Editor’s note: This story is the third and final installment in a Herald Journal series on home canning safety.

As harvest time approaches and home food canning begins, it is essential that procedures are done correctly to avoid what was a brush with death in January for Debbie Miller of Logan due to botulism poisoning.

With the help of the health care providers at Salt Lake Regional Medical Center, the Utah Health Department, and the Centers for Disease Control, Miller has safely returned home. Though Miller’s ordeal was terrible, the rarity and intensity of her case provided not only a valuable reminder to home canners to follow safe procedures but an invaluable education for those healthcare providers in knowing how to treat future victims.

The neurotoxin produced by Clostridium botulinum bacteria as it grows is considered one of the world’s deadliest poisons because of its ability to quickly paralyze respiratory muscles. Botulism toxin is second only to Anthrax on the Centers for Diseases Control’s “Category A” list of bioterroism agents and diseases, which is why health care providers and facilities are required to immediately report even a suspected diagnosis to public health departments.

Though deadly, botulism is also very rare. Jeffrey Eason, the Utah Department of Health’s assistant manager for the Disease and Response Evaluation Analysis and Monitoring Program, said that Utah averages 1-2 confirmed cases out of less than 200 across the United States. With so few cases, hospital doctors and staff cannot hope to have enough experience to treat this life-threatening disease, let alone have on hand the testing equipment and medication to treat it.

Such as happened in Miller’s case, Eason said that once a health provider even suspects a diagnosis of botulism, health providers send specimen samples to the health department for testing.

“They send the samples to us because we have the testing that is not typically done in regular laboratories,” Eason said, “It requires the use of mice that are injected with the specimens … most laboratories don’t have mice and the tests are time sensitive. It also requires a high level of laboratory expertise to conduct the tests.”

Eason said that the Health Department consults with the physician and the Centers for Disease Control and then requests antitoxin be sent as quickly as possible.

“We can request the antitoxin be sent to the health care providers even before the testing is completed,” Eason said, “sometimes even before the specimen is collected — even just upon suspicion. There is great enough concern for patients with botulism that the antitoxin can be provided just on the health care provider’s suspicion.”

Without the antitoxin, victims can survive with the aide of ventilators, but because the antitoxin helps prevent further damage to nerves, the sooner a patient receives the medication, the easier the recovery may be and less risk for permanent damage. But because of the rarity of data for the disease, Renee Petty, Director of Pharmacy at SLRMC, said that it is still not known exactly how soon the medication must be administered to do the most good.

“We have a lot of different diseased states that we know a lot about,” Petty said, “because we practice treating them every day so we know that the best results comes from treating the patient within 12 or 24 hours after a specific incident. … With strokes, for example, we can tell you within how many minutes you don’t want to wait before you get treatment. But with botulism, we just don’t have a lot of experience with it as a nation so even if it’s been 30 days, we’re still going to give you the full dose.”

Because of botulism’s rarity, its antitoxin is stockpiled at only a few locations around the United States. Petty said that it is financially not in a pharmaceutical company’s’ best interest to produce much of medications that are only used a few times a year. The closest location of the toxin in Miller’s case was in California.

On the day of Miller’s admittance to the hospital, Petty said that the CDC notified her that the antitoxin was being flown into the Salt Lake City International Airport. While Petty went to retrieve the antitoxin herself, the hospital staff researched the best possible ways to treat the disease, had completed patient prep and were ready when Petty returned. The CDC stayed in constant contact with Petty to make sure the antitoxin arrived safely, was reconstituted correctly, and administered. The whole process from first contact to administration only took about 10 hours.

“That’s a pretty darn good turn around,” Petty said, “considering how many people were involved and that it had to come from a few states away. … In this whole process, I was the one wondering how much this antitoxin was going to cost, but not once was I asked by the administration to find out....They just told me to get it taken care of now!”

From what Petty was even able to roughly estimate, the cost was in the 10’s of thousands just for the medication, but Petty never found out the exact amount because the CDC never charged the hospital nor the patient.

“This was a fantastic education not only for myself and my pharmacists, but for the physicians and the nurses that were all involved in this,” Petty said, “I felt like we here at SL Regional were really excited to step up and help someone and got to expand our education and experience. … Because botulism is so rare, this is also a good opportunity for the CDC to study the effectiveness of the antitoxin and track the cases so that we’re prepared for the future.”

Six months after her diagnosis, Miller is off the ventilators, out of rehabilitation, beginning to slowly jog, and even to garden and can again.

Eason says that though botulism bacteria is ubiquitous throughout the soil, but food-born botulism can easily be prevented by following correct canning guidelines. Infant botulism can be prevented by making sure that children under the age of one do not eat honey which is easily contaminated from the bees’ contact with dirt. Honey then acts as an ideal anaerobic environment in which the bacteria can grow. Adult immune systems can destroy the amount of bacteria involved, but young developing systems cannot.

Eason, himself, cans foods at home and is a strong proponent of it.

“I just recommended people meet with their local extension offices and learn about proper food safety,” Eason said. “If people pay attention to the time and temperatures, it’s safe and has been for generations.”