WEBVTT 1 00:00:16.960 --> 00:00:21.239 Welcome to the Wellness Transcription Podcast, the podcast that combines the power of Christian 2 00:00:21.320 --> 00:00:26.039 values with evidence based nutrition, fitness, and lifestyle content. I'm your host, 3 00:00:26.039 --> 00:00:30.280 doctor Patrick Early. Join me each week as we explore the intersections of 4 00:00:30.359 --> 00:00:34.479 Christianity and wellness, offering you insights to help nourish your body, mind, 5 00:00:34.560 --> 00:00:38.719 and soul. Whether you're looking to improve your physical health or simply strengthen your 6 00:00:38.759 --> 00:00:44.119 personal relationship with Jesus, We've got you covered. Stay tuned for inspiring discussions, 7 00:00:44.359 --> 00:00:47.799 expert guests, interviews, and practical tips to help you live the life 8 00:00:47.799 --> 00:01:00.960 God calls us to live. All right, guys, welcome back to another 9 00:01:02.000 --> 00:01:04.519 episode of the Wellness Transcription Podcast. I have a close friend of mine, 10 00:01:04.760 --> 00:01:08.599 another expert in his field. He's a great mentor of mine. He taught 11 00:01:08.599 --> 00:01:14.400 me in pharmacy school and all things toxicology, and he also runs the Poison 12 00:01:14.439 --> 00:01:19.840 Center in Arkansas right now, and he has a board certification in toxicology. 13 00:01:19.920 --> 00:01:23.920 So we're going to be basically talking about what toxicity actually means, what does 14 00:01:23.959 --> 00:01:27.000 it mean for something to be poisonous or not, and then we'll kind of 15 00:01:27.000 --> 00:01:32.359 bleed into just kind of how the poison Center operates. Some interesting things you 16 00:01:32.439 --> 00:01:34.200 might want to know on when to call them, what things that you should 17 00:01:34.200 --> 00:01:38.640 be looking out for. But I've got doctor half Auster on the show. 18 00:01:38.799 --> 00:01:42.079 I really appreciate you being here. How it means a lot that you joined 19 00:01:42.120 --> 00:01:45.319 me today. I appreciate it. Well, I really appreciate you asking me 20 00:01:45.359 --> 00:01:47.680 to be on here, Patrick, And for the listeners out there, I 21 00:01:47.680 --> 00:01:51.879 will just say this, Patrick's dead taught me, so I'm just kind of 22 00:01:52.280 --> 00:01:55.760 passing it along. His dad's a great friend and mentor of my own. 23 00:01:56.040 --> 00:02:00.120 So I sometimes forget about that that he taught you in pharmacy school. But 24 00:02:00.120 --> 00:02:01.760 he was there for thirty years, so that does make a whole lot of 25 00:02:01.799 --> 00:02:06.640 sense. But I will get into maybe I'll ask you some questions off the 26 00:02:06.640 --> 00:02:09.159 regulator about how everything's going at UMSCS. I haven't been back since we moved 27 00:02:09.199 --> 00:02:14.199 to Austin. But how real quick with the audience, just kind of give 28 00:02:14.240 --> 00:02:17.199 us your background. How'd you get involved in the field that you're at now? 29 00:02:17.240 --> 00:02:21.719 What was that process like for you when you were in pharmacy school and 30 00:02:21.759 --> 00:02:25.599 going forward? Well, honestly, toxicology came looking for me. I didn't 31 00:02:25.599 --> 00:02:30.280 come looking for it necessarily. I did a rotation my senior year in the 32 00:02:30.280 --> 00:02:37.599 Poison Center, and it was a drug information talks based rotation, and I 33 00:02:37.719 --> 00:02:40.360 left and went and did a residency at the VA, And in the process 34 00:02:40.400 --> 00:02:44.879 of doing that, they had gotten funding at the Poison Center and had been 35 00:02:44.919 --> 00:02:47.560 completely funded by the College of Pharmacy up until that time, and they had 36 00:02:47.560 --> 00:02:53.000 picked up some extra funding and offered me a spipend to come over and take 37 00:02:53.039 --> 00:02:57.680 some call in the evenings for them, and I did that as a resident. 38 00:02:58.400 --> 00:03:00.719 I finished my residency, I went worked for the VA and had worked 39 00:03:00.719 --> 00:03:04.759 there for not quite a year and a half, and in fact, my 40 00:03:04.879 --> 00:03:08.280 thirtieth anniversary in the Poison Center was three days ago. Doctor Charlie Campbell, 41 00:03:08.280 --> 00:03:12.199 who was the director at that time I was working over at the VA, 42 00:03:12.280 --> 00:03:14.639 gave me a call and said, Hey, would you like to come to 43 00:03:14.680 --> 00:03:17.560 work for me? I really like that. It was interesting, lots of 44 00:03:19.039 --> 00:03:23.280 different clinical type questions and we did a ton more drug information back in those 45 00:03:23.360 --> 00:03:25.520 days than we do now. The phones and the access to the internet is 46 00:03:25.560 --> 00:03:29.759 so much better now than it was then. But I was like sure, 47 00:03:29.879 --> 00:03:34.400 So I came over and worked as a specialist in the center for the first 48 00:03:34.439 --> 00:03:38.439 seven years. And took over as director in two thousand, been the director 49 00:03:38.479 --> 00:03:40.879 ever since. Yeah, so tell me real quick. I know you have 50 00:03:40.960 --> 00:03:46.319 a a toxicology certification, So what was that process like? And I could 51 00:03:46.360 --> 00:03:49.960 be wrong, but I know certain practitioners have to go through. It's quite 52 00:03:49.960 --> 00:03:53.039 a rigorous process to get that Board of Applied Toxicology certification. Can you kind 53 00:03:53.039 --> 00:03:57.039 of elaborate on that a little bit. Yeah, there's really two ways to 54 00:03:57.080 --> 00:04:00.319 get to it. The easiest way, honestly in a way, is to 55 00:04:00.360 --> 00:04:04.439 do a fellowship and once you get out of fellowship, certain fellowships around the 56 00:04:04.439 --> 00:04:10.280 country allow you to fast track to take the board exam. If you don't 57 00:04:10.360 --> 00:04:14.759 do that method, it's going to take you a minimum of about five years 58 00:04:14.759 --> 00:04:17.040 to be able to even get to the point that you could meet all the 59 00:04:17.040 --> 00:04:23.079 criteria for certification. There's research things, you have to consult where you're doing 60 00:04:23.120 --> 00:04:27.439 actually clinical consultations and have people consulting with you directly, and you have to 61 00:04:27.519 --> 00:04:30.920 keep up with all of that. And it's a scoring system that you can 62 00:04:30.959 --> 00:04:34.600 go out to. The It's quintox dot org www. Dot clintox dot org, 63 00:04:34.639 --> 00:04:40.639 which is the website for the American Academy of a clinical toxicology and you 64 00:04:40.680 --> 00:04:44.639 can go out. There's a place on there for the a bat and see 65 00:04:44.639 --> 00:04:49.800 what all of the criteria are. But pretty rigorous process, pretty tough test. 66 00:04:50.199 --> 00:04:54.519 So yeah, I can imagine. I mean, the field of pharmacy 67 00:04:54.519 --> 00:04:58.360 in general is the exams are tough. But I've I can only imagine. 68 00:04:58.439 --> 00:05:01.480 I mean, I know Jesse Is who also had you as a priest. 69 00:05:01.639 --> 00:05:06.000 We were both in pharmacy school. She's studying right now to do her pediatric 70 00:05:06.279 --> 00:05:12.199 board certification and it's those board certification tests aren't easy and that it shouldn't be. 71 00:05:12.759 --> 00:05:15.759 But how one of the things one of the reasons I thought about you 72 00:05:15.079 --> 00:05:19.639 when I in the nutrition space that I've kind of found myself in, especially 73 00:05:19.680 --> 00:05:24.839 the pharmacy field in Austin, Texas, I get questions about this all the 74 00:05:24.879 --> 00:05:29.399 time, and I think a lot of people tend to have some fear around 75 00:05:29.439 --> 00:05:32.839 what exactly toxicity means. Like I'll have patients, for example, I'll have 76 00:05:32.879 --> 00:05:38.600 patients come in and then it'll ask me nutrition advice, which happens quite frequently 77 00:05:38.680 --> 00:05:41.639 in the pharmacy that I'm at, and they'll say, well, my doctor 78 00:05:41.680 --> 00:05:46.000 told me to avoid gluten because it's toxic for me, and I'll ask them 79 00:05:46.560 --> 00:05:50.279 what do they mean by toxic for you? Do you have Celiac disease likes? 80 00:05:50.560 --> 00:05:55.279 What does that mean? And elaborate and you can tell that they really 81 00:05:55.319 --> 00:05:58.920 have no idea. It's just something that they're scared about and that they're trying 82 00:05:58.959 --> 00:06:01.800 to get some answers and kind of figure out how to combat this issue that 83 00:06:01.839 --> 00:06:05.720 they didn't know that they had. So in your field, when you hear 84 00:06:05.800 --> 00:06:09.879 someone refer to something as toxic, what does that exactly mean? Its like 85 00:06:10.199 --> 00:06:15.199 from a poison center toxicologist perspective, when you hear the word poison or toxin, 86 00:06:15.319 --> 00:06:17.839 like, what do you define that as well? I mean as well 87 00:06:17.920 --> 00:06:23.000 you know and you've touched on it. There's one thing as an expert or 88 00:06:23.040 --> 00:06:26.079 a clinician, the way you look at and then there's the other way the 89 00:06:26.160 --> 00:06:30.199 lay public looks at it. So from my perspective, if you come in, 90 00:06:30.560 --> 00:06:36.160 all toxins are poisons, and toxins are substances produced by bacteria, animals, 91 00:06:36.279 --> 00:06:43.399 plants, So it's a much more narrow poison than just the broad term 92 00:06:43.480 --> 00:06:46.439 poison. So poison in and of itself, to me, most things can 93 00:06:46.480 --> 00:06:50.160 be poisonous if you can get exposed to enough ONEm dose makes the poison. 94 00:06:50.600 --> 00:06:56.560 As Paracelsus said that a little over five hundred years ago. But what happens 95 00:06:56.560 --> 00:07:02.759 with that is people either give a half for or they look at in vitro 96 00:07:02.920 --> 00:07:08.399 data, but the NVivo data shows nothing along those lines. And one of 97 00:07:08.439 --> 00:07:11.879 the big areas to do that with is look at some of the sunscreens. 98 00:07:11.879 --> 00:07:14.279 Now, there have been a few that have been pulled off the market, 99 00:07:14.639 --> 00:07:18.079 but if you look at the end vitro data of sunscreens, you would probably 100 00:07:18.120 --> 00:07:24.160 never use because of the issues it can cause with DNA. But we have 101 00:07:24.319 --> 00:07:28.560 this lovely little thing just below the layer of our skin called our stratum cornium 102 00:07:29.000 --> 00:07:32.120 that keeps things from being absorbed, and most of the sunscreen then that you 103 00:07:32.240 --> 00:07:35.839 slather on you is not absorbed. In fact, some of them are not 104 00:07:35.920 --> 00:07:40.920 absorbed at all, really, and they offer you protection from that stem. 105 00:07:41.720 --> 00:07:45.879 So you really have to look at where they're coming from. As far as 106 00:07:45.920 --> 00:07:50.360 with the gluten thing, men, you both know that while Siliact disease is 107 00:07:50.399 --> 00:07:57.199 real and gluten will reacg havoc on a Siliact patient, for most of us, 108 00:07:57.360 --> 00:08:01.480 it's probably not much of an issue at all, And I think sometimes 109 00:08:01.560 --> 00:08:07.720 it's easier to tell a patient to avoid things with gluten in them as opposed 110 00:08:07.720 --> 00:08:11.199 to getting them to fall away better diet. If you just cut out all 111 00:08:11.199 --> 00:08:13.639 of this stuff, you're going to cut out a lot of processed wheat flour 112 00:08:13.720 --> 00:08:18.519 and things like that. I think that's where it comes from. But the 113 00:08:18.560 --> 00:08:22.360 patient doesn't know what really is poisonous and what isn't. That's a perfect I'm 114 00:08:22.399 --> 00:08:26.519 glad you brought up sunscreens too, because we get asked those questions all the 115 00:08:26.519 --> 00:08:31.079 time as well. And I think the big thing that I've come to find 116 00:08:31.079 --> 00:08:33.879 out is and again you have to kind of go through the training associated to 117 00:08:33.879 --> 00:08:37.360 be able to figure these things out. But study design is something that just 118 00:08:37.440 --> 00:08:41.360 most people don't know anything about, and unless you're in that field and really 119 00:08:41.759 --> 00:08:46.360 know how research is conducted, especially the types of research, you can get 120 00:08:46.600 --> 00:08:50.919 vastly different results and it's not the easiest thing to interpret. So for your 121 00:08:50.919 --> 00:08:54.879 example with sunscreen, I think that was perfect. Is in the in vitro 122 00:08:54.039 --> 00:08:58.399 cell culture studies, where you're looking at just certain cell types in a peatridition, 123 00:08:58.399 --> 00:09:03.720 you're exposing to bring high amounts of a particular chemical yeah, of course 124 00:09:03.720 --> 00:09:07.919 you're going to see some really scary stuff happen, and you're gonna and again 125 00:09:07.960 --> 00:09:09.440 that's like the first step in research is to see, well what does this 126 00:09:09.519 --> 00:09:13.039 look like? And then you kind of keep going. But when you apply 127 00:09:13.159 --> 00:09:16.960 it to the a normal person, you just don't see that. I think 128 00:09:18.120 --> 00:09:22.480 people tend to think are our bodies and our biology is way simpler than it 129 00:09:22.519 --> 00:09:26.919 really is. Like we have many different mechanisms and routes to kind of deal 130 00:09:26.960 --> 00:09:30.559 with certain issues, especially when it comes to toxicity and stuff like that, 131 00:09:30.960 --> 00:09:35.039 and there are ways to handle that. But again, one big thing that 132 00:09:35.080 --> 00:09:39.679 bothers me is that people throw around that term to where the more you say 133 00:09:39.720 --> 00:09:43.519 stuff is toxic, because it's almost like hearing the same thing over and over 134 00:09:43.519 --> 00:09:46.799 again, you just stop listening at some point and it's like, well, 135 00:09:46.799 --> 00:09:48.039 what isn't a toxic at this point? Or what can I eat? Or 136 00:09:48.080 --> 00:09:52.519 what can I eat? And I think that's a very important point that you 137 00:09:52.559 --> 00:09:58.039 elaborated on because a lot of people just don't understand all that goes into defining 138 00:09:58.080 --> 00:10:01.440 a dose of something is toxic if you drink too much of it. But 139 00:10:01.759 --> 00:10:05.600 and again, like drugs are the same way, like I hear this one 140 00:10:05.600 --> 00:10:09.960 a lot, especially on social media. It's like, well, the big 141 00:10:09.960 --> 00:10:13.080 pharma just wants to keep poisoning us so we can be sick all the time 142 00:10:13.120 --> 00:10:16.080 so they can take more of our medications. I hear that all the time 143 00:10:16.200 --> 00:10:18.080 as a practitioner now, and it kind of rubs me the wrong way. 144 00:10:18.440 --> 00:10:22.320 So are there let me see how I want to phrase this, Like, 145 00:10:22.799 --> 00:10:26.879 let's I'd say the biggest one would be let's say glyphis eate for example, 146 00:10:26.919 --> 00:10:28.679 like round up, there's been that's been kind of in the news a little 147 00:10:28.720 --> 00:10:33.039 bit. People are It's certain areas are starting to try to pull glyphasate off 148 00:10:33.039 --> 00:10:35.960 the shelves because if you use it to kill weeds in your yard, you 149 00:10:35.960 --> 00:10:39.639 may get exposed to too much of it. But I've seen kind of Charlatan 150 00:10:39.759 --> 00:10:45.039 type figures in the nutrition space say, well, the oatmeal off the shelf 151 00:10:45.039 --> 00:10:46.919 that you get at the supermarket has glyphys in it, and it's poisoning you 152 00:10:46.960 --> 00:10:50.960 if you eat oatmeal every day. So I don't know if if when I 153 00:10:52.039 --> 00:10:56.000 was on rotation with you, if I had any glyphis eight calls, I'm 154 00:10:56.000 --> 00:10:58.639 pretty sure I didn't have. You guys seen any of that? Is that 155 00:10:58.759 --> 00:11:01.399 some then that y'all get calls about in the poison center, And then how 156 00:11:01.399 --> 00:11:07.279 would y'all manage that if someone were to be exposed to something like that in 157 00:11:07.399 --> 00:11:09.759 Arkansas with all the farming. I'm sure that's probably popped up a time or 158 00:11:09.799 --> 00:11:13.240 two. Well, I couldn't even begin to tell you how many cases of 159 00:11:13.279 --> 00:11:20.039 glyfoss eate exposure I've been subjected to over the last thirty years, but I 160 00:11:20.080 --> 00:11:24.519 would guess it's probably well into the hundreds as a general rule, at least 161 00:11:24.600 --> 00:11:28.639 acutely. Unless somebody is trying to commit suicide and goes out and drinks a 162 00:11:28.639 --> 00:11:33.440 bunch of concentrated round up, I don't worry too much about a small exposure 163 00:11:33.480 --> 00:11:37.559 to glyfossate. In fact, even in that situation that I just said, 164 00:11:37.600 --> 00:11:41.639 where somebody's trying to commit suicide, I'm less worried about the glyphoss eate and 165 00:11:41.679 --> 00:11:48.320 typically more worried about the surfactant that's added in there and that actually causing the 166 00:11:48.320 --> 00:11:52.000 acute poisoning or a problem. So I will just tell you the data that 167 00:11:52.080 --> 00:11:58.159 I have seen. I'm scientifically on even long term glyphoss eate is pretty weak. 168 00:11:58.679 --> 00:12:03.000 And we'll go back to sunscreens because I will use I will juxtapose it 169 00:12:03.039 --> 00:12:07.559 against this whenever I've got He's twelve years old now. But I was doing 170 00:12:07.600 --> 00:12:13.320 some work for the National Talk Center for the FDA on sunscreens and I came 171 00:12:13.440 --> 00:12:18.960 home and I pulled every sunscreen that had oxy in it out of our house 172 00:12:20.039 --> 00:12:24.960 through the trash can due to the fact it would cross the stratum corneum, 173 00:12:24.000 --> 00:12:30.000 and I was worried about potentially DNA changes. I have a large bottle of 174 00:12:30.120 --> 00:12:33.480 round upsetting in my garage right now that I used to spray weeds with, 175 00:12:33.159 --> 00:12:39.679 so and I do take safety pretty seriously. I think there's a lot of 176 00:12:39.720 --> 00:12:45.519 money to be made suing people, and I think the amount of life phiss 177 00:12:45.559 --> 00:12:50.399 sate that was used around the country was pretty low hanging fruit for somebody to 178 00:12:50.440 --> 00:12:56.759 try to attack. And that's my general feeling. Like I said, I'm 179 00:12:56.759 --> 00:13:03.759 not overwhelmingly convinced of its long term toxicity or cumulative toxicity, whatever you want 180 00:13:03.799 --> 00:13:07.600 to call it. So, yeah, I've seen that there's certain articles and 181 00:13:07.639 --> 00:13:09.200 I can't remember the name of the group I should have done my due diligence, 182 00:13:09.240 --> 00:13:13.960 and I think it's the Environmental Working Group or something along those lines, 183 00:13:13.360 --> 00:13:18.879 is they'll take a lot of the USDA's data on glyphysate exposure and other pesticide 184 00:13:18.919 --> 00:13:24.639 exposures, and they'll say they found all these adverse health effects associated with it, 185 00:13:24.759 --> 00:13:28.519 and this is why no one should you should use organic versions of these 186 00:13:28.519 --> 00:13:33.519 things instead of glyphys aate or whatever herbicide spectra side whatever that's currently out there. 187 00:13:33.879 --> 00:13:37.480 But what they don't what they'll do is they'll take all the acute exposure 188 00:13:37.480 --> 00:13:41.600 from people who work with it on a daily basis, farmer stuff like that, 189 00:13:41.639 --> 00:13:45.879 where they've accidentally been exposed to large amounts of it in the workplace, 190 00:13:46.279 --> 00:13:48.519 and they'll lump that data in and use it to kind of scare people, 191 00:13:48.879 --> 00:13:52.480 when in reality, if you look at the amount of glyphysate you've been exposed 192 00:13:52.480 --> 00:13:56.080 to when eating a certain food, I'm pretty sure if I recall correctly, 193 00:13:56.720 --> 00:14:01.840 I think the milligrams per kilogram for like an acceptable daily intake is zero point 194 00:14:01.879 --> 00:14:05.480 five for glyphyss. So I mean, assuming you would even know the amount 195 00:14:05.480 --> 00:14:09.039 of live state in a food you're eating routinely, I mean you'd have to 196 00:14:09.120 --> 00:14:11.679 you'd have to eat quite a bit of it to even get to the point 197 00:14:11.679 --> 00:14:16.000 where you'd be concerned with that. I yeah, I think it's Take me 198 00:14:16.080 --> 00:14:20.120 example, if I'm two hundred and fifteen pounds and we do the math, 199 00:14:20.480 --> 00:14:26.480 I mean, I'd have to essentially stay under fifty milligrams of glyphyssate a day 200 00:14:26.519 --> 00:14:30.480 for me to not be worried about an issue. And again, I'm not 201 00:14:30.519 --> 00:14:35.320 getting nearly exposed at any of that. From a dietary perspective, I am 202 00:14:35.480 --> 00:14:39.200 interested to kind of d are there some and we can kind of piggyback and 203 00:14:39.200 --> 00:14:43.440 bounce back and forth with these topics. But are there certain things? And 204 00:14:43.639 --> 00:14:46.399 I kind of know the answer to this question being on your rotation and stuff 205 00:14:46.440 --> 00:14:50.679 in pharmacy school, But are there certain things that when you get phone calls 206 00:14:50.679 --> 00:14:54.120 in the poison center about them that you're the hair on the back of your 207 00:14:54.120 --> 00:14:58.559 neck stands up like as a poison At the poison control center, you get 208 00:14:58.600 --> 00:15:03.440 also calls for all sort of sorts of things. What are some of the 209 00:15:03.440 --> 00:15:07.759 things you've seen that I guess the audience might be better suited to know than 210 00:15:07.799 --> 00:15:11.200 worrying about someone calling something toxic on the internet that they don't really understand. 211 00:15:11.840 --> 00:15:15.240 So what are some of the things that they really need to worry about So 212 00:15:15.320 --> 00:15:18.080 let me ask you this. Let's ask it a different way. I guess. 213 00:15:18.200 --> 00:15:20.200 Okay, So are we talking about a toddler getting into something, or 214 00:15:20.200 --> 00:15:26.559 are we talking about something in your garage somebody intentionally overdosing, because all of 215 00:15:26.600 --> 00:15:31.320 those go down different paths. Sure, and I will tell you, in 216 00:15:31.399 --> 00:15:35.879 general, inside your home, if you use reasonable safety precautions, most of 217 00:15:35.919 --> 00:15:43.480 the things other than medicinals in the general part of your home are usually reasonably 218 00:15:43.559 --> 00:15:48.519 safe. Obviously, if you dose make some poison, you drink enough something, 219 00:15:48.639 --> 00:15:50.519 you can have a problem. Now under the sink, there are a 220 00:15:50.559 --> 00:15:54.799 few things under there that can be really problematic. Drain cleaners are one that 221 00:15:56.399 --> 00:16:00.399 jumps out really quick that you would find under your counter. Some of those 222 00:16:00.399 --> 00:16:06.120 can be incredibly caustic, and even a mouthful could cause just horrific damage in 223 00:16:06.200 --> 00:16:08.879 someone, even an adult. Once you leave your house and step out into 224 00:16:08.919 --> 00:16:12.480 the garage, there are a lot of things that can be found in your 225 00:16:12.519 --> 00:16:18.639 garage that could be really problematic in the wrong situation. I guess. Fuel 226 00:16:18.759 --> 00:16:22.919 additives are one that jumps out. Because it's this time of year, people 227 00:16:22.960 --> 00:16:26.679 are went arising their boat and things like that. Some of those have large 228 00:16:26.720 --> 00:16:30.480 amounts of ethanol in them, and small ingestions in a small child or even 229 00:16:30.480 --> 00:16:36.360 relatively small ingestions in an adult could potentially be a problem. Anaphreezes ethylene glycol 230 00:16:36.399 --> 00:16:41.200 containing products are problematic if you're a mechanic or tend to do mechanic work and 231 00:16:41.279 --> 00:16:45.399 things like that. Break fluids can have both ethylene glycol and diethylene glo call 232 00:16:45.480 --> 00:16:49.679 in them, which are all potentially problematic substances. And then we move over 233 00:16:49.720 --> 00:16:53.440 we're talking about glyphoss ate on herbicide. Like I said, if somebody got 234 00:16:53.480 --> 00:16:57.120 a mouthful of it, I'm actually more worried acutely about the surfacta that's in 235 00:16:57.159 --> 00:17:03.720 there than I am glyphoss itself. But as we move over into some insecticides, 236 00:17:03.039 --> 00:17:07.599 some of the insecticides with small ingestions could be problematic. Fortunately, some 237 00:17:07.680 --> 00:17:11.640 of the more problem ones have been removed from the market. But something for 238 00:17:11.680 --> 00:17:15.960 whatever reason, and I don't know why this is. I don't know if 239 00:17:15.960 --> 00:17:19.240 we're using more of it now in the rule or in the farm community, 240 00:17:19.680 --> 00:17:23.960 but paraquat has been one that has cropped up quite a bit now. It's 241 00:17:23.960 --> 00:17:27.640 a little different than die quot, which you can actually find in combination oddly 242 00:17:27.759 --> 00:17:33.359 enough with clite foss eight, but paraquat is a much more sinister substance, 243 00:17:33.839 --> 00:17:40.160 and a mouthful of it and an otherwise healthy adult could be fatal so and 244 00:17:40.200 --> 00:17:44.319 even more so to a small child. So there are those types of things 245 00:17:44.440 --> 00:17:48.160 now medications, the list can get long really quick. But I will tell 246 00:17:48.240 --> 00:17:52.119 one that is we're kind of getting into the cough, cold time of the 247 00:17:52.200 --> 00:17:56.440 year. That really scares me that I think even most pharmacists do not appreciate 248 00:17:57.119 --> 00:18:04.000 the toxicity of this substance. And that is that is a very scary substance. 249 00:18:04.319 --> 00:18:08.119 They're little, round gel looking beads. I can see a toddler looking 250 00:18:08.119 --> 00:18:11.920 at those thinking, hey, that's candy. They are potent sodium cha. 251 00:18:12.000 --> 00:18:17.559 It's a potent sodium channel blocker, so you can develop cardiotoxicity with it really 252 00:18:17.640 --> 00:18:21.599 quickly. You can get two hundred milligram little capsules of it, just a 253 00:18:21.640 --> 00:18:25.359 few of them, and a small child is really bad. We actually had 254 00:18:25.480 --> 00:18:30.759 a fatal case, it's probably been about two years ago in a thirteen year 255 00:18:30.759 --> 00:18:37.319 old. They made a suicidal gesture and they took twelve thirteen capsules and it 256 00:18:37.480 --> 00:18:41.599 killed them. So that's one that people get their little small things. They 257 00:18:41.599 --> 00:18:47.359 look pretty innocuous and they're pretty nasty. Some other meds that we use, 258 00:18:47.440 --> 00:18:51.079 the one pill can kill kind of a thing. One pill won't do it. 259 00:18:51.119 --> 00:18:55.480 But cold is a drug that is really nasty. Methyl treks eight, 260 00:18:55.640 --> 00:19:00.279 which people use for rheumatoid arthritis, can be really problematic. We've got the 261 00:19:00.319 --> 00:19:07.039 big people don't like to hear this, but hydroxychloroque is really a poisonous substance, 262 00:19:07.359 --> 00:19:12.720 and everybody was wanting to push that out to during COVID and if it 263 00:19:12.799 --> 00:19:17.400 works, that's fine. With something that you really need to pay attention to 264 00:19:17.519 --> 00:19:19.319 and how it was stored and things like that, it would not take very 265 00:19:19.319 --> 00:19:22.559 many tablets to really be a problem in someone. And then, of course, 266 00:19:22.839 --> 00:19:27.400 if somebody's on different blood pressure medicines or medicines that directly affect the heart, 267 00:19:27.680 --> 00:19:32.920 those all can be pretty concerning pretty quickly. So yeah, that's It's 268 00:19:32.960 --> 00:19:37.160 interesting you brought up benzono tape because I've I'm not as familiar with that, 269 00:19:37.200 --> 00:19:40.359 but I have heard that of late, and you're exactly right. We're starting 270 00:19:40.400 --> 00:19:44.599 to dispense quite a bit of it in the pharmacy with cough and colds and 271 00:19:44.640 --> 00:19:47.759 even with COVID, Like, we were seeing a lot of coughing symptoms and 272 00:19:47.799 --> 00:19:51.359 that's one of the common things that we would see that was prescribed with it. 273 00:19:51.839 --> 00:19:55.559 And those things I don't like dispensing them because you're exactly right. They're 274 00:19:55.599 --> 00:19:59.400 bright yellow colored. The higher dose ones have this kind of oblong, candy 275 00:19:59.440 --> 00:20:03.680 looking shape and they can kind of easily spell on the counter to where like 276 00:20:03.759 --> 00:20:06.720 if you weren't careful and you drop some, you may not even they just 277 00:20:06.759 --> 00:20:11.079 scurry away really fast, so you wouldn't even see them. And so when 278 00:20:11.119 --> 00:20:14.720 you if you get if you take a call like that, and let's let's 279 00:20:14.720 --> 00:20:18.400 just use benzonotate and are as an example. What are some of the what's 280 00:20:18.440 --> 00:20:22.839 the kind of protocol y'all follow in the poison center to kind of manage that? 281 00:20:22.880 --> 00:20:26.000 How does that look? Well, pretty much, it's not going to 282 00:20:26.039 --> 00:20:30.720 take much benxonotape to get me moving you to the emergency room, especially if 283 00:20:30.720 --> 00:20:34.759 it's a child. So and my staff know this and they're well trained with 284 00:20:34.799 --> 00:20:41.640 it, they're going to in most situations if somebody just immediately did that and 285 00:20:41.720 --> 00:20:45.599 we felt like we could get them to the emergency room. Quicker by car 286 00:20:45.000 --> 00:20:49.359 sends you by car now. In other situations, we may direct you to 287 00:20:49.400 --> 00:20:53.519 call an ambulance to come get the tool. Because these things are absorbed pretty 288 00:20:53.559 --> 00:20:57.839 quickly. They're going to get symptomatic pretty quickly, and we're going to move 289 00:20:57.880 --> 00:21:02.720 on them pretty quickly. I mean, basically, in my opinion, we 290 00:21:02.839 --> 00:21:07.759 got a barely small toddler. If they knock off more than two three hundred 291 00:21:07.799 --> 00:21:11.759 milligrams, or I have any uncertainty about those, they're going we're not keeping 292 00:21:11.799 --> 00:21:15.079 them at home. On the therapeutic side, I will just throw this one 293 00:21:15.079 --> 00:21:19.880 out there. On benzonotate, since we're talking about it, do not bite 294 00:21:21.240 --> 00:21:25.119 and swallow. That used to be a pretty common way that we would see 295 00:21:25.279 --> 00:21:30.240 prescriptions written, and I get it. An it's a potent sodium channel blocker, 296 00:21:30.240 --> 00:21:33.039 and that's why we're worried about the toxicity. But if you think about 297 00:21:33.039 --> 00:21:36.839 what are sodium channel blockers, a lot of them are anesthetics. They take 298 00:21:36.880 --> 00:21:38.680 away pain and stuff, which is why we're giving it to you for sore 299 00:21:38.759 --> 00:21:42.519 throat to a degree and cough. So biting that thing will numb your throat. 300 00:21:42.559 --> 00:21:47.759 The problem is you can numb your throat so much that you relax your 301 00:21:47.839 --> 00:21:52.160 upper airway. That you can't clear secretions. Oh you can run into a 302 00:21:52.200 --> 00:21:56.000 problem with that. Not being able to swallow or even cough at all is 303 00:21:56.319 --> 00:22:00.839 there's some issues related with that. So yeah, I always counsel on that, 304 00:22:02.039 --> 00:22:04.519 and no matter when I dispense that awhat, please do not crush or 305 00:22:04.559 --> 00:22:07.839 chew this. And you'd be surprised, Like a lot of people don't think 306 00:22:07.880 --> 00:22:11.720 about that kind of thing, and they'll ask me, well, why shouldn't 307 00:22:11.759 --> 00:22:15.519 I. I'm like, well, this is why. However, you just 308 00:22:15.519 --> 00:22:18.680 don't want to get all that dose at one time, especially you don't want 309 00:22:18.680 --> 00:22:22.720 it locally getting absorbed quickly before it gets to where it's supposed to. That's 310 00:22:22.759 --> 00:22:25.920 one that was surprising to me because I don't know if we were taught that 311 00:22:26.039 --> 00:22:30.759 one, particularly in pharmacy school. I know I have a lot of friends 312 00:22:30.799 --> 00:22:33.839 of mine that are starting to have kids. Me and my wife are in 313 00:22:33.880 --> 00:22:37.640 that realm here at some point like in the near future, that something will 314 00:22:37.680 --> 00:22:41.839 start considering, And I get questions all the time, especially from close friends 315 00:22:41.880 --> 00:22:45.839 of mine. Hey, I have a toddler. They're in that mobile phase 316 00:22:45.880 --> 00:22:51.359 where they're running around getting into everything. What do I need to not have 317 00:22:51.480 --> 00:22:55.400 in the house or what is there any like what stuff gets me concerned? 318 00:22:55.720 --> 00:23:00.599 And I remember answering this question for someone. They asked me like, Hey, 319 00:23:00.759 --> 00:23:03.559 I'm not talking about the drain cleaners and stuff like that. We don't 320 00:23:03.599 --> 00:23:06.880 have that in the house. He goes, there anything else that we're concerned 321 00:23:06.880 --> 00:23:11.559 about, And I go and I just happen to know that this the wife 322 00:23:11.599 --> 00:23:15.519 of my friend has been diagnosed with anemia in the past, so she takes 323 00:23:15.599 --> 00:23:18.799 fair sulfate, I mean, routinely to help with that. I mean, 324 00:23:18.839 --> 00:23:22.599 that's pretty common medication. But I told them you need to really be careful 325 00:23:22.640 --> 00:23:26.759 with iron, especially around little kiddos. And I remember you giving us quite 326 00:23:26.839 --> 00:23:32.400 a lecture on that in pharmacy school and how that gets your attention, especially 327 00:23:32.400 --> 00:23:36.319 if there's too much of it. So I would that's a fairly innocuous substance 328 00:23:36.359 --> 00:23:37.839 that I feel like a lot of people wouldn't think twice about. But what 329 00:23:37.960 --> 00:23:41.839 happens if let's say a kid gets into a bottle of that kind of thing, 330 00:23:42.000 --> 00:23:47.240 or at what point with multi vitamins or something, do you get concerned 331 00:23:47.319 --> 00:23:49.480 stuff that kids could easily get into. So that's a pretty good question. 332 00:23:49.680 --> 00:23:52.599 We'll go off in a couple of different directions here, but we'll stay with 333 00:23:52.680 --> 00:23:57.000 iron. Initially, those three hundred and twenty five milligram fair sulfate tablets that 334 00:23:57.160 --> 00:24:03.440 get dispensed as a prescription, particularly when predatal situations, most of those all 335 00:24:03.480 --> 00:24:07.559 look like candy to a toddler. They're all sugar coated. They're either green 336 00:24:07.640 --> 00:24:12.480 or red usually, And the thing that we forget as adults sometimes is a 337 00:24:12.599 --> 00:24:18.119 child will pop that tablet in their mouth and they will begin to suck that 338 00:24:18.160 --> 00:24:22.279 sugar coating off of it, and as soon as that sweet taste leaves and 339 00:24:22.359 --> 00:24:26.000 any other taste replaces it, they're either going to do one or two things. 340 00:24:26.079 --> 00:24:30.880 They're either gonna spit it out or they're gonna swallow it. And sadly, 341 00:24:30.240 --> 00:24:34.599 lets use a twenty two pound child. So technically that supposedly is a 342 00:24:34.640 --> 00:24:38.000 normal two year old had twenty two pounds up. I may beg to differ 343 00:24:38.039 --> 00:24:42.279 with that in our society now, but that's a ten kilo child. So 344 00:24:42.839 --> 00:24:48.119 a three twenty five fairsulfate tablet, it's gonna have sixty five milligrams of elemental 345 00:24:48.160 --> 00:24:52.480 iron. So ten of those would put you at sixty five milligrams per kila 346 00:24:52.519 --> 00:24:56.519 of elemental iron that is gonna put that child. They're definitely going to have 347 00:24:56.599 --> 00:25:02.000 symptoms. They're gonna have some geosymptoms from that vomiting, probably some diarrhea. 348 00:25:02.480 --> 00:25:07.559 That is a threshold that begins to make me really concerned. And as you 349 00:25:07.599 --> 00:25:11.759 start adding it only took ten tablets for us to get there. If you've 350 00:25:11.799 --> 00:25:14.599 ever watched a kid eat a bag of Skittles or a bag of M and 351 00:25:14.759 --> 00:25:18.680 m's or whatever, then take down ten pretty quick. You push that out 352 00:25:18.680 --> 00:25:22.880 to twenty. That's a lethal dose. So and unfortunately, and I hate 353 00:25:22.880 --> 00:25:26.559 to talk about cases, and I will keep them as generic as I possibly 354 00:25:26.599 --> 00:25:32.640 can because of hippo. But we've in the last year and a half had 355 00:25:32.680 --> 00:25:36.440 a case. Mom's in the shower, two and a half year old, 356 00:25:36.640 --> 00:25:41.519 gets into her she's pregnant, gets into her supplemental iron that is on the 357 00:25:41.519 --> 00:25:45.400 counter. She gets out of the shower. There are tablets spilled on the 358 00:25:45.480 --> 00:25:48.519 floor. She questioned. The toddler basically says no, I didn't need any. 359 00:25:48.920 --> 00:25:53.279 She gets the tablets picked up, and the child begins to have a 360 00:25:53.359 --> 00:25:59.480 half hour forty five minutes later, begins to have protracted nauseam vomiting, and 361 00:26:00.240 --> 00:26:03.720 they call the center we refer them in. They go to the small rural 362 00:26:03.759 --> 00:26:10.920 hospital that's adjacent to where they live at child is definitely really symptomatic at this 363 00:26:11.039 --> 00:26:14.839 point, definitely got some metabolic changes. Whenever we look at some of their 364 00:26:14.839 --> 00:26:19.599 blood and we call and get transferred to Children's. Child is transferred to Children's 365 00:26:19.599 --> 00:26:25.960 within the first three to four hours of the ingestion. Child's dead eleven hours 366 00:26:26.039 --> 00:26:30.960 later. So and we in that situation, that's a pretty quick timeframe to 367 00:26:32.079 --> 00:26:34.839 us. We got them to a place where we could start giving them death 368 00:26:34.880 --> 00:26:41.440 peroximine. We pushed the dose of deferoxymine, We did some really interesting things 369 00:26:41.480 --> 00:26:45.079 with some plasma exchange on them, trying to do that to get the iron 370 00:26:45.119 --> 00:26:48.119 out just could You're just too far behind the eight ball at that point, 371 00:26:48.440 --> 00:26:52.559 even though we have an antidote. If you really start doing the math on 372 00:26:52.640 --> 00:26:56.160 how much deferoxymene will will bind, you just can't get ahead of the You 373 00:26:56.160 --> 00:27:00.039 can't get ahead of it. So and I don't mean to scare people, 374 00:27:00.119 --> 00:27:04.079 but I do mean it to scare people, I guess, because those are 375 00:27:04.119 --> 00:27:07.920 things that from a pharmacist standpoint, and I tell students this all the time, 376 00:27:08.279 --> 00:27:11.960 that bottle should not leave the pharmacy in a snapcap. It should have 377 00:27:12.000 --> 00:27:17.920 a child resistant cap on. And just because it has a child resistant cap 378 00:27:18.000 --> 00:27:21.160 on, it doesn't mean the child can't open it. It just means that 379 00:27:21.200 --> 00:27:23.839 a certain percentage of children cannot open it. And there's still some that will 380 00:27:23.880 --> 00:27:29.119 be able to open it because we made them completely child proof. Adults couldn't 381 00:27:29.160 --> 00:27:33.039 get in them either, correct. So iron, I'm glad you brought up 382 00:27:33.079 --> 00:27:36.440 iron. That's a good one. So one of the things is now with 383 00:27:37.000 --> 00:27:41.839 tooble vitamins and gum things like that. Everything seemed to come in a dad 384 00:27:41.839 --> 00:27:47.279 gum gummy now. But the thing, for whatever reason, kits seem to 385 00:27:47.279 --> 00:27:51.200 tolerate the iron that is in those tooled tablets a little better than they do 386 00:27:51.359 --> 00:27:55.839 for whatever reason, in that big dose affair of sulfate, And we're it's 387 00:27:55.960 --> 00:28:00.000 unusual for a child to be able to get enough of the toolble. Iron 388 00:28:00.079 --> 00:28:03.440 tablets are the chewable multi bottoms that have some iron in them for them to 389 00:28:03.480 --> 00:28:08.000 get to a really serious point with those, and part of it is just 390 00:28:08.079 --> 00:28:11.519 due to the amount of iron that's in. But there's that. The other 391 00:28:11.559 --> 00:28:15.839 one, though, is you see some bad press out there about melotonin. 392 00:28:15.319 --> 00:28:21.039 And I'll just tell you my general feeling on melatonin is melatonin in and of 393 00:28:21.119 --> 00:28:26.319 itself is probably not much of a toxica. It doesn't cause cumulative sleepiness. 394 00:28:26.359 --> 00:28:30.200 So it's not like taking a benzodazepene for sleep, where if you take one 395 00:28:30.279 --> 00:28:33.279 you get a little sleepy, but if you take twenty you get the CNS 396 00:28:33.359 --> 00:28:38.880 depression is significantly more. Melotonin is not that way and doesn't appear to be 397 00:28:38.920 --> 00:28:41.400 a problem. Now. Where the problem lies where you look at some of 398 00:28:41.440 --> 00:28:48.480 the data that's out there that implicates melatonin, there's usually something else. And 399 00:28:48.559 --> 00:28:52.000 so those are the areas where we get a little concerned. We ask a 400 00:28:52.039 --> 00:28:55.559 few more questions about melatonin, but in general we don't get too up in 401 00:28:55.680 --> 00:28:59.519 arms about melotone. Yeah, I tell people that all the time. I 402 00:28:59.559 --> 00:29:02.960 get some of those questions occasionally, like my kid got into some meltonin and 403 00:29:02.880 --> 00:29:06.960 and then I'll I still remember from my time with you guys the month at 404 00:29:07.000 --> 00:29:10.759 the Foison centers, that's really not a concern unless there's other products again, 405 00:29:10.839 --> 00:29:14.039 or if they're taking it with other things. One of the big things for 406 00:29:14.119 --> 00:29:15.880 me is I and I don't know why they still make it this way. 407 00:29:15.920 --> 00:29:19.000 But since we talked about iron, I feel like this is an important thing 408 00:29:19.039 --> 00:29:22.720 to know about. Like ferisulfate is not the most appealing looking. It does 409 00:29:22.720 --> 00:29:26.960 look like candy or skittles or something. But I would say the one that 410 00:29:27.000 --> 00:29:32.319 I really worry about it like looking like candy, is the fair s gluconate, 411 00:29:32.680 --> 00:29:36.799 like the little green ones I mean eb Hardpress. If you glanced at 412 00:29:36.799 --> 00:29:37.960 that, or if that fell on the floor, that would let like green 413 00:29:38.000 --> 00:29:41.240 Eminem's to a kid. And that's one of the things that I think we 414 00:29:41.319 --> 00:29:45.799 do kind of bad as a society, is like it's sometimes it's really hard 415 00:29:45.880 --> 00:29:52.359 to distinguish between medicines or candy. And I remember going to elementary schools and 416 00:29:52.480 --> 00:29:56.480 middle schools in pharmacy school and talking to them about it. We had a 417 00:29:56.519 --> 00:30:00.319 little slideshow where I would have them guess which one was candy in which one 418 00:30:00.359 --> 00:30:06.279 wasn't, and you'd be surprised by how many like people couldn't tell the difference, 419 00:30:06.319 --> 00:30:07.640 even adults, even teachers in the room were like, I had no 420 00:30:07.680 --> 00:30:11.920 idea. It's just it's startling, and I think a lot of people don't 421 00:30:11.960 --> 00:30:17.400 know. And what's another point I'll make is like, I think people need 422 00:30:17.440 --> 00:30:19.960 to realize that, Like, if there's any question in mind, if a 423 00:30:21.039 --> 00:30:23.480 kid got into something, just police call the poison center, because even if 424 00:30:23.480 --> 00:30:29.519 you're not sure, having that resource at your disposal is crucial, I think. 425 00:30:29.640 --> 00:30:32.240 I mean, I remember getting all sorts of calls when I was on 426 00:30:32.400 --> 00:30:36.279 rotation with you. I got a call one time about and then a pig 427 00:30:36.640 --> 00:30:40.440 in like another state got in and then got in and ingested a bunch of 428 00:30:40.559 --> 00:30:44.839 fire ant killer. Like it was just this crazy call that I remember getting 429 00:30:44.839 --> 00:30:47.119 that, and I asked you, I go, how, I don't know 430 00:30:47.160 --> 00:30:48.839 how to handle this. He goes, oh, yeah you do, like 431 00:30:48.839 --> 00:30:52.200 you're good, Like just you know what that is, and it just happens 432 00:30:52.240 --> 00:30:55.759 to be in an animal and not a human. And there's also vet poison 433 00:30:55.839 --> 00:30:57.799 control, which I think is kind of cool too, because my dog, 434 00:30:57.920 --> 00:31:00.680 if I drop anything on the floor, if I'm not right there, I 435 00:31:00.720 --> 00:31:06.839 mean, it's cone. So well that's I mean, not to really get 436 00:31:06.880 --> 00:31:11.599 off into veterinary stuff, because I'm definitely not veterinary trained, but this time 437 00:31:11.640 --> 00:31:14.440 of year, I mean, there are a few things that you probably should 438 00:31:14.440 --> 00:31:18.200 worry about with your pets. And one of those things a lot more candy 439 00:31:18.240 --> 00:31:21.480 around this time of year. We just had Halloween, went into Christmas, 440 00:31:21.559 --> 00:31:25.680 be a lot of different kinds of candy. Then it's sugar free candies and 441 00:31:26.119 --> 00:31:32.599 particularly dogs. Zolatol, which is an artificial sweetener or technically, I don't 442 00:31:32.599 --> 00:31:36.440 guess, it's just a sugar alcohol. But it doesn't take much zolotol to 443 00:31:36.519 --> 00:31:40.359 kill a dog, and we can eat zalona. It probably causes some gastritis 444 00:31:40.359 --> 00:31:44.720 and diarrhea if we eat too much of it, but it causes them to 445 00:31:44.720 --> 00:31:48.240 release insulin and they'll develop an insulin coma and die. So you need to 446 00:31:48.240 --> 00:31:52.720 be really careful with that chocolate in the dogs. We get a lot of 447 00:31:52.799 --> 00:31:56.839 questions still about that build chocolate in of itself. Most of it really isn't 448 00:31:56.880 --> 00:32:00.519 chocolate to begin with, a lot of what is labeled as milk. There 449 00:32:00.559 --> 00:32:04.519 is real milk chocolate out there, don't get me wrong, but milk chocolate 450 00:32:04.640 --> 00:32:07.799 probably isn't a big deal in most situations. Now. The darker chocolate, 451 00:32:08.000 --> 00:32:15.000 especially this stuff, when you start seeing seventy percent, those can be problematic 452 00:32:15.039 --> 00:32:20.519 pretty quick, so be aware of those. It's animals are interesting and well. 453 00:32:20.680 --> 00:32:22.480 A lot of the things will affect us pretty much in the same way 454 00:32:22.480 --> 00:32:28.480 as it will them. They can there are some definite, really interesting differences 455 00:32:28.519 --> 00:32:31.920 between us and cats and dogs and whatnot. Yeah, I think I remember 456 00:32:31.920 --> 00:32:36.319 one time our great Dane that we have. I love her to death, 457 00:32:36.359 --> 00:32:40.039 she's the best dog. But I had inadvertently dropped a pack of gum on 458 00:32:40.079 --> 00:32:44.279 the floor and she ran over to look at it. But again, it's 459 00:32:44.279 --> 00:32:45.839 all wrapped up in foil, so you can't really smell it too much, 460 00:32:45.920 --> 00:32:49.720 but I was and then I picked it up real quick. But that's one 461 00:32:49.720 --> 00:32:52.599 of those things, is Aylotol's in chewing gum, So like if you gave 462 00:32:52.640 --> 00:32:54.319 a dog or if a dog got it in chewing gum, it's not only 463 00:32:54.359 --> 00:32:59.599 a choking hazard to them potentially, but there's a decent amount of alatol in 464 00:32:59.640 --> 00:33:01.319 there, and it's in places you may not think of. I mean, 465 00:33:02.160 --> 00:33:07.279 that's that's one of the downsides to not knowing these things. I'm also glad 466 00:33:07.319 --> 00:33:12.640 you brought up Metatro because I remember you giving us quite a scare fun Metatres 467 00:33:12.640 --> 00:33:15.920 eight when I was in pharmacy school. I still remember that conversation and every 468 00:33:16.079 --> 00:33:21.720 single student that comes through our pharmacy on rotation I always ask them what they 469 00:33:21.799 --> 00:33:24.799 know about it and what their concerns are. I don't I do see a 470 00:33:24.799 --> 00:33:29.400 lot of methatrex. It's still for rheumatoid arthritis and stuff. I don't get 471 00:33:29.440 --> 00:33:31.119 too many questions about it, but it's one of those things where I always 472 00:33:31.119 --> 00:33:36.200 had to be on an alert on if how it's packaged in the pharmacy, 473 00:33:36.359 --> 00:33:39.519 or you never want that a patient to take that daily instead of once a 474 00:33:39.559 --> 00:33:45.440 week, or in situations where they're maybe undergoing chemotherapy where they're getting high doses 475 00:33:45.480 --> 00:33:47.759 of it. What other ones like are there? Let me ask you this 476 00:33:47.839 --> 00:33:52.279 question. Are there any situations I get asked this one a lot too? 477 00:33:52.480 --> 00:33:57.039 Is people will ask about activated charcoal, like if a kig, if they 478 00:33:57.119 --> 00:34:00.599 thought O Kay got into something, how if they call the poison center immediately. 479 00:34:00.640 --> 00:34:05.519 Let's say the mom was there and saw a kid in just something at 480 00:34:05.559 --> 00:34:10.320 what time frame do y'all think that activating charcoal is useful or like bend tonight 481 00:34:10.400 --> 00:34:15.360 clay or something like that to help with an acute toxicity issue of something. 482 00:34:15.719 --> 00:34:17.440 Well, the one way we're going to handle it is we're going to look 483 00:34:17.800 --> 00:34:22.760 and if we didn't give any charcoal at all would we refer the child. 484 00:34:22.280 --> 00:34:27.599 And if the answer to that is GS, I think the chances that we're 485 00:34:27.599 --> 00:34:31.679 going to recommend that you give charcoal at home it's probably pretty So we've moved 486 00:34:31.719 --> 00:34:36.960 away from using We don't use nearly as much charcoal as we used to. 487 00:34:37.960 --> 00:34:42.239 And if you don't need to give charcoal, then if you determine well, 488 00:34:42.239 --> 00:34:45.119 no, I mean it's something that will the charcoal will actually bind, but 489 00:34:45.199 --> 00:34:49.360 we don't need to give the charcoal, well, then there's a pretty good 490 00:34:49.480 --> 00:34:53.280 chance if the dose wasn't high enough for us to even consider giving the charcoal, 491 00:34:53.880 --> 00:34:57.360 probably going to keep you at home and just watch you for a certain 492 00:34:57.400 --> 00:35:01.679 set of symptoms. So from it at home standpoint, we're rarely gonna use 493 00:35:01.719 --> 00:35:07.119 charcoal in most situations. Though, if you're going to give charcoal, you 494 00:35:07.199 --> 00:35:09.920 want to give it within the first hour. If you look at a large 495 00:35:10.000 --> 00:35:15.519 number of medications, a bunch of them, we have almost a complete absorption 496 00:35:15.599 --> 00:35:19.280 within about sixty to ninety minutes. Now there obviously there are plenty of meds 497 00:35:19.280 --> 00:35:22.800 we can go out and look at that have much more delayed absorption factors to 498 00:35:22.880 --> 00:35:30.760 them, but that's the general rule. Now from a clinician standpoint, say 499 00:35:30.800 --> 00:35:36.719 somebody hasn't ingested it's an intentional ingestion, and they they've ingested a seedamnifit diphin 500 00:35:36.760 --> 00:35:40.480 hydromene combination product, and if we were going to give charcoal in that situation, 501 00:35:40.559 --> 00:35:45.679 I may actually as long as we have good gimotility and we wanted to 502 00:35:45.679 --> 00:35:50.760 give charcoal in that situation, I may give it hours after the ingestion. 503 00:35:51.320 --> 00:35:55.239 Due to the fact of the diphen hydromene decreasing some gimotility and not empty in 504 00:35:55.320 --> 00:35:59.599 the gut is fast, and there's data to show that really does happen. 505 00:35:59.679 --> 00:36:02.880 We get delayed peaks and stuff with the see to benefit in combination with diaphen 506 00:36:02.960 --> 00:36:07.480 hydromine. So you know, there are some situations where we may go hours 507 00:36:07.800 --> 00:36:12.559 out and give it in. Then there are situations where we actually give repeat 508 00:36:12.639 --> 00:36:16.800 dose activated charcoal. So we're trying to pick up drugs that undergo in a 509 00:36:16.880 --> 00:36:22.000 oropadic recirculation and we'll pick them up in the in the small part of the 510 00:36:22.039 --> 00:36:25.960 gut once they're once they're excreded back into the gut loom and you could pick 511 00:36:25.960 --> 00:36:30.159 them up again even though they've already been absorbed which is kind of an interesting 512 00:36:30.239 --> 00:36:34.199 concept in and of itself, But that list of substances we're going to do 513 00:36:34.239 --> 00:36:37.920 that with are pretty small. So what are again? I know a lot 514 00:36:37.960 --> 00:36:39.840 of the answers to these questions and I'm sorry to like I would. I'd 515 00:36:39.920 --> 00:36:43.719 love to go off on rabbit holes and get into the weeds, for like, 516 00:36:43.840 --> 00:36:45.320 most of the people that listen to the show are wanting to know simple 517 00:36:45.320 --> 00:36:51.639 things, so I'd be hard pressed to interview someone with expertise and toxicology without 518 00:36:51.679 --> 00:36:54.599 asking about Thailand all. Is that still? I mean, that's pretty well 519 00:36:54.679 --> 00:36:58.920 known, especially in the medical community, of what to look out for. 520 00:36:58.960 --> 00:37:02.159 As far as Graham's per day, do you guys still see a lot of 521 00:37:02.280 --> 00:37:07.639 talanol issues? I know we've kind of touched on it briefly, and the 522 00:37:07.800 --> 00:37:10.920 answers that you've given is that it's something that a lot of people aren't aware 523 00:37:10.960 --> 00:37:14.880 of, but it does happen. As suicides are a big call that you 524 00:37:14.880 --> 00:37:19.159 guys get. So could you just give for someone who may not know anything 525 00:37:19.159 --> 00:37:22.360 about taiwan all toxicity, what does that look like? What amounts concern you? 526 00:37:23.000 --> 00:37:28.400 And then what type of situations would you use to treat that? Like 527 00:37:28.440 --> 00:37:30.599 I said, I know all the answers to these, but it's important that 528 00:37:30.800 --> 00:37:36.079 people know those types of what amounts of taiwan al get you guys concerned. 529 00:37:36.519 --> 00:37:40.239 So in general, tanaw isn't quite as cut and dry as everybody wants to 530 00:37:40.280 --> 00:37:45.880 make it out to be from a toxin standpoint, I guess are if we 531 00:37:45.960 --> 00:37:52.320 got to discussing a seedamenticant toxicity at a toxicology convention for clinical toxicologists, it 532 00:37:52.320 --> 00:37:54.519 would not take more than just a couple of minutes for an argument to break 533 00:37:54.559 --> 00:38:00.760 out over how approach. These are certain aspects of it, but in general 534 00:38:00.119 --> 00:38:05.280 you should adhere to the no more than four grams a day, and in 535 00:38:05.280 --> 00:38:08.880 in any single, one time dose of ten grams in an adult, you 536 00:38:09.000 --> 00:38:14.800 definitely we're definitely going to be concerned about that. And we actually typically still 537 00:38:14.920 --> 00:38:19.000 use the seven and a half gram threshold in our own center for referring people 538 00:38:19.280 --> 00:38:22.679 because let's think about that, So seven and a half grams is going to 539 00:38:22.760 --> 00:38:29.239 be fifteen five hundred milligram tablet. The chances that's an accidental single ingestion are 540 00:38:29.280 --> 00:38:32.039 pretty small. So what we're going to err on the side of caution. 541 00:38:32.360 --> 00:38:39.519 A sedamnifen in the United States is the number one overdosed substance, hands down. 542 00:38:39.679 --> 00:38:46.000 There is not a close second. We deal with it every single day, 543 00:38:46.679 --> 00:38:54.119 multiple times a day, and it still kills lots and lots of people 544 00:38:54.840 --> 00:38:59.960 in the overdose world. Here's the sad thing about mental health in this kind 545 00:39:00.360 --> 00:39:01.840 And I'm not going to sit here and tell you I know any answers. 546 00:39:01.880 --> 00:39:06.800 I just know there's a problem. So I've recently ran our data in our 547 00:39:06.840 --> 00:39:12.639 own center and it does match what I know nationally, and that is since 548 00:39:12.679 --> 00:39:17.320 two thousand and five in the Arkansas Center, our number of suicide cases has 549 00:39:17.400 --> 00:39:22.599 more than doubled. Whenever we start to break yeah, whenever you go to 550 00:39:22.719 --> 00:39:28.079 pediatrics in general. So we're using eighteen years and less, it's over three 551 00:39:28.199 --> 00:39:36.760 hundred percent increase in suicide attempts bar exposure volume. Here's the really frightening, 552 00:39:36.920 --> 00:39:40.199 scary, sad part of all of that. If we take and look at 553 00:39:40.320 --> 00:39:46.000 just kids twelve years of age or less, our increase is over eight hundred 554 00:39:46.079 --> 00:39:52.960 percent. I don't know. I can't, Like I said, I don't 555 00:39:52.000 --> 00:39:55.800 know the answer. I just know there's a real problem with mental health in 556 00:39:55.840 --> 00:40:01.599 this country. And I mean we've had I had a case of an attempted 557 00:40:01.599 --> 00:40:07.000 suicide in a five year old, and there's no doubt in my mind it 558 00:40:07.079 --> 00:40:10.360 was an actual attempt. I don't know what world you live in, or 559 00:40:10.559 --> 00:40:13.800 I would like to do kind of know what world you live in. You 560 00:40:13.840 --> 00:40:15.960 live in the same world I do for the most part. But what is 561 00:40:16.000 --> 00:40:22.039 so messed up in a five year old's life that pushes them to do something 562 00:40:22.159 --> 00:40:25.679 like that? And I'm not talking this, I mean this was a full 563 00:40:27.039 --> 00:40:32.280 blown, verbalized rational reason, or at least as rational as a five year 564 00:40:32.280 --> 00:40:36.840 old could be answer to the question as to why you did this. And 565 00:40:37.320 --> 00:40:39.920 man, it's hard to wrap it's hard to wrap your head around a twelve 566 00:40:40.000 --> 00:40:45.559 year old. So I couldn't imagine having have as a I mean, I'm 567 00:40:45.599 --> 00:40:49.719 not a parent yet, but I mean any parent that would not be something 568 00:40:50.239 --> 00:40:53.320 like just in general, I wouldn't think to worry about my five my kindergartener 569 00:40:53.840 --> 00:40:58.960 having going through some sort of issue at school, whether it be bullying or 570 00:40:59.519 --> 00:41:02.360 exposure to social media to earlier in an age, which I think those two 571 00:41:02.400 --> 00:41:07.159 things definitely play a role. I'm not saying that's the only reason some a 572 00:41:07.199 --> 00:41:10.079 kid like that would have. There's tons of other issues, and I've it 573 00:41:10.199 --> 00:41:15.119 still startles me today that even like this is more prevalent with like teenagers and 574 00:41:15.159 --> 00:41:19.639 college students. I don't know if how prevalent this is in schools still, 575 00:41:19.679 --> 00:41:22.960 but when I was in college, there was there was a notorious night where 576 00:41:23.280 --> 00:41:27.800 I was showing up to basically get some of the guys from my school from 577 00:41:27.840 --> 00:41:30.639 a party. They were like they went, They were like, hey, 578 00:41:30.679 --> 00:41:32.199 we don't this isn't looking good, Like we don't want to be around this 579 00:41:32.239 --> 00:41:34.840 stuff. So they were like, hey, can you come get us. 580 00:41:34.840 --> 00:41:37.000 They knew I was up studying for something, so we went to the we 581 00:41:37.039 --> 00:41:40.559 went, I went picked them up, but I walked in the fraternity house 582 00:41:42.000 --> 00:41:45.719 to kind of find them, and I look off to my left and there's 583 00:41:45.840 --> 00:41:50.119 just people sitting there with a giant it looks like a big bowl you would 584 00:41:50.159 --> 00:41:53.800 put Halloween candy in, and there were just pills and tablets just everywhere. 585 00:41:54.079 --> 00:41:59.639 If people were just taking handfuls of just random capsules and tablets and taking them 586 00:42:00.159 --> 00:42:02.480 knowing what they're ingesting. And I don't know how prevalent that is still, 587 00:42:02.559 --> 00:42:09.559 but I know that it's prescription medications and it's not too out of the realm 588 00:42:09.559 --> 00:42:14.320 of possibility for a kid to go into a medicine cabinet and find something. 589 00:42:14.800 --> 00:42:20.039 And that's definitely something that I really don't know as a pharmacist how much better 590 00:42:20.599 --> 00:42:23.559 we can do to prevent that issue. And I always tell people like, 591 00:42:23.679 --> 00:42:28.119 especially if you have small children at home, just if you have any medications 592 00:42:28.159 --> 00:42:31.320 anywhere, they cannot be within arm reach of that child at any point. 593 00:42:31.440 --> 00:42:36.719 And then child resistant containers, I even with young kids in the house, 594 00:42:36.760 --> 00:42:42.679 will it discourage parents from having those little pill pill dividers where they like, 595 00:42:42.760 --> 00:42:47.039 well, organize the Monday, Tuesday, Wednesday's dose and those little snap containers 596 00:42:47.079 --> 00:42:51.320 just so kids don't get into those. Are there any tips that you would 597 00:42:51.360 --> 00:42:55.519 give, like from a center perspective, on how to prevent accidental overdoses? 598 00:42:55.599 --> 00:43:00.440 I mean, the intentional ones is a whole different ballgame. But as a 599 00:43:00.480 --> 00:43:02.599 parent listening, who wants to know what's the best thing that they could do 600 00:43:02.719 --> 00:43:06.880 or what are some of the things that you would do as a parent, 601 00:43:06.960 --> 00:43:10.880 how in that situation to just try your best to hedge from to try to 602 00:43:10.920 --> 00:43:15.000 hedge your bets from any of that happening. Well, the first thing that 603 00:43:15.079 --> 00:43:17.679 you said or one of the things you said, Well ago that I believe 604 00:43:17.679 --> 00:43:22.199 it absolute is it can't be in arms reach. You just you don't have 605 00:43:22.280 --> 00:43:27.239 them setting on the nightstand. You don't where a toddler can just walk up 606 00:43:27.280 --> 00:43:31.519 and get it. In general, up high and out of sight is the 607 00:43:31.559 --> 00:43:36.119 best thing. And then I mean, I'll tell you my sister, my 608 00:43:36.199 --> 00:43:40.000 older sister, great mother, great parent, had an eight ounce bottle of 609 00:43:40.039 --> 00:43:45.119 a cedamnefital elixir in the top of their clothes. You go into a bedroom, 610 00:43:45.199 --> 00:43:49.360 you open the closet and there's that shelf that's up high. Should put 611 00:43:49.360 --> 00:43:52.559 the diaper bag up there. My nephew, whenever he was about two, 612 00:43:52.079 --> 00:43:58.000 climbed on top of the dresser, got the strap on the diaper bag, 613 00:43:58.079 --> 00:44:02.400 pulled it down and drank and hire eight ounce bottle of a seed them Benefita 614 00:44:02.440 --> 00:44:07.599 leixor and you do the milligram per kilo on that and he's way over he 615 00:44:07.719 --> 00:44:10.039 had, so yeah, he had to go in and I had to call 616 00:44:10.079 --> 00:44:15.920 the hospital and basically give them a recommendation on my own nephew. And so 617 00:44:15.400 --> 00:44:19.960 even I guess I'm telling you that to say we're gonna have some kids that 618 00:44:20.000 --> 00:44:22.559 are really gonna be climbers. They're really gonna be adventures. And if they 619 00:44:22.599 --> 00:44:27.159 get into stuff once up high, you got to start thinking about what else 620 00:44:27.199 --> 00:44:30.519 do you do? Do you lock the cabinet, Go get a toolbox that 621 00:44:30.639 --> 00:44:34.239 has a locking mechanism on it and put them in that if you have to. 622 00:44:34.719 --> 00:44:37.599 If you have a toddler that is really driven to do things, and 623 00:44:38.119 --> 00:44:43.119 you know, we have toddlers that are repeat offenders, and you know, 624 00:44:43.199 --> 00:44:45.480 the moms and dads are like, you know, I'm doing everything I can 625 00:44:45.480 --> 00:44:47.800 do to keep them out of it, and they just seem to be able 626 00:44:47.840 --> 00:44:52.320 to get into it. And you've got to take some pretty extreme measures whenever 627 00:44:52.360 --> 00:44:54.199 that starts happening. Lock and key. And I know that's not convenient, 628 00:44:54.599 --> 00:45:00.519 but setting in an emergency department while your child is intubated and Abby's and all 629 00:45:00.679 --> 00:45:04.960 going on them is not very convenient either. I can assure you that it's 630 00:45:05.039 --> 00:45:08.960 the really scary. So, yeah, what are again? I really wish 631 00:45:08.960 --> 00:45:13.400 I could have had Jessica on the podcast too, because she's well in the 632 00:45:13.400 --> 00:45:16.880 pediatric space, especially down here at Dull Children's in Austin. There's all sorts 633 00:45:16.920 --> 00:45:22.239 of kids get into all sorts of things down there. One thing that again, 634 00:45:22.360 --> 00:45:23.800 I still don't know how this is. Well, I do, but 635 00:45:23.880 --> 00:45:28.119 I mean because kids can get into it pretty easily. But it's still concerning. 636 00:45:28.280 --> 00:45:32.119 I've had quite a few cases of a button battery issues then, at 637 00:45:32.199 --> 00:45:37.039 least I've heard of recently. I know parents are kind of aware of what 638 00:45:37.079 --> 00:45:40.280 can happen with those, but I'd be hard pressed to not ask you about 639 00:45:40.360 --> 00:45:44.800 those because parents are kind of aware. How does what happens if a kid 640 00:45:44.880 --> 00:45:46.760 gets into that? At what point? I mean, how many of those 641 00:45:46.800 --> 00:45:50.880 have you seen? And then I'll ask you a few more simple ones, 642 00:45:50.920 --> 00:45:52.760 and then we can get into some obscure things before we end the show. 643 00:45:52.760 --> 00:45:55.840 Okay, I go down the rabbit hole. Yeah, just a little bit. 644 00:45:57.079 --> 00:45:59.599 I wouldn't be my bred son if we didn't go down the rabbit hole 645 00:45:59.639 --> 00:46:01.519 or get into the weeds. Satisfak this a little bit. Well, that's 646 00:46:01.559 --> 00:46:05.079 what I've missed most about your dead being up there. I would go down 647 00:46:05.119 --> 00:46:07.719 to his office and we would go down the rabbit holes together. But the 648 00:46:07.719 --> 00:46:13.079 button battery issue, it's a really big issue. And I can tell you 649 00:46:13.719 --> 00:46:21.239 the lithium batteries are probably not probably they are a bigger issue than the alkalin 650 00:46:21.599 --> 00:46:25.039 type. Little batteries if you get the big So if you look at the 651 00:46:25.119 --> 00:46:29.880 numbers on some of the batteries, it will tell you how many millimeters they 652 00:46:29.880 --> 00:46:34.840 are essentially, and if you start getting into those batteries that are twenty millimeters 653 00:46:34.880 --> 00:46:38.480 in size are bigger, and those are the large flat batteries like you'll see 654 00:46:38.480 --> 00:46:42.840 in a camera and things like that. Often. In fact, I think 655 00:46:42.920 --> 00:46:45.920 my like on my iPad, I have a keyboard for it, and it's 656 00:46:45.039 --> 00:46:50.159 run off of two of those batteries. Those are problematic in kids big time 657 00:46:50.239 --> 00:46:55.119 because they're much more likely to have an esophagewel location, are not past the 658 00:46:55.159 --> 00:47:00.079 plores and and get If we can get them to move in and get the 659 00:47:00.159 --> 00:47:02.719 out, they're probably going to be okay. But man, if you get 660 00:47:02.760 --> 00:47:07.280 one that stops somewhere, that's really a problem. So one of the things 661 00:47:07.320 --> 00:47:13.400 we will do at home with the button battery is in that first hour, 662 00:47:13.960 --> 00:47:21.760 every every ten minutes, give basically two teaspoons of honey, so that by 663 00:47:21.800 --> 00:47:25.559 the end of an hour you've gotten sixty meals of honey into somebody, and 664 00:47:25.880 --> 00:47:30.760 that honey will coat in the stomach or in the esophagus, will help coat 665 00:47:30.800 --> 00:47:36.599 that battery and it will decrease its ability to conduct, so you have less 666 00:47:37.320 --> 00:47:42.440 risk of having damage secondary to that. That's what you worry about, is 667 00:47:42.440 --> 00:47:46.599 that battery getting caught in a fold and being able to conduct electricity across that 668 00:47:46.679 --> 00:47:51.480 fold. You can end up with a burn and things like that. So 669 00:47:52.239 --> 00:47:54.599 the honey thing is pretty much into everyone's protocol. If you go out and 670 00:47:54.639 --> 00:48:00.760 look at the National Button Battery guidelines, they're going to recommend ten cs honey 671 00:48:00.119 --> 00:48:05.039 every ten minutes, so six times over an hour. That's sixty meals, 672 00:48:05.400 --> 00:48:07.760 and it's to help coat that battery. I can honestly say I have never 673 00:48:07.840 --> 00:48:12.480 heard of that, and I will tell you this. If they're really big 674 00:48:12.519 --> 00:48:15.800 batteries were probably there ain't no probably to it. If they're above twenty millimeters, 675 00:48:15.800 --> 00:48:20.159 we're definitely sending you in and we're going to try to get an X 676 00:48:20.239 --> 00:48:22.920 ray to see if we can locate it and then make sure we get it 677 00:48:22.920 --> 00:48:24.559 to move in and if not, we got to go get them. So 678 00:48:24.920 --> 00:48:29.079 yeah, that's no fun. I know. Yeah, I know of certain 679 00:48:29.119 --> 00:48:32.199 stories of parents that they're like, we don't have any of those anywhere near 680 00:48:32.280 --> 00:48:36.239 and then they'll be like, oh, I forgot that I left the TV 681 00:48:36.360 --> 00:48:40.639 remote out or something and it fell on the floor. The back felt flew 682 00:48:40.679 --> 00:48:44.159 off of it, and the button battery got out of there. And I've 683 00:48:44.199 --> 00:48:47.320 seen some scary I've heard some scary stories about those. I think that's on 684 00:48:47.360 --> 00:48:52.440 a lot of kids radar. I know some other things that at least I 685 00:48:52.519 --> 00:48:55.239 always try to go out of my way to counsel patients on. And again 686 00:48:55.400 --> 00:49:00.639 I don't see this too often, but I do caution parents who do CBD 687 00:49:00.760 --> 00:49:04.320 products to kind of keep those away, especially the flavored ones, away from 688 00:49:04.440 --> 00:49:09.000 kiddo's just because I honestly, despite my dad's expertise in CBD and stuff, 689 00:49:09.039 --> 00:49:13.360 I really I don't know enough about it to go, oh, if they 690 00:49:13.400 --> 00:49:16.000 had this much, they'll be fine. And I know with certain CBD products 691 00:49:16.039 --> 00:49:20.960 you never know what other exposure to, whether that be THC or some other 692 00:49:21.119 --> 00:49:25.239 licit drug. How common CBD is now, I know that's another concern that 693 00:49:25.280 --> 00:49:30.360 I have, well, keeping that out of the reach. Yeah, I 694 00:49:30.360 --> 00:49:35.400 didn't bring it up specifically, but with the melatonin sometimes we'll see CBD added 695 00:49:35.400 --> 00:49:37.800 to melotone and and that's one we look for. So here's the thing. 696 00:49:37.880 --> 00:49:46.599 And do I think in general most THC is pretty safe. Yeah it is. 697 00:49:46.920 --> 00:49:51.800 But whenever we start to look at the literature, and everybody goes, 698 00:49:51.840 --> 00:49:54.360 well, look at all of this literature that we have on THC, and 699 00:49:54.400 --> 00:49:58.519 it shows that it's really really safe. And I'm like, Okay, what 700 00:49:58.719 --> 00:50:04.280 percentage of T did they use in those studies? And if you look at 701 00:50:04.320 --> 00:50:09.639 the overwhelming bulk of literature that's out there, if it's more than six percent, 702 00:50:09.920 --> 00:50:15.400 it's an outlying study. We've got THC products now that are will over 703 00:50:15.480 --> 00:50:21.840 forty percent. Oh yeah, And a toddler gets into that they're going to 704 00:50:21.920 --> 00:50:25.440 have some scary type symptoms to try to manage it home, and people go, 705 00:50:25.519 --> 00:50:30.119 well, there's never been a fatality associated with one, Well, there 706 00:50:30.159 --> 00:50:31.760 is one in the literature. If it's not in the literature, it's going 707 00:50:31.800 --> 00:50:36.920 to come out in the literature. Now. Did the kid get positional and 708 00:50:37.000 --> 00:50:42.119 asphyxiate or something like that from having so much C and S depression from it? 709 00:50:42.199 --> 00:50:46.360 Maybe? But these products are not for the faint of heart. Sometimes, 710 00:50:46.400 --> 00:50:50.119 as far as the amount of THC in, I mean, I don't 711 00:50:50.159 --> 00:50:53.159 really know where to hang my shingle out there, draw my line in the 712 00:50:53.199 --> 00:50:57.800 sand with some of this, because there's just not any data out there on 713 00:50:57.840 --> 00:51:01.239 the really high concentrated products. Yeah, I see that. I remember who 714 00:51:01.320 --> 00:51:04.840 I went and visited when I was still in pharmacy school. I went and 715 00:51:04.960 --> 00:51:09.400 visited my dad when he first moved down to Mississippi to work for ENDCMPR, 716 00:51:10.000 --> 00:51:15.480 and he introduced me to one of the world's experts on CBD and THHG doctor 717 00:51:15.519 --> 00:51:17.519 El Sholey, who I'm trying to get on the show. At some point. 718 00:51:19.800 --> 00:51:22.440 They were doing a CBD study at the time, and what they'd done 719 00:51:22.639 --> 00:51:29.000 is they had gone around Mississippi and grabbed random CBD products from a variety of 720 00:51:29.000 --> 00:51:34.079 different CBD shops and stuff like that, and they tested them to see if 721 00:51:34.119 --> 00:51:37.880 what the amount in the bottle was on the label and again, these aren't 722 00:51:37.880 --> 00:51:42.320 your these are They also had products where they were third party tested, they'd 723 00:51:42.320 --> 00:51:45.639 gone through extensive testing to the doss right, and those were fine. But 724 00:51:45.719 --> 00:51:50.280 there were some that had they claimed to have these crazy amounts of CBD in 725 00:51:50.320 --> 00:51:52.599 them and they had none. And they were also I remember him showing me 726 00:51:52.679 --> 00:51:58.800 one bottle and there was this big just it looked like someone dropped a rock 727 00:51:58.920 --> 00:52:00.440 in this bottle, and I go, he goes, you see what's at 728 00:52:00.440 --> 00:52:02.719 the bottom of that and I go, yeah, I see it in there, 729 00:52:02.719 --> 00:52:05.559 but that doesn't look like it belongs in there. He goes, O, 730 00:52:05.639 --> 00:52:09.920 yeah, so one pure CBD like there, it's I can't even begin 731 00:52:09.960 --> 00:52:14.519 to fathom how much of a dose that is in that bottle. And then 732 00:52:14.559 --> 00:52:16.800 most of them just had like I think one of them just had like olive 733 00:52:16.800 --> 00:52:20.920 oil or something like that in there, and it was just the whole point 734 00:52:20.960 --> 00:52:22.239 of all of it was all over the map, and you have no idea 735 00:52:22.239 --> 00:52:28.519 what you're getting, so and I can see that making your job harder trying 736 00:52:28.559 --> 00:52:30.679 to figure out. Hey, that would be a thought in the back of 737 00:52:30.679 --> 00:52:35.960 my mind is do I treat this like this is exactly the dose each time 738 00:52:36.039 --> 00:52:38.199 that's in there? Or are we really not sure? And I feel like 739 00:52:38.280 --> 00:52:42.000 at that point you would just have to hedge your bets on Well, we're 740 00:52:42.000 --> 00:52:45.239 not entirely sure, but we need to have them go get evaluated anyway. 741 00:52:45.599 --> 00:52:50.719 See what are some other interesting questions. I asked my wife this the other 742 00:52:50.800 --> 00:52:53.400 day, especially when over the summertime it's not so prevalent. Now, I 743 00:52:53.519 --> 00:52:57.639 just this is more of in my curiosity, just because I want to hear 744 00:52:57.639 --> 00:53:00.880 your opinion on it. We're both I'm in Tech and you're in Arkansas, 745 00:53:00.920 --> 00:53:06.639 so I know snake bites are common as well. I have to ask your 746 00:53:06.639 --> 00:53:09.880 opinion because Jesse's told me her opinion on it. When what kind? I 747 00:53:09.920 --> 00:53:13.880 know, if you guys are dealing with a rattlesnake or a copperhead or one 748 00:53:13.880 --> 00:53:17.639 of those types of snakes, and I know the protocol is either some form 749 00:53:17.679 --> 00:53:22.840 of anti venom. Do you guys use it either at UAMS or some other 750 00:53:22.920 --> 00:53:27.639 institution. Do you all typically reach for from a poison control center aspect? 751 00:53:27.639 --> 00:53:29.760 Do you all reach for Crowfab or do you all reach for one of the 752 00:53:29.800 --> 00:53:32.679 other ones? Well, we have I don't want to get in any trouble 753 00:53:32.719 --> 00:53:37.960 here. I know people at both companies really well. We have Crowfab on 754 00:53:38.079 --> 00:53:46.119 Formulay at UAMS, and but whenever anyone calls the center and asks me which 755 00:53:46.320 --> 00:53:51.800 anti ven and do you recommend, I will say whichever one you have, 756 00:53:52.000 --> 00:53:54.880 Yep, it doesn't if I'm going to need to give you anti v in 757 00:53:55.000 --> 00:54:00.199 and I'm just going to give you the appropriate dose of whichever product you have. 758 00:54:00.639 --> 00:54:04.800 Now, with that being said, here's something that falls into the nutritional 759 00:54:04.880 --> 00:54:09.920 world that we need to think about and at least geographically here and maybe not 760 00:54:10.039 --> 00:54:15.320 so much where you're at. So the Lone Star tick, named after Texas 761 00:54:15.320 --> 00:54:22.000 because of the white spot on its back and Bolognia americanum and Beloma americanum, 762 00:54:22.280 --> 00:54:28.000 has been shown in some individuals that get bit by the tick to predispose them 763 00:54:28.119 --> 00:54:32.400 to developing hypersensitivity or reactions to Alpha Gail. I have a very close friend 764 00:54:32.480 --> 00:54:36.920 whose wife has that exact thing, got it from a tick bait. So 765 00:54:37.760 --> 00:54:43.079 our experience right now, this is unpublished data and we're working on some things. 766 00:54:43.480 --> 00:54:50.280 My right now, my best guess is individuals are more likely that have 767 00:54:50.440 --> 00:54:55.639 Alpha Gael's sensitivity, maybe more likely to react. And the reason that I 768 00:54:55.679 --> 00:54:59.760 say that and we're actually doing this, we're doing work on this right now, 769 00:55:00.000 --> 00:55:02.159 so that is my bias in this, and I had to be careful 770 00:55:02.199 --> 00:55:09.119 with that. We're running roughly in our center about a thirty percent adverse reaction 771 00:55:09.280 --> 00:55:15.960 clip to ANAVIP, with about six seven percent adverse reaction rate with CROPA, 772 00:55:16.239 --> 00:55:20.400 and we're beginning to show, or we're beginning to pull a little data to 773 00:55:20.440 --> 00:55:25.519 show that at least some of these reactions the patients are Alpha gal positive and 774 00:55:27.159 --> 00:55:30.079 am I to the point that I'm going to come out and tell somebody not 775 00:55:30.159 --> 00:55:32.119 to carry ANAVIP. No, I'm not to this point. I mean, 776 00:55:32.559 --> 00:55:37.400 yeah, the data isn't robust enough, but we're definitely looking at that right 777 00:55:37.480 --> 00:55:42.599 now. And are there things that we potentially could do to reduce the risk 778 00:55:42.639 --> 00:55:47.199 of reaction, because I think ANAVIP has some really cool properties to it that 779 00:55:47.280 --> 00:55:52.440 make it different than crofab. And I can tell you if I was in 780 00:55:52.719 --> 00:55:55.960 Arizona and we're pretty much all I got, We're rattlesnake bites, and I 781 00:55:57.000 --> 00:56:00.800 have no real risk at alpha gel there and the length of time that it 782 00:56:00.840 --> 00:56:07.760 may prevent coagulation issues, and it's pretty appealing. So it's kind of a 783 00:56:07.239 --> 00:56:13.800 it's a hard thing there. So but the long, the short answer to 784 00:56:14.159 --> 00:56:17.280 a long winded discourse here is the fact that we'll use whatever you have. 785 00:56:17.760 --> 00:56:22.440 And like I said, I've had pharmacy managers call and say, which one 786 00:56:22.480 --> 00:56:25.679 do you recommend us carrying, And I'm like, whichever one your P and 787 00:56:25.719 --> 00:56:30.800 T committee wants you to have on formulay. So yeah, and that's pretty 788 00:56:30.840 --> 00:56:31.960 much the way it is. Go ahead, Sorry, I mean to cut 789 00:56:32.000 --> 00:56:35.519 you off now. If you need it, We're gonna We're gonna use what, 790 00:56:35.679 --> 00:56:37.719 like I said, the appropriate dose of whatever you have. So, 791 00:56:38.239 --> 00:56:40.440 yeah, it was I was talking to Jesse that I was going to have 792 00:56:40.480 --> 00:56:43.679 you on it. She was like, you know what I've seen, especially 793 00:56:43.840 --> 00:56:46.639 for the summertime, especially here in Texas, there's a certain flower that like 794 00:56:46.719 --> 00:56:52.079 blooms on the side of the road. Here there are these little blue they're 795 00:56:52.239 --> 00:56:54.559 the blue bonds, the blue bonnets. That's correct. I was blanking on 796 00:56:54.639 --> 00:56:59.159 it. So Jesse was telling me that a lot of kids will go take 797 00:56:59.199 --> 00:57:01.800 photos and the blue bonnets and they won't see the snakes that are there. 798 00:57:01.880 --> 00:57:06.000 So they said that they were getting a lot of snake bites at that time. 799 00:57:06.599 --> 00:57:07.880 And when I told her I was thinking about having you on the show 800 00:57:07.960 --> 00:57:12.199 before I asked you, she was like, ask how if he has any 801 00:57:12.760 --> 00:57:15.800 any preference, not necessarily a preference, but what his opinions are on crovaverse 802 00:57:15.880 --> 00:57:20.400 and of it. They have both at the adult Children's and they use whatever 803 00:57:20.480 --> 00:57:23.199 they feel like they need to. But it's one of those things I just 804 00:57:23.239 --> 00:57:27.199 would have wouldn't have thought too much of because, like you said, my 805 00:57:27.840 --> 00:57:30.079 gut reaction be whatever you have. So we'll do that. I'll forget it. 806 00:57:30.280 --> 00:57:34.039 I had no idea about. Yeah, it's it's pretty interesting. You 807 00:57:34.039 --> 00:57:37.880 said, tuxa AB is the product that was the big New England article, 808 00:57:37.039 --> 00:57:43.039 and those patients were reacting, and those reactions were really severe. I mean 809 00:57:43.760 --> 00:57:47.280 so, and that's all alpha gall related. And if you lay, if 810 00:57:47.280 --> 00:57:52.440 you look at the reactions to tuxon AB and look at the distribution of the 811 00:57:52.480 --> 00:57:58.440 loan start tick, the two areas overlay, and the folks that were not 812 00:57:58.519 --> 00:58:01.800 reacting to tux of MAB in the other regions of the country, they just 813 00:58:01.840 --> 00:58:07.079 weren't. They weren't reacting in the same way. This was a regionalized thing. 814 00:58:07.960 --> 00:58:13.039 And our feeling right now is is that alpha gal binding site on one 815 00:58:13.079 --> 00:58:17.039 of those fragmented portions of those antibodies. Is it more prominent on the FAB 816 00:58:17.199 --> 00:58:24.239 two as it opposed to just the FAB portion of the other product. And 817 00:58:23.920 --> 00:58:27.840 I don't know the answer to that, and I don't think right now anybody 818 00:58:27.920 --> 00:58:30.440 knows the answer to that, but we feel like that that is driving some 819 00:58:30.480 --> 00:58:35.800 of this difference in reaction that we're seeing. So we're actually working with Oklahoma 820 00:58:35.840 --> 00:58:38.199 and we're trying to pull a couple of other regions in the country in to 821 00:58:38.480 --> 00:58:44.039 really look at this and see is it something that's just an anomaly here and 822 00:58:44.800 --> 00:58:47.920 really isn't Alpha gal related or is it kind of the same regions of the 823 00:58:47.960 --> 00:58:52.280 country showing this reaction. One other question I get a lot about, or 824 00:58:52.280 --> 00:58:55.679 I get asked a lot about in the pharmacy, and then well, I 825 00:58:55.719 --> 00:59:00.599 want to touch on one other thing that's not poison Center related. Is I 826 00:59:00.639 --> 00:59:04.960 have been asked multiple times if I need to be because apparently scorpions are a 827 00:59:05.000 --> 00:59:08.159 thing here that we had some of them in Arkansas and I'd see them occasionally, 828 00:59:08.239 --> 00:59:13.960 but apparently down here in Austin, there everywhere our little neighborhood Facebook group 829 00:59:13.960 --> 00:59:17.440 where we live, I mean I see scorpion postings all the time. And 830 00:59:17.559 --> 00:59:21.719 I've had a few patients at the pharmacy that are new to Austin because we 831 00:59:21.719 --> 00:59:24.000 have a lot of people moving here asking what they need to do if they 832 00:59:24.119 --> 00:59:27.960 run in any scorpion issues. So I'd be hard pressed to ask. I 833 00:59:28.000 --> 00:59:30.320 know you've dealt with that at the poison Center. Is there anything there that 834 00:59:30.360 --> 00:59:36.119 you're monitoring for? Is there a particular kind in our areas that we would 835 00:59:36.119 --> 00:59:40.719 be concerned about? Again, most scorpions things in the United States hurt. 836 00:59:42.320 --> 00:59:45.920 Yeah, period. I mean, that's the thing. It's yeah, I'm 837 00:59:45.960 --> 00:59:51.199 sorry you got stung. That's really it's uncomfortable. I get it. Let's 838 00:59:51.400 --> 00:59:54.960 treat things a little bit symptomatically. It's gonna be not fun for a day 839 00:59:55.079 --> 01:00:00.360 or two, and but you're gonna be okay if you move into The area 840 01:00:00.440 --> 01:00:05.639 is mainly areas of Arizona down in along the Mexican border. There they had 841 01:00:05.639 --> 01:00:09.519 the bark scorpion, which is a centrality species and I can't remember the exact 842 01:00:10.159 --> 01:00:15.119 species centroites. I can't remember it's species name. Those are a little more 843 01:00:15.119 --> 01:00:21.719 problematic. And there is antivin and actually for those, it's Anna scorped and 844 01:00:21.760 --> 01:00:24.239 it's actually made by the same company that makes antaviib, which is rare disease 845 01:00:24.280 --> 01:00:30.559 therapeutics RDT, and they will use it there. So, but in Austin, 846 01:00:30.039 --> 01:00:34.039 you don't have that scorpion. There, you got the same variety of 847 01:00:34.079 --> 01:00:37.760 scorpions we have here. Yea, they stayed and they hurt. So yeah, 848 01:00:37.800 --> 01:00:39.119 that's that's the question. That's what I tell people. It's like, 849 01:00:39.159 --> 01:00:42.840 hey, they just hurt, but there's really nothing I'd be concerned about. 850 01:00:42.920 --> 01:00:45.280 But I get I get it's always on. I work a lot of Saturday 851 01:00:45.280 --> 01:00:50.119 shifts at our pharmacy, and I get all sorts of just weird off the 852 01:00:50.159 --> 01:00:52.920 wall questions. And I got asked about that from a lady who'd recently moved 853 01:00:52.960 --> 01:00:57.039 here. If she goes, everybody's telling me I need to worry about scorpions 854 01:00:57.039 --> 01:01:00.559 and blah blah blah. How are there any before we in the picking your 855 01:01:00.920 --> 01:01:05.079 I could talk to you for a long period of time about different pharmacy and 856 01:01:05.519 --> 01:01:08.360 toxicity issues. Are there any other areas out the top of your head that 857 01:01:08.400 --> 01:01:12.880 we may not have touched on here that you feel like the audience may need 858 01:01:12.920 --> 01:01:15.760 to know if they're curious about those things. And then this is a real 859 01:01:15.800 --> 01:01:17.800 simple question to follow up with that is how do they get in contact with 860 01:01:17.880 --> 01:01:22.079 you guys out the poison center. Well, let's take care of that one 861 01:01:22.119 --> 01:01:25.159 first, because that one's really easy. So anywhere in the United States, 862 01:01:25.480 --> 01:01:30.639 you can call eight hundred two two two one two and that will rout you 863 01:01:30.760 --> 01:01:35.159 to the poison center based on the area code from which you are calling. 864 01:01:35.480 --> 01:01:37.880 So that's the only number you need to know nationally, and that will get 865 01:01:37.920 --> 01:01:42.280 you get you to a poison center in your area. Then again is eight 866 01:01:42.360 --> 01:01:45.400 hundred two two two, so pretty easy to remember. Three twos one, 867 01:01:45.480 --> 01:01:50.639 three twos. It's the holiday season and we get a lot of questions about 868 01:01:50.719 --> 01:01:53.559 things around the holidays. For the most part, most of the things points 869 01:01:53.599 --> 01:01:58.639 set is. I was told as a kid old they're poisonous when set is 870 01:01:58.719 --> 01:02:02.199 are really not much to worry about. If you handle them a lot. 871 01:02:02.280 --> 01:02:07.239 There's a risk of maybe some contact dermatitis from it. Mistletoe, somebody ate 872 01:02:07.320 --> 01:02:09.920 quite a bit of it. I think they might could have some problems with 873 01:02:10.000 --> 01:02:14.800 it. Usually not much of a problem. A couple of holly berries and 874 01:02:14.800 --> 01:02:17.079 a child really not much of an issue. Actually, worry more about a 875 01:02:17.159 --> 01:02:22.960 kid maybe halfway swallowing a leaf and getting one of those spiny things it's stuck 876 01:02:22.079 --> 01:02:27.360 somewhere down in their esophagus or something. But for the most part they're pretty 877 01:02:27.360 --> 01:02:30.039 benign. Let me see, what are some other interesting things. One thing, 878 01:02:30.400 --> 01:02:35.960 it's not as prevalent now. People don't make as much homemade candy as 879 01:02:36.000 --> 01:02:39.400 probably they used to. But my mom used to make winter green candy every 880 01:02:39.440 --> 01:02:44.800 year. She had a little jar of methyl solicylate that she would flavor. 881 01:02:45.360 --> 01:02:50.320 This pan of candy with and I was always amazed as a kid that she 882 01:02:50.360 --> 01:02:53.400 would make it in these a nine x thirteen cookie sheet and it would only 883 01:02:53.480 --> 01:03:00.239 take a few drops of oil of winter green to flavor that entire pan of 884 01:03:00.360 --> 01:03:05.519 cant And she had this little three and a half meal bottle that she kept 885 01:03:05.639 --> 01:03:08.440 up in her cabinet, and she had that my entire childhood, and it 886 01:03:08.519 --> 01:03:14.000 was still three quarters or better pool the last time I remember seeing it. 887 01:03:14.320 --> 01:03:20.079 With that being said, methyl halicylate has a skull and crossbones on it for 888 01:03:20.079 --> 01:03:22.440 a reason. And it gets back into kind of what we started with. 889 01:03:22.920 --> 01:03:29.320 Dose makes the poison. What's there? So oil of winter green flavoring is 890 01:03:29.400 --> 01:03:34.239 methyl solicylated. It's akin to aspirn in a way. It's a solicylate. 891 01:03:36.280 --> 01:03:37.880 But you can get bigger bottles of it. You can get a thirty mel 892 01:03:37.960 --> 01:03:43.360 bottle of it, a tea spoon in our toddler. Again is enough to 893 01:03:43.440 --> 01:03:46.920 kill them. So you got this deadly poison that you can make something really 894 01:03:47.039 --> 01:03:51.440 nice out of, which I really enjoyed my mother's ol of winter green candy 895 01:03:51.480 --> 01:03:53.519 when I was a kid. But that's one of the things if you're going 896 01:03:53.559 --> 01:03:57.599 to have around your house. Definitely, there's a reason why it has a 897 01:03:57.639 --> 01:04:00.400 skull and crossbones on the bottle. Most of the other things around the holidays 898 01:04:00.440 --> 01:04:04.239 aren't too much of a problem. You'll something will crop up from time to 899 01:04:04.280 --> 01:04:08.559 time, a new toy or things like that may have an issue related to 900 01:04:08.639 --> 01:04:12.719 it, but it's usually a reasonably saved month. So yeah, correct. 901 01:04:12.960 --> 01:04:15.519 An interesting question that you just brought up in So what area of the like, 902 01:04:15.559 --> 01:04:18.280 what time of year do you guys say you would get most of your 903 01:04:18.320 --> 01:04:24.480 calls. What would be summertime when kids are home from school. That's a 904 01:04:24.480 --> 01:04:29.000 good question and the answer is absolutely that is the correct answer. If you 905 01:04:29.159 --> 01:04:32.800 look at Poison Center data January, February, March, April, May, 906 01:04:33.559 --> 01:04:40.840 it's flat. It's the volume is statistically the same. About June, we 907 01:04:40.880 --> 01:04:45.119 start to see this uptick. It peaks toward the end of July and begins 908 01:04:45.159 --> 01:04:50.039 to start it's downhill slope again in August, and by September it's pretty much 909 01:04:50.079 --> 01:04:55.000 flat again. In September, October, November it's flat again. It's the 910 01:04:55.079 --> 01:04:59.079 same. So yeah, those summer months, and there are multiple reasons where 911 01:04:59.159 --> 01:05:01.719 kids are out of school, more people are outside, they come in contact 912 01:05:01.719 --> 01:05:05.639 with more plants, they come in contact with more animals, things that bite 913 01:05:05.639 --> 01:05:11.159 and sting, using more chemicals, you're using more herbicides or you're using more 914 01:05:11.199 --> 01:05:16.320 pesticides. So all that equals are busier summer. Yeah, I figure that 915 01:05:16.440 --> 01:05:19.320 was the case. Just I mean that's typically how it goes. I mean, 916 01:05:19.400 --> 01:05:21.960 you have more to put traffic in the pharmacy, we have more, 917 01:05:23.559 --> 01:05:27.119 Jesse says. The hospitals are definitely more active in the summer now that when 918 01:05:27.199 --> 01:05:30.960 kids are at home. So one last thing I wanted to ask you about 919 01:05:30.000 --> 01:05:34.639 because I was curious, when are you still involved in And I don't know 920 01:05:34.679 --> 01:05:38.519 if you have liberty to talk about this, but I know you're correct me 921 01:05:38.519 --> 01:05:41.599 if you're wrong, you're the CEO of a company. Is that correct? 922 01:05:41.639 --> 01:05:45.960 Is it ATP Therapeutics? Yes, sir, so can you think me and 923 01:05:45.000 --> 01:05:47.719 you've talked about this in the past, but it's been a while. What 924 01:05:47.960 --> 01:05:51.199 is all that intel? How's that going? If you want to talk about 925 01:05:51.199 --> 01:05:55.199 it? This is one of the last things I wanted to touch on because 926 01:05:55.199 --> 01:05:58.119 I know that was like a personal interest of yours. So what is ATV 927 01:05:58.239 --> 01:06:02.679 Therapeutics all about? So we are have the air in the process and we 928 01:06:02.719 --> 01:06:06.280 have two patents or a patent in the US penning and a patent in Europe 929 01:06:06.360 --> 01:06:12.519 pinning, and is the repurposing of two generic drugs. And I can go 930 01:06:12.559 --> 01:06:16.679 as deep into that as you want me to. So back to drug information. 931 01:06:17.039 --> 01:06:20.400 I get a call one day from a physician and says, hey, 932 01:06:21.039 --> 01:06:27.079 I started my patient on tramadol about a week ago, and he came in 933 01:06:27.159 --> 01:06:30.280 and says, he can't ejaculate. Do you think that could be related to 934 01:06:30.320 --> 01:06:32.440 the tramadol? I said, yeah, this is kind of how it would 935 01:06:32.480 --> 01:06:36.679 do it, and I didn't think anything else about it. And six weeks 936 01:06:36.719 --> 01:06:42.599 go by and someone else asked me a question about tramadol, completely unrelated to 937 01:06:42.679 --> 01:06:45.599 the first question, and jay was more just of a docing type question, 938 01:06:46.039 --> 01:06:50.119 and in the process, for whatever reason, talking to that person, I 939 01:06:50.199 --> 01:06:55.400 was like, huh, there's not a drug on the market for premature ejaculation. 940 01:06:55.880 --> 01:06:59.239 So I go back to my office and I set around and I think 941 01:06:59.239 --> 01:07:01.719 about it for a little wall and I was like, if somebody came to 942 01:07:01.760 --> 01:07:05.920 me and asked me to treat premature ejaculation in someone, how would I do 943 01:07:06.039 --> 01:07:10.039 it? And I thought about it for a pretty good while and actually went 944 01:07:10.159 --> 01:07:14.400 down to your dad's office and said, hey, Bill, what do you 945 01:07:14.440 --> 01:07:17.840 think about this idea? And he goes, man, that's a pretty good 946 01:07:17.880 --> 01:07:25.079 idea. So I went began to look through the literature and I had already 947 01:07:25.079 --> 01:07:30.519 decided on a combination of two drugs, and one is using s ctalopram and 948 01:07:30.920 --> 01:07:33.639 to dalafill. And I did that for a couple of reasons. One, 949 01:07:33.760 --> 01:07:39.440 s ctalan pram is devoid of nora epi effects, wh's less likely to cause 950 01:07:39.480 --> 01:07:45.000 any your rectile type issues. It's purely a serotonin drug and has a lot 951 01:07:45.039 --> 01:07:48.159 of alisteric binding. If you look at some of the data out there, 952 01:07:48.320 --> 01:07:53.679 s ctalan pram appears to work quicker in depression. Well, some of that 953 01:07:53.719 --> 01:07:56.519 may be the alisteric binding. There may be some other reasons for that, 954 01:07:56.840 --> 01:08:00.000 but it was surrounded little lot of this alisteric binding that I was in true. 955 01:08:00.800 --> 01:08:03.760 And then their kinetics matched their half lives, their duration of action are 956 01:08:03.800 --> 01:08:12.119 fairly similar, and so I thought the combination would work better than the single 957 01:08:12.119 --> 01:08:17.039 agent alone. Got a men's clinic in a part of the country here to 958 01:08:17.159 --> 01:08:21.760 actually do a little proof of concept for us on some compounded medication. It 959 01:08:21.800 --> 01:08:26.840 appeared to work and we filed a patent. That's awesome, and it's been 960 01:08:26.880 --> 01:08:30.560 a long process. Hopefully the light is at the end of the tunnel. 961 01:08:30.760 --> 01:08:35.039 So and like I said, I got a patent pending here for it's a 962 01:08:35.079 --> 01:08:39.399 method's patent, and I have a method's patent pending in the EU, so 963 01:08:39.880 --> 01:08:42.560 that's cool. I remember I figured that was what it was for. But 964 01:08:42.640 --> 01:08:45.279 I just wanted to touch face on that. ACCO mean, you talked about 965 01:08:45.279 --> 01:08:48.479 that when I was on Rotation and stuff, and I know how difficult that 966 01:08:48.520 --> 01:08:54.079 patent process can be because one of my men has been on the show a 967 01:08:54.079 --> 01:08:57.640 couple of times. We've talked about the very product. We have a product 968 01:08:57.920 --> 01:09:02.600 containing it's a variety of different methylation donor groups, but it also has got 969 01:09:02.640 --> 01:09:08.039 an active ingredient from sessime Well called cessimon in it. We've seen some interesting 970 01:09:08.359 --> 01:09:12.920 lowering effects in the small clinical trials that they've done at the center, and 971 01:09:13.039 --> 01:09:16.520 it took them quite a while to get a patent for it. And it's 972 01:09:16.560 --> 01:09:19.359 just it's a lot of work that I don't think people realize just how much 973 01:09:19.399 --> 01:09:23.720 effort goes into that whole thing. And it's tough. It's tough so I 974 01:09:23.760 --> 01:09:27.239 commend you for doing that. I was I was gonna I meant to ask 975 01:09:27.279 --> 01:09:29.880 you about that a while ago. Was an old chat every now and then 976 01:09:29.920 --> 01:09:33.000 on occasion. But it's really interesting because me and me at my work we're 977 01:09:33.000 --> 01:09:38.039 in are one of our startups at Nimbus Healthcare. We do a lot of 978 01:09:38.079 --> 01:09:42.720 like men's foremone optimization type stuff, and we're now in the hair loss space 979 01:09:42.760 --> 01:09:45.600 as well as the weight loss space too, and that's definitely an area that 980 01:09:45.640 --> 01:09:50.960 we do get questions about. So it's interesting to know that there's answers out 981 01:09:51.000 --> 01:09:55.680 there. And I haven't had to counsel on anything like that in the pharmacy, 982 01:09:55.760 --> 01:09:59.279 but again, it's always good to know a mover and a shaker in 983 01:09:59.279 --> 01:10:01.640 the field that does know some things about that. For sure. I don't 984 01:10:01.760 --> 01:10:04.039 know, Like I said, it was just it was a good or at 985 01:10:04.079 --> 01:10:08.399 least I thought it was a good idea or at least an interesting idea. 986 01:10:08.840 --> 01:10:13.439 And it does hit when then COVID hit, which just really, I mean, 987 01:10:13.520 --> 01:10:16.920 it derailed everything. Yeah, it's not a fast process in general. 988 01:10:16.960 --> 01:10:19.640 And then if you have something like that happened, I mean, I want 989 01:10:19.680 --> 01:10:23.239 to pick your brain on one last thing and I've said that like four times. 990 01:10:23.279 --> 01:10:28.600 I apologize. I don't know how. I know you've got some friends, 991 01:10:29.199 --> 01:10:32.239 doctor Barkley, I'm pretty sure you're in close kind of are you guys 992 01:10:32.359 --> 01:10:36.560 any idea on what's going on with the drug shortages right now? It's been 993 01:10:36.680 --> 01:10:42.800 kind of crazy to me how hard it's been to just get generic medications from 994 01:10:42.840 --> 01:10:45.319 our wholesaler in general, and it's it just seems random at this point. 995 01:10:45.399 --> 01:10:48.359 Initially I thought it was COVID and the supply chain issues, and it very 996 01:10:48.359 --> 01:10:51.039 well could be that, but I was interesting to see if you know, 997 01:10:51.199 --> 01:10:56.600 if you had any thoughts on why there's so many random products that I just 998 01:10:56.640 --> 01:11:00.640 can't order for people, because it's starting to get really frustrating having to have 999 01:11:00.720 --> 01:11:03.079 gaps in therapy for certain things for patients simply just because I can't get them 1000 01:11:03.079 --> 01:11:08.239 at at time. And I don't know the answer to that. I do 1001 01:11:08.359 --> 01:11:12.760 know that it is incredibly frustrating just dealing with one of the individuals at the 1002 01:11:12.760 --> 01:11:17.920 hospital there that has to supply purement for the hospital ums and just Eve was 1003 01:11:17.960 --> 01:11:25.520 complaining every day it was something and there seemed to be no rhyme or reason 1004 01:11:25.560 --> 01:11:29.439 to it. I'm not a conspiracy theory person. But it almost seems like 1005 01:11:29.479 --> 01:11:33.119 some of this is almost contrived at times. But it yeah, I mean, 1006 01:11:33.279 --> 01:11:40.319 it's a real it's a real issue. So right now, there's no 1007 01:11:40.359 --> 01:11:46.079 one in the country that manufactures fizostick main, so we were we moved around 1008 01:11:46.119 --> 01:11:50.079 and trying to figure out how to use rivstick mean in people within an anti 1009 01:11:50.119 --> 01:11:56.840 colon ergic syndrome, and we found a pretty reasonable workaround with riverstick Mean. 1010 01:11:56.960 --> 01:11:59.760 It doesn't work as fast, but it does seem to work pretty well. 1011 01:12:00.119 --> 01:12:03.640 We have been able to procure a little bit of FISO that was recently released 1012 01:12:04.000 --> 01:12:09.479 by the FDA, so we have a little bit, but a manufacturer out 1013 01:12:09.520 --> 01:12:13.520 there needs to kick it back in and start making some of it. Yeah, 1014 01:12:13.560 --> 01:12:16.600 it's crazy. We've had some interesting shortages and there's and and what blows 1015 01:12:16.720 --> 01:12:21.359 my mind about it all is some of it stuff that's not commonly prescribed, 1016 01:12:21.960 --> 01:12:27.239 like we have I have. We have a few people that take I won't 1017 01:12:27.239 --> 01:12:31.039 even get into the specifics, but like certain medications for transplants that they'll use 1018 01:12:31.640 --> 01:12:34.840 that they've been on for years, and it's just like it's it really it's 1019 01:12:34.920 --> 01:12:40.920 concerning to me that I have to check I have to even think about that. 1020 01:12:41.159 --> 01:12:43.279 Let me hold, let me check and make sure I can get that 1021 01:12:43.319 --> 01:12:47.520 before we fill that prescription. Same thing with with Kreon's been a big one 1022 01:12:47.760 --> 01:12:51.680 for people with pancreatic enzyme issues. That one's been really hard to get. 1023 01:12:51.880 --> 01:12:55.399 But I was just curious if you had any insider knowledge because I was like, 1024 01:12:55.399 --> 01:12:58.800 if this is affecting me at the local independent pharmacy level, I'm sure. 1025 01:12:58.800 --> 01:13:01.600 At the I'm sure, and an institution like UMS, it's probably worse. 1026 01:13:02.640 --> 01:13:05.840 Not to mention, you're in the whole IV drug space and you're dealing 1027 01:13:05.880 --> 01:13:11.399 with other medications that I wouldn't normally come across in just a normal pharmacy setting. 1028 01:13:11.720 --> 01:13:15.079 It's it hits everybody, and like you said, I mean there is 1029 01:13:15.319 --> 01:13:19.560 a very weird quality to it. I mean it's I'm trying to remember what 1030 01:13:19.720 --> 01:13:24.720 size IV bags they were out of for a while. I just couldn't get 1031 01:13:24.720 --> 01:13:27.600 them. Oh yeah, I remember that too. I may have been a 1032 01:13:27.680 --> 01:13:31.119 hundred mil bags, But I'm not sure. It's I don't have the answers 1033 01:13:31.159 --> 01:13:34.640 to that. We need to start a sorrow manufacturing company, Patrick, Yeah, 1034 01:13:34.680 --> 01:13:39.079 we might. That might be the next thing, because something something's got 1035 01:13:39.079 --> 01:13:42.399 to give. Yeah, I think another big one. We do some medication 1036 01:13:42.640 --> 01:13:46.920 ordering for certain surgical centers in the area too, and it's been really hard 1037 01:13:46.920 --> 01:13:50.399 to find lighty Kain with epinephrin. It's weird. It's stuff that you wouldn't 1038 01:13:50.439 --> 01:13:55.520 even think twice about. But about how I appreciate you being on the show, 1039 01:13:55.600 --> 01:13:58.319 it's we're at about an hour and a half, which I could, 1040 01:13:58.439 --> 01:14:00.840 like I said, I know you for a long enough time that I could 1041 01:14:00.880 --> 01:14:04.960 talk to you for a long period of time about a variety of different topics. 1042 01:14:05.000 --> 01:14:08.239 Because I'm not trying to toot your own horn, but you're one of 1043 01:14:08.239 --> 01:14:12.479 the smartest people that I've met in my entire tenure of pharmacy school and all 1044 01:14:12.520 --> 01:14:15.319 the interactions that I've had with you, Saman I really appreciate you coming on. 1045 01:14:15.399 --> 01:14:18.319 I'd love to have you back on other episodes. If there's any other 1046 01:14:18.399 --> 01:14:21.960 topics you want to dive into, I'm more than happy to sit down and 1047 01:14:23.039 --> 01:14:27.119 talk with you. Give your give my best to Tammy and Boone as well. 1048 01:14:27.640 --> 01:14:30.560 I miss you guys back in Arkansas. I need to come back in 1049 01:14:30.920 --> 01:14:33.600 and say hi, well, I miss you being here. And some other 1050 01:14:33.640 --> 01:14:36.880 time we probably are to there's some other areas we can delve off into. 1051 01:14:36.920 --> 01:14:40.920 Fennil would be one of them. We didn't even bring that up tonight. 1052 01:14:41.239 --> 01:14:44.359 Yeah, it's another area for sure. I will definitely have you on because 1053 01:14:44.439 --> 01:14:48.000 I would love to pick your brain on that whole opioid crisis and stuff. 1054 01:14:48.000 --> 01:14:53.279 I have my own opinion on it as a pharmacist in general. But that's 1055 01:14:53.319 --> 01:14:58.039 something that I didn't even honestly think to bring up tonight because I didn't think 1056 01:14:58.359 --> 01:15:00.439 we'd get to it. But is that that's something before we before? Is 1057 01:15:00.479 --> 01:15:04.079 that something you'll see more from? Do you'll get calls about that at the 1058 01:15:04.119 --> 01:15:08.680 center? Now we get a few it. A lot of times physicians won't 1059 01:15:08.680 --> 01:15:12.560 call with a typical opioid overdose. I mean, they deal with them so 1060 01:15:12.880 --> 01:15:16.600 frequently that they won't call, And I don't blame them. The Finnel issue 1061 01:15:16.680 --> 01:15:20.960 is a really interesting issue and there are a lot of nuances to it that 1062 01:15:21.439 --> 01:15:25.399 and I have some pretty strong opinions on it, and I'll probably make a 1063 01:15:25.399 --> 01:15:30.920 few people mad with them, so so i'd love to That's a topic for 1064 01:15:30.960 --> 01:15:32.720 another day, yes, sir, I was. Yeah, I definitely would 1065 01:15:32.760 --> 01:15:35.239 love to have you back on here soon and talk about that because I have 1066 01:15:35.319 --> 01:15:39.520 some I tend to bite my tongue a lot of times with my opinions on 1067 01:15:39.560 --> 01:15:41.960 the whole matter. But again, I'd like to hear yours on that. 1068 01:15:42.039 --> 01:15:45.439 So that's definitely I definitely love to touch on that topic. But how man, 1069 01:15:45.520 --> 01:15:47.479 I appreciate you, Thank you for your time, and I'll have you 1070 01:15:47.520 --> 01:15:50.760 on again soon. Sure, thank you, man, I appreciate it and 1071 01:15:50.880 --> 01:16:12.159 enjoyed it. Thank you for joining us on today's episode of the Wellness Transcription 1072 01:16:12.279 --> 01:16:15.800 Podcast. We hope you're inspired to live a healthier, more purpose filled life 1073 01:16:15.840 --> 01:16:19.840 in Christ. Remember your well being is a gift from God, and by 1074 01:16:19.880 --> 01:16:24.520 taking care of your body, you give him the glory. If you enjoy 1075 01:16:24.560 --> 01:16:28.000 today's episode, please subscribe, share, and leave us a review. We'd 1076 01:16:28.000 --> 01:16:30.640 love to hear from you. Guys. Your continued support helps us spread this 1077 01:16:30.760 --> 01:16:34.840 message of health and faith. Until next time, May God's grace and good 1078 01:16:34.920 --> 01:16:40.039 choices guide your path to a life soul with joy, vitality, and a 1079 01:16:40.079 --> 01:16:43.720 deeper connection with Jesus. God bless you all and we'll see you in the 1080 01:16:43.720 --> 01:16:53.479 next episode.