Featured Speaker

Dr. Richard Bebb

MD, ABIM, FRCPC Endocrinologist Victoria, BC

BIO:

Dr. Richard Bebb, endocrinologist, Vancouver BC completed his clinical training in endocrinology at the University of British Columbia in Vancouver, followed by BC Research Training at the University of Washington in Seattle.

Dr. Richard Bebb, was the Acting Head of the Division of Endocrinology at St. Paul’s Hospital from 2005 to 2007 and is currently both an active and consultative staff member at the hospital, working as an endocrinologist and as a staff physician in the Healthy Heart Program Prevention Clinic. In addition, Dr Richard Bebb, endocrinologist, Vancouver BC is a founding partner of Pacific Western Medical Education.

D.r Richard Bebb, is in good standing with the College of Physicans and Surgeons. Dr Richard Bebb, treats a variety of conditions, including diabetes (insulin therapy). https://drrichardbebb.com/

( Dr. Richard Bebb, Endocrinologist, Victoria, BC ) is in good standing with the College of Physicians and Surgeons.

o once your surgery is over, we may recommend a radioactive iodine therapy.

And there’s two ways that can be given. The old-fashioned way, if you will, is just not taking a thyroid hormone for perhaps four to six weeks, and having a dose of reactive iodine.

In recent years, we’ve had a product that can stimulate your thyroid or any residual thyroid tissue to take up radioactive iodine, which is much more kind and gentle in terms of impact on how you feel.

Because very quickly, you will feel back to normal. You should feel back to normal on an appropriate dose of thyroid replacement, and the radioactive iodine itself very rarely has side effects like nausea or discomfort.

It’s not like conventional external radiation for other cancers. It’s actually quite unique, radioactive iodine.

The only organ in the body that takes up iodine and hangs on to it is in fact the thyroid. The kidney takes it up and excretes it out of the body, and it has a transient passage through salivary glands and a few other tissues. But to hang on to it when it’s ingested, it’s the thyroid. So it’s a very unique, effective therapy.

The treatment for radioactive iodine therapy occurs in nuclear medicine departments in hospitals, and you would come in. You’d have a previously decided upon dose, either taken in pill or liquid format, and you leave, depending on the actual dose.

In high dose therapy, we sometimes require patients to be admitted to hospital for a very short period of time. And that’s basically to limit the potential exposure of radiation to others.

If you have further questions about the diagnosis or treatment or long-term follow-up of thyroid cancer, discuss it with your family doctor, or your family doctor may refer you to a physician experienced with this particular type of cancer.

Presenter: Dr. Richard Bebb, Endocrinologist, Victoria, BC

Local Practitioners: Endocrinologist

Dr. Richard Bebb, MD, ABIM, FRCPC, Endocrinologist, discusses where medical cannabis can play a role in the treatment of peripheral neuropathy in diabetes.

Diabetes can affect nerves in many ways, and one of the most common ways is peripheral neuropathy. And by that I mean the nerves, the long nerves to your feet get damaged, slowly and progressively, starting with symptoms in your toes, then the forefoot, then the whole foot and with time, involving the lower leg.

We try to prevent diabetic nerve damage by keeping blood sugars as low as possible, avoiding other toxins or medications that might hurt the nerves, but we’re not always successful. Some diabetic neuropathy is mostly a numbness in the feet, and not that troublesome and doesn’t require a specific therapy to make someone feel better.

It can have an importance in terms of risk of foot infections and ulcerations. Painful diabetic neuropathy is much more troublesome for the patients. It can take the form of a burning sensation in your feet, or a shooting, lancing sensation, or deep internal pain. And unfortunately, tends to be worse as the day goes on, and many of our patients complain that it bothers them in the evenings, and it will affect their ability to sleep.

How do we treat it? We use medications to try and suppress the pain. Opioids have been used for many, many years, opium derivatives, and there’s many, many of them that have been tried. And they have a role, but a small role in treating neuropathy, as they really don’t tend to be long-term solutions.

Other drugs that have been used are some of the antidepressants. The tricyclic antidepressants, for example, amitriptyline, which has been used for many, many years to treat neuropathy, and is probably even today the most studied medication to decrease the pain, is another class of drugs that can be tried.

Anti-seizure medications are another class of drugs that’s successful, and all of these have a role, but no one drug is perfect in given patients with diabetic neuropathy. And there are some patients, that despite working the way through the established evidence-based medications that we have, do not find sufficient relief from their neuropathy.

Or, the relief that they get comes at a price of complications and side effects from those drugs, and they need something else. And that’s where medicinal marijuana seems to have a role. Medical marijuana can be prescribed in different ways. It can be smoked, which is the historical way marijuana was used.

There’s vapourizers now, ingested or taken orally, or some have attempted to extract components out of the raw marijuana , and either use that orally, or actually in the case of peripheral neuropathy from diabetes, to apply the extract directly to the feet, where the pain is.

Now, which is best? Like most facts, or questions about marijuana, we really don’t know. It’s my bias, and it’s I think a logical position with the data we have right now that it’s probably best not to smoke marijuana, and the reason for that is we know there are some tars and compounds liberated, that are probably in the absence of good studies at least, not good for you lungs. So why expose yourself to them when you have another option, for example taking it orally, which won’t expose you to potential danger.

To summarize the use of medicinal marijuana in the treatment of painful diabetic neuropathy, the first course of action is to try and prevent it. If you can’t prevent it and you’re having pain, work through the available validated therapies that are available to you.

And if they work, super. If they don’t and you’ve run out of options, it’s a serious consideration to try some medicinal marijuana with the direction of your physician, who you should consult to guide you through these various stages and options that you have and discuss what’s best for your particular situation.

Dr. Richard Bebb

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