WEBVTT - Ep 48 Botulism: Why are you the way you are? 0:00:01.120 --> 0:00:04.640 Hi, I'm Georgia Hardstark and I co host the podcast 0:00:04.720 --> 0:00:05.720 My Favorite Murder. 0:00:06.200 --> 0:00:09.320 And uh, of course I had heard about botox for years. 0:00:09.360 --> 0:00:12.640 I think everyone you know knew about it, knew what 0:00:12.680 --> 0:00:15.960 it was, and it didn't even cross my mind until 0:00:16.640 --> 0:00:18.520 I had a friend who got it done and she 0:00:18.720 --> 0:00:20.720 was you know, we were both in our mid thirties, 0:00:20.880 --> 0:00:23.319 so you're thinking like, well, I don't need it yet, 0:00:24.600 --> 0:00:28.360 and then I saw her face and it looked it's 0:00:28.440 --> 0:00:31.720 just you know, she didn't She looked awake. I guess 0:00:31.840 --> 0:00:34.720 was the thing that really hit struck me. And then 0:00:34.760 --> 0:00:38.640 I was in this really cool, like secret Los Angeles 0:00:38.720 --> 0:00:43.279 Ladies Facebook group and they all got it done, and 0:00:43.320 --> 0:00:46.000 so I kept like it normalized it for me and 0:00:46.040 --> 0:00:48.040 we were all you know, they were there from their 0:00:48.040 --> 0:00:51.239 mid twenties to thirties to forties. It was all ages, 0:00:51.920 --> 0:00:53.920 so it didn't suddenly feel like this thing that only 0:00:54.120 --> 0:00:55.760 you know, you had to get when you were older 0:00:55.800 --> 0:00:58.720 and already you know, having issues. 0:00:59.280 --> 0:01:00.920 The way I read it about it was that it 0:01:00.960 --> 0:01:03.840 was preventative, which I found really interesting. 0:01:03.840 --> 0:01:08.120 Because you know, the less you're making the furrowing your 0:01:08.120 --> 0:01:11.319 brows and making those creases, the less the lines are 0:01:11.319 --> 0:01:12.360 going to stick around. 0:01:12.800 --> 0:01:13.720 And I was really. 0:01:13.520 --> 0:01:16.679 Nervous because it's you know, I had to get past 0:01:16.760 --> 0:01:21.639 feeling vain about it, which I think is a normal thought. 0:01:22.120 --> 0:01:24.399 And then I, you know, I just. 0:01:24.400 --> 0:01:28.480 Realized there were these little things about my you know, 0:01:28.520 --> 0:01:29.840 wrinkles that were bothering me. 0:01:29.920 --> 0:01:31.840 And I think that's the main thing, is like it's. 0:01:31.680 --> 0:01:35.760 Not for everyone, and everyone and wrinkles are beautiful and 0:01:35.800 --> 0:01:38.000 not everyone you know, is going to want to do it, 0:01:38.040 --> 0:01:40.400 and I think that's totally fair. But I think if 0:01:40.400 --> 0:01:43.800 it's for me, it's like a simple fix that will 0:01:43.800 --> 0:01:47.200 make me just feel a little more confident, you know, 0:01:47.360 --> 0:01:50.960 which is a big, huge plus for me. So you know, 0:01:50.960 --> 0:01:52.760 it's not going to change your face, not going to 0:01:52.880 --> 0:01:58.320 change your life, but you know, yeah, So so I went. 0:01:58.440 --> 0:02:00.400 It was and I got it the first time right 0:02:00.440 --> 0:02:03.640 before mine, Evince's wedding, so it was like thirty five 0:02:03.760 --> 0:02:07.920 or thirty six, and I was super nervous. I was 0:02:07.920 --> 0:02:10.000 gonna I was scared I was going to completely change 0:02:10.000 --> 0:02:13.120 my face. You know, it's a little needle, so of 0:02:13.160 --> 0:02:15.880 course it's not going to feel good. And then you know, 0:02:15.919 --> 0:02:18.280 they poke it in and so do you want to 0:02:18.320 --> 0:02:20.160 do a lot of little spots. You don't just do 0:02:20.200 --> 0:02:22.680 it in one spot. And I get it done in 0:02:22.880 --> 0:02:29.280 my forehead and between my eyebrows and on my smile lines, 0:02:29.840 --> 0:02:33.280 and so you get it's a couple different pokes, like 0:02:33.360 --> 0:02:38.440 maybe I think mine are like twelve pokes total, and 0:02:38.480 --> 0:02:40.959 you can kind of it's really gross. You can kind 0:02:41.000 --> 0:02:44.560 of hear when they're injecting it. It's like a sqush 0:02:44.760 --> 0:02:47.800 in like your inner ear. You can hear it. That's 0:02:47.840 --> 0:02:53.000 the only horrible part. Yeah, it doesn't it hurts because 0:02:53.000 --> 0:02:55.080 it's a needle, But I feel like with that and 0:02:55.120 --> 0:02:58.240 like tattoos, when you're excited about what you're doing, it 0:02:58.280 --> 0:03:00.120 doesn't hurt as bad. And they give you a you know, 0:03:00.160 --> 0:03:02.960 a stress ball to squeeze, and it's over so quickly, 0:03:03.680 --> 0:03:06.680 and you know, it's just part of it. If you 0:03:06.880 --> 0:03:09.400 if you're totally afraid of needles, obviously you're not gonna 0:03:09.960 --> 0:03:12.840 want to do it. But and it takes like two 0:03:12.919 --> 0:03:16.640 weeks to start showing up, so it's kind of good 0:03:16.639 --> 0:03:17.399 that it's. 0:03:17.120 --> 0:03:18.000 Slow and subtle. 0:03:18.000 --> 0:03:22.280 It's not this like right away change. And so when 0:03:22.320 --> 0:03:25.400 I finally, you know, no one knew that I had 0:03:25.400 --> 0:03:27.760 gotten it done. None of my even my closest friends 0:03:28.160 --> 0:03:32.520 hadn't known. So when I finally told, like my best friend, 0:03:32.919 --> 0:03:36.240 she was shocked and she was like, now that you're 0:03:36.280 --> 0:03:38.680 saying it, I see it. And I was like, I 0:03:38.720 --> 0:03:42.200 look like I'm thirty again, and she's she blurted, you 0:03:42.240 --> 0:03:47.800 look better than that, and I was like, Okay, I 0:03:47.920 --> 0:03:48.280 like this. 0:04:33.120 --> 0:04:36.359 Well, that was one of the most exciting things to 0:04:36.480 --> 0:04:40.640 ever happen. Absolutely thrilling. Thank you so much, Georgia for 0:04:40.760 --> 0:04:43.200 being a part of this and sharing your story and 0:04:43.279 --> 0:04:48.360 wealth of knowledge. Yes, thank you, thank you. That was thrilling. 0:04:48.720 --> 0:04:54.920 Oh my gosh, uh huh, and much more uplifting than 0:04:55.480 --> 0:05:00.159 other first hand accounts of the subject of today's episode, which. 0:05:00.000 --> 0:05:08.039 Which is botchelism bochelism, well like batchulinum toxin sure, Clasterdium botulinum. 0:05:08.080 --> 0:05:09.240 How about that ye have about? 0:05:10.360 --> 0:05:14.240 Hi? I'm Aaron Welsh and I'm Erin Alman Updike and this. 0:05:14.200 --> 0:05:16.799 Is this podcast will kill you today. 0:05:16.839 --> 0:05:20.119 We're talking you know what we're talking boche line. 0:05:25.320 --> 0:05:29.359 Well, we have a couple of pieces of business to 0:05:29.520 --> 0:05:32.440 get into before we start this episode, which I know 0:05:32.480 --> 0:05:35.080 we say this all the time, but I am so 0:05:35.440 --> 0:05:39.600 excited for this. It got to the point where I 0:05:39.680 --> 0:05:41.520 was telling, because I know I didn't want to tell 0:05:41.560 --> 0:05:44.159 you the things I was learning yet. But I was 0:05:44.200 --> 0:05:47.560 like texting everyone else like, oh my gosh. 0:05:47.120 --> 0:05:49.640 No, yeah, I do the same thing. Ye yesterday, I 0:05:49.680 --> 0:05:51.960 was like Brett, did you know? And I just like 0:05:52.000 --> 0:05:54.640 started shouting botox facts at him. 0:05:55.480 --> 0:05:58.839 Yeah. Well, I'm glad that we finally get to lit 0:05:58.880 --> 0:06:00.600 it all off our chests. Me too. 0:06:00.920 --> 0:06:02.960 It's going to be It's gonna be a good one. 0:06:02.839 --> 0:06:03.160 I think. 0:06:03.200 --> 0:06:03.279 So. 0:06:04.160 --> 0:06:08.280 Okay, So, like I said, though, some business Number one 0:06:08.800 --> 0:06:12.919 is that we are going to keep doing these regularly 0:06:13.080 --> 0:06:19.040 scheduled episodes or whatever, and we are going to keep 0:06:19.080 --> 0:06:20.400 them COVID free. 0:06:20.839 --> 0:06:23.520 We are COVID. This is a COVID free zone right now. 0:06:23.600 --> 0:06:26.640 Yeah, so we promise we won't even say it after 0:06:26.640 --> 0:06:30.320 too many more times and so and so what we're 0:06:30.320 --> 0:06:32.880 doing is is, as you may have seen in your feed, 0:06:33.000 --> 0:06:36.840 we're going to keep dropping those COVID nineteen episodes every 0:06:36.880 --> 0:06:40.040 so often, just on a We don't really have a 0:06:40.080 --> 0:06:41.080 particular schedule for. 0:06:41.040 --> 0:06:44.520 That's just whenever they happen. Happen, but in order. 0:06:44.560 --> 0:06:47.440 But we also recognize that people may not want to 0:06:47.520 --> 0:06:50.200 hear about what's going on or it might be too 0:06:50.240 --> 0:06:52.440 stressful or whatever, and we totally get that, and so 0:06:53.080 --> 0:06:57.760 all of these normal episodes will just be normal normal episodes. 0:06:59.000 --> 0:06:59.320 Jinks. 0:07:00.080 --> 0:07:02.080 So okay, all. 0:07:02.080 --> 0:07:02.600 Right, all right. 0:07:03.120 --> 0:07:07.880 Number two, we have now joined the affiliate program of 0:07:08.000 --> 0:07:11.440 this organization called bookshop dot org. And so what this 0:07:11.640 --> 0:07:15.320 is is it's a website that it's an online bookstore 0:07:15.440 --> 0:07:20.760 website that works with independent bookstores. And so as an affiliate, 0:07:20.800 --> 0:07:24.000 we have a page where you can see our lists 0:07:24.080 --> 0:07:28.400 that we have curated for what books, you know, nonfiction books, 0:07:28.400 --> 0:07:32.360 fiction books, memoirs about disease and about health and stuff 0:07:32.400 --> 0:07:34.600 like that. And so if you are so interested, you 0:07:34.640 --> 0:07:37.160 could go on our website under the books tab and 0:07:37.200 --> 0:07:40.280 you'll find a link to bookshop dot org. And also 0:07:40.480 --> 0:07:44.480 we have links in each of our uh so, in 0:07:44.520 --> 0:07:46.800 each of our episodes where we list our sources, we 0:07:46.840 --> 0:07:52.520 will provide links to those books on bookshop if they 0:07:52.680 --> 0:07:53.600 exist there. 0:07:54.040 --> 0:07:54.320 Cool. 0:07:55.120 --> 0:07:55.440 Cool. 0:07:56.240 --> 0:07:59.080 One other piece of business, if you are not aware yet, 0:07:59.280 --> 0:08:03.240 we have now alcohol free episodes available on our website 0:08:03.280 --> 0:08:05.640 if you'd like to use those for whatever reason, if 0:08:05.680 --> 0:08:07.960 you don't want to hear us talk about quarantinies, you 0:08:08.000 --> 0:08:10.960 can find those on our website yep. 0:08:11.440 --> 0:08:11.720 Cool. 0:08:11.760 --> 0:08:14.160 Speaking of quarantinies. 0:08:13.680 --> 0:08:15.960 It's quarantiny time, it is. 0:08:17.080 --> 0:08:18.640 What are we drinking this week? 0:08:19.000 --> 0:08:28.760 This week we're drinking can of Germs. 0:08:26.000 --> 0:08:29.600 And we have a big thank you to Bloodmobile for 0:08:29.640 --> 0:08:32.480 providing that's the quarantine. 0:08:31.960 --> 0:08:34.720 Name for this episode and all of our episode. Just 0:08:34.760 --> 0:08:38.679 kidding a lot of our episodes though, Ah, thank. 0:08:38.520 --> 0:08:40.679 You Bloodmobile slash Daniel my brother. 0:08:42.200 --> 0:08:47.679 Really that's a phenomenal drink name. Can of Germs from watchlism. 0:08:48.240 --> 0:08:53.120 Oh my god, what is in can of germs? It 0:08:53.280 --> 0:09:00.320 is rum canned pineapple of course, honey. Also, of course 0:09:00.320 --> 0:09:03.760 we'll talk about it and lime juice. 0:09:04.960 --> 0:09:06.640 Yeah, it's pretty good. 0:09:06.800 --> 0:09:09.480 It's pretty good. Actually, yeah, it's not bad. 0:09:10.320 --> 0:09:11.200 So awesome? 0:09:11.520 --> 0:09:14.959 All right, then anything else or can we just get 0:09:15.000 --> 0:09:16.280 into this episode, Erin. 0:09:16.640 --> 0:09:18.840 Let's get into the episode please? 0:09:19.360 --> 0:09:53.480 Awesome right after this break. So when we talk about botchelism, 0:09:53.520 --> 0:09:58.600 when we talk about bocheln, botox, whatever, we're talking about 0:09:58.640 --> 0:10:04.200 a specific pathogen that I'm very excited, Erin, for you 0:10:04.240 --> 0:10:06.360 to tell me about where this pathogen came from, because 0:10:06.360 --> 0:10:08.480 you specifically told me not to look that up. 0:10:08.920 --> 0:10:11.280 Oh, I was very adamant, like, don't read about this. 0:10:11.679 --> 0:10:15.560 I didn't read them at all all caps text. You're 0:10:15.559 --> 0:10:16.800 not gonna talk about this, are you. 0:10:17.160 --> 0:10:20.040 Nope, I am not. But we will talk a little 0:10:20.080 --> 0:10:23.920 bit about the bacterium itself. So this bacterium is called 0:10:24.000 --> 0:10:30.439 Clostridium botulinum. You may have heard the term clustridium if 0:10:30.440 --> 0:10:35.439 you've ever heard of, for example, Claustridium difficile see diff Yeah, 0:10:35.480 --> 0:10:38.359 a lot of people probably have. This is another Claustridium 0:10:38.360 --> 0:10:43.680 species that causes disease in humans. It causes massive, very 0:10:43.720 --> 0:10:47.559 serious diarrhea. It's a pathogen of pretty big concern, especially 0:10:47.559 --> 0:10:53.360 in hospitals. So Claustridium botulinum is another bacterium in the 0:10:53.440 --> 0:10:59.600 same genus. These Claustridium species are gram positive, which means 0:10:59.640 --> 0:11:03.280 they stay purple when you look at them under a microscope. 0:11:04.240 --> 0:11:07.160 That's what we always say on this podcast. It means 0:11:07.160 --> 0:11:12.760 that they have a thick cell wall. Okay. Clusterdium species 0:11:13.000 --> 0:11:17.320 are rod shaped, so they look like little tic TACs. Okay, 0:11:18.520 --> 0:11:23.839 and very importantly, they are what we call spore forming anaerobes. 0:11:24.520 --> 0:11:27.360 It's a lot of technical terms. Let's talk about what 0:11:27.360 --> 0:11:32.800 they mean. So anaerobe means that this is a bacteria 0:11:32.920 --> 0:11:38.520 that grows and lives without any oxygen. Okay, that's really important. 0:11:38.760 --> 0:11:41.240 So it can't just grow like on your table out 0:11:41.280 --> 0:11:44.439 in the open, or on your fingernail or in your 0:11:44.480 --> 0:11:47.000 nose or something like that. Okay, I don't know why 0:11:47.000 --> 0:11:47.880 I said fingernail. 0:11:48.160 --> 0:11:53.760 The fingernail is my favorite frame of reference. I want 0:11:53.800 --> 0:11:55.920 to swab my fingernail now and see what's. 0:11:55.920 --> 0:11:56.800 I mean growing there. 0:11:56.880 --> 0:12:00.000 Probably find some weird stuff, but not clusterdium species. 0:12:00.120 --> 0:12:02.520 Okay. 0:12:02.880 --> 0:12:07.920 Our atmosphere, of course, is twenty one percent oxygen. So 0:12:08.320 --> 0:12:13.160 how can this bacteria survive if it's like surrounded by 0:12:13.160 --> 0:12:14.320 oxygen all the time? 0:12:15.320 --> 0:12:19.760 Quick question? Did you know that off just like the 0:12:19.800 --> 0:12:20.960 back of your hand that it was? 0:12:22.760 --> 0:12:25.960 Yes? I did? Did you not? Oh? Well, now you 0:12:26.000 --> 0:12:30.960 know listeners, did you know? Huh, it's yeah, that's I 0:12:30.960 --> 0:12:33.720 did know. That's a that's a trivia fact. I did know. 0:12:33.840 --> 0:12:37.800 And it's important because we talk about it in medicine, 0:12:37.800 --> 0:12:39.960 because you know, when you put someone on oxygen, you 0:12:40.040 --> 0:12:42.600 have to think about how much oxygen they're getting and 0:12:42.640 --> 0:12:44.640 what that is compared to what is what they're normally 0:12:44.640 --> 0:12:47.560 breathing in at room air. So if they're on twenty 0:12:47.600 --> 0:12:49.760 one percent oxygen that's actually like room air. 0:12:49.880 --> 0:12:51.360 Oh so awesome. 0:12:51.480 --> 0:12:58.640 Yeah, oh how fun. Look medicine teaches you things who knew? Okay, so, 0:12:59.559 --> 0:13:04.160 how did does this bacterium survive if it's surrounded by 0:13:04.160 --> 0:13:06.680 oxygen and it needs to live and grow in an 0:13:06.760 --> 0:13:11.280 environment without oxygen. The answer is that it's a spore former. 0:13:12.440 --> 0:13:15.319 I can't remember if we've talked on this podcast before 0:13:15.559 --> 0:13:21.360 about spore forming bacteria, So let's talk about what spores are. 0:13:21.960 --> 0:13:26.120 So bacteria that are spore formers here, we're talking about 0:13:26.120 --> 0:13:32.400 specifically what are called endospores. So these are things, for 0:13:32.520 --> 0:13:35.720 lack of a better word, that bacteria produce that are 0:13:35.760 --> 0:13:41.400 super environmentally stable. They're basically a stripped down structure that 0:13:41.480 --> 0:13:46.400 contains the DNA of the bacteria but can persist in 0:13:46.440 --> 0:13:49.959 the environment for a really, really long time. So these 0:13:50.000 --> 0:13:53.720 are not reproductive structures. When you hear the word spore, 0:13:53.840 --> 0:13:55.880 you might think of like a fern spore or a 0:13:55.960 --> 0:14:03.480 mushroom spore. Those are like reproductive things. So endospores, bacterial 0:14:03.600 --> 0:14:08.240 endospores are not reproductive structures. They're basically just a form 0:14:08.480 --> 0:14:13.640 that the bacteria can produce in order to resist bad 0:14:13.800 --> 0:14:15.199 environmental conditions. 0:14:15.559 --> 0:14:17.400 Yeah, just kind of like a wait and see a 0:14:17.440 --> 0:14:19.360 little blueprint for the future. 0:14:19.440 --> 0:14:23.760 Exactly right. And so when a bacteria senses that environmental 0:14:23.760 --> 0:14:26.640 conditions might be deteriorating to the point where they're not 0:14:26.680 --> 0:14:29.040 going to be able to survive and continue to reproduce, 0:14:29.120 --> 0:14:32.120 they begin to form this endospore. And then if those 0:14:32.200 --> 0:14:36.720 environmental conditions deteriorate and the bacteria around that endospore dies 0:14:36.920 --> 0:14:43.080 and deteriorates, the endospor stays alive. Essentially, it doesn't do anything. 0:14:43.120 --> 0:14:47.520 It just exists until conditions are right, and then it 0:14:47.560 --> 0:14:52.400 can reactivate okay, yeah, and go on to form another living, 0:14:52.600 --> 0:14:58.560 reproducing bacteria. So these endospores are really important because they're 0:14:58.600 --> 0:15:02.440 resistant to things like UV. They're in the case of anaerobes, 0:15:02.440 --> 0:15:07.600 they're resistant to oxygen, which could kill reproducing Clostridium botulinum. 0:15:08.040 --> 0:15:12.560 They're resistant to alcohol, to soaps too hot, too cold, 0:15:12.800 --> 0:15:16.720 to certain levels of radiation. They're really really hardy little 0:15:16.840 --> 0:15:20.880 packets of DNA, which can make them especially dangerous in 0:15:20.920 --> 0:15:23.720 a hospital setting if things aren't sterilized properly. And so 0:15:23.760 --> 0:15:26.840 that's part of the reason why sea diff Claustridium difficile 0:15:27.200 --> 0:15:30.160 is really scary in hospital settings. Because like just using 0:15:30.160 --> 0:15:34.040 alcohol based hand sanitizer doesn't kill the spores of these. 0:15:33.920 --> 0:15:36.800 Bacteria, right, And we'll do a whole episode on sea 0:15:36.840 --> 0:15:39.960 diff in the future at some point because it's definitely 0:15:40.560 --> 0:15:44.760 worthy of its own massive episode, absolutely, And we're also 0:15:44.760 --> 0:15:47.000 going to do another episode at some point on another 0:15:47.040 --> 0:15:50.640 Clostridium species, tetanus. 0:15:51.560 --> 0:15:54.040 Oh yeah, Oh my gosh. I forgot that tetanus was 0:15:54.320 --> 0:16:00.640 another another tops I think that's why. Yeah, I I 0:16:00.680 --> 0:16:02.960 went back and watched the sketchy micro videos for this, 0:16:03.120 --> 0:16:07.880 and like, tetanus and and botulism are kind of opposite 0:16:08.040 --> 0:16:10.680 ends of the spectrum, which is really interesting, and so 0:16:10.760 --> 0:16:13.360 I remember like comparing the two between them. So maybe 0:16:13.400 --> 0:16:17.040 I thought that we had done tetanus already. I don't know. 0:16:17.200 --> 0:16:19.600 The only other spore former I can think of off 0:16:19.640 --> 0:16:21.080 the top of my head is anthrax, and. 0:16:21.040 --> 0:16:24.200 I, yeah, antax, we haven't done that. Yeah, we'll do 0:16:24.240 --> 0:16:28.120 that eventually too. Anyways, there's more, but those are the 0:16:28.160 --> 0:16:33.400 big ones. Yeah, Okay, but the spore isn't actually the 0:16:33.440 --> 0:16:36.960 story here, Okay, of course not, of course not. It's 0:16:37.000 --> 0:16:38.720 part of the story, but it's not the story that 0:16:38.760 --> 0:16:42.080 we're focusing on on this podcast. Will kill you. What 0:16:42.120 --> 0:16:44.040 we want to talk about, of course, is the part 0:16:44.080 --> 0:16:48.520 of this bacteria that makes you sick. So we're here 0:16:48.560 --> 0:16:53.560 today to talk about botulism. It turns out that botulism 0:16:54.000 --> 0:16:59.080 is caused not by the bacterium itself, not by the 0:16:59.200 --> 0:17:05.959 spore itself, but by the toxin that that bacterium produces. Okay, 0:17:06.119 --> 0:17:10.919 oh yeah, this is called botulinum toxin. So what I 0:17:10.960 --> 0:17:13.680 want to do first is we'll talk about that toxin itself, 0:17:13.760 --> 0:17:17.480 the mechanism of action of that toxin, which will pretty 0:17:17.520 --> 0:17:20.359 clearly tell you what the symptoms that you're going to 0:17:20.440 --> 0:17:25.719 see are of this like of poisoning from botulinum toxin. 0:17:26.359 --> 0:17:28.080 And then we'll talk about the ways that you can 0:17:28.119 --> 0:17:30.560 get exposed to this toxin, because there's a few different, 0:17:30.800 --> 0:17:34.520 very distinct ways that you can be exposed to this toxin. Okay, 0:17:35.040 --> 0:17:38.560 all right, so first of all, what is boculinum toxin. 0:17:39.560 --> 0:17:42.560 We've definitely talked about toxins a lot on this podcast 0:17:42.600 --> 0:17:45.760 because lots of bacteria produce different kinds of toxins. It's 0:17:45.760 --> 0:17:50.400 basically just usually proteins that a bacteria produces that have 0:17:50.600 --> 0:17:54.880 an effect that do something for that bacterium. Okay, so 0:17:55.000 --> 0:17:59.720 like cholera toxin exactly. Cholera toxin we talked about staff 0:17:59.840 --> 0:18:04.880 or produces a lot of different toxins that have different effects, right, 0:18:06.240 --> 0:18:10.040 So in the case of botulinum toxin, this is a 0:18:10.320 --> 0:18:17.119 neurotoxic protein that the bacteria produces, so it has effects 0:18:17.160 --> 0:18:22.960 specifically on our peripheral nervous system and largely on our 0:18:23.119 --> 0:18:27.440 somatic nervous system. So if you remember in our episode 0:18:27.440 --> 0:18:32.159 on Belladonna way back when cast my mind back so 0:18:32.720 --> 0:18:35.040 way back when we talked about there's a lot of 0:18:35.080 --> 0:18:39.880 different ways that you can divide up the nervous system. Right, 0:18:39.920 --> 0:18:42.000 we have our central nervous system, which is like your 0:18:42.000 --> 0:18:45.399 brain and your spinal cord. You have your peripheral nervous system, 0:18:45.440 --> 0:18:48.040 which is everything outside your brain and your spinal cord 0:18:48.080 --> 0:18:50.440 that like where your nerves go to your muscles and 0:18:50.480 --> 0:18:55.280 your organs. You can also divide it into your somatic 0:18:55.520 --> 0:18:59.239 and your autonomic nervous system. So your somatic meaning like 0:18:59.400 --> 0:19:04.199 your sury and muscles nervous system, and then your autonomic 0:19:04.240 --> 0:19:08.399 nervous system, which is like your parasympathetic and sympathetic rest 0:19:08.400 --> 0:19:13.240 and digest versus fire or flight. Remember that kind of Okay. 0:19:13.880 --> 0:19:18.120 So in this case, the effects of boculinum toxin, they 0:19:18.160 --> 0:19:20.400 act on a couple of different places. They act both 0:19:20.440 --> 0:19:25.280 on the parasympathetic nervous system, but largely on the somatic 0:19:25.640 --> 0:19:30.680 peripheral nervous system. So let's first talk about what that 0:19:31.040 --> 0:19:32.919 nervous system is and how it works, so that we 0:19:33.040 --> 0:19:39.160 understand how botulinum toxin interferes with that process. Excellent, Okay, 0:19:40.680 --> 0:19:45.919 So you're I'm also not a neurologist or a neuroscientist, 0:19:45.960 --> 0:19:51.439 so this is real basic okay. So your brain, of course, 0:19:51.520 --> 0:19:53.879 is what controls all of the movements of your body. 0:19:54.000 --> 0:19:57.240 So how does your brain do that. You have nerves. 0:19:57.280 --> 0:19:59.240 Your brain is connected to your spinal cord, which is 0:19:59.280 --> 0:20:04.520 connected to nerve that innervate your muscles, okay, or your organs. 0:20:06.040 --> 0:20:10.080 So the way that this kind of happens is that 0:20:10.240 --> 0:20:15.399 electrical signals in your brain are transmitted along those nerves, 0:20:15.440 --> 0:20:19.040 along what are called axons of those nerves, and then 0:20:19.160 --> 0:20:21.760 when they get to the end of the nerve, which 0:20:21.800 --> 0:20:25.600 is called a synapse, there's a gap between that nerve 0:20:26.000 --> 0:20:29.720 and for example, your muscle, and so in order for 0:20:29.760 --> 0:20:34.480 that electrical signal in the nerve to transmit across that 0:20:34.680 --> 0:20:39.000 gap and have an effect on the muscle. That electrical 0:20:39.000 --> 0:20:43.919 signal has to be translated into a chemical signal, and 0:20:43.960 --> 0:20:47.800 then the chemicals can travel across that gap, that synapse 0:20:48.080 --> 0:20:52.440 between the nerve and the muscle, and they can propagate 0:20:52.480 --> 0:20:56.000 that signal into the muscle. Does that make sense? Yeah, yeah, cool, 0:20:56.720 --> 0:20:58.679 that's the first time I've ever explained that. So that 0:20:58.800 --> 0:21:04.840 was fun. Okay, So when you're looking at the synapse, 0:21:04.880 --> 0:21:06.679 the gap between the end of your nerve and the 0:21:06.680 --> 0:21:11.200 start of your muscle, there's the presynaptic end that's basically 0:21:11.240 --> 0:21:14.560 the nerve that came like from your spinal cord, and 0:21:14.600 --> 0:21:16.399 then the post synaptic end. You can think of that 0:21:16.440 --> 0:21:21.040 as your muscle. It turns out that the for your muscles, 0:21:21.160 --> 0:21:27.760 especially like your skeletal muscles, the transmitter, the chemical signal 0:21:28.080 --> 0:21:34.560 that is used to transmit that signal is called acetylcholine. Okay. 0:21:34.920 --> 0:21:38.399 Acetyl Coline is released at the pre synaptics, So from 0:21:38.440 --> 0:21:43.080 the nerve ending, acetyl coline is released, it travels across 0:21:43.080 --> 0:21:47.880 that gap and binds to a receptor on your muscle end, 0:21:48.640 --> 0:21:51.400 and then that is what actually causes your muscle to go, hey, 0:21:51.560 --> 0:21:53.440 I'm gonna contract and boom contracts. 0:21:53.520 --> 0:21:54.040 Gotcha. 0:21:55.359 --> 0:21:58.919 So acetyl colin is really important in that. So how 0:21:58.920 --> 0:22:04.960 does botulism work. So it turns out that botulinum toxin 0:22:06.240 --> 0:22:13.000 blocks the release of acetylcholine from that presynaptic nerve ending. Gotcha. 0:22:13.600 --> 0:22:17.000 So you have an electrical signal that's transmitted from your brain, 0:22:17.200 --> 0:22:20.840 it gets to the end and boculinum toxin is there 0:22:20.960 --> 0:22:24.679 and says, Nope, you can't release acetylcholine. So then your 0:22:24.720 --> 0:22:28.160 muscle goes it's got nothing. 0:22:28.480 --> 0:22:35.120 Are there toxins or venoms or something that block from 0:22:35.200 --> 0:22:37.960 the other end from the muscle binding site. 0:22:38.359 --> 0:22:42.800 We already talked about one and that was oh yeah, 0:22:43.000 --> 0:22:46.000 So belladonna and belladonna tends to act only on the 0:22:46.040 --> 0:22:51.680 parasympathetic receptors because there are two different types of acetylcholine receptors, 0:22:51.720 --> 0:22:56.320 there's muscarinic and nicotinic, and so botulinum acts on the 0:22:56.359 --> 0:22:59.679 presynaptic end, so it blocks all acetylcholine release. 0:23:00.000 --> 0:23:00.480 Oh my god. 0:23:00.480 --> 0:23:05.840 Atropine binds to the receptor, but only the muscarinic receptor, 0:23:05.920 --> 0:23:08.400 so not the ones in your skeletal muscle. Oh my gosh, 0:23:08.480 --> 0:23:11.640 this is so thrilling, I know, right, I'm so glad 0:23:11.640 --> 0:23:12.320 you find it thrilling. 0:23:12.400 --> 0:23:14.400 Yes, I do too, This is so exciting. 0:23:14.920 --> 0:23:15.160 Yeah. 0:23:15.200 --> 0:23:18.640 Oh wow. So yes, there absolutely are things that bind 0:23:18.760 --> 0:23:21.200 that you know do and there's other toxins as well too. 0:23:21.200 --> 0:23:24.040 There's other there's other venoms, there's other toxins that interfere 0:23:24.080 --> 0:23:27.359 with this acetylcholine and whether they do it, and and 0:23:27.400 --> 0:23:30.600 so that question is really important because in the case 0:23:30.600 --> 0:23:35.120 of botulinum, by blocking the release of acetylcholine, you leave 0:23:35.160 --> 0:23:40.119 those acetylcholine receptors on the muscle empty, which means the 0:23:40.200 --> 0:23:43.920 muscle is not getting a signal to contract, which means 0:23:43.960 --> 0:23:49.240 the muscle is relaxed. So the symptoms that we see 0:23:49.440 --> 0:23:59.320 of botulinum poisoning are a flaccid paralysis rather than a 0:23:59.480 --> 0:24:04.040 contract did paralysis, which we see in other toxins that 0:24:04.160 --> 0:24:06.240 have different mechanisms of action. 0:24:06.200 --> 0:24:11.080 Like tetanus. Like tetanus. Yeah, that's really cool. 0:24:11.359 --> 0:24:15.560 I know, Okay, it's very cool. I love it. I 0:24:15.560 --> 0:24:18.920 mean I don't love it. It's horrible. Okay. So, now 0:24:18.960 --> 0:24:23.040 that we know the action of botulinum toxin, it's acting 0:24:23.119 --> 0:24:26.760 at the neuromuscular junction, the synapse between nerve and muscle 0:24:27.160 --> 0:24:30.840 and it's blocking the release of acetylcholine, which means your 0:24:30.920 --> 0:24:34.080 muscles are getting no signal, which means they are relaxed 0:24:34.119 --> 0:24:37.000 and flaccid. So we pretty much know what the symptoms 0:24:37.040 --> 0:24:41.400 of botulism are, right, They're a flacid paralysis. These symptoms 0:24:41.440 --> 0:24:46.280 are the same no matter how you get exposed to 0:24:46.400 --> 0:24:52.200 botulinum toxin, right, because this is a toxin, it's traveling 0:24:52.240 --> 0:24:55.160 throughout your bloodstream once it gets into you, no matter 0:24:55.200 --> 0:24:58.360 how it gets in, it's going to travel through your bloodstream, 0:24:58.600 --> 0:25:03.080 and it's going to act on any nerve ending that 0:25:03.119 --> 0:25:07.320 it comes in contact with. Okay, is the. 0:25:06.600 --> 0:25:10.120 Flaccid paralysis just sort of generally distributed throughout your body 0:25:10.280 --> 0:25:13.159 or is it concentrated depending on your root of exposure? 0:25:13.800 --> 0:25:21.280 Great question, Arin, So what's very interesting about botulism specifically 0:25:22.680 --> 0:25:27.040 is that it causes a descending paralysis. Okay, So the 0:25:27.080 --> 0:25:30.159 paralysis starts in your face and your head. It starts 0:25:30.160 --> 0:25:34.720 with your cranial nerves. It causes a bilateral so both 0:25:34.800 --> 0:25:41.000 sides symmetric cranial nerve palsies that then eventually travels down 0:25:41.200 --> 0:25:45.720 and will cause flaccid paralysis throughout no matter the root 0:25:45.720 --> 0:25:48.160 of entry and we'll talk about the specific different roots 0:25:48.160 --> 0:25:52.199 of entry. This is botulism. Yeah, so you're exposed to 0:25:52.400 --> 0:25:55.800