Episode 41: Sunday June 13

Part 2 of our fascinating discussion: 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)
2021.06.13 CBD (Cannabidiol) for post-operative pain management Part 2
Dr. Lisa Gardner-Phillips: [00:24:29] And even it's funny, like I think it was like two or three months ago.
I read that scape daily and it came across my desk. It said, doctor, you better be on board because one in seven of your patients is already taking it. So I thought that was really interesting. They're taking it anyway. So we want to be, we want to be a doctor that's yeah, tell me what you're taking.
Cause now it's funny, my patients that now that I'm doing CBD, they're like, oh, now I can tell you, I take THC too. Like it's almost like allowing people to see like about the things that they're taking, because how many times stands that patient committed, then they don't really disclose. When they're on because they're embarrassed or they feel like, oh, you're going to be their judge.
That's 
Trey Phillips: [00:25:16] the, what? It's still a huge stigma associated with it. And I think it's really important being the only non-doctor in the room that you guys, become, educated in this, even if you're not advocates for cannabis. I think it's really important that medical professionals become educated because the problem I see, not from the medical side is.
Dr. Sam in New Jersey, they just legalized marijuana there, but you have all these states where essentially it's politicians that are determining, laws and regulations who 99% of them have no medical training whatsoever. So they don't understand how to treat a patient. They've never treated a patient before, and they don't understand how the body works or the systems work, let alone do they actually understand cannabis, but these are the people that are determining how you can treat your patients.
And. Me personally, I have a big problem with that. I think the decision to use, whether it's cannabis, marijuana or CBD should be between a patient and their doctor and that's it. You're the expert, you're there, you're their advocate. And so I think it's really important as more and more doctors become educated that we take this power out of the hands of local and state politicians and really put it into your hands.
To determine what's best for you. 
Dr. Lisa Gardner-Phillips: [00:26:23] Isn't that what we want to fulfill is that your, the doctor's I don't know, did you get into seven 11 is in something, because what we have found is there a heavy metals and pesticides within a lot of these CBD products that you're just buying on?
Whatever, and don't buy CBD on Amazon by the way. Cause it's not what it says. It is. So it's completely. Yeah. 
Trey Phillips: [00:26:45] If we go back to 2018 and we opened up our brick and mortar store, What's different about our store is one. We're not a franchise, so we don't sell franchise products. We decided, Hey, let's go out there and see who's doing it the best in the country.
That's bringing those products here. They're not in glass cases, it doesn't have this kind of sketchy smoke shop feel, looks this bright educational experience, but we went a step further and we said, we're going to run lab tests on these products independently. So if you're a brand and you approach our store, you're going to provide us with a lab report that says what's in your product.
We went a step further and we said we're going to independently lab test ourself. And then when we put these lab reports together, they should match up and say the same thing. And what we found was that there was a huge margin that didn't. And so yeah, we found led, we found arsenal.
We found Blahniks that were mislabeled that, said there was a thousand milligrams and there was 500. We found products that literally coconut oil. With a layer of CBD on it. What we found was there's really no one to tell them that they can't do that. And so it's really incumbent not only on the provider but the consumer as well, to be really educated on what brand they're buying, where is the hemp sourced?
How is it manufacturer, how does it wind up on your shelf? What are those processes that it goes through? 
Dr. Lisa Gardner-Phillips: [00:28:00] Which Sam said it earlier. You said we all, as a physician, our standards are naturally higher. They just operate higher. And that is, it's just, that's just yeah, of course. I'm going to make it work.
Does that pesticide me now? I don't want to take it to the pesticide. So I have an invested, interested because I'm giving it to my own patient. So the, my standard is always going to be above some guy that made it out of this apartment, obviously. Cause my name is on it and I really want it to help people.
Cause I, it's got my name on 
Trey Phillips: [00:28:31] it, right? Yeah. So it really born. Yeah. We also was born again out of this solution. So Lisa got into CBD, needing a solution for a patient. We got into CBD. We found these problems in the market and so well, so it was really, again, born out of another need for a solution to.
Deliver a product that had the, the safety, the consistency and the efficacy that she was used to on the medical side and stuff. And how do you source 
Dr. Sam Rhee: [00:28:55] your product and how do you manufacture it as well? Sell? So what is it that you do that's better or different than say what's out there now?
Your sources, like how did you get about that? 
Trey Phillips: [00:29:04] And I'll frame it in the way of what a consumer should look for when they purchase a product. So one it's very important that they source a product that uses American grown hemp. There's a huge influx in the market of foreign hemp.
And hemp is a great plant because you plant it in the ground. It grows very quickly and it also soaks up any contaminants. And if there's a chemical spill and you can plant hemp over that, and it's going to suck all that stuff out of the soil and you can begin to reuse that soil now in other countries.
Sometimes they don't really care. Did they use that to clean up a toxic spill and then they just sell it on the market. And so that's where you start finding these CBD products here in the us that have these high metal concentrations NetApp. So you want to make sure that it's American grown hemp grown to organic standards.
So there is a little bit of confusion on being USDA certified and it's still a gray area right now in the market, but at least grown to organic standards. You want to make sure that it's extracted using one of the, one of the more beneficial techniques. We use a CO2 extraction because it's one of the cleanest ways to extract it.
And then finally, how do you manufacture it? So well, still was manufactured in a certified GMP facility. So it is controlled by the FDA and how it's manufactured and the quality standards that go along with it. And so you really want to make sure as a consumer of the product you're buying. All those steps are controlled along the way.
And one of the problems in the market, she mentioned the white labeling is probably about 75% of the products on the market are only made by a handful of manufacturers. And so they sell their house product. I decided I want to be a CBD brand. I just bought their product. I slap my label on it. And so if I created it and we're a little bit different and our formulation is a hundred percent proprietary.
Lisa developed it with. It's a pretty amazing chemist and manufacturers. And so what we do is not only use that super high quality CBD American grown hemp she has infused it with high quality organic bio ceuticals like tumeric ginger and peppermint, and have their own wellness properties that are well-documented.
And so we really believe combining all those together in this proprietary formula really raises the bar for us. And then we do batch level testing, which is different. And so again, if you're a consumer. Buying a product anywhere you want to make sure that there's batch local testing. And what that means is every time we make a product batch, that batch is individually tested as a final product.
But a lot of people do is they run a lab report because lab testing is very expensive. It's six, $700 to test a product. And so that a lot of people, what they do is they test a product and they use that same lab report in the next day for the next five, six batches, whatever. So we're different than every batch is lab tested.
Every product. And if you could see that it has a QRC code on it, so you can scan any one of our Chromebooks and be taken directly to the lab report that's associated with your product and we do full panels. So we're going to test for potency. We test for heavy metals, mold, solvents the full range.
And again, as the consumer, we're giving you the power to see what's actually in your product and not just some general. A lab report at the end of 
Dr. Lisa Gardner-Phillips: [00:32:11] the day, we all know it could be used, whether it's a hard body, do we go to for surgeon whatever transparency is, everything. And I think that's how we build.
I know that's how I built my career is I've been honest about everything, what I've done when I do see. Just being honest and it, honesty is the best policy cliche does really matter. So that's what I think is important as surgeons. It's you have to be honest with your patients. We full disclosure.
Everybody might when they come in the door. And so I've used all of that information from my past and what I've learned as a doc and doing surgery on people to is be honest with people. So that's translated over to my new business with tray. It's the same thing. We're just extremely transparent. And that's what, that's how you become successful.
Dr. Sam Jejurikar: [00:33:02] I love it. I have one question that is not directly related to surgery, but literally I think three times a week, I hear an advertisement on the radio for Delta eights. What is Delta aids? I heard Trey mentioned Delta nine in the very beginning. What's Delta eight. Why is it become such a thing recently?
All right 
Trey Phillips: [00:33:20] well, Delta nine is your traditional THC molecule. And. Delta nine is the only cannabinoid mentioned in the hemp bill in Texas and the us with a limit on it. So either again, it's at three tenths of 1% of Delta nine. That's the most you can have now, Delta a is a close cousin to Delta, not just slightly different and molecular structure.
And what they found is in a natural setting, Delta eight. Does not get you hot, but if they take Delta eight and they concentrate it, it does give a slightly high feeling, not as strong as Delta nine, but it is psychoactive. And so Delta eight has become this legal workaround for THC in Texas.
Because again, as long as it's not Delta nine you're. Okay. And so don't say it's become this kind of legal THC work around in Texas. However there is a couple Medical marijuana bills and the Texas legislature right now. And I think it was Friday nights Senator inserted an amendment into a medical marijuana reform bill to ban Delta eight in Texas.
And now it's going to go, 
Dr. Sam Jejurikar: [00:34:31] so to legalize medical marijuana, but band Delta eight, is that what's his publisher? 
Trey Phillips: [00:34:35] There's a lot of special interests involved in this decision. It, wasn't probably done in a way, the last minute at the end of the night, they threw something in but yeah.
And so you also have Delta eight and now you're seeing Delta 10 emerge which is another cannabinoid found in the hemp plant. That's just slightly different and molecular structure than Delta nine. And it has its own psychoactive effects that are different than Delta eight and Delta nine two. And in Texas for hemp farmers and producers, Delta H and Delta 10 essentially are, large sources of revenue for them.
And Within Texas. I know there's probably people listening all over within Texas. You're going to see Delta eight and Delta 10 become a really hot topic in the next two weeks as it goes to the house floor to 
talk 
Dr. Lisa Gardner-Phillips: [00:35:17] about. But again, I think it's another way to show that the, everybody that people are looking for alternatives they're desperate.
They don't want to be on Ambien. They don't want to feel. Yeah, ambience terrible. And it alters your brain. It, no way worse than in like a Delta eight or a Delta 10 potentially would you can still function on Delta eight, but not like THC does not. So it'd be like the ambulance of the world that Lexa pros, all the beds and the beds and the Xanax and all that kind of stuff.
It's way better than that kind of stuff. So again, we don't love the politicians. Are deciding what patients are trying to do for their own benefit to sleep. Look at the anxiety and everything else has come out in 2020 with more depression than we've ever seen. The biggest cause of disability in the world is anxiety and depression.
That is the biggest reason people seek. Disability from their jobs because of that. So here we are trying to like, get this out here so people can just chill out, basically just perform and be happy. You've probably seen the depression that comes along with it too, within your patients. I've seen it.
It's crazy. So I felt like we had another alternative for them. And now they're trying to take it away 
Trey Phillips: [00:36:32] and and not to get too political. Not Dr. Salmon, New Jersey. You're a little bit different because your patients have much more access to two solutions. And the Dr. Sam does here in Texas, but Texas actually has a current medical marijuana program.
It's called the compassionate use program. It is seen as a laughing stock of medical marijuana programs in the nation. Essentially, there's almost 30 million people in Texas and right now currently a little over 5,000 people in Texas have access to this program. What they did is they kept the THC amount at five tenths of 1%.
And I'm sorry, half a percent. And so it's really it's like a nothing burger. You can take a half percent THC product and basically receive nothing from it, but it was believed to be done. Leadership in Texas could say, look. We're compassionate. We care about kids with epilepsy, blah, blah, blah.
And they basically created this plan that really does nothing for note for nobody. They've made it very difficult to access a physician to even get a referral for this. And if you do get a referral, then they make it very difficult to get your product. So you can only get it in Austin.
It's very expensive. And so part of what we're seeing in Texas is this moves forward, this medical marijuana reform bill. It goes to the houseboat which was great. But at the end of the day, both Lisa and I believe that the politicians outta be audited, it should be out of, it should be between 
Dr. Lisa Gardner-Phillips: [00:37:50] you and her.
It's not about why should I have to be a neurologist to prescribe it. I know to the brain, it's other things. 
Dr. Sam Rhee: [00:37:57] New Jersey's been pretty liberal with their medical marijuana program. And right now the debate is they expect a lot of demand with the recreational marijuana. And as you can't ship marijuana interstate.
So everything that is sold in New Jersey has to be grown in New Jersey. And there's not enough. Supply yet. So that was, that's a big thing but in any case, the politics aside, one of the questions I wanted it, I would want to know as a consumer is. So I, I have some idea of what some of these different pain.
Medications that we currently prescribe do for people, typically opioids will make people sleepy. They may cause some nausea, they get them loopy. And obviously there are major issues of if too much is taken at one dose, ibuprofen or an INSEAD. Can be very helpful with pain, but then if you take too much, it's going to rip up your stomach.
You can cause gastros, gastritis. So what are they general reports that people have when they take ingestible CBD? Do they have a sense of what are some of the general effects that you might expect to feel or see along with it in a acute pains setting and then what happens if you accidentally take, say too much?
What could you also expect as a patient? So there's, 
Dr. Lisa Gardner-Phillips: [00:39:12] there's a lot of pain relief with it, in a sense at more of a sense of relief. So it changed her brain away from worrying worrying, and then you just take it and you can have a sense not before yet necessarily, but just a sense of.
Just bringing it down, the noise, you bring the thought 
Trey Phillips: [00:39:29] like that stereo speaker now, 
Dr. Lisa Gardner-Phillips: [00:39:32] like the pain may still be there, but you're not so my gosh. Oh my gosh. And then you get yourself, worked up and then you call Sam and you're like, oh my God. I can't whatever. And but that's, the goal is to just turn the volume down for people.
But I think that's why they're turning to all these alternative things because that's not what happens. What if I get it, you're out. You do so loopy. You can even with one, I've had a little mini patients that are just out with one. So what 
Dr. Sam Rhee: [00:39:59] happens if you take too much or you accidentally take.
A ginormous dose, 
Dr. Lisa Gardner-Phillips: [00:40:04] nothing, really, nothing side effect wise, nothing bad happens. You can have a little diarrhea. So those are some of the little things that can happen with it. Some people do get a little sleepy, but it's not like a TFC sleepy where you're completely out. You don't remember anything. It's not 
Trey Phillips: [00:40:19] like that.
That's the greatest thing about cannabis in general, but then CBD specifically is no one has ever overdosed. There's never been a documented case of an overdose or the CBD or cannabis products. And so 
Dr. Lisa Gardner-Phillips: [00:40:35] a hundred thousand in 10 years, since 2009 to 2019, there was 500,000 opioid overdoses. And that's not okay.
That's what we're trying to. It's 
Trey Phillips: [00:40:49] interesting. We get a lot of feedback depending on again, how much you take of a product and give you different results. A lot of people take very small doses of CBD, like in the morning microdosing. So they'll take. Anywhere from five to 25 milligrams in the morning and they actually find it very uplifting.
They use it in substitution of coffee. But it makes them actually a carrier, but it makes them very alert without like caffeine jitters. And then they will begin to take larger amounts during the day, especially in the evening time. A lot of people say that it makes you sleepy. I think.
I think it makes you more relaxed than sleepy. So you're able to sleep at that point. But again, using the same products in two different ways can give you two different routes results. I know I can't, I don't know what 
Dr. Lisa Gardner-Phillips: [00:41:33] that means. If I phasic is same product different was different results, same product, different results.
Yeah. Yeah. 
Trey Phillips: [00:41:41] And then we get the question a lot. If I drink the whole bottle, will it make me high? And the answer is no. So remember CBD is not psychoactive, even though it has trace amounts of THC in it. Even if I drank the entire bottle, once my receptors are full, it won't titrate in my body fast enough before I get rid of it.
And so I could drink a gallon of it. It may make me sick to my stomach, but I'm not going to get hot for me. 
Dr. Lisa Gardner-Phillips: [00:42:07] But you don't have receptors surviving it necessarily. And that's why people feel well. So we don't, we're not Lexapro. We don't have receptors, the ambient, all these medications, we just, our body doesn't know what to do with it.
And it just, we have the opposite effect. But I think obviously in plastic surgery, you do have a place for opioids. And that is coming from a person that has had it. Yes. There was a time that I needed to get off of it and reason the next thing. And then, but there was, what else do you do?
So then once you do ends up being something that we can help out with after that. 
Trey Phillips: [00:42:42] Yeah.
Dr. Sam Jejurikar: [00:42:46] No go ahead, Trey. I don't want it. I don't want it. 
Trey Phillips: [00:42:49] I had spinal fusion done late last year. I did opioids for about two to three days post surgery. And it was pretty significant. I had rods and everything put in. And then after two or three days of using opioids, I transitioned off and use CBD products exclusively.
And again, I started at higher doses than what I normally take. And then as I felt those symptoms relieving being relieved and I started to take her off and back down to my normal, daily dose that I just take for wellness in general. And like your, 
Dr. Lisa Gardner-Phillips: [00:43:18] your cohost he's the doc again in the 
Trey Phillips: [00:43:21] nice.
Dr. Lisa Gardner-Phillips: [00:43:25] So that would be a good one for postdoc pain control would be the topical roller for his knee because when you have these scopes, the incisions are so tiny, not like in plastic surgery necessarily where you want a big Tommy tack abdominoplasty scar. So with him, I would definitely say, Hey, do that roll around at me because those issues are so tiny and closed over that he would be a perfect example of how Topco 
Trey Phillips: [00:43:49] would work.
But I everyone knows that. The whole opiod thing, it's a huge issue. I was in Wichita falls about three weeks ago. And actually it was one of our Wellstone champions. And he finally got the courage up to come talk to me. This guy's a retired Navy veteran.
He is a current first responder and a medical first responder and he was suffering from neck issues and they got worse and he finally had neck surgery done. They gave them opioids to to deal with the pain. And he he got addicted and he kinda kept going back to get more.
And all of a sudden 30 days worth, it only lasted four or five days. And he made the decision to start buying opioids on the street. That's what he, that he couldn't get out of bed otherwise. And so here you have this Navy that, this medical first responder, who, whose doctor just cut them off. So how am I doing anymore?
But didn't give him another solution. And now he's out on the streets, buying drugs and yeah. And to the point where his wife caught him doing it and said, Hey, if this ever happens again, we're done. And so he ended up having another surgery and I was supposed to get the two years of relief, gave him about eight months and the pain started coming back and he said, I was honestly.
Really considering buying drugs on the street again, because I can't get out of bed. I can't go to work. And so he found CBD and began using it. And he said, day, one day, two day, three day four, nothing all the way to day seven. He said, they sound and I got out of bed and stretched and just realized, holy shit, I just got out of bed.
Because before this, his wife had to help him out of bed. And he really credits having this alternative therapy too. I don't want to be dramatic and say saving his life, but to save his marriage, he didn't have to go back out and buy drugs on the street, but it gave him another option to deal with his pain other than an opioid, which, had the potential incorrectly to destroy his life.
And so again, I think it's all about giving people and giving your patients options. For you guys, you need those tools in the toolbox and it's CBD or THC. The answer for everybody. Absolutely not. At least I'm never say this is a miracle cure. It's not some panacea but it may be right or certain people and, again, it all comes down to giving providers those options.
Dr. Sam Jejurikar: [00:46:02] Know. Yeah, that's really a powerful story. And I think what Sam and I, and every other surgeon out there is looking for as alternatives to opioids for all the reasons that you guys are saying. And thanks so much for your insights today. I think everyone who's listening to our program should immediately go to Instagram at well sell CBD.
Because what's very clear listening to two of you talk is that I know less about CBD than I thought I did. But it's good to know other people that actually know a ton about it. So with that, I want to thank you guys so much for being on our podcast. It's been a blast catching up and I've learned so much.
Trey Phillips: [00:46:35] Thank you very much 
Dr. Lisa Gardner-Phillips: [00:46:37] because you make women's lives different. You change our lives too, and give us our confidence back. So thank you.