DRHOOK- Step wrong? You'll wish you'd had that tetanus shot

the handsome doctor John Hong of Charlottesville

"Shut Up!" is What Not to Wear Stacy London's favorite expression when she's excited. I wonder when flipping the bird will become a sassy expression? "Shut up! I love what you're wearing!" [Flip Middle Finger Up].

Don't get me wrong. I love that show. Shirley Jones' character in The Partridge Family did "shut up" when she was going to perform on stage for the first time. She couldn't open her mouth because she was so nervous. (I would be, too, wearing all that ruffle!) It was almost like she had lockjaw!

When is "shutting up" due to tetanus?

We all hear about getting a tetanus shot when we have a cut, but what exactly is tetanus? It's caused by Clostridium tetani, bacteria that primarily live in the dirt, because it's anaerobic (hates oxygen). It enters the body through wounds, which has been common knowledge since the ancient Greeks and Egyptians. The incubation period is around seven days, but can come as soon as one day or as late as several months.

C. tetani releases a toxin called tetanospasmin that causes muscles spasm. (Remember how Elaine danced on Seinfeld like a spaz cadet? It's worse than that.) The toxin irreversibly binds to the spinal cord and brain stem, so if the person survives, he or she has to wait a long time until new axonal nerve terminals grow.

The spasms are excruciatingly painful. I wonder if J.K. Rowling used tetanus symptoms for her Crucio curse in the Harry Potter series. A spasm attack mimics a person being electrocuted: clenched fists, arched back. These attacks can be triggered by stimuli such as loud noises, light, or being touched. Cracking a joke can crack their back because laughing can trigger the spasms.

Tetanus makes the neck stiff. Face spasms cause a sardonic smile, and lockjaw, rigid abdomen, and swallowing difficulties are also common. Seizures can occur. Breathing can be impaired—to the point where the person may suffocate. Sounds awful, and unfortunately, one million people a year get tetanus worldwide, resulting in 300,000 deaths annually. The illness is responsible for five to seven percent of neonatal deaths worldwide.

Since the nervous system is attacked, autonomic instability occurs. That means catecholamines are released to make a person feel like he's being chased by a lion: fast heart rate, high blood pressure, sweating, fever, and irritability. These symptoms usually occur within the first two weeks of the onset of tetanus.

Fortunately in the USA, tetanus doesn't occur very often due to the tetanus vaccine, which was developed in the 1940s. After completing the tetanus series of shots as a kid, adults should have a booster shot every 10 years. For clean cuts it is recommended at 7-10 years and for dirty cuts every five years. Stepping on something contaminated with dirt like a nail carries a higher risk of C. tetani. Any puncture wounds from gun shots to splinters can carry the germs. Burns are also bad because the skin isn't there to protect the body from bugs, and C. tetani is one that might move in.

People 25-59 years of age and IV drug users are at high risk. But so are those with dental infections (which is why I really push all my patients to regularly see the dentist), diabetics with chronic ulcers, and people who have undergone certain types of surgeries. 

I'm sure there are folks (who must be very mean-spirited) who would like me to have lockjaw, but I stay up to date with my tetanus shots. 

Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.