Hi Dr Bernard here. The point of this video, which is based off a case published in literature,
is to tell you, if you dont need to put it in your body, don’t put it
in your body. There is no turning back from intentionally causing permanent damage to it.
A man bought a cheese making kit on the internet. He took one of the ingredients
and inserted it in-between his legs. This is what happened to his testes.
CC is a 28 year old man, presenting to the emergency room with suprapubic pain. Supra
meaning above and pubic referring to the region in-between the legs.
One week earlier, CC had been living his regular life, which meant something was
wrong. Everyday at work, he’d see people and he couldnt get certain thoughts about them out of
his head. These thoughts would seep into his mind, and he had to control himself,
staring blankly into the void in an effort to mask everything racing through his head.
He would think about doing very specific and explicit activities with every single
person he encountered face to face, and those thoughts would linger in his mind,
when finally, he’d have to go to the bathroom to fix himself up, just to have those same thoughts
rush right back into his head, afterwards. These compulsive fantasies were ruining his life.
CC couldn’t remember a time when he didn’t have these thoughts. When he finished college
and started working, he immediately realized that he had to keep himself under control,
because expressing any hint that his mind was even bordering into this territory,
was not only taboo, but it would completely ruin his livelihood.
On the internet, looking for help. CC came across some image boards that referred him to a forum,
where he would find people spreading around information that he thought could help him
“fix” himself. Taking some of these leads, he started doing his own research. Over the
years he studied this topic closely. At first, he started reading more about chemicals that could
be put into his body, directly to the pair where he believe all this wrongdoing originated from,
but he noticed most of the scientific papers that he’d follow were all veterinarian studies;
there was hardly any human data on this. But as he kept reading more and more,
he started extrapolating this information before finally coming to his own conclusion
of what exactly he was going to do because he needed to get these thoughts out of his head.
Shopping online, CC serendipitously came across a cheese-making-kit that contained
exactly what he was looking for. As he picked up his package, he extracted the liquid, and
applied it inbetween his legs. Immediately after plunging the syringe, CC felt a burn. At first he
was more scared of the needle, which he didn’t think he could feel. But as he plunged another
syringe’s contents in a second time, finishing off the pair, he knew he could feel something.
As the days pass, CC would wake up at night in a pool of his own sweat. Sometimes, randomly,
he would feel a dull burning sensation just under his stomach. But as time continued,
this pain would get worse and worse until finally,
he couldn’t take it anymore as he drives himself to the emergency room where we are now.
At examination, CC appeared to be normal. Suprapubic pain can be caused by many different
problems, and he told the medical team that he had been experiencing night sweats and anxiety.
These could be associated with a previous diagnosis of depression he got a few years
ago. But he also told them about a noticeable decrease, in testicular size without telling
them anything more, and this gives the medical team some clues of where to start looking.
A scrotal ultrasound finds 2 large spherical masses, one in each testicle. Unsure exactly
what this was, the medical team asked if CC would have any possible idea of what this could be,
and his answer would start to explain to them, most of what’s happening.
The cheese-making kit had included calcium chloride, an ingredient used to increase calcium
content in milk because when pasteurization happens, the changed milk proteins and fats
make coagulation difficult for cheese production make cheese. This doesn’t [shouldn't] happen if raw milk is
used to make cheese, but at least in many parts of the United States, raw milk is
unlawful milk. Calcium in the right amounts in the body is required for normal function,
your bones are made of it. But excesses of calcium can cause problems like we’re seeing in CC.
Calcium chloride is a salt, similar macroscopically to table salt,
which is SODIUM chloride. The joining of positive and negative charged ions,
makes a solid, in this case one that dissolves in water.
Calcium is the most common mineral in the body, but like sodium and potassium close by on the
periodic table of elements, it is also an electrolyte that’s important in signaling
in the body. Telling tissues and organs to do things. While sodium is mostly outside of cells,
and potassium is mostly inside cells, calcium as an electrolyte is different, because it’s inside
cells, but most of it is sequestered even deeper inside cell organelles. But why is it like that?
Sodium, because there’s so much of it floating around in the body,
is often used to start a signal by going in to a cell. Potassium is often exchanged
out with sodium to further that signal. But once calcium is involved, that signal is committed.
Take for example muscle contraction. Sodium rushes into the muscle cell to initiate the contraction.
Potassium is exchanged out of the muscle cell to balance the sodium going in, and calcium
commits to the contraction, and we know you can’t terminate a muscle contraction midway through.
And humans have more than one kind of muscle. Skeletal muscle moves our arms and legs, but
the stomach and the GI tract are made of smooth muscle, and the heart is also made of muscle,
and so are the blood vessels, all of which need calcium to signal to commit to a contraction.
But the body runs on more signals than just that. Normally, different parts of
the body will need to communicate with one another, and sometimes these parts
are physically far away. They’re not directly attached. So the body will employ hormones,
which are chemical messengers secreted into the blood to establish this communication,
and that initial hormone release can be signaled by calcium.
Cells can’t be alive forever, because, while the person’s alive, cells are dividing and
replicating, meaning there can be too many if they all live forever. Programmed cell death,
or apoptosis, has a signal start from a large release of calcium from the stores
inside the cell, all of this giving us some clues as to what’s happening to CC.
CC tells the medical team that his testes have shrunk since he put the
calcium chloride in-between his legs. That this shrinkage was happening at
a time when a terrible burning pain was present in the region.
If blood vessels are a kind of muscle, and the parts in-between the legs are highly vascularized,
then CC injecting calcium chloride into this soft tissue that has a lot of blood vessels in it,
means that possibly the sudden massive influx of
calcium to the region committed a muscle contraction in those blood vessels. This
vasoconstriction then starves the parts of blood and oxygen, suffocating them.
But this wouldn’t be CC’s only problem. A sudden injection of calcium could also be
taken by cells as an apoptotic signal, causing them to suddenly die. This kind of injury is
well known when calcium chloride is injected, usually into a blood vessel, through the skin,
causing extravasation. Then the dead skin tissue activates the immune system,
causing even more damage. Luckily for CC, the region to which he applied his calcium chloride
is known to be immune privileged, meaning that white blood cells and inflammation typically
don’t happen there likely in an effort to not damage the reproductive cells. But the
medical team wouldn’t know for sure the extent of inflammation that could be happening in CC
without going in and taking tissue samples of his testes. And going in to do that,
could cause even more damage. The damage to CC’s testes could be due to a different mechanism.
Do you remember the scrotal ultrasound suggesting masses in each testicle? Well, the thing about
salts, is that some of them don’t dissolve in water. While calcium chloride is water soluble,
the body has other negative ions floating around, one of which is phosphate most notably from
adenosine tri-phosphate, also known as ATP and is the molecule used by cells for energy. Calcium
phosphate is one salt that doesn’t dissolve in water. It becomes a solid and it could be
the cause of the of these masses. And if these are calcified masses of necrotic tissue, it’s
probably disrupting normal function, because as the medical team take a blood test, they find CC
has hypogonadal function. Hypo meaning low. Gonadal referring to gonad, the organ that
produces gametes, or haploid cells that have one set of chromosomes, but in this case relying on a
biomarker level for specific hormones. His bioavailable testosterone was 7% the lower limit of normal.
As the medical team look further at CC in the emergency room, there isn’t really much that
they can do. There isn’t an antidote that they can use that would suddenly reverse the soft
tissue damage within. They can give him medicine for the pain, they can give him supportive care,
but there isnt anything they can do to suddenly regrow him a brand new set of testes.
In the hospital, Calcium chloride can be an intravenous medicine that’s used in hospitals
to treat hypocalcemia. Hypo meaning low. Calc referring to calcium and –emia meaning presence
in blood. Low calcium presence in blood. The problem is, calcium chloride is known to have
a very high risk of extravasation injury to skin, because the route of administration
is through a needle. Some of the calcium chloride can drip out, and “splash” around under the skin,
causing tissue necrosis. If you touch some calcium chloride with unbroken skin,
it probably won’t cause a burn because there’s protective proteins on the outermost layer of the
skin, and needles penetrate deeper where those proteins aren’t present. All of this to say,
in the hospital we typically elect to use calcium gluconate instead, which is calcium attached to a sugar
molecule. This contains less elemental calcium which then decreases the risk of this injury.
This soft tissue damage that happens gives us an idea of why calcium chloride caused CC to have
what looks like testicular shrinkage, hypogonadal function, suprapubic pain,
and scrotal masses at the sites of his injection. The mechanisms are relatively unclear,
but we know that calcium chloride dissolving in water creates heat. Calcium complexes with at
least phosphate to create a water-insoluble salt. We know that it commits to signals,
including one that induces cell death, and it can also cause oxidative stress and damage to
cells when present in large amounts, which is why cells choose to sequester
calcium inside specialized organelles, only releasing it when it is needed.
This is something that we’re not going to have a lot information on in humans, because you can’t,
at least you shouldn’t, gather a bunch of people and just inject this in there,
knowing that you can cause permanent damage. The veterinarian studies that CC likely came across,
highlight that this can be a standard practice in some animals, if that’s what you wanna do. But our
best bet here to know CC’s course is really just extrapolation from both these animal reports,
and the background knowledge that calcium chloride, specifically,
has a high propensity of calcinosis due to extravasation injury in soft tissue.
At 2 month follow up, CC appeared to be in better spirits, with no more suprapubic pain,
no more night sweats, and no more anxiety. He started to feel like his regular self once again,
unknown the extent of permanent damage that may have been caused
by this self-inflicted episode. So we can say he appeared to make a recovery.
Thanks so much for watching. Take care of yourself. And be well.