Normally when I think of Botox I think of women (very much like those in Desperate Housewives) who want to somehow reverse the traces of time and maintain their youth. After my visit to Pediatrics Physical Therapy and Rehabilitation, I realized that Botox serves a purpose much more important than the superficial beautifying one we know of.
Firstly, what is Botox? It is Botulinum toxin produced by certain bacteria. This toxin blocks neuromuscular transmission through decreased acetylcholine release. In other words, it blocks the signals from brain and nerves to muscle. How could it possibly be useful to block signals to the muscles?
Patients with Cerebral Palsy have cognitive deficits. The part of their brain that controls motor functions is damaged, and so signals that make their muscles contract are sent out unwillingly. These patients come in and have Botox injected into the nerves and muscles in their legs, arms, and even necks, to relax their muscles so that they may be more comfortable in their everyday lives. The procedure to inject the problematic nerve sending out the signals was very interesting. The doctor would first use electro-stimulation to locate the nerve or the muscle. And then he would inject the saline-Botox solution into the nerve. If he didn't get the appropriate impulse response from the nerve, he would move the needle around until he found the right spot.
This procedure was most likely uncomfortable, if not painful. It was heartbreaking to hear the patients whimpering and seeing them flinching, but I was told that the doctor used a sedative, “Versed”, that acted as a relaxant and, in addition, made the patients forget what they had just gone through. Although the procedure seemed painful, the lifelong muscle stiffness seemed much worse. Leading a life with constant muscle spasm is much worse than the 35 second discomfort for each leg.
It was amazing to see how long some of the patients live, a testament to how effective modern medicine has become. One patient, with muscular dystrophy, was 28 years old. A doctor explained that the reason he has to come in to see a pediatrician is because most patients do not live to be adults, so adult doctors are not specialized to treat patients like these. I was also amazed to learn that one of the patients with cerebral palsy was graduating from high school and going on to college to be a video game programmer. Although his motor skills were severely affected by his CP, his brain was completely functioning, and he had the capacity to learn and think the way a person without any deficiency could.
Again, my second day was wonderful: I learned a lot, and laughed a lot. I learned a bit about the manifestations of the effects of extra copies of chromosomes, which I had read about in my first day at obstetrics. I was able to see a small child with a very rare disease, Edwards Syndrome, caused by an extra copy of the 18th chromosome (we normally have 2, one from mom and one from dad). The syndrome has a very low rate of survival, resulting from heart abnormalities, kidney malformations, and other internal organ disorders. However sad the disease of each patient, the doctors still had a very keen sense of humor, jesting about my having gotten into a “small community college in Cambridge” and laughing when getting kicked by a patient. It seems to me that the patients at Tufts Medical are in very good hands.
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