A Rare Condition That’s Hard to Swallow : Health: Severe ptyalism strikes some pregnant women, causing bitter saliva, nausea and nine months of discomfort.
When she is pregnant, Pam Todd feels as if she is tethered to a cup or a box of tissues. Every few seconds her mouth floods with bitter saliva and she has to spit it out or discreetly wipe her mouth to avoid severe nausea or drooling.
The condition kept Todd, a resident of Roslyn Heights, away from her community college graduation in May and has prompted her to stop driving.
“Basically,” she said, “I don’t want to go out at all.”
The problem lasted throughout her first pregnancy three years ago and now she is uncomfortably bracing for a repeat during her current pregnancy. Todd suffers from ptyalism (pronounced TIAL-ism), a rare condition associated with pregnancy.
She doesn’t have any more saliva than anyone else, doctors say, she just has a harder time swallowing what she has. The constant nausea that doctors believe women with severe pytalism share makes them unable to swallow their saliva, which becomes bitter because of hormonal changes during pregnancy.
Since in severe cases women can discharge three to four quarts of saliva a day, sufferers of ptyalism often find that life has become a constant search for relief coupled with embarrassment, discomfort and frustration. “I don’t do anything. I only spit,” Todd said. “I didn’t want to get pregnant again because I was afraid of the same thing. My husband and friends said it might be easier.” But it hasn’t been.
What causes ptyalism to become so severe in some women is a medical mystery. The extreme cases are so rare, doctors said, that researchers have not yet taken on the issue, which means that no one is sure how many women even suffer from ptyalism.
Because it doesn’t affect the fetus, “it is not as big a clinical problem as a lot of issues we deal with,” said Dr. Barbara D. Wesley, director of maternal-fetal medicine at Howard University in Washington, D.C.
Doctors do not know the cause and, therefore, can offer only limited relief--and no cure.
But there may be some hope. A senior clinical nurse specialist at the University of Wisconsin plans to begin the only known research project to determine how many women suffer from ptyalism and what solutions are helpful.
The nurse, Maureen Van Dinter, said that the modest project, provided with $500 and a lot of computer access from the university, will involve a random sampling of Midwest women through a questionnaire. The project may later expand to other parts of the country, she said. She expects to complete the work in about a year and a half.
Van Dinter decided to do the research after getting at least 15 calls and letters from women across the nation after they read an article she wrote on ptyalism two years ago for the Journal of OB-GYN and Neonatal Nursing. Van Dinter has had several patients who suffered from severe ptyalism.
Van Dinter’s hunch is that the problem may be more widespread than is thought because so many doctors are unfamiliar with the condition and some women are too ashamed to report it.
“One of the reasons it’s underreported is that many health care providers don’t know the symptoms and don’t know to ask if it’s a problem,” she said. “And many patients are embarrassed and don’t report it.” In fact, she said, some physicians still tell women that it’s all in their minds and even recommend psychotherapy.
Most women in the first trimester of pregnancy experience the sensation of increased saliva to some degree, said Dr. Boris Petrikovsky, chief of the division of maternal-fetal medicine at North Shore University Hospital in Manhasset, N.Y. Pregnancy hormones change the composition of saliva, so it has less sodium and more potassium, making it taste bitter, said Dr. Joanne Stone, an assistant professor in the department of maternal-fetal medicine at Mt. Sinai Hospital in New York City.
But while some women complain, they get used to a slight saliva problem, Stone said, because “pregnant women are used to tolerating a lot of small unpleasantries. It doesn’t usually affect their lifestyles.”
Not so for severe ptyalism sufferers. Sheron Patterson, pastor of the Crest-Moore King United Methodist Church in Dallas, said she always carried a cup, even to the pulpit, when she was pregnant with her sons. She said she would fill a four-ounce cup about every 30 minutes and that she “perfected the art of preaching and pausing to spit.”
To make herself feel better, she would color-coordinate the cup with her outfits. “I had to take it with me wherever I went,” Patterson said. “I could not keep the saliva in my mouth, and the thought of swallowing it would make me even more sick.”
Ptyalism is almost always associated with a “fair amount” of nausea and morning sickness early in the pregnancy, Wesley said.
There are some things known about the condition. It seems to run in families, for instance, and the women who suffer from it are likely to experience it in subsequent pregnancies. It can start as early as six weeks into pregnancy and last until delivery.
Although some pregnant women secrete large amounts of saliva, they don’t dehydrate because they lose fluid from the salivary glands, not blood vessels, Van Dinter, of the University of Wisconsin, said.
Generally, doctors in the United States have been treating ptyalism like morning sickness. Drugs are not prescribed for fear of birth defects.
Some physicians suggest that women eat smaller meals every two to three hours. They suggest dry foods like crackers and cereal, although they advise that too much starch can stimulate secretion. They also suggest cheese and vegetables. Gum, throat lozenges and flavored water may help mask the bitter saliva tastes.
But Todd says she’s tried a variety of these methods and found nothing that really helped her.
What Van Dinter finds most disturbing is that some doctors still dismiss the problem as psychosomatic. “Women are often told that it’s emotional, that it means there may be a psychological rejection of the pregnancy,” she said.
Van Dinter said when she told a colleague about her project, he said that it wouldn’t be something of “earth-shattering significance.”
But Van Dinter countered: “To the women I have spoken to, it’s very important. It’s a nuisance that really clouds the entire pregnancy.”
