Long-COVID Sufferers Are Flocking to a Texas Clinic to Treat Smell Disorders
On a chilly Sunday in March 2021, Sam Arscott walked into her home in Utica, New York, expecting the familiar scent of pot roast that had been simmering in a slow cooker all day. Instead, when she entered her kitchen, a waft of floral-scented garbage overwhelmed her senses. A professional caterer, Arscott wondered if she had accidentally cooked spoiled meat and called in her husband to take a whiff. He was confused: the roast smelled fine. She suffered through the nauseating smell for the duration of the dinner, unable to eat.
That evening, as Arscott went to bed, the smell of cigarettes hung in the air, but when she checked outside her house, no one was smoking in the street. Over the ensuing days, more places and things smelled foul. A strong chemical odor overrode the normal scent of her body wash; cafes and restaurants smelled like rotting garlic; the litany of rancid scents in the grocery store made it difficult to even enter.
Soon, Arscott could no longer operate her catering business. The short list of foods that didn’t make her ill included broccoli, grilled chicken, salmon, and green grapes (but not red). Unable to work directly with most foods, she pivoted her business and began offering clients nutrition advice, rather than making them meals. All the while, Arscott was uncertain as to what was causing her condition. A bout of COVID-19 the previous December had left her briefly without any sense of smell, but she hadn’t read about distortion of odors as a symptom of the virus. Eventually, Arscott’s internet research led her to discover parosmia (pair-ahz-me-uh), a condition whereby common odors smell rancid. A disorder that used to affect roughly 4 percent of adults, parosmia is a widely reported symptom of “long COVID,” the catchall term for a variety of health problems present in many patients long after their infection from the coronavirus has cleared.
Arscott’s primary care doctor dismissed her concerns and her research about parosmia, which remained little understood by the medical community early in the pandemic. She was prescribed a course of steroids that didn’t prove effective. Arscott, who lives with her four children, fell into a deep depression and her weight yo-yoed as the condition waxed and waned. For months, she slept restlessly and felt she was losing her mind. To find support and answers, she joined a Facebook group for parosmia sufferers. Amid posts about non-foul-smelling recipes and questions from newcomers, she noticed one name popping up repeatedly: David Gaskin, a certified registered nurse anesthetist, who runs a pain-management clinic in Bryan. Gaskin was offering an experimental treatment for parosmia called the stellate ganglion block. Administered via a shot into a bundle of sympathetic nerves in the neck, the block has been used for decades to treat chronic pain and is thought to also offer relief for symptoms of post-traumatic stress disorder. (There’s now an active trial examining the block’s effects on various long COVID–related smell disorders.)
In social media posts, Gaskin explains that the procedure doesn’t help everyone, but his reputation has quickly spread among parosmia sufferers. Desperate, Arscott booked a flight for her first-ever visit to Texas.
When Arscott entered Republic Pain Specialists this past September, the anodyne hallways of the medical center seemed to reek of chemical odors and garbage. Gaskin, wearing caiman-hide cowboy boots under his medical scrubs, greeted her. After explaining the procedure, Gaskin injected a numbing agent and a steroid into the stellate ganglion on the right side of her neck. She felt her right eye and the right side of her face droop, a sign the procedure was performed correctly. He repeated the process with a second shot targeting a slightly different spot.
After waiting for fifteen minutes and evaluating her ability to swallow, Gaskin offered Arscott a Reese’s peanut butter cup to see if the shots had been effective. She gingerly took a small bite of the candy and tears flooded her eyes. For the first time in nineteen months, the candy smelled normal and she could taste the rich nutty flavor of peanut butter and chocolate. Across the room, her mother, who accompanied her, FaceTimed Arscott’s husband so he could watch.
Gaskin advised Arscott to leave the clinic to try foods on her “no-go” list before coming back at 4:30 p.m. the same day for the second round of injections, in the left side of her neck. Arscott craved a burger and found a nearby joint. Once served, she began deconstructing the sandwich to smell each part and tentatively taste it, starting with a pickle—“It tastes like a pickle! Like a real pickle!” she called to her mom—then bacon, fried onion, ketchup, and lettuce. She eagerly went back to Gaskin for a second round of injections.
Later that day, when Arscott left the clinic, Gaskin thanked her for visiting. “It’s kind of scary to come all the way from New York to Texas to try something and spend a lot of money,” he told her. “It’s certainly very experimental. There’s not a lot of that scientific data yet to help prove what we’re doing. You’re going off of patient accounts on social media, which is kind of scary, so I congratulate you for having the courage to try something.” Gaskin wasn’t mincing words. There is indeed not much research backing the stellate ganglion block’s use to treat parosmia.
While COVID-19 is known to disrupt the olfactory system, medical professionals are still researching exactly what causes parosmia and its sister syndrome, anosmia, the complete loss of smell suffered by many long COVID patients. Many specialists believe COVID damages cells inside the nose responsible for helping us accurately decode odor; others say the symptoms of smell loss or distortion are neurological. In the suite of olfactory disorders, parosmia is often the most unpleasant but also the one that offers the greatest hope for recovery. That the brain is detecting odor at all is a positive sign.
Still, for sufferers facing an onslaught of vile smells at every turn, the experience of suddenly mistrusting every bite you take is disorienting. In Facebook support groups such as the one Arscott found, sufferers report spikes in anxiety, extreme weight fluctuation (some patients have even experienced recurrence of disordered eating after years of recovery), and medical conditions exacerbated by malnourishment. Home remedies abound—eating a burned orange or piercing your septum have been promoted by nonprofessionals on the forums—but there is no accepted cure for parosmia. Many who suffer say their doctors don’t understand the severity of the condition. They are prescribed ineffective nasal rinses or referred to psychologists. One parosmia patient, Hannah Higgins, a thirty-year-old Instagram and YouTube content creator in Denton, in the Dallas suburbs, said she lost sixty pounds but was shrugged off by her doctor. “I remember my MD saying it shouldn’t last more than a year,” she said. “And at that point, I was five months postpartum and I thought to myself, ‘I hope I survive mentally. I hope I can make it until a year.’ ”
Many patients turn to Google or social media for answers, in the face of confusing or unsatisfactory medical advice, says Mike Mackert, the director of the University of Texas at Austin’s Center for Health Communication. That’s where Gaskin, a 58-year-old, fifth-generation Texan, comes in, offering parosmia sufferers something they haven’t found elsewhere: a possible treatment and hope that they can get better.
Gaskin, who grew up in Buffalo, seventy miles east of Waco, and joined his family trade as a bull rider and horse trainer, has worked as a nurse anesthetist since his rodeo days came to an end decades ago. In 2018, he completed a pain-management fellowship at Texas Christian University and opened his own clinic to treat chronic pain, a condition he was intimately familiar with after fifteen surgeries to treat the many injuries he sustained from bull riding.
Since opening his practice in 2019, Gaskin has offered the stellate ganglion block as a pain-management tool for head, neck, and upper body pain syndromes. When he came across a paper in a medical journal in the fall of 2021 tracking two parosmia patients over sixty days in Alaska suggesting that the block could treat smell issues, he was intrigued. Not long after, Gaskin tried the block on a fellow practitioner who suffered from COVID-related parosmia. The treatment was successful, and the practitioner posted about his experience in one of the larger Facebook support groups. Gaskin began offering the block, at a cost of $500 for each side of the neck (if patients respond positively to the first round, Gaskin advises it’s optional to get the second round)—which insurance usually doesn’t cover. After the husband of one early patient shared his wife’s experience on TikTok, Gaskin’s office received 95 emails overnight and his receptionists couldn’t keep up with the calls. Now, patients from around the country and as far afield as Germany, Israel, and South Africa seek him out. As of October, Gaskin’s clinic has treated 1,100 patients with parosmia and reports that 85 percent of patients recover at least 50 percent of their customary sense of smell. (I spoke with seventeen patients I found through social media reviews, eleven of whom told me they had experienced significant, sustained improvement following the block.)
While Gaskin acknowledges the treatment is experimental, he’s an enthusiastic believer in its effectiveness, at least in certain patients. In partnership with TCU, he has launched a study tracking the first three hundred parosmia patients he treated. That study is currently being peer reviewed.
According to the mounting list of success stories on social media, the block seems to provide relief to many patients and, if administered properly, is considered safe, though serious side effects of botched procedures can include nerve injury, vascular damage, and collapsed lungs. But several doctors I spoke with aren’t convinced of its healing properties. Broader data supporting the block’s effect on the olfactory system is still lacking. And if physical damage to nasal cells causes parosmia, as three olfactory experts I spoke to believe, the block shouldn’t be effective. “I think if people find benefit from this block, it is likely in the way it helps other types of issues that it’s used for [such as] PTSD, anxiety,” says Zara Patel, a sinus surgeon and professor of otolaryngology at Stanford University. “But do I think it’s actually changing something about the olfactory system itself? No, not at all.”
What, then, could account for the instantaneous change in the ability to smell that many report? Experts suggested it could be a placebo effect, or reduced mental distress after the procedure, which could help patients better cope with their condition. Eric Holbrook, the director of rhinology at Massachusetts Eye and Ear and an associate professor of otolaryngology at Harvard Medical School, also doubts the block’s clinical effectiveness. He says subjective self-reports of smell recovery cannot be relied on, without objective baseline tests. If you haven’t eaten a burger in fifteen months, say, it’s possible to regain the normal smell of the food without even knowing it, or to not notice steady improvements over time, which Holbrook believes could be the reason the block has a high self-reported success rate.
Gaskin acknowledges the treatment would not be effective if parosmia is caused by olfactory damage, which is why he’s convinced long COVID affects the nervous system. He offers this explanation to his patients: COVID is a traumatic event that sends the nervous system into fight-or-flight mode and creates a heightened state of stress and inflammation. Blocking the sympathetic nerves, in his telling, forces the nervous system to reset.
He’s not alone in this theory. Luke Liu, a pain-management doctor in Alaska and the author of the study that inspired Gaskin, also thinks the block’s success points to long COVID being at least partially a nervous system response. He has not seen the same success rate treating parosmia with the block at his clinic and cautions that it is not a confirmed solution to the condition and other long COVID symptoms. But compared to the detrimental effects of parosmia, he sees the block as a low-risk option.
Gaskin is skeptical of doctors who outright dismiss the treatment, accusing some of spreading “misinformation.” “I don’t want to promote myself as a scientist,” he told me, “but I’m a clinician, and when you see thousands of patients, you just cannot deny that [the block] is reversing not all of these symptoms but the vast majority of them.”
Many parosmia sufferers say they can’t wait years for more research and are willing to try a procedure that seems to be working for other patients. Every patient I spoke with—even those for whom the block did not work—praised their experience with Gaskin, noting his genuine concern for their condition.
Jena Whitener, a 55-year-old project manager at a manufacturing company in Tulsa, told me that even the scent of rain made her vomit before the procedure. When she visited Buc-ee’s after receiving the block, she was overwhelmed by the aromas of barbecue, caramel popcorn, and taffy. Tammy Phillips, a 50-year-old office manager in Arkansas, couldn’t kiss her husband for a year because his breath smelled to her like rotten food. Her hair started falling out, she lost fifty pounds, and she got winded while performing simple tasks. “He is my hero,” Phillips said of Gaskin. “He changed my life.”
Gaskin acknowledges that some patients don’t experience any improvement in their ability to smell normally after the block. And some patients who excitedly post in Facebook support groups immediately after their block experience regression weeks or months later. One told me that her relief only lasted six hours.
But among the patients I interviewed, many of those who didn’t regain their normal sense of smell during their first treatment said they would be willing to go back to Bryan multiple times, if that’s what it took to find relief. Higgins, the social media influencer in Denton, said she didn’t regain any of her previous sense of smell after receiving the block, but said the experience of being listened to by Gaskin was emotionally healing. Others said he was the first medical provider who empathized with their pain, even if the procedure didn’t work.
Two months after receiving the stellate ganglion block, Arscott says she still has a normal sense of smell. The week she got home from Bryan, she relaunched her catering business. She can concentrate better without the persistent nagging odors, and her sleep is deeper now that the phantom cigarette smoke is gone. She can even make meals for her children without gagging, liberally use lotion and perfume, and confidently walk into grocery stores. If her symptoms were to regress, however, she said she had no doubts about returning to Gaskin’s clinic. “I would be on a plane in a heartbeat.”
Courtney Runn is an Austin-based writer.
This article originally appeared in the January 2023 issue of Texas Monthly with the headline “Our Bodies, Our Smells.” Subscribe today.