Q&A: risks of marijuana use; changing primary care providers; estrogen for older women; & preventing degenerative spine disease

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📣 Join me TODAY, February 21, at 3 pm ET for our WEEKLY live chat in the Substack App!

This is a free event! Paid subscribers can submit questions by commenting below or via the paid subscriber group chat here! 📣

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In this week’s reader-submitted Q&A, we’re tackling these questions:

• Is marijuana safe to use?

• How should I approach switching primary care providers?

• Should I take estrogen as a 70-year-old?

• How can I prevent becoming bent over as I age?

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Photo by Kym MacKinnon on Unsplash

The following subscriber questions have been lightly edited for length and clarity.

QUESTION #1: HEALTH RISKS OF MARIJUANA

We hear all the time now that even one drink a day of alcohol has negative health benefits. But what does current scientific research say about daily use of marijuana?

-Nina

Dear Nina,

Great question! It is particularly relevant as societal attitudes and the legal landscape around marijuana evolve. You are correct—even moderate alcohol consumption can have negative health impacts, and daily cannabis use carries its own set of issues.

Regular cannabis use, particularly from a young age, has been linked to cognitive impairments affecting memory, attention, and learning. The CDC notes that cannabis can impact brain development, with potential long-term effects on cognitive function. Additionally, studies have associated frequent use with mental health issues such as depression, anxiety, and an increased risk of psychosis, especially in individuals predisposed to these conditions.

Daily marijuana smoking also can lead to respiratory issues, including chronic bronchitis-like symptoms. While the link between cannabis use and lung cancer remains inconclusive, the inhalation of smoke from any source isn’t good for lung health.

Contrary to the belief that cannabis is non-addictive, about 9% of users may develop a dependence, a figure that rises with daily use. Withdrawal symptoms can include irritability, sleep disturbances, and cravings, making cessation challenging for regular users.

A less commonly known condition, cannabinoid hyperemesis syndrome (CHS), is characterized by severe, cyclic nausea and vomiting resulting from prolonged, high-dose cannabis use. While relatively rare, its prevalence appears to be increasing with higher rates of daily use.

The potency of THC, the primary psychoactive component in cannabis, has increased significantly over the past decades. Higher THC concentrations may elevate the risk of adverse effects, including cognitive and mental health issues. This trend underscores the importance of being aware of the strength of cannabis products consumed. As is the case with alcohol, just because it’s legal doesn’t mean it is harmless. I hope that helps!

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QUESTION #2: SWITCHING PRIMARY CARE PROVIDERS

Hi Dr. McBride, The nurse practitioner I saw as my primary care provider has moved away, so the clinic system I am part of has connected me to an MD for care going forward. I’m having my “establishing” visit soon-ish, and she has access to my records in the meantime. Any advice on how to approach a visit like this to establish a new relationship? I’m also slightly worried that, as an MD, she will have less time during visits than my previous NP, but of course that remains to be seen.

-Tamara

Hi Tamara,

Starting with a new doctor can feel like a mix of opportunity and uncertainty, but going in with a plan can help you establish a solid foundation. The first visit is about building a relationship, setting expectations, and making sure your new doctor understands your health history and priorities.

One approach is to come prepared with a short summary of your medical history, key concerns, and any ongoing treatments. Even though your new doctor has access to your records, highlighting the most important aspects of your health—chronic conditions, past surgeries, medications, and what has worked well for you in the past—can help streamline the conversation.

Be upfront about your preferences. If you appreciated the extra time and personalized approach of your NP, let your new doctor know. MDs try work efficiently by necessity, but sometimes that can come at the expense of rapport when, in my experience, most doctors truly value the patient-doctor relationship. Expressing that you appreciate a provider who listens and takes a whole-person approach can help set the tone.

Clarify logistics. Ask about the best way to communicate between visits, how refills and referrals work, and whether there are ways to optimize your time together (such as sending questions in advance via a patient portal).

Finally, be open but also advocate for yourself. If something feels rushed or impersonal, don’t hesitate to speak up. The first visit is just the start—relationships with doctors, like any relationship, take time to develop. If, after a few visits, you feel like the fit isn’t right, you can always reassess. But with a proactive mindset, you’re already setting yourself up for a productive partnership.

Does that help?

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QUESTION #3: ESTROGEN FOR OLDER WOMEN

I am 70- and wondering if I could benefit from a low dose of estrogen.

-Cindi

Hi Cindi,

In the 70s, the decision to start or continue estrogen therapy depends on several factors, including your overall health, medical history, and the specific symptoms you hope to address. Estrogen therapy is most commonly prescribed for menopause-related symptoms like hot flashes, vaginal dryness, and bone health. When started early in menopause (typically within 10 years of the last period), it can offer significant benefits—both in the short-term and over time. However, starting estrogen later in life requires a more nuanced approach.

Some potential benefits of low-dose estrogen at this stage include improved vaginal and urinary health, as estrogen helps maintain the integrity of vaginal tissues and may reduce urinary symptoms like frequency and urgency. Bone health is another consideration, as estrogen helps prevent bone loss and fractures, though other osteoporosis treatments may be preferred if that is your primary concern. Some women also report improved skin elasticity and joint comfort with estrogen.

The potential risks include an increased likelihood of blood clots, stroke, and possibly heart disease, especially if you have preexisting cardiovascular risk factors. There is also a potential link to breast cancer with long-term use, particularly in combination with progestin. That said, vaginal estrogen, which is often used for genitourinary symptoms, carries minimal systemic risk and is generally considered safe at any age.

If you’re considering estrogen, it’s best to have a conversation with your doctor about your specific health profile. They can help weigh the benefits and risks based on your individual needs. If systemic estrogen isn’t the best option, localized therapies (like vaginal estrogen) or other medications might be alternatives. The key is to align any treatment with your long-term health goals and overall well-being.

Wishing you all the best!

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QUESTION #4: PREVENTING DEGENERATIVE SPINE DISEASE

I recently moved into independent senior living. Many people here are bent over either at the neck or back. Is being bent over an inevitable natural part of aging? How to avoid this? Is exercise enough?

- Melissa

Hi Melissa,

I know exactly what you are talking about. As you probably know, muscle mass and tone decline with age. The muscles in our upper body are particularly vulnerable because we don’t regularly use them like we do our lower bodies (i.e. carrying our own body weight helps maintain muscles in our legs). When we don’t actively work the muscles in our upper back and the backs of our shoulders, for example, we tend to hunch. When we don’t work on our core muscles, our low back muscles have to “work harder” and can cause pain and discomfort. Simply being aware of our posture as we drive, sit at our desk, or watch TV, can help us be more aware of our skeletal muscles.

Here is a nice video with some specific exercises for posture. I recommend it to my own patients. I hope it’s helpful!

Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.