The Dantastic Mr Tox & Howard

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!

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 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 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 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!