The Pharmacist Answers Podcast

Diabetes Madlib #2

 in Blog / Diabetes  tagged Diabetes / lies / misconceptions / november / relationships by

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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Taste Buds – Episode 108

 in Podcasts  tagged bitter / eat / flavors / food / salty / savory / science / smell / sour / sweet / taste buds / tongue / umami by

An image for your taste buds. A plate of bread and cheese with sliced salmon, a cup of yogurt with berries, a container of fancy crackers, a mug of black coffee, and a plate with red and black grapes, circular orange slices, and a half of grapefruit. It's all laid out on brown parchment paper on a table of raw wood planks.

Review

Smell plays a big part in your ability to taste.  The bumps on your tongue that you can see are actually papillae.

4 Types of Papillae

Filiform

Filiform papillae are the most numerous papillae and are arranged in regular rows running parallel to the median sulcus.  They are cone-shaped – either a single cone (like a volcano shape) or a frill of cones.  These papillae don’t actually taste flavors but they do sense touch.  They work as cleaners, helping your tongue create friction with other parts of your mouth to loosen bits of food from the nooks and crannies.

Foliate

These papillae are located on the sides of the tongue near the back.  They are flat, leaf-like folds, and can be visible in some people.  These papillae contain taste buds for flavors.

Fungiform

These are mushroom-shaped.  They are scattered all over the tongue but seem to be more concentrated on the edges and tip of the tongue.  They contain taste buds for flavor as well as the sense of touch.

Vallate (Circumvallate)

These papillae are dome-shaped with a border.  The best description is that they appear as a circular fort with a mote around it and then a wall on the outside.  Or maybe they look like a bunch of “outie” belly buttons!  They are laid out on the back of the in a V-shaped pattern, pointing towards the back of the throat.  These papillae can be visible in some people, and they contain taste buds for flavors as well.

Each papilla contains many taste buds.  They are called “buds” because, microscopically, they appear as unopened rosebuds. Taste buds have a swirl-like funnel with an opening in the middle that contains fluid.

How You Taste

You put food in your mouth. Your saliva dissolves bits of it to free up molecules.  The molecules that are mixed in your saliva wash into the funnels of each taste bud.  There, the molecules mix into the taste bud fluid and get swirled around to come in contact with as many taste sensors (nerves) as possible.  From here, the chemical signal changes into an electrical signal as the taste messages zoom into your brain.  In the brain, the signal is translated and identified – including details such as flavor, pain, temperature, texture, intensity, and smell (while your saliva mixes with some molecules, other molecules are released into the air as aromatics and contact the olfactory sensors in your nose).

Taste Buds Map Truth

The taste bud map that has been used for years in textbooks was created in 1901.  Even with all the things that we’ve learned about how taste buds work, where they’re located, and what they look like, this map has never been re-written.  The original map identified four basic flavor categories: sweet, sour, salt, bitter.  Yet, just nine years later, the Japanese were able to identify “umami” – that savory flavor that doesn’t quite fit into the other four.  Yet, the map still wasn’t re-written.  Even now, scientists are learning and updating the database on what the tongue can taste and how – including categories like “fatty” and “metal” and even “water”.

So, while the taste buds are not grouped into sections based on the flavor they can taste, some taste buds may have a greater affinity or sensitivity to a certain type of flavor.

It is estimated that we have about 2000-4000 tastebuds, and since the surface of the tongue is like your skin, the tastebuds recycle about every week or two.  This rapid and continuous recycling might be why it is acclaimed that your taste (preference and enjoyment from your taste buds) changes approximately every seven years.

Conclusion

Even though the tastebud categories are still too complicated to rewrite the map, I still plan to use my taste buds to their fullest potential.  Eat up!

Resources

I gathered some of my information from a PubMed article that is actively being updated by real scientists – How Does Our Sense of Taste Work?

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Smell

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Burning Mouth & Pepto Lips – Episode 107

 in Podcasts  tagged bismuth / burning / chemistry / lips / mouth / Pepto-Bismol / syndrome / tongue / upset stomach by

An image of black lips, partially open to show some of the top and bottom teeth. Maybe the person has a burning mouth, or just had too much Pepto!

 

Burning Mouth Syndrome

Burning Mouth Syndrome is defined as a burning sensation with no underlying cause.  It may include dry mouth sensations with no true symptoms of dry mouth.  BMS is accompanied by unremitting burning or pain but no mucosal changes or signs of injury or swelling.

3 Categories

  • Increases throughout the day after waking
  • Stays the same morning, during the day, and at night
  • Has no pattern

Common Symptoms

  • Bilateral pain of the tongue
  • Chronic pain labeled as moderate to severe, or a 6-10 on the pain scale.
  • Worsened by talking, stress, fatigue, or hot, spicy, or acidic foods.

Subjective Descriptions

  • Dry mouth
  • Change in ability to taste
  • Accompanied by a headache
  • Decreased appetite
  • Improved by cold foods or drinks

Those who suffer from BMS may see temporary relief with topical analgesics (i.e. lidocaine or benzocaine) but see no improvement from systemic medications.  Fifty percent of the cases have no apparent cause but do have some correlation with depression.  This is a case of “the chicken or the egg”.  Are people with depression more likely to have symptoms of BMS?  Or are people with BMS more likely to become depressed?

Before someone can be said to have Burning Mouth Syndrome, many other issues must be ruled out.

  • Deficiencies (iron, folate, B vitamins, zinc)
  • Dry mouth
  • Nerve damage
  • Hypothyroidism
  • Type 2 Diabetes
  • Nocturnal habits (clenching, grinding, tongue-thrusting)
  • Infection (thrush, herpes, HIV)
  • A hiatal hernia (GERD)
  • Medications (ACE inhibitors, anticholinergics)
  • Myeloma (a blood cancer involving plasma cells)

Pepto Lips

Pepto-Bismol, aka Bismuth subsalicylate, has been used for decades for a variety of stomach complaints.

Bismuth is a good binder of toxins, in a similar way that carbon is in activated charcoal.  And yes, bismuth is one of those elements on the periodic table.  Subsacylate activates into salicylic acid (related to aspirin) and works to decrease inflammation of the gastric lining.

When bismuth binds with sulfur that is naturally in your saliva, it becomes bismuth sulfide, which has a black color and can stain your tongues and lips temporarily.  Pepto overuse is the obvious cause of black lips.

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Tongue Issues – Episode 106

 in Podcasts  tagged congenital / degenerative / disease / hairy tongue / infection / issues / strawberry / tongue by

Born With…

Ankyloglossia is also known as a tongue tie.  It is a result of a short frenulum.  This issue is easily corrected if it interferes with eating and talking.

Macroglossia is am abnormally large tongue.  This is one of the visible characteristics of Down’s Syndrome.  It is described as the tongue looks and feels to be bigger than space in the mouth.

Infected With…

Strawberry tongue

The tongue can appear extremely red and papillae are swollen to look like seeds on a strawberry.  This is a symptom of several conditions.

  • Kawasaki Disease is a rare but serious childhood disease.  The blood vessels become inflamed, and this includes the blood vessels in the tongue, making it appear red.
  • Scarlet Fever is caused by the same bacteria as strep throat.  The infection goes from being just in the throat to the bacteria toxins spreading in the bloodstream.
  • Toxic Shock Syndrome is when the bacteria called Staph aureus (yes, this is the staph that lives on your skin and can cause wound infections) gets into the bloodstream.  This is a medical emergency and needs to be treated immediately.

Hairy Tongue

White hairy tongue appears as patches on the sides of the tongue.  It can happen when someone who is immunocompromised gets the Epstein-Barr Virus. (Epstein-Barr is a virus that causes mild childhood illness or a disease we know as Mono when teens and adults.)

Black hairy tongue is a little more obscure with several possible root causes.

  • Smoking, excessive coffee or tea consumption, excessive alcohol consumption, or soft diet can lead to the inability to shed dead skin cells.
  • Antibiotic overuse leads to overgrowth of fungus or bacteria.
  • Overuse of peroxide-based mouthwash causes oxidation and discoloration of the skin cells.

Function Lost

Motor Neuron Disease occurs in the later stages of ALS or Lou Gerig’s Disease when the nerves and muscles of the tongue for speech and swallowing become affected.

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Your Tongue – Episode 105

 in Podcasts  tagged anatomy / eat / extrinsic / glossus / intrinsic / muscles / organ / skin / speech / swallow / tongue by

Tongue Basics

Your tongue is made up of eight muscles.  This is why it is called a muscular organ.  It is the most important articulator in speech production. (A brief word dissection:  articulate means to communicate something clearly.  In medicine, articulate means to make a connection.  It all makes sense!)

The tip is called the apex.  The crease down the middle is called the median lingual sulcus.  There is another crease at the back of your tongue and it is called the sulcus terminalis.

Tongue Muscles

The tongue has two types of muscles.  Extrinsic muscles attach to bones boarding the mouth.  Intrinsic muscles are completely contained inside the tongue borders.

Extrinsic Muscles

These muscles are responsible for moving your tongue front to back and side to side.  There are four of them and they are named for the facial bones that they are anchored to.

  • The genioglossus muscle moves it forward so you can stick it out of your mouth.
  • The Hyoglossus muscle pulls it back and presses it down.
  • The Styloglossus muscle raises the sides of it during swallowing.
  • The Palatoglossus muscle raises the back of it during swallowing.  It also presses the soft palate down and squeezes the palatoglossal arch inward during that same step of swallowing.

Intrinsic Muscles

These muscles are responsible for all the shapes and movements your tongue makes when you talk and eat.

  • The superior longitudinal muscle covers the top side.
  • The inferior longitudinal muscle covers the bottom side.
  • The vertical muscle fibers are in the middle and connect the superior to the inferior muscles.
  • The transverse muscle fibers start at the median sulcus and connect to the outer edges.

The Tongue Has Skin?!

The surface of your tongue is known as the masticatory mucosa, which basically means it’s the surface that food comes in contact with.  The surface is made up of epithelial cells just like your skin.  The cells are keratinized (or filled with a toughening protein) so it is tough and does not get damaged by the wide variety of things we eat.

Call Backs

Wrinkly Brain

Skin 101

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Teeth Issues – Episode 104

 in Podcasts  tagged baby teeth / belladonna / benzocaine / cavities / chip / Coffee / discoloration / fracture / plaque / stains / tartar / teeth / teething / teething tablets / tetracycline / toddlers / trauma by

teething

Teething

Teething is mostly known as the phase of babies growing their first teeth.  Eruption is when the tooth enamel shows through the gum tissue.  A baby’s first teeth grow in between 6 months and 2 years old.  Before any of the teeth show, the gums can be swollen and bumpy.  These symptoms can cause fussiness, sleeplessness, drooling, decreased appetite, excessive chewing, and overall grumpiness.  A few controversial symptoms include fever, diarrhea, and rash. A fever less than 100.4*F can be indicative of inflammation going on, which can be true for some teething babies.  Diarrhea is blamed on excessive saliva ending up in the digestive tract (eh, many things can change the consistency of a baby’s poop, especially in the early stages where they’re only drinking milk or just learning to eat new foods).  A rash is a little more questionable, but can also be a result of inflammation going on.

Treatments

Treatments for teething babies include Infant’s Tylenol or Infant’s Ibuprofen (for children older than 6 months).  Other medications that used to be recommended for teething babies were Teething Tablets and Orajel.  An active ingredient in the Teething Tablets is Belladonna.  This medication can constrict blood vessels, which is good when there’s inflammation (increased blood flow) to an area, but bad when baby’s blood vessels are already tiny and they need to get blood to very important places (i.e. the brain).   The bottom line is that Belladonna can decrease the amount of blood, and therefore oxygen to a baby’s brain, and the outcome can potentially be SIDS.

This is also true of Benzocaine, the ingredient in Orajel.  Benzocaine is a topical numbing agent.  The key word here is topical.  It is not intended to circulate in the body.  The problem comes when you use a TOPICAL product in your mouth, you can’t help but swallow some of it.  When Benzocaine is swallowed, it can cause a serious side effect that involved decreased oxygen in the blood.  Again, if oxygen doesn’t get to important places in the baby’s body, bad things can happen.

PSA: NO Belladonna and NO Benzocaine for babies!

Plaque

Your teeth are covered in a biofilm that is mostly made up of bacteria. That bacteria can compromise the seal that is formed between healthy teeth and healthy gums.  If this seal is breached by bacteria, then infection and gum disease (gingivitis) can occur.

Tartar

Plaque can harden, and when it does, it becomes known as tartar.  Mouth bacteria eat the sugars in the food that gets stuck in the crevices of your teeth.  A waste product of this process is lactic acid, and lactic acid can actually dissolve enamel of your teeth.  Minor erosion can be repaired by your body.  The problem is that saliva cannot break through the plaque.

Cavities

Tooth decay is the result of long-term enamel erosion that can’t be repaired by the body.  If the erosion is deep enough, it can expose the softer parts of the tooth to irritants and injury.  When this happens, the only way to repair and protect the tooth is to get a filling from your dentist. *womp womp*

Discoloration

Extrinsic stains are when substances change the tooth color from the outside. So this is how coffee, tea, wine, and tobacco can make the teeth yellow or brown.  Also, certain bacteria, excessive chlorophyll, or excess copper and nickel can make the teeth look green.

Intrinsic stains are when the building blocks of teeth are altered and changes the color from the inside.  Tetracycline antibiotics have been a common treatment for acne in teenagers for quite a long time.  It is well-documented that these antibiotics can bind up free calcium in the body.  Therefore, it is not recommended for pregnant women or children younger than 8 years old to use these medications.  There are many cases of developing fetuses and children with quickly-developing teeth ending up with grey or brown teeth due to this missing calcium (remember, calcium built into the enamel is what makes it white).

Injuries

A chipped tooth is when a part of the enamel breaks away.  A fractured tooth is when a crack involves the enamel and the dentin.  An abscess is an infection in the gum around the tooth or in the accessible or exposed pulp of a tooth.  Luxation is a dislocated tooth, and may or may not include injury to the periodontal ligaments or jawbones.

Dental Trauma Guidelines

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Teeth – Episode 103

 in Podcasts  tagged canines / crown / dentin / enamel / episode / incisors / molars / pulp / root / teeth / wisdom teeth by

Types of Teeth

Incisors: You have 4 on the top and 4 on the bottom.  Yes, it sounds like “scissors”; they are the teeth and cut and tear food (or the enemy?).  They are in the very front of your mouth.

Canines:  You have 2 on the top and 2 on the bottom.  Yes, canine, like a dog; they are sharp and pointed.  These teeth are good for gripping and tearing.  Also known as cuspids (one point).  They are located at the “corners” of your teeth arch.

Premolars: You have 4 on the top and 4 on the bottom.  These are permanent teeth only.  They have a flatter surface for crushing food.  Also known as bicuspids (two points).

Molars: You have 6 on the top and 6 on the bottom.   They have large flattish surfaces for grinding up food.  Four of these molars are also known as your wisdom teeth.

Parts of a Tooth

Outside In

Enamel: This is the part that you can see.  It is mostly made up of a crystalline structure of calcium phosphate, and that’s what makes them look white.  Enamel all by itself can be very brittle.

Dentin: This layer is made of a softer, yet still strong calcium-containing crystals.  This acts as a tough and supportive scaffold for enamel.

*These two layers together are what make your teeth so hard and strong.

Pulp: The soft connective tissue that contains the nerves and blood vessels that feed the tooth.

Top to Bottom

Crown: This is the part of the tooth that is above the gum line that you can see.  And since you can only see the outside of the tooth, when you look at your teeth, you only see enamel.

Neck:  This is the enameled part of the tooth that is below the gum line.

Root: The part of the tooth that is embedded in the jawbone and provides the openings for the nerves and blood vessels to run up into the pulp.  The roots are covered by a specialized bone structure called cementum (yes, it sounds like cement).

*The roots are actually attached to the jawbone by periodontal ligaments. (Ligaments are connective tissue that connects bone to bone).

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Mouth Issues – Episode 102

 in Podcasts  tagged bumps / cancer / cleft palate / cracking / episode / fungus / infection / issues / lips / mouth / probiotics / thrush / ulcers / yeast by

open mouth

Mouth Issues

Ulcers

They are uncomfortable and mostly non-serious.  Also known as “canker sores”.  Can take 2-3 weeks to completely heal.  Anything lasting over 3 weeks should be checked out by your doctor or dentist.  Ulcers can appear on the inside of the cheeks or lips, the roof of the mouth, or the tongue.  A minor ulcer versus a major ulcer is determined by the size of the sore and the layers of skin affected.  Any ulcer that is bleeding should be checked out despite the length of time.  The edges are red while the center can be yellow, white, or grey.  And they are PAINFUL!!

Ulcers can be caused by acidic or spicy foods, braces, stress, hormones, and some medications (such as beta-blockers for blood pressure or NSAIDs).  Nutritional deficiencies can increase your risk of ulcers.  Malabsorption due to conditions like celiac or deficiencies in B-vitamins and iron are the most common culprits.  Also, decreased immunity can make the skin inside the mouth more prone to ulcer recurrence.

Thrush

This is a yeast infection the mouth caused by the overgrowth of Candida, known as oral candidiasis.  It appears as white patches on the inside of the cheeks, tongue, or roof of the mouth, and the spots cannot be scraped off.  Candida is normal in the body and is kept in balance by the rest of the body’s normal flora.  Overgrowth can occur after antibiotic treatments, during times of decreased immunity due to treatments or disease states, or from inhaled steroid treatments.

Thrush is treated with a topical antifungal that the doctor directs you to swish around in the mouth to coat the affected areas, usually Nystatin.  If yeast is wide-spread, a systemic antifungal will be used.  Probiotics are a great way to keep your normal flora in balance.

Angular cheilitis (ky-ly-tis)

Cheilitis = inflammation of the lips.  This is the cracking that can occur in the corners of your mouth.  Many sources will tell you this is caused by a vitamin deficiency – like B-vitamins, iron, and zinc.  Other times, it may be a wound caused by contact dermatitis from increases contact with the tongue or your hands, and then they may become infected with normal skin bacteria or other bacteria in saliva.  An infected wound is one that doesn’t ever appear to heal.  Fungal infections, in the same way, cause the skin to crack open and appear overly dry and never-healing.

Lie Bumps

Transient Lingual Papillitis (swollen taste buds).  They can appear to be white or red, and they can be asymptomatic or very bothersome.  Not sure what exactly causes it.  Definitely NOT caused by lying.  *I used to think they were “lye bumps” as in sodium hydroxide that is a strong base and used to be popular as a detergent.*

Cleft lip/palate

A birth defect that has a strong genetic component, but also linked to environmental components that have not been pinpointed yet.  A cleft lip or palate is a result of parts of the mouth and face not fusing together during fetal development, and requires surgical correction after the baby is born.  The oral and nasal cavities are supposed to be separate and when they are not, it can increase the risk of sinus and ear infections.  Ear tubes are usually recommended.

Even after repair, a child may require speech and occupational therapies to develop the muscles needed for normal speech and eating habits.  Many times, a follow-up surgery is required as the child grows, and many other types of mental support are needed.

Bonus

*Mouth Cancers: the most common cause of mouth cancers is tobacco use (smoking, chewing).  It can start out as something that appears minor like a mouth sore, but can develop quickly into something deadly.  In the end, it can result in large areas of the mouth having to be surgically removed.

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Probiotics

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Mouth Parts – Episode 101

 in Podcasts  tagged episode / glands / gums / lips / mouth / palate / teeth / tongue / uvula by

bright red lips in a slight smirk behind a window covered in droplets of water

Mouth Parts

Lips:  They are red due to blood flow.  They have lots of nerve ending so they can be very sensitive.  Our lips are used to manipulate food as we eat and make sounds as part of our speech.
* The Divot above the center of your upper lip is called the philtrum.

Gums:  They are also known as the gingiva.  Even though they are wet and look fleshy, healthy gums are quite resilient.

Teeth: They are used for chewing, and possibly as a tool.  Healthy teeth and gums seal together tightly to keep out invaders.  We will talk about teeth in a separate episode.

Tongue:  It is a muscular organ made up of many muscles and nerve endings.  It just happens to be an organ that we can voluntarily move around.  We use our tongue to manipulate food and to make sounds for speech.  And, of course, it is covered in taste buds.  We will cover all of this in a separate episode.

Hard Palate:  A flesh-covered bone that connects the upper teeth.  Our tongue will smash food against it when we eat and use to make certain sounds in speech.

Soft Palate: It is a muscle behind the hard palate and it moves up to close off the nose when we swallow and sneeze.  It also interacts with the back of the tongue to make certain sounds when we talk.

Palatoglossal arch:  It marks the front edge of the soft palate.

Palatopharyngeal arch: It makes the back edge of the soft palate and the end of the “mouth”.

Salivary Glands

Parotid glands: The largest salivary glands are located by your jaws, below your ears.
Submandibular glands: They are located under the jaw and back molars
Sublingual glands: They are located under the tongue, behind your chin.
~1000 of mini glands: They cover the buccal (cheek) tissue, soft palate, uvula, and tongue to keep everything moist.  This is what allows the inside of the mouth to be known as a mucous membrane.

Sublingual papilla: This is the folds of skin under the tongue.  This area contains many blood vessels close to the surface.  Medicine development has learned this is a great place for medication absorption directly into the bloodstream.

Palatine raphe (ray-fee): This is the seam down the middle of the hard palate.

Frenula: Plural for frenulum.  These are folds of skin that connect one place to the other.  You have three: for your upper lip, lower lip, and tongue.

Uvula: Latin for “small bunch of grapes”.  It is attached to the soft palate and contains a gag reflex trigger.  It is also involved in snoring if it dries out.

 

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Sneezing

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When I Was A Little Girl…My Story

 in Blog  tagged cheerleader / chemistry / girl / growing up / medicine / pharmacist / story / teacher by

My story starts like this…

When I was a little girl…

Don’t freak out, this is not my whole life’s story.
When I was a little girl, I told everyone that I wanted to be a cheerleader when I grew up. Later, I changed my mind and decided I wanted to be a teacher, like my mom (*Hi Mom!*). That was my career of choice until my favorite Jewish Physics teacher from New Jersey, with one leg shorter than the other, and a love for hiking pointed me in the direction of medicine. I ruled out every option that involved large amounts of blood and high risks of smelling people’s bath breath and settled on being a Pharmacist. And this is the trajectory I’ve been on ever since.

Yet something was missing from my story…

So, I ask myself “Is it possible to be a cheerleader, a teacher, AND a pharmacist?”
That is how the Pharmacist Answers Podcast was born. It is a place that I can take my expertise as a pharmacist, teach it to you, and cheer you on to independent and collaborative decision-making in your own health (rather than the amorphous entity we call Healthcare or Big Pharma making those decisions for you)!
Visit my Patreon page to see how you can help support this dream of mine and get another chapter of why The Pharmacist Answers Podcast is here!