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Medical Forum / Diseases and Disorders / Sinusitis / July 2009Swab Culture anguish
Using the same ENT for years, not sure where to go. Pain and pressure worse as ever. Top of head hurts to touch ( classic sphenoid infection) cheek pressure and pain and teeth hurting ( maxillary...). ENT does swab culure ( my ethmoids gone plus I am "wide open" so he can get back to sphenoid). Results : nothing grew. Meanwhile , 3 weeks of Levaquin and then two weeks of Avelox did not much. Note though, the Bactroban spraying has brought some relief. I cough up yellow. I rinse out green. yellow, brown. Too fatigued to work. I am 15 year sufferer and do all the reading. But here I am. Have apt for CT scan and follow up next Friday. Nurse called, I asked her of they do puncture and flush and would send that to lab for culture ....she was not familiar ( so I guess no) but noted a CSR test might be something to ask for. I need a new surgeon to discuss maxillary recirculation , whether my frontal ostia open, the condition of the sphenoid et al. Every do I profile on line here, same thing : Universtity of Indiana trained. I think they all sing from the same hymn book. Do an ethmoidectomy, if that and some allergy shots doesn't do it , cut them loose. still searching... Where are you located? Susan > Using the same ENT for years, not sure where to go. > [quoted text clipped - 28 lines] > > still searching... > x-no-archive: yes > [quoted text clipped - 36 lines] > > - Show quoted text - Indianapolis > Using the same ENT for years, not sure where to go. > [quoted text clipped - 28 lines] > > still searching... It is nice to know the Bactroban spraying has given you some relief. Thanks for keeping us informed. Becca > Using the same ENT for years, not sure where to go. > [quoted text clipped - 28 lines] > > still searching... Brown may be fungal, but the mupirocin working may also suggest staph. My suggestion : if it's not fungal, try a macrolide such as azythromycin and, failing that, then nebulize immediately an aminoglycoside such as tobramycin. There is a chance that azythromycin may sensitize the germ to tobramycin (PMID: 19188376 hypothesizes such a possibility for pseudomonas - no guarantee at all it will work, though). Nebulized mupirocin also exists : http://www.sinusscience.com (Steven already wrote on that a long while ago). > Using the same ENT for years, not sure where to go. > [quoted text clipped - 28 lines] > > still searching... Changed my life... (seriously) http://www.google.com/#hl=en&q=pulmicort+irrigation&btnG=Google+Search&fp=XDZvdCURD98 > > Using the same ENT for years, not sure where to go. > [quoted text clipped - 34 lines] > > - Show quoted text - Why would irrigating with a pulmicort solution have > efficacy than just using a spray steroid? >>> Using the same ENT for years, not sure where to go. >>> Pain and pressure worse as ever. Top of head hurts to touch ( classic [quoted text clipped - 26 lines] > Why would irrigating with a pulmicort solution have > efficacy than > just using a spray steroid? Because you can stand there, touching your toes, and let the solution reach all parts of your head. It works 10,000 times better than steroid spray. No joke. I had severe polyps, infections, orbit erosion and 100% loss of of smell. I can breathe and I can smell and I love it. You truly should give it a try if you are suffering. Try it three times a week and in two months you'll be a new person. "ENT does swab culure ( my ethmoids gone plus I am "wide open" so he can get back to sphenoid). Results : nothing grew ..." Duke: There is hope for the future at least, see below. Hope some help for the morale if nothing else, for won't be of immediate practical help for answers (unless you can get Stanford to take you on as a test subject) but means there might be a light at the end of the tunnel that is not just another oncoming train. Michael Dissecting biological “dark matter” with single-cell genetic analysis of rare and uncultivated TM7 microbes from the human mouth Yann Marcy,*† Cleber Ouverney,‡ Elisabeth M. Bik,§¶ Tina Lösekann,§¶ Natalia Ivanova,‖ Hector Garcia Martin,‖ Ernest Szeto,‖ Darren Platt,‖ Philip Hugenholtz,‖ David A. Relman,§¶ and Stephen R. Quake Proc Natl Acad Sci U S A. 2007 July 17; 104(29): 11889–11894. Published online 2007 July 9. doi: 10.1073/pnas.0704662104. We have developed a microfluidic device that allows the isolation and genome amplification of individual microbial cells, thereby enabling organism-level genomic analysis of complex microbial ecosystems without the need for culture. This device was used to perform a directed survey of the human subgingival crevice and to isolate bacteria having rod-like morphology ... Link to full text:- http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=17620602 > Using the same ENT for years, not sure where to go. > [quoted text clipped - 18 lines] > that to lab for culture ....she was not familiar ( so I guess no) but > noted a CSR test might be something to ask for. The only doctor I ever found who did a complete aspiration culture (flush all sinuses with saline, aspirate out, culture it) was Dr. Wellington Tichenor in New York City. And that's after years of searching for one here in Massachusetts where I live. Can you travel to see Dr. Tichenor, for the aspiration culture at least?  SignatureSteven L. Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > The only doctor I ever found who did a complete aspiration culture > (flush all sinuses with saline, aspirate out, culture it) was Dr. > Wellington Tichenor in New York City. And that's after years of > searching for one here in Massachusetts where I live. > > Can you travel to see Dr. Tichenor, for the aspiration culture at least? If so, he might try my ENT/surgeon. No cultures; bases diagnosis and need for surgery on imaging, or failing that, patient symptoms. And he's in most insurance plans. Susan > > Using the same ENT for years, not sure where to go. > [quoted text clipped - 32 lines] > > - Show quoted text - If I planned ahead I could take a day or two. I am more interested now in again approaching Dr. Kennedy ( who had replied to me a couple years ago) he would consult with me on my CT scans. From there perhaps someone on his staff take an endo look see > > > Using the same ENT for years, not sure where to go. > [quoted text clipped - 37 lines] > years ago) he would consult with me on my CT scans. From there perhaps > someone on his staff take an endo look see Duke: Don't know if you and your physician have tried Bactrim recently (and have no problem with side effects) -- Levaquin and Avelox stopped helping me about two years ago but bactrim still will help some of the clog to loosen and slide about 1 - 1 1/2 hours after taking same, along with some guafenesin, so that washing at that point removes a little more crud. For me it does help to get some of the mucous clog sliding and some relief till it builds up again surprisingly quickly. Also Steve L's past suggestion of a double dose of +/- 1 gram N-Acetyl- Cysteine one hour apart on an empty stomach, also along with some guafenesin, also helps me to get some stuff out. (I find I need a pretty cast iron stomach for this, on some days will bother me others not.) Best wishes, Michael > Also Steve L's past suggestion of a double dose of +/- 1 gram N-Acetyl- > Cysteine one hour apart on an empty stomach, also along with some > guafenesin, also helps me to get some stuff out. (I find I need a > pretty cast iron stomach for this, on some days will bother me others > not.) Does it completely fail if you take it with food? That hasn't been my experience with NAC. Both of those kill my stomach. I think guaifenesin is useless, as compared to just drinking tons of water. Susan >>> Using the same ENT for years, not sure where to go. >>> Pain and pressure worse as ever. Top of head hurts to touch ( classic [quoted text clipped - 29 lines] > years ago) he would consult with me on my CT scans. From there perhaps > someone on his staff take an endo look see You should also have a complete blood workup and metabolic workup and immunological workup. Sometimes, failure to cope with chronic infection suggests a systemic problem that has gone undiagnosed. Systemic problems that may exacerbate chronic sinus infection include: a) Anemia b) Vitamin D deficiency*** c) Metabolic insufficiency d) Immune system disorders (CVID, AIDS, etc.) *** In the 19th century, before antibiotics, affluent patients suffering from tuberculosis or other chronic respiratory infections would "take the cure": Stay at a health resort in a tropical or hot desert climate, and soak up the sunshine. This often worked. We now know it was due to the sunshine falling on the skin making more vitamin D. SignatureSteven L. Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > You should also have a complete blood workup and metabolic workup and > immunological workup. Sometimes, failure to cope with chronic infection > suggests a systemic problem that has gone undiagnosed. Or the very development of chronic, recalcitrant infection is due to systemic problems that allow them to develop. > Systemic problems that may exacerbate chronic sinus infection include: > > a) Anemia > b) Vitamin D deficiency*** > c) Metabolic insufficiency > d) Immune system disorders (CVID, AIDS, etc.) Cushing's syndrome/disease. Hard to find a Cushing's patient without chronic sinus infection. Makes sense, since steroid excess suppresses immunity same as exogenous steroids. > *** In the 19th century, before antibiotics, affluent patients suffering > from tuberculosis or other chronic respiratory infections would "take > the cure": Stay at a health resort in a tropical or hot desert climate, > and soak up the sunshine. This often worked. We now know it was due to > the sunshine falling on the skin making more vitamin D. Those cures weren't necessarily tropical or sunny climes. Saranac Lake, NY (which I LOVE) has a history as a cure location, and cure cottages sell for a premium due to their historical significance. I think that fresh air was a primary concern, and peacefulness. Susan |
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