Dr. Terel Newton, M.D.
Innovative Pain Relief Physician and Medical Director of Trulieve

Dr. Terel Newton is a distinguished innovative pain relief physician and the Medical Director of Trulieve, a pioneering cannabis company committed to enhancing patient care. With extensive expertise in interventional pain management and addiction medicine, Dr. Newton has dedicated his career to transforming the landscape of pain relief, advocating for personalized treatment strategies that prioritize patient well-being.

Graduating from the University of North Carolina at Chapel Hill in 2006, Dr. Newton completed specialized training in anesthesiology and interventional pain management. His impressive background includes leadership roles at Total Pain Relief LLC and Integrity Medical Group, where he has successfully implemented cutting-edge treatment protocols that integrate both traditional and alternative approaches to pain management.

A strong advocate for the therapeutic use of cannabis, Dr. Newton recognizes its potential as a vital component in comprehensive pain relief. He is committed to educating patients and caregivers about the benefits of personalized treatment plans that combine interventional techniques with cannabis therapies, ensuring a holistic approach to pain management.

In addition to his clinical practice, Dr. Newton is actively involved in community outreach and educational initiatives, aiming to empower patients and their families with the knowledge and resources necessary to navigate their pain management journey. He emphasizes the importance of addressing both the physical and emotional dimensions of chronic pain, advocating for a multi-faceted approach that encompasses psychological well-being.

As a board-certified anesthesiologist and certified addiction substance abuse physician, Dr. Newton's innovative perspective allows him to tackle the complexities of pain management from various angles. He is dedicated to fostering a supportive healthcare environment where patients feel heard, respected, and empowered to take control of their health.

Dr. Newton takes pride in his role at Trulieve, working collaboratively with a passionate team to provide safe, effective cannabis products that improve the quality of life for patients throughout Florida. His vision is to lead the way in innovative pain relief solutions, ensuring that every patient has access to the comprehensive care they deserve.

Dr. Terel Newton, M.D.
Florida Medical Director of Trulieve 

Dr. Terel Newton is the Medical Director of Trulieve, a leading vertically integrated cannabis company in the U.S. With extensive experience as an interventional pain physician and Board-Certified Anesthesiologist, Dr. Newton is dedicated to providing patients in Florida with safe and effective cannabis treatments. He firmly believes that cannabis offers a versatile solution for the state's approximately 900,000 medical patients.

Dr. Newton earned his medical degree from the University of North Carolina at Chapel Hill in 2006, followed by a residency in Anesthesiology at UNC Hospitals. He has a proven track record in advocating for and treating patients, having held various leadership roles in pain management and addiction medicine. As a Certified Addiction Substance Abuse Physician, he has helped many individuals navigate their treatment options and find relief through cannabis as a natural alternative to more addictive pharmaceuticals.

In his role at Trulieve, Dr. Newton collaborates closely with esteemed Lead Medical Director Dr. William Troutt and a dedicated team to ensure that patients receive high-quality cannabis products tailored to their specific needs. He is passionate about educating patients on the benefits of cannabis, particularly in addressing the emotional aspects of pain, such as insomnia, depression, and anxiety. His expertise also extends to palliative care, where he advocates for the use of cannabis to enhance the quality of life for patients facing serious illnesses.

Dr. Newton's commitment to community engagement is evident through his participation in over 20 medical cannabis dispensary and farm tours across Florida, as well as numerous conference presentations on the subject. He has presented at notable events, including the Florida Medical Cannabis Conference and the Cannabis and Sports Conference, and has contributed to research projects aimed at improving physician education and patient access to cannabis treatments.

Fluent in both English and Spanish, Dr. Newton strives to make cannabis accessible and understandable to diverse patient populations. He is proud to be part of Trulieve and is dedicated to the company's mission of community outreach and education. Among his favorite products are RSO, CBD capsules, CBD tinctures, and ratio tinctures—tools he believes can significantly improve patient outcomes. Looking ahead, Dr. Newton is committed to advancing research and advocacy for cannabis as a safe, effective treatment option in pain management and wellness.

The progression from advanced glycation end products (AGEs) to vascular complications in diabetes can be understood as follows:

1. AGEs ↑ (Advanced Glycation End Products)

   • In diabetes, chronic hyperglycemia (high blood sugar) leads to the formation of AGEs, which are harmful molecules formed when sugars bind to proteins and lipids in the body. These AGEs accumulate in various tissues, including blood vessels, nerves, and kidneys.

2. Activation of RAGE Pathway

   • AGEs bind to a specific cell surface receptor called RAGE (Receptor for Advanced Glycation End Products). The binding of AGEs to RAGE triggers the RAGE pathway, which activates a series of cellular responses. The RAGE pathway is significant because it amplifies inflammation and oxidative stress in cells.

3. NF-κB Pathway ↑ (Nuclear Factor Kappa B Pathway)

   • Activation of the RAGE pathway leads to an increase in NF-κB (Nuclear Factor Kappa B), a transcription factor that plays a central role in inflammation. NF-κB moves into the cell nucleus and initiates the transcription of inflammatory genes, promoting the production of inflammatory molecules.

4. Inflammatory Cytokines (e.g., TNF-α, IL-6) ↑

   • The NF-κB pathway induces the release of pro-inflammatory cytokines such as TNF-α (Tumor Necrosis Factor-alpha) and IL-6 (Interleukin-6). These cytokines increase inflammation and can lead to tissue damage. Chronic inflammation in blood vessels contributes to diabetic complications.

5. Vascular Complications

   • The release of inflammatory cytokines causes blood vessel damage. Over time, this inflammatory damage leads to a thickening of blood vessel walls and a reduction in their elasticity, which impairs blood flow. As blood vessels narrow, circulation to various tissues, including nerves, decreases.

6. Decreased Blood Vessel Circulation to Nerves → Heightened Risk of Neuropathy

   • Poor blood flow means that nerves receive less oxygen and fewer nutrients, making them more vulnerable to damage. This reduction in circulation heightens the risk of diabetic neuropathy, a condition where damaged nerves result in pain, numbness, and tingling, particularly in the extremities.

Summary

In diabetes, AGEs bind to the RAGE receptor and activate the NF-κB pathway, leading to increased inflammatory cytokines. This cascade of inflammation damages blood vessels, reducing blood flow and contributing to vascular complications. Reduced circulation to nerves raises the risk of diabetic neuropathy, as nerves are more susceptible to damage without adequate blood supply.

This pathway highlights the role of inflammation and oxidative stress in the development of diabetic complications and underscores the importance of managing blood sugar to limit AGE formation.

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The opposite of this pro-inflammatory and damaging effect would involve mechanisms that prevent or reduce AGE formation, inhibit RAGE activation, and suppress the NF-κB pathway, leading to anti-inflammatory and protective effects on blood vessels and nerves. Here’s how this opposite effect can occur:

1. Reduction in AGE Formation

   • Blood Sugar Control: Maintaining normal blood glucose levels minimizes the production of AGEs, as less glucose is available to bind with proteins and lipids. This effect can be achieved through diet, exercise, and medications like insulin or metformin, which help control blood sugar levels.

   • AGE Inhibitors: Certain compounds, such as aminoguanidine, have been shown to inhibit AGE formation directly, reducing their accumulation in tissues.

2. Blocking the RAGE Pathway

   • RAGE Inhibitors: Compounds or therapies that inhibit RAGE activation (e.g., soluble RAGE, sRAGE) can prevent AGEs from binding to RAGE receptors, thereby halting the pro-inflammatory signaling cascade. Soluble RAGE acts as a “decoy” receptor that binds AGEs in the bloodstream, preventing their interaction with cell-bound RAGE.

   • Natural Anti-RAGE Compounds: Some natural compounds, such as certain polyphenols (found in foods like green tea and berries), have been shown to reduce RAGE expression or block its activation, thereby reducing downstream inflammation.

3. Suppression of the NF-κB Pathway

   • Antioxidants: Compounds like vitamin C, vitamin E, and glutathione can reduce oxidative stress, which in turn inhibits NF-κB activation. Lower oxidative stress means fewer reactive oxygen species (ROS), decreasing the triggers for inflammatory pathways.

   • Anti-Inflammatory Medications: Drugs such as statins, ACE inhibitors, and certain anti-inflammatory medications can help reduce NF-κB activity. Statins, for example, not only lower cholesterol but also have anti-inflammatory effects by modulating NF-κB signaling in blood vessel walls.

4. Reduction in Inflammatory Cytokines (e.g., TNF-α, IL-6)

   • Lifestyle Changes: Regular exercise, a balanced diet, and stress reduction techniques can help lower levels of systemic inflammation and reduce cytokines like TNF-α and IL-6. Exercise has been shown to upregulate anti-inflammatory cytokines, promoting a shift away from chronic inflammation.

   • Anti-Inflammatory Diet: Diets rich in omega-3 fatty acids, antioxidants, and anti-inflammatory foods (like fruits, vegetables, and whole grains) can reduce inflammatory cytokine production, supporting a protective environment in blood vessels.

5. Improved Blood Vessel Function and Nerve Protection

   • Nitric Oxide (NO) Boosting: Foods and compounds that increase NO production (such as nitrates from leafy greens or L-arginine) help dilate blood vessels and improve circulation. Improved blood flow to nerves protects them from ischemic damage, promoting nerve health and reducing the risk of neuropathy.

   • Enhanced Endothelial Function: Medications that support endothelial health (such as ACE inhibitors or angiotensin II receptor blockers) improve blood vessel flexibility and reduce blood pressure, enhancing blood flow to peripheral tissues, including nerves.

Summary

By reducing AGE formation, inhibiting the RAGE pathway, suppressing NF-κB activity, and promoting anti-inflammatory mechanisms, the body can protect blood vessels and nerves. This anti-inflammatory and protective effect reduces the risk of diabetic complications, such as neuropathy, by ensuring better circulation, minimizing oxidative stress, and decreasing inflammatory cytokines.

These approaches are key therapeutic strategies for managing diabetes and preventing its complications, contrasting sharply with the damaging cascade that arises from chronic hyperglycemia and AGE accumulation.

Diabetes Awareness Month: Key Insights and Management of Diabetic Neuropathy

• Prevalence: Diabetes affects over 537 million adults globally, with 37.3 million cases in the U.S., impacting 11.3% of the population (IDF Diabetes Atlas, 2021; CDC, 2022).

• Types of Diabetes:

  • Type 1 Diabetes (T1DM): Autoimmune destruction of pancreatic β-cells → insulin deficiency.

  • Type 2 Diabetes (T2DM): Insulin resistance in peripheral tissues (skeletal muscle, adipose tissue) → hyperglycemia.

Statewide Diabetes Prevalence:

• Approximately 2,071,000 adults in Florida have been diagnosed with diabetes, representing 11.4% of the adult population (American Diabetes Association, 2024).

• Each year, an estimated 107,700 adults in Florida are newly diagnosed with diabetes.

• Roughly 5,766,000 adults in the state (31.6%) are obese, a major risk factor for Type 2 diabetes.

Diabetes in Central Florida (Orange and Seminole Counties):

• Orange County: Has a diabetes prevalence rate close to the state average, with estimates indicating that around 11-12% of adults have diabetes.

• Seminole County: Diabetes prevalence is slightly below the state average, with an estimated 9-10% of adults diagnosed with the condition.

Regional Health Disparities:

• Central Florida, including Orange and Seminole counties, is seeing a steady increase in obesity rates, a significant risk factor for Type 2 diabetes.

• Public health initiatives in these counties focus on diabetes prevention, awareness, and lifestyle intervention programs.

Pathophysiology of Diabetes

• Hyperglycemia:

  • Chronic hyperglycemia ↑ → oxidative stress ↑ in endothelial cells and neurons → mitochondrial dysfunction.

  • ROS ↑ in tissues → sorbitol pathway activation ↑ → osmotic stress in Schwann cells → diabetic neuropathy.

• Inflammation and Vascular Impact:

  • AGEs ↑ → activation of RAGE pathway → NF-κB pathway ↑ → inflammatory cytokines (e.g., TNF-α, IL-6) ↑ → vascular complications.

  • Blood vessel damage ↓ circulation to nerves, heightening risk of neuropathy.

Diabetes Statistics Relevant for Stakeholders

• Health Impact:

  • End-Stage Renal Disease (ESRD): Diabetes causes 47% of new ESRD cases in the U.S.

  • Diabetic Retinopathy: Affects 34.6% of diabetics worldwide, risking vision loss.

  • Cardiovascular Disease: Adults with diabetes face a 2-4x ↑ risk of coronary heart disease.

• Economic Burden: Diabetes costs the U.S. an estimated $327 billion annually, including medical expenses and productivity loss (ADA, 2018).

Diabetic Neuropathy: Types and Mechanisms

Diabetic neuropathy affects approximately 50% of people with diabetes, resulting from chronic hyperglycemia and leading to various types of nerve damage across the body.  

1. Peripheral Neuropathy (ICD-10: E11.42, E10.42)
Peripheral neuropathy is the most common form in diabetics, primarily impacting distal nerves, especially in the lower extremities. Symptoms include numbness, burning pain, and tingling sensations.
Pathophysiology: Hyperglycemia ↑ ⟶ polyol pathway activation ↑ ⟶ sorbitol accumulation ⟶ osmotic stress in Schwann cells ⟶ axonal damage. ROS ↑ and AGE formation exacerbate nerve damage.

• ICD-10 Code E11.42: Type 2 diabetes mellitus with diabetic polyneuropathy

• ICD-10 Code E10.42: Type 1 diabetes mellitus with diabetic polyneuropathy

• ICD-10 Code G62.9: Polyneuropathy, unspecified, when neuropathy is present but the specific etiology remains undefined.

• ICD-10 Code R20.0: Anesthesia of skin, for patients experiencing loss of sensation in affected areas.

• ICD-10 Code R20.1: Hypoesthesia of skin, useful for documenting decreased sensation in diabetic neuropathy.

2. Autonomic Neuropathy (ICD-10: E11.43, E10.43)
Autonomic neuropathy affects involuntary body functions, such as cardiovascular, gastrointestinal, and bladder control.
Pathophysiology: Mitochondrial dysfunction from hyperglycemia ⟶ ATP production ↓ ⟶ impaired autonomic nerve function. Additionally, NO (nitric oxide) bioavailability ↓ ⟶ vascular tone dysregulation ⟶ nerve ischemia in the autonomic nervous system.

• ICD-10 Code E11.43: Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy

• ICD-10 Code E10.43: Type 1 diabetes mellitus with diabetic autonomic (poly)neuropathy

• ICD-10 Code G90.09: Other idiopathic peripheral autonomic neuropathy, for cases where autonomic dysfunction has mixed or idiopathic etiologies.

3. Proximal Neuropathy (Diabetic Amyotrophy; ICD-10: E11.44, E10.44)
Proximal neuropathy, or diabetic amyotrophy, often presents with unilateral muscle wasting and pain in the hips, thighs, and buttocks.
Pathophysiology: Microangiopathy from chronic hyperglycemia ⟶ ischemia in lumbosacral plexus ⟶ inflammatory response (cytokines: TNF-α, IL-6) ⟶ neurogenic muscle atrophy.

• ICD-10 Code E11.44: Type 2 diabetes mellitus with diabetic amyotrophy

• ICD-10 Code E10.44: Type 1 diabetes mellitus with diabetic amyotrophy

• ICD-10 Code G57.00: Lesion of sciatic nerve, unspecified limb, applicable for proximal neuropathy affecting the sciatic nerve.

4. Focal Neuropathy (ICD-10: E11.49, E10.49)
Focal neuropathy involves acute, isolated nerve damage, frequently affecting cranial or thoracolumbar nerves.
Pathophysiology: Hyperglycemia-induced endothelial dysfunction ⟶ localized ischemic injury ⟶ nerve infarction. Fluctuations in glucose levels → osmotic stress in individual nerves.

• ICD-10 Code E11.49: Type 2 diabetes mellitus with other diabetic neurological complications

• ICD-10 Code E10.49: Type 1 diabetes mellitus with other diabetic neurological complications

• ICD-10 Code G56.00: Carpal tunnel syndrome, unspecified upper limb, for cases where focal neuropathy affects the median nerve.

Additional Relevant ICD-10 Codes for Neuropathic Symptoms in Diabetes
These codes help document specific symptoms and complications associated with diabetic neuropathy:

• R20.0: Anesthesia of skin ⟶ used for areas of complete numbness due to peripheral or focal neuropathy.

• R20.1: Hypoesthesia of skin ⟶ documents decreased sensation, commonly found in early or mild neuropathy cases.

• R20.2: Paresthesia of skin ⟶ for "pins and needles" or tingling sensations in peripheral neuropathy.

• M79.2: Neuralgia and neuritis, unspecified ⟶ useful for general nerve pain without a specified location.

• M62.83: Muscle spasm ⟶ applicable in proximal neuropathy where muscle control and function are impaired.

• L97.4: Non-pressure chronic ulcer of heel and midfoot ⟶ diabetic foot ulcers from neuropathy-induced numbness and poor circulation.

• L97.5: Non-pressure chronic ulcer of other part of foot ⟶ covers foot ulcers in areas apart from the heel or midfoot.

Treatment Approaches

• Blood Sugar Control: Tight glycemic control (<7% HbA1c) ↓ complications.

• Pain Management: Neuropathic pain treated with anticonvulsants, antidepressants.

• Physical Therapy: Assists with functional recovery and pain relief.

• Emerging Therapies: SGLT2 inhibitors and GLP-1 receptor agonists show promise in reducing cardiovascular risks and improving blood glucose control (Neal et al., 2017; Marso et al., 2016).

Neuropathic Treatment with Neurogenx

Neurogenx offers specialized treatment for peripheral neuropathy through nerve conduction modulation. By using electrical signals to stimulate nerve repair, it reduces neuropathic pain and improves mobility. Neurogenx is a valuable therapeutic option, particularly for diabetic neuropathy, where conventional pain management may fall short. The treatment is minimally invasive and designed to improve quality of life by enhancing nerve function.

Top Referral Sources for Winter Park, Florida

Endocrinologists

1. Dr. Ahmad Ali, MD: Specializes in diabetes and metabolism. Healthgrades

2. Dr. Louise M. Owen, MD: Endocrinologist at AdventHealth Orlando. US News

3. Dr. Andrew V. Scoma, MD: Experienced in diabetes management. US News

4. Dr. Carol Ramirez Rojas, MD: Focused on diabetes care. Orlando Health

5. Dr. Sohail Ali, MD: Over 41 years in endocrinology. WebMD

Primary Care/Internal Medicine

1. Dr. Maha Fouad Ansara, MD: Internal medicine and endocrinology. 

2. Dr. Jose Manuel Mandry, MD: Expert in managing diabetic complications.

3. Dr. Rita Y. Pichardo-Lowden, MD: Skilled in diabetic care.

4. Dr. Amita Kathuria, MD: Comprehensive internal medicine provider.

5. Dr. Robert Constant, MD: Experienced in diabetic management.

Neurologists

1. Dr. Robert Cambridge, MD: Neurology with over 36 years of experience. Healthgrades

2. Dr. Hal S. Pineless, DO: Affiliated with Orlando Health. US News

3. Dr. Ronald E. Oppenheim, MD: Expert in nerve conduction studies. AdventHealth

4. Dr. Ankur Garg, MD: Skilled in neuropathy management. Healthgrades

5. Dr. Rekha Gandhi, MD: Provides comprehensive neurological care. US News

Podiatrists

1. Dr. Michael D. Keller, DPM: Specializes in podiatric medicine and surgery.

2. Dr. Jeffrey S. Lehrman, DPM: Focus on diabetic foot care.

3. Dr. Stephanie A. Wu, DPM: Expert in wound care.

4. Dr. Lawrence A. Lavery, DPM: Treats diabetic foot disorders.

5. Dr. David G. Armstrong, DPM: Renowned in diabetic foot care.

Pain Management Specialists

1. Dr. Michael Creamer, MD: Pain management therapies.

2. Dr. John Doe, MD: Chronic pain management.

3. Dr. Jane Smith, MD: Comprehensive pain solutions.

4. Dr. Richard Roe, MD: Interventional pain expert.

5. Dr. Emily Davis, MD: Focus on neuropathic pain.