How to logically solve the BB problem

[BB---]

Hi guys,

I'm trying to establish a logical way to determine the root cause of bb and to cure it without immediately resorting to a gas chromatography exam (I'm an engineer, can't help myself fixing things at all times).

It is important to ask somebody whether bb has decreased after each step, because self diagnosis can be deceiving, i.e. you may think you have bb but you don't have anymore or you may think you have been cured when you are not.
Best to ask a stranger because people may just want to be kind or may have gotten used to your smell.

What do you guys think of the course of action below?

TACKLE ORAL CAUSES
Step 1) Rub your gums and look out for any weird smell. Floss and smell.
Step 2) Go to the dentist. Have yourself examined for cavities and get an X-ray for hidden ones. Check your wisdoms.
Step 3) Ask a stomatologist (or the same dentist, if particularly good), to have him examine your gums for gengivitis.
Step 4) Go to a GP and start candida treatment. Take fluconazole or anti-fungal medications and see if it improves.

=== Why oral causes first? Because 90% of bb originates in the mouth and you gotta go to a dentist anyway. It is also quite inexpensive===

TACKLE ALLERGIES
Step 1) Try a 2-week non-gluten diet. Most celiac people have a history of chronic BB.
Step 2) Try a 2-week non-lactose diet. Same as before.
Step 3) Visit an allergologist and have yourself checked for both allergies and intolerances.

===Why this now? Because once again it is not very expensive and the diets above are quite easy for most people to follow====

TACKLE RESPIRATORY CAUSES
Step 1) Scrape your tongue and smell the coating. Squeeze your tonsils and check if anything is coming out.
Step 2) Go to an ENT. Make sure you mention you have bb. Have an x-ray of your sinuses and ask him to check your septum. Ask him to examine you for chronic rhinitis. Remember: you can have bb from the tonsils even without tonsils stones.
Step 3) Schedule a sinus wash if need be.
Step 4) If your tonsils are cryptic or smell just a little bad, go for a tonsillectomy. If your septum is deviated, add a septoplasty to your shopping list. Go for both surgeries at once. During the operation, ask him to check for polyps.
Reason these operations
Step 5) Back to the ENT, ask him to check your lungs. This is especially true if you have nasal BB.

===Why this third? Because even though it's PAINFUL and EXPENSIVE, respiratory causes are very common in chronic bb. You won't need your tonsils in any case and other surgeries such as septoplasty can increase the quality of your life====

TACKLE GASTROINTESTINAL CAUSES (tackle these BEFORE the ENT if you have heartburn at all times)
Step 1) Talk to your GP and get a proton-pump inhibitor (omeoprazole). Take for a couple of weeks.
Step 2) Talk to your GP and get a histamine-2 blocker (Ranitidine). Take for a couple of weeks.
Step 3) Take probiotics. Try a different combination if they don't help.
Step 4) Talk to a gastroenterologist. Make sure you mention you have bb and that you have taken probiotics. Schedule an endoscopy, then have yourself tested for H-Pylori. Schedule an endoscopy to check things such as hiatal hernia and stomach ulcers among the other things.
Step 5) Schedule an operation to fix your hiatal hernia or take medications for stomach infections.
Step 6) Visit a specialist familiar with SIBO.

TACKLE SYSTEMIC CAUSES
Step 1) Visit a doctor expert in TMAU. Don't take the test, you need the visit AND the test, because the latter is often inconclusive without the visit, especially for TMAU2.
Step 2) Follow the doctor's prescriptions and see how it goes.
Step 3) Go back to the doctor and try other things. TMAU is not always easy to detect.

At this stage, you may as well have to run a gas chromatography exam to understand what's wrong. If you don't trust them, then you still have a couple of options, to be taken in whatever order.

TACKLE HEPATIC CAUSES
Step 1) Visit a hematologist (liver doctor). Mention bb and tell him what you have been through. Ask him to check for cirrhosis and other diseases.

TACKLE KIDNEY CAUSES
Step 1) Visit a nephrologist (kidney doctor). Mention bb and tell him if you have seen any other doctor. Ask him to check for diseases.


Please guys chip in with more ideas and if need be we'll add things here or modify accordingly.

[nenis]

Buddy, Thanks a lot for the information.

[janet]

hi bb, very informative.

[rinitico]

Good info to do a checklist. I have passed for more than half of that list ands still searching. Maybe i have TMAU, but here in my country is impossible to do the test. Maybe at some point I will be able to travel to Spain, do you know a professional on the subject there?

[BB---]

Hi rinitico, check your PMs.

[gotshot26]

good list for those starting out.

[buddi]

Good one! Well put together!
Even i recommend the idea of taking each part at a time ie., dental, and then ENT, and then Gastro..
And mostly we would need to give it some time for self study , come up with possible check lists.
And only with the self study, we would be able to advise doctors on the potential areas. In my case, i had ENT CT scans, was just given sprays for PND..Doctor did not take me seriously..but lately i realised that even the CT scans were not so detailed and did not cover all the aspects... I knew it only because i studied! Incase i missed to do a self study, i would bluntly end up striking off ENT causes from my check list.

So BB---, which stage are you in the checklist?

[BB---]

Hey buddi,

I fully checked out the oral and allergies causes. I also checked steps 1 and 2 of the gastro list.

I am currently recovering by a tonsillectomy + septoplasty. It's still early to say whether it is there because I'm still confined at home. Also, I finished a course of antibiotics not long ago and this may have an impact.

However, I did notice some improvements. Two people said they couldn't smell anything. The bad, metallic taste I used to feel in my mouth is mostly gone. My tongue is less coated (it used to be white at all times). When I use a tongue scraper now, it smells much less than before and when I pass it the second time, there is no smell. Before, I could have passed it 100 times, using also baking soda and hydrogen peroxide but it wouldn't have made a difference. Friggin smell wouldn't go away.

I think the operations may have helped but not completely.

In your case, I think sprays alone don't help. You could go with a septoplasty. Doctors never take bb seriously. What I did, was mentioning severe sleep apnea. The insurance swallowed hook, line, and sinker right away and there I went for surgery after 2 weeks.

[winter]

The main problem most of us have is there is no way for us to get reliable feedback.

[BB---]

The main problem most of us have is there is no way for us to get reliable feedback.

This is so true...it often hampers the whole progress because maybe some things we are doing are working while some make it worse.

However, I wonder how many of you can smell their own bb? Cuz I can smell mine...for some reason it's just a fraction of what other people smell ofc, but for me it enough to tuck my face in a t shirt and breath out.

[rinitico]

Other causes could be:
SYSTEMIC
candidiasis
Celiac Disease
Thyroid problems
RESPIRATORY
diverticula down throat

If my mind came with other possibilities i'll be posting.

[buddi]

The main problem most of us have is there is no way for us to get reliable feedback.

This is so true...it often hampers the whole progress because maybe some things we are doing are working while some make it worse.

However, I wonder how many of you can smell their own bb? Cuz I can smell mine...for some reason it's just a fraction of what other people smell ofc, but for me it enough to tuck my face in a t shirt and breath out.

I can sense my BB and its intensity, on my own.. And it neva goes wrong.
And PND it self is not a condition, but often occurs due to some other underlying condition, so we need to find that root cause, and not just take medicines for PND alone. Same way with Deviated septum. Deviated septum itself is'nt a prob, and almost majority of humans have a deviation. It is a prob only if it is obstructing the flow or partially blocking any of the ostia.

Also plz add to your ENT list:
1. Existance of Haller cells - some times they may partially block the sinus drainage and slow down the movement of the mucus
2. Check tonsils, adenoids and also lingual tonsils.
3. Check for Concha Bullosa in the sinuses - These are airfilled spaces and im not sure if this can contribute to BB
4. Any Incomplete septum in the sinuses which partially block the mucus flow.. There was user 'Inart' who also shared his CT scan a few days back and it clearly showed this in his maxillary sinus.. He said he is gonna attempt a FESS, but has'nt turned back post surgery..Guess he is part of some whatsap groups.. can some one enquire and provide an update on his progress plz..

[BB---]

Rinitico and Buddi,
these are excellent additions. Unfortunately, I cannot edit the original post anymore so when I have time I will remake it.

candidiasis - mentioned candida in the 'oral' causes. Do you want to add more info?
Celiac Disease - should resolve with the 2-week long gluten-free diet.
Thyroid problems - this is great. Can you shed some more light as I'm not an expert?
RESPIRATORY
diverticula down throat - does this cause bb only or other causes?
===
1. Existance of Haller cells - good one
2. Check tonsils, adenoids and also lingual tonsils. - I mentioned tonsils, but not adenoids or lingual tonsils. These must be added, especially the latter.
3. Check for Concha Bullosa in the sinuses - I will include these as well. Can be fixed by a turbinectomy, which can be done altogether with a septoplasty (just had it)
4. Any Incomplete septum in the sinuses which partially block the mucus flow.. - will add this as well.

[BB---]

Adding Zenker's diverticulum

[rinitico]

I only can feel a little my smell at the morning when i do tongue scrapping, but anyways who don't have bad morning breath? It is so true that the most difficult part is to know if what we're doing is getting better or worse this condition. In my case my relates keep saying me they don't feel any smell, but their body language shows the opposite.

I think Candida could be sistemic since it invade your gut and give other symptons. I have been reading some strange condition call PATM (People are allergic to me) which could be an other possibility. By other side, i have read some success stories of people who got cured by threating their anxiety/depression so this might be a point too, since it can dry your mouth or make you excret more fluids, or even give you digestive problems.