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Medical Forum / Diseases and Disorders / Sinusitis / April 2006Irrigation Question
Hi Folks, I called my ENT to get a Grossan Sinus Irrigator. The nurse said his patients had never been asked for one, but another doc in the practice sold them and would be in the first part of the week with one. I said ok. It arrived Wednesday. It wasn't a Grossan, but it fit and works. I've never irrigated with saline before (although I'm ready to, as I've bought some pickling salt, baking soda and have a recipe to mix it). Right now, I'm using 20 ml of Amphotericin-B in each nostril. That's obviously not very much to put in the Water Pik, so I have to do some maneuvering to make sure the Ampho gets in the hole in the basin. I have the setting on low. So far, so good. The Ampho goes in one nostril and out the other. Having said all that, should I also be irrigating with saline solution or is that too much irrigation? Anybody ever used a Water Pik irrigator with Ampho B? There's still some of it that comes out my nostril when I take out the attachment, so I'm wondering should I increase the speed? Remember, there's just a little that's going in to my sinuses anyway. I guess I should also say that I've been trying to fight off another infection the last week. I haven't contacted the docs for an antibiotic, as the last two courses didn't work. I still used Nasonex once a day, Astelin 2x, and Singulair at night. Any help or comments appreciated. TIA. Rick Burt rick.burt@spamgmail.com > Hi Folks, > [quoted text clipped - 29 lines] > > Any help or comments appreciated. I've never irrigated with meds, but my understanding is that you irrigate with the saline, then turn the machine off when there's about an inch left in the container, add the meds, and irrigate with them more concentrated that way. Susan >I've never irrigated with meds, but my understanding is that you >irrigate with the saline, then turn the machine off when there's about >an inch left in the container, add the meds, and irrigate with them more >concentrated that way. > >Susan Susan (and all), Would you please tell me where you got your understanding of this? Book, website, etc. if you recall. Given your above scenario, my issue would be: It seems to me this would be diluting the Ampho-B. Instead of full-strength. Is diluting the Ampho-B what I should be doing? >>I've never irrigated with meds, but my understanding is that you >>irrigate with the saline, then turn the machine off when there's about [quoted text clipped - 11 lines] > would be diluting the Ampho-B. Instead of full-strength. Is diluting > the Ampho-B what I should be doing? I just read it somewhere the other day, but I can't for the life of me remember where it was. How else are you going to irrigate with it? Of course it's diluted some, but it's also going directly to its target, where orals rarely get to very well. Susan >x-no-archive: yes > [quoted text clipped - 22 lines] > >Susan Susan (and all), Per Steven's post, his EMT says it's not a good idea to do it that way, that it would dilute the Ampho. That sounds reasonable. 20 ml isn't much to irrigate with, but using the Water Pik and attachment, (also with some maneuvering of the pik's basin so it all goes down the tiny hole), most of it goes up into one side of my nostril and drains out the other. When I take the attachment out of my nose, some of the Ampho poured out, but I attribute this to there not being enough force at the end of this procedure to send the Ampho into the sinuses on that side. The loss of what I'm not getting is probably equal in amount I wasn't getting using the bulb/syringe technique. What I might do to compensate is to up the dosage to 25 ml from 20 ml. Even accounting for a few accidental spills of the Ampho, there will be plenty of Ampho left at the end of the Rx before I need to get a refill. Any comments about this are welcome, as I wonder whether the dosage of 20 ml is the amount I'm *supposed* to have go into my sinuses, or whether that 20 ml dosage is with expecting some of it never to get to the sinuses. As far as *orals* I'm not sure what you mean. rick.burt@spamgmail.com > x-no-archive: yes > [quoted text clipped - 31 lines] > an inch left in the container, add the meds, and irrigate with them more > concentrated that way. NO. Amphotericin cannot be mixed with saline. My ENT suggests that a topical med delivered via irrigation or nasal spray can remain inside the sinuses for up to 2 hours before the cilia have swept it all out. So if you want to irrigate with saline, do that at least 2 hours after you've irrigated with the ampho solution. Otherwise you'll just flush the ampho out of your sinuses before it has a chance to work. Except for that caveat, my ENT sees nothing wrong with doing multiple saline irrigations as well as the topical med applications.  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >NO. Amphotericin cannot be mixed with saline. >My ENT suggests that a topical med delivered via irrigation or nasal >spray can remain inside the sinuses for up to 2 hours before the cilia [quoted text clipped - 5 lines] >Except for that caveat, my ENT sees nothing wrong with doing multiple >saline irrigations as well as the topical med applications. Steven, Thanks for the info. Just what I needed. I use Nasonex, and then Astelin, right after the morning irrigation and then Astelin right after the evening irrigation. Any problems with doing that? rick.burt@spamgmail.com On 4/2/06 9:57 AM, in article 6l3032p7d6bulf38uidjhfnft4uuqnoles@4ax.com, > suggests that a topical med delivered via irrigation or nasal >> spray can remain inside the sinuses for up to 2 hours before the cilia >> have swept it all out. ??????????????????????? By spray???????????????? >> x-no-archive: yes >> [quoted text clipped - 33 lines] > > NO. Amphotericin cannot be mixed with saline. My ENT has a pharmacy that mixes Ampho and saline. I've used it. You have to shake it before use because it doesn't totally dissolve. I used it with an irrigation bottle. What you shook up was a salt solution as the Amphotericin was THEN worthless ...because NO. Amphotericin cannot be mixed with saline. >>> x-no-archive: yes >>> [quoted text clipped - 37 lines] > it. You have to shake it before use because it doesn't > totally dissolve. I used it with an irrigation bottle. On 4/3/06 1:46 AM, in article vh5Yf.25101$w86.19942@tornado.socal.rr.com, > What you shook up was a salt solution as the Amphotericin was THEN > worthless ...because NO. Amphotericin cannot be mixed with saline. This is correct. Ampho precipitates out in saline. |
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