A Chef Ate Gas Station Nachos For Dinner. This Is What Happened To His Limbs.

A Chef Ate Gas Station Nachos For Dinner. This Is What Happened To His Limbs.


A Chef Ate Gas Station Nachos and Hot Dogs
For Dinner. This Is What Happened To His Limbs. GP is a 34 year old man, presenting to the
emergency room with shortness of breath and blurred vision. He tells the admitting nurse that he knew
something was wrong when he had to burp, but a lot more than just air came up. 2 days ago, GP left home to go on a road trip. He was a chef who recently sold his failed
restaurant. His life was going nowhere, so he left home
with no intention of ever coming back. At a gas station, hours later. GP needed to make a pit stop. He was hungry. Coming from the culinary world, he had high
taste for food. But nothing like some sketchy nachos and roller
hot dogs for dinner, he thought. Immediately after finishing his gas station
dinner, GP felt, wonderful. He stopped at a nearby motel to finish his
day. On the road, the next morning. GP didn’t eat breakfast because he felt
there was a rock in his stomach. As he kept driving, he noticed that it was
getting harder for him to breathe. His throat and chest were getting tighter. He had a history of asthma and allergies,
and he’s in an unfamiliar place now, so maybe close the windows, he thought. As the hours go by, GP becomes increasingly
short of breath. A tingling in his fingers begins to develop
into pins and needles as his vision starts to double. As he pulls into the hospital parking lot,
he feels the mass in his stomach getting heavier as he dry heaves again on the pavement. He crawls into the emergency room where we
are now. GP appears ill and uncomfortable. His skin is flushed and he complains of dry
mouth. Both physical and neurological exams seem
to be normal. His heart rate slightly elevated. His blood pressure a little low. If he’s in a place he’s never been to
before, having eaten food he doesn’t normally eat, from a place he’s never eaten, then
this sounds like an allergic reaction, a little delayed in onset after eating his gas station
dinner of nachos and hot dogs. This anaphylaxis is pretty easy to treat as
the medical team starts to give him medicines for it. They start with Diphenhydramine, also known
as Benadryl. This blocks a chemical called histamine, which
explains why it’s harder for him to breathe now. Histamine is released when the body finds
allergens, which is something that causes the immune system to react inappropriately. Inappropriately in that it causes the blood
vessels to dilate, allowing more of the immune system to enter the site to react to those
allergens. And this swelling is happening to his tongue. It’s closing up his throat. It’s making it harder for him to breathe. So blocking histamine, should stop this from
happening. If his blood vessels are dilating, then we
need to constrict them, so GP was also given epinephrine, or adrenaline, to tighten up
all his blood vessels causing vasoconstriction, to counteract the dilation because of his
allergic reaction. He was rehydrated with intravenous fluids,
as he seemed to recover. But several hours pass. GPs vision starts to double. He describes what sounds like heartburn to
the nurse. Two more hours pass, and an oral antacid solution
arrives from the pharmacy for him to drink. This tastes like chalk he thought. I really don’t want to drink it, he thought. A few sips and another hour in, GP is physically
no longer able to drink the rest of the mixture as he becomes unable to swallow. He frantically tries to signal this to the
nurse because he’s no longer able to speak now. Immediately, the medical team re-evaluates
GP as they draw blood from him to test. He can now only communicate with them in writing. He tells them he feels like he’s suffocating. His eyelids start to droop as his heart beat
is now elevated, as surgery and neurology doctors are called in. A new examination finds that GP’s reflexes
are still normal. His senses are still intact. But the muscles of his eyes now have some
weakness on abduction An MRI of his brain returns normal. Nothing’s wrong here. Over the next 3 hours, a wheezing sound could
be heard from GP as he tries to breathe. Weakness of his face and tongue worsen, as
breathing becomes dangerously shallow. Examination of his throat finds that he’s
unable to swallow not because it’s swollen, but that the muscles of his throat are actually
paralyzed, meaning that whatever is happening to him, it’s definitely wasn’t an allergic
reaction. Weakness in his arms and legs were found,
as he’s admitted into the intensive care unit. At 36 hours after eating his gas station dinner
of nachos and roller hot dogs, GP is no longer able to use his arms and legs. He’s no longer able to breathe on his own,
as he’s intubated and a tube is put down his throat, for a machine to breathe for him. He can still hear. It looks like he can still respond to pain. But he’s now trapped in a body that can’t
breathe for itself. Can’t speak for itself. And can’t move by itself. This rapidly progressive, generalized weakness
descending from the muscles of his eyes to the skeletal muscles of his limbs gives the
medical team some clues as to what’s happening. GP’s brain MRI returned normal. The weakness he developed was symmetric meaning
it was about equal on both sides. Together, this means that there probably isn’t
anything wrong with his brain or spinal cord, something that we would say is a central cause
of acute weakness. The central nervous system, made up of the
brain and the spinal cord, is responsible for the senses. GP can likely hear the medical team. He can feel the medical team. But he can’t speak to them because his throat
is paralyzed. He can’t see them because he can’t open
his eyes. He might be able to smell them, but he can’t
breathe on his own because those muscles don’t work anymore too. And because the peripheral nervous system
operates on the muscles, then this could be where his problem lies. But how did this develop? In the emergency room, medical staff saw his
problems progress from nausea, and double vision, shortness of breathe, to being unable
to swallow, unable to speak, descending rapidly to muscle paralysis. If he no longer has control over his motor
function, then this means the problem could be coming from his nerves only, it could be
coming from his muscles only, or, the problem is from the junction where the nerves connect
to the muscles. There aren’t too many things that are a
problem of just the nerves, that causes muscle paralysis and doesn’t affect the brain. Polio is a virus that destroys nerves and
causes paralysis. West nile virus does it too. But these are just like any other infection
at first, meaning it would cause things like a fever and respiratory illness lasting a
few days. But GP never reported a fever or recent past
illness, so this is probably not a problem of just his nerves. But how about his muscles? Some muscle diseases can cause paralysis,
but those don’t usually affect the ocular and respiratory muscles together. So we’re probably clear here too. But how about the neuro-muscular junction? This specialized region is where the nerves
connect and communicate with the muscles. If nothing is wrong with only the nerves and
only the muscles, then it means GP’s paralysis could be because no signals are being relayed
between the two tissues. You see, the muscles don’t contract by themselves
in normal function. There has to be motivation behind the movement. Your brain controls your muscles and it’s
the nerves that deliver that signal to them, by releasing a chemical, at this neuromuscular
junction. And we’ve already established that GP’s
brain is fine, meaning that somewhere in this line, the signal is getting lost. What if the messenger chemical is there to
deliver, but the muscles can’t receive it? This would happen because the body’s immune
system has attacked the parts of the muscles that receive the signal. But if the immune system is involved, the
sharp decline in function isn’t going to happen as quickly as 48 hours. GP also would have had a past history of this
disease. It would have been obvious. But he doesn’t. So, we can assume here that his muscles aren’t
damaged and can receive it. Meaning that his problem is because his nerves
are not able to release the chemical to signal to his muscles to contract. Specifically, the decline in function started
with his ocular and respiratory muscles, descending to his limbs. Meaning the proteins that control the chemical’s
release from the vesicles is being disturbed by a toxin. This disease is called botulism. As the blood test results from his ICU admission
return 4 days later, GP returns positive for Clostridium botulinum, the bacteria known
for producing the botulinum toxin, which cleaves the proteins involved in the nerve vesicles
that release chemical into the synapse of the neuromuscular junction, preventing signals
to the muscles, paralyzing all his muscles, and causing his respiratory failure. But where would this bacteria come from? Downstairs the hospital, in the emergency
room, another patient presents with the same paralysis, oculomotor weakness, and respiratory
failure as GP. Days later, this patient too, tests positive
for Clostridium botulinum as the state health department and Centers For Disease Control
were already contacted in advance, because this reportable disease must be notified to
authorities, in case of an outbreak, because possible widespread paralysis of many people,
can have bad outcomes. Anti-toxin was received from the CDC and administered
to GP as soon as the medical team suspected botulism. This protein, binds to the toxins floating
around in his circulation and prevents the nerves from absorbing any more of it. But the antitoxin isn’t able to reverse
the damage already done. It cannot do anything about GP’s paralysis
or his respiratory failure. The CDC tracked the past activity of GP and
the other patient. The common activity between the two, was consumption
of food, at the same gas station. Laboratory analysis of the nacho cheese found
Clostridium botulinum and was determined to be the cause of this outbreak, as 8 other
people in the local area were reported to have the same poisoning. This is an incredibly, incredibly rare source
of botulism, which typically comes up in canned food, because for the bacteria to become active
and produce actual toxin, both the temperature and the pH of its environment must be absolutely
spot on. And in this case, some unfortunate of mishandling
of the cheese, enabled it to be spot on as it affected all these people. The thing about botulinum toxin is that you
might know it as BoTox— the most potent toxin known to humans, which happens to be
naturally occurring. Naturally occurring, meaning anyone who tries
to sell you something solely based on the fact that “it’s natural,” can shove
it. And potent meaning the smallest amount on
the order of less than 1 nanogram, or 1 billionth of a gram, can be fatal. Meaning, humans have found out ways to use
it therapeutically. Because it prevents the release of the neurotransmitter
acetylcholine at the neuromuscular junction, it inactivates muscles that pull on skin. Some of those are the ones that cause wrinkles. But it doesn’t just stop there. Sweat is modulated through a similar process,
and botulinum toxin injection produces a temporary chemical denervation of the sweat gland, resulting
in local reduction in sweating. In sensory neurons, botulinum toxin interferes
with the nerve’s ability to communicate pain through modulating release of acetylcholine,
thus treating migraines with injections in specific areas of the head and neck. All of these can work as injections and not
spread throughout the body because they’re delivered locally and the toxin doesn’t
travel very far. But for GP, he ate it in his gas station nacho
cheese. It absorbed through his stomach and small
intestine as it entered his circulation, spread systemically, and bound to neuromuscular junctions,
impairing oculomotor function, paralyzing all 4 of his limbs, and his respiratory muscles
as it wrecked this havoc over a timespan of a couple of days. If therapeutic botox injections only last
for a couple of weeks before wearing off, then the good news for GP is that even if
the anti toxin can’t reverse his paralysis, the toxic effect will eventually wear off. But, when will it, exactly? Over the next 3 weeks, GP stayed paralyzed
and on mechanical ventilation. The first sign of improvement was when he
was able to slightly abduct both eyes. Then slowly, he was able to keep his eyes
open, move his tongue, and breathe on his own. And after spending 6 weeks at the rehabilitation
hospital, GP was able to return home from a road trip he never intended to return from,
with limited mobility and function, that fully returned after 6 months. Thank you so much for watching. Don’t take it if it’s nacho cheese. And be well.

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