Do you like RSS? Add Smash Notes to your daily!
This Won't Hurt A Bit on Smash Notes

9 - BOTULISM

This Won't Hurt A Bit podcast.

April 13

On this episode of This Won’t Hurt a Bit we talk about botulinum toxin. It seems to be everywhere: in your dirt, in your honey, in your celebrities. But how can you stay safe from this deadly poison? And if you get it, can you be saved? Also, Mel teaches us why babies are especially at risk, Jess teaches us why movie stars aren’t just like us, and Dave attempts to describe canning.

0:00
0:00
download episode
0:0

way gonna get this thing started. We're gonna do this. Yeah. Yeah, we're gonna do it. You know why we're gonna do it? Because this this this, this viscous halos and young boys and girls, it's that time of the month again. That's right. It's time for this. Won't hurt a bit. And I'm with just Mason.

0:18

Hello?

0:19

Dave Mason. That's me. My name's Mel Herbert. Jesse's a physician. I'm a physician. Time not not a physician.

0:25

And Dave, I want to start this out by telling you a little bit of a story.

0:28

Okay. Okay, wait. Has a story. What are we talking about?

0:31

Well, you're going

0:32

to get it from a story

0:33

we're gonna find out. Okay? All right. So this story takes place in the 19 sixties. It's San Francisco. Free love, right? And especially for an ophthalmologist named Dr Alan Scott. So, Dr Scott, he is studying something called strabismus. So strabismus. That's when your eyes don't line up totally normally. So some people would call that like, a lazy eye, like Oh, right.

1:4

Uh, what's the one that we're

1:6

like him. That's nystagmus. When you have that sort of, like, kind of wiggling, decide. That's Nice tag. This is stra business in stir businesses. A misalignment of the eyes or cross eyes. Okay. All right. So at that time, the only treatment that there was for this was surgery. But Dr Scott, he has an idea. He comes up with this idea that what if you could temporarily paralyze certain my muscles and by relaxing certain eye muscles, it would bring the eyes back into alignment? Sounds kind of

1:39

crazy, right? It would wear off, right? And then it'll go back.

1:42

Well, maybe it depends on what he chooses as a method to paralyze his muscles. And he comes up with the idea of taking a very, very potent toxin that comes from Clostridium botulinum. Botulism? Yeah, botulism. How would you feel if your doctor said, Hey, we're doing a study here? Basically, what I do is I take botulism and I injected

2:5

into your I I'd say tested

2:7

on that guy first, so it sounds like a crazy idea, but this is what we go with. And he's got this research fellow that he was working with Dr Jean Carruthers. She's also an ophthalmologist, and she is studying a problem called Blair. Feroz has um, which is this really painful and forceful blinking of the eyes? It's involuntary and its basic. If you see someone that, like blinks for too hard and for too long okay, and it looks it looks uncomfortable. And she thinks, Hey, maybe we could use this toxin that temporarily paralyzes muscles to help treat bluffer. Oh, spasm this involuntary, forceful blinking. And so she starts doing this on her patients. But

2:51
Is Botulinum toxin dangerous?

Extremely dangerous. A tiny amount of toxin is enough to kill you so in order to use it in medicine the amount has to be diluted to just the right dosage by a professional.



how do you figure out how much you're going to inject into somebody the stuffs like, How much does it take before it kills you? A tiny, tiny, tiny man. It's been estimated that one teaspoon of botulism can kill about a 1,000,000,000 people. So you've got a deluded Yeah, adopted a gated, and then you test it. Now wave your hand over the aroma of modular su song.

3:17

But everything's poison in high enough quantities. Right? Right. So this is just using the right dose. Okay. Okay. So she starts doing this treatment on her patients with Blair Feroz faz, Um, and one day, one of her female patients, she comes to this realization that she really likes this treatment because it takes away those pesky wrinkles around her eyes, and then the light bulb goes off. So, Dr Caruthers, she's married to a dermatologist, and together they make this connection that mmm wrinkles. Maybe we can harness the power of botulism toxin and use it for cosmetic purposes. Therefore, creating the first product of Bo talks in 1992. That's when the first paper came out about using Botox for wrinkles.

4:7
When did we start using Botox for skin wrinkle care?

Dr. Krauser and her husband decided to harness the power of botulism toxin for cosmetic purposes. 1992 is the time when the first paper come out on application of botulism for cosmetics.



It all comes around, Oh, comes back to cosmetics, baby space or cosmetics. That's the only two

4:15

things there is. So for this opposite of this won't hurt a bit. We are gonna talk about botulism, not just how it's used for cosmetic purposes, but what it does to your body and how it's created and why it's a problem and where people get it from.

4:34

So just there's something I don't know about cosmetic injections of books, shoeless, and we're gonna talk about a lot of other stuff.

4:39

But can

4:40

you Has anybody gotten sick from this like anybody overdose like we were saying before accidentally given the wrong dose and

4:46

killed somebody with this right? I mean, that would be the fear, right? Someone who's gonna go in for their first like injection like, Oh my God, maybe I'm gonna die and you're not. It's basically it's pretty darn safe, but there are some case reports pretty darn rare, but there are some case reports of some bad things happening, but this is usually because someone's doing something really sketchy that they shouldn't be doing. For example, there was a doctor, Uh, and he was practicing with a suspended license, and what he did is he ordered a whole bunch of botulinum toxin, and this toxin was meant for research purposes.

It was not meant to be injected into people's faces, and he did his own dilution. And he wasn't very good at math. He did it wrong, and he accidentally injected 2000 times the right dose.

5:33

That sounds like a lot into people's faces. Math is important.

5:37

Yeah, so, fortunately, no one died. Ah, but a few people did get hospitalized. I got quite sick, and ah, some people actually had to be intubated and on a ventilator. But other than, like, really weird cases like this, then it's fine. Yeah, like bad things can happen like, uh, a cemetery of the face. If you do one side a little more than the other side. You know, you constantly look inquisitive, but most part sometimes

6:3

you see on the news someone's having some sort of like Bo tox party and somebody's faces like gangrene and falling off. And it's like they went. They had this person come over and they gave injections and they had a fun time. And now their faces falling out. What? So what's that from? That's from again, the same thing. So that's usually from bogus practitioners who have picked it up on the black market or had their license suspended because a dermatologist or ophthalmologist somebody who's trained to you this somebody with medical degrees somebody's lessons by the state is not going to come over to your party an injector Bo talks that would be considered poor fucker. So this is that sort of on the fringes. That's not medicine. That's, Ah, bed. It's like a little cocaine party. Let's do a boat talks at the same time, so don't get your boat talks down at your friend's house.

So have the anyone done anything else with Bo talks like a botulism can. You are not Bo talks, but just the botulism bacteria has anyone figured out another use for it? Well, Bo talks is actually used. Botulism toxin is used for a lot of things. We talked about this, bless her spares, and we took a bit stir business. But there's a whole bunch of other disorders where muscles are working too much in this fundamentally works to reduce the muscles working. So things like cerebral palsy to reduce some of the spasms. People with hand tremors, even sometimes with chronic migraines. Maybe that triggered by a lot of tension in some muscles. Overactive bladder. I mean, there's actually a lot of medical uses with Bo. Talks has been used. The Wonder Drug.

7:34

You know what, though, it's it's only been around since the early nineties, and no one really knows what the long term effects are

7:41

or its full potential. Okay, so let's discuss then what botulism is actually doing to your body in order to create these neat effects that people are paying lots

7:55
What is Botox actually doing to your body?

People are paying lots of money for botulism, what does it do? Botox is a neurotoxin and it acts on neuromuscular junctions. Nerves usually send signals to your muscles, but Botox interferes in this communication and the muscle becomes essentially paralyzed. Botox actually permanently kills this neuro-muscular junction, but fortunately it regrows over time. That is why Botox wears of every six months.



of money for. Okay, You ready for some science thistles? The scythe. All right, so it's basically a neurotoxin, and it acts at something called the neuro muscular junction. So you got nerves, right? Nerves send signals to your muscles. Like, not that your legs of muscle, but it's made up of some muscles, like he made miss the nerve sends a signal your muscle contracts and you do the movement that your brain wanted you to. D'oh! So this communication happens where the nerve needs the muscle and extends this little chemical signal by a chemical called Aceto Colin. Right.

So that little signal goes from the dirt. It hits the muscle and the muscle contractions. Perfect. Okay, so now I want you to picture that this junction is blocked. It blocks that neuro transmitter blocks a seal Coley Nasedo calling can't even get released. It can't get released from the nerve. And therefore, it never makes it to the muscle to give the signal that it should contract on. That's exactly what botulinum toxin does. So the message is going down the nerve. But once it gets to the part where supposed to jump over from the nerve to the muscle, it doesn't work. Goalie. Yeah, and so,

basically, it's a seagull calling cannot leave the nerve. And so the muscle is essentially paralyzed. Okay, Right. And this is a A Permanent deaths is permanent. permanent death. But fortunately you heal and you re grow a new neuromuscular junction. It just takes about six months to do that. That's why it wears off. Eventually. People who get this, this poisoning eventually can heal from it as that neuro muscular junction regenerates, You know, like a lizard tail.

9:37

What are the symptoms of getting botulism? Naturally defined naturally, like I am canning food or I'm making salami and I was really careless while doing it, and I grew a botulism bacteria and I ate the food and I start getting this paralysis, paralysis and what else like Is that just it? Like they lose like the ability to breathe? Yes, so there's a lot of actually different types of ways. You can get botulism into your body and have bad things. So what you're describing is sort of food borne, so it's in the food and you ingest the food, and then you can sort of have food poisoning taken. Just feel nosy. It and I feel very good. And then what happens over time is that you start to get muscle weakness and the muscle weakness. It tends to go to those muscles which have the most motor inn plates that have really fine nose making really fine movements, which tends to be in your face.

You're smiling your eyes. You're swallowing muscles, your upper airway sort of breathing muscles, so you start to get in a double vision. You can't talk properly. Accounts wallow properly. That's classically how you would get it initially when you ingest it that way, it sounds like you're also implying there's other ways to get botulism. Yeah, they can't foods s so you can get botulism by eating it by eating the spores. And this cares in baby. So let's talk about infant botulism a little tiny bit. And classically, this was with honey person. Don't give your baby's honey right so they ingest the spores. And a spore is like a bacteria that's put a shell around.

It's also can live for a long time in harsh environments so it doesn't leak water. And so once that sport gets to a place where it's nice to live in and goes, Hey, that's some water around here and it's warm and it's just the right place. Then that still start to divide and make lots of botulism bacteria so in infant botulism, you ingest the honey and the spores go in, and then they start to replicate. And then when those bacteria replicate, they start pooping out the botulism toxin. It's a side effect of being infected, so this is something that they leak out of themselves. And so Mom brings the baby in and says he doesn't eat properly and he's not moving. And he usually is really active and you can't suckle on. And that's a floppy baby in one of the classic causes of a floppy baby is bachelor it actually That brings up a question like this. Honey, why does Honey Hood kids and not adults?

And it's because babies near their stomach isn't as acidic. They don't have lots of other bacteria, and so the environment in most adults guts is not very good for these sports to germinate. They look around like too much competition here. This is not a good place to live wires and little babies gets. Oh, look, there's no other bacteria. Very few. I think this is a good place to set up shop. I went to many people to fight with, so that's why infants and much more likely to get it from honey than adults.

12:26

So we've talked about this like food born cause, right, the classic bulging can that's full of preformed toxin, as opposed to honey, which isn't the toxin. It's the spore and in the spore germinates and then bacteria Forman Bacteria formed the toxin, and the infant botulism is the most common. But the one that I've actually seen before is wound botulism.

12:50

Okay, how do you get that? So from a wood well, what I mean, like, where does botulism naturally live?

12:57

Well, it's Clostridium. Botulinum is the is the bacteria. So anything that's, ah, you know, anaerobic. Not a lot of oxygen and the environment. It's dirty. It's nasty. Think about yeah, think about Ivy drug users and think about exposures on a dirty needle that they're injecting into their skin and basically putting whatever is on that needle into an oxygen deprived environment like under their skin. You get in, you can get the bacteria right into a wound,

13:26

so the but the bacteria would be living on the tip of that needle you injected underneath your skin, and it starts multiplying under your skin. And that's how you get the

13:34

poison. Yeah, or the bacteria could be living in whatever you know, you're drawing up in the syringe.

13:40
What is wound botulism?

Where does botulism naturally live? Anything that is anaerobic. Druggies put a needle under their skin and with it they inject a bacteria right under the skin. The bacteria then ends up living and replicating under the skin.



Other place. It's endured it all over the place. So that's why I need clean needles and you wash out wounds to get all these bad victor. So it's probably all over the place. Wow, I didn't know. Is that prevalent? I thought it was like the's really special circumstances that'll, well, to get sick from it is under the special circumstances, but the bacteria itself is actually pretty prevalent. It's everywhere. It's scary.

14:4

Yeah, And then the one that people kind of theoretically talk about is this inhalational toxin What

14:9

you can breathe it

14:10

in? Well, it's basically like, you know, people sitting around thinking, How could terrorists capture the power of botulinum toxin and kill a ton of people? If you were able to basically make a form of it that you could Aarhus allies, you could you could harm a lot of

14:25

people that were really bad. A teaspoonful,

14:27

Yeah, potentially, it's ah, it's a bio weapon. It's just never been done because it's really apparently hard to do.

14:34

Thank God So as well, least this immediate group knows. I like to cook, and I like to ferment things. And I like canning. And I would like to know because I'm always That's the one thing on my mind, right? Like canning food. I'm going to see a bulgy lid, and I'm getting up killing my whole family. So So what? What? I mean, I sort of know, You know, you gotta, like,

put it in the pressure cooker or you got a water boil it. You basically cooked the food in this water bath in a can. And this heat sort of tricks the bacteria into thinking this is a great place to live and set up shop, and then it starts like multiplying and sending out these toxins. Although it doesn't know that you're boiling that water to 200 something degrees and the extended amount of time sort of kills off the toxin to So then you're free to eat it, right?

15:34

Is that a question or a statement?

15:35

Well, that's my understanding.

15:36

Okay, so that sounded mostly right. Okay. Okay. So what makes a spore Germany? Because you're worried about the spores getting into the things that you've canned and then germinating talks? Yeah, and a lot of the conditions that you would can with are also good conditions that the spores like in order to Germany. So they want little to no oxygen. They want a low pH like some acidity.

16:0

That's why they always say, like, tomato sauce is one of those big like,

16:4

yes, higher. And they like warm temperatures. You know, in the 25 to 37 Celsius range, which is hot male, interpret that in from Australian too American

16:16

for just 25

16:17

25 to 37 Celsius.

16:19

Uh, 80 tsunamis.

16:21

Okay, you're getting heated up probably harder than that. Like warm temperatures. That's just their favorite. But, you know, they like a good tropical environment, doesn't. Okay, so then the bacteria goes into its life cycle from sport to bacteria to toxin. OK, so how do you get these spores out of the food, right? Because they're spores everywhere. I mean, it sounds kind of impossible, like if you just get a carrot out of the ground, it's gonna be covered in botulism supporters. Disgusting.

16:50

Oh, a garden urine.

16:53

But that's why you're using a pressure cooker and and the exact amount of time in the amount of heat and everything

16:59

that waterbed there was like a study I read, um, I think, from so some university. I don't remember which one, but they did A They did a comparison between pressure cookers and water baths and found really no difference. Um, that partial to both. Yeah, hot water about like a pressure cooker is better, obviously. But a water bath for a sufficient amount of time is also pretty good,

17:24

right? I think you just need a certain amount of heat in a certain amount of time in a pressure cooker lets you achieve that more quickly, and the other factor is how acidic is the food that you're trying to prepare. And also what is your altitude? So there's a lot of different factors. And that's why whatever you're making your canning at home, that's why you just got to kind of look it out right and find out.

17:43

Yeah, water,

17:44

Sure, and that's why we have food. Scientists like Lin Muk lands bro from the University of Massachusetts. She's a professor in the Department of Food Science, and she's gonna explain to us now how hot and how long before it's considered adequate so foods have to be heated for long enough to show that you have a 12 law reduction of clostridium botulinum spores. And to achieve that, you have to heat it in a pressure cooker of re torch is what they're called commercially. So you retort the food so that you would get at theoretical 12 law reduction of your Clostridium botulinum sports, which is 99 point 9999999999%

18:29

reduction. Yes, I have decided that we should always have a doctor friend in our life, a lawyer friend in our life, in a food

18:37

scientist friend in our life. That's it.

18:39

That's all you need to find him. I could see you being a food scientist. I think it's so cool. Super interesting, because it's science and its favorite food. Okay, when my mom would take me to the store and we'd buy food, she would always say, Don't buy the dented cans. Dented cans are bad. They can kill you. So did you ask the food scientist if a dented can can kill you? And if it can? Why

19:17

I did you ever notice when you open a can you hear wish they're going in so vacuum forms. So if there's a dent in the can and now you're cooling and water, what if some water gets sucked into the can? And what if they're viable spores a prostrating much mine in there If they're spoilage within the can, you could see some bloating of the cans, so sometimes you'll see a little bit can. That's kind of poofed up. So all these things are indications that there could be spoilage in the

19:47

can. So basically, she's saying that there's only enough room in the can for what the manufacturer wanted in the can. Any dent, puncture or expansion of that can means there's something else other. Some other thing that got in that can that it's not

20:4

supposed to be there. Well, I think with the dent, that is not necessarily true. Like if you take a perfectly good can of food that's got no botulism in it and you just throw it on the floor, it's probably gonna dent. But that doesn't mean that it has

20:20

all right. It would need a whole yeah, but the dentist, signifying that there's being some trauma to the cancer they could be a whole and there could be bacteria in there. And that big here now may have replicated and produced. Just grab another can get the den in. One exactly bowled in Cannes, is it? There's bacteria in their end as part of their dividing and nice thing to live there. They're also giving us some gases, which is expanding that thing. That's when that, yeah, that's when it starts getting all puffy. Yeah, that's why when you're canning, they tell you to put the lid right.

It comes. There's two parts of the lid. They tell you to put the lid on. You put in the water bath, you wait till it heats up, and then the vacuum seal happens, right? The little Indian pops in. Then you take it out of the water bath. You wait till well, actually, you wait till it cools, and that's when the vacuum happens. But then, when it's all cool, you take off the first part of the lid and you store the can away. So if it starts to expand, that first part of the lid will pop off. And then if you walk into your pantry and the lids have popped off. You know that had botulism.

21:22

Eso, you mean? So there's, like, the piece that you put on the top. And then there's a circular part that you threw on over the actual list

21:30

for the

21:31

water bath. Right? You'll either both on for the water bath. But after it cools, you removed the circular part screws on. Okay, so it's just

21:39

the top, just the top part. And it's on there pretty good. Yeah. Okay. And then over time, if something bad is in there, it'll pop off the food and then, you know, like that's a bad one,

21:49

right? Which is probably easier to see them having a little bit of pressure. But but just the screw top is holding

21:54

it down. Exactly. So botulism gets in me and starts paralyzing me and you and you said it goes away after time. So what do you do for somebody with bachelor? I guess you just have to wait it out.

22:8

Well, yeah. I mean, people probably aren't gonna come in and say I have botulism right there. How fast

22:15

does it take to get botulism?

22:17

It depends on how much

22:19

toxin you get in here. You get it. You know, the theoretical worst one is this inhaled form the terrorists that could probably kill you within minutes. Wound botulism, slowly forming can take weeks and weeks and

22:31

weeks and they'll explain what it is. It's actually killing you.

22:34

So what's killing you is what we talked about is that this toxin is stopping the nose working and the nerves that you really need to work things. For example, like your respiratory muscles. If you paralyze your restaurant, your muscles, you stop breathing. If you stop breathing, you die.

22:50
What do you do for somebody with botulism?

The time it takes to get rid of the botulism toxin depends on the amount and method it was acquired. A lot of the toxin into your breathing system, for example, could kill you by paralyzing your breathing, and thus preventing the rest of your body from working.



People, you know, usually wouldn't come in with some sort of like clear history. Maybe they have a really nasty looking wound and you suspected a little bit. But, you know, it takes some detective work. So you got to suspect that diagnosis in the first place if you're ever going to get there and some of the things that would maybe tip us off our if they have the things that mill had described, so they have a little bit of double vision or slurred speech may be a little bit of facial a cemetery of certainly if they're feeling like they're not able to take a deep breath. That's a big concern because then you're worried that this paralysis is starting to affect their diaphragm and maybe they're gonna need to be intubated and put on a mechanical ventilator until we were able to treat them.

23:30

Does that sound sort of sound like a stroke?

23:32

In some ways, strokes usually effective a very specific territory, like one side of the face or one side of the body. And this is probably gonna be both sides. But, you know, you may see more effects on one side, more so than the other at any given point in time, so but yeah, that could be definitely confusing early on.

23:54

So what just was talking about is there are three keys to the treatment of botulism. One is supportive care, and what that means is, just has to breathe for you and look after your blood pressure. And so she's supporting your normal functions that you would do. The second thing is to get rid of the source. So if you were an I V drug user, for example, and you've got an infected wound that has Boches, and we need to take that to the operating room, we need to clean it up and get rid of all that stuff, making more botulism all the time. And then the 3rd 1 is the anti talks and tell us about that. Just

24:26

okay, So mostly ours don't have this laying around. Actually, this is so rare that if you think someone has botulism and botulinum toxin, you call up the poison control center or the CDC, and you say I'm suspicious. This patient has botulinum toxin. I want the anti toxin. And so they send it to you really fast by career. Yes. Yeah, they bring it to you really fast, and then you administer the anti toxin and unfortunately, it doesn't just, like, fix it like reverse it immediately. Like I think it wouldn't hope it would. And it probably doesn't improve survival in the end, but it does do some good for patients who received the anti toxin. They generally don't need to be intubated on a ventilator for as long as other patients, and they can usually make it out of the hospital sooner than compared to patients who did not get the anti

25:16

toxin. So really just comes down. We're just waiting until your body can clear it right? And so this antitoxin basically soaps up the toxin that's still around and still doing bad things. But it can't reverse the damage that's already done. You just have to grow new employees. It's

25:30

okay. Yes, So it might be a while that you're in an intensive care unit on a ventilator until all of that heals. A few months later, cheese bring it home will give us a summary.

25:41

So he's the summary. Clustered in botulinum is a bacterium that is in lots of places and soil and all over the place and most the time. We don't worry about it. It conforms spores this sort off cocoons so that it can live a long time. If you ingest those, you can get botulism. If you inject those, you can get botulism. Sometimes. If you eat them, you can get botulism and botulinum bacteria as they divide producer toxin, and it's that toxin. That's the problem. And that toxin stops your nerves, being able to talk to your muscles. And if your muscles can't work, then things like not being able to breathe this problem. And so you've got to make sure you prepare food Well, you're gonna make sure that you don't give some certain foods to certain people like don't give kids, honey. And you've got to not inject drugs because drugs are bad.

26:32

Just doesn't

26:33

know the reason Drinks got a lot of reasons, but under controlled circumstances, this very powerful toxin which construct muscles working has a lot of medical uses. The most frequent use is to make you look pretty.

26:48

And if you're gonna use it for that purpose, you should probably go to someone who has an active medical license and they're not suspended.

26:54

Don't do it at your friend's house. Thanks to Dr Lin Muk plans for Dr Jess Mason Day Mason and I'm Mel. Huh? This one heard of it is a production of fool Abou Incorporated produced by CC. Have it, Bill Connor, the information you here on this front hood of it should not be taken as actual medical advice. If you have actual medical questions about actual medical things, you should see an actual medical practitioner even though we are actually doctors were not your actual doctor. So be sensible in keep it real. And this Oh, this this this this

27:26

this viscous a bit.

27:31

If somebody gets botulism poisoning and comes into the E. R. Will there Frankel's go away in their face By the time it makes all your wrinkles Go away, You're already day. Okay, here's to good thoughts. Okay,

27:46

He'll die. A beautiful death. Oh,

27:49

he's dead. But he looks of smoke. Great, great.

share this

Suggested Episodes