What is Ototoxicity?

Dale Johnson: The health of your hearing matters to us. Of course it does, think about it we’re radio. You’re hearing really, really matters to me and it matters too to Dr. Sandra Miller of Complete Hearing in Lincoln. Every Saturday morning, Dr. Miller brings her experience to the radio and the conversation starts here. Good morning, Dr. Miller.

Dr. Sandra Miller Au.D.: Good morning Dale.

Dale Johnson: Let’s extend our conversation. Hopefully good listeners have gone to your website, complete-hearing.com because there they can hear podcasts. There’s a podcast tab and pick up on where we will continue today, conversation with Mike Mueri, from Mueri Drug out of Seward. We just got started and talking about drug interactions, medication interactions, and how some are good for your ears when they’re applicable and how others can seem innocent, but yet have issues with your hearing.

Dr. Sandra Miller Au.D.: Well, Mike, I think it’s really great that we continue the conversation and we just talk about. I think I took away so much from our first conversation is that people have multiple doctors now and is there a way that there’s a communication system happening between all these physicians? Does it tend to be that the primary care is the go-to and then that’s where the list of medications is kept or does it seem to be that there’s not a good communication system happening? What do you see in that area?

Mike Mueri: Well, what I have noticed is, is there’s not a good trail because people will go to their primary and the primary has most of their information in their chart, but then it’ll be after hours or it’ll be on a weekend and they’ll go to an urgent care and then that urgent care physician or nurse practitioner or PA, or whomever has to rely on the patient saying, “This is what I’m on. This is what I’m taking.” And sometimes as I said last week, that list isn’t always complete. And the other thing we’re seeing right now, and actually just this morning, I had a doctor from San Francisco who was a tele doctor send in a prescription and the person had an allergy. And so what are you going to do? I couldn’t get back ahold of the doctor. They just don’t have all the information. And yet, unfortunately in these days of COVID, that’s kind of what the insurance companies and they’re pushing us to a little bit, is to, instead of going and seeing the physician, getting a tele doctor and going that route.

Dr. Sandra Miller Au.D.: What a great point, I think it’s so interesting. I love the fact that you are there as their pharmacist to say, “Hey, wait a minute, we can’t do that.” And I got to tell you, I think people know their list of medications. They may not know I’d maybe take this for this, or maybe I’m not sure what I take that for. I just think it’s so valuable and what I took away last week too, that you said is that the interactions that these prescribed medications can have with all the other things that they take. So if we don’t have a full picture of what’s happening, how do you best treat the patient, I guess is the question?

Mike Mueri: It makes it difficult because you just have to ask a lot of questions and again, a lot of my clientele out here have been with me for a long, long time. And so I know them if they’re on, I’m on fourth generation of people, families of treating them. So I get to know a little bit about them, but you just have to be patient with them and go slow and take your time and try to extract the information that you can because you need it all.

Dr. Sandra Miller Au.D.: What I love about you, Mike, is the fact that you’re a local pharmacy. And I think we get to the point where we’re trying to find the cheapest place. We can get it and who’s prescribing it and how can I get this more efficiently? And just having somebody who knows you and knows your history is so valuable. So working with your hometown pharmacy, and sometimes is much better than working with a big chain. And when you drive up to the window to pick up your prescription, they don’t know you from the next guy. So I love that relationship that you have with the people who come to you for so many years.

Mike Mueri: Well, I’m very, very fortunate. My customer base has been very, very loyal and we have a good relationship back and forth with each other.

Dr. Sandra Miller Au.D.: That’s wonderful. I’m really wondering to now that we are definitely in the day of COVID and all the different things that we are doing, are you seeing an uptick now at all, with all this social distancing and people feeling more isolated, are you seeing any uptick in anxiety medications, any depressants, has this had an effect on their overall health that way?

Mike Mueri: I really have and it’s really sad to me because again, I talk about these people who I’ve known for 40 years and they’re scared and they’re very anxious and apprehensive, and the doctors are giving them some anti-anxiety medications to help kind of take that edge off a little bit. But then the side effects of a lot of those make it… It’s kind of six, one half dozen of the other, which is the worst evil, but there has been an obvious, a very definite increase in prescribed anti-anxiety, antidepressant medications.

Dr. Sandra Miller Au.D.: Absolutely. I think what it really happens too, is as a society, we want a quick fix. And so maybe we could talk a little bit about what happens when people watch the news and they hear, “You should do this, or you should do that.” Tell me a little bit about your take on those things of, there’s somebody who comes out and said, if you test your… We were talking earlier, if you do an oximeter and you find out how much oxygen you have, and then that’s going to tell you X, Y, Z, and people run to the store and they buy something they don’t need, and doesn’t give them what they need. So with so much false information out there, maybe we can address that topic just a little bit.

Mike Mueri: I’m not able to watch the news in the mornings very much, but I can tell within the first half hour, 45 minutes of being open in the morning, what was on the news in the morning or what’s the latest cure? Be it oximeter, or be it magnesium, there’s my vitamins. I wiped out my entire vitamin section in about three days when they came out with the vitamin Cs and the magnesiums and the zincs. And now that’s over with everyone moved on to something else. The scary one, the scary thing I think that I see is when they start talking about prescribed medications, like the hydroxychloroquine and the erythromycin where they really aren’t, they don’t have any testing on it.

Mike Mueri: And there are factions out there that are saying, this is the next cure, but who’s saying that? And that’s always a little nervous because medications take a long time to come down the road before they’re approved with tests and the placebo tests. And so that makes it that’s I worry that because I have people calling, asking on a daily basis if I have hydroxychloroquine because that’s still seems to be the drug. And they’ve had some results in some cases with hydroxychloroquine, but it’s really not a proven entity yet.

Dr. Sandra Miller Au.D.: That’s so interesting because what we’re seeing in the audiology community is that’s typically something that we look at because hydroxychloroquine is autotoxic over time and taking it erythromycin is toxic over time. And when you combine those two medications, now you have two autotoxic drug to the ear, and there’s no studies of what potentially could happen…

Mike Mueri: Well, and plus doctor, what else they’re taking that’s autotoxic.

Dr. Sandra Miller Au.D.: Exactly.

Mike Mueri: You know what I mean? And so then you throw these two big guns in, and then you really, I can see on your end, you’re going to have a real bad situation there.

Dr. Sandra Miller Au.D.: Yeah. And so I think when people are, I think it’s so interesting. I’ve learned so much just through this process of how long does it really take to develop a drug that’s approved and the trial that has to go through. And when we push things so quickly, we don’t know the ramifications and we want the easiest quickest fix, and it’s not necessarily what that’s supposed to be. And so where’s the information coming from, who’s saying it and is it safe? I mean, I think you’re in the same boat where we’re like, we want to do the best for our patient, but keep them ultimately the safest they possibly can be.

Dale Johnson: What I’m hearing when I combine last week’s conversation with this week’s conversation is medications that have the greatest impact on blood, whether it’s thinning, whether it’s blood pressure, whether it’s a heart problem and now we throw COVID in on that. Some people might not think that it would cause a problem for their ears if it’s for blood pressure, for example. Is that fair to say that some of these medications, what we’ve talked about the last couple of weeks deal with a treatment for blood issues?

Mike Mueri: Yes, I would think that would be a fair assumption.

Dr. Sandra Miller Au.D.: I would completely agree with you. When we have patients come in and I start redoing their med list, they kind of look at me and I tell them we do a full assessment of you, not just of your ears. And so we know what type of medications you take. And high blood pressure is very much tied to having tinnitus. And this medication you’re taking is very much a side effect that it may be toxic to the ear, or it may have a side effect of you having balance issues. So when we review their med list, we’d go into detail of okay, you’re taking these things and you’re coming to me with these symptoms, is that related to your medication?

Dr. Sandra Miller Au.D.: So we talked through that and we also talk about, have you discussed this with your physician? Because it’s important that sometimes they don’t even tell their physician they’re having the symptoms. And so we need to make sure is this something we need to look into further, or is this simply tied to your medication as a side effect? And if you don’t know those things, you have to dig deep and take into the account that patient, let’s make sure we look at you as an entire person and make sure we address, where is this symptom coming?

Dale Johnson: Dr. Miller, is the ear a tough part of the body? Is it resilient? Can it take a lot or is it so sensitive that maybe short term use of a drug can do permanent damage?

Dr. Sandra Miller Au.D.: I love that question, Dale. What I would tell you, it’s so patient dependent, and I think this comes with any type of disease process that we have come along, how it affects the body. Where we could use the example of COVID, some people are asymptomatic and have no symptoms and we have people who get deathly sick. And more of the time, those people who have an immune, an auto immune disorder, they have a compromised system because of other disease processes that they have, they may have more of an impact on that. And so some of my patients can be exposed to loud noise over and over and over again, and have no issues and other people do. So it’s really patient dependent. I would tell you that the ear is very resilient, but the more you abuse it and affect the blood flow and affect the other things that potentially could do damage, over time it is definitely going to have an impact.

Dale Johnson: Mike in closing people might be a little shy to ask a pharmacist this question, but if they would ask you to print out a list, is that something that a pharmacist can do? You in particular would do?

Mike Mueri: Oh, heavens yes. And you’re in this day and age of technology requires hitting about three buttons and it’s done.

Dale Johnson: Dr. Miller, how can someone reach out to Complete Hearing?

Dr. Sandra Miller Au.D.: Best way to reach us is go ahead and check us out online, complete-hearing.com. Give us a phone call (402) 489-4418. And we are here to serve you as well, so we have curbside service at 4200 Pioneer Woods Drive, which is about 72nd and Pioneer.

Dale Johnson: I would highly recommend going to complete-hearing.com for more information. And of course, listen to us every Saturday morning on KFOR for the conversation starts here.