D (4:54)

I think probably a lot of your listeners, if they had to choose one sense that they had to lose. If you thought about sight or your hearing, your touch, all of these things seem so important. And so people often would say, oh yeah, I'd give up my smell. But you really don't know until it's gone, until you've lost it, how truly impactful that is to people's quality of life and the way in which we relate to each other.

A (5:20)

That's Dr. Zahra Patel. I spoke with her three years ago on Chasing Life. She is a rhinologist with which means basically a nose expert. She's a professor at Stanford University and she's been researching treatments for disorders related to the ears, nose and throat for over a decade now. And she told me that patients with loss of Smell. They haven't typically always received the care or the attention they deserve. But then Covid happened, and that put the problem squarely on the map. But the larger question Marlene is asking is, what can you do do about it? So the good news is that the neurons in our olfactory system. Olfactory, again, that's your smell system. They do have the ability to regenerate. Okay, so there's the good news. About every three to four months, the nerves die off and new nerves take over. And this is happening continuously throughout the course of our life. But here's the other part of it. They need the guidance of supporting cells to restore the right connections. And that often is where the problem lies.

D (6:25)

That's the problem overall. When people have this more permanent type of loss in smell and taste, that natural inherent regenerative capacity of the olfactory epithelium of all these different types of cells has taken a hit that's just too great that it cannot then bounce back and regenerate. And that's what a lot of our therapies are actually aimed at targeting, trying to kickstart that natural regenerative capacity to turn back on again.

A (6:52)

It's called olfactory training.

D (6:56)

That's really just a structured smelling protocol. It's something that I describe to patients, like, if you had a stroke and you lost function of an arm, you would go to physical therapy and do rehab until you could work that arm again. And it's the same idea about your sense of smell. So you basically take something that has a smell. Essential oils are easy because they. They hold onto a smell for a long period of time. The four that we commonly start with are rose, lemon, eucalyptus, and clove. The reason we start with those is that they're in different categories of odor. So you're going to be stimulating different types of olfactory receptor neurons inside your nose. But anything that has a smell that you would recognize, you bring it to your nose. You just breathe normally, nice and slowly, deep in and out, but you focus your memory on what that smell used to smell like to you. That's a very integral and key components of the exercise because of that connection between our memory and our smell. And you just rotate through the fourth. And I have people do that twice a day every day. I have people do that for a very long period of time, like six months, because, as we just discussed, the olfactory nerves are turning over, and they don't all do that at the same exact time. So you want to cover all that time frame when all this regeneration is occurring. Occurring, helping to stimulate that regenerative capacity.

A (8:18)

Now, Marlene, I realize this is not a fast solution, it is not a high tech solution, but as Dr. Patel told me, it can work. So you may want to give it a try again. Know that it's not going to be quick or sudden. It will take discipline, patience and time. Expect progress to be incremental. Also, you know you can visit a healthcare provider like an entire to rule out any other causes for your smell loss and to really teach you the proper technique here, which includes sniffing each of those four scents separately, about 20 to 30 seconds each. Do it twice daily, preferably once before breakfast and once before bed. And do this for around 24 weeks. Again, this takes time. Dr. Patel says that smell training works best when it's combined with other therapies or one option she prescribes is a steroid rinse, which is essentially rinsing the nose with the steroid medicine and adding.

D (9:18)

The steroid irrigation, like in a big sinus rinse in salt water. That does have significantly increased efficacy versus gest olfactory training itself. So that is helpful. And that is something that I tell all my COVID 19 and many other smell loss patients to do as part of their treatment.

A (9:36)

And in forecasting to the future, there are some promising treatments in the pipeline. Studies, including one by Dr. Patel have found that injections of platelet rich plasma can also help. But that's early. Larger studies are going to be necessary. So Marlene, I hope this helps and hopefully by next New Year's Eve you can smell the roses, or at least the champagne, maybe the fireworks. Coming up after the break, we'll tell you about a condition linked to cannabis use that is on the rise in the United States. Okay, I know that sound. Another question has landed. Kira. Who do we have?

B (10:18)

Alright, so our next caller doesn't exactly have a question, but she does want to tell you what happened to her daughter and why she thinks it's important for people to hear about it. Let's take a listen.

C (10:28)

My name is Jen, I'm 46, I'm calling from Michigan, not far from Ann Arbor.

B (10:34)

Go blue.

C (10:34)

I'm calling because our daughter, who's 20 years old, had been experiencing severe nausea in the mornings. A few months ago she woke up, she was throwing up blood, went to the er. She eventually got a scope. They couldn't really find anything, but they asked about her marijuana use. Anyway, long story short, this got really bad. Over a course of a couple of months we come to find out that this is called CHS and that it's becoming pretty common in compulsive marijuana vape users. It seems like this is something that no one's talking about. And with the widespread accessibility to these high concentration vapes, seems like this is a conversation worth having.

A (11:21)

Thanks. Okay, Jen, thank you for calling in to raise awareness about this. What Jen is talking about is cannabis or cannabinoid hyperemesis syndrome, something known as chs. Hyperemesis means severe vomiting, and in the case of chs, it occurs in cycles, and these can go on for hours, along with nausea and abdominal pain. The condition has been dubbed scromming on social media because of this combination of vomiting and screaming that a sufferer might exhibit. This isn't something that happens to people who occasionally pop a gummy. It happens to long term heavy chronic users, and certainly not all of them. And that's one of the condition's mysteries. So, going back, CHS was first recognized in 2004 by Australian researchers. They identified 19 patients, all chronic cannabis users, who had this cyclical vomiting syndrome. And they wrote about nine of them for a medical journal. It's not common, and today's exact numbers are hard to come by, but studies do show that CHS seems to be a growing problem. A 2020 study found that nearly 1 in 5 people hospitalized for cyclical vomiting did did report using cannabis at the same time. And it does seem to have increased over the last several years. One reason for the growth of this new phenomenon could be the increasing potency of cannabis products overall. So one of the authors of these studies, a pediatric emergency specialist and toxicologist at Children's Hospital, Colorado, noted that the amount of THC that now comes in cannabis has increased substantially. So it used to be an average of 4 to 5% in the 1990s, closer to 15 to 20% today. So, like Jen's daughter, many CHS patients end up in the emergency room where they are treated, typically with anti nausea medications and IV fluids. To combat dehydration, patients often undergo a battery of tests to make sure you rule out other causes. Blood and urine tests, CT scans, upper GI endoscopy, gastric emptying tests. You want to make sure you have the correct diagnosis. Now, one thing that has popped up as well is strangely, taking a hot shower can sometimes help people with CHS find some relief, at least temporarily. It's not clear why, but the theory seems to be that tetrahydrocannabinol, or thc, the main psychoactive compound in weed, that seems to target the body's pain receptors. So the distracting sensation of the extreme heat seems to interrupt the pain cycle, easing symptoms. That is just a theory. We don't know why. And again, these hot showers don't necessarily work for everyone, but they do seem to provide significant benefit for some. The only real cure so far as you might guess, is to stop using cannabis. CHS does come back in people who quit, waited a while and then return to using again. So Jen, it's a concern. Thank you for calling in to let listeners, especially parents, know about this. It's not common, but when it does happen it can be quite frightening. So good luck to your daughter and yes, go blue in 2026. Alright, that's all the time we have for today's episode. Thanks to everyone who sent in questions. Thank you. Your curiosity, your stories, your voices, that's what brings this show to life. So keep the great questions coming. If there's something health related you've been wondering about, send it to us. We might even answer it next week. Record a voice memo, email it to pagingdrgupta.com that's pagingdr. Gupta.com or give us a call 470-396-0832 and leave a message.