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Medical Forum / Diseases and Disorders / Sinusitis / March 2007Fatigue in Chronic Sinusitis
How much fatigue would someone have with long-term chronic sinusitis with nasal polyps? I have tried all the treatments (antibiotics, nasal steroid, irrigation, nasal decongestants, allergy meds) and can't tolerate prednisone because of bad reactions. Could the fatigue be so debilitating that a person could not work, or to the degree that taking a shower or doing daily tasks around the house is exhausting? I was told that sinusitis does not cause the degree of fatigue that I'm having. I've tried to find an answer for this fatigue and I can't find the answer. I thought maybe it was caused from the chronic sinusitis that I've had for many years. Please give me your advice on this. Thanks, Paul > How much fatigue would someone have with long-term chronic sinusitis > with nasal polyps? I have considerable fatigue. Part of it is due to all the work it takes to cope with the damn thing. In the winter particularly, the coughing knocks me out. But the low-level infection is probably the main culprit. Chronic sinusitis has been known to cause sufficient fatigue that patients have even been misdiagnosed with depression or PMS. > I have tried all the treatments (antibiotics, > nasal steroid, irrigation, nasal decongestants, allergy meds) and > can't tolerate prednisone because of bad reactions. Have you tried surgery?  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. Thanks everyone for the replies to my post about fatigue. I have had a CT scan and it has been recommended that I have surgery since I've tried all the treatments. This will be my first sinus surgery and having the surgery is a scary thought to me! I have chosen Dr. Stankiewicz in Chicago to perform the surgery. I found him to be very friendly and polite to both me and my wife. After looking at my CT scan and doing a scope, he stopped counting at 10 polyps and said there could be many more. There are some pre-op tests I have to get done before surgery...cardio, pulmonary, etc. I don't know how I'm going to get through a treadmill test feeling so fatigued and out of shape. I've been suffering with these sinuses for many years. One more question to you sinus sufferers, I have lost my sense of smell and they say after surgery I may get it back. But I've also lost my sense of taste. I can only taste salt and sugar. Has anyone else lost their ability to taste food? Thanks again, Paul > One more question to you sinus sufferers, I have lost my sense of > smell and they say after surgery I may get it back. But I've also > lost my sense of taste. I can only taste salt and sugar. Has anyone > else lost their ability to taste food? Your sense of taste is a function of your sense of smell. The human tongue's sense of taste is very crude--your taste buds only register salty, sweet, bitter and acidic tastes (that's why you can still taste those now). The delicate nuances of flavor you used to enjoy with food actually came from your sense of smell. If your sense of smell improves, your sense of taste may also. Good luck with your surgery. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. On 3/25/07 6:04 PM, in article 1174871071.403072.287600@n59g2000hsh.googlegroups.com, "dr5460@aim.com" > Thanks everyone for the replies to my post about fatigue. I have had > a CT scan and it has been recommended that I have surgery since I've [quoted text clipped - 15 lines] > Thanks again, > Paul Having loss of smell and taste due to polyps is "good". That means that unless permanent damage has already occurred in the organ of smell, when the blockage is relieved, you should get your sense of smell back. The taste loss is part of the smell problem and hopefully that will return too. The majority of my patients with polyp blockage get the smell back when the polyps are gone. Best wishes, > Having loss of smell and taste due to polyps is "good". That means that > unless permanent damage has already occurred in the organ of smell, when the [quoted text clipped - 5 lines] > > - Show quoted text - Thank you for responding. It is very encouraging to hear that the majority of your patients regain their sense of smell when polyps are removed. I was looking up information on loss of smell and ran across Dr. Alan Hirsch who does studies on the association of the loss of smell and the connection to the effects on the brain. Who would ever think that smell would have that much effect on the brain? Paul > How much fatigue would someone have with long-term chronic sinusitis > with nasal polyps? I have tried all the treatments (antibiotics, [quoted text clipped - 9 lines] > > Please give me your advice on this. Have your immune subclasses tested, and your adrenal function. In my case, sinus infection can lead to vertigo, extreme fatigue and sleepiness along with painful leg cramps and spasms. Susan > x-no-archive: yes > [quoted text clipped - 13 lines] > > Have your immune subclasses tested, and your adrenal function. A complete immunological workup is a pretty drastic step. The OP didn't mention surgery so it sounds like he hasn't even had a CT scan from an ENT yet. An immunological workup is a last resort shot-in-the-dark after even surgery has either failed or doesn't seem to be indicated either. True immunodeficiency is relatively uncommon; maybe 1 in 700 people has it. Besides, in my own experience, some managed care health plans won't pay for an immunological workup just for chronic sinusitis. I was forced to pay out of pocket: $4,000. That's a lot of money for a 1-in-700 shot-in-the-dark. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. x-no-achive: yes > A complete immunological workup is a pretty drastic step. Compared to the way you frequently recommend surgeries "for the heck of it?" Nah, it's a blood drew and can be very informative about how to approach the overall health status allowing infections to become chronic. The OP didn't > mention surgery so it sounds like he hasn't even had a CT scan from an > ENT yet. An immunological workup is a last resort shot-in-the-dark > after even surgery has either failed or doesn't seem to be indicated > either. True immunodeficiency is relatively uncommon; maybe 1 in 700 > people has it. There's a whole wide range of immune compromise, from those using nasal and inhaled steroid or topicals, or those with chronic infections, or those like Judy's family with a specific pattern of immune subclass abnormalities. People become immunocompromised by events and exposures, not only by genetics or HIV. > Besides, in my own experience, some managed care health plans won't pay > for an immunological workup just for chronic sinusitis. I was forced to > pay out of pocket: $4,000. That's a lot of money for a 1-in-700 > shot-in-the-dark. I''ve never had any questions nor approvals required for immune subclass testing. My sister just had it done no prob from Aetna HMO. I know zillions of folks've who've had it done. Susan > There's a whole wide range of immune compromise, from those using nasal > and inhaled steroid or topicals, or those with chronic infections, or > those like Judy's family with a specific pattern of immune subclass > abnormalities. People become immunocompromised by events and exposures, > not only by genetics or HIV. I stand by my previous statement: True immunodeficiencies (such as Common Variable Immunodeficiency or Functional Antibody Deficiency) that are sufficient to warrant treatment with IV ImmunoGlobulin are uncommon. Perhaps 1 in 700 people suffers from them. Borderline cases (such as a couple of the IgG subtypes being on the low side) are more common. In fact, that was my situation with the usual pneumococcal challenge, so the immunologist ordered a second, custom challenge for me: killed H. influenzae. And I reacted just fine to that one. But borderline cases like that don't justify being pumped full of IVIG on a regular basis. Yes, I know there are doctors who will give that treatment to desperate sinusitis patients with borderline results from their immunological workup. No, I'm not going to waste my money on it. I'm not saying that immunodeficiency shouldn't ever be investigated. But all other things being equal, it's a lot less likely to lead to effective treatment than either IV antibiotics or surgery and it remains a desperate shot-in-the-dark when all else has failed. Because compared to immunodeficiency, there is a far greater incidence of dental problems or persistent bone infections or physical abnormalities (mucoceles, polyps, and the like), for which IV antibiotics and/or surgery are the standard treatments. >> Besides, in my own experience, some managed care health plans won't >> pay for an immunological workup just for chronic sinusitis. I was [quoted text clipped - 4 lines] > testing. My sister just had it done no prob from Aetna HMO. I know > zillions of folks've who've had it done. United Health Care's PPO refused to pay for my immunological workup. And the doctor (Tichenor) told me that's more the rule than the exception. Of course, that was a *long* time ago and maybe the HMOs have loosened up more recently. I did get the figure wrong, though; it was more like $2,500 out of pocket for me. Bottom line: Surgery remains the treatment of choice. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > I stand by my previous statement: True immunodeficiencies (such as > Common Variable Immunodeficiency or Functional Antibody Deficiency) that [quoted text clipped - 18 lines] > polyps, and the like), for which IV antibiotics and/or surgery are the > standard treatments. If someone has an intractable infection and immune compromise, there is a good reason to pursue it as an option, vs. multiple unsuccessful surgeries, countless rounds of antibiotics, etc. > United Health Care's PPO refused to pay for my immunological workup. And > the doctor (Tichenor) told me that's more the rule than the exception. [quoted text clipped - 3 lines] > > Bottom line: Surgery remains the treatment of choice. In your opinion. It's entirel possible that your insurance co's failure to pay had everything to do with how the request (if any) was coded and how the rationale was presented to them. Susan Paul: Chronic Sinusitis is strongly associated with Chronic Fatigue. It disrupts sleep. It is socially isolating, as well as phycially draining, which is depressing. http://www.sciencedaily.com/releases/2003/08/030814072847.htmv You say that you have a bad reaction to predisone. Not sure just what that reaction was, but people with a chronic infection as opposed to an allergy frequently get worse while taking predisone because it interfers with immune response. Chronic infection wears the body down, and many treatment failures have been due to the medical establishment being unwilling to realize that bacteria and other microzoa live in humans in the same conditions that they live practially everywhere else,in ad hoc multispecies communities that excrete a protective extra cellular polysacride and lace themselves together with amyloid fibers. Bacteria in Biofilms are up to 1000 times as difficult to kill as free swimming bacteria. It almost always takes a combination drug treatment to kill it, or to just peal it off, but such combinations DO exist. One problem is that using combinations of two or more antibotics for what is seen as a non live threatenng illness seems to go against the practice guidelines set down in an attempt to limit antibotic resistance. And very frequently if you believe Mayo and my own findings, biofilms have a strong fungal componant, which needs to be treated as well. Do a search at pubmet.gov for biofilm disrupters and you will see what is going on in drug treatment. The CDC estimates that 80% of chronic conditions are caused by biofilm infections, but it is a rare ENT that even knows about them. And them they want to remove them by surgical debridement. The risk to this approach is that little chunks of the community can set up shop in some other cranny of your nasopharynax.. Of the people that I know that have had sinus surgery, the one guy that is totally happy had something like image guided laser surgery and flew to Vagas three weeks later. I have also heard relaively good things about somnoplasty. My guess is that both of these techniques sterilize the debris as the infected tissue is removed. I know you feel lousy, but take heart. Have hope. Things change every day, and you still have a part to play. Primary immunodeficiencies, which have a 1-300 or 1-600 rate depending on ethnicity are easily uncovered by a CBC, and quantitative immunoglobulins, with IgG subclasses. The labs are a few hundred dollars retail, and less with contracted insurance rates. I found a patient to have absolute IgA deficiency this week: which requires a medic alert bracelet because she could die if she receives blood that has IgA in it. She had fatigue and chronic sinusitis. It's a simple work up, not expensive, and with the relatively high prevelance, it's worth it if people have recurrent infections. There was a national mailing to all physicians last year alerting them to be suspicious of patients with recurrent infections and to do the work up. My daughter, with a relative IgA deficiency--she has a low level--is doing well with medical management and has declined two ENT's offers of surgery. Our local ENT was frank with her and told her that even with a "perfect" CT he couldn't promise a decrease in infections. She stuck with immunotherapy, low dose biaxin, and has responded beautifully. Prior to figuring out the IgA deficiency she was quite ill. Judy If this was a simple problem, then one approach would fit all, and we'd have it figured out by now. Clearly there's immunodeficiencies, cystic fibrosis-like genetic abnormalities, biofilms. The mechanical approach: it's blocked, so opening it up will fix it, is over simplified and clearly only benefits some people. > x-no-achive: yes > [quoted text clipped - 28 lines] > > Susan > How much fatigue would someone have with long-term chronic sinusitis > with nasal polyps? I have tried all the treatments (antibiotics, Adrenal failure's been mentioned. You should check your cortisol, DHEA and pregnenolone levels. That can happen with chronic infections. Sometimes chronic sinus infections - often caused by fungal overgrowth in the sinuses - are related to more severe underlying food allergies/antibody responses/autoimmunity and nutritional deficiencies caused by intestinal malabsorption. For instance, you may have an allergy to gluten or an intolerance to various sugars in your diet. Constantly exposing yourself to them on a daily basis could cause enough inflammation in the gut to affect B12 or magnesium absorption. This, in turn, could cause fatigue.
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