Caregiving for Someone Whose Nose Doesn't Always Know

When the Nose Doesn't Know: The Observant Caregiver

Traumatic brain injury makes quirky seem quirkier, especially when a person is in the initial months of recovery. Strange behavior can simply be the result of skewed perception. Some caregivers must be observant to make sure their loved one stays safe. Case in point:

Rosemary: “Honey, what’s that you’re eating?”

Hugh: “Chocolate pudding?”

Rosemary: “You’re making a face.”

Hugh: “It doesn’t taste so good.”

Rosemary: “Let me see that. It’s leftover chicken gravy.”

Hugh: “Oh. Ew. I don’t like gravy.”

After his TBI, Hugh lost his sense of smell, and his other perceptions were skewed over a period of months. So when he saw a small bowl of brown, cold stuff in the fridge, he figured it was pudding. He loves chocolate pudding!

“The human tongue can only detect four basic taste sensations. sweet, sour, bitter, and salty, plus a fifth sensation called Umami that is stimulated by MSG. All other taste is a result of the sense of smell.”1

Since Hugh had completely lost his sense of smell — and it never came back — he had trouble enjoying his food. He has always loved pizza, but after his TBI, he covered his pizza with red pepper flakes. My eyes would tear up from across the table just watching him eat his pepper-coated pizza, but he enjoyed it. He also developed a taste for spicy chicken wings with names like Three Mile Island. The intense flavor gave him something to savor. Most of his food tasted bland. Unfortunately, all this spicy food can result in stomach upsets, and thankfully, over time, he used less and less spice as he grew accustomed to his new taste sensations. We also learned to flavor food with milder spices such as basil, garlic, or oregano. We both like pesto.

The loss of a sense of smell can be dangerous, too. Someone who cannot smell may not know to turn away from dangerous odors such as ammonia. The fumes from paint thinner can be harmful as well as flammable. If his nose does not warn him that there are fumes in the air, he is more at risk of starting a fire. So Hugh must be extra careful when he is around certain toxic chemicals since his nose won’t tell him to back away. One thing he can do is ensure that his space is well ventilated when working with any chemicals.

If your loved one is layering on the spices or seems unhappy with food after TBI, and he or she has not had a smell test, you may want to consult your physician to schedule this simple test. “In an accident, if there is enough force to cause a brain injury, then there certainly will also be enough force to cause damage to the olfactory nerves and/orolfactory bulb.”2

In the meantime, watch carefully what your loved one decides to eat!

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