Tuesday, June 26, 2018

CBD Extracts online vary in their actual concentrations.

There is growing consumer demand for cannabidiol (CBD), a constituent of the cannabis plant, due to its purported medicinal benefits for myriad health conditions.1 Viscous plant-derived extracts, suspended in oil, alcohol (tincture), or vaporization liquid, represent most of the retail market for CBD. Discrepancies between federal and state cannabis laws have resulted in inadequate regulation and oversight, leading to inaccurate labeling of some products.2 To maximize sampling and ensure representativeness of available products, we examined the label accuracy of CBD products sold online, including identification of present but unlabeled cannabinoids.
CBD bought online can have a wide range of variation from labeled amounts. Tinctures are less variable.

Monday, June 25, 2018

CBD for Epilepsy: FDA Approves Prescribed CBD as an Epilepsy Medication, but there is a catch ...

Epidiolex adds another tool indicated for DRAVET and LGS ... but wait, CBD must still be rescheduled by the DEA. 

Will CBD be completely rescheduled? Call your legislator to ensure CBD a relatively safe and non-addictive substance is rescheduled. - JR

FDA Green Lights Marijuana-Based Pharmaceutical Drug

June 25, 20185:33 PM ET
 Allison Aubrey - 2015 square


The U.S. Food and Drug Administration has approved a marijuana-derived drug for the treatment of two rare and serious forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome, that begin in childhood but can persist in adulthood.

The drug is made from purified cannabidiol, or CBD, a compound found in the cannabis plant. The drug will be marketed under the brand name Epidiolex.

CBD has medicinal effects, but it does not cause the mind-altering high that comes from THC, the primary psychoactive component of marijuana.

The FDA says this is the first drug approved in the U.S. that contains a purified substance derived from marijuana. The agency has previously approved drugs made from synthetic versions of THC and other marijuana constituents.

Dr. Rotenberg prescribes CBD for refractory epilepsy
under the CURT program
approved by the  State of Texas
"This approval serves as a reminder that advancing sound development programs that properly evaluate active ingredients contained in marijuana can lead to important medical therapies," said FDA Commissioner Scott Gottlieb during a call with reporters about the approval.

Anxiety Relief Without The High? New Studies On CBD, A Cannabis Extract
Anxiety Relief Without The High? New Studies On CBD, A Cannabis Extract
Several states have legalized CBD oil specifically for the treatment of intractable epilepsy or seizure disorders. And, as NPR has reported, CBD supplements are available widely online and in dispensaries in the form of oils or tinctures. CBD oil has gained popularity with consumers as a remedy for a variety of other ailments. However, the legal status of these products is uncertain, as is their quality. They're not regulated the way pharmaceutical drugs are, so the consistency and dose can vary widely.

Having an FDA-approved, pharmaceutical-grade CBD drug will open up a new treatment option for epilepsy patients by delivering a high-quality, consistent dose

Saturday, June 02, 2018

SPECIAL EDUCATION: Are we killing kids or just letting them die?

"Is there a difference between killing someone and letting them die?" 

Suppose you were walking by a person drowning in the bathtub. If you do nothing, did you kill them?

Often posed as a common biomedical ethics dilemma, the situation begs the question about "passive versus active". I never thought that this life and death drama might apply to public education.  I have seen this dilemma play out again and again at the micro and macro levels in our Texas public educational system.

Here is this week’s outrage. 

How many hours of advanced training are required BEFORE a certified general education teacher can teach a special education student? 
  • Go ahead....Guess. 
  • Zero

How many hours of advanced training are required before a general education teacher teaches Gifted and Talented? 

Texas Administrative Code requires 30 hours of pedagogic training before teachers can instruct gifted & talented students. The code also requires SIX hours yearly to maintain this certification.

How does this disparity play out? An educational plan may put a general education teacher straight out of school OR perhaps even a "Teach for America" instructor in charge of a special education student's INDIVIDUALIZED educational plan with minimal oversight by a certified special education teacher. 

A general education teacher without any specialized training is responsible for planning, monitoring and reporting on details MANDATED by federal law, and MONITORED by the TEA. Can you guess what happens next for many children?  

On its face, it appears that our laws mandate that Texans keep on walking while special education children thrash in the bathtub. 

Its time we put our money and attention on both sides of the bell curve. 14% of HISD children are identified as GT. 15% of children have a learning difference. 25% of families have a child with a chronic health problem. 

 Its time that Texas took equal pride in how we gather in the sparks of all our children who learn differently, on both sides of the curve.  

I am grateful to have met HISD trustees, educators and professionals who are aligned on this same vector for change. But, we need help undoing unhelpful beliefs and practices translated into rules - written and unwritten. Its difficult to fix the plane while we are flying in it. 

  • Ensure special ed families are involved in your campus PTO.
  • Ensure special ed families are on your campus planning committee.
  • Listen with an open mind to children and parents who live another reality. 
  • Advocate for change in our laws. 

Educational equity is not just an issue of morality. Its a compelling public infrastructure problem impeding growth and development. 

Taking action, we send an unconditional message to all people that we care how a child grows and becomes, no matter what. 

Dr. Josh

(Parenthetically, BY willful neglect, are we  forcing our teachers and administrators to violate Federal Law? We set our well-meaning educators up to deny free access to public education). 

CONCUSSION Symptoms can Persist 1 to 2 years later! You just have to ask.

Administrators commonly reject a family applying for 504 because concussion symptoms are temporary. 

Post-concussive symptoms after a mild traumatic

brain injury during childhood and adolescence

Pages 617-626 | Received 08 Apr 2017, Accepted 07 Feb 2018,
Published online: 15 Feb 2018

Objective: Mild traumatic brain injury (mTBI) is common injury during childhood and adolescence but the long-term outcomes are poorly understood. This study examined post-concussive symptoms and behavioural outcomes in children and adolescents up to 24 months post-mTBI.
Method: Parents of children aged 8–15 years with mTBI completed the BASC-2 and Rivermead Post-Concussion Symptoms Questionnaire at baseline, 1-, 6-, 12- and 24 months post-injury. An age-matched traumatic brain injury-free cohort was recruited and assessed at 12- and 24 months.
Results: PCSs decreased significantly over the first 12 months post-injury.
At 12- and 24 months post-injury, the mTBI group reported more PCSs and behavioral symptoms compared to controls.

Parents of children with mTBI were more likely to report ≥4 problematic symptoms
(28% at both time points) vs  controls (7.7% and 1.7% at 12 and 24 months, respectively).

The mTBI group was 4.63 times more likely to have four or more ongoing PCS symptoms at 12 months post-injury compared to controls.

Headache was the most common acute post-injury symptom (55%)
the most commonly reported persistent symptoms were:

  •  irritability, 
  • frustration, 
  • forgetfulness and 
  • fatigue.

Conclusions: PCSs are common 2 years post-mTBI in childhood or adolescence.
Given this, additional intervention and support is needed for families post-injury.

Monday, May 21, 2018

Ritalin, School Shootings, Ignorance - Col North You are wrong. So wrong.

Dear Col North,
Image result for oliver  north wallace
I salute you and your service. I'm a 10 year veteran of the USAF.

Most respectfully, YOU ARE WRONG to link adhd treatment with school shootings.  Video HERE  

Early antisocial behavior IS linked to such shootings.  

 P.S. Please dont blame mental illness tomorrow. Serious mental illness only accounts for 3% of shootings.

Childhood ADHD is  associated with adolescent and adulthood arrests (RR: 2.2, 95% CI: 1.3-3.5), convictions (RR: 3.3, 95% CI: 2.1-5.2) and incarcerations (RR: 2.9, 95% CI: 1.9-4.3).

BUT ADHD  treatment reduces rates of criminality, and substance abuse. Perhaps the unnamed kids you are referencing were inadequately treated? Perhaps they were non-compliant?

You, the NRA, and good law-abiding Americans risk credibility and good-will when you squawk falsehoods.

I assume that you are not yet informed. I do not expect that you would spread fear of treatment among good people, as to do so would perpetuate  the very problems you claim to oppose. 

Please call me with questions. 

Most Respectfully,

Dr Josh

Want data? More here 

Criminality and ADHD



Treatment Effect



Monday, March 26, 2018

Cannabis for Epilepsy - Low doses of CBD already working!

Medical cannabis working in kids with epilepsy. Answer to family prayers?!?
Very gratifying day.- JR

Cannabis for Epilepsy - Low doses of CBD already working!

10-year-old boy one of first in Houston area to receive legal cannabis oil.The oil is used to treat his seizures that are caused from epilepsy.

Low THC Marijuana  Cannabis / CBD for Epilepsy in Texas 

Author: Ron TrevinoPublished: 5:52 PM CDT March 26, 2018

Ten-year-old James Challenger is one of the first patients in the Houston area to start using legal marijuana prescribed by a doctor.

It comes in the form of cannabis oil and only a small group of Texans are allowed to use it. They are epilepsy patients who are not getting any results from other medications.

James’ parents say it’s the answer to their prayers after he began taking the oil March 20.

"We saw a drastic improvement in him,” said Michael Challenger, James’ father. “His face lit up, his personality lit up, he is much happier.”

"I can show you school records of just horrible marks, to now where we haven’t had one bad mark since we started the medicine on Tuesday afternoon," says Mikelle Challenger, James’ mother.

The oil is prescribed by their neurologist, Dr. Josh Rotenberg, and it’s not covered by their insurance. M & M figure on spending around $200 a week for the oil. But, they say, if their son continues to improve, it’s well worth it.

Tests have shown James has been having at least a hundred seizures a day, and the 15 pills he takes each day don’t seem to help and have major side effects.

"He had been described as unhinged, just out of his mind, he wasn't there, you'd look at him and his eyes just weren’t there," Mikelle said.


The family is very involved in their church community. In fact, James’ grandfather is an associate pastor Sagemont Church. M...

The way this family sees it, the cannabis oil is the answer to their prayers.

Video Here from KHOU

Sunday, March 11, 2018

Special Education Report about HISD from AIR American Institutes for Research (AIR)

The AIR American Institutes for Research (AIR) report of HISD special education is accessible.


This report poses fundamental and even spiritual questions about how our community treats our most vulnerable children. 

Special education should not just be "integrated".  SPED should lead. 

Biology has diversity. Our kids are not McNuggets. SPED is the advanced course in educational theory and application.   If we fail SPED we are failing all children. 

And, I hope its translated to Spanish.

Offer feedback to your trustee or to Trustee at Large @annesung.

Dr. Rotenberg

Here is my summary of the report(my personal opinion, representing no one):  

For the most vulnerable of our children...

In a state that actively discourages identification and treatment of the approximately 15% of children with developmental disorders....

HISD has decent people, trying their best. 

But, HISD also:

  • Under-identifies children while not really communicating/ understanding the process for identification.
  • Places children without data ("sorting hat" vs data based approach?)
  • Inequitably deprives children of resources (e.g resource room).
  • Pokes the "I" out of the IEP.
  • Supports no accountability.
  • Does not adequately communicate.
  • Does not adequately train.
  • Suffers instructional / outcomes failure for SPED.
  • Has no idea a) what happens in transition or after graduation nor attends to this on its report.

Saturday, February 17, 2018

low-THC Cannabis & Epilepsy in Texas on Texas Public Radio

 ... Doctor Joshua Rotenberg, of Houston Specialty Clinic, agrees with Newmark. Rotenberg, who is also registered in the CURT, notes he senses “a lot of hesitation” and “fear” among physicians regarding the low-THC cannabis treatment in Texas, partly because of doubts about the legal aspects surrounding it, and partly because of what is still a lack of knowledge about the treatment itself by those not specialized in epilepsy or not familiar with the research yet. 

Cannabis Treatment Raises Hope For Parents Of Epileptic Children; But Costs, Side Effects Are A Matter Of Concern 

Full Article Here

Dr. Joshua Rotenberg, who works at Houston Specialty Clinic, is one of the 21 physicians that have so far been approved by the Texas Department of Public Safety to prescribe low-THC cannabis treatments for intractable epilepsy.
Rotenberg says the discussion about low-THC cannabis treatments for epilepsy has increased over the last five years and adds that “this medicine is helping a group of people that are really suffering and are really impaired from their epilepsy.” There are over 20 other states in the country where cannabis has been legalized for medical purposes. 
An impactful illness
Rotenberg underlines an illness as impactful as epilepsy typically affects more than just the patient. “It’s not just them, it’s their whole families, these are kids that are having many, many dozens of seizures a day and they have no life, or they have very little quality of life and, so, most of the parents that I see are running towards it as an option to help their children,” explains the physician about the treatment. 
Rotenberg also notes several parents of children with epilepsy have gone to other states to buy low-THC cannabis treatments.
Buying the treatment in other states up until now is something Donna Stahlhut, CEO of the Houston office for the Epilepsy Foundation in Texas, is familiar with.....

Tuesday, February 13, 2018

Coughing? Wheezing? Asthma? Airway is FIRST ...then watch for developmental problems!

Could sleep apnea cause the developmental problems? Yes. Could reflux cause both asthma, and 
disrupted sleep? Yes. 

Regardless see your physician or a  pediatric pulmonary specialist to ask about asthma treatment. 


 2016;53(3):277-81. doi: 10.3109/02770903.2015.1089277. Epub 2015 Oct 30.

The association of childhood asthma with mental health 

and developmental comorbidities in low-income families.



The objective of the study was to determine 
the relationship of childhood asthma with mental health 
and developmental indicators in low-income families.


Parents/guardians of approximately 400 children, 
aged 2-14 years, were recruited from a charity hospital 
serving low income neighborhoods in the outskirts of Karachi, 
Pakistan. Mothers of children were interviewed in their 
local language by a trained nurse. Eight self-reported 
comorbidities were grouped into two constructs based 
on factor analysis and conveniently labeled as mental health 
(anxiety, attention and behavioral problems) and developmental 
problems (learning, developmental delay, hearing impairment, 
sleep and speech problems). 
Data were analyzed using multiple logistic regression, 
adjusted for age, sex, presence of older siblings, 
number of people in the household, child birth weight, p
resence of mold, and family history of asthma or hay fever.


Children with asthma had 18 times greater odds 
of mental health problems 
(adjusted OR = 18.0, 95% CI: 9.2, 35.1) as compared to 
children without asthma. 
The odds of developmental problems were more than 
14 times greater for children with asthma 
(adjusted OR = 14.3, 95% CI: 7.8, 26.1) 
as compared to children without asthma.


This study found mental and developmental
 adverse consequences of childhood asthma in low-income 
families. Identifying and treating asthma at an early age 
could reduce the burden of comorbidities in this population.


Asthma; attention problems; children; developmental delay
[Indexed for MEDLINE]

Saturday, February 10, 2018

Cannabis Treatment for Epilepsy: Where is the evidence?

Is there good evidence for cannabis efficacy and safety in treating epilepsy?  Yes.  - JR

Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last?

Evidence for cannabidiol / CBD superiority over placebo in treating
refractory epilepsy syndromes. 
The interest in cannabis-based products for the treatment of refractory epilepsy has skyrocketed in recent years. Marijuana and other cannabis products with high content in Δ(9) - tetrahydrocannabinol (THC), utilized primarily for recreational purposes, are generally unsuitable for this indication, primarily because THC is associated with many undesired effects. Compared with THC, cannabidiol (CBD) shows a better defined anticonvulsant profile in animal models and is largely devoid of adverse psychoactive effects and abuse liability. Over the years, this has led to an increasing use of CBD-enriched extracts in seizure disorders, particularly in children. Although improvement in seizure control and other benefits on sleep and behavior have been often reported, interpretation of the data is made difficult by the uncontrolled nature of these observations. Evidence concerning the potential anti-seizure efficacy of cannabinoids reached a turning point in the last 12 months, with the completion of three high-quality placebo-controlled adjunctive-therapy trials of a purified CBD product in patients with Dravet syndrome and Lennox-Gastaut syndrome. In these studies, CBD was found to be superior to placebo in reducing the frequency of convulsive (tonic-clonic, tonic, clonic, and atonic) seizures in patients with Dravet syndrome, and the frequency of drop seizures in patients with Lennox-Gastaut syndrome. For the first time, there is now class 1 evidence that adjunctive use of CBD improves seizure control in patients with specific epilepsy syndromes.
J Epilepsy Res > Volume 7(2); 2017 > Article

Friday, February 02, 2018

CBD & Epilepsy: Medical cannabis delivered in Texas - Interview with Epilepsy Specialist Dr. Joshua Rotenberg

Interesting times. - JR

Report on KHOU HERE
For those latter cases—known as intractable epilepsy—Rotenberg, a Houston pediatric neurologist, and 17 other statewide neurologists have a new treatment tool at their disposal: low-THC medical cannabis.
“It’s incredible for them, I think, to reduce the burden of seizures and increase quality of life,” Rotenberg said. “It changes the whole world.”
The cannabis comes in the form of oil with low amounts of tetrahydrocannabinol, the main ingredient in marijuana that causes a high. Instead, the oil contains high amounts of cannabidiol (CBD) that doesn't come with a high and is used to treat epilepsy and other medical conditions.
CBD Oil For Epilepsy Now dispensed in Texas
It was legalized in 2016 when Gov. Greg Abbott signed the Compassionate Use Act into law. Not only did it authorize the legal use of cannabis oil for patients who suffer from intractable epilepsy, but it created a state registry of neurologists to prescribe the oil and for the creation of three dispensaries to cultivate marijuana to be processed into cannabis oil and dispensed statewide.
A 6-year-old girl in Central Texas, who wasn’t identified, was the first recipient of legal medical cannabis after an order was delivered to her home Thursday.
“This is a great day for patients in Texas,” said State Rep. Stephanie Klick (R-Fort Worth), in a conference call Friday. Klick authored the Compassionate Use Act. “Many of these patients have exhausted all options—brain surgery, multiple pharmaceutical products—and their seizures are not controlled.”
Knox Medical, a Florida-based company with a dispensary in Schulenburg, made Thursday’s delivery. The company declined to release more details about the girl, citing patient privacy, but a spokesperson said the company is honored to make the “first delivery of medical cannabis to a patient in Texas.” 

About 160,000 Texans suffer from intractable epilepsy, according to Knox Medical, though Rotenberg estimates the number to be around 130,000.
Texas has long taken a hard stance against marijuana, even for medical purposes. Meanwhile 28 states  have legalized the use of medical marijuana, while nine states plus the District of Columbia have outright legalized the recreational use of marijuana.
There’s a growing trend among Texans who support marijuana’s legalization, too. Eighty-three percent of Texans support legalizing marijuana for some use, according to a 2017 University of Texas/Texas Tribune Poll. 
Rotenberg said he’s aware of people who have traveled to states like Colorado, where recreational marijuana use is legal, to purchase cannabis oil to help combat intractable epilepsy. It’s long travel for families who swear by its benefits. Rotenberg said in some cases cannabis oil has cut a person’s seizures in half.
“If it helps in that way, that’s great,” he said.