Recently my loved one's asthma and sinus congestion has been getting worse. He tried azithromycin (sp?) for about a month, but it didn't seem to help. Perhaps this is not surprising given that his nasal discharge is clear. A CAT scan showed congestion consistent with his symptoms. He went to see an ENT who was only interested in doing surgery and refused to perform a sinus culture or endoscopic examination. Obviously we need a new ENT.
Surprisingly the only thing recently that has helped his asthma (or nasal congestion) is Sudafed. Has anyone heard of sudafed being effective for asthma? What does the alleviation of the asthma symptoms by Sudafed mean?
Of course Sudafed is no longer available from shelves in our area, and I have to wait in line at the prescription counter to purchase it.
-- Alison Chaiken "From:" address above is valid. (650) 236-2231 [daytime]http://www.wsrcc.com/alison/ Predators fail often; prey fail only once. -- Tom Evslin
Alison Chaiken wrote:> Recently my loved one's asthma and sinus congestion has been getting> worse. He tried azithromycin (sp?) for about a month, but it didn't> seem to help. Perhaps this is not surprising given that his nasal> discharge is clear. A CAT scan showed congestion consistent with his> symptoms. He went to see an ENT who was only interested in doing> surgery and refused to perform a sinus culture or endoscopic> examination. Obviously we need a new ENT.>
Surprisingly the only thing recently that has helped his asthma (or> nasal congestion) is Sudafed. Has anyone heard of sudafed being> effective for asthma? What does the alleviation of the asthma> symptoms by Sudafed mean?>
Of course Sudafed is no longer available from shelves in our area, and> I have to wait in line at the prescription counter to purchase it.>
In my case, anything that stops the constant nasal dripping stops me from having asthma symptoms.
Has he considered allergic desensitization? I had it done aggressively, complete in 12 weeks, with dramatic sinus and asthma improvement.
Alison Chaiken wrote:> Recently my loved one's asthma and sinus congestion has been getting> worse. He tried azithromycin (sp?) for about a month, but it didn't> seem to help. Perhaps this is not surprising given that his nasal> discharge is clear. A CAT scan showed congestion consistent with his> symptoms. He went to see an ENT who was only interested in doing> surgery and refused to perform a sinus culture or endoscopic> examination. Obviously we need a new ENT.>
Surprisingly the only thing recently that has helped his asthma (or> nasal congestion) is Sudafed. Has anyone heard of sudafed being> effective for asthma? What does the alleviation of the asthma> symptoms by Sudafed mean?>
Of course Sudafed is no longer available from shelves in our area, and> I have to wait in line at the prescription counter to purchase it.
Hi Alison,
I wonder why they jumped on the "surgery" wagon so quickly. Did they say there was blockage that was causing the congestion? If that's the reason, that may be why they want to do surgery. My sinus was so blocked up that when they tried to do an endoscopic exam, they couldn't see around many of the blockages. Now, after FESS, they can look all around up there.
I wonder if your loved one's asthma is a result of the sinusitis. This is true in my case. For me, something that helps clear my sinuses, also clears up the asthma. As a matter of fact, before I had the FESS surgery, I was coughing horribly and barely sleeping. The day of the surgery my husband could tell a difference in the cough. Today, 2 months later, I don't cough at all.
NorthShoreCEO 2 October 2005 00:29:19 [ permanent link ]
"Alison Chaiken" <alison+gnus20051001T094701@dailyplanet.dontspam.wsrcc.com> wrote in message news:868xxdgoqv.fsf@capsicum.wsrcc.com...>
Recently my loved one's asthma and sinus congestion has been > getting> worse. He tried azithromycin (sp?) for about a month, but it > didn't> seem to help. Perhaps this is not surprising given that his > nasal> discharge is clear. A CAT scan showed congestion consistent > with his> symptoms. He went to see an ENT who was only interested in > doing> surgery and refused to perform a sinus culture or endoscopic> examination. Obviously we need a new ENT.>
Surprisingly the only thing recently that has helped his asthma > (or> nasal congestion) is Sudafed. Has anyone heard of sudafed > being> effective for asthma? What does the alleviation of the asthma> symptoms by Sudafed mean?>
Of course Sudafed is no longer available from shelves in our > area, and> I have to wait in line at the prescription counter to purchase > it.>
-- > Alison Chaiken "From:" address above is valid.> (650) 236-2231 [daytime] http://www.wsrcc.com/alison/> Predators fail often; prey fail only once. -- Tom Evslin>
Yes, and you hijacked my thread becaaaaaaaaaaaaaaaaaaaaaaauuuuuuuuuuusssssssseee...........??????????????
Murray Grossan 2 October 2005 01:13:36 [ permanent link ]
On 10/1/05 1:36 PM, in article spC%e.62$9K2.39@bignews1.bellsouth.net, "Lily" <smorris@nospambellsouth.net> wrote:
Alison Chaiken wrote:>> Recently my loved one's asthma and sinus congestion has been getting>> worse. He tried azithromycin (sp?) for about a month, but it didn't>> seem to help. Perhaps this is not surprising given that his nasal>> discharge is clear. A CAT scan showed congestion consistent with his>> symptoms. He went to see an ENT who was only interested in doing>> surgery and refused to perform a sinus culture or endoscopic>> examination. Obviously we need a new ENT.>>
Surprisingly the only thing recently that has helped his asthma (or>> nasal congestion) is Sudafed. Has anyone heard of sudafed being>> effective for asthma? What does the alleviation of the asthma>> symptoms by Sudafed mean?>>
Of course Sudafed is no longer available from shelves in our area, and>> I have to wait in line at the prescription counter to purchase it.>
Hi Alison,>
I wonder why they jumped on the "surgery" wagon so quickly. Did they say> there was blockage that was causing the congestion? If that's the> reason, that may be why they want to do surgery. My sinus was so blocked> up that when they tried to do an endoscopic exam, they couldn't see> around many of the blockages. Now, after FESS, they can look all around> up there.>
I wonder if your loved one's asthma is a result of the sinusitis. This> is true in my case. For me, something that helps clear my sinuses, also> clears up the asthma. As a matter of fact, before I had the FESS> surgery, I was coughing horribly and barely sleeping. The day of the> surgery my husband could tell a difference in the cough. Today, 2 months> later, I don't cough at all.>
Best wishes to you and yours,> Lily>
I can understand your concern when the doctor recommends surgery at the first visit. But what is the ethics here? . But understand the ethical dilemma I face every day. For example: I see the child with thick almost solid fluid behind the ear drum. She has a hearing loss. She has already had loads of treatment. I KNOW that the only treatment that will work is to drain the fluid, irrigate the ear at surgery and place a tube. I also know that if I recommend surgery at the first visit the parents will flee.
Do I lie and say let's try this and that and then if it doesn't work, we will consider surgery? That way I can "sell " the surgery? Or do I tell the truth and say that surgery is the only thing that will work and have them flee out the door to a more caring doctor?
This dilemma comes often and doctors have to choose what they believe is best for the patient.
Murray Grossan wrote:> On 10/1/05 1:36 PM, in article spC%e.62$9K2.39@bignews1.bellsouth.net,> "Lily" <smorris@nospambellsouth.net> wrote:>
Alison Chaiken wrote:>>
Recently my loved one's asthma and sinus congestion has been getting>>>worse. He tried azithromycin (sp?) for about a month, but it didn't>>>seem to help. Perhaps this is not surprising given that his nasal>>>discharge is clear. A CAT scan showed congestion consistent with his>>>symptoms. He went to see an ENT who was only interested in doing>>>surgery and refused to perform a sinus culture or endoscopic>>>examination. Obviously we need a new ENT.>>>
Surprisingly the only thing recently that has helped his asthma (or>>>nasal congestion) is Sudafed. Has anyone heard of sudafed being>>>effective for asthma? What does the alleviation of the asthma>>>symptoms by Sudafed mean?>>>
Of course Sudafed is no longer available from shelves in our area, and>>>I have to wait in line at the prescription counter to purchase it.>>
Hi Alison,>>
I wonder why they jumped on the "surgery" wagon so quickly. Did they say>>there was blockage that was causing the congestion? If that's the>>reason, that may be why they want to do surgery. My sinus was so blocked>>up that when they tried to do an endoscopic exam, they couldn't see>>around many of the blockages. Now, after FESS, they can look all around>>up there.>>
I wonder if your loved one's asthma is a result of the sinusitis. This>>is true in my case. For me, something that helps clear my sinuses, also>>clears up the asthma. As a matter of fact, before I had the FESS>>surgery, I was coughing horribly and barely sleeping. The day of the>>surgery my husband could tell a difference in the cough. Today, 2 months>>later, I don't cough at all.>>
Best wishes to you and yours,>>Lily>>
I can understand your concern when the doctor recommends surgery at the> first visit. But what is the ethics here? .> But understand the ethical dilemma I face every day.> For example: I see the child with thick almost solid fluid behind the ear> drum. She has a hearing loss. She has already had loads of treatment. I KNOW> that the only treatment that will work is to drain the fluid, irrigate the> ear at surgery and place a tube.> I also know that if I recommend surgery at the first visit the parents will> flee.>
Do I lie and say let's try this and that and then if it doesn't work, we> will consider surgery? That way I can "sell " the surgery?> Or do I tell the truth and say that surgery is the only thing that will work> and have them flee out the door to a more caring doctor?>
This dilemma comes often and doctors have to choose what they believe is> best for the patient. >
I think you should discuss the dilemma with the patient, honestly, the way you have here.
Doctor Murray I know you are a scientist and would like the luxury of being transparent with your patient.
Not always possible. Your first loyalty is to your profession Medicine, which has always and will probably continue to feaure a measure of Priesthood and Shaminism, along with Science.
Setting up the situation, in this case surgery, where you can be most effective as a practitioner takes priority over the luxury (in the case you mentioned) of candor.
Try not to make a habit of it. Enough mad doctors in the past, and this attitude was one of the reasons they got unhinged.
Great respect for your sensitivity and concern, Doctor.---Jack
"Alison Chaiken" <alison+gnus20051001T094701@dailyplanet.dontspam.wsrcc.com> wrote in message news:868xxdgoqv.fsf@capsicum.wsrcc.com...>
Recently my loved one's asthma and sinus congestion has been getting> worse. He tried azithromycin (sp?) for about a month, but it didn't> seem to help. Perhaps this is not surprising given that his nasal> discharge is clear. A CAT scan showed congestion consistent with his> symptoms. He went to see an ENT who was only interested in doing> surgery and refused to perform a sinus culture or endoscopic> examination. Obviously we need a new ENT.
It is hard to comment on this without knowing more. Sometimes surgery is obviously required (either due to the anatomy or what has previously been tried and failed) and sometimes (contrary to a commonly expressed opinion here) the primary doc actually does do a good job of doing all the non-surgical stuff prior to referring.
Of course, a second opinion if there is some doubt is never a bad idea.
Endoscopy and culture is warranted if the problem is suspected to be a drug resistant infection. If that is not the case then it will not do much good. Usually prolonged courses of antibiotics are attempted first. If infection is not suspected then antihistamines with decongestants, nasal steorids, and nasal irrigation can help. A referal to an allergist may be helpful.
Surprisingly the only thing recently that has helped his asthma (or> nasal congestion) is Sudafed. Has anyone heard of sudafed being> effective for asthma? What does the alleviation of the asthma> symptoms by Sudafed mean?
It is probably being triggered by the sinus congestion and post nasal drip. Trying the above stuff may help.
Of course Sudafed is no longer available from shelves in our area, and> I have to wait in line at the prescription counter to purchase it.
"Murray Grossan" <hydromed@adelphia.net> wrote in message news:BF645820.22E4%hydromed@adelphia.net...> Do I lie and say let's try this and that and then if it doesn't work, we> will consider surgery? That way I can "sell " the surgery?> Or do I tell the truth and say that surgery is the only thing that will > work> and have them flee out the door to a more caring doctor?>
This dilemma comes often and doctors have to choose what they believe is> best for the patient.
That is the art of medicine. Not only do you have to try to divine the best course but you then need to convince the patient to follow it. Often the second part is harder than the first. Since no treatment plan will work if it is not followed it is also the most important.
Whatever has the best chance of getting the patient well is the ethical course.
Alison, I was in a similar situation as you described. I tried a couple of courses of antibiotics over 6-8 months and nothing worked. I was getting progressively worse but I was afraid of the surgery. Over that time, I got two ENT opinions and also visited my allergist for his opinion before agreeing to the surgery. (also had new round of allergy tests which showed new allergies had developed). It is very important to know what kind of surgery they will do. Next I found the doctor with the best reputation in the area. The doctor who performed my surgery showed me exactly on the CAT scan where there were polyps and blockages. He showed me what areas they would open up. I had version of FESS called MIST (at a Boston area hospital) which does not remove turbinates or bone or the mucuous membraines. Once the sinuses were opened I feel about 95% better. I still have some allergy symptoms and irrigate twice daily with the grossan irrigator to keep things healthy.
If you are near a major medical center try to go there for an opinion. Not to scare you (just a warning), there are some ENTs still performing an older sinus surgery where they take out too much sinus tissue and the patient can be left with more problems (called empty nose syndrome).
Check the FAQ posting for this group. There is a lot of good info on books to read and things to do to help this condition especially irrigating which has been a salvation for me.
Murray Grossan 4 October 2005 00:34:17 [ permanent link ]
On 10/2/05 10:06 AM, in article 86psqndf1r.fsf@capsicum.wsrcc.com, "Alison Chaiken" <alison+gnus20051002T093648@dailyplanet.dontspam.wsrcc.com> wrote:
I don't really understand the connection between PND and asthma.> Normally mucus goes from the back of your sinuses into your digestive> system. With PND the cilia are weak and the patient is more conscious> of mucus in the throat, but it still goes on the normal path into the> stomach, right? So how does PND exacerabate asthma? Does mucus leak> into the bronchial tubes or does its slower transit cause a> generalized inflammatory response?
There is a chapter in Emedicine on sinusitis and asthma. Any product, bug, radioactive tagged bug, appears in trachea form the sinuses in about 16 hours. PND is a common trigger for asthma, but is not the cause of asthma.
On Mon, 03 Oct 2005 14:34:17 -0700, Murray Grossan <hydromed@adelphia.net> wrote:
There is a chapter in Emedicine on sinusitis and asthma.>Any product, bug, radioactive tagged bug, appears in trachea form the>sinuses in about 16 hours. PND is a common trigger for asthma, but is not>the cause of asthma.
Would it be correct to say that t he underlying cause of the asthma is probably the same as the underlying cause of the PND and sinusitis - allergic inflammation?
My advice: Do the surgery just for the heck of it. Don't make the same > mistake I did.>
You realize that may not be the most *compelling* reason for sinus surgery ever seen here, right?
Your and I have had a lot of common experiences, but I don't know if you ever pursued allergic desensitization. It helps me a great deal. Not curative, certainly, once I get a cold, I have to decongest and irrigate like crazy, but otherwise, I'm pretty much okay now.
NorthShoreCEO 8 October 2005 06:16:41 [ permanent link ]
"Don Brady" <dbrady@pobox.com> wrote in message news:mn8ek1pnrhi85htfb6i88l0o5uig8vhlej@4ax.com...> On Fri, 7 Oct 2005 15:59:45 -0500, "NorthShoreCEO" > <NorthShoreCEO@aol.com>> wrote:>
I don't think anyone should ever have surgery "just for the >>heck>>of it". It should be the final solution after exhausting >>other>>options.>>
It was obvious to me that Steven it not mean it literally.>
He meant "despite your persoanl reservations, since nothing > else has worked for> you."
Since the loved one of the original poster hasn't really tried a different number of things to resolve his problem, it isn't at all obvious to me.
"Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote in message > news:GdA1f.7926$zQ3.3126@newsread1.news.pas.earthlink.net...>
My advice: Do the surgery just for the heck of it. >>>-- >>Steven D. Litvintchouk>>Email: sdlitvin@earthlinkNOSPAM.net>>
I don't think anyone should ever have surgery "just for the heck > of it". It should be the final solution after exhausting other > options.
That's where you're wrong. Surgery should NOT be the final option for sinusitis, any more than it is the final option for a malignant tumor. When you have a malignant tumor (cancer), surgery is often the first-line treatment (often followed up by chemotherapy or radiation).
There have been very few scientific follow-up studies to prove once and for all what the best treatments for chronic sinusitis are. But the only follow-up studies I have seen, show that surgery has a cure rate of about 80%, while antibiotics and everything else don't do anywhere near as well.
Right now, in the medical state of the art, surgery should be the treatment of choice.
-- Steven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net
"Don Brady" <dbrady@pobox.com> wrote in message > news:mn8ek1pnrhi85htfb6i88l0o5uig8vhlej@4ax.com...>
On Fri, 7 Oct 2005 15:59:45 -0500, "NorthShoreCEO" >><NorthShoreCEO@aol.com>>>wrote:>>
I don't think anyone should ever have surgery "just for the >>>heck>>>of it". It should be the final solution after exhausting >>>other>>>options.>>>
It was obvious to me that Steven it not mean it literally.>>
He meant "despite your persoanl reservations, since nothing >>else has worked for>>you.">
Since the loved one of the original poster hasn't really tried a > different number of things to resolve his problem, it isn't at > all obvious to me.
I remember what my ENT said: "Most patients don't want to have surgery. They will try steroids and antibiotics and alternative medicine. And after they've given up, then they come back to me and ask for the surgery."
-- Steven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net
In my case, anything that stops the constant nasal dripping stops me>>>> from having asthma symptoms.>>>
I don't really understand the connection between PND and asthma.>>> Normally mucus goes from the back of your sinuses into your digestive>>> system. With PND the cilia are weak and the patient is more conscious>>> of mucus in the throat, but it still goes on the normal path into the>>> stomach, right? >>
No.>> Especially at night, PND can drip all the way down thru the trachea, >> right into the bronchial tubes. If the PND is infected, the infection >> can spread into the bronchial tubes, causing bronchitis and the >> inflammation can trigger asthma.>>
I often get acute bronchitis as a consequences of a bad cold or sinus >> infection.>>
Your comments get to the crux of the matter, which is: is the sinus>>> congestion allergy-related or the result of an infection? He has had>>> a stuffed nose continuously for months except when he's taken big,>>> continuous Sudafed doses. Since the nasal discharge is clear and he>>> has no sinus pain, I'm quite doubtful that he has an infection. The>>> CAT scan shows heavy congestion but no mechanical problems with the>>> septum, etc. It's consideration of all these indicators that makes me>>> dubious about the surgery. Perhaps Susan has hit the nail on the>>> head: we need not a new ENT but an allergist! >>
No, I was in the same boat.>> The CT scan showed no evidence of sinus infection.>> I suffered for years until I found an ENT willing to operate on me >> anyway. And when he did, he found sinus blockages that hadn't showed >> up on the CT scan.>>
CT scans aren't perfect. They have a finite resolution and they can >> miss tiny pockets of infection.>>
My advice: Do the surgery just for the heck of it. Don't make the >> same mistake I did.>
I had a inf in my sinus for over 15 years that *never* showed on a CT > scan. This year I got another inf on the other side, and the CT scan > picked it up!>
The dr decided a FESS was the best way to go. While in there, he found > the other inf that I always knew was there. Though I tried and begged > through the years, I was never able to get an ENT willing to operate > without proof that something was up there.
In my case, I finally found an ENT--just one--who still believes that a very detailed patient history and a very detailed list of the patient's exact symptoms are still the best diagnostic tool, not CT scans. He disregarded the negative CT scan and agreed to try surgery. In fact, when I woke up in the Recovery Room after the surgery, he told me that he had my CT scan films in the operating room and while his surgical assistant was telling him the CT scan showed no blockages, he was looking right at the blockages with his endoscope.
In fact, right now my ENT is in a disagreement with my allergist! My allergist did allergy tests on me and they were all negative. But my ENT says that based on his visual inspection of my turbinates (hypersensitive, hypersecretory, etc.), he is convinced I have allergies. I told him that my allergy tests were negative. He retorted, "I don't care what the allergy tests showed! You've got allergies, Steven!!!"
-- Steven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net
In fact, right now my ENT is in a disagreement with my allergist! My > allergist did allergy tests on me and they were all negative. But my > ENT says that based on his visual inspection of my turbinates > (hypersensitive, hypersecretory, etc.), he is convinced I have > allergies. I told him that my allergy tests were negative. He > retorted, "I don't care what the allergy tests showed! You've got > allergies, Steven!!!">
I've heard of folks whose allergies didn't appear on skin testing, some whose allergies weren't detected with RAST testing, but who got positive detection using environmental medicine, increasing doses of antigen in one sitting til reaction occurs.
Right now, in the medical state of the art, surgery should be the > treatment of choice.>
I may one day decide that I need to consider surgery for my one chronic ethmoid sinus, but so far, resuming aggressive allergic desensitization, along with irrigation, Astelin and decongestants when needed works for me.
When I was between colds, I was able to maintain sinus health without irrigating or anything but Astelin for a couple of months, recently.
NorthShoreCEO 8 October 2005 18:11:26 [ permanent link ]
"Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote in message news:SsQ1f.8483$oc.4131@newsread2.news.pas.earthlink.net...> NorthShoreCEO wrote:>
"Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote in message >> news:GdA1f.7926$zQ3.3126@newsread1.news.pas.earthlink.net...>>
My advice: Do the surgery just for the heck of it. >>>>-- >>>Steven D. Litvintchouk>>>Email: sdlitvin@earthlinkNOSPAM.net>>>
I don't think anyone should ever have surgery "just for the >> heck of it". It should be the final solution after >> exhausting other options.>
That's where you're wrong.> Surgery should NOT be the final option for sinusitis, any more > than it is the final option for a malignant tumor. When you > have a malignant tumor (cancer), surgery is often the > first-line treatment (often followed up by chemotherapy or > radiation).>
There have been very few scientific follow-up studies to prove > once and for all what the best treatments for chronic sinusitis > are. But the only follow-up studies I have seen, show that > surgery has a cure rate of about 80%, while antibiotics and > everything else don't do anywhere near as well.>
Right now, in the medical state of the art, surgery should be > the treatment of choice.>
-- > Steven D. Litvintchouk> Email: sdlitvin@earthlinkNOSPAM.net>
Remove the NOSPAM before replying to me.
So I guess I interpreted Stevens message correctly, Don Brady.
"Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote in message news:zLQ1f.222$y14.99@newsread3.news.pas.earthlink.net...
I told him that my allergy tests were negative. He retorted, "I don't > care what the allergy tests showed! You've got allergies, Steven!!!"
I'm sure you have irritation of some type. It may or may not be a true allergy. The real point is that if the allergist can't figure out to what you are reacting then he can't give you immunotherapy. You are left with the non-specific advice on environmental exposures and meds. Sometimes docs say there is nothing wrong when it would be more accurate to say there is nothing I can fix. In this case it sounds like the difference may be academic.
You could try a second allergy opinion. Maybe even say to the guy that even if he can't find a specific target for immunotherapy that you would like to work on the non-specific measures that can be taken.
One odd ball thing that you may want to try is to be tested for "autoantigens" like thyroid antigens, nucleae antigens, and celiac disease. There are a few others that I forget off the top if my head but an allergist would probably know. I hate to add fuel to anyone's fire but an elimination diet to look at "hidden" food allergies may also help.
"00doc" <00doc@comcast.net> wrote in message news:K9ednT-0G8FcctreRVn-iQ@comcast.com...>
"Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote in message > news:zLQ1f.222$y14.99@newsread3.news.pas.earthlink.net...>
I told him that my allergy tests were negative. He retorted, "I don't >> care what the allergy tests showed! You've got allergies, Steven!!!">
I'm sure you have irritation of some type. It may or may not be a true > allergy. The real point is that if the allergist can't figure out to what > you are reacting then he can't give you immunotherapy. You are left with > the non-specific advice on environmental exposures and meds. Sometimes > docs say there is nothing wrong when it would be more accurate to say > there is nothing I can fix. In this case it sounds like the difference may > be academic.>
You could try a second allergy opinion. Maybe even say to the guy that > even if he can't find a specific target for immunotherapy that you would > like to work on the non-specific measures that can be taken.>
One odd ball thing that you may want to try is to be tested for > "autoantigens" like thyroid antigens, nucleae antigens, and celiac > disease. There are a few others that I forget off the top if my head but > an allergist would probably know. I hate to add fuel to anyone's fire but > an elimination diet to look at "hidden" food allergies may also help.>
On Sat, 8 Oct 2005 10:11:26 -0500, "NorthShoreCEO" <NorthShoreCEO@aol.com> wrote:
So I guess I interpreted Stevens message correctly, Don Brady.
Probably I did not express myself too clearly. Too be honest , I did not look back through earlier threads as to the particular patient's history so I made the assumption that they had tried other things.
In any case, I agree with him Steven that surgery should not be regarded solely as a treatment of "last resort," as some posters have suggested. That maxim seems to carry the implication that there are horrible risks to it. Properly done, there are not.
There are quite a few cases where it is appropriate to do it fairly promptly. The need for surgery *may* be clear right away. If several opiniosn back that up, do it right away.
There are quite a few variables.
Foremost among them is that the patient is often totally confused as to - whether he can resaonably expect a resolution without surgery - what results to expect from surgery - the nature of sinusitis itself - how to decide among conflicting advise from different doctors and lay people - the motivations and appropriate roles of doctors in different specialties
Once the patient understands all of these issues thoroughly (this newsgroup can help, as can consultations with several different doctors ) then the course to take in an individual case will normally become clearer.
But relegating surgery solely to a role of "last resort" would not be correct, in my opinion, any more than would be having it done it too casually.
On Sat, 08 Oct 2005 14:31:59 GMT, "Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote: ere.>
In my case, I finally found an ENT--just one--who still believes that a >very detailed patient history and a very detailed list of the patient's >exact symptoms are still the best diagnostic tool, not CT scans. He >disregarded the negative CT scan and agreed to try surgery. In fact, >when I woke up in the Recovery Room after the surgery, he told me that >he had my CT scan films in the operating room and while his surgical >assistant was telling him the CT scan showed no blockages, he was >looking right at the blockages with his endoscope.>
In fact, right now my ENT is in a disagreement with my allergist! My >allergist did allergy tests on me and they were all negative. But my >ENT says that based on his visual inspection of my turbinates >(hypersensitive, hypersecretory, etc.), he is convinced I have >allergies. I told him that my allergy tests were negative. He >retorted, "I don't care what the allergy tests showed! You've got >allergies, Steven!!!"
I'll bet he's right.
It seems that some of ust react to the common allergens/ irritants in the same way as if we scored much more positively on the tests.
Usually ti does not make that much practical difference because the treatments are often the same whether it alleric or non-allergic rhinitis or sinusitis...
NorthShoreCEO 9 October 2005 03:13:59 [ permanent link ]
"Don Brady" <dbrady@pobox.com> wrote in message news:vckgk11blvqikbk9tjo7h6f99va1iimigj@4ax.com...> On Sat, 8 Oct 2005 10:11:26 -0500, "NorthShoreCEO" > <NorthShoreCEO@aol.com>> wrote:>
So I guess I interpreted Stevens message correctly, Don Brady.>
Probably I did not express myself too clearly. Too be honest , > I did not look> back through earlier threads as to the particular patient's > history> so I made the assumption that they had tried other things.>
In any case, I agree with him Steven that surgery should not > be regarded> solely as a treatment of "last resort," as some posters have > suggested. That> maxim seems to carry the implication that there are horrible > risks to it.> Properly done, there are not.>
There are quite a few cases where it is appropriate to do it > fairly promptly.> The need for surgery *may* be clear right away. If several > opiniosn back that> up, do it right away.>
There are quite a few variables.>
Foremost among them is that the patient is often totally > confused as to> - whether he can resaonably expect a resolution without surgery> - what results to expect from surgery> - the nature of sinusitis itself> - how to decide among conflicting advise from different doctors > and lay people> - the motivations and appropriate roles of doctors in different > specialties>
Once the patient understands all of these issues thoroughly > (this newsgroup can> help, as can consultations with several different doctors ) > then the course to> take in an individual case will normally become clearer.>
But relegating surgery solely to a role of "last resort" would > not be correct,> in my opinion, any more than would be having it done it too > casually.>
Is it underemployed overall? Probably so.
I didn't think we were talking about cases where there is a clear cut need for surgery - I thought we were talking about cases more like the one the original poster wrote about. And that's how I responded.
My ENT, who works closely with your ENT though they're not located in the same city, has tole me more than once that chronic sinus infections are generally infections that have gone under treated, so they keep recurring. A six week round of antibiotics is needed to completely eradicate them. Many ENTs don't treat for that long, however. And while surgery may be underemployed in some cases, it's probably recommended too quickly in others. In the case of the original poster, that's exactly what I believe is happening.
On Sat, 8 Oct 2005 19:13:59 -0500, "NorthShoreCEO" <NorthShoreCEO@aol.com> wrote:
I didn't think we were talking about cases where there is a clear >cut need for surgery - I thought we were talking about cases more >like the one the original poster wrote about. And that's how I >responded.
Fine. I do not recall the details of the original poster any more so I was commenting in general terms.
My ENT, who works closely with your ENT though they're not >located in the same city, has tole me more than once that chronic >sinus infections are generally infections that have gone under >treated, so they keep recurring. A six week round of antibiotics >is needed to completely eradicate them. Many ENTs don't treat >for that long, however.
I've heard that said a lot.
Multi-month courses of antiobiotics didn't do anything for me when I tried them years ago. Maybe they do in some people. The question might be, what are the percentages?
And while surgery may be underemployed >in some cases, it's probably recommended too quickly in others.
I agree.
In the case of the original poster, that's exactly what I believe >is happening.
What were the circumstances if you don't mind summarzing them briefly?
NorthShoreCEO 9 October 2005 03:27:53 [ permanent link ]
"Don Brady" <dbrady@pobox.com> wrote in message news:tdogk15plqel93bpn5g53a4qh8tu3nrnkt@4ax.com...>
In the case of the original poster, that's exactly what I >>believe>>is happening.>
What were the circumstances if you don't mind summarzing them > briefly?
Me be brief, Don? Surely you jest....lol.
Here's Alison's original post, cut and pasted:
"Recently my loved one's asthma and sinus congestion has been getting worse. He tried azithromycin (sp?) for about a month, but it didn't seem to help. Perhaps this is not surprising given that his nasal discharge is clear. A CAT scan showed congestion consistent with his symptoms. He went to see an ENT who was only interested in doing surgery and refused to perform a sinus culture or endoscopic examination. Obviously we need a new ENT.
Surprisingly the only thing recently that has helped his asthma (or nasal congestion) is Sudafed. Has anyone heard of sudafed being effective for asthma? What does the alleviation of the asthma symptoms by Sudafed mean?
Of course Sudafed is no longer available from shelves in our area, and I have to wait in line at the prescription counter to purchase it."
On Sat, 8 Oct 2005 19:27:53 -0500, "NorthShoreCEO" <NorthShoreCEO@aol.com> wrote:
Here's Alison's original post, cut and pasted:>
"Recently my loved one's asthma and sinus congestion has been >getting>worse. He tried azithromycin (sp?) for about a month, but it >didn't>seem to help. Perhaps this is not surprising given that his >nasal>discharge is clear. A CAT scan showed congestion consistent with >his>symptoms. He went to see an ENT who was only interested in doing>surgery and refused to perform a sinus culture or endoscopic>examination. Obviously we need a new ENT.>
Surprisingly the only thing recently that has helped his asthma >(or>nasal congestion) is Sudafed. Has anyone heard of sudafed being>effective for asthma? What does the alleviation of the asthma>symptoms by Sudafed mean?>
Of course Sudafed is no longer available from shelves in our >area, and>I have to wait in line at the prescription counter to purchase >it."
Ah thanks - I remember now.
Well from the first sentence, my guess would be that the individual had had asthma and sinusiits for a long time and had probably already tried various therapies without success.
Perhaps the CT scan clearly indicated the need for surgery. What is there to lead us to assume the contrary?
I certainly would get some additional opinions (preferably from a major University medical center) to confirm that though.....
NorthShoreCEO 9 October 2005 17:10:59 [ permanent link ]
"Don Brady" <dbrady@pobox.com> wrote in message news:1e6hk1tvrah3oe6debh3uvqajt06k3mnoo@4ax.com...> On Sat, 8 Oct 2005 19:27:53 -0500, "NorthShoreCEO" > <NorthShoreCEO@aol.com>> wrote:>
Ah thanks - I remember now.>
Well from the first sentence, my guess would be that the > individual had had> asthma and sinusiits for a long time and had probably already > tried various> therapies without success.>
Perhaps the CT scan clearly indicated the need for surgery. > What is there to> lead us to assume the contrary?>
I certainly would get some additional opinions (preferably from > a major> University medical center) to confirm that though.....
You're welcome, Don. In my initial reply to Alison, I said that if congestion was the only thing pointed out to them by the ENT as the reason to have surgery, they should find another ENT. I added that without specific mechanical problems, such as deviated septum or enlarged turbinates, congestion alone would not be enough to justify surgery. So I think we're on the same page here.
It was also suggested by others that her loved one have allergy testing done, with desensitization shots, if they find allergies are present. No allergy tests have been done yet. No allergy meds have been tried, but interesting that Sudafed was the only thing that helped.
You see where we were all going with this, and why I said in the original posters case, not enough had been tried yet to resolve the congestion, and not enough evidence given to justify surgery at this time.
I'm with you on the second opinion thing, and as both of our ENTs are in major University medical centers, and are forward thinking doctors, it's a great place to start.
On Sat, 08 Oct 2005 14:31:59 GMT, "Steven L." <sdlitvin@earthlinkNOSPAM.net>> wrote:> ere.>
In my case, I finally found an ENT--just one--who still believes that a >>very detailed patient history and a very detailed list of the patient's >>exact symptoms are still the best diagnostic tool, not CT scans. He >>disregarded the negative CT scan and agreed to try surgery. In fact, >>when I woke up in the Recovery Room after the surgery, he told me that >>he had my CT scan films in the operating room and while his surgical >>assistant was telling him the CT scan showed no blockages, he was >>looking right at the blockages with his endoscope.>>
In fact, right now my ENT is in a disagreement with my allergist! My >>allergist did allergy tests on me and they were all negative. But my >>ENT says that based on his visual inspection of my turbinates >>(hypersensitive, hypersecretory, etc.), he is convinced I have >>allergies. I told him that my allergy tests were negative. He >>retorted, "I don't care what the allergy tests showed! You've got >>allergies, Steven!!!">
I'll bet he's right.>
It seems that some of ust react to the common allergens/ irritants in the same> way as if we scored much more positively on the tests.
My ENT pointed out to me that there are some 200 strains of mold commonly in the Massachusetts area where I live, yet the allergy tests only tested me for about six strains. I do know that my symptoms are geographic-specific. Whenever I've traveled to Arizona, New Mexico, Nevada, even Dallas Texas, I feel great. But as soon as I've flown back to Boston, I start coughing immediately--while I'm still waiting for my luggage at the carrousel at Boston Logan Airport!
Usually ti does not make that much practical difference because the treatments> are often the same whether it alleric or non-allergic rhinitis or sinusitis...
Do you think I ought to try a course of minimally nonsedating antihistamines despite the negative allergy tests?
-- Steven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net
I'm with you on the second opinion thing, and as both of our ENTs > are in major University medical centers, and are forward thinking > doctors, it's a great place to start. >
"Don Brady" <dbrady@pobox.com> wrote in message news:tdogk15plqel93bpn5g53a4qh8tu3nrnkt@4ax.com...>>
My ENT, who works closely with your ENT though they're not>>located in the same city, has tole me more than once that chronic>>sinus infections are generally infections that have gone under>>treated, so they keep recurring. A six week round of antibiotics>>is needed to completely eradicate them. Many ENTs don't treat>>for that long, however.>
I've heard that said a lot.>
Multi-month courses of antiobiotics didn't do anything for me when I tried > them> years ago. Maybe they do in some people. The question might be, what > are> the percentages?
I think the other thing is that another aspect of "undertreatment" is not hitting the non-antibiotic meds enough (like nasal steroids, antihistamines, decongestants, saline washes). If the sinuses are open they will drain and there will be no infection. For there to be an infection there must first be blockage; often from anatomy, allergy, or viral infection; and fluid accumulation. Then that fluid can get infected.
What I see a lot of is people who go on the appropriate meds but then stop them once they feel better and then wonder why it keeps recurring and if they have a chronic infection that is not being fully eradicated. Often they come in with recurrent symptoms of simus congestion without clear evidence of infection. They usually say something to the effect that first it starts with the congestion but them always becomes infected.
On Sun, 09 Oct 2005 15:09:08 GMT, "Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote:
My ENT pointed out to me that there are some 200 strains of mold >commonly in the Massachusetts area where I live, yet the allergy tests >only tested me for about six strains. I do know that my symptoms are >geographic-specific. Whenever I've traveled to Arizona, New Mexico, >Nevada, even Dallas Texas, I feel great. But as soon as I've flown back >to Boston, I start coughing immediately--while I'm still waiting for my >luggage at the carrousel at Boston Logan Airport!
Well as long as other unidentified factors are not at work (stress, rest, diet, who knows) then that clue may indeed point you in the right directioin.
I have deluded myself so many times by reasoning based on apparent patterns in symptoms that I a have learned to be cautious..
Usually ti does not make that much practical difference because the treatments>> are often the same whether it alleric or non-allergic rhinitis or sinusitis...>
Do you think I ought to try a course of minimally nonsedating >antihistamines despite the negative allergy tests?
Yes if that is the treatment you would take had the tests been positive.
On Sun, 9 Oct 2005 14:48:14 -0400, "00doc" <00doc@comcast.net> wrote:
I think the other thing is that another aspect of "undertreatment" is not >hitting the non-antibiotic meds enough (like nasal steroids, antihistamines, >decongestants, saline washes). If the sinuses are open they will drain and >there will be no infection. For there to be an infection there must first be >blockage; often from anatomy, allergy, or viral infection; and fluid >accumulation. Then that fluid can get infected.
Yes, people and doctors tend to spend am awful lot of time, in cases of chronic sinusitis with fluid-filled largely blocked sinuses, trying multiple courses of different antibiotics to see if that will cure the infection.
It may be worth the effort but alone, it's probably not going to do the trick in many cases......
What I see a lot of is people who go on the appropriate meds but then stop >them once they feel better and then wonder why it keeps recurring and if >they have a chronic infection that is not being fully eradicated. Often they >come in with recurrent symptoms of simus congestion without clear evidence >of infection. They usually say something to the effect that first it starts >with the congestion but them always becomes infected.
But the> only follow-up studies I have seen, show that surgery has a cure rate of> about 80%,
I wonder how they came to that figure?
I've had a few sinus surgeries, and certainly am not cured. Several writers to this board have had surgery (including yourself, Steven), and it doesn't sound like any of them have been cured. So, I would not recommend surgery so strongly like you do. It might be the best action for some people, but I certainly would not make a blanket recommendation of it.
I don't think there is a "cure" for chronic sinusitis, just ways to ameliorate symptoms. I sure hope they do come out with a cure! (Perhaps with the new genetic medicine?)
"Steven L." <sdlitvin@earthlinkNOSPAM.net> wrote in message news:zLQ1f.222$y14.99@newsread3.news.pas.earthlink.net...
In fact, right now my ENT is in a disagreement with my allergist! My> allergist did allergy tests on me and they were all negative. But my> ENT says that based on his visual inspection of my turbinates> (hypersensitive, hypersecretory, etc.), he is convinced I have> allergies. I told him that my allergy tests were negative. He> retorted, "I don't care what the allergy tests showed! You've got> allergies, Steven!!!"
That's what allergists have told me too, that I am non-allergic, although common sense and symptoms would indicate that I am very allergic.
I think the allergy skin tests are pretty flawed. I think it's possible to have allergic reactions in the nose, throat, eyes, without having a skin reaction.
"Susan" <nevermind@nomail.com> wrote in message news:3qv9lgFgget0U1@individual.net...
A term like "non-drying" appearing on a box is actually rather
meaningless.> >
Actually, the meaning is that it contains the expectorant, guaifenesin.>
Susan
Not necessarily. There is no legal definition of the term "non-drying". Any manufacturer can put that term on a box, regardless of the ingredients.
In fact, if the cold or allergy product does not have a first-generation antihistamine in it, they might quite likely put "non-drying" as well as "non-drowsy" on the box. Says nothing about guaifenesin.
If a mixed product does have guaifenesin in it, it is likely to be a very small amount. And I have taken the max dose of guaifenesin (2400 mg per day) for years, and I doubt it has done any good. Medical studies of it have been inconclusive, there is no real proof that it works.
MS wrote:> "Susan" <nevermind@nomail.com> wrote in message> news:3qv9lgFgget0U1@individual.net...>
A term like "non-drying" appearing on a box is actually rather>
meaningless.>
Actually, the meaning is that it contains the expectorant, guaifenesin.>>
Susan>
Not necessarily. There is no legal definition of the term "non-drying". Any> manufacturer can put that term on a box, regardless of the ingredients.>
In fact, if the cold or allergy product does not have a first-generation> antihistamine in it, they might quite likely put "non-drying" as well as> "non-drowsy" on the box. Says nothing about guaifenesin.>
If a mixed product does have guaifenesin in it, it is likely to be a very> small amount. And I have taken the max dose of guaifenesin (2400 mg per day)> for years, and I doubt it has done any good. Medical studies of it have been> inconclusive, there is no real proof that it works.>
I was> on antibiotics four to six times a year, and at one point, I told my > doctor the only time I felt really GOOD, was on the last day of a three > week round of antibiotics. The link between bacteria and asthma is being > studied by National Jewish Medical and Research Center in CO, but they're > actually undertreating their patients, so my fear is that they'll > eventually make a statement saying the theory isn't valid, despite world > renowned researchers saying otherwise.
umm then why even try to treat it if their goal is to underscore it? I think they have good reasons to tell the truth and truthfully speaking what your talking about doesn't sound like asthma . It sounds like some kind of pathogen that might or might not respond to antibiotics or other methods of treatment but?.
NorthShoreCEO 7 November 2005 19:35:40 [ permanent link ]
"NorthShoreCEO" <NorthShoreCEO@aol.com> wrote in message news:j_ednc6ZlcqB-vLenZ2dnUVZ_t-dnZ2d@comcast.com...>
infections. Since I was treated to completely eradicate the > bacteria in the spring of 2003, I have been asthma and > asthma-med free, my allergies have gone from severe to mild, > and I haven't gotten a sinus infection or bronchitis.
Correction - I did have one sinus infection that began about four days after my son was diagnosed with one.
NorthShoreCEO 8 November 2005 14:54:16 [ permanent link ]
"Murray Grossan" <hydromed@adelphia.net> wrote in message news:BF9588FA.2959%hydromed@adelphia.net...
Ask your doctor about adding medicaitons to the pulsatile > irrigator.>
I hate to say this, but I no longer irrigate my sinuses. It didn't do much for me before I was treated, and I haven't had any sinus infections since being treated.
I have been a severe asthmatic since the age of eight (23 years now). I have had increasingly worsening asthma symptoms the past 10 years or so. I have used my albuterol at least 10-15 times a day, have taken Symbicort along with Singulair and I continued to worsen. I started taking Sudafed (pseudophedrine) the past 4 days and NOT ONCE have I used my inhaler. I have also had severe "sinus problems". I have never even been able to breath through my nose. My doctors have said that I provoke my attacks from anxiety and that is why I can not control my asthma. I did not believe that Sudafed would really work, but for the first time in YEARS I slept through the night without being woken up from an asthma attack. It is simply amazing and a Godsend for me. My sinuses are much better and I feel like I have my life back! I dont know, maybe my body doesnt produce antihistamines at all or not nearly enough for all of my allergies, because I am allergic to EVERYTHING.... hope this info is helpful. (Also, I am a registered nurse and have researched this before trying it out... I am skeptical on alot of meds and this one really does work for me!)
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