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Medical Forum / Diseases and Disorders / Sinusitis / October 2006Irrigation and allergy treatment
Hi Folks, As I've posted many times here, I was sick most of last year and this year with a chronic sinus infection . I was at the brink of ethmoid and maxillary surgery when I switched to an ENT who changed his treatment to 30 day Levaquin, Medrol pak, and horse pill size decongestant. I had been using a Water Pik (with a non-Grossnan heavy duty attachment) daily. I was irrigating daily. I was CT scanned again, and the new scans showed no infection, and he said I didn't need surgery. So I went to the allergist. My allergies to mold were so bad that I have been getting two shots, twice a week - one shot just dedicated to fighting mold. The great news, as I've posted here before, is that but for one relapse at the beginning of my shot regimen where I took some Biaxin XL (which I had sworn would never work again, I had taken so much of it) until now about 3 months later, I have been infection-free. And during this time, except for maybe once or twice when I've felt like uh-oh, here we go again, I haven't irrigated at all. So the discussion of diseased irrigators isn't much of an issue with me. I would say get a more heavy duty tip than the Grossnan, however. Certainly, my case doesn't fit all. I'm enough of a realist to realize that maybe the immunity my body has built up won't last, and I could relapse. I live in Houston, Texas, probably one of the worst places to live because of this problem. So the point, if there is one to this long post, is that not one size fits all. Irrigating is obviously of tremendous benefit to some, and immunotherapy doesn't work in others. As far as irrigation, in my case, it didn't really matter. I never produced the thick mucous many others experienced that came out while irrigating, yet I did this twice a day for a long time. Although it felt good, it probably didn't do much good for me, since I was still getting sick. So for those of you who haven't gone the route of allergy testing, but are faced with a doctor recommending surgery, I first say, get another opinion (asking the second doc about a second course of treatment), switch doctors if you have to, and go to the allergist even if the ENT says it won't help. Don't be dissuaded like I was by my first doctor who said it would take 12-18 months for immunotherapy to work. He was WRONG! And if you're worried about the costs of these shots, my health insurance is paying for all the costs. Rick > Hi Folks, > [quoted text clipped - 45 lines] > And if you're worried about the costs of these shots, my health > insurance is paying for all the costs. Rick, congratulations! I read your post with great interest and hope. I get very aggressive allergy desensitization in general, and it's helped, but enough. As soon as I can get a good sample sent off for analysis, my immunologist will add the nearly invisible white mold that I've identified as the source of my worst symptoms to my allergy shots. Your post gives me great hope that that'll be the end to a lot of what I have to do and put up with. Susan Rick My daughter has an IgA deficiency which predisposes her to sinusitis and asthma. She was really sick last year, living in a moldy dorm room. She started aggressive immunotherapy 12/05, and it's helped her considerably. She saw an ENT at Lahey clinic who wanted her to immediately get surgery--she declined. Recently after a flare, she saw our local ENT who said: "I can make you look better on a CT scan, but I can't promise it will decrease your infections. I'd advise keeping up the immunotherapy." I thought your comments about irrigation were really interesting. It does seem like you can over irrigate, and if it was going to cure us, this site wouldn't exist. I still irrigate twice a day: you're right, it does feel good. For me, low dose biaxin, coupled with immunotherapy made a huge difference in my frequency of sinus infections. After 5 surgeries, I was still getting infected. I'm glad you're doing so much better. Judy > x-no-archive: yes > [quoted text clipped - 61 lines] > > Susan >x-no-archive: yes > [quoted text clipped - 61 lines] > >Susan Susan, From what I've read, my solution is not for everyone. Plus, I don't even know if what I describe is a "solution" per se, but at least I'd say it's a "reprieve". That reprieve, in terms of feeling well and not having a constant cash outflow for antibiotics, doctor visits, etc. is indescribable, and has done wonders for my mental health as well. I stopped taking antidepressants (Lexapro) soon after the immunotherapy *kicked in* and feel even better in that area. Anyone who has gone and is going through this frightening, anxiety-ridden, lousy-feeling journey where you feel like a spring on a Third World jitney knows that this disease of sinusitis affects all areas of a person's life, I did want to add a couple of items here: First, along with my two shot, twice a week regimen, I am still using the nasal sprays Nasonex once a day and Astelin twice a day. A bonus with those is that both of their websites allow a $10 rebate. Also, I am reminded of a lady in the allergist's office the other day who said she weighed the advice of some of constant cleaning, dusting, getting rid of every known piece of whatever allergy-producing particle could bother her. She travels a lot, so she figures, quite rightly I think, that instead of being a cleaning freak at home, where she spends only half her time, she'll take the injections. It works for her. I think it would be helpful to hear from others who have had good success with immunotherapy. Susan, it seems like you have had at least some success, maybe in time they can get the right antidote for your mold problem. Good luck with that and keep at it. You apparently realize that giving up is not an option. That's the attitude to have. Note that I have several past posts about my trials and tribulations with irrigating with ampho-B, which proved useless in my case. But it will be interesting to see what effects will occur once you collect enough mold for further treatment in that regard. Another good thing would be to hear from people whose ENTs and such have downplayed the effects of immunotherapy, said it was useless, or said (as was my case) that it would take 12-18 months to work (when it only took 2). And since we have Dr. Grossnan as a regular contributor, what are your thoughts about any of this? Rick > From what I've read, my solution is not for everyone. Plus, I don't > even know if what I describe is a "solution" per se, but at least I'd [quoted text clipped - 12 lines] > once a day and Astelin twice a day. A bonus with those is that both > of their websites allow a $10 rebate. I will never touch a steroid spray for more than a day or two, with days off between. They cause adrenal suppression, which makes everything worse, eventually, in rebound. I still use Astelin nasal spray daily. > Also, I am reminded of a lady in the allergist's office the other day > who said she weighed the advice of some of constant cleaning, dusting, [quoted text clipped - 3 lines] > she spends only half her time, she'll take the injections. It works > for her. I do both. Though I pay someone to clean freakishly for me, and do routine stuff in between. Having hard floors and easy to vacuum window treatments helps, too, along with bedding made of all natural latex and dust mite covers on it. > I think it would be helpful to hear from others who have had good > success with immunotherapy. Susan, it seems like you have had at > least some success, maybe in time they can get the right antidote for > your mold problem. Good luck with that and keep at it. You > apparently realize that giving up is not an option. I've had miraculous success in terms of eradicating my seasonal allergy symptoms and improving my dust reactions, but dust and the mystery mold in my bathroom still trigger sinus issues. Once I test the mold in the bathroom and it's added to my shots, I expect my sinusitis to become much less an issue in my life. That's the > attitude to have. Note that I have several past posts about my trials > and tribulations with irrigating with ampho-B, which proved useless in > my case. But it will be interesting to see what effects will occur > once you collect enough mold for further treatment in that regard. Now that the weather is dry and the radiators come on, it's very tricky trying to grow the damned mold, that's the holdup. I already don't react to the mold in my garage or basement since doing my allergy shots; they used to make me asthmatic and give me itchy eyes and headaches. Susan How much irrigation is too much? The nose produces good white cells and lysozyme which are healers. But if you have allergy you also get allergens on the nasal membranes when the cilia don't wash them out, and IgE which combines with the allergens to give symptoms. So four times a day is definitely going to take out the lysozyme. Twice a day seems to be best, plenty of time to bring back the lysozyme. If you use pulsatile irrigation you also encourage return of cilia function so you need less irrigation. If its a chronic sinus condition, if you don't get a purulent return, maybe once a day with pulsatile irrigation is enough. If your return is purulent, twice a day may be best. Once the nose is normal, cilia are functioning, you don't need to irrigate further. You don't need to be more normal. Patients today have an advantage. A sinus CAT can be done in the office and advice re further irrigation can be given at the visit. Whatever, no one size fits all. Murray Grossan, M.D. Www.grossan.com > If you use pulsatile irrigation you also encourage return of cilia function > so you need less irrigation. Are there any studies establishing this?? I haven't ever found one, but you keep saying it. > If its a chronic sinus condition, if you don't get a purulent return, maybe > once a day with pulsatile irrigation is enough. If your return is purulent, > twice a day may be best. > > Once the nose is normal, cilia are functioning, you don't need to irrigate > further. You don't need to be more normal. I've never seen evidence of improved cilia function in a year and a half of pulsatile irrigation. > Patients today have an advantage. A sinus CAT can be done in the office and > advice re further irrigation can be given at the visit. I've never had a CT scan pick up my ethmoid sinusitis, no matter how much pain or evidence of infection was present. Susan On 10/23/06 12:48 PM, in article 4q4kl1Fldcg0U1@individual.net, "Susan" <nevermind@nomail.com> wrote: > Are there any studies establishing this?? I haven't ever found one, but > you keep saying it. Please see bibliography at www.ent-consult.com I tried to find your bibliography on your site, and couldn't. Could you post the URL? Judy > On 10/23/06 12:48 PM, in article 4q4kl1Fldcg0U1@individual.net, "Susan" > <nevermind@nomail.com> wrote: [quoted text clipped - 3 lines] > > Please see bibliography at www.ent-consult.com I found the bibliography page: http://www.ent-consult.com/irr_bibliog.html Also, I did a pubmed search on nasal saline irrigations and pulsatile irrigation, I found a number of articles that promoted hypertonic saline, an article from Australia comparing rhinoflow (no longer marketed), to nasal douche with the head down position--they used nuclear medicine markers and preferred the nasal douching. No head to head trials of pulsatile irrigation. The bibliography goes back to the 1970's and the most compelling article was on wound debridement using pulsatile irrigation. The bottom line: I'm sure it's effective, I'm not so sure we have proof that it restores the cilia--in vivo, although there was an article from the 1970's using a saccarine test--and per Dr. Ferguson, just be sure you don't introduce iatrogenic infection. > I tried to find your bibliography on your site, and couldn't. Could you > post the URL? [quoted text clipped - 6 lines] > > > > Please see bibliography at www.ent-consult.com |
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