Friday, 26 August 2016


The razor bumps. The ingrown hairs. The sensitive skin. The tough angles... There are few places on the body more challenging to maintain than the bikini line, as many women have learned struggling to shave, pluck, wax, and laser their way to smooth skin. Even more unfortunate, there are a ton of myths floating around about hair down there. Marisa Garshick, MD, a dermatologist at Manhattan Dermatology & Cosmetic Surgery, reveals the myths she hears patients repeat the most in her office. 

Myth: Hair grows back thicker if you shave it

Dr. Garshick says that shaving anywhere on your body will not cause the hair to come back in thicker; diameter will always stay the same over time. “After shaving, the ends of the hairs are simply blunted, as opposed to the natural soft tip, which may cause the hair to seem coarse,” Dr. Garshick explains. “But the actual thickness remains unchanged.” After shaving, she suggests using a mild cleanser and a gentle moisturizer to keep your skin feeling soft and smooth, even when hairs are growing back. Try CeraVe Hydrating Body Wash  and Eucerin Original Healing Rich Lotion.

Myth: Tweezing is the best treatment for ingrown hairs
Lots of women think tweezing an ingrown hair is the fastest and most effective way to deal with it, according to Dr. Garshick. They're simply wrong. “Tweezing can lead to trauma of the hair follicle, which will just cause more redness and inflammation,” she explains. “Avoid picking or squeezing as this can lead to scarring.” If you have razor bumps or ingrown hairs, Dr. Garshick says to leave them be. “Often, simply letting the hair grow a little will allow the hair to break free from being trapped in the skin,” she says, at which point you can remove it carefully. You can also use a hot compress to help the point break free. If the ingrown hasn't popped out after a week or two, call your derm, who can extract the ingrown for you.
Myth: You should shave down there every day
A lot of women believe the skin on their bikini line will get used to razoring if they do it daily, says Dr. Garshick, but all that does is bring on more irritation and razor bumps. Wait until a few millimeters of hair are visible, or about two days. To reduce your risk of sensitivity, shavein the direction of the hair growth with a clean razor blade that you replace after five to 10 shaves. “Sometimes a prescription for a topical steroid may be needed to treat razor bumps, but you should discuss this with a specialist,” says Dr. Garshick. “And if you're looking for a more long-term option, laser hair removal can help.”

Myth: It's smart to wax between laser hair removal treatments
Laser hair removal treatments from a board-certified dermatologist leave you hair-free in five to eight treatments. The key: five to eight treatments, not one or two. The laser specifically targets growing hairs, which is only a portion of your total hairs, Dr. Gars hick explains. “Although you will notice a significant improvement after your laser hair removal sessions, you may still notice some hairs that don't go away right away,” she says. “Do not attempt to remove this hair with waxing, because the laser targets the pigment in the hair. If the hair has been removed, the laser can't do its job.” Dr. Gars hick says to leave the hair alone. Don’t wax, pluck, or bleach between laser hair treatments, although it’s okay to shave, which will still allow the hair to be zapped by the laser during your next treatment.
It’s totally OK to have body hair, but if you do decide to remove it, you may not be exactly sure which method is best. Laser hair removal and waxing are two popular procedures that women and men can book at a salon or spa. Yet, there are still big misconceptions tied to them — including the rumor that laser treatment doesn’t work on black people, and wax rips your skin off. 
To debunk common myths about these two hair removal techniques, we turned to Spruce & Bond specialist Kristen Rogers to set the record straight. Scroll down to find out what we learned about the difference between laser and waxing. Then, share your hair removal stories in the comments section.
It is more about the color of the hair rather than texture or complexion when determining if laser hair removal will work for you.
MYTH: Black people can’t do laser hair removal.
According to Rogers, there is no skin type or tone that laser will not work on. It is more about the color of the hair rather than texture or complexion. “There are different settings and machines for different skin types, which makes it possible for all skin tones to do laser,” she says.
FACT: The darker your body hair is, the better for laser hair removal.
Individuals with dark hair are prime clients for this method. Basically, the more contrast there is between your skin tone and hair color, the better. Rogers doesn’t believe people with blonde, red or gray hair will benefit from laser.
MYTH: You must be close-shaven before getting laser hair removal.
While Rogers says that most of her clients prefer to shave the areas where they will get laser treatment, it isn’t uncommon for the aesthetician to shave an area such as the bikini line. “It is scary and difficult for them,” she explains. “The only downside to having the specialist shave you in the room, is that it is a dry shave.”
FACT: It takes more than one laser hair removal session to see a significant reduction in hair growth. 
“Laser hair removal works as a continuous process of removing the hair follicle of the given area over a specific amount of time,” says Rogers. “The laser works under the skin’s surface to damage the hair follicles and stunt future growth.” The professional notes that you should start to see results within two weeks of your first treatment. As the hair grows back slower, it will be very patchy. She adds, “I always recommend my clients to treat at least five times, spaced apart four to six weeks, to see the best results. Each session reduces hair growth by 10 to 15 percent.”
MYTH: You won’t experience any pain during laser hair removal.
It isn’t out of the ordinary for you to experience discomfort while getting laser treatments. To help minimize pain, Rogers says that some of her clients take two Advils 30 minutes before their treatment. 

When done correctly, waxing actually grabs onto the hair and pulls the follicle. This is why the area is smoother than after a shave, according to Rogers.
FACT: It is recommended that you allow hair to grow 1/8 of an inch before waxing.
“It’s surprising how many people think they need to shave before a wax,” says Rogers.”The longer the hair, within reason, the smoother of a wax you’ll receive.”
MYTH: Waxing grabs onto the skin in order to pull hair out.
When done correctly, waxing actually grabs onto the hair and pulls the follicle. This is why the area is smoother than after a shave, according to Rogers.
FACT: Hair grows back less quickly when waxing versus shaving. 
Rogers attributes the slower growth to the hair follicle being completely removed during the wax process. “It is waiting for the next growth stage,” she adds.
MYTH: There is no need to exfoliate after waxing because the hair removal method does it for you.
Not entirely true. On the third day of post-waxing, Rogers recommends using a sugar scrub to exfoliate along with a natural form of salicylic acid like willow bark to keep the pores in the area closed and less prone to bacteria. Exfoliation also helps to minimize ingrown hairs. 


There’s a body of research showing that painkiller abuse and overdose are lower in states with medical marijuana laws. These studies have generally assumed that when medical marijuana is available, pain patients are increasingly choosing pot over powerful and deadly prescription narcotics. But that’s always been just an assumption.
Now a new study, released in the journal Health Affairs, validates these findings by providing clear evidence of a missing link in the causal chain running from medical marijuana to falling overdoses. Ashley and W. David Bradford, a daughter-father pair of researchers at the University of Georgia, scoured the database of all prescription drugs paid for under Medicare Part D from 2010 to 2013.
They found that, in the 17 states with a medical-marijuana law in place by 2013, prescriptions for painkillers and other classes of drugs fell sharply compared with states that did not have a medical-marijuana law. The drops were quite significant: In medical-marijuana states, the average doctor prescribed 265 fewer doses of antidepressants each year, 486 fewer doses of seizure medication, 541 fewer anti-nausea doses and 562 fewer doses of anti-anxiety medication.
But most strikingly, the typical physician in a medical-marijuana state prescribed 1,826 fewer doses of painkillers in a given year.

These conditions are among those for which medical marijuana is most often approved under state laws. So as a sanity check, the Bradfords ran a similar analysis on drug categories that pot typically is not recommended for — blood thinners, anti-viral drugs and antibiotics. And on those drugs, they found no changes in prescribing patterns after the passage of marijuana laws.
“This provides strong evidence that the observed shifts in prescribing patterns were in fact due to the passage of the medical marijuana laws,” they write.
In a news release, lead author Ashley Bradford wrote, “The results suggest people are really using marijuana as medicine and not just using it for recreational purposes.”
One interesting wrinkle in the data is glaucoma, for which there was a small increase in demand for traditional drugs in medical-marijuana states. It’s routinely listed as an approved condition under medical-marijuana laws, and studies have shown that marijuana provides some degree of temporary relief for its symptoms.
The Bradfords hypothesize that the short duration of the glaucoma relief provided by marijuana — roughly an hour or so — may actually stimulate more demand in traditional glaucoma medications. Glaucoma patients may experience some short-term relief from marijuana, which may prompt them to seek other, robust treatment options from their doctors.
The tanking numbers for painkiller prescriptions in medical marijuana states are likely to cause some concern among pharmaceutical companies. These companies have long been at the forefront of opposition to marijuana reform, funding research by anti-pot academics and funneling dollars to groups, such as the Community Anti-Drug Coalitions of America, that oppose marijuana legalization.
Pharmaceutical companies have also lobbied federal agencies directly to prevent the liberalization of marijuana laws. In one case, recently uncovered by the office of Sen. Kirsten Gillibrand (D-N.Y.), the Department of Health and Human Services recommended that naturally derived THC, the main psychoactive component of marijuana, be moved from Schedule 1 to Schedule 3 of the Controlled Substances Act — a less restrictive category that would acknowledge the drug’s medical use and make it easier to research and prescribe. Several months after HHS submitted its recommendation, at least one drug company that manufactures a synthetic version of THC — which would presumably have to compete with any natural derivatives — wrote to the Drug Enforcement Administration to express opposition to rescheduling natural THC, citing “the abuse potential in terms of the need to grow and cultivate substantial crops of marijuana in the United States.”
The DEA ultimately rejected the HHS recommendation without explanation.
In what may be the most concerning finding for the pharmaceutical industry, the Bradfords took their analysis a step further by estimating the cost savings to Medicare from the decreased prescribing. They found that about $165 million was saved in the 17 medical marijuana states in 2013. In a back-of-the-envelope calculation, the estimated annual Medicare prescription savings would be nearly half a billion dollars if all 50 states were to implement similar programs.
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“That amount would have represented just under 0.5 percent of all Medicare Part D spending in 2013,” they calculate.
Cost-savings alone are not a sufficient justification for implementing a medical-marijuana program. The bottom line is better health, and the Bradfords’ research shows promising evidence that medical-marijuana users are finding plant-based relief for conditions that otherwise would have required a pill to treat.
“Our findings and existing clinical literature imply that patients respond to medical marijuana legislation as if there are clinical benefits to the drug, which adds to the growing body of evidence suggesting that the Schedule 1 status of marijuana is outdated,” the study concludes.
One limitation of the study is that it only looks at Medicare Part D spending, which applies only to seniors. Previous studies have shown that seniors are among the most reluctant medical-marijuana users, so the net effect of medical marijuana for all prescription patients may be even greater.


Judy Bjerke Severson wants to be normal — visit friends and family, go to the grocery store or even sleep in her own bed — but she says the crippling pain from fibromyalgia and back surgery complications, as well as a painkiller-induced fog, have made her a shell of her former self.
Monday brings a sliver of hope to her and other Minnesota residents who have incurable pain: They can finally buy medical marijuana. Bjerke Severson will be the first to be seen Monday at a Bloomington clinic, one of eight statewide that sell the medicine.
“I could just cry I’m so excited,” the 70-year-old Edina woman said. “I don’t enjoy this life I have right now.”
Expanding the list of qualifying conditions to include intractable pain marks a critical juncture in the year-old program, which is among the most restrictive in the country. Manufacturers and patients have big hopes that it will usher in thousands of new patients, eventually bringing down high costs — which exceed $1,000 a month for some patients — and easing dependence on addictive narcotic painkillers.
Those hopes were buoyed by data from the state showing nearly 500 patients suffering intractable pain had registered in July, the first month of registration and a month before legal sales could begin. That’s more than five times the number of people who signed up in the month ahead of the program’s launch.
The Minnesota Legislature legalized medical marijuana in 2014. The law bans the plant form, but allows pills, oils and vapors to be used by patients with nine serious conditions who received their doctor’s permission.
The Legislature directed Minnesota’s health commissioner to determine if intractable pain should be added as a 10th condition within the program’s first year.
Commissioner Ed Ehlinger cited the program’s successful first few months when announcing in December that intractable pain would qualify starting Aug. 1.
Kyle Kinglsey at Minnesota Medical Solutions, one of the state’s two medical marijuana manufacturers, said he’s confident a largely problem-free first year and his company’s own outreach efforts to the medical community would make it easier in the second year. He also said he thinks doctors, many of whom patients have said are wary of the health benefits and possible drawbacks of marijuana, will be convinced it’s an attractive alternative to addictive and often deadly opiate painkillers.
“The reason why I left a comfortable job … was to help fight the opioid scourge. Medical cannabis is one of the tools that will help fight the crisis,” said Kingsley, the company’s chief executive.
The long-awaited expansion is welcome for patient advocacy organizations, though Maren Schroeder doubts whether it would have any impact on the program’s costs. Her patient advocacy group, Sensible Minnesota, is pushing to allow patients to use the plant form and has petitioned Ehlinger to add post-traumatic stress disorder as a qualifying condition next year.
For now, manufacturers and patients are focused on intractable pain, which the state defines as pain that can’t be otherwise treated or cured.
For Bjerke Severson, that means muscle spasms, tingling and fiery pain so severe she can barely walk. Having lived the last two decades with chronic pain, she struggles to describe it.
Bjerke Severson knows medical marijuana won’t be a magic cure. But she is hoping to kick the hydrocodone and get some relief.


A man was arrested and charged with drug violations after Union County deputies say a plane spotted marijuana plants growing in his back yard from the air.
Rembert Dantzler Parler, 57, was charged with manufacturing marijuana by the Union County Sheriff’s Office on Friday. Deputies say they coordinated with the State Law Enforcement Division at the S.C. National Guard to fly planes to search for marijuana plants.
The pilot radioed deputies, who then went to a home in Buffalo.
Deputies say Parler was growing several plants outside his home on Mt. Lebanon Road. Deputies say he admitted to having the plants along with more pot in a refrigerator in the home.
Investigators say they removed 51 marijuana plants and 23 grams of pot from the home while arresting him.


Support for marijuana legalization in the United States has risen steadily over the years. Today, a majority of Americans are in favor of legalizing the drug, although the number of people actually smoking weed is far lower. Slightly more than 13% of Americans 12 years old and over report using marijuana in the past year.
1. Colorado
> Pct. using marijuana in past year: 21.6%
> Total users: 909,000 (13th highest)
> Pct. using illicit drugs other than marijuana in past month: 4.4% (the highest)
> Max. fine for possession: $100,000
2. Oregon
> Pct. using marijuana in past year: 19.9%
> Total users: 649,000 (19th highest)
> Pct. using illicit drugs other than marijuana in past month: 3.7% (10th highest)
> Max. fine for possession: $6,250
3. Vermont
> Pct. using marijuana in past year: 19.8%
> Total users: 108,000 (4th lowest)
> Pct. using illicit drugs other than marijuana in past month: 3.7% (11th highest)
> Max. fine for possession: $500,000
4. Alaska
> Pct. using marijuana in past year: 19.5%
> Total users: 114,000 (6th lowest)
> Pct. using illicit drugs other than marijuana in past month: 3.4% (20th highest)
> Max. fine for possession: $50,000
5. Washington
> Pct. using marijuana in past year: 19.5%
> Total users: 1,105,000 (9th highest)
> Pct. using illicit drugs other than marijuana in past month: 4.0% (4th highest)
> Max. fine for possession: $10,000
6. Maine
> Pct. using marijuana in past year: 19.4%
> Total users: 224,000 (15th lowest)
> Pct. using illicit drugs other than marijuana in past month: 2.9% (11th lowest)
> Max. fine for possession: $20,000
7. Rhode Island
> Pct. using marijuana in past year: 18.7%
> Total users: 170,000 (11th lowest)
> Pct. using illicit drugs other than marijuana in past month: 3.6% (13th highest)
> Max. fine for possession: $500
8. Massachusetts
> Pct. using marijuana in past year: 17.6%
> Total users: 989,000 (10th highest)
> Pct. using illicit drugs other than marijuana in past month: 2.8% (9th lowest)
> Max. fine for possession: $500
9. New Hampshire
> Pct. using marijuana in past year: 17.1%
> Total users: 194,000 (13th lowest)
> Pct. using illicit drugs other than marijuana in past month: 3.7% (9th highest)
> Max. fine for possession: $2,000
10. New Mexico
> Pct. using marijuana in past year: 15.6%
> Total users: 267,000 (19th lowest)
> Pct. using illicit drugs other than marijuana in past month: 3.4% (19th highest)
> Max. fine for possession: $5,000
11. Michigan
> Pct. using marijuana in past year: 15.6%
> Total users: 1,304,000 (6th highest)
> Pct. using illicit drugs other than marijuana in past month: 3.1% (22nd lowest)
> Max. fine for possession: $2,000
12. California
> Pct. using marijuana in past year: 14.9%
> Total users: 4,633,000 (the highest)
> Pct. using illicit drugs other than marijuana in past month: 4.2% (3rd highest)
> Max. fine for possession: $500


A goiter is an abnormal enlargement of the thyroid gland. The thyroid is a butterfly-shaped gland found in your neck, just below the Adam’s apple. While some goiters are painless, they can become big enough to cause a cough, sore throat, and/or breathing problems. A variety of underlying conditions can cause goiters to develop. There are many treatment options that are recommended to treat goiters depending on their cause and severity.

Diagnosing a Goiter

Learn about goiters. To diagnose and then treat a goiter, you must first learn what a goiter is. A goiter is an abnormal, but usually benign, growth in the thyroid gland. This may be associated with normal, decreased, or increased thyroid production.

    • Goiters are usually painless, but they can cause coughs, breathing problems, difficulty swallowing, diaphragm paralysis, or superior vena cava (SVC) syndrome.
    • Treatment depends on the size of your goiter and symptoms, as well as the reasons the goiter developed
Know the symptoms of a goiter. To figure out if you may have a goiter, know the symptoms. If you’re experiencing any of the following, you should make a visit to your primary care doctor for an official diagnosis:

  • A visible swelling the base of your neck, which may be very obvious when you shave or put on makeup
  • A tight feeling in your throat
  • Coughing
  • Hoarseness
  • Difficulty swallowing
  • Difficulty breathing
Prepare for your appointment. As goiters are somewhat nebulous medical conditions — they can be caused by a number of conditions and there are a variety of options for treatment —come in with a list of questions. Questions should include:
  • What is causing this goiter?
  • Is it serious?
  • How should I treat its underlying causes?
  • Are there any alternative treatments I can try?
  • Can I use a watch and wait approach?
  • Will the goiter get bigger?
  • Will I have to take medication? If so, for how long?

Visit your physician. Your doctor will perform a variety of tests to diagnose a goiter. These tests depend on your medical history and what the doctor suspects is causing the goiter.
  • Your doctor may perform a hormone test to see the amounts of hormones produced by your thyroid and pituitary gland. If the levels are too low or too high, this is likely the cause of the goiter. Blood will be drawn and sent to a lab.[4]
  • An antibody test might be performed, as abnormal antibodies can cause goiters. This is done through blood tests.[5]
  • In ultrasonography, a device is held over your neck and sound waves from your neck and back form images on the computer screen. Abnormalities that cause goiters can be identified.
  • A thyroid scan might also be performed. A radioactive isotope is injected into the vein in your elbow and you then lie on the table. A camera produces images of your thyroid on a computer screen, providing information about what’s causing the goiter.
  • A biopsy may be performed, usually used to rule out cancer, in which tissues is drawn from your thyroid for testing.

Seeking Medical Treatments
Use radioactive iodine to shrink the enlarged thyroid gland. In some cases, radioactive iodine can be used to treat an enlarged thyroid gland.
    • The iodine is taken orally and reaches the thyroid gland through your bloodstream, destroying thyroid cells. This treatment option is common in Europe, and its usage dates back to the 1990’s.
    • The treatment is effective in that 90% of patients have a 50 – 60% reduction in goiter size and volume after 12 to 18 months.
    • This treatment can result in an underactive thyroid gland, but such an issue is rare and usually shows up in the first two weeks after treatment. If you’re concerned about the risk, talk this option over with your doctor beforehand.
    Use medications. If you’re diagnosed with hypothyroidism, that is an underactive thyroid, medications will be prescribed to treat the condition.

    • Thyroid hormone replacements, such as Synthroid and Levothroid, help with symptoms of hypothyroidism. This also slows the release of hormones from your pituitary gland, a compensatory response of your body, which may decrease goiter size.
    • If your goiter does not decrease with hormone replacements, you will still stay on the medication to treat other symptoms. However, your doctor might suggest aspirin or a corticosteroid cream.[9]
    • Thyroid replacement hormones are usually well tolerated in patients, but some side effects can occur. Side effects may include chest pain, increased heart rate, sweating, headaches, insomnia, diarrhea, nausea, and irregular menstrual cycles.

    Consider surgery. The goiter can be removed surgically. A 3 to 4 inch cut will be made in the middle of your neck, on top of the thyroid gland, and all or part of the thyroid is removed. The surgery takes about four hours and most people go home the day of the surgery.
    • If your goiter is large enough to cause compression of the neck and esophagus, resulting in difficulty breathing and nighttime choking episodes, surgery is usually recommended.
    • Although rare, a goiter can be caused by thyroid cancer. If malignancy is suspected, your doctor will likely want to remove the goiter surgically.
    • A less common reason for surgery is cosmetic concerns. Sometimes, a large goiter is simply a cosmetic concern and patients may opt for surgery in this case. However, if it’s a cosmetic concern insurance may not cover the cost of the operation.
    • The same kind of hormone replacement therapy used for an underactive thyroid usually becomes necessary for life after the removal of the thyroid.

    Trying At Home Care

    Watch and wait. If your doctor finds your thyroid to be functioning normally, and your goiter isn’t big enough to cause health problems, she might recommend simply watching and waiting. Medical intervention can cause side effects, and if there’s no problem other than a small amount of irritation you should wait and see if the problem clears up with time. Down the road, if the goiter increases in size or begins to cause problems, you can make other decisions.
    Get more iodine. Sometimes, goiters can be caused by problems in your diet. Iodine deficiencies have been linked to goiters, so getting more iodine in your diet can reduce their size.

    • Everyone needs at least 150 micrograms of iodine a day.[14]
    • Shrimp and other shellfish are high in iodine, as are sea vegetables such as kelp, hiziki, and kombu.[15]
    • Organic yogurt and raw cheese are high in iodine. One cup of yogurt contains 90 micrograms, and an ounce of raw cheddar contains 10 to 15 micrograms.
    • Cranberries are extremely high in iodine. There are 400 micrograms in 4 ounces of cranberries. Strawberries are another great berry choice. One cup has 13 micrograms.
    • Navy beans and potatoes also contain high amounts of iodine.
    • Make sure you get iodized salt.


    Brett Messer and Stephanie Caron operate Brigid Farm in a nondescript building in Saco’s industrial zone. There are no signs that hint at what takes place behind the building’s locked doors.
    In Unity, Dawson Julia operates a 14,000-square-foot warehouse on a main road through town, with a sign that indicates the former dairy building is the home of East Coast CBDs.
    And up in Fort Kent, Steve Rusnack runs his businesses, Full Bloom Head Shop and Full Bloom Cannabis, out of a storefront on Main Street.
    All are medical marijuana caregivers, part of what was once a cottage industry that is now rapidly expanding as growers move from garages and basements into commercial spaces where they can cultivate more plants to serve a population of patients that has grown to as many as 48,000 statewide.
    Nearly 3,000 caregivers are now in business across Maine, up from around 750 in 2011.
    These caregivers – the small-scale growers licensed by the state to grow marijuana for up to five patients – were once the only source of cannabis for patients who didn’t want to grow their own, but now operate alongside eight highly regulated dispensaries which opened in 2011. That competition, along with the need to cover operating expenses and a desire to provide medicine to more people, has prompted caregivers to invest in larger growing operations, diversify their products and find ways to increase the number of patients they serve.
    Some have increased business – and revenue – by keeping a revolving list of patients, a practice that takes advantage of a gray area in state law but draws criticism from dispensaries and prompts inspections from the Department of Health and Human Services, which regulates the medical marijuana program.
    Many caregivers in Maine are also poised to make the move into the recreational marijuana industry if voters in November approve Question 1, a citizen initiative that would legalize marijuana for adults and require that 40 percent of licenses to go to small-scale growers. Industry leaders in Maine believe the state is poised to become a leader in the billion-dollar cannabis market.
    “What we’ve seen over the past six years is the recognition that caregivers are legitimate small businesses in Maine,” said Paul McCarrier, a longtime caregiver in central Maine and a medical marijuana consultant. “Caregivers are spending their supply money with local vendors and bringing money into their communities when patients are coming into those towns. With the legitimization of these small farms, local municipalities have seen their tax bases increase. Formerly vacant buildings are being filled with a new, vibrant industry.”
    For the first decade after the state’s medical marijuana law was approved, patients either grew their own plants or designated a family member as a caregiver to do it for them. That changed in 2009, when amendments to the law allowed caregivers to serve up to five patients, not just their own family.
    Those changes allowed the program and the caregiver industry to expand as more patients sought alternatives to pharmaceuticals. The caregiver industry continued to evolve with a 2013 amendment to state law that allows caregivers to hire an employee.
    The number of individual caregivers jumped by more than 80 percent from 2013 to 2014, to 2,161 caregivers. Since then, the number of caregivers has increased to 2,726, according to the Maine Medical Marijuana Program. The number of caregiver employees jumped by 493 percent in 2014, from 14 to 83. Seventy-six of those employees were new, according to data provided by the Maine Medical Marijuana Program. There are now 158 active registered caregiver employees.
    The economic impact of caregivers is hard to pin down because the state doesn’t specifically track their sales, income or the tax revenue they generate, but industry experts say caregivers operate thousands of “mom and pop” businesses across the state. The dispensaries last year sold $23.6 million of marijuana and generated $1.3 million in tax revenue, according to Maine Revenue Services. Caregivers charge an average of $150 to $250 for an ounce of medical marijuana and can sell up to 5 ounces to each patient every month.
    Caregivers themselves can take home between $24,000 and $50,000 a year while creating jobs and supporting other small businesses, according to industry experts.
    Kim Printy, executive director of the trade group Medical Marijuana Caregivers of Maine, said the revolving slot business model, where patients designate a caregiver only for the length of a single transaction, grew out of a desire by caregivers to serve more than five patients. Efforts in the Legislature to remove the cap on patients have been unsuccessful.
    The exact number of patients is not tracked by the state, but 48,346 forms certifying people as patients have been printed by doctors in the past year. It is possible some of those forms were duplicate or replacement forms, according to the Department of Health and Human Services.
    State law says caregivers can have up to five patients at one time. Though the intent of the law was for caregivers and patients to have long-term relationships, the law doesn’t specify a length of time the relationship must be in place. Some caregivers say they use that flexibility to serve many patients in a day, while making sure that only five have designated them as the caregiver at one given time.
    A patient’s caregiver is determined solely by the patient’s preference as indicated on a state-approved designation form given by the patient to the caregiver, according to state law. The patient can end the relationship whenever he or she wants. When a patient uses a caregiver’s revolving slot, the patient will designate the caregiver just long enough to meet and purchase the medical marijuana. The patient then takes the designation form home, effectively ending the relationship.
    “This was a coping mechanism for a lot of those caregivers because they could not sustain their businesses with just five patients,” Printy said. “It’s a gray area. They’re operating like a dispensary and getting away with it.”
    The Department of Health and Human Services, which oversees the medical marijuana program, did not respond to several requests for comment.
    Julia, the caregiver from Unity, knows he’s operating East Coast CBDs using a gray area of the law, but says that’s what needs to be done to stay in business and provide medicine to patients who are looking for strains of cannabis that don’t make them feel high. Julia’s wife and mother are also caregivers operating out of the same building. They have three full-time employees.
    After he first became a caregiver in 2010, Julia had patients reach out to him who occasionally wanted cannabidiol, or CBD, strains, but it was difficult to reserve a slot for patients who didn’t buy from him regularly. Cannabidiol is one of two main ingredients in the marijuana plant but is non-psychoactive like tetrahydrocannabiniol, or THC.
    “That’s when I reached out to my attorney and asked them how we could do this in a way so I could never have more than five patients and be in compliance with the law,” he said.
    Julia and the other caregivers at East Coast CBDs now each keep four long-term patients and reserve their fifth spot as a revolving slot. He won’t disclose how many patients they work with, but adds, “Let’s just say it’s a lot.” Patients can go to his building to pick up their medicine and meet with caregivers.
    “There are about a dozen of us who have storefronts like me,” Julia said. “We’re pioneering this and taking this business to the next level. It’s an uphill battle because you want to make sure you’re doing everything right.”
    Rusnack opened his storefront on Main Street in Fort Kent in May. The space is divided into two sections: a head shop that is open to anyone and a medical marijuana store open only to the patients he and his wife serve.
    Rusnack, who ran logging equipment before injuring his shoulder, became a caregiver more than four years ago. While growing at home, he began talking to others in the medial marijuana community about his business.
    “They advised me I was doing a good job growing medicine and I should do it commercially,” he said.
    Once he set up shop downtown, Rusnack adopted a business model similar to the one Julia uses. He now works with a larger number of patients, but declined to disclose exactly how many. He said keeping revolving slots and operating out of a storefront is beneficial to his patients and helps bring the caregiver industry out of the shadows.
    “It’s beneficial for my business because I have access to more people,” he said. “Most patients don’t buy their allowable amount of 5 ounces a month. For them, it’s good they have somebody like me to sign up with who doesn’t have a minimum amount for purchases. That (minimum amount) disenfranchises patients who are only buying a small amount of marijuana.”
    Rusnack, 36, will be closely watching the results of the November legalization vote, as will Julia and Messer.
    “If voters approve Question 1, I plan on being prepared,” he said of the prospect of opening his marijuana store to non-patients. “If it doesn’t pass, I”m already operating. I’ll just carry forward with what I’m doing now.”
    Legal pot sales across the U.S. – both for medical and recreational marijuana – soared to $5.4 billion in 2015, up more than 17 percent from $4.6 billion in 2014, according to the ArcView Group, with tracks cannabis markets. Adult use sales grew to $998 million from $351 million in 2014. Colorado alone recorded more than $996 million in recreational and medical marijuana sales in 2015, generating $135 million in marijuana taxes, according to the state Department of Revenue.
    Messer, of Brigid Farm in Saco, operates his business in a more traditional way than Julia and Rusnack. He and Caron try to keep the same patients for long periods of time, but say that can be tricky in a market where patients want the flexibility to use different caregivers and dispensaries.
    “Patients want to do one transaction at a time. We prefer to keep our patients long-term,” Messer said. “I don’t think DHHS would look kindly on (revolving slots) because I don’t think that’s what the program was intended to do. We really want to be a model for compliance.”
    Caron said Brigid Farm has expanded its line of products – ranging from various strains of bud to edibles like chocolate peanut butter balls – to keep patients from looking elsewhere. They also make capsules and vape cartridges.
    The couple, who are engaged, moved into a 5,000-square-foot facility in 2014. Messer, 28, had become a licensed caregiver after graduating from college in 2012 with a degree in finance. Caron, 26, became a caregiver 15 months later.
    At first, they grew their plants in a residential setting, but needed to move into a bigger space if they wanted to cultivate the maximum 72 plants they are allowed to grow. A year after moving into their industrial space, they added a commercial kitchen so they could expand their product line to include edibles.
    Their building, which has no signs on the outside and is guarded with an elaborate security system, includes several grow rooms, a space for processing harvested marijuana and the commercial kitchen. Their patients never visit the facility, instead relying on deliveries from Messer.
    Messer and Caron now have two full-time employees, who make $30,000 to $40,000 a year with full benefits. Messer said they could use additional employees if they were allowed to hire more. The couple last year took home about $40,000, a number they hope to increase by adding a more diverse line of edibles. Messer also works as a consultant, helping caregivers set up grows that range in cost from $10,000 to $150,000.
    Messer, whose first exposure to medical marijuana dispensaries was in Colorado when he visited during college, is excited at the prospect of legalization of recreational marijuana, which he supports. If voters say yes to a legal market, Messer and Caron plan to open a storefront.
    “But we don’t want to abandon this existing (medical) business,” he said. “It’s exciting to see these opportunities.”
    The changes in the caregiver industry have come with some growing pains.
    As caregivers move into commercial spaces, municipal officials have grappled with how to zone a type of business they’ve never dealt with before. In Sanford, the City Council recently approved zoning regulations for caregivers in commercial spaces after months of working with growers to understand their businesses.
    “We recognize this is a business activity that will happen in our community. The bulk of our work has been on focused on what unique standards need to be addressed with medical marijuana growers,” said Steven Buck, the city manager. “We’re not debating the merits of medical marijuana. We’re simply recognizing this is a new business happening that our land use and licensing do not address.”
    There also has been increased scrutiny of the caregivers who have storefronts or keep a revolving list of patients. Julia says he and other caregivers like him have had multiple visits by inspectors from DHHS who want to count their plants and look at patient paperwork to make sure the caregivers are operating within the law.
    Julia – who says he passed two inspections without any issues – said many caregivers would like to see the patient cap lifted so that caregivers can sell more of the marijuana they’re already growing. Most plants yield a quarter- to half-pound, giving caregivers the ability to produce more marijuana than their patients can buy. Caregivers can now donate their excess to patients or surrender it to law enforcement, but Julia said the current rules also leave open the temptation for caregivers to divert marijuana to the black market.
    Roy McKinney, director of the Maine Drug Enforcement Agency, said his agency has discussions with DHHS when there are concerns about marijuana being diverted from the medical market. He said diversion of marijuana is “always a concern,” but not one he can dedicate much of his resources to.


    Ulcerative Colitis Illustration

    What is ulcerative colitis?

    Ulcerative colitis is a chronic inflammation of the large intestine (colon). The colon is the part of the digestive system where water is removed from undigested material, and the remaining waste material is stored. The rectum is the end of the colon adjacent to the anus. In patients with ulcerative colitis, ulcers and inflammation of the inner lining of the colon lead to symptoms of abdominal pain, diarrhea, and rectal bleeding.
    Ulcerative colitis is closely related to another condition of inflammation of the intestinescalled Crohn's disease. Together, they are frequently referred to as inflammatory bowel disease (IBD). Ulcerative colitis and Crohn's diseases are chronic conditions. Grohn's disease can affect any portion of the gastrointestinal tract, including all layers of the bowel wall. It may not be limited to the GI tract (affecting the liver, skin, eyes, and joints). UC only affects the lining of the colon (large bowel). Men and women are affected equally. They most commonly begin during adolescence and early adulthood, but they also can begin during childhood and later in life.
    UC found worldwide, but is most common in the United States, England, and northern Europe. It is especially common in people of Jewish descent. Ulcerative colitis is rarely seen in Eastern Europe, Asia, and South America, and is rare in the black population. For unknown reasons, an increased frequency of this condition has been observed recently in developing nations.
    First degree relatives of people with ulcerative colitis have an increased lifetime risk of developing the disease, but the overall risk remains small. 

    What causes ulcerative colitis?

    The cause of ulcerative colitis is not known. To date, there has been no convincing evidence that it is caused by infection or is contagious.
    Ulcerative colitis likely involves abnormal activation of the immune system in the intestines. This system is supposed to defend the body against harmful bacteria, viruses, fungi, and other foreign invaders. Normally, the immune system is activated only when the body is exposed to harmful invaders. In patients with ulcerative colitis, however, the immune system is abnormally and chronically activated in the absence of any known invader. The continued abnormal activation of the immune system causes chronic inflammation and ulceration portions of the large intestine. This susceptibility to abnormal activation of the immune system is genetically inherited. First degree relatives (brothers, sisters, children, and parents) of patients with IBD are therefore more likely to develop these diseases.
    There have been multiple studies using genome wide association scans investigating genetic susceptibility in ulcerative colitis. These studies have found there to be approximately 30 genes that might increase susceptibility to ulcerative colitis including immunoglobulin receptor gene FCGR2A, 5p15, 2p16, ORMDL3, ECM1, as well as regions on chromosomes 1p36, 12q15, 7q22, 22q13, and IL23R. At this early point in the research, it is still unclear how these genetic associations will be applied to treating the disease, but they might have future implications for understanding pathogenesis and creating new treatments.

    What are the symptoms of ulcerative colitis?

    Common symptoms of ulcerative colitis include rectal bleeding, abdominal pain, and diarrhea, but there is a wide range of symptoms among patients with this disease. Variability of symptoms reflects differences in the extent of disease (the amount of the colon and rectum that are inflamed) and the intensity of inflammation. Generally, patients with inflammation confined to the rectum and a short segment of the colon adjacent to the rectum have milder symptoms and a better prognosis than patients with more widespread inflammation of the colon. The different types of ulcerative colitis are classified according to the location and the extent of inflammation:
    1. Ulcerative proctitis refers to inflammation that is limited to the rectum. In many patients with ulcerative proctitis, mild intermittent rectal bleeding may be the only symptom. Other patients with more severe rectal inflammation may, in addition, experience rectal pain, urgency (sudden feeling of having to defecate and a need to rush to the bathroom for fear of soiling), and tenesmus (ineffective, painful urge to move one's bowels caused by the inflammation).
    2. Proctosigmoiditis involves inflammation of the rectum and the sigmoid colon (a short segment of the colon contiguous to the rectum). Symptoms of proctosigmoiditis, like that of proctitis, include rectal bleeding, urgency, and tenesmus. Some patients with proctosigmoiditis also develop bloody diarrhea and cramps.
    3. Left-sided colitis involves inflammation that starts at the rectum and extends up the left colon (sigmoid colon and descending colon). Symptoms of left-sided colitis include bloody diarrhea, abdominal cramps, weight loss, and left-sided abdominal pain.
    4. Pancolitis or universal colitis refers to inflammation affecting the entire colon (right colon, left colon, transverse colon and the rectum). Symptoms of pancolitis include bloody diarrhea, abdominal pain and cramps, weight loss, fatigue, fever, and night sweats. Some patients with pancolitis have low-grade inflammation and mild symptoms that respond readily to medications. Generally, however, patients with pancolitis suffer more severe disease and are more difficult to treat than those with more limited forms of ulcerative colitis.
    5. Fulminant colitis is a rare but severe form of pancolitis. Patients with fulminant colitis are extremely ill with dehydration, severe abdominal pain, protracted diarrhea with bleeding, and even shock. They are at risk of developing toxic megacolon (marked dilatation of the colon due to severe inflammation) and colonic rupture (perforation). Patients with fulminant colitis and toxic megacolon are treated in the hospital with potent intravenous medications. Unless they respond to treatment promptly, surgical removal of the diseased colon is necessary to prevent colonic rupture.
    While the intensity of colon inflammation in ulcerative colitis waxes and wanes over time, the location and the extent of disease in a patient generally stays constant. Therefore, when a patient with ulcerative proctitis develops a relapse of his or her disease, the inflammation usually is confined to the rectum. Nevertheless, a small number of patients (less than 10%) with ulcerative proctitis or proctosigmoiditis can later develop more extensive colitis. Thus, patients who initially only have ulcerative proctitis can later develop left-sided colitis or even pancolitis.