Sunday, March 29, 2009

Oh Poo!

This a blog post about vulture poop. It's a long story, but let me just say that when you're a rock climber there are certain hazzards of the sport that you just have to accept: bats sleeping in crevices, nasty long spinning falls, copperhead snakes and, yes, vulture poop.

Vulture poop is probably the most vile smell I have ever come across, and that includes a four month stint crouched over a formaldehyde-soaked corpse in anatomy lab. It's bad.

The trick with writing a blog post about this is that you have to tie it in somehow with psychiatry. This is problematic since I haven't had any patients with delusions about vultures, vulture obsessions or vulture phobias (does anybody know the word for vulture phobia? Ornithophobia is for birds as a whole). I'm left grasping at nasal straws, so to speak.

I have had patients who smelled bad and patients who suffered from bad smells. If the smell doesn't actually exist, it's an olfactory hallucination. Olfactory hallucinations are rare, much less common than visual or auditory hallucinations. Typical olfactory hallucinations are very unpleasant experiences and are often described as resembling rotting meat, burning rubber or excrement (although not necessarily vulture poop). I've seen olfactory hallucinations in a patient with major depression and in one or two psychotic patients. Another "bad smell" illness is a rare but interesting delusional disorder known as olfactory reference syndrome. In this disorder the patient is convinced that he or she smells bad and that others around them can also smell them. Olfactory reference patients may shower multiple times a day to get rid of the "smell", or may seek repeated medical consultations to find the source of the problem. Like most delusional disorders, olfactory reference syndrome tends to be resistant to medication. I've seen two cases of this disorder and they both improved (but didn't get completely well) on neuroleptics.

Olfactory hallucinations can be seen in other medical conditions, specifically in migraine sufferers and in people with seizure disorders. In this case the smell generally precedes the onset of the headache or seizure and is sometimes described as a 'burning rubber' smell. Treatment of the odor depends upon control of the underlying condition.

So there's my vulture poop post. I even made it relevant to psychiatry. Climb on!

And for those without cathartophobia (my proposed name for vulture fear, after the genus cathartidae):

The Turkey Vulture Society