SINGAPORE: For six years and counting, Ms Nirmala Ramasamy has been putting up with the anxiety and ostracisation that body odour has caused her.
But what the 34-year-old suffers from is beyond what good personal hygiene can solve.
“I have tried everything, from changing my deodorant and perfume to showering a few times a day,” she said. “I can’t detect it but I’ve been told that I smell like rotting fish, garbage or even faeces.”
Ms Ramasamy recounted her odour’s sudden onset in January 2011: “I went to work as usual but on that day, the minute I stepped into the office, everyone reacted to how I smelled. It was peculiar because not only did it not smell like BO, it was so strong it permeated the whole room.”
Ms Ramasamy had worked for 18 months as an assistant executive in the healthcare sector before her condition surfaced. She quit her job a few months later.
“My colleagues couldn’t believe it when I told them that doctors didn’t know what was wrong with me,” she said of her early attempts to seek medical help. “They’ll say things like, how can Singapore not have a cure for BO?”
AN UNUSUAL CAUSE
Rather than a personal hygiene issue, the root of Ms Ramasamy’s condition is a metabolic disorder known as trimethylaminuria or TMAU.
The odour is caused by an accumulation of trimethylamine (TMA), which is produced in the intestine when certain types of food are digested, explained Dr Tan Ee Shien, senior consultant at the genetics service department of paediatrics at KK Women’s and Children’s Hospital.
Normally, the body produces an enzyme that breaks down TMA. But owing to mutations in the FMO3 gene, which prevents the enzyme from working properly, the body is unable to do its job. As the level of TMA builds up, it is released through the person’s sweat, urine and breath instead.
"In most cases, TMAU is a genetic condition," said Dr Tan, who is Ms Ramasamy's physician. "However, not everyone with TMAU has the faulty FMO3 gene. Some cases may be caused by an excess of certain proteins in the diet, or an abnormal increase in the gut bacteria that produces TMA."
TMAU is also a rare condition, both locally and internationally. "There is no central tracking registry for the condition in Singapore," said Dr Tan. Because of its rare occurrence, doctors had a hard time diagnosing Ms Ramasamy.
"What made it worse was not everyone can smell the odour," said Ms Ramasamy. "The doctors who saw me couldn't."
It was at KK Women's and Children's Hospital that Ms Ramasamy found her answer. Dr Tan explained: "TMAU is diagnosed by measuring the amount of TMA in the patient’s urine. The level of TMA measured from the urine test will serve as an objective marker."
Since "TMA is produced by bacterial action on food in the intestine, particular those containing choline", diet plays a big part in managing TMAU, said Dr Tan. For this reason, she has advised Ms Ramasamy to reduce her intake of choline-rich food such as poultry, fish, dairy products, eggs, nuts, seeds and whole grains.
Other treatments include short courses of antibiotics, charcoal tablets and riboflavin supplements, said Dr Tan. She has also advised Ms Ramasamy to switch to a low-pH soap to counter the alkaline nature of TMA.
After leaving her job, Ms Ramasamy enrolled in a full-time degree course in June 2012. But she was not spared the ostracisation at school either.
"My classmates would whisper behind my back or suddenly stop talking when I show up," she said. Her lecturer even played a video on personal hygiene during class.
"I was so anxious on some mornings before going for lessons that I would vomit," said Ms Ramasamy. To control and mask her odour, she would pop charcoal pills and allow herself just one apple before heading out.
Ms Ramasamy was not able to hold down a permanent job when she had just graduated with a degree in commerce in 2014. "I had a contract job handling administrative work for two months but I wasn't able to convert it to a full-time position. It's hard to stay employed when people talk about me."
Her condition has also strained her relationship with her family. "My family members can't smell me, so they find it hard to understand why I couldn't find a job."
MOVING ON FROM TMAU
Rare medical conditions with unusual symptoms such as TMAU can be difficult to recognise and diagnose, said Dr Sandy Julianty Umboh, consultant at KK Women’s and Children’s Hospital’s Department of Psychological Medicine, Women’s Mental Wellness Service.
But it is important for patients to have a diagnosis.
"Having a diagnosis may give some a sense of relief as it gives them an identifiable cause for their symptoms, and learn to accept and manage the condition, and begin treatment, if any,” she said.
Socially, patients may often encounter people who "wrongly jump to conclusions about the cause and effects" of their condition, said Dr Adrian Wang, consultant psychiatrist at Gleneagles Medical Centre. And patients "have to keep explaining to others what the condition actually is".
"Sometimes, people say insensitive things not because they are willfully impolite, but because they lack education," said Dr Wang.
"It's important to give them some benefit of doubt, and be able to clarify and explain. It can be tiring though, which is why having a strong support network is important."
In addition, Dr Wang highlighted the importance of general stress management skills to help individuals like Ms Ramasamy.
"It's important to manage your thoughts and be mindful of negative thinking," he said. "Build confidence by participating in social activities. Make sure you get enough sleep and exercise, and most importantly, learn to reach out to good friends when you have to."
Ms Ramasamy said that it was also important for society to accept TMAU patients like herself.
"Many people commented that I won't be able to get a job because of my condition," she said. She has recently found full-time employment with an accounting firm as a team assistant, and credits her employer's open-mindedness for making it possible.
Read more at http://www.channelnewsasia.com/news...ing-with-fishy-body-odour-caused-by-a-9380938
But what the 34-year-old suffers from is beyond what good personal hygiene can solve.
“I have tried everything, from changing my deodorant and perfume to showering a few times a day,” she said. “I can’t detect it but I’ve been told that I smell like rotting fish, garbage or even faeces.”
Ms Ramasamy recounted her odour’s sudden onset in January 2011: “I went to work as usual but on that day, the minute I stepped into the office, everyone reacted to how I smelled. It was peculiar because not only did it not smell like BO, it was so strong it permeated the whole room.”
Ms Ramasamy had worked for 18 months as an assistant executive in the healthcare sector before her condition surfaced. She quit her job a few months later.
“My colleagues couldn’t believe it when I told them that doctors didn’t know what was wrong with me,” she said of her early attempts to seek medical help. “They’ll say things like, how can Singapore not have a cure for BO?”
AN UNUSUAL CAUSE
Rather than a personal hygiene issue, the root of Ms Ramasamy’s condition is a metabolic disorder known as trimethylaminuria or TMAU.
The odour is caused by an accumulation of trimethylamine (TMA), which is produced in the intestine when certain types of food are digested, explained Dr Tan Ee Shien, senior consultant at the genetics service department of paediatrics at KK Women’s and Children’s Hospital.
Normally, the body produces an enzyme that breaks down TMA. But owing to mutations in the FMO3 gene, which prevents the enzyme from working properly, the body is unable to do its job. As the level of TMA builds up, it is released through the person’s sweat, urine and breath instead.
"In most cases, TMAU is a genetic condition," said Dr Tan, who is Ms Ramasamy's physician. "However, not everyone with TMAU has the faulty FMO3 gene. Some cases may be caused by an excess of certain proteins in the diet, or an abnormal increase in the gut bacteria that produces TMA."
TMAU is also a rare condition, both locally and internationally. "There is no central tracking registry for the condition in Singapore," said Dr Tan. Because of its rare occurrence, doctors had a hard time diagnosing Ms Ramasamy.
"What made it worse was not everyone can smell the odour," said Ms Ramasamy. "The doctors who saw me couldn't."
It was at KK Women's and Children's Hospital that Ms Ramasamy found her answer. Dr Tan explained: "TMAU is diagnosed by measuring the amount of TMA in the patient’s urine. The level of TMA measured from the urine test will serve as an objective marker."
Since "TMA is produced by bacterial action on food in the intestine, particular those containing choline", diet plays a big part in managing TMAU, said Dr Tan. For this reason, she has advised Ms Ramasamy to reduce her intake of choline-rich food such as poultry, fish, dairy products, eggs, nuts, seeds and whole grains.
Other treatments include short courses of antibiotics, charcoal tablets and riboflavin supplements, said Dr Tan. She has also advised Ms Ramasamy to switch to a low-pH soap to counter the alkaline nature of TMA.
After leaving her job, Ms Ramasamy enrolled in a full-time degree course in June 2012. But she was not spared the ostracisation at school either.
"My classmates would whisper behind my back or suddenly stop talking when I show up," she said. Her lecturer even played a video on personal hygiene during class.
"I was so anxious on some mornings before going for lessons that I would vomit," said Ms Ramasamy. To control and mask her odour, she would pop charcoal pills and allow herself just one apple before heading out.
Ms Ramasamy was not able to hold down a permanent job when she had just graduated with a degree in commerce in 2014. "I had a contract job handling administrative work for two months but I wasn't able to convert it to a full-time position. It's hard to stay employed when people talk about me."
Her condition has also strained her relationship with her family. "My family members can't smell me, so they find it hard to understand why I couldn't find a job."
MOVING ON FROM TMAU
Rare medical conditions with unusual symptoms such as TMAU can be difficult to recognise and diagnose, said Dr Sandy Julianty Umboh, consultant at KK Women’s and Children’s Hospital’s Department of Psychological Medicine, Women’s Mental Wellness Service.
But it is important for patients to have a diagnosis.
"Having a diagnosis may give some a sense of relief as it gives them an identifiable cause for their symptoms, and learn to accept and manage the condition, and begin treatment, if any,” she said.
Socially, patients may often encounter people who "wrongly jump to conclusions about the cause and effects" of their condition, said Dr Adrian Wang, consultant psychiatrist at Gleneagles Medical Centre. And patients "have to keep explaining to others what the condition actually is".
"Sometimes, people say insensitive things not because they are willfully impolite, but because they lack education," said Dr Wang.
"It's important to give them some benefit of doubt, and be able to clarify and explain. It can be tiring though, which is why having a strong support network is important."
In addition, Dr Wang highlighted the importance of general stress management skills to help individuals like Ms Ramasamy.
"It's important to manage your thoughts and be mindful of negative thinking," he said. "Build confidence by participating in social activities. Make sure you get enough sleep and exercise, and most importantly, learn to reach out to good friends when you have to."
Ms Ramasamy said that it was also important for society to accept TMAU patients like herself.
"Many people commented that I won't be able to get a job because of my condition," she said. She has recently found full-time employment with an accounting firm as a team assistant, and credits her employer's open-mindedness for making it possible.
Read more at http://www.channelnewsasia.com/news...ing-with-fishy-body-odour-caused-by-a-9380938
