Diagnosing and Treating “Sewer Breath” via Telemedicine

Those are actually the words patients use to describe their breath, though sometimes it’s “poop breath.” The medical term for bad breath, as you probably know, is halitosis, so if you don’t mind I’ll stick with that.

For some people, the self-perception of chronic halitosis is more socially isolating that anything demanded by Covid-19. At least with this coronavirus you can talk to your fellow locked-down housemates. But for some people beleaguered by halitosis, there’s a reluctance to speak to their partner or even their kids, lest they hear the dreaded “Mommy, your breath smells like poo.”

I’ve written a couple of Health Tips on this subject, and described a case history, and you can look these up at your leisure, which these Covid days is likely plentiful.

By the time a patient with severe halitosis comes in and schedules with one of our practitioners here at WholeHealth Chicago, she’s usually seen quite a few physicians and dentists of varying but conventional specialties. Her family dentist may have given her a deep cleaning and pronounced everything perfect.

The dentist may even have said “I don’t smell anything,” which she doubts is true.

She may be convinced her bad breath has something to do with her sinuses and so schedules an appointment with an ear-nose-throat (ENT) specialist. That doctor might suggest sinus endoscopy, which looks like this, or even recommend surgery, which, when it comes to halitosis, sometimes actually is effective if a chronic sinus infection is found.

But when it’s not, she may move on to a gastroenterologist, who might look at her stomach and esophagus through a gastroscope. If there’s evidence of stomach contents refluxing back up into her esophagus, that too is a possible halitosis cause and the doc might suggest she take Nexium to treat the reflux.

But if sinus surgery or taking Nexium were effective for your halitosis, you wouldn’t have read this far into today’s Health Tip.

At the same time all these invasive procedures are going on, it’s likely the person’s medicine chest and all the cabinets below her sink have become crowded with mouthwashes (both chemical and “natural”), toothbrushes, sinus rinsers, tongue scrapers, and dental flosses plain and peppermint, waxed and unwaxed.

How a WholeHealth Chicago telemedicine consultation is different
Your consultation will proceed like this:

After you call our Patient Services team at 773-296-6700 and schedule with any of our Functional Medicine practitioners, you’ll be sent patient registration forms and a health history questionnaire.

It’s important to note that nothing we do during these consultations is meant to take the place of your primary care physician. In fact, we strongly encourage you to share our findings with her.

In addition to the forms we ask that you send us three additional pieces of information to review before your actual telemedicine appointment:
–A history of your problem (when it started, what makes it worse, and what you’ve done so far, especially the specialists you’ve seen and any treatment you’ve received). These will be used as discussion points.
–Copies of any recent lab tests.
–A list of foods you commonly eat.

Using this information and after discussion, your practitioner might suggest lab tests. Commonly ordered functional tests include an analysis of your digestion (using a stool sample) and your breath. You’ll receive any necessary test kits directly from the lab and you’ll send payment to the lab directly with your specimens. (Yes, you’ll be instructed on exactly how to send breath samples.)

You’ll also schedule a second appointment with us two weeks later, mainly to answer any questions that have come up after your initial visit.

In a third appointment, two weeks later, you and your practitioner will review your test results and, based on these, a plan (including lifestyle changes and treatment options) will be recommended.

You’ll also schedule a fourth appointment four weeks later to discuss progress, options, and possible referrals to a good functional physician in your area to continue your care.

These telemedicine consultations are based on the treatment and outcomes of hundreds of patients WholeHealth Chicago has treated over its 25-year history.

Let’s face it, Covid-19 has changed our lives. To meet the needs of patients who have chronic health problems and are rightfully reluctant to sit in waiting rooms, we realized doctors have to change how they practice medicine.

Be well,
David Edelberg, MD

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