How Topical Compounding Has Worked For My Patients

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How Topical Compounding Has Worked For My Patients: Allen Jacobs, DPM FACFAS
Source: PodiatryToday.com
You may have noticed the increasing presentation of the subject of topical compounded medications at our podiatry meetings. The reason for this is that the science of topical pharmaceutical compounding has advanced significantly over recent years. 
Topical compounding allows the local delivery of high doses of medication to an area of pathology. Examples include the treatment of Achilles tendinosis, plantar fasciitis or following an acute injury. This technique provides the delivery of medications locally at levels significantly higher than with the administration of the same medications given systemically, typically as orals. In addition, the utilization of topical compounded medications provides for lower systemic levels of the same medication administered orally, generally less than 5 percent of the serum levels when one administers the same medications systemically. Furthermore, given the low systemic levels of the medications when administered topically, drug interactions are far less likely to occur. 
Topical compounded medications expand the ability of the podiatric physician to effectively treat a variety of problems commonly encountered in daily practice. Many podiatric physicians are reluctant to utilize systemic medications for fear of adverse sequella or drug interactions, as a result denying some patients optimal efforts at pain relief or the reduction of inflammation. In addition, topically compounded medications are frequently accepted by the “I am already taking too many medications” patient and the ‘needle-phobic’ patient. 
A particular aspect of topical compounded medications is the fact that they are medication(s), allowing me to combine multiple agents with multiple mechanisms of action. As a result, my ability to provide a patient with pain relief is substantially greater. 

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Report from April 2014 NM Racing Commission Meeting--issue of compounding preparations at racetrack was tabled for further discussion

The New Mexico Racing Commission held its monthly meeting at its headquarters in Albuquerque on Thursday, April 17.
New Mexico Horse Breeders’ Association executive director Anna Fay Davis gave the commission her race-a-day report for Sunland Park, which opened its 76-day season on December 6. During the first 72 days of the meet, the track ran 354 New Mexico-bred races -- 247 for Thoroughbreds and 107 for Quarter Horses. By comparison, Sunland Park carded 348 state-bred races -- 245 for Thoroughbreds and 103 for Quarter Horses -- during the first 72 days of its 2012-13 season.
An average of 4.92 New Mexico-bred races per day were run during the first 72 days of the Sunland Park meet, an increase of 1.7 percent over the 4,84 state-bred races per day contested during the first 72 days of the track’s 2012-13 season.
Also, during the first 63 days of the 2013-14 Sunland Park meet, a total of 484 New Mexico-breds competed in open overnight races, of which 126 (26 percent) finished first, second, or third. Of this total, 49 were Thoroughbreds and 77 were Quarter Horses. Bonuses totaling $98,916.10 were paid to the owners of these horses.
By comparison, 468 state-breds raced in open overnight races during the first 63 days of the 2012-13 Sunland meet, of which 96 (21 percent) finished first, second or third.
Also at the meeting, commissioner Ray Willis of Roswell, chairman of the NMRC medication committee, reported on the committee’s meeting on April 16. Willis said that the main topic of discussion was the acceptable levels of corticosteroids recently established by the Association of Racing Commissioners International.
“The RCI set standards of corticosteroids that might be acceptable for Thoroughbreds and Standardbreds, but at the meeting several veterinarians suggested we do our own studies on levels for Quarter Horses, which are a big part of our industry in New Mexico,” Willis said. “We’re going to have another meeting as soon as possible, before our next regular commission meeting in May, and kick around some ideas what what we can do.”
The issue of compounding agencies at racetracks was tabled for further discussion.
“This was the best-attended medication meeting I’ve ever been to, and it was a very productive meeting,” Willis said. “Hopefully, we can build on what was discusssed.”
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A look at Oklahoma's execution drug secrecy case

The Oklahoma Supreme Court ruled late Wednesday that death row inmates Clayton Lockett and Charles Warner are not entitled to know the source of the drugs that will be used to kill them. The court, which is the highest in the state for civil cases, had previously halted their executions, even though critics said only the Oklahoma Court of Appeals can issue stays. The Court of Appeals is the highest in the state for criminal cases. Here is a look at the inmates' legal challenge:
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Feb. 26: The inmates, whose executions are scheduled for March, file a civil lawsuit against the state seeking details about the drugs that will be used to execute them, including their source.
March 10: District Court Judge Patricia Parrish says that she's willing to take the civil case but that she cannot set aside the inmates' execution dates. Parrish says the state Court of Criminal Appeals, which sets execution dates, must decide on requests for stays of execution.
March 11: Defense attorneys ask the Oklahoma Supreme Court to delay the executions.
March 13: The Supreme Court forwards to the Oklahoma Court of Criminal Appeals the request from the inmates to halt their executions.

Read more at http://www.ksl.com/?nid=157&sid=29608534#dXKllhOx0eBHqlvX.99

Elkhart woman recovering from fungal meningitis

ELKHART, Ind. (AP) — Terry Trost smiles more these days.
For the past year and half, she has struggled to regain control of her health, but things seem to be looking up. Trost, who lives in Elkhart, was among 750 people across the country who contracted a fungal infection linked to contaminated steroid injections in 2012. And just recently, she was taken off medications that have helped her fight the illness.
Trost had gone to OSMC Outpatient Surgery Center in Elkhart to manage back pain on Sept. 26, 2012. That evening, batches of the medications she had taken were recalled for contamination. OSMC was among six clinics in Indiana that had received vials of tainted drugs distributed by the New England Compounding Center in Massachusetts. Trost was diagnosed with fungal meningitis five months after the shot in her lower back.
"It seemed like it was going to take forever to make the pain go down," Trost told The Elkhart Truth (http://bit.ly/1l7jc9Q). "You get the shot to get rid of pain, and all that did was create more pain. It was pain on pain on pain."
There have been 93 cases of fungal infections reported in Indiana, including 11 deaths. Three of those deaths were Elkhart County residents.
After more than a year of medical testing and taking medications, the fungus that Trost was exposed to is not gone from her body.
"My infectious disease doctor said there's nothing else the medication can do for me," Trost said. "The fungus is out of the bone, but it's still there inside me. It's not dead. I have a 50-50 chance. It can either continue to die, or it can bounce back and resume again."
However, Trost added that her doctor told her that she has not seen cases of fungal meningitis resurfacing in patients.
"That gives me hope," Trost said.
She says it's going to take a very long time, though.
"It's not going to be a month or two months for it to be totally out of my system," she said.
She's encouraged with how people have reacted to the drugs.
Despite some lingering pain, Trost said she is feeling more like herself lately. She is less weak, she has more energy, she is gaining more muscle in her arms and best of all, Trost said, she's feeling more emotionally stable.

Read more at http://www.ksl.com/?nid=157&sid=29612216#lwHev7u7Bv4i1mEJ.99

UAE approves draft law to criminalise horse doping

By Andy Sambidge

• Friday, 25 April 2014 1:22 AM
• The UAE has approved a new draft law banning the use of illegal substances in the country's horseracing and equestrian industries.
  A Federal National Council committee, which oversees foreign affairs, planning, petroleum, mineral wealth, agriculture and fisheries, said it has revised and approved the law, which is part of the UAE's Vision 2021, news agency WAM reported.
  The legislation incorporates stricter provisions to combat the circulation and use of banned substances in the UAE and will work towards ensuring that international standards on doping are being met
  Representatives from the Ministry of Water and Environment, the National Anti-Doping Committee, UAE Racing Authority and the Emiri Court in Dubai were also present at the meeting.
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