January 6, 2010

physician, heal thyself

Pretty much every winter, I get a bad case of sinusitis which then may or may not lead into bronchitis. You name it, I've pretty much tried it all. Last year, from Thanksgiving up until February, I was in the doctor's office 5, count'em 5 times for recurring sinusitis. It finally took prednisone and leviquin (after low dose methylprednisolone and two rounds of antibiotics) to knock it out. This year, I was determined it would be different. I don't have sick days anymore. School keeps marching unabated. I had to figure it out. First, what doesn't work.
  1. Letting it run its course. It starts viral but then after about 4-5 days, it goes bacterial and runs rampant.
  2. Been to the ENT. Even had rhinoplasty to correct a deviated septum and hypertrophied turbinates. I can breathe better but the sinusitis didn't get better. It may have helped it from dropping into my lungs, though. CT scan post surgery shows clean cavities.
  3. Asthma. Been tested and blew through the test with flying colors, though once it's in my chest, an albuterol inhaler does help alleviate symptoms.
  4. Front line antibiotics like penicillins. Macrolides like zithromax are hit or miss. Flouroquinolones like levaquin have always worked. But it's always been paired with a steroid. Hmmm....
  5. Nasal decongestants like afrin. It helps me to breathe but then the stuffiness rebounds worse after it wears off.
  6. Antihistamines. More than one doc told me to "keep my allergies under control" and it'd help to prevent it from occurring. Nasal antihistamines may have role in the acute phase, though. Chronically, they make my nose bleed so that's out of the question. The other part was that it always hit me when pollen counts are at the lowest. Doesn't sound allergy driven to me. Doesn't work anyways. I've tried.

Last year's 5 trips was educational after a whopping one semester, well a half loaded semester, of med school. I'm feeling all edumicated now. #1 - It happens every winter, not spring or fall when I actually have bad allergies. It ain't allergies, though perhaps vitamin D may help. #2 - My family doc, who is very astute, used the term "reactive airway disease". Use that term with a lot of docs, and they'll roll their eyes. It's such a vague diagnosis as to mean nothing. But it did start get the little hamster running upstairs. Perhaps the infection is a red herring. I've been trying to treat the reaction rather than the cause. Perhaps the cause is not a weak immune system, though I definitely do have a pretty pathetic one. Perhaps the cause is an dysfunction of inflammation. The irritated mucousal membranes filled with dripping goo provide a nice environment for the bacteria to move in after the virus has already set things off.

So armed with new ideas, I've tried a few new ideas and combined them with older ones.

  1. Vitamin D. In Houston, it ain't hard to get it in the summer and I made more of a conscious effort to use it. I never burned, I just got a bit of tan. Once the sun got lower in the horizon, I started taking oral vitamin D at 2,000 mg daily. It didn't prevent me from getting sick in the long run but I did make longer than previous years. Usually, it would hit me around October or November and then by late February, I was fine. This year, I made it until the first week in January. Not a complete waste.
  2. Smoothies. One winter, miracle of miracles, I didn't get sick at all. In looking back, I was on an exercise kick and I had been drinking smoothies consisting of orange juice, berries (raspberry, blackberry, blueberry, etc), a banana, and whey protein. To paraphrase Bull Durham, don't mess with a winning streak.
  3. Corticosteroids. Earlier in the semester, I felt a tickle at the back of my throat and a tightness in my chest. I immediately popped some pseudoephedrine, sucked on Cold-eeze and started 5 mg of prednisolone. I also snorted nasonex since it's a tad faster acting corticosteroid than prednisolone. After two days, the stufiness went away and the tightness evaporated. Since I don't have money for doctor's visits and hey, I'm technically a doctor in training, I had no problem making the call to administer myself pred knowing that I had to taper it off and use it short term. I've tried the combo without the steroid before with hit or miss results. This time it worked so I'm 2/2 with a steroid on board.
  4. Cold-eeze are hit or miss for me. From my experience, I have to take them immmediately at the onset of symptoms for them to help shorten the duration. If I wait so much as a half a day, then nothing. I stay away from the nasal zinc like zicam as I'm not too keen on losing my sense of smell. I'm not aware of any cases of anosmia with zinc lozenges, though. Caveat emptor.
  5. Nasal rinse via NeilMed. My ENT turned me onto this technique. I don't know how much it helps with the actual sinusitis but it helps my allergies IMMENSELY. It takes a bit of getting used to squirting water up your nose but if I forget to do it for a couple of days, I notice.
  6. Sinusbuster. This is just plain lunacy. Then again, so is trying the same thing over and over and expecting different results. I had to find an alternative to afrin. Like I said, I'll try anything. If you didn't click on the link, here's the stupidity of it all. You squirt capsaicin, you know the stuff that makes jalapenos dangerous, up your nose. Makes sense, right? Let me take something that's going to irritate the hell outta my mucous membranes and shove it up my nose. Aside from the "mild discomfort" (if that's mild, I'd hate to see moderate to severe), I have to say that after I do the nasal rinse and then the sinusbuster, about an hour later, I can breathe much better than doing nothing or just the nasal rinse. Beware, it hurts like hell, though. At least it's only about 3-4 seconds. My wife always knows when I take it because I'm banging my fist on the shower wall. I'm not a total idiot, though. There is some data on it in humans. Not exactly high quality trials, small, need to be repeated, yada, yada...desperation will make you try strange things. Aside from obviously opening you up, it seems to have longer term effects by desensitizing your nose to irritants.

We'll see how it goes. The crud in my sinuses started on Sunday after a get together with friends. I'm also trying Sinupret. I haven't made up my mind on it yet, though there is some data in Europe on using it to treat chronic rhinitis with it.

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