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Medical Forum / Diseases and Disorders / Asthma / November 2005BDS is alive and well and living on alt.support.asthma
Bush Derangement Syndrome Charles Krauthammer (archive) December 5, 2003 | Print | Send Diane Rehm: ``Why do you think he (Bush) is suppressing that (Sept. 11) report?'' Howard Dean: ``I don't know. There are many theories about it. The most interesting theory that I've heard so far -- which is nothing more than a theory, it can't be proved -- is that he was warned ahead of time by the Saudis. Now who knows what the real situation is?'' -- ``Diane Rehm Show,'' NPR, Dec. 1 It has been 25 years since I discovered a psychiatric syndrome (for the record: ``Secondary Mania,'' Archives of General Psychiatry, November 1978), and in the interim I haven't been looking for new ones. But it's time to don the white coat again. A plague is abroad in the land. Bush Derangement Syndrome: the acute onset of paranoia in otherwise normal people in reaction to the policies, the presidency -- nay -- the very existence of George W. Bush. Now, I cannot testify to Howard Dean's sanity before this campaign, but five terms as governor by a man with no visible tics and no history of involuntary confinement is pretty good evidence of a normal mental status. When he avers, however, that ``the most interesting'' theory as to why the president is ``suppressing'' the 9/11 report is that Bush knew about 9/11 in advance, it's time to check on thorazine supplies. When Rep. Cynthia McKinney first broached this idea before the 2002 primary election, it was considered so nutty it helped make her former Rep. McKinney. Today the Democratic presidential front-runner professes agnosticism as to whether the president of the United States was tipped off about 9/11 by the Saudis, and it goes unnoticed. The virus is spreading. It is, of course, epidemic in New York's Upper West Side and the tonier parts of Los Angeles, where the very sight of the president -- say, smiling while holding a tray of Thanksgiving turkey in a Baghdad mess hall -- caused dozens of cases of apoplexy in otherwise healthy adults. What is worrying epidemiologists about the Dean incident, however, is that heretofore no case had been reported in Vermont, or any other dairy state. Moreover, Dean is very smart. Until now, Bush Derangement Syndrome (BDS) had generally struck people with previously compromised intellectual immune systems. Hence its prevalence in Hollywood. Barbra Streisand, for example, wrote her famous September 2002 memo to Dick Gephardt warning that the president was dragging us toward war to satisfy, among the usual corporate malefactors who ``clearly have much to gain if we go to war against Iraq,'' the logging industry -- timber being a major industry in a country that is two-thirds desert. It is true that BDS has struck some pretty smart guys -- Bill Moyers ranting about a ``right-wing wrecking crew'' engaged in ``a deliberate, intentional destruction of the United States way of governing'' and New York Times columnist Paul Krugman, whose recent book attacks the president so virulently that Krugman's British publisher saw fit to adorn the cover with images of Dick Cheney in a Hitler-like mustache and Bush stitched-up like Frankenstein. Nonetheless, some observers took that to be satire; others wrote off Moyers and Krugman as simple aberrations, the victims of too many years of neurologically hazardous punditry. That's what has researchers so alarmed about Dean. He had none of the usual risk factors: Dean has never opined for a living, and has no detectable sense of humor. Even worse is the fact that he is now exhibiting symptoms of a related illness, Murdoch Derangement Syndrome (MDS), in which otherwise normal people believe that their minds are being controlled by a single, very clever Australian. Chris Matthews: ``Would you break up Fox?'' Howard Dean: ``On ideological grounds, absolutely yes, but ... I don't want to answer whether I would break up Fox or not. ... What I'm going to do is appoint people to the FCC that believe democracy depends on getting information from all portions of the political spectrum, not just one.'' Some clinicians consider this delusion -- that Americans can only get their news from one part of the political spectrum -- the gravest of all. They report that no matter how many times sufferers in padded cells are presented with flash cards with the symbols ABC, NBC, CBS, CNN, MSNBC, NPR, PBS, Time, Newsweek, New York Times, Washington Post, L.A. Times -- they remain unresponsive, some in a terrifying near-catatonic torpor. The sad news is that there is no cure. But there is hope. There are many fine researchers seeking that cure. Your donation to the BDS Foundation, no matter how small, can help. Mailing address: Republican National Committee, Washington DC, Attention: psychiatric department. Just make sure your amount does not exceed $2,000 ($4,000 for a married couple). ©2003 Washington Post Writers Group 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.  SignatureAlison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Predators fail often; prey fail only once. -- Tom Evslin > 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 [quoted text clipped - 11 lines] > 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. Susan > 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? So how does PND exacerabate asthma? Does mucus leak into the bronchial tubes or does its slower transit cause a generalized inflammatory response? Susan continues: > Has he considered allergic desensitization? I had it done > aggressively, complete in 12 weeks, with dramatic sinus and asthma > improvement. Lily writes: >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. NSCEO offers: >Find a new ENT, though, if all his current ENT pointed to was >congestion as a need for surgery. Did the CAT scan show any >mechanical problems, such as deviated septum, or enlarged turbinates >that would require surgery in order to relieve him of congestion? 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! I suppose that allergists and ENTs both treat chronic nasopharyngeal problems but you are offered surgery by one and weekly shots by the other. Would sinus irrigation likely be effective in cases of severe allergies? I suppose it might help remove irritants from the sinuses. NSCEO continues: >If he's on an antihistamine, like Zyrtec or Allegra, he may want to >ask his doctor if he can try Zyrtec-D or Allegra-D, which has the >decongestant added. Thanks, that's an option I wasn't aware of. I'll have a look at drugstore.com. SignatureAlison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Predators fail often; prey fail only once. -- Tom Evslin >>In my case, anything that stops the constant nasal dripping stops me >>from having asthma symptoms. [quoted text clipped - 6 lines] > into the bronchial tubes or does its slower transit cause a > generalized inflammatory response? Alison, I have no idea, but it happens to me every time. > Susan continues: > [quoted text clipped - 29 lines] > Would sinus irrigation likely be effective in cases of severe > allergies? I suppose it might help remove irritants from the sinuses. It may help, but in terms of my chronic sinusitis, it wasn't nearly effective enough til I got aggressively desensitized. Any allergist that tells you you must have weekly shots for a year or more isn't going to help, though that's become the standard convention, based upon about 26 deaths in 40 years of practice. I got dramatic improvement with 12 weeks to desensitize. > NSCEO continues: > [quoted text clipped - 4 lines] > Thanks, that's an option I wasn't aware of. I'll have a look at > drugstore.com. I don't advise such preparations unless they also contain an expectorant. I take regular Zyrtec and add non drying formula pseudoephedrine when needed (during colds). I don't think the combination anthistamine/antidecongestants have the non-drying feature, which is an important one. Susan > x-no-archive: yes >> NSCEO continues: >> [quoted text clipped - 3 lines] >>>the >>>decongestant added. From Susan: > I don't advise such preparations unless they also contain an > expectorant. I take regular Zyrtec and add non drying formula [quoted text clipped - 3 lines] > > Susan All the -D does is add pseudoephedrine, so taking Allegra-D and Zyrtec-D is the same as taking Allegra or Zyrtec plus pseudoephedrine. I've been taking the -D seasonally for years and have had no problem. > All the -D does is add pseudoephedrine, so taking Allegra-D and > Zyrtec-D is the same as taking Allegra or Zyrtec plus > pseudoephedrine. I've been taking the -D seasonally for years > and have had no problem. That's great, but most recommendations are to use non drying formulations. One could add the use of Humibid or Mucinex to the product you use. I don't use Zyrtec D because I don't usually need a decongestant. Susan > It may help, but in terms of my chronic sinusitis, it wasn't nearly > effective enough til I got aggressively desensitized. Any allergist > that tells you you must have weekly shots for a year or more isn't > going to help, though that's become the standard convention, based > upon about 26 deaths in 40 years of practice. I got dramatic > improvement with 12 weeks to desensitize. Thanks for posting your experience. What form does "aggressive desensitization" take? Is it just higher-dose allergy shots? I got allergy shots for about a dozen years and didn't find that they did much for me, but I recognize that treatment methods may have improved. NSCEO posted: >>>If he's on an antihistamine, like Zyrtec or Allegra, he may want to >>>ask his doctor if he can try Zyrtec-D or Allegra-D, which has the >>>decongestant added. Susan continues: > I don't advise such preparations unless they also contain an > expectorant. I take regular Zyrtec and add non drying formula > pseudoephedrine when needed (during colds). I don't think the > combination anthistamine/antidecongestants have the non-drying > feature, which is an important one. How do you tell non-drying decongestants from drying ones? SignatureAlison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Predators fail often; prey fail only once. -- Tom Evslin > Thanks for posting your experience. What form does "aggressive > desensitization" take? Is it just higher-dose allergy shots? I got > allergy shots for about a dozen years and didn't find that they did > much for me, but I recognize that treatment methods may have improved. Methods seem to have gotten better. The fact is that most folks conclude the shots don't work because they're being given such weak formulations. My last allergist re-sensitized me with teensy doses on a one to two year desensitization schedule. 12 weeks or less than 6 months of weekly shots til maintenance would be considered aggressive. 12 weeks worked great for me both times (I went back to my effective allergist after the one in my new town brought back all my symptoms). > How do you tell non-drying decongestants from drying ones? They say they're non drying on the box. The ingredients should include an expectorant. Susan > They say they're non drying on the box. Advertising on a box tells you nothing really. They put on it whatever they think will help sell it, often quite contrary to fact. A term like "non-drying" appearing on a box is actually rather meaningless. >>They say they're non drying on the box. > > Advertising on a box tells you nothing really. They put on it whatever they > think will help sell it, often quite contrary to fact. > > A term like "non-drying" appearing on a box is actually rather meaningless. Actually, the meaning is that it contains the expectorant, guaifenesin. Susan > > 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. >>>A term like "non-drying" appearing on a box is actually rather > [quoted text clipped - 15 lines] > 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. Yeah, okay, whatEVerrrr. Susan 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 [quoted text clipped - 3 lines] > 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. >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? >>In my case, anything that stops the constant nasal dripping stops me >>from having asthma symptoms. [quoted text clipped - 4 lines] > 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 [quoted text clipped - 5 lines] > 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. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > 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. Susan > My advice: Do the surgery just for the heck of it. > 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. >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." > On Fri, 7 Oct 2005 15:59:45 -0500, "NorthShoreCEO" > <NorthShoreCEO@aol.com> [quoted text clipped - 11 lines] > 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. >>On Fri, 7 Oct 2005 15:59:45 -0500, "NorthShoreCEO" >><NorthShoreCEO@aol.com> [quoted text clipped - 15 lines] > 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." SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >>My advice: Do the surgery just for the heck of it. > > > 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. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > 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. Susan >>>My advice: Do the surgery just for the heck of it. > >> [quoted text clipped - 17 lines] > Right now, in the medical state of the art, surgery should be > the treatment of choice. So I guess I interpreted Stevens message correctly, Don Brady. >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. > On Sat, 8 Oct 2005 10:11:26 -0500, "NorthShoreCEO" > <NorthShoreCEO@aol.com> [quoted text clipped - 46 lines] > > 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. >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? >>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." >Here's Alison's original post, cut and pasted: > [quoted text clipped - 20 lines] >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..... > On Sat, 8 Oct 2005 19:27:53 -0500, "NorthShoreCEO" > <NorthShoreCEO@aol.com> > wrote: > Ah thanks - I remember now. > [quoted text clipped - 11 lines] > 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. > 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. In what state/locations, please? Susan > x-no-archive: yes > [quoted text clipped - 5 lines] > > Susan Susan, I'm in Illinois and Don is in Pennsylvania. Here are bio's of his doctor, Dr. Kennedy, and my doctor, Dr. Stankiewicz. In case anyone is wondering, I once had MAJOR sinus problems - several infections a year - and used to participate in the Sinusitis forum (I THINK under my current handle...), and that's how I know Don sees Dr. Kennedy. My allergies were greatly improved and so were my sinus problems when I had a once a week round of antibiotics for twelve weeks, which also resolved my 33 year bout with asthma. David W. Kennedy, M.D. Professor and Chair Department of Otorhinolaryngology: Head and Neck Surgery University of Pennsylvania Medical Center David W. Kennedy, M.D., F.R.C.S.I., F.A.C.S., is currently Professor and Chair of the Department of Otorhinolaryngology: Head and Neck Surgery at the University of Pennsylvania and Chair of the School's Academic Review Committee. Prior to this, Dr. Kennedy spent 17 years at Johns Hopkins, where he was Associate Professor and Director of the Otolaryngology Residency Training Program. Originally from the British Isles, he spent his school years in England and Ireland. He graduated from the Royal College of Surgeons with many awards and transmigrated directly to Hopkins following his internship. While in Baltimore, he served as a member of the Board of Directors of the Hearing and Speech Agency of Metropolitan Baltimore, and as Otolaryngology Consultant to the Maryland State Department of Health. In 1985, Dr. Kennedy introduced the concept of managing sinus disease under endoscopic control to the United States, a technique that he termed 'Functional Endoscopic Sinus Surgery'. Dr. Kennedy is interested in the pathogenesis of sinusitis, sinusitis outcomes and mucociliary clearance. He has participated in approximately 200 courses nationally and internationally, teaching the current concepts of rhinosinusitis management to otolaryngologists and other heath care professionals. The Department of Otorhinolaryngology: Head and Neck Surgery at Penn is considered a premier department internationally for its work in the field of sinus disease, olfaction and nasal disorders, and Dr. Kennedy's clinical interests are in endoscopic sinus surgery and minimally invasive surgery for tumors and skull base defects. Dr. Kennedy is Board Certified in Otolaryngology and a Fellow of the Royal College of Surgeons in Ireland and of the American College of Surgeons. At Penn, he has served as Chief of the Medical Staff, as a member of the Board of Trustees of the Medical Center and on the Medical Center Steering Committee. He is Past-President of the American Rhinologic Society, Past-President of the International Symposium of Infection and Allergy of the Nose and currently serves as Editor-in-Chief of the American Journal of Rhinology. He also serves on the editorial boards of nine other journals and is a member of the Board of Directors of the American Academy of Otolaryngology and is Vice President of the International Rhinologic Society. He has published well over 100 journal articles and chapters in his field, has received a number of international awards. In 1999, he was elected to the Institute of Medicine of the National Academy of Sciences and in 2002 is honored with a Presidential Citation from the American Academy of Otolaryngology-Head and Neck Surgery. return to top -------------------------------------------------------------------------------- James Stankiewicz, M.D. Professor and Vice-Chairman Department of Otorhinolaryngology: Head and Neck Surgery Loyola University Health Systems Dr. Stankiewicz is vice-chairperson of Otolaryngology-Head and Neck Surgery. He also is a consultant to Edward J. Hines, Jr. Veterans Affairs Hospital and Chicago Children's Memorial Hospital. Dr. Stankiewicz received his medical degree from the University of Chicago in 1974 and completed his residency at the University of Chicago. A fellow of the American Academy of Otolaryngology since 1978 and the American College of Surgeons since 1980, Dr. Stankiewicz has served as a member of numerous boards, societies, and task forces including the National Committee on Paranasal Sinus Diseases and American Rhinological Society. He is co-director of Loyola's Nasal Sinus Center. He has taught and directed several courses on laser surgery and endoscopic sinus surgery. He is a past president of the Chicago Laryngologic and Otologic Society. Dr. Stankiewicz gives numerous local and national presentations on many topics including endoscopic sinus surgery and its complications. He has produced over 100 scientific articles, chapters, teaching topics, and abstracts. Several of Dr. Stankiewicz's publications deal with reconstruction in head and neck surgery, infectious disease in the head and neck, complications of intranasal sinus surgery, and new surgical approaches to paranasal sinuses. Dr. Stankiewicz is the Residency Program Director for Otolaryngology at Loyola University Chicago. return to top > Susan, I'm in Illinois and Don is in Pennsylvania. Here are > bio's of his doctor, Dr. Kennedy, and my doctor, Dr. Stankiewicz. > In case anyone is wondering, I once had MAJOR sinus problems - > several infections a year - and used to participate in the > Sinusitis forum (I THINK under my current handle...), and that's > how I know Don sees Dr. Kennedy. Thanks for the info. My allergies were greatly > improved and so were my sinus problems when I had a once a week > round of antibiotics for twelve weeks, which also resolved my 33 > year bout with asthma. My asthma is most definitely triggered by sinusitis, almost exclusively. I've been on very long courses of very broad spectrum antibiotics many times. Some of these (Ceftin, Zithromax) no longer work very well for me. Earlier this year, I found that even after 6 weeks of my best drug, during which all sx resolved, the clear heavy drainage began the day I stopped the drug. Irrigating, going after my allergies with aggressive desensitization has helped a lot (especially with hydrogen peroxide irrigation in the mix). Each time I get a cold, the jig is up, though. Please describe your weekly rounds of abx? I should mention that I suffer from chronic, relapsing tick borne diseases which went undiagnosed for many years, and this often causes immune compromise in the host. I have taken doxycycline for very extended periods for several years in order to keep functioning, neurologically. Susan > x-no-archive: yes > [quoted text clipped - 33 lines] > > Susan Susan, there are researchers all over the world who have stated they feel asthma is caused by different things, one of which is exposure to bacteria - either mycoplasma or chlamydia pneumoniae, to name two of the more common ones. These are airborne and can come in the form of a cold, flu, bronchitis or pneumonia. In the case of chlamydia pneumoniae, it's Dr. Hahns theory (he discovered this link and began studying it twenty years ago), that much like the sexually transmitted chlamydia, the airborne variety can enter the body (in this case through the mouth or nasal passages), and then go deeper into the body, such as sinuses and eventually the lungs. There are certain factors to look for - such as several illnesses a year, every cold turning into a secondary sinus or lung infection, never feeling quite good, even when not currently ill, being tired all the time, not getting the same kind of relief others do even though you've found the best mix of medications to manage your symptoms. 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. In some instances, the sinus problem or asthma won't be eradicated, but will be greatly improved, once the bacteria causing the flareups has been eradicated. If you're interested in this topic, you'll find more information, including many links to medical studies, at www.asthmastory.com. I don't own the site, but I am a moderator there, and I hang out on the asthma forum to direct people there if it sounds like they have a problematic history. My ENT is now treating some of his patients with the antibiotic regimen that Dr. Hahn used on me. I believe he's tweaked it somewhat, but he has a .pdf file on the homepage of the site I noted above, and you can check it out. I was prescribed three days of Azithromycin (aka Zithromax or Zpak) at 500 mgs, followed by weekly doses of 750 mgs for a total of twelve weeks. I've been asthma and asthma med free for more than two years, my allergies have gone from severe to mild, and my sinus infections have stopped, with the exception of one - possibly two. One I got when my son had one, and the other I got during chemo earlier this year for Non-Hodgkins lymphoma. I'm not even sure it was a sinus infection, I just felt achy and had a temp of 101 and my oncologist prescribed an antibiotic for me because they don't mess around with this stuff when your immune system isn't good to begin with. So, really, I think I only had one sinus infection in the two plus years since I've been treated. I even caught a cold and had just a normal cold - something that hasn't happened since I was a kid. (I'm 50) These bacteria are actually thought to be linked to a number of autoimmune diseases, so you don't really want to play host to them. See www.immed.org for more information on that front. > Susan, there are researchers all over the world who have stated > they feel asthma is caused by different things, one of which is [quoted text clipped - 12 lines] > getting the same kind of relief others do even though you've > found the best mix of medications to manage your symptoms. My illness was initiall diagnosed as CFS, so I'm very well aware of al this work. In the early years of my illness, I had a major URI every 4-6 weeks. Then I stopped getting them, even when those around me are ill, for the past several years. > 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 [quoted text clipped - 12 lines] > on the asthma forum to direct people there if it sounds like they > have a problematic history. As it happens, my PCP is a very fine infectious diseases doc. I've been tested for all the related potential pathogens, and, in fact, have spent months and years on certain indicated antibiotic and even anti parasitic protocols. I'm at my best on high dosages of oral doxy; my primary problems are CNS related, and neurocogntive, not respiratory. Asthma is a non-issue in my life since irrigating regularly. > My ENT is now treating some of his patients with the antibiotic > regimen that Dr. Hahn used on me. I believe he's tweaked it > somewhat, but he has a .pdf file on the homepage of the site I > noted above, and you can check it out. I was prescribed three > days of Azithromycin (aka Zithromax or Zpak) at 500 mgs, followed > by weekly doses of 750 mgs for a total of twelve weeks. I've been on it far longer than that, numerous times, including in combination with atovaquone. I also took it as long as I could stand it this past spring; for the first time, my gut reacted badly, despite probiotics. I've > been asthma and asthma med free for more than two years, my > allergies have gone from severe to mild, and my sinus infections [quoted text clipped - 12 lines] > autoimmune diseases, so you don't really want to play host to > them. See www.immed.org for more information on that front. I don't buy into the autoimmune theory of everything. I think it's more often than not probably a case of undetected pathogens. May be why such a large % of arthritis patients, even those dx'ed with RA respond so well to antibiotics. Thanks for all the info. Susan 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 [quoted text clipped - 3 lines] > 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?. On 11/5/05 2:25 AM, in article 9M%af.225$Y97.180@trndny05, "mcs" <mcs@yahoo.com> wrote: 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 mistake here is that you don't treat a patient with just antibiotics. You have to treat the whole person including BP, nutrients, drainage, respiratory exercises, etc etc etc. One of the top respiratory guys here cures his "always sick" patients with tea and chicken soup. Another cures his sinus "terminal" patients with "OOOOOMMMMMMMM" You know what I use of course. My point is, its not only the antibiotic that needs attention for the cure. The concept of giving antibiotics and not removing pus / bacteria is not correct. This week I had two patients whose ONLY problem was the benzalkonium in the saline they were using. No wonder the antibiotics didn't work! My point, it not only antibiotics that needs to be addressed . > On 11/5/05 2:25 AM, in article 9M%af.225$Y97.180@trndny05, > "mcs" [quoted text clipped - 26 lines] > saline they were using. No wonder the antibiotics didn't work! > My point, it not only antibiotics that needs to be addressed . In my case, none of the above helped, including sinus surgery and sinus irrigation using Grossan tips. I think the rest of my post went into this detailed information, but if not, I'll go into it here. My 33 year bout with asthma, and 20 year bout with getting one illness after the next, with every cold turning into a secondary sinus infection and/or bronchitis, and/or pneumonia, was because my asthma and sinus problems were caused by unresolved bacteria. Researchers feel there are different causes for asthma, one of which is bacteria. Unless a person is treated with the correct antibiotic, at the correct dose, for the correct period of time, the bacteria will remain in the tissue of ones sinuses and lungs causing a chronic condition, with several yearly acute 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. I even had a cold in 2004 and it resulted in no secondary infection, for the first time in 25 - 30 years. In the past two plus years, my sons have gotten sick and I haven't caught their illness - for the first time since they've been born. My ENT, who is well known and highly regarded in his field, is now treating some of his patients with the protocol to eradicate mycoplasma or chlamydia pneumoniae, which can settle in the tissue of the sinuses and/or lungs. There are many things that need to be addressed when assessing a patient's ongoing problems, but if bacteria is the cause, then sinus surgery and sinus irrigation will help, but not eliminate the ongoing problem of getting one infection after the next. > 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. On 11/7/05 6:39 AM, in article j_ednc6ZlcqB-vLenZ2dnUVZ_t-dnZ2d@comcast.com, >> On 11/5/05 2:25 AM, in article 9M%af.225$Y97.180@trndny05, >> "mcs" [quoted text clipped - 58 lines] > irrigation will help, but not eliminate the ongoing problem of > getting one infection after the next. Ask your doctor about adding medicaitons to the pulsatile irrigator. > 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. >> 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. Correction - I haven't had any sinus problems since being treated. One sinus infection, and I did irrigate at that time. >>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 [quoted text clipped - 10 lines] > 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. Signature00doc >>>My ENT, who works closely with your ENT though they're not >>>located in the same city, has tole me more than once that [quoted text clipped - 28 lines] > infection. They usually say something to the effect that first > it starts with the congestion but them always becomes infected. One more scenario nobody has mentioned yet, is the group of people who take all their allergy meds, but continue to have problems with breathing and sinus infections because they have an allergy to cats or dogs, and refuse to give theirs up. Meds and superb housekeeping do allow some people to keep their pets, but in many cases, the person with allergies continues to suffer in spite of those things. When the person suffering is a child, and the parents don't want to let go of the family pet, that really irritates me. > One more scenario nobody has mentioned yet, is the group of > people who take all their allergy meds, but continue to have > problems with breathing and sinus infections because they have an > allergy to cats or dogs, and refuse to give theirs up. :-) Well, to be fair, I used to have a more serious cat allergy, now I test negative to very low for it. I no longer get itchy eyes if I touch a cat and then my face. I wouldn't get rid of my child due to bad reactions, either, even during the teen years, where it's occurred to me. :-) Meds and > superb housekeeping do allow some people to keep their pets, but > in many cases, the person with allergies continues to suffer in > spite of those things. When the person suffering is a child, and > the parents don't want to let go of the family pet, that really > irritates me. Me, too. We know of a child who's a very badly controlled asthmatic. Her room is carpeted, with curtains, the birds are put in there to protect them from all the cats and dogs her mom keeps adopting and telling her to lie to the pulmonologist about. I've considered calling CPS at times. Susan >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. G'day everyone, firstly in Susan's post she mentions a circumstance where she was aware of a child in a circumstance where she suspected the situation was conducive for that child's asthmatic problem. FYI I would chastise the responsible person to the point of absolute intimidation, I would also not hesitate to call in the applicable authorities and explain the problem to them if there was no notice taken. Although this would probably have no positive outcome for the child directly it would make a point and at least possibly make the parent think. You would also be able to be in a situation where if the child were to have an asthmatic attack and die you would be able to sleep knowing you had done your best. People keep ridiculing my suggestions of the cold shower method of assisting asthmatic problems. What is missed is the natural contaminated mucus removal which can be achieved on a daily or regular basis using the involuntary breathing created by it. This daily clearance is usually incredibly beneficial for anyone with these kinds of problems and is achieved without any drug use. The mucus clearance and it's benefits extend into reduced infection kinds of areas by frequent growth medium clearance thus reducing the whole series of connected effects and in turn assists reducing sensitivity and properly addressing the problem naturally. Cheers, Merlin. > >I think the other thing is that another aspect of "undertreatment" is not > >hitting the non-antibiotic meds enough (like nasal steroids, antihistamines, [quoted text clipped - 16 lines] > >of infection. They usually say something to the effect that first it starts > >with the congestion but them always becomes infected. > G'day everyone, firstly in Susan's post she mentions a circumstance > where she was aware of a child in a circumstance where she suspected [quoted text clipped - 3 lines] > authorities and explain the problem to them if there was no notice > taken. Yes, well, that's often the course taken by folks with no sense of the larger picture. Those who resort first to chastisement and intimidation are doing so to please themselves, not because it's the most effective intervention, IME. Susan G'day Susan, sorry but I have no time for a situation where persons, most especially children have there well being diminished by trivial events, especially in the case of unneccessary alergen exposure. I don't believe these kind of actions should be condoned at all. The pets are getting priority over the childs prospective health. In my book that is abuse. Cheers, qldit. > It (antibiotics) may be worth the effort but alone, it's probably not going to do the trick > in many cases...... True, but I doubt anything will "do the trick", in any case. (If "do the trick" means a cure. Some things will help with symptoms, of course.) > I didn't think we were talking about cases where there is a > clear cut need for surgery - I thought we were talking about [quoted text clipped - 10 lines] > quickly in others. In the case of the original poster, that's > exactly what I believe is happening. I should have added that I stand by my remark that I don't think surgery should ever be recommended "just for the heck of it". If a person has a CAT scan showing mechanical problems that require surgery, risks of having this type of surgery must be discussed with the patient who will make the final call. It IS a very risky surgery and things can go wrong, so I still think that in cases where things like a deviated septum, etc. 'may' be the cause of breathing problems and sinus infections - other options should be explored first, unlike cases where things are more definitive. Too many people have under treated infections, anaerobic infections that are not identified and treated accordingly, or issues with allergies that are not being properly attended to. Then there's the case of bacteria such as mycoplasma and chlamydia pneumoniae causing asthma and sinus infections. No surgery would help given that scenario. I had two myself, and continued to have several sinus infections a year. It wasn't until I had a longer round of the right antibiotic at the right dose that the sinus infections stopped, I stopped getting sick all the time, and my asthma was completely resolved. There are certain things many ENTs aren't looking at closely enough that surgery will not have any bearing on. Luckily, my ENT is not one of them, and he's told me he feels that too many are too quick to suggest surgery. > 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 [quoted text clipped - 3 lines] > Right now, in the medical state of the art, surgery should be the > treatment of choice. I admit to not having seen a lot of studies that give the follow-up info you describe. However, I can tell you that in my experience while it is common for patients to have their symptoms improve, often from intractable to bearable (and treatable with meds), it is rare for a person to go from severe symptoms to no symptoms (or even just mild symptoms) with sinus surgery. I would be curious to know how these studies defined cure. I agree with you that the person should not be long suffering before seeing the surgeon. A fairly aggressive and "prolonged" course of medical therapy can be accomplished fairly quickly (with in 2 or 3 months). I also agree that tests are helpful tools but should not trump treating the patient. Signature00doc >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?) >>> In my case, anything that stops the constant nasal dripping stops me >>> from having asthma symptoms. [quoted text clipped - 35 lines] > 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. I'm not saying I blame the ENTs, or that surgery is the answer for everyone's problems. I just believe there should be another type of test, or even an "exploratory-type" surgery that could be done in the event a person continues to be sick, but the CT scan is negative. As for asthma, I would wake up gagging from PND and had a chronic asthma cough for months prior to the surgery. A pulmonologist dxd me with asthma about a year ago. The actual day of my surgery it was already better. Now I have very little to no PND , and no cough at all. I'm so grateful! I hope telling my situation will help someone else. Lily >>>> In my case, anything that stops the constant nasal dripping stops me >>>> from having asthma symptoms. [quoted text clipped - 44 lines] > 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!!!" SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > 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 [quoted text clipped - 3 lines] > 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. Susan > 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. Signature00doc >> 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!!!" [quoted text clipped - 16 lines] > 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. Like gasoline on the Hindenburg.... ;-) 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 [quoted text clipped - 12 lines] >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... > ere. > [quoted text clipped - 19 lines] > 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? SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > 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 [quoted text clipped - 3 lines] > to Boston, I start coughing immediately--while I'm still waiting for my > luggage at the carrousel at Boston Logan Airport! Let me say this about that <Nixon voice off>. I was told the same thing, discussed it with my own allergist, who felt that desensitization to the molds I'm most likely to encounter regularly would work. It has, even though I live in a house at the bottom of a hill with mold at the sill plate on two sides of the basement and a black slick of mold in the underground garage fit for a sci fi horror movie. I no longer become asthmatic walking into the garage, though I choose to hold my breath anyway. >> Usually ti does not make that much practical difference because the >> treatments [quoted text clipped - 3 lines] > Do you think I ought to try a course of minimally nonsedating > antihistamines despite the negative allergy tests? Just for the heck of it? ;-) I would. Zyrtec gets my vote, but every person seems to have one that works best for him/her. Claritin works well for only 30% of the population, but that 30% is mighty pleased with it. Susan >> Do you think I ought to try a course of minimally nonsedating >> antihistamines despite the negative allergy tests?+ > >Just for the heck of it? ;-) A lighter touch - I like it..... > I would. Zyrtec gets my vote, but every >person seems to have one that works best for him/her. Claritin works >well for only 30% of the population, but that 30% is mighty pleased with it. >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 [quoted text clipped - 3 lines] >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. > 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 [quoted text clipped - 3 lines] > 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. > 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 [quoted text clipped - 11 lines] > 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 On 10/1/05 1:36 PM, in article spC%e.62$9K2.39@bignews1.bellsouth.net, >> 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 [quoted text clipped - 30 lines] > 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. > On 10/1/05 1:36 PM, in article spC%e.62$9K2.39@bignews1.bellsouth.net, > [quoted text clipped - 50 lines] > 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. Susan 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 > 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? [quoted text clipped - 4 lines] > 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. Signature00doc > Recently my loved one's asthma and sinus congestion has been > getting [quoted text clipped - 20 lines] > I have to wait in line at the prescription counter to purchase > it. Yes, and you hijacked my thread becaaaaaaaaaaaaaaaaaaaaaaauuuuuuuuuuusssssssseee...........?????????????? > Recently my loved one's asthma and sinus congestion has been > getting [quoted text clipped - 20 lines] > I have to wait in line at the prescription counter to purchase > it. Peoples allergies have been really BAD this year - at least in Illinois. Not sure about where you are. Sudafed, a decongestant, is probably clearing him of mucous that may be causing him to breathe through his mouth, or may be creating post nasal drip, which can exacerbate asthma. If he's on an antihistamine, like Zyrtec or Allegra, he may want to ask his doctor if he can try Zyrtec-D or Allegra-D, which has the decongestant added. My ENT has told me more than once, that most sinus infections that appear to be chronic, are merely under-treated, and they require a six week round of antibiotics. Find a new ENT, though, if all his current ENT pointed to was congestion as a need for surgery. Did the CAT scan show any mechanical problems, such as deviated septum, or enlarged turbinates that would require surgery in order to relieve him of congestion? If not, he sounds surgery-happy, and some ENTs are. Can you order Sudafed online, from someplace like www.drugstore.com? That might be your easiest bet, and it may even be cheaper in the long run. > Sudafed, a decongestant, is probably clearing him of mucous that may be > causing him to breathe through his mouth, or may be creating post nasal > drip, which can exacerbate asthma. If he's on an antihistamine, like > Zyrtec or Allegra, he may want to ask his doctor if he can try Zyrtec-D or > Allegra-D, which has the decongestant added. That would work if he is old enough. The problem is that the kids have to get to be a good isze before they can take the 240mg of Sudafed that is in the tabs (I think it is about 12 years old but always have to look it up). > My ENT has told me more than once, that most sinus infections that appear > to be chronic, are merely under-treated, and they require a six week round > of antibiotics. I think this is definately true. If it is sinusitis then a longer course of a broad spectrum antibiotics can be helpful. The other way it is undertreated is that people don't hit the medical ways of opening things up hard enough. They either treat allergic congestion as "sinusitis" and then wonder why it keeps relapsing or, even of there is a bacterial component, don't work hard enough on getting the sinuses draining. Fluid will become infected whenever it sits around where it doesn't belong (and sinuses that are open will not be infected no matter what bacterial may be present). If you treat the infection but not the drainage you have not really gotten to the root of the problem. > Did the CAT scan show any mechanical problems, such as deviated septum, or > enlarged turbinates that would require surgery in order to relieve him of > congestion? Those are the relevant questions. Some things just can't be fixed with drugs. -- 00doc |
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