Pharmacist Rosella Pirulli Menta, LDN Radio Show 19 June 2019 (LDN, low dose naltrexone) from LDN Research Trust on Vimeo.
Linda Elsegood: Today I'm joined by a pharmacist and naturopathic doctor, Rosella Pirulli, mentor. Thank you for joining us today. Rosella.
Rosella: Thank you for having me.
Linda Elsegood: Now you said that you got an extraordinary story to tell us: Your journey. Would you like to explain that to us?
Rosella: Well, I went to St John's University in Queens, and that's where I got my degree in pharmacy and when I started working at a pharmacy in the Bronx of New York I wasn't very happy with just filling prescriptions and checking them and I felt that was not for me. I felt that, if I was going to have a profession and be successful, I wanted to show my children a different way to have a great life and also to be a part of a profession that helps people feeling amazingly well.
So that was my goal and so I only worked in that type of scenery for a few years and then I decided to look into other avenues. I went into homoeopathy where I did get a certificate in homoeopathy and I also looked into supplemental products because I really enjoy the supplements and teaching people how to take the correct supplements, especially if they are on certain medications that require supplements because of the problems that supplements can cause as a side effect. And the first thing I did learn was when patients were taking stands that they need to coQ10 we had a lot of patients that would complain of muscle weakness, fatigue and so I said: " You know what? I need to help patients with drug issues and side effects." And that was the first step. And then patients would come into the store and I had a lot of patients that would complain about half flashes. And so I said, let me look into that avenue. And so, I started to dwell on how I could start a career in compounding and in that store I really couldn't do it as well but I did get my training to PTCA, and they are an FDA approved facility where I got most of my training from compounding and also in the avenue of bioidentical hormones. And then from there Rye Beach pharmacy took me on because they had a full compounding lab at the time and so they asked me if we did the store for a few years afterwards to be more in compliant, because we're now accredited by the board of PCAB and we also 700 compliance, soon to be 800 compliant by the end of the year.
But in the interim, I had to move to Florida where I worked part-time for Rye Beach pharmacy, and then I worked for a pharmacy in Florida so I had my license there as well. And I was commuting back and forth. I would come here and market to doctors because when I did graduate, I received my bachelor's in pharmacy, but I also, not knowingly, I minored in marketing, so I was I guess then I knew I was going to market, which is great because I enjoy networking.
That's like the passion for me to get doctors together, doctors and pharmacies together. It's my passion to help people get to know each other and there's always room for other avenues. So that's my enjoyment. And right now, I do have my own office where I see patients, I do phone consults as well and I also review blood work with patients. I'm really close to many of the doctors. So that's where I learned more about LDN because I went to PTCA conference and learned about LDN and how important it was for patients in different disease states.
Linda Elsegood: So, you are a supermom. You have five children.
Wow. How does it fit in with a career?
Rosella: Well, it's amazing because my kids understand that we're a team. That's it. We're a team. We work together and we all love each other so much. So my kids are so amazing with each other. They all help each other out.
So the oldest is 22. That's my daughter. My son's 20. My other daughter's 18. And I have a 15-year-old and ten years old. So we are constantly figuring things out and make it work and I think that makes them stronger and closer to the family
Linda Elsegood: Wow, wonderful! And when did you first really get involved with LDN?
Was it at that PCCA meeting? Had you heard about LDN before then?
Rosella: I heard about it before then because we had a specific doctor that was a Lyme specialist that was working with LDN. So I asked her why was she prescribing LDN and she said it was because she had a lot of patients that were immunocompromised and fatigued, and the LDN is really helpful because it increases immune response. So I said:" That's really interesting. I'd like to learn more about it." So I did some research on it, I spoke with other doctors that were writing for it, why they were writing for it and I had one particular patient that had Crohn's disease. I asked him if he would want to try it and he's been on it ever since. So this is, at least six years that he's been on LDN. He's doing really well and will not stop it. That's for sure. I also took an autoimmune class on LDN. Not only is it great for pain. I actually had another patient that came to see me. She had a severe car accident. She had a lot of neurological issues going on and was on many other pain medications. So I helped wean her off of those pain medications and put her on LDN. Her starting dose was at 1.5 mg. We went up to 4.5 mg and then I said to her: "Let's try 5 milligrams and see if that works for you." That's when she started getting a side effect. She felt very strange. She said in mind a little weird. We went back down to 4.5 mg and she's been on 4.5 mg since about two years now. She's very happy with it. Every once in a while she has to take a Lyrica or something else.
It depends on the stressful situation in our lives, but, I mean, she's off most of her other pain meds because LDN is really working well for her.
Then I have a few other patients that I'm looking into the fertility aspect of it because I do work with a lot of fertility doctors and a lot of them don't know about LDN.
So I did more research on it to see how effective it would be. So right now I'm working with an endocrinologist who's going to start his patients on LDN and see how they do. A lot of people are fascinated by it and they want to try it. They want to help patients this way and I'm happy about that too.
Linda Elsegood: Well, there was a paper released last week by Dr Scott Zashin. He's a rheumatologist in Texas for Sjogren's Syndrome. That was quite good. The more papers and research that people do, it's going to make prescribers more confident in prescribing LDN.
Rosella: I forgot to mention I do have an ALS patient that is using it. This is amazing because he wasn't able to move his fingers and he wasn't speaking. Now it took a little bit of time. He can move his fingers, he can speak a little bit. At one point he didn't have the LDN. His doctor didn't authorize it because I think he was away and he wasn't speaking. So his sister said they need it because this was the only thing that they noticed that he needed. So I called the doctor, and I said:" Just put like PRN refills because this man is doing well with it.
Linda Elsegood: Interesting. So what I was going to say was, how long has the pharmacy been compounding LDN?
Rosella: Let's see. They've been in business for over 50 years and compounding around maybe 15 years.
Linda Elsegood: And what forms do you compound LDN in?
Rosella: Capsules right now for the most part and some creams. I haven't done any sublingual yet, but I think it's worth a try for some patients.
Linda Elsegood: Sublingual is quite a useful tool when people have gut issues that obviously absorb differently and bypasses the stomach so that is hell in some patients, but maybe all your patients can tolerate the capsules quite well. What filler do you use?
Rosella: We use acidophilus. Most patients don't have any issues with that.
Linda Elsegood: Yes. Do you know roughly what patient population you normally treat or is it all autoimmune condition patients?
Rosella: It is hard to say because I'm not in the lab that much. There are a few days that I do work in the lab when they need me but basically working in my own office and I work with a lot of bioidentical patients. So my thought is to really work with thyroid issues and help patients with Hashimoto's.
From what I've read and what I've seen with other patients, LDN really helps to decrease the antibodies in Hashimoto's patients. So that'll also help them with their thyroid. That's going to be my push as well as other autoimmune diseases. And I was looking into other inflammatory diseases like endometriosis, PCOS because I feel that LDN may have a good positive result with those patients as well.
Linda Elsegood: It certainly does. I can speak from experience myself, and with endometriosis worked amazingly.
Rosella: Good to hear. Very good to hear.
Linda Elsegood: I would also like to mention when you treat thyroid patients with LDN, you have to be very careful of the levels of the dose if they're taking thyroid medication because normally they have to start reducing the dose as you increase the LDN.
That is something to look out for. This is why we always say to people who have thyroid conditions to keep in constant contact with the prescriber because you can hit some problems if you are taking too much of your thyroid medication.
Rosella: I agree with you on that. I do work with a lot of patients and I have one endocrinologist that we monitor thyroid and we compound different strengths of thyroid T3, T4 depending on their blood levels. So we do look at that TSH really carefully and free T3. We also look at FT4, but mainly I look at the TSH and FT3. That to me is very important. I could see a difference in patients if their level changes just a bit. They can start having hair loss or weight gain and fatigue.
That's why I do tell my patients it's so important that we monitor them, get blood levels done every few weeks to see where they are.
Linda Elsegood: The internet is an amazing tool. It helps people do their own research, but the warning is you can't take notice as gospel truth from just a person on the internet who's not a doctor, not a prescriber, but who is giving advice.
We always say the proper advice is to speak to a pharmacist or a prescriber. You people have had years of training and experience where it's all well and good listening to other people, but when you are talking about your health, you should be talking to a medical professional.
Rosella: Correct. I agree with you on that.
Linda Elsegood: Yes. I mean, it's quite scary. We had an email from a lady who had been given some kind of advice from a friend of a friend of a doctor and their advice was totally wrong. And also you should not buy LDN off the internet. It's illegal. Naltrexone is a prescription-only drug, and therefore you need a prescription to make sure all the safety standards are met.
You said that you were PCAB accredited. So just to explain to people what you have to go through to prove that your pharmacy and your compounding is spot on with the regulations.
Rosella: The regulations are intense and immense. It took us, at least about two years and we're still perfecting it to pass all of the inspection qualifications because if we're ever audited, yes. PCAB is a credentialing organization. It takes some time for us to make sure we follow every different legality as to having our compounding lab as perfect as possible. Every aspect of it is really important. We have SLPs, and we have meetings every week to make sure that we're following our SLPs. Keeping every temperature in the lab correct, the airflow. We have to make sure that they're wearing their masks, their hats, jackets and gloves and everything has to be precise and follow to the T. If we ever get inspected, they could definitely find us for anything that they feel that is necessary. We're trying our best to make sure we keep up with it. It's very intense. It really is. That's why we always offer our doctors to come to visit the lab or patients. We have them look through the window because they can't come into the lab and see how we are following protocol per se.
Linda Elsegood: And what are your thoughts on people purchasing LDN off the internet?
Rosella: I just found out that they're selling a prescription item on the internet, and I'm appalled. I don't know how they're doing it. I feel the same way as you. Being that we're a credential lab and we work really hard to keep up with all the laws and the regulations, I don't know where this lab is. It's making the LDN. I have no idea. I would not recommend it at all.
Linda Elsegood: Exactly. The MHRA, which is the medicines regulatory body here in the UK quoted something like 85% of drugs that are shipped into the UK without a prescription is counterfeit. Mostly they're just fillers, they are harmless but some of them are actually lethal.
They're very dangerous. Don't play Russian roulette with your life. Get LDN from a reputable compounding pharmacy.
Rosella: I agree with you. We require to keep it as clean, pure and stable and it's really important to deal with the pharmacy credentials because you never know what you're getting out there. We work hard and we respect it.
Linda Elsegood: And not only that. You have your LDN tested so you have to prove in a 4.5 capsule that there is 4.5 of Naltrexone.
Rosella: Yes, we do.
Linda Elsegood: So if there were no checks, it could be 1 mg, 6 mg, or it could just all be fillers.
Rosella: Exactly. You're right. We do send it out for testing. We send out batches every day of different types of compounds, and then we get our results back within the right range, and we're happy we dispense it. So it's important that we do that.
It can cost up to $200 or more depending on what you're testing.
Linda Elsegood: So pain. Are you using any ultra-low-dose naltrexone yet? It's quite relatively new still. I don't know if that's something that your doctors yet know about.
Rosella: No, I don't think so.
I really haven't heard of that either. So how low is the dose then because I'd like to speak to my doctors about that.
Linda Elsegood: Well it's micro-dosing. It's probably 0.01 kind of thing. But it's really interesting. People who are on high doses of pain medication and have been for years, it's awful how it's not just America, it's all around the world how people are becoming addicted to these pain medications. I know that the whole idea is to try and get patients off the pain medications, but the withdrawals can be quite horrendous. So by using this ultra-low-dose naltrexone in micro-dosing, you can use that alongside with opioids.
They don't have to be off the opioids, but such a small dose makes the opioids far more effective. So it makes them work better, and therefore the patient is able to reduce the amount that they're taking. If you look at it as a sliding scale, you slowly increase the ultra-low dose, and we're still talking microdosing here, and then they can gradually reduce their opioids until they're on the LDN.
Most pain specialists say that they can get their patients off the opioids completely. Some say that they just take it when they need to. They're not taking it constantly. So I think that is something that's really interesting and something new to many people but how wonderful to get these people off pain medications. I've spoken to many people who've been on Morphine, Fentanyl, patches, and cocktails of medication and they say that they're still in pain. It doesn't work. So if we can get LDN out there and use to help these people to come off all these pain medications.
how wonderful is that? Tell us what do high doses of painkillers long term do to the body?
Rosella: They can cause a whole host of things, bone loss, blood pressure issues. It depends. I'm looking at patients that not only the opioids but if they take a NSAID what it could cause in the long run. I just believe that most of these medications, some patients become suicidal too. Depression is another problem, weight gain. So many different things that opioids cause. I think that if we can help patients come off of them and give them more supplementation and also LDN in a combination that'd be great.
Even Curcumin, Boswellia. There are so many amazing products out there that patients don't know about. They're just scared to come off of their opioids because of the dependency.
Linda Elsegood: Definitely. So how do patients get hold of you for a consultation?
Rosella: On the website. There is the introduction of what I do. I have a video there as well and there's also an evaluation form they can download. So on the website, there is an appointment maker there called shore, so they can make an appointment with me and it makes it really convenient for them.
Most doctors that know what I do, tell the patients to call me or go on the website or email. I have my business cards and I have that for them and that's how they get in touch with me. They used to call here. I have an assistant, her name is Tiffany, and she helps me with setting up appointments, and she's also a technician that helps to fill our scripts.
So that works out really help me.
Linda Elsegood: And do you have a waiting list, or can you see patients quite quickly?
Rosella: It depends on the month because I do marketing two days a week. So that's why it's really convenient for them to make their own schedule. It could range from a week waiting, maybe two weeks at most, then I try to fit them in. So for instance, if they can't see me within the special time frame that I have, which is usually between like eight in the morning and six, I see them on the weekends if I can. I'll set up that schedule for patients. So I try to make it convenient, try to fit people in as quickly as possible.
Linda Elsegood: And where are you situated?
Rosella: Where am I situated? I'm in the Rye, New York. In Westchester County.
Linda Elsegood: Is it wheelchair friendly for patients too?
Rosella: Well, it is. We are a hybrid store, so downstairs is mainly where we have the retail establishment.
We have home health care and our vitamin line where we have a pharmacist that's full time working in that area. We also have the upstairs where my lab is, and where also is my office and other offices as well. If a patient needs to see me and can't walk up the stairs, there is another office downstairs that I could see them in. That works out for those patients.
Linda Elsegood: Wonderful! And could you just tell us your website?
Rosella: It's www.ryerx.com.
Linda Elsegood: Wonderful. Wow. We need to end of the show.
Rosella: Oh, great. I just wanted to clear something up. I'm not a physician. I'm a naturopath, so I cannot prescribe. I just wanted to clarify that if you don't mind.
Linda Elsegood: No, that's absolutely fine.
Just explain what a naturopath does.
Rosella: Well, I took some courses in it, and I basically learned more about supplementation. It's a little bit different. I wanted to become a naturopathic physician, but I didn't have the time. I was basically between the kids and working full time.
I didn't go into that avenue. But it's been mainly as like learning about supplementation, helping patients with that as well as a little bit of nutrition. So I would like to go into clinical nutrition as well, but we'll see if I can cross that path when I get a chance to, once all the kids are in college, I guess, I don't know.
I'll figure it out.
Linda Elsegood: Do you test for supplementation to find out what people are low in?
Rosella: We do some blood work for sure. New York is really tough when it comes to other types of testing, so we can only do blood tests and that's how we test and we just saliva testing for the hormones. We are limited to a lot of different types of testing unless a patient lives in Connecticut or New Jersey, then we can test them with the different kits that we have.
Linda Elsegood: What about vitamins? Can you test for vitamin levels or not in New York?
Rosella: It could be tested for sure because we work with a lot of doctors that do a lot of IV therapy and they test all sorts of vitamins.
It depends on the lab that does it. But here are many labs that do testing for vitamins.
Linda Elsegood: Do you find that people in New York are deficient in vitamin D? Do you get enough sunshine there?
Rosella: I would say that everyone is deficient in vitamin D, everyone in America must be, but definitely in New York.
And then, once we rectify that, they feel better. We get them to a certain level, and they could stay on the supplementation for a good long time. Usually, I don't recommend that they come off of it, but if they have levels to go higher than 50, with the doctors ok, we'll bring down the dose a little bit.
Linda Elsegood: How would a patient feel if the vitamin D levels were low?
Rosella: Some patients tell me that they feel achy, others tell me they feel tired or depressed.
Some patients don't have any symptoms at all, so it just depends on the person. I know when I had my levels low, I would feel a little down and when it was a rainy day, I wouldn't feel myself. But now that my levels are normal it doesn't bother me.
So it's really strange how I used to feel.
Linda Elsegood: That's really interesting, isn't it? So anybody out there who would like to come and see you go online, they can find out more about you, play the video and make an appointment, come and see you and the bonuses is they can actually have a look at your compounding lab looking through the window, of course.
But that's also interesting to some people. I'm sure.
Rosella: Yes, absolutely. They love it, especially because we have a clean room as well, and it's separate from the rest of the lab, and that's where we make all the injections of HTG and b12 and they find that very interesting.
Linda Elsegood: Well, thank you very for being our guest today. We learned a lot from you.
Rosella: Thank you very much for having me and have a great day.
Linda Elsegood: Thank you.
Rosella: Thank you. Bye-bye.
Linda Elsegood: Each pharmacy has been family owned since 1946 they are a PCAB accredited compounding pharmacy growing from a corner drugstore to a wellness centre that helps patients to achieve their optimal health covering Connecticut, Florida, Illinois, Massachusetts. New Jersey, New York, Pennsylvania, and Rhode Island.
Visit www.ryerx.com, and I hope for the opportunity to earn trust.
Any questions or comments you may have, please Contact Us. 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.
