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conuly
Here.
Failing the Sniff Test: The Nose, Ruined
By PAUL LUKAS
ROBERT WEINSTOCK doesn't remember the accident.
"It was Oct. 7, 2003, and I was going to get a prescription from my doctor," he recalled recently. "It was just two blocks away, but I was running late, so I took my bicycle. I'd only been biking for about five seconds when I turned a corner. The next thing I remember is waking up in the hospital."
Mr. Weinstock, a 37-year-old illustrator and children's book author who lives in Greenwich Village, soon learned that he had been hit by a truck, resulting in a broken arm, hearing loss in one ear, spinal fluid leakage and a fractured skull. He spent two weeks in the hospital, where he underwent two spinal taps and skull surgery.
Given the gravity of his injuries, Mr. Weinstock didn't worry too much about how his food was tasting. "My mother was bringing me soup from some fancy market," he said, "and I realized at some point that it all tasted like chicken fat, schmaltz. I didn't say anything, because I figured there was just something off with the food."
But after he left the hospital, he realized the problem was wide-ranging.
"Coffee smelled a bit rank, anything with garlic tasted horrible - and I always loved garlic!" he said. "Then I had mint chocolate chip ice cream, one of my favorite foods, and it tasted really chemical-y."
Mr. Weinstock was experiencing a loss of smell, or anosmia. Because smell and taste are so closely related, anosmia patients usually complain first about food that doesn't taste right. They find themselves in a world where they can no longer take for granted that chocolate will taste like chocolate, longtime favorites are suddenly unpleasant, and the parameters of good and bad flavor, or ripe and spoiled, become a guessing game. A lifetime's worth of learned assumptions and preferences are sent back to square one.
"The taste buds can only detect sweet, sour, salty and bitter - the full symphony of flavor comes from the nose," said Dr. Charles P. Kimmelman, a Manhattan anosmia specialist. "But when your brain is hit really hard, it wiggles like Jell-O, and the little fibers going from the smell nerve endings up to the brain are stretched taut. Some of them get torn, injured or bruised."
Can the damaged fibers regenerate? "To a certain extent," Dr. Kimmelman said. "But not necessarily along the same pathways they had before. It's like a crossed circuit. And there's usually a phantom sensation, like when a person loses a foot but still feels like his toe is hurting. The brain is trying to make sense of what little information it has coming in."
So some things may be perceived differently than they were before the injury, and others may not be perceived at all. Dr. Kimmelman said that most anosmia patients recover only 20 to 30 percent of their sensory function, and that there is little doctors can do about it.
Anosmia may be caused not only by head trauma but also by upper respiratory infection, nasal or sinus disease and exposure to toxins. Some people are born with the condition. People from all these camps usually find their way to a Yahoo anosmia message board (health.groups.yahoo.com/group/anosmia) that has emerged as a popular support group.
Many anosmic people say the biggest challenge is in the kitchen. "I wasn't a great cook to begin with, but with anosmia you can't tell when something's burning," said Lori Mesnik, a computer consultant from Edison, N.J., who suffered a head injury in December. "One time I steamed some broccoli, and it wasn't until I cleaned up later that evening that I realized the water had boiled out and burned the Teflon from the inside of the pot."
Another common complaint: dealing with the frequent perception that compared with other disabilities, anosmia is no big deal.
"Most people treat me like a circus oddity," said Maria Topper, a school science coordinator from Oceanside, Calif., who became anosmic about two years ago, apparently because of allergies. "They do not realize how much of a life-changing experience it is to lose these senses."
Mr. Weinstock initially played down his condition.
"At first my attitude was that I was grateful not to be a vegetable," he said. "I thought, 'If this is the worst I have to deal with, that's fine.' But it did take a lot of the joy out of eating. It was deflating to bite into something and have it taste bad." Because eating is such a social activity, he sometimes felt left out at dinner gatherings. Restaurant outings became crapshoots at best, pointless extravagances at worst.
But the problems of this condition go beyond culinary inconvenience. Anosmic patients may not be able to smell a gas leak or a fire, and they can unwittingly eat spoiled food. Mr. Weinstock once handed a milk carton to his girlfriend, Dana Stevens, who poured milk in her coffee and discovered it had turned sour. Mr. Weinstock, completely oblivious, had already finished his cereal.
Mr. Weinstock was eventually referred to Dr. Kimmelman, who gave him the University of Pennsylvania Smell Identification Test, considered the gold standard for assessing olfactory function (available from smelltest.com for $26.95; minimum order seven tests). Mr. Weinstock initially thought he'd done "fairly well" on the test but was disappointed to hear that his score placed him among the bottom 5 percent of the population. "That's when it began seeming more real," he said. "I realized this was going to be a problem."
Undaunted, Mr. Weinstock slowly began orienting himself to his reconfigured palate. "Thai, Japanese and fruit were O.K., but almost anything else tasted off," he said. "Anything with a sauce or a melding of flavors tasted muddy and schmaltzy. Processed foods like candy, soda and toothpaste were very chemical-y, almost astringent."
Ms. Stevens, a freelance journalist who occasionally writes film reviews for The New York Times, helped out by setting up blind taste tests for Mr. Weinstock. She primarily used ice creams and sorbets, since they all had similar, neutral textures. Slowly but steadily, Mr. Weinstock showed progress: At first he couldn't tell chocolate ice cream from vanilla, but later on he successfully distinguished between the relatively similar coffee and dulce de leche. Both he and Ms. Stevens remember that as a milestone.
"My theory was that immersion therapy would help - lots of stimulus, lots of flavors," Ms. Stevens said. "Besides, the alternative seemed so grim. At one point I found this anosmia web site where people posted messages like, 'There's more to food than flavor - there's still texture and color and temperature!' And that just seemed depressing, like, 'Ah, here's a red cube, and it's tepid, oh boy!' The taste tests made me feel like we were working on something, making progress."
Whatever the impetus, Mr. Weinstock's taste sense appears to have improved. "I've definitely gotten better at eating things with garlic, especially cooked garlic," he said. "In general, there are more things that taste good. And I'm better at understanding what tastes good and what doesn't."
At a Brooklyn cafe recently, he tucked into a lemon buttermilk soufflé with obvious gusto.
Although he estimates that he's recovered about 70 percent of his taste capacity, he concedes that this could simply be a matter of acclimating to his new sensory environs - after all, he initially thought he did well on the smell identification test, too. Taste, it turns out, is a difficult thing to pin down.
"It's like asking a kid, 'Do you feel taller today?' " he said. "Any changes have been happening so gradually that it's hard to tell. I've had more than a year to forget what it was that I lost."
One thing he hasn't forgotten: his old favorite, mint chocolate chip ice cream - or "mint chocolate R.I.P.," as he now calls it. "I kept trying it, but eventually I gave up, because it became too dispiriting," he said. His new favorite foods are blood orange juice and salad.
"And as sad as it may sound, vanilla may now be my favorite ice cream. It tastes very vanilla-y." He paused, and then added: "Or at least how I remember vanilla tasting."
Hey, did you know that the Times now has a section on autism? I hope I'm not the last to know or anything.
Failing the Sniff Test: The Nose, Ruined
By PAUL LUKAS
ROBERT WEINSTOCK doesn't remember the accident.
"It was Oct. 7, 2003, and I was going to get a prescription from my doctor," he recalled recently. "It was just two blocks away, but I was running late, so I took my bicycle. I'd only been biking for about five seconds when I turned a corner. The next thing I remember is waking up in the hospital."
Mr. Weinstock, a 37-year-old illustrator and children's book author who lives in Greenwich Village, soon learned that he had been hit by a truck, resulting in a broken arm, hearing loss in one ear, spinal fluid leakage and a fractured skull. He spent two weeks in the hospital, where he underwent two spinal taps and skull surgery.
Given the gravity of his injuries, Mr. Weinstock didn't worry too much about how his food was tasting. "My mother was bringing me soup from some fancy market," he said, "and I realized at some point that it all tasted like chicken fat, schmaltz. I didn't say anything, because I figured there was just something off with the food."
But after he left the hospital, he realized the problem was wide-ranging.
"Coffee smelled a bit rank, anything with garlic tasted horrible - and I always loved garlic!" he said. "Then I had mint chocolate chip ice cream, one of my favorite foods, and it tasted really chemical-y."
Mr. Weinstock was experiencing a loss of smell, or anosmia. Because smell and taste are so closely related, anosmia patients usually complain first about food that doesn't taste right. They find themselves in a world where they can no longer take for granted that chocolate will taste like chocolate, longtime favorites are suddenly unpleasant, and the parameters of good and bad flavor, or ripe and spoiled, become a guessing game. A lifetime's worth of learned assumptions and preferences are sent back to square one.
"The taste buds can only detect sweet, sour, salty and bitter - the full symphony of flavor comes from the nose," said Dr. Charles P. Kimmelman, a Manhattan anosmia specialist. "But when your brain is hit really hard, it wiggles like Jell-O, and the little fibers going from the smell nerve endings up to the brain are stretched taut. Some of them get torn, injured or bruised."
Can the damaged fibers regenerate? "To a certain extent," Dr. Kimmelman said. "But not necessarily along the same pathways they had before. It's like a crossed circuit. And there's usually a phantom sensation, like when a person loses a foot but still feels like his toe is hurting. The brain is trying to make sense of what little information it has coming in."
So some things may be perceived differently than they were before the injury, and others may not be perceived at all. Dr. Kimmelman said that most anosmia patients recover only 20 to 30 percent of their sensory function, and that there is little doctors can do about it.
Anosmia may be caused not only by head trauma but also by upper respiratory infection, nasal or sinus disease and exposure to toxins. Some people are born with the condition. People from all these camps usually find their way to a Yahoo anosmia message board (health.groups.yahoo.com/group/anosmia) that has emerged as a popular support group.
Many anosmic people say the biggest challenge is in the kitchen. "I wasn't a great cook to begin with, but with anosmia you can't tell when something's burning," said Lori Mesnik, a computer consultant from Edison, N.J., who suffered a head injury in December. "One time I steamed some broccoli, and it wasn't until I cleaned up later that evening that I realized the water had boiled out and burned the Teflon from the inside of the pot."
Another common complaint: dealing with the frequent perception that compared with other disabilities, anosmia is no big deal.
"Most people treat me like a circus oddity," said Maria Topper, a school science coordinator from Oceanside, Calif., who became anosmic about two years ago, apparently because of allergies. "They do not realize how much of a life-changing experience it is to lose these senses."
Mr. Weinstock initially played down his condition.
"At first my attitude was that I was grateful not to be a vegetable," he said. "I thought, 'If this is the worst I have to deal with, that's fine.' But it did take a lot of the joy out of eating. It was deflating to bite into something and have it taste bad." Because eating is such a social activity, he sometimes felt left out at dinner gatherings. Restaurant outings became crapshoots at best, pointless extravagances at worst.
But the problems of this condition go beyond culinary inconvenience. Anosmic patients may not be able to smell a gas leak or a fire, and they can unwittingly eat spoiled food. Mr. Weinstock once handed a milk carton to his girlfriend, Dana Stevens, who poured milk in her coffee and discovered it had turned sour. Mr. Weinstock, completely oblivious, had already finished his cereal.
Mr. Weinstock was eventually referred to Dr. Kimmelman, who gave him the University of Pennsylvania Smell Identification Test, considered the gold standard for assessing olfactory function (available from smelltest.com for $26.95; minimum order seven tests). Mr. Weinstock initially thought he'd done "fairly well" on the test but was disappointed to hear that his score placed him among the bottom 5 percent of the population. "That's when it began seeming more real," he said. "I realized this was going to be a problem."
Undaunted, Mr. Weinstock slowly began orienting himself to his reconfigured palate. "Thai, Japanese and fruit were O.K., but almost anything else tasted off," he said. "Anything with a sauce or a melding of flavors tasted muddy and schmaltzy. Processed foods like candy, soda and toothpaste were very chemical-y, almost astringent."
Ms. Stevens, a freelance journalist who occasionally writes film reviews for The New York Times, helped out by setting up blind taste tests for Mr. Weinstock. She primarily used ice creams and sorbets, since they all had similar, neutral textures. Slowly but steadily, Mr. Weinstock showed progress: At first he couldn't tell chocolate ice cream from vanilla, but later on he successfully distinguished between the relatively similar coffee and dulce de leche. Both he and Ms. Stevens remember that as a milestone.
"My theory was that immersion therapy would help - lots of stimulus, lots of flavors," Ms. Stevens said. "Besides, the alternative seemed so grim. At one point I found this anosmia web site where people posted messages like, 'There's more to food than flavor - there's still texture and color and temperature!' And that just seemed depressing, like, 'Ah, here's a red cube, and it's tepid, oh boy!' The taste tests made me feel like we were working on something, making progress."
Whatever the impetus, Mr. Weinstock's taste sense appears to have improved. "I've definitely gotten better at eating things with garlic, especially cooked garlic," he said. "In general, there are more things that taste good. And I'm better at understanding what tastes good and what doesn't."
At a Brooklyn cafe recently, he tucked into a lemon buttermilk soufflé with obvious gusto.
Although he estimates that he's recovered about 70 percent of his taste capacity, he concedes that this could simply be a matter of acclimating to his new sensory environs - after all, he initially thought he did well on the smell identification test, too. Taste, it turns out, is a difficult thing to pin down.
"It's like asking a kid, 'Do you feel taller today?' " he said. "Any changes have been happening so gradually that it's hard to tell. I've had more than a year to forget what it was that I lost."
One thing he hasn't forgotten: his old favorite, mint chocolate chip ice cream - or "mint chocolate R.I.P.," as he now calls it. "I kept trying it, but eventually I gave up, because it became too dispiriting," he said. His new favorite foods are blood orange juice and salad.
"And as sad as it may sound, vanilla may now be my favorite ice cream. It tastes very vanilla-y." He paused, and then added: "Or at least how I remember vanilla tasting."
Hey, did you know that the Times now has a section on autism? I hope I'm not the last to know or anything.
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
no subject
Date: 2005-05-19 01:53 am (UTC)I have often had other people tell me the milk I was consuming had gone bad. I'm used to asking other people to check foods for me to make sure they're okay. It's worse now... missed that some bread had gone moldy recently, still not sure if that's what made me get sick shortly thereafter. But it's not one of the things I generally view as a serious hardship, because it's one of the things that has been true all of my life, and I'm adapted to it. It's new stuff that bugs me. Just as the migraines I find almost quaint as long as they don't get too severe, whereas anyone who newly developed migraines like mine would likely not take it at all well.
*shrugs* I guess I'm just saying that everything is relative. So, I'd be curious about people who were born this way. I think I know one such person, and it doesn't seem to bother him. Although it can bother other people when he doesn't realize things are smelly.
no subject
Date: 2005-05-19 02:43 am (UTC)http://www.maxuk.net/nose.html ....The comments on this page are SO true that they made me cry, even though I'm not overly concerned about my condition normally. And some are VERY funny.
no subject
Date: 2005-05-19 03:21 am (UTC)Don't mind me... I'll be fine in a moment when I remember that I can read more Braille than most people and I know more ASL than most (not enough to be at all useful, but if they ever need someone to sign "moose" at a deaf signer, I am prepared!). And I have all sorts of cool tricks. I can navigate safely in the dark with just a stick to guide me. So nyah:P Who needs senses when we have stick technology!
no subject
Date: 2005-05-19 03:50 am (UTC)It must be very hard for you, with your ears giving you trouble too...But you're mastering things to help and I'm sure you'll put up a good fight. And hell, you can use LJ! What more could a person want? Hehehe. (Hug)
no subject
Date: 2005-05-19 01:56 am (UTC)no subject
Date: 2005-05-19 08:13 am (UTC)no subject
Date: 2005-05-19 02:42 am (UTC)Please, please I say to all doctors out there - do not talk about the brain wiggling like jello. There are some things that doctors just should not say.
no subject
Date: 2005-05-19 06:18 am (UTC)no subject
Date: 2005-05-19 01:53 am (UTC)I have often had other people tell me the milk I was consuming had gone bad. I'm used to asking other people to check foods for me to make sure they're okay. It's worse now... missed that some bread had gone moldy recently, still not sure if that's what made me get sick shortly thereafter. But it's not one of the things I generally view as a serious hardship, because it's one of the things that has been true all of my life, and I'm adapted to it. It's new stuff that bugs me. Just as the migraines I find almost quaint as long as they don't get too severe, whereas anyone who newly developed migraines like mine would likely not take it at all well.
*shrugs* I guess I'm just saying that everything is relative. So, I'd be curious about people who were born this way. I think I know one such person, and it doesn't seem to bother him. Although it can bother other people when he doesn't realize things are smelly.
no subject
Date: 2005-05-19 02:43 am (UTC)http://www.maxuk.net/nose.html ....The comments on this page are SO true that they made me cry, even though I'm not overly concerned about my condition normally. And some are VERY funny.
no subject
Date: 2005-05-19 03:21 am (UTC)Don't mind me... I'll be fine in a moment when I remember that I can read more Braille than most people and I know more ASL than most (not enough to be at all useful, but if they ever need someone to sign "moose" at a deaf signer, I am prepared!). And I have all sorts of cool tricks. I can navigate safely in the dark with just a stick to guide me. So nyah:P Who needs senses when we have stick technology!
no subject
Date: 2005-05-19 03:50 am (UTC)It must be very hard for you, with your ears giving you trouble too...But you're mastering things to help and I'm sure you'll put up a good fight. And hell, you can use LJ! What more could a person want? Hehehe. (Hug)
no subject
Date: 2005-05-19 01:56 am (UTC)no subject
Date: 2005-05-19 08:13 am (UTC)no subject
Date: 2005-05-19 02:42 am (UTC)Please, please I say to all doctors out there - do not talk about the brain wiggling like jello. There are some things that doctors just should not say.
no subject
Date: 2005-05-19 06:18 am (UTC)