Wednesday, June 10, 2009

Abilify testimonial

I wrote recently about a patient whose 'delusional parisitosis' was ruining her life. She felt that bird mites had invaded her home, her car, and her siblings' homes, making her too anxious and distracted to work or carry on any semblance of normalcy. A psychiatrist started her on Abilify last month during a brief involuntary hospitalization orchestrated by her frantic family.

She came in today, 5 weeks into her Abilify treatment. She looked well--rested and tear-free. She declared that things were 'almost back to normal'; she was back in her home, no longer experienced abnormal skin sensations, and had returned to work. I didn't ask her if the mites were gone, nor did she volunteer anything along the lines of 'what do you suppose that crazy business was all about?' I didn't feel like she needed to acknowledge whether or not the mites were real or imagined; it was more than sufficient that they were no longer front and center in her mind and her life.

I hope her insurance pays for this medication. It's four-plus expensive, but what an amazing difference it's made for her.

Sunday, June 07, 2009

Bacteria, bad breath, and oil pulling

I've been thinking about bad breath and mouth hygiene lately (and as soon as I get the big "L" off my forehead, perhaps I'll think about something fun). First of all, I wonder what to do about patients with bad breath--not the ones who complain of it who frankly never have bad breath on examination, but rather the clueless ones who have bad breath and don't know it. Should I say something to them? Perhaps I could include "Do you have bad breath?" in my review of systems during the annual physical, and if they answer "No," tell them "Not so fast on the negative buster!"

My latest foray into alternative medicine includes a month-long experiment in the Ayurvedic practice of oil-pulling. I'm not quite sure where I came across it, but it seemed like an intriguing way to use up a bottle of organic sesame oil sitting in my 'frig. First of an a.m. on an empty stomach, I sip but don't swallow a tablespoonful of sesame oil. As I bring in the paper, make coffee, empty the dishwasher, and do the little morning chores, I 'pull' the oil through my teeth or poke at the mouthful with tongue against teeth for (theoretically) 20 minutes or until my mouth is too full and I'm too grossed-out to go on which got up to 14 whole minutes today. Spit and rinse follows, then on to breakfast.

Testimonials abound on the Internet in support of the practice which, among other things, is supposed to enhance oral hygiene, and lessen tooth decay, bad breath, and dry lips. So far, one week into it, it only dampens my enthusiasm for breakfast and seems to make me less prone to eating the crap that drug reps bring in to the office (despite new Pharma regulations against the practice!).

An article in the Journal of the Indian Society of Pedodontics and Preventive Dentistry reported a study wherein 10 adolescent boys were somehow convinced to oil-pull in the a.m. for 10 minutes, and then their levels of streptococcus mutans (a bacteria associated with tooth decay) were compared with another group of 10 who swished instead of a morning with chlorhexidine mouth wash. Both groups experienced the same drop in levels of those s mutans bad boys.

But...I dare you to find a bunch of health nuts waxing poetic over the morning use of chlorhexidine mouthwash! Consider this on oil pulling from Molly of SanFrancisco: The really bad stuff that forms plague [sic], is very attracted to the acids in the oil. So it melts this bad stuff and then you spit it out. That's why your teeth get much cleaner than by conventional means, like alcohol based rinses. And so, when you melt this bad stuff, you simply spit it out..buh bye.

On now to my real story here which is breaking news from the first ever symposium on the microbiology of odors held last month in Philadelphia. Israeli microbiologists have developed a new saliva test called OkayToKiss that tests for the presence of certain enzymes produced by gram-positive bacteria (such as s mutans) that make it easier for gram-negative bacteria in the mouth to break protein into malodorous compounds.

The doc-in-charge of the research, Dr. Mel Rosenberg, is described as an "international authority on the diagnosis and treatment of bad breath." He invented a two-phase mouthwash (containing saline and oil) based on his studies of petroleum microbiology wherein he discovered that oral microorganisms from dental plaque when mixed with nontoxic oils became bound to the oil. Voila! Does that not sound like a variation on oil-pulling to you? Check out if you want a ton of technical on the process. And the 1-2 mouthwash known as Assuta bested Listerine with respect to longterm control of halitosis.

So back to this OkayToKiss test. Due out next year, this pocket-sized test I gather is a treated piece of paper that you lick and check. If it turns blue, keep your mouth to yourself. This Dr. Rosenberg is a kick--don't miss his smellwell site for more ideas on keeping fresh as a daisy.

September, 2009 update: Still oil-pulling. I can last 15 or more minutes at it, no problem. Teeth so white that my 20-something year old daughter who commented below about how gaggingly gross this sounded is now doing it herself. My first visit with the dental hygienist post oil-pulling is next month; I'll let you know how I fare.