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Speaker 1: Hello.

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Speaker 2: This is the Itchy and Bitchy Podcast because being itchy

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is bitchy and our medical system sucks. I'm doctor Keith Nolica,

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a vetnary, allergist and dermatologist.

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Speaker 3: And I'm Stephen Miller, a doctor of nursing practice and

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a Q Care nurse practitioner.

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Speaker 2: Send us your questions at ask at itch not dot com.

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We love you, but we're not your doctors. The information

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we discuss is not direct medical advice. Please talk to

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your provider who is the expert on your care. The

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Itchy and BITCHI Podcast is sponsored by doc Itchy Medical

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Pets supplements designed to optimize your pet's health with the

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latest veterinary medical research. Visit docichi dot com or find

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us on Amazon and please click that follow button and

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send us a question at ask at itchnot dot com.

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Thanks all right, welcome back, and it's good to see

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you guys again, or at least have you join us.

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This is one of our clinic Crawl episodes where doctor

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Miller and I tell you talk to you about one

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of the more interesting, intriguing, weird, crazy situations that happened

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in the hospital or the clinic. How are you doing today,

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doctor Miller Spectac excellent. Are you ready with a story

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or you want me to go first? No, I'm good,

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you're good.

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Speaker 1: You want to go first? All right, we'll hit us up, baby.

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Speaker 3: So my scenario revolves around the number one leading cause

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of cardiovascular.

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Speaker 1: Death, which is happy. You can just be funny, Wall

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like this sounds like a bummer.

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Speaker 3: Funny, not so funny.

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Speaker 1: I'm sorry, but it's real, not funny. People need to know, Okay,

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So okay, I'll be quiet.

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Speaker 3: So I get these people who come in and they

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have hypertenngine, and we put them on medicine, and then

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we and we put them on more medicine. We just

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and then they get up to four or five medicines

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and they come in and they and you ask, and

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their blood pressure is still really high, like one hundred

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and sixty one hundred and seventy systemic, and you're like, well,

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are you taking the medicine you know, I mean, which

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compliance is very poor, and people will say yes, yeah,

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and I are taking I've given them enough medicine at

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this point to knock them down. And I'm like, you've

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got so So the issue comes down to clinically, you're

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looking at multiple A. So you're looking at compliance, you're

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looking at secondary causes of hypertension, so things like renal

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arteries to nosis or feel chromosot homa which feel chromosoft

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home is very rare.

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Speaker 1: Is it a compliance problem?

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Speaker 3: Or sleep at which we talked about renal arteries. And

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then you get these folks coming in and they end

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up in the emergency room because I don't know, they're

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on like six pills and they're systelic blood pressures one

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hundred and eighty and they end up in the er.

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So then you give someone the meds in the hospital and.

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Speaker 1: Ban they work.

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Speaker 3: No, they're now hypotensive requires oh yeah, because they suddenly

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are on all the medicines and so it's it becomes

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challenging clinically to assess. But it's important for people to

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remember that yes, it's very very important to take the

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medications as prescribed and if you're having side effects and

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you can't tolerate AMoD, make sure you discuss that with

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your provider. There are newer therapies available renal nerved innervation

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or alcohol ablation injections long acting injections, YEP. Sometimes we

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use that in passion. I actually get really sarcastic. So

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I mean, obviously the dog's not going to open the

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bottle and take the pills. So I actually will look

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at the owners, the pet pa parents and say, you know,

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the medicines work better in the dog only if you

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take them. Yes, yes, Well, so then it comes down

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to I think people feel shame that they're not taking them,

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so they come in. You've got to tease through all that.

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Speaker 2: And you may not know this, but compliance is a

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really really big issue with chronic diseases, so inventory medicine, diabetes, behavior, allergies,

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so we actually will look and see how many pills

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we prescribed, and maybe even count pills that are left over.

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Speaker 1: Or if the owner says.

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Speaker 2: Oh, well I have two weeks left and they should

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have run out a week ago, we do monitor that.

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Speaker 3: So in our clinical trials that we've done of hypertension,

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they actually do blood levels on people to check and

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compliance is very low. Let's just leave it at that.

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And so again, if you're coming into your provider and

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they're giving you all these prescriptions or whatever, please please

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be honest about taking them. About how many times a

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week you take them. Sometimes people are like, oh, yeah,

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I take them and then you narrow down they're like, well,

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how many times a week might you take them? And

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they get a look and they're and it's like this, yeah.

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Speaker 2: So, And being honest is really important because if they

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add another medication, especially with like hypertension, cardiac, neurologic, seizures,

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all of those kind of have really big side effects.

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So you know, for me it's an allergist, doing an

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extra dose of benadryll is not going to be a

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big deal. But the other thing that we work really

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hard with is that if there is a problem with

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remembering or some barrier to compliance, then we'll work with

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the owner and say, okay, well what about putting the

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bottle next to your coffee so that every time you

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get the coffee, or if for allergy, if you take

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an any histamine, great, your dog probably needs one because

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they have allergies too, so you know, share the antihistamine.

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Speaker 3: It is absolutely shocking the number of people that come

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into into a cardiology office or into a clinic, into

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their provider and they'll say, oh, I just decided not

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to do that, and you're like take the medicine. You're

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like okay, okay. Again, that's why the medicine only works

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if one puts it down the trap, and so it's

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just interesting. I mean blood pressure hypertension again is a

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leading calls of cardiovascular death. And so you really want

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to know that you've treated your you're blood pressure and

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you don't want to go from one eighty to one

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hundred and five. So you want to bring it down

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slowly over time, and you need sustainable sustainability.

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Speaker 2: And again, if you don't want to take the medicines,

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don't just start and stop willing Nelly, talk to your provider. Yeah,

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that's why I ask why is it you don't want

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to or you think they're poisonous, or you don't like

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the taste, or you forget, And we can help work

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through some of those hurdles.

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Speaker 3: So compliance, we have to work on compliants and burier

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assessment of the claim. To be honest, they do work

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better in the body they do dog cat person.

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Speaker 1: Yes, magic.

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Speaker 2: Okay, we're going to take a brief break and then

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we'll be back and I'll tell my story which is

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a little bit more funny. So okay, here we go

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join us on the other side. All right, welcome back.

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So definitely compliance and they are all sorts of compliance stories.

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You know, I had a client that took her dog's

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pills and so that's you know, yeah, well I wouldn't

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say crazy, but yes, maybe neuro divergent nowadays vergent. Okay, anyway,

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so I had a client this week that we were

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doing an exam and I have two students who are

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actually really good and very thorough, and they were doing

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an exam and they kept finding ticks on this dog.

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And so ticks are not very good. They spread all

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sorts of diseases that ticks bits is.

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Speaker 3: Ticks are nasty bad and they have.

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Speaker 2: Or likia, lime disease, rocky mountain, spotted fever, bibesiosisantaplasma, all

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of these bad diseases. And so we are very aggressive

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about insect prevention. We use a class of preventatives called

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isox as eleens, which even though it's an oral once

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a month, you have less than one percent side effects

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because the active and.

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Speaker 3: Grade games for the audience. Medicines that are intended for

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the animal world, well.

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Speaker 2: There is a human version for demodex blephritis, but talk

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to your provider about that. But anyway, this is my

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vet story. In my clinics, we're talking to yes, so

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isoxays ilings less than one percent side effects, and they

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go The active ingredient just goes right through the mammal

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but is super sensitive for the insects. So anyway, we

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keep pulling these ticks off the dog. And the dog's

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supposed to be on a product called Simperica, which is

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my favorite, full regular strength Symperica. And so so we

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go to the owner and we say, you know, we're

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finding all of these ticks. Are they on the Symperica?

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And they look at us and say yeah, And we're like, okay,

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do you know what's going on? And they said are

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they all dead? And they were really excited about this,

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And why do you think they asked me if they

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were all dead? They weren't concerned that they had ticks.

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They knew the dog had ticks.

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Speaker 3: Did they mix it and spray it on the body

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or no?

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Speaker 2: No, So they apparently had read the literature and if

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the ticks are dead, they're not feeding and they're not

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injecting spit into the body and transmitting diseases. So they

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read the literature and they just want to know if

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they were dead, and the dead ticks the sympirical So.

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Speaker 3: They left them on the body the entire time until

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they died.

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Speaker 1: I well, yes, so they had the hot Well it's

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not that crazy.

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Speaker 2: So they had such a high burden that they knew

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the dog had ticks and they were just too many

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to get them all off. And so anyway, the dog

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at tics. But what's medically important is are two things. One,

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if the ticks are killed within twenty four hours, they

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won't transmit the tick born diseases, and that's what these

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isock scene xileing socks of xiling products to the Other

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thing that's important is that ethically, we actually have a

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big discussion with public health issues with this and dogs.

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So we can put the dog on a repellent, but

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then the dog brings the ticks in, and the ticks

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get off the dog and onto the human, and then

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the human has exposure.

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Speaker 1: So actually it sounds.

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Speaker 2: A little bit maybe not so nice, but it's better

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that the ticks bite the dog and die within twenty

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four hours, then bring them in and share them with

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the humans. So finding the dead ticks on the dog

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is actually better for the family than having live ticks

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on the dog or having them transmitted to the people.

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People they were really really excited that they were all

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dead ticks. They had done their do your prevention. Yeah,

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tick checks are good, but definitely within twenty four hours.

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Get the ticks off, kill the ticks is socks as

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eileens are excellent.

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Speaker 1: Talk to your provider. Okay, any last.

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Speaker 3: Word, Steven, Nope, I think again. We're back to compliance

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and compliants and complaints and complaints. I don't like the

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word complaints. I like the word adherence because adherence is

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a little more neutral and it gives you the ability

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to assess marriers.

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Speaker 2: I like compliance because it's nicer and softer. Okay, anyway,

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join us. Visit our sponsor dot kitchi dot com. Visit

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our web page, the Itchy and Bitchy dot com. Visit

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Facebook Where do we find Facebook? DRM, mellow at I

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n B podcasts. All right, we'll see you next time,

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and have a great week. Stay healthy, stay safe, get

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up and move.

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Speaker 3: And watch for your podcast release on Monday morning.

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Speaker 2: Monday mornings, and hit the follow button. It really helps

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us a lot. All right, Thanks to you next time. Bye,

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Thank you for joining us. This is the Itchy and

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Itchy Podcast, and please click that follow button and send

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us a question. At ask at itchnoth dot com.

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Speaker 1: Thanks