December 12, 2024 • 38 mins
What if common medications like aspirin or antibiotics could be silently affecting your hearing? Join us for a thought-provoking conversation with Dr. Robert DiSogra, a trailblazer in the intersection between pharmacology and audiology. Dr. DiSogra has dedicated over 25 years to understanding how more than 2,000 drugs can impact auditory and vestibular health. His insights, shaped through collaborations with figures like Dr. George Osborne and Dr. Jerry Northern, have transformed educational courses and continue to influence audiologists worldwide.
Our discussion highlights the hidden ototoxic risks lurking in everyday medications, such as ibuprofen and aminoglycosides. We unravel the critical importance of safe dosages and the consequences of ignoring the root causes of symptoms in favor of quick fixes. This episode encourages open dialogue with healthcare providers and stresses the need for careful diagnosis and treatment approaches. It’s a call for listeners to become proactive in conversations about their medication and health, emphasizing the need to understand the potential auditory side effects of popular drugs.
We also navigate the complex world of dietary supplements and their claim to manage conditions like tinnitus. Reflecting on the 50 years since the Dietary Supplements and Health Education Act, we shed light on the placebo effect, anecdotal evidence, and the gaps in scientific backing for products like ginkgo and lipoflavonoids. In a powerful closing, we honor the life-saving role of blood donation, sharing personal stories of gratitude and the difference a single donation can make. This episode is a compelling journey through the nuanced connections between drugs, supplements, and hearing health, offering invaluable insights for both professionals and patients.
Connect with the Hearing Matters Podcast Team
Email: hearingmatterspodcast@gmail.com
Instagram: @hearing_matters_podcast
Twitter: @hearing_mattas
Facebook: Hearing Matters Podcast
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Douglas L. Beck (00:00):
If you have tinnitus, the very best thing
to do is not start experimentingwith molecules and chemicals.
I think the very best thing todo is go see a licensed hearing
care professional who practiceswith best practices according to
AAA, asha or IHS and get acomprehensive audiometric
evaluation, and I don't meanjust press the button when you
hear the beeps.
Blaise M. Delfino, M.S. (00:24):
You're tuned in to the Hearing Matters
podcast, the show thatdiscusses hearing technology,
best practices and a globalepidemic hearing loss.
Before we kick this episode off, a special thank you to our
partners.
sycle, built for the entirehearing care practice.
Redux, the best dryer handsdown.
(00:46):
CaptionC all by Sorenson - Lifeis calling.
CareCredit here today to helpmore people hear tomorrow.
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Welcome back to another episodeof the Hearing Matters podcast.
I'm founder and host, BlaiseDelfino and, as a friendly
(01:08):
reminder, this podcast isseparate from my work at Starkey
.
Dr. Douglas L. Beck (01:13):
Good afternoon.
This is Dr Douglas Beck withthe Hearing Matters Podcast, and
today we're honored to have mydear friend, Dr Robert DiSogra
with us.
And Bob has dedicated themajority of his career to
promoting an understanding ofthe pharmacologic effects on
hearing imbalance across hearingcare professionals across the
world.
While teaching at Rutgers over25 years ago, he questioned why
(01:35):
his patients had clinicalcomplaints of hearing loss, yet
their test data showed noevidence of peripheral hearing
loss.
He then went beyond hisclinical practice to initiate an
unprecedented review ofevidence that identified the
influences of pharmaceuticalsand nutraceuticals on hearing
loss and tinnitus In a series ofpublications for audiologists
(01:56):
over the past couple of decades.
Dr DeSogra distinguished hisaudiology career by identifying
more than 400 adverse auditoryand vestibular side effects
related to more than 2,000 drugs.
He later developed and taughtthe pharmacology ototoxicity
distance learning course whilepursuing his own doctorate at
Salus University.
(02:17):
Dr DeSogra has left a legacyfor our field.
He recently served on theAcademy's pharmacology task
force, which explored therequirements for prescriptive
privileges for audiologists.
That's a mouthful, I stumbledthrough it, but I love you, Bob,
and it's so nice to see you.
Dr. Bob DiSogra (02:31):
How the heck are you, doug?
Thanks very much and thank youfor your kind words.
I really appreciate that Laborof love, as they say, but there
was a need and I just took itupon myself to just explore it.
And well, the rest is historyas far as how our profession
responded to my work, and I'mgrateful for that.
Dr. Douglas L. Beck (02:49):
I think it's been very positive.
I'll tell you, I tookpharmacology courses gosh, it
must have been 20, 25 years agoand I found it to be fascinating
.
And I know that you startedgetting really involved with
that when our mutual friend,jerry Northern, asked you to
write.
I think it was 2001, 2002, anedition of Audiology Today on
pharmacology right.
Dr. Bob DiSogra (03:09):
I did that.
The original publication wasback in 93.
Oh right, what had happened isthat when the AUD programs were
coming online, I was talkingwith the late Dr George Osborne
who was heading up the programat PCO, pennsylvania College of
Optometry, now part of DrexelUniversity.
What happened is that he hadasked me to teach the
(03:29):
pharmacology class and he saidyou know, you had that
publication back in 93.
He says why don't you update it?
And I did.
And that's when all the numbersgot larger and larger and I
submitted it to Audiology Todayand the editor, dr Jerry
Northern, looked at this and hecalled me up and said Bob, I
can't do this, bob, I can'tpublish this.
And I was ready to accept thedefeat, you know, and the
(03:50):
rejection and walk away, but hesaid no, he says this is we have
to do a special issue, this is.
He said this was basically toogood to get lost in the pages.
Dr. Douglas L. Beck (03:59):
And yeah, I call out and let me just say
some people don't know Dr GeorgeOsborne because he passed quite
a few years ago, I want to say18 or 20 years ago.
But he was also a dentist, sohe himself had a lot of specific
knowledge on pharmacology thathe used every day in his patient
care for his dental patientsand, of course, his audiology
patients.
So coming from him asking youto update that, that's quite a
(04:23):
nice stepping stone.
Dr. Bob DiSogra (04:24):
Yeah, it was very flattering, very impressive
that someone of his stature andbackground would say to me we'd
like you to update, and so on.
And then, going to JerryNorthern, who had been just a
wonderful pioneer in ourprofession, he said listen,
we're going to do a specialissue Now.
Aaa, every once in a while dida special issue and I think
historically they've only doneabout eight or nine.
I haven't seen a special issueand I think historically they
(04:45):
only done about eight or nine.
I haven't seen a special issuein such a long time.
So to have a special issue atthat time was like I'm at the
top of the mountain here, youknow and like, and it was just
so flattering for me that helooked at that work and he
published it and that was in2001.
But every audiologist that wasa member of AAA around the world
got a copy of that and thefeedback that I got from that
(05:07):
was very positive.
People said, oh, I have ithanging on my wall in my
vestibular office.
Great stuff from around theworld.
So what had happened is thatyou know, so I'm settling in
with all that.
I'm getting calls to do, talksto do, you know, well, I was
going to say.
Dr. Douglas L. Beck (05:20):
I think that launched your speaking
career.
Dr. Bob DiSogra (05:23):
Yeah, and it actually did.
And then in 2003, just a coupleof years later, I got it
updated because there were somany more drugs coming out and
we just became more aware ofother side effects that
audiologists would be concernedwith.
Dr. Douglas L. Beck (05:38):
And when did the book come out?
Because your book onpharmacologic OTC products.
When did that come out?
Dr. Bob DiSogra (05:42):
That was in the late 2000s, 2008, 2009,
somewhere around there.
Well, what had happened is thatwhen I was teaching the online
class at Salus, one of thestudents was from New Zealand
and she had a copy of thebooklet, and I didn't know this,
but she was the president ofthe New Zealand Audiological
Society.
Fast forward two years.
Blaise M. Delfino, M.S. - (06:05):
Guess you're in New Zealand, right?
I love that.
Dr. Bob DiSogra (06:07):
And it was just like wow, and I still thank
George for that opportunity thatgot me and my two sons to head
over there to New Zealand.
Oh yeah, and this happens.
Dr. Douglas L. Beck (06:19):
It's such a great evolution academic and
clinical and social issues.
Because in 1993, I was workingwith Jerry on an issue of
Seminars in Hearing and whathappened?
We called it Audiology, theScope of Practice.
And Jerry and I think JimJerger at the time said, eh,
it's not a great name because itlooks like that's going to
define our scope of practice.
And Jerry, I think, came backwith the name Audiology Beyond
(06:43):
the Sound Booth booth Cause youknow we were talking about a
neurophysiology, intraocularcranial nerve monitoring,
electrococleography, umsomatosensory, no pharmacology.
Dr. Bob DiSogra (06:53):
I know that.
Dr. Douglas L. Beck (06:54):
No pharmacology, and we talked
about legal issues as well.
And so Jerry came back and hewas so insightful and he said
here's what we should do.
We should call it beyond thesound booth, because it's not.
It wasn't about audiometricclinical testing.
You know airbone and speech,but it was everything beyond
that, or many things beyond that, and that kind of launched my
speaking career as well.
And then, you know, I thinkwe're both very grateful to
(07:16):
Jerry for his guidance, hisinsight and his intellect, and
he was able to recognize thatthese are things that
audiologists need to know,because it's going to impact
where we're going as aprofession in the future.
And so this story that you'rerelaying I think is very
important, and I think it's veryimportant for younger people to
understand that as you become aprofessional, you're going to
(07:36):
realize things that you had noidea were even in your universe,
and sometimes, when you grabonto those like pharmacology for
you, neurophysiology for methat actually sets the rest of
your career and you neverpredicted it or planned on it.
Dr. Bob DiSogra (07:50):
No, not at all.
Not at all.
I just saw myself as privatepractice audiologist till the
day of retirement and have anice life and walk away, and
then all of a sudden, somethingsparks an interest and you run
with it and before you know ityou still have your private
practice, but you have anotherhat that you're wearing now in
your profession, or 10 hats.
And yeah, and a recognitionthat you never even dreamed of.
Dr. Douglas L. Beck (08:11):
So in pharmacology and audiology,
let's talk about three or fourareas.
I want to talk about hearing, Iwant to talk about tinnitus, I
want to talk about balance ordizziness.
So in hearing, what are themost dangerous drugs?
Which drugs over-the-counter orprescribed are most likely to
have a negative impact on puretone?
Dr. Bob DiSogra (08:31):
thresholds.
Well, we've known about certainmedications that can cause
hearing loss.
There's pages of documentationgoing back since our profession
started and probably one of themost common ones was aspirin.
This was before we had a lot ofthese other more potent
medications for aspirin, butback then 20 to 30 aspirins a
(08:52):
day for an arthritis patient wasnot uncommon and of course,
that type of an overload createda lot of problems with the
inner ear.
Dr. Douglas L. Beck (09:00):
Now stop there for a moment, if I may.
If you're taking aspirin rightnow, whether it's baby aspirin
for vascular things or whetherit's multiple aspirins a day for
arthritis, at what level do youbecome concerned If you're
taking four aspirin a day, six,12, 18?
Dr. Bob DiSogra (09:15):
Well, the smaller dosage, the 81
milligrams, that's safe.
Okay.
Then you get up into the 240,480 milligrams.
Okay, now you're starting toget into some areas where
there's going to be maybe somechanges in vascularity in the
cochlear and so on.
Once you start getting past 500milligrams a day per dosage and
if you're taking six or sevendoses, 3,500 milligrams, like
(09:39):
you're just you're overloadingyourself.
You're just like going out inthe sun in the Caribbean with no
sunblock on.
Okay, you're gonnaing yourself.
You're just like going out inthe sun in the Caribbean with no
sunblock on.
Dr. Douglas L. Beck (09:45):
Okay, You're going to ask for problems
okay.
And this is why I want to bereal specific here.
But the bottom line is, whenyou're looking at doses three,
four times a day, right, soyou're looking at TID, qid,
something like that and you'retalking about 500 to 1,000
milligrams of aspirin that's areally good time to talk to your
(10:06):
doctor about ototoxic effects,but if you're taking two or
three aspirins a day, probablynot an issue.
Dr. Bob DiSogra (10:10):
Not an issue, no.
And now you have other drugs.
You know your Relieves, yourMotrins and so on.
Dr. Douglas L. Beck (10:15):
So let's talk about that because, these
are essentially ibuprofen andacetaminophen.
Yeah, and at what point do weworry about ototoxic effects
from either of those?
Dr. Bob DiSogra (10:24):
Well, I'm currently being treated for an
arthritic condition in my neck,and my neck specialist
orthopedic doc tapped me at3,000 milligrams of
acetaminophen a day.
Dr. Douglas L. Beck (10:34):
And that acetaminophen is Tylenol.
Yeah, and at 3,000, you feelcomfortable.
You're not worried aboutototoxic effects.
Dr. Bob DiSogra (10:40):
I haven't had any issues with that, and that's
only on a PRN basis.
So really it's there when Ineed it, but it's not that I'm
on a regular dosage, and if Iwas, I would start to talk to
the doctor about well, what'sthe long-term effect on this?
Dr. Douglas L. Beck (10:54):
And what about ibuprofen?
Because ibuprofen is an NSAIDor non-steroidal
anti-inflammatory drug, and Ithink a lot of people take Advil
Motrin.
These are all the same drugs.
They're all ibuprofen and thereare generics.
At what point do you worryabout those?
Dr. Bob DiSogra (11:08):
What happens?
You have capillary constriction, okay, in the inner ear and
what happens is that, you know,when there's capillary
constriction, so there's oxygenin the blood going up to the
nerve cells in there and thenthere's going to be some
problems.
Okay, it may start out astinnitus and if it continues
because of discomfort you'reexperiencing, which is why
you're taking that medication,it could turn into hearing loss.
So you're dealing with thenon-steroidal and the
(11:30):
inflammatories, so this is whatthey can do, but, again, always
look at the cause of why you'retaking this.
You know when patients wouldcome into my office, I would
tell them your hearing loss is acomplaint to you, but to me
it's a symptom and I need tofind out those pieces of the
puzzle.
And so just tell me everythingand let me sort it out for you.
And I think it's the same thing.
(11:55):
I think a lot more patients arehaving better dialogue with
their doctors about theirmedications, with so many
direct-to-consumer ads on thetelevision about prescription
meds and discuss this with yourdoctor, and that's great.
Ok, it opens this with yourdoctor and that's great, okay,
it opens up a dialogue.
And again, you can selfmedicate, which is another issue
that you have with over thecounter medications and that's a
whole different issue.
But again, you know, for thepeople that are on this podcast,
clearly you know, just rememberthat pain is a symptom.
Hearing loss is a symptom, youknow, and when you treat the
(12:18):
symptom and it's not going away,there's the underlying cause.
Has to be further explored.
Dr. Douglas L. Beck (12:22):
I'm glad you remind us of that, because
in all of healthcare I wouldlike to think that what we do is
diagnosis first, treatmentsecond.
But we don't necessarily.
We have a symptom and we treatthe symptom.
We never really got to thediagnosis, and that symptom can
be hearing loss, it can betinnitus, it could be dizziness,
it could be vertigo, and then,of course, we have all sorts of
antibiotics and antivirals.
(12:43):
Now Is there a particular redflag that you see in antibiotic?
Which ones are the most commonthat we worry about?
Dr. Bob DiSogra (12:50):
ototoxic effects.
The aminoglycosides okay, thoseantibiotics, they've been
around for the longest time,yeah, and, as a matter of fact,
I met the chief researcher whodeveloped streptomycin okay,
which was developed here atRutgers in here in New Jersey
many years ago.
And what happens with theseantibiotics is anywhere up to
like 20 to 60% risk, dependingon the individual's health and
(13:15):
any other comorbidities thatmight be a player over here.
So there is a risk of hearingloss.
And again, this data isaccessible to consumers and, of
course, the physicians haveaccess to it also, and there's
nothing wrong with askingquestions like this.
But it's better to ask thequestions and get some guidance
rather than to self-medicate andjust go online and find out for
yourself, because once you getpast the three-syllable words,
(13:37):
some people just get confused.
Dr. Douglas L. Beck (13:40):
I like that .
If it's four syllables or more,you should be concerned.
Three and I'm free.
That's it.
So aminoglycosides arecertainly an issue in long-term
care at high doses and, again,it's a good conversation to have
with your doctor.
And let me just be clear thatthe Hearing Matters podcast is
not telling people what to takeor what not to take.
We're saying when it shouldraise a red flag and when you
(14:02):
should have a conversation withyour doctor.
It's okay to ask questions.
There are many patients who areoncology patients that are on
chemotherapy for differentcancers.
Some of them are carbon-baseddrugs and things like that.
What are your concerns there?
Dr. Bob DiSogra (14:14):
Well, before any drug gets approved by the
FDA it has to go through theclinical trials, and when
hearing loss was showing up witha lot of these carbon-based
drugs, you know the red flaggoes out in the information
sheet to the physicians and soon.
And there's a counseling issuethat has to be done here Because
, in the words of my dear friend, dr Kathy Campbell, who was
(14:34):
basically my mentor inpharmacology out in the
University of Southern IllinoisKathy even said it she says the
benefits outweigh the risks, andso if a person is going to have
a cancer medication that'sgoing to improve the quality of
your life but there's going tobe, you know, maybe some hearing
loss involved with that, thecounseling issue comes in.
(14:55):
And then you know, then thehearing aid trials and so on and
the family gets.
Then you know, then the hearingaid trials and so on and the
family gets involved.
You know it's like even withthe hair loss with certain chemo
meds, and so you know there's alot of counseling.
So it's not just a pop a pill,feel better, walk out.
Dr. Douglas L. Beck (15:07):
No, and it's a good point.
It's a good call out becausethere's always a trade-off in
these situations and the value,you know, what do you get versus
what did you give.
Right, that's between thepatient and the physician.
And of course, there are timeswhen carboplatinum drugs are
going to cause hearing loss,hair loss as well and all these
other negative side effects,when you feel absolutely awful.
But by the same token, it's apersonal decision because if you
(15:31):
go through that, there's areasonable opportunity for you
to beat the cancer in manyrespects, and it's not just oh,
this drug is going to causehearing loss, so we're not going
to open that up.
Dr. Bob DiSogra (15:42):
You know the hearing loss is it goes to the
bottom of the list.
You know if this drug is goingto get you to improve the
quality of your life for thenext five to 10 years, I'll deal
with the hearing loss.
Right, right.
Dr. Douglas L. Beck (15:52):
And I'm so glad you said that because I
think a lot of young cliniciansget caught up in you know.
Oh, we've got to talk to thedoctor and change the drugs.
You know, it's not aconversation that's going to go
well, I think.
No, it's not at all.
You know, it's certainlysomething to talk about if you
choose.
Yeah, I probably wouldn'tengage with most oncologists on
their selection ofpharmaceuticals to treat cancer.
(16:15):
No, I'm not qualified for that.
Dr. Bob DiSogra (16:16):
We come in much later on.
I had a patient who came in, acardiac patient came in and was
on a new med and was gettingtinnitus in the morning only.
And you know, do the casehistory and you find out what
the timeline is, and we piecedit all together and it turns out
that the medication he wastaking had tinnitus as a side
effect.
And the timeline just fit rightinto place.
So I contacted the primary andI told him what I found, you
(16:38):
know, and so on, because hereferred for the tinnitus and
the guy was in his like late 70s, early 80s.
He had some mild, highfrequency age related loss, not
a big deal, not a hearing aidcandidate, but the tinnitus was
why he was sitting in front ofme.
So I spoke to the doc and Isaid what do you think of the
possibility of maybe changingthe medication or changing the
dosage?
So he came up and he said Bobby, listen, I'll take care of his
(17:00):
heart, you take care of thetinnitus, okay?
And I thought, okay, you knowhe put me down.
But I asked and all you have todo is ask.
Two weeks later his father comesin as a patient.
It's a great story, you know,but there are times I've had
some dementia patients that camein and they had hearing loss
and we fitted them with hearingaids and the one lady told me
that she's living with a new man.
I mean because he's like he'sredialed back in again.
(17:22):
I called the primary and I justsaid, can we lower the dosage?
But he reduced the dosage like25 milligrams down to five as a
maintenance bed and and the ladysaid, like you know, like we're
going on a cruise, he's like awhole different.
You know, that's the kind ofstuff that gets you real
interested in this?
That keeps the fires burning.
Dr. Douglas L. Beck (17:40):
Tell me about OTC products and tinnitus,
because you wrote a whole bookon this and you know we have
lots of people who will takethings like lipoflavonoids,
which, by the way, that's prettymuch just the peel from a lemon
.
They will take things likeginkgo biloba and I think taking
ginkgo might have value, but Ithink it's probably more value
(18:01):
eating the box.
Don't eat the box, I'm notrecommending that but there's no
proof and I know that there aresome holistic centers that will
say, oh, we put all ourpatients on this.
But I have to be honest.
I mean, after 40 years ofstudying tinnitus, I think those
benefits are nice.
I don't doubt that they couldhave happened, but I think to
(18:21):
the largest degree, they'replacebo and a lot of people want
to believe it's doing better,so they're comforted by that.
They find comfort there, andthe New England Journal of
Medicine I think it was 2016,did a whole section on placebo
and they were saying somethingalong the lines of one-third of
all of our medicines areessentially placebo, that is,
they're not necessarily known tocure that problem, but they do
(18:43):
make the patient feel better.
Feel better, yeah, absolutely.
So tell me your thoughts onthat.
Dr. Bob DiSogra (18:47):
Okay, we got to rewind about 50 years, okay,
and this is the 50th anniversaryof the Dietary Supplements and
Health Education Act, or betterto say 1974.
And basically what thegovernment did in the early 70s
is that they really tackled thiswhole thing about dietary
supplements.
But the path that they tookreally had to do with what the
(19:09):
manufacturers were saying on thelabel and what was actually in
the pill or the gel or theliquid that was in the package.
Okay, and the majority of thelaw basically specified
compliance with making sure thatif you said that you had 25
milligrams of Siberian ginsengroot in your product, okay, and
(19:32):
they did an analysis on thatcapsule, there better be 25
milligrams of Siberian ginsengroot.
You know in that, and that'swhat they were really going for.
But they did not have to reallydemonstrate efficacy and safety
.
So you basically could putanything you want in there.
And if anybody who's listeningto this or not, if anybody I
(19:53):
know a lot of people that arelistening or watching this just
take any of your multiplevitamins that you might have at
home or any of the supplementsyou may have at home.
Just turn the label around andtake a look at the ingredients
and look at the column, you see,like the minimal daily
requirement, okay, the MDR, orthe required daily allowance as
we used to call it back in theday.
Okay, there's one column therethat says what the Food and Drug
(20:13):
Administration says as aminimal daily requirement of
vitamin C and B12, whatever.
Then there's another column,okay, and then you may see an
asterisk, okay, and the asterisk, when you read the small print
on the bottom, says you know, nominimum requirement has been
evaluated.
And that's most of them.
Dr. Douglas L. Beck (20:29):
Yeah, yeah, and there's a lot of asterisks
on a lot of these labels butthat's legal, though, that's
legal Doug, because they'redisclosing that they don't know,
we don't know.
Dr. Bob DiSogra (20:39):
But why is it in?
Dr. Douglas L. Beck (20:40):
there.
Well, if you take and I'll callthem out like Centrum or One A
Day, which are multivitamins,they're fine.
I have nothing against eitherof them.
But it's really an interestinglabel to read because you see
that vitamin C, which peopletake 1,000, 5,000, 10,000 units
of, you know the minimum is 60milligrams.
And you know, and Linus Pauling, all those years ago, 70 years
(21:02):
ago, tried to prove that if youtook enough vitamin C it would
prevent colds or whatever it was, and that never panned out, and
he was one of the smartest guysin the history.
What did we know?
Dr. Bob DiSogra (21:10):
at that time.
Dr. Douglas L. Beck (21:10):
So the thing about supplements, two
things.
Number one I remember when Iwas in college back in the late
seventies, working my bachelor's, I took a class on drugs and
drug abuse and we actually wentthrough minerals and supplements
in that class and I rememberhearing at that time
water-soluble drugs versusfat-soluble drugs and minimal
daily requirements, as you'resaying, or recommended daily
(21:33):
minimums and things like that.
And I learned back then andmaybe I'm wrong, but your body
can only use 60 milligrams ofvitamin C per day, right, that's
it.
Dr. Bob DiSogra (21:42):
Anything else over the minimum daily
requirement and the body doesn'tneed the body will pass out.
Dr. Douglas L. Beck (21:47):
Well, if it's water soluble, otherwise
you're going to be storing it,right, yeah?
Now the other thing aboutsupplements is when you think
about tinnitus in particular.
I remember there was this ASHApublication let's say 2014,
where they absolutely testeddozens and dozens of supplements
and at the end they said we donot recommend supplements for
tinnitus.
There's no proven evidence thatin controlled or random
(22:09):
controlled trials, that there'sany benefit to the patients.
And so I'd like to ask you, ifyou have a patient with tinnitus
and they tell you they're onginkgo, or they tell you you're
on lipoflavonoids, what I do,you know, is I say, well, if
that's working well for you,that's fantastic.
But I don't ever say, gee,there's great evidence, or gee,
you shouldn't do that.
I mean, if somebody's happy,right, so clinically, and I'm
(22:31):
going to drink some coffee whilewe're talking here Clinically
what do you do in that situation?
Dr. Bob DiSogra (22:35):
All right, I had that problem with the
patient also an engineer patientwho came in, and you know what
I would tell the patients otherthan this person here, the first
part of your comment.
You know, when a patient comesin and they tell you that
they've been taking Ginkgo orwhatever they've been taking for
their tinnitus, and you know,and it's really wonderful, on
the outside I say well, I'm gladyou found relief.
On the outside I say well, I'mglad you found relief.
(22:57):
But on the inside I'm saying Ihave no clue why you found
relief.
Okay, but probably the beststory that I had and this was an
eye-opener.
This was an eye-opener for meand I tell the story and
especially to the neweraudiologists coming on up.
This gentleman came in, hadmacular degeneration and so I
(23:18):
was asking him about hismedications and over-the-counter
stuff.
And he was taking Bilberry,which is a form of blueberry,
and he had heard from hissister's neighbor in Idaho,
whose cousin's brother inLouisiana you know the trail was
all over the country and thatit helped.
So he started taking it and hesaid, like you know, for the
(23:41):
past three years his maculardegeneration diagnosis has been
stable.
So I pulled out my PDR forherbal medicines.
And I looked up Bilberry andnothing.
There's not a thing in theliterature that said anything
about Bilberry maculardegeneration.
So of course you know I hadjust had the publication, so I'm
feeling like I'm on top of thewave over here right now.
And I told him.
I said, like you know, there'sreally no public.
(24:02):
This guy was an engineer so Ican talk at that level to this
guy and I said, like there'sreally no published information
about the effects.
You know, the application ofBilberry in macular degeneration
management.
So he says so you're telling me, bob, is that if I stop this
macular degeneration becauseyou're telling me that there's
(24:23):
no problems, that it's notindicated for that, and let's
say I have a change in mymacular degeneration after I
stop he goes, will you takeresponsibility for that?
And I said you enjoy that, billBarry, as far as you want to.
I mean he backed me into.
I wasn't prepared for that.
Dr. Douglas L. Beck (24:43):
Well, I'm so glad you bring this up,
because this is a real clinicalissue.
Some people will say, oh, thedoctors don't want you to know.
The truth of the matter is, ifthere were a magic pill that
would stop tinnitus, everyphysician, every audiologist,
every hearing instrumentspecialist would know all about
that.
We would tell you what that isbecause we would like to help
you.
Nobody is withholding thatinformation.
(25:04):
What we're withholding is thatpeople go ahead and just try
different chemicals anddifferent molecules and see what
happens, because some of theeffects are not very good.
One of the things you sharedwith me was a document where you
summarized the 2016 worldwidesurvey of 53 countries involving
1,700 respondents, and this isresearch on dietary supplements
for tinnitus and, by the way,this is very much the same sort
(25:25):
of thing that ASHA found whenthey looked at it.
About 26% of all of the peopleinvolved 1,700 people took
ginkgo.
About 12% took lipoflavonoids,About 8% vitamin B12, 8% zinc,
7% magnesium, 5% melatonin sothose are pretty common
supplements.
These are things that peoplewill take when they have
tinnitus, but the importantthing are the results.
(25:47):
70% of the respondents saidthese drugs were not effective
at all.
One out of five.
19% said oh yes, it improved,but that means four out of five
didn't get improvement.
10% their tinnitus got worsefrom the supplements and 5% had
adverse reactions to thesesupplements.
So my point is, if you havetinnitus, the very best thing to
(26:08):
do is not start experimentingwith molecules and chemicals.
I think the very best thing todo is go see a licensed hearing
care professional who practiceswith best practices according to
AAA, asha or IHS.
Get a comprehensive audiometricevaluation, and I don't mean
just press the button when youhear the beeps.
I want to see otoacousticemissions.
I want to see extendedhigh-frequency hearing loss.
(26:30):
I want to see, you know,ipsilateral contralateral
reflexes.
I want a good overall pictureof your auditory system, not
just press the button when youhear the beep.
When I have all of that and youhave tinnitus, the chance of me
effectively managing that withyou is about 90%.
Now some people will say Idon't want to manage it, I want
to cure it.
But most diseases, most neuroprocessing problems, we can't
(26:53):
cure, we can manage.
You know you think aboutdiabetes.
We can manage that veryeffectively.
When you think about multiplecancers, we can't cure them, but
we can manage them.
When you talk about headaches,we can't cure them, but we can
manage them.
When you talk about eyesight wecan't cure presbyopia, but we
can manage it with glasses andcontacts and other things.
So good management is worth alot, and I think that's the
(27:16):
bottom line.
On pharmaceuticals and tinnitusis there's really not one,
although there are some thingsthat contribute to tinnitus
which we need to be aware of.
So what we've talked about istinnitus, and is there a
supplement or a chemical ormolecular cure that we might
approach?
I think what we've discussedand what I hope is clear to most
people, is that supplements andover-the-counter cures for
(27:39):
tinnitus really don't exist.
Some people do get better.
We showed one out of five doget better, but four out of five
don't, and that one out of fivethat got better.
Nobody has been able to excludeplacebo.
In other words, it's verylikely in my mind that one out
of five people with tinnituswould do better with any
treatment just because we'remanaging them well, we're
(28:00):
empathetic, we're taking theirthoughts and concerns in and
we're trying to help them.
So one out of five, I think,placebo we can't rule that out.
But here's the thing.
We can measure tinnitus, and Iwant to talk about your
experience with the tinnitushandicap inventory.
Dr. Bob DiSogra (28:19):
Well, what we've done with our tinnitus
patients when they've come in,we'll do the THI as a baseline
and then we will do whateverworkup has to get done, any
counseling that has to get done,amplification if necessary, and
then we'll just pull out theTHI three months later and then
we just start going back intothe same issues that they still
might have.
But the numbers always getbetter.
They always get better and forsome patients, you know, they're
(28:41):
just pleased, no-transcriptOkay.
And sometimes that's a surprisewhen you hear that.
I mean, one of the times that Idiagnosed a little child with
hearing loss, you know, childwas like two years old and you
hold your breath because likeit's a major impact statement
that's going to come out of yourmouth, that's going to change
this whole family's dynamic.
In some case I had so, you know.
So you break the diagnosisprofessionally and you know,
(29:02):
caringly, and so on, and theparents just sat back and they
just said like, oh, I'm so gladthat's it, because we thought it
was something worse.
And it's like, wow, I didn'texpect that, you know, because
they didn't teach me that inschool, right, yeah, that's a
good point.
It's a wonderful tool that'squick to administer, yeah, and
the patients actually see theirinitial responses from three
(29:25):
months earlier.
Dr. Douglas L. Beck (29:34):
And they just said, yeah, I know what's
there, but I don't pay that muchattention to it anymore.
So, bob, here we are, closingin on the end of 2024.
And I'm wondering does the FDAhave any products that they say
are approved for tinnitusmanagement?
Dr. Bob DiSogra (29:42):
For tinnitus management.
No, there are no FDA approvednutraceuticals or
pharmaceuticals for tinnitus.
There's a tremendous amount ofresearch that's going on.
There's a great website thatthe National Institutes of
Health have that's accessible toconsumers.
It's called Clinical Trials oneword, clinicaltrialsgov and
then you navigate your waythrough this and you can just
(30:02):
type in any type of diagnosisand it'll tell you exactly where
the research is.
You can zero it down to males,females, children, all ages, and
it takes a while to play aroundwith it, but once you get the
hang of it, my goodness, you canfind out so much information.
But right now, as of the end of2024, there are no FDA approved
over-the-counter products fortinnitus or hearing loss.
(30:23):
There's a lot of clinicalresearch on hearing loss at
pharmaceuticals, but still manyin clinical trials none FDA
approved right now.
So if anybody wants to find outwhat's going on, not only with
TIDIS but any pathology,clinicaltrialsgov.
Dr. Douglas L. Beck (30:40):
That's great.
I appreciate that.
So I think a lot of peoplewatching this would be surprised
to find out that about three orfour years ago you were
diagnosed with leukemia.
That's correct, and I wonder ifyou could spend a few minutes
telling us about that.
Dr. Bob DiSogra (30:52):
Yes, this was something that came out of the
blue.
I had no exposure to anychemicals or anything in my
lifetime like that, and just hada black and blue mark on my
forearm that I thought I gotfrom just banging it because I
was moving it.
You know, a television holdingit up, flat screen, and this
black and blue mark had likemany undefined margins and it
(31:13):
was like a color I had neverseen before and it was large, it
almost covered my entireforearm.
And then I started havingexperiences with and after two
weeks it didn't go away andexperiencing with fatigue,
shortness of breath I couldn'tgo 10 feet without sitting down
to catch my breath.
And so back to the primary, allthe diagnostic tests they
(31:35):
thought it was COVID, chestx-rays, the whole package.
Then they, you know.
So we went through like twoweeks of extensive testing and
it was Labor Day weekend and Icalled the primary up and said,
like this is not getting better,you know, and I'm huffing and
puffing, you know, just atremendous amount of fatigue.
And she said get to the ER.
And got to the ER, my localhospital and they did further
(31:57):
blood tests and so on and beforeI knew it they wheeled me up to
an oncology floor and I waslike what the heck is this?
You know, if I get a littleemotional I apologize.
And my grandson was just born,like two weeks earlier, which I
hadn't who, I haven't seen it.
And I'm thinking like what theheck is going on here, because
from the neck down, I mean, Ididn't feel sick, you know, I
(32:18):
mean you couldn't see anything,it just said you know all these
blood chemistries and behaviorsand one thing led to another and
it was acute myeloid leukemia.
And they started me on a brandnew drug that was only FDA
approved, like eight monthsearlier.
It's called venetoclax and noauditory side effects.
I didn't really care at thatpoint because, you know, I just
wanted to get better and I wasin the hospital for two weeks
(32:39):
and I was getting injections, Iwas getting orals.
So what happened?
So I'm in the hospital for twoweeks and as part of that, with
all these new medications I'dnever heard of before, they
wanted to do a bone scan, a bonemarrow biopsy, because they
thought they were going to haveto just change my entire immune
system, which means four weeksin the hospital I still would
have.
You know, there was all thesedifferent horror images that
(33:01):
were coming through my head.
And all of a sudden, you knowI'm discharged, I'm taking these
medications, I'm getting allthese MRIs and so on and I'm
getting tapped, you know, and soon.
And all of a sudden the numbersstart coming up and up and they
sent me up to the RutgersCancer Institute here in New
Jersey, which is part of NCI.
At the time I was like 71 yearsold and they said, like we
(33:23):
don't have a lot of data onpeople your age.
And I said, well, that doesn'thelp me right now.
Thank you so very much, you know.
But I'm just taking a high road.
You know, I'm kind of aspiritual person and my church
was, you know, working with meas best that they could.
And by January, 90 days later,I had this, what they call the
MRD test, you know, to see ifthere's any detection of the
(33:44):
cancer cells at all 0.0.
Dr. Douglas L. Beck (33:47):
And it's like whoa you know I have to
break in here.
So, you had this amazingrecovery.
But I think what people don'tknow is, while this is going on,
you're calling me and you'reprobably calling eight or 10
other people and your mainconcern was not leukemia, your
main concern was a triple Apresentation we're putting
together and you're goingthrough all these details and I
(34:09):
keep saying, bob, bob, take careof your health, bob, we'll talk
when you're cured.
Dr. Bob DiSogra (34:14):
God bless you.
God bless you, Doug.
It meant a lot, but you know.
Dr. Douglas L. Beck (34:19):
But I mean, you know, and now I look at it
in retrospect and I realize youwere trying to just focus your
brain on something else.
I had to.
Dr. Bob DiSogra (34:25):
One of the more interesting experiences because
it was.
You know, we talked aboutmedications and drug side
effects and now I'm on thereceiving end.
You know so I'm.
You know I'm hearing thingsthat I used to talk about, but
it's me.
And one of the things that theydid as far as the management,
is that they decided to do someblood transfusions and over the
course of two months I had sevenblood transfusions.
(34:47):
Funny story it was Halloweenwhen I was getting one of my
transfusions and my niece sentme some fangs, so we took a
picture of me all hooked up withthe blood and fangs.
Oh, perfect, the nurses losttheir minds.
It was good.
But what happened is that I hadseven blood transfusions and you
know we talk about donatingblood, giving blood.
(35:07):
You know, give a pint, save alife.
Well, as I told you earlier, Ihad seven strangers come into my
life.
These are people I never met.
They had the same blood type asme.
They donated blood.
I got seven pints of this bloodand in part, that was part of
the success of the recovery thatI had.
So when I do my lectures, Iusually end the lectures by
(35:29):
saying if you can think aboutdonating a pint of blood.
It only takes an hour to donate, but it takes three hours to
get it.
You know and again it's.
I don't know who these peopleare these were seven angels that
came into my life and you knowwhen I just thank God every day
that you know that they did thatand I just encourage everybody
that I that, when theconversation comes up, if you're
(35:50):
healthy enough and well enoughto do it, donate a pint of blood
, donate to Plaza, become adonor and your local Red Cross
chapter is going to help you outand in part, it saved my life.
So I put that out there.
Dr. Douglas L. Beck (36:01):
Well, more than in part, it saved your life
.
I mean, you had the impact andyou had the good fortune to be
at the right place at the righttime.
You had the right doctors, theright medical center and you
know.
You've come out on the otherside and you're still even more
of a glorious human being.
It is an honor to know you.
I am so proud of you.
I always enjoyed when you and Iwould lecture at the same
(36:22):
facilities and that happened atleast, I want to say, 20 or 30
times, right.
Dr. Bob DiSogra (36:26):
And we were in Georgia.
I brought my whole class intoyour class, if you remember.
I can't thank you enough forthis opportunity, and I hope
that the audience walks awaywith at least one thing that
they can use professionally.
Then we've done our job Okay.
Doug, thank you so very much.
You're a kind man and I loveyou too.
Thank you very much.
Thank you so much.
If you have tinnitus, the very best thing
to do is not start experimentingwith molecules and chemicals.
I think the very best thing todo is go see a licensed hearing
care professional who practiceswith best practices according to
AAA, asha or IHS and get acomprehensive audiometric
evaluation, and I don't meanjust press the button when you
hear the beeps.
Blaise M. Delfino, M.S. (00:24):
You're tuned in to the Hearing Matters
podcast, the show thatdiscusses hearing technology,
best practices and a globalepidemic hearing loss.
Before we kick this episode off, a special thank you to our
partners.
sycle, built for the entirehearing care practice.
Redux, the best dryer handsdown.
(00:46):
CaptionC all by Sorenson - Lifeis calling.
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Welcome back to another episodeof the Hearing Matters podcast.
I'm founder and host, BlaiseDelfino and, as a friendly
(01:08):
reminder, this podcast isseparate from my work at Starkey
.
Dr. Douglas L. Beck (01:13):
Good afternoon.
This is Dr Douglas Beck withthe Hearing Matters Podcast, and
today we're honored to have mydear friend, Dr Robert DiSogra
with us.
And Bob has dedicated themajority of his career to
promoting an understanding ofthe pharmacologic effects on
hearing imbalance across hearingcare professionals across the
world.
While teaching at Rutgers over25 years ago, he questioned why
(01:35):
his patients had clinicalcomplaints of hearing loss, yet
their test data showed noevidence of peripheral hearing
loss.
He then went beyond hisclinical practice to initiate an
unprecedented review ofevidence that identified the
influences of pharmaceuticalsand nutraceuticals on hearing
loss and tinnitus In a series ofpublications for audiologists
(01:56):
over the past couple of decades.
Dr DeSogra distinguished hisaudiology career by identifying
more than 400 adverse auditoryand vestibular side effects
related to more than 2,000 drugs.
He later developed and taughtthe pharmacology ototoxicity
distance learning course whilepursuing his own doctorate at
Salus University.
(02:17):
Dr DeSogra has left a legacyfor our field.
He recently served on theAcademy's pharmacology task
force, which explored therequirements for prescriptive
privileges for audiologists.
That's a mouthful, I stumbledthrough it, but I love you, Bob,
and it's so nice to see you.
Dr. Bob DiSogra (02:31):
How the heck are you, doug?
Thanks very much and thank youfor your kind words.
I really appreciate that Laborof love, as they say, but there
was a need and I just took itupon myself to just explore it.
And well, the rest is historyas far as how our profession
responded to my work, and I'mgrateful for that.
Dr. Douglas L. Beck (02:49):
I think it's been very positive.
I'll tell you, I tookpharmacology courses gosh, it
must have been 20, 25 years agoand I found it to be fascinating
.
And I know that you startedgetting really involved with
that when our mutual friend,jerry Northern, asked you to
write.
I think it was 2001, 2002, anedition of Audiology Today on
pharmacology right.
Dr. Bob DiSogra (03:09):
I did that.
The original publication wasback in 93.
Oh right, what had happened isthat when the AUD programs were
coming online, I was talkingwith the late Dr George Osborne
who was heading up the programat PCO, pennsylvania College of
Optometry, now part of DrexelUniversity.
What happened is that he hadasked me to teach the
(03:29):
pharmacology class and he saidyou know, you had that
publication back in 93.
He says why don't you update it?
And I did.
And that's when all the numbersgot larger and larger and I
submitted it to Audiology Todayand the editor, dr Jerry
Northern, looked at this and hecalled me up and said Bob, I
can't do this, bob, I can'tpublish this.
And I was ready to accept thedefeat, you know, and the
(03:50):
rejection and walk away, but hesaid no, he says this is we have
to do a special issue, this is.
He said this was basically toogood to get lost in the pages.
Dr. Douglas L. Beck (03:59):
And yeah, I call out and let me just say
some people don't know Dr GeorgeOsborne because he passed quite
a few years ago, I want to say18 or 20 years ago.
But he was also a dentist, sohe himself had a lot of specific
knowledge on pharmacology thathe used every day in his patient
care for his dental patientsand, of course, his audiology
patients.
So coming from him asking youto update that, that's quite a
(04:23):
nice stepping stone.
Dr. Bob DiSogra (04:24):
Yeah, it was very flattering, very impressive
that someone of his stature andbackground would say to me we'd
like you to update, and so on.
And then, going to JerryNorthern, who had been just a
wonderful pioneer in ourprofession, he said listen,
we're going to do a specialissue Now.
Aaa, every once in a while dida special issue and I think
historically they've only doneabout eight or nine.
I haven't seen a special issueand I think historically they
(04:45):
only done about eight or nine.
I haven't seen a special issuein such a long time.
So to have a special issue atthat time was like I'm at the
top of the mountain here, youknow and like, and it was just
so flattering for me that helooked at that work and he
published it and that was in2001.
But every audiologist that wasa member of AAA around the world
got a copy of that and thefeedback that I got from that
(05:07):
was very positive.
People said, oh, I have ithanging on my wall in my
vestibular office.
Great stuff from around theworld.
So what had happened is thatyou know, so I'm settling in
with all that.
I'm getting calls to do, talksto do, you know, well, I was
going to say.
Dr. Douglas L. Beck (05:20):
I think that launched your speaking
career.
Dr. Bob DiSogra (05:23):
Yeah, and it actually did.
And then in 2003, just a coupleof years later, I got it
updated because there were somany more drugs coming out and
we just became more aware ofother side effects that
audiologists would be concernedwith.
Dr. Douglas L. Beck (05:38):
And when did the book come out?
Because your book onpharmacologic OTC products.
When did that come out?
Dr. Bob DiSogra (05:42):
That was in the late 2000s, 2008, 2009,
somewhere around there.
Well, what had happened is thatwhen I was teaching the online
class at Salus, one of thestudents was from New Zealand
and she had a copy of thebooklet, and I didn't know this,
but she was the president ofthe New Zealand Audiological
Society.
Fast forward two years.
Blaise M. Delfino, M.S. - (06:05):
Guess you're in New Zealand, right?
I love that.
Dr. Bob DiSogra (06:07):
And it was just like wow, and I still thank
George for that opportunity thatgot me and my two sons to head
over there to New Zealand.
Oh yeah, and this happens.
Dr. Douglas L. Beck (06:19):
It's such a great evolution academic and
clinical and social issues.
Because in 1993, I was workingwith Jerry on an issue of
Seminars in Hearing and whathappened?
We called it Audiology, theScope of Practice.
And Jerry and I think JimJerger at the time said, eh,
it's not a great name because itlooks like that's going to
define our scope of practice.
And Jerry, I think, came backwith the name Audiology Beyond
(06:43):
the Sound Booth booth Cause youknow we were talking about a
neurophysiology, intraocularcranial nerve monitoring,
electrococleography, umsomatosensory, no pharmacology.
Dr. Bob DiSogra (06:53):
I know that.
Dr. Douglas L. Beck (06:54):
No pharmacology, and we talked
about legal issues as well.
And so Jerry came back and hewas so insightful and he said
here's what we should do.
We should call it beyond thesound booth, because it's not.
It wasn't about audiometricclinical testing.
You know airbone and speech,but it was everything beyond
that, or many things beyond that, and that kind of launched my
speaking career as well.
And then, you know, I thinkwe're both very grateful to
(07:16):
Jerry for his guidance, hisinsight and his intellect, and
he was able to recognize thatthese are things that
audiologists need to know,because it's going to impact
where we're going as aprofession in the future.
And so this story that you'rerelaying I think is very
important, and I think it's veryimportant for younger people to
understand that as you become aprofessional, you're going to
(07:36):
realize things that you had noidea were even in your universe,
and sometimes, when you grabonto those like pharmacology for
you, neurophysiology for methat actually sets the rest of
your career and you neverpredicted it or planned on it.
Dr. Bob DiSogra (07:50):
No, not at all.
Not at all.
I just saw myself as privatepractice audiologist till the
day of retirement and have anice life and walk away, and
then all of a sudden, somethingsparks an interest and you run
with it and before you know ityou still have your private
practice, but you have anotherhat that you're wearing now in
your profession, or 10 hats.
And yeah, and a recognitionthat you never even dreamed of.
Dr. Douglas L. Beck (08:11):
So in pharmacology and audiology,
let's talk about three or fourareas.
I want to talk about hearing, Iwant to talk about tinnitus, I
want to talk about balance ordizziness.
So in hearing, what are themost dangerous drugs?
Which drugs over-the-counter orprescribed are most likely to
have a negative impact on puretone?
Dr. Bob DiSogra (08:31):
thresholds.
Well, we've known about certainmedications that can cause
hearing loss.
There's pages of documentationgoing back since our profession
started and probably one of themost common ones was aspirin.
This was before we had a lot ofthese other more potent
medications for aspirin, butback then 20 to 30 aspirins a
(08:52):
day for an arthritis patient wasnot uncommon and of course,
that type of an overload createda lot of problems with the
inner ear.
Dr. Douglas L. Beck (09:00):
Now stop there for a moment, if I may.
If you're taking aspirin rightnow, whether it's baby aspirin
for vascular things or whetherit's multiple aspirins a day for
arthritis, at what level do youbecome concerned If you're
taking four aspirin a day, six,12, 18?
Dr. Bob DiSogra (09:15):
Well, the smaller dosage, the 81
milligrams, that's safe.
Okay.
Then you get up into the 240,480 milligrams.
Okay, now you're starting toget into some areas where
there's going to be maybe somechanges in vascularity in the
cochlear and so on.
Once you start getting past 500milligrams a day per dosage and
if you're taking six or sevendoses, 3,500 milligrams, like
(09:39):
you're just you're overloadingyourself.
You're just like going out inthe sun in the Caribbean with no
sunblock on.
Okay, you're gonnaing yourself.
You're just like going out inthe sun in the Caribbean with no
sunblock on.
Dr. Douglas L. Beck (09:45):
Okay, You're going to ask for problems
okay.
And this is why I want to bereal specific here.
But the bottom line is, whenyou're looking at doses three,
four times a day, right, soyou're looking at TID, qid,
something like that and you'retalking about 500 to 1,000
milligrams of aspirin that's areally good time to talk to your
(10:06):
doctor about ototoxic effects,but if you're taking two or
three aspirins a day, probablynot an issue.
Dr. Bob DiSogra (10:10):
Not an issue, no.
And now you have other drugs.
You know your Relieves, yourMotrins and so on.
Dr. Douglas L. Beck (10:15):
So let's talk about that because, these
are essentially ibuprofen andacetaminophen.
Yeah, and at what point do weworry about ototoxic effects
from either of those?
Dr. Bob DiSogra (10:24):
Well, I'm currently being treated for an
arthritic condition in my neck,and my neck specialist
orthopedic doc tapped me at3,000 milligrams of
acetaminophen a day.
Dr. Douglas L. Beck (10:34):
And that acetaminophen is Tylenol.
Yeah, and at 3,000, you feelcomfortable.
You're not worried aboutototoxic effects.
Dr. Bob DiSogra (10:40):
I haven't had any issues with that, and that's
only on a PRN basis.
So really it's there when Ineed it, but it's not that I'm
on a regular dosage, and if Iwas, I would start to talk to
the doctor about well, what'sthe long-term effect on this?
Dr. Douglas L. Beck (10:54):
And what about ibuprofen?
Because ibuprofen is an NSAIDor non-steroidal
anti-inflammatory drug, and Ithink a lot of people take Advil
Motrin.
These are all the same drugs.
They're all ibuprofen and thereare generics.
At what point do you worryabout those?
Dr. Bob DiSogra (11:08):
What happens?
You have capillary constriction, okay, in the inner ear and
what happens is that, you know,when there's capillary
constriction, so there's oxygenin the blood going up to the
nerve cells in there and thenthere's going to be some
problems.
Okay, it may start out astinnitus and if it continues
because of discomfort you'reexperiencing, which is why
you're taking that medication,it could turn into hearing loss.
So you're dealing with thenon-steroidal and the
(11:30):
inflammatories, so this is whatthey can do, but, again, always
look at the cause of why you'retaking this.
You know when patients wouldcome into my office, I would
tell them your hearing loss is acomplaint to you, but to me
it's a symptom and I need tofind out those pieces of the
puzzle.
And so just tell me everythingand let me sort it out for you.
And I think it's the same thing.
(11:55):
I think a lot more patients arehaving better dialogue with
their doctors about theirmedications, with so many
direct-to-consumer ads on thetelevision about prescription
meds and discuss this with yourdoctor, and that's great.
Ok, it opens this with yourdoctor and that's great, okay,
it opens up a dialogue.
And again, you can selfmedicate, which is another issue
that you have with over thecounter medications and that's a
whole different issue.
But again, you know, for thepeople that are on this podcast,
clearly you know, just rememberthat pain is a symptom.
Hearing loss is a symptom, youknow, and when you treat the
(12:18):
symptom and it's not going away,there's the underlying cause.
Has to be further explored.
Dr. Douglas L. Beck (12:22):
I'm glad you remind us of that, because
in all of healthcare I wouldlike to think that what we do is
diagnosis first, treatmentsecond.
But we don't necessarily.
We have a symptom and we treatthe symptom.
We never really got to thediagnosis, and that symptom can
be hearing loss, it can betinnitus, it could be dizziness,
it could be vertigo, and then,of course, we have all sorts of
antibiotics and antivirals.
(12:43):
Now Is there a particular redflag that you see in antibiotic?
Which ones are the most commonthat we worry about?
Dr. Bob DiSogra (12:50):
ototoxic effects.
The aminoglycosides okay, thoseantibiotics, they've been
around for the longest time,yeah, and, as a matter of fact,
I met the chief researcher whodeveloped streptomycin okay,
which was developed here atRutgers in here in New Jersey
many years ago.
And what happens with theseantibiotics is anywhere up to
like 20 to 60% risk, dependingon the individual's health and
(13:15):
any other comorbidities thatmight be a player over here.
So there is a risk of hearingloss.
And again, this data isaccessible to consumers and, of
course, the physicians haveaccess to it also, and there's
nothing wrong with askingquestions like this.
But it's better to ask thequestions and get some guidance
rather than to self-medicate andjust go online and find out for
yourself, because once you getpast the three-syllable words,
(13:37):
some people just get confused.
Dr. Douglas L. Beck (13:40):
I like that .
If it's four syllables or more,you should be concerned.
Three and I'm free.
That's it.
So aminoglycosides arecertainly an issue in long-term
care at high doses and, again,it's a good conversation to have
with your doctor.
And let me just be clear thatthe Hearing Matters podcast is
not telling people what to takeor what not to take.
We're saying when it shouldraise a red flag and when you
(14:02):
should have a conversation withyour doctor.
It's okay to ask questions.
There are many patients who areoncology patients that are on
chemotherapy for differentcancers.
Some of them are carbon-baseddrugs and things like that.
What are your concerns there?
Dr. Bob DiSogra (14:14):
Well, before any drug gets approved by the
FDA it has to go through theclinical trials, and when
hearing loss was showing up witha lot of these carbon-based
drugs, you know the red flaggoes out in the information
sheet to the physicians and soon.
And there's a counseling issuethat has to be done here Because
, in the words of my dear friend, dr Kathy Campbell, who was
(14:34):
basically my mentor inpharmacology out in the
University of Southern IllinoisKathy even said it she says the
benefits outweigh the risks, andso if a person is going to have
a cancer medication that'sgoing to improve the quality of
your life but there's going tobe, you know, maybe some hearing
loss involved with that, thecounseling issue comes in.
(14:55):
And then you know, then thehearing aid trials and so on and
the family gets.
Then you know, then the hearingaid trials and so on and the
family gets involved.
You know it's like even withthe hair loss with certain chemo
meds, and so you know there's alot of counseling.
So it's not just a pop a pill,feel better, walk out.
Dr. Douglas L. Beck (15:07):
No, and it's a good point.
It's a good call out becausethere's always a trade-off in
these situations and the value,you know, what do you get versus
what did you give.
Right, that's between thepatient and the physician.
And of course, there are timeswhen carboplatinum drugs are
going to cause hearing loss,hair loss as well and all these
other negative side effects,when you feel absolutely awful.
But by the same token, it's apersonal decision because if you
(15:31):
go through that, there's areasonable opportunity for you
to beat the cancer in manyrespects, and it's not just oh,
this drug is going to causehearing loss, so we're not going
to open that up.
Dr. Bob DiSogra (15:42):
You know the hearing loss is it goes to the
bottom of the list.
You know if this drug is goingto get you to improve the
quality of your life for thenext five to 10 years, I'll deal
with the hearing loss.
Right, right.
Dr. Douglas L. Beck (15:52):
And I'm so glad you said that because I
think a lot of young cliniciansget caught up in you know.
Oh, we've got to talk to thedoctor and change the drugs.
You know, it's not aconversation that's going to go
well, I think.
No, it's not at all.
You know, it's certainlysomething to talk about if you
choose.
Yeah, I probably wouldn'tengage with most oncologists on
their selection ofpharmaceuticals to treat cancer.
(16:15):
No, I'm not qualified for that.
Dr. Bob DiSogra (16:16):
We come in much later on.
I had a patient who came in, acardiac patient came in and was
on a new med and was gettingtinnitus in the morning only.
And you know, do the casehistory and you find out what
the timeline is, and we piecedit all together and it turns out
that the medication he wastaking had tinnitus as a side
effect.
And the timeline just fit rightinto place.
So I contacted the primary andI told him what I found, you
(16:38):
know, and so on, because hereferred for the tinnitus and
the guy was in his like late 70s, early 80s.
He had some mild, highfrequency age related loss, not
a big deal, not a hearing aidcandidate, but the tinnitus was
why he was sitting in front ofme.
So I spoke to the doc and Isaid what do you think of the
possibility of maybe changingthe medication or changing the
dosage?
So he came up and he said Bobby, listen, I'll take care of his
(17:00):
heart, you take care of thetinnitus, okay?
And I thought, okay, you knowhe put me down.
But I asked and all you have todo is ask.
Two weeks later his father comesin as a patient.
It's a great story, you know,but there are times I've had
some dementia patients that camein and they had hearing loss
and we fitted them with hearingaids and the one lady told me
that she's living with a new man.
I mean because he's like he'sredialed back in again.
(17:22):
I called the primary and I justsaid, can we lower the dosage?
But he reduced the dosage like25 milligrams down to five as a
maintenance bed and and the ladysaid, like you know, like we're
going on a cruise, he's like awhole different.
You know, that's the kind ofstuff that gets you real
interested in this?
That keeps the fires burning.
Dr. Douglas L. Beck (17:40):
Tell me about OTC products and tinnitus,
because you wrote a whole bookon this and you know we have
lots of people who will takethings like lipoflavonoids,
which, by the way, that's prettymuch just the peel from a lemon
.
They will take things likeginkgo biloba and I think taking
ginkgo might have value, but Ithink it's probably more value
(18:01):
eating the box.
Don't eat the box, I'm notrecommending that but there's no
proof and I know that there aresome holistic centers that will
say, oh, we put all ourpatients on this.
But I have to be honest.
I mean, after 40 years ofstudying tinnitus, I think those
benefits are nice.
I don't doubt that they couldhave happened, but I think to
(18:21):
the largest degree, they'replacebo and a lot of people want
to believe it's doing better,so they're comforted by that.
They find comfort there, andthe New England Journal of
Medicine I think it was 2016,did a whole section on placebo
and they were saying somethingalong the lines of one-third of
all of our medicines areessentially placebo, that is,
they're not necessarily known tocure that problem, but they do
(18:43):
make the patient feel better.
Feel better, yeah, absolutely.
So tell me your thoughts onthat.
Dr. Bob DiSogra (18:47):
Okay, we got to rewind about 50 years, okay,
and this is the 50th anniversaryof the Dietary Supplements and
Health Education Act, or betterto say 1974.
And basically what thegovernment did in the early 70s
is that they really tackled thiswhole thing about dietary
supplements.
But the path that they tookreally had to do with what the
(19:09):
manufacturers were saying on thelabel and what was actually in
the pill or the gel or theliquid that was in the package.
Okay, and the majority of thelaw basically specified
compliance with making sure thatif you said that you had 25
milligrams of Siberian ginsengroot in your product, okay, and
(19:32):
they did an analysis on thatcapsule, there better be 25
milligrams of Siberian ginsengroot.
You know in that, and that'swhat they were really going for.
But they did not have to reallydemonstrate efficacy and safety
.
So you basically could putanything you want in there.
And if anybody who's listeningto this or not, if anybody I
(19:53):
know a lot of people that arelistening or watching this just
take any of your multiplevitamins that you might have at
home or any of the supplementsyou may have at home.
Just turn the label around andtake a look at the ingredients
and look at the column, you see,like the minimal daily
requirement, okay, the MDR, orthe required daily allowance as
we used to call it back in theday.
Okay, there's one column therethat says what the Food and Drug
(20:13):
Administration says as aminimal daily requirement of
vitamin C and B12, whatever.
Then there's another column,okay, and then you may see an
asterisk, okay, and the asterisk, when you read the small print
on the bottom, says you know, nominimum requirement has been
evaluated.
And that's most of them.
Dr. Douglas L. Beck (20:29):
Yeah, yeah, and there's a lot of asterisks
on a lot of these labels butthat's legal, though, that's
legal Doug, because they'redisclosing that they don't know,
we don't know.
Dr. Bob DiSogra (20:39):
But why is it in?
Dr. Douglas L. Beck (20:40):
there.
Well, if you take and I'll callthem out like Centrum or One A
Day, which are multivitamins,they're fine.
I have nothing against eitherof them.
But it's really an interestinglabel to read because you see
that vitamin C, which peopletake 1,000, 5,000, 10,000 units
of, you know the minimum is 60milligrams.
And you know, and Linus Pauling, all those years ago, 70 years
(21:02):
ago, tried to prove that if youtook enough vitamin C it would
prevent colds or whatever it was, and that never panned out, and
he was one of the smartest guysin the history.
What did we know?
Dr. Bob DiSogra (21:10):
at that time.
Dr. Douglas L. Beck (21:10):
So the thing about supplements, two
things.
Number one I remember when Iwas in college back in the late
seventies, working my bachelor's, I took a class on drugs and
drug abuse and we actually wentthrough minerals and supplements
in that class and I rememberhearing at that time
water-soluble drugs versusfat-soluble drugs and minimal
daily requirements, as you'resaying, or recommended daily
(21:33):
minimums and things like that.
And I learned back then andmaybe I'm wrong, but your body
can only use 60 milligrams ofvitamin C per day, right, that's
it.
Dr. Bob DiSogra (21:42):
Anything else over the minimum daily
requirement and the body doesn'tneed the body will pass out.
Dr. Douglas L. Beck (21:47):
Well, if it's water soluble, otherwise
you're going to be storing it,right, yeah?
Now the other thing aboutsupplements is when you think
about tinnitus in particular.
I remember there was this ASHApublication let's say 2014,
where they absolutely testeddozens and dozens of supplements
and at the end they said we donot recommend supplements for
tinnitus.
There's no proven evidence thatin controlled or random
(22:09):
controlled trials, that there'sany benefit to the patients.
And so I'd like to ask you, ifyou have a patient with tinnitus
and they tell you they're onginkgo, or they tell you you're
on lipoflavonoids, what I do,you know, is I say, well, if
that's working well for you,that's fantastic.
But I don't ever say, gee,there's great evidence, or gee,
you shouldn't do that.
I mean, if somebody's happy,right, so clinically, and I'm
(22:31):
going to drink some coffee whilewe're talking here Clinically
what do you do in that situation?
Dr. Bob DiSogra (22:35):
All right, I had that problem with the
patient also an engineer patientwho came in, and you know what
I would tell the patients otherthan this person here, the first
part of your comment.
You know, when a patient comesin and they tell you that
they've been taking Ginkgo orwhatever they've been taking for
their tinnitus, and you know,and it's really wonderful, on
the outside I say well, I'm gladyou found relief.
On the outside I say well, I'mglad you found relief.
(22:57):
But on the inside I'm saying Ihave no clue why you found
relief.
Okay, but probably the beststory that I had and this was an
eye-opener.
This was an eye-opener for meand I tell the story and
especially to the neweraudiologists coming on up.
This gentleman came in, hadmacular degeneration and so I
(23:18):
was asking him about hismedications and over-the-counter
stuff.
And he was taking Bilberry,which is a form of blueberry,
and he had heard from hissister's neighbor in Idaho,
whose cousin's brother inLouisiana you know the trail was
all over the country and thatit helped.
So he started taking it and hesaid, like you know, for the
(23:41):
past three years his maculardegeneration diagnosis has been
stable.
So I pulled out my PDR forherbal medicines.
And I looked up Bilberry andnothing.
There's not a thing in theliterature that said anything
about Bilberry maculardegeneration.
So of course you know I hadjust had the publication, so I'm
feeling like I'm on top of thewave over here right now.
And I told him.
I said, like you know, there'sreally no public.
(24:02):
This guy was an engineer so Ican talk at that level to this
guy and I said, like there'sreally no published information
about the effects.
You know, the application ofBilberry in macular degeneration
management.
So he says so you're telling me, bob, is that if I stop this
macular degeneration becauseyou're telling me that there's
(24:23):
no problems, that it's notindicated for that, and let's
say I have a change in mymacular degeneration after I
stop he goes, will you takeresponsibility for that?
And I said you enjoy that, billBarry, as far as you want to.
I mean he backed me into.
I wasn't prepared for that.
Dr. Douglas L. Beck (24:43):
Well, I'm so glad you bring this up,
because this is a real clinicalissue.
Some people will say, oh, thedoctors don't want you to know.
The truth of the matter is, ifthere were a magic pill that
would stop tinnitus, everyphysician, every audiologist,
every hearing instrumentspecialist would know all about
that.
We would tell you what that isbecause we would like to help
you.
Nobody is withholding thatinformation.
(25:04):
What we're withholding is thatpeople go ahead and just try
different chemicals anddifferent molecules and see what
happens, because some of theeffects are not very good.
One of the things you sharedwith me was a document where you
summarized the 2016 worldwidesurvey of 53 countries involving
1,700 respondents, and this isresearch on dietary supplements
for tinnitus and, by the way,this is very much the same sort
(25:25):
of thing that ASHA found whenthey looked at it.
About 26% of all of the peopleinvolved 1,700 people took
ginkgo.
About 12% took lipoflavonoids,About 8% vitamin B12, 8% zinc,
7% magnesium, 5% melatonin sothose are pretty common
supplements.
These are things that peoplewill take when they have
tinnitus, but the importantthing are the results.
(25:47):
70% of the respondents saidthese drugs were not effective
at all.
One out of five.
19% said oh yes, it improved,but that means four out of five
didn't get improvement.
10% their tinnitus got worsefrom the supplements and 5% had
adverse reactions to thesesupplements.
So my point is, if you havetinnitus, the very best thing to
(26:08):
do is not start experimentingwith molecules and chemicals.
I think the very best thing todo is go see a licensed hearing
care professional who practiceswith best practices according to
AAA, asha or IHS.
Get a comprehensive audiometricevaluation, and I don't mean
just press the button when youhear the beeps.
I want to see otoacousticemissions.
I want to see extendedhigh-frequency hearing loss.
(26:30):
I want to see, you know,ipsilateral contralateral
reflexes.
I want a good overall pictureof your auditory system, not
just press the button when youhear the beep.
When I have all of that and youhave tinnitus, the chance of me
effectively managing that withyou is about 90%.
Now some people will say Idon't want to manage it, I want
to cure it.
But most diseases, most neuroprocessing problems, we can't
(26:53):
cure, we can manage.
You know you think aboutdiabetes.
We can manage that veryeffectively.
When you think about multiplecancers, we can't cure them, but
we can manage them.
When you talk about headaches,we can't cure them, but we can
manage them.
When you talk about eyesight wecan't cure presbyopia, but we
can manage it with glasses andcontacts and other things.
So good management is worth alot, and I think that's the
(27:16):
bottom line.
On pharmaceuticals and tinnitusis there's really not one,
although there are some thingsthat contribute to tinnitus
which we need to be aware of.
So what we've talked about istinnitus, and is there a
supplement or a chemical ormolecular cure that we might
approach?
I think what we've discussedand what I hope is clear to most
people, is that supplements andover-the-counter cures for
(27:39):
tinnitus really don't exist.
Some people do get better.
We showed one out of five doget better, but four out of five
don't, and that one out of fivethat got better.
Nobody has been able to excludeplacebo.
In other words, it's verylikely in my mind that one out
of five people with tinnituswould do better with any
treatment just because we'remanaging them well, we're
(28:00):
empathetic, we're taking theirthoughts and concerns in and
we're trying to help them.
So one out of five, I think,placebo we can't rule that out.
But here's the thing.
We can measure tinnitus, and Iwant to talk about your
experience with the tinnitushandicap inventory.
Dr. Bob DiSogra (28:19):
Well, what we've done with our tinnitus
patients when they've come in,we'll do the THI as a baseline
and then we will do whateverworkup has to get done, any
counseling that has to get done,amplification if necessary, and
then we'll just pull out theTHI three months later and then
we just start going back intothe same issues that they still
might have.
But the numbers always getbetter.
They always get better and forsome patients, you know, they're
(28:41):
just pleased, no-transcriptOkay.
And sometimes that's a surprisewhen you hear that.
I mean, one of the times that Idiagnosed a little child with
hearing loss, you know, childwas like two years old and you
hold your breath because likeit's a major impact statement
that's going to come out of yourmouth, that's going to change
this whole family's dynamic.
In some case I had so, you know.
So you break the diagnosisprofessionally and you know,
(29:02):
caringly, and so on, and theparents just sat back and they
just said like, oh, I'm so gladthat's it, because we thought it
was something worse.
And it's like, wow, I didn'texpect that, you know, because
they didn't teach me that inschool, right, yeah, that's a
good point.
It's a wonderful tool that'squick to administer, yeah, and
the patients actually see theirinitial responses from three
(29:25):
months earlier.
Dr. Douglas L. Beck (29:34):
And they just said, yeah, I know what's
there, but I don't pay that muchattention to it anymore.
So, bob, here we are, closingin on the end of 2024.
And I'm wondering does the FDAhave any products that they say
are approved for tinnitusmanagement?
Dr. Bob DiSogra (29:42):
For tinnitus management.
No, there are no FDA approvednutraceuticals or
pharmaceuticals for tinnitus.
There's a tremendous amount ofresearch that's going on.
There's a great website thatthe National Institutes of
Health have that's accessible toconsumers.
It's called Clinical Trials oneword, clinicaltrialsgov and
then you navigate your waythrough this and you can just
(30:02):
type in any type of diagnosisand it'll tell you exactly where
the research is.
You can zero it down to males,females, children, all ages, and
it takes a while to play aroundwith it, but once you get the
hang of it, my goodness, you canfind out so much information.
But right now, as of the end of2024, there are no FDA approved
over-the-counter products fortinnitus or hearing loss.
(30:23):
There's a lot of clinicalresearch on hearing loss at
pharmaceuticals, but still manyin clinical trials none FDA
approved right now.
So if anybody wants to find outwhat's going on, not only with
TIDIS but any pathology,clinicaltrialsgov.
Dr. Douglas L. Beck (30:40):
That's great.
I appreciate that.
So I think a lot of peoplewatching this would be surprised
to find out that about three orfour years ago you were
diagnosed with leukemia.
That's correct, and I wonder ifyou could spend a few minutes
telling us about that.
Dr. Bob DiSogra (30:52):
Yes, this was something that came out of the
blue.
I had no exposure to anychemicals or anything in my
lifetime like that, and just hada black and blue mark on my
forearm that I thought I gotfrom just banging it because I
was moving it.
You know, a television holdingit up, flat screen, and this
black and blue mark had likemany undefined margins and it
(31:13):
was like a color I had neverseen before and it was large, it
almost covered my entireforearm.
And then I started havingexperiences with and after two
weeks it didn't go away andexperiencing with fatigue,
shortness of breath I couldn'tgo 10 feet without sitting down
to catch my breath.
And so back to the primary, allthe diagnostic tests they
(31:35):
thought it was COVID, chestx-rays, the whole package.
Then they, you know.
So we went through like twoweeks of extensive testing and
it was Labor Day weekend and Icalled the primary up and said,
like this is not getting better,you know, and I'm huffing and
puffing, you know, just atremendous amount of fatigue.
And she said get to the ER.
And got to the ER, my localhospital and they did further
(31:57):
blood tests and so on and beforeI knew it they wheeled me up to
an oncology floor and I waslike what the heck is this?
You know, if I get a littleemotional I apologize.
And my grandson was just born,like two weeks earlier, which I
hadn't who, I haven't seen it.
And I'm thinking like what theheck is going on here, because
from the neck down, I mean, Ididn't feel sick, you know, I
(32:18):
mean you couldn't see anything,it just said you know all these
blood chemistries and behaviorsand one thing led to another and
it was acute myeloid leukemia.
And they started me on a brandnew drug that was only FDA
approved, like eight monthsearlier.
It's called venetoclax and noauditory side effects.
I didn't really care at thatpoint because, you know, I just
wanted to get better and I wasin the hospital for two weeks
(32:39):
and I was getting injections, Iwas getting orals.
So what happened?
So I'm in the hospital for twoweeks and as part of that, with
all these new medications I'dnever heard of before, they
wanted to do a bone scan, a bonemarrow biopsy, because they
thought they were going to haveto just change my entire immune
system, which means four weeksin the hospital I still would
have.
You know, there was all thesedifferent horror images that
(33:01):
were coming through my head.
And all of a sudden, you knowI'm discharged, I'm taking these
medications, I'm getting allthese MRIs and so on and I'm
getting tapped, you know, and soon.
And all of a sudden the numbersstart coming up and up and they
sent me up to the RutgersCancer Institute here in New
Jersey, which is part of NCI.
At the time I was like 71 yearsold and they said, like we
(33:23):
don't have a lot of data onpeople your age.
And I said, well, that doesn'thelp me right now.
Thank you so very much, you know.
But I'm just taking a high road.
You know, I'm kind of aspiritual person and my church
was, you know, working with meas best that they could.
And by January, 90 days later,I had this, what they call the
MRD test, you know, to see ifthere's any detection of the
(33:44):
cancer cells at all 0.0.
Dr. Douglas L. Beck (33:47):
And it's like whoa you know I have to
break in here.
So, you had this amazingrecovery.
But I think what people don'tknow is, while this is going on,
you're calling me and you'reprobably calling eight or 10
other people and your mainconcern was not leukemia, your
main concern was a triple Apresentation we're putting
together and you're goingthrough all these details and I
(34:09):
keep saying, bob, bob, take careof your health, bob, we'll talk
when you're cured.
Dr. Bob DiSogra (34:14):
God bless you.
God bless you, Doug.
It meant a lot, but you know.
Dr. Douglas L. Beck (34:19):
But I mean, you know, and now I look at it
in retrospect and I realize youwere trying to just focus your
brain on something else.
I had to.
Dr. Bob DiSogra (34:25):
One of the more interesting experiences because
it was.
You know, we talked aboutmedications and drug side
effects and now I'm on thereceiving end.
You know so I'm.
You know I'm hearing thingsthat I used to talk about, but
it's me.
And one of the things that theydid as far as the management,
is that they decided to do someblood transfusions and over the
course of two months I had sevenblood transfusions.
(34:47):
Funny story it was Halloweenwhen I was getting one of my
transfusions and my niece sentme some fangs, so we took a
picture of me all hooked up withthe blood and fangs.
Oh, perfect, the nurses losttheir minds.
It was good.
But what happened is that I hadseven blood transfusions and you
know we talk about donatingblood, giving blood.
(35:07):
You know, give a pint, save alife.
Well, as I told you earlier, Ihad seven strangers come into my
life.
These are people I never met.
They had the same blood type asme.
They donated blood.
I got seven pints of this bloodand in part, that was part of
the success of the recovery thatI had.
So when I do my lectures, Iusually end the lectures by
(35:29):
saying if you can think aboutdonating a pint of blood.
It only takes an hour to donate, but it takes three hours to
get it.
You know and again it's.
I don't know who these peopleare these were seven angels that
came into my life and you knowwhen I just thank God every day
that you know that they did thatand I just encourage everybody
that I that, when theconversation comes up, if you're
(35:50):
healthy enough and well enoughto do it, donate a pint of blood
, donate to Plaza, become adonor and your local Red Cross
chapter is going to help you outand in part, it saved my life.
So I put that out there.
Dr. Douglas L. Beck (36:01):
Well, more than in part, it saved your life
.
I mean, you had the impact andyou had the good fortune to be
at the right place at the righttime.
You had the right doctors, theright medical center and you
know.
You've come out on the otherside and you're still even more
of a glorious human being.
It is an honor to know you.
I am so proud of you.
I always enjoyed when you and Iwould lecture at the same
(36:22):
facilities and that happened atleast, I want to say, 20 or 30
times, right.
Dr. Bob DiSogra (36:26):
And we were in Georgia.
I brought my whole class intoyour class, if you remember.
I can't thank you enough forthis opportunity, and I hope
that the audience walks awaywith at least one thing that
they can use professionally.
Then we've done our job Okay.
Doug, thank you so very much.
You're a kind man and I loveyou too.
Thank you very much.
Thank you so much.
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