Speaker 1: Hi, I'm Georgia Hardstark and I co host the podcast
Speaker 1: My Favorite Murder.
Speaker 2: And uh, of course I had heard about botox for years.
Speaker 1: I think everyone you know knew about it, knew what
Speaker 1: it was, and it didn't even cross my mind until
Speaker 1: I had a friend who got it done and she
Speaker 1: was you know, we were both in our mid thirties,
Speaker 1: so you're thinking like, well, I don't need it yet,
Speaker 1: and then I saw her face and it looked it's
Speaker 1: just you know, she didn't She looked awake. I guess
Speaker 1: was the thing that really hit struck me. And then
Speaker 1: I was in this really cool, like secret Los Angeles
Speaker 1: Ladies Facebook group and they all got it done, and
Speaker 1: so I kept like it normalized it for me and
Speaker 1: we were all you know, they were there from their
Speaker 1: mid twenties to thirties to forties. It was all ages,
Speaker 1: so it didn't suddenly feel like this thing that only
Speaker 1: you know, you had to get when you were older
Speaker 1: and already you know, having issues.
Speaker 2: The way I read it about it was that it
Speaker 2: was preventative, which I found really interesting.
Speaker 1: Because you know, the less you're making the furrowing your
Speaker 1: brows and making those creases, the less the lines are
Speaker 1: going to stick around.
Speaker 2: And I was really.
Speaker 1: Nervous because it's you know, I had to get past
Speaker 1: feeling vain about it, which I think is a normal thought.
Speaker 2: And then I, you know, I just.
Speaker 1: Realized there were these little things about my you know,
Speaker 1: wrinkles that were bothering me.
Speaker 2: And I think that's the main thing, is like it's.
Speaker 1: Not for everyone, and everyone and wrinkles are beautiful and
Speaker 1: not everyone you know, is going to want to do it,
Speaker 1: and I think that's totally fair. But I think if
Speaker 1: it's for me, it's like a simple fix that will
Speaker 1: make me just feel a little more confident, you know,
Speaker 1: which is a big, huge plus for me. So you know,
Speaker 1: it's not going to change your face, not going to
Speaker 1: change your life, but you know, yeah, So so I went.
Speaker 1: It was and I got it the first time right
Speaker 1: before mine, Evince's wedding, so it was like thirty five
Speaker 1: or thirty six, and I was super nervous. I was
Speaker 1: gonna I was scared I was going to completely change
Speaker 1: my face. You know, it's a little needle, so of
Speaker 1: course it's not going to feel good. And then you know,
Speaker 1: they poke it in and so do you want to
Speaker 1: do a lot of little spots. You don't just do
Speaker 1: it in one spot. And I get it done in
Speaker 1: my forehead and between my eyebrows and on my smile lines,
Speaker 1: and so you get it's a couple different pokes, like
Speaker 1: maybe I think mine are like twelve pokes total, and
Speaker 1: you can kind of it's really gross. You can kind
Speaker 1: of hear when they're injecting it. It's like a sqush
Speaker 1: in like your inner ear. You can hear it. That's
Speaker 1: the only horrible part. Yeah, it doesn't it hurts because
Speaker 1: it's a needle, But I feel like with that and
Speaker 1: like tattoos, when you're excited about what you're doing, it
Speaker 1: doesn't hurt as bad. And they give you a you know,
Speaker 1: a stress ball to squeeze, and it's over so quickly,
Speaker 1: and you know, it's just part of it. If you
Speaker 1: if you're totally afraid of needles, obviously you're not gonna
Speaker 1: want to do it. But and it takes like two
Speaker 1: weeks to start showing up, so it's kind of good
Speaker 1: that it's.
Speaker 2: Slow and subtle.
Speaker 1: It's not this like right away change. And so when
Speaker 1: I finally, you know, no one knew that I had
Speaker 1: gotten it done. None of my even my closest friends
Speaker 1: hadn't known. So when I finally told, like my best friend,
Speaker 1: she was shocked and she was like, now that you're
Speaker 1: saying it, I see it. And I was like, I
Speaker 1: look like I'm thirty again, and she's she blurted, you
Speaker 1: look better than that, and I was like, Okay, I
Speaker 1: like this.
Speaker 3: Well, that was one of the most exciting things to
Speaker 3: ever happen. Absolutely thrilling. Thank you so much, Georgia for
Speaker 3: being a part of this and sharing your story and
Speaker 3: wealth of knowledge. Yes, thank you, thank you. That was thrilling.
Speaker 4: Oh my gosh, uh huh, and much more uplifting than
Speaker 4: other first hand accounts of the subject of today's episode, which.
Speaker 3: Which is botchelism bochelism, well like batchulinum toxin sure, Clasterdium botulinum.
Speaker 3: How about that ye have about?
Speaker 4: Hi? I'm Aaron Welsh and I'm Erin Alman Updike and this.
Speaker 3: Is this podcast will kill you today.
Speaker 4: We're talking you know what we're talking boche line.
Speaker 3: Well, we have a couple of pieces of business to
Speaker 3: get into before we start this episode, which I know
Speaker 3: we say this all the time, but I am so
Speaker 3: excited for this. It got to the point where I
Speaker 3: was telling, because I know I didn't want to tell
Speaker 3: you the things I was learning yet. But I was
Speaker 3: like texting everyone else like, oh my gosh.
Speaker 4: No, yeah, I do the same thing. Ye yesterday, I
Speaker 4: was like Brett, did you know? And I just like
Speaker 4: started shouting botox facts at him.
Speaker 3: Yeah. Well, I'm glad that we finally get to lit
Speaker 3: it all off our chests. Me too.
Speaker 4: It's going to be It's gonna be a good one.
Speaker 3: I think.
Speaker 1: So.
Speaker 3: Okay, So, like I said, though, some business Number one
Speaker 3: is that we are going to keep doing these regularly
Speaker 3: scheduled episodes or whatever, and we are going to keep
Speaker 3: them COVID free.
Speaker 4: We are COVID. This is a COVID free zone right now.
Speaker 3: Yeah, so we promise we won't even say it after
Speaker 3: too many more times and so and so what we're
Speaker 3: doing is is, as you may have seen in your feed,
Speaker 3: we're going to keep dropping those COVID nineteen episodes every
Speaker 3: so often, just on a We don't really have a
Speaker 3: particular schedule for.
Speaker 4: That's just whenever they happen. Happen, but in order.
Speaker 3: But we also recognize that people may not want to
Speaker 3: hear about what's going on or it might be too
Speaker 3: stressful or whatever, and we totally get that, and so
Speaker 3: all of these normal episodes will just be normal normal episodes.
Speaker 4: Jinks.
Speaker 3: So okay, all.
Speaker 4: Right, all right.
Speaker 3: Number two, we have now joined the affiliate program of
Speaker 3: this organization called bookshop dot org. And so what this
Speaker 3: is is it's a website that it's an online bookstore
Speaker 3: website that works with independent bookstores. And so as an affiliate,
Speaker 3: we have a page where you can see our lists
Speaker 3: that we have curated for what books, you know, nonfiction books,
Speaker 3: fiction books, memoirs about disease and about health and stuff
Speaker 3: like that. And so if you are so interested, you
Speaker 3: could go on our website under the books tab and
Speaker 3: you'll find a link to bookshop dot org. And also
Speaker 3: we have links in each of our uh so, in
Speaker 3: each of our episodes where we list our sources, we
Speaker 3: will provide links to those books on bookshop if they
Speaker 3: exist there.
Speaker 4: Cool.
Speaker 3: Cool.
Speaker 4: One other piece of business, if you are not aware yet,
Speaker 4: we have now alcohol free episodes available on our website
Speaker 4: if you'd like to use those for whatever reason, if
Speaker 4: you don't want to hear us talk about quarantinies, you
Speaker 4: can find those on our website yep.
Speaker 5: Cool.
Speaker 3: Speaking of quarantinies.
Speaker 4: It's quarantiny time, it is.
Speaker 3: What are we drinking this week?
Speaker 4: This week we're drinking can of Germs.
Speaker 3: And we have a big thank you to Bloodmobile for
Speaker 3: providing that's the quarantine.
Speaker 4: Name for this episode and all of our episode. Just
Speaker 4: kidding a lot of our episodes though, Ah, thank.
Speaker 3: You Bloodmobile slash Daniel my brother.
Speaker 4: Really that's a phenomenal drink name. Can of Germs from watchlism.
Speaker 4: Oh my god, what is in can of germs? It
Speaker 4: is rum canned pineapple of course, honey. Also, of course
Speaker 4: we'll talk about it and lime juice.
Speaker 3: Yeah, it's pretty good.
Speaker 4: It's pretty good. Actually, yeah, it's not bad.
Speaker 3: So awesome?
Speaker 4: All right, then anything else or can we just get
Speaker 4: into this episode, Erin.
Speaker 3: Let's get into the episode please?
Speaker 4: Awesome right after this break. So when we talk about botchelism,
Speaker 4: when we talk about bocheln, botox, whatever, we're talking about
Speaker 4: a specific pathogen that I'm very excited, Erin, for you
Speaker 4: to tell me about where this pathogen came from, because
Speaker 4: you specifically told me not to look that up.
Speaker 3: Oh, I was very adamant, like, don't read about this.
Speaker 3: I didn't read them at all all caps text. You're
Speaker 3: not gonna talk about this, are you.
Speaker 4: Nope, I am not. But we will talk a little
Speaker 4: bit about the bacterium itself. So this bacterium is called
Speaker 4: Clostridium botulinum. You may have heard the term clustridium if
Speaker 4: you've ever heard of, for example, Claustridium difficile see diff Yeah,
Speaker 4: a lot of people probably have. This is another Claustridium
Speaker 4: species that causes disease in humans. It causes massive, very
Speaker 4: serious diarrhea. It's a pathogen of pretty big concern, especially
Speaker 4: in hospitals. So Claustridium botulinum is another bacterium in the
Speaker 4: same genus. These Claustridium species are gram positive, which means
Speaker 4: they stay purple when you look at them under a microscope.
Speaker 4: That's what we always say on this podcast. It means
Speaker 4: that they have a thick cell wall. Okay. Clusterdium species
Speaker 4: are rod shaped, so they look like little tic TACs. Okay,
Speaker 4: and very importantly, they are what we call spore forming anaerobes.
Speaker 4: It's a lot of technical terms. Let's talk about what
Speaker 4: they mean. So anaerobe means that this is a bacteria
Speaker 4: that grows and lives without any oxygen. Okay, that's really important.
Speaker 4: So it can't just grow like on your table out
Speaker 4: in the open, or on your fingernail or in your
Speaker 4: nose or something like that. Okay, I don't know why
Speaker 4: I said fingernail.
Speaker 3: The fingernail is my favorite frame of reference. I want
Speaker 3: to swab my fingernail now and see what's.
Speaker 2: I mean growing there.
Speaker 4: Probably find some weird stuff, but not clusterdium species.
Speaker 3: Okay.
Speaker 4: Our atmosphere, of course, is twenty one percent oxygen. So
Speaker 4: how can this bacteria survive if it's like surrounded by
Speaker 4: oxygen all the time?
Speaker 3: Quick question? Did you know that off just like the
Speaker 3: back of your hand that it was?
Speaker 4: Yes? I did? Did you not? Oh? Well, now you
Speaker 4: know listeners, did you know? Huh, it's yeah, that's I
Speaker 4: did know. That's a that's a trivia fact. I did know.
Speaker 4: And it's important because we talk about it in medicine,
Speaker 4: because you know, when you put someone on oxygen, you
Speaker 4: have to think about how much oxygen they're getting and
Speaker 4: what that is compared to what is what they're normally
Speaker 4: breathing in at room air. So if they're on twenty
Speaker 4: one percent oxygen that's actually like room air.
Speaker 3: Oh so awesome.
Speaker 4: Yeah, oh how fun. Look medicine teaches you things who knew? Okay, so,
Speaker 4: how did does this bacterium survive if it's surrounded by
Speaker 4: oxygen and it needs to live and grow in an
Speaker 4: environment without oxygen. The answer is that it's a spore former.
Speaker 4: I can't remember if we've talked on this podcast before
Speaker 4: about spore forming bacteria, So let's talk about what spores are.
Speaker 4: So bacteria that are spore formers here, we're talking about
Speaker 4: specifically what are called endospores. So these are things, for
Speaker 4: lack of a better word, that bacteria produce that are
Speaker 4: super environmentally stable. They're basically a stripped down structure that
Speaker 4: contains the DNA of the bacteria but can persist in
Speaker 4: the environment for a really, really long time. So these
Speaker 4: are not reproductive structures. When you hear the word spore,
Speaker 4: you might think of like a fern spore or a
Speaker 4: mushroom spore. Those are like reproductive things. So endospores, bacterial
Speaker 4: endospores are not reproductive structures. They're basically just a form
Speaker 4: that the bacteria can produce in order to resist bad
Speaker 4: environmental conditions.
Speaker 3: Yeah, just kind of like a wait and see a
Speaker 3: little blueprint for the future.
Speaker 4: Exactly right. And so when a bacteria senses that environmental
Speaker 4: conditions might be deteriorating to the point where they're not
Speaker 4: going to be able to survive and continue to reproduce,
Speaker 4: they begin to form this endospore. And then if those
Speaker 4: environmental conditions deteriorate and the bacteria around that endospore dies
Speaker 4: and deteriorates, the endospor stays alive. Essentially, it doesn't do anything.
Speaker 4: It just exists until conditions are right, and then it
Speaker 4: can reactivate okay, yeah, and go on to form another living,
Speaker 4: reproducing bacteria. So these endospores are really important because they're
Speaker 4: resistant to things like UV. They're in the case of anaerobes,
Speaker 4: they're resistant to oxygen, which could kill reproducing Clostridium botulinum.
Speaker 4: They're resistant to alcohol, to soaps too hot, too cold,
Speaker 4: to certain levels of radiation. They're really really hardy little
Speaker 4: packets of DNA, which can make them especially dangerous in
Speaker 4: a hospital setting if things aren't sterilized properly. And so
Speaker 4: that's part of the reason why sea diff Claustridium difficile
Speaker 4: is really scary in hospital settings. Because like just using
Speaker 4: alcohol based hand sanitizer doesn't kill the spores of these.
Speaker 3: Bacteria, right, And we'll do a whole episode on sea
Speaker 3: diff in the future at some point because it's definitely
Speaker 3: worthy of its own massive episode, absolutely, And we're also
Speaker 3: going to do another episode at some point on another
Speaker 3: Clostridium species, tetanus.
Speaker 4: Oh yeah, Oh my gosh. I forgot that tetanus was
Speaker 4: another another tops I think that's why. Yeah, I I
Speaker 4: went back and watched the sketchy micro videos for this,
Speaker 4: and like, tetanus and and botulism are kind of opposite
Speaker 4: ends of the spectrum, which is really interesting, and so
Speaker 4: I remember like comparing the two between them. So maybe
Speaker 4: I thought that we had done tetanus already. I don't know.
Speaker 3: The only other spore former I can think of off
Speaker 3: the top of my head is anthrax, and.
Speaker 4: I, yeah, antax, we haven't done that. Yeah, we'll do
Speaker 4: that eventually too. Anyways, there's more, but those are the
Speaker 4: big ones. Yeah, Okay, but the spore isn't actually the
Speaker 4: story here, Okay, of course not, of course not. It's
Speaker 4: part of the story, but it's not the story that
Speaker 4: we're focusing on on this podcast. Will kill you. What
Speaker 4: we want to talk about, of course, is the part
Speaker 4: of this bacteria that makes you sick. So we're here
Speaker 4: today to talk about botulism. It turns out that botulism
Speaker 4: is caused not by the bacterium itself, not by the
Speaker 4: spore itself, but by the toxin that that bacterium produces. Okay,
Speaker 4: oh yeah, this is called botulinum toxin. So what I
Speaker 4: want to do first is we'll talk about that toxin itself,
Speaker 4: the mechanism of action of that toxin, which will pretty
Speaker 4: clearly tell you what the symptoms that you're going to
Speaker 4: see are of this like of poisoning from botulinum toxin.
Speaker 4: And then we'll talk about the ways that you can
Speaker 4: get exposed to this toxin, because there's a few different,
Speaker 4: very distinct ways that you can be exposed to this toxin. Okay,
Speaker 4: all right, so first of all, what is boculinum toxin.
Speaker 4: We've definitely talked about toxins a lot on this podcast
Speaker 4: because lots of bacteria produce different kinds of toxins. It's
Speaker 4: basically just usually proteins that a bacteria produces that have
Speaker 4: an effect that do something for that bacterium. Okay, so
Speaker 4: like cholera toxin exactly. Cholera toxin we talked about staff
Speaker 4: or produces a lot of different toxins that have different effects, right,
Speaker 4: So in the case of botulinum toxin, this is a
Speaker 4: neurotoxic protein that the bacteria produces, so it has effects
Speaker 4: specifically on our peripheral nervous system and largely on our
Speaker 4: somatic nervous system. So if you remember in our episode
Speaker 4: on Belladonna way back when cast my mind back so
Speaker 4: way back when we talked about there's a lot of
Speaker 4: different ways that you can divide up the nervous system. Right,
Speaker 4: we have our central nervous system, which is like your
Speaker 4: brain and your spinal cord. You have your peripheral nervous system,
Speaker 4: which is everything outside your brain and your spinal cord
Speaker 4: that like where your nerves go to your muscles and
Speaker 4: your organs. You can also divide it into your somatic
Speaker 4: and your autonomic nervous system. So your somatic meaning like
Speaker 4: your sury and muscles nervous system, and then your autonomic
Speaker 4: nervous system, which is like your parasympathetic and sympathetic rest
Speaker 4: and digest versus fire or flight. Remember that kind of Okay.
Speaker 4: So in this case, the effects of boculinum toxin, they
Speaker 4: act on a couple of different places. They act both
Speaker 4: on the parasympathetic nervous system, but largely on the somatic
Speaker 4: peripheral nervous system. So let's first talk about what that
Speaker 4: nervous system is and how it works, so that we
Speaker 4: understand how botulinum toxin interferes with that process. Excellent, Okay,
Speaker 4: So you're I'm also not a neurologist or a neuroscientist,
Speaker 4: so this is real basic okay. So your brain, of course,
Speaker 4: is what controls all of the movements of your body.
Speaker 4: So how does your brain do that. You have nerves.
Speaker 4: Your brain is connected to your spinal cord, which is
Speaker 4: connected to nerve that innervate your muscles, okay, or your organs.
Speaker 4: So the way that this kind of happens is that
Speaker 4: electrical signals in your brain are transmitted along those nerves,
Speaker 4: along what are called axons of those nerves, and then
Speaker 4: when they get to the end of the nerve, which
Speaker 4: is called a synapse, there's a gap between that nerve
Speaker 4: and for example, your muscle, and so in order for
Speaker 4: that electrical signal in the nerve to transmit across that
Speaker 4: gap and have an effect on the muscle. That electrical
Speaker 4: signal has to be translated into a chemical signal, and
Speaker 4: then the chemicals can travel across that gap, that synapse
Speaker 4: between the nerve and the muscle, and they can propagate
Speaker 4: that signal into the muscle. Does that make sense? Yeah, yeah, cool,
Speaker 4: that's the first time I've ever explained that. So that
Speaker 4: was fun. Okay, So when you're looking at the synapse,
Speaker 4: the gap between the end of your nerve and the
Speaker 4: start of your muscle, there's the presynaptic end that's basically
Speaker 4: the nerve that came like from your spinal cord, and
Speaker 4: then the post synaptic end. You can think of that
Speaker 4: as your muscle. It turns out that the for your muscles,
Speaker 4: especially like your skeletal muscles, the transmitter, the chemical signal
Speaker 4: that is used to transmit that signal is called acetylcholine. Okay.
Speaker 4: Acetyl Coline is released at the pre synaptics, So from
Speaker 4: the nerve ending, acetyl coline is released, it travels across
Speaker 4: that gap and binds to a receptor on your muscle end,
Speaker 4: and then that is what actually causes your muscle to go, hey,
Speaker 4: I'm gonna contract and boom contracts.
Speaker 3: Gotcha.
Speaker 4: So acetyl colin is really important in that. So how
Speaker 4: does botulism work. So it turns out that botulinum toxin
Speaker 4: blocks the release of acetylcholine from that presynaptic nerve ending. Gotcha.
Speaker 4: So you have an electrical signal that's transmitted from your brain,
Speaker 4: it gets to the end and boculinum toxin is there
Speaker 4: and says, Nope, you can't release acetylcholine. So then your
Speaker 4: muscle goes it's got nothing.
Speaker 3: Are there toxins or venoms or something that block from
Speaker 3: the other end from the muscle binding site.
Speaker 4: We already talked about one and that was oh yeah,
Speaker 4: So belladonna and belladonna tends to act only on the
Speaker 4: parasympathetic receptors because there are two different types of acetylcholine receptors,
Speaker 4: there's muscarinic and nicotinic, and so botulinum acts on the
Speaker 4: presynaptic end, so it blocks all acetylcholine release.
Speaker 3: Oh my god.
Speaker 4: Atropine binds to the receptor, but only the muscarinic receptor,
Speaker 4: so not the ones in your skeletal muscle. Oh my gosh,
Speaker 4: this is so thrilling, I know, right, I'm so glad
Speaker 4: you find it thrilling.
Speaker 3: Yes, I do too, This is so exciting.
Speaker 5: Yeah.
Speaker 4: Oh wow. So yes, there absolutely are things that bind
Speaker 4: that you know do and there's other toxins as well too.
Speaker 4: There's other there's other venoms, there's other toxins that interfere
Speaker 4: with this acetylcholine and whether they do it, and and
Speaker 4: so that question is really important because in the case
Speaker 4: of botulinum, by blocking the release of acetylcholine, you leave
Speaker 4: those acetylcholine receptors on the muscle empty, which means the
Speaker 4: muscle is not getting a signal to contract, which means
Speaker 4: the muscle is relaxed. So the symptoms that we see
Speaker 4: of botulinum poisoning are a flaccid paralysis rather than a
Speaker 4: contract did paralysis, which we see in other toxins that
Speaker 4: have different mechanisms of action.
Speaker 3: Like tetanus. Like tetanus. Yeah, that's really cool.
Speaker 4: I know, Okay, it's very cool. I love it. I
Speaker 4: mean I don't love it. It's horrible. Okay. So, now
Speaker 4: that we know the action of botulinum toxin, it's acting
Speaker 4: at the neuromuscular junction, the synapse between nerve and muscle
Speaker 4: and it's blocking the release of acetylcholine, which means your
Speaker 4: muscles are getting no signal, which means they are relaxed
Speaker 4: and flaccid. So we pretty much know what the symptoms
Speaker 4: of botulism are, right, They're a flacid paralysis. These symptoms
Speaker 4: are the same no matter how you get exposed to
Speaker 4: botulinum toxin, right, because this is a toxin, it's traveling
Speaker 4: throughout your bloodstream once it gets into you, no matter
Speaker 4: how it gets in, it's going to travel through your bloodstream,
Speaker 4: and it's going to act on any nerve ending that
Speaker 4: it comes in contact with. Okay, is the.
Speaker 3: Flaccid paralysis just sort of generally distributed throughout your body
Speaker 3: or is it concentrated depending on your root of exposure?
Speaker 4: Great question, Arin, So what's very interesting about botulism specifically
Speaker 4: is that it causes a descending paralysis. Okay, So the
Speaker 4: paralysis starts in your face and your head. It starts
Speaker 4: with your cranial nerves. It causes a bilateral so both
Speaker 4: sides symmetric cranial nerve palsies that then eventually travels down
Speaker 4: and will cause flaccid paralysis throughout no matter the root
Speaker 4: of entry and we'll talk about the specific different roots
Speaker 4: of entry. This is botulism. Yeah, so you're exposed to
Speaker 4: enough toxin that it is distributed throughout your body and
Speaker 4: causing botulism. If you are exposed, for example, like in
Speaker 4: our first hand account, to a very small amount of
Speaker 4: very very dilute toxin in a very specific place, there's
Speaker 4: not enough of that toxin to travel throughout your body
Speaker 4: and cause systemic effects. Right, it's a doge thing exactly. Yeah,
Speaker 4: and so all of the symptoms that we see with botulism,
Speaker 4: even with botulism, are dose dependent, right of course. Yeah,
Speaker 4: why does it start in your head? It's such a
Speaker 4: good question, and I don't I don't know. I couldn't
Speaker 4: figure out the exact answer to this. And what's interesting though,
Speaker 4: is that it does distinguish. So if you clinically see
Speaker 4: someone with paralysis, a flaccid paralysis, you know you have,
Speaker 4: as a clinician in your head a list of what
Speaker 4: you call differential diagnoses. What could be causing this? What
Speaker 4: are all the different things that could be causing the
Speaker 4: symptoms that I'm seeing? Right, And there's a few different
Speaker 4: things that you have to think about, things like gion
Speaker 4: beret for example. But gion beret causes an ascent paralysis.
Speaker 4: So knowing the timeline of symptoms, like where they began
Speaker 4: and how they've changed over time, is really important in
Speaker 4: trying to diagnose spotulism. And I think that this is
Speaker 4: also partly why for a long time it was thought
Speaker 4: that this was a central nervous system toxin, because your
Speaker 4: cranial nerves are closest to your brain, right. Yeah, they're
Speaker 4: coming out like directly from your brain stem, right, But
Speaker 4: it's actually a peripherally acting toxin. It's acting at the
Speaker 4: neuromuscular junction. So it's very interesting that your cranial nerves
Speaker 4: are still the first ones affected.
Speaker 3: This is fascinating, I know.
Speaker 4: Okay, so here are the symptoms, right, So the first
Speaker 4: signs and symptoms are things like blurred vision. As the
Speaker 4: muscles that innervate your eyes become affected, then you'll get toosis,
Speaker 4: which is a great word that means your eyelids are droopy, okay,
Speaker 4: because your eyelid muscles are not working right. Then you'll
Speaker 4: get slurred speech. As the muscles of your mouth and
Speaker 4: face get affected, then the paralysis will continue moving down
Speaker 4: your body. You can get mouth and throat because again
Speaker 4: that parasympathetic nervous system is also affected. So that's actually
Speaker 4: similar symptoms as to what we saw in Belladonna poisoning,
Speaker 4: dry mouth, dry as a cracker or whatever, I don't
Speaker 4: remember what that one was. Dry as a bone, mad
Speaker 4: as a hatter, a chicken, mad as a hatter, dry
Speaker 4: as a bone.
Speaker 3: Dry as a bone, etc.
Speaker 4: And then your voluntary muscles will start to become paralyzed,
Speaker 4: so first your neck, your shoulders, your upper arms, lower arms,
Speaker 4: upper legs, lower legs. Eventually everyone would end up with
Speaker 4: constipation as the muscles that innervate your gut are paralyzed,
Speaker 4: because gut in order to have poop at all, your
Speaker 4: gut has to be able to contract. Cause of death
Speaker 4: is usually respiratory arrest, and there's two different ways that
Speaker 4: this sort of ends up happening. The muscles that control
Speaker 4: your breathing, your diaphragm and your innercostal muscles of your ribs,
Speaker 4: those become paralyzed just like everything, and you can also
Speaker 4: get airway obstruction as the muscles of your pharynx are paralyzed,
Speaker 4: your airway can kind of collapse inward and you can't,
Speaker 4: so it's kind of a combination of those two that
Speaker 4: ends up causing death in the case of botulism.
Speaker 3: Oh cool, cool, cool, cool. That's horrifying.
Speaker 4: It's horrifying the rate that this progresses. So how long
Speaker 4: this all takes and how far it actually progresses, So
Speaker 4: whether it makes it all the way to your respiratory
Speaker 4: muscles or whether you just have like only facial palsy
Speaker 4: depends largely, like I said, on the dose of toxin exposure. Right. However,
Speaker 4: and this part's really important. Botulinum toxin binds irreversibly, so
Speaker 4: you cannot undo any damage that has already been done.
Speaker 4: But your body does eventually regenerate those acetylcholine channels on
Speaker 4: the terminal. It's just a slow process. So it's not
Speaker 4: like if you have facial palsy, you're not going to
Speaker 4: have a paralyzed face forever, but you can't undo that paralysis.
Speaker 4: You just have to wait for it to resolve.
Speaker 3: So how long are we talking?
Speaker 4: Generally weeks? Possibly months?
Speaker 3: Okay, A couple questions. The first is something that I've
Speaker 3: read somewhere about maintaining consciousness.
Speaker 4: Aaron, this is what I have next. Okay, for you,
Speaker 4: this is just for you. Aarin. Okay, your sensory system
Speaker 4: is generally unaffected and your intellectual function is unaffected. So yes, aarin,
Speaker 4: it's your greatest fear. It can leave you essentially locked.
Speaker 3: In Cool cool, right, awesome, because why can we keep
Speaker 3: doing these?
Speaker 4: Yeah? Because you're paralyzed. And here's what's really scary is
Speaker 4: that because the muscles, like the voluntary muscles of your
Speaker 4: face and your throat and things, are paralyzed, as you
Speaker 4: begin to have respiratory distress, you don't show any of
Speaker 4: the outward signs or symptoms of respiratory distress. There's no agitation,
Speaker 4: there's no restlessness. You're not gasping or thrashing or flailing
Speaker 4: because you're paralyzed. Great, So the way that you know
Speaker 4: that someone is in respiratory distress is because their oxygen
Speaker 4: saturation is dropping on a monitor. So if you're at home,
Speaker 4: then you wouldn't.
Speaker 3: At that point what can be done?
Speaker 4: So that is jumping the gun. But let's talk about treatment.
Speaker 4: The good news is there is treatment for this. It's
Speaker 4: absolutely can be fatal, but it is also treatable. We
Speaker 4: have an anti toxin. This anti toxin neutralizes circulating toxin
Speaker 4: and prevents it from binding to the nerve terminal, so
Speaker 4: it doesn't do anything for the toxin that's already bound. Right,
Speaker 4: we can't unbind that toxin, but it can neutralize any
Speaker 4: additional toxin that's circulating. So it's really important if these
Speaker 4: signs and symptoms start to appear that you get to
Speaker 4: a hospital for treatment, because then they can continue supportive
Speaker 4: care even if it gets to the point where you
Speaker 4: have like respiratory distress and things like that.
Speaker 3: To get the anti toxin early is yes, clutch, The
Speaker 3: earlier the better, is clutch, is right?
Speaker 4: Okay, So that's like what botulism looks like clinically, what
Speaker 4: the picture looks like. So how do you get it?
Speaker 4: How do we avoid it? Right? Yea? How do we
Speaker 4: not get it? Is what we want to know. There's
Speaker 4: three main ways and then a couple of ancillary ways
Speaker 4: as well. The first, most famous, I think, is food poisoning. Right,
Speaker 4: So if food is contaminated with Claustritium botulinum bacteria, and
Speaker 4: then those bacteria live in an environment that allows for
Speaker 4: them to grow, so no oxygen, not too low of
Speaker 4: pH so not too acidic, and just basically like a
Speaker 4: good environment for them to start growing and reproducing, they
Speaker 4: will then produce that toxin. You get botulism when you
Speaker 4: ingest that toxin, not by ingesting the bacteria themselves, gotcha. Yeah,
Speaker 4: So this is the same way that you might remember
Speaker 4: when we talked about in our staff Oreus episode, our
Speaker 4: Mersa episode, you get food poisoning from staff oureus from
Speaker 4: the toxin. Right, This is the same thing you get
Speaker 4: infected with the toxin. So if you have, for example,
Speaker 4: like canned tomatoes are a really good example because they're
Speaker 4: actually not that acidic. So if tomatoes are canned improperly
Speaker 4: and you have a bunch of Clustriti and boculinum growing
Speaker 4: in there and then producing to even if you reheat
Speaker 4: those tomatoes, you might kill the bacteria, but that toxin
Speaker 4: is still going to be there, so you can still
Speaker 4: get sick from.
Speaker 3: It, Okay, but you can neutralize the toxin.
Speaker 4: You can absolutely, Yeah, if you like, boil it for
Speaker 4: I don't remember how long exactly, Yeah, you can definitely yeah, yeah, okay.
Speaker 4: But that's why it's that's why it's like so common
Speaker 4: in foods. The bacteria can die, you know, after a
Speaker 4: certain period of time, but that toxin can still be
Speaker 4: in those cans of food, right, So that's one way.
Speaker 4: That's the most common way food poisoning botulism. Okay, yep.
Speaker 4: Now you can get infected with the bacteria themselves or
Speaker 4: the spores which you're more likely to come in contact
Speaker 4: with in the environment, right, in a couple of different ways.
Speaker 4: The least common but less depressing is wound botulism. Oh yeah, okay,
Speaker 4: So if you have a wound that gets can tam
Speaker 4: ned either with Clustridium botulinu bacteria or they're spores, which
Speaker 4: are very common in the environment. If that wound festers,
Speaker 4: it can become anoxic. In that environment, the bacteria or
Speaker 4: those spores can reactivate and begin to reproduce and produce toxin.
Speaker 4: So then you the bacteria are making toxin in your
Speaker 4: own body. The effects are the same as if you
Speaker 4: got botulism from food poisoning. Okay, they're the same because
Speaker 4: this is a toxin that has neuromuscular effects, so it's
Speaker 4: the overall it's the same right now. The most common,
Speaker 4: and I think the most depressing form of botulism, of course,
Speaker 4: is infant botulism. It's always depressing when it's babies, so
Speaker 4: and this is different. Even though this happens when an
Speaker 4: infant ingests like so it's technically a food poisoning, it
Speaker 4: is not the same as when an adult it's botulism.
Speaker 4: And that's because infant botulism happens when infants ingest the
Speaker 4: spores of Clustridium botulinum, So unlike adults, infants, especially of
Speaker 4: a certain age so it's usually greater than like three
Speaker 4: weeks but less than one year old, they have a
Speaker 4: very naive and naked gut flora, so their guts are
Speaker 4: not able to inactivate or prevent those botulinum spores from
Speaker 4: becoming activated and colonizing their guts. Gotcha, So then the
Speaker 4: bacteria in the infant gut reproduce and produce toxin inside
Speaker 4: of the baby, rather than the baby eating toxin directly.
Speaker 3: Yeah, that's horrible.
Speaker 4: And infant botulism is often called floppy baby syndrome. Okay,
Speaker 4: that makes sense with the Flacci paralysis exactly right. It
Speaker 4: is possible. However, it's extremely extremely rare for an adult
Speaker 4: to become colonized with clustering boculinum and then have that
Speaker 4: same syndrome as infant botulism. It's called adult intestinal toxemia.
Speaker 4: It's just very rare because we have other microflora that
Speaker 4: are much better at competing and outcompete those clusterdium species.
Speaker 4: It's similar with Clusterdium difficill Like, that's an opportunistic infection, right,
Speaker 4: it's not good at taking over our gut flora.
Speaker 3: Right, So it's usually it's like following a huge rounds
Speaker 3: of antibiotics and stuff like that, right.
Speaker 4: Yeah. One question is where do infants get exposed to? Yeah, honey,
Speaker 4: So that's like and it's just because honey is a
Speaker 4: it just has a ton of spores like it. There
Speaker 4: are a lot of Clushodium boculinum spores very commonly found
Speaker 4: in honey, and because an infant gut can't neutralize those spores,
Speaker 4: they can get infected with botulism or with clus shooting
Speaker 4: boculinum and developed botchulism from honey. It's not the only
Speaker 4: thing in the world, but it's sort of the most
Speaker 4: one of the most common roots of exposure. So that's
Speaker 4: why infants under twelve months can't have honey. Yep, shouldn't
Speaker 4: have honey.
Speaker 5: Yeah.
Speaker 4: It's also possible to be infected through aerosolized toxin, so
Speaker 4: you could in theory inhale this. I don't know that
Speaker 4: it's ever been recorded. It would have to be intentional.
Speaker 4: Oh a little bit about that, can't just a little
Speaker 4: And then of course you could get it through injection
Speaker 4: as well. So if you injected a large amount of
Speaker 4: this toxin into your veins or muscles, then it could
Speaker 4: spread through your body and cause botulism that way as well.
Speaker 3: Cool.
Speaker 4: But now, so botulinum toxin is considered the most potent
Speaker 4: toxin that we know of. Are you going to talk
Speaker 4: more about that?
Speaker 3: Aaron, Well, I can drop the knowledge right here if
Speaker 3: you want me to.
Speaker 4: Let's because I'm I I want to know about it.
Speaker 3: Okay, Well, all I know about in terms of that
Speaker 3: is I read somewhere in one of these papers that
Speaker 3: because the amount of botch linem toxin that it takes
Speaker 3: to kill an average human is xinec whatever amount.
Speaker 4: Yeah, if you some very small amount, some.
Speaker 3: Tiny, tiny, minuscule, unfathomably small amount, if you multiplied that
Speaker 3: by the number of people on Earth, estimates are that
Speaker 3: it takes approximately forty grams of botchulinum toxin to wipe
Speaker 3: out humanity.
Speaker 4: That's why you wanted me to weigh out forty grams
Speaker 4: of something?
Speaker 3: Yeah, I texted. I texted you, and I was like, so,
Speaker 3: can you just put like, how many slices of bread
Speaker 3: is forty grams? Because I visualize this, So how many
Speaker 3: slices of bread is forty grams?
Speaker 4: Okay, the sour dough bread that I have right now,
Speaker 4: one slice of it weighs forty five grams. Okay. For
Speaker 4: another visual a half a cup of coffee beans is
Speaker 4: forty grams.
Speaker 3: There you go.
Speaker 4: So that's how much botchulinum toxin it would take to
Speaker 4: kill all of the humans on the planet right now.
Speaker 4: That's what I Yeah, I have, and I have the paper.
Speaker 3: All cite the paper on our web site so you
Speaker 3: can go and read it for yourself. But yeah, like
Speaker 3: thirty nine point four grams or something. Whoa that wild?
Speaker 4: Yeah man, that's whoa. Well, that's botulism. That was it.
Speaker 4: That's all I got. We already talked about how you
Speaker 4: treat it. So oh that's it's a little terrifying. But
Speaker 4: we'll talk later about how how innovative people have gotten
Speaker 4: with something that is so terrifying.
Speaker 3: Yeah, I'll talk about it it's super it's really fascinating.
Speaker 3: This is I think one of my favorite episodes so far.
Speaker 3: I don't know why tell.
Speaker 4: Me about it, Aaron. How did we get here? Where
Speaker 4: did this thing come from? How did it evolve? Why
Speaker 4: does it have a toxin that can kill all of humanity? Like?
Speaker 4: What's up with that?
Speaker 3: I'm so glad you asked. I will answer as well
Speaker 3: as I can after this break. Okay, doesn't this remind
Speaker 3: you of an episode of one of our crossover episodes
Speaker 3: with Matt.
Speaker 4: One hundred percent? Yes? Yeah, that's why I kept talking
Speaker 4: about atropine and stuff exactly.
Speaker 3: Matt. We miss you.
Speaker 4: Yeah, we'll do another crossover soon.
Speaker 3: Yeah, we will. He doesn't know it, but he doesn't
Speaker 3: know it. We want to do another crossover soon, Matt. Okay, So,
Speaker 3: just like you asked, uh, why does this toxin exist?
Speaker 3: Why does this bacterium produce this toxin? And so that's
Speaker 3: what I want to start off by trying to answer, basically,
Speaker 3: why are you the way you are?
Speaker 5: So?
Speaker 3: In our normal episodes, this type of question is generally
Speaker 3: pretty easy to answer, right because it mostly has to
Speaker 3: do with the pathogen increasing its chances of transmission or
Speaker 3: something like that that's generally the pattern that we see.
Speaker 3: Like for example, as we mentioned earlier, the toxin that
Speaker 3: the color of bacterium produces makes you poop out a
Speaker 3: ton of Bibrio cholera cells, so it can spread to
Speaker 3: other people.
Speaker 4: I'm so excited about this, I can't wait, Like, yeah,
Speaker 4: why then?
Speaker 3: But with batulism, humans seem more like unfortunate bystanders than
Speaker 3: the stars of the show, right, right, So it's not
Speaker 3: spread from person to person. Really, so what purpose does
Speaker 3: this paralytic or fatal toxin serve? How does it actually
Speaker 3: help the bacterium? Does it even help the bacterium? To
Speaker 3: answer that question, I got to talk a little bit
Speaker 3: about the ecology of claustride and bochulinum.
Speaker 4: Your favorite, my favorite.
Speaker 3: A lot of the research on botulism focuses on humans,
Speaker 3: like outbreaks at potlux, the toxins use in therapeutics, the
Speaker 3: physiological mechanism of the toxin itself, et cetera. But to
Speaker 3: these bacteria, humans play a very small role, right, Aaron,
Speaker 3: this is jumping the gun. But around how many cases
Speaker 3: of botulism do we see a year in the US.
Speaker 4: Like one hundred and eighty two in twenty seventeen.
Speaker 3: Yeah, like very low. Yeah, but it's a whole other
Speaker 3: story for some other animals, especially migratory birds. Really really
Speaker 3: botulism is one of the biggest, if not the biggest
Speaker 3: disease of migratory birds, especially those that like water, like
Speaker 3: shore birds and waterfowl swamp birds.
Speaker 4: This is literally blowing my mind.
Speaker 3: I'm so excited that it is a typical outbreak of
Speaker 3: avian bochulism. So they happen pretty much every year. It
Speaker 3: seems like they're pretty common. Might claim the lives of
Speaker 3: fifty thousand birds or more, but there have been outbreaks
Speaker 3: with over a million birds dying.
Speaker 4: What on Earth?
Speaker 3: Yeah, and most of these outbreaks and you didn't really
Speaker 3: talk about types, but just fyi, it's like types of toxins,
Speaker 3: because it's a whole nother canama terms. Oh that's good,
Speaker 3: but these are just for reference type C.
Speaker 4: Bochulinum toxic. Okay, yeah, okay.
Speaker 3: So the reason that we see these outbreaks occurring among
Speaker 3: these water loving birds is that the environments where they
Speaker 3: like to hang out they can be full of decaying
Speaker 3: organic matter, which can make for a perfect setting for
Speaker 3: the growth of these anaerobic bacteria. And these anaerobic bacteria
Speaker 3: can then be easily ingested by like a dabbling duck
Speaker 3: or a filter feeding shoveler. Dabbling duck, that's like an
Speaker 3: actual term. Oh really, it's just a cute little It's like,
Speaker 3: you know when they like kind of like across the
Speaker 3: surface and they duck their their heads in and they
Speaker 3: like the little butt stick out. That's like a dabble dabbling.
Speaker 4: You're making me like birds.
Speaker 3: Also, apologies to any bird people who are like, wow,
Speaker 3: you're getting all of this wrong.
Speaker 4: So get an email from like Fred and Nick.
Speaker 3: And Maria and if we have a lot of bird friends,
Speaker 3: I know. Sorry. Okay, So let's say that one of
Speaker 3: these birds, one of these dabbling ducks ingest some swamp
Speaker 3: stuff containing Clustridi and bachulinum. The bacteria may colonize that
Speaker 3: birds and testines or liver without any apparent effects. Maybe okay, yeah,
Speaker 3: And then let's say the bird dies for whatever reason.
Speaker 3: Maybe it's because of the toxin. Maybe it's because it
Speaker 3: hit a power line, maybe it's because it ate some whatever,
Speaker 3: Maybe it just dies. Right, that decomposing bird is a
Speaker 3: great environment for Clustridium bochulinum. It's warm, it's anaerobic, it's
Speaker 3: everything you could ask for. Okay, if you're a clusterridian botchulinum, Yeah,
Speaker 3: soon that carcass is teeming with C. Bochulinum and it's toxin,
Speaker 3: and it's also hosting a ton of other decomposers, for instance,
Speaker 3: some invertebrate decomposers like blowfly larvae. Yeah yeah, And so
Speaker 3: normally waterfowl won't directly munch on vertebrate carcasses. But do
Speaker 3: you know what they will munch on?
Speaker 4: Blowflies maggots.
Speaker 3: Yes, yeah, So the larvae that these blowflies laid in
Speaker 3: the carcass become loaded with botulinum toxin, and invertebrates are
Speaker 3: not affected by the toxin, and so other words, eat
Speaker 3: these maggots die from the excessive amounts of toxin, and
Speaker 3: that leads to more toxic maggots and so on. Whoa,
Speaker 3: And so that's how these AVI and Bochulnum outbreaks can
Speaker 3: be absolutely explosive. It's called like the carcass hold on,
Speaker 3: let me find it's like the carcass maggot cycle.
Speaker 4: What how have I never heard of this? Erin?
Speaker 3: I know? It blew my mind?
Speaker 4: Oh my, Because they don't affect invertebrates. Uh huh, oh
Speaker 4: my gracious.
Speaker 3: And then of course other vertebrates might directly feed on
Speaker 3: the contaminated carcass and then die, which would then create
Speaker 3: another amazing anaerobic environment for the bacterium to replicate, and
Speaker 3: then that would spread the bacterium of the environment and
Speaker 3: provide more anaerobic grin it just sort of the cycle continues.
Speaker 4: Oh wow, I'm getting chilled.
Speaker 3: Well, this is why I was so excited for this episode. Okay,
Speaker 3: So I went into all of this to show like
Speaker 3: a natural cycle of Cbochulinum and its ecological role. And
Speaker 3: I did this to get at the question earlier, why
Speaker 3: are you the way you are? Yeah, it could be accidental,
Speaker 3: but most researchers believe that by killing a vertebrate host,
Speaker 3: or even increasing the probability of a host dying, it
Speaker 3: carves out a space for itself to replicate and produce
Speaker 3: more toxin totally, and so the mechanism of that, like
Speaker 3: the paralysis and blurred vision and so on, those are
Speaker 3: things that even if the toxin doesn't necessarily kill you outright,
Speaker 3: it will in the wild greatly increase your chances of
Speaker 3: becoming a carcass.
Speaker 4: Absolutely of becoming a carcass. Also, I think that that's
Speaker 4: our title, Aaron is why are you the way you are?
Speaker 3: Why are you are? Okay?
Speaker 4: I love it, It's fantastic. See it should just be see
Speaker 4: bochul line. No, it has to be botulism, but botulism,
Speaker 4: Why are you the way? So good?
Speaker 3: Are so good? I also liked no wrinkles in time,
Speaker 3: which was tender for us.
Speaker 4: That's funny, but this is better.
Speaker 3: But yeah, so and so, if you think about it,
Speaker 3: we've done so much laboratory research, not we, but the
Speaker 3: world has done so much laboratory research on botchuline of toxin.
Speaker 3: But those are under laboratory settings. And so the amount
Speaker 3: that is that it takes to kill an animal in
Speaker 3: a lab setting is much much, much greater than what
Speaker 3: it takes to lead to death, right lead to natural setting.
Speaker 4: Yeah yeah, yeah, yeah yeah, Oh that makes so much sense.
Speaker 3: Yeah. So that I think is why this toxin exists.
Speaker 1: That is.
Speaker 4: Episode over. That's all I need to know. It's so cool.
Speaker 3: I know, I honestly was had the time of my life.
Speaker 4: What a fun fact, you know, I know, I don't know. Yeah,
Speaker 4: what a clever little bacterium though.
Speaker 3: I know, I know, yeah, I think the whole like clever,
Speaker 3: but you know, comparative evolution, and there's so there's so
Speaker 3: much more that goes into this, like ecology, like why
Speaker 3: are there multiple toxins? Why is there variation among their
Speaker 3: toxicity or potency or whatever? Why, you know, why do
Speaker 3: we see these different seasonalities, what triggers these avian bachulism outbreaks?
Speaker 4: Why quite so potent? You know what I mean, Like,
Speaker 4: why couldn't you be like, you know, the amount it's.
Speaker 3: Yeah, yes, it's I mean, yeah, we could spend all
Speaker 3: day talking about just this part of it, but but
Speaker 3: that's not this podcast. Let's go back to the human
Speaker 3: side of things. I guess. Okay, So see Bachulinum, as
Speaker 3: you know, an environmental bacteria is probably super old, you know,
Speaker 3: and it doesn't really seem though, to have a long
Speaker 3: evolutionary history with humans because of this more incidental nature
Speaker 3: of infection or impact. But at the same time, it
Speaker 3: has not been a stranger to humans throughout history, like
Speaker 3: probably all of human history. That makes sense, Yeah, I mean, essentially,
Speaker 3: as soon as humans started to try to preserve or
Speaker 3: store food, there were cases or outbreaks of botulism, right,
Speaker 3: and probably honey. Honey's one of the oldest foods in
Speaker 3: the world. Yeah, so infant botulism boom. And so while
Speaker 3: in ancient times people may not have recognized exactly what
Speaker 3: was causing food related paralysis or death that they may
Speaker 3: have seen, it does seem like they took note of
Speaker 3: the foods where it seemed more likely to happen, like
Speaker 3: blood sausages or cured ham or fermented fish.
Speaker 4: Interesting.
Speaker 3: Yeah, let me give you a couple of examples. The
Speaker 3: powder of blood sausage dried under anaerobic conditions appears as
Speaker 3: an ingredient and at least one recipe for a deadly potion. Ooh,
Speaker 3: and Emperor Leo the sixth of Byzantium, who ruled in
Speaker 3: the late ninth and early tenth centuries, just go with it.
Speaker 3: He outlawed blood sausages, like the production of them and
Speaker 3: then whatever.
Speaker 4: And where you get your facts. I just love it.
Speaker 3: But some researchers think that him outlying blood sausages is
Speaker 3: tied to blood sausages being a more common source of botulism. Okay,
Speaker 3: And some descriptions of poisoning with atropine aka belladonna may
Speaker 3: have actually been botulism instead, because they describe a different
Speaker 3: They describe like the consciousness and then like the.
Speaker 4: Full the paralysis. Yeah right, yeah, because you don't get
Speaker 4: that with atropine because it doesn't affect your skeleton muscles,
Speaker 4: right yeah, oh yeah.
Speaker 3: But Si Bachelinum really began to get the widespread recognition
Speaker 3: it deserved. Starting in the late seventeen hundreds, Napoleon had
Speaker 3: been waging his wars all throughout Europe and kind of
Speaker 3: devastating the land. Like these wars devastated the land, there
Speaker 3: was tons of poverty. Hygiene went way down, and particularly
Speaker 3: in Central Europe, and one of the victims of this
Speaker 3: was apparently safety standards in food production. I don't know
Speaker 3: exactly what safety standards were like for food productions downhill, yeah,
Speaker 3: but whatever they were, it just went down from there.
Speaker 3: And so the number of fatal food poisoning cases jumped
Speaker 3: in a region in the southwest of Germany called Apologies
Speaker 3: for the pronunciation Wurtemberg whatever, and in one outbreak in
Speaker 3: seventeen ninety three, thirteen people became sick and six died.
Speaker 4: Wow, And the cases.
Speaker 3: Had won thing in common blood sausages, a blood sausage
Speaker 3: can be many things, but it's generally a pig's stomach
Speaker 3: stuffed with meat, grease, blood, herbs, bread, cereals. Sometimes the
Speaker 3: pigs inerts and it smoked and then boiled and then eaten.
Speaker 3: If you don't boil it long enough, guess what can happen.
Speaker 3: Over the next couple of decades, these reports of fatal
Speaker 3: food poisoning continued to pour in, and the term sausage
Speaker 3: poisoning became the in vogue term to describe them. Okay,
Speaker 3: in a small town in this Wurtemberg region, a twenty
Speaker 3: nine year old medical officer by the name of Justinis Eustinus.
Speaker 3: I'm not sure Kerner had become very interested in this
Speaker 3: sausage poisoning situation. He and he would end up making
Speaker 3: enormous strides in research on sibachulinum even before germ theory
Speaker 3: had been developed. Cool. This is very cool, all right,
Speaker 3: So let's go through his is various discoveries. Number one,
Speaker 3: He began doing his own groundwork on sausage poison in cases,
Speaker 3: and in eighteen twenty he published case reports of seventy
Speaker 3: six patients and the first clinical description of botulism that
Speaker 3: tracks very closely with how it's described today.
Speaker 4: Wow.
Speaker 3: So I'm going to read this and I want you
Speaker 3: to just like, this is eighteen twenty and just say, wow, eron,
Speaker 3: just react for me.
Speaker 4: That's my job during this section anyway, okay.
Speaker 3: Quote, the tear fluid disappears, the gullet becomes a dead
Speaker 3: and motionless tube. In all mucous cavities of the human machine,
Speaker 3: the secretion of the normal mucus stands still from the
Speaker 3: biggest the stomach toward the tier canal and the excratory
Speaker 3: ducts of the lingual glands. No saliva is secreted, No
Speaker 3: drop of wetness is felt in the mouth, No tear
Speaker 3: is secreted anymore, No ear wax appears in the auditory canal. Also,
Speaker 3: signs of drying out of the Eustachian tube become apparent.
Speaker 3: No mucus is secreted in the nose, No more sperma
Speaker 3: is secreted. The testicles decrease. Urination can only be performed
Speaker 3: by standing and with difficulty. Extreme drying out of the palms,
Speaker 3: the souls, and the eyelids occurs.
Speaker 4: That is a great description.
Speaker 3: Yeah, it seems funny.
Speaker 4: I especially loved that he said the human machine machine.
Speaker 4: That is my new favorite term. Oh yeah, no, yeah,
Speaker 4: that's now. I will say that that description could also
Speaker 4: have been Beladona because he didn't really talk about the
Speaker 4: paralysis aspect of the skeleton.
Speaker 3: Muscles he does in others. So that was like an
Speaker 3: excerpt from this yeah. Yeah, and as we'll see, yeah
Speaker 3: he did. He did tons and tons of work, so
Speaker 3: he did like expound more upon the paralysis aspects of it.
Speaker 4: It's a good like you should we should use that
Speaker 4: in school to talk about the effects of the parasympathetic
Speaker 4: nervous system because he did a really good job of
Speaker 4: going through them all.
Speaker 3: Yeah. Nice, yeah, good job Curner. Okay, number two, that's
Speaker 3: only number one. Okay, wow, number two. He didn't stop
Speaker 3: with just describing sausage poisoning. He wanted to understand what
Speaker 3: exactly was causing these symptoms and how so he collected
Speaker 3: the sausages that he suspected were involved in the poisonings
Speaker 3: and he compared their ingredients and the only two commonalities
Speaker 3: he found were salt, which he believed to be innocent,
Speaker 3: and fat. So he came to the conclusion that fat,
Speaker 3: what he called fatty acid, was the cause of this
Speaker 3: sausage poisoning, okay, And so he attempted to isolate this
Speaker 3: fatty acid or sausage poison from these poison sausages and
Speaker 3: conduct some experiments to see if he could recreate the symptoms.
Speaker 3: And so he fed this fatty acid to birds, cats, rabbits, frogs, flies, locusts, snails,
Speaker 3: and so on, and some of these experiences. Yeah, and
Speaker 3: some of these experiments worked like they developed paralysis. And
Speaker 3: he also experimented on himself a few times and described
Speaker 3: what happened there, and then his professor was like, dude,
Speaker 3: what are you doing. Stop doing that. You're going to die.
Speaker 4: Dude, stop doing that.
Speaker 3: Stop doing that.
Speaker 4: Oh my god.
Speaker 3: Yeah, all right, so number three, through these experiments, he
Speaker 3: was able to closely examine the stages of paralysis and
Speaker 3: even develop some hypotheses as to just how the toxin
Speaker 3: causes these symptoms, basically deducing that it was through an
Speaker 3: interruption of the peripheral and autonomic nervous signal transmission. What
Speaker 3: isn't that amazing?
Speaker 4: Wow? That is incredible.
Speaker 3: This is what he wrote. Quote, the nerve conduction is
Speaker 3: brought by the toxin into a condition in which its
Speaker 3: influence on the chemical process of life is interrupted. The
Speaker 3: capacity of nerve conduction is interrupted by the toxin in
Speaker 3: the same way as an electrical conductor by rust.
Speaker 4: One hundred percent in eighteen twenty. Like, this is incredible,
Speaker 4: That is phenomenal.
Speaker 3: You're about to be even more blown away because number four.
Speaker 3: He went on to suggest possible ways to prevent sausage
Speaker 3: poisoning through longer boiling times, through storing the sausage in
Speaker 3: dry in aerobic conditions, and he also suggested a way
Speaker 3: to treat it. He invented an elastic tube that some
Speaker 3: people view as the first gastric tube to make sure
Speaker 3: that his patients got enough nutrition and didn't choke to
Speaker 3: death or didn't aspire it. Yeah. Wow, okay, number five,
Speaker 3: this is the last one. He went on to propose
Speaker 3: that this toxin could be used therapeutically to calm over
Speaker 3: excited nervous systems. He suggested it could be used to
Speaker 3: cure Saint Vitus's dance remember from Dancing plague episodes. Yeah,
Speaker 3: and also some other things which are a little less
Speaker 3: grounded in mechanism, excess sweat, rabies, plague, yellow fever. Again,
Speaker 3: it was pre germ theory days, so you know, we
Speaker 3: can give him a break on that, but it's amazing
Speaker 3: that he would recommend therapeutic applications like one hundred and
Speaker 3: fifty years before they were put into practice.
Speaker 4: Phenomenal amazing.
Speaker 3: Okay, So to recap real quick, Number one, the first
Speaker 3: clinical description, Number two, isolation of the toxin. Number three
Speaker 3: explanation of the mechanism of the toxin. I mean, and
Speaker 3: also number two it's a little handwavy, but he was
Speaker 3: able to actually he tried, he tried. Number three, explanation
Speaker 3: of the mechanism of the toxin. Number four prevention and
Speaker 3: treatment methods, and number five suggestions for therapeutic use.
Speaker 4: Incredible human ingenuity, right there.
Speaker 3: Human ingenuity.
Speaker 4: That is the kind of human that doctor who is
Speaker 4: like all about yeah, yeah, yeah, no exactly anyways, Wow,
Speaker 4: yep wow.
Speaker 3: His work on sausage poisoning earned him a bit of
Speaker 3: notoriety as the leading expert, and he was known as
Speaker 3: vers Kerner sausage Kerner. Also, he was apparently a very
Speaker 3: accomplished poet, especially in his later years. You can read
Speaker 3: his poetry online.
Speaker 4: Very cute.
Speaker 3: Okay, so I've gotten this far in the history of
Speaker 3: Bochulinum toxin se bochulinum, botulism, whatever, And I have yet
Speaker 3: to talk about etymology, Oh, Aaron, uh huh. Bochelism like
Speaker 3: the term bochelism, that it got its official name in
Speaker 3: eighteen seventy and its scientific name for sea Bochelnum in
Speaker 3: eighteen ninety seven, And I'll tell that story in a
Speaker 3: second about that, But first claustride and Bochulinum. Originally it
Speaker 3: was called Bacillis botchulinum basills just basically as you said,
Speaker 3: meaning rod shaped, but it was later renamed Claustridium from
Speaker 3: the Greek cluster meaning spindle because the colonies of bacteria
Speaker 3: in this genus apparently resemble spindles, and Bochulinum from the
Speaker 3: Latin word botulis, meaning sausage.
Speaker 4: Stop it.
Speaker 3: Sausage, sausage.
Speaker 4: Not what I was expecting. But after that story, not surprise,
Speaker 4: sindal sausage, spindle sauce.
Speaker 3: Isn't that incredible?
Speaker 4: That is hilarious sausage. Yeah.
Speaker 3: So, by the late eighteen hundreds, botulism and its association
Speaker 3: with sausages was well known throughout Europe. But it would
Speaker 3: take a funeral with pickled Ham nearly three dozen people
Speaker 3: falling ill and three dead for it to be recognized
Speaker 3: as being caused by bacteria. Ooh. In December of eighteen
Speaker 3: ninety five, in a small town in Belgium, around thirty
Speaker 3: four musicians in the local brass band gathered to play
Speaker 3: at the funeral of eighty seven year old Antoine Creture,
Speaker 3: a town elder. After the funeral was over, they were
Speaker 3: given dinner at the local inn, and this dinner consisted of,
Speaker 3: among other things, smoked or pickled ham. Unfortunately, it hadn't
Speaker 3: been preserved or cured properly, and within a few days
Speaker 3: the entire band began showing signs of botulism. The entire band,
Speaker 3: all thirty four members, all thirty four, three ended up dying.
Speaker 4: Oh dear.
Speaker 3: A microbiologist named Emil Pierre van Ermingham jem Ermine gem
Speaker 3: erminghem I don't know anyway. He was professor at the
Speaker 3: University of Ghent at the time, but he had previously
Speaker 3: worked with Robert Coch and he had caught wind of
Speaker 3: the outbreak. He examined the ham and tissues from those
Speaker 3: who had died and went about looking for microbes, and
Speaker 3: he found them and called them Basillis botulinum. It would
Speaker 3: take nearly another thirty years for the toxin itself to
Speaker 3: be discovered and isolated, but during that time people grew
Speaker 3: to realize that this was certainly not just a disease
Speaker 3: of sausages or ham or fish. It could also come
Speaker 3: from white beans in one of the first canning outbreaks, olives,
Speaker 3: or basically anything. Cases of botulism continued to rise as
Speaker 3: the technology to can or preserve food continued to develop
Speaker 3: into the twentieth century, and both commercial and home canning
Speaker 3: or food preservation carried risks of botulism, and it took many,
Speaker 3: many outbreaks, both from mass produced cans and home canned
Speaker 3: foods for people to gain an understanding of the techniques
Speaker 3: you had to use to properly prevent bosulism from happening
Speaker 3: or the toxin from developing. Right, and because treatment for
Speaker 3: a good portion of this history was not an option,
Speaker 3: like we didn't have the anti toxin until relatively recently,
Speaker 3: I think the past few decades.
Speaker 4: Would just be supportive care in that case, then yeah,
Speaker 4: m hm, okay.
Speaker 3: So in eighteen twenty at the University of California, a
Speaker 3: researcher named doctor Hermann Summer was finally able to isolate
Speaker 3: a bochelnem toxin type A if you're interested, makes sense
Speaker 3: that it was a So it was the first one.
Speaker 3: An additional research showed it to be the most toxic
Speaker 3: substance known to humans, as we discussed earlier. So why
Speaker 3: do you think this research was being conducted. Why were
Speaker 3: people interested in bachelism?
Speaker 4: Oh, I don't know, maybe like biowarfare or something like that.
Speaker 1: There you go.
Speaker 3: Yeah, so it was probably a good thing that it
Speaker 3: was isolated, that the toxin was isolated a couple of
Speaker 3: years after World War One ended. Oh dear, But guess
Speaker 3: what was just around the corner World War two? Not
Speaker 3: that World War Two was exactly looming on the horizon
Speaker 3: in nineteen twenty, but you know it kind of whatever,
Speaker 3: there was always, you know, a reason to be able
Speaker 3: to produce a bio weapon, right, So the US Army
Speaker 3: Biological Warfare Laboratories at Fort Dietrich in Maryland had a
Speaker 3: special interest in developing bochelism or bochulnum tocsin as a
Speaker 3: weapon to use in the war during World War II,
Speaker 3: and supposedly, supposedly they had even developed a plan to
Speaker 3: try that out that involved having people assassinate high ranking
Speaker 3: officers in the Japanese Army by dropping a gelatin capsule
Speaker 3: containing bachulinum toxin into their food or drink. WHOA. The
Speaker 3: plan was abandoned when the capsules were tried out on
Speaker 3: donkeys and had no effect.
Speaker 4: They didn't make a good enough capsule or something.
Speaker 3: I well, So one of the hypotheses is that donkeys
Speaker 3: are in immune to botch lineum toxin, but that seems
Speaker 3: to be really debated, and so it just seems unclear
Speaker 3: what interesting. Yeah, In any case, botch lineum toxin was
Speaker 3: abandoned as a bioweapon for a lot of the same
Speaker 3: reasons that ricin was abandoned. If you remember in that episode,
Speaker 3: it doesn't spread person a person, the dosage is hard
Speaker 3: to control, it's easily inactivated, and it now can be treated.
Speaker 3: So you know, in terms of a bioweapon, it's not great.
Speaker 4: It also like it it's not super fast acting. I
Speaker 4: don't know if that's a good thing or a bad
Speaker 4: thing in terms of bioweapons. I've never I don't know
Speaker 4: what the objective is, like to terrorize people. Then you know,
Speaker 4: then it's not that great.
Speaker 3: Yeah, And now you know Fort Dietrich is now all
Speaker 3: about biodefense rather than offense. So anyway, it was abandoned. Okay,
Speaker 3: So in keeping with the theme of poisons that we
Speaker 3: usually use for these types of for those crossover episodes
Speaker 3: that we take, I think it's time to chat about
Speaker 3: the other side of the coin.
Speaker 4: Yes, the other side of the can, the other side
Speaker 4: of the can. Okay, they tell me about it, okay.
Speaker 4: Bochulenum toxin in therapeutics, so Kerner suggested it in eighteen twenty,
Speaker 4: way ahead of the game, way ahead of the game.
Speaker 3: But it wasn't until the nineteen sixties or nineteen seventies
Speaker 3: that it was developed for treatment purposes.
Speaker 4: Cool.
Speaker 3: The first pilot study of type A botchelinum toxin to
Speaker 3: treat strabismus in humans basically cross eyedness, right.
Speaker 4: Yeah, misalignment of your eyes.
Speaker 3: Here we go. This first study was done in nineteen
Speaker 3: seventy eight and was shown to be effective. The FDA
Speaker 3: approved its use a year later. Cool, and that really
Speaker 3: opened the door for doctors to use it to treat
Speaker 3: all kinds of involuntary muscle contractions. Yeah, and Aaron, I'm
Speaker 3: sure you're going to talk more about what those treatments are.
Speaker 3: Absolutely in the next section. But before we get to that,
Speaker 3: we have one more little piece of business to cover,
Speaker 3: the botox business. To be precise, how did this begin?
Speaker 3: So let's head to nineteen eighty seven. Okay, Botulinum toxin
Speaker 3: had been used for these various things about ten years
Speaker 3: at that point, and an ophtalmologist named doctor Gene Carruthers
Speaker 3: had been shooting bochulinum toxin into her patients to treat
Speaker 3: abnormal involuntary blinking. Do you know what the technical terms
Speaker 3: for that?
Speaker 4: God, I feel like I should so to the b
Speaker 4: ends in spasm, oh, blarfospasm or something.
Speaker 3: Yeah, blufferospasm. It's a very awkward sounding word.
Speaker 4: It really is. Yeah.
Speaker 3: So she noticed that when she did this, when she
Speaker 3: injected this botulinum toxin into her patients near their eyes,
Speaker 3: their frown lines disappeared, some of the wrinkles around their
Speaker 3: eyes disappeared. So she went home and mentioned it to
Speaker 3: her husband, who happened to be a dermatologist. Oh, and
Speaker 3: they were like, holy cow, we just stumbled upon what
Speaker 3: might be the most revolutionary cosmetic procedure yet.
Speaker 4: Yep.
Speaker 3: And they worked on it for about ten years before
Speaker 3: publishing their first report in nineteen ninety six, and since
Speaker 3: then it has become, perhaps and you'll maybe talk more
Speaker 3: about this, perhaps the most widespread and profitable cosmetic treatment
Speaker 3: by far.
Speaker 4: So absolutely, that's kind.
Speaker 3: Of where my story ends from sausage poisoning to wrinkle
Speaker 3: reducing the glorious story of Clastidium bachelino.
Speaker 4: Wow, that is so fun. Isn't that fun?
Speaker 3: Migratory birds, blood sausages?
Speaker 4: What a like? What an interesting story?
Speaker 3: Do you see it? Where I was like, so, it's
Speaker 3: like one of my favorites. It just feels, you know,
Speaker 3: I don't know, it's very satisfying.
Speaker 4: The whole satisfying. It is so fun.
Speaker 3: And there's a lot too, Like, you know, I didn't
Speaker 3: mention sort of the food outbreaks that have happened throughout
Speaker 3: the twentieth century, because there have been a lot, but
Speaker 3: I didn't go into detail on those, but I will
Speaker 3: say there have been many.
Speaker 4: Yeah, So let's talk about where we stand with botulism
Speaker 4: and clusterating bochulatum today.
Speaker 5: Let's take a quick break.
Speaker 4: So let's talk first just about kind of the depressing
Speaker 4: botulism part of it and get that out of the
Speaker 4: way so we can end on happy notes. Okay, yeah, Okay,
Speaker 4: So in twenty seventeen in the United States, like I
Speaker 4: mentioned already when you asked, there were one hundred and
Speaker 4: eighty two laboratory confirmed cases of botulism reported to the CDC.
Speaker 4: Botulism is a reportable illness because it is very rare
Speaker 4: and serious. Most of those the vast majority, and this
Speaker 4: has been true, like at least since the eighties, the
Speaker 4: vast majority of botulism cases are infant botulism. So like
Speaker 4: seventy to eighty percent of all cases of botulism in
Speaker 4: the US are infant botulism, about ten percent are food born,
Speaker 4: or at least in twenty seventeen they were, and about
Speaker 4: ten percent were wound botulism. Okay, there were at least
Speaker 4: in twenty seventeen three classified as other. So two of
Speaker 4: them were iatrogenic, so they somehow got infected through like
Speaker 4: hospital procedures or something like that, and then one was
Speaker 4: suspected adult intestinal colonization, which I mentioned can happen but
Speaker 4: is of course exceedingly rare. Cool, yes, and so I
Speaker 4: don't really have a lot of details on like these
Speaker 4: are the foods that are most common to cause botulism,
Speaker 4: because I just don't really find it that interesting. Like,
Speaker 4: in theory, almost any canned food, if it doesn't have
Speaker 4: enough acid in it can be a medium for Claustridium
Speaker 4: bochulinum to grow, right, therefore, could put you at risk.
Speaker 3: It's like, there's like a decent temperature range and a
Speaker 3: decent pH range where this bacterium can reproduce under anaerobic conditions,
Speaker 3: and so.
Speaker 4: You can google that and then if you're gonna can food,
Speaker 4: just do it properly. That's fine, no big deal. But anyways,
Speaker 4: it's you know, it is still possible. It absolutely still happens,
Speaker 4: but the vast majority of cases are infant botulism, and
Speaker 4: most of those are from honey. So uh yeah, Okay,
Speaker 4: So let's talk about the more interesting and kind of
Speaker 4: fun cool aspects of botulinum toxin, and that is all
Speaker 4: the different ways that we use it currently. Okay. Botulinum
Speaker 4: toxin is used medically to treat a lot of different dystonias,
Speaker 4: which is what you mentioned aaron A. Dystonia is inappropriate
Speaker 4: muscle contractions, and these can be really really painful. So
Speaker 4: one of the most common uses for botulism is to
Speaker 4: treat cervical dystonia, which is a contraction of your neck
Speaker 4: muscles that can be really, really painful. It's also used
Speaker 4: to treat laryngial dystonia, so contraction of your larynx that's inappropriate.
Speaker 4: It has been used to treat tremors, certain types of tremors.
Speaker 4: It's often used in the treatment of cerebral palsy, which
Speaker 4: is you have a lot of inappropriate contraction in cerebral palsy. Interestingly,
Speaker 4: it's more recently been used to treat headaches, both migraine
Speaker 4: headaches and chronic like contraction like muscle type headaches. I
Speaker 4: saw that how how does that work? It's such a
Speaker 4: good question. We don't really know because from what I
Speaker 4: understand the there have been a number of studies, although
Speaker 4: not a ton, but a number of studies, like placebo
Speaker 4: controlled studies that show that injection of botox like in
Speaker 4: your like pair of vertebrals, like a near your cervical vertebrae,
Speaker 4: is more effective than place ebo in treating chronic headaches.
Speaker 4: But when they have tested like whether you're muscles like
Speaker 4: whether you can still have pain conduction that is intact
Speaker 4: and it's the same as placebo, so they don't actually
Speaker 4: understand what the mechanism is that is relieving these headaches.
Speaker 4: But we also don't really understand what causes a lot
Speaker 4: of headaches.
Speaker 3: That's what I was going to say. We don't really
Speaker 3: know about headaches and migraines. That's very especially migraines. Yeah,
Speaker 3: it's very interesting. And they just discovered this by accident.
Speaker 4: No, I think it was because a lot of the
Speaker 4: a lot of treatments for migraines have to do with
Speaker 4: like vascular dilation and things like that, so like and
Speaker 4: a lot of you can achieve that type of dilation
Speaker 4: by relaxing the muscles around the blood vessels as well.
Speaker 4: So I don't know if they if that was the
Speaker 4: thought process behind it. But also not just it's not
Speaker 4: just migraine headaches, it's other tension headaches as well, which
Speaker 4: is not Maybe that has to do with you know,
Speaker 4: muscle tension right right.
Speaker 3: Right, that's so interesting.
Speaker 4: Also going still in your head and neck area, TMJ
Speaker 4: has been treated with botox, I know. I was like,
Speaker 4: can I get some of that? Anyways, you mentioned the
Speaker 4: that it was suggested to be treated for a sessive
Speaker 4: sweating that is actually a use of botox today. Yeah,
Speaker 4: so hyperhedrosis, which is excessive sweat, you can treat that
Speaker 4: with botox.
Speaker 3: Kurder got one thing right, he sure did.
Speaker 4: I have to tell you this is really fun. I
Speaker 4: have injected botox into someone ooh me personally. I have
Speaker 4: injected botox into the detruser muscle of the bladder during
Speaker 4: my obie gine rotation.
Speaker 3: That's exciting.
Speaker 4: So this is a treatment for overactive bladder.
Speaker 3: Oh that makes sense.
Speaker 4: Uh huh, yeah, you relax that muscle. I want to
Speaker 4: say that the physician that was doing the surgery actually
Speaker 4: stuck the needle in and was guiding the camera. I
Speaker 4: literally just pushed the plunger. So I was very well
Speaker 4: supervised in doing this. So yeah, there are a lot
Speaker 4: of different ways that botox is one of the uh
Speaker 4: like trade names I guess.
Speaker 3: For registered or copyrighted or trademarked or whatever.
Speaker 4: Yeah, there's a whole bunch of different forms of it.
Speaker 4: There's so in addition to botox, which was the first one,
Speaker 4: there's one called die Sport that's actually a type B
Speaker 4: toxin where botox is type A. There's myoblock, there's neuroblock.
Speaker 4: There's a brand in China called Hengley. There's a lot
Speaker 4: of different types, but botox was like the first that
Speaker 4: was commercially available bochulinum toxin. Right, Okay, so then let's
Speaker 4: talk about botox because when you hear botox, you think of.
Speaker 3: Face injections for wrinkle reducing.
Speaker 4: Yes, you think of face injections wrinkle reducing botox. And
Speaker 4: this is absolutely, without a doubt, not only the most
Speaker 4: common use of botox but also or of bochulinum toxin,
Speaker 4: but also the most common cosmetic procedure by far. So
Speaker 4: according to the twenty eighteen Plastic Surgery Statistics Report put
Speaker 4: out by the American Society of Plastic Surgeons, there were
Speaker 4: in twenty eighteen over seven million botox procedures. Wow, isn't
Speaker 4: that amazing?
Speaker 3: Yeah, that's a lot.
Speaker 2: That's a lot.
Speaker 3: That's a lot of procedures.
Speaker 4: It is by far the most common minimally invasive cosmetic procedure.
Speaker 4: And this has grown a ton. So it was licensed
Speaker 4: by the FDA for cosmetic use in two thousand and two,
Speaker 4: and it's increased in like popularity and demand like over
Speaker 4: seven hundred and fifty percent in like twenty years. Yeah,
Speaker 4: so it's just on the rise because At first, when
Speaker 4: I was looking up statistics on how man any people
Speaker 4: get botox or how many botox procedures, this is not
Speaker 4: people who get botox. This is botox procedures. In twenty fourteen,
Speaker 4: it was like six million that they estimated, So now
Speaker 4: we can see in twenty eighteen it was over seven million,
Speaker 4: close to eight million. Actually, gotcha, gotcha, seven and a
Speaker 4: half million. So yeah, it just it it's really really increasing,
Speaker 4: which is it's fascinating. So I want to talk about
Speaker 4: a few things having to do with botox. Okay, So
Speaker 4: the reason that botox works to reduce your wrinkles is
Speaker 4: because you inject a very small, very very small, very
Speaker 4: dilute amount directly into the muscles, and that toxin is
Speaker 4: going to affect the neuromuscular junction. It's going to block
Speaker 4: the release of acetylcholine, and it's going to cause those
Speaker 4: muscles that are innervated by those nerves to relax. Ok
Speaker 4: And if you have relaxed muscles, then you're not going
Speaker 4: to have the appearance of wrinkles because those are caused
Speaker 4: by muscles contracting in different ways. Okay, However, even though
Speaker 4: botulinum toxin binds irreversibly to those nerve terminals. Eventually your
Speaker 4: body regenerates the ability to release the seedle colin. So
Speaker 4: eventually you're going to have movement of those muscles again
Speaker 4: when your body is able to kind of work around
Speaker 4: the fact that those have been blocked by botulinum toxin.
Speaker 4: Does that make sense, Yeah, So the effects of botox
Speaker 4: or botulinum toxin don't last forever, which is why you
Speaker 4: have to re up your botox every however many months,
Speaker 4: and it depends you know, how much you inject and
Speaker 4: also just person to person variation how often that is
Speaker 4: going to be. The other thing I want to say
Speaker 4: is that because so this is a but obviously a
Speaker 4: very very very potent toxin. This is a drug that
Speaker 4: is highly regulated. I found at least one paper that
Speaker 4: I don't think was legit that was like someone collapsed
Speaker 4: and died in a beauty salon after botox injection. And
Speaker 4: I just want to say that, like, even if someone
Speaker 4: were to die from getting too much botox, because in
Speaker 4: theory that is of course possible, because it's a very
Speaker 4: deadly toxic.
Speaker 3: Getting too much botox is in too much botulinum toxin, right,
Speaker 3: not the treatment.
Speaker 4: Yeah, yeah, yeah, exactly too, like inappropriate use of botulinum
Speaker 4: toxin rejection, not just like you know, Huan a little
Speaker 4: heavy or whatever. Uh, you wouldn't die right away, right,
Speaker 4: That's not how botulinum toxin works. You wouldn't just collapse
Speaker 4: and die.
Speaker 3: Yeah.
Speaker 4: Even the effects of botox take time to work. That
Speaker 4: it's not something that happens automatically. This isn't a toxin
Speaker 4: that just like blocks all of your nerve signals and
Speaker 4: kills you right away or anything like that. That's not
Speaker 4: the mechanism of how you would die from bachulanum toxin
Speaker 4: to begin with. So if you ever see something like that,
Speaker 4: that's not real. That's not how it works. And I
Speaker 4: found it on a cursory search, So I feel like
Speaker 4: I need to put that out there. But it's very
Speaker 4: it's very interesting. I think it's it's very fascinating that
Speaker 4: we have so many uses for something that is so deadly.
Speaker 4: It's so cool.
Speaker 3: It's so cool. I think it's amazing. I mean, it's
Speaker 3: just more of those like I don't know, being very
Speaker 3: innovative with h and open minded in terms of like
Speaker 3: what can we do and then and also testing it
Speaker 3: out in like very regulated ways and sort of letting
Speaker 3: it build upon what we see.
Speaker 4: Yeah.
Speaker 3: Absolutely amazing. Yeah, I feel like this is such a
Speaker 3: big like, this topic is so much bigger than I
Speaker 3: thought it was going to be starting out.
Speaker 4: Yeah, and it's so much more fun. Like, I mean,
Speaker 4: bochelism poisoning is really depressing, but of course, but the
Speaker 4: overall story of Clostridium bochulinum and of bochulinum toxin is
Speaker 4: fascinating and fun.
Speaker 3: It's so interesting. It's just so interesting.
Speaker 4: Yeah, I love it.
Speaker 2: Cool.
Speaker 3: Okay, Well, sources sources, I have a bunch, but I
Speaker 3: want to highlight a few that I really enjoyed or
Speaker 3: relied heavily on. The first is a chapter called avian
Speaker 3: botchulism in a book titled Infectious Diseases of wild Birds,
Speaker 3: and the other one someone named HERB. Guth Okay wrote many,
Speaker 3: many papers on the history of bochulism, and so there
Speaker 3: are several of those. One that I'll call it in
Speaker 3: particular was from two thousand and eight. And then another
Speaker 3: paper about sort of the why of bochulism is by
Speaker 3: Mansfield and Doxy from twenty eighteen. It's titled Genomic Insights
Speaker 3: into the evolution and ecology of Botchulinum neurotoxins. And then
Speaker 3: finally Montecuco and Risotto from twenty fifteen titled on Botchulinum
Speaker 3: neurotoxin Variability awesome.
Speaker 4: I have a couple really in depth papers on the
Speaker 4: toxin of clushrity and botchulinum, especially if you want to
Speaker 4: know more about all the different types because there are
Speaker 4: a lot of different types of this toxin. Those are
Speaker 4: old papers, but they're still valid. There's a nice clinical
Speaker 4: infectious diseases paper just titled botulism that I used if
Speaker 4: you want to know kind of about the disease syndrome
Speaker 4: of botulism. And then a few other papers that I'll
Speaker 4: put up about kind of Boulis botchulinum toxin use in
Speaker 4: clinical scenarios. So yeah, all right.
Speaker 3: As that it. I think that's.
Speaker 4: It, so wow cool. Thank you to Bloodmobile for providing
Speaker 4: our quarantine title and the music for this episode in
Speaker 4: all of our episodes.
Speaker 3: And thank you to you listeners for listening. And also
Speaker 3: we want to especially thank everyone who keeps jumping on
Speaker 3: the quarantiny posts and stuff and saying tpwkhy did it first?
Speaker 4: We love you, We really do. I get a warm
Speaker 4: feeling in my heart every time I see.
Speaker 3: Those me too. Also, it came to our attention that
Speaker 3: apparently we didn't really do it first, that it was
Speaker 3: on an episode of Scrubs. But I genuinely like, I
Speaker 3: haven't watched that show, and so.
Speaker 4: And you like, definitely, I we thought that you came
Speaker 4: up with it, so like in our hearts, we yeah, we.
Speaker 3: Tried, so, you know, I mean, I think that just
Speaker 3: goes to show that there's nothing new, ever invented ever
Speaker 3: so ever, that's fine by us.
Speaker 4: Except photox that first time. Except verst Contra did it first.
Speaker 3: What was his name vers versed Kerner.
Speaker 4: Verse Curner, He did it first.
Speaker 3: The sausage King s.
Speaker 4: Okay, well, good lord, with that, wash your hands, you
Speaker 4: filthy animals.
Speaker 2: Mm hmmm