This Isn't Your Grandma's Botox

My doctor told my family and me that recovery from the traumatic brain injury I’d endured  would have a window of about five years, after which I would just plateau forever.  Later, she realized that my recovery could be a lifelong process.  This was the same doctor who originally told my parents that I’d never speak again, or leave the wheelchair.  After I’d proved her wrong on both counts, she stopped putting limitations on me and my recovery.  My determined attitude became a lighthearted joke between us.  When I went back to see her after months out of the rehabilitation center, she smiled and shook her head, saying, “I’ve never been more happy to be proved wrong.”

I put a stop to my outpatient therapy in high school when I decided to focus more on academics and being a teenager.  I finished high school, went to college, and maintained a healthy social life without physical therapy (PT).  But there came a time when I knew I had to take responsibility for my own recovery.  After ten years with no organized rehabilitation, I went back voluntarily to the same clinic I’d left and made an appointment with my old doctor.  My initial question:  “Is there anything new in the realm of therapy or medical procedures?”  That’s when I first heard about Botox.

In The Beginning, There Was Botox

About two decades ago, Dr. Allen Scott discovered the effects a bacteria called Clostridium botulinum has on muscle groups.  It was found to greatly reduce spasticity, or overactive muscles.  When a solution of the bacteria, diluted with water, was injected directly into specific ocular muscles, it diminished a spastic eye condition.  This hypothesis followed:  if the toxin works there then it stands to reason it would work elsewhere.  It did.  Medical science was onto something.

Botox remains, to date, the best defense against spasticity.  In patients undergoing PT, the goal is to hinder spastic muscles so work can be done to strengthen the opposing muscle groups.  To give you an idea of how this works, I’ll put this on a personal level.  The flexor muscles (bottom of the forearm) of my left arm are spastic and stronger than my extensors (top of the forearm).  Thus, they are constantly pulling my wrist down and curling my fingers into a fist, and I have to work very hard to relax my hand into even a partially “normal” position.  Botox, injected directly into my flexors, essentially lays a barrier against the nerve endings, blocking the signals from the nerves to those muscles.  In simple terms, it paralyzes the muscle it enters not complete paralysis rendering the patient totally unable to use that muscle, but more like a light tranquilizer to reduce the involuntary muscular activity.  In my case, it allows more control over my wrist and fingers.  The wrist becomes more relaxed and the fingers are able to open more.

It takes anywhere from two days to about a week for the toxin to take full effect and the results last about three months, though, as with most medical procedures, results vary.  Some patients have reported longer lasting effects, some have only needed one treatment, and some experience little or no result.  It depends greatly on the type and severity of the injury.  But for the vast majority, the toxin is administered at three-month intervals.  Because it is a toxin (Botox is, in essence, botulism a type of food poisoning), a three-month interval is required even if the effects wear off before that.  If introduced into the body any more frequently, the body will build up a natural resistance to it.  It is also dose-effective, that is, the more you administer during a treatment, the stronger the results.  Still, less is more.  Until you find out how much your body can take, it is best to begin with a small dosage, as there have been some who have experienced flu-like side effects.

A plus is that Botox pretty much stays put.  There is little risk of it diffusing into adjacent muscle areas.  It can happen, but it’s rare and there is no real long-term danger.  The only true risk is if the bacteria somehow gets into the bloodstream.  Due to the way it’s administered, however, that really can’t happen unless there’s a major error with the treatment and/or equipment used.  The electromyograph (EMG) is a fairly accurate device.  Its needle is attached to a receiver which picks up muscular activity and transmits it in the form of radio static, audible to the human ear.  When the needle hits overactive muscle tissue, the activity is heard through the speaker, helping the doctor determine where
best to inject the toxin.  The more static, the higher the activity.

Having undergone several treatments of a dozen or more injections per session, I can attest that it really is as close to a miracle as I’ve ever seen.  I have much more control over and use of my left arm under the influence of the toxin than I do otherwise.  Ideally, the objective is to use the drug therapy in conjunction with PT to strengthen the opposing muscle groups.  However, Botox works even without PT, which is good for people like me who haven’t, of late, found time for such a regimen.

Mirror, Mirror On The Wall  

The most intriguing aspect of the Botox evolution revolution is the very recent discovery that it also works for cosmetic purposes.  When injected into the skin, the muscles relax and wrinkles virtually disappear.  So this therapeutic miracle has become a kind of nonsurgical face-lift.  Because of cosmetic use, recent demand has pushed mass distributors to make Botox available to more people at a lower cost.  On the surface this sounds like a good thing, but when something is mass-produced, it forces manufacturers to look for ways to cut costs and increase profits.  One way is to offer a more diluted solution.  That is, more water and less of the bacteria.  Diluting can weaken the results and shorten the time period those results are visible.  So, beware the “bargain Botox,” as the headline in the Minneapolis Star Tribune warned, though that article spoke only of the cosmetic applications of the toxin.

Which makes an interesting point.  Since the cosmetic advantages of Botox were discovered, that’s all we hear about.  It wasn’t until very recently that the Star Tribune mentioned the “newer” medical uses of Botox for stroke victims and migraine sufferers.  And still, little or nothing is generally known about the real origins of this gem of therapeutic magic that has been evolving for nearly a quarter of a century.  It is now credited as nothing but a cosmetic drug a 21st century fountain of youth.  When I tell my friends and coworkers that I’ve undergone and will soon start my Botox treatments again, I hear:  “Why do you need to worry about wrinkles?”  It makes me angry that I have to explain the initial uses of the bacteria that in all the mainstream publicity, barely one word has been uttered about how or why the idea ever began.  It’s a wonder drug, all right, but credit needs to be given to the necessity of invention to those patients who had a need and inspired Dr. Scott to explore the possibilities that led to this medical advancement. 

Cosmetics over therapeutics.  Sad commentary on what we value as a whole in this society.

Derek VanderVeen is a freelance writer for Access Press and is considering furthering his education in psychology.  The author would like to thank John Barrett and Dr. Mark Gormley, both of Gillette, for their determination and patience in helping with this article.