Medical Forum / Diseases and Disorders / Sinusitis / July 2008
An Improved Technique for Balloon Sinuplasty
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Steven L. - 08 Jun 2008 01:26 GMT A new startup company, Entellus Medical, is developing a new technique for balloon sinuplasty. The original technique, which we had discussed on this NG a couple times before, involved the use of fluoroscopy for proper positioning. This new technique is entirely endoscopic, eliminating the risks associated with X-radiation to the head.
http://www.entellusmedical.com/directapproach.htm
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Susan - 08 Jun 2008 01:50 GMT > A new startup company, Entellus Medical, is developing a new technique > for balloon sinuplasty. The original technique, which we had discussed [quoted text clipped - 3 lines] > > http://www.entellusmedical.com/directapproach.htm My PCP told me that my new ENT does these, though I don't know which technique. If it comes up as an option in my case, I'll ask.
Thanks. Just had another C-T scan Friday, my head is so irradiated now it's just not funny.
Susan
Steven L. - 08 Jun 2008 02:35 GMT > x-no-archive: yes > [quoted text clipped - 12 lines] > Thanks. Just had another C-T scan Friday, my head is so irradiated now > it's just not funny. Given what has happened to Senator Ted Kennedy, that's definitely not funny. (The biggest risk factor for malignant glioma is X-rays of the head)
I've taken just about the safe limit of radiation myself.
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truehawk - 08 Jun 2008 06:54 GMT > > x-no-archive: yes > [quoted text clipped - 22 lines] > Email: sdlit...@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me. What exactly is the rational behind the balloon procedure?
Susan - 08 Jun 2008 16:59 GMT > What exactly is the rational behind the balloon procedure? To open up the sinuses without cutting. My new PCP says the ENT she sent me to has really helped a few of her patients tremendously with this procedure.
I don't know if it's going to do the trick where bone is infected or without debreding, but it's far preferable to general anesthesia and cutting stuff out, IMO, as a first resort.
Susan
truehawk - 09 Jun 2008 07:23 GMT > x-no-archive: yes > [quoted text clipped - 9 lines] > > Susan And you think it is likely that the 'film is going to give up and move on because it will be depressed?
Susan - 09 Jun 2008 13:51 GMT >>x-no-archive: yes >> [quoted text clipped - 12 lines] > And you think it is likely that the 'film is going to give up and move > on because it will be depressed? Elizabeth, he doesn't *only* open the sinuses, he debredes them. I hope he also puts meds anti microbials up there. At least he's cured some patients my doctor knows of.
I am in a constant state of adrenal insufficiency due to these infections and I have to do what's available to me. Since I have at least one sinus with NO opening, I need to do something.
Susan
truehawk - 09 Jun 2008 23:36 GMT > x-no-archive: yes > [quoted text clipped - 24 lines] > > Susan Susan: By all means do something.
From your history and the presence of oral papilloma I think it likey that you will benefit quite a bit by debredment as long as they start you on antibiotics before they cut and keep you on them until the area heals so that it does not get reinfected. Come to think of it he does not necessarily have to debred, GWU used phenol to chemically bebred with good effect.
There are a couple of kinds of bug that wall themselves in, and it needs to be opened up.
The kind of surgery that I am against is the hacking out of the vanes in the nose with no idea, septoplasty and turbinate trimming that totally messes up the areodynamics of the nasal passages without curing anything, just making it so that one REALLY can't effectively suck or blow the crud out. I have seen a couple of people in just this condition and their x-rays looked like half a greatfruit worth of goo they could not get any air behind to move out. But it sounds kind this guy is not bone-cut happy and he may even know what a biofilm is. Hope so. Were I you I would take the risk.
truehawk - 10 Jun 2008 00:01 GMT > > x-no-archive: yes > [quoted text clipped - 49 lines] > Hope so. > Were I you I would take the risk. http://www.sciencedaily.com/releases/2000/05/000519064214.htm Of course the bit about mast cells is rubbish, but the technique evidently works if the sinus is opened up so the phenol can get at it.
Susan - 10 Jun 2008 01:59 GMT > http://www.sciencedaily.com/releases/2000/05/000519064214.htm > Of course the bit about mast cells is rubbish, but the technique > evidently works if the sinus is opened up so the phenol can get at > it. I didn't see any misstatements about the role of mast cells and inflammation there. They're hugely implicated in triggering the HPA due to inhalant allergies, and that regulates both immunity and inflammation.
Interesting technique, though.
Susan
Susan - 10 Jun 2008 01:56 GMT > Susan: > By all means do something. [quoted text clipped - 20 lines] > Hope so. > Were I you I would take the risk. I am also concerned about turbinate trimming and aggressive bone cutting, and will ask those questions, along with antibiotic treatment during and after surgery.
He does not appear to be cut happy, but I saw him today and he said now both my maxillaries are completely sealed shut.
He said I'm not a candidate for balloon, must cut openings for at least both maxillaries and "clean out the ethmoid cells or you'll be continuously reinfected." I asked if he thought it was in the bone, and I think he said it's possible, particularly the maxillaries.
He's very acquainted with biofilms, isn't sure he knows exactly what role they play but says his patients are having very good results, that irrigation is important once things are open, too. Told me to stay on abx for now.
Before surgery, I'll ask to speak to him about my questions. He wants instructions from the endo first about stress dosing for adrenal insufficiency during surgery, from my allergist about my allergies being treated (something he does for sinus patients, too), which ones.
I also forgot to ask about what kinds of anesthesia, to make sure I get the least HPA suppressive sedation. I don't even know if it's general or heavy sedation, but either could lower my ACTH and cortisol.
This is really bad timing; I don't know if my mother is going to have curative surgery to remove a MRSA infected mitral valve, or die, with a DNR in place, of her medical mistreatment and the effects of severe chemo toxicity. I don't know if I can fly to FL after a sinus surgery, or if I can withstand it before one.
Susan
Susan - 10 Jun 2008 02:14 GMT > x-no-archive: yes > [quoted text clipped - 56 lines] > > Susan Oh, yeah. And he's going to straighten my apparently twisted septum. I'm not sure why, since I don't have nasal blockage, but he seems to think it matters.
Susan
truehawk - 10 Jun 2008 03:41 GMT > x-no-archive: yes > [quoted text clipped - 64 lines] > > Susan Just about every CT or x-ray of someone's head from the top view shows some irregularity of the septum. Of course most of the CTs I have seen are those of other sinus sufferers, and of members of my family, but quite a few years ago, I used to have a friend that was an engineer getting his chiropractic degree and was setting up. He had quite a few x-rays around of people that he was doing neck adjustments for, mostly co-workers that he was doing for free at that point and only two out of maybe 5 or 6 had a straight septum. I don't know who was who, but I don't think there was much correlation. If all those people were having sinus problems they were collectively good at hiding it.
Susan - 10 Jun 2008 04:25 GMT > Just about every CT or x-ray of someone's head from the top view shows > some irregularity of the septum. Of course most of the CTs I have seen [quoted text clipped - 6 lines] > don't think there was much correlation. If all those people were > having sinus problems they were collectively good at hiding it. Yes, I think it's very, very common. I'm not sure why I need the whole thing straightened, except maybe the very top, which veers sharply left. One of my questions; why do I care? One thing, though, I have a very narrow nose at the top, where it veers sharply left, that may be worth fixing. Plus, maybe it'll be less likely to be destroyed if it's not in the way of a possible transsphenoidal pituitary surgery in my future.
Susan
MS - 10 Jul 2008 08:39 GMT > Oh, yeah. And he's going to straighten my apparently twisted septum. I'm > not sure why, since I don't have nasal blockage, but he seems to think it > matters. > > Susan Be wary of septoplasty. Perhaps get a second opinion on that.
I had a septoplasty, when sinus surgery was performed. As a result, I have a permanent hole in my septum, which is not good.
Susan - 10 Jul 2008 15:05 GMT > Be wary of septoplasty. Perhaps get a second opinion on that. > > I had a septoplasty, when sinus surgery was performed. As a result, I have a > permanent hole in my septum, which is not good. Well, I have to think that this surgeon won't screw me up, but thanks for the heads up. He's told me that his approach is "very conservative."
Susan
Steven L. - 12 Jul 2008 18:18 GMT > x-no-archive: yes > [quoted text clipped - 5 lines] > Well, I have to think that this surgeon won't screw me up, but thanks > for the heads up. He's told me that his approach is "very conservative." Which I'm not a fan of. I had to have a second (revision) surgery because in the first procedure, my surgeon was reluctant to operate that close to my brain and left a pocket of infection in one ethmoid cell.
The UPenn School of Medicine swears by a radical approach. They believe that sinusitis is usually worst in the ethmoid cells. So their approach is to totally remove all the bony partitions inside each and every ethmoid sinus, reaming them all out routinely.
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Susan - 12 Jul 2008 20:33 GMT > Which I'm not a fan of. I had to have a second (revision) surgery > because in the first procedure, my surgeon was reluctant to operate that > close to my brain and left a pocket of infection in one ethmoid cell. Well, he didn't say he wouldn't remove all the infection, only that he would not do a radical sinectomy nor would he trim turbinates at all, since they're so crucial.
> The UPenn School of Medicine swears by a radical approach. They believe > that sinusitis is usually worst in the ethmoid cells. So their approach > is to totally remove all the bony partitions inside each and every > ethmoid sinus, reaming them all out routinely. My doc has an awful lot of satisfied patients, and if I have to repeat it, oh well. I'd rather do less, at first, and see how my HPA axis and immune function recuperate and sequester any remaining infection, if any. He said he'll only remove bone to create openings or to remove involved material.
My own instinct is that radical surgeries shouldn't be a first line approach.
I guess We'll know by the end of the year if I've taken the right route.
Susan
Steven L. - 10 Jun 2008 19:22 GMT > x-no-archive: yes > [quoted text clipped - 7 lines] > without debreding, but it's far preferable to general anesthesia and > cutting stuff out, IMO, as a first resort. It wouldn't have worked for me; my surgeon told me my sinuses were way too far gone for just opening up the sinus ducts to be sufficient. I needed the whole nine yards--septoplasty, double ethmoidectomy and removal of a pus-filled mucocele.
That's my main concern with it: Since it's elective surgery, most patients try to avoid sinus surgery as much as possible and go with other treatments. By the time they throw up their hands and decide to try surgery, the sinusitis has progressed too far for balloon sinuplasty to be of much value.
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Susan - 10 Jun 2008 20:36 GMT > It wouldn't have worked for me; my surgeon told me my sinuses were way > too far gone for just opening up the sinus ducts to be sufficient. I > needed the whole nine yards--septoplasty, double ethmoidectomy and > removal of a pus-filled mucocele. Me, too.
> That's my main concern with it: Since it's elective surgery, most > patients try to avoid sinus surgery as much as possible and go with > other treatments. By the time they throw up their hands and decide to > try surgery, the sinusitis has progressed too far for balloon sinuplasty > to be of much value. I didn't, the doctors ignored my symptoms and neither the radiologists nore the ENTs saw the glaring, fulminant infections and defects!
Susan
Duff2 - 08 Jun 2008 15:55 GMT >> x-no-archive: yes >> [quoted text clipped - 17 lines] > >I've taken just about the safe limit of radiation myself. I've had two CT Scans of the sinus area plus several full dental shots over the past ten years. No more.
Steven L. - 08 Jun 2008 19:43 GMT >>> x-no-archive: yes >>> [quoted text clipped - 19 lines] > I've had two CT Scans of the sinus area plus several full dental > shots over the past ten years. No more. I've had *six* CT scans in the last 15 years.
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Susan - 08 Jun 2008 21:37 GMT > I've had *six* CT scans in the last 15 years. I think I've had five.
Susan
Steven L. - 08 Jun 2008 23:58 GMT > x-no-archive: yes > >> I've had *six* CT scans in the last 15 years. > > I think I've had five. Oct. 21, 2003 -- Researchers know that airline pilots and flight attendants have a higher rate of certain types of cancer. What's less concrete is exactly why.
In the past three years, at least 10 studies on the subject have been conducted. Most found an increased risk of breast and skin cancer among those who make their living in the skies.
But what has eluded scientists is the exact cause and effect: Is it the higher altitudes that boost risk?
http://tinyurl.com/5rps4b
[ The article didn't even mention what I thought was the most likely reason: Up in the stratosphere, you're more exposed to cosmic rays. Today's transcontinental jets fly at 40,000 feet.
And if we ever take the next step into suborbital passenger flights, we're really asking for trouble--unless the spaceships will be equipped with deflector shields. ]
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Susan - 09 Jun 2008 01:47 GMT > Oct. 21, 2003 -- Researchers know that airline pilots and flight > attendants have a higher rate of certain types of cancer. What's less [quoted text clipped - 18 lines] > with deflector shields. > ] GREAT. If anyone had read the earlier ones right, I might not have needed any of the others, including the one I had two days ago.
Susan
Steven L. - 09 Jun 2008 04:21 GMT > x-no-archive: yes > [quoted text clipped - 23 lines] > GREAT. If anyone had read the earlier ones right, I might not have > needed any of the others, including the one I had two days ago. Well, I could be wrong. I've heard another theory that it's really *artificial light* that causes breast cancer:
Lights at Night Are Linked to Breast Cancer Study Bolsters Theory About Interference With Production of Key Hormone
By Rick Weiss Washington Post Staff Writer Wednesday, February 20, 2008; Page A04
Women who live in neighborhoods with large amounts of nighttime illumination are more likely to get breast cancer than those who live in areas where nocturnal darkness prevails, according to an unusual study that overlaid satellite images of Earth onto cancer registries.
The finding adds credence to the hypothesis that exposure to too much light at night can raise the risk of breast cancer by interfering with the brain's production of a tumor-suppressing hormone....
Scientists have known for years that rats raised in cages where lights are left on for much of the night have higher cancer rates than those allowed to sleep in darkness. And epidemiological studies of nurses, flight attendants and others who work at night have found breast cancer rates 60 percent above normal, even when other factors such as differences in diet are accounted for.
On the basis of such studies, an arm of the World Health Organization announced in December its decision to classify shift work as a "probable carcinogen." That put the night shift in the same health-risk category as exposure to such toxic chemicals as trichloroethylene, vinyl chloride and polychlorinated biphenyls (PCBs).
The mechanism of such a link, if real, remains mysterious, but many scientists suspect that melatonin is key. Secreted by the pineal gland in the brain, the hormone helps prevent tumor formation. The body produces melatonin primarily at night, and levels drop precipitously in the presence of light, especially light in the blue part of the spectrum produced in quantity by computer screens and fluorescent bulbs.
In keeping with the melatonin hypothesis, mice in cages with night lighting have normal cancer rates if they get shots of the hormone. And blind women, whose eyes cannot detect light and so have robust production of melatonin, have lower-than-average breast cancer rates.
http://tinyurl.com/2n9due
And airline flight crews are always drenched in artificial light. They sleep at all odd local times because of their flight schedule.
So buy light-darkening window shades or eyeshades, and NEVER fall asleep with the lights on. And NEVER fall asleep in front of your computer screen.
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