Speaker 1: Hello.
Speaker 2: This is the Itchy and Bitchy Podcast because being itchy
is bitchy and our medical system sucks. I'm doctor Keith Nolica,
a vetnary, allergist and dermatologist.
Speaker 3: And I'm Stephen Miller, a doctor of nursing practice and
a Q Care nurse practitioner.
Speaker 2: Send us your questions at ask at itch not dot com.
We love you, but we're not your doctors. The information
we discuss is not direct medical advice. Please talk to
your provider who is the expert on your care. The
Itchy and BITCHI Podcast is sponsored by doc Itchy Medical
Pets supplements designed to optimize your pet's health with the
latest veterinary medical research. Visit docichi dot com or find
us on Amazon and please click that follow button and
send us a question at ask at itchnot dot com.
Thanks all right, welcome back, and it's good to see
you guys again, or at least have you join us.
This is one of our clinic Crawl episodes where doctor
Miller and I tell you talk to you about one
of the more interesting, intriguing, weird, crazy situations that happened
in the hospital or the clinic. How are you doing today,
doctor Miller Spectac excellent. Are you ready with a story
or you want me to go first? No, I'm good,
you're good.
Speaker 1: You want to go first? All right, we'll hit us up, baby.
Speaker 3: So my scenario revolves around the number one leading cause
of cardiovascular.
Speaker 1: Death, which is happy. You can just be funny, Wall
like this sounds like a bummer.
Speaker 3: Funny, not so funny.
Speaker 1: I'm sorry, but it's real, not funny. People need to know, Okay,
So okay, I'll be quiet.
Speaker 3: So I get these people who come in and they
have hypertenngine, and we put them on medicine, and then
we and we put them on more medicine. We just
and then they get up to four or five medicines
and they come in and they and you ask, and
their blood pressure is still really high, like one hundred
and sixty one hundred and seventy systemic, and you're like, well,
are you taking the medicine you know, I mean, which
compliance is very poor, and people will say yes, yeah,
and I are taking I've given them enough medicine at
this point to knock them down. And I'm like, you've
got so So the issue comes down to clinically, you're
looking at multiple A. So you're looking at compliance, you're
looking at secondary causes of hypertension, so things like renal
arteries to nosis or feel chromosot homa which feel chromosoft
home is very rare.
Speaker 1: Is it a compliance problem?
Speaker 3: Or sleep at which we talked about renal arteries. And
then you get these folks coming in and they end
up in the emergency room because I don't know, they're
on like six pills and they're systelic blood pressures one
hundred and eighty and they end up in the er.
So then you give someone the meds in the hospital and.
Speaker 1: Ban they work.
Speaker 3: No, they're now hypotensive requires oh yeah, because they suddenly
are on all the medicines and so it's it becomes
challenging clinically to assess. But it's important for people to
remember that yes, it's very very important to take the
medications as prescribed and if you're having side effects and
you can't tolerate AMoD, make sure you discuss that with
your provider. There are newer therapies available renal nerved innervation
or alcohol ablation injections long acting injections, YEP. Sometimes we
use that in passion. I actually get really sarcastic. So
I mean, obviously the dog's not going to open the
bottle and take the pills. So I actually will look
at the owners, the pet pa parents and say, you know,
the medicines work better in the dog only if you
take them. Yes, yes, Well, so then it comes down
to I think people feel shame that they're not taking them,
so they come in. You've got to tease through all that.
Speaker 2: And you may not know this, but compliance is a
really really big issue with chronic diseases, so inventory medicine, diabetes, behavior, allergies,
so we actually will look and see how many pills
we prescribed, and maybe even count pills that are left over.
Speaker 1: Or if the owner says.
Speaker 2: Oh, well I have two weeks left and they should
have run out a week ago, we do monitor that.
Speaker 3: So in our clinical trials that we've done of hypertension,
they actually do blood levels on people to check and
compliance is very low. Let's just leave it at that.
And so again, if you're coming into your provider and
they're giving you all these prescriptions or whatever, please please
be honest about taking them. About how many times a
week you take them. Sometimes people are like, oh, yeah,
I take them and then you narrow down they're like, well,
how many times a week might you take them? And
they get a look and they're and it's like this, yeah.
Speaker 2: So, And being honest is really important because if they
add another medication, especially with like hypertension, cardiac, neurologic, seizures,
all of those kind of have really big side effects.
So you know, for me it's an allergist, doing an
extra dose of benadryll is not going to be a
big deal. But the other thing that we work really
hard with is that if there is a problem with
remembering or some barrier to compliance, then we'll work with
the owner and say, okay, well what about putting the
bottle next to your coffee so that every time you
get the coffee, or if for allergy, if you take
an any histamine, great, your dog probably needs one because
they have allergies too, so you know, share the antihistamine.
Speaker 3: It is absolutely shocking the number of people that come
into into a cardiology office or into a clinic, into
their provider and they'll say, oh, I just decided not
to do that, and you're like take the medicine. You're
like okay, okay. Again, that's why the medicine only works
if one puts it down the trap, and so it's
just interesting. I mean blood pressure hypertension again is a
leading calls of cardiovascular death. And so you really want
to know that you've treated your you're blood pressure and
you don't want to go from one eighty to one
hundred and five. So you want to bring it down
slowly over time, and you need sustainable sustainability.
Speaker 2: And again, if you don't want to take the medicines,
don't just start and stop willing Nelly, talk to your provider. Yeah,
that's why I ask why is it you don't want
to or you think they're poisonous, or you don't like
the taste, or you forget, And we can help work
through some of those hurdles.
Speaker 3: So compliance, we have to work on compliants and burier
assessment of the claim. To be honest, they do work
better in the body they do dog cat person.
Speaker 1: Yes, magic.
Speaker 2: Okay, we're going to take a brief break and then
we'll be back and I'll tell my story which is
a little bit more funny. So okay, here we go
join us on the other side. All right, welcome back.
So definitely compliance and they are all sorts of compliance stories.
You know, I had a client that took her dog's
pills and so that's you know, yeah, well I wouldn't
say crazy, but yes, maybe neuro divergent nowadays vergent. Okay, anyway,
so I had a client this week that we were
doing an exam and I have two students who are
actually really good and very thorough, and they were doing
an exam and they kept finding ticks on this dog.
And so ticks are not very good. They spread all
sorts of diseases that ticks bits is.
Speaker 3: Ticks are nasty bad and they have.
Speaker 2: Or likia, lime disease, rocky mountain, spotted fever, bibesiosisantaplasma, all
of these bad diseases. And so we are very aggressive
about insect prevention. We use a class of preventatives called
isox as eleens, which even though it's an oral once
a month, you have less than one percent side effects
because the active and.
Speaker 3: Grade games for the audience. Medicines that are intended for
the animal world, well.
Speaker 2: There is a human version for demodex blephritis, but talk
to your provider about that. But anyway, this is my
vet story. In my clinics, we're talking to yes, so
isoxays ilings less than one percent side effects, and they
go The active ingredient just goes right through the mammal
but is super sensitive for the insects. So anyway, we
keep pulling these ticks off the dog. And the dog's
supposed to be on a product called Simperica, which is
my favorite, full regular strength Symperica. And so so we
go to the owner and we say, you know, we're
finding all of these ticks. Are they on the Symperica?
And they look at us and say yeah, And we're like, okay,
do you know what's going on? And they said are
they all dead? And they were really excited about this,
And why do you think they asked me if they
were all dead? They weren't concerned that they had ticks.
They knew the dog had ticks.
Speaker 3: Did they mix it and spray it on the body
or no?
Speaker 2: No, So they apparently had read the literature and if
the ticks are dead, they're not feeding and they're not
injecting spit into the body and transmitting diseases. So they
read the literature and they just want to know if
they were dead, and the dead ticks the sympirical So.
Speaker 3: They left them on the body the entire time until
they died.
Speaker 1: I well, yes, so they had the hot Well it's
not that crazy.
Speaker 2: So they had such a high burden that they knew
the dog had ticks and they were just too many
to get them all off. And so anyway, the dog
at tics. But what's medically important is are two things. One,
if the ticks are killed within twenty four hours, they
won't transmit the tick born diseases, and that's what these
isock scene xileing socks of xiling products to the Other
thing that's important is that ethically, we actually have a
big discussion with public health issues with this and dogs.
So we can put the dog on a repellent, but
then the dog brings the ticks in, and the ticks
get off the dog and onto the human, and then
the human has exposure.
Speaker 1: So actually it sounds.
Speaker 2: A little bit maybe not so nice, but it's better
that the ticks bite the dog and die within twenty
four hours, then bring them in and share them with
the humans. So finding the dead ticks on the dog
is actually better for the family than having live ticks
on the dog or having them transmitted to the people.
People they were really really excited that they were all
dead ticks. They had done their do your prevention. Yeah,
tick checks are good, but definitely within twenty four hours.
Get the ticks off, kill the ticks is socks as
eileens are excellent.
Speaker 1: Talk to your provider. Okay, any last.
Speaker 3: Word, Steven, Nope, I think again. We're back to compliance
and compliants and complaints and complaints. I don't like the
word complaints. I like the word adherence because adherence is
a little more neutral and it gives you the ability
to assess marriers.
Speaker 2: I like compliance because it's nicer and softer. Okay, anyway,
join us. Visit our sponsor dot kitchi dot com. Visit
our web page, the Itchy and Bitchy dot com. Visit
Facebook Where do we find Facebook? DRM, mellow at I
n B podcasts. All right, we'll see you next time,
and have a great week. Stay healthy, stay safe, get
up and move.
Speaker 3: And watch for your podcast release on Monday morning.
Speaker 2: Monday mornings, and hit the follow button. It really helps
us a lot. All right, Thanks to you next time. Bye,
Thank you for joining us. This is the Itchy and
Itchy Podcast, and please click that follow button and send
us a question. At ask at itchnoth dot com.
Speaker 1: Thanks