Podcasts


Voice Troubles – Episode 117

A cartoon depiction of a white male with black hair with a tear coming form his eye. You're getting an inside look of his mouth and throat, where there are two 10-spiked, googly-eyed representations of a virus causing sore throat and hoarseness. In front of him are four treatment options. Starting at the top, a while megaphone icon with three curved sound waves with a red X over it, indicating no talking. Below that are two pink pills that say "aspirin" on them. Below that is a bowl with a yellowish liquid and what's possibly a chicken leg to represent warm broth. And at the bottom is a glass with a straw and a little left as a garish filled with brown liquid to represent tea. This is a representation of the top treatment advice given for hoarseness.

Laryngitis

Laryngitis, known as inflammation of the larynx, is the most common cause of hoarseness and voice loss.  It is very common in viral infections, such as a cold, flu, or adenovirus.  Acute laryngitis is caused by an illness, while chronic laryngitis may be a secondary symptom of another problem like acid reflux, smoking, or severe thrush.

There is a lot of advice that goes around about what can “cure” laryngitis or get rid of hoarseness.  Hydration is always key.  Some of the other advice is more anecdotal.  But above all, whatever you do for a hoarse voice, DO NOT WHISPER!

Laryngopharyngeal Reflux Disease (LPRD)

LRPD is a condition where stomach acid refluxes into and burns the vocal cords.  It may or may not accompany GERD.  It causes intermittent to chronic hoarseness, swallowing troubles, throat pain, or a constant sensation that something is stuck in your throat.

Misuse and Overuse

Misuse of your voice is defined as the inefficient use of your voice.  It may stem from poor posture, poor breath support, or poor hydration.  Overuse of your voice is defined as excessively loud or prolonged use of your voice.

Lesions

Vocal cord lesions are benign growths on the vocal cords that interfere with normal vibration. These can result from repeatedly prolonged periods of misuse or overuse.  They will cause chronic hoarseness or sporadic voice-silencing.  They come in three varieties and are all treatable:  nodules, polyps, and cysts.

Nodules require vocal rest and voice therapy and training to help make sure they don’t happen again.  Polyps and cysts require micro-surgery where the growth is removed, and then rest and therapy and training will follow.

Hemorrhage

If you have a sudden loss of voice after yelling, then it is possible a hemorrhage occurred.  A hemorrhage is when blood vessels in the surface of the vocal cord burst and fill it with blood.  COMPLETE REST is required until the blood is reabsorbed by the body.

Paresis and Paralysis

Paresis is the fancy word for weakness.  Vocal weakness can occur during a viral infection or after neck or throat surgery.  It can be temporary and strength will return on its own after a recovery period, or it can be permanent.  Prolonged or permanent vocal weakness can be improved somewhat through therapy and training.

Paralysis, on the other hand, is neurologically based, whether damage happened in the area of the brain that controls the voice and supporting structures, or the nerves in and around the larynx are damaged.  This can also be temporary or permanent and is generally one-sided.

Symptoms of a weakened or paralyzed vocal cord include noisy breathing – like something is hanging in the way of the air flow.  And breathy talking – like when someone is trying to use their “sexy” voice and there’s more air making noise than vocal vibrations.  There is a surgical repair process that involves taking the working vocal fold and stretching it over so when it activates, it will still come in contact with the unmoving vocal fold.

Callbacks

Voice
Thrush – Mouth Issues

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Voice – Episode 116

A black and white photo looking directly at the metal-grated end of a microphone on a stand, as if it's ready for you to use your voice and speak or sing. The microphone is clear and in focus, while the background is blurred to the point that nothing pasted the microphone is recognizable.

Voice Anatomy

Larynx: a structure on top of the trachea (windpipe) and holds the vocal folds

Vocal Folds: also known as vocal cords; the soft tissue that vibrates and creates sound when air passes through them.  There’s one on each side.

Vocal Box: the structure that surrounds the vocal cords.  It’s made of 3 parts – a cover that is made of epithelial cells (similar to the inside of your mouth), vocal ligaments that hold it all in place, and the thyroarytenoid muscle that is responsible for relaxing the vocal cords into place.

Glottis: the opening in the middle of the vocal folds where they sperate for breathing and closes for talking and swallowing.

Voice Production

There are 3 levels of sound production to equal talking.

  1. Voiced Sound: this is the basic vibration of the vocal cords and creates a “buzzing” sound.  This is the first step of babies learning to talk and communicate.  We say the baby is “discovering their voice.”
  2. Resonance: the “buzzing” sounds are amplified by resonating chambers that include the throat, mouth, and nasal cavity.  The sound produced by these chambers is what give you your distinct voice. To produce sound without using one or more of these resonating areas alters your voice significantly.
  3. Articulation: movement of the tongue, soft palate, lips, and jaw modifies and changes the sound to produce words and intelligible speech.

Singing

Singing adds the breathing system to regulate the air pressure that vibrates the vocal cords.  The rhythm of putting words to music to create singing changes the pattern and length of words and syllables, and the strength of the diaphragm plays a big part in that.

Just like guitar strings, the tighter the vocal cords, the higher the pitch.  More relaxed vocal cords produce a lower pitch. *If you listened to this episode, I’m so sorry for your ears!*

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Gag Reflex – Episode 115

A cartoon image of a white male with short brown hair, in a blue, long-sleeved collared shirt and reck necktie, with his face tipped upward. He is holding a coffee pot at arm's length above his face and pouring coffee straight down his throat. Your gag reflex protects you from things improperly entering your throat, airway, and esophagus - whether it is a liquid like coffee or something solid like a sword.

Gag Reflex Basics

The official name of your gag reflex is the pharyngeal reflex or laryngeal spasm.  Trigger points for the gag reflex can be found on the roof of the mouth, back of the tongue, in the tonsil area, the uvula, and the back of the throat.  The purpose of this reflex is to prevent objects from entering the throat that did not first progress through the normal swallowing process.  It also helps prevent choking.

Gag Reflex Progress

When the reflex is triggered, the soft palate raises to close off the nasal passage.  Then the pharyngeal muscles contract on both sides to try and force whatever made it too far down back up into the mouth.  If the input is strong enough, it can also trigger vomiting (this is how vomiting is induced in eating disorders such a bulimia).

Do you Gag?

One in three people lacks a gag reflex, which means rather large things can enter their throats without triggering a reflex.  This is possibly how sword-swallowing got its start.

The other side of this coin is someone with a hypersensitive gag.  They can have trouble swallowing large pills and large bites of food.  Dentist visits and even neckties can trigger this unpleasant reflex.  It can be a part of a larger issue, such as Sensory Processing Disorder or Autism.  Or it can be a preconditioned issue due to a previous experience.  In either case, speech or occupational therapy can be done and will include desensitizing areas of the mouth to touch.

Other Protective Reflexes

  1. The Reflexive Pharyngeal Swallow is a triggered swallow that clears the pharynx of residue.  The glottis will close and allow the pharynx to move stuff to the digestive tract.  This is a protective mechanism to keep stuff out of the airways.
  2. Phayngoglottal Closure Reflex happens when the glottis closes inside the larynx without the continuation of a swallow.
  3. Phango-Upper Esophageal Sphincter Contractile Reflex occurs during any type of reflux from the stomach.  While some stomach contents may make it past the lower esophageal sphincter, so the upper one prevents it reaching into the throat and mouth.

Bottom Line

All of these reflexes are protective to prevent choking or improper ingesting of things.  They can be damaged to different degrees during head trauma or stroke.  But surprisingly, smoking causes the most damage to the protective reflexes on the pharynx.

Callbacks

Swallowing

Mouth Parts

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Bad Breath – Episode 114

A cartoon of two guys. One with black hair and blue shirt is laughing with a green cloud of bad breath. The green cloud of bad breath has surrounded the second guy with brown hair, goatee, and brown shirt. The second guy is grimacing with crossed eyes at the smell.

Bad Breath Basics

Halitosis, aka bad breath, can have many causes.  Some bad breath you can prevent with the choices you make, but some bad breath can be a sign of a more serious issue or disease.

Oral Health

You should brush your teeth for at least 2 minutes twice a day, including the surface of your tongue, then rinse your mouth with an antibacterial mouthwash.  Follow one of your brushing sessions with a good flossing.  This allows you to get any food debris and bacteria build-up out of the way on a daily basis.

You should see your dentist twice a year for a deep cleaning and a check-up on your overall oral health.  Your dentist will be able to help you with bad breath issues that may stem from more complicated issues like cavities, gum disease, poorly-fitting dentures, or thrush.

Dry mouth, whether due to your natural biology, medication side effects, or mouth-breathing, can lead to bad breath due to the imbalance of bacteria growth.

Your Choices

Smoking and other tobacco products can make your breath smell bad even when you are not actively using it.

The foods you eat also affect the status of your breath.  The compounds that cause eaten and digested foods to smell contain sulfur-based compounds.  These include broccoli, cabbage, brussel sprouts, onions and garlic, coffee, and fish.  The funny thing about these smelly compounds is that they can actually make your WHOLE BODY smell (including your breath as well as other exiting air) until they have passed all the way out of your body!

Diseases

Infections, such as bronchitis, pneumonia, and sinusitis, can lead to distinctive bad breath.  Postnasal drip can lead to bad breath as well.  Pharyngeal diverticula that trap old food bits can make your breath smell, as well as tonsil stones that are calcified debris trapped by the tonsils.  Bad breath can also be indicative of acid reflux or GERD.

Certain diseases that have telltale breath smells include diabetes, liver disease, and kidney disease.

People with diabetes are at risk of a medical emergency known as Diabetic Ketoacidosis, in which a lack of insulin renders the body’s cells unable to use the available sugar.  The body starts burning fatty acids for energy and the waste product is ketones.  Ketones cause the body to become very acidic.  This leads to a rapid transfer of water (extracellular fluid rushes into the blood to try and neutralize and dilute the ketones and then the kidneys rapidly try to flush out the acidic fluid through the urine) which can lead to fatal dehydration.  Clinicians are taught that people experiencing ketoacidosis may have fruity-smelling breath or breath that smells like acetone or nail polish remover.

People with liver disease may have breath that smells musty or like a mildewing basement.  And people with kidney disease may have breath that smells fishy or like urine or ammonia.  Ammonia is a typical by-product that is released in urine.  Someone with kidney disease may not be able to filter out the ammonia compounds effectively.  Therefore, the ammonia compounds will circulate in the blood.

Call Back

Brush your tongue – Tastebuds
Tonsil stones – Tonsils
Pharyngeal diverticula – Dysphagia

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Dysphagia – Episode 113

An image of a striped snake with black top scales and yellow underbelly scales slithering through sand. The snake has had no difficulty swallowing a rather large animal that has stretched out the rounded body behind the head with the last bit of the animals feet sticking out of the snake's mouth.

Dysphagia Basics

Having difficulty swallowing or the inability to swallow is known as dysphagia.

Symptoms of dysphagia include:

  • Pain while swallowing
  • The sensation of food stuck in the throat or chest
  • Drooling
  • Hoarseness
  • Regurgitation
  • Reflux
  • Unexpected weight loss
  • Choking, coughing, or gagging when swallowing
  • Taking tiny bites

Dysphagia by Phase

There are several conditions that can affect each phase of the swallowing process.

Oral Phase

Dysphagia during the oral phase, or voluntary phase, can be caused by neurological conditions like Multiple Sclerosis, Muscular Dystrophy, advanced Parkinson’s.  Brain damage caused by trauma or stroke can also cause trouble swallowing in adults.

Dysphagia in Kids

Babies start out nursing or feeding through a bottle and their swallowing mechanism is reversed.  A reverse swallow is when the tongue is thrust forward or out of the mouth to open the throat and allow food or drink down the esophagus.  As children learn to eat solid food and drink from a cup, the swallowing procedure changes. Children can also have trouble swallowing, but the root causes are completely different.  Premature birth, low birth weight, cleft lip or palate, and tongue or lip ties can lead to swallowing issues if not corrected with therapy.  These issues can cause swallowing issues with the reverse mechanism as well as make it difficult to convert to a regular swallow.  Children with low muscle tone are also more likely to stick with the reverse swallow because it is easier.

Pharyngeal Phase

Pharyngeal diverticula are pouches that form in the mucous membrane above the esophagus.  These pouches can collect food particles that don’t get swallowed.  This can cause bad breath, as well as coughing, and constant throat-clearing because it feels like something is stuck in the throat.

Esophageal Phase

There are several swallowing issues that stem from the esophagus and esophageal phase.

  • Achalasia is an issue where the sphincter that opens into the stomach doesn’t relax to allow food to pass through.  This can cause pressure in the chest and may possibly lead to regurgitation if it persists.
  • Diffuse spasms happen when the peristalsis rhythm of the esophagus muscles is poorly coordinated.
  • Stricture is also known as a narrowed esophagus.  It can be a result of injury and scarring from GERD.
  • An esophageal ring is when a thin area of the lower esophagus is narrowed.  This is also a result of scar tissue from chronic GERD.  The scar tissue from acid damage tends to be less flexible which can cause pain.
  • Eosinophilic esophagitis is the overpopulation of eosinophils in the esophageal lining due to food allergies.  Eosinophils are a type of white blood cells that show up in very specific situations – parasitic infections, cancer, or allergies.

Dysphagia Risk

The risk of dysphagia increases with age, mostly because the risk of the conditions that cause dysphagia increases with age as well.  And while dysphagia can be very uncomfortable, the biggest concern is with the risk of aspiration, or breathing food or drink into the lungs, that leads to pneumonia.

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Swallowing
Muscle Tone discussion – Accordion in Your Brain

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Swallowing – Episode 112

 

A young child with no shirt and light brown hair against a blue sky is swallowing gulps of orange juice from a clear plastic bottle.

The 3 Phases of Swallowing

Oral Phase

This phase includes chewing and saliva mixing with the food to form a bolus (a little glob of mashed up food). Then the tongue moves the bolus towards the back of the mouth.  The tongue starts by pressing against the hard palate behind the front teeth.  Then the sides of the tongue raise up to also press against the hard palate inside the teeth.  At this point, the bolus has nowhere to go except towards the back of the throat.

Pharyngeal Phase

The vocal folds in the larynx close to keep food out. The larynx also moves up as the epiglottis covers it to seal off the airway. Then the soft palate and uvula move up and close off the nasal passage  So now there is only one way out.

Esophageal Phase

The bolus moves into the esophagus (because it is the only open path). The esophageal muscles contract from top to bottom (this waving, rhythmic muscle movement is called peristalsis) to push the bolus into the stomach.

Swallowing Reflex

There are sensory receptors in the pharynx and tongue that receive touch signals.  When they are touched by a bolus, the signals are sent to the brain stem and the return signal results in involuntary and automatic movements of the larynx and epiglottis.  This is a good thing since swallowing is a very rhythmic process and you want food and drink to continue going in the correct direction.

This reflex cannot be triggered by sticking your finger in your throat.  You are more likely to trigger a gag reflex that way.  The voluntary steps of swallowing must be initiated before the involuntary portion of the process takes over.

Weird Swallowing Scenarios

How do you swallow with your mouth open?

At the dentist, you are usually laying in the chair on your back and facing the ceiling.  There are at least three tools and two hands in your mouth.  Things in your mouth trigger saliva production.  Also, generally one of the tools the dentist is using is emitting water.  The natural reflex when you have to hold your mouth open for a long time is to bring the back of the tongue and the soft palate together.  This seals off the throat and allows you to still breathe through your nose.  The liquid in your mouth plus gravity creates a puddle at the seal of your tongue and soft palate.  Because the touch sensors to trigger your swallowing reflex are also in this area, it is likely you begin to panic because if they don’t hurry and use the suctioning straw to remove the liquid, you’re going to swallow!

Do you swallow in your sleep?

A study was done to find that the only times you swallow while sleeping is during arousal and during REM.  My logical deduction regarding why is that when you’re aroused or in one of the more shallow phases of sleep, that is when you can voluntarily move – roll over, adjust the bedding, and swallow.  During REM sleep, most people will experience sleep paralysis, so whatever exciting things are happening in their brain, the body is not likely to act it out.  Because the brain cannot tell if a dream is real or imaginary, the feeling solicited can trigger hormones secretions and saliva production. Increased saliva, just like in the dentist scenario, can trigger swallowing.

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Tonsillectomy – Episode 111

A close-up image of surgical tools laying on a tray covered in a teal colored cloth. From left to right, there is a scalpel, a pair of scissors, two pairs of tongs, a suturing tool, and a pair of tweezers. Many of these tools are used in the traditional surgical methods for a tonsillectomy.

What is a Tonsillectomy?

A Tonsillectomy is a surgical procedure to remove the tonsils.  Tonsil – immune system tissue in the back of the throat.  -Ectomy = to remove something from the body.

Removing the tonsils may be required if chronic tonsilitis is a problem.  Chronic tonsilitis is defined as multiple infections in a row or an infection lasting 3 months or longer.  Severe snoring and sleep apnea may be another reason to remove the tonsils, for the purpose of opening up the airway.

Adenoids

Adenoids are another set of immune system glands in the back of the nasal cavity.  They can also swell during infections and interfere with breathing.  Depending on the severity of the infections or the risk of sleep apnea, these may also be removed in the same or a similar procedure.

Tonsillectomy Methods

Since general anesthesia is used in all methods to remove the tonsils, no eating is allowed before the procedure.  They also recommend no NSAIDs (non-steroidal anti-inflammatory drugs) are to be used before and after due to their ability to thin the blood and increase the risk of bleeding.  In general, a tonsillectomy will take between 30 and 60 minutes.  Recovery time afterward is estimated to be about two weeks.

  1. Scalpel
    This is the old school method of using a very sharp surgical knife to cut out the tonsil.  This method has the highest risk of bleeding.
  2. Cauterization
    This method involves a hot knife that separates the tonsil tissue from the throat.  The heat also closes off the blood vessels so bleeding is not as severe.  A downside is that the tissue has been burned, so I imagine the pain after this method is more severe.
  3. Ultrasonic Vibration
    Ultrasonic waves are sound waves that have a higher frequency than the human ear hears.  The waves cause a very rapid vibration and the energy of those waves is what causes the tissue to separate as well as the blood vessels to clot.  This is the newest method developed and seems to have the least bleeding and pain.

After the Tonsillectomy

The side effects of a tonsillectomy include swelling of the throat, as well as the face and jaw, bleeding, and infection.  To avoid the bleeding and infection, it is important to follow all the instructions given for the recovery period.  Because of the swelling, cold foods like ice cream and popsicles are popular because cold things reduce swelling.  Popsicles can also help with hydration because swallowing bigger sips or gulps of water can be painful the first few days.  Hot foods are not recommended because the heat can increase the pain or reinjure the surgical site.  And while ice cream is the most popular post-tonsillectomy food, any soft, non-abrasive foods are fine to eat.

Why do adults have more issues than kids?

Kids heal faster because they are still growing and developing.  Kids also have smaller body parts than adults – the tonsils are smaller and the blood vessels are smaller.  Smaller blood vessels clot and heal faster than larger ones.  This is even true between the different sized blood vessels in your own body.  And a factor no one wants to admit: adults are terrible at following directions and truly resting after a surgery or procedure.  Rest is the best thing for a healing body of any age or size.

Strep Carriers

Generally, when we think of severe tonsilitis that leads to a tonsillectomy, we think of strep throat.  A carrier is someone who carries the germ around with them but does not get sick from the germ (pertussis is another example). In 1998, a study found that 5-15% of school-aged children were asymptomatic carriers of strep.  This means they tested positive on a strep swab but had no symptoms of being sick.  This causes concern because it means that you can be sick with something else that causes vague symptoms like fever and sore throat but because the strep test is positive, antibiotics are prescribed when they might not be necessary (meaning that you were sick from a virus).  This study showed that providers and caregivers were unaware of the number of unnecessary antibiotics they were prescribing.

Strep is eradicated from a carrier by an extensive treatment of antibiotics, or by removing the tonsils from the carrying family member as well as the tonsils of the chronically sick family member. #tonsillectomyforeveryone

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2851340/

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Facebook Memory: Episode 74
Sleep Hygiene
All About Sleep

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Tonsils – Episode 110

An image of a caucasian child's mouth, open wide with their teeth, tongue, and uvula visible. This is representative of the way one may open wide for a doctor to inspect the tonsils and throat.

Tonsils Basics

Your tonsils can be found in the back of your throat.  You can open your mouth and look in the mirror and see them on each side of your mouth behind your teeth and tongue.  You can also feel them below your earlobes and behind your jaw bone.

Tonsils are composed of lymph tissue since they are a part of your lymph system.  They store white blood cells that help you fight off infection.  Their activation during sickness is why they swell and get sore.

They are covered with the same mucosal membrane as the rest of the inside of your mouth.  This mucosa layer has pits and crevices called crypts.  These crypts increase the surface area of the mucosa that comes in contact with the lymph tissue and allows more opportunity for infectious material to be directly accessed by the immune system.

Infectious Tonsil Issues

Tonsillitis is the inflammation of the tonsils.  It can be classified as acute or chronic.  Acute tonsillitis is directly related to a viral or bacterial infection.  Chronic tonsillitis can be either a persistent, long-lasting infection or multiple consecutive acute episodes that can appear to be one long sickness.

Swollen tonsils can cause simple activities such as swallowing, talking, and breathing very painful.  You can see your swollen tonsils when you look in the mirror.  They will appear red or possibly blistered.

Mono, an infection caused in adolescents and adults by the Epstein-Barr virus, cause severe swelling in all the lymph nodes, including the tonsils.  This is one of the situations where your tonsils will be so inflamed, you can see the swelling on the outside of your face and neck.  Because such a large portion of your lymph system is involved, including your spleen, this is a serious sickness.

Strep throat is probably the first infection you think about when you think of swollen tonsils.  The bacteria, streptococcus, infect the lining of the tonsils and throat.  This is why the doctor will swab your tonsils when they’re testing for strep.

Non-Infectious Tonsil Issues

A non-infectious reason the tonsils will be large is a condition caused hypertrophic tonsils.  The tonsil tissue and/or mucosa overgrow and become oversized without any infection or immune activation being involved.  Overgrown tonsil tissue can lead to snoring or sleep apnea, and that’s bad.

Another non-infectious issue with your tonsils is called tonsilloliths or tonsil stones.  These stones happen when dead bacteria or food debris gets stuck in the crypts and they become calcified.  They cause a sensation many describe as a crumb stuck in your throat.   They can become quite large and can interfere with swallowing and eustachian tube function.  Because the eustachian tubes run from your eardrum into your throat, if the tonsil is swollen enough, it may close off the tube to the ear and cause ear pressure/pain.  Some tonsil stones are large enough to be visible and may have to be manually removed.  Lastly, due to the composition of the stones (dead bacteria and old food), frequent tonsil stones can be the cause of bad breath.

There’s no way to prevent tonsil stones 100%.  Good oral hygiene can certainly help reduce the frequency of stones, and can also help remove them quickly if they occur.  The most common way of trying to remove a tonsil stone involve coughing, clearing your throat, or hissing.  All three of these ways produce vibrations in the lining of the throat and mouth.  So along with the exhalation of these methods, hopefully, the result is the stone coming out of the tonsil and out of your mouth.

PSA:  Please DO NOT scratch your tonsils with your fingernails to remove a tonsil stone!

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Sleep Hygiene
All About Sleep

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Metallic Taste – Episode 109

A table covered in pennies with varying luminosity. They will add a metallic taste to your water. Ha ha!

Glossary

Aguesia: no taste

Hypoguesia: reduced ability to taste (no the same as when taste changes due to changes in ability to smell)

Dysgeusia: dysfunctional taste (bad, salty, rotten, or metallic taste).  Metallic is most common.

Causes for Change

Chemotherapy and radiation for cancer causes taste changes because the taste buds are rapid-cycling cells and the goal of chemo and radiation is to kill fast-growing cells (cancer cells are definitely fast-growing).

Head trauma or brain damage may damage the path of taste from the mouth to the brain.

Conditions like GERD, diabetes, urinary retention, and dry mouth can cause dysgeusia.  Zinc deficiencies can too (in case you can’t tell, zinc plays a big role in many processes in your mouth).

Over 250 medications can causes changes in taste.  These include blood pressure medications, antibiotics, chemotherapy, asthma medications, and lithium.  Some of them are secreted in the saliva, so the change in taste is because you actually taste the medicine.  Other changes are because the medication disrupts or alters receptor or signal transport (i.e. ion transport – sodium, calcium, potassium, or chloride).

My Own Metallic Taste

I was taking generic Biaxin, AKA clarithromycin, for a sinus infection.  Clarithromycin is in a class of medication called macrolides.  Macrolides work on infections by disrupting the DNA-copying proteins in the bacteria.  They are known as bacteriostatic antibiotics, which means they stop the bacteria from growing and dividing, but do not kill them.  This allows your own immune system to get rid of the bacteria itself.

It was the worst!  Everything tasted so bad.  I had to take it for 10 days, so I spent those 10 days eating the strongest and spiciest foods I could find to try and cover it up.

Your saliva contains clarithromycin in a concentration of ~2.72 mg/L.  To get an idea of how small this amount is, it takes you 12-24 hours to produce 1 liter of saliva.  Only 3-7% of adults report metallic taste with clarithromycin.

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Music Credits: Up In My Jam (All Of A Sudden) by – Kubbi https://soundcloud.com/kubbiCreative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 http://creativecommons.org/licenses/b…Music provided by Audio Library https://youtu.be/tDexBj46oNI


Diabetes Madlib #2

Clueless About Diabetes Madlib

[source: diabetesduo.com]

With November being National Diabetes Awareness Month, here is another version of the Diabetes Madlibs.  How many of these misconceptions have you held?  Have you ever thought that all types of diabetes are the same?  It may be time to get to know someone with diabetes, they can teach you a lot.

(Answers provided by Ronei, but they are not representative of her knowledge and support of people with diabetes, this is for comic value only.)

“Oh, you have Diahbeedees? So your stomach doesn’t work, right? Well, at least you don’t have emphysema. My Grandmother has it and got it because she ate too much fruit. Last year, she had her toe cut off! I hear you can cure it by drinking water? I feel joyful for you because those fuzzy needles would make me pant. And I could never have someone burp one of those pump things in my knee. My cousin had juvenile diabetes but outgrew it when she turned 54. I was reading in the Enquirer that Helen Mirren had it but reversed it by eating only sushi. And Jimmy Fallon has it and he’s lived a long time with no problems. I also read where lots of people who have it bad travel to Ireland because they have a cure for it there. Don’t get excited, Dr. Who said there will be a cure here in America in 9 years. Then you can start eating kale again!” 

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