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Medical Forum / Diseases and Disorders / Sinusitis / December 2005Afrin + Singuir + Claritin in a spray = only thing that works for me
Here is my history: - Allergy shots for several years - Septoplasty & turbinectomy 3 years ago - Using oral claritin and singulair before bed - tried all the various nasal sprays to no avail - tried irrigation both isotonic and hypertonic and it didn't help much - allergist had me try Afrin a few times just to see what would happen. It did almost nothing. After reading this board for awhile I tried concocting my own spray. First I tried saline + Singulair + Benedryl and this spray seemed to work a bit, but was still disappointing Next, I tried 1/2 oz Afrin, mixed with 30mg crushed Singulair and 3 crushed Claritin tablets. This actually works pretty well. Next, I'm going to try saline (Breathe Ease) 1/2 ounce + 3 crushed Singulair tabs and 3 crushed Claritin tabs to see if it will have the same effect WITHOUT the Afrin. My question is: 1) am I using too much of the Claritin or Singulair and 2) could I mix these with a cortisone spray instead? Also, I believe the spray I tried mixing in Benadryl, I used too little Benadryl. I wonder if I should try Benadryl instead of Claritin at a higher dose? I only use the Afrin combination once a day, before bed. This helps my sleep a LOT. I clearly have a real problem breathing through the nose and also some twitchy lower airways (and possible nocturnal asthma) and I'm hoping to come up with a spray combination that I can use several times per day without worrying about resistance or making the problem worse. I'm thinking: 1) Use a corisone + Singulair + Claritin spray 2) Start hypertonic irrigation again with Breathe EaseXL twice per day 3) Hopefully, combining #1 and #2 will keep my nose clear. 4) Continue allergy shots and hope that eventually, they cure my nose ailments. All comments welcome. Doug I should note as well that between my nose and lower airways, I get sleep apnea as a result. When I use Advair and the Afrin / Singulair / Claritin nasal spray before bed, I sleep better than I have ever slept. If I only use Advair and no nasal spray I still have restless sleep and visa versa. >Here is my history: > [quoted text clipped - 36 lines] > >All comments welcome. Afrin is often (always?) addictive if used for over a few days so it is not recommended to use it continually. Some of the others are antihistamines. They can be ok but can tend to dry out your sinuses too much which can limit the drainage needed to keep them clear. Yes this stops the irritating drainage onto the turbinates but may have its own price long term. I would get a CT scan to make sure that sinusitis is not the underlying problem (if not done already) and that you would not make it worse by preventing drainage with too much drying. The steroid spray has few problems. I'd bet you are allergic or sensitive to dust or mold in your work or home and that if you could totally clear that up (very hard to do), that might eliminate the need for all of these medicines. Meanwhile and get whatever medication combo you are taking signed off on by your allergist. As long as you do the latter, then you are a lot safer than totally winging it on your own... > Afrin is often (always?) addictive if used for over a few days so it is not > recommended to use it continually. Not if used only once per day, I've found. Susan On 12/1/05 7:30 PM, in article 7uevo1tgdobbcic79n1eo220jqvevb9mfh@4ax.com, >> Here is my history: >> [quoted text clipped - 58 lines] > your allergist. As long as you do the latter, then you are a lot safer than > totally winging it on your own... Your are out there all alone, no one can guide you because no one has studied this. Merck spoke of a singular nasal spray some years ago but ... I don't know what the solubility of these products are. In theory you can open the benadryl capsule and use that. The coating of the claritin is a problem. Let us know how your experiment works out. If it does, get a patent. Don and Susan, thank you for your comments about Afrin. I have found unfortunately that my nose becomes "addicted" to Afrin even using it only once per day, before bed. :( However, it is my understanding that it is a preservative in Afrin that causes this and not the actual active ingredient??? Why on EARTH would they not change their formula if that is the case, or why wouldn't a competitor release a generic with a preservative that does not have this problem?? As far as cleaning up my area goes, before having to move for work reasons I had a brand new house built with all hardwood flooring, and the best Consumer Reports whole-house Aprilaire air purifier. I also had top of the line HEPA room units in my bedroom and my office. All pillows / bedding allergen proofed. There literally was NOWHERE for any allergen to be in those rooms. They may have well have been Intel cleanrooms. This didn't help, either. My allergist referred me to an ENT and I had a CT which showed no infection but I did have oversized turbinates, and one turbinate had a cyst / nodule or something on it. I had at turbinectomy and that didn't help, either. Dr. Grossan, I'm actually not using Claritin, I am using Costco generic and this does not appear to have any sort of coating on it. Since Afrin was starting to give me rebound problems I quit using it and started using Singulair + Claritin in saline. It seemed to help a bit, but not NEARLY as much. Not enough help to even bother so I quit using spray entirely. My nose has completely recovered from the Afrin as I didn't use it very long. However, I HAVE continued to use my Hydropulse 2X per day, hypertonic. This time around, it seems to be having a positive effect and it's only been a few days now. I am using Breathe Ease XL this time, whereas last time I was just using regular salt and baking soda. Since irrigating however, (and this happened last time as well) I have felt TERRIBLE - I would liken it to the "withdrawal" one may feel when going on a diet that restricts a lot of foods they previously ate. Really foggy head, very tired, can definitely feel it in my sinuses and eyes. I am guessing that this is my body reacting to the abscencse (or greatly reduced level) of offending allergens in my nasal passages and hence the "withdrawal" feeling? I am hoping that what will happen if I continue to irrigate is, this will go away and I will feel better than before. How common are these symptoms and any idea how long this process can take? >Don and Susan, thank you for your comments about Afrin. I have found >unfortunately that my nose becomes "addicted" to Afrin even using it [quoted text clipped - 3 lines] >if that is the case, or why wouldn't a competitor release a generic >with a preservative that does not have this problem?? Actually I think it is the active ingredient but I am sure that others will claify. >As far as cleaning up my area goes, before having to move for work >reasons I had a brand new house built with all hardwood flooring, and [quoted text clipped - 3 lines] >any allergen to be in those rooms. They may have well have been Intel >cleanrooms. This didn't help, either Really! Hmm I wonder if there could possibly be a metabolic or immune status issue then. Do you know what your TSH (thyroid) numeric value is? It is a blood test. If possible, the numeric value is desirable rather than a conclusion as refernce ranges vary and are being revised. Also I would check fasting B12 level and white blood cell morphology. Are you tired all the time? Are you on any kind of fad diet or do you have major digestive problems? >>Don and Susan, thank you for your comments about Afrin. I have found >>unfortunately that my nose becomes "addicted" to Afrin even using it [quoted text clipped - 6 lines] > Actually I think it is the active ingredient but I am sure that others will > claify. It think it's the active ingredient, too. He may be referring to the harm to cilia by the preservative. >>As far as cleaning up my area goes, before having to move for work >>reasons I had a brand new house built with all hardwood flooring, and [quoted text clipped - 8 lines] > Hmm I wonder if there could possibly be a metabolic or immune status issue > then. New construction outgasses a LOT, even green built homes trigger reactions in very sensitive folks. > Do you know what your TSH (thyroid) numeric value is? It is a blood test. If > possible, the numeric value is desirable rather than a conclusion as refernce [quoted text clipped - 5 lines] > > Are you on any kind of fad diet or do you have major digestive problems? More horse than zebralike, I wonder if the irrigation solution is sterile? Susan >More horse than zebralike, I wonder if the irrigation solution is sterile? Fair enough question but I actually think that slow metabolism is a major factor in soem forms of sinsusitis. View may differ on which is the horse and which is the zebra.... >>More horse than zebralike, I wonder if the irrigation solution is sterile? > > Fair enough question but I actually think that slow metabolism is a major > factor in soem forms of sinsusitis. > > View may differ on which is the horse and which is the zebra.... It appears he's irrigating with unsterile water. That one's a lot more obvious and easy to fix. I'm interested in your metabolism theory; do you have cites or some material that indicates this may be the case? Also, what do you mean by slow? Are you referring to thyroid status, insulin resistance, or something else? Susan >It appears he's irrigating with unsterile water. That one's a lot more >obvious and easy to fix. As I said, I do not agee that it is more obvious. I happen to think it is extremely unlikely that mere unsterile water matters much. Lots of people go swimming every day. >I'm interested in your metabolism theory; do you have cites or some >material that indicates this may be the case? Also, what do you mean by >slow? Are you referring to thyroid status, insulin resistance, or >something else? The most common cause of slow metabolism is low thyroid (which is extremely common!. Here's one reference: http://health.yahoo.com/centers/allergy/154 "Non-allergic rhinitis may also be triggered by pregnancy, thyroid problems, stress or by certain medications. These triggers of non-allergic rhinitis do not cause your body's immune system to react. Thus they are not an allergen. But they may still irritate your mucous membranes, causing inflammation and your rhinitis symptoms." Really it is no surprise - low thyroid has effects throughout the body and on the skin. How could it not have the potential to affect the linings of the sinuses and nose also? These matters are covered in any book on endocrinology. As to sleep, it also profoundly affects natural cortisol levels. Inflammation throughout the body will result from lack of enough sleep. The worst thing is that if this is the case in an individual, the sinuses are just one marker. Elevated inflammation will increase the risk of heart disease also amd many other diseases. This is covered in many recent articles on sleep. My sinuses are now getting back close to what they were right after surgery (very good) just by getting *lots* more sleep. In me, sleep is *far* more signficant than streroid sprays. My thyroid is also bodferline low (TSH is borderline high) but in me it is part;y caused by low caloric intake, which is not too hard to remedy..... >>It appears he's irrigating with unsterile water. That one's a lot more >>obvious and easy to fix. Let's see; the OP said specifically that the onset of the increased symptoms was directly related to irrigation... Odd that his thyroid would slow to a crawl each time he irrigated, eh? :-) > As I said, I do not agee that it is more obvious. I happen to think it is > extremely unlikely that mere unsterile water matters much. Lots of people go > swimming every day. Swimming is very different than shooting stuff deep into your head under pressure. >>I'm interested in your metabolism theory; do you have cites or some >>material that indicates this may be the case? Also, what do you mean by [quoted text clipped - 3 lines] > The most common cause of slow metabolism is low thyroid (which is extremely > common!. Actually, it's probably less common than insulin resistance, and is often driven by it, but I agree that thyroid dysfunction is very common. > Here's one reference: > [quoted text clipped - 5 lines] > But they may still irritate your mucous membranes, causing inflammation and > your rhinitis symptoms." This article appears to be about having a stuffy nose, not about sinusitis. > Really it is no surprise - low thyroid has effects throughout the body and on > the skin. How could it not have the potential to affect the linings of the > sinuses and nose also? This is very non-specific opinion. I was hoping you'd have some scientific cites relating chronic sinusitis to metabolism. > These matters are covered in any book on endocrinology. Which ones, and can you quote them about sinusitis caused by metabolic slowdown? > As to sleep, it also profoundly affects natural cortisol levels. Inflammation > throughout the body will result from lack of enough sleep. The worst thing is > that if this is the case in an individual, the sinuses are just one marker. > Elevated inflammation will increase the risk of heart disease also amd many > other diseases. I was hoping you'd have something to substantiate the connection between metabolism and chronic sinusitis? > This is covered in many recent articles on sleep. Inflammation is very non-specific. Do you have any cites about metabolic rates and causal relationship to sinusitis? > My sinuses are now getting back close to what they were right after surgery > (very good) just by getting *lots* more sleep. In me, sleep is *far* more > signficant than streroid sprays. That's good news for you. But we were talking about metabolic rate. That's all I asked you about. > My thyroid is also bodferline low (TSH is borderline high) but in me it is > part;y caused by low caloric intake, which is not too hard to remedy..... Which borderline? The lab range, or the range that's lower, which many thyroid patients feel much better at? Susan >Let's see; the OP said specifically that the onset of the increased >symptoms was directly related to irrigation.. One can't tell reliably what is related to what just by sequence of occurrences. Better to look for underlying factors to avoid mixing up triggers with causes. >. Odd that his thyroid >would slow to a crawl each time he irrigated, eh? :-) >>Let's see; the OP said specifically that the onset of the increased >>symptoms was directly related to irrigation.. > > One can't tell reliably what is related to what just by sequence of > occurrences. So you're saying that irrigation is the trigger of a metabolic slowdown? He's made it very clear that irrigation leads to the symptoms directly. > Better to look for underlying factors to avoid mixing up triggers with causes. Sure. I've asked you for any clinical or scientific data that demonstrate metabolic slowdown leads to sinusitis. I'm completely open to it if you can produce any. Susan >So you're saying that irrigation is the trigger of a metabolic slowdown? No I am not. I am not using bottled water, just a PUR filter on my faucet. Should I use distilled water with the Breathe Ease XL? > I am not using bottled water, just a PUR filter on my faucet. Should I > use distilled water with the Breathe Ease XL? I just nuke the filtered tap water to kill any microbes that might be present. Your experience sounds like irrigating is making your sinuses worse (I don't think you're withdrawing from antigens) and it made me wonder if you were shooting pathogens up your nose. It sounds as if that's a strong possibility. Susan > I just nuke the filtered tap water to kill any microbes that might be > present. Your experience sounds like irrigating is making your sinuses > worse (I don't think you're withdrawing from antigens) and it made me > wonder if you were shooting pathogens up your nose. > > It sounds as if that's a strong possibility. How much time is required to ensure that all microbes are killed? I assume just bring the water to a boil and let it cool? > How much time is required to ensure that all microbes are killed? I > assume just bring the water to a boil and let it cool? I nuke two cups for 3 mimutes. Not quite a boil because I once had the exploding nuked liquid happen to me, it's not an urban legend. Just shy of boiling. Susan On 12/5/05 1:23 PM, in article 1133817823.808457.32960@g43g2000cwa.googlegroups.com, "dougreding@gmail.com" > I am not using bottled water, just a PUR filter on my faucet. Should I > use distilled water with the Breathe Ease XL? Unless your tap water is especially bad,regular PUR filter or any bottled water is OK with Breathe.ease XL > Really! > > Hmm I wonder if there could possibly be a metabolic or immune status issue > then. This is entirely possible; I am actually a hypopituitary patient. My endocrinologist Dr. Te Friedman is actually at Cedars Sinaii where Dr. Grossan is. I've been planning to make an appointment with Dr. Grossan the next time I see Dr. Friedman. In a nutshell - Dr. Friedman is about as thorough an endocrinologist as can be found anywhere, and he's gotten all of my hormones into the mid to high normal range that were low (which was most of them). > Do you know what your TSH (thyroid) numeric value is? It is a blood test. If > possible, the numeric value is desirable rather than a conclusion as refernce > ranges vary and are being revised. I don't recall TSH or T3, T4 measurements but at the time I was on 88mcg of T4 which Dr. Friedman raised to 125mcg, and based on a later test, back down to 117mcg. > Also I would check fasting B12 level and white blood cell morphology. I can't answer either of these at the moment, although I do take B12 supplements. > Are you tired all the time? Yes indeed. I am not sure if this is due to some yet to be found hormonal issue related to my pituitary (head trauma is what caused the damage) or if this is sleep related. I suspect sleep, as there HAVE been times when I have slept well and noticed a definite improvement. But, it appears to be dependent on both possible nocturnal asthma being under control, AND clear nasal breathing. Nasal CPAP was worthless as I had predicted considering how closed off my nasal passages are. You can't force air through pinholes. I have a CPAP machine and I'm considering trying it with an OPAP (oral) mask as it seems at the moment at least, mouth breathing at night is my best and possibly only option. > Are you on any kind of fad diet or do you have major digestive problems? No fad diets. I don't believe in them. No digestive problems that I am aware of aside from excess stomach acid and this can be eliminated by dietary adjustments. But, I LOVE hot / spicy foods unfortunately lol. Thank you for the help. :) Doug >> Really! >> [quoted text clipped - 37 lines] >mask as it seems at the moment at least, mouth breathing at night is my >best and possibly only option. Ok that is what I suspected - there are some underlying metabolic/hormonal factiors here. You are right on top of them though. Lack of sleep also will cause inflammation through the body, so it could be that alone. I think that it is among those factors that the cause of your sinusitis lies..... > Ok that is what I suspected - there are some underlying metabolic/hormonal > factiors here. You are right on top of them though. [quoted text clipped - 4 lines] > I think that it is among those factors that the cause of your sinusitis > lies..... Unfortunately if that is the case I don't know what can be done, as all of my hormone levels are now at least midrange and in most cases towards high normal. >> Ok that is what I suspected - there are some underlying metabolic/hormonal >> factiors here. You are right on top of them though. [quoted text clipped - 8 lines] >of my hormone levels are now at least midrange and in most cases >towards high normal. If it was only recently then it will take time for all layers of the skin etc. to fully recover. But the sleep angle is the other one I referred to. On 12/5/05 2:03 PM, in article d0e9p15e7ofpv4tf2ge3smtfv4p4umclh3@4ax.com, >>> Really! >>> [quoted text clipped - 48 lines] > I think that it is among those factors that the cause of your sinusitis > lies..... One of the important findings re sleep apnea is the need to take antioxidant vitamin supplements due to the accumulation of oxidative products during the apneic periods. On 12/5/05 11:52 AM, in article 4569p19iud5l544s8bc1ju1hlpbv5cv9ps@4ax.com, >> Don and Susan, thank you for your comments about Afrin. I have found >> unfortunately that my nose becomes "addicted" to Afrin even using it [quoted text clipped - 29 lines] > > Are you on any kind of fad diet or do you have major digestive problems? \one way to break the afrin addicition is to dilute the afrin with saline 1/2 and 1/2 each week. |
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