALGIA Chronic Pain of back or spine or limbs, an Arthritis are the leading cause of disability among U.S. adults Western Medicine are still struggling with surgeries located in the Back, Neck, Shoulder and Elbow. “These patients with chronic neck, shoulder, elbow and back pain are like little devils-always complaining that they are not getting better. But after surgery some of these patients become Satan-cause now they are worse” Quote from the Chairman of UCLA Orthopedic department. If your qualifying diagnosis(es) involves chronic pain/muscle spasm/ myalgias/ neuralgia or arthritis/ arthralgia, I recommend Cannabis Indica. Indica has a unique property in that it changes the perception of pain. The potential significance for pain management is that cannabinoids may reduce opioid use and/or side effects, may increase efficacy and quality of pain management, and may assist in more rapid patient rehabilitation. Cannabinoids are moderate analgesics with low toxicity and with a dose potency several times that of codeine, but with longer duration. CB-2 receptors are found in immune cells and peripheral tissues and may be associated with “peripheral analgesia.” They would thus have a different side-effect profile to existing analgetics and perhaps be additive or synergistic for efficacy, and would be expected to be excellent candidates for multimodal analgesia. I encourage that you continue with physical therapy and/ or range of motion exercises and increase muscle strength/ligament strength, and increase mobility in the __________________. I encourage you to engage in regular exercise/stretching and maintaining your ideal body weight (women at 5ft should weigh 100lbs, add 5 lbs for every 1”, men at 5 ft should weigh 106 lbs add 6 lbs for 1”). Dr. Jimenez also encourages a weekly regimen of Yoga (http://layogamagazine.com). Dr. Jimenez also suggests that you stay ahead of your pain and don’t wait until your pain is unbearable. Patients who don’t stay ahead of their pain play ‘catch up’ and end up using more prescription drugs. This results in unwanted side effects and can lead to more problems. For those with severe chronic pain, try to treat your symptoms in ‘cocktail’ approach (i.e. Use long acting opiates, NSAIDS, Neurotin and only use short acting opiates for break through pain, behavior modifications, biofeedback, physical therapy, regular exercise and stretching, acupuncture or chiropractic). Ten steps for Managing Chronic Pain: STEP 1: Accept the Pain STEP 2: Get Involved STEP 3: Learn to Set Priorities STEP 4: Set Realistic Goals STEP 5: Know Your Basic Rights STEP 6: Recognize Emotions STEP 7: Learn to Relax STEP 8: Exercise and proper Diet are key STEP 9: See the Total Picture STEP 10: Reach Out http://www.theacpa.org/people/ten_steps.asp MOOD/BEHAVIOR/IMPULSE/ PTSD DISORDERS “70% of All Americans who use anti-depressants or anxiolytics, still reporting symptoms of anxiety and depression” ANTIDEPRESSANTS and SUICIDE RISK According to the CDC there is evidence that children and adolescents taking antidepressants exhibit a risk of increased suicidal ideation and/or suicidal behaviors (suicidally). Given this, the concern is that antidepressants could potentially lead to completed suicides. The U.S. Food and Drug Administration (FDA) concluded that the risk of suicidally in children and adolescents who were prescribed antidepressants was 4%, twice the placebo risk of 2% (www.fda.gov). More research is required to determine if antidepressants are related to suicidally in children, adolescents and adults. FDA ‘BLACK BOX’ WARNINGS The Food and Drug Administration (FDA) is now requiring manufacturers of antidepressants to add a ‘black box’ warning label describing the potential risks of suicidally and the need for close monitoring of ANYONE prescribed this type of pharmacotherapy. Backlash against antidepressants is fueling new interest in alternative treatments. Nancy Keates, Wallsteet journal reports. From lobotomies with ice picks to early antidepressants that caused brain hemorrhaging, Americans have a complicated and ever-changing approach to treating mental illness. Now, spurred by the growing disenchantment with antidepressants, an increasing number of people are seeking treatment for depression, anxiety and eating disorders from naturopaths, acupuncturists, chiropractors and even Cannabis specialist. At the same time, more traditional psychiatrists are incorporating massage and meditation in their practices. ...more http://naturopathic.org/viewbulletin.php?id=173 Patient quote: “In 1996, my GP came right out and told me to go buy some pot. He said that it might help relieve some of the symptoms, but if nothing else, it might help me smile again.” If you’re qualifying diagnosis(es) involves a mood disorder(s) (i.e., Depression/Anxiety, Bipolar) or a behavior/impulse disorder(s) (i.e. mental agitation, anger, or controlling inappropriate behavior. OCD or ADD/ ADHD), Dr. Jimenez recommends Cannabis Sativa. Dr. Jimenez recommends as with chronic pain to stay ahead of your mood and don’t play ‘catch up’. Don’t wait until you get too depressed and anxious or angry/agitated causing difficulties in relationships or at the work place. While in a Big Ten Medical School studying Neuroantomy he realized that the ‘nerve freeways’ responsible for mood follow the same nerve pathways as pain does. In his training at UCLA and UH he was taught to educate patients to stay ahead of their pain and no to wait until the pain gets unbearable only to play ‘catch up’ and end up using more prescription drugs. This results in unwanted side effects and can lead to more problems. In a way, depression/anxiety and mental agitation is just another form a pain - ‘psychological pain’ - so stay ‘ahead of your psychological pain’ before you bring down everyone around you. So it is recommended you take Sativa in edible form at 12 noon, 4:20 pm and after dinner. (Why these times? There are three important neurotransmitters that play a key role in mood/behavior-Dopamine, nor epinephrine, and Serotonin that fluctuate during the day. Because these neurotransmitters dip in the afternoon and evening. Its is recommended you ingest at 12 noon because around 2 pm one may see the first dip in these neurotransmitters, 4:20 pm ~ 1 to 2 hrs before you get home to your love ones, and after dinner because most people engage in important interactions/ relationships after dinner up to going to bed). Cannabis Sativa has a very important role in treating Anxiety by controlling ‘fear’. Patients who suffer from a Anxiety disorder are really suffering from a pathological obsession with ‘fear’ or ‘phobia’ (i.e. fear of illness, fear of death, fear of flights, fear of social interactions, fear of failure, fear of spiders, “medical students’ disease” acquired by reading too many books on illness etc...). Fear is an important instinct for survival and is there to protect or warn one from harm. But if ‘fear’ interferes with activities of daily living, relationships, sleep, then it becomes a pathological obsession and needs to be addressed. So use Sativa and stay ahead of it, don’t play ‘catch up’ - it isn’t healthy to use a highly additive benzodiapines like Xanax for anxiety, sleep or panic attacks. In addition, anxious patients shouldn’t smoke cannabis because the smell may cause anxious feelings that someone may be offended. Instead it is recommended that the preferred method is by ingestion (baked goods, candies, pastries, sauce, tea, mari-pills [encapsulated cannabis in oil], butter, oil, tincture, drink, potion or other edible form). It may take 1 to 1 1/2 hrs to feel the effect of cannabis, but lasting up to three to four hours. (It is recommended to only ingest small sample ( i.e. less than 1/4 of cookie - don’t eat the WHOLE COOKIE!) during your first dose of new edible. Concentration and potency and absorption of the active compound delta-9 THC varies greatly among edibles. In Post Traumatic Stress Disorder (PTSD) patient studies on veterans (Israeli Military is currently using Satvia to treat PTSD) show that Sativa helps reduce nightmares, anger, or rage caused by PTSD. Brain chemicals similar to those in cannabis wipe out bad memories - and could point to new drugs for severe anxiety. The chemicals are called cannabinoids. They suggest that the chemicals wipe fearful memories from the brain. Drugs that boost cannabinoids could help people who suffer post-traumatic stress disorder, phobias and panic attacks, say the researchers. Its “a great new idea,” says neuroscientist Pankaj Sah of the Australian National University in Canberra: “It introduces a whole new target,” for such therapies, he says. Phobics are often treated by gradually exposing them to the object of their fear in a safe environment, to erase the bad association. Lutz suggests that cannabinoid-enhancing drugs, taken at the same time as this exposure, might aid memory clearance.  Circadian rhythms play an important role in a number of other disorders, for example bipolar disorder and some sleep disorders are associated with irregular or pathological functioning of circadian rhythms. (There are clear patterns of brain wave activity, hormone production, cell regeneration and other biological activities linked to this daily cycle). You should refrain from Alcohol and encourage a lifestyle change or behavior modification that encourages good emotional mental health. People who are emotionally healthy are in control of their thoughts, feelings and behaviors. They feel good about themselves and have good relationships. They can keep problems in perspective. According to researchers at of the University of Saskatchewan in Canada delta 9 THC has showed to increased brain cells and appeared to cut anxious, depressed behavior in rats. They found new brain cells in the rats’ brains after chronic use of delta 9 THC. Those new cells were in the hippo campus, a brain area that’s associated with motivation, emotion, and memory formation. The findings suggest that cannabinoids are the only Schedule I drug that can promote the creation of new hippocampal brain cells in adults after chronic administration of Delta 9 THC. They point out that other drugs (such as opiates, alcohol, nicotine, and cocaine) have been shown to block the creation of new brain cells in the hippocampus. In another study, a psychology professor at the State University of New York at Albany, and, of the University of Southern California, recently completed a study claiming that people who smoke marijuana daily and regularly were less depressed than those who never smoke. Due to the above finding Dr. Jimenez recommends to use medical marijuana daily and regularly indefinitely. Dr. Jimenez states “Right now the ‘Mainstream Drug Companies’ approach to fighting depression and anxiety is essentially a failure. The analogy would be how a Fireman would fight a fire-Instead of pointing his/her fire hose at the fire it is instead pointing at the smoke. The ‘Mainstream Drug Companies’ should instead focus on how the brain works and research and produce drugs that increase brain cells that produce important neurotransmitters like Seratonin, Dopamine, and norepinephrine-this is the root of the problem. Tips on Dealing With Your Emotions Learn to express your feelings in appropriate ways. It’s important to let people close to you know when something is bothering you. Keeping feelings of sadness or anger inside takes extra energy and can cause problems in your relationships and at work or school. Think before you act. Emotions can be powerful. But before you get carried away by your emotions and say or do something you might regret, give yourself time to think. Strive for balance in your life. Make time for things you enjoy. Focus on positive things in your life. Take care of your physical health. Your physical health can affect your emotional health. Take care of your body by exercising regularly, eating healthy meals and getting enough sleep. Don’t abuse drugs or alcohol. It is important to clear or purge you conscience (certain religions have recognized the power of this and have ‘confession days’ which allows people to purge their ‘sins’ or conscience). If you suffer from Anxiety feelings and stress, Dr. Jimenez recommends you to refrain from watching TV shows that encourage or influence your anxiety or fear (i.e. news, violent programs, some sports shows, some reading material and horror flicks, etc.). Watch what you eat and avoid eating shellfish, ocean bottom feeders - like shrimp, and avoid meats (Dr. Jimenez reports “Before animals are killed a surge of hormones are release into the bloodstream, and therefore the meat you are about to eat, that are related to the ‘flight or fight’ response. These hormones cause an increase in heart rate, blood pressure, anxious feelings, and insomnia”). Keep mood at home relaxed with low lighting and he encourages you to light a few candles that will create or encourage a relaxed home environment. Aromatherapy is a very important part of relaxing and can trigger long term memory thoughts (Aromatherapy will remind you ‘it is time to relax’). Incense or Sage (Dr. Jimenez prefers Sage) should be used for Aromatherapy while at home. If you own an iPod, Dr. Jimenez’s encourages you download relaxation soundtracks and listen with Acoustic Noise Canceling headphones (i.e. Bose Headphones) (http://www.apple.com/downloads/macosx/home_learning/pzizz.html ) (http://familydoctor.org/589.xml ) CHRONIC INSOMNIA Sleep deprivation should be taken serious and does lead to Mental and Health problems. Unfortunately, in the USA having only a few hours a sleep a night has been accepted as being cool, or not taken seriously. If your qualifying diagnosis(es) involves chronic insomnia Dr. Jimenez recommends you inhale or ingest Cannabis Indica after dinner. Cannabinoids Associated With “More Restful Sleep,” Study Says Salisbury, United Kingdom: The use of both natural cannabinoids and cannabis extracts are associated with improved sleep in patients with various debilitating illnesses, according to a review of clinical trial data published in the journal Chemistry & Biodiversity. “Cannabis… has been utilized for [the] treatment of pain and sleep disorders since ancient times,” authors wrote. “Modern clinical trials indicate that patients administered cannabis extracts report experiencing “more restful sleep, [an] increase [in] their daytime level of function, and [a] markedly improve[d]… quality of life.” According to available data, of the 2,000 subjects that have been administered cannabis extracts in clinical trials, most “demonstrate marked improvement in subjective sleep parameters.” Trial volunteers have not reported developing tolerance to the drug, even after using it for several years. Postprandial sedation means that following a meal (especially dinner), sedation or food coma causes lethargic state induced by having a large or heavy meal like dinner. Also try eating foods high in TRYPTOPHAN. Turkey does have the makings of a natural sedative in it, an amino acid called tryptophan. Tryptophan is an essential amino acid, meaning that the body cannot manufacture it. The body has to get tryptophan and other essential amino acids from food. Tryptophan helps the body produce the B-vitamin niacin, which, in turn, helps the body produce serotonin, a remarkable chemical that acts as a calming agent in the brain and plays a role in sleep. So you might think that if you eat a lot of turkey, your body would produce more serotonin and you would feel calm and want a nap. In addition, Indica doesn’t interfere with the third stage of sleep (REM) and doesn’t cause dependence. Long term use of Indica will not worsen insomnia or mental health. Remember, Edibles take 1 to 2 hours to work, so if you want to get to sleep sooner then either smoke or use a vaporizer to help you get to sleep and use an edible to help you stay asleep. Dr. Jimenez recommends the following tips to help you sleep: Avoid or limit your use of caffeine (coffee, tea, and sodas, chocolate), decongestants, antihistamines (cold or allergy medicines) alcohol and tobacco. Exercise more often, but don’t exercise within a few hours before going to bed. Learn to reduce or manage the stress in your life. Don’t lie in bed worrying about things. Set aside another time just for worrying. For example, spend 30 minutes after dinner writing down what’s worrying you and what you can do about it. Try eating a light snack before going to bed, but don’t eat too much right before bedtime. A glass of warm milk or some cheese or turkey and crackers may be all you need. Don’t nap during the day if naps seem to make your insomnia worse. Avoid sleeping pills (prescription or over the counter). Sleeping pills can help in some acute or short-term cases, but they are not a cure for chronic insomnia. They are only a temporary form of relief. They are best used for only a few days - max six weeks. Regular use can lead to rebound insomnia. Sleeping pills can be unsafe to use if you have certain health problems. Dr. Jimenez’s recalls attending a conference titled “Chronic Insomnia” by a world renowned Sleep Specialist from Stanford. After a great discussion on chronic insomnia he asked this physician how he treats chronic insomnia since their are no good treatments. He stated “I use Ambien (the conference by sponsored by Ambien)” But Dr. Jimenez and other physicians, being concern and wanting clarification, asked “How long do we keep these patients on Ambien and other Ambien like drugs that are classified as benzodiapines (i.e. Xanax, valium, Sonata, Lunestra etc.), since it is a known fact that these drugs should not be used for more that six weeks?” He replied, “I have prescribed Ambien for some of my patients for 2 years or more, and I admit maybe I shouldn’t be doing this.” The whole room gasped with disbelief. http://familydoctor.org/110.xml COPING WITH CHRONIC ILLNESS If you’re qualifying diagnosis(es) involves a chronic illness, you should be aware that some chronic conditions have no known evidence-based medical treatments, but the medical profession continues to fail the patient. For example, “mainstream” doctors frequently complicate these disorders by encouraging poly-pharmacy - the use of multiple drugs, usually five or more (NSAIDS, e.g. ibuprofen), short and long acting opiates (e.g. Vicodin & Oxycontin), muscle relaxants (e.g. Soma, Flexeril) , SSRIs ( e.g. Prozac, Paxil), Anti-depressants (e.g. Elavil), Sedatives, Anti-anxiety medications (e.g. Xanax), sleeping agents (e.g. Ambien), steroids (e.g. Prednisone), Antibiotics and other controversial medications. Coping or dealing with your chronic illness is in itself a burden. Living with a long-lasting health condition, also called a chronic illness (the word “chronic” comes from the Greek word chronos, meaning time), presents a person with new challenges. Learning how to meet those challenges is a process — it doesn’t happen right away. But understanding more about your condition, and doing your part to manage it, can help you take health challenges in stride. Many people find that taking an active part in the care of a chronic health condition can help them feel stronger and better equipped to deal with many of life’s trials and tribulations. Tips to Help You Cope With Your Chronic Illness: Sativa: Dr. Jimenez recommends Medical Marijuana -Cannabis Sativa. Sativa has a unique property in that it can put one in a state of Depersonalization or Derealization- in other words -’Getting High’. This allows one to escape from oneself or the chronic illness. Dr. Jimenez states “It gives the patient with chronic illness a ‘break’ for a few hours. It’s only a few hours in day, but it could mean a world to someone coping with their ailment.” Depersonalization or derealization is dose dependent so one needs to ingest more THC to achieve this important state. Five Basic Steps to help you cope with your diagnosis, make decisions, and get on with your life. Step 1: Take the time you need. Do not rush important decisions about your health. In most cases, you will have time to carefully examine your options and decide what is best for you. Step 2: Get the support you need. Look for support from family and friends, people who are going through the same thing you are, and those who have “been there”. They can help you cope with your situation and make informed decisions. Step 3: Talk with your doctor. Good communication with your doctor can help you feel more satisfied with the care you receive. Research shows it can even have a positive effect on things such as symptoms and pain. Getting a “second opinion” may help you feel more confident about your care. Step 4: Seek out information. When learning about your health problem and its treatment, look for information that is based on a careful review of the latest scientific findings published in medical journals. Step 5: Decide on a treatment plan. Work with your doctor to decide on a treatment plan that best meets your needs. As you take each step, remember this: Research shows that patients who are more involved in their health care tend to get better results and be more satisfied. http://www.ahrq.gov/consumer/diaginfo.htm     Your recommended daily ‘usable cannabis’*/THC % content is: 1 gram (0.035 oz) to 3 grams (0.10 oz) /or 0.38 % to 1.16% THC per day. Unless otherwise specified here, this dose may be increased to ______grams/ day (The amounts that are necessary depend on many factors - i.e. a patient with chronic pain may use more, a patient who uses edible may consume 4 times the amount to have the same medicinal effect, a patient may have increased tolerance to medicines from previous pharmaceutical or street drug use. As grow cycles are variable a patient must set aside enough medicine to carry him through until next harvest, which can be as long as one year. You understand that the cannabis plant is not regulated by the United States Food and Drug Administration and therefore may contain unknown quantities of active ingredients, impurities and/ or contaminants. In requesting an approval or recommendation for the use of this herb as medication you assume full responsibility for any and all risks of this action________ (initials). There are two types of Medical Marijuana - Sativa and Indica. Sativa is usually recommended for ailments involving the ‘head’ i.e. mood disorders, behavior problems or for coping with your ailment (depersonalization or derealization). Indica is from India and is usually recommended for ailments involving the ‘body’, i.e. chronic pain or spasm, helping with insomnia. Indica can change the perception of pain. Dr. Jimenez cautions the qualifying patient that the use of medicinal cannabis may mask an acute or treatable progressive condition that could lead to a worsening of that condition. Your recommended frequency of medical cannabis is ______ / day/ bedtime/ week/ month. It is clear that without a properly controlled dosage regimen, the results of most past, and probably future, trials of the medical benefits of cannabis will remain difficult to interpret. It is also likely that any successful future clinical development of cannabis, such as for pain management, requires the development of safe and reliable, inexpensive, rapid-onset, non- injected, and preferably parental, delivery systems. There is a widespread anticipation that such systems are “close to being developed,” but this is not yet the case. Your recommended route of administration is: by mouth (edibles) or inhalation (inhaled smoke is not recommended by Dr. Jimenez especially in Asthma/ COPD/ Chronic Bronchitis, Emphysema , Heart Disease, Inflammatory bowel disease, Irritable bowel syndrome and Migraine patients. Although smoking is unacceptable as a therapeutic method, history suggests that the lung offers the most promising route for delivery of cannabinoids, and new technologies are developing for controlled drug delivery by inhalation.), and topical. ‘Usable cannabis’ means the dried leaves and flowers of the plant Cannabis family Moraceae, and any mixture [or] preparation thereof, that are appropriate for medical use of cannabis. Hashish (concentrated cannabis, 11357a) is included in the medical marijuana laws per legal opinion from the Attorney General of the State of California (Also SB 420 includes all the sections of 11357 H&S). Your follow-up appointment will be within 6 months___________________ to review your plan of care and treatment efficacy. You must call our office prior to the above date to set up your follow-up appointment. During this appointment Dr. Jimenez will asked for proof* of medical or psychological diagnosis(es) from a licensed provider *(letterhead, or Rx form or other properly documented medical or psychological or legal report). Once this step is completed you will be renewed or approved for the medicinal use of cannabis for one year _________ (initials). I have examined and/or reviewed my patients verbal and/or medical records and I certify that my patient has been diagnosed with a qualifying medical condition, and that in my professional opinion, the potential benefits of the medical use of marijuana would likely outweigh the health risk to the qualifying patient, and I certify that I have issued a written physician statement (California Health and Safely code 11362.5) recommending medical marijuana - fact that a patient may take this to a dispensary or collective is not necessarily discussed. Dr. Jimenez reports that there are no claims about the medical efficacy of cannabis. I, the physician have in no way established himself as the primary care provider. Should an approval be made for the medicinal use of cannabis this patient understands that there is a renewal date specified by the doctor. I hereby certify that I am a duly licensed physician to practice medicine in the State of California. Dr. Jimenez has not been, nor shall be, punished or denied any right or privilege, for having recommended medical marijuana to any patient for medicinal purposes. The reason for Dr. Jimenez’ recommendation is none of the court’s business (People v. Spark 2004 - the question of whether the medical use of marijuana is appropriate for a patients illness is a determination to be made by Dr. Jimenez or other California license physician MD or DO - SB420 11362.7(a)). Doctor Alfonso Jimenez, CA LICENSE# 20A6499 American Board of Family Practice Fellow, American Academy of Family Physicians Qualified Medical Marijuana Examiner I, the undersigned, hereby request a consultation by the physician for purposes of determining the appropriateness of medicinal cannabis treatment. I acknowledge and understand the above treatment plan and objectives and agree to comply with them. I understand that it is my responsibility to see the physician to assess the possible continuance of cannabis use beyond the term of the approval. Furthermore, the undersigned, my heirs, assigns, or anyone acting on my behalf, hold the physician and his/principals, agents, and employees, free of and harmless from any liability resulting from the use of cannabis. I certify that the information provided is true and I consent to allow Dr. Jimenez or my primary caregiver to discuss or release any protected health information pertaining to my ‘Qualifying Diagnosis (es)’ as it pertains to the use of medical marijuana with the law enforcement official or verification/ registration program officials or collective and cooperative operations or dispensaries who request verification of physician statement recommending medical marijuana. I shall have only one ‘primary caregiver’ and promise to report changes in information to Dr. Jimenez within 7 working days. I understand that I must be a California State resident and 18 years or older to obtain an approval or recommendation for the use of cannabis. Any person who knowingly or intentionally furnishes false or fraudulent material information in or omits any material information from your verbal or medical records would be in violation and may not be protected by Prop 215. I further understand that by signing below, I am authorizing the release of any part of this record, except for identifying information, for use in data analysis of cannabis treated patients. ____________________________________________________________________ Qualifying Patient’s signature. ________/________/____________ Date.