An elderly, Chinese gentleman took a seat in the dental chair before me. He complained of an uncomfortable mouth - "dry," he said, "and sticky. Saliva sticky." He put his fingers together as he spoke, trying to demonstrate the painstaking effort to pull them apart. Water could fix the roughening of his throat. Food could soothe the burning of his tongue. But to this man, sticky saliva was the glue sealing him from a quality life.
We weren't the first clinic this man had visited. He had seen a dentist, two Ear, Nose, and Throat doctors. He visited his primary care physician, and honestly, he amazed me with how well he navigated our complex medical system without ever being offered interpreter services! But from his understanding, from what he learned at the other providers’ offices, nothing was wrong; it was all in his head.
>> Have you ever been told it was ‘all in your head.’ I know I have! Tell me your story, help the world to understand the impact of those four simple words. Together, by adding your stories to the comments, we can turn a ripple of our own frustration into a wave of change! <<
And yet, for this man, the problem was, well, really in his head . . . in his mouth, anyways. This man had a condition called Burning Mouth Syndrome. It’s an experience of burning in the mouth – sometimes medicine is that simple! – that worsens throughout the day, comes and goes, or, for nearly half the patients, remains constant throughout the day. No one really knows the cause of this hypothesized neuropathic pain, but we do know that 2% of the population experiences these symptoms with women seven times more likely to be diagnosed. Treatment is not curative – it can’t be, since we are still at a loss for the pathogenesis of this disease. Yet, treatment can relieve symptoms, using local medications similar to valium to quiet the nerves of your mouth and tongue. As for that sticky saliva, nothing in the saliva itself has actually changed. Rather, with a hypothesized change in sensitivity of the nerve endings, it seems even one’s saliva can feel different in the mouth.
If you are experiencing these symptoms, of course I urge you to visit your doctor. Iron deficiency anemia, lichen planus, geographic tongue, and yeast infections are among the long list of differential diagnoses that you and your physician will work through. But to this gentleman in the clinic, to the many who have heard those four frustrating words before, I want you to remember, it is NOT all in your head.
As a medical provider, we cannot always offer the cure and quick fix, as much as we all wish we could. Time, effort, and research hours focus on finding cures to so many ailments. Equal or greater hours are devoted to simply understanding the mechanism of a disease. And yet, with this elderly man, with many of the patients in our clinics, our current treatments are little more than diagnosis and symptom relief.
Oh, but the power of a diagnosis!
Between you and me, diagnosis, being able to call out that burden of an ailment and put a word to its pain, is, in and of itself, an important part of healing and symptom relief! In fact, it’s the only kind of name-calling I’d actually encourage! So together, let’s #CallitOut:
Give it a name. Your worries. Your struggles. Your pain. Your disorder. Give it a name. Assign it a plaque. And then #CallitOut! Holler its syllables before every trusted friend and family member, doctor, therapist and guide. #CallitOut in the mirror and under the steam of a shower. We cannot go on ignoring our suffering, but neither can we hold onto that suffering alone. So give it a name. And make that name heard.
Together, with the strength of our voices, this will be a season of healing.
The doctor said she would live in a nursing home, confined to a wheelchair, crippled by pain; that was thirteen years ago. Instead, Mirissa D. Price is a 2019 DMD candidate at Harvard School of Dental Medicine, spreading pain-free smiles, writing through her nights, and, once again, walking through her days.