A Scentless Christmas
Brobson Lutz, M.D.
“Three weeks before Christmas, we decorated the tree. We always have a real tree for Christmas and love the smell. But I couldn’t smell a thing. And cooking a traditional Christmas dinner without over-cooking anything isn’t easy when you can’t smell. I cooked a stuffed turkey without smelling a thing. By then I was cooking with a timer. You don’t realize the importance of the sense of smell until you lose it,” adds Huntsinger, who was 46 at the time.
Huntsinger didn’t have just a diminished or an altered sense of smell. She completely lost it. Her sensory horror story had a cast of three – herself and two dogs. The setting was their large lumberyard at 5383 Tchoupitoulas St. that expands posteriorly and laterally beyond its street-front drive-in entrance.
The yard is filled with nooks, crannies and sheds with all sorts of stacks of building supplies, from expected new lumber and plywood to exotic older lumber and finishing items not carried by chain stores. Liberty Lumber Yard is known for having great value with easy in-and-out access that attracts contractors with medium-size construction and renovation jobs in addition to the Uptown residential do-it-yourselfers in the know.
All day long Huntsinger stays in the office answering the phone and keeping the books. Her constant companions and guardians behind her desk are two German Shepherds – Archie and Heidi. But once the customers left and the gates closed late on that September 2007 afternoon, both dogs and Huntsinger took a romp through the lumberyard. Archie made a move that Huntsinger missed, and all of a sudden she tripped over Archie, scaring him and taking a major spill herself.
“I tumbled about 6 feet, falling on my head. I didn’t lose consciousness but I was sore all over, especially the back of my head,” Huntsinger recalls. She must’ve landed on a blunt surface, as there was no obvious skin breakage.
By the next day she had, in New Orleans lingo, a “major bobo” – a palpable bump on the back of her scalp and a roaring headache. Except for the scalp tenderness and swelling, her physician found no abnormalities. A CT scan of her head was normal. There was no evidence of any abnormal blood collections within the brain signaling a neurosurgical emergency. In doctor lingo she was “neurologically intact.” Her diagnoses were scalp hematoma and mild concussion.
“My headache is much less now but you know what? I haven’t been able to smell anything since I fell and everything tastes bad. I thought it was the headache. But something else is wrong,” Huntsinger told her physician about three weeks later.
Her headaches had diminished along with the scalp bruise but her sense of smell had gotten up and gone. She could neither smell nor taste food. Her physician advised her to take zinc, an old remedy favored by anecdotal accounts for smell and taste problems, and to see a neurologist.
“Mrs. Huntsinger has a fairly straightforward onset of posttraumatic anosmia, but most concussion patients do not come away with such profound loss of smell,” wrote Dr. Charles Fiore, an Uptown neurologist, in his report to her referring internist. He performed comprehensive tests to evaluate her mental status, cranial nerves, peripheral nerves, muscle strength, coordination, reflexes and sensation.
“I would like to look into things a little bit further and check a few labs and order an MRI of her brain with some special cuts through the cribriform plate,” he concluded. These subsequent tests were all normal.
All nerves originate in the brain. The spinal cord is a thick collection of nerves that travels down the spine encased in the cervical, thoracic and lumbar vertebral bones. Numerous segments or peripheral nerves leave the spinal cord to innervate various body parts and muscles. Cranial nerves, on the other hand, emerge directly from the brain stem to innervate mostly functions of the head and neck such as the muscles of facial expression and all the special senses including hearing, vision, taste and smell.
Victor Sherrel is a first-year medical school student and a teaching assistant in anatomy at Tulane University. Most practicing internists have long forgotten the specific anatomy associated with each cranial nerve and have no recent memory of any structure called a cribriform plate. Medical students under the tutelage of increasing ancient anatomy professors still memorize these things.
“There are 12 cranial nerves, and the first – or olfactory – nerve is mostly responsible for our ability to smell. The cribriform plate is part of a small delicate bone that separates the nasal cavity from the skull. Olfactory nerve fibers branch down each nostril setting up a sniffing field where scent molecules send signals via the olfactory nerve to the brain where odors are recognized,” says Sherrel.
“As far as clinical applications go, that’s beyond what they have taught us so far,” adds Sherrel, who moved to New Orleans from Marianna, Fla., to attend Tulane.
Christmas was only the crescendo of Huntsinger’s problems. She and her husband took a trip to Istanbul in June, and she still couldn’t smell a thing.
And their Port Sulphur fishing camp no longer had the refreshing smell of salt water intermingled with fish. It was a summer of cooking fish and not smelling a thing. It was living in New Orleans and going to restaurants without being able to savor the smells of cooking.
“Besides eating, department stores were a challenge. My sister helped me pick out some scented pine cones at the Clearview mall, but they just looked like pine cones to me. Since I couldn’t pick up smells at the perfume counter, I was afraid to try anything new. Before I lost my smell, I used Beautiful by Estée Lauder. I knew two squirts early in the morning was the right amount. I was afraid to use anything else.”
According to Fiore, head injuries are a relatively common cause of loss of smell, but a complete loss of smell is rare with more minor falls. Anything that damages the olfactory nerve from a minor concussion to a severe blow to the head can shear or stretch the nerve. Other causes of complete loss of smell are certain tumors, complications from ENT and neurological surgeries, and radiation treatment of head and neck cancers.
Treatment options vary from good to none. ENT surgeons can undo the obstructions caused by nasal polyps and deviated septums. An occasional patient responds to steroids that decrease mucosal swelling by blocking inflammatory processes. But Huntsinger had no anatomical derangements to fix. After 10 months with no smells, it appeared that her olfactory nerve damage was permanent.
But this story has a happy ending. Suddenly, last August, Huntsinger detected an odor from a pot of coffee, but it wasn’t how she remembered the aroma of coffee. Bleach was another odor that returned early, thought at first it also smelled differently. Then she smelled freshly cut grass and the scent was as she had remembered. By this past September, her normal sense of smell had fully returned.
And this December, Huntsinger is looking forward to the smells of Christmas with much more gusto than usual.