She could not get rid of the awful taste in her mouth. Metallic, she described it, like having pennies in your mouth. Two years it had been. She’d tried a tongue scraper to no avail. Changed her diet, swished an assortment of mouthwashes, rinsed her sinuses with a neti pot, and then, thinking she might have a sinus infection, consulted her family doctor, who prescribed antibiotics that had no effect. Next she saw an ENT (ear nose throat) specialist who scoped her sinuses and found nothing wrong.
She asked her husband if she smelled like anything unusual. “Your breath smells like a big bag of pennies,” he said.
And for her, the metallic taste was horrible.
Then she read about candida overgrowth syndrome, the controversial diagnosis in which a yeast organism (candida albicans) starts flourishing everywhere there are mucous membranes. For women, the main symptom is a vaginal discharge, the body’s attempt to rid itself of the candida. With serious overgrowth, candida can occur in your mouth (called thrush in infants) and intestines and even on your skin. The result is a constellation of apparently unrelated symptoms: from digestive issues (including bloating), itchy ears, and food sensitivities to sugar cravings and a bad taste in the mouth.
Although Dr. William Crook’s pioneering book The Yeast Connection, first published in 1986, awakened the public to candida overgrowth, during the decades that followed the medical profession was openly hostile to this diagnosis. To me, it’s part of the larger physician tunnel vision I recently wrote about. But the anger candida has generated among doctors over the years is breathtaking. One medical licensing board in the southwest actually recommended punishing any physician who diagnosed candida overgrowth by taking away her license to practice medicine.
Of course, asking a doctor to actually read The Yeast Connection and make up her own mind is sort of like asking ISIS to listen to some Grateful Dead tracks before issuing a fatwa on the audience.
“The Yeast Connection describes my symptoms”
The girl who smelled like pennies read everything she could about candida, and made an appointment at WholeHealth Chicago.
I thought her self-diagnosis was a reasonable one. In addition to the bad taste in her mouth, she had a persistent vaginal discharge and she also mentioned food sensitivities, sugar cravings, bloating, and nasal congestion. It was almost like she’d memorized Dr. Crook’s symptom list.
I had her fill out his Candida Questionnaire, created for the original edition of his book at a time when resources for diagnosing candida overgrowth were limited. You can see the questionnaire here. Even now, it’s a fairly reliable tool.
I ordered a stool culture for candida and a diagnostic blood test for candida. To the patient who smelled like pennies and me, this diagnosis made so much sense that I agreed to start her on the antifungal medication ketoconazole even before the test results were back from the lab. The drug is safe and she could always contact me if she noticed any unusual side effects.
Unfortunately, she was back a month later with no improvement at all. Same awful taste in her mouth, same discharge, same aura of pennies. (Listening to her, I was reminded of the painting The Birth of Venus, her seashell now a huge sack of pennies.) Her blood test and stool culture were both negative for candida.
“Okay,” I said. “We were wrong. Back to square one.”
Since it was a metallic taste, I asked if she happened to be taking anything regularly she hadn’t told me about. For example, the sleeping pill Lunesta can cause a pretty awful metallic taste in some people.
Was she in contact with anything at work or in her home that could be a source of metal exposure (an old house, water pipes, and so on).
“No. I’ve thought about all of this!”
Since pennies are made of copper, was she using any copper cookware? No. Is there any copper in her life, anywhere? Anything she can think of, no matter how remote?
Silence. Something was dawning on her. I repeated “Anywhere? Anything?” Then her eyes opened wide.
“My IUD (intrauterine device)! Paragard, it’s called. Isn’t it made of copper?”
Googling for confirmation
If you look at the list of side effects from copper IUDs, everything is pretty much limited to a woman’s pelvic area (cramps, backache, and yes, vaginal discharge). But if you use my favorite diagnostic tool, Google, and type in “copper IUD metallic taste” you hit pay dirt in the patient chat rooms.
To say I have a love affair with patient chatrooms is not an exaggeration. In chatrooms, I can be the fly on the wall, listening as patients ask each other for the help they can’t get from their doctors. Maybe the doctor simply doesn’t know, or doesn’t take the problem seriously, or the patient’s too embarrassed to ask about. Once you say you’re having problems in these chatrooms you’ll get help, if not an actual answer at least a sympathetic ear. The chatroom advice may not always be correct, but at least you’ll know you’re not alone.
I turned my laptop around and simply said “Here…read.”
I saw her nodding her head, smiling, and she looked up at me. “Well, that does sound completely correct. And, if that’s it, my problem is over.”
“I had the thing taken out two days ago. I simply couldn’t stand it.”
Then she paused. “And that explains what happened when it was removed. As the doctor pulled it out there was this…kind of explosion…of metallic taste in my mouth. That’s the only way to describe it. An explosion.”
My guess was that her body had been trying to reject the IUD from day one. The persistent vaginal discharge probably was acidic, part of her body’s attempt to dissolve what it perceived as a foreign invader. But the IUD was firmly in place, constantly releasing copper, which she could taste and which her husband could actually smell.
Google, along with the patient chatrooms it leads me to, is an extraordinary diagnostic tool. I should have checked it sooner.
David Edelberg, MD