07 July 2004

From Poison To Medicine

By this time you might have heard of Botox or Botox treatments. Before its claim to fame, Botox started its career as a poison. Actually it remains to be one of the deadliest poisons known to man, so much so that, today in the US and Europe, detailed plans are in existence and can be put into ready action in case of a bioterrorist attack liberating the poison in their midst.

Botox is botulinum toxin Type A. It is a neurotoxin produced by the soil-dwelling bacterium Clostridium botulinum. Seven types of this poison are recognized --- A, B, C, D, E, F and G. Types A, B, E and F cause human botulism. Types C and D cause most cases of botulism in animals. For purposes of brevity, I will just limit today's post to Type A because this the only type used for medical purposes. Foodborn botulism, the illness caused by this poison, needs only a very small amount (a few nanograms) of the toxin to produce symptoms like weakness and vertigo, double vision, progressive difficulty in speaking/swallowing, difficulty in breathing, abdominal distension, and constipation.

In the 1950s, Dr. Vernon Brooks made a breakthrough discovery when he showed that botulinum toxin type A when injected into a hyperactive muscle caused the blockade of acetylcholine release from motor nerve endings, thereby inducing a temporary "paralysis" of the targeted muscle. Researchers hypothesized correctly that if the powerful nerve toxin paralyzes muscles, tiny amounts might have therapeutic uses. In the 1960s and 1970s, a doctor named Dr. Alan B. Scott found that by injecting a small amount of botulinum toxin in the hyperactive eye muscles of monkeys he was able to correct their strabismic condition. Strabismus is a condition known as "duling" or "banlag" in Tagalog. This was the start of the rise to fame and fortune of both Dr. Scott and his Botox discovery. Dr. Scott formed his own company, Oculinum, Inc., and in 1978, he received permission from the US FDA to test Botox in human volunteers. The rest is history. Today, the small Botox bottle you see below sells for nearly P20,000 (!!!) or about $350. I haven't asked my now famous classmate Dr. Manny Calayan of Cosmetiderm how much he charges for Botox treatments, but I'm quite sure the price would be pretty splendid considering he counts the top celebrities as his clients.

Botox is fast emerging as the "aspirin" of this generation. For the past several years, eye doctors have used it for eye conditions like "pagkaduling" (strabismus) and blepharospasm (frequent blinking of the eyes). It has also been used as treatment for facial spasms and this was were doctors noted its now more famous use: erasing facial wrinkles. Today it is used cosmetologically for erasing forehead wrinkles, the furrows between the eyes, crows feet around the eyes, and laugh lines (see picture below). A Botox injection works by temporarily paralysing the muscles around the forehead, eyes and brow that make wrinkles and lines in the face as people age. When used at the right dose, it achieves this without affecting normal facial expressions.
Areas where Botox removes wrinkles

Even Dubya contender John Kerry was rumored to have undergone Botox treatments when there was a noted disappearance of his tired Capitol Hill looks. While the anti-wrinlkling effects of Botox usually lasts up to 3 months, I've heard from my friend dermatologists and cosmetic surgeons that they usually advise their Botox patients to come back for a follow-up injection after 6 to 8 months. Can this be because Filipinos are more susceptible to Botox compared to Western patients?
Notice the missing wrinkles?

Today, Botox is being groomed to have many other uses like treatment for migraine, hyperhidrosis or excessive sweating of the palms, armpits, face, and feet, vaginismus (vaginal spasms causing painful intercourse), upper limb spasticity (paralysis of both arms) in children and post-stroke patients, and as a very potent painkiller.

A word of caution to those who would want Botox treatments in the future: be sure your doctor is competent enough to give you Botox for your wrinkles. Not just any doctor can administer Botox. He must be a specialist --- either a cosmetic surgeon or a qualified dermatologist. Doctors giving the injections should know the anatomy of the face in great detail. If too much is injected into the wrinkles around the eyes or if it is injected into the forehead and it seeps into the wrong place, the patient can be left with a drooping eyelid for 3 months. Also, if Botox is injected unequally, the patient could come out of the clinic with one side of their face wrinkle-free and the other side as deeply-etched with wrinkles as before.

Remember, it is your right to ask your doctor about his qualifications to do a particular procedure.

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