Nonagon Device

We're the first practice of any kind in Texas to implement this device for telemedicine.

It is an All-in-One stethoscope, otoscope, thermometer, pulse, oxygen saturation, and camera.

With it, we can listen to heart, lungs, abdomen, evaluate eyes, ears, nose, and throat, and skin like never before,

and at your convenience!

Tips: When presenting us with a concern, it is helpful to let us know

• Are there any vitals recently done, and are there any abnormalities

• How is there a change from the person’s usual function

• Are they eating/drinking/moving at their usual function

• When did the problem start

• What makes it worse / better 

• Does the problem affect other areas of the body / other new/different symptoms

• Has the person taken any medications to help with the problem

Quick Start Guide

1. Look at the device, see what the buttons do

2. Make sure batteries are installed.

3. Download the app, Log in the app using

   1. Email:

   2. Password:

   3. Service Provider:

1. Press ‘On’ Button

2. Pair the device

3. Decide on Exam Mode:

   1. Online Call

   2. Offline Exam - Decide which exams are needed for the problem.  Once you have selected the exam type, click the lower right button on the App that says Exam ->

      1. Body temperature and heart rate, oxygen saturation are always helpful.

      2. If you need assistance with learning how to perform an exam, Check out these videos

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Understanding Dementia Behaviors: For Caretakers 

Remember anger isn't anger. A person with dementia often can't express their emotions. They are often scared, confused, sad, or frustrated. They often know they are supposed to remember people and things, and it's upsetting to be aware but not able to remember what to do about it.  There is usually loss of the part of the brain that regulates judgement.  They simply don't have full use of the part that controls temper and the "right" behavior.  You do, and must not take it personally.
Be patient. Treat this person with patience, kindness and respect. Read their body language if they are escalating and move away if they are going to hit you. Never take it personally and never hit back. If they are being uncooperative, try to not give them yes/no options.
Maintain a Structured Routine: Establishing a consistent daily routine can provide a sense of familiarity and reduce confusion or agitation. Stick to regular mealtimes, activities, and rest periods.  Sometimes leaving the facility to go out for family gatherings creates more stress.  Be sure to pay attention to body language and head back if you take a person out and they seem to be more stressed.
Simplify and Break Tasks into Manageable Steps: Complex instructions or tasks can be overwhelming for individuals with dementia. Break tasks into simple, manageable steps, and provide clear and concise instructions.
Provide Clear and Positive Communication: Speak slowly and clearly, using simple words and short sentences. Maintain eye contact, use a calm and reassuring tone, and give the person ample time to process information and respond.
Offer Choices: Provide limited options to allow the person to maintain a sense of autonomy and control. For example, offer a choice between two outfits or two activities, enabling them to make decisions within their capabilities.Ask them if they want option A or B. Ask them if they want to do it now, or in 10 minutes. Get an old-fashioned egg timer set to 5 minutes and when it dings, ask them again and remind them they agreed to it. If they still disagree, ask them if they would like to get an ice cream or other favorite food after completing the request. If they still refuse, give them a few options to see what they want to do. They like to be given a choice and make decisions for themselves. Try again later. If still no success, report to your supervisor.
Validate Feelings and Emotions: Acknowledge and validate the person's emotions, even if you cannot understand the cause. Show empathy, listen actively, and provide reassurance. Avoid arguing or dismissing their feelings.
Create a Calm and Supportive Environment: Minimize noise, distractions, and excessive stimulation that can contribute to agitation. Ensure the environment is well-lit, organized, and familiar. Use calming music or aromatherapy if it helps the individual relax.
Use Reminders and Visual Cues: Utilize memory aids such as written notes, labels, calendars, or clocks to help the person with dementia remember important information or follow routines.
Encourage Engagement in Meaningful Activities: Provide opportunities for the individual to engage in activities they enjoy and that match their abilities. This can include listening to music, looking at photo albums, doing puzzles, or participating in gentle exercises.
Practice Patience and Flexibility: Understand that behavioral changes and challenges are part of the disease progression. Approach the person with patience, flexibility, and a willingness to adapt strategies as needed.
Seek Professional Support: Let us know if you need further guidance and support in managing challenging behaviors associated with dementia.
Remember, each individual with dementia is unique, and it may take time and experimentation to find the most effective strategies for encouraging positive behavior.

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Medical Cannabis for Dementia and other Symptoms

If you're ready to request enrollment, or just need a refill, Click Here.

Brief Overview

Dr. Valdez is one of few physicians certified to prescribe medical marijuana under a Texas-approved Compassionate Use program.

He completed extensive training, certification courses, research, combined with over 20 years of experience and Board Certification in Palliative Care.

We have been able to successfully reduce the need for antipsychotics, benzodiazepines, and opioid pain medications, while improving quality of life, sometimes quite dramatically.

It is indicated for Dementia, Parkinson's, Neuropathy, Cancer, PTSD, and more.  We have found it especially helpful, often more effective, and safer than traditional medications for dementia-related behavior such as agitation, anxiety, insomnia, anorexia, and sadness.

We work with your staff and other physicians to educate on proper management, what to expect, and how to achieve the best outcomes.  There is almost always a noticeable improvement in quality of life.  Like fine wine to complement a good meal, this small, controlled dosing, is a great addition to a traditional medication regimen.

Check out www.thclinicians.com for more information and videos, and how to access for others who are not facility patients.

It should be managed no differently as other controlled medications and there are no federal regulations prohibiting its use within a facility.

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More Information

How and why does it work?  

The Endocannabinoid system is a whole system within our bodies with receptors for certain molecules that our body produces. It was only recently discovered in the 1990’s. It is not included in most medical school training. There’s still much to be learned but appears to be involved in regulating the body's state of balance in different ways.  What we used to think was endorphins involved in the "runner's high" is actually the endocannabinoid system.  Like an air conditioner thermostat, the system affects the brain and different organs that regulates the body's balance of wellness.  Stress and danger triggers the "fight or flight" response.  When the danger goes away, the endocannabinoid systems tells our body to calm down.  It's okay now.  Our body makes its own chemicals that interact with the system.  The cannabis plant makes chemicals (phytocannabinoids) that interact effectively with the body’s system.  It is important to react to danger and stress when it is there, but some conditions cause the body to be stuck in a constant state of stress.  The system is off balance.  A person with dementia is aware that they are losing their memory.  They are aware that the people around them are supposed to be familiar, that they are supposed to remember how to do things, and they can't.  They don't know where they are, but this is not what they remember as home.  They are in a constant state of stress.  Cannabis doesn't change the memory loss or confusion, but it does tell them "it's okay".  They don't recognize certain people, but it's okay, they're nice.  They don't know where they are, but it's okay, it's safe.  They don't know who's trying to bathe them, but they're here to help.  For us, cannabis is not alternative medicine.  It is an important part of the treatment when a person has more moments and days with anxiety and agitation.  It's also extremely safe.  Although due to federal restrictions  on research, and the stigma associated, there isn't great evidence for guidelines, but there is great evidence for safety.  We prescribe it regularly for fragile 98-100 year olds, with serious heart conditions.  If a side effect is noted, it is mild and we adjust the medication.  If it doesn't work, we can stop it, but most people have a noticable improvement in quality of life after about a month.

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Where does it fit into a person's medication regimen?

Benzodiazepines (Valium, diazempam, Xanax, alprazolam, Ativan, lorazepam, and similar meds) are very much like a glass of wine.  They cause loosening of thinking, relaxing.  The problem with dementia is they are already losing connections with their brain activity.  As they get tired later in the day, the disconnection becomes more obvious, leading to "sundowning."  Effectively, we are giving wine to someone already drunk.  This does work for some people, but in order to prevent falls and harm, it is important to carefully consider and minimize.  When a person is younger, a glass of wine helps relax after a tough day.  As a person heads into dementia, the anxiety is not from a tough day.  It is the anxiety of losing memory, of becoming disconnected.  Alcohol and benzodiazepines should be discouraged and minimized as people begin to have memory challenges.  When it comes to cannabis, we imagine people acting silly, laughing, and eating too much.  This is from too much endocannabinoid stimulation, high dose and high strength.  A person who has the opposite issue, in a state of suffering, using small controlled doses, actually becomes more alert and more calm.

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For pain, it doesn't change the damage, but it changes the quality of the pain.  It's there, but it's over there, not on top of the person.  Currently in Texas, to be prescribed only for pain, there must be demonstrated neuropathy pain, not just bone and joint pain alone.  Sleep is more natural, more restful, and appetite is more normal due to less stress and suffering.

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What about antipsychotics? 

Antipsychotics are discouraged from use in dementia and have a black-label warning.  That being said, we still use them regularly, and they do have a place in treatment.  Antipsychotics help with more aggressive behavior.  Aggressive behavior can lead to a person harming another person, or themselves. While there are potential side effects from the medicine, they are outweighed by the risk of not managing behavior.  When antipsychotics are used first in low doses and gradually increased as needed, the side effects are minimal.  The goal is using the lowest dose needed to control the aggressive or agitated behavior.  Antipsychotics are necessary to treat hallucinations and delusions.  Cannabis can be used to reduce the dose and need for antipsychotics, and can sometimes but not always replace them.

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How does the prescription process work?

The prescription process is different from 'usual' medications, but it is straightforward. 

Instead of a pharmacy, it's filled at a dispensary.  We collect information using a form.  Click here to access the form.  The information is entered into the CURT (Compassionate Use Registry of Texas) registry just like sending a prescription to a pharmacy. If a person has dementia or otherwise unable to pick up the prescription, there needs to be a 'guardian' listed.  The patient or guardian calls the dispensary which has access to the registry system.  This gives permission for someone to have it in their possession.  There is no 'marijuana card' like other states.  The only people who have access to the registry are the doctor, the dispensary, and law enforcement.  So, if a person is picking it up and is pulled over for a routine traffic violation, the officer will confirm permission there will be no issues.  

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The dispensary will access the prescription.  They will let you know the cost, as well as the nearest pickup location or delivery options.  Prices change and there are often specials, and the dispensary staff are always helpful finding the best option for you.

Text us when you are bringing the medication to the facility.  The facility must have written orders from us on how to dispense.  We'll send the order when you bring to the facility (This is considered routine and not done after hours or weekends).  Text us 'gummies' or 'herbal supplement'. If you use THC, CBD, Cannabis, or Marijuana, your text will be blocked by our system and we won't receive it.  This is related to nation phone carrier policies that should change soon, but haven't yet.

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Call the Dispensary first for refills.  We approve usually more than enough supply for three months.  You can fill all at once, or monthly, but call them for refills first.  After three months, you'll need us to approve refill.  You'll fill out the check-in form again, letting us know how the medication is effective and what improvements have been noted.  

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