Authors: Bonnie Blodgett
"These are very ballpark estimates," he added. "Again, we don't really know."
"And the Zicam users? What about them?"
Dr. Cushing explained that the Food and Drug Administration does not regulate homeopathic remedies, and Zicam falls into that category. There's no requirement to prove the safety and efficacy of a homeopathic product, so there are no reliable data showing if it's helpful or harmful. In spite of that, he said, in 2005 Zicam's manufacturer, a company called Matrixx Initiatives, settled a class-action suit brought by Zicam victims totaling $12.5 million. "That tells me there's a problem and they know it."
No wonder homeopathic remedies are so popular. Their promoters can make promises and then escape any consequences if the remedies fail to deliver or turn out to be harmful. I found out later that the right-wing radio spin doctor Rush Limbaugh was Zicam's advertising voice, and this seemed like a match made in heaven. The homeopathic-drug makers have nothing to gain from big government.
I made a mental note to call one of my neighbors, a personal-injury attorney, when I got home. Maybe I could get in on some of that class-action cash. Maybe I could even take on this Matrixx Initiatives myself and win. Force them to stop making the stuff. I would just have to prove that the disgusting odors brought to me by the makers of Zicam were as emotionally debilitating as they, in fact, were. What jury in its right mind would choose the free-market philosophy over consumer protection in a case like this?
"So how long before I'll notice any improvement?" I asked. It hadn't sunk in that there might not be any improvement.
"Cell repair takes time, up to six months," he said.
"A CT scan will almost certainly rule out a brain tumor," he added. "Be sure and stop by the front desk to schedule one. We'll get it done later today so you'll have the results tomorrow.
He pulled his stool closer until he was sitting opposite me, knees to knees. He needed to look at my sinuses, just to make sure no polyps were distorting my smell. Unable to grasp how a common cold or, even more improbably, an over-the-counter cold remedy could so royally mess up my sense of smell, I trusted that his long metal scope, thinner than a paper clip, would find the real problem and fix it.
He strapped on a headlamp. A white light beamed from his forehead like a third eye. His nurse sat beside me and took my hand. "Try not to move," she said. "This could sting." Hearing this, Alex moved her chair closer and took my other hand. "Squeeze when it hurts," she whispered. I closed my eyes. Something cool pressed against my nostril. Then a series of sharp pricks. I squeezed Alex's hand. Hard.
"That's it," Dr. Cushing said when he was finished. "Not so bad, eh? Your sinuses are clear, no sign of polyps." He reiterated that the bad smells were nothing serious. Nothing, period. The smells weren't real. "We call them olfactory hallucinations. The patient smells things no one else can."
Then came the thunderbolt.
"I'm afraid that once the phantosmia stops, you won't be able to smell anything. You may find it a relief."
"Excuse me?"
"You've lost your sense of smell."
He handed me a box of Kleenex (his scope had given me the sniffles) and suggested that I should consider myself fortunate. He'd recently given the same bad news to a patient who made his living as a chef.
"What did he do?" I asked. Stupid question, but I had to say something, if only to avoid falling apart in this man's office.
"He had to figure out another way to make a living, of course. Did you tell me you're a writer? That's lucky for you."
I suddenly detested this man. How could I find comfort in the fact that I don't make my living "by my nose"? In fact, as a garden writer, I do. And I don't just write about plants. I enjoy smelling them almost as much as looking at them. My garden smells like, like ... like heaven, in late summer especially.
I put the Kleenex box on the floor beside me. I was beyond crying. Phantosmia, this harbinger of an odorless existence, was, whatever this doctor might think, profoundly disturbing. How would he know what phantosmia felt like? How would anyone? People get colds. They get cancer. They don't get—
"
Anosmia
is the medical term for loss of smell," he went on. "
Osmia
means 'smell' in Greek, and
an,
of course, is the Latin word for 'without.' I'm going to put you on steroids, though they usually don't help with healing unless they're given immediately after the injury. And it's been ... what, three months now?
It had actually been just a little over eight weeks. Now there was no doubt in my mind—or seemingly in his—that it was Zicam that had destroyed my ability to smell. What else it might have done to my brain was anyone's guess. So why hadn't the stuff been banned? Joining the class-action suit seemed laughable now. How could a few thousand bucks compensate for this? How could I have considered joining a lawsuit, calling up my friend the lawyer? The diagnosis of a temporary olfactory malfunction was one thing, but permanent loss of smell? Unthinkable.
Dr. Cushing said he wanted to put me on an antidepressant to treat the phantom smells. "It's an old-fashioned tricyclic called amitriptyline, a very good and safe drug that was developed to treat depression. That was before the new SSRIs, which directly target the low serotonin levels that are the underlying cause of depression in most people. You've heard of Prozac. Tricyclics are a blunt instrument by comparison, and we still don't fully understand how they work on brain disorders like yours. The drug may give you a little dry mouth, and you'll have to watch your alcohol intake and sun exposure. It's all explained in the directions."
"But I'm not depressed. At least, I wasn't before this happened."
"No, what you have is a sort of psychosis. Like your brain is having a panic attack. The drug seems to trick the brain into settling down. Maybe the brain thinks you're smelling again and stops trying to do it for you. Phantom sensations are not well understood. There's a disconnect between the brain and the body. Signals get crossed. Nerves misfire. But it's possible the brain is trying to compensate for the lost or damaged body part. It'll give up after a while even without the drug, but why wait when we can shut the smell factory down with a pill?"
This was astounding. Phantosmia is the olfactory equivalent of phantom limb syndrome?
Too upset to absorb the full implications of Dr. Cushing's latest revelation, I fixed my attention instead on the antidepressant he wanted me to take to extinguish the bad smells. Why would I want to erase the last vestiges—even if they were the last gasp, the death throes—of my beloved sense of smell? I finally managed to ask a good question.
"Why are the smells so awful?"
"I'm afraid we don't know." Dr. Cushing was silent for a few seconds, mulling this over. "One could speculate, of course."
He checked his watch and rose from his stool, which clearly meant
We won't be going there. Not today
. "I want you to take the pill before bed. It will help you sleep. Insomnia can be a problem for patients with phantosmia. During the day you can take a tranquilizer if you need it." He was scribbling on his prescription pad now. "The drug is called Ativan. It's similar to Valium." This was the same pill my internist had prescribed. It was effective, all right, if you wanted a cumulus cloud for a brain. He added, "Don't be concerned if they make you feel a little anxious. The smells, I mean. It's a normal response."
Normal? How could this be in any way normal? To be fair, I
had
told him just twenty minutes earlier that deliverance from foul odors was my fondest wish. Deliver me forever from smell itself, if that's what it takes, I'd told him. I now officially emended that statement. Without smell, my long, straight nose was a joke, an impostor. My nose was a useless lump of bone and cartilage, good for only one thing: breathing. What is breathing, what is living, without smell?
"Just remember that the phantosmia you're experiencing is nothing to be concerned about," Dr. Cushing was saying. "That's
phant,
of course, from
phantom,
and—"
"
—osmia,
meaning 'smell,'" I blurted out before he could.
"Exactly. The drug will work, and even if it doesn't, the smells will stop eventually."
"When?"
"Hard to say. Sometimes it takes years. But the odds of them lasting forever are very low. Fortunately, with the amitriptyline you won't have to wait long at all. I'm going to go out on a limb and
promise
you that you won't be smelling a thing by Christmas."
"So this really is permanent?"
"You mean the anosmia?"
That word again. I nodded.
"Most likely, yes," he said. "Just in case the cells aren't all dead, I'm putting you on a five-day course of steroids, the standard treatment. Steroids can sometimes jump-start a healing process. But again, they usually don't help unless you start taking them immediately after the injury. Given that, well—I guess I wouldn't get my hopes up."
"So there's no way of knowing?"
"You could have a piece of the olfactory epithelium biopsied," he said. He didn't recommend it. "It's excruciating and dangerous. We're talking about brain cells. You don't want to mess with those if you don't have to."
Dr. Cushing extended his right hand to signal that our appointment was over. "I'll want to see you again in three weeks," he said. "You'll lose some weight at first. All my anosmics do. You'll put it back on and probably more over the next year or so. The typical anosmic is about twenty-five pounds overweight. They think this has to do with satiety. The hormone that's re-leased in the brain to tell us we're full can't function without a working nose.
"For now, though, you're going to have to watch the appetite. You may have to force yourself to eat."
A
LEX GENTLY REMINDED
me we had shopping to do. Though as stunned by my new diagnosis as I was, she immediately became my life support. Just by holding my hand, she allowed me to inhale and then exhale. Get out of the chair and find my purse. I was able to schedule the CT scan, walk to the elevator, and get the scan done. With Alex beside me, her hand in mine, I found the car in the parking lot and nodded in agreement when she suggested we stop at Macy's on the way home. Somehow I drove. I entered the department store and together we picked out a new sweater for Cam, a skirt for Caroline. Eventually I found my voice and began spouting platitudes: Aren't I lucky it's just my nose? Think of what others endure. People just go on. People live full, rich lives even when they're confined to wheelchairs and can't move, when they're deaf and blind—think about Helen Keller—and even when they know they're dying, for God's sake. People really are remarkable, aren't they?
By the time Alex and I got home, my mood had gone from giddy to black. When I announced to my husband that I'd never smell again, something in his manner—his struck-dumb disbelief?—made me feel as if I were being pulled out to sea by an undertow. This sensation did not fade even as we talked. I watched as Cam rolled up newspapers and stuffed them under the fireplace grate, laid down the logs, and then lit the match, blowing on the tiny bluish flame to encourage it to spread so the thin birch log on the bottom would catch. Confessing my immediate fears (what would the CT scan discover?) to my husband was out of the question. I already knew the scan was nonsense. Dr. Cushing had found nothing suspicious when he put his scope up my nose, but he had made a curious comment. The long, thin olfactory bulb connects directly to the amygdala and the septum, which are parts of the limbic system, the structure that controls our most emotional and instinctive behaviors. Many physicians consider the organ for smell part of the limbic system, and not just because the two are located close to each other. Unlike images and sounds, one pathway for odors goes directly to the brain's emotion and memory centers without being filtered by the circuits involved in higher intelligence.
Fear is a hard-wired emotion tied to survival. It is the amygdala's default setting, the primal emotion in all animals. In humans, brain areas responsible for problem-solving capabilities, such as superior vision and executive function, developed and formed in layers around the ancient midbrain, where the limbic system is located. But the midbrain maintained its primal status and situation, just upstream from the nasal passages. This means that once fear takes over, reason may be a help or a hindrance, but it will always be secondary. As Jonah Lehrer explains in his book
How We Decide,
contrary to popular (human) belief, we are a feeling species first, a thinking species second. This I knew from personal experience. Underlying my various worst-case scenarios—only yesterday I'd been fretting about schizophrenia, and now I was imagining inoperable cancer—was the grim reality that those crazy notions had been summoned to suppress: the reality of anosmia itself.
I can't smell and I don't know what that means.
Without my sense of smell, the world would seem flat and featureless; tasteless too.
Don't go there.
Sitting by the fire with Cam, I painted an uncharitable picture of Dr. Cushing. Reasonableness and calm were impossible responses to such a catastrophic loss. The limbic system had taken full possession of my wits. Instead of overwhelming it with logical arguments, I tried to focus my overheated amygdala in a new direction, toward anger and away from fear. I put on my best scowl and raised my voice to stop its quavering. That man, I complained loudly, had been attached to his scope and headlamp so long, he seemed to think people were basically computers. He'd probably completely lose it if he found dog poop on his shoe.
"So he really thinks the Zicam zapped your nose?" Cam said.
"Are you trying to tell me you
don't?
" I snapped. "I'm just making this up? Is that what you really think?"
My husband sat beside me on the sofa. "Of course I don't think that," he said.
How I wished I could be angry, and that I could believe my husband.