Dawn Ipsen, PharmD - 4th Dec 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.
Linda Elsegood: Today I'd like to welcome my guest pharmacist, Dr Dawn Ipsen, who is not only the owner of one compounding pharmacy but two confounding pharmacies in Washington State. Thank you for joining me today, Dawn.
Dawn Ipsen: [00:01:35] Well, thank you Linda so much for having me. It's an absolute pleasure.
Linda Elsegood: [00:01:39] Great. So tell us, we're all interested. What made you decide you wanted to be a pharmacist?
Dawn Ipsen: [00:01:47] Oh, yes. So I knew at a, pretty early on that I wanted to be in healthcare on some aspect and pharmacy was very intriguing to me and started on that path and lucky for me, I got an opportunity to be a compounding pharmacy intern while I was in pharmacy school in a compounding pharmacy and immediately fell in love.
And so that was my path. I loved how personalized it was, how unique it was, how I was doing things that none of my classmates and colleagues was doing and so that started my journey. This was in the Seattle area. I went to the University of Washington School of pharmacy, and it was almost 20 years ago now and got my doctor and pharmacy degree there, and I've enjoyed it thoroughly.
Linda Elsegood: [00:02:43] So how did you get from pharmacy school to owning to compounding pharmacies?
Dawn Ipsen: [00:02:50] So I've always been an entrepreneur and really loved business sides of things and kind of had this long term goal that someday I was going to own a pharmacy and it definitely happened earlier in my career than I expected.
I had been working for the Kusler's family at Kusler's compounding pharmacy and had always told them: "When you're ready to do something else, keep me in mind." And got that call. Became owner of Kusler's compounding pharmacy. And Linda, that was almost six years ago now and was just minding my own business, running my pharmacy, helping my community, doing great work.
And a couple of years into that, I received a call from another owner, the owner of Clark's compounding pharmacy in Bellevue, and he was looking for a buyer. He wanted to retire and he'd done his research and determined that he thought I would be a good fit, that I did the kind of pharmacy work that he liked to do, and I help people the way that he felt was the best way.
And so I've owned now Clark's compounding pharmacy in Bellevue, Washington for three years and even the pharmacies are only 25 miles apart. They kind of do similar, but yet different things or both, compounding, online pharmacies, Sterile. Kusler's does contract with some insurance plans, so we do help patients with that.
And Clark's is licensed in nine states, so we work with patients and not only Washington state, but Oregon, Idaho, Arizona and Nevada. And we have Colorado and a couple of other States as well. So that's been really wonderful, great, fun and challenging. And it's just really neat that I get to use my really strong chemistry and biology background and help people really solve medication problems, for people and pets.
We helped the whole family. So that's intriguing and fun.
Linda Elsegood: [00:04:59] Wow. We never know. It is been three years. You might get another phone call from another pharmacy.
Dawn Ipsen: [00:05:07] You never know. However, my staff might call crazy people if I do that, but no, I enjoy it, and I love the challenge and I think that it's something that, we're really successful at. We pride ourselves in the quality and in our teamwork and how we take care of patients and that we treat our patients like their family, and how we would want our family to be treated and very personalized with that care.
Linda Elsegood: [00:05:36] So with all your compounding, what forms do you compound LDN into?
Dawn Ipsen: [00:05:44] So Low Dose Naltrexone is expanding. Actually had been working with Odell style Trek zone for roughly 10 years now, and kind of decided to become a state expert Low Dose Naltrexone about five years ago. And back then it was very primarily capsules only, and that's what we saw and actually five, 10 years ago it was even the doses were very structured at certain doses, not a lot of variability to it. And we've learned so much, right? Over the research and over the years. Now we're doing a much wider array of doses. Everything from ultra-low or micro-dosing for maybe patients who
are on pain therapies already and need some extra help with their immune system to even much higher doses, more frequent doses for mood situations or post-traumatic stress or depression. And along with that, we're also helping patients who maybe there's an autism spectrum situation going on and they don't want to or aren't willing to take capsules in which we're able to make flavoured liquids and we're able to do now LDN in a transdermal.
And a transdermal is very different than just a topical. This is a cream-based that's very special and it's designed to drive the drug into the body, but it's a great way to go when you have a patient who won't participate or can't participate in taking an oral medicine. And on top of it, we've started doing a lot of topical LDN treatment for skin conditions specifically for psoriasis, eczema, things of that nature. So those are primarily the most dosage forms we see. So different ways to do oral, different way to do a transdermal, and then we have the topicals as well.
Linda Elsegood: [00:08:03] If I could just ask you, the topical cream or lotion, what do you call it?
Dawn Ispen: [00:08:11] It's usually a topical cream for the skin dermatology conditions.
Linda Elsegood: [00:08:17] So if you've got eczema or allergies or psoriasis and the other skin conditions like backtracked syndrome, Haley Haley's disease, applying that directly to the skin, what do you see? Does it take away the itchy, flaky redness? What do you see when people use it?
Dawn Ispen: [00:08:45] Definitely, so what we were noticing is, in psoriasis patients that were just on oral low dose naltrexone that they would typically get to effect at some point. But it took a very, very long time. And it was, as you can imagine, hard for patients to be patient, so to speak, and wait for that. Because I mean, we all know how miserable it is to have skin that's irritated. It's red, it itches, it burns, it stings, all those things. It's very difficult to have any sort of quality of life. So we started doing both. We would help doctors with the normal oral therapies that we would be used to seeing, but then we would start making a customized cream for them, naltrexone being one of the ingredients. And we would put it in a cream base that actually had nutraceutical components to it that would help calm the skin already on its own with no drug in it. So yes, they often risked with the naltrexone and that cream base would find relief of redness and inflammation, and we'd start seeing the healing of autoimmune skin disorders much faster than if they were doing the oral alone.
On top of that, we could work more closely meeting their direct needs. So if it was causing pain, we could add an ingredient to help with that. If it was a histamine reaction, we could add another ingredient to help with that. And so it gave us a lot more flexibility to be very, very specific and customized with the treatment they needed on the skin that was bothering them.
Linda Elsegood: [00:10:31] So my question would be, Dawn. If, for example, 3 mg, the highest dose that you could tolerate orally and you're putting a topical lotion or cream on, does it matter how much naltrexone is in that cream? Does it get absorbed into the system? How does it work? Do you see what I'm saying? If three is all you can take and you've got three in the cream, does it matter?
Dawn Ispen: [00:11:03] Well, it depends. So if we are doing the topical cream base, there's a slim chance you could have some added absorption, but then we may want to go back and talk about what does it mean they couldn't tolerate more than three? Was it directly affecting their stomach and they were having nausea or cramps or something like that?
Or was it affecting sleep or why was it three their oral stealing number, right? So when we go topical or even transdermal, a lot of times we can go higher than one would have thought than they could do orally and still avoid the side effects because they're avoiding that, what we call it in pharmacy, the first-pass effect. When a drug is swallowed it goes to the stomach and then it goes to the liver, and that's sometimes the portion of the system that's causing the side effect. And if we're avoiding that, we can get away with that. The other thing is that, given in these dermatology conditions, if we're doing Naltrexone and it is just topical, we're not getting the systemic absorption that we would be getting in oral or transdermal delivery.
So in that sense, the amount probably doesn't quite matter, but also the amount of drug that's in that cream, they could put quite a bit on and not be getting a significant dose directly into the bloodstream.
Linda Elsegood: [00:12:34] okay. And then would it be exactly the same as oral LDN and that if it kicks into the bloodstream, it would be the, and then go quite quickly.
Dawn Ispen: [00:12:44] Righ, so if it did go into the bloodstream or it was a transdermal delivery, what was driven in intentionally, you would expect to get the same effect as if they were on oral. You may avoid side effects of the stomach directly because again, you're not putting that drug directly in their stomach, and that can be helpful for some patients for sure.
Linda Elsegood: [00:13:09] okay. Now, patient feedback. What has been the outcomes of your patients taking LDN?
Dawn Ispen: [00:13:21] The feedback has been very, very positive. It definitely seems to be a drug that Is extremely safely tolerated with very few side effects, if any, and if there are side effects, they're typically dose-related and things that can be managed by proper titrations and proper dosing.
The benefit can be anywhere from subtle improvement to very profound improvement with a huge direct link to a much better quality of life. Even on my more subtle improved patients, they often find that their improvement was way more than they anticipated because they'll sometimes take a vacation or a holiday from LDN and realized symptoms are coming back.
They are not feeling as good, more fatigued, on and on. And then when they restart low dose naltrexone they can then more clearly see how much benefit it was providing to them.
Linda Elsegood: [00:14:23] And what conditions would you say patients are taking LDN for? Do you know that?
Dawn Ispen: [00:14:30] Yeah. I often do know that. Of course, we have our longterm patients that have been on it for five, even five-plus years at this point that had the Fibromyalgia, Multiple Sclerosis, Crohn's disease, of course. We're seeing even more though conditions that are just in general inflammation-based and in which we're trying to control the body's autoimmune system. So Hashimoto's and Graves', Lyme disease, Rheumatoid Arthritis. We have patients that are using it, as I mentioned, for psoriasis specifically. And then, more recently in the last couple of years, we're seeing patients who do have post-traumatic stress disorder or depression that is been not responding to normal therapies and even cancer conditions that have been very helped by low dose naltrexone.
Linda Elsegood: [00:15:30] So do any of your doctors around your area prescribe LDN for infertility issues?
Dawn Ispen: [00:15:41] We don't have too many in our area that is doing naltrexone for infertility. However. there ts definitely known, it's definitely talked about. There's pretty good literature on its use and it just might be that I'm not right next to where the infertility clinics are that are working with that.
Linda Elsegood: [00:16:09] What about mental health issues?
Dawn Ispen: [00:16:13] Yes, we definitely have doctors who are using this for mental health issues and are really trying great because they're trying to bring to light the whole topic of mental health and how important it is. And they become so much more open to other ways of thinking, other treatments, other modalities for these patients. So we're seeing things like the use of ketamine for depression. We're seeing the naltrexone being used for depression and PTSD. And I mean, I can honestly say that had patients who had been very concerned about their wellbeing and that once they work with these types of providers, down the road, their quality is just so much better and they're doing great with it.
Linda Elsegood: [00:17:02] And of course, so many mental health issues with antidepressants, etc can make people feel a bit sluggish, drowsy whether naltrexone actually makes you feel brighter and better, and it's not addictive either.
Dawn Ispen: [00:17:24] Right. You get that endorphin release, which is so important to our wellbeing and how we feel in our motivation and our willingness and desire to interact with others in our community and those are all such important things for being part of this world.
Linda Elsegood: [00:17:45] Do you have any patient case studies you could share with us?
Dawn Ispen: [00:17:49] I'm sure. A couple of my favourites is one, she's a younger patient. Actually, she's only in her 20s, and she comes into the pharmacy and she's been coming in a long time getting naltrexone. At this point, it's usually just a quick pickup: " Hey, how are you?" And out the door, we go. And I was at the counter with her and I literally had to stop and scratch my head and I couldn't. She looked just so great, so normal, so just young and vibrant. And I honestly couldn't remember why she even has started low dose naltrexone. And so I asked her. I was like, can you remind me why do you take the naltrexone?
What is it doing for you? And, and she's actually multiple sclerosis patients, which we actually have a lot of in Washington state because where we're located in our sunlight exposure and vitamin D levels and all that. And it has hot her completely in remission with her vitamin D and other things she's doing as well.
But she looks just so normal. Is the only way I can describe it. And how cool is that? They here we have a twenty-something who, who is able to be a vibrant member of the community and have a well-rounded life and do what she wants to do. So she's one of my favourites because thank goodness you're staying on it to help slow any progression of the disease process that might occur later on.
And then I do have one psoriasis patient that I've ever seen psoriasis-like this before. She actually had it even on the back of her calves, which is an unusual location. And started naltrexone. Did that for about a month, just the naltrexone orally itself. And then when we added in the cream.
And when she would come back for refills, I just couldn't get over it, how fast it was healing and we marked it. I actually took pictures of when she first picked up and then when she came in for refills and then now there's nothing left. So it's been really awesome to see somebody who had been dealing with this for most of her life, who now is doing great, well-controlled.
Her immune system is just functioning properly.
Linda Elsegood: [00:20:05] How long did that take before her skin looked normal again?
Dawn Ispen: [00:20:12] Yeah. So skin is always slow. I mean, that's with patience is a virtue. It's on any skin condition as you have to allow for the full all derm cycle, which usually is right about six weeks on average.
And so, you start in with treatment knew at the beginning or just trying to get the treatments on board and help with any symptom relief they might need. And then usually, like in this particular case, it was really about at the three-month mark that she was coming in happy that the condition was starting to reverse and go back to how the skin was supposed to be.
And then of course for full healing, it's another month or two after that. And then he'd go into maintenance mode at that point.
Linda Elsegood: [00:21:00] Well, that's amazing, isn't it? I mean, psoriasis, if you have it, and I know somebody with psoriasis, how embarrassing it is. People look at you when it's really bad. I'm not comfortable either, is it? So something that can heal and clear that up It's amazing.
Dawn Ispen: [00:21:26] Yeah, it's wonderful because it can be, like you said, not only visibly unappealing and they will often try to hide it if they can with clothing and coverage, but it hurts, it clot cracks, it bleeds, it burns, it itches.
It's just horribly uncomfortable and unrelenting, you know, it doesn't just stop. It continues.
Linda Elsegood: [00:21:50] Do you have many children as patients?
Dawn Ispen: [00:21:53] We do. We actually work with some doctors who are very in touch with the pediatric population and that's their speciality. And they use naltrexone usually in the kids that they have some sort of a spectrum disorder where they're noncommunicative and they aren't interacting as we hoped they would be able to.
They're a great population to work with and that's where we get to become very creative and work really closely with the family itself on determining how does this child want to receive its medication and is it as simple as custom dosing and maybe they want the capsule a certain colour because it might be more appealing visually to them. Fine, perfectly great with that. Or do they need a liquid and do they want it to be flavoured a certain way or do they need a lozenge? And then for the most difficult of patients, we can do the transdermal cream delivery that I even have a couple of families that they actually apply it to the child's back, back skin area at night when the child is sleeping. So they can receive their dose that way.
Linda Elsegood: [00:23:25] Wow. So what else do you know about LDN that you haven't shared with us?
Dawn Ispen: [00:23:35] With LDN there are lots of things can augment the therapy of LDN and getting the most out of it. And it's really looking at the patient at a whole and trying to discover what ways can we reduce inflammation load in that patient's body along with optimizing the dosage form and the regimen, the strength and the timing, it should be taken.
I do work a lot on talking with patients about the importance, especially in Washington, of vitamin D, the importance of good gut health and probiotics. We're working more with patients on using full-spectrum C-- to help with pain and anxiety as well, antioxidants and organic diet and how important all of these things are to get inflammation loads down, to get the best effect out of it.
Linda Elsegood: [00:24:32] Yes. Diet is a big one, isn't it? People do notice a big difference by changing their diet.
Dawn Ispen: [00:24:42] Diet is so huge, and you know, us living in a suburban area, gardening and farming is not simple, right? And our seasons make that challenging too, and just really encouraging our community to buy from the farmer's market get organic as much as you can, grow your food when you can yourself and just eat well, take care of your body, you're worth it. You know? It's like you are worth the extra effort in doing that.
Linda Elsegood: [00:25:14] And sugar is another big thing, isn't it? If you can't cut it out, at least cut it down.
Dawn Ispen: [00:25:21] Right, and look for good alternatives that are natural and if you do have to have that sweet because, you're right, it's in everything and it's hidden often it's hard to even know it's there.
Linda Elsegood: [00:25:36] It surprises me when you look at a tin food. Dugar is in pipe beans, it's in..Just trying to think of something else. It's gone. Slipped my mind. But...
Dawn Ispen: [00:25:52] Ketchup, salad dressings.
Linda Elsegood: [00:25:55] Exactly. Sugar, sugar, sugar, sugar. It's not easy, but it's, it's similar if you're buying foods and you read the labels, gluten is in so many things.
Dawn Ispen: [00:26:13] Absolutely.
Linda Elsegood: [00:26:14] I mean, when I first started to be gluten-free, it took me ages to do my shopping because I was looking at everything and trying very hard not to get anything with gluten in it.
But it becomes easier because you know which things you can have and which things you can't have. Once you've gone through reading everything, it does become easier and you do find alternative things. I use honey as a sweetener and I use coconut sugar but it's brown colour so I can still make cakes and waffles occasionally, but there isn't a different colour but if you close your eyes you don't know, you can't see that it's a different colour. You can be creative. It's very expensive to eat organic here, and I should think it's pretty similar in the US isn't it?
Dawn Ispen: [00:27:18] It is. It definitely can be challenging to be able to do that and hard for some families to make that happen. And I always like to refer to the dirty dozen as they call it, of if you really have to pick and choose which product is most important to purchasing, organic versus maybe you could save the finances on something else. That's at a nice way to integrate or ended up the pathway. Lucky for us in our area, at least, we do have a substantial number of farmer's markets that are all close by and available different days of the week but that can be an option for patients that are really trying to do those things, but maybe not able to get it from the grocery store all the time.
Linda Elsegood: [00:28:16] And the thing is, with organic food, it doesn't last as long as a non-organic without us being sprayed with things to keep it fresh longer.
Dawn Ispen: [00:28:28] And it sometimes doesn't look as pretty, does it either? There are more bruises and changes in how it grows and things like that.
But it's funny how our minds have that used to be the normal, right? That produce always looked like that. And then we've changed to think that that product should look perfect in every instance and that's not necessarily the case. It comes back to what you're saying with the sugar.
Linda Elsegood: [00:28:59] We have a supermarket here that sells half-price vegetables from the supplier, and they're all packaged and they're called wonky vegetables. So the carrots, parsnips, that probably got deformed but they're perfectly fine. There's nothing wrong with them. It's just as they call them wonky, they're not perfect and I think that's great.
Linda Elsegood: [00:29:34] We've come to the end of the show so we could have carried on talking for ages. We'll have you back again another time and until then, stay well and we will speak to you again soon.
Dawn Ispen: [00:29:48] Wonderful. Thank you. Have a great day.
Linda Elsegood: [00:29:50] Thank you. Bye-bye. This show is sponsored by Kusler's compounding pharmacy and Clark's compounding pharmacy. They are more than a drug store. They are highly trained, compounding pharmacy experts, combining the art and science of preparing personalized medications to meet your specific needs, improving lives by solving medication problems for people and pets, creating solutions to medication challenges.
Visit www.kuslerspharmacy.net
Any questions or comments you may have, please email us at Contact@ldnresearchtrust.org. I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time, stay safe and keep well.
