Welcome to the Wellness Transcription Podcast, the podcast that combines the power of Christian
values with evidence based nutrition, fitness, and lifestyle content. I'm your host,
doctor Patrick Early. Join me each week as we explore the intersections of
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God calls us to live. All right, guys, welcome back to another
episode of the Wellness Transcription Podcast. I have a close friend of mine,
another expert in his field. He's a great mentor of mine. He taught
me in pharmacy school and all things toxicology, and he also runs the Poison
Center in Arkansas right now, and he has a board certification in toxicology.
So we're going to be basically talking about what toxicity actually means, what does
it mean for something to be poisonous or not, and then we'll kind of
bleed into just kind of how the poison Center operates. Some interesting things you
might want to know on when to call them, what things that you should
be looking out for. But I've got doctor half Auster on the show.
I really appreciate you being here. How it means a lot that you joined
me today. I appreciate it. Well, I really appreciate you asking me
to be on here, Patrick, And for the listeners out there, I
will just say this, Patrick's dead taught me, so I'm just kind of
passing it along. His dad's a great friend and mentor of my own.
So I sometimes forget about that that he taught you in pharmacy school. But
he was there for thirty years, so that does make a whole lot of
sense. But I will get into maybe I'll ask you some questions off the
regulator about how everything's going at UMSCS. I haven't been back since we moved
to Austin. But how real quick with the audience, just kind of give
us your background. How'd you get involved in the field that you're at now?
What was that process like for you when you were in pharmacy school and
going forward? Well, honestly, toxicology came looking for me. I didn't
come looking for it necessarily. I did a rotation my senior year in the
Poison Center, and it was a drug information talks based rotation, and I
left and went and did a residency at the VA, And in the process
of doing that, they had gotten funding at the Poison Center and had been
completely funded by the College of Pharmacy up until that time, and they had
picked up some extra funding and offered me a spipend to come over and take
some call in the evenings for them, and I did that as a resident.
I finished my residency, I went worked for the VA and had worked
there for not quite a year and a half, and in fact, my
thirtieth anniversary in the Poison Center was three days ago. Doctor Charlie Campbell,
who was the director at that time I was working over at the VA,
gave me a call and said, Hey, would you like to come to
work for me? I really like that. It was interesting, lots of
different clinical type questions and we did a ton more drug information back in those
days than we do now. The phones and the access to the internet is
so much better now than it was then. But I was like sure,
So I came over and worked as a specialist in the center for the first
seven years. And took over as director in two thousand, been the director
ever since. Yeah, so tell me real quick. I know you have
a a toxicology certification, So what was that process like? And I could
be wrong, but I know certain practitioners have to go through. It's quite
a rigorous process to get that Board of Applied Toxicology certification. Can you kind
of elaborate on that a little bit. Yeah, there's really two ways to
get to it. The easiest way, honestly in a way, is to
do a fellowship and once you get out of fellowship, certain fellowships around the
country allow you to fast track to take the board exam. If you don't
do that method, it's going to take you a minimum of about five years
to be able to even get to the point that you could meet all the
criteria for certification. There's research things, you have to consult where you're doing
actually clinical consultations and have people consulting with you directly, and you have to
keep up with all of that. And it's a scoring system that you can
go out to. The It's quintox dot org www. Dot clintox dot org,
which is the website for the American Academy of a clinical toxicology and you
can go out. There's a place on there for the a bat and see
what all of the criteria are. But pretty rigorous process, pretty tough test.
So yeah, I can imagine. I mean, the field of pharmacy
in general is the exams are tough. But I've I can only imagine.
I mean, I know Jesse Is who also had you as a priest.
We were both in pharmacy school. She's studying right now to do her pediatric
board certification and it's those board certification tests aren't easy and that it shouldn't be.
But how one of the things one of the reasons I thought about you
when I in the nutrition space that I've kind of found myself in, especially
the pharmacy field in Austin, Texas, I get questions about this all the
time, and I think a lot of people tend to have some fear around
what exactly toxicity means. Like I'll have patients, for example, I'll have
patients come in and then it'll ask me nutrition advice, which happens quite frequently
in the pharmacy that I'm at, and they'll say, well, my doctor
told me to avoid gluten because it's toxic for me, and I'll ask them
what do they mean by toxic for you? Do you have Celiac disease likes?
What does that mean? And elaborate and you can tell that they really
have no idea. It's just something that they're scared about and that they're trying
to get some answers and kind of figure out how to combat this issue that
they didn't know that they had. So in your field, when you hear
someone refer to something as toxic, what does that exactly mean? Its like
from a poison center toxicologist perspective, when you hear the word poison or toxin,
like, what do you define that as well? I mean as well
you know and you've touched on it. There's one thing as an expert or
a clinician, the way you look at and then there's the other way the
lay public looks at it. So from my perspective, if you come in,
all toxins are poisons, and toxins are substances produced by bacteria, animals,
plants, So it's a much more narrow poison than just the broad term
poison. So poison in and of itself, to me, most things can
be poisonous if you can get exposed to enough ONEm dose makes the poison.
As Paracelsus said that a little over five hundred years ago. But what happens
with that is people either give a half for or they look at in vitro
data, but the NVivo data shows nothing along those lines. And one of
the big areas to do that with is look at some of the sunscreens.
Now, there have been a few that have been pulled off the market,
but if you look at the end vitro data of sunscreens, you would probably
never use because of the issues it can cause with DNA. But we have
this lovely little thing just below the layer of our skin called our stratum cornium
that keeps things from being absorbed, and most of the sunscreen then that you
slather on you is not absorbed. In fact, some of them are not
absorbed at all, really, and they offer you protection from that stem.
So you really have to look at where they're coming from. As far as
with the gluten thing, men, you both know that while Siliact disease is
real and gluten will reacg havoc on a Siliact patient, for most of us,
it's probably not much of an issue at all, And I think sometimes
it's easier to tell a patient to avoid things with gluten in them as opposed
to getting them to fall away better diet. If you just cut out all
of this stuff, you're going to cut out a lot of processed wheat flour
and things like that. I think that's where it comes from. But the
patient doesn't know what really is poisonous and what isn't. That's a perfect I'm
glad you brought up sunscreens too, because we get asked those questions all the
time as well. And I think the big thing that I've come to find
out is and again you have to kind of go through the training associated to
be able to figure these things out. But study design is something that just
most people don't know anything about, and unless you're in that field and really
know how research is conducted, especially the types of research, you can get
vastly different results and it's not the easiest thing to interpret. So for your
example with sunscreen, I think that was perfect. Is in the in vitro
cell culture studies, where you're looking at just certain cell types in a peatridition,
you're exposing to bring high amounts of a particular chemical yeah, of course
you're going to see some really scary stuff happen, and you're gonna and again
that's like the first step in research is to see, well what does this
look like? And then you kind of keep going. But when you apply
it to the a normal person, you just don't see that. I think
people tend to think are our bodies and our biology is way simpler than it
really is. Like we have many different mechanisms and routes to kind of deal
with certain issues, especially when it comes to toxicity and stuff like that,
and there are ways to handle that. But again, one big thing that
bothers me is that people throw around that term to where the more you say
stuff is toxic, because it's almost like hearing the same thing over and over
again, you just stop listening at some point and it's like, well,
what isn't a toxic at this point? Or what can I eat? Or
what can I eat? And I think that's a very important point that you
elaborated on because a lot of people just don't understand all that goes into defining
a dose of something is toxic if you drink too much of it. But
and again, like drugs are the same way, like I hear this one
a lot, especially on social media. It's like, well, the big
pharma just wants to keep poisoning us so we can be sick all the time
so they can take more of our medications. I hear that all the time
as a practitioner now, and it kind of rubs me the wrong way.
So are there let me see how I want to phrase this, Like,
let's I'd say the biggest one would be let's say glyphis eate for example,
like round up, there's been that's been kind of in the news a little
bit. People are It's certain areas are starting to try to pull glyphasate off
the shelves because if you use it to kill weeds in your yard, you
may get exposed to too much of it. But I've seen kind of Charlatan
type figures in the nutrition space say, well, the oatmeal off the shelf
that you get at the supermarket has glyphys in it, and it's poisoning you
if you eat oatmeal every day. So I don't know if if when I
was on rotation with you, if I had any glyphis eight calls, I'm
pretty sure I didn't have. You guys seen any of that? Is that
some then that y'all get calls about in the poison center, And then how
would y'all manage that if someone were to be exposed to something like that in
Arkansas with all the farming. I'm sure that's probably popped up a time or
two. Well, I couldn't even begin to tell you how many cases of
glyfoss eate exposure I've been subjected to over the last thirty years, but I
would guess it's probably well into the hundreds as a general rule, at least
acutely. Unless somebody is trying to commit suicide and goes out and drinks a
bunch of concentrated round up, I don't worry too much about a small exposure
to glyfossate. In fact, even in that situation that I just said,
where somebody's trying to commit suicide, I'm less worried about the glyphoss eate and
typically more worried about the surfactant that's added in there and that actually causing the
acute poisoning or a problem. So I will just tell you the data that
I have seen. I'm scientifically on even long term glyphoss eate is pretty weak.
And we'll go back to sunscreens because I will use I will juxtapose it
against this whenever I've got He's twelve years old now. But I was doing
some work for the National Talk Center for the FDA on sunscreens and I came
home and I pulled every sunscreen that had oxy in it out of our house
through the trash can due to the fact it would cross the stratum corneum,
and I was worried about potentially DNA changes. I have a large bottle of
round upsetting in my garage right now that I used to spray weeds with,
so and I do take safety pretty seriously. I think there's a lot of
money to be made suing people, and I think the amount of life phiss
sate that was used around the country was pretty low hanging fruit for somebody to
try to attack. And that's my general feeling. Like I said, I'm
not overwhelmingly convinced of its long term toxicity or cumulative toxicity, whatever you want
to call it. So, yeah, I've seen that there's certain articles and
I can't remember the name of the group I should have done my due diligence,
and I think it's the Environmental Working Group or something along those lines,
is they'll take a lot of the USDA's data on glyphysate exposure and other pesticide
exposures, and they'll say they found all these adverse health effects associated with it,
and this is why no one should you should use organic versions of these
things instead of glyphys aate or whatever herbicide spectra side whatever that's currently out there.
But what they don't what they'll do is they'll take all the acute exposure
from people who work with it on a daily basis, farmer stuff like that,
where they've accidentally been exposed to large amounts of it in the workplace,
and they'll lump that data in and use it to kind of scare people,
when in reality, if you look at the amount of glyphysate you've been exposed
to when eating a certain food, I'm pretty sure if I recall correctly,
I think the milligrams per kilogram for like an acceptable daily intake is zero point
five for glyphyss. So I mean, assuming you would even know the amount
of live state in a food you're eating routinely, I mean you'd have to
you'd have to eat quite a bit of it to even get to the point
where you'd be concerned with that. I yeah, I think it's Take me
example, if I'm two hundred and fifteen pounds and we do the math,
I mean, I'd have to essentially stay under fifty milligrams of glyphyssate a day
for me to not be worried about an issue. And again, I'm not
getting nearly exposed at any of that. From a dietary perspective, I am
interested to kind of d are there some and we can kind of piggyback and
bounce back and forth with these topics. But are there certain things? And
I kind of know the answer to this question being on your rotation and stuff
in pharmacy school, But are there certain things that when you get phone calls
in the poison center about them that you're the hair on the back of your
neck stands up like as a poison At the poison control center, you get
also calls for all sort of sorts of things. What are some of the
things you've seen that I guess the audience might be better suited to know than
worrying about someone calling something toxic on the internet that they don't really understand.
So what are some of the things that they really need to worry about So
let me ask you this. Let's ask it a different way. I guess.
Okay, So are we talking about a toddler getting into something, or
are we talking about something in your garage somebody intentionally overdosing, because all of
those go down different paths. Sure, and I will tell you, in
general, inside your home, if you use reasonable safety precautions, most of
the things other than medicinals in the general part of your home are usually reasonably
safe. Obviously, if you dose make some poison, you drink enough something,
you can have a problem. Now under the sink, there are a
few things under there that can be really problematic. Drain cleaners are one that
jumps out really quick that you would find under your counter. Some of those
can be incredibly caustic, and even a mouthful could cause just horrific damage in
someone, even an adult. Once you leave your house and step out into
the garage, there are a lot of things that can be found in your
garage that could be really problematic in the wrong situation. I guess. Fuel
additives are one that jumps out. Because it's this time of year, people
are went arising their boat and things like that. Some of those have large
amounts of ethanol in them, and small ingestions in a small child or even
relatively small ingestions in an adult could potentially be a problem. Anaphreezes ethylene glycol
containing products are problematic if you're a mechanic or tend to do mechanic work and
things like that. Break fluids can have both ethylene glycol and diethylene glo call
in them, which are all potentially problematic substances. And then we move over
we're talking about glyphoss ate on herbicide. Like I said, if somebody got
a mouthful of it, I'm actually more worried acutely about the surfacta that's in
there than I am glyphoss itself. But as we move over into some insecticides,
some of the insecticides with small ingestions could be problematic. Fortunately, some
of the more problem ones have been removed from the market. But something for
whatever reason, and I don't know why this is. I don't know if
we're using more of it now in the rule or in the farm community,
but paraquat has been one that has cropped up quite a bit now. It's
a little different than die quot, which you can actually find in combination oddly
enough with clite foss eight, but paraquat is a much more sinister substance,
and a mouthful of it and an otherwise healthy adult could be fatal so and
even more so to a small child. So there are those types of things
now medications, the list can get long really quick. But I will tell
one that is we're kind of getting into the cough, cold time of the
year. That really scares me that I think even most pharmacists do not appreciate
the toxicity of this substance. And that is that is a very scary substance.
They're little, round gel looking beads. I can see a toddler looking
at those thinking, hey, that's candy. They are potent sodium cha.
It's a potent sodium channel blocker, so you can develop cardiotoxicity with it really
quickly. You can get two hundred milligram little capsules of it, just a
few of them, and a small child is really bad. We actually had
a fatal case, it's probably been about two years ago in a thirteen year
old. They made a suicidal gesture and they took twelve thirteen capsules and it
killed them. So that's one that people get their little small things. They
look pretty innocuous and they're pretty nasty. Some other meds that we use,
the one pill can kill kind of a thing. One pill won't do it.
But cold is a drug that is really nasty. Methyl treks eight,
which people use for rheumatoid arthritis, can be really problematic. We've got the
big people don't like to hear this, but hydroxychloroque is really a poisonous substance,
and everybody was wanting to push that out to during COVID and if it
works, that's fine. With something that you really need to pay attention to
and how it was stored and things like that, it would not take very
many tablets to really be a problem in someone. And then, of course,
if somebody's on different blood pressure medicines or medicines that directly affect the heart,
those all can be pretty concerning pretty quickly. So yeah, that's It's
interesting you brought up benzono tape because I've I'm not as familiar with that,
but I have heard that of late, and you're exactly right. We're starting
to dispense quite a bit of it in the pharmacy with cough and colds and
even with COVID, Like, we were seeing a lot of coughing symptoms and
that's one of the common things that we would see that was prescribed with it.
And those things I don't like dispensing them because you're exactly right. They're
bright yellow colored. The higher dose ones have this kind of oblong, candy
looking shape and they can kind of easily spell on the counter to where like
if you weren't careful and you drop some, you may not even they just
scurry away really fast, so you wouldn't even see them. And so when
you if you get if you take a call like that, and let's let's
just use benzonotate and are as an example. What are some of the what's
the kind of protocol y'all follow in the poison center to kind of manage that?
How does that look? Well, pretty much, it's not going to
take much benxonotape to get me moving you to the emergency room, especially if
it's a child. So and my staff know this and they're well trained with
it, they're going to in most situations if somebody just immediately did that and
we felt like we could get them to the emergency room. Quicker by car
sends you by car now. In other situations, we may direct you to
call an ambulance to come get the tool. Because these things are absorbed pretty
quickly. They're going to get symptomatic pretty quickly, and we're going to move
on them pretty quickly. I mean, basically, in my opinion, we
got a barely small toddler. If they knock off more than two three hundred
milligrams, or I have any uncertainty about those, they're going we're not keeping
them at home. On the therapeutic side, I will just throw this one
out there. On benzonotate, since we're talking about it, do not bite
and swallow. That used to be a pretty common way that we would see
prescriptions written, and I get it. An it's a potent sodium channel blocker,
and that's why we're worried about the toxicity. But if you think about
what are sodium channel blockers, a lot of them are anesthetics. They take
away pain and stuff, which is why we're giving it to you for sore
throat to a degree and cough. So biting that thing will numb your throat.
The problem is you can numb your throat so much that you relax your
upper airway. That you can't clear secretions. Oh you can run into a
problem with that. Not being able to swallow or even cough at all is
there's some issues related with that. So yeah, I always counsel on that,
and no matter when I dispense that awhat, please do not crush or
chew this. And you'd be surprised, Like a lot of people don't think
about that kind of thing, and they'll ask me, well, why shouldn't
I. I'm like, well, this is why. However, you just
don't want to get all that dose at one time, especially you don't want
it locally getting absorbed quickly before it gets to where it's supposed to. That's
one that was surprising to me because I don't know if we were taught that
one, particularly in pharmacy school. I know I have a lot of friends
of mine that are starting to have kids. Me and my wife are in
that realm here at some point like in the near future, that something will
start considering, And I get questions all the time, especially from close friends
of mine. Hey, I have a toddler. They're in that mobile phase
where they're running around getting into everything. What do I need to not have
in the house or what is there any like what stuff gets me concerned?
And I remember answering this question for someone. They asked me like, Hey,
I'm not talking about the drain cleaners and stuff like that. We don't
have that in the house. He goes, there anything else that we're concerned
about, And I go and I just happen to know that this the wife
of my friend has been diagnosed with anemia in the past, so she takes
fair sulfate, I mean, routinely to help with that. I mean,
that's pretty common medication. But I told them you need to really be careful
with iron, especially around little kiddos. And I remember you giving us quite
a lecture on that in pharmacy school and how that gets your attention, especially
if there's too much of it. So I would that's a fairly innocuous substance
that I feel like a lot of people wouldn't think twice about. But what
happens if let's say a kid gets into a bottle of that kind of thing,
or at what point with multi vitamins or something, do you get concerned
stuff that kids could easily get into. So that's a pretty good question.
We'll go off in a couple of different directions here, but we'll stay with
iron. Initially, those three hundred and twenty five milligram fair sulfate tablets that
get dispensed as a prescription, particularly when predatal situations, most of those all
look like candy to a toddler. They're all sugar coated. They're either green
or red usually, And the thing that we forget as adults sometimes is a
child will pop that tablet in their mouth and they will begin to suck that
sugar coating off of it, and as soon as that sweet taste leaves and
any other taste replaces it, they're either going to do one or two things.
They're either gonna spit it out or they're gonna swallow it. And sadly,
lets use a twenty two pound child. So technically that supposedly is a
normal two year old had twenty two pounds up. I may beg to differ
with that in our society now, but that's a ten kilo child. So
a three twenty five fairsulfate tablet, it's gonna have sixty five milligrams of elemental
iron. So ten of those would put you at sixty five milligrams per kila
of elemental iron that is gonna put that child. They're definitely going to have
symptoms. They're gonna have some geosymptoms from that vomiting, probably some diarrhea.
That is a threshold that begins to make me really concerned. And as you
start adding it only took ten tablets for us to get there. If you've
ever watched a kid eat a bag of Skittles or a bag of M and
m's or whatever, then take down ten pretty quick. You push that out
to twenty. That's a lethal dose. So and unfortunately, and I hate
to talk about cases, and I will keep them as generic as I possibly
can because of hippo. But we've in the last year and a half had
a case. Mom's in the shower, two and a half year old,
gets into her she's pregnant, gets into her supplemental iron that is on the
counter. She gets out of the shower. There are tablets spilled on the
floor. She questioned. The toddler basically says no, I didn't need any.
She gets the tablets picked up, and the child begins to have a
half hour forty five minutes later, begins to have protracted nauseam vomiting, and
they call the center we refer them in. They go to the small rural
hospital that's adjacent to where they live at child is definitely really symptomatic at this
point, definitely got some metabolic changes. Whenever we look at some of their
blood and we call and get transferred to Children's. Child is transferred to Children's
within the first three to four hours of the ingestion. Child's dead eleven hours
later. So and we in that situation, that's a pretty quick timeframe to
us. We got them to a place where we could start giving them death
peroximine. We pushed the dose of deferoxymine, We did some really interesting things
with some plasma exchange on them, trying to do that to get the iron
out just could You're just too far behind the eight ball at that point,
even though we have an antidote. If you really start doing the math on
how much deferoxymene will will bind, you just can't get ahead of the You
can't get ahead of it. So and I don't mean to scare people,
but I do mean it to scare people, I guess, because those are
things that from a pharmacist standpoint, and I tell students this all the time,
that bottle should not leave the pharmacy in a snapcap. It should have
a child resistant cap on. And just because it has a child resistant cap
on, it doesn't mean the child can't open it. It just means that
a certain percentage of children cannot open it. And there's still some that will
be able to open it because we made them completely child proof. Adults couldn't
get in them either, correct. So iron, I'm glad you brought up
iron. That's a good one. So one of the things is now with
tooble vitamins and gum things like that. Everything seemed to come in a dad
gum gummy now. But the thing, for whatever reason, kits seem to
tolerate the iron that is in those tooled tablets a little better than they do
for whatever reason, in that big dose affair of sulfate, And we're it's
unusual for a child to be able to get enough of the toolble. Iron
tablets are the chewable multi bottoms that have some iron in them for them to
get to a really serious point with those, and part of it is just
due to the amount of iron that's in. But there's that. The other
one, though, is you see some bad press out there about melotonin.
And I'll just tell you my general feeling on melatonin is melatonin in and of
itself is probably not much of a toxica. It doesn't cause cumulative sleepiness.
So it's not like taking a benzodazepene for sleep, where if you take one
you get a little sleepy, but if you take twenty you get the CNS
depression is significantly more. Melotonin is not that way and doesn't appear to be
a problem. Now. Where the problem lies where you look at some of
the data that's out there that implicates melatonin, there's usually something else. And
so those are the areas where we get a little concerned. We ask a
few more questions about melatonin, but in general we don't get too up in
arms about melotone. Yeah, I tell people that all the time. I
get some of those questions occasionally, like my kid got into some meltonin and
and then I'll I still remember from my time with you guys the month at
the Foison centers, that's really not a concern unless there's other products again,
or if they're taking it with other things. One of the big things for
me is I and I don't know why they still make it this way.
But since we talked about iron, I feel like this is an important thing
to know about. Like ferisulfate is not the most appealing looking. It does
look like candy or skittles or something. But I would say the one that
I really worry about it like looking like candy, is the fair s gluconate,
like the little green ones I mean eb Hardpress. If you glanced at
that, or if that fell on the floor, that would let like green
Eminem's to a kid. And that's one of the things that I think we
do kind of bad as a society, is like it's sometimes it's really hard
to distinguish between medicines or candy. And I remember going to elementary schools and
middle schools in pharmacy school and talking to them about it. We had a
little slideshow where I would have them guess which one was candy in which one
wasn't, and you'd be surprised by how many like people couldn't tell the difference,
even adults, even teachers in the room were like, I had no
idea. It's just it's startling, and I think a lot of people don't
know. And what's another point I'll make is like, I think people need
to realize that, Like, if there's any question in mind, if a
kid got into something, just police call the poison center, because even if
you're not sure, having that resource at your disposal is crucial, I think.
I mean, I remember getting all sorts of calls when I was on
rotation with you. I got a call one time about and then a pig
in like another state got in and then got in and ingested a bunch of
fire ant killer. Like it was just this crazy call that I remember getting
that, and I asked you, I go, how, I don't know
how to handle this. He goes, oh, yeah you do, like
you're good, Like just you know what that is, and it just happens
to be in an animal and not a human. And there's also vet poison
control, which I think is kind of cool too, because my dog,
if I drop anything on the floor, if I'm not right there, I
mean, it's cone. So well that's I mean, not to really get
off into veterinary stuff, because I'm definitely not veterinary trained, but this time
of year, I mean, there are a few things that you probably should
worry about with your pets. And one of those things a lot more candy
around this time of year. We just had Halloween, went into Christmas,
be a lot of different kinds of candy. Then it's sugar free candies and
particularly dogs. Zolatol, which is an artificial sweetener or technically, I don't
guess, it's just a sugar alcohol. But it doesn't take much zolotol to
kill a dog, and we can eat zalona. It probably causes some gastritis
and diarrhea if we eat too much of it, but it causes them to
release insulin and they'll develop an insulin coma and die. So you need to
be really careful with that chocolate in the dogs. We get a lot of
questions still about that build chocolate in of itself. Most of it really isn't
chocolate to begin with, a lot of what is labeled as milk. There
is real milk chocolate out there, don't get me wrong, but milk chocolate
probably isn't a big deal in most situations. Now. The darker chocolate,
especially this stuff, when you start seeing seventy percent, those can be problematic
pretty quick, so be aware of those. It's animals are interesting and well.
A lot of the things will affect us pretty much in the same way
as it will them. They can there are some definite, really interesting differences
between us and cats and dogs and whatnot. Yeah, I think I remember
one time our great Dane that we have. I love her to death,
she's the best dog. But I had inadvertently dropped a pack of gum on
the floor and she ran over to look at it. But again, it's
all wrapped up in foil, so you can't really smell it too much,
but I was and then I picked it up real quick. But that's one
of those things, is Aylotol's in chewing gum, So like if you gave
a dog or if a dog got it in chewing gum, it's not only
a choking hazard to them potentially, but there's a decent amount of alatol in
there, and it's in places you may not think of. I mean,
that's that's one of the downsides to not knowing these things. I'm also glad
you brought up Metatro because I remember you giving us quite a scare fun Metatres
eight when I was in pharmacy school. I still remember that conversation and every
single student that comes through our pharmacy on rotation I always ask them what they
know about it and what their concerns are. I don't I do see a
lot of methatrex. It's still for rheumatoid arthritis and stuff. I don't get
too many questions about it, but it's one of those things where I always
had to be on an alert on if how it's packaged in the pharmacy,
or you never want that a patient to take that daily instead of once a
week, or in situations where they're maybe undergoing chemotherapy where they're getting high doses
of it. What other ones like are there? Let me ask you this
question. Are there any situations I get asked this one a lot too?
Is people will ask about activated charcoal, like if a kig, if they
thought O Kay got into something, how if they call the poison center immediately.
Let's say the mom was there and saw a kid in just something at
what time frame do y'all think that activating charcoal is useful or like bend tonight
clay or something like that to help with an acute toxicity issue of something.
Well, the one way we're going to handle it is we're going to look
and if we didn't give any charcoal at all would we refer the child.
And if the answer to that is GS, I think the chances that we're
going to recommend that you give charcoal at home it's probably pretty So we've moved
away from using We don't use nearly as much charcoal as we used to.
And if you don't need to give charcoal, then if you determine well,
no, I mean it's something that will the charcoal will actually bind, but
we don't need to give the charcoal, well, then there's a pretty good
chance if the dose wasn't high enough for us to even consider giving the charcoal,
probably going to keep you at home and just watch you for a certain
set of symptoms. So from it at home standpoint, we're rarely gonna use
charcoal in most situations. Though, if you're going to give charcoal, you
want to give it within the first hour. If you look at a large
number of medications, a bunch of them, we have almost a complete absorption
within about sixty to ninety minutes. Now there obviously there are plenty of meds
we can go out and look at that have much more delayed absorption factors to
them, but that's the general rule. Now from a clinician standpoint, say
somebody hasn't ingested it's an intentional ingestion, and they they've ingested a seedamnifit diphin
hydromene combination product, and if we were going to give charcoal in that situation,
I may actually as long as we have good gimotility and we wanted to
give charcoal in that situation, I may give it hours after the ingestion.
Due to the fact of the diphen hydromene decreasing some gimotility and not empty in
the gut is fast, and there's data to show that really does happen.
We get delayed peaks and stuff with the see to benefit in combination with diaphen
hydromine. So you know, there are some situations where we may go hours
out and give it in. Then there are situations where we actually give repeat
dose activated charcoal. So we're trying to pick up drugs that undergo in a
oropadic recirculation and we'll pick them up in the in the small part of the
gut once they're once they're excreded back into the gut loom and you could pick
them up again even though they've already been absorbed which is kind of an interesting
concept in and of itself, But that list of substances we're going to do
that with are pretty small. So what are again? I know a lot
of the answers to these questions and I'm sorry to like I would. I'd
love to go off on rabbit holes and get into the weeds, for like,
most of the people that listen to the show are wanting to know simple
things, so I'd be hard pressed to interview someone with expertise and toxicology without
asking about Thailand all. Is that still? I mean, that's pretty well
known, especially in the medical community, of what to look out for.
As far as Graham's per day, do you guys still see a lot of
talanol issues? I know we've kind of touched on it briefly, and the
answers that you've given is that it's something that a lot of people aren't aware
of, but it does happen. As suicides are a big call that you
guys get. So could you just give for someone who may not know anything
about taiwan all toxicity, what does that look like? What amounts concern you?
And then what type of situations would you use to treat that? Like
I said, I know all the answers to these, but it's important that
people know those types of what amounts of taiwan al get you guys concerned.
So in general, tanaw isn't quite as cut and dry as everybody wants to
make it out to be from a toxin standpoint, I guess are if we
got to discussing a seedamenticant toxicity at a toxicology convention for clinical toxicologists, it
would not take more than just a couple of minutes for an argument to break
out over how approach. These are certain aspects of it, but in general
you should adhere to the no more than four grams a day, and in
in any single, one time dose of ten grams in an adult, you
definitely we're definitely going to be concerned about that. And we actually typically still
use the seven and a half gram threshold in our own center for referring people
because let's think about that, So seven and a half grams is going to
be fifteen five hundred milligram tablet. The chances that's an accidental single ingestion are
pretty small. So what we're going to err on the side of caution.
A sedamnifen in the United States is the number one overdosed substance, hands down.
There is not a close second. We deal with it every single day,
multiple times a day, and it still kills lots and lots of people
in the overdose world. Here's the sad thing about mental health in this kind
And I'm not going to sit here and tell you I know any answers.
I just know there's a problem. So I've recently ran our data in our
own center and it does match what I know nationally, and that is since
two thousand and five in the Arkansas Center, our number of suicide cases has
more than doubled. Whenever we start to break yeah, whenever you go to
pediatrics in general. So we're using eighteen years and less, it's over three
hundred percent increase in suicide attempts bar exposure volume. Here's the really frightening,
scary, sad part of all of that. If we take and look at
just kids twelve years of age or less, our increase is over eight hundred
percent. I don't know. I can't, Like I said, I don't
know the answer. I just know there's a real problem with mental health in
this country. And I mean we've had I had a case of an attempted
suicide in a five year old, and there's no doubt in my mind it
was an actual attempt. I don't know what world you live in, or
I would like to do kind of know what world you live in. You
live in the same world I do for the most part. But what is
so messed up in a five year old's life that pushes them to do something
like that? And I'm not talking this, I mean this was a full
blown, verbalized rational reason, or at least as rational as a five year
old could be answer to the question as to why you did this. And
man, it's hard to wrap it's hard to wrap your head around a twelve
year old. So I couldn't imagine having have as a I mean, I'm
not a parent yet, but I mean any parent that would not be something
like just in general, I wouldn't think to worry about my five my kindergartener
having going through some sort of issue at school, whether it be bullying or
exposure to social media to earlier in an age, which I think those two
things definitely play a role. I'm not saying that's the only reason some a
kid like that would have. There's tons of other issues, and I've it
still startles me today that even like this is more prevalent with like teenagers and
college students. I don't know if how prevalent this is in schools still,
but when I was in college, there was there was a notorious night where
I was showing up to basically get some of the guys from my school from
a party. They were like they went, They were like, hey,
we don't this isn't looking good, Like we don't want to be around this
stuff. So they were like, hey, can you come get us.
They knew I was up studying for something, so we went to the we
went, I went picked them up, but I walked in the fraternity house
to kind of find them, and I look off to my left and there's
just people sitting there with a giant it looks like a big bowl you would
put Halloween candy in, and there were just pills and tablets just everywhere.
If people were just taking handfuls of just random capsules and tablets and taking them
knowing what they're ingesting. And I don't know how prevalent that is still,
but I know that it's prescription medications and it's not too out of the realm
of possibility for a kid to go into a medicine cabinet and find something.
And that's definitely something that I really don't know as a pharmacist how much better
we can do to prevent that issue. And I always tell people like,
especially if you have small children at home, just if you have any medications
anywhere, they cannot be within arm reach of that child at any point.
And then child resistant containers, I even with young kids in the house,
will it discourage parents from having those little pill pill dividers where they like,
well, organize the Monday, Tuesday, Wednesday's dose and those little snap containers
just so kids don't get into those. Are there any tips that you would
give, like from a center perspective, on how to prevent accidental overdoses?
I mean, the intentional ones is a whole different ballgame. But as a
parent listening, who wants to know what's the best thing that they could do
or what are some of the things that you would do as a parent,
how in that situation to just try your best to hedge from to try to
hedge your bets from any of that happening. Well, the first thing that
you said or one of the things you said, Well ago that I believe
it absolute is it can't be in arms reach. You just you don't have
them setting on the nightstand. You don't where a toddler can just walk up
and get it. In general, up high and out of sight is the
best thing. And then I mean, I'll tell you my sister, my
older sister, great mother, great parent, had an eight ounce bottle of
a cedamnefital elixir in the top of their clothes. You go into a bedroom,
you open the closet and there's that shelf that's up high. Should put
the diaper bag up there. My nephew, whenever he was about two,
climbed on top of the dresser, got the strap on the diaper bag,
pulled it down and drank and hire eight ounce bottle of a seed them Benefita
leixor and you do the milligram per kilo on that and he's way over he
had, so yeah, he had to go in and I had to call
the hospital and basically give them a recommendation on my own nephew. And so
even I guess I'm telling you that to say we're gonna have some kids that
are really gonna be climbers. They're really gonna be adventures. And if they
get into stuff once up high, you got to start thinking about what else
do you do? Do you lock the cabinet, Go get a toolbox that
has a locking mechanism on it and put them in that if you have to.
If you have a toddler that is really driven to do things, and
you know, we have toddlers that are repeat offenders, and you know,
the moms and dads are like, you know, I'm doing everything I can
do to keep them out of it, and they just seem to be able
to get into it. And you've got to take some pretty extreme measures whenever
that starts happening. Lock and key. And I know that's not convenient,
but setting in an emergency department while your child is intubated and Abby's and all
going on them is not very convenient either. I can assure you that it's
the really scary. So, yeah, what are again? I really wish
I could have had Jessica on the podcast too, because she's well in the
pediatric space, especially down here at Dull Children's in Austin. There's all sorts
of kids get into all sorts of things down there. One thing that again,
I still don't know how this is. Well, I do, but
I mean because kids can get into it pretty easily. But it's still concerning.
I've had quite a few cases of a button battery issues then, at
least I've heard of recently. I know parents are kind of aware of what
can happen with those, but I'd be hard pressed to not ask you about
those because parents are kind of aware. How does what happens if a kid
gets into that? At what point? I mean, how many of those
have you seen? And then I'll ask you a few more simple ones,
and then we can get into some obscure things before we end the show.
Okay, I go down the rabbit hole. Yeah, just a little bit.
I wouldn't be my bred son if we didn't go down the rabbit hole
or get into the weeds. Satisfak this a little bit. Well, that's
what I've missed most about your dead being up there. I would go down
to his office and we would go down the rabbit holes together. But the
button battery issue, it's a really big issue. And I can tell you
the lithium batteries are probably not probably they are a bigger issue than the alkalin
type. Little batteries if you get the big So if you look at the
numbers on some of the batteries, it will tell you how many millimeters they
are essentially, and if you start getting into those batteries that are twenty millimeters
in size are bigger, and those are the large flat batteries like you'll see
in a camera and things like that. Often. In fact, I think
my like on my iPad, I have a keyboard for it, and it's
run off of two of those batteries. Those are problematic in kids big time
because they're much more likely to have an esophagewel location, are not past the
plores and and get If we can get them to move in and get the
out, they're probably going to be okay. But man, if you get
one that stops somewhere, that's really a problem. So one of the things
we will do at home with the button battery is in that first hour,
every every ten minutes, give basically two teaspoons of honey, so that by
the end of an hour you've gotten sixty meals of honey into somebody, and
that honey will coat in the stomach or in the esophagus, will help coat
that battery and it will decrease its ability to conduct, so you have less
risk of having damage secondary to that. That's what you worry about, is
that battery getting caught in a fold and being able to conduct electricity across that
fold. You can end up with a burn and things like that. So
the honey thing is pretty much into everyone's protocol. If you go out and
look at the National Button Battery guidelines, they're going to recommend ten cs honey
every ten minutes, so six times over an hour. That's sixty meals,
and it's to help coat that battery. I can honestly say I have never
heard of that, and I will tell you this. If they're really big
batteries were probably there ain't no probably to it. If they're above twenty millimeters,
we're definitely sending you in and we're going to try to get an X
ray to see if we can locate it and then make sure we get it
to move in and if not, we got to go get them. So
yeah, that's no fun. I know. Yeah, I know of certain
stories of parents that they're like, we don't have any of those anywhere near
and then they'll be like, oh, I forgot that I left the TV
remote out or something and it fell on the floor. The back felt flew
off of it, and the button battery got out of there. And I've
seen some scary I've heard some scary stories about those. I think that's on
a lot of kids radar. I know some other things that at least I
always try to go out of my way to counsel patients on. And again
I don't see this too often, but I do caution parents who do CBD
products to kind of keep those away, especially the flavored ones, away from
kiddo's just because I honestly, despite my dad's expertise in CBD and stuff,
I really I don't know enough about it to go, oh, if they
had this much, they'll be fine. And I know with certain CBD products
you never know what other exposure to, whether that be THC or some other
licit drug. How common CBD is now, I know that's another concern that
I have, well, keeping that out of the reach. Yeah, I
didn't bring it up specifically, but with the melatonin sometimes we'll see CBD added
to melotone and and that's one we look for. So here's the thing.
And do I think in general most THC is pretty safe. Yeah it is.
But whenever we start to look at the literature, and everybody goes,
well, look at all of this literature that we have on THC, and
it shows that it's really really safe. And I'm like, Okay, what
percentage of T did they use in those studies? And if you look at
the overwhelming bulk of literature that's out there, if it's more than six percent,
it's an outlying study. We've got THC products now that are will over
forty percent. Oh yeah, And a toddler gets into that they're going to
have some scary type symptoms to try to manage it home, and people go,
well, there's never been a fatality associated with one, Well, there
is one in the literature. If it's not in the literature, it's going
to come out in the literature. Now. Did the kid get positional and
asphyxiate or something like that from having so much C and S depression from it?
Maybe? But these products are not for the faint of heart. Sometimes,
as far as the amount of THC in, I mean, I don't
really know where to hang my shingle out there, draw my line in the
sand with some of this, because there's just not any data out there on
the really high concentrated products. Yeah, I see that. I remember who
I went and visited when I was still in pharmacy school. I went and
visited my dad when he first moved down to Mississippi to work for ENDCMPR,
and he introduced me to one of the world's experts on CBD and THHG doctor
El Sholey, who I'm trying to get on the show. At some point.
They were doing a CBD study at the time, and what they'd done
is they had gone around Mississippi and grabbed random CBD products from a variety of
different CBD shops and stuff like that, and they tested them to see if
what the amount in the bottle was on the label and again, these aren't
your these are They also had products where they were third party tested, they'd
gone through extensive testing to the doss right, and those were fine. But
there were some that had they claimed to have these crazy amounts of CBD in
them and they had none. And they were also I remember him showing me
one bottle and there was this big just it looked like someone dropped a rock
in this bottle, and I go, he goes, you see what's at
the bottom of that and I go, yeah, I see it in there,
but that doesn't look like it belongs in there. He goes, O,
yeah, so one pure CBD like there, it's I can't even begin
to fathom how much of a dose that is in that bottle. And then
most of them just had like I think one of them just had like olive
oil or something like that in there, and it was just the whole point
of all of it was all over the map, and you have no idea
what you're getting, so and I can see that making your job harder trying
to figure out. Hey, that would be a thought in the back of
my mind is do I treat this like this is exactly the dose each time
that's in there? Or are we really not sure? And I feel like
at that point you would just have to hedge your bets on Well, we're
not entirely sure, but we need to have them go get evaluated anyway.
See what are some other interesting questions. I asked my wife this the other
day, especially when over the summertime it's not so prevalent. Now, I
just this is more of in my curiosity, just because I want to hear
your opinion on it. We're both I'm in Tech and you're in Arkansas,
so I know snake bites are common as well. I have to ask your
opinion because Jesse's told me her opinion on it. When what kind? I
know, if you guys are dealing with a rattlesnake or a copperhead or one
of those types of snakes, and I know the protocol is either some form
of anti venom. Do you guys use it either at UAMS or some other
institution. Do you all typically reach for from a poison control center aspect?
Do you all reach for Crowfab or do you all reach for one of the
other ones? Well, we have I don't want to get in any trouble
here. I know people at both companies really well. We have Crowfab on
Formulay at UAMS, and but whenever anyone calls the center and asks me which
anti ven and do you recommend, I will say whichever one you have,
Yep, it doesn't if I'm going to need to give you anti v in
and I'm just going to give you the appropriate dose of whichever product you have.
Now, with that being said, here's something that falls into the nutritional
world that we need to think about and at least geographically here and maybe not
so much where you're at. So the Lone Star tick, named after Texas
because of the white spot on its back and Bolognia americanum and Beloma americanum,
has been shown in some individuals that get bit by the tick to predispose them
to developing hypersensitivity or reactions to Alpha Gail. I have a very close friend
whose wife has that exact thing, got it from a tick bait. So
our experience right now, this is unpublished data and we're working on some things.
My right now, my best guess is individuals are more likely that have
Alpha Gael's sensitivity, maybe more likely to react. And the reason that I
say that and we're actually doing this, we're doing work on this right now,
so that is my bias in this, and I had to be careful
with that. We're running roughly in our center about a thirty percent adverse reaction
clip to ANAVIP, with about six seven percent adverse reaction rate with CROPA,
and we're beginning to show, or we're beginning to pull a little data to
show that at least some of these reactions the patients are Alpha gal positive and
am I to the point that I'm going to come out and tell somebody not
to carry ANAVIP. No, I'm not to this point. I mean,
yeah, the data isn't robust enough, but we're definitely looking at that right
now. And are there things that we potentially could do to reduce the risk
of reaction, because I think ANAVIP has some really cool properties to it that
make it different than crofab. And I can tell you if I was in
Arizona and we're pretty much all I got, We're rattlesnake bites, and I
have no real risk at alpha gel there and the length of time that it
may prevent coagulation issues, and it's pretty appealing. So it's kind of a
it's a hard thing there. So but the long, the short answer to
a long winded discourse here is the fact that we'll use whatever you have.
And like I said, I've had pharmacy managers call and say, which one
do you recommend us carrying, And I'm like, whichever one your P and
T committee wants you to have on formulay. So yeah, and that's pretty
much the way it is. Go ahead, Sorry, I mean to cut
you off now. If you need it, We're gonna We're gonna use what,
like I said, the appropriate dose of whatever you have. So,
yeah, it was I was talking to Jesse that I was going to have
you on it. She was like, you know what I've seen, especially
for the summertime, especially here in Texas, there's a certain flower that like
blooms on the side of the road. Here there are these little blue they're
the blue bonds, the blue bonnets. That's correct. I was blanking on
it. So Jesse was telling me that a lot of kids will go take
photos and the blue bonnets and they won't see the snakes that are there.
So they said that they were getting a lot of snake bites at that time.
And when I told her I was thinking about having you on the show
before I asked you, she was like, ask how if he has any
any preference, not necessarily a preference, but what his opinions are on crovaverse
and of it. They have both at the adult Children's and they use whatever
they feel like they need to. But it's one of those things I just
would have wouldn't have thought too much of because, like you said, my
gut reaction be whatever you have. So we'll do that. I'll forget it.
I had no idea about. Yeah, it's it's pretty interesting. You
said, tuxa AB is the product that was the big New England article,
and those patients were reacting, and those reactions were really severe. I mean
so, and that's all alpha gall related. And if you lay, if
you look at the reactions to tuxon AB and look at the distribution of the
loan start tick, the two areas overlay, and the folks that were not
reacting to tux of MAB in the other regions of the country, they just
weren't. They weren't reacting in the same way. This was a regionalized thing.
And our feeling right now is is that alpha gal binding site on one
of those fragmented portions of those antibodies. Is it more prominent on the FAB
two as it opposed to just the FAB portion of the other product. And
I don't know the answer to that, and I don't think right now anybody
knows the answer to that, but we feel like that that is driving some
of this difference in reaction that we're seeing. So we're actually working with Oklahoma
and we're trying to pull a couple of other regions in the country in to
really look at this and see is it something that's just an anomaly here and
really isn't Alpha gal related or is it kind of the same regions of the
country showing this reaction. One other question I get a lot about, or
I get asked a lot about in the pharmacy, and then well, I
want to touch on one other thing that's not poison Center related. Is I
have been asked multiple times if I need to be because apparently scorpions are a
thing here that we had some of them in Arkansas and I'd see them occasionally,
but apparently down here in Austin, there everywhere our little neighborhood Facebook group
where we live, I mean I see scorpion postings all the time. And
I've had a few patients at the pharmacy that are new to Austin because we
have a lot of people moving here asking what they need to do if they
run in any scorpion issues. So I'd be hard pressed to ask. I
know you've dealt with that at the poison Center. Is there anything there that
you're monitoring for? Is there a particular kind in our areas that we would
be concerned about? Again, most scorpions things in the United States hurt.
Yeah, period. I mean, that's the thing. It's yeah, I'm
sorry you got stung. That's really it's uncomfortable. I get it. Let's
treat things a little bit symptomatically. It's gonna be not fun for a day
or two, and but you're gonna be okay if you move into The area
is mainly areas of Arizona down in along the Mexican border. There they had
the bark scorpion, which is a centrality species and I can't remember the exact
species centroites. I can't remember it's species name. Those are a little more
problematic. And there is antivin and actually for those, it's Anna scorped and
it's actually made by the same company that makes antaviib, which is rare disease
therapeutics RDT, and they will use it there. So, but in Austin,
you don't have that scorpion. There, you got the same variety of
scorpions we have here. Yea, they stayed and they hurt. So yeah,
that's that's the question. That's what I tell people. It's like,
hey, they just hurt, but there's really nothing I'd be concerned about.
But I get I get it's always on. I work a lot of Saturday
shifts at our pharmacy, and I get all sorts of just weird off the
wall questions. And I got asked about that from a lady who'd recently moved
here. If she goes, everybody's telling me I need to worry about scorpions
and blah blah blah. How are there any before we in the picking your
I could talk to you for a long period of time about different pharmacy and
toxicity issues. Are there any other areas out the top of your head that
we may not have touched on here that you feel like the audience may need
to know if they're curious about those things. And then this is a real
simple question to follow up with that is how do they get in contact with
you guys out the poison center. Well, let's take care of that one
first, because that one's really easy. So anywhere in the United States,
you can call eight hundred two two two one two and that will rout you
to the poison center based on the area code from which you are calling.
So that's the only number you need to know nationally, and that will get
you get you to a poison center in your area. Then again is eight
hundred two two two, so pretty easy to remember. Three twos one,
three twos. It's the holiday season and we get a lot of questions about
things around the holidays. For the most part, most of the things points
set is. I was told as a kid old they're poisonous when set is
are really not much to worry about. If you handle them a lot.
There's a risk of maybe some contact dermatitis from it. Mistletoe, somebody ate
quite a bit of it. I think they might could have some problems with
it. Usually not much of a problem. A couple of holly berries and
a child really not much of an issue. Actually, worry more about a
kid maybe halfway swallowing a leaf and getting one of those spiny things it's stuck
somewhere down in their esophagus or something. But for the most part they're pretty
benign. Let me see, what are some other interesting things. One thing,
it's not as prevalent now. People don't make as much homemade candy as
probably they used to. But my mom used to make winter green candy every
year. She had a little jar of methyl solicylate that she would flavor.
This pan of candy with and I was always amazed as a kid that she
would make it in these a nine x thirteen cookie sheet and it would only
take a few drops of oil of winter green to flavor that entire pan of
cant And she had this little three and a half meal bottle that she kept
up in her cabinet, and she had that my entire childhood, and it
was still three quarters or better pool the last time I remember seeing it.
With that being said, methyl halicylate has a skull and crossbones on it for
a reason. And it gets back into kind of what we started with.
Dose makes the poison. What's there? So oil of winter green flavoring is
methyl solicylated. It's akin to aspirn in a way. It's a solicylate.
But you can get bigger bottles of it. You can get a thirty mel
bottle of it, a tea spoon in our toddler. Again is enough to
kill them. So you got this deadly poison that you can make something really
nice out of, which I really enjoyed my mother's ol of winter green candy
when I was a kid. But that's one of the things if you're going
to have around your house. Definitely, there's a reason why it has a
skull and crossbones on the bottle. Most of the other things around the holidays
aren't too much of a problem. You'll something will crop up from time to
time, a new toy or things like that may have an issue related to
it, but it's usually a reasonably saved month. So yeah, correct.
An interesting question that you just brought up in So what area of the like,
what time of year do you guys say you would get most of your
calls. What would be summertime when kids are home from school. That's a
good question and the answer is absolutely that is the correct answer. If you
look at Poison Center data January, February, March, April, May,
it's flat. It's the volume is statistically the same. About June, we
start to see this uptick. It peaks toward the end of July and begins
to start it's downhill slope again in August, and by September it's pretty much
flat again. In September, October, November it's flat again. It's the
same. So yeah, those summer months, and there are multiple reasons where
kids are out of school, more people are outside, they come in contact
with more plants, they come in contact with more animals, things that bite
and sting, using more chemicals, you're using more herbicides or you're using more
pesticides. So all that equals are busier summer. Yeah, I figure that
was the case. Just I mean that's typically how it goes. I mean,
you have more to put traffic in the pharmacy, we have more,
Jesse says. The hospitals are definitely more active in the summer now that when
kids are at home. So one last thing I wanted to ask you about
because I was curious, when are you still involved in And I don't know
if you have liberty to talk about this, but I know you're correct me
if you're wrong, you're the CEO of a company. Is that correct?
Is it ATP Therapeutics? Yes, sir, so can you think me and
you've talked about this in the past, but it's been a while. What
is all that intel? How's that going? If you want to talk about
it? This is one of the last things I wanted to touch on because
I know that was like a personal interest of yours. So what is ATV
Therapeutics all about? So we are have the air in the process and we
have two patents or a patent in the US penning and a patent in Europe
pinning, and is the repurposing of two generic drugs. And I can go
as deep into that as you want me to. So back to drug information.
I get a call one day from a physician and says, hey,
I started my patient on tramadol about a week ago, and he came in
and says, he can't ejaculate. Do you think that could be related to
the tramadol? I said, yeah, this is kind of how it would
do it, and I didn't think anything else about it. And six weeks
go by and someone else asked me a question about tramadol, completely unrelated to
the first question, and jay was more just of a docing type question,
and in the process, for whatever reason, talking to that person, I
was like, huh, there's not a drug on the market for premature ejaculation.
So I go back to my office and I set around and I think
about it for a little wall and I was like, if somebody came to
me and asked me to treat premature ejaculation in someone, how would I do
it? And I thought about it for a pretty good while and actually went
down to your dad's office and said, hey, Bill, what do you
think about this idea? And he goes, man, that's a pretty good
idea. So I went began to look through the literature and I had already
decided on a combination of two drugs, and one is using s ctalopram and
to dalafill. And I did that for a couple of reasons. One,
s ctalan pram is devoid of nora epi effects, wh's less likely to cause
any your rectile type issues. It's purely a serotonin drug and has a lot
of alisteric binding. If you look at some of the data out there,
s ctalan pram appears to work quicker in depression. Well, some of that
may be the alisteric binding. There may be some other reasons for that,
but it was surrounded little lot of this alisteric binding that I was in true.
And then their kinetics matched their half lives, their duration of action are
fairly similar, and so I thought the combination would work better than the single
agent alone. Got a men's clinic in a part of the country here to
actually do a little proof of concept for us on some compounded medication. It
appeared to work and we filed a patent. That's awesome, and it's been
a long process. Hopefully the light is at the end of the tunnel.
So and like I said, I got a patent pending here for it's a
method's patent, and I have a method's patent pending in the EU, so
that's cool. I remember I figured that was what it was for. But
I just wanted to touch face on that. ACCO mean, you talked about
that when I was on Rotation and stuff, and I know how difficult that
patent process can be because one of my men has been on the show a
couple of times. We've talked about the very product. We have a product
containing it's a variety of different methylation donor groups, but it also has got
an active ingredient from sessime Well called cessimon in it. We've seen some interesting
lowering effects in the small clinical trials that they've done at the center, and
it took them quite a while to get a patent for it. And it's
just it's a lot of work that I don't think people realize just how much
effort goes into that whole thing. And it's tough. It's tough so I
commend you for doing that. I was I was gonna I meant to ask
you about that a while ago. Was an old chat every now and then
on occasion. But it's really interesting because me and me at my work we're
in are one of our startups at Nimbus Healthcare. We do a lot of
like men's foremone optimization type stuff, and we're now in the hair loss space
as well as the weight loss space too, and that's definitely an area that
we do get questions about. So it's interesting to know that there's answers out
there. And I haven't had to counsel on anything like that in the pharmacy,
but again, it's always good to know a mover and a shaker in
the field that does know some things about that. For sure. I don't
know, Like I said, it was just it was a good or at
least I thought it was a good idea or at least an interesting idea.
And it does hit when then COVID hit, which just really, I mean,
it derailed everything. Yeah, it's not a fast process in general.
And then if you have something like that happened, I mean, I want
to pick your brain on one last thing and I've said that like four times.
I apologize. I don't know how. I know you've got some friends,
doctor Barkley, I'm pretty sure you're in close kind of are you guys
any idea on what's going on with the drug shortages right now? It's been
kind of crazy to me how hard it's been to just get generic medications from
our wholesaler in general, and it's it just seems random at this point.
Initially I thought it was COVID and the supply chain issues, and it very
well could be that, but I was interesting to see if you know,
if you had any thoughts on why there's so many random products that I just
can't order for people, because it's starting to get really frustrating having to have
gaps in therapy for certain things for patients simply just because I can't get them
at at time. And I don't know the answer to that. I do
know that it is incredibly frustrating just dealing with one of the individuals at the
hospital there that has to supply purement for the hospital ums and just Eve was
complaining every day it was something and there seemed to be no rhyme or reason
to it. I'm not a conspiracy theory person. But it almost seems like
some of this is almost contrived at times. But it yeah, I mean,
it's a real it's a real issue. So right now, there's no
one in the country that manufactures fizostick main, so we were we moved around
and trying to figure out how to use rivstick mean in people within an anti
colon ergic syndrome, and we found a pretty reasonable workaround with riverstick Mean.
It doesn't work as fast, but it does seem to work pretty well.
We have been able to procure a little bit of FISO that was recently released
by the FDA, so we have a little bit, but a manufacturer out
there needs to kick it back in and start making some of it. Yeah,
it's crazy. We've had some interesting shortages and there's and and what blows
my mind about it all is some of it stuff that's not commonly prescribed,
like we have I have. We have a few people that take I won't
even get into the specifics, but like certain medications for transplants that they'll use
that they've been on for years, and it's just like it's it really it's
concerning to me that I have to check I have to even think about that.
Let me hold, let me check and make sure I can get that
before we fill that prescription. Same thing with with Kreon's been a big one
for people with pancreatic enzyme issues. That one's been really hard to get.
But I was just curious if you had any insider knowledge because I was like,
if this is affecting me at the local independent pharmacy level, I'm sure.
At the I'm sure, and an institution like UMS, it's probably worse.
Not to mention, you're in the whole IV drug space and you're dealing
with other medications that I wouldn't normally come across in just a normal pharmacy setting.
It's it hits everybody, and like you said, I mean there is
a very weird quality to it. I mean it's I'm trying to remember what
size IV bags they were out of for a while. I just couldn't get
them. Oh yeah, I remember that too. I may have been a
hundred mil bags, But I'm not sure. It's I don't have the answers
to that. We need to start a sorrow manufacturing company, Patrick, Yeah,
we might. That might be the next thing, because something something's got
to give. Yeah, I think another big one. We do some medication
ordering for certain surgical centers in the area too, and it's been really hard
to find lighty Kain with epinephrin. It's weird. It's stuff that you wouldn't
even think twice about. But about how I appreciate you being on the show,
it's we're at about an hour and a half, which I could,
like I said, I know you for a long enough time that I could
talk to you for a long period of time about a variety of different topics.
Because I'm not trying to toot your own horn, but you're one of
the smartest people that I've met in my entire tenure of pharmacy school and all
the interactions that I've had with you, Saman I really appreciate you coming on.
I'd love to have you back on other episodes. If there's any other
topics you want to dive into, I'm more than happy to sit down and
talk with you. Give your give my best to Tammy and Boone as well.
I miss you guys back in Arkansas. I need to come back in
and say hi, well, I miss you being here. And some other
time we probably are to there's some other areas we can delve off into.
Fennil would be one of them. We didn't even bring that up tonight.
Yeah, it's another area for sure. I will definitely have you on because
I would love to pick your brain on that whole opioid crisis and stuff.
I have my own opinion on it as a pharmacist in general. But that's
something that I didn't even honestly think to bring up tonight because I didn't think
we'd get to it. But is that that's something before we before? Is
that something you'll see more from? Do you'll get calls about that at the
center? Now we get a few it. A lot of times physicians won't
call with a typical opioid overdose. I mean, they deal with them so
frequently that they won't call, And I don't blame them. The Finnel issue
is a really interesting issue and there are a lot of nuances to it that
and I have some pretty strong opinions on it, and I'll probably make a
few people mad with them, so so i'd love to That's a topic for
another day, yes, sir, I was. Yeah, I definitely would
love to have you back on here soon and talk about that because I have
some I tend to bite my tongue a lot of times with my opinions on
the whole matter. But again, I'd like to hear yours on that.
So that's definitely I definitely love to touch on that topic. But how man,
I appreciate you, Thank you for your time, and I'll have you
on again soon. Sure, thank you, man, I appreciate it and
enjoyed it. Thank you for joining us on today's episode of the Wellness Transcription
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