Counterfeit Botox Harmful Reactions

Dry Mouth and Slurred Speech

The CDC reported that several Health Departments and the FDA “are investigating reports of harmful reactions among people who receive injections of counterfeit or mishandled botulinum toxin (commonly called “Botox”).”

These “harmful reactions” happened “after receiving botulinum toxin injections from unlicensed or untrained individuals or in non-healthcare settings, such as homes and spas.”

The CDC provided this list of harmful reactions:

• Blurry vision

• Droopy eyelids

• Difficulty swallowing

• Dry mouth

• Slurred speech

• Difficulty breathing

• Fatigue

• Generalized weakness

Some affected people were hospitalized.

(CDC April 19, 2024)

So, if you are considering Botox treatment, you would be wise to seek treatment by a medical professional with proper training in how to administer it.

The Mayo Clinic points out that only purified botulinum toxin that meets the FDA requirements should be administered.

It works by “blocking chemical signals from nerves to muscles.” Botox has a number of indications for its use including treatment of “wrinkles, frown lines, neck muscle spasm, sweating, overactive bladder, preventing frequent migraine headaches, lazy eye, and other conditions.”

Done correctly, it can be a valuable treatment for a number of conditions.

Mayo Clinic 2024 https://www.mayoclinic.org

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Psilocybin for Anxiety & Depression

Anxious and Depressed

Psilocybin is a psychedelic that affects the serotonin system in the brain. This is the same system that is targeted by many medications prescribed by health care practitioners for anxiety and/or depression

For that reason (and others) researchers have investigated whether psilocybin could be used successfully to treat anxiety and depression. International research has shown that psilocybin can be very helpful to treat these two categories of mental illnesses.

Unlike recreational use of psilocybin , researchers use purified psilocybin, and the dose given is precise. Also, controlled studies use either a placebo or much lower doses for comparison purposes.

Also, most formal research includes having a therapist present to help the research subject discuss what they are experiencing and to process it in a way that is therapeutic. This approach is called “psilocybin-assisted therapy.”

In Germany, psychiatrists can legally provide treatment for anxiety and depression using psilocybin during a psychotherapy session. The psychiatrists have to demonstrate competency providing appropriate psychotherapy with these patients.

Yerubandi and colleagues wanted to find out about possible side-effects from psilocybin-assisted treatment. They published results from an analysis of 6 clinical trials with a total of 528 patients in JAMA Network Open on April 10, 2024.

The patients were mostly white, middle-aged adults. The doses of psilocybin used in the studies were: low dose 1-3 mg, moderate dose 10-20 mg, and high dose 20-30 mg.

The research showed that “… headaches, nausea, anxiety, dizziness, and elevated blood pressure occurred significantly more frequently with psilocybin vs comparators,” i.e., placebo, low-dose psilocybin, niacin, or escitalopram (Lexapro is the common Brand name). Headache and nausea were the two most common side-effects.

They did not find any association “with risk of paranoia and transient thought disorder” even though researchers thought they might occur.

The side-effects they did identify “resolved within 48 hours” and were found to be “tolerable.” The authors acknowledged that the studies did not look into the possibility of rare long-term adverse effects; additional studies will need to be done to find out if that occurs.

To me, the bottom line is that purified psilocybin given at precise doses during a therapy session can provide meaningful benefit to patients with depression and anxiety disorders such as PTSD.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

What To Do With The “Stomach Flu”

Stomach Cramps and Diarrhea

According to an excellent article by Sara Berg, MS from the AMA Association, the “stomach flu” is not a type of flu. It is caused by a different type of virus (the norovirus) that attacks the stomach and intestines rather than the respiratory tract. (This article is based on the above reference by Berg).

Norovirus is the most common cause of “acute gastroenteritis,” which means an inflammation of the stomach and intestines.

People with a norovirus infection typically have the sudden onset of nausea, vomiting, stomach cramps, and diarrhea. Unfortunately, it is becoming more common in the U.S.

It is spread by the “fecal-oral route” meaning that billions of the viruses are found in infected peoples’ stool. If that stool gets into a water supply or on food, the virus is taken in by mouth.

The virus can continue to shed for “up to two weeks after … symptoms are gone.” The virus can live on surfaces such as tables and hand rails “for days to weeks.”

Noroviruses cannot be treated with an antibiotic. Also, even though many people refer to it as the “stomach flu,” medicines for the flu such as decongestants are ineffective and may even cause harm since they dry out tissues.

Treatment consists primarily of maintaining good hydration by drinking lots of fluids with electrolytes. Example include Gatorade, Powerade, and Pedialyte (this last one is to be used in children but can also be used in adults).

Adults may want to try Kaopectate, Pepto Bismol or Lomotil to reduce diarrhea. Avoid caffeine products. Kids can be placed on a BRAT Diet (bananas, rice, applesauce, and toast).

Prevention is better than treatment. Good handwashing is key. Rinse all fruit and vegetables before eating them. Cook shellfish thoroughly with a goal of an internal temperature of 145 degrees.

Stay home if you are sick from acute gastroenteritis.

Symptoms usually last 24-48 hours, but remember, the virus can be present in the stool for up to two weeks after symptoms are gone. If symptoms persist for 72 hours or more, it would be prudent to see your doctor.

Some people notice a return of some symptoms when they begin to eat normally after the initial symptoms have resolved.

Most often, this is due to temporary lactose intolerance caused by diarrhea. This typically lasts only 48 hours. So, you may want to avoid milk products for a couple of days after norovirus symptoms have stopped.

While most people recover from norovirus infections, young children (ages 6-18 months) and adults over age 65 can get seriously ill and a few may even die. These individuals need to be monitored closely.

Peter M. Hartmann, MD

Family Medicine & Psychiatry

Ashamed of Your Appearance?

Ashamed About Her Appearance

Sometimes people are so ashamed how they look, they avoid social situations. At the extreme, some people think they have physical defects that are actually not visible to anyone else.

This is called, Body Dysmorphic Disorder (BDD). The Mayo Clinic defines it as “a mental health condition in which you can’t stop thinking about one or more perceived defects or flaws in your appearance – a flaw that appears minor or can’t be seen by others. But you may feel so embarrassed, ashamed and anxious that you may avoid many social situations.”

An example would be a 14-year-old girl who is certain that her nose is too large and misshapen that she begs her parents to let her get a “nose job.” However, her parents can see that her nose is normal, even attractive.

To help her feel better, her parents take her to a plastic surgeon. He tells her and her parents that her nose is 100% normal, and he will not operate on it.

A study in England of children and adolescents age 5-19, showed that body dysmorphic disorder (BDD) and preoccupation with appearance were more common than realized.

BDD was more common in adolescents and girls than children and boys. Preoccupation with appearance was more common than full-blown BDD.

However, preoccupation with appearance had the same rate and type of negative effects and associated impairment seen with BDD (Krebs G and colleagues Journal of Child and Adolescent Psychiatry, March 17, 2024).

The most common associated mental health conditions were anxiety and depression. Also, the children & adolescents and their parents reported “psychosocial impairment, self-harm and suicide attempts.”

Clearly, BDD and appearance preoccupation in children and adolescents are worrisome and warrent an evaluation by a mental health professional.

Peter M. Hartmann, MD

Family Medicine & Psychiatry