The physician assistant at the ENT office did not thrill me when she said, after I told her about my loss of taste, “That’s usually a mystery.”
We hadn’t even yet talked about what had happened to me in any detail. She hadn’t asked a single question about it and had already used the word “mystery.” I wasn’t in the mood for a mystery. I wanted non-fiction.
We had finished talking about the hearing loss in my left ear. It is enough to warrant a hearing aid if I want one but not a significant impairment. Her concern was that my hearing loss was asymmetrical. The hearing loss in my right ear is minimal and normal for a 54-year-old, but the left ear’s hearing loss is more severe, and hearing loss is usually the same for both ears. That imbalance had concerned her, but a test had revealed no tumor, which had been the big worry. She suggested I have my hearing checked regularly and eventually decide about a hearing aid for the left ear. I can live with that.
My loss of taste and smell, on the other hand, called for more investigation. She ordered an MRI of my nasal area, to see what was going on. One possible cause could have been nasal polyps, non-cancerous growths that can block air flow to the olfactory cells, which, I learned, are crucial to smelling and tasting. Having warts in my nose would not normally please me, but I was hoping they would find polyps because they can be removed—which meant SOMETHING COULD BE DONE. But, alas, none were found and everything looked normal.
This became a pattern: No one can find anything wrong with me. The good news is that I’m one of the healthiest 54-year-olds you’ll meet; the bad news is there is nothing they can fix.
“If you can’t smell it, you can’t taste it,” the PA had explained. “Taste is 80% smell.” If you hold your nose while eating chocolate, it’s not nearly the same experience. There is a cluster of cells at the top of the nose that are connected to the olfactory nerve, which sends signals to the brain about smell. Without those smell signals, taste is toast. Bland, uninteresting toast.
Smell and taste often diminish with age, but normally at an age much higher than mine. Loss of taste and smell is a possible side effect of some medications, but I take none. Besides killing you, smoking tobacco can diminish taste, but I never picked up the nasty habit. Loss of smell and taste can also be an early sign of Alzheimer’s disease or Parkinson’s, and I will now go into complete denial that one of those is a possibility. Remind me in 20 years. Sometimes those cells get knocked out of whack by a bad upper respiratory infection, and smell—and, thus, taste—is diminished, or lost. A head injury can also affect taste and smell. I had not had a respiratory infection in a long time or fallen out of a tree, so I am in that other category: We don’t know what caused it.
I learned from the American Academy of Otolaryngology web site that we have a “chemical sensing system (chemosensation)” that handles taste and smell, and it is more complicated than merely food touching taste buds and taste buds identifying a taste—which is what I had assumed. We have nerve cells in the nose, mouth, and throat, which are stimulated by molecules released by many things: bacon, flowers, gasoline, tar, perfume, wood being sawed, and so on. These cells send messages to the brain, which sorts everything out and tells you what’s going on. Smell is processed through the olfactory cells (the ones clustered in the upper part of your nose). The gustatory (taste) cells are in your tongue and throat. Other nerve endings contribute to the sensation of smell and taste by adding to the context. When you smell smoke, your sensitive eyes may also sting, another “chemosensation.” These different sensations work together to create the complex experience we call “tasting” and “smelling.”
I hadn’t thought as much about my loss of smell as I had about the loss of taste, I guess because eating is more important to me than smelling. Since I am a hospice chaplain and am in nursing homes often, maybe I was enjoying not smelling geriatric urine—and whatever else is mixed with it. Smell, however, is pretty important. One day I was making a turkey sandwich, and as I was about to put the sliced turkey on bread, I thought it felt a little slimy. I tried to smell it, but sensed nothing. I asked my daughter, and she said, “It smells like chlorine.” I threw it away. I hardly notice it when I fart, but my wife and daughter do. Sometimes I am not a popular guy in my house. I’m thinking, “What’s the big deal?” They’re thinking, “Man, this guy stinks.”
At my last appointment at this ENT office, I spoke with the MD for the first time. He showed me some of the MRI pictures and explained how it all looked good. He said I had to wait to see if my taste returned to normal on its own. He said sometimes it never returns; sometimes it partially returns; and sometimes it returns completely. He suggested I take zinc tablets, use Nasonex spray in each nostril, and begin using a saline nasal rinse daily. He said these might encourage the healing, which may or may not take place.
Later, while scouring the internet for information, I found that insufficient zinc could lead to loss of taste and smell, so the zinc tablets made sense. Nasonex is used to treat nasal allergy symptoms, so that might help, although I was not clear why. The nasal saline rinse is…a little hard to explain. There are two ways to rinse out your nose with a saline solution. (Here is what Wikipedia says about it: http://en.wikipedia.org/wiki/Nasal_irrigation.) One is the neti pot, which looks like a little tea pot, or the container that someone rubs to release a genie from a lengthy imprisonment. Fill it with a solution of water, baking soda, and very fine salt, lean over your bathroom sink, tilt your head to one side, and pour the solution in one nostril. I promise it will drain out the other nostril, and you won’t drown. The other way, which I chose, since my 54-year-old lower back does not like leaning over very far, involves putting the solution in a small plastic squeezable bottle with a tip like a neti pot, and, while leaning forward only slightly and tilting the head, squooshing that solution in one nostril and out the other. This is best done in the shower, unless you like cleaning up—a lot.
I got the zinc tablets, the Nasonex spray, the plastic bottle (Nasopure brand: www.nasopure.com), baking soda, and very fine salt. And I swallowed, sprayed, and squooshed them, as instructed. Maybe something good would happen. I’m a person of faith and mostly an optimist—and trained since birth to do what authority figures tell me to do.
Still, I was troubled by the uncertainty of it all. I asked a doctor at work to recommend another ENT, for a second opinion. She confidently recommended someone, and I made an appointment, thinking maybe, just maybe, he would have an insight that would lead to healing.
The second ENT agreed with the first one that it was difficult to know what caused my loss of taste and smell. He also agreed that it might return (fully or partially), and it might not at all. I brought the CD of my nasal MRI, and he didn’t see anything the first ENT didn’t see. About the Nasonex and zinc tablets, he said, with a dismissive wave of the hand, “That’s just something we do to make it look like we’re doing something.” I recalled that I daily ingest a multi-vitamin anyway, which includes the recommended zinc dosage. I had to pay a lot for the Nasonex, so I was happy to let that go. The nasal rinse, however, he said was a good idea, although not because it would restore my taste. It’s just good hygiene. “If everybody did this,” he said, “I might go out of business.” I still rinse my nose daily.
I had told him when I arrived that I was aware he might not tell me anything new and that this might be something that won’t be fixed. He was, thus, appropriately direct and no-nonsense. The only new procedure he did was use some kind of probe to look inside my nostrils—which, of course, look fine. I did learn I have a crooked septum—which explains why, if I inhale quickly, one side of my nose collapses before the other. He concluded, rather flippantly I thought, “Don’t worry about it. Just get on with your life.”
I thought, “Easy for you to say, jerk, as you go home and enjoy a steak.” I (and my HMO) wasn’t paying him to be sympathetic, but I was still ticked off. I had allowed myself to be a bit hopeful, so I guess I went from denial to anger.
That evening my wife and I had dinner plans with friends, at a very nice restaurant. By then the disappointing news had sunk in firmly. I wasn’t a charming dining companion, as I imagined a future not tasting delicious food such as what was placed in front of me. Our friends, Max and Carolyn, are two of our favorite dining companions. Conversation with them over dinner is always stimulating; they are smart, interesting, and witty. She is an outstanding critical care nurse, with a specialty in cardiology. He is a top-rate sixth-grade teacher—the kind you would be thrilled to have as your child’s teacher. Also, they know a lot about food. Carolyn is one of the best cooks I know, and Max always makes excellent wine choices. Talking about food with them has always been fun. My challenge now is to learn to enjoy good company, such as theirs, over a meal, when I have little enthusiasm for talking about food. About that night, let’s just say I wasn’t off to a good start.
I resented what had happened to me and felt cheated. Then at the end, our half of the tab came to around $100. I paid $50 to chew.
Several people had suggested I see a neurologist, so I made an appointment and tried my best to feel hopeful. Would she tell me anything new, or hopeful?