The Dantastic Mr Tox & Howard

We’re back! Join Dan (@drusyniak) &Howard (@heshiegreshie) as they explore the GI tract of the city, build a career of excrement, and determine which bathroom is the cleanest with Dr. Peter Chai (@PeterRchai). We hope that everyone stays safe, washes their hands and wears a mask. Let’s beat this virus together. Delicious Links It’s robots all the way down, influencing many of us in countless ways. From the Fembots, to the Daleks, to Bender. You can make a battery out of almost anything, from a potato, to pennies, to an apple, to a lemon. Although, there are those that would find the latter UNACCEPTABLE. The future is filled with possibility. There are myriad technologies applicable to medicine and toxicology that range from wearable head-mounted devices, to ingestible sensors. There are approaches that can be used to help combat the opioid crisis. From an individual level, using digital pills to measure ingestion patterns, to the community, analyzing opioid exposure in wastewater. The technology can also be used to measure medication adherence and help influence adherence interventions. There’s even current research analyzing wastewater applicable to the COVID-19 crisis. You’ll never really want to know How Dirty Is Your Bathroom . . . But you can also use technology to help keep it clean. There are, naturally, methods to eliminate poop splash from the splash zone. And, of course, Everything Comes Down To Poo from Scrubs Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! We love doing this podcast, and hope you do as well. If you like what you hear, maybe you’d like to buy us a cup of coffee! Thank you to our house band Pretty Simple Duo (@prettysimpleduo) feat. Julia Helene and McKenzie Taylor, our announcer Josh Shelov (@shelovj), and Reverend Matt Winston of Witness Protection Products. Ad at 25:00 . . . Music "Night In Venice" by Kevin MacLeod. License: CC BY Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love! Toilet Paper and Mask by engin akyurt We Have Coffee by Leon Bublitz

  Join Dan (@drusyniak) &Howard (@heshiegreshie) as they get deep into the nephron with Dr. Josh King (@nephrotox). Gather round as we quote Homer Smith, learn why we have a heart (to pump blood to the kidneys, ‘natch), trigger Howard about lithium, and always remember to request the right dose of dialysis. Delicious Links The one, the only, Homer William Smith. "Superficially, it might be said that the function of the kidneys is to make urine; but in a more considered view, one can say that the kidneys make the stuff of philosophy itself." A great article that frames our discussion of how to define kidney injury, Han and Bonventre 2004 "This is analogous to beginning the treatment of patients with acute myocardial infarction 48–72 hours after the coronary occlusion." Here are the AKIN criteria for acute kidney injury And a nice review of biomarkers in acute kidney injury Learn about the signs and symptoms of dialysis disequilibrium syndrome and the diagnosis, treatment, and prevention of hemodialysis emergencies. For the DIY crowd, the CKD-EPI equation and calculator (AKA where that GFR on the labs comes from) Dr. Mitch Halperin’s fantastic physiology study of toluene and why it doesn’t cause RTA . . . Nice review of Balkan endemic nephropathy (and aristolochic acid) The EXTRIP workgroup for extracorporeal treatment of poisoning Here’s the paper by Amdisen and Skjoldborg that showed lithium exiting the CSF in 1969 Here are some more Dad jokes if you didn’t get enough from this episode . . . and of course, this. Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), our announcer Josh Shelov (@shelovj), and Reverend Matt Winston of Witness Protection Products. Ad at 30:03 . . . Music "Pamgaea" by Kevin MacLeod. License: CC BY.  The Bean! By Ravi Patel Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love!

Join Dan (@drusyniak) & Howard (@heshiegreshie) as they take a dive into the world of political poisoning with Dr. Chris Holstege (@ChrisHolstege) and learn why the cure for that acne may be more chips (or not). Thanks as always to @shelovj and @prettysimpleduo. Comments & suggestions - @dantastictox

Welcome home, listeners! Sit back, relax, and join Dan (@drusyniak) &Howard (@heshiegreshie) as they learn how to prevent scorpions from coming home, explore pharmacogenetics, and explore the incredible importance of mentorship, representation, diversity, and equality with Dr. Ayrn O’Connor (@MedToxPGx). Stay safe, wash your hands, physically distance, and wear a mask. Happy Holidays and Happy New Year! Delicious Links Just in case you move to Arizona, here are 5 Simple Ways to Deter Scorpions. Not my face! Some unusual locations for snakebites have been reported. Some information related to the business of Medical Toxicology, including billing and reimbursement for bedside toxicology practice, a medical toxicology admitting service or dedicated toxicology unit, the impact of a toxicology service on the ICU, or among inpatients discharged with a poisoning-related diagnosis, lessons learned and the impact of a specialty code on private practice. Women In Toxicology and the move Towards Gender Equality in Medical Toxicology. There is a beneficial impact of patient-physician racial concordance that impacts infant and maternal mortality, HIV care, cancer screening, provider visits and overall communication. Mentorship in the health professions, and doing it with intention. So now I’m a mentor, what’s in it for me? Special Thanks Thank you for your continued support. We missed you and hope to provide more in 2021. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! We love doing this podcast, and hope you do as well. If you like what you hear, maybe you’d like to buy us a cup of coffee! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), now reincarnated as Bloomington Delta Music (@BloomDeltaMusic), our announcer Josh Shelov (@shelovj), and Reverend Matt Winston and High Priestess Amy Winston of Witness Protection Products. Ad at 27:23 . . . Acknowledgements Music "Funkorama" by Kevin MacLeod. License: CC BY. Sound effects from bbc.co.uk – © copyright BBC, and zapsplat.com. Do Infinite Good by Nick Fewings and We Have Coffee by Leon Bublitz both on unsplash.com. Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love!

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they explore the world of gene editing with Dr. Jillian Theobald (@JillianTheobald). Dive deep into CRISPR and how it is revolutionizing the way we view the genome and what can be done with it, both good and bad. From Bristle blocks to genetic terrorism, it’s a warm hand-knit Holiday Snuggie™ for you to enjoy the end of the year. Happy Holidays from everyone here at Dantastic HQ! Delicious Links Here are a few videos that give an overview of CRISPR and how it works, including a TED talk from Jennifer Doudna who co-invented the technique. Here’s a great episode of Radiolab that also discusses CRISPR. Here’s Part 1 from 2015, and then the update from 2017. “It’s you, Daddy!” Bristle blocks, an indelible toy from childhood. How your morning yogurt revolutionized gene editing. CRISPR is a powerful tool. Many now see this easy-to-use technique as a threat to national safety. Or an uncertain future for humanity. While it can certainly be used nefariously, CRISPR can also help to determine the characterization of putative cancer genes. Or, you can build a better vaccine. Or cure a devastating neuromuscular disease like Duchenne muscular dystrophy? There’s a CRISPR for that. Some even try to build a better self by biohacking their genes. Whenever I read a story of self-experimentation, I always have to link to Who Goes First? The Story of Self-Experimentation in Medicine by Lawrence K. Altman. Got Mutation? Advanced gene editing can correct one base pair at a time. Even the tomatoes aren’t safe. How CRISPR is revolutionizing crops. Just because we can kill all the mosquitos, should we? Here are the most important gene editing stories of 2019. Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! We love doing this podcast and hope you do as well. If you like what you hear, maybe you’d like to buy us a cup of coffee! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), our announcer Josh Shelov (@shelovj), and Reverend Matt Winston of Witness Protection Products. Ad at 26:51 . . . Music "Jingle Bells" by Kevin MacLeod. License: CC-BY Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love!

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they set out to change the conversation about substance use with Bill Kinkle (@billkinkle). This one comes with a warning. We will discuss graphic descriptions of drug use, addiction behaviors and stigmatizing language. Help us to end the stigma associated with addiction. Take the pledge. We pledge to use compassionate, person-centered language when discussing a person with a substance use disorder, and to stop the stigma associated with addiction. Words matter. We pledge to use better ones. Delicious Links As we will continue to repeat over and over, words matter. There’s evidence that word choice impacts on recovery. Biased labels influence medical care and perceptions by health professionals, although it's not so clear for individuals in recovery. Dan is taller than Howard. Dan is better at podcasting. Therefore, taller people are better at podcasting. Think that those things are related? Well, maybe in this case, yes. But, you may be suffering from Berkson’s Bias (or Paradox) . . . Don't treat Berkson’s bias with Maslow's hammer . . . Decriminalization works. Just ask the Portuguese. Institutionalized racism and the war on drugs. Highlighting the analogy of diabetes, albeit in a tongue in cheek fashion. The Use of Insulin in the Treatment of Diabetes: An Analogy to Methadone Maintenance A really good twitter thread from Renee Johnson, looking for suggestions ways to address misperceptions about substance use. Safe injection sites. Another excellent tool in the battle. Why don't we approach substance use disorders like other illnesses with risk mitigation strategies and looking for the root causes? Adverse childhood experiences (ACEs) and social determinants of health may be the direction to follow. Learn more about the neurobehavioral underpinnings of addiction with Dr. Andy Chambers in one of our earlier episodes, Life Is a Highway (S01E07). A fascinating look by Maia Szalavitz at addiction that challenges the idea that it is a disease with a radical perspective. If you want more resources by people who are really good at this, check out Changing The Narrative. Special thanks to them for inspiring this episode. Listen to more of Bill at the Health Professionals in Recovery podcast. Or check out their website or twitter account (@ HPIRPodcast). Read more of Bill’s story here. You really only need to watch this to understand. Narcan Saved my Daddy. Bill with his son Micah in the waiting room of a local urgent care. At the time of this photo, Bill was in acute opioid withdrawal, which negates the idea that people who use drugs don’t care about anything except drugs. Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! We love doing this podcast, and don’t want to stop (Dan . . . ) It takes a lot of time and effort to produce each episode. Like what you hear? Buy us a cup of coffee! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), our announcer Josh Shelov (@shelovj), and Reverend Matt Winston of Witness Protection Products. Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love!  

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they turn on, tune in, and drop out with Dr. Howard McKinney, Jr. during the Summer of Love and the “Decade of Tox”. They’ll remind you to always know your chemist, round up your spotters, chill out in the space station, experience the Wall Of Sound and never drink the Flavor-Aid. Strap in for a wild ride. Delicious Links A brief history of Rock Medicine. Learn more about the Wall of Sound, “the largest, most technologically innovative sound system ever built”, and it’s inventor, Owsley Stanley. It’s really all about the music, the likes of which it is unlikely we will experience again. After Van Halen, but before morning radio host, find out what David Lee Roth’s perfect job was. Ride with the Angels, and one of their founders, Sonny Barger. But be careful, and don’t take a beating, Hunter. Opioid crisis got you in a MOUD? An older way of managing opioid addiction - propoxyphene. A must read for anyone with an interest in toxicology, The Case of the Frozen Addicts. A chemical love story and it’s continuation - PiHKAL and TiHKAL. Psychedelics are now medicine. Rick Doblin played a role in that. If you weren’t already aware of the People's Temple, the Jonestown massacre, we’ve got you. Stop saying “Drink the Kool-Aid”. It was Flavor-Aid, not Kool-Aid, which was used as a genericized trademark. Give the poor Kool Aid man a break. Although, granted, he is feeding the children his own blood . . . Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), our announcer Josh Shelov (@shelovj), and Reverend Matt Winston of Witness Protection Products. Ad at 32:28 . . . And always, thank you Charlie Pellet, The Most Recognizable Voice in New York! Acknowledgements VW Van “Injustice Anywhere” by Vasilios Muselimis. Music from filmmusic.io: "Glitter Blast” by Kevin MacLeod. License: CC BY. Sound effects from Free Sounds Library, Attribution 4.0 International (CC BY 4.0). Cow Moo Sounds, Cow Noises, Running Footsteps, Crowd Sounds , Fly Noise, Water Splash Noise. Additional sound effects from zapsplat.com Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love!

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they explore the world of veterinary toxicology with Dr. Ahna Brutlag, Director of Veterinary Services at the Pet Poison Helpline. Find out how the approach to the poisoned veterinary patient is both similar and different to our bipedal brethren. Explore the overlapping arenas of oral anticoagulant toxicity. Find out what you should never, ever feed your cat or dog, and why dogs are basically quadrupedal stomachs. . . Delicious Links Have a question about a potentially poisoned pet? Check out the website for the Poison Pet Helpline. Here’s a link that takes you directly to What Did Your Pet Ingest? You can also find them on Facebook, follow them on Twitter and ?pin? them on Pinterest. One lick, get sick. Spare the lily, save the kitty. You Ate What was started back in 2012 when Dan and Howard reviewed this article in JMT. It just so happens that Dr. Brutlag was the first author on that paper. Here’s a clip from the podcast, or you can listen to the whole episode here. We sound so young . . . ;) Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), our announcer Josh Shelov (@shelovj), and Reverend Matt Winston of Witness Protection Products. Ad at 30:19. . . Orbie Enjoying a Donut Treat by Camylla Battani. Music from filmmusic.io: "Carefree” by Kevin MacLeod. License: CC BY Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love! Orbie Enjoying a Donut Treat by Camylla Battani

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they speak with Dr. Rick Vetter about all things brown recluse, why you should always inspect your packages very, very carefully, and why Howard will never move to Kansas. Delicious Links The USPS should be known as “The Fearless” . . . Arachnids submitted as suspected brown recluse spiders. . . And brown recluse spiders live where they do. How to Identify and Misidentify a Brown Recluse Spider. Step #1 - Check the Map. . . Step #999999 - if you can count the eyes, YOU ARE TOO CLOSE. A reason for this family to play the lottery . . . An infestation of 2,055 brown recluse spiders and no envenomations in a Kansas home. . . The Myth of the Brown Recluse - Fact, Fear, and Loathing by Dr. Vetter Don’t forget that systemic symptoms can occur as well. Hemolytic anemia following a presumptive brown recluse spider bite. NOT RECLUSE - a mnemonic device to avoid false diagnoses of brown recluse spider bites. Dan is happy to remind NYC of mistakes we’ve made . . . Cutaneous Anthrax Infection initially diagnosed as a brown recluse spider bite. Maratus volans, or the peacock spider, is a species in the jumping spider family with a very interesting mating dance. . . To be an Explorer. A special meal with tempura tarantula in ponzu sauce. “Eight legs. Two fangs. And an attitude.” Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), our announcer Josh Shelov (@shelovj), and Reverend Matt Winston of Witness Protection Products. Ad at 26:15 . . . Peacock Spider Maratus volans by Jurgen Otto. Special thanks to Ice T, Dick Wolf and the cast and crew of Law & Order: SVU for the years of amazing television. Made with love and respect. Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love!

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they speak with Dr. Brent Furbee about Orville Lynn Majors, Jr. a nurse serial killer who was convicted of the murder of 7 patients, but was likely involved in countless others. Find out why nurses know, doctors deny, and administrators push back. Learn why bolus potassium is like a Japanese train during rush hour, find out our favorite physician killers, and why Dan is now heretofore known as “675”. . . Delicious Links Weren’t scared enough by the episode? Awake Under Anesthesia should do just the trick. . . Read about our main subject in the Trial of Orville Lynn Majors, Jr. Another article here. Always trust the nurses. The literature that provided the information to help crack the case. The clinical syndrome of potassium intoxication. And some additional evidence. Some kinetic information about central bolus injections of potassium chloride, and the pharmacokinetics of bolus potassium for you to geek out on. If you’ve never been to Japan, here’s a visual for the “packing of the train” traveling potassium quanta analogy. Both sides of the potassium coin. Hypokalemic periodic paralysis. Don’t forget barium poisoning and toluene abuse and it’s mechanism behind the RTA. #FOAMtox More murder! Blind Eye, by James B. Stewart, the story of serial killer doctor Michael Swango. Must Read. The Devil in the White City, by Erik Larson. Recounts the 1893 World’s Fair in Chicago and the serial killer physician H. H. Holmes and his “murder castle.” They called him Dr. Death. The story of Christopher Duntsch. Also a podcast, but you don’t need another one, do you? Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), our announcer Josh Shelov (@shelovj), and Reverend Matt Winston of Witness Protection Products. Ad at 23:45 . . . Music from filmmusic.io: "Cheery Monday” by Kevin MacLeod. License: CC BY Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love! Ominous Birds by Alex Jones

  Join Dan (@drusyniak) &Howard (@heshiegreshie) as they speak with Dr. Ed Boyer about therapies for opioid use disorder, including kratom, ibogaine, and loperamide. Great stuff, deep science and a dispelling of some myths while recognizing some less than savvy science out there. . . Looking forward to part 2, where we find that the dulcet tones of Dan and Howard are the right frequency to treat your blues. Delicious Links Many of the therapeutics both prescribed and otherwise in the Pharmacological Treatment of Opioid Use Disorder. Mitragynia speciosa korth - self-treatment of opioid withdrawal using kratom. Not only adults are affected by these agents. Neonatal abstinence syndrome due to maternal kratom use. Where can you get these products and agents? Look at the impact of internet pharmacy regulation on opioid analgesics availability. But be careful where you buy. Suspected adulteration of commercial kratom products with 7-hydroxymitragynine. Get intracellular with mu-opioid receptor desensitization by beta-arrestin-2 determines morphine tolerance but not dependence. Some more information as described in beta-arrestin 2 knockout mice. How strong do you like your tea? Quantification of Morphine, Codeine, and Thebaine in Home‐Brewed Poppy Seed Tea by LC‐MS/MS. While out guest certainly doesn’t believe in the magic of ibogaine, there are many out there that still do. Here’s one example of what to look out for . . . in a patient with prolonged multiple cardiac arrhythmias after ingestion of internet purchased ibogaine. Some interesting stuff on addiction research and the use of ibogaine, a “vast, uncontrolled experiment.” Keep your eyes peeled for more cases of tianeptine misuse as reported in poison control center experience with tianeptine: an unregulated pharmaceutical product with potential for abuse. And if you haven’t already read it (and why not?) here is a great post about the toxicity of loperamide used for opioid use disorder - The Worst of Both Worlds. Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), our announcer Josh Shelov (@shelovj), and Reverend Matt Winston of Witness Protection Products. Kraken image by Bryan Alexander. Music "Pamgaea" by Kevin MacLeod. License: CC BY Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love!  

That’s not a lump of coal in your stocking . . . Join Dan (@drusyniak) &Howard (@heshiegreshie) as they speak with Dr. Dan Rusyniak (@drusyniak) live on stage at the 2018 North American Congress of Clinical Toxicology Pre-Meeting Symposium. Dan cleverly tricked Howard into being the foil for his live presentation. Enjoy a couple of turkey burgers as they discuss MDMA and other amphetamines, brown fat, fatigue and why Dan is going straight away to rat-hell. Wishing you all a wonderful holiday season and a Happy New Year from all of us at Mus Maximus. Delicious Links (or a brief preview of Dan’s CV . . . ) What area of the brain mediates exercise-induced fatigue and exhaustion? Very likely the dorsomedial hypothalamus (DMH). Just in case you were wondering, inhibition of the DMH decreases hyperthermia and mortality from MDMA given in a warm environment. But, you may ask, how does one go about suppressing the MDMA-evoked sympathetic and behavioral responses? Running on the treadmill, however, will restore the MDMA-mediated hyperthermia prevented by inhibition of the DMH. Running the Indianapolis half-marathon instead of a treadmill? You might wind up taking a bath . . . Running the Boston Marathon may put you at risk for hyponatremia . . . Ergogenic. adjective Intended to enhance physical performance, stamina, or recovery. As in the ergogenic effect of amphetamine. Can you use dantrolene for MDMA-mediated hyperthermia? Nope. Just remember the Dirty on Dantrolene. Body temperature regulation involves a homeostatic balance between heat production and dissipation. This review examines cellular mechanisms involved in MDMA-induced thermogenesis. Turkey burgers . . . delicious turkey burgers pair well with . . . ? Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), Josh Shelov (@shelovj), Reverend Matt Winston and Witness Protection Products. Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love! Local Forecast Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 License http://creativecommons.org/licenses/by/3.0/  

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they welcome the first Chief Opioid Officer at UMass Memorial Health Care, Dr. Kavita Babu (@kavitababu) and talk about tackling the opioid crisis as toxicologists from boots on the ground to the halls of government. Get involved and get “the right, smart people in the room.” Also welcome a new sponsor, онлайн-журнал интернет-мошенничества! Delicious Links “That’s why we’re here. That’s why we’re crusaders.” UMass launches opioid task force with Dr. Babu as the first chief opioid officer. Physician self-perception of opioid prescribing is frequently inaccurate A novel assay for detecting clandestine opioids after a heroin overdose Self identification of non pharmaceutical fentanyl exposure The relationship between opioid analgesics and patient satisfaction UMass Tox Overdose Prevention Fund UMass Tox Opioid Safety Videos Dont’ forget to check out Establishing an Opioid Stewardship Program in Your Health System - webinar featuring Dr. Jeanmarie Perone and Dr. Scott Weiner Another compelling video from Dr. Perrone - The Opioid Crisis Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), Josh Shelov (@shelovj) and Witness Protection Products. Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love! Kalinka music https://www.youtube.com/watch?v=XzjRwbQdASg  

  Join Dan (@drusyniak) &Howard (@heshiegreshie) as they chat with Dr. Steve Aks as they talk about one of the more concerning toxicologic outbreaks in recent memory - the exposure to brodifacoum through synthetic cannabinoid use. Although still ongoing, this crisis highlights the importance of teamwork and collaboration. Delicious Links From the Department of Health in Illinois - synthetic cannabinoids. A brief discussion of this very topic from Leon Gussow. Not the first problem associated with the synthetic cannabinoids. From the archive, Zombie Day in NYC. The emerging threat of superwarfarins: history, detection, mechanisms, and countermeasures. A case of brodifacoum intoxication with marijuana smoking. And if that wasn’t good enough, a case of severe coagulopathy as a consequence of smoking crack cocaine laced with rodenticide. Why is vitamin K so expensive? Rattled by drug price increases, hospitals seek ways to stay on guard. Why don’t we worry about kids with unintentional exposures to brodifacoum? From the Illinois Poison Center on the dangers of “Fake Weed” on NPR. Who was Wally Pipp? Why is Steve the “Wally Pipp” of the Dantastic Tox? That’s an answer for over a few drinks . . . Where have you gone, McGruff the Crime Dog? Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), Josh Shelov (@shelovj) and Witness Protection Products. Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love!  

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they chat with Dr. Vik Bebarta and learn about cyanide infused bacon, hydrogen sulfide, detergent suicide, military teletoxicology and the variety of antidotes and therapies to make you well. Chock full of smoky goodness, this is a delightful listen for your holiday weekend. Delicious Links Looking out for salad bar terrorism Think salad bar terror is new? Don’t forget the OG, the one, the only, Bhagwan Shree Rajneesh Be thoroughly entranced by this excellent Netflix series on the same. I am Dan’s Ma Anand Sheela. . . Terrorists attempt to use a hydrogen sulfide bomb to destroy a plane. Which also happens to be a the agent in ‘detergent suicide’ in Japan. . . While we’re on the subject, check out the surprising items found at OBL’s compound. Don’t forget to pack your Landjäger in your rucksack Always a good refresher at the Khan Academy Lots of famous cyanide malfeasance . . . The Chicago Tylenol Murders . . . Cyanide Coffee . . . Dr. Robert Ferrante and Dr. Autumn Klein . . . The Peoples Temple Agricultural Project . . . It was inevitable: the scent of bitter almonds always reminded him of the fate of unrequited love. A selection of the excellent work that Dr. Bebarta has done. Hydroxocobalamin vs sodium thiosulfate for acute cyanide Hydroxocobalamin and thiosulfate versus sodium nitrite and sodium thiosulfate for acute cyanide IM sodium nitrite and thiosulfate for acute cyanide Does this smoke inhalation victim require treatment with cyanide antidote? IV cobinamide vs hydroxocobalamin or saline for H2S Bedside toxicology consultation in a combat theater Wartime toxicology - Evaluation of military medical toxicology telemedicine Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), Josh Shelov (@shelovj) and Witness Protection Products. Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love! Sign by Antonio Barroro

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they chat with Dr. Diane Calello and learn what a pediatrician, pediatric emergency physician, addiction specialist, medical toxicologist and lyric soprano does for fun. Learn what makes a kid a kid and what special things to look out for when managing future big humans. Lots to learn here. Delicious Links This one is for our tox peeps. What’s the best non-toxicology diagnosis you’ve made on a toxicology call? #toxnottox Check out this excellent podcast from Radiolab on Poison Centers. Read all about it. Small Poisoned Humans via Tox and Hound. Pediatric Toxicology: Specialized Approach to the Poisoned Child. The great battle rages on. Pork Roll vs Taylor Ham. Who ya gonna chat, text or call? NJPIES! The Prevention of Childhood Lead Toxicity. Listen to more of Diane with the Caritas Chamber Chorale. Or, check her out at The Princeton Singers. Then Governor Christie explains why Jersey Girls don’t pump their own gas. Special Thanks Thank you for your continued support. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), Josh Shelov (@shelovj) Witness Protection Products, @Thor_T_Thor, and of course the multi-talented @DrDianeC and the amazing Caritas Chamber Chorale and Simply Strings for the outro song. Available for download at caritaschamberchorale.org. Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love! Nicola Ricca

Join Dan (@drusyniak) &Howard (@heshiegreshie) as they chat with Dr. Laura Tormoehlen about her experience as a neurologist and toxicologist. Dispel the myths and common misperceptions about the determination of brain death in the toxicology patient and learn the mimics that you need to look out for. Beware the oculovestibular reflex and welcome to Season 2! Delicious Links ACMT Position Statement: Determining Brain Death in Adults After Drug Overdose. American Academy of Neurology. Evidence-based guideline update: Determining brain death in adults. Pediatric determination of brain death. Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations. Know your local regulations. Organ donation legislation and policy Scary. Baclofen overdose mimicking brain death. Grab your copy of Dr. Schaumburg’s excellent textbook. Experimental and Clinical Neurotoxicology. A video demonstrating cold calorics in an awake patient. Nauseating. Fascinating article from the New Yorker. What Does It Mean to Die? Special Thanks Thank you for your continued support and determined feedback. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), Josh Shelov (@shelovj) and Witness Protection Products. Interested in #FOAMtox? Like this podcast? Take a gander at The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love!  

  Join Dan (@drusyniak) &howard (@heshiegreshie) as they palaver with Dr. Geoff Isbister (@geoff_isbister) about the poison playground that is Australia. Snakes, spiders and quetiapine, oh my! Learn what color of snake to look out for (hint: all of them), learn how Australians do research (on themselves), and why generally leaving your house down under is a terrible idea. So be like an Aussie, have no fear and turn up the volume. Delicious Links Join Dr. Isbister at The University of Newcastle Australia clinical toxicology research group The amazing, and bizarre, discovery of Irukandji Syndrome A great overview of neurotoxic marine poisoning And what discussion of Australia would be complete without a discussion of spider bites. And another. . . More than dermal problems. Catecholamine-induced cardiomyopathy resulting from life-threatening funnel-web spider envenoming. “A pints a pound the whole world round”. As it is with intentional overdoses.Quetiapine Poisoning - A Case Series Potentially practice changing, practical approach to a commonly misinterpreted value. Drug induced QT prolongation: the measurement and assessment of the QT interval in clinical practice Hungry? Not sure what to do with that little yellow and brown jar? Hugh Jackman Shows Jimmy How to Really Eat Vegemite The official Twitter account of Vegemite Before trying anything, learn about the pioneers who did it first. Who Goes First? The Story of Self-Experimentation in Medicine by Lawrence K. Altman How a prank phone call to Tobias Drundridge sparked an international controversy. Well, it's true. Apparently, the dingo really did eat (kill) the baby. ReBOA Official Translation Australian: Strewth, I got into a bingle after chucking a u-e on my way to the bottle o. Coppas and ambos came, blood everywhere. Took me to the A&E, it was chockablock. Non-bogan / English: Oh no. I was in a car accident, when I was on my way to the liquor establishment. I was performing a U-turn. The police and the paramedics arrived, there was blood all around. I was taken to the ER and it was full. Australian: G’day ya bastards! Howaaaare youse, awrite? Out in the whoop whoop, if trauma strikes, you’re in the sticks kilometers away from bugger all. With a massive injury, you’d be stuffed if you used outdated technology like the MAST snake. Its pretty flaky mate and is all cracking the shits. Non-bogan / English: Hello friends. How are you? Good? In the Outback, if trauma strikes, you’re in the remote countryside, quite isolated. With massive trauma, you’d be in trouble if you used outdated technology like the MAST (military anti shock trouser) snake. It’s pretty unreliable and quite frustrating. Australian: But thanks to your ‘ol cobbers at Witness Protection Products Straya, we have a better way. ReBOA - Resuscitative Extra-Vascular BOA constrictor. She’s a bloody ripper. It’s got a swish design, unlike other devices that have heads like a dropped pie and frankly, I reckon they’ve got a few ‘roos loose in the top paddock. But with ReBOA, she’ll be right mate. Non-bogan / English: But thanks to your friends at Witness Protection Products Australia, we have a better way. ReBOA. Resuscitative Extravascular BOA constrictor. It’s great. It’s got a nice design, unlike other unattractive devices that I don’t consider sensible. But with ReBOA, it’s going to be fine. Australian: When you’re flat out like a lizard drinking and need to make sure patients, who are like dog’s breakfast, get a fair suck of the sauce bottle, you don’t want to carry on like a pork chop. ReBOA is an absolute piece of piss. Just take the snake and apply right above the budgie smugglers and let nature do her work. No complications. Just continuous, unremitting abdominal pressure. Is that good or what? Bloody oath!! And its a fair dinkum mate. Non-bogan / English: When you’re very busy and need to make good decisions for patients that are a mess, you don’t want to be dramatic. The ReBOA is super easy. Just take the snake and apply right above the undies and let nature do her work. No complications. Just continuous, unremitting abdominal pressure. Is that good? The answer is an enthusiastic yes. Honestly. Australian: In Straya, everything’s out to kill ya, so get the toughest gear around. Don’t be a drongo. REBOA - it’s Aussie for resuscitation. Non-bogan / English: In Australia, everything’s deadly, so get the best tool for the job. Don’t be a fool. ReBOA - it’s Australian for resuscitation. Special Thanks We just want to take a moment to thank you, our listeners, for one year of toxicology fun. This is the last episode of our first season, and we’re thrilled to have you along with us for the ride. As a bit of housekeeping, we’re going to be discontinuing the @dantastictox Twitter handle, and focus our social media efforts on the larger endeavor at The Tox & The Hound. As always, we are looking for feedback - comments, questions, suggestions, recipes, etc. Let us know. Reach us at @toxandhound. We want to hear from you! Thank you to our house band Pretty Simple Duo (@prettysimpleduo), Josh Shelov (@shelovj) and Witness Protection Products, Australia. Interested in #FOAMtox? Like this podcast? Join us over on The Tox and The Hound. It’s like a podcast, but for your eyes. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love! Koala by Holger Link Down Under by lurii78

Join Dan (@drusyniak) &howard (@heshiegreshie) as they discuss all things marijuana with Dr. Andrew Monte (@PreciseMDMonte) on this very special day. Learn about the interaction between marijuana and ERs in Colorado before and after legalization, the influence of Big Green, and why Turtle isn’t the only one experiencing the Entourage effect. We discuss the issues with edibles, airport amnesty bins, and the issues surrounding increased exposure to marijuana including a disturbing uptick in psychiatric presentations. Learn from the experts the management of cannabinoid hyperemesis syndrome with a new item from Chili’s™, olanzapine-to-go. And find out Where’s Waldos? Delicious Links Wang GS. Pediatric Concerns Due to Expanded Cannabis Use: Unintended Consequences of Legalization. J Med Toxicol 2017. doi: 10.1007/s13181-016-0552-x. PMID: 27139708. Colorado Department of Public Health & Environment Marijuana use trends and health effects Hall KE, Monte AA, et al. Mental Health-related Emergency Department Visits Associated With Cannabis in Colorado. Acad Emerg Med 2018. doi: 10.1111/acem.13393. PMID: 29476688. Kim HS, Anderson JD, Saghafi O, Heard KJ, Monte AA. Cyclic vomiting presentations following marijuana liberalization in Colorado. Acad Emerg Med 2015. doi: 10.1111/acem.12655. PMID: 25903855. Bradford AC, Bradford WD. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D. Health Aff 2016. doi: 10.1377/hlthaff.2015.1661. PMID: 27385238. Bell C, Slim J, Flaten HK, Lindberg G, Arek W, Monte AA. Butane Hash Oil Burns Associated with Marijuana Liberalization in Colorado. J Med Toxicol. 2015 Dec; 11(4):422-5. doi: 10.1007/s13181-015-0501-0. PMID: 26289652. Nappe, T. M, & Hoyte, C. O. (2017). Pediatric Death Due to Myocarditis After Exposure to Cannabis. Clinical Practice and Cases in Emergency Medicine, 1(3). http://dx.doi.org/10.5811/cpcem.2017.1.33240. See also the response in the Washington Post, by Ellie Silverman. What to watch Up in Smoke (1978) Fast Times at Ridgemont High (1982) Friday (1995) Half Baked (1998) Harold & Kumar Go to White Castle (2004) What to eat Taylor Ham and Egg sandwich Special Thanks Thanks to Scott Holmes for use of his song “We Made It” (CC BY-NC 4.0). Check out more of his music http://www.scottholmesmusic.com Thanks to the Digital Scholarship Accelerator for providing Dr. Monte with his setup to record this episode. And as always, thank you to our house band Pretty Simple Duo (@prettysimpleduo), Josh Shelov (@shelovj) and Witness Protection Products. Interested in #FOAMtox? Like this podcast? Join us in our new endeavor The Tox and The Hound. It’s like a podcast, but writing. Listen on iTunes or Spotify! Earholes happy? Rate and review! Show the love! Excerpted dialog from the months-long marijuana conversation . . . DR - Sweet. Thanks Andrew. This will be a smoking good podcast. AM - Sounds good. I hadn’t decided on ACMT yet but perhaps this will push me over the edge to go. I’ve got to clear it with my wife and am coming back from DC now so will wait a couple of days to have that discussion, for strategic reasons! Otherwise I get vaporized at home. . . DR - Understand. Give yourself some time to let the smoke clear. AH - Was OOT last week too. Worried I’ll get stoned at home if I push it too early. DR - Yes, wait. You don’t want to get into the weeds on this one. HG - Thanks Andrew. I find that whenever my wife wants to vaporize me for a blitz of behavior that leaves me fried, a nice baked item brings a sense of mellow. Look forward to talking with you, ACMT or not. AM - She gets green with envy when I travel too much. HG - She’s jealous that you are a toke-n ganjapreneur. Alright. I’m wrecked. AM - Alright, these double entendres are way too low bar. Like CBD low. We’ll need to raise the bar for this podcast. Cannabis Cup level. Much higher. KH - And I expect we will have relive these all on Twitter when the podcast drops... AM - Hey guys. I’m just updating you that I won’t be at ACMT after all. Hopefully that will save you the extra podcast baggage, at least. Should I keep a block of time free on 4/20 or do you want to pre-record it? Figured we should hash it out before schedules get too tight. . . DR - Bummer dude. Howard was hoping to say high. We don’t record live so will need to schedule this month. Are their daze that work better for you. This will be a smoking podcast. KH - Please stop. All these puns are going to give me hyperemesis... AM - Take a hot shower and settle down, Kennon. OK, I'm available. Just let me know what works. Is this a joint session or am I going dolo? HG - Don’t harsh on it, bud. It’ll all be mellow. I could do whichever daze sparks your interest. KH - I just wish you guys could hash this out like adults  

A very special episode, on this First Day of April. We want to welcome you to our new endeavor! Rabid Toxicologists are FOAMing at the mouth to launch their blog As medical toxicologists we have sat, laid down, and rolled over, as other medical professionals have dominated FOAMtox and social media. We know that you are begging for toxicology content. We know that the contributions we have individually made over the years are only scratching at the surface. We know this is our territory and it is time we mark it. That is why we are unleashing The Tox and The Hound. We’re collectively taking all of those meaty toxicology bones we have squirreled away over the years and dropping them at the feet of the FOAM community. As you can see, our pack has some of brightest toxicology minds in the country. Each week our hounds will sniff out the toxicology controversies. We will dig up the issues buried in the literature. We will fetch those topics that we have been itching to tackle. We have been slobbering to do this. But we need you, our loyal friends. We don’t want to be nosey, but we want to know what you, the reader, thinks. Let us know what you would like us to sink our teeth into. Hound us. We will do our best to be obedient. But, be patient. It is going to take some training. There will be accidents along the way. But with your help we can get over the hump and become The Big Dog in FOAMtox. Feeling friendly? You know how we like to say hi. Who’s a good dog? We are! @toxandhound