Cans are scary because in my mangled mental state I believe that 'all cans have botulism'. As with my issue about rabies (i.e. all bats have rabies, all squirrels have rabies) and tetanus (all pins, needles, and nails can give you tetanus) I am not quite rational in my fear of botulism. I had an interesting encounter with a can recently, which prompted me to go ahead and create this post about one of the "Big Three" fears of my psyche. I posted the Big Three post to introduce the topic, and then I dealt with my rabies fear in my second post about bats, Bats are Scary.
So let's talk about botulism. Wheeee!
Okay, my fear started in high school, when I read a caption to a figure in my science textbook. It said something bizarre, like only 2000 'molecules' of botulism are necessary to kill someone, and it implied that the only result of being infected was death, or very rarely, if you survived, total paralysis. All this stuff isn't true, by the way, but I didn't know that then. So when I read that caption, the information settled down somewhere into the irrational part of my brain that keeps facts ready for my later torture. When my OCDs and panic burst forth fully formed in my early twenties, they tapped into this reservoir of ready-made fears, and botulism came up as one of the top three, beleaguering me for the seventeen years or so since.
The practical result is that since the age of 24 I have been unable to open a can and then eat the contents. Very rarely, and by that I mean a handful of times in the last seventeen years, I have been able to open a can and use the contents if someone else pronounced it 'good' and then ate the contents first - and then if they didn't die for a day after eating it. I have literally opened only six cans in seventeen years.
Interestingly, this fear has centered almost completely on metal cans. For whatever reason, they have bothered me much more than jars. Although I went many years unable to open a jar, even a glass jar of bottled juice, I have at least been able to use jars with some regularity in the last five to seven years. Metal cans, though, no go. (Additionally, for almost two years I couldn't eat frozen food, either, as it somehow became guilty by association.)
Of course, everyone but me uses cans in cooking. And I can eat at someone's house and at restaurants just fine, as long as I don't see the can. If I see an open can on a counter, that's it. I can't eat the food. This has meant a lot of very embarrassing incidents, and even perceived offenses, where people think I 'don't trust them' because I can't eat the food. That has played directly into my social anxiety, exacerbating that already chronically bad condition. Eating dinner at someone's house can be potential nightmare, so I've often avoided it.
Anyway, so that sets the stage for a new look at the big 'B'.
So let's see some facts for a change. The bacteria that cause botulism are naturally occurring in soil. They tend to thrive in low-oxygen environments (anaerobic). This means they colonize generally when contained, as in sealed cans and jars, but also occasionally inside wounds or someone's intestines. The latter usually only happens to infants. I always knew of the anaerobic nature of this bacteria, and so have been nervous in any situation that has a container that has been closed for a long time - for example, having to clean out a cooler that was used on a camping trip after it had sat closed with water in the bottom for many months. The chance there was danger of botulism in that scenario? About zero. But as I've noted in the past, if it were a rational fear I wouldn't be on meds.
Botulism is super rare. The CDC says (emphasis mine), "In the United States, an average of 145 cases are reported each year. Of these, approximately 15% are foodborne, 65% are infant botulism, and 20% are wound. Adult intestinal colonization and iatrogenic botulism also occur, but rarely. Outbreaks of foodborne botulism involving two or more persons occur most years and usually caused by eating contaminated home-canned foods. The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of black-tar heroin, especially in California"
WebMD says the following, "Any case of foodborne or unexplained botulism is considered to be a public health emergency because of the potential for toxin-containing foods to injure others who eat them and because of the potential misuse of botulinum toxin as a biological weapon. State and local public health officials by law must be informed immediately whenever botulism is suspected in a human patient." This is another point underscoring the rarity, since I don't have a lot of memories of 'botulism' emergencies - certainly not like the E. coli. emergencies that seem to happen all the time.
On top of the rarity of the disease, my idea that it was instantly fatal was not quite true, either. It is true that a survivor can face weeks, months or even years of rehabilitation from the paralysis. But it is possible, and more likely than ever. Again, the CDC says, "Botulism can result in death due to respiratory failure. However, in the past 50 years the proportion of patients with botulism who die has fallen from about 50% to 3-5%."
The CDC article goes on to indicate the specific ways one can drop their risk of botulism to near zero. Don't give infants honey - the bacteria can exist in honey, and infants are at risk in a way adults are not. Don't use drugs. Duh. Be exceptionally careful with home-canned food, and "Because the botulism toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure safety."
And there it is. The fear and the facts. As usual, the facts are not of terribly good use in fighting the fear, but they are useful. I am now able to use jars, like those above, on an occasional basis (although if they are 'home canned' instead of 'factory canned' I still can't touch them.) The longer I live, the less I fear dying in general. After all, I've managed to get the first forty years down, and I can now imagine that if I kept doing what I have been, I figure I should have a pretty good shot at another forty. And if not, I have this idea that botulism isn't going to end up being the problem.
Your Hostess With Neuroses
Saturday, November 14, 2009
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