Podcasts about stevens johnson

When FDA guidelines failed their client, trial partners Austin Dana and Karen Zahka flipped the script by arguing for clinical judgment, typically a defense position. Hospitalized with an epileptic seizure at age 13, their client was old enough to receive an adult dosage of an anti-seizure medication, according to the FDA – but she weighed only 61 pounds, the weight of a child. That adult dosage led to their client getting Stevens-Johnson syndrome. “Our position was that the defendant should have deviated from the guidelines,” Karen explains to hosts Ben Gideon and Rahul Ravipudi. Tune in as Austin and Karen break down how they secured an $11.9 million verdict.Learn More and Connect☑️ Karen Zahka | LinkedIn☑️ Trial Lawyers For Justice on LinkedIn | Instagram | Facebook | YouTube☑️ Austin Dana | LinkedIn ☑️ Keches Law Group on LinkedIn | Instagram | Facebook | YouTube☑️ Ben Gideon | LinkedIn | Facebook | Instagram☑️ Rahul Ravipudi | LinkedIn | Instagram☑️ Panish Shea Ravipudi LLP on LinkedIn | Facebook | YouTube | Instagram☑️ Gideon Asen on

It's Bizarre News time again! The segment were we discuss timely news stories that are just downright strange.This month, we discuss:- A woman in New York State discovered large, 21-inch human-like footprints in the snow on her driveway, sparking Bigfoot speculation after her dog was alarmed by something in the nearby woods. While the recorded footage has fueled discussion among enthusiasts in a region known for similar reports, skeptics suggest the tracks may simply be animal prints distorted by melting snow.- Victoria Goodwin, wife of "Ghost Adventures" star Aaron Goodwin, was arrested in Nevada for allegedly conspiring to murder her husband after authorities discovered text messages between her and a Florida inmate discussing hitman plans and $11,515 she reportedly set aside for the killing.- A perplexed mother recorded her toddler playing when she noticed an unexplained movement that appeared as if something was pulling the child's leg into the air behind her, sparking speculation about paranormal activity while others suggested optical illusions or natural causes.- A 33-year-old Canadian massage therapist who lost his sight to Stevens-Johnson syndrome is undergoing an innovative osteo-odonto keratoprosthesis procedure that involves removing one of his teeth, inserting an optical lens, placing it in his cheek to develop tissue, and then implanting it into his eye to potentially restore his vision.Patreon: Support Believing the Bizarre and get tons of extra content by joining our Patreon.For updates, news, and extra content, follow Believing the Bizarre on social media:InstagramFacebookTwitterDiscordShop Merch: You can rep Believing the Bizarre and buy some unique merchWant to send BTB something? Ship it here: 3570 Executive Drive, Suite 218, Uniontown, Ohio 44685

Cohost Ogul E. Uner, MD, invites the original host of the podcast, Sila Bal, MD, MPH, to discuss a case of possible Stevens-Johnson syndrome (SJS). The patient is a 55-year-old woman with a recent treatment of ibuprofen and doxycycline for cellulitis on her left foot. She was referred to Dr. Bal due to a concern for SJS. Dr. Bal outlines how patients with SJS typically present and describes her diagnosis and treatment approach in these cases. 

Watch every WBH episode on demand: https://covid19criticalcare.com/courses/whole-body-health-with-dr-saleeby/ In this crucial video, Dr. Saleeby sheds light on the severe, potentially life-threatening interaction between Mebendazole and Metronidazole. As more individuals turn to repurposed drugs like Mebendazole for cancer treatment due to systemic healthcare shortcomings, awareness of this drug interaction is vital. The combination can trigger severe dermatological reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN). It is essential for anyone considering these treatments to work closely with a doctor, whether their oncologist or an adjunctive integrative specialist, and ensure all medications and supplements are disclosed to avoid dangerous interactions. Learn more about 'Whole Body Health' here:
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Featuring perspectives from Dr Matthew S Davids, including the following topics: Introduction: Is Chronic Lymphocytic Leukemia (CLL) the New Chronic Myeloid Leukemia? Cases We Didn't Hear About Last Week (0:00) Case: A man in his early 70s with IGHV-unmutated CLL (trisomy 12, del[17p]) receives ibrutinib for several years and is switched to acalabrutinib to lower the risk of cardiotoxicity — Warren S Brenner, MD (16:39) Case: A man in his mid 70s with relapsed atypical del(17p) CLL who previously received ibrutinib receives venetoclax/obinutuzumab — Bhavana (Tina) Bhatnagar, DO (22:10) Case: A woman in her early 80s with IGHV-mutated CLL begins treatment with zanubrutinib and 6 months later develops altered mental status due to cryptococcal meningitis — Erik Rupard, MD (33:00) Case: A woman in her early 80s with relapsed CLL (del[17p]/TP53 mutation) develops Stevens-Johnson syndrome while receiving ibrutinib — Spencer H Bachow, MD (38:21) Case: A man in his mid 90s with del(13q) CLL under observation for 12 years begins treatment with zanubrutinib and develops significant bruising/ecchymosis — Dr Rupard (41:14) Case: A woman in her late 70s with relapsed del(13q) CLL receives acalabrutinib and develops hyperleukocytosis — Dr Bhatnagar (45:44) Case: A woman in her mid 80s with rising white blood cell counts and asymptomatic recurrence of CLL (trisomy 12) receives rituximab with subsequent addition of venetoclax — Dr Brenner (50:20) Transformed CLL; CAR T-Cell Therapy (53:38) Journal Club with Dr Davids (54:26) CME information and select publications

Pharmacogenomics plays a critical role in personalised medicine, as some adverse drug reactions are genetically determined. Adverse drugs reactions (ADRs) account for 6.5% of hospital admissions in the UK, and the application of pharmacogenomics to look at an individuals response to drugs can significantly enhance patient outcomes and safety. In this episode, our guests discuss how genomic testing can identify patients who will respond to medications and those who may have adverse reactions. We hear more about Genomics England's collaboration with the Medicines and Healthcare products Regulatory Agency in the Yellow Card Biobank and our guests discuss the challenges of implementing pharmacogenomics into the healthcare system. Our host Vivienne Parry, Head of Public Engagement at Genomics England, is joined by Anita Hanson, Research Matron and the Lead Research Nurse for clinical pharmacology at Liverpool University Hospitals NHS Foundation Trust, and Professor Bill Newman, Professor of translational genomic medicine at the Manchester Center for Genomic Medicine, and Professor Matt Brown, Chief Scientific Officer at Genomics England.   "I think we're moving to a place where, rather than just doing that one test that might be relevant to one drug, we'd be able to do a test which at the same price would generate information that could be relevant at further points in your life if you were requiring different types of medicine. So, that information would then be available in your hospital record, in your GP record, that you could have access to it yourself. And then I think ultimately what we would really love to get to a point is where everybody across the whole population just has that information to hand when it's required, so that they're not waiting for the results of a genetic test, it's immediately within their healthcare record."   To learn more about Jane's lived experience with Stevens-Johnson syndrome, visit The Academy of Medical Sciences' (AMS) YouTube channel. The story, co-produced by Areeba Hanif from AMS, provides an in-depth look at Jane's journey. You can watch the video via this link: https://www.youtube.com/watch?v=v4KJtDZJyaA  Want to learn more about personalised medicine? Listen to our Genomics 101 episode where Professor Matt Brown explains what it is in less than 5 minutes: https://www.genomicsengland.co.uk/podcasts/genomics-101-what-is-personalised-medicine  You can read the transcript below or download it here: https://www.genomicsengland.co.uk/assets/documents/Podcast-transcripts/Can-genomic-testing-prevent-adverse-drug-reactions.docx   Vivienne: Hello and welcome to Behind the Genes.  Bill: What we've seen is that the limited adoption so far in the UK and other countries has focused particularly on severe adverse drug reactions. They've been easier to identify and there's a clear relationship between some drugs and some genetic changes where that information is useful. So, a good example has been the recent adoption of pharmacogenetic testing for a gene called DPYD for patients undergoing cancer treatment, particularly breast and bowel cancer. And if you have an absence of the enzyme that that gene makes, if you're given that treatment, then you can end up on intensive care and die, so it's a really significant side effect. But as you say, the most common side effects aren't necessarily fatal, but they can have a huge impact upon people and on their wellbeing.  Vivienne: My name's Vivienne Parry and I'm head of public engagement at Genomics England, and today we'll be discussing the critical role of pharmacogenomics in personalised medicine, highlighting its impact on how well medicines work, their safety, and on patient care. I'm joined today by Professor Bill Newman, professor of translational genomic medicine at the Manchester Centre for Genomic Medicine, Anita Hanson, research matron, a fabulous title, and lead research nurse for clinical pharmacology at the Liverpool University Hospital's NHS Foundation Trust, and Professor Matt Brown, chief scientific officer for Genomics England. And just remember, if you enjoy today's episode, we'd love your support, so please like, share and rate us on wherever you listen to your podcasts.  So, first question to you, Bill, what is pharmacogenomics?  Bill: Thanks Viv. I think there are lots of different definitions, but how I think of pharmacogenetics is by using genetic information to inform how we prescribe drugs, so that they can be safer and more effective. And we're talking about genetic changes that are passed down through families, so these are changes that are found in lots of individuals. We all carry changes in our genes that are important in how we transform and metabolise medicines, and how our bodies respond to them.  Vivienne: Now, you said pharmacogenetics. Is it one of those medicine things like tomato, tomato, or is there a real difference between pharmacogenetics and pharmacogenomics?  Bill: So, people, as you can imagine, do get quite irate about this sort of thing, and there are lots of people that would contest that there is a really big important difference. I suppose that pharmacogenetics is more when you're looking at single changes in a relatively small number of genes, whereas pharmacogenomics is a broader definition, which can involve looking at the whole genome, lots of genes, and also whether those genes are switched on or switched off, so the expression levels of those genes as well would encompass pharmacogenomics. But ultimately it's using genetic information to make drug prescription safer and more effective.  Vivienne: So, we're going to call it pharmacogenomics and we're talking about everything, that's it, we'll go for it. So Matt, just explain if you would the link between pharmacogenomics and personalised medicine. And I know that you've done a big Genomics 101 episode about personalised medicine, but just very briefly, what's the link between the two?  Matt: So, personalised medicine's about using the right dose of the right drug for the right individual. And so pharmacogenomics helps you with not only ensuring that you give a medication which doesn't cause problems for the person who receives it, so an adverse drug reaction, but also that they're actually getting the right dose. Of course, people's ability to metabolise, activate and respond to drugs genetically is often genetically determined, and so sometimes you need to adjust the dose up or down according to a person's genetic background.  Vivienne: Now, one of the things that we've become very aware of is adverse drug reactions, and I think they account for something like six and a half percent of all hospital admissions in the UK, so it's absolutely huge. Is that genetically determined adverse drug reactions?  Matt: So, the answer to that is we believe so. There's quite a bit of data to show that you can reduce the risk of people needing a hospital admission by screening genetic markers, and a lot of the very severe reactions that lead to people being admitted to hospital are very strongly genetically determined. So for example, there are HLA types that affect the risk of adverse drug reactions to commonly used medications for gout, for epilepsy, some HIV medications and so on, where in many health services around the world, including in England, there are already tests available to help prevent those leading to severe reactions. It's likely though that actually the tests we have available only represent a small fraction of the total preventable adverse drug reactions were we to have a formal pre-emptive pharmacogenomics screening programme.  Vivienne: Now, I should say that not all adverse drug reactions are genetic in origin. I mean, I remember a rather nasty incident on the night when I got my exam results for my finals, and I'd actually had a big bee sting and I'd been prescribed antihistamines, and I went out and I drank rather a lot to celebrate, and oh my goodness me, I was rather ill [laughter]. So, you know, not all adverse drug reactions are genetic in origin. There are other things that interact as well, just to make that clear to people.  Matt: Yes, I think that's more an interaction than an adverse drug reaction. In fact frankly, the most common adverse drug reaction in hospitals is probably through excess amounts of water, and that's not medically determined, that's the prescription.  Vivienne: Let me now come to Anita. So, you talk to patients all the time about pharmacogenomics in your role. You've been very much involved in patient and public involvement groups at the Wolfson Centre for Personalised Medicine in Liverpool. What do patients think about pharmacogenomics? Is it something they welcome?  Anita: I think they do welcome pharmacogenomics, especially so with some of the patients who've experienced some of the more serious, life threatening reactions. And so one of our patients has been doing some work with the Academy of Medical Sciences, and she presented to the Sir Colin Dollery lecture in 2022, and she shared her story of having an adverse drug reaction and the importance of pharmacogenomics, and the impact that pharmacogenomics can have on patient care.  Vivienne: Now, I think that was Stevens-Johnson syndrome. We're going to hear in a moment from somebody who did experience Stevens-Johnson's, but just tell us briefly what that is.  Anita: Stevens-Johnson syndrome is a potentially life threatening reaction that can be caused by a viral infection, but is more commonly caused by a medicine. There are certain groups of medicines that can cause this reaction, such as antibiotics or anticonvulsants, nonsteroidal anti-inflammatories, and also a drug called allopurinol, which is used to treat gout. Patients have really serious side effects to this condition, and they're often left with long-term health complications. The morbidity and mortality is considerable as well, and patients often spend a lot of time in hospital and take a long time to recover.   Vivienne: And let's now hear from Jane Burns for someone with lived experience of that Stevens-Johnson syndrome. When Jane Burns was 19, the medicine she took for her epilepsy was changed.  Jane: I remember waking up and feeling really hot, and I was hallucinating, so I was taken to the Royal Liverpool Hospital emergency department by my parents. When I reached A&E, I had a temperature of 40 degrees Celsius. I was given Piriton and paracetamol, and the dermatologist was contacted. My mum had taken my medication to hospital and explained the changeover process with my epilepsy medication. A decision was made to discontinue the Tegretol and I was kept in for observation. Quite rapidly, the rash was changing. Blisters were forming all over my body, my mouth was sore and my jaw ached. My temperature remained very high. It was at this point that Stevens-Johnson syndrome, or SJS, was diagnosed.  Over the next few days, my condition deteriorated rapidly. The rash became deeper in colour. Some of the blisters had burst, but some got larger. I developed ulcers on my mouth and it was extremely painful. I started to lose my hair and my fingernails. As I had now lost 65 percent of my skin, a diagnosis of toxic epidermal necrolysis, or TEN, was made. Survivors of SJS TEN often suffer with long-term visible physical complications, but it is important to also be aware of the psychological effects, with some patients experiencing post-traumatic stress disorder. It's only as I get older that I realise how extremely lucky I am to have survived. Due to medical and nursing expertise, and the research being conducted at the time, my SJS was diagnosed quickly and the medication stopped. This undoubtedly saved my life.  Vivienne: Now, you've been looking at the development of a passport in collaborating with the AMS and the MHRA. Tell me a bit more about that.  Anita: Yes, we set up a patient group at the Wolfson Centre for Personalised Medicine approximately 12 years ago, and Professor Sir Munir Pirmohamed and I, we wanted to explore a little bit more about what was important to patients, really to complement all the scientific and clinical research activity within pharmacogenomics. And patients recognised that, alongside the pharmacogenomic testing, they recognised healthcare professionals didn't really have an awareness of such serious reactions like Stevens-Johnson syndrome, and so they said they would benefit from having a My SJS Passport, which is a booklet that can summarise all of the important information about their care post-discharge, and this can then be used to coordinate and manage their long-term healthcare problems post-discharge and beyond. And so this was designed by survivors for survivors, and it was then evaluated as part of my PhD, and the findings from the work suggest that the passport is like the patient's voice, and it really does kind of validate their diagnosis and raises awareness of SJS amongst healthcare professionals. So, really excellent findings from the research, and the patients think it's a wonderful benefit to them.  Vivienne: So, it's a bit like a kind of paper version of the bracelet that you sometimes see people wearing that are on steroids, for instance.  Anita: It is like that, and it's wonderful because it's a handheld source of valuable information that they can share with healthcare professionals. And this is particularly important if they're admitted in an emergency and they can't speak for themselves. And so the passport has all that valuable information, so that patients aren't prescribed that drug again, so it prevents them experiencing a serious adverse drug reaction again.   Vivienne: So, Stevens-Johnson, Bill, is a really scary side effect, but what about the day to day benefits of pharmacogenomics for patients?  Bill: So, what we've seen is that the limited adoption so far in the UK and other countries has focused particularly on severe adverse drug reactions. They've been easier to identify and there's a clear relationship between some drugs and some genetic changes where that information is useful. So a good example has been the recent adoption of pharmacogenetic testing for a gene called DPYD for patients undergoing cancer treatment, particularly breast and bowel cancer. And if you have an absence of the enzyme that that gene makes, if you're given that treatment, then you can end up on intensive care and die, so it's a really significant side effect. But as you say, the most common side effects aren't necessarily fatal, but they can have a huge impact upon people and on their wellbeing.   And it's not just in terms of side effects. It's in terms of the effectiveness of the medicine. Because if a person is prescribed a medicine that doesn't or isn't going to work for them then it can take them longer to recover, to get onto the right medicine. That can have all sorts of detrimental effects. And so when we're thinking about introducing pharmacogenetics more broadly rather than just on a single drug or a single gene basis, we're thinking about that for common drugs like antidepressants, painkillers, statins, the drugs that GPs are often prescribing on a regular basis to a whole range of patients.  Vivienne: So, to go back to you, Anita, we're really talking about dose here, aren't we, whether you need twice the dose or half the dose depending on how quickly your body metabolises that particular medicine. How do patients view that?  Anita: Well, the patient in question who presented for the Academy of Medical Sciences, I mean, her take on this was, she thinks pharmacogenetics is wonderful because it will allow doctors and nurses to then prescribe the right drug, but also to adapt the dose accordingly to make sure that they get the best outcome, which provides the maximum benefit while also minimising any potential harm. And so from her perspective, that was one of the real benefits of pharmacogenomics. But she also highlighted about the benefits for future generations, the fear of her son taking the same medicine and experiencing the same reaction. And so I think her concerns were, if we have pharmacogenetic testing for a panel of medicines, as Bill mentioned then, then perhaps this would be fantastic for our children as they grow up, and we can identify and predict and prevent these type of reactions happening to future generations.  Vivienne: And some of these drugs, Bill, are really very common indeed, something like codeine. Just tell us about codeine, ‘cos it's something – whenever I tell this to friends [laughter], they're always completely entranced by the idea that some people don't need nearly as much codeine as others.  Bill: Yeah, so codeine is a drug that's very commonly used as a painkiller. To have its real effect, it needs to be converted in the body to a different drug called morphine, and that is done by an enzyme which is made by a gene called CYP2D6. And we all carry changes in CYP2D6, and the frequency of those variants, whether they make the gene work too much or whether they make it work too little, they vary enormously across the world, so that if you go to parts of Africa, about 30 percent of the population will make more of the CYP2D6, and so they will convert the codeine much more quickly, whereas if you go to the UK, maybe up to ten percent of the white population in the UK just won't be converting codeine to morphine at all, so they won't get any benefit from the drug. So at both ends, you have some people that don't respond and some people that respond a little bit too much so that they need either an alternative drug or they need a different dose.  Vivienne: So, all those people who say, you know, “My headache hasn't been touched by this painkiller,” and we say, “What a wimp you're being,” actually, it's to do with genetics.  Bill: Yeah, absolutely. There's a biological reason why people don't – not for everybody, but for a significant number of people, that's absolutely right, and we can be far more tailored in how we prescribe medication, and get people onto painkillers that work for them much more quickly.  Vivienne: And that's so interesting that it varies by where you come from in the world, because that means we need to give particular attention – and I'm thinking, Anita, to working with patients from different community groups, to make sure that they understand the need for pharmacogenomics.  Anita: I think that's really important, Vivienne, and I think we are now having discussions with the likes of Canada SJS awareness group, and also people have been in touch with me from South Africa because people have requested the passport now to be used in different countries, because they think it's a wonderful tool, and it's about raising awareness of pharmacogenomics and the potential benefits of that, and being able to share the tools that we've got to help patients once they've experienced a serious reaction.  Vivienne: So, pharmacogenomics clearly is important in the prevention of adverse drug reactions, better and more accurate prescribing, reduced medicines wastage. Does this mean that it's also going to save money, Bill, for the NHS?  Bill: Potentially. It should do if it's applied properly, but there's lots of work to make sure that not only are we using the right evidence and using the right types of tests in the laboratory, but we're getting the information to prescribers, so to GPs, to pharmacists, to hospital doctors, in a way that is understandable and meaningful, such that they can then act upon that information. So, the money will only be saved and then can be reused for healthcare if the whole process and the whole pathway works, and that information is used effectively.  Vivienne: So, a lot of research to make sure that all of that is in place, and to demonstrate the potential cost savings.  Bill: Yes. I mean, there are very nice studies that have been done already in parts of the world that have shown that the savings that could be accrued for applying pharmacogenetics across common conditions like depression, like in patients to prevent secondary types of strokes, are enormous. They run into hundreds of millions of pounds or dollars. But there is an initial investment that is required to make sure that we have the testing in place, that we have the digital pathways to move the information in place, and that there's the education and training, so that health professionals know how to use the information. But the potential is absolutely enormous.  Vivienne: Matt, can I turn now to the yellow card. So, people will be very familiar with the yellow card system. So, if you have an adverse reaction, you can send a yellow card in – I mean, literally, it is a yellow card [laughter]. It does exactly what it says on the tin. You send a yellow card to the MHRA, and they note if there's been an adverse effect of a particular medicine. But Genomics England is teaming up with the MHRA to do something more with yellow cards, and we're also doing this with the Yellow Card Biobank. Tell us a bit more.  Matt: So, yellow card's a great scheme that was set up decades ago, initially starting off, as you said, with literally yellow cards, but now actually most submissions actually come online. And it's important to note that submissions can come not just from healthcare providers, but majority of submissions actually come from patients themselves, and that people should feel free, if they feel they've had an adverse drug reaction, to report that themselves rather than necessarily depending on a medical practitioner or the healthcare provider to create that report. So, Genomics England is partnering with the MHRA in building what's called the Yellow Card Biobank, the goal of which is to identify genetic markers for adverse drug reactions earlier than has occurred in the past, so that we can then introduce genetic tests to prevent these adverse drug reactions much sooner than has occurred previously.   So, what we're doing is basically at the moment we're doing a pilot, but the ultimate plan is that in future, patients who report a serious adverse drug reaction through the Yellow Card Biobank will be asked to provide a sample, a blood sample, that we then screen. We do a whole genome sequence on it, and then combine these with patients who've had like adverse drug reactions and identify genetic markers for that adverse drug reaction medication earlier, that can then be introduced into clinical practice earlier. And this should reduce by decades the amount of time between when adverse drug reactions first start occurring with medications and us then being able to translate that into a preventative mechanism.  Vivienne: And will that scheme discover, do you think, new interactions that you didn't know about before? Or do you expect it to turn up what you already know about?  Matt: No, I really think there's a lot of discovery that is yet to happen here. In particular, even for drugs that we know cause adverse drug reactions, mostly they've only been studied in people of European ancestry and often in East Asian ancestry, but in many other ancestries that are really important in the global population and in the UK population, like African ancestry and South Asian ancestries, we have very little data. And even within Africa, which is an area which is genetically diverse as the rest of the world put together, we really don't know what different ethnicities within Africa, actually what their genetic background is with regard to adverse drug reactions.  The other thing I'd say is that there are a lot of new medications which have simply not been studied well enough. And lastly, that at the moment people are focused on adverse drug reactions being due to single genetic variants, when we know from the model of most human diseases that most human diseases are actually caused by combinations of genetic variants interacting with one another, so-called common disease type genetics, and that probably is similarly important with regard to pharmacogenomics as it is to overall human diseases. That is, it's far more common that these are actually due to common variants interacting with one another rather than the rare variants that we've been studying to date.  Vivienne: So, it's a kind of cocktail effect, if you like. You know, you need lots of genes working together and that will produce a reaction that you may not have expected if you'd looked at a single gene alone.  Matt: That's absolutely correct, and there's an increasing amount of evidence to show that that is the case with medications, but it's really very early days for research in that field. And the Yellow Card Biobank will be one of many approaches that will discover these genetic variants in years to come.  Vivienne: Now, Matt's a research scientist. Bill, you're on the frontline in the NHS. How quickly can this sort of finding be translated into care for people in the NHS?  Bill: So, really quickly is the simple answer to that, Viv. If we look at examples from a number of years ago, there's a drug called azathioprine that Matt has used lots in some of his patients. In rheumatology, it's used for patients with inflammatory bowel disease. And the first studies that showed that there was a gene that was relevant to having bad reactions to that drug came out in the 1980s, but it wasn't until well into this century, so probably 30-plus years later that we were routinely using that test in clinical medicine. So, there was an enormous lot of hesitancy about adopting that type of testing, and a bit of uncertainty. If you move forward to work that our colleague Munir Pirmohamed in Liverpool has done with colleagues in Australia like Simon Mallal around HIV medicine, there was this discovery that a drug called abacavir, that if you carried a particular genetic change, that you had a much higher risk of having a really severe reaction to that. The adoption from the initial discovery to routine, worldwide testing happened within four years.   So, already we've seen a significant change in the appetite to move quickly to adopt this type of testing, and I see certainly within the NHS and within other health systems around the world, a real desire to adopt pharmacogenetics into routine clinical practice quickly and at scale, but also as part of a broader package of care, which doesn't just solely focus on genetics, but thinks about all the other parts that are important in how we respond to medication. So, making sure we're not on unusual combinations of drugs, or that we're taking our medicine at the right time and with food or not with food, and all of those other things that are really important. And if you link that to the pharmacogenetics, we're going to have a much safer, more effective medicines world.  Vivienne: I think one of the joys of working at Genomics England is that you see some of this work really going into clinical practice very fast indeed. And I should say actually that the Wolfson Centre for Personalised Medicine, the PPI group that Anita looks after so well, they've been very important in recruiting people to Yellow Card Biobank. And if anyone's listening to this, Matt, and wants to be part of this, how do they get involved? Or is it simply through the yellow card?  Matt: So at the moment, the Yellow Card Biobank is focusing on alopurinol.   Vivienne: So, that's a medicine you take for gout.  Matt: Which I use a lot in my rheumatology clinical practice. And direct acting oral anticoagulants, DOACs, which are used for vascular disease therapies and haemorrhage as a result of that. So, the contact details are available through the MHRA website, but I think more importantly, it's just that people be aware of the yellow card system itself, and that if they do experience adverse drug reactions, that they do actually complete a report form, ‘cos I think still actually a lot of adverse drug reactions go unreported.  Vivienne: I'm forgetting of course that we see Matt all the time in the Genomics England office and we don't think that he has any other home [laughter] than Genomics England, but of course he still sees some patients in rheumatology clinic. So, I want to now look to the future. I mean, I'm, as you both know, a huge enthusiast for pharmacogenomics, ‘cos it's the thing that actually, when you talk to patients or just the general public, they just get it straight away. They can't think why, if you knew about pharmacogenomics, why you wouldn't want to do it. But it's not necessarily an easy thing to do. How can we move in the future, Bill, to a more proactive approach for pharmacogenomics testing? Where would we start?  Bill: Yes, so I think we've built up really good confidence that pharmacogenetics is a good thing to be doing. Currently, we're doing that predominantly at the point when a patient needs a particular medicine. That's the time that you would think about doing a genetic test. And previously, that genetic test would only be relevant for that specific drug. I think we're moving to a place where, rather than just doing that one test that might be relevant to one drug, we'd be able to do a test which at the same price would generate information that could be relevant at further points in your life if you were requiring different types of medicine. So, that information would then be available in your hospital record, in your GP record, that you could have access to it yourself. And then I think ultimately what we would really love to get to a point is where everybody across the whole population just has that information to hand when it's required, so that they're not waiting for the results of a genetic test, it's immediately within their healthcare record. That's what we'd call pre-emptive pharmacogenetic testing, and I think that's the golden land that we want to reach.  Vivienne: So for instance, I might have it on my NHS app, and when I go to a doctor and they prescribe something, I show my app to the GP, or something pops up on the GP's screen, or maybe it's something that pops up on the pharmacist's screen.  Bill: I think that's right. I think that's what we're looking to get to that point. We know that colleagues in the Netherlands have made some great progress at developing pathways around that. There's a lot of public support for that. And pharmacists are very engaged in that. In the UK, the pharmacists, over the last few years, have really taken a very active role to really push forward this area of medicine, and this should be seen as something that is relevant to all people, and all health professionals should be engaged with it.  Vivienne: And on a scale of one to ten, how difficult is it going to be to implement in the NHS?  Bill: So, that's a difficult question. I think the first thing is identifying what the challenges are. So I have not given you a number, I've turned into a politician, not answered the question. So, I think what has happened over the last few years, and some of our work within the NHS Network of Excellence in pharmacogenetics and some of the other programmes of work that have been going on, is a really good, honest look at what it is we need to do to try to achieve pharmacogenetics implementation and routine use. I don't think the challenge is going to be predominantly in the laboratory. I think we've got phenomenal laboratories. I think we've got great people doing great genetic testing. I think the biggest challenges are going to be about how you present the data, and that data is accessible. And then ensuring that health professionals really feel that this is information that isn't getting in the way of their clinical practice, but really making a difference and enhancing it, and of benefit both to the healthcare system but more importantly to the patients.  Vivienne: Now, when I hear you both talk, my mind turns to drug discovery and research, and Matt, I'm quite sure that that's right at the top of your mind. Tell us how pharmacogenomics can help in drug discovery and research.  Matt: So, pharmacogenomics, I think actually just genetic profiling of diseases in itself just to start off with is actually a really good way of identifying new potential therapeutic targets, and also from derisking drug development programmes by highlighting likely adverse drug reactions of medications that are being considered for therapeutic trials, or targets that are being considered for therapeutic development. Pharmacogenomics beyond that is actually largely about – well, it enables drug development programmes by enabling you to target people who are more likely to respond, and avoid people who are more likely to have adverse drug reactions. And so that therapeutic index of the balance between likely efficacy versus likely toxicity, genetics can really play into that and enable medications to be used where otherwise they might have failed.  This is most apparent I think in the cancer world. A classic example there, for example, is the development of a class of medications called EGFR inhibitors, which were developed for lung cancer, and in the initial cancer trials, actually were demonstrated to be ineffective, until people trialled them in East Asia and found that they were effective, and that that turns out to be because the type of cancers that respond to them are those that have mutations in the EGFR gene, and that that's common in East Asians. We now know that, wherever you are in the world, whether you're East Asian or European or whatever, if you have a lung adenocarcinoma with an EGFR mutation, you're very likely to respond to these medications. And so that pharmacogenomic discovery basically rescued a class of medication which is now probably the most widely used medication for lung adenocarcinomas, so a huge beneficial effect. And that example is repeated across multiple different cancer types, cancer medication types, and I'm sure in other fields we'll see that with expansive new medications coming in for molecularly targeted therapies in particular.  Vivienne: So, smaller and more effective trials rather than larger trials that perhaps seem not to work but actually haven't been tailored enough to the patients that are most likely to benefit.  Matt: Yeah, well, particularly now that drug development programmes tend to be very targeted at specific genetic targets, pharmacogenetics is much more likely to play a role in identifying patients who are going to respond to those medications. So, I think many people in the drug development world would like to see that, for any significant drug development programme, there's a proper associated pharmacogenomic programme to come up with molecular markers predicting a response.  Vivienne: We're going to wrap up there. Thank you so much to our guests, Bill Newman, Anita Hanson, Matt Brown, and our patient Jane Burns. Thank you so much for joining us today to discuss pharmacogenomics in personalised medicine, and the benefits, the challenges and the future prospects for integrating pharmacogenomics into healthcare systems. And if you'd like to hear more podcasts like this, please subscribe to Behind the Genes. It's on your favourite podcast app. Thank you so much for listening. I've been your host, Vivienne Parry. This podcast was edited by Bill Griffin at Ventoux Digital and produced by the wonderful Naimah. Bye for now. 

My guest this week is California rapper-producer BbyAfricka. We spoke about Saltburn, Joker, A Clockwork Orange, how she transitioned from producing to rapping, the difference between being funny and being real, how her battle with Stevens-Johnson syndrome changed the way she makes music, and the creative process behind her last two albums—2022's The Art of Geekin' and this year's The Rapture. Come fuck with us.The Art of Geekin' and The Rapture are both available wherever music is sold, streamed, or stolen. Follow BbyAfricka  on Instagram and TikTok (@bbyafricka) and Twitter (@jasminearmanii)Join the Reel Notes Patreon today for as little as $5/month to get early access to episodes, our Discord server, exclusive bonus interviews and reviews, and more!  My first book ever, Reel Notes: Culture Writing on the Margins of Music and Movies, is out on March 8, 2024, via 4PM Publishing. Pre-order a digital copy on Amazon here.Reel Notes stands in solidarity with the oppressed peoples of Palestine, the Congo, Sudan, Tigray, and Haiti. Please consider donating to the Palestine Children's Relief Fund,  The Palestinian Youth Movement, Medical Aid for Palestinians, HealAfrica, FreeTigray, and/or Hope For Haiti.  For information about contacting your representatives to demand a ceasefire, finding protests, and other tools, check out CeasefireToday!Follow me on Instagram (@cinemasai), Twitter (@CineMasai_), TikTok (@cinemasai), and Letterboxd (@CineMasai)Support the show

We cover both Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), including their definitions, causes and pathophysiology. Also includes the signs and symptoms, diagnosis and severity scoring, and treatment options. Consider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Stevens-Johnson Syndrome / What is Toxic Epidermal Necrolysis? 0:37 Stevens-Johnson Syndrome Pathophysiology2:15 Stevens-Johnson Syndrome Signs and Symptoms3:23 Stevens-Johnson Syndrome Diagnosis4:39 Stevens-Johnson Syndrome TreatmentReferencesBMJ Best Practice (2022) Stevens-Johnson syndrome and toxic epidermal necrolysis. Available at https://bestpractice.bmj.com/topics/en-gb/237Julia Benedetti  MD - MSD Manual Pro (2022) Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) ****Available at https://www.msdmanuals.com/professional/dermatologic-disorders/hypersensitivity-and-reactive-skin-disorders/stevens-johnson-syndrome-sjs-and-toxic-epidermal-necrolysis-tenPlease remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition.  The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice. 

El vocalista de la banda de rock Maldita Vecindad, Rolando Ortega, mejor conocido como Roco Pachukote, está hospitalizado y bajo cuidados especiales debido a una reacción alérgica causada por una intoxicación extrema de antibióticos, según informó la agrupación a través de un comunicado en sus redes sociales. A través de su comunicado, la banda explicó que Roco fue diagnosticado con el síndrome de Stevens Johnson, una enfermedad rara y potencialmente mortal que afecta la piel y las mucosas, y que se produce pornuna reacción adversa a ciertos medicamentos. Esta condición le impide realizar cualquier actividad física y exponerse al aire libre. Por esta razón, la Maldita Vecindad anunció que se verá en la necesidad de reprogramar todos los compromisos de febrero y marzo de 2024 que tenían agendados, incluyendo conciertos y presentaciones en diversos foros y festivales.

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Epidermal necrolysis refers to severe cutaneous reactions that cause extensive necrosis of tissue and detachment of the epidermis. It encompasses three conditions which are on a continuum of severity and how much of the body's surface area is affected: Stevens-Johnson syndrome (SJS): Less than 10% of BSA is detached Toxic epidermal necrolysis (TEN) - More than 30% of BSA is detached SJS/TEN overlap: Between 10 and 30% of BSA is detached In this episode you'll learn:  Epidermal necrolysis pathophysiology and risk factors High risk medications that can cause SJS/TEN Complications of SJS/TEN Signs and symptoms in the prodromal and acute phase Important assessment for a patient with SJS/TEN Key tests utilized to diagnose and evaluate a patient with epidermal necrolysis Treatments for SJS/TEN, including medications Vital education components for patients and families ________ Full Transcript - Read the article and view references Factor - Support our sponsor and get 50% off ready-to-eat meals with code nursemo50 FREE CLASS - If all you've heard are nursing school horror stories, then you need this class! Join me in this on-demand session where I dispel all those nursing school myths and show you that YES...you can thrive in nursing school without it taking over your life! DIC - Learn more about disseminated intravascular coagulation in this episode! Nursing School with a Chronic Illness - Hear more from Christina Brown, RN and how she managed nursing school with a chronic illness. Study Sesh - Change the way you study with this private podcast that includes dynamic audio formats that help you review and test your recall of important nursing concepts on-the-go. Free yourself from your desk with Study Sesh!  Med Surg Solution - Are you looking for a more effective way to learn Med Surg? Enroll in Med Surg Solution and get lessons on 57 key topics and out-of-this-world study guides. LATTE Method Template - Download the free LATTE Method Template so you can streamline how you study and focus on what a nurse needs to know.

Stevens Johnson. You must be a pretty bad dude to be named after this condition...Let's talk about this dermatologic nightmare that might be the only way to get a dermatologist to come to the hospital after hours. Want to experience the greatest in board studying? Check out our interactive question bank podcast- the FIRST of its kind here. Cite this podcast as: Briggs, Blake; Wosisk-Kuhn, Marlena. 195. Stevens Johnson Syndrome. October 16th, 2023. Accessed [date].

BUFFALO, NY- October 2, 2023 – A new priority research paper was published on the cover of Aging (listed by MEDLINE/PubMed as "Aging (Albany NY)" and "Aging-US" by Web of Science) Volume 15, Issue 18, entitled, “Gene expression signatures of human senescent corneal and conjunctival epithelial cells.” In this new study, researchers Koji Kitazawa, Akifumi Matsumoto, Kohsaku Numa, Yasufumi Tomioka, Zhixin A. Zhang, Yohei Yamashita, Chie Sotozono, Pierre-Yves Desprez, and Judith Campisi from the Buck Institute for Research on Aging, Kyoto Prefectural University of Medicine and Lawrence Berkeley National Laboratory aimed to investigate the senescent phenotypes of human corneal and conjunctival epithelial cells. “Here, we induced cellular senescence in human corneal and conjunctival epithelium using X-irradiation, and analyzed gene expression profiles of each cell type to determine the characteristics of senescent ocular surface cells.” The team examined cell morphology, senescence-associated β-galactosidase (SA-β-gal) activity, cell proliferation, and expression of senescence markers (p16 and p21). RNA sequencing analysis was conducted to compare gene expression profiles between senescent and non-senescent cells. Finally, the potential involvement of senescent cells in the pathogenesis of ocular surface diseases was investigated. X-irradiated corneal and conjunctival epithelial cells exhibited typical senescence phenotypes, i.e., flattened morphologies, increased SA-β-gal activity, decreased cell proliferation, and increased expression of senescence markers, p16 and p21. RNA-seq analysis revealed substantial differences in gene expression profiles between senescent corneal (SCo) and conjunctival epithelial cells (SCj). Moreover, SCj were detected in pathological conjunctival tissues associated with limbal stem cell deficiency (LSCD) due to Stevens-Johnson syndrome or chemical burns, potentially being involved in abnormal differentiation. “This study highlights the cellular and molecular characteristics of senescent ocular surface cells, particularly in SCj that show abnormal keratin expression, and their potential roles in severe ocular surface diseases and pathology.” DOI - https://doi.org/10.18632/aging.205113 Corresponding authors - Koji Kitazawa - kkitazaw@koto.kpu-m.ac.jp, and Judith Campisi - jcampisi@buckinstitute.org Sign up for free Altmetric alerts about this article - https://aging.altmetric.com/details/email_updates?id=10.18632%2Faging.205113 Subscribe for free publication alerts from Aging - https://www.aging-us.com/subscribe-to-toc-alerts Keywords - aging, cellular senescence, cornea, conjunctiva, Stevens-Johnson syndrome, limbal stem cell deficiency About Aging-US Launched in 2009, Aging-US publishes papers of general interest and biological significance in all fields of aging research and age-related diseases, including cancer—and now, with a special focus on COVID-19 vulnerability as an age-dependent syndrome. Topics in Aging-US go beyond traditional gerontology, including, but not limited to, cellular and molecular biology, human age-related diseases, pathology in model organisms, signal transduction pathways (e.g., p53, sirtuins, and PI-3K/AKT/mTOR, among others), and approaches to modulating these signaling pathways. Please visit our website at https://www.Aging-US.com​​ and connect with us: SoundCloud - https://soundcloud.com/Aging-Us Facebook - https://www.facebook.com/AgingUS/ Twitter - https://twitter.com/AgingJrnl Instagram - https://www.instagram.com/agingjrnl/ YouTube - https://www.youtube.com/@AgingJournal LinkedIn - https://www.linkedin.com/company/aging/ Pinterest - https://www.pinterest.com/AgingUS/ Media Contact 18009220957 MEDIA@IMPACTJOURNALS.COM

In this episode of Eyeway Conversations, George Abraham catches up with Harshit Lohia, who works at the Reserve Bank of India. Harshit's life took a dramatic turn after completing his 12th standard when he fell ill and took medication that triggered Stevens-Johnson syndrome, resulting in the loss of his eyesight. He spent the next year and a half at home, coping with this life-altering condition. Harshit's determination and resilience shone through as he embarked on his educational journey once more. Opting for distance education, he pursued a BA while simultaneously preparing for banking exams. However, his path was not without its challenges, as accessibility during his graduation was limited. His decision to take up banking was influenced by computer instructors who secured jobs in the banking sector at NAB Lucknow, making him realize that opportunities were indeed available to individuals with visual impairments. Harshit emphasizes the significance of technical proficiency for blind and visually impaired individuals. Throughout his journey, Harshit received unwavering support from his family, especially his sister. Beyond his professional pursuits, he is passionate about music, particularly playing the keyboard, and enjoys listening to jokes. Tune in to Eyeway Conversations to explore Harshit Lohia's inspiring journey and gain valuable insights into his life, career, and interests. This podcast is brought to you by Score Foundation. To support our work, kindly visit our website at : https://scorefoundation.org.in/get-involved/

In this captivating episode of Eyeway Conversations, George Abraham engages in an inspiring dialogue with Masoom Reza, a remarkable individual hailing from Bihar's West Champaran. His early life was marked by adversity when, in the third grade, he was diagnosed with Stevens- Johnson syndrome, a condition causing skin deterioration due to a medicine reaction. Tragically, by the age of 8, he had lost his sight entirely. Born into a farming family, young Masoom's world was forever changed. Facing the challenge of blindness at such a tender age was undeniably disheartening, with few role models to look up to. However, Masoom's indomitable spirit would eventually lead him to become a budding lawyer, an academic teaching law at Jamia Millia Islamia, and a poet. His educational journey began at a special school for blind students. Sadly, opportunities to study subjects like science and math were limited for visually impaired students. The turning point came in 2017, as the demand for accessibility and the rights of persons with disabilities gained momentum following the 2016 Disabilities Act. Masoom seized the power of law as a catalyst for change. He shared his admissions struggles as a blind student, navigating the extensive reading demands of law studies. Despite these challenges, he achieved an impressive educational background, including a bachelor's degree from Jamia Millia Islamia, an LLM from NLSIU, and a PG Diploma from NALSAR. His journey continued into the field of intellectual property rights law, where he interned with a prominent intellectual property law firm. However, driven by a desire to explore the academic domain, he transitioned into a role as a guest lecturer at Jamia. Masoom Reza is also a Javed Abidi Fellow, a prestigious fellowship offered by the National Centre for Promotion of Disabled Persons (NCPEDP). Balancing his teaching responsibilities with his fellowship, Masoom also finds solace in poetry, which he graciously shared during the conclusion of this enlightening conversation. His life journey is a testament to resilience, determination, and the profound impact one individual can make in advocating for accessibility and inclusion. Tune in to Eyeway Conversations to hear Masoom Reza's inspiring story and gain valuable insights into his world of law, academia, and advocacy. To access the podcast transcript, click on the link: https://otter.ai/u/GaRbxeEcBNGHHAhXojwW7k-rOyI?utm_source=copy_url This podcast episode is brought to you by Score Foundation. To support our work kindly visit our website.

Yes, today we have the pleasure of listening to and talking with Penn Street who survived being bitten twice by a rattlesnake when she was nine and a half. Ok, you may say. So she was bitten. A little antivenom should take care of that. Not in Penn's case. She had an incredibly severe reaction to the medications and acquired Stevens-Johnson Syndrome (SJS). This syndrome did a lot of damage to Penn's body including causing her blindness. She decided not to let SJS nor anything else stop her. Was it also due to her seven older brothers? Penn will tell us.   After college Penn discovered a talent for sales when she married her husband and joined him in promoting his professional photography business.   Today, Penn Street has a podcast entitled “Aftersight” which she operates as part of what she does with the Audio Information Network of Colorado.   Our conversation by any standard this time is inspiring and very enjoyable. I hope you like it.     About the Guest:   Penn Street lost most of her eyesight at age nine from Stevens-Johnson Syndrome (SJS) after being bit by a rattlesnake. SJS is a rare Adverse Drug Reaction that attacks the body by burning it alive from the inside out. 75% of Penn's body was covered by second-and third-degree burns. All the soft tissue is compromised. Her parents were told if she survived, she would be deaf, blind, cognitively damaged, remain of a feeding tube for life, and would not be able to breathe on her own. Thanks to prayer and Penn's tomboy spirit she did not only survive, but she exceeded all medical expectations. Penn's vision, hearing, and major organs were compromised, but that did not slow Penn down for long.   Growing up Penn discovered that accessibility was the key to her community, career, and the possibility of living the life she wanted. Penn sought out solutions to her new life with low vision, hearing loss, and chronic pain by learning to navigate life differently than before. Penn was a bright student a held a GPA hovering around 4.0 through her entire education. Penn set her sights on becoming an advocate for people with disabilities. However, life happens, and opportunities arise unexpectedly. Penn met her husband, Moses Street a professional nationally known photographer. Penn became the Studio Gallery Manager where she found the skill of managing a team and sales a strength, she did not know she had. After decades of a lucrative run with the studio and gallery Penn was pulled back into her desire to work with people with disabilities. For the past 15 years Penn has worked at several non-profits as a leader on their development and outreach teams. All the organizations have a focus on low vision and blindness. Currently Penn is the Development and Outreach Director for Audio Information Network of Colorado. Penn sits on several boards and commissions and is a sought-after public speaker.   In the winter you can find Penn on the alpine slopes of Colorado's mountains searching for the best powder and the steepest runs. In the summer Penn enjoys camping, hiking, and paddleboarding.     Ways to connect with Travis:   You can contact Penn Street through Audio Information Network of Colorado's website www.aincolorado.org. Follow Penn Street on social media – Instagram https://www.instagram.com/the_blind_chick/ Facebook https://www.facebook.com/penn.street YouTube https://www.youtube.com/@TheBlindChick TikTok  https://www.tiktok.com/@theblindchicklife     About the Host: Michael Hingson is a New York Times best-selling author, international lecturer, and Chief Vision Officer for accessiBe. Michael, blind since birth, survived the 9/11 attacks with the help of his guide dog Roselle. This story is the subject of his best-selling book, Thunder Dog.   Michael gives over 100 presentations around the world each year speaking to influential groups such as Exxon Mobile, AT&T, Federal Express, Scripps College, Rutgers University, Children's Hospital, and the American Red Cross just to name a few. He is Ambassador for the National Braille Literacy Campaign for the National Federation of the Blind and also serves as Ambassador for the American Humane Association's 2012 Hero Dog Awards.   https://michaelhingson.com https://www.facebook.com/michael.hingson.author.speaker/ https://twitter.com/mhingson https://www.youtube.com/user/mhingson https://www.linkedin.com/in/michaelhingson/   accessiBe Links https://accessibe.com/ https://www.youtube.com/c/accessiBe https://www.linkedin.com/company/accessibe/mycompany/ https://www.facebook.com/accessibe/       Thanks for listening! Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below!   Subscribe to the podcast If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can also subscribe in your favorite podcast app.   Leave us an Apple Podcasts review Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts.     Transcription Notes Michael Hingson ** 00:00 Access Cast and accessiBe Initiative presents Unstoppable Mindset. The podcast where inclusion, diversity and the unexpected meet. Hi, I'm Michael Hingson, Chief Vision Officer for accessiBe and the author of the number one New York Times bestselling book, Thunder dog, the story of a blind man, his guide dog and the triumph of trust. Thanks for joining me on my podcast as we explore our own blinding fears of inclusion unacceptance and our resistance to change. We will discover the idea that no matter the situation, or the people we encounter, our own fears, and prejudices often are our strongest barriers to moving forward. The unstoppable mindset podcast is sponsored by accessiBe, that's a c c e s s i  capital B e. Visit www.accessibe.com to learn how you can make your website accessible for persons with disabilities. And to help make the internet fully inclusive by the year 2025. Glad you dropped by we're happy to meet you and to have you here with us.   Michael Hingson ** 01:21 Well, hi there once again, here it is another day and it's time for unstoppable mindset. We have a wonderful guest today I got to meet a couple of months ago. Her name is Penn Street Penn is short for Penny. But we're going to call her pen because that's what she seems to like. And she hasn't hit me or anyone else yet for calling her Penn. And she seems to be pretty used to it. So we'll stick with pen. And she has an interesting and I think a great story to tell and we'll get to all of that. But Penn, welcome to unstoppable mindset. We're really glad you're here.   Penn Street ** 01:55 Thanks, Michael. I really appreciate it.   Michael Hingson ** 01:59 So, as we were talking about just before we started, you are one daughter among six or seven other boys, right?   Penn Street ** 02:09 Actually, there's three girls and the other three   Michael Hingson ** 02:12 girls. Oh my gosh, but you were the first girl.   Penn Street ** 02:14 No, I was the second. So yeah, my parents had two boys. And then they had a girl and they really, really, really wanted another girl. So they had five more boys. And then I was born. And so story tells us says that my mom looked at me and said I was her her lucky shiny Penny. So she wanted to name me Penny. And then so that's the second girl. And then my little sister almost three years later came and was a complete surprise because my mom thought and dad thought I was it. But my little sister came along which I was very thankful for. Because imagine a little girl with seven older brothers it was, you know, it was unfair at times   Michael Hingson ** 03:01 will add an older sister. Yeah. But   Penn Street ** 03:03 she was so much older than me. It felt like, you know, she was my babysitter which she sort of was.   Michael Hingson ** 03:11 So what was your younger sister's name?   Penn Street ** 03:15 Sorry, Ed. She was actually named after my oldest brother's girlfriend at the time. Because he found out my mom was pregnant and you know, his first girlfriend. He thought it would be really cool to say, you know, oh, my mom, you know really likes you. She's going to name the baby after you. And my mom really didn't have another girl's name. So Sherry is out there somewhere. My little sister actually was named after you.   Michael Hingson ** 03:46 Wow. Yeah. So older brother and Sherry didn't stay together.   Penn Street ** 03:52 Not I doubt if I don't know how long they are teenagers who know?   Michael Hingson ** 03:57 Yeah, yeah. Well, there is that. Well, so you you've had, needless to say, an interesting life, which, which we'll talk about as much as you want. But you grew up like any kid and then went to school, I guess. And then did all those things that kids do. But then things changed for you at the age of nine.   Penn Street ** 04:20 Yes, they did. I was bit by a western diamondback rattlesnake. And actually a bit me twice and then a bit my little sister sherry. Oh my gosh. But I took the bulk of the venom, which was a good thing because she was smaller than me. So but yeah, where   Michael Hingson ** 04:40 were you guys where you weren't supposed to be?   Penn Street ** 04:43 That is another story. But we were we were in the woods of Arkansas. And I actually Arkansas has several super venomous snakes, which are definitely not my my favorite animals but but yeah, it was They gave me you know, anti venom, they gave me all the right, you know medication to save my life. But in doing so it triggered a syndrome called Stevens Johnson Syndrome, which was named after the two doctors that came up with the name Stevenson Johnson. And it's a severe, you know, adverse drug reaction. And at that time, the fatality rates for children was 75%. And you're treated in a burn unit, just as if you've been in a fire because your body the way it reacts to the drugs is it burns from the inside out. So all of my organs were affected. 75% of my body was covered in second, third degree burns. So you can imagine in a fire, all the soft tissue was compromised. And, of course, your eyes are nothing but soft tissue. So the eyes were definitely the obvious. But, but yeah, they the I was a tomboy, being with seven older brothers, I had to be strong, right, I never would have survived those first nine years, if I wasn't a tomboy, and I, I didn't understand what was happening. But you know, you're a kid, you just kind of this is what's happening today, and I'll get through it, and then tomorrow will be better. And, you know, every day that I survived, you know, the chances of me sir, you know, living increased, and then I, you know, I really did, especially at that time, because I didn't know a lot about Stevens Johnson Syndrome, they really thought that I would be totally blind, deaf, you know, my fever was above 103 for many, many days. So they thought that I would be cognitively impaired, I'd be on a feeding tube, I would never be able to breathe on my own all those things. But, you know, as I as I fought they, you know, unchecked those boxes, from my future. And, and yes, you know, everything is compromised, I, you know, obviously, my vision is compromised, and hearing is compromised, those kinds of things. But really, I don't look at those things as a disability. To me, my disability is my fire doesn't like to keep up with my lifestyle that I like to do my love. So I like to climb mountains, and you know, downhill ski, and I like to do all these things that require a good health. So my heart's not very happy with me most of the time, but neither on my lungs, but it's, it's my life. It's, I'm, I appreciate every single day that I have. And just like when I was a kid, I look at Oh, today is today, and tomorrow will be better. And it always is.   Michael Hingson ** 07:55 I bet however, that your older brothers were supportive.   Penn Street ** 08:00 They were, I think that they were threatened with their lives that when I did finally get to come home, that they were supposed to treat me different, you know, don't tease her Don't roughhouse with her. She's very fragile. And I was I was extremely fragile, but, but behind the scenes, sort of mom and dad weren't there, you know, they, they, they didn't treat me exactly like they did before. But I did appreciate more than they will ever know, you know, those, those big brother, you know, kind of pushes and shoves and calling me a dork and stuff like that, because it made me feel like me again, ya know, because I didn't look like me anymore. You know, imagine a burn, you know, burn victim. And, you know, I didn't move around quite as fast, especially in the beginning until I, you know, had those skills, you know, the cane skills and, you know, those independent skills that I had to learn, but that they, you know, it was what it was and my little sister and I became super close. Actually, probably closer than we were before, because I was forced to be inside a lot more and unlike me being the tomboy, she was the little princess and she loved playing with dolls and wearing pink and all those kinds of things. And I think she really liked having me sort of forced into being inside more and so we got to know each other more and you know, she she still is, you know, my absolute closest friend on the planet.   Michael Hingson ** 09:47 Now, were you from Arkansas originally?   Penn Street ** 09:50 Yes. But I was 12 it became apparent that in Arkansas, yes, they had a great Children's Hospital's state of the art that saved my life. But they really didn't have a lot of other resources and services. After that initial, you know, hospitalization and so my parents found out about the Children's Hospital in Denver, Colorado, and it was definitely at that time, you know, the leader in working with children and illnesses and all those kinds of things. And then also just resources, you know, they didn't really have blind teachers. There was blindness was looked at very differently in Arkansas than, than it was in Colorado. And there weren't a lot of teachers and resources and services, and my parents knew that I was going to need those. So they packed us up and moved us to Colorado, which I'm very thankful I love Colorado. And so I was given a lot, a lot better care here, and definitely a better education.   Michael Hingson ** 11:01 So what do your parents do for a living?   Penn Street ** 11:04 So they're both gone now. But my father was a mill, right. And he worked for a union. So he worked at power plants, all across the country had a very specific skill set. And my mom, when we were young, she was a stay at home mom with 10 kids, it's hard to get a baby's that on. But as we got older, she actually went into health care and worked with seniors. And, you know, with a health care provider for seniors so so kind of runs on my family the work that I do, I think it might lead.   Michael Hingson ** 11:42 Well, you certainly did come out of it, and certainly your tomboy attitude. Saying it facetiously or not certainly had to help, because you you had to survive, and you learned how to be a survivor. And certainly Stevens Johnson made you into a survivor, which, which isn't important. And that, of course, is a characteristic and a trait that is second to none that you certainly don't want to live without.   Penn Street ** 12:16 That's true. That's true. I really do love my life. I it always angers me when people feel sorry for me, or, or like they say, Oh, I'm sorry. I'm like, Don't be sorry. Love my life. I, you know, I do wish my heart work better. And I do whereas work, you know, I wish my lungs worked better. But it's, besides those things, like I didn't even those things, you know, it's it is what it is? It is what it is. Yeah. And they're part of who I am. And I, I like who I am. And you know, not that I don't want I love learning and growing and I love learning different ways to approach situations and I'm always a sponge when I'm around new cultures and things like that. So it's not like this is it? I'm happy with the way I am. I'm gonna stay right here. Because I'm not. I have a lot more to learn and and to experience of this world. But, but there is nothing to be sorry about or, you know,   Michael Hingson ** 13:20 well, when you go into kind of an overexertion mode, if you will, what what is your heart do? What, what how do you notice it? Does it just yell at you and go slow down or? No?   Penn Street ** 13:31 Well here, I actually, actually right now I have a pretty crazy heart monitor on a week ago. Actually, a week ago last night, I ended up in the emergency room and Durango, Colorado because my heart decided it didn't really want to work anymore. And it goes from zero, you know, 100 to zero. So I was out hiking that weekend, I had been paddleboarding and camping in the mountains of Colorado and I was over a friend's house in Durango, Colorado, and we're about to have dinner and sitting on the couch and totally blacked out and woke up in the, you know, in the ambulance, which, unfortunately is not abnormal for me. But so we're gonna see what's going on right now. There's definitely an infection going on. And they don't know what that is. But whatever it needs to happen to get me back outside. thoughts and prayers are with you. Thank you. Thank you.   Michael Hingson ** 14:34 Well, it's it's interesting. And you're right, we all we all have gifts. We all have challenges. Yeah. And it's it's like anything, as I tell people talking about September 11. We couldn't prevent it. And I'm not convinced that even with the September 11 Report, I'm not seeing enough evidence to say that we could have foreseen it happening. But the issue is Since that had happened, the issue is how we deal with it. And you're facing the same sort of thing. Every day, excuse me every day as we all are, yeah, we, we have challenges. And the issue is we either deal with them and we grow and become better or not. And that's our that's our choice. Yeah,   Penn Street ** 15:19 absolutely. You know, people, even right now, they're like, Oh, you have to rest you have to, and I am resting. This one was pretty scary. And it was still so recent. But I'm like, you know, if my heart wants to blow out, or my lungs want to keep up, I'd rather be doing that standing on top of a mountain or, you know, rafting a river or, you know, doing something that I love, and instead of sitting on a couch, you know, it's or it but that's the way I am. I'm not saying that's the correct way, you know, other people may totally disagree with me. But it's, it's my life. And that's the way I want to live it and   Michael Hingson ** 16:02 well, you can decide when you want to not be so, so active on any given day. That's your choice.   Penn Street ** 16:11 Absolutely. All of us have that choice, though.   Michael Hingson ** 16:15 Absolutely. Absolutely. We all have that choice. So you but you How did school go for you after that? After Stevens Johnson and so on?   Penn Street ** 16:25 Actually really well. I have, I don't know where it came from. And I don't know, school was always easy for me. It's not that I'm the best student, I don't have a super IQ. I don't know what my IQ is. But school was always really easy. To me, I always looked at it sort of as a puzzle or a game. Depending on what the teacher needed or wanted from me, that's what I gave them, which got me good grades. And it just it always worked for me. I was always a good problem solver. And so, whenever I got a new teacher, which was you know, every year, or every quarter, whatever, whatever grade I was in, I really studied the teacher and what they needed and wanted and, and that's what I gave them. And so even though because of, you know, my bad, bad health or whatever you want to call it, I was kept home a lot. I don't think I went a full week of school when I was finally allowed to go back to school. You know, I think if I hit four days a week actually being, you know, my butt in the seat left classroom, that was rare. And but I still made I made straight A's I was I was always on the honor roll even in college. You know, when I went to university, I made the Dean's list, I worked full time. It was I I don't think there's anything special or gifted about me. I just, it's just the way my brain works. And I learned what it took to get good grades. And that's what I did. And I and I was disciplined about it. You know, and I did my work when I'm supposed to do my work. And it just worked out for me, Michael, it was, you know, I did go through public school, there was a time in middle school that my parents were concerned because I started you know, typical started getting teased and all that kind of thing. And they were they were concerned about my mental health, you know, but then I did i They allowed me to go, you know, research it and I even did, you know, some visits with a couple different schools. You know, and it just I it didn't feel right. I wanted, I wanted to be in the public school system. And it wasn't just because that's where my friends were. It's it's just that's what felt like what I needed. And   Michael Hingson ** 19:04 so what year was this? What years were you in high school?   Penn Street ** 19:07 I graduated in 87.   Michael Hingson ** 19:09 Okay, so, you I never had any of the real teasing and bullying growing up as a blind kid. Because we lived in Palmdale, which was a pretty rural area 65 miles north of Los Angeles, but I know that over time, I guess more and more bullying happened. So maybe there was more of it. When you were in high school then even I experienced Of course it's a whole different ballgame now with all the things that exists but   Penn Street ** 19:37 I was I can't imagine now. Yeah, I   Michael Hingson ** 19:41 I wouldn't want to be a kid now. It's got to be so challenging. Exactly. But I was very fortunate that I didn't really have a lot and I I did have issues. I was denied access to the school bus for a while in my freshman year of high school because we had a bully of a superintendent in the district, we had a rule, we had a rule that said no live animals a lot on the school bus, which I understand. But there was a state law that said that, that blind people with guide dogs could take their dogs anywhere that the public could go. And under case law that included meat taking my dog on the school bus, well, the superintendent didn't care. And so I was actually denied. And when we got a board meeting about it at the local school board level, the board sided three to two with the superintendent, even though we showed them what the law said. And it actually took reaching out to the Governor of California who was at that time, Edmund G, Pat Brown, Jr. To get it reversed, and the superintendent then left us alone, but it took that level to to make it happen. But that's the but it was a great lesson for me, because I learned that you can fight city hall and when you gotta do it for the right reasons.   Penn Street ** 20:59 Yeah. Yeah. Wow, I that is crazy to me. That it's ignorance, right. But I always wonder where did that I always want to sit down people like like that, like that superintendents. Like, where's this coming from? It   Michael Hingson ** 21:23 from everything I knew about this guy, it was you do what I say? And that's all that matters. And so I don't know. But that's what I heard. But you certainly went through a lot. What did you major in, in college?   Penn Street ** 21:36 Special Education in journalism?   Michael Hingson ** 21:39 Ah, oh my gosh, that's two divergent majors.   Penn Street ** 21:42 Yes, I always wanted to be a writer. And, but I also, I was, I feel like I was really lucky that I always had amazing mentors. Not every teacher was amazing. But I always learned something from each one of them. But I, but there were a few really big standouts and, but I always had these people in my life that were just really awesome role models for different, you know, different reasons. And, but one of the things that I think my mom, you know, she was, she was a very caring person. And she was a big believer, you know, we went to church and things like that. And I always saw her giving, you know, rather was like, you know, taking soup to somebody who was sick, or we had a neighbor who, across the street who was in a wheelchair, and my mom would go over, and, you know, just do chores for him not get paid, she just did it because she was a good person she wanted to, yeah, and that she didn't, we didn't ever really talk about it, but it really instilled in me that there are really awesome people out there. And whenever you can give back you should, and will on as a kid with a disability. You know, I, I was, you know, I was given things and I was given opportunities that my other siblings weren't given, you know, I got to go to summer camp, they didn't none of them a summer camp. You know, I, I, you know, had I was I took bowling lessons, you know, nobody else in my family to bowling lessons. So they're always, there was always this opportunities. And so as I got, you know, even in high school, I was given the opportunity to be a teacher's assistant in the special deeds class, and all of the students that were in there, you know, had different different abilities. And I, I loved it, I loved it. And they were my tribe. I didn't think of them as being any different than me. And I think that's why we all got along. And, and then I became involved with the program. It's called Cooper home, where seniors in high school that had various disabilities could go there to stay after. Yeah, Monday after school, and then they would come over and then, you know, so Monday night, Tuesday, Wednesday night, Thursday night, they would come over after school, and we would teach them independent living skills, transportation, all the things that they needed to be successful when they went, you know, left home after they graduated high school or went on to school or whatever they were going to do. And again, I just, I just loved it. Teaching was fun to me. It was It fills my cup. And I always learned I think I learned more from them than what I was teaching them. And it was it was just a gift take situation and And I really, really liked it. And so that's why I went into I wanted to be a teacher. But I also loved writing. And so So yeah, so it was it just made sense that that was the direction that I thought I was going to go with my career. I think we know our best, right when we're able to   Michael Hingson ** 25:20 get for thinking right. Now, are you totally blind?   Penn Street ** 25:24 I know I'm not I'm my ride is prosthetic, I finally made the choice a few years ago, it was an eye that was not usable. I had no vision and it hurt. Oh, and I, but I have on you know, like, well, someday I'm going to be the bionic woman. And we're going to come up with the bio. And I was like, why am I wasting all this energy being in pain was something that it's just paid. And so I had it removed and then my left eye, I have a little peripheral on the on the outer at the left hand side. But it's fuzzy. It's super fuzzy. That's what I call it fuzzy.   Michael Hingson ** 26:03 Got it? Yeah, I was just curious to put it in perspective. But you went on to college, and that was was a certainly cool. And you You certainly seem to have a very positive attitude about you and about being blind and so on. You don't pity yourself. Why do you think that is?   Penn Street ** 26:21 It's exhausting to feel sorry for yourself?   Michael Hingson ** 26:25 Good idea. Good answer.   Penn Street ** 26:28 I don't know. I think it's my, my, it was my parents, it was my teachers it was, you know, I think even before I got, you know, Stevens Johnson Syndrome, I had to learn to sort of pull up my bootstraps. And, you know, and again, I do think it was having seven older brothers, you know, they, even though I was way smaller than them and could never keep up with them. They expected me to, you know, like, oh, you can climb to the top of that tree, you can, you know, jump your bike over the obstacle. So, I think I was always pushing myself physically and mentally, that I just kept doing that, you know, and, you know, and again, that problem solving and, you know, in my mother, my mother was visually impaired and hearing impaired. And when she was a young child, she got very ill. It was from a medication. They think that possibly she had Stevens Johnson Syndrome, but not as, you know, as ferocious of cases I had, but at that time, they didn't call it Stevens Johnson said, Yeah. And so she just growing up with a mother that was visually impaired and hearing impaired. She, she didn't drive, but boy, could she ride the bus or walk across town through alleyways and that I didn't even know existed, right. And she was she was a really good example of, okay, you can't hear well, you can't see well, well, then you walk. You know, you use what, what assets you do have and you strengthen those. And it was sure No, I do. I think it was just part of my DNA. That   Michael Hingson ** 28:30 it certainly did. certainly good for you. How are all your older brothers today?   Penn Street ** 28:38 Um, I've I've lost two of them. And the oldest one passed away. He was he was actually in the at the very tail end of Vietnam. They think that it was some of the, you know, the war things that happened to him, that he, you know, he didn't live a very healthy life when he came home either. And then my brother who's just older than me, Tim, he was my Superman. He, the three the three of us, you know, Tim Sherry and I were, we were a little you know, the three musketeers and we always stood up for each other and he esophagus cancer runs in my family. And so he he passed away with the esophagus cancer, I have two other brothers that are still alive that also live with you know, the effects of the esophagus cancer in the My father's mother, my grandmother passed away of the esophagus cancer, so sorry to hear it. Yeah, but but they, you know, I don't I'm not real close to my other brothers, even though there wasn't a huge age gap between us. It was just enough, you know, but my little sister and I are very close. She lives in Colorado, too. So we we get together as often as we can, and at least send a funny emoji or some text every single day. So   Michael Hingson ** 30:00 My brother and I were two years apart, but clearly very different. He was not blind. And so we weren't as close as we could have been. We did communicate, but still definitely different lives. So I understand what you're saying. And sometimes you're just not as close and at the same time, they're still your brothers. And and so it's still part of part of you in every way.   Penn Street ** 30:25 Yeah, I posted. I'm on Tik Tok. And I posted a video about bullying. I don't know, a month or so maybe it's been two months now. And one of my older brothers who lives in Kansas, he posted like anybody messes with my little sister, they have to come through me. And then at the end, he goes, Well, what am I saying? No, she could probably kick your butt. Probably more than I can at this point. For him, yeah, but it was it was still nice to   Michael Hingson ** 30:55 have some. What did you do after college?   Penn Street ** 30:58 So I met my husband, Moses, and did you have one of those around? Yes, it is, he is a professional photographer. So the complete opposite scope as I am as far as visual goes, and he, we, I always say I hear he, he has had two little girls. And I always tell people, I fell in love with the girls, but and then he was just the icing happened to be there. Exactly. So yeah, so and a lot of it was because of meeting houses, my life really changed. My career changed my, what I what I thought it was going to end up doing in life changed, he, I was a really good salesperson. And I think it's because of my positive attitude. And, and if I'm passionate about something I can, like sell it. And so he was looking for a studio and gallery manager and even though I was visually impaired, you know, or low vision or whatever term you use, I, I really believed in him and I believed in what he was doing, he has a philosophy with photography, that how you look in a photograph has nothing to do with how you look, or the makeup you're wearing, or the hair or the clothes or whatever it has to do with how you feel. And if you feel beautiful, if you feel strong, then that's the way you come across in the photograph. And so that whole philosophy is of his i That's I, I, I bought it hook line and sinker. And it was something I could sell. And boy did I you know, we, we had decades of a very wealthy lifestyle, because of, of that, and, and it was it really changed lives, you know, people would come in that, you know, it could have been their wedding was coming up, or, you know, whatever the event was, and they would take this class, this photo class, and then Moses would do the shoot, the photoshoot, and their lives would really be changed because of it. And it's things that it's not like you come in and you do it, and then you can't redo it when you're your home or with your when you're with your family or your community. He actually taught you how to use the skills so that you could go on and be photographed by your Uncle Joe or, you know, the local newspaper or whatever it was, and you could still use those tools. And so it was it was a concept I really appreciated. And yeah, and so we so I went into sales, and I managed our studio and our gallery for four decades. And then we kind of hit this point, I lost another big chunk of vision overnight. And I was like, you know, it's it's time for me to get I really miss the teaching and the writing and, and I miss working with people with disabilities. And so we made the decision that I would I went back to I went through Division of Vocational Rehabilitation and you know, sort of sharpened all those skills   Michael Hingson ** 34:27 needed to be a survivor, but go ahead.   Penn Street ** 34:30 Yeah, don't get me started. But, but and then i i You know, put my resume out there and got scooped up by a nonprofit and the the rest of sort of history I you know, I do get to write now and I work now I work pretty much specifically with people who are blind or visually impaired, but I've had several opportunities to work for amazing organizations. that have that I've gotten to travel and meet extraordinary people. And do, you know, really, life dream? Things like I got to wrap the entire Grand Canyon with a group of high schoolers that were blind, you know, low vision. And one of them actually was profoundly deaf as well. And boy with this was that an experience of a lifetime and loved every moment of it. So I, you know, we don't make you know, we're I work for a nonprofit. So we're not making those huge dollar amounts that we did when we had the studio and gallery but life is life is just this   Michael Hingson ** 35:43 rich. But But Moses is still doing okay.   Penn Street ** 35:46 He is he's semi retired. And he he, he probably does, I would say, maybe a dozen jobs a year, but that's fine. It's fine. We like we like we like where we are, you know, we have a beautiful life.   Michael Hingson ** 36:02 Well, if you if you ever have to just point out to him that no matter what he says, it may be the picture's worth 1000 words, but they take up a whole heck of a lot more memory. I like that. Yeah, I saw that once a few years ago. I thought it was great. Well, you, I do. figure I might as well since you brought it up. I do like to use the term low vision as opposed to visually impaired. And I'll tell you why. I've talked about it a few times here. But I think there are two problems with the whole terminology of visually impaired first of all, deaf people would shoot you if you call them visual or human hearing impaired? Oh, yes, absolutely. Because they have recognized that they shouldn't be compared to a person who can hear and if you say impaired, you're immediately putting a stigma in the same way visually impaired. But the other problem with visually impaired is visually, we're not necessarily different just because we don't see,   36:59 unless we look, some of us look exactly   Michael Hingson ** 37:02 the same. Some of us not necessarily, but that's why low vision is so much better. And we we've got to get people into the habit of trying to stop comparing us.   Penn Street ** 37:12 Exactly, yeah, I actually I interviewed you for my podcast after sight. And we had this discussion. We have a hike coming up. And I actually purposely banked made sure that I put low vision that are visually impaired, and I've been trying pretty much daily trying to get my team where I work to use low vision instead of visually impaired,   Michael Hingson ** 37:40 it makes a lot more sense. I mean, you can make the case of low vision isn't fair, because so we don't see good. We got lots of vision. But I can cope with that, you know, because eyesight and vision are so closely equated. And I don't think you're going to get rid of that one. But visually impaired is a ridiculous thing. Anyway. But so you're working with nonprofits. And and you mentioned after site, so we should talk about that some because you have a nice, successful podcast. And that seems to be going pretty well.   Penn Street ** 38:12 Yes. It's called the after site. And it's all one word. And when I started working as the development and Outreach Director for the nonprofit audio information network of Colorado, here in Colorado, they had had a previous podcast, it was called Community Conversations. And they but if they hadn't had it in several years, and so they asked me if I would, you know, bring it back to life. And I did, but I didn't really like community conversations. I wanted it, it was so broad. I wanted   Michael Hingson ** 38:49 something doesn't mean anything necessarily anymore. What does that   Penn Street ** 38:53 mean? It sounds I don't know, it. It just, it just didn't strike home to me. And so I went to, you know, the executive director and the board and I said, you know, I really would, I really liked doing the podcast, but I would like to be more focused. And, you know, since we work, you know, our resources and services that we're providing here are for people who are blind and low vision is it should be about vision loss, and that's, that's my wheelhouse, right? You know, and I and I know a ton of people that have incredible stories and incredible resources are incredible services. And I that's where I would like the focus to go and so we actually with my, my grant manager, and I were brainstorming, and he's the one that came up with after sight. Because I often say there is life after sight, you know, after losing your vision and so he so it's stuck and so that's why it became after sight, and I do love doing it. It's I I just, I've met so many just amazing people worldwide through it. And they it became so successful that it was becoming a little overwhelming to keep up with, along with my, you know, my regular duties being development director and doing outreach. And so they hired a Podcast Producer Jonathan, shout out to you. And Jonathan really took it to the level where it is now. And because he knew he had the skills and so he brings on just amazing guests. And I do you know, throw him a few people that I know like you with you, Michael. You know, I had your name on the on my list for quite a while before, our mutual friend Kevin, you know, introduced us again, so   Michael Hingson ** 40:49 well, and it was fun doing that podcast. And yeah. And I hope that people will seek out after site as well. How long have you been doing the podcasts now?   Penn Street ** 40:59 Two years now? Okay.   Michael Hingson ** 41:02 Yeah, we're coming up on our second year in August, we reached out to a lot of people on LinkedIn who have expressed interest in being on the podcast, and because of that last year, we've gone to two episodes a week.   Penn Street ** 41:16 That's me. I, we had talked about that. But I just I'm like I, I can.   Michael Hingson ** 41:22 Yeah, well, it's fun to work at home. So I'm able to do a lot of that you're actually the second person today that I've had the opportunity to have an interview with, but it's careful. But it's fun to do. And, like you. I love learning. And I've learned a lot from every person who I have the opportunity to talk with. Yes. And so it's so much fun. Now, you use you use a guide dog, as I recall,   Penn Street ** 41:54 I do which he barked earlier, which I'm glad he isn't doing   Michael Hingson ** 42:01 well, as Jonathan could probably tell you, if he edits podcast, you could actually edit that out without any difficulty. There is technology today to do all that kind of stuff. It's pretty amazing. But what what made you wait so long to start to use a guide dog?   Penn Street ** 42:16 Well, because of the Stevens Johnson Syndrome. I don't have any I shouldn't say don't have any, but I have very little mucous membranes. And so breathing and dog hair is not I mean, I will occasionally on special occasions, I'll do it. But I usually pay for it in the end. But so I never thought I could have a guide dog because I only knew of shepherds and labs. And so I never really researched it. And then a friend said, when I saw this article about they're using standard poodle, as guide dogs, and I was like, You gotta be kidding me. And I, as a kid, I love dogs. And so I had a, you know, the miniature poodle, little Behringer and then even when I met Moses, our his, his oldest daughter, who you know, is my stepdaughter, she she really wanted a dog and so we got to beach on Friday, which again, is hypoallergenic and, and so one I don't think I'd ever even seen a standard poodle, like I couldn't pitch are these enough to guide me around? I'm five nine. So it's like I did, but I did some research and and at that time, the Guide Dogs for the Blind out of California was they had a poodle program. So they went through their whole thing where they come out, they do the Juna walk and all that. And but then every poodle that came up, got reassigned to something else. And they finally gave up on poodles. If but they've referred me to pilot dogs, which is where I met you, Michael for the first time. So many years ago, they referred me to pilot dogs because the executive director at pilot dogs at the time, really love standard poodles and they actually had a pretty big vibrant program. And so that's how I ended up there. And my first two guide dogs was through pilot dogs. And then I went on to my last two dogs have been from the Guide Dog Foundation for the Blind out of Smithtown,   Michael Hingson ** 44:30 New York, right? So all peoples   Penn Street ** 44:32 all poodles, I did try. What are they called? The poodle lab crossover doodles. Yeah. But I was still enough allergic like they were still laugh enough in there that it wasn't. It wasn't a good match.   Michael Hingson ** 44:49 I have to be careful how I say this, because there's somebody over here on the floor listening but so the story goes poodles are about the most intelligent dog there.   Penn Street ** 44:59 Release they are, which is quite,   Michael Hingson ** 45:03 he's not gonna bite me.   Penn Street ** 45:06 But that's sometimes not a blessing, because they are so intelligent that they can be stubborn. And you really have to be the alpha dog 24/7 Because they, they will, they will test you, you, you have to have a certain, and there's that tomboy attitude. Right. You know, and, but I've been very, very fortunate with with my dogs and they I every time it will, you know, Michael, they know they don't live that long. And it drives me crazy. And they definitely don't guide as long as we would like them to and no. So the last one I, I was like, This is it, I I'm gonna go back, I'll just be a king user, like, I'm fine. I have good cane skills. And but here I am. And so now with him, he's nine and a half. And I have a feeling guy duck foundation will send out their trainer to do his evaluation in the spring. And there'll be like, I think it's time because he has slowed down a lot. And he's got some arthritis in his hips and that kind of thing. He's healthy. He's, he's 60. But it's not fair to him. And I'll keep him though. Sure. I will not even though I have a list of people, like I'll take him on like, no. But I I thinking he might be my last guy. But I thought that last time, so I should be open to whatever.   Michael Hingson ** 46:46 Yeah, I I agree. I think the issue is that these dogs love to work. And they would work till they drop. And so it's up to us, as you said to be the alpha dog, but also to be the real team leader and understand when it's time to retire. But it doesn't mean that you shouldn't get another one, it just means you're going to develop new memories. We had a cat, my wife had a cat named Bojangles. And Bo was, was a she lived to be I think, almost 15. But she so when I got married, I got married to both of them. And when she passed the The vet said, don't wait a long time to get a new cat. Remember, you're not replacing the memories or the cat, you're going to create new memories. And I've always told that to people, both getting animals after one died and and also just dealing with guide dogs and so on. The reality is it's new memories, you're going to learn new things. And it's an adventure. So you should you should continue.   Penn Street ** 48:00 Yeah, yeah. I mean, I can't imagine my life without, you know. I mean, they are sort of part of my identity. But it's we'll see. We'll see.   Michael Hingson ** 48:13 Yeah, you'll do what's right for you. Now, I understand that you've met Erik Weihenmayer. Tell me about   Penn Street ** 48:19 that. Yeah, Eric and I are good friends. I've never met Eric. He's he's a big goofball is it's in very giving. He So Eric is the first blind person to summit Mount Everest. Now, Lonnie Bedwell. I don't know if he's, he's up on Everest right now. If he summits he'll be the third. So I remember when the second I can't remember his name. The second blind person that summited Everest, Eric, Eric had to change his title to first instead of the only blind person   Michael Hingson ** 48:56 they have to grow and change, you know? Yeah.   Penn Street ** 48:59 So I met I met Eric I, when I think I mentioned I lost a big chunk of vision pretty much overnight and, and even though I had all the skills, the tools to took to move on, but it kind of put me in a dark place. Mostly because it I was really afraid of my career, which at that moment was working the studio and gallery. And so a friend of mine Diantha she's from Czechoslovakia. She goes, You know, I heard that there's this blind guy that summited Mount Everest, and his his premiere of his filmless is showing and I think we should go on top of the world, right? Yes. And so she pretty much kidnapped me forced me to go and she of course had the best seats right up front. And I couldn't really see the screen. But I could hear everything. Yeah. And, and then Eric, and his, you know, group of goofballs that submitted with him got up on stage. And it was the first person. I mean, I had met other blind people, but it was the first person that who was blind that was alive. That became a mentor to me. And I met him afterwards because we had, you know, the VIP ticket or whatever. And we just really hit off this friendship. Now this was before, he's the Eric, why, Marius today. So you could just walk up and meet him. And I was working for the actually the Stevens Johnson Syndrome Foundation, and I was putting together a fundraiser, and I said, Eric, this film would be great for me to, to use as a fundraiser, and I did pay the, you know, the filming rights and stuff to show the film, come up with the money. And I did, he didn't give me any favors, discounts. And I showed the film, and it was a huge success, and and then he started asking me to volunteer for his nonprofit, which has no barriers, and I would go to speaking gigs and, you know, do different things for him. And we just a friendship grew out of that. And then there was a position open with no barriers. And I, I applied, and I got it and went to work full time for him. And it was, it was incredible ride. Incredible, right? They just did a big hike actually on Saturday, which I was supposed to be at, but with what's going on with my heart right now. I didn't dare I didn't even go up to to the mountain. And I was thinking about, well, I'll just go up and I'll just sit at the base camp. But I didn't, it was too, too painful. So I usually do one hike a year with him. And that I think I might get another opportunity in August, hopefully. But But yeah, we he really did become a mentor of mine, because I love the outdoors. So much. And I really didn't know anybody who was blind or low vision that did outdoor sports until I met Eric. And then of course, I met Eric and he introduced me to, you know, everybody, and it was it was like, oh, again, it was like, okay, no big deal, I just have to do it a little bit differently. And so I kept doing it. And it's it's, it really opened a door that I didn't even know existed. So I really, really appreciate. Appreciate what and he's done that for 1000s of people. And and I shouldn't say you can't just walk up and meet him, you can if you if you're in the right place at the right time. And he really is generous with his time. But he definitely has that buffer now, you know, between himself and the general public because he has to he can't, he can't be there for everybody all the time. You know, he has a lot of responsibilities with what he does. So   Michael Hingson ** 53:31 well, you had to face a lot of things and in your world and in your life. Well, how do you face your fears? And why is it important to face them?   Penn Street ** 53:42 That's a really good question. I think I think when you don't face your fears, it gets it gets harder to face the next one, where if you keep on top of them, it I think it becomes a little bit easier. And so to me, if I if I come across things that scare me on whatever level whether they're physically or or mentally or it could be somebody telling me oh, you can't do that because you're blind. i It makes me want to do it more. Because Because I'm afraid it will if I if I don't face this fear, then the next one that comes along I'm not going to be able to face that one. And so and I do pick, you know, I I pick my battles, but you know, I don't I don't I don't think I seek out fear. I'm not I'm not I don't think I'm adrenaline junkie, you know, but on any level, especially compared to people like Eric Kim, you know, and that level of athlete, but I really think that we have to keep on top of our fears, because there's so many things out there day to day things that are scary. You know, and if we don't keep that fear in check, and, and Michael, I mean, you know this if you face a fear and you're able to break through it and learn from it and grow from it, the next one that's just doesn't seem as scary. So if we, I feel like if I get lazy about that, I'll give in and be like, I'll let the fear take over there. There was a book that came out, I didn't even read the book, it was just the title. I think it came out in the late 80s, early 90s. It was called fear, feel, sale, the fear and do it anyway. And just the title of that book became my mantra, you know, it's like, it's okay to be afraid, it is totally okay for me to be afraid. But to feel that and acknowledge it as a feeling. But I can go ahead and do it just just because I'm afraid of it doesn't, there's not a stop sign, it just means that it's I'm afraid.   Michael Hingson ** 56:15 I think we talked a little bit during our time on after site, podcast about fear. And one of the things I talked about as we're starting to write actually, it's now at the publisher being looked at, it's called a guide dogs Guide to Being brave. That's our working title. But I realized during the pandemic, that what I haven't done most of the time I've been speaking, is while I talk about not being afraid, I've not really worked to try to teach other people how to deal with fear. And I put it that way, because I'm not going to say how not to be afraid because I agree with you fear is part of what we do. The issue is, can we learn to control our fear? And the answer is yes, we can. And there's no question that we can learn how to not as I call it, be blinded by see her. And that's what we need to do. So I started working on that during the pandemic, I have a friend, I'm working with Carrie Wyatt, Kenton. So we've written the book, and now we're waiting to hear from the publisher what they want to edit or change or or do, we've done that once. And now we're, we're on our second shot at it, and we're working toward it, the expectation is that we can put something out. And it's called a guide dogs Guide to Being brave, because we base it all around the eight guide dogs that I've had and lessons I learned from them and how they behaved. And one of them could not face fear very well, and actually created her own fear, and only worked about 18 months before having to retire because she couldn't get any more she was too afraid of it. But it's a it's a fascinating set of stories. So looking forward to that coming out. But I agree with you, it's a matter of facing fear. But learning to recognize that fear can be a very powerful, positive tool for each of us.   Penn Street ** 58:10 Yeah. I agree. You know, I think some of because even rafting the Grand Canyon, I am not a good swimmer. I'm not a big, you know, like dog paddle. And I had never rafted in my entire life. And guess what there's lots of in the Grand Canyon snakes. So I, but I've really wanted to do it, I really, really wanted this experience. And I wanted to meet these kids from all over the United States, and do this adventure with them. And I it was really, it was sometimes hour by hour. And it was day by day, but but I also I shared my fear with the kids. And, and at first I wasn't going to because I was afraid to tell these high school kids because high school kids, they can be rough on you, and especially my experience getting bullied in high school. And so I was actually afraid to tell the kids about my fears. And I talked with the other leaders on the group and they said you you should tell them. Yes, I bet you. I bet you these kids have fears of their own. And you're here to be their mentor. So   Michael Hingson ** 59:39 plus, plus, if you don't, they'll see through you every time.   59:46 So I did I told them about, you know, how I lost my vision and with the rattlesnake by initiating the whole thing. And it was amazing. So at night The kids because we slept outside on Paco pads, of course. And they would put their their pads around me in a circle. And they said, you know, Miss Penn, if we feel a snake golfer as well, yeah, well, before it gets to you, I don't know if that's gonna help. But   Michael Hingson ** 1:00:19 that probably isn't a good idea, but nice, but good thought nevertheless was,   Penn Street ** 1:00:23 and they shared some of the fears that they had, and that they had not shared in their paperwork, you know, because you have to fill out a book, you know, booklet of paperwork before you get to come. And it was, it was amazing, because they got to be vulnerable, and they got to share their fears. And then the other kids got to support them, you know, and getting over their fears. And, you know, it was, and what ended up happening is we all learned each other's strengths and weaknesses. And so, you know, the really strong swimmers did the swimming, and then they taught some of us weaker ones, you know, some of the tricks, you know, and gave us some skills. And it was it was just, it ended up being a really neat thing. So I think it's okay to, and I think it's important to tell people when you're afraid, yeah, no,   Michael Hingson ** 1:01:19 I agree, it's important to do that. And everyone is different. And some of us don't necessarily face fear, and have negative reactions a lot. I think that's a lot of my upbringing, but some of us do. And there's no right or wrong way. It's a question though, of what we learn with it, and, and how we learn to address and deal with fear and challenges that we face. I'm assuming that you did not encounter any rattlesnakes in the Grand Canyon,   Penn Street ** 1:01:50 not any of that were alive there. What we thought we did a hike one day back into where this waterfall was. And one of the I was at the back, I like to be it's called the sweeper, it's the person in the back of the pack that makes sure nobody gets left behind. And that's always my favorite roll. And one of the kids came back coming to me and I was like, you're supposed to be going the opposite way. And they said, Miss Penn, there's there's a rattlesnake up there. But it's in it's right on the side of the trail. And it's right when you get to the waterfall. And and it but it's Dad and I said you could lead with it's so it was really sweet. When I got up there. I say like, do you want to see it? It's dead. I was like, Nope, I don't   Michael Hingson ** 1:02:37 need to have enough exposure to them already. I've ever been there, done that. But then   Penn Street ** 1:02:43 I was standing in the pool at the bottom of the waterfall. And one of the guides, you know, he's been a river rat forever, has hundreds, probably hundreds of times, rafting the Grand Canyon. He was standing near me and I said, What do you think killed that rattlesnake, you know, was its head crushed into something? Because Oh no, it probably got caught in the current above. And then when it came down the waterfall either got sucked under and drowned or just the impact of and I said, so there are rattlesnakes coming to Vegas? Well, it's probably rare. But yeah, I was like, Okay, I'm gonna go stand up.   Michael Hingson ** 1:03:25 He could have told you that it was afraid of you.   Penn Street ** 1:03:27 But now they'd have mentioned that. Yeah.   Michael Hingson ** 1:03:31 So what's next for Penn Street in the world?   Penn Street ** 1:03:34 Oh, wow. I I am really, uh, you know, I'm, I turned 55 This year, which, to some people doesn't sound old to others. I sound ancient. But, you know, my, my body is definitely maybe plateauing. And so, I'm really looking at these next few years of things that I really, really, really want to accomplish physically, and make sure that I do those things. So, you know, there are trips my brother who I mentioned my Superman when he passed away, my father's side of the family is from Scotland and, and Tim was really proud of his Scottish roots. My mother was Cherokee, Choctaw, Native American Indian. But Tim wanted his ashes taken back to Scotland and so it's been 10 years, next year will be 10 years. So we are going to some family and really close friends of my brothers are we're going to take his ashes to Scotland and I'm looking at different either biking trips or hiking, you know, trails that I would like to do there. That's a really big deal to me. And then the there's just there's some big trips like that that I want to accomplish. In the next couple of years, and I really, really would like to rap the Grand Canyon one more time, while I'm as healthy as I possibly. So, that's, that's really what's what's next for me. I love working at audio information network of Colorado. And I am so blessed to have such an amazing team. And Kim is such a great executive director. And so I see myself hopefully, you know, knock on wood here, that that's where my career will, you know, go until I retire, but who knows, you never know what what doors are gonna open and   Michael Hingson ** 1:05:44 well, when you go to Scotland, you'll have to go eat some haggis   Penn Street ** 1:05:48 hog I've heard about haggis. No, thank you.   Michael Hingson ** 1:05:52 I went to New Zealand and had haggis pie was very tasty. Now I don't know what was in it, as opposed to what they say is in haggis. It was very tasty. So you know, I'll bet it will be not not so bad. When you go there. Go to a restaurant and get haggis. I bet it won't be what? I would try it. I think it's worth exploring. Be brave. I will. I will. They won't have rattlesnake in it. I guarantee you that   Penn Street ** 1:06:19 that's good. I guess there are places that serve rattle steak in the south. But I've never   Michael Hingson ** 1:06:28 I had steak once somebody gave me a piece of snake and it tasted like chicken. There was way too much cartilage. And that was enough for me. I don't need to do it anymore. I can say   Penn Street ** 1:06:39 I'm a pescetarian I guess they call it I'm vegetarian, but I will eat salmon. You know fish occasionally. Yeah. And but you know, when you're traveling, especially abroad, you kind of need to go with the flow and open   Michael Hingson ** 1:06:53 you to give me a good piece of garlic bread any day. Yes. Well pin this has been absolutely fun. And I'm really glad we had a chance to do this. And I want to hear more about your exploits as you go forward. So we need to do this again in a year or two when you've done some of your other adventures. And I hope everyone has enjoyed this. We'd love to hear your comments reach out to us. But how can people reach out to you and learn more about you and what you're doing and all that kind of stuff?   1:07:27 Absolutely. I'm on most social media, Tik Tok, Instagram, Facebook, you can either use my name Penn P E N N Street, or my tagline is the blind check. Which came out of me running for city council. And so that's another story. But the blind check. And also you can reach out to me at audio information network of Colorado and find out more about what we do there. We are state based so if you're in Colorado, check us out it but it's Penn p e n n at A I N Colorado dot O R G. So I'd love to hear from you.   Michael Hingson ** 1:08:11 And after say podcast has a website.   1:08:14 It does not have a website that you can reach it through our website, which is the A I N colorado.org. Or it's on everything Apple, Spotify, Google, you know all of all of the big podcast platforms. Just it's after sight all one word. And yeah, we'd love to have you check us out there as well.   Michael Hingson ** 1:08:37 Cool. Well, we appreciate you being here and telling us all that as well. And for all of you out there, go seek out Penn street, I think it will be a treat. And she's got lots of interesting and relevant things to say needless to say. And again, I want to thank you all for listening. Please give us a five star rating wherever you're listening to us, we would appreciate it. And I hope that you'll reach out to me I'd love to hear what you think of today's episode. You can reach me at Michael M I C H  A E L H I at accessibe A C C E S S I B E.com. Or at WWW dot Michael Hingson M I C H A E L H I N G S O N .com/podcast. So we're findable. And we'd love to hear from you. I'd love to hear your thoughts and Penn for you and for anyone else's thing. If you've got any thoughts of other people who we ought to have as guests. We always appreciate introductions and emails about that. So please let us know and introduce us to anyone who you think we ought to have as a guest. We'll do it. We're glad to and once more Penn. I want to thank you for being with us today. This has been an absolute joy.   Penn Street ** 1:09:49 Thank you, Michael.   Michael Hingson ** 1:09:53 You have been listening to the Unstoppable Mindset podcast. Thanks for dropping by. I hope that you'll join us again next week, and in future weeks for upcoming episodes. To subscribe to our podcast and to learn about upcoming episodes, please visit www dot Michael hingson.com slash podcast. Michael Hingson is spelled m i c h a e l h i n g s o n. While you're on the site., please use the form there to recommend people who we ought to interview in upcoming editions of the show. And also, we ask you and urge you to invite your friends to join us in the future. If you know of any one or any organization needing a speaker for an event, please email me at speaker at Michael hingson.com. I appreciate it very much. To learn more about the concept of blinded by fear, please visit www dot Michael hingson.com forward slash blinded by fear and while you're there, feel free to pick up a copy of my free eBook entitled blinded by fear. The unstoppable mindset podcast is provided by access cast an

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Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name Celecoxib Trade Name Celebrex Indication Osteoarthritis, rheumatoid arthritis, acute pain Action Decreases pain and inflammation by inhibiting synthesis of prostaglandins Therapeutic Class Antirheumatics/NSAID Pharmacologic Class Cox 2 inhibitor Nursing Considerations • Use caution with cardiovascular disease • Increases risk for MI, CVA, thrombosis • May cause GI bleeding, Stevens-Johnson syndrome, dermatitis • Notify provider for new-onset abdominal pain or black stool

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name Azithromycin Trade Name Zithromax Indication URI, chronic bronchitis, lower respiratory infections, otitis media, skin infections, various STIs, prevention of bacterial endocarditis, treatment of cystic fibrosis Action Inhibits bacterial protein synthesis Therapeutic Class Agents for atypical mycobacterium, anti-infectives Pharmacologic Class Macrolide Nursing Considerations • May lead to pseudomembranous colitis, pain, diarrhea, nausea, Stevens-Johnson syndrome, angioedema • May increase risks for warfarin toxicity • Monitor patient for signs of anaphylaxis • Instruct patient to notify physician for diarrhea, or blood or pus in stool • Instruct patient to take medication exactly as prescribed

Visit https://nursing.com/140meds to request your free copy of "140 Must Know Meds"   Generic Name Acetylsalicylic Acid Trade Name Aspirin Indication Rheumatoid arthritis, osteoarthritis, ischemic stroke, and MI prophylaxis Action Inhibits the production of prostaglandins which leads to a reduction of fever and inflammation, decreases platelet aggregation leading to a decrease in ischemic diseases Therapeutic Class Antipyretics, non-opioid analgesics Pharmacologic Class Salicylates Nursing Considerations • Use caution in bleeding disorders, chronic alcohol use • May lead to Stevens-Johnson syndrome, laryngeal edema, and anaphylaxis • Increases risk for bleeding with warfarin, heparin, and clopidogrel • Increased risk for GI bleeding with NSAID use • Monitor liver function tests • Concurrent use with alcohol may increase risk for GI bleeding • Aspirin with viral infections can cause Reye's syndrome

Download the cheat: https://bit.ly/50-meds  View the lesson:     Generic Name levofloxacin Trade Name Levaquin Indication urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections Action inhibits DNA synthesis in bacteria Therapeutic Class Anti-infective Pharmacologic Class fluoroquinolone Nursing Considerations • contraindicated in allergies • may cause QT prolongation, avoid use with other drugs that can cause QT prolongation • can cause seizures, arrhythmias, pseudomembranous colitis, anaphylaxis, Stevens Johnson syndrome • increases the risk for tendinitis or tendon rupture • may decrease plasma concentration of phenytoin • monitor renal panel • assess for infection, obtain cultures prior to therapy • monitor liver function tests

Hace nueve años, Alejandro Aguirre Riveros estuvo a punto de morir. Contrajo el síndrome de Stevens-Johnson, una enfermedad autoinmune que provoca daños a las mucosas del cuerpo y a la piel. Entre 2016 y 2017 Fernando "Micro" Hernández viajó a La Paz para entrevistarlo a él y a María Malvina Riveros, su madre, y el resultado fue el episodio de la primera temporada de Esto no es radio, titulado “Ojos Quemados”. Cinco años después, Micro volvió a La Paz para entrevistarlos nuevamente. En este episodio un poco distinto de lo que solemos presentar en Esto no es radio, escuchamos algo que faltó hace cinco años: madre e hijo conversando sobre lo que habían vivido y sobre lo que siguen viviendo. Desde sobrevivir al colapso de un edificio en el temblor del 85 en la ciudad de México al síndrome de Stevens-Johnson que todavía tiene secuelas en Alex.  Recomendamos que escuches nuestro episodio “Ojos quemados”, que está abajito en nuestro feed, antes de escuchar este episodio. Advertencia, este episodio describe situaciones que podrían no ser aptas para menores de edad. Recomendamos cuidado. Alejandro también reporteó y produjo el episodio “La noche larga del huracán Liza” de Esto no es radio. Síguelo en instagram en @alex.escribe   Este episodio fue producido y escrito por Fernando "Micro" Hernández Becerra.  Mezcla, diseño sonoro y música original de Luis Raúl López. Dirección de sonido de Micro. Natalia Luján es editora de comunidades y productora. Sandra Fernández es nuestra asistente de producción. Esta temporada contamos con ilustraciones de Xitlalli Rayas. Para más créditos y enlace a nuestras redes sociales puedes visitar estonoesradio.mx

Hace nueve años, Alejandro Aguirre Riveros estuvo a punto de morir. Contrajo el síndrome de Stevens-Johnson, una enfermedad autoinmune que provoca daños a las mucosas del cuerpo y a la piel. Entre 2016 y 2017 Fernando "Micro" Hernández viajó a La Paz para entrevistarlo a él y a María Malvina Riveros, su madre, y el resultado fue el episodio de la primera temporada de Esto no es radio, titulado “Ojos Quemados”. Cinco años después, Micro volvió a La Paz para entrevistarlos nuevamente. En este episodio un poco distinto de lo que solemos presentar en Esto no es radio, escuchamos algo que faltó hace cinco años: madre e hijo conversando sobre lo que habían vivido y sobre lo que siguen viviendo. Desde sobrevivir al colapso de un edificio en el temblor del 85 en la ciudad de México al síndrome de Stevens-Johnson que todavía tiene secuelas en Alex.  Recomendamos que escuches nuestro episodio “Ojos quemados”, que está abajito en nuestro feed, antes de escuchar este episodio. Advertencia, este episodio describe situaciones que podrían no ser aptas para menores de edad. Recomendamos cuidado. Alejandro también reporteó y produjo el episodio “La noche larga del huracán Liza” de Esto no es radio. Síguelo en instagram en @alex.escribe   Este episodio fue producido y escrito por Fernando "Micro" Hernández Becerra.  Mezcla, diseño sonoro y música original de Luis Raúl López. Dirección de sonido de Micro. Natalia Luján es editora de comunidades y productora. Sandra Fernández es nuestra asistente de producción. Esta temporada contamos con ilustraciones de Xitlalli Rayas. Para más créditos y enlace a nuestras redes sociales puedes visitar estonoesradio.mx

Insíonn máthair Liam do Mháire Bríd Ní Chualáin faoi chomh tinn agus a bhí a mac in Ospidéal na Leanaí i gCromghlinn le gairid leis an Siondróim Stevens Johnson. Bhí Liam i mbaol báis agus b-éigean obráid a chur ar air mar go raibh imní go gcailleadh sé radharc na súl.

The Filtrate:Joel TopfSwapnil HiremathJosh WaitzmanJordy CohenSpecial Guest:Sean Barbour. Clinical Associate Professor, Division of Nephrology, University of British Columbia Chair, BC Glomerulonephritis Committee and Network, BC RenalEditor:Joel TopfShow Notes:NephJC Summary of TESTING: Re-TESTING Steroids for IgA Nephropathy (have you ever noticed how good the titles for the NephJC summaries are?)TESTING in JAMASTOP-IgA NephJC Summary: Don't just do something, stand there. Another great title, this one from from a long time ago.The British Columbia GN network really owes its existence to TESTING: An overview of the British Columbia Glomerulonephritis network and registry: integrating knowledge generation and translation within a single framework (PubMed)Dunning–Kruger effect WikipediaPrior Art for steroids in IgA nephropathy:Italian study: Randomized controlled clinical trial of corticosteroids plus ACE-inhibitors with long-term follow-up in proteinuric IgA nephropathyAnother, earlier, Italian study: Corticosteroids in IgA nephropathy: a randomised controlled trialChinese study: Combination therapy of prednisone and ACE inhibitor versus ACE-inhibitor therapy alone in patients with IgA nephropathy: a randomized controlled trialOriginal TESTING publication from 2017, also in JAMA. Oh, and we covered that in NephJC too, IgA Nephropathy: Testing Steroids Again.NephJC also talked about Sean Barbour's risk score for IgA Nephropathy: Summary | Freely Filtered Podcast episode 5A Controlled Trial of Fish Oil in IgA Nephropathy in the NEJM!Stevens-Johnson Syndrome. “When to see a doctor Stevens-Johnson syndrome requires immediate medical attention. Seek emergency medical care if you experience signs and symptoms of this condition.” Change in Albuminuria and GFR as End Points for Clinical Trials in Early Stages of CKD: A Scientific Workshop Sponsored by the National Kidney Foundation in Collaboration With the US Food and Drug Administration and European Medicines Agency (PubMed)Adaptive Trials in NephMadness 2016 with Selection Committee Member, Perry Wilson!TreifGeographic Differences in Genetic Susceptibility to IgA Nephropathy: GWAS Replication Study and Geospatial Risk AnalysisThe MEST score provides earlier risk prediction in lgA nephropathyDAPA-IgA: A pre-specified analysis of the DAPA-CKD trial demonstrates the effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathySwap and Josh fight about SGLT2i in IgA NephropathySignificance of serum galactose deficient IgA1 as a potential biomarker for IgA nephropathy: A case control study (PubMed)FDA approves first drug to decrease urine protein in IgA nephropathy, a rare kidney disease. FDA has granted accelerated approval for  budesonide delayed release capsules to reduce proteinuria in adults with primary IgA nephropathy at risk of rapid disease progression. It has not been established whether budesonide delayed release capsules slow kidney function decline in patients with IgA nephropathy. Targeted-release budesonide versus placebo in patients with IgA nephropathy (NEFIGAN): a double-blind, randomised, placebo-controlled phase 2b trial (Lancet)Omicron in Ontario.Prescribing Nirmatrelvir/Ritonavir for COVID-19 in Advanced CKD by SwapStar Trek: Strange New WorldsOrigins of Renal Physiology: Fellows 2022 Medical Students: Kidney TREKSApplication of the International IgA Nephropathy Prediction Tool one or two years post-biopsy (Kidney International)The Triple Crown in Virginia

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/CiprofloxacinCiproNursingConsiderations    Generic Name Ciprofloxacin Trade Name Cipro Indication Urinary tract infections, gonorrhea, respiratory tract infections, bronchitis, pneumonia, skin and bone infections, infectious diarrhea, abdominal infections Action Inhibits bacterial DNA synthesis Therapeutic Class Anti-infectives Pharmacologic Class Fluoroquinolone Nursing Considerations • Contraindicated in allergies • May cause QT prolongation, avoid use with other drugs that can cause QT prolongation • Can cause seizures, arrhythmias, pseudomembranous colitis, anaphylaxis, Stevens Johnson syndrome • May decrease effects of phenytoin • Monitor renal panel • Assess for infection, obtain cultures prior to therapy • Monitor liver function tests

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/CelecoxibCelebrexNursingConsiderations    Generic Name Celecoxib Trade Name Celebrex Indication Osteoarthritis, rheumatoid arthritis, acute pain Action Decreases pain and inflammation by inhibiting synthesis of prostaglandins Therapeutic Class Antirheumatics/NSAID Pharmacologic Class Cox 2 inhibitor Nursing Considerations • Use caution with cardiovascular disease • Increases risk for MI, CVA, thrombosis • May cause GI bleeding, Stevens-Johnson syndrome, dermatitis • Notify provider for new-onset abdominal pain or black stool

Our guest for this episode is Dr. Dan Rosenquist, a family medicine physician in Nebraska and risk manager for COPIC. The focus is on Stevens-Johnson syndrome and toxic epidermal necrolysis, which are commonly caused by medications or infections and typically present as skin reactions. Dr. Rosenquist walks through the causes and symptoms to be aware of, the role of certain medications in this condition, and discussing the issue with patients. The conversation also touches on having a high index of suspicion, particularly early in its presentation, as the findings may be subtle or confused with more common conditions. Email the show at wnlpodcast@copic.com

Timothy West trying to outrun his demons. He was a happy four-year-old who loves cars, until one day he was rushed to the emergency room for an ear infection, he was given amoxicillin to cure that air infection, and it did, but at the same time because of the new problems. TJ found a condition called Stevens-Johnson syndrome which is a hi allergic reaction to the medication. It made all of his skin burn off, hair fell out, and so much more. The one thing he still has from this condition 30 years later, TJ is legally blind. He had to navigate this world with a very mediocre vision, on top of that being molested in school, bullied, mental health, and more. He is now 33 years old, he created his own podcast called My Blurred Opinion to give a safe space to others to be themselves and to share their amazing stories.   My Blurred Opinion Podcast: https://podcasts.apple.com/us/podcast/my-blurred-opinion/id1521610750?uo=4 Facebook: https://www.facebook.com/tj.west.96/ Instagram: https://www.instagram.com/tjssafespaceforall/   To learn more about James, visit Professor of Perseverance. You may also contact him through email, James@professorofperseverance.com or call 615 – 336 – 2181

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/AzithromycinZithromaxNursingConsiderations    Generic Name Azithromycin Trade Name Zithromax Indication URI, chronic bronchitis, lower respiratory infections, otitis media, skin infections, various STIs, prevention of bacterial endocarditis, treatment of cystic fibrosis Action Inhibits bacterial protein synthesis Therapeutic Class Agents for atypical mycobacterium, anti-infectives Pharmacologic Class Macrolide Nursing Considerations • May lead to pseudomembranous colitis, pain, diarrhea, nausea, Stevens-Johnson syndrome, angioedema • May increase risks for warfarin toxicity • Monitor patient for signs of anaphylaxis • Instruct patient to notify physician for diarrhea, or blood or pus in stool • Instruct patient to take medication exactly as prescribed

En esta ocasión no hay una descripción para el episodio, porque no hay nadie mejor para describirlo que la misma invitada. En su lugar, el equipo de Ser Nutritivo Podcast quiere darte un agradecimiento muy especial a ti Cynthia por habernos elegido como la plataforma para contar tu historia y la de Fer, que mutuamente se llenaron de enseñanzas que permanecerán. Estamos seguros que tu experiencia llegará a las personas adecuadas para seguir cumpliendo con esa misión de servicio y generosidad que te mostró Fer desde el día de su nacimiento. Muchas gracias querida Cynthia. [Cynthia López es nutrióloga especialista en Parálisis Cerebral Infantil; empática no solo en palabra, sino que literalmente sabe lo que es estar en los zapatos de una madre con un hijo con PCI. A través del episodio escucharás su historia, así como los retos y enseñanzas que su hijo Fer le regalaron]. OTROS EPISODIOS PARA SEGUIR NUTRIENDO TU SER: T2.E1 Maternidad al natural T2.E22 La lactancia materna MOMENTOS IMPORTANTES: 00:00 Introducción al episodio 04:11 Presentación de la invitada 05:42 El inicio de su historia 16:58 Causas de la PCI 20:25 Desarrollo de un niño con PCI 31:15 Síndrome de Dumping 36:20 Terapia y rehabilitación 42:00 Síndrome de Stevens-Johnson 49:28 Retos en la alimentación con PCI 58:46 Respeto y empatía 1:02:11 Preguntas a la invitada --- Send in a voice message: https://anchor.fm/sernutritivopodcast/message

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/ASAAspirinNursingConsiderations    Generic Name Acetylsalicylic Acid Trade Name Aspirin Indication Rheumatoid arthritis, osteoarthritis, ischemic stroke, and MI prophylaxis Action Inhibits the production of prostaglandins which leads to a reduction of fever and inflammation, decreases platelet aggregation leading to a decrease in ischemic diseases Therapeutic Class Antipyretics, non-opioid analgesics Pharmacologic Class Salicylates Nursing Considerations • Use caution in bleeding disorders, chronic alcohol use • May lead to Stevens-Johnson syndrome, laryngeal edema, and anaphylaxis • Increases risk for bleeding with warfarin, heparin, and clopidogrel • Increased risk for GI bleeding with NSAID use • Monitor liver function tests • Concurrent use with alcohol may increase risk for GI bleeding • Aspirin with viral infections can cause Reye's syndrome

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/AcyclovirZoviraxNursingConsiderations  What is the Generic Name Acyclovir What is the Trade Name for Acyclovir Zovirax What is the Indication for Acyclovir Genital herpes, herpes zoster, chicken pox What is the Action of Acyclovir Interferes with viral DNA synthesis What is the Therapeutic Class of Acyclovir Antiviral What is the Pharmacologic Class of Acyclovir Purine analogues What are the Nursing Considerations for Acyclovir   May cause seizures, renal failure, Stevens-Johnson syndrome, thrombotic thrombocytopenic purpura syndrome, diarrhea, dizziness, nausea Monitor renal panel during administration Assess lesions Instruct patient to use proper protection during sexual intercourse

Merhabalar, bu yazımızda sizlere acil serviste nadir de olsa karşılaştığımız Steven-Johnson sendromu (SJS) ve toksik epidermal nekrolizden (TEN) bahsedeceğim. Ufacık bir patofizyolojiden sonra SJS ve TEN ayrımından daha sonra da skorlama sistemi, mortalite oranları ve tedavi yaklaşımından bahsederek konuyu sonlandırağız. Stevens-Johnson sendromu (SJS) ve toksik epidermal nekroliz (TEN), en yaygın olarak ilaçlarla tetiklenen, ateş, yoğun nekroz ve epidermisin ayrılması ile karakterize şiddetli mukokutanöz advers reaksiyonlardır. Mukoza zarları, hastaların yüzde 90'ından fazlasında, genellikle iki veya daha fazla farklı bölgede (oküler, oral ve genital) etkilenir.1 Yaygın epidermis hasarının nedeni keratinositlerin apotozisidir. İlaçlar ya da metabolitlerinin, hapten görevi görerek keratinositlerin yüzeyine bağlanmasının ve onları antijenik hale getirmesinin olayı başlattığı düşünülmektedir. İlaca özgül CD8 (+) sitotoksik T hücrelerinin Fas/FasL ve perforin/granzim B yolağı ile keratinosit apotozisini tetikleyerek hastalığı başlattığı düşünülür.2 SJS ve TEN, bir hastalık sürekliliği olarak kabul edilir ve esas olarak, cilt dekolmanı ile ilgili vücut yüzeyinin yüzdesine dayalı olarak ayırt edilir: ●SJS, cilt dekolmanının vücut yüzeyinin yüzde 10'undan az olduğu, daha az şiddetli durumdur.  SJS Deri Değişiklikleri ●TEN, vücut yüzey alanının yüzde 30'undan fazlasının ayrılmasını içerir. Toksik Epidermal Nekroliz ●SJS/TEN örtüşmesi, vücut yüzey alanının yüzde 10 ila 30'u, cilt dekolmanı olan hastaları tanımlar. SJS/TEN örnekleri3 Şiddet ve Prognozun Hızla Değerlendirilmesi SJS ve TEN olduğundan şüphelenilen hastalar hastaneye yatırılmalıdır. SJS veya TEN tanısı konur konmaz, uygun tıbbi ortamı tanımlamak için hastalığın şiddeti ve prognozu hızla belirlenmelidir. Bireysel hastaların prognozu, SCORTEN (Score of toxic epidermal necrolysis) adı verilen prognostik skorlama sistemi kullanılarak başvuru anında hızla değerlendirilebilir.3 SCORTEN, yedi bağımsız ve kolayca ölçülebilen klinik ve laboratuvar değişkenine dayanmaktadır ve SJS/TEN için hastaneye yatışın birinci ve üçüncü günlerinde kullanım için onaylanmıştır. Parametreler SkorSkor aralığı Mortalite hızı(%)Yaş ≥ 4010-13,2Malignite1212,1Tutulan vücut yüzeyi ≥ %101335,3Taşikardi ≥1201458,3BUN >10 mmol/L ( >28 mg/dL)1≥590Serum Glukoz >14 mmol/L (>252 mg/dL) 1Serum Bikarbonat < 20 mmol/L1Skor7Stevens-Johnson Sendromu/Toksik Epidermal Nekroliz için SCORTEN Skoru11 SCORTEN skoru, aşağıda açıklanacağı gibi, her bir hastanın tedavisi için hangi klinik ortamın (yoğun tedavi/yanık ünitesi veya uzman olmayan servis) uygun olduğunu belirlemek için kullanılabilir.  Yoğun Tedaviye veya Yanık Ünitesine Sevk  Hastayı yoğun bakım veya yanık ünitesine sevk etme kararı, cilt tutulumunun kapsamına ve komorbiditelerin varlığına bağlı olarak vaka bazında verilmelidir. Hızla ilerlemeyen sınırlı cilt tutulumu olan, ve SCORTEN skoru 0 veya 1 olan hastalar, bu alanda uzmanlaşmamış servislerde tedavi edilebilir. Daha şiddetli hastalığı (cilt dekolmanı > vücut yüzey alanının % 30'u) veya SCORTEN skoru ≥2 olan hastalar, varsa yoğun bakım ünitelerine, yanık ünitelerine veya özel dermatoloji ünitelerine transfer edilmelidir. Birkaç çalışma, yanık bakım ünitesine veya yoğun bakım ünitesine hemen nakledilen hastalarda prognozun daha iyi olduğunu göstermektedir.4 Neden Olan İlaçların Hemen Kesilmesi İlaçların neden olduğu SJS ve TEN şüphesi olan hastalar için, kusurlu ajanın erken tanımlanması ve geri çekilmesi prognozu iyileştirebilir. Kesinlikle İlişkiliİlişkiliŞüpheli İlişik/Düşük RiskAllopurinolDiklofenakPantopazolLamotrijinDoksisiklinGlikokortikoidlerSülfametoksazolAmoksisilin/AmpisilinOmeprazolKarbamazepinSiprofloksasinTetrazepamFeniotinLevofloksasinDipiron (metamizol)NevirapinAmifostinTerbinafinSülfasazalinOkskarbazepinLevetirasetamDiğer SülfonamidlerRifampin (rifampisin) Oksikam NSAID'lerFenobarbitalEtorikoksibStevens-Johnson Sendromu/...

An interview with Dr. Milan Anadkat from Washington University & Dr. Aung Naing from MD Anderson Cancer Center, authors on “Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update.” They discuss recommendations for cutaneous toxicities in patients receiving ICPis, including rash, bullous dermatoses & SCAR in Part 3 of this 13-part series. For more information visit www.asco.org/supportive-care-guidelines   TRANSCRIPT [MUSIC PLAYING] SPEAKER: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content, and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey. And today, we're continuing our series on the management of immune-related adverse events. I am joined by Dr. Milan Anadkat from Washington University in St. Louis, Missouri. And Dr. Aung Naing from the University of Texas M.D. Anderson Cancer Center in Houston, Texas, authors on Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: ASCO Guideline Update and Management of Immune-Related Adverse Events in Patients Treated with Chimeric Antigen Receptor T-Cell Therapy: ASCO Guideline. And today, we're focusing on cutaneous toxicities in patients treated with immune checkpoint inhibitor therapy. Thank you for being here Dr. Anadkat and Dr. Naing. AUNG NAING: Thank you for having us. MILAN ANADKAT: Thank you. BRITTANY HARVEY: I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guidelines in the Journal of Clinical Oncology. Dr. Anadkat, do you have any relevant disclosures that are directly related to these guidelines? MILAN ANADKAT: As listed in the document, I don't have any direct disclosures. I do have a number of indirect disclosures, as I've consulted on similar topics in the past. BRITTANY HARVEY: Thank you. Then Dr. Naing, do you have any relevant disclosures that are related to these guidelines? AUNG NAING: I do not have. BRITTANY HARVEY: Great, then let's get into the content of this guideline and the cutaneous toxicities that we're here today to talk about. So Dr. Naing, what are the immune-related cutaneous toxicities addressed in this guideline? AUNG NAING: Well, with the advancement of immunotherapy, we've seen better response in our cancer patients. However, together with such positive outcomes, we are also seeing side effects caused by the immunotherapy. Disruption of the homeostatic mechanisms include a unique spectrum of side effects or immune related adverse events, commonly called IRAEs. The most common immune related adverse events in patients receiving checkpoint inhibitors are dermatitis, enterocolitis, transmitis, and endocrinopathies. However, if you look at the most commonly reported IRAE of any grade, it is dermatologic toxicity. So here in this guideline, we addressed how to take care of the patients when they are having these side effects, particularly with the cutaneous toxicities. So when you look at that time to median onset of skin toxicities, it ranges from two to five weeks. And using CTCAE criteria for grading is a challenge for skin toxicity, as it may not reflect the true picture. So, therefore, severity may be graded based on body surface area, tolerability, mobility, and durations. Those are the points also we discuss in this guideline. Broadly speaking, they are three groups of cutaneous IRAEs. They are rash inflammatory dermatitis, bullous dermatoses, and finally, Severe Cutaneous Adverse Reactions, SCAR. It is important to have thorough physical exam and rule out any other etiology of skin problems. In general, it's also important to work closely with our colleagues from dermatology. While some of those low grade skin toxicities could be treated in outpatient setting, consulting the cases with dermatologists is important for higher grades of skin toxicities, such as bullous dermatoses and SCAR. My colleague, Dr. Milan Anadkat, will follow with a discussion on the role of dermatologists in taking care of patients with cutaneous toxicities caused by immunotherapy. BRITTANY HARVEY: Thank you, Dr. Naing for reviewing those. So then you just mentioned three categories of toxicity. And I'd like to review the key recommendations for each. So Dr. Anadkat, starting with what is recommended for the identification, evaluation, and management of rash or inflammatory dermatitis? MILAN ANADKAT: Thank you, Brittany. And thank you Dr. Naing for teeing up this discussion. I think, as was mentioned, there are three major categories of cutaneous toxicity that are seen from immunotherapy. By and large, the most common is rash or inflammatory dermatitis, from which there are multiple different phenotypes or looks by which physicians may be seeing. The most common phenotypes within rash or inflammatory dermatitis, which account for over 90% of the cutaneous toxicity seen from immunotherapy, include lichenoid, which is a purple, flat topped bumpy rash that can involve the skin or the mucosal membranes. The psoriasiform, which resembles psoriasis, morbilliform, or oftentimes, maculopapular, which resembles a measles-like pink exanthem over the trunk, or generalized eczema and itching. So what's important is identifying the particular phenotype and categorizing it as an inflammatory dermatosis and excluding the other two phenotypes of cutaneous toxicity, such as bullous dermatoses or Severe Cutaneous Adverse Reactions. BRITTANY HARVEY: Great, and then moving into that second category that you both mentioned, what are the key recommendations for bullous dermatoses? MILAN ANADKAT: And so the key phenotypes for bullous dermatoses, by and large, is bullous pemphagoid, which is the most common phenotype seen in this category. Although other phenotypes resembling autoimmune bullous diseases, such as pemphigus or bullous drug reactions may also be seen. With bullous pemphigoid we see tense blisters, or tense bullae, frequently overlying a bed of erythema on the skin. Patients typically complain of considerable itching, far more than pain, with this category of eruption. BRITTANY HARVEY: Got it. Thank you for reviewing that for bullous dermatoses. So then the third group is Severe Cutaneous Adverse Reactions. So what are the key recommendations there? MILAN ANADKAT: And so the third group, being Severe Cutaneous Adverse Reactions, is a term used worldwide to encompass conditions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, acute generalized exanthematous pustulosis, and DRESS or drug reaction with eosinophilia and systemic symptoms. These are, fortunately, rare, but can be life threatening skin eruptions. They account for less than 1% of all skin reactions seen from immunotherapy. When practitioners are approaching a patient who may potentially have one of these conditions, patients typically will exhibit symptoms of malaise, fatigue, fever, and a dramatic cutaneous eruption, which will either present with peeling or sloughing of the top layers of the skin, or a generalized erythema covered with multiple sterile pinpoint pustules. Oftentimes, there are associated symptoms of lymphadenopathy and organ toxicity that is noticed simultaneously, such as hepatotoxicity, or eosinophilia, or acute renal failure. BRITTANY HARVEY: Great, I appreciate you reviewing the identification of all three of those groups. So then I'd like to hear from you both on this last question. But in your view, how will these recommendations for the management of cutaneous toxicities impact both clinicians and patients? AUNG NAING: I would say that recognition of the toxicity is really important, particularly if you can actually catch the toxicity when it is in the mild grade. If you take care of them, then you can actually stop them from being mild to severe toxicity. That's number one. Number 2 is in that way, we may not have to halt or stop the immunotherapy treatment that could be beneficial to the patients. And also, working together with the dermatologists is very important, because as I discussed earlier, some of them, we could take care of as an outpatient. But there will be certain dermatology toxicities, where we need to work closely with our dermatologists. And please also remember that these are the guidelines. You will be seeing the patient in the setting. So I think using that guideline and clinical judgment, that would actually help our patients at large. MILAN ANADKAT: I think that's excellent. One, I think, important aspect of these guidelines is not only to correctly identify the phenotypes of cutaneous toxicity, but as Dr. Naing mentioned, it assists in management of these toxicities. The goal of these guidelines, especially as it pertains to the skin toxicity, is to accurately identify what toxicity is occurring for the patient, but then more importantly, to guide on appropriate management strategies to allow the patient to continue on immunotherapy and minimize or avoid unnecessary treatment interruption or treatment discontinuation. The guidelines assist in management strategies according to the severity by which patients present. And as mentioned, I think ultimate priority will be given to the practitioner directly treating the patient. But consideration towards not only extent of body surface area involved, but severity of cutaneous eruption is thoroughly reviewed. And in addition to phenotype, including such patient reported outcomes, such as degree of pain, itch, or interruption on activities of daily living help guide the degree of management that can be provided. BRITTANY HARVEY: Those are excellent points. I want to thank you so much for your work on these guidelines and for taking the time to speak with me today, Dr. Naing and Dr. Anadkat. AUNG NAING: Thank you. MILAN ANADKAT: Thank you. BRITTANY HARVEY: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. Stay tuned for additional episodes on the management of immune-related adverse events. To read the full guideline, go to www.asco.org/supportive care guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app, available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast. And be sure to subscribe, so you never miss an episode. [MUSIC PLAYING]

Daniel-André Tande er gjest i dagens episode. Daniel snakker om blant annet fallet i Planica, vegen tilbake i bakken, tiden med Stevens-Johnson syndrom, VM gull i skiflyging i Oberstdorf og da sammenlagtseieren i hoppuka glapp. Her blir det mye interessant! alt fra slippers til brødrene Ruud. Kos dere med en og en halv time med lagets selvutnevnte klovn!

This week's guest is Dr. CE Payne Hull. Payne by birth, Hull by choice, Dr. Payne Hull is an educator, wife, mother, author, mentor and survivor of Stevens Johnson syndrome, amongst many other things. A woman of precise vision, Dr. Payne Hull shares her intimate journey with us from a preacher's daughter to head of school. Facebook: CE Payne Hull, Maat Adorned 2016, Queendom 101 Twitter: @101queendom; @maatadorned Instagram: @queendom_101org; @maatadorned Website: www.queendom101.org; www.maatadorned.com - The Holy Bible - the ISIS Papers by: Frances Cress Welsing - Nigger by Dick Gregory - Caste by: Isabel Wilkerson - Blink by: Malcolm Gladwell - Just as I Am: Cicely Tyson - Medical Apartheid by: Harriet Washington - Assata by Assata Shakur - The New Jim Crow by: Michelle Alexander - 48 Laws of Power by Robert Greene - The Art of War by Sun Tzu - The Post-Racial Negro Green Book (1st edition) - Dust Tracks on the Road by Zora Neale Hurston Recommended Music: - Gospel (Acapella Groups) - Tai Chi - Smooth Jazz - Reggae - My Pandora Stations: Common, Talib Kweli, Lauryn Hill, Bob Marley Recommended Podcasts: - Holt Street Church of Christ Montgomery - The Network - Latoya Okeia (for aspiring life coaches) - The Dr. Will Show Ya Didn't Ask: "A reminder message for black women and girls- Black women are given a small room for error. As black women we must always be on top of our game and know that God controls everything, understand the art of war, the 48 laws of power, how to influence without authority, and make every effort to be our very best at everything we do every minute of every day!" --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/mike493/message

This episode covers Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).Written notes can be found at https://zerotofinals.com/paediatrics/dermatology/sjs/ or in the dermatology section of the Zero to Finals paediatrics book.The audio in the episode was expertly edited by Harry Watchman.

Dr Sarah Walsh of the EADV Education Committee sits down and speaks with prominent researchers Dr Pauline O'Reilly and Prof. Jean-Pascal Lefaucheur to discuss two previously poorly-explored aspects of SJS/TEN. Prof Lefaucheur gives insights in to the prevalence of chronic skin pain and possible pathomechanisms, and Dr O'Reilly discusses her research in the area of post-traumatic stress disorder and other psychological consequences of this devastating disease, for patients themselves, their families and their care-givers.   Articles referenced in this episode can be found in the JEADV: Patients', family members' and healthcare practitioners' experiences of Stevens–Johnson syndrome and toxic epidermal necrolysis: a qualitative descriptive study using emotional touchpoints https://www.onlinelibrary.wiley.com/doi/10.1111/jdv.16958   Involvement of small‐diameter nerve fibres in long‐term chronic pain after Stevens–Johnson syndrome or toxic epidermal necrolysis. A neurophysiological assessment https://www.onlinelibrary.wiley.com/doi/10.1111/jdv.16940   Chronic pain: a long‐term sequela of epidermal necrolysis (Stevens–Johnson syndrome/toxic epidermal necrolysis) – prevalence, clinical characteristics and risk factors https://www.onlinelibrary.wiley.com/doi/10.1111/jdv.16891

In this episode, I get to talk to an old friend and reminisce about our condition. Julie is a person who went through Stevens-Johnson syndrome and was a scared little girl when I met her and now has turned into a woman who raises her own little girl and deals with the challenges that come with that, while also being an advocate for our traumatic condition. For more support for Stevens Johnson syndrome check out her website Sjsupport.org Sjskidsupport.org  

In this episode, I get to talk to an old friend and reminisce about our condition. Julie is a person who went through Stevens-Johnson syndrome and was a scared little girl when I met her and now has turned into a woman who raises her own little girl and deals with the challenges that come with that, while also being an advocate for our traumatic condition. For more support for Stevens Johnson syndrome check out her website Sjsupport.org Sjskidsupport.org  

Episode #10 - Taking a chance for a dance, a career in Nursing, Family Life & parenting with challenges. Judy Stefnitz shares her story of a varied and fascinating life with ups and downs, and she comes through shining.  Joining Erin Davis and Lloyd Hetherington on the green bench from The Village of Tansley Woods in Burlington. How do you start your day? Share with us on Twitter (@GreenBenchStory) and don't forget to use the #ElderWisdom tag. Judy starts her day with brain exercises, learning, scrabble, and of course breakfast. She loves life!  Has a plan for every day that is not carved in stone. A Salute To Nurses: The World Health Assembly has designated 2020 the International Year of the Nurse and the Midwife. Judy shares about her broad nursing career at Sick Kids in Toronto and at Oakville Hospital. “Nurses dispense Comfort, Compassion & Caring without even a prescription” – Val Saintsbury Parenting doesn't come without challenges.  Judy, taking care of her children had a number including convulsions, falling off the roof, Stevens-Johnson syndrome, asthma, swellings, rashes, and allergies.   A move to Montreal to support her husband's career in 1972, after the FLQ crisis. Without being fluent in French, Judy could not work as a nurse in Montreal. "It's amazing how life works." reading the paper, seeing a notice - 'If family life is important to you, Concordia University is offering a new program' - So she went for it. Excited to continue learning at 38 and still today at 81. "Life is the curriculum." Judy Stefnitz If the opportunity presents itself, Judy responds. Family Life taught to look at all the issues from the womb to tomb.  Her practicum was helping parents to be sex educators - it is as important today as it was then.  Teaching attitudes, values, and respect, etc.  "Attitude is our greatest power. We control that for ourselves." - Judy Stefnitz Subscribe, rate, and review our podcast on any network and share your thoughts on social media using the #ElderWisdom tag to help others find us. ----more---- The Green Bench is a symbol of elder wisdom. Physically or virtually, the bench invites us all to sit alongside a senior, share a conversation, or give and offer advice. It challenges the stigma seniors face; the ageism still so prevalent in society. It reminds us of the wealth of wisdom our elders offer and in doing so, helps restore them to a place of reverence. "The greatest untapped resource in Canada, if not the world, is the collective wisdom of our elders." -Ron Schlegel This podcast is brought to you by Schlegel Villages, retirement & long-term care homes in Ontario, Canada. #ElderWisdom | Stories from the Green Bench is produced by Memory Tree Productions  Learn more about our host, Erin Davis, at erindavis.com  Learn more about co-host, Lloyd Hetherington  Learn more about #ElderWisdom at elderwisdom.ca

El síndrome de Stevens-Johnson y la necrólisis epidérmica tóxica son toxicodermias graves que forman parte de un mismo espectro de enfermedad. Ambas entidades se deben a la apoptosis masiva de queratinocitos, generalmente inducida por medicamentos, y se diferencian según el porcentaje de superficie corporal comprometida. Existen controversias en cuanto a su clasificación, fisiopatología y manejo. Pese a su baja frecuencia, pro­ducen una morbimortalidad importante y son unas de las enfermedades más catastróficas en dermatología.

Este es medical commons, a continuación intentaremos dar una revisión sistemática por los temas mayormente  preguntados en los exámenes de residencias médicas en Colombia y que frecuentemente son motivo de consulta en atención primaria.  Todas las decisiones médicas y recomendaciones aquí expresadas deben de ser comparadas con la información académica oficial y jamás deben de ser tomados como un absoluto, los actos médicos derivados de estos audios son responsabilidad de aquellos que ejercen. Si un paciente comienza a mostrar signos de una posible tendinitis o rotura del tendón, la recomendación es suspender inmediatamente la quinolona y evitar el uso de la zona afectada. Dichos signos pueden incluir dolor, hinchazón o inflamación en los tendones. También se recomienda suspender las quinolonas e iniciar medidas de apoyo inmediatas en casos con eventos adversos graves, incluido el síndrome de Stevens-Johnson, necrólisis epidérmica tóxica, hepatotoxicidad y anafilaxia.    Referencia Yan A, Bryant EE. Quinolones. [Updated 2020 May 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557777/     Este podcast se distribuye bajo los términos de Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), que permite su uso, duplicación, adaptación, distribución y reproducción en cualquier medio o formato, siempre que otorgue el crédito apropiado al autor o autores originales y la fuente, se proporciona un enlace a la licencia Creative Commons, y se indican los cambios realizados.

Cephalon Inc., the company that first licensed modafinil drug and listed it as a sleep disorder medication, lists Stevens-Johnson syndrome (SJS) as a possible adverse reaction that can occur when taking the medication. At a clinical phase trial, one patient was reported to have developed this adverse condition. Since this awakening health side effect, there have been no documented cases of Stevens-Johnson syndrome condition in response to modafinil medication. Luckily, this condition is very rare, only affecting about 1 or 2 individuals per million. Nevertheless, the severity of this allergic reaction makes it extremely necessary to know & understand the early signs as well as symptoms. This https://modafinil.org/modafinil-sjs/ guide shares some modafinil SJS tips & tricks to make sure it doesn't happen to you when taking modafinil. It introduces you to Stevens-Johnson syndrome, how significant it is to know, some of the chances of developing it, how it is treated, and how to prevent this health problem by taking modafinil correctly. Read this guide on excellent tips about modafinil and Stevens-Johnson syndrome and why modafinil reward your brain chemical substances for other added benefits that promote wakefulness & cognitive function. Timestamp 00:47 What Is Modafinil? 02:01 Where to Buy Modafinil 02:50 What Is Stevens-Johnson syndrome? 03:51 What Causes Stevens-Johnson syndrome? 06:21 Is It Dangerous? 06:41 How Common Is Stevens-Johnson syndrome? 07:27 How Is Stevens-Johnson Syndrome Treated? 08:11 How to Prevent Stevens-Johnson syndrome 08:22 1. Risk Assessment 09:22 2. Start Small with Modafinil 10:19 Should I Be Worried About Stevens-Johnson Syndrome?

In the August 2020 episode, Kris Maday, PA-C, and Adrian Banning, PA-C, discuss CME articles on ADHD and low back pain as well as articles on Stevens-Johnson syndrome and toxic epidermal necrolysis and a case about a curious skin lesion.

The Filtrate:Joel TopfSwapnil HiremathSamira FaroukAnd special guests:Katalin Susztak, Professor of Medicine Perlman School of Medicine, University of Pennsylvania. @KSusztakShow Notes:CKD-FIX: Effects of Allopurinol on the Progression of Chronic Kidney DiseasePERL: Serum Urate Lowering with Allopurinol and Kidney Function in Type 1 DiabetesCoverage at NephJC: Effects of Allopurinol on the Progression of Chronic Kidney DiseaseRichard Johnson’s theory in pay-walled Nature Reviews Nephrology: Hypothesis: fructose-induced hyperuricemia as a causal mechanism for the epidemic of the metabolic syndromeRichard Johnson’s theory in open access Nehrology Dialysis and Transplantation: Uric acid and chronic kidney disease: which is chasing which?PERL: Preventing early renal lossIohexol, good for measuring GFR as well as causing contrast associated nephropathy?Uric acid versus urate: The Crystallization of Monosodium UrateAssociation of HLA-B*5801 allele and allopurinol-induced Stevens Johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysisWHO list of essential medicationsFixing the numbers, specifically phosphorousGFR Decline as an End Point for Clinical Trials in CKD: A Scientific Workshop Sponsored by the National Kidney Foundation and the US Food and Drug AdministrationCost of allopurinol: $7/month but it is only $9 for 3 monthsFebuxostat Therapy for Patients With Stage 3 CKD and Asymptomatic Hyperuricemia: A Randomized TrialTipping point analysis - multiple imputation for stress test under missing not at random (MNAR) or a YouTube video if that’s your speed (sorry, I couldn’t find a TikTok on imputation stress tests).Mendelian randomization study of urate and CKD by Ron Do and teamDad jokesFake systematic review by Johnson’s group showing Urate lowering prevented CKDHyperuricemia As a trigger of Immune Response in Hypertension and Chronic Kidney Disease by Claudio Ponticelli published the week after these two RCTs were published.NEJM Editorial: Urate-Lowering Therapy and Chronic Kidney Disease Progression by Daniel FeigCOVID and PPI manuscriptHashtag the cowboy‘WhatsApp®’ening in nephrology trainingArkana LIVE Pathology SessionsNephJC Summer Book Club. Read Rana Awdish’s In Shock

This episode Goes deeper into my fight with Stevens Johnson syndrome, when my mom, and grandma give their take on what really happened --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

This episode Goes deeper into my fight with Stevens Johnson syndrome, when my mom, and grandma give their take on what really happened--- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Alejandro tenía dolor de garganta, se tomó una pastilla y se fue a dormir. Cuando despertó, su vida ya no era la misma. Este episodio fue escrito, producido y editado por Fernando "Micro" Hernández. Mitzi Pineda es la Productora Asociada.  Síguenos en instagram como @estonoesradiomx y twitter @estonoesradio. Micro twitea e instagramea como @microgdl   La ilustración de “Ojos quemados” corrió a cargo de Alejandra Puga. Agradecimientos especiales a Lizeth Arámbula, a Abril Rayas y a la familia Aguirre Riveros, por abrirme las puertas de su hogar y vivir muy de cerca la lucha cotidiana que libran contra las secuelas del síndrome Stevens Johnson. No olviden compartir este episodio, y dejarme una reseña en iTunes, eso ayuda a que más gente llegue a este podcast. Música en este episodio con una licencia Creative Commons Attribution ShareAlike a cargo de: Monplaisir - Happy harpy volume  https://bit.ly/2PN8M2q Monplaisir - Sub  https://bit.ly/2S9B09w Tracky Birthday - Pivoting on salsa key 11  https://bit.ly/2rI9R1L Monplaisir - 08  https://bit.ly/2A8pwfl Monplaisir - Confortablement installé·e  https://bit.ly/2ClQIc9 Rafael Archangel - Deep dive  https://bit.ly/2UX5IVg Nctrnm - In Medias Res  https://bit.ly/2BvnNAR The Freeharmonic Orchestra - Deep Space  https://bit.ly/2PMg0n6 P C I I I - PCGCP  https://bit.ly/2R2JGBk Andy G Cohen - A perceptible shift  https://bit.ly/2S9VG11

Alejandro tenía dolor de garganta, se tomó una pastilla y se fue a dormir. Cuando despertó, su vida ya no era la misma. Este episodio fue escrito, producido y editado por Fernando "Micro" Hernández. Mitzi Pineda es la Productora Asociada.  Síguenos en instagram como @estonoesradiomx y twitter @estonoesradio. Micro twitea e instagramea como @microgdl   La ilustración de “Ojos quemados” corrió a cargo de Alejandra Puga. Agradecimientos especiales a Lizeth Arámbula, a Abril Rayas y a la familia Aguirre Riveros, por abrirme las puertas de su hogar y vivir muy de cerca la lucha cotidiana que libran contra las secuelas del síndrome Stevens Johnson. No olviden compartir este episodio, y dejarme una reseña en iTunes, eso ayuda a que más gente llegue a este podcast. Música en este episodio con una licencia Creative Commons Attribution ShareAlike a cargo de: Monplaisir - Happy harpy volume  https://bit.ly/2PN8M2q Monplaisir - Sub  https://bit.ly/2S9B09w Tracky Birthday - Pivoting on salsa key 11  https://bit.ly/2rI9R1L Monplaisir - 08  https://bit.ly/2A8pwfl Monplaisir - Confortablement installé·e  https://bit.ly/2ClQIc9 Rafael Archangel - Deep dive  https://bit.ly/2UX5IVg Nctrnm - In Medias Res  https://bit.ly/2BvnNAR The Freeharmonic Orchestra - Deep Space  https://bit.ly/2PMg0n6 P C I I I - PCGCP  https://bit.ly/2R2JGBk Andy G Cohen - A perceptible shift  https://bit.ly/2S9VG11

When you get a consult for concern of Stevens Johnson syndrome or TEN, you cannot get tunnel vision and have to keep a broad differential, which should include many of the toxin-mediated disorders we’ll discuss in today’s episode, including Staphylococcal scalded skin syndrome, toxic shock syndrome, Kawasaki disease, and scarlet fever.   Connect with us:         • … Continue reading "Ep24 VASC – Toxin-mediated rashes (SSSS, TSS, Kawasaki DZ, Scarlet Fever)"

We continue our vascular reaction pattern with Dr. DOOD by discussing one of the most important dermatology emergencies, Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis.   Connect with us:         •       Facebook:  https://www.facebook.com/learndermpodcast/         •       IG: https://www.instagram.com/learndermpodcast/?hl=en         •       Website (includes episode study guide!):  www.learndermpodcast.com         •       … Continue reading "Ep22 VASC – SJS/TEN"

Dr. Jan Dutz speaks with JCMS Editor-in-chief Dr Kirk Barber about the article Dutz co-authored in the Nov/Dec 2019 edition of the Journal of Cutaneous Medicine and Surgery. The article focuses on how East Asians exposed to the urate-lowering drug allopurinol have a predilection for severe cutaneous drug reactions such as drug-induced hypersensitivity syndrome or drug reaction with eosinophilia and systemic symptoms and Stevens-Johnson syndrome/toxic epidermal necrolysis. Dr Barber and Dr Dutz discuss why screening of patients of East Asian descent for the presence of HLA-B*58:01 prior to allopurinol initiation has been a Canadian missed opportunity. And what more can be done to encourage wider use of this inexpensive screening test.Dr. Jan Dutz is Professor and Head of the Department of Dermatology and Skin Science at UBC. He is also a Senior Scientist with the British Columbia Children's Hospital Research Institute.Theme music by Lee RosevereProduced by David McGuffin - Explore Podcast Productions 

Dr. Jan Dutz speaks with JCMS Editor-in-chief Dr Kirk Barber about the article Dutz co-authored in the Nov/Dec 2019 edition of the Journal of Cutaneous Medicine and Surgery. The article focuses on how East Asians exposed to the urate-lowering drug allopurinol have a predilection for severe cutaneous drug reactions such as drug-induced hypersensitivity syndrome or drug reaction with eosinophilia and systemic symptoms and Stevens-Johnson syndrome/toxic epidermal necrolysis. Dr Barber and Dr Dutz discuss why screening of patients of East Asian descent for the presence of HLA-B*58:01 prior to allopurinol initiation has been a Canadian missed opportunity. And what more can be done to encourage wider use of this inexpensive screening test. Dr. Jan Dutz is Professor and Head of the Department of Dermatology and Skin Science at UBC. He is also a Senior Scientist with the British Columbia Children’s Hospital Research Institute. Theme music by Lee Rosevere Produced by David McGuffin - Explore Podcast Productions  

Dr. Robert Micheletti, University of Pennsylvania in-patient complex dermatology physician, talks to Dermcast.tv about urgent patient presentations for community dermatology providers to be aware of – Stevens-Johnson syndrome, DRESS syndrome and other complex drug reactions of the skin. Posted December 11, 2019

Joann Tweh PharmD, drugsandcoffee co-founder and co-host, shares how she used her clinical knowledge to help her own mother. Learn how she quickly recognized rare Stevens-Johnson syndrome (on 3 separate occasions), and how she helped her mother navigate health care system when she was diagnosed with brain tumor. All of these examples highlight importance of acting as a patient advocate. Small acts of support can have a very significant impact. For the video version of this podcast, please visit https://www.drugsandcoffee.com/watch/ ~~~~~~~~~~~~ You can find more Drugs&Coffee content at: + Soundcloud: https://soundcloud.com/drugs-and-coff... + Spotify: https://open.spotify.com/show/0CjrawR... + iTunes podcast: https://podcasts.apple.com/us/podcast... + Google Play: https://play.google.com/music/listen?... + Facebook: https://www.facebook.com/drugsandcoffee/ + Instagram: https://www.instagram.com/drugsandcof... + Twitter: https://twitter.com/drugsandcoffee + Youtube: https://www.youtube.com/channel/UCRpH... + LinkedIn: https://www.linkedin.com/company/drug... ~~~~~~~~~~~~

How can you integrate decision-making resources into your clinical practice? In this resident takeover of the podcast, three dermatology residents — Dr. Daniel Mazori, Dr. Elisabeth Tracey, and Dr. Julie Croley — discuss clinical decision support tools such as scoring systems and other resources available for dermatologists. These tools should be used as a supplement, not as a substitute for one’s clinical judgment. “The optimal treatment for patients in a complex medical system requires not just coming to the correct diagnosis and using your clinical judgment to make a decision but effectively communicating that decision to the insurance companies [and] to the primary team that’s taking care of them on the inpatient service. ... Some objective data can really be useful in those situations,” advises Dr. Tracey. *   *   * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 *   *   * We bring you the latest in dermatology news and research: 1. No tacrolimus/cancer link in atopic dermatitis in 10-year study 2. PASI-75 with ixekizumab approaches 90% in pediatric psoriasis study 3. NAM offers recommendations to fight clinician burnout *  *  *   Things you will learn in this episode: Evaluate for psoriatic arthritis with the Psoriasis Epidemiology Screening Tool (PEST). “It’s the kind of thing that I’ll use in addition to asking a patient with psoriasis questions about symptoms like joint pain and morning stiffness,” Dr. Mazori says. Consider UpToDate.com and VisualDx.com for clinical decision support, to formulate differential diagnoses, and as a resource for patient education. “The other day, I had a patient who was diagnosed with scabies,” Dr. Tracey explains. “We were counseling the patient on how to decontaminate their environment. I wanted to get the exact number of hours their belongings needed to be in a plastic bag or how to wash their clothes. So, we went on UpToDate and read it together in the clinic.” The SCORTEN system predicts hospital mortality from Stevens-Johnson syndrome/toxic epidermal necrolysis and is useful for the primary team. “I’ve found it useful ... as a measure of risk to communicate to the primary team, even the patient’s family,” Dr. Mazori says. But the SCORTEN isn’t perfect. “There are studies that have found it can overestimate or underestimate mortality,” he warns. To differentiate cellulitis from pseudocellulitis in adult patients, consider the ALT-70 score. “It gives me an objective measure of risk to communicate to the primary team in support of one diagnosis or another in addition to my clinical judgment,” advises Dr. Mazori. The Mohs Appropriate Use Criteria (AUC) helps guide decision making for Mohs micrographic surgery, but it has been scrutinized for classifying most primary superficial basal cell carcinomas as appropriate for treatment, omitting important European trials, and for having ratings that are based on expert opinion rather than evidence. The MyDermPath+ app can assist clinicians in forming differentials based on histopathologic patterns. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Daniel R. Mazori, MD (State University of New York Downstate Medical Center); Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation); Julie Ann Amthor Croley, MD (University of Texas Medical Branch at Galveston) Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie   For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm

  In this episode, three dermatology residents -- Dr. Daniel Mazori,  Dr. Julie Croley, and Dr. Elisabeth Tracey -- discuss items they keep in their on-call bags in this special resident takeover of the podcast. Beginning at 14:50, they talk about premade biopsy kits, tricks for achieving hemostasis in the hospital, portable electronic gadgets, and creative alternatives for basic items. They also discuss bedside diagnostics and unique cases while being on-call. “After rotating through the consult service, you really do grow as a dermatologist,” reports Dr. Croley. “You see rare things; you see severe disease processes. You learn to be efficient and self-sufficient.”  We also bring you the latest in dermatology news and research: 1. Study finds inconsistent links with aspirin, nonaspirin NSAIDs, and reduced skin cancer risk. 2. Justin M. Ko, MD, MBA, of Stanford (Calif.) University discusses the American Academy of Dermatology's position statement on augmented intelligence. Dr. Ko is director and chief of medical dermatology for Stanford Health Care at Stanford Medicine, Redwood City, Calif. He is the chair of the AAD's Ad Hoc Taskforce on Augmented Intelligence, which wrote the position statement. 3. Prior authorizations for dermatology care nearly doubled in the last 2 years at one center. Things you will learn in this episode: Recommendations on what type of bag to use for your on-call bag. Premade biopsy kits are key for your on-call bag so that you can perform shave or punch biopsies. Tricks for obtaining hemostasis in the hospital. The utility of dermatoscopes has been expanding in recent years, and it can be a helpful bedside electronic device. Purple surgical markers can be used as a topical antimicrobial. Normal saline or honey can be used if you run out of Michel solution. Nonmedical items to keep in your on-call bag may include a handheld guide for drug eruptions and consult templates. Examples of unique cases of misdiagnosed Stevens-Johnson syndrome, highlighting the expertise of dermatologists: “In our field, especially as a consultant, our expertise can be so crucial in the care of complex patients.” Be comfortable with bedside diagnostics such as Tzanck smear to diagnose viral infections and a positive Nikolsky sign for staphylococcal scalded skin syndrome. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Daniel R. Mazori, MD (State University of New York, Brooklyn); Julie Ann Amthor Croley, MD (the University of Texas Medical Branch at Galveston); and Elisabeth (Libby) Tracey, MD (Cleveland Clinic Foundation). Show notes by Melissa Sears, Alicia Sonners, and Elizabeth Mechcatie. Contact us: podcasts@mdedge.com Twitter: @MDedgeDerm Rate us on iTunes! To subscribe to this podcast and more, go to mdedge.com/podcasts.

Jay and Jason discuss the latest news and headlines ahead of the trade deadline, the St. Louis Blues 11-game winning streak, poor protoplasm, Stevens-Johnson syndrome, Jason's giddiness for The Russian Five movie, the San Jose Shahobs, Tampa Bay, New York Islanders, destinations for trade deadline candidates, Gritty torture, and David Puddy's puck drop fail.

Mark Halstensgard was given 10 days to live after being diagnosed with a severe case of Stevens-Johnson syndrome. In this episode of The Rclaimed Podcast, Ellie Herringshaw interviews Mark about his experience receiving miraculous healing after his diagnoses. Although Mark's physical healing was almost instantaneous, the emotional healing is still ongoing. Mark shares his theology of pain, sickness as well as healing.

Mark Halstensgard was given 10 days to live after being diagnosed with a severe case of Stevens-Johnson syndrome. In this episode of The Rclaimed Podcast, Ellie Herringshaw interviews Mark about his experience receiving miraculous healing after his diagnoses. Although Mark's physical healing was almost instantaneous, the emotional healing is still ongoing. Mark shares his theology of pain, sickness as well as healing.

Alejandro tenía dolor de garganta, se tomó una pastilla y se fue a dormir. Cuando despertó, su vida ya no era la misma. Este episodio fue escrito, producido y editado por Fernando "Micro" Hernández. Mitzi Pineda es la Asistente de Producción.  Síguenos en instagram como @estonoesradiomx y twitter @estonoesradio. Micro twitea e instagramea como @microgdl  La ilustración de “Ojos quemados” corrió a cargo de Alejandra Puga. Agradecimientos especiales a Lizeth Arámbula, a Abril Rayas y a la familia Aguirre Riveros, por abrirme las puertas de su hogar y vivir muy de cerca la lucha cotidiana que libran contra las secuelas del síndrome Stevens Johnson. No olviden compartir este episodio, y dejarme una reseña en iTunes, eso ayuda a que más gente llegue a este podcast. Música en este episodio con una licencia Creative Commons Attribution ShareAlike a cargo de: Monplaisir - Happy harpy volume  https://bit.ly/2PN8M2q Monplaisir - Sub  https://bit.ly/2S9B09w Tracky Birthday - Pivoting on salsa key 11  https://bit.ly/2rI9R1L Monplaisir - 08  https://bit.ly/2A8pwfl Monplaisir - Confortablement installé·e  https://bit.ly/2ClQIc9 Rafael Archangel - Deep dive  https://bit.ly/2UX5IVg Nctrnm - In Medias Res  https://bit.ly/2BvnNAR The Freeharmonic Orchestra - Deep Space  https://bit.ly/2PMg0n6 P C I I I - PCGCP  https://bit.ly/2R2JGBk Andy G Cohen - A perceptible shift  https://bit.ly/2S9VG11

Alejandro tenía dolor de garganta, se tomó una pastilla y se fue a dormir. Cuando despertó, su vida ya no era la misma. Este episodio fue escrito, producido y editado por Fernando "Micro" Hernández. Mitzi Pineda es la Asistente de Producción.  Síguenos en instagram como @estonoesradiomx y twitter @estonoesradio. Micro twitea e instagramea como @microgdl  La ilustración de “Ojos quemados” corrió a cargo de Alejandra Puga. Agradecimientos especiales a Lizeth Arámbula, a Abril Rayas y a la familia Aguirre Riveros, por abrirme las puertas de su hogar y vivir muy de cerca la lucha cotidiana que libran contra las secuelas del síndrome Stevens Johnson. No olviden compartir este episodio, y dejarme una reseña en iTunes, eso ayuda a que más gente llegue a este podcast. Música en este episodio con una licencia Creative Commons Attribution ShareAlike a cargo de: Monplaisir - Happy harpy volume  https://bit.ly/2PN8M2q Monplaisir - Sub  https://bit.ly/2S9B09w Tracky Birthday - Pivoting on salsa key 11  https://bit.ly/2rI9R1L Monplaisir - 08  https://bit.ly/2A8pwfl Monplaisir - Confortablement installé·e  https://bit.ly/2ClQIc9 Rafael Archangel - Deep dive  https://bit.ly/2UX5IVg Nctrnm - In Medias Res  https://bit.ly/2BvnNAR The Freeharmonic Orchestra - Deep Space  https://bit.ly/2PMg0n6 P C I I I - PCGCP  https://bit.ly/2R2JGBk Andy G Cohen - A perceptible shift  https://bit.ly/2S9VG11

This is a continued share/discussion on the new, independent report released last month from the Institute for Safe Medication Practices (ISMP) where they pointed out four adverse drug reactions that stood out from all others in the 2017 FDA data of adverse drug reactions reports received by the FDA.  From severe muscle damage to a deadly viral infection of the brain, their annual report covers it all and we're talking about it.  (This is part 2 of a 2-part episode) Show note links: Some of the specific drugs mentioned in this episode = nivolumab, sacubitril-valsartan, aripiprazole, acetaminophen, ibuprofen, Tramadol, lamotrigine, ciprofloxacin, natalizumab, rituximab, fingolimod, mycophenolate Drug classes of note = statins, antipsychotics, pain meds, epilepsy meds, oncology meds, antidepressants, opioids The annual report we're talking about can be found here -->> ISMP QuarterWatch Annual Report There were 4 serious adverse drug events highlighted in this annual report, namely... *Rhabdomyolisis (life-threatening breakdown of skeletal muscles, causing high risk for kidney failure) *Serotonin or Neuroleptic Malignant Syndrome (life-threatening disruptions of the central nervous system) *Stevens-Johnson syndrome/Toxic Epidermal Necrolysis, or SJS/TEN (severe skin disorder caused primarily by drugs, reveals as blister-like lesions on areas like the face, eyes, and genitals but can extend beyond these areas) *Progressive Multifocal Leukoencephalopathy, or PML (a small DNA virus that harmlessly exists in 50% to 70% of the population and is considered latent when harmless...however, once "activated" by certain drugs, for example, can harmfully spread to the brain causing changes in behavior, confused thinking, problems speaking, impaired gait, visual disturbances and even death) Show credits: Many thanks to the authors of the annual report over at the ISMP.  To learn more about this nonprofit, visit www.ismp.org Email: talk@overprescribedpodcast.com Twitter: @_overprescribed Enjoying the show?  Support our Patreon page. Got side effects? Report them to the FDA today.  They are limited in what they can do and how quickly they can act to help protect Americans from harmful adverse drug reactions without your reporting and you can report suspected & confirmed adverse drug reactions. Call 1-800-332-1088 or report online at www.fda.gov/medwatch *Advertisement* Support a good cause while going green by buying a pair of dope kicks. For the month of October, Vita Shoes is running a campaign to raise $1000 to support free housing for cancer patients & their families. You can support today by buying a pair of shoes www.vitashoesco.com/hope and for every pair of their eco-friendly shoes sold, Vita Shoes will donate $10.  Use the discount code "PRESCRIBED" for 10% off your purchase!

In this podcast episode, originally from the Outbreak News This Week Radio Show in Mar. 2017, I look at the rare condition, usually brought on by medications or infections, Stevens-Johnson syndrome (SJS) with a person that actually went through this painful immune-complex–mediated hypersensitivity complex. Donna Rushing of Tampa was diagnosed with SJS one year ago and talks about the beginnings of the syndrome, symptoms, diagnosis, the treatment and her long recovery.

In this podcast episode, originally from the Outbreak News This Week Radio Show in Mar. 2017, I look at the rare condition, usually brought on by medications or infections, Stevens-Johnson syndrome (SJS) with a person that actually went through this painful immune-complex–mediated hypersensitivity complex. Donna Rushing of Tampa was diagnosed with SJS one year ago and talks about the […] The post Stevens-Johnson Syndrome: A personal story appeared first on Outbreak News Today.

Stevens-Johnson syndrome survivor, Kennitra Thompson, talks about overcoming a rare disease and a death scare to owning a dance studio. See acast.com/privacy for privacy and opt-out information.

Wed, 09 May 2012 14:32:37 GMT http://saveyourskin.ch/podcast/DE/1.1.14.SJS.mp4 Prof. Dr. Dr. h. c. Günter Burg, MD Zürich 2013-03-10T14:32:37Z Prof. Dr. Dr. h. c. Günter Burg, MD Zürich no Stevens