The Dantastic Mr Tox & Howard

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”. . .

1. Weren’t scared enough by the episode? Awake Under Anesthesia should do just the trick. . .
2. Read about our main subject in the Trial of Orville Lynn Majors, Jr. Another article here.
3. Always trust the nurses. The literature that provided the information to help crack the case.
4. The clinical syndrome of potassium intoxication. And some additional evidence.
5. Some kinetic information about central bolus injections of potassium chloride, and the pharmacokinetics of bolus potassium for you to geek out on.
6. If you’ve never been to Japan, here’s a visual for the “packing of the train” traveling potassium quanta analogy.
7. 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
8. More murder! Blind Eye, by James B. Stewart, the story of serial killer doctor Michael Swango.
9. 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.”
10. They called him Dr. Death. The story of Christopher Duntsch. Also a podcast, but you don’t need another one, do you?

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.

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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.

1. Many of the therapeutics both prescribed and otherwise in the Pharmacological Treatment of Opioid Use Disorder.
2. Mitragynia speciosa korth - self-treatment of opioid withdrawal using kratom.
3. Not only adults are affected by these agents. Neonatal abstinence syndrome due to maternal kratom use.
4. Where can you get these products and agents? Look at the impact of internet pharmacy regulation on opioid analgesics availability.
5. But be careful where you buy. Suspected adulteration of commercial kratom products with 7-hydroxymitragynine.
6. Get intracellular with mu-opioid receptor desensitization by beta-arrestin-2 determines morphine tolerance but not dependence.
7. Some more information as described in beta-arrestin 2 knockout mice.
8. How strong do you like your tea? Quantification of Morphine, Codeine, and Thebaine in Home‐Brewed Poppy Seed Tea by LC‐MS/MS.
9. 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.
10. Some interesting stuff on addiction research and the use of ibogaine, a “vast, uncontrolled experiment.”
11. 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.
12. 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.

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.

1. What area of the brain mediates exercise-induced fatigue and exhaustion? Very likely the dorsomedial hypothalamus (DMH).
2. Just in case you were wondering, inhibition of the DMH decreases hyperthermia and mortality from MDMA given in a warm environment.
3. But, you may ask, how does one go about suppressing the MDMA-evoked sympathetic and behavioral responses?
4. Running on the treadmill, however, will restore the MDMA-mediated hyperthermia prevented by inhibition of the DMH.
5. Running the Indianapolis half-marathon instead of a treadmill? You might wind up taking a bath . . .
6. Running the Boston Marathon may put you at risk for hyponatremia . . .
7. Ergogenic. adjective Intended to enhance physical performance, stamina, or recovery. As in the ergogenic effect of amphetamine.
8. Can you use dantrolene for MDMA-mediated hyperthermia? Nope. Just remember the Dirty on Dantrolene.
9. Body temperature regulation involves a homeostatic balance between heat production and dissipation. This review examines cellular mechanisms involved in MDMA-induced thermogenesis.
10. Turkey burgers . . . delicious turkey burgers pair well with . . . ?

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!

1. “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.
2. Physician self-perception of opioid prescribing is frequently inaccurate
3. A novel assay for detecting clandestine opioids after a heroin overdose
4. Self identification of non pharmaceutical fentanyl exposure
5. The relationship between opioid analgesics and patient satisfaction
6. UMass Tox Overdose Prevention Fund
7. UMass Tox Opioid Safety Videos
8. Dont’ forget to check out Establishing an Opioid Stewardship Program in Your Health System - webinar featuring Dr. Jeanmarie Perone and Dr. Scott Weiner
9. Another compelling video from Dr. Perrone - The Opioid Crisis

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.

1. From the Department of Health in Illinois - synthetic cannabinoids.
2. A brief discussion of this very topic from Leon Gussow.
3. Not the first problem associated with the synthetic cannabinoids. From the archive, Zombie Day in NYC.
4. The emerging threat of superwarfarins: history, detection, mechanisms, and countermeasures.
5. A case of brodifacoum intoxication with marijuana smoking.
6. And if that wasn’t good enough, a case of severe coagulopathy as a consequence of smoking crack cocaine laced with rodenticide.
7. Why is vitamin K so expensive? Rattled by drug price increases, hospitals seek ways to stay on guard.
8. Why don’t we worry about kids with unintentional exposures to brodifacoum?
9. From the Illinois Poison Center on the dangers of “Fake Weed” on NPR.
10. Who was Wally Pipp? Why is Steve the “Wally Pipp” of the Dantastic Tox? That’s an answer for over a few drinks . . .
11. Where have you gone, McGruff the Crime Dog?

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. 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!

1. ACMT Position Statement: Determining Brain Death in Adults After Drug Overdose.
2. American Academy of Neurology. Evidence-based guideline update: Determining brain death in adults.
3. Pediatric determination of brain death. Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations.
4. Know your local regulations. Organ donation legislation and policy
5. Scary. Baclofen overdose mimicking brain death.
6. Grab your copy of Dr. Schaumburg’s excellent textbook. Experimental and Clinical Neurotoxicology.
7. A video demonstrating cold calorics in an awake patient. Nauseating.
8. Fascinating article from the New Yorker. What Does It Mean to Die?

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 explore the neurobehavioral underpinnings of addiction. Learn about the Google Maps of the motivational system of the brain and gain insight into why psychiatric patients and adolescents are such vulnerable populations. And make sure that you check out Dr. Andy Chambers book, The 2 x 4 Model: A Neuroscience-Based Blueprint for the Modern Integrated Addiction and Mental Health Treatment System.

Here is a link to the Robinson and Berridge article from 1993 cited by Dr. Chambers, The Neural Basis of Drug Craving: An Incentive-Sensitization Theory of Addiction.

Who is your favorite addicted character in pop culture?

• Dr. Rick Sanchez
• Dr. Gregory House
• Jessie Pinkman
• Nurse Jackie
• Tyrone Biggums
• Robert Palmer

Special thanks to @prettysimpleduo and @shelovj. Comments, questions, suggestions, guests, recipes? Hit us up @dantastictox

Stay Healthy, True Believers!

Join Dan (@drusyniak) &howard (@heshiegreshie) as they talk turkey with Dr. Guy Weinberg (@lipidguy) about intralipid emulsion therapy. Learn the history of this therapy and some ideas about where it's headed, along with some holiday tips and very special treats. . . 

Truly Delicious Links

• Martha Stewart's Topless Christmas
• How To Spatchcock a Turkey
• Apple Pumpkin Pecan Pie
• Dressing vs Stuffing
• Porcini Turkey Gravy
• SeriousEats.com Guide to Thanksgiving
• NYT Guide to Thanksgiving

Special thanks to @prettysimpleduo and @shelovj. Comments, questions, suggestions, recipes? @dantastictox

Stay Healthy, True Believers!

Special bonus episode. Recorded in the thick of NACCT 2017 in beautiful Vancouver, join Dan (@drusyniak) and &howard (@heshiegreshie) as they ask the tough questions of some of your favorite toxicologists and finally learn what a "nerdle" is. . . 

Follow us on twitter @dantastictox. Let us know if you have any comments, questions or suggestions for upcoming episodes or guests.

Join Dan &howard as we talk with Dr. Jeanmarie Perrone (@JMPerroneMD) about the FDA and taking on “Big Pain” during her time on the FDA Drug Safety and Risk Management committee. Don’t drink the raspberries . . . Brought to you by BrownApron. Stay healthy true believers!

Delicious Links:
John Oliver and Supplements
LA Times - Oxycontin’s 12-hour Problem
The Guardian - These Mothers Saw The Opioid Epidemic Before Anyone Else
Mel Gibson for the Supplement Industry

This statement has not been evaluated by the Food and Drug Administration. This podcast is not intended to diagnose, treat, cure, or prevent any disease.