 This is Think Tech Hawaii, Community Matters here. Good afternoon. I'm Ethan Allen, host of Likeable Science here on Think Tech Hawaii. Welcome to another episode. Likeable science is all about how science is a vital and interesting part of everyone's life. And I have a great guest today to help me explore this, Dr. Dara O'Carroll. Welcome, Dara. Hi, thanks. Dara works as an emergency room physician and has a slew of interesting experiences there. I'm going to go through some of that and talk also about a very interesting article that Dara wrote recently on ketamine, which some viewers may know as a party drug, others may know it as a veterinary anesthetic. Yeah, a little bit of everything. And Dara wrote a really intriguing piece about that. But let's start with a little bit about how did you get into this whole emergency medicine phase? I guess I can talk about how I got into medicine first was I originally started my academic career as an engineer. And I quickly found out that getting into calculus, whatever it was, 13, 14, and not that high, but like, you know, three at least, I wasn't enjoying it. And so I transferred into a slide of something that was somewhat similar. It was biomedical engineering, so that would be engineering prosthetic hearts, prostheses. And it still required a lot of the mathematics that while I could do, I just didn't really feel like I was enjoying. And I'd always was into sports as a young guy. And after that second year in college, I shadowed my father's general practitioner and realized that, yeah, I think medicine is for me. I always liked biology. I always liked chemistry as well. And combining that to medicine really kind of hit the bill. And so there I was, second year in college, just slinging head on into the world of medicine. That's how it started. And I originally wanted to be an orthopedic surgeon that I found it was a little bit too narrow for me. Fixing bones and joints is while a great service, I kind of felt like I would forget everything else I learned about the body. So emergency physician is kind of akin to an old school physician, where you can take care of anything that could walk into the, or walk, crawl, fly, or be a heart attack stroke, you know, severe infection. I still do get the broken bones and get to fix the broken bones. It's kind of grabbing everything that's cool and really emergent about every, every aspect of medicine. Yeah, because there must be a lot of, a lot of different fields contribute to the advancement of emergency room medicine, right? Yes, yes. So I kind of have to speak the lingo of every kind of specialist. Like I need to know how to talk to an eye doctor when something comes in about an eye, a fish hook in the eye. Like what part of the eye is actually hurt. I need to be able to talk to a cardiologist about, all right, this is, I think this guy actually has a heart attack in this artery, or not a severe heart attack, different types of heart attacks. I need to be able to talk to a neurologist about where I think the stroke is, or what's going on. So get to borrow a little bit of everything. So that's what I kind of like about it. And you're useful no matter where you go. And at the same time, you get a very funny, I guess, funny, very intensive, but limited interactions with your patients, right? Yes, yeah. I mean, sometimes you get none. You know, they come in unconscious and who you are interacting with is family. And sometimes you've got 30 seconds. Sometimes you've got five minutes. But what every good emergency physician does do is somehow make the patients feel comfortable. And when they're coming into the emergency room, by far and large, it's not the best day of their life. It's usually the worst. So I think each emergency physician has their own way of making somebody feel comfortable when they come in. Yeah. But you've got to establish that relationship so you're on the same team. Yeah. And on the same token, sometimes our relationships are so quick that we don't get the long-term kind of relationship that your general practitioner will develop with you. Or other specialists or a surgeon who follows you for a long time. It's good and bad, but sometimes I wish that I had a little bit more interaction, but it's okay. And it was interesting right before the show we were talking, you were telling me it's not that you show up at the same hospital every day and work some sort of regular hours. You have a very oddly rotating schedule. Yeah. You live around among a number of hospitals. Yeah, it kind of depends on which group you work for. And when I say group, how emergency rooms are usually staffed is there's a group of ER doctors that get together and we call them a group. And they approach your hospital and say, hey, we will staff your emergency room. You don't have to worry about hiring any other emergency physicians. And sometimes it's one hospital, sometimes it's two hospitals. The current group I work for contracts with almost nine hospitals, around nine. And so I like keeping myself on my toes and I like kind of the a little bit more rural medicine. So I travel to Moloka'i and Kauai and work there as well. And a couple of ERs around here in Oahu and I like that. Yeah, it gives you some sense that you'll see a different kinds of issues and cases, right? Yes. Yeah, what I see on Moloka'i is not the same as what I see here in Oahu, which is not the same as what I see on Kauai as well. Yeah, it keeps me whatever can walk in and fly in is going to happen. So how does this group, though, get together initially? I mean, how does your... Generally, kind of how I initially described it was group of guys get together and say, approach a hospital and say, we will staff your hospital. Well, it's fairly informal. It's not like an organ. Well, no, there's contracts involved and that sort of thing, but that's the gist. Yeah. And then sometimes that's how most ERs work. There are hospitals where the ER physicians are actually contracted through the hospital. And then there's some ERs that are just contracted by locums physicians where physicians will just come in for a couple months and then leave. Okay. Yeah. So you get to know these different ERs and the support staff are part of your teams? Are they part of the hospitals? Part of the hospital teams, yeah. So the... There's some continuity there then. Yeah, yeah. And they have their routines they got to go through. Right. Yeah, although at the amount of hospitals I work in, it's sometimes hard to remember the nurse's names, but I always say, forgive me. Excellent. Yeah. So this, I was so intrigued by this article that you had written. Yeah, it appeared in Tonic, is the name of the column, I guess? Sure, yeah. It's the health vertical of Vice Magazine. Vice is a digital online publication. Also, it started off as a written publication, but it's their health section of the article. Okay. I was wondering, Tonic, now it makes sense, right? Yeah, I'm not sure how they came up with that name, I don't know. But you wrote about this drug ketamine, which gave a great summary of its history and how it was developed and initially intended to be used and sort of the recognition these days of early impressive array of qualities as a pharmaceutical agent, right? Oh, yeah. In that it can... The only sort of anesthetic that we know of, it doesn't depress respiration, right? Sure, I wouldn't say the only, but it's the predominant one and the safest one and the easiest one to use. And it's the reason why it's so versatile is that what you alluded to is the most other general anesthetics where you're talking about propofol, which is the one Michael Jackson used and unfortunately succumbed to, he succumbed to because he stopped breathing. If you take too much of these general anesthetics, it affects your breathing centers of your brain and you stop breathing, which is the same way that say an opioid overdose passes away is that their brain centers are inactivated, whereas ketamine does not affect the brain center, breathing center of the brain. So when you use ketamine, many times you do not have... You have to monitor the airway, but very, very rarely do you ever have to make any... Put somebody on a breathing machine because of it. And that's when it was first used in humans in somewhere in the early 1960s, late 60s in the Vietnam War. So they use it for Medevac patients. And there might be somebody who's... Maybe their arm or leg was completely blown off or severe traumatic injury and giving them ketamine not only put them to sleep and they're able to be transported easier, also gives them a lot of pain relief. Yeah. I remember having... Using it when I was working as a research technician on tomato sensory neurophysiology on macaque monkeys that would use ketamine. Really? Yeah. I mean, that's how it originally started was it was a veterinary vet anesthetic and it was first synthesized in the 1920s. And it's a family. Everybody's kind of surprised to hear this. It's actually only a few atoms away from PCP. So it's the same family of medication as PCP. Obviously that PCP lasts... The reason why PCP doesn't really work as well is that it lasts so long. PCP will stay in your system for days. Whereas ketamine will last no longer than 30 minutes to an hour at most two hours. So that's if you get a whopping big dose of ketamine. So, yeah. So started as a veterinary anesthetic and then in the Vietnam War is when they really started to use it on humans. And since then Navy SEALs carry it in their pocket. They're carrying morphine as well. But what they're using mostly is ketamine. Yeah, I found that really interesting. And you've... This stuff is what all we say for kids. You talk in this article about using it on squirming kids who are upset. Yeah, yeah. I would say that I use it predominantly in kids. It's actually a little bit better in kids because kids have smaller muscles. The one sort of side effect you can get with ketamine is you get a little bit of locking of the muscles. I wouldn't call it like complete locking, but the muscles get a little bit stiff. And so how I use it in kids is a kid has a big laceration on their forehead or their face or something in their ear. They don't have the mental capacity to be able to... We're trying to help you. If you stay still, we can help you better. And also they're terrified. They're in a new place. They're the bright lights everywhere. They don't know who I am. Don't know who the nurses are. So giving them a low dose of ketamine putting them to sleep completely safe because their airway is safe. Sometimes there's a low rate of complications and it mostly happens with kids. It's where your vocal cord spasm called laryngeal spasm on the order of 0.04 percent but something to be aware of. But usually give it to the kids that puts them in a nice kind of gentle relaxed state. They're asleep and whatever is kind of the big laceration on their head we're able to take care of that, stitch it up really well, take the foreign body, whatever it is, a pebble or rock or seashell that they put in their ear and throw up their nose or anywhere. And get it out. Yeah. Excellent. Excellent. And so why is there sort of controversy? Why it sounds like this is like everyone should be like, hey, this is great. This is good stuff. Yeah. I mean, before I was in the world of medicine I knew it as a horse tranquilizer. And if anybody ever mentioned ketamine or as it's known mostly on the street drug, Special K, they're like, oh my gosh, that's such a hard drug. But being more familiar with it now and using it all the time, as I've alluded to, a very safe medication. It's also abused quite highly in the rave scene and most predominantly in Southern China and Southeast Asia, because that's where most of the world's ketamine is produced. So instead of using a lot of the club drugs like ecstasy and cocaine, they're using a lot of ketamine over there. Oh, I see. I see. Yeah. This is why China wants to move it up to a schedule one or something. Yeah, they've been harking at it for years. I don't think they'll ever get it because it's listed on the World Health Organization as one of the top. The World WHO comes out with a list of about 130 to 180 medications that they say are priority medications and that every medical system should have it. And ketamine is on that list. And especially in third world countries or resource poor areas, ketamine provides so much use of not only pain relief, but allowing sometimes they don't have access to these general anesthetics and gases that are surgeons and that's what's used in the United States and in the first world. Ketamine doesn't need to be refrigerated. It doesn't need to be, as long as it's in a vial, it can be out in the sun for a little while, but it's very easy to be transported. And so in these third world countries, it's used quite a bit. And I don't ever think China will actually get get it. But I don't know if they've given it up yet, but I know the last couple of years they've been trying. Yeah, again, I was interested in that article. You said it sometimes it's dispensed in pill form too. I never. Yeah, yeah, you can actually get it in pill form and the predominant way they use the pill form is it's also been used in depression. And so they've been shown, it's shown that ketamine, and this is in the drip form. They can do a slow, titrated drip in 30 minutes. The actively severe suicidal ideation patients who are actively having suicidal thoughts who have not been responsive to traditional medications who have not been responsive to the electroconvulsive therapy. And that's where they put the two electrodes here. Using ketamine gets rid of the suicidal ideations in 30 to 45 minutes. Yeah, that's amazing. Yeah, we're going to dig more deeply into this, but we have to take a little break right now. Daryl Carroll, emergency room position is with me here on likable science. I'm your host Ethan Allen, and we'll be back in one minute. Aloha, I'm Winston Welch, and every other Monday at 3 p.m., you can join me at Out and About, a show where we explore a variety of topics, organizations, events, and the people who fuel them in our city, state, country, and world. So please join us every other Monday at 3 and we'll see you then. Aloha. Good afternoon. My name is Howard Wig. I am the proud host of Code Green, a program on Think Tech Hawaii. We show at 3 o'clock in the afternoon every other Monday. My guests are specialists, both from here and the mainland, on energy efficiency, which means you do more for less electricity and you're generally safer and more comfortable while you're keeping dollars in your pocket. Welcome back to likable science. I'm your host Ethan Allen here on Think Tech Hawaii. I'm talking to Dr. Adara O'Carroll here, emergency room physician extraordinaire, and we've been discussing sort of the practice of emergency room medicine and we're just before the break talking about ketamine and the fact that it's quite safe has a lot of good uses. You were saying it seems to treat depression now too. So it's a growing array of appreciation for the power of this chemical. Not only depression, but also chronic pain because how ketamine works in the brain and in the central nervous system is that it blocks a receptor called the MDA, those four letters MDA receptor. And those receptors are not only in your brain, but also in your nerves and your arms, legs, all over throughout your body. So people with chronic pain, fibromyalgia, phantom limb as well, they've been experiments have been showing good results with ketamine because they are blocking those pain receptors throughout the body. All right, that's fine. So delivered how in that case? That is usually by pill. Yeah, by pill. You can also, they also do a drip as well with that, but usually by pill. Also if somebody comes in with severe asthma and what asthma is, is really a disease of the airways just constricting. The small airways of the lungs are lined by these smooth muscles and when somebody has an asthma attack, something is triggering those muscles to clamp down. And so ketamine, if somebody is severely bad enough where the breathing machine isn't working, the albuterol, the breathing treatments, I'll jump to one magnesium, magnesium, but two, ketamine is the next thing that I'll actually give and it does help dilate the airways. So don't go asking for, you know, ketamine to replace your inhalers, but only a severe life-threatening asthma. You had written another article about the oxygenation machine who said this was a machine that had been around for since like the 50s. Oh yeah, the ECMO machine. ECMO, ECMO, extracorporeal membrane oxygenation. And what that pretty much means is oxygenating blood without the use of the lungs. Okay. And so ECMO is having a resurgence. It's been used in operating rooms quite frequently because, you know, putting people on the pump or on bypass, that's what an ECMO machine is traditionally, bypass machine. But recently, since probably the mid- late 90s, early 2000s, there's a couple of different hospitals that are pioneering this, one in San Diego sharp hospital and one in, I believe it's in Atlanta, where they are bringing ECMO machines down into the emergency room, a venue that they've never had before. And these machines, as you alluded to, are from the 50s. They've gotten smaller, definitely, but, you know, the technology is pretty much the same since the 50s. Everything's just shrunken. And if somebody comes in and their lungs aren't working, or their heart isn't working, put them on the pump. Like there was one instance of a young guy who had such a severe asthmatic attack, everything that they tried wasn't working. And this allergic attack actually was from, he ate a bunch of peanuts, unknowingly, that they put them on the pump because his lungs had just stiffened up so much, nothing was working. They put them on the pump, let the allergen kind of perfuse out of the system over a lot of over two to three days. And once his lungs were able to function again, they made sure that those were working. And the pump saved his life, ECMO, so to speak. Yeah, somebody comes in, like say a young girl comes in or male comes in with a heart disease. Sometimes you can get viruses that attack your heart and your heart will actually, you can be young and healthy, but your heart will actually be so stricken with this virus that it's unable to pump well and you'll pass away from it. That's another great indication for ECMO. Your heart or lungs aren't working, put them on a machine that can substitute for either one of those. Yeah, if you don't want to, you've got to keep the blood oxygenated. Yeah, if you don't. So we're pretty quick. Yeah, it was whoever, Zack Shiner and Joe Belezzo really are the pioneers of it in San Diego. And it's really a case of just human pioneering. Nothing really changed in technology. It's like, hey, we have this machine. Why aren't we using it over here? Yeah. Yeah. And again, that's sort of actually like what you were talking about before the show a little bit, right? This increasing use of these sensory deprivation tanks, right? Yes, yeah. An issue or sort of a woo-woo kind of thing. Yeah, they were a woo-woo kind of thing and they gained popularity in the 80s, I believe, and then they kind of waned and now they're coming up again. But so what a sensory deprivation tank is, if nobody's familiar with it, is it's an enclosure, whether it could be metal, it could be fiberglass, it could be just canvas, basically something that's very, very dark. It's usually four foot by eight foot filled with 10 inches of water. And that water has got about a thousand pounds of epsom salt in it. So it's like the Dead Sea when you sit in there, no matter what type of body type you are, you're going to float. Teed it to your skin temperature, which is not 98.5 degrees. That's your core temperature. It's 93.5. So you're not feeling anything and you're not hearing anything because it got ear plugs then. So we'll forget taste, because that's not your taste. You're not tasting anything either. So sensory input is completely taken away. Yeah, absolutely. So uniform or unchanging that your body very rapidly zeroes it out. Exactly, yeah. And so what does your mind do? Specifically, there's a couple areas like your reticular activating system, which is kind of deciphering what's your environment and what's important in your environment. What does it do when it has nothing? You're used to having things going on. What does it do when you don't? Right, this is an unusual, indeed almost unheard of state for us in this day and age, particularly when we've got all this sensory stimulation happening, these distractions, you've got people around, you've got your phone, you've got your laptop. You've got all this stuff going on so much of the time. And yet, as you were pointing out, that's not a sort of natural level of stimulation in some way. No, no, physiologically, our brains are the same as when we were walking around the African savanna when we only had one object in our mind, what we're hunting, what we're gathering, or what we're running away from, maybe two objects. And now that we have all these things, all this stimuli coming at us, all the time, I think it's really, really important to find ways to detach from that, put your phone away. I'm not saying everybody has to do a sensory deprivation tank, but I think the way our society is going in a constant input, being able to kind of take a break and devoid yourself of any sensory input makes you appreciate what sensory input is important. So that's why I like it personally, but also they're showing there's great research going on with the treatment of anxiety, all sorts of anxiety, OCD, general anxiety disorder, bipolar disorder, excuse me, not bipolar, all the whole spectrum and showing good results and PTSD especially, and also depression as well, showing some good results, almost as good as taking the standard depression medications. And you were saying something about some athletic teams are now using these with their players? Yeah, yeah, so Steph Curry has been a huge proponent. He even has some commercials where he's doing it and been featured on ESPN doing it as well. And so he says mostly kind of what I'm alluding to personally, like it helps them calm down and helps them relax, but there's some great physiological and exercise research coming out of the University of Cincinnati and University of Ohio and they're teaming up with this US Special Forces. So these guys are, you know, the United States is putting money into this research to make our Special Forces as good as they can be. And you know that, you know, we always need them to be on the top of their game. And so they are using sensory deprivation tanks as recovery tools, because these guys are pretty much elite athletes, you know, they're putting 80 pounds in their backpack climbing, you know, eight miles. And they got to do that in two to three hours. So that's a really strenuous activity. And so they're putting people in these sensory deprivation tanks and I won't give out all of the research isn't completely out, but basically the athletic trainer who's behind this is saying, and he's been an athletic trainer for 35 years, that the results that they're seeing makes him want to take out and rip out all of the cold tubs in his facility and replace them, the cold tubs being those big ice baths that they sit in, rip those out and put in, replace them with sensory deprivation tanks. So if he thinks, based on his preliminary research, that he wants to do that, that the guy's been working for 35 years with all these elite college athletes, there's got to be something to it. Yeah, yeah. Well, it makes sense. Again, it's a, you know, it's sort of, it's what you were alluding to earlier, sort of taking a technology from one area and putting it into other uses or somebody saying, huh, maybe this could be a good thing to... Yeah, it's recycling different, I want to say, taking other people's or stealing other people's ideas, but it's just finding new uses for everything that we have. Yeah, which is, I mean, that's human ingenuity, right? That's what your bioengineering program was going to teach right now. Yeah, it's science. That's intriguing, because I had used a century deprivation tank many years ago for chronic neck pain, and it was one thing the findings sort of broke me out of that cycle. Yeah. Even the epsom salts in there, the magnesium that's in there has shown to improve skin, turgor, skin tone, and muscle relaxation as well. Really? Yeah. More and more good. I might have to revisit these things. I think so, yeah. Put a shot. And so, what is the, so it sounds like this is very, I don't want to say throw in, but a very fulfilling career for you. Can you give out maybe a quick highlight story? Highlight story. Yeah, it has been a very fulfilling career. Being able to help people at their most dire times of need is very rewarding, and it can affect a physician in ways that you can't really imagine until you're kind of there and doing it. And it does make you appreciate the day-to-day and the beauty of everything day-to-day, and that I don't want to get morbid in any way, but things happen every day. So appreciate everything that you have and that you have your health or your family and everybody, especially in this, you know, coming up against the holidays. No, you was in emergency room. Must bring to mind how fragile we really are, right? Yes. How easy it is for things to go vastly wrong. Yeah, yeah. Especially when there's drinking involved. So before we go up, I want to ask an off-the-wall question though. Sure, off the wall, okay. Here it is. Not a lot of thought in this. If you could have the superpower of either being able to fly or be invisible, which would you choose and why? Fly. Why? I've had so many dreams about being able to fly. You have flying dreams. Yeah, yeah. Oh, that's true. Yeah, I've never, I never have had these dreams. I don't know what it means, but there's some dreamer, psychologist out there who can probably tell us, but yeah, flying for sure. Excellent, super. Well, Dara, it's been great having you on the show. I've learned a lot. I always do all my shows and you've been a wonderful guest and it sounds great. What you're doing, you're doing important work and most happy to have you here. All right, thank you. All right, having me. And thank you for watching likable science again here and we will see you next week. I'm your host, Ethan Allen, signing off.