Triamcinolone

We know that these wounds tend to be rapidly progressing because that inflammation is very, very active.

We know that patients can have quite a lot of pain because of the activity of the inflammatory infiltrate, and we also know that the fact that these wounds are broad open and are on parts of the body that are vulnerable to secondary infection, we have to also watch these patients closely on a clinical basis to make sure that their trajectory of recovery and healing matches the therapeutics they're being given, just like you did with the patient that wasn't responding to the intralesional Kenalog.

And I think that that therapeutic ladder is something that some people are afraid to climb up a rung when they need to, and sometimes do maybe leave the patient on more conservative measures longer than is beneficial for them.

As we're coming to this era where we may have a targeted therapeutic for this disease state, I kind of find myself reflecting back over my experience and patients I've treated in the past, and some of which have had such severe pyoderma gangrenosum that it eventually was part of the process that ended their life.

And Dr. Jackson says to me, "I'm pretty sure you have strep throat.

I gave you a shot of penicillin, and I gave you a shot of Kenalog, which would reduce the inflammation in your vocal cords." But I just wanna set the scene for everybody.

I'm flying on the president's plane, arguably the most powerful person in the world, with my ass hanging out- [laughs] ... because Donald Trump is a germaphobe.

[laughs] And so anyway, uh, I then got the clearance to go back into the meeting with the president.

And Dr. Jackson says to me, I'm pretty sure you have strep throat.

I gave you a shot of penicillin, and I gave you a shot of Kenalog, which would reduce the inflammation in your vocal cords, but I just wanna set the scene for everybody.

I'm flying on the president's plane, arguably the most powerful person in the world, with my ass hanging out, because Donald Trump is a germaphobe.

And so anyway, I then got the clearance to go back into the meeting with the president.

You talk to your medical provider with it.

But for me, when we go through the risks and benefits, it's such a low percentage of Kenalog.

Extremely low.

So, I mean, for me, I think the risk of doing anything is so low that it's okay.

Do you-- if, if a guy is coming to a urologist and say, "Hey, I heard this podcast.

I want a spermatic cord denervation," what do you do ahead of time? Are there pre-op tests? Are you-- do you do spermatic cord blocks, Kenalog injections? Walk me through how a guy gets to your operating room.

Yeah.

So I'm still gonna do a really thorough history physical, and I'm gonna, you know, get the ultrasound and then, uh, rule out all the other things.

In my practice, I really only take people who have a good core block.

So the first core block, personally, I use lidocaine and Marcaine, so a short-acting, long-acting.

I don't even put in Kenalog-

Oh, okay

We recently led a three hundred and fifty million dollar round for Advancel in their radiopharm space.

So, um, I actually covered triple A when I was at, uh, Kenacort.

It was one of the first, uh, RLT companies.

Um, and that, that was a decade ago.

That's a powerful one.

Triamcinolone, of course, is a workhorse and Triamcinolone is fantastic because it comes in an ointment base and it comes in a 454 gram jar.

So one pound.

It's great.

I think that familiarity can sometimes make us a bit too comfortable with them.

It's just easy to send off another refill of a one-pound jar of Triamcinolone sometimes.

Do you feel it's a similar phenomenon in your space, like interventional pain medicine, where It's just such an easy, quick fix that people reach for it so easily without considering potentially the bigger and maybe compounded consequences.

I do.

Yes.

Where the red bump was in the eyelid, I injected Kenalog into it.

Okay.

Now this is like dermatology adjacent.