Thursday, July 29, 2010

Following My Nose

NoseImage via Wikipedia
Just saw Dr. Palmer, otolaryngologist specializing in the nose to start understanding why I can't smell very well.

I am getting good at giving medical histories now and presented a succinct discussion of my journey through the cortex and how I started looking up the nose.  For those of my gentle readers who have not been reading every post of this blog with bated breath like readers of Dickens' The Old Curiosity Shop, I will recap.  Unlike the readers of Dickens,  I don't believe that there are hordes of readers standing on the docks awaiting each installment so I will summarize the journey by saying that I started feeling inordinately disorganized and unfocused and got a diagnosis of Non Verbal Learning Disorder from a Neuropsychiatrist at Columbia Presbyterian.  I looked up the co-morbidities of NLD and found that there are an associated plethora of sensory integration problems involving vision, hearing, motor, balance and digestion.  Given that  I have problems in each area of the five senses so I thought that I would check out smell and taste.  Not many doctors care about a lack of the ability to smell.  I have told every General Practioner that I have seen throughout my adult life and they have all cheerfully ignored the problem.  A Nutritionist took it seriously enough to have me screened for vitamin D and zinc deficiency.  We found a lack of vitamin D and I started taking a supplement which helped my sense of smell a bit.

Why am I so concerned with smell?
It would be nice to smell perfume and flowers and bad food in the refrigerator.  However, more than that, smell has a direct path to the amygdala, the emotional center of the brain.  Unlike other senses such as vision or hearing that have pathways from the organ to the thalmus and the amygdala.  The expert on executive function (higher order thinking such as goal-setting, task initiation, organization, etc). Dr. Elhonon Goldberg believes that a central problem in autism may be poor integration between the amygdala and the prefontal cortex (the center of executive function).  There is also a bit of research about using oxycotin for autism and developing research linking a sense of smell to poor social function.

Smell and Taste are the most primitive of senses and the ones that develop first in infants.  However, there is not much research done in their malfunctions so there aren't many practioners.  There are about a dozen Smell and Taste clinics throughout the country.  However, insurance coverage is non-existant or spotty, so I figured I would try and see a specialist that is covered by my insurance and let him figure out what I need to do rather than take a pot shot at a clinic that may or may not help me

Dr. Palmer does work with the Smell and Taste Clinic at Penn.  As far as Dr. Palmer is concerned, in the best of all worlds, a patient would go to the S&T Clinic and get formally diagnosed with either no sense of smell or a blocked sense of smell and then come to him if the patient had a blocked sense of smell.  But, he is used to the real world of interference by insurance companies and is willing to try to screen me before I go off to the S&T Clinic.

So, he squirted something up my nose to make the passageways a bit larger and then took a camera and peeked up the nose.  Unfortunately, I was positioned so I couldn't see my nose which is a shame.  How many times in your life do you get to look up your nose?  Really.  He thinks my airways are a bit tight.

Dr. Palmer asked me if I had an MRI.  Fortunately for him, Dr. Bigelow had one done a few months ago.  I told him there was nothing remarkable about it but he wanted to look anyhow as radiologists don't often pay close attention to issues pertaining to the nose (sound familiar?) unless there is something truly remarkable about it.  So he pulled up my MRI (good thing I had this all done at Penn which has an electronic medical records system) and took a look for himself.  He satisfied himself that there was nothing wrong in the brain.

So as far as Dr. Palmer is concerned, what he could do is to give me some prednisone and see if my sense of smell gets any better.  If, in 3 months, my smell does improve, we could discuss surgery to open up my airways.  If there are still issues after 3 months with my sense of smell not improving or if the sense of smell is not back fully after surgery, I could go to the S&T clinic at a later date.

If there are further issues with sensory integration relating to smell, the S&T clinic can provide answers with that.  Apparently, there is some further things that can be tried to reactivate nerves that haven't developed such as Vitamin A or sniff therapy (ie sniffing different things on a daily basis), but the insurance companies aren't on board with these treatments and it would be done at my own expense.

I do think that my sense of smell can be recovered.  Just opening up my passageways made a bit of difference.  When I left the Hospital of the University of Pennsylvania, I made my way up Johnson Walk to the Biomedical Library past the Research Buildings.  As I past the laboratories, I could smell the dank ventilator smell and a bit of the funky lab smell.   Twenty five years ago, I worked in these buildings and I never smelled anything on my way to work. So maybe, there's some hope for my nose.


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