I made this cartoon about my recent balloonplasty using Sketch . It was to make light of the fact that I was unaware of what I was getting into. I had no idea that what the doc described as "widening" the passageway was a euphemism for "smash the heck out of the small bones in your sinuses." I didn't realize they were going to irrigate between "widening" each passageway.
Sinus pressure can be a real problem during the cold, winter months. Do I take decongestants or antihistamines? Sudafed or Zyrtec? Are my allergies acting up?
Here are some pointers on dealing with sinus infections and sinus pressure with some really cool slides at the end:
- Most allergens are gone in December-January, so the statement “my allergies are bothering me” is actually misplaced. You are meaning to say that sinus pressure is causing congestion and runny nose. Inflammation and swelling definitely exist in your sinuses, it’s just that your symptoms during the winter are not caused by allergy, but rather sinus infection.
- Treatment of a sinus infection is “all or nothing”. In other words, if you only remove 50% of the infection, it is likely your symptoms will quickly recur. Your body requires a mucociliary blanket in the sinuses to gradually remove bacteria and excessive snot. This protective blanket is destroyed during any infection, and won’t grow back until the inflammation subsides. Often it takes 30 days of antibiotics and prednisone to restore the sinuses back to their original condition.
- One of the pictures in your slide set (slide 3 of 15) shows what normal mucociliary blanket looks like under the microscope. If this giant vacuum sweeper was operating normally all of the time, you wouldn’t have to use all your medication.
Here are some suggestions on how to treat your sinuses better:
- Make sure you eliminate nasal congestion. For the short term, use Afrin or similar equivalent (OTC) if you limit to < 1 week per month. This allows the nasal airflow to drive away the excessive mucous in your nose which would otherwise become a great meal for hungry bacteria. Sick but true!
- Find out if you have allergy! The winter season gives you a reprieve from outdoor allergens, but during the spring, summer, and fall, tree pollen, Bermuda grass, and ragweed are more than willing to invade your sinuses and cause irreparable damage to your mucous membranes and make you always sick.
- Use your prescribed nasal spray EVERYDAY as prescribed by your doctor. I know, Americans hate to put anything in their nose (except your finger), but regular use of nasal steroids and antihistamines will reduce the swelling in your sinuses and guess what? You got it, fewer infections.
- Get smart! Go through the slides below, and if you don’t learn anything new, I’ll buy your favorite drink at Starbucks.
The next issue of The Medical Letter includes an article on electronic cigarettes, which have lately received considerable space in the popular press. With LED bulbs at their tips and flavors like chocolate, it becomes easy to forget that what they bring to the table is nicotine, which has caused a lot of trouble in its day.
Researching our article led us to an excellent old (1998) book called Nicotine Safety and Toxicity, edited by Neal L.
The next issue of The Medical Letter (November 25, 2013) will include an article on a new combination of the opioid hydrocodone and the first-generation H1- antihistamine chlorpheniramine that will be marketed as Vituz for treatment of cough and cold and allergy symptoms. Hydrocodone (in combination with acetaminophen for treatment of pain—Vicodin, Lortab, and others), as we wrote 2 blogs ago, will likely soon be reclassified as a Schedule II controlled substance because of concerns about its abuse.
Without a doubt, driving on ice and snow should be reserved for the experienced drivers only. We don’t need more wrecks on Hwy 169 that what we already have to endure. But when the forecast for a winter storm brings on a run for bread and milk, we may have gone a bit too far. We have our own version of Black Friday…it’s called snow storm panic! Here I was shopping at Target to get a few items I really did need. Usually, my wait at the pharmacy is very short, but last night I guess EVERYONE thought it was important to get their medications filled before the storm arrived in case medications would no longer be available. Come on, pharmacies stay open even in Minnesota. Did you happen to go down the bread aisle? Nothing left and not a snowflake on the ground. No wonder you can’t yell fire in a theatre. The most shocking behavior, however, found in Oklahoma in preparation for a winter storm is to cancel school before it even starts to snow. Will you catch us off guard and unprepared? Not a chance. No wonder our kids have never seen snow or had a chance to make those lovely snow angels. They’re never in it. All joking aside, we did have a pretty nasty snowstorm 2 years ago with almost 20 inches in one night. That amount of snow shut the city of Tulsa down for a week! Could it happen again? Sure could, but the video below is enough for me:
Now, you’re probably wondering if I always pontificate about a totally irrelevant topic such as how Tulsans prepare for snow storms. Fortunately, this can have some relevance to cold weather illness:
- Asthma can be a real problem during the cold weather. Inhaling cold air causes drying of the airway wall and more severe bronchospasm that moderate temperatures. Don’t think that coughing and shortness of breath is just cold air; it may be your asthma getting out of control. Learn how to cover your nose and mouth with a scarf or mask, even if you’re outside for a short period of time. And most of all, use your regular inhaler (controller) during the winter months if cold air or upper respiratory infections are triggers for your asthma.
- Another problem with the winter season is trying to figure out if I have a cold, flu, sinus, or allergy problems. Let me make this much easier for you. Most ragweed is done pollinating by the end of October, so without much pollen in the air, your sneezing and coughing is probably not due to allergy (no exposure). A cold usually lasts < 1 week and any congestion or runny nose that doesn’t resolve from one Saturday to the next is probably a sinus infection. Why does this matter? Sinus infections should be treated with the “all or nothing” approach as any infection left in the sinuses will only result in more infection. Catching the flu makes you feel terrible and you’re already coughing. What could be worse? Add a fever with muscle aches and your diagnosis is most likely some type of influenza. Good motivation to get your flu shot!
- Am I Allergic to the Cold? I’m glad you asked. Cold-induced hives stays hidden for most of the year and comes out with a vengeance during cold weather. Some instances can be life-threatening and this condition is nothing to take lightly. Cold-induced urticaria of course, responds best to a vacation at Key West, but if you don’t have the luxury or flexibility to do that, antihistamines are still the backbone of treatment. Be careful when shoveling snow as shortness of breath and chest tightness may be associated with hives and a cold-induced reaction.
Although you must be careful with cold weather illness, you have to do something outside or you’ll get cabin fever. The link below is from AAAAI on how to control your asthma and still participate in winter activities. It’s a good read in front of the fireplace with a cup of hot chocolate. In the meantime, I’m heading for the slopes!
Food allergy is a constant source of anxiety to parents of children who could in fact die or suffer a severe reaction to foods. Believe it or not, the government has done a nice job with information pertaining to public safety, in this case, food allergy in schools. In case you think I’m kidding about the severity of food allergy, the YouTube link below should change your mind. The second link from the CDC is the “official word” on food allergy in schools.
With allergies, comes decision-making; should I eat this, should I go there, should I risk it? You need to remember to always do what is right for you! You know what situations may be dangerous for you and need to do what is best for your health and safety.
With the holidays quickly approaching, potlucks are upon us. Trusting other people with food allergies can often be a tricky thing to do.
Always be careful when you didn't make the food!
This question comes up in my office almost everyday….should I do skin testing or blood work? As you can see from the response of national experts, it depends. There is NO test that can boast 100% accuracy to predict whether or not you will react to a food. In fact, the gold standard if you will, is still the oral food challenge. Here is some food for thought (really, do you have to pun)
- Clinical history is very important in determining food allergy. If you can eat a food without difficulty breathing, rash, or hives, you are most likely not allergic. You may have a positive test, but that only means you’ve had previous exposure to the food.
- I will often obtain both skin testing and ImmunoCap (blood work) to clarify the presence of IgE-mediated allergy. If both tests are negative, you may have an adverse reaction to a food, not the severe life-threatening anaphylaxis. Very important distinction!
- If in doubt, a food challenge is always a procedure to consider. Here’s why.
- Sometimes the food in question just isn’t worth the trouble to challenge. No one says you have to eat strawberries!
- If you challenge peanuts for example, in the doctor’s office and experience anaphylaxis, better there than at home. Epinephrine is more readily available and in many cases, IV access and full resuscitation is available within minutes of your reaction.
- This is another reason why a single test or treating allergy without experience is not a good idea. Read the link below and tell me just how complicated things can become!