With education in mind, alum Ryan Feldman creates a podcast to share curious patient cases and toxicology history
By Emma Gran
Ryan Feldman (PharmD ’14) is accustomed to getting paged in the middle of the night, whether it’s to manage frantic parents of a child who ingested an unidentified wild berry or to peel back layers of complicated symptoms that just may be linked to a drug.
Feldman, one of just 120 board-certified clinical toxicologists in the United States, is a consultant clinical toxicologist at Wisconsin’s one and only poison center, where he helps navigate possible toxin or poison exposures in children and adults across all regions of the state.
And now, Feldman, an alum of the University of Wisconsin–Madison School of Pharmacy, is turning his unusual daily experiences and rich knowledge into episodes of a podcast: The Poison Lab.
Since he launched the podcast in May 2020, Feldman and his robot co-host, Dr. Toxo, have been sharing the history, toxicity, and medical management of poisons in monthly hour-long episodes.
“I have some pretty wild stories of things that happen in the emergency department. The only place where you get even more wild stories is a poison center.”
—Ryan Feldman
“Producing The Poison Lab allows me to explore my own interests in toxicology beyond the constraints of my work and professional workplaces,” Feldman says. “At the same time, public health is a huge motivator. I want to educate medical providers who aren’t familiar with many of these poisons and how to manage them.”
Launching the podcast
Amid the highest levels of restrictions imposed in response to the COVID-19 pandemic, Feldman decided to utilize his increased free time to start The Poison Lab.
“I had always wanted to explore podcasting because I think it’s really interesting and a great way to spread a valuable message,” he says. “I had the time, so I just decided to do it.”
With no prior training or experience in producing audio stories, Feldman says it was a steep learning curve understanding how to record, edit, and publish podcasts all from his home while also trying to build an audience of listeners.
Now 11 episodes in, Feldman feels like he’s hitting his stride. The themes of each episode of The Poison Lab, available on Spotify and Apple Podcasts, are inspired by Feldman’s real interactions with chemicals and poisons in his many professional and teaching roles at Froedtert Hospital in Milwaukee, where he is primarily an emergency medicine clinical pharmacist and toxicologist. Along with his full-time clinical role, Feldman serves as a preceptor for both toxicology and emergency medicine rotations for pharmacy students.
As a consultant clinical toxicologist at the Wisconsin Poison Center, he is on call for 24 hours roughly five times each month. He carries a pager and assists the center in responding to situations that lack a clear answer or speaks with medical staff from across the state who request a toxicologist consultation.
“I have some pretty wild stories of things that happen in the emergency department,” Feldman says. “The only place where you get even more wild stories is a poison center.”
The Poison Lab episodes are split into two categories: deep-dives into a particular poison or “toxicologists vs. the internet,” where Feldman and a guest delve into random questions posted online about drugs. Dr. Toxo, Feldman’s robot co-host, or a guest speaker from the world of toxicology help to spice up the discussion and provide an additional perspective in most episodes.
The episodes featuring one toxin or poison are based on real poisoning scenarios Feldman encountered in his past clinical experiences, such as a patient presenting with painful, bloody urination up to 40 times a day and hydronephrosis (enlarged kidneys). He and Dr. Toxo discuss the patients’ strange symptoms, unveil the toxin that caused them, and cover the appropriate course of treatment.
In the case of the patient urinating three dozen times a day, the problem was long-term use of recreational ketamine, which had essentially left the patient’s bladder so badly scarred that it couldn’t expand to hold more than a tablespoon. In another episode, Feldman breaks down treatment for a patient who was experiencing high levels of lead poisoning from a retained bullet.
“[The Poison Lab] has turned into a central communication point for people within the toxicology community.”
—Ryan Feldman
For “toxicologists vs. the internet,” Feldman and a guest toxicologist turn to Reddit, an online social discussion forum, to answer questions posted on a drug-related community. While he always stops short of offering medical advice, he sees the forum as opportunity to help people avoid poisoning their body while pushing the boundaries of knowledge and learning to think in new ways.
“We discuss the toxicological principles that would be relevant to the problem they’re asking and any risks,” he said. “Last episode, someone asked ‘Can I do cocaine and drink?’ So we discussed the risks associated with combining alcohol and cocaine from a toxicology perspective — things we might consider if we were consulted on a patient who has been using both.”
Growing expertise
Feldman said he discovered his passion for toxicology during his second year of residency, when he answered calls as a poison information provider at the Poison Center. He quickly learned that toxicology allowed him to use his skills from pharmacy school while delving deeper into his interest in human physiology and how toxins disrupt it.
“In the emergency department, I never get to talk about the Krebs cycle, for example, which is how your body makes energy. In the Poison Center, the Krebs cycle comes up because you have drugs that disrupt the Krebs cycle steps and redox potentials,” Feldman says. “It’s a really unique and rewarding career path that enriches my day-to day-life.”
Feldman became credentialed as a Board-Certified Clinical Toxicologist through the American Board of Applied Toxicology (ABAT) in 2018 and currently serves as the co-chair for the Acute and Intensive Care Section of the American Academy of Clinical Toxicology.
While Feldman intentionally geared The Poison Lab toward healthcare workers looking to gain deeper insights on the effects of poisons and how to properly treat them, he did not expect to get responses from medical workers from across the country and world.
Earlier this year, he was contacted by a group of South American physicians worried about the toxicity of a COVID-19 “natural cure” circulating in their community — chlorine dioxide, which can cause acute liver failure.
“They were worried the misinformation in their country was so rampant that other health care workers were starting to believe it and, reportedly, they couldn’t access studies on its toxicity due to internet search restrictions in their country,” Feldman says. “I helped explain how it could be toxic, found them research on its toxicity, and gave them research author contacts so they could access literature outside of their internet restrictions.”
Feldman has heard from many others too, spanning from toxicology textbook editors to people doing research on cancer and chemotherapeutics.
“It has turned into a central communication point for people within the toxicology community. I didn’t expect to get messages from people from every sector of toxicology, but it’s been really cool,” he says.
Feldman plans to continue producing The Poison Lab as long as he can continue juggling his three other jobs and responsibilities.
“I don’t see it stopping anytime soon. I think it’s useful for toxicology trainees and it provides me with a fun avenue to explore some concepts,” Feldman says. “So, it’s a win-win. I’m excited to keep going.”