Episode 40: Sunday June 6

Drs. Sam Jejurikar @samjejurikar, and Sam Rhee @bergencosmetic welcome guests Trey Phillips @welcelCBD and Dr. Lisa Gardner-Phillips @docfortworth, founders of WelCel, a company specializing in CBD (cannabidiol). If you ever wondered about CBD, and if it would be useful for postoperative pain, these experts break down CBD - what it is, what kind of CBD products are available, and what to look for in a great CBD product. Effective pain control is a critical component of great surgical outcomes. If you ever worried about pain management after surgery, this episode is a MUST WATCH

#podcast #plasticsurgery #cosmeticsurgery #rheeplasticsurgery #boardcertified #plasticsurgeon #beauty #bergencosmetic #boardcertified #aesthetic #3plasticsurgeonsandamicrophone ⁠#bestplasticsurgeon #painmanagement #postoperativepain #CBD #cbd #cannabis #thc #cannabiscommunity #hemp #cbdoil #cbdproducts #cbdlife #cbdmovement #cbdcommunity

Full Transcript (download PDF here)
2021.06.06 CBD (Cannabidiol) for post-operative pain management Part 1
CBD episode 1 and 2
Dr. Sam Jejurikar: [00:00:00] Good morning, everyone. Welcome to another episode of three plastic surgeons and a microphone. I'm Dr. Sam Jejurikar at Sam.  not Instagram. And I'm with Sam Murray as always. Who's at Bergen cosmetic. Unfortunately we are not joined today by salpa Chella. Who's our third plastic surgeon. We wish him a speedy recovery after arthroscopic knee surgery, but instead we have the pleasure of talking to about Trey Phillips and Lisa Gardner Phillips.
We're. We're going to introduce in a second. Okay. But you can find Lisa at doc Fort worth and their brand that they're going to talk about at well sell CBD. Before we get on with the meat of the program, I'm going to turn it over to Sam. Who's going to tell us the usual disclaimer, information we must, we 
Trey Phillips: [00:00:39] must tell.
Dr. Sam Rhee: [00:00:41] Thanks, Sam. This show is not a substitute for professional medical advice, diagnosis, or treatment. This show is for informational purposes, only treatments and results may vary based on the circumstances or situation and medical judgment after appropriate discussion and always seek the advice of your surgeon or other qualified health provider.
With any questions you may have regarding medical care and never disregard professional medical advice or delay seeking advice because of something in this show. 
Dr. Sam Jejurikar: [00:01:06] Thanks Sam. A few weeks ago we did an episode on alternative approaches to post-surgical pain that at least four or five patients have already talked to me about, and it was very well received.
And so we thought we would continue that theme a little bit more by inviting Dr. Gardner Dr. Gardner Phillips and Trey onto the show. So I've known Lisa for several years. She's actually a board certified physician. Who's based in Fort worth, Texas who transitioned to it. From a thriving practice in OB-GYN to an even busier practice in both aesthetic and regenerative medicine.
She's incredibly talented at the pleasure of collaborating with her on several patients and she's beloved by her patients. She has an almost cult-like following with their patients where she basically tells them what to do, and they basically do it through, through Emma and that's benefited me cause she sent many people to me.
So I'm grateful for that. Through Lisa I've had the pleasure of meeting her husband Cray. Tres impressed me from the moment I met him with his very analytical and tactical approach to business, which isn't surprising because he's a formal former SWAT team leader in in Fort worth. But both train lease are intensely in fitness and have a holistic approach to not only medicine, but to life in general.
And a few years ago, they began to espouse the benefits of CBD to me. In fact, in 2018, they were so passionate. They found that the first and only physician zoned CBD apothecary in Fort worth, which is called thrive. And they basically are able to hold their products to a higher standard. Like doctors basically try to do and, really have taken CBD to the next level.
So in 2020, they actually developed their own brand of CBD products. Sell, which I'm sure they'll tell us about which is part of their broader vision to promote the benefits of CBD throughout the country. So we're thrilled to walk them to the podcast today. And I'm really excited to learn about how I might incorporate CBD into my surgical practice.
So Trane, Lisa, thank you so much.
Dr. Lisa Gardner-Phillips: [00:02:53] That means a lot to us. It really does. So thank 
Dr. Sam Jejurikar: [00:02:55] you again. Oh, thank you guys. I'm going to start with the basics just because some people listening to the podcast may not know anything about CBD, they just hear it advertised. And they think that it's still, a form of marijuana and they're a little skeptical about it.
So how does CBD differ from marijuana? Why should we feel okay about promoting it to our patients? 
Trey Phillips: [00:03:15] Sure. So I'll go backwards just a little bit. So CBD is short for cannabidiol. Cannabidiol is a chemical compound that is found in the Kemp and the cannabis plant. And within the cannabis plant, there's over a hundred of these chemical compounds that, that make cannabis.
And so the us government actually defines the difference between what is him and what is marijuana by the amount of Delta nine THC. That naturally occurs. And so U S government says anything with a Delta nine THC content higher than three tenths of 1%. Is marijuana, anything below that three tenths of 1% is him that you can find CBD in both hemp and marijuana.
And there's different strains. There's different species of it that determines. Is it a high THC producing plant or is it a high CBD producing plant? And so for years, Delta nine, THC was the most known cannabinoid because it gets you high. It has the psychoactive properties, and it really wasn't until several years ago that the cannabinoids CBD really started to make headway and scientists and doctors were starting to see the most therapeutic benefits from CBD itself versus is THC, California.
Dr. Sam Jejurikar: [00:04:37] Okay. So what are some of those benefits that, that you can see with CBD man? 
Dr. Lisa Gardner-Phillips: [00:04:44] There's just so many. And then also I want to preface this with CBD has been around for a really long time since 1980. So it was actually discovered by Dr. Mochila in Israel. I don't know if you guys know that part of it either.
It's pretty impressive. So it's been around for a long time and. In a very short period of time. It's been like a new thing in America, but it's actually really old. It's been around for a really long time. So American medicine has been very pharmaceutical, as we all know. And that's what we're taught to do not get a little Percocet after, after you deliver a baby or, we were definitely using Demerol.
We were doing all kinds of stuff. But we found, in you notice and medicine. There's a lot of side effects after you have an operation or any surgical procedure, minor or major doesn't make any difference. You end up getting some side effects, but like good example, constipation from an opioid after you've had surgery, doesn't work very well because you're hurting already.
And then your guts start hurting. We went away from when I changed. My practice is a big part of that. When I left the OB and retired from that, I started realizing how many of my patients were actually on NES, just generally speaking, whether it was postdoc or not, they were on opioids. And I just couldn't get over that.
So we were like, there's gotta be a better way. And then we started caring a lot more about CBD and then decided, we need to make this something that is more of a professional grant, so people believe, and then they trust. So that was the biggest problem we were having is getting people to trust the fact that this has been around for a really long time.
Yeah. And I 
Trey Phillips: [00:06:27] think to even go back to your question, what does it do? CBD for us was born out of the need for a solution for Lisa stopped writing prescriptions. So three years ago, and despite her parents, her patients doing really well on hormone replacement therapy and better diet and lifestyle, 99.9% of them still came to her and said, I have anxiety.
I can't sleep I'm in chronic pain depression, the whole gamut and. Lisa really felt like she didn't have another tool in her toolbox to offer her patients. And when she started researching cannabis and CBD specifically she did it in her medical journals and she felt there's gotta be a little bit of information out there in others.
And yeah, so she found tens of thousands of documented medical journals, clinical trials, things like that. And I think. I think he felt even a little bit of a betrayal of that. And she's been a doctor for 20 years and nobody had talked to her about, this potential treatment, instead it was just drug rep after drug rep coming to her office, but nobody talked to her about this holistic approach.
And I think it was really revealing to her. And it really started us on this whole new path of where she could take her practice and really how else could she better serve her community by offering, another solution? 
Dr. Sam Rhee: [00:07:44] Okay, let me ask you at, as a provider who doesn't know a whole lot about CBD or use it if you were to simplify it for me.
And I said, okay, I'm a plastic surgeon and I have a patient who had a breast augmentation. What should I do? Or what are your recommendations for me as a provider in terms of how do I incorporate CBD into my practice? 
Dr. Lisa Gardner-Phillips: [00:08:06] I would say. A few, maybe even a week of opioids is necessary. I've had that surgery done with Sam twice.
So I can tell you, there is pain associated with it. It's not terrible. I had a tummy tuck also. That was way more painful than that. I have both done at the same time, the second time. And I forgot completely that I had breast augmentation because it was so uncomfortable. Because your skin is so tight.
It's amazing. I do it again. People always ask me, would you do it over? And the answer is always, yes, I would absolutely do the river, but I would say a week of opioids would probably be sufficient, maybe two, and then transitioning us into a pretty decent dose of CBD. But I would not recommend taking them both together because CBD can potentiate opioids.
So you're, you have to be really careful about that. So people are all in like other beds. It can actually make it work better, which is not always a good thing. For example, high blood pressure, right? High blood pressure. Now you can drop out potentially your blood pressure, even like too low, low diastolic or whatever, if they're already running low as it is.
So you never wanted to do both of those at the same time, or you can do a little bit with your blood pressure or your opioid. So what you do with CBD is like. Docent where as you're coming off of the opioid, you would go higher so that you have to trial it because people aren't necessarily, they don't know how much to take.
So we have a little bit of a solution to that because we have a nurse group that we also work with for patients that they can call in and then they can help and all that trade 
Trey Phillips: [00:09:48] kind of, yeah. And tobacco a little bit further too. So you said now how much CBD should I take? There's actually three major kinds of CBD that are recognized in the United States, by the industry.
So you have full spectrum CBD, you have broad spectrum CBD, and then you have a CBD isolate and so three very different forms of it. And so a full spectrum product. If you remember, I said, there's a, there's over a hundred compounds found in the cannabis plant, including THC fatty acids, you have proteins flavonoids.
He had all this great stuff and so a full spectrum product takes all those compounds together. All those compounds are extracted to make a full spectrum product. So you're getting multiple cannabinoids, including low amounts of THC and a full spectrum product. And then you have a broad spectrum product, which is essentially like full spectrum.
You have a wide range of connect cannabinoids. But then the TAC is chemically grabbed from it and removed from it. So it becomes detectable levels of THC, which can become important if you're a physician or a truck driver or a firefighter, and you may be drug tested for your employment. You don't want any kind of false positives being caused by trace amounts of THC, even though they're illegal.
And then finally you have a CBD isolate, which is the most refined form of TC of CBD. It's also the cheapest to make, and basically everything's been removed. But the CBD. So the only chemical compound that there that is their CBD. And then Lisa was talking about, what we've done because one of the biggest issues is really patient education and even provider education.
You guys are busy, you're seeing patients and you really have no idea what your staff is telling people. You know what they're finding on Google, which is pretty dangerous. And so what we did with our company Wellstone, we've partnered with a nonprofit nurses group called lead for one one.
And what that does is they are a pure patient advocacy group and provider advocacy group. And you can call in and talk to a registered cannabis nurse, whether you're a physician, a customer, or not even a Wellstone customer, you simply call our number and we connect you with a registered nurse and they will cover everything from.
CBD education, hemp education, dosing protocols medical interactions, prescription interactions. And so we've really, we've really provided this kind of safety net for customers and providers to be able to talk to registered condition nurses, that this is all they do every single day. And they're not well sell nurses.
They're not Lisa's nurses. They're they are pure patient advocates. And they will tell you if the product is not right for you, they're not there to sell products. They're there to advocate for the patients and advocates advocate for the plants. And and they takes it 
Dr. Lisa Gardner-Phillips: [00:12:27] away from you because then they're not calling patients, aren't calling you.
And I found that, you don't have this. People forget, or it's not on the list of themes, postdoc, whatever. So that's acid patient of Sam and having had plastic surgery myself, I would say a week to week and a half with maybe open those because that's what I used it for. And after that, I was pretty much done with the whole thing, because I didn't like the way it made me feel.
Anyway. Sam knows, I have a funny story about. That's my third set. I have to throw the scenario. It's all transparent. I injected my own lids. 
Dr. Sam Jejurikar: [00:13:07] Wow.
Dr. Lisa Gardner-Phillips: [00:13:11] I don't know why did it? I don't remember. And I ordered a bunch of stuff with a monogram on it. If my name.
I don't know what happened. I monogrammed literally everything that came in the door and then I ended up. So as you have fluid during surgery, too, that it's been there. It's very hydrophilic. I ended up with the biggest cartoon lips she could ever imagine. I was the most embarrassing time I've ever had in my life.
And that was on Vicodin. So I can tell you and attest. That's what these meds will do to you. It changes your brain and it's not okay. And thank God I was able to hyaluronic days my own libs. Otherwise that would have been my lips. For a very long time. I'm just like, the next day my daughter comes over and she's what the heck have you done?
I'm like, oh my God, this is so bad. So anyway, so if I wouldn't have CBD, maybe it would have been more of a pleasant experience, but but I would say about a week to week and a half of opioids and then transitioning patients over to a high dose. CBD. So you control the panty cause it is those dependent.
Trey Phillips: [00:14:18] Yeah. And one of the most difficult things about CBD is it's not a one size fits all solution for everyone. And there's really not a firm playbook. If. You have this, then you do this. And so it's a much more personalized game plan, a personalized, solution for a patient. And so typically, when we're talking about just general wellness, we're talking 20 to 50 milligrams of a high quality.
I stress the high quality part, full spectrum or broad spectrum product ending on, the liabilities associated with it. And then as you move up into. Much more specific, symptom relief and you're talking about pain. You're going to see that dose start to increase. We have some people that take hundreds of milligrams of CBD every day, because that's what it takes for them to reach relief.
And typically we encourage people to start out on the slower side. Take the products, see, does it relieve their symptoms after two or three days? If it does not, then you generally start increasing and titrating that amount up until your symptoms are relieved, but it's a very personal and patient specific plan.
And that's one thing that we love about having the nurses is you could call them 10 times a day every day, if you wanted to. And they're going to be there and walk, charts and walk you through. But that is a difficult art for provider is that it's not alright, you have stomach pain and I'm going to give you X amount of whatever and that'll take care of it.
There is a little bit of trial or, we always recommend it out to our customers and patients to journal, how are you feeling? How much did you take? What kind of relief did you find? And cause, you just forget day-to-day well, did I feel good yesterday? I'm not really sure.
And it was really found that, a patient actually taking charge of their own treatment and journaling, how they feel is really powerful for them. And it really helps them find. Where that sweet spot is where they can take the right amount of products and get the relief that they want.
Dr. Lisa Gardner-Phillips: [00:16:06] But even if you like a big advocate office with just like your 15 to 16 milligrams daily, we're trying to normalize this for people where this is just what you do. We take, I take 50 milligram capsules daily just for my general health and wellness, but then as you need more, you can always take more, I've taken up to 200 milligrams depending on.
Whatever's happening in a day and that's okay. But it is also a little bit weight dependent as well. So training came needs me.
Dr. Sam Jejurikar: [00:16:39] No, sorry. I I was going to ask I noticed that most of what you guys were referring to seem to be oral dosing of CBD, when you walk into any sort of dispensary, there's a lot of topical formulations as well. Do you guys. See there being a role for this as well on the management of surgical pain.
And is there a difference in CBD in the topical form that's derived predominantly from hemp versus one that has a higher THC concentration 
Trey Phillips: [00:17:03] price? Yeah so what we see in both her practice, our brick and mortar store and then our private brand we see a lot of people using topicals in conjunction.
With an ingestible form of CBD. So we do have some people that, have just got a little ache in my elbow and I'm going to rub the top bill on it. But the people that we get the most positive feedback from is they're using an adjustable form of CBD. Cause you can get much higher concentrations.
So they're treating themselves internally first to control the inflammation or whatever the symptom is. And then they're coming back and they're layering a topical for acute issues and flare ups. A lot of the topicals on the market, especially CBD related are going to be isolated because it's a lot easier to make a isolate into a lotion or a topical than it is a full spectrum of broad spectrum product.
But you're going to see a lot of benefits, but we get the most positive feedback that people are using in conjunction with an adjustable man. If a top bill was made from a high THC plant versus a high CBD plant like him, you're going to have different benefits. And so we always tell people, even in this age, as we're seeing in a recreational marijuana become more prominent and more states, there's a big difference between CBD and THC and what those benefits we recommend 
Dr. Lisa Gardner-Phillips: [00:18:19] both.
If it is legal in your state. So CBD has a completely different system to receive it. And THC debts, there are two different things. So people think, I think people think that, oh, once my state goes legal, I don't have to take CBD anymore. Like it's THC and that's not true. There are two completely different benefits.
So I'm just say yes, but you can still take THC if it becomes legal, but CBD is also, it's like it's. Twin, it's like a good it, good thing to take along with. But I wouldn't recommend a topical over an incision site. For anything, because I've done like a member of Sam and I'll be very transparent here.
My first surgery was Sam. I took it upon myself to treat my surgical staff with and was like, oh, this is like coming in pathic oils and all that. It's split my incision open. I had to go back, that's why I'm going to go back to my second one. Because my incisions were actually. Just, they didn't kill very well, and that was completely my fault.
So I don't recommend Samsung. It's like people can't ever take all the way, leave it on. And of course I went ahead and decided I'm a doctor. I know how to do this stuff too. And I didn't, and I ruined my operating sites. I would never recommend rolling anything over your surgical incisions. Keeping them dry with a paper tape is always best.
Dr. Sam Rhee: [00:19:44] Yeah, we thank you for we thank you for sacrificing your 
body.
Trey Phillips: [00:19:52] Well, 
Dr. Lisa Gardner-Phillips: [00:19:54] now I can tell my patients don't do this, don't do that. And I tell them what I've done. And I'm like, just listen to what he has to say. Don't do what I did. 
Trey Phillips: [00:20:03] And we've talked about it a couple of different times and never really expanded on it. So you actually have a system to receive these cannabinoids within your body.
Whether you're taking, CBD for general wellness, or you're taking it for post-op pain, you have a system within your body, the endocannabinoid system, it's a medically recognized system. And a lot of the science shows that, we believe it to be the Maya, the Maestro of the symphony conductor, and the endocannabinoid systems main function is to regulate the other Sims of the other systems in the body.
And so your body actually makes cannabinoids itself. And so when you're feeling stress, anxiety, pain, Your body releases these cannabinoids, they call them the boy scout molecules because they go around to the other systems and say, do you need help? Do you need help? Do you need help? And their ultimate goal is to bring homeostasis to the body.
The problem in today's society, from the food we eat to the stresses we're under, all the different things in our lifestyle. Our bodies either can make, or don't make enough indogenous canal, cannabinoids to really satisfy what our body needs. And so what scientists have found are the cannabinoids.
In the cannabis plant are easily recognized by our body. Like they're indogenous. And so you can supplement your own endocannabinoid system using cannabis. And so that's where it becomes really powerful is, you're not telling your patients to take something that their body doesn't recognize.
It's not, some potion out there, snake oil, your body has a system. Every mammal has the system in their body. To receive it and it's going, it's really powerful. 
Dr. Lisa Gardner-Phillips: [00:21:39] It's called receptors. I'm telling you guys,
Trey Phillips: [00:21:46] I'm the dumbest one on this call. So they know a lot.
Dr. Lisa Gardner-Phillips: [00:21:56] He knows a lot. So yeah, we have receptors just like we do to everything in our body to receive these they're CB one and CB two receptors to pick why is mostly brain. With CB two receptors are your gut and your immune system. So everybody now, since 2020 knows about immunity. Thank God. And finally, we're talking about immune system function, but this is very similar to saying like a D three.
I check vitamin D three on people to check, Status and all of that, not, we know it helps the community, but it's very similar to that. We have a system that will receive it because we're not getting it from the sun anymore. And so we have to take by I literally have to take vitamin D because I can't process it.
So I take it every single day because I know I have a system to receive it just like I take CBD. So it should just be like a normal supplement you take every day. Like I take vitamin C those sorts of things. So we're just trying to make it where people understand. It's something that you just take.
And then when you take post-op you take more. 
Dr. Sam Jejurikar: [00:22:59] Yeah, that makes a ton of sense. If I didn't tell me if I'm the take home message is wrong here, but I'm getting a few things out of this one CBD, maybe not really for the acute surgical pain, but as you're transitioning in that period of time where it becomes more severe, make you a higher dose of it, too.
What you guys have set up with the nursing line is huge. So for listeners out there because I don't know anything about CBD, Sam doesn't know anything about CBD. You guys know everything about CBD, but I know when I walk into a store, I don't know what I'm buying. I don't know. There's a CBD shop, every block it's like in the state of Texas.
So being able to actually have a place where people can actually get a reputable nurse is huge. So for listeners that are interested in this, how do they get a hold of the nursing line involved with your 
Trey Phillips: [00:23:45] sure. So all you do is call us as well. So it's (817) 989-6219. Your first option when you call will be to connect with a nurse and you just hit the number one button and you'll be transferred to a registered cannabis nurse there, they're actually located all over the country.
But yeah, and you just give us a call. It's free. You can call once you can call the cops. And the same thing goes for more worse. With our Wellstone brand, we were in physician's offices, chiropractors, offices, things like that. And so it's been really beneficial, not only to those people, but their staff as well.
If they're standing there with a patient. Who has a question they can literally just call up, right there in the office and get the solution that they need. And that way, the patient walks out with what they need that.