Bo­tox safety risk be­low alarm lev­els

The Weekend Australian - Travel - - Health - LINDA CAL­ABRESI

I am­con­sid­er­ing hav­ing Bo­tox to get rid of my frown lines, but I have heard there have been some con­cerns about the treat­ment’s safety. How safe is Bo­tox? I am53, healthy and not on any med­i­ca­tions. BO­TOX is brand name for a pu­ri­fied form of a chem­i­cal toxin known as bo­tulinum toxin type A, pro­duced by the bac­te­ria Clostrid­ium bo­tulinum . Peo­ple who de­velop this bac­te­rial in­fec­tion can be ex­posed to large amounts of the bo­tulinum toxin, which can cause lifethreat­en­ing paral­y­sis. How­ever, the amount of this toxin used for cos­metic pur­poses (as in Bo­tox) is very, very small by com­par­i­son and has a very good safety profile. Of course no treat­ment is risk-free, but gen­er­ally the side ef­fects re­ported have been lo­cal, in­clud­ing pain, ten­der­ness and bruis­ing at the site of the in­jec­tion. There is also a slight chance that the eye­lid will be af­fected, caus­ing it to droop. If this hap­pens it usu­ally lasts only a few days, some­times a lit­tle longer.

Aside from its cos­metic uses, Bo­tox is used to treat a num­ber of med­i­cal con­di­tions such as ble­pharospasm (spasm of the eye­lid), cer­vi­cal dys­to­nia (spasm of the neck mus­cles) and mus­cle spas­tic­ity due to cere­bral palsy, to name a few.

The re­cent safety con­cerns you men­tion are com­ing from the US, where a con­sumer group has asked the au­thor­i­ties to strengthen the warn­ings on Bo­tox and sim­i­lar drugs af­ter re­ports there had been 16 deaths as­so­ci­ated with the treat­ment since it first be­came avail­able. Ap­par­ently the deaths were re­lated to mus­cle weak­ness caus­ing dif­fi­culty swal­low­ing af­ter the bo­tulinum toxin spread from where it was in­jected. But ap­par­ently only one of th­ese cases in­volved cos­metic treat­ments, and what isn’t clear is where the toxin was orig­i­nally in­jected, and for what in­di­ca­tion. But at this stage the au­thor­i­ties haven’t changed their warn­ing about the drug, sug­gest­ing there’s been no new dan­ger dis­cov­ered. I ama 46-year-old man. Re­cently I had a scan of my ab­domen and they in­ci­den­tally dis­cov­ered I had two gall­stones sit­ting in my gall blad­der. They have not caused any prob­lems, ever. What is the pos­si­bil­ity that they will cause symp­toms in the fu­ture — and should I get them re­moved? GEN­ER­ALLY, with pain­less gall­stones, it’s a case of leave well enough alone. Chances are they will not cause you any prob­lems. One study, pub­lished in the Bri­tishMed­i­cal Jour­nal a few years ago (2001;322:91-94), looked at just this sit­u­a­tion and found that only 3 per cent of peo­ple with pain­less gall­stones de­vel­oped symp­toms re­lated to their stones over the course of 10 years. My wife and I have been ar­gu­ing about whether al­co­hol is an im­por­tant fac­tor when you’re try­ing to lose weight. Is it? AL­CO­HOL can in­flu­ence weight for a few rea­sons. First, there are the other in­gre­di­ents com­monly as­so­ci­ated with an al­co­holic drink. Hav­ing a stan­dard drink will mean you con­sume 10g of al­co­hol, which is only about 30 kilo­joules. How­ever, a stan­dard glass of wine con­tains about 450 kJ, and a mid­die of full-strength beer about 585 kJ. To put this in con­text, a wo­man’s daily in­take is gen­er­ally around 8500 kJ, and a man’s is around 11,000 kJ if they are not di­et­ing.

An­other fac­tor to con­sider is that the body can­not store al­co­hol as an en­ergy source. It will metabolise the al­co­hol in pref­er­ence to any other fuel. So while the body is burn­ing off’’ the al­co­hol, it won’t be metabolis­ing any other en­ergy source such as fats that you may have eaten — and th­ese then tend to be stored, lead­ing to weight gain. Most di­ets gen­er­ally rec­om­mend at least min­imis­ing al­co­hol in­take if you are try­ing to lose weight. Linda Cal­abresi is a Syd­ney GP and ex­ec­u­tive ed­i­tor of www.6min­, a news ser­vice for Aus­tralian doc­tors. Send your queries to lin­da­cal­

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