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Medical Forum / Diseases and Disorders / Sinusitis / March 2006No Cure?
History : two surgeries 8-10 years ago. FESS, turbinate reduction, pathways opened , good head and neck surgeon . On and off sinusitis since. Chronic. Worse in winter. Negative for allergies, but still, use all hypoallegeric products and removed carpets from house ( etc, usual things you read on this site). Have been into irragation for 8 years, before ENT even knew of it. Usually 4 bouts per year bad infection , but let's say two for sure that have been successfully treated with up to 5 week course antibiotics. Last successfully treated with Omnicef. Thanksgiving 2005 infection begins. Has been entrenched. Unresponsive to 5 weeks Omnicef this time. ENT took CT scan. Shows all clear ( minor thickening RT front maxillary). He took culture ( no word yet ) and expressed, perhaps rightlyfully, not wanting to "dump more antibiotics into you without knowing how to approach". ( yet previous experience with swab type culturing and my reading does not give me hope).. Meantime, he got me script for anti-fungal rinse ala Mayo research etc. Although I am not immune deficient in anyway, it is a stab in the dark. May I insert here, he also has had me use a cipro/predisne saline rinse as well. I think the theory is valid based on recent research that the mucosal lining hosts culprits more than tissues. HOWEVER, I have classic dull ache. Terrible malaise. Night sweats. Right side sinus pain ( turbinate raw, swollen) and expel pus on occassion. In short, I know infection, this is infection 101. I think head and neck guys , once they do surgery and open things are stuck. But kudos to my guy for trying, antibiotic rinses, anti-fungal etc. But he never talks flushing or IV ( I know temporay,but I am sick). Baffled. Any advice ? Hello duke ... sounds like the same battle with sinus as me ....my latest sinus rinse is in 2 quarts r.o. water 1/2 table spoon sea salt 3 drops lugos iodine ...been using for 12 days now no more yellow/green wash outs , this is the best I've done yet hoping it continues......lugos is strong only use a little......mahalo michael > History : two surgeries 8-10 years ago. FESS, turbinate reduction, > pathways opened , good head and neck surgeon . On and off sinusitis [quoted text clipped - 21 lines] > trying, antibiotic rinses, anti-fungal etc. But he never talks flushing > or IV ( I know temporay,but I am sick). Baffled. Any advice ? Thanks Michael. I believe you mean Lugol's iodine. Where can you buy this ? ? I have tried Betadine rinse before ( after flying for example) and kicked things before they got a foothold. This one is very entrenched. Weeks into months ! Began with a virus of course. I fear I grew a resistant bug. Too many antiiotics over the years. > History : two surgeries 8-10 years ago. FESS, turbinate reduction, > pathways opened , good head and neck surgeon . On and off sinusitis [quoted text clipped - 21 lines] > trying, antibiotic rinses, anti-fungal etc. But he never talks flushing > or IV ( I know temporay,but I am sick). Baffled. Any advice ? Here are a few things worth checking: My ENT has a theory that low-level chronic sinus infections that don't show up in the sinus cavities on a CT scan, can be hiding in the bones of the face (osteomyelitis): http://tinyurl.com/s35xk In fact, over the years, we've had some sinus sufferers come forward on this NG to say that they were diagnosed with such bone infections. For patients who have that, IV antibiotics are the best bet. I have one question: Can you recall how and when you developed chronic sinusitis in the first place? Did you have it all your life, or did some lifestyle change or other event trigger it? Like after moving to a new locale or something? If you can think of a possible cause, maybe that can be corrected. Finally, while it's a shot in the dark, you might also want to have an immunological workup to test your immune system responses. If you're one of those folks who was always susceptible to infections much of your life, then an immunological workup may show some immune disorder that may be making it harder for your immune system to fight off these chronic infections.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. Thank you Steven. I have read your posts, you are very insightful. I did have an immune system workup some years back when an ENT at wits end sent me to Indiana University Infectious Disease expert, John BlackMD. Get this, doc Black told me he suffered the same thing! Sinususitis. Anyway, nothing wrong with my immune system. I smoked cigarettes ( quit 13 years ago) and recall sinus issues toward the end. I did have a very bad nose break as a kid ( say 20 years old, I am 51) and after the surgery the doc said it was bad , I would have problems later ! However, I have had the septum fixed and of course the FESS . I have moved , and as I said, carpets removed , etc on triggers. Usually what happens is I get a cold ( once a year let's say ) and committently, have to take a flight somewhere. Then, as they say, I am screwed. I get one I cannot shake. I think that while I respect my ENT and really give him a nod for the "out of the box" rinses ....in the end, it is still poor treatment. The chronic patient suffering a bad bout needs ( perhaps) an endioscopically obtained speciman for culture then some serious antibiotics for as long as it takes. I think these things are simply untreated until they are entrenched. I read one web where an ENT wrote he would like to take patients who present as I do , and once per week for so many weeks, put them asleep , rinse their sinuses and leave an anibiotic in place along with an IV. I believe he was half serious but alluding to pooling in the maxillary ( or otherwise) that simply always leaves residual infection behind. Meantime, here I sit waiting day 8 for a cal back from ENT for "5 days" results on a swab culture ---that I already know will show negative as they are a waste of time. While, I am sick, and expell dark yellow pus when I rinse or apply warm compress. Day aftter day----virtually since Christmas. Sucks. Oh, and Steven....I had already sent my ENT an e-mail asking him about bone infection possibilities negative on CT that would only show on nuclear imaging. No response to that either. I am calling to push today. Again, great surgeon, but....might be time to consider changing. Finding one that is aggressive and schooled in this chronic biz though, could be a needle in a haystack search. I live in Indianapolis if anyone reads this .... >Oh, and Steven....I had already sent my ENT an e-mail asking him about >bone infection possibilities negative on CT that would only show on >nuclear imaging. No response to that either. I am calling to push >today. Again, great surgeon, but....might be time to consider changing. >Finding one that is aggressive and schooled in this chronic biz though, >could be a needle in a haystack search. Dr. David Kennedy at U. Pa and many who follow him believe that removing fairly extensive ethmoid bone is often necessary to resolve chronic sinusitis. If youc all his office, they may be able to suggest someone near you...... >I live in Indianapolis if anyone reads this .... Thank you Don. I may have read something along these lines on this site when I discovered it. Perhaps one of your posts in fact. I put forth "ethmoidendectomy" to my ENT . He was abrupt with , " don't need any more surgery". Head and Neck guy. I think he thinks he is done, that's that. I agree with you though Don, as a mere well read layman, I nonetheless have reason to think that may be key. Most all infections begin in that region and end up elsewhere. Seems to me, attack that area, everywhere else ( usually maxillary) will heal. If my guy will not consider, I am foolish to not seek more help. >Thank you Don. I may have read something along these lines on this site >when I discovered it. Perhaps one of your posts in fact. I put forth [quoted text clipped - 6 lines] >else ( usually maxillary) will heal. If my guy will not consider, I am >foolish to not seek more help. Right and if you do want the more extensive ethmoidectomy,, it is really essential to have it done by soemone who has experience with it anyway. It does not pay to try to convince a surgeon to go against his own experience. If he does not beleive in an approach and have expericne with it, he would be just experimenting on you effectivel, would be likely to do it half-way in-between, etc. Better to go to a surgeon whi has a lot of experience with the "Kennedy approach." There are actually quite a number of them...... Hello duke.....http://secure.sciencecompany.com/Lugols-Iodine-4oz-P6409C670.aspx good price also for lugol's ....thanks for finding the droped l .....also on yahoo http://groups.yahoo.com/group/iodine/ good info ....Mahalo Michael > Thank you Don. I may have read something along these lines on this site > when I discovered it. Perhaps one of your posts in fact. I put forth [quoted text clipped - 6 lines] > else ( usually maxillary) will heal. If my guy will not consider, I am > foolish to not seek more help. >Hello >duke.....http://secure.sciencecompany.com/Lugols-Iodine-4oz-P6409C670.aspx >good price also for lugol's ....thanks for finding the droped l .....also >on yahoo http://groups.yahoo.com/group/iodine/ good info ....Mahalo Iodine will stimulate your thyroid. This will speed up your metabolism and often improve your sinuses, but is not generally considered safe because of its cardiac effects etc. Now, a lot of people are actually hypothyroid, but I would suggest they get the numeric TSH value from a blood test and start with that. Iodine would be a very crude and undesirable way to remedy low thyroid. Excess iodine will also cause thyroid disease in susceptible individuals. Interestingly ( or not !) I have hypothroidism. Diagnosed about 9 years ago ( hmmm, when sinsusitis began in earnest) . Anyway, I take synthroid and cytomel combo ( T4 T3) and keep my TSH as close to the edge to hyper as I can.Good internist works with me . Arguably then, I have crossed thyroid off the list as the immediate culprit ---as is noted elsewhere on the posts. Everything leads me the believe I could do with another ENT versed in looking for causes ( endioscopically) not just looking at CT scan ....and ....pursuing removal of ethmoid bones. I saw a description of same on a site featuring a Dr. Peter Casano in Mississippi ( of all places, no offense meant) . In short , taking the ethmoid bulbs if you will, and drilling through to make one cavern the size of the thumb . The idea of course to promote drainage straight through instead of the series of nooks and crannies. Need to find ENT locally who has done this , and many times. Or by goly I may have to go out of network ( insurance) and have one of these docs elsewhere take a look ---possibly do it. >Interestingly ( or not !) I have hypothroidism. I suspect it is a factor in a lot of sinusitis so I am not surprised. > Diagnosed about 9 >years ago ( hmmm, when sinsusitis began in earnest) Exactly. > . Anyway, I take >synthroid and cytomel combo ( T4 T3) and keep my TSH as close to the >edge to hyper as I can.Good internist works with me . Arguably then, I >have crossed thyroid off the list as the immediate culprit ---as is >noted elsewhere on the posts. Or at least you have done everything reasonably possible in regard to the thyroid. (I would not be surprised if the medically supplemented thyroid is not quite the equivalent of the real thing). There are two possibilities: (1) that the current problems are derivative of old issues and old disease never completely cleared. This is quite likely and would indicate you may be able to make good progress if the original cause has been addressed now.. (2) alternatively, that there are other subtle metabolic issues working against us. In either case, you want to do the best you can. >Everything leads me the believe I could do with another ENT versed in >looking for causes ( endioscopically) not just looking at CT scan [quoted text clipped - 4 lines] >The idea of course to promote drainage straight through instead of the >series of nooks and crannies. Right well Dr. Kennedy at U.Pa invented that procedure to the best of my knowledge and has published papers in it, but many others do it. I had it done by Dr Kennedy although I was not even in all that bad shape to begin with. By the way Dr. Kennedy is very famous - he was the first to perform endoscopis surgery in the U.S. and is editor of journals, runs conferences. writes books etc. And others in his Department do it too. Dr. Brent Senior here in N.C. is a former student of Dr. Kennedy and he does it and is getting very well-known too. >Need to find ENT locally who has done this , and many times. Or by goly >I may have to go out of network ( insurance) and have one of these docs >elsewhere take a look ---possibly do it. Right there is no reason not to travel really. I did. >>Interestingly ( or not !) I have hypothroidism. > > I suspect it is a factor in a lot of sinusitis so I am not surprised. It is an interesting correlation, and one that continue to hear. I have hypothroidism as well, and 4 surgeries later, still have chronic sinusitis... >It is an interesting correlation, and one that continue to hear. I have >hypothroidism as well, and 4 surgeries later, still have chronic >sinusitis... Do you know what your typical body temperature is? - I have had in the 97's quite often.......it may be that much more difficult to fry those germs at the lower temperatures...... >>It is an interesting correlation, and one that continue to hear. I have >>hypothroidism as well, and 4 surgeries later, still have chronic [quoted text clipped - 5 lines] > the > lower temperatures...... I am almost always in the 97's, and have wondered about that very thing. It's good to see someone else consider that correlation. >> Do you know what your typical body temperature is? - I have had in the >> 97's [quoted text clipped - 3 lines] > >I am almost always in the 97's I suspected as much. It is well known that body temperature is low in those with hypothyroidism (or tendencies for it).. Body temperature used to be used to check for hyothroisism until the TSH and other blood tests came into wide use. It is still a good guide in a lot of cases, alhough its use for that purpose is considered primitive now .... >, and have wondered about that very thing. >It's good to see someone else consider that correlation. Hey Don, I was out of town. Meantime, Dr.Kennedy sent word via the appointment people there he would review my CT scans and is Ok with consulting with me ( or will send word whether I should bother after he reviews scans). I want to talk to him ! I just recieved his book as well. Ordered it on-line. I would book a room locally and do a surgery with him no question . I am convinced as well from all I have just read it is ethmoid bones related and that Dr.Kennedy is the man ! >Hey Don, I was out of town. Meantime, Dr.Kennedy sent word via the >appointment people there he would review my CT scans and is Ok with [quoted text clipped - 3 lines] >with him no question . I am convinced as well from all I have just read >it is ethmoid bones related and that Dr.Kennedy is the man ! Excellent! He may or may not take you though but it is definitely worth a try.... Would any iodine be absorbed during irrigations, unless it was ingested? I have my annual appt with my GP later this month, and I think i'm going to request some bloodwork with thyroid testing. ~4 years ago, before my sinuses because a daily burden, I had my thyroid levels checked. While i'm not sure of the specific numbers, my doctor said i was in the normal range. I think that would be a good baseline to determine if my sinus issues correlate with thyroid level changes. Tyler >Would any iodine be absorbed during irrigations, unless it was >ingested? If it is just for irrigation I would nto be worried too much about uit. >I have my annual appt with my GP later this month, and I think i'm >going to request some bloodwork with thyroid testing. ~4 years ago, >before my sinuses because a daily burden, I had my thyroid levels >checked. While i'm not sure of the specific numbers, my doctor said i >was in the normal range. I think that would be a good baseline to >determine if my sinus issues correlate with thyroid level changes. There are several differen variations of "normal range". Basically, many doctors and labs are out of date and will call anything "normal range" unless you practically dead and buried. Try to get the exact numerical TSH value. >Tyler Thanks Don. Regarding 'normal' range......I totally agree on the interpretation of 'ranges'. I am interested in seeing the numbers because my last thyroid work was done before I was experiencing the sinus issues. Rather than say any number is in a normal range, I want to directly compare my current readings with the readings done when I considered my sinuses/allergies 'healthy'. What amount of TSH variation would it take to set of alarms? > Thanks Don. > [quoted text clipped - 5 lines] > sinuses/allergies 'healthy'. What amount of TSH variation would it > take to set of alarms? If you're concerned about thyroid dysfunction, the TSH test has more than once been described to me as a "garbage test" by endocrinologists. You want a direct measurement of your active thyroid hormone, free T3. It's helpful also to test for T4 to see how efficiently you're converting inactive T4 to the active T3 hormone. In my case, my TSH was always low normal, my T4 was very high normal, but my free T3 was at the bottom of the normal range. The body requires adequate selenium in order to convert T4 to T3; if your diet isn't providing this, a 200mcg daily supplement may help. In my case, supplemental chromium GTF helped stimulate my thyroid so much that I had to go off of the small dose of Cytomel (T3) I was taking because I had become hyperthyroid. I haven't needed it in years since. Susan It sounds like I should request a T4, T3 and TSH test. I *think* I also had these 3 tested in the previous test I mentioned. If so, then I have a good baseline to compare results to. Thanks Susan and Don. > It sounds like I should request a T4, T3 and TSH test. I *think* I > also had these 3 tested in the previous test I mentioned. If so, > then I have a good baseline to compare results to. > > Thanks Susan and Don. Make sure it's *free* T3. If your doctor is ultra cooperative, you can ask for rT3 (reverse T3) to see if yours is more the inactive form. Susan >Thanks Don. > [quoted text clipped - 5 lines] >sinuses/allergies 'healthy'. What amount of TSH variation would it >take to set of alarms? Here is a good discussion. http://thyroid.about.com/od/gettestedanddiagnosed/a/tshtestwars.htm They have been continually narrowing the range over the years - the same as with blood pressure. Now, it is a tricky subject. Let's say you find your TSH is borderline high (which means potentially hypothyroid) by the newest standard. It might be better to live with it or it might not. But at least you know some of what is going on then... Too little caloric intake will also cause similar readings (not that that is a common situation but it does happen......) Meal frequency etc. is also a factor..... Never accept your doc saying "normal". Get the numbers. Go to Mary Solomon (?) About.com ....read on thyroid. I took info to my doc years ago on "normal" TSH for me needing to be closer to 1.0-2.0. Labs in those days would tell docs normal was 3.0-6.0. People would feel near dead at those levels. Not "normal" . Docs like to treat lab tests, not people. In sinus world, they like to treat Ct Scans, not suffering patients. ( sorry to sound bitter ! ) . Go get that TSH tested. Push for dosage changes if you feel sluggish . |
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