Welder’s burns, arc burns, flash burns and snow blindness result from direct exposure of the eye’s cornea to ultraviolet light.
There is a tendency for those with welder’s burns to arrive at the emergency room in the evening or the wee hours, when their coping nears zero.
One night, a young man, who had watched welding earlier in the day, arrived in the ER. His history and the pain just about clinched the diagnosis. However, anyone with this presentation needs a thorough exam – including a slit-lamp exam – to ensure that there is no penetrating injury or foreign body under the eyelids or in or on the cornea itself. The slit lamp is a low power microscope, horizontally mounted, with a chin rest for the patient. There is nearly face-to-face contact as the patient’s and examiner’s noses are only inches apart.
On this occasion, our man had generously self-medicated with alcohol, and he might have been a smoker to boot. Early in the procedure, I said: “Your breath would knock a coyote off a manure wagon.” He not perceiving and I not intending any insouciance, we simultaneously began laughing! (I might add that no one entering an ER for an emergency needs to apologize for their appearance.) I treated his pain, assured him that he would improve in 24 to 48 hours and requested he return if otherwise.
Bad breath is something even a good friend may not report to us. Known as halitosis, bad breath can be offensive and embarrassing. The term derives from the Latin halitus, “breath,” and “osis,” condition or disease.
Some chronic diseases produce characteristic odors: liver failure, a fishy odor; kidney failure, an ammoniac or uriniferous smell; and uncontrolled, elevated blood sugar (diabetic ketoacidosis), a sweet or fruity odor. One medical condition, fortunately very rare, is a gastrocolic (stomach and colon) fistula, a connection between two tubular organs. The cause is usually cancer or stomach ulcer. The fistula allows fecal contents to reach the stomach and higher, producing odors far worse than the proverbial skunk at a lawn party.
Ninety percent of bad breath is simply from the mouth: garlic, onions, some meats and fish, cheese (How about Limburger?), tobacco and rotgut booze. Bad breath may be considerably worse in the morning – that bottom-of-the-birdcage quality. Bacteria, more than 600 species in the mouth alone, may thrive during sleep, especially on the back of the tongue. The above-noted problems are likely episodic, and brushing tongue and teeth, flossing and mouthwashes may help.
Probably worse and more difficult to treat are diseases of the gums and teeth. Gum disease, gingival crevices and periodontal pockets, which may harbor bacteria and lead to abscess formation, are not uncommon. Teeth fundamentally rotten may hold impacted food, producing an odor. Dentures also may be a problem.
Ninety percent of bad breath originates from the mouth. So, if a good friend tells you, then your dentist could be the resource of choice.
www.alanfraserhouston.com. Dr. Fraser Houston is a retired emergency room physician who worked at area hospitals after moving to Southwest Colorado from New Hampshire in 1990.
