Question:
"Steven L." <sdlit…@earthlinkNOSPAM.net> wrote in message
news:SsQ1f.8483$oc.4131@newsread2.news.pas.earthlink.net… – Hide quoted text — Show quoted text -> NorthShoreCEO wrote: >> "Steven L." <sdlit…@earthlinkNOSPAM.net> wrote in message >> news:GdA1f.7926$zQ3.3126@newsread1.news.pas.earthlink.net… >>>My advice: Do the surgery just for the heck of it. > >>>– >>>Steven D. Litvintchouk >>>Email: sdlit…@earthlinkNOSPAM.net >> I don’t think anyone should ever have surgery "just for the >> heck of it". It should be the final solution after >> exhausting other options. > That’s where you’re wrong. > Surgery should NOT be the final option for sinusitis, any more > than it is the final option for a malignant tumor. When you > have a malignant tumor (cancer), surgery is often the > first-line treatment (often followed up by chemotherapy or > radiation). > There have been very few scientific follow-up studies to prove > once and for all what the best treatments for chronic sinusitis > are. But the only follow-up studies I have seen, show that > surgery has a cure rate of about 80%, while antibiotics and > everything else don’t do anywhere near as well. > Right now, in the medical state of the art, surgery should be > the treatment of choice. > — > Steven D. Litvintchouk > Email: sdlit…@earthlinkNOSPAM.net > Remove the NOSPAM before replying to me.
So I guess I interpreted Stevens message correctly, Don Brady.
Response:
"Steven L." <sdlit…@earthlinkNOSPAM.net> wrote in message
news:SsQ1f.8483$oc.4131@newsread2.news.pas.earthlink.net… > There have been very few scientific follow-up studies to prove once and > for all what the best treatments for chronic sinusitis are. But the only > follow-up studies I have seen, show that surgery has a cure rate of about > 80%, while antibiotics and everything else don’t do anywhere near as well. > Right now, in the medical state of the art, surgery should be the > treatment of choice.
I admit to not having seen a lot of studies that give the follow-up info you describe. However, I can tell you that in my experience while it is common for patients to have their symptoms improve, often from intractable to bearable (and treatable with meds), it is rare for a person to go from severe symptoms to no symptoms (or even just mild symptoms) with sinus surgery. I would be curious to know how these studies defined cure. I agree with you that the person should not be long suffering before seeing the surgeon. A fairly aggressive and "prolonged" course of medical therapy can be accomplished fairly quickly (with in 2 or 3 months). I also agree that tests are helpful tools but should not trump treating the patient. — 00doc
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On Fri, 7 Oct 2005 15:59:45 -0500, "NorthShoreCEO" <NorthShore…@aol.com> wrote: >I don’t think anyone should ever have surgery "just for the heck >of it". It should be the final solution after exhausting other >options.
It was obvious to me that Steven it not mean it literally. He meant "despite your persoanl reservations, since nothing else has worked for you."
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"Don Brady" <dbr…@pobox.com> wrote in message
news:mn8ek1pnrhi85htfb6i88l0o5uig8vhlej@4ax.com… – Hide quoted text — Show quoted text -> On Fri, 7 Oct 2005 15:59:45 -0500, "NorthShoreCEO" > <NorthShore…@aol.com> > wrote: >>I don’t think anyone should ever have surgery "just for the >>heck >>of it". It should be the final solution after exhausting >>other >>options. > It was obvious to me that Steven it not mean it literally. > He meant "despite your persoanl reservations, since nothing > else has worked for > you."
Since the loved one of the original poster hasn’t really tried a different number of things to resolve his problem, it isn’t at all obvious to me.
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- Hide quoted text — Show quoted text -NorthShoreCEO wrote: > "Steven L." <sdlit…@earthlinkNOSPAM.net> wrote in message > news:GdA1f.7926$zQ3.3126@newsread1.news.pas.earthlink.net… >>My advice: Do the surgery just for the heck of it. > >>– >>Steven D. Litvintchouk >>Email: sdlit…@earthlinkNOSPAM.net > I don’t think anyone should ever have surgery "just for the heck > of it". It should be the final solution after exhausting other > options.
That’s where you’re wrong. Surgery should NOT be the final option for sinusitis, any more than it is the final option for a malignant tumor. When you have a malignant tumor (cancer), surgery is often the first-line treatment (often followed up by chemotherapy or radiation). There have been very few scientific follow-up studies to prove once and for all what the best treatments for chronic sinusitis are. But the only follow-up studies I have seen, show that surgery has a cure rate of about 80%, while antibiotics and everything else don’t do anywhere near as well. Right now, in the medical state of the art, surgery should be the treatment of choice. — Steven D. Litvintchouk Email: sdlit…@earthlinkNOSPAM.net Remove the NOSPAM before replying to me.
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- Hide quoted text — Show quoted text -NorthShoreCEO wrote: > "Don Brady" <dbr…@pobox.com> wrote in message > news:mn8ek1pnrhi85htfb6i88l0o5uig8vhlej@4ax.com… >>On Fri, 7 Oct 2005 15:59:45 -0500, "NorthShoreCEO" >><NorthShore…@aol.com> >>wrote: >>>I don’t think anyone should ever have surgery "just for the >>>heck >>>of it". It should be the final solution after exhausting >>>other >>>options. >>It was obvious to me that Steven it not mean it literally. >>He meant "despite your persoanl reservations, since nothing >>else has worked for >>you." > Since the loved one of the original poster hasn’t really tried a > different number of things to resolve his problem, it isn’t at > all obvious to me.
I remember what my ENT said: "Most patients don’t want to have surgery. They will try steroids and antibiotics and alternative medicine. And after they’ve given up, then they come back to me and ask for the surgery." — Steven D. Litvintchouk Email: sdlit…@earthlinkNOSPAM.net Remove the NOSPAM before replying to me.
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- Hide quoted text — Show quoted text -Lily wrote: > Steven L. wrote: >> Alison Chaiken wrote: >>> Susan <neverm…@nomail.com> writes: >>>> In my case, anything that stops the constant nasal dripping stops me >>>> from having asthma symptoms. >>> I don’t really understand the connection between PND and asthma. >>> Normally mucus goes from the back of your sinuses into your digestive >>> system. With PND the cilia are weak and the patient is more conscious >>> of mucus in the throat, but it still goes on the normal path into the >>> stomach, right? >> No. >> Especially at night, PND can drip all the way down thru the trachea, >> right into the bronchial tubes. If the PND is infected, the infection >> can spread into the bronchial tubes, causing bronchitis and the >> inflammation can trigger asthma. >> I often get acute bronchitis as a consequences of a bad cold or sinus >> infection. >>> Your comments get to the crux of the matter, which is: is the sinus >>> congestion allergy-related or the result of an infection? He has had >>> a stuffed nose continuously for months except when he’s taken big, >>> continuous Sudafed doses. Since the nasal discharge is clear and he >>> has no sinus pain, I’m quite doubtful that he has an infection. The >>> CAT scan shows heavy congestion but no mechanical problems with the >>> septum, etc. It’s consideration of all these indicators that makes me >>> dubious about the surgery. Perhaps Susan has hit the nail on the >>> head: we need not a new ENT but an allergist! >> No, I was in the same boat. >> The CT scan showed no evidence of sinus infection. >> I suffered for years until I found an ENT willing to operate on me >> anyway. And when he did, he found sinus blockages that hadn’t showed >> up on the CT scan. >> CT scans aren’t perfect. They have a finite resolution and they can >> miss tiny pockets of infection. >> My advice: Do the surgery just for the heck of it. Don’t make the >> same mistake I did. > I had a inf in my sinus for over 15 years that *never* showed on a CT > scan. This year I got another inf on the other side, and the CT scan > picked it up! > The dr decided a FESS was the best way to go. While in there, he found > the other inf that I always knew was there. Though I tried and begged > through the years, I was never able to get an ENT willing to operate > without proof that something was up there.
In my case, I finally found an ENT–just one–who still believes that a very detailed patient history and a very detailed list of the patient’s exact symptoms are still the best diagnostic tool, not CT scans. He disregarded the negative CT scan and agreed to try surgery. In fact, when I woke up in the Recovery Room after the surgery, he told me that he had my CT scan films in the operating room and while his surgical assistant was telling him the CT scan showed no blockages, he was looking right at the blockages with his endoscope. In fact, right now my ENT is in a disagreement with my allergist! My allergist did allergy tests on me and they were all negative. But my ENT says that based on his visual inspection of my turbinates (hypersensitive, hypersecretory, etc.), he is convinced I have allergies. I told him that my allergy tests were negative. He retorted, "I don’t care what the allergy tests showed! You’ve got allergies, Steven!!!" — Steven D. Litvintchouk Email: sdlit…@earthlinkNOSPAM.net Remove the NOSPAM before replying to me.
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Susan <neverm…@nomail.com> writes: > In my case, anything that stops the constant nasal dripping stops me > from having asthma symptoms.
I don’t really understand the connection between PND and asthma. Normally mucus goes from the back of your sinuses into your digestive system. With PND the cilia are weak and the patient is more conscious of mucus in the throat, but it still goes on the normal path into the stomach, right? So how does PND exacerabate asthma? Does mucus leak into the bronchial tubes or does its slower transit cause a generalized inflammatory response? Susan continues: > Has he considered allergic desensitization? I had it done > aggressively, complete in 12 weeks, with dramatic sinus and asthma > improvement. Lily writes: >I wonder if your loved one’s asthma is a result of the >sinusitis. This is true in my case. For me, something that helps >clear my sinuses, also clears up the asthma.
NSCEO offers: >Find a new ENT, though, if all his current ENT pointed to was >congestion as a need for surgery. Did the CAT scan show any >mechanical problems, such as deviated septum, or enlarged turbinates >that would require surgery in order to relieve him of congestion?
Your comments get to the crux of the matter, which is: is the sinus congestion allergy-related or the result of an infection? He has had a stuffed nose continuously for months except when he’s taken big, continuous Sudafed doses. Since the nasal discharge is clear and he has no sinus pain, I’m quite doubtful that he has an infection. The CAT scan shows heavy congestion but no mechanical problems with the septum, etc. It’s consideration of all these indicators that makes me dubious about the surgery. Perhaps Susan has hit the nail on the head: we need not a new ENT but an allergist! I suppose that allergists and ENTs both treat chronic nasopharyngeal problems but you are offered surgery by one and weekly shots by the other. Would sinus irrigation likely be effective in cases of severe allergies? I suppose it might help remove irritants from the sinuses. NSCEO continues: >If he’s on an antihistamine, like Zyrtec or Allegra, he may want to >ask his doctor if he can try Zyrtec-D or Allegra-D, which has the >decongestant added.
Thanks, that’s an option I wasn’t aware of. I’ll have a look at drugstore.com. — Alison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Predators fail often; prey fail only once. — Tom Evslin
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"Susan" <neverm…@nomail.com> wrote in message
news:3qakmlFe2mrpU1@individual.net… > x-no-archive: yes >> NSCEO continues: >>>If he’s on an antihistamine, like Zyrtec or Allegra, he may >>>want to >>>ask his doctor if he can try Zyrtec-D or Allegra-D, which has >>>the >>>decongestant added.
From Susan: > I don’t advise such preparations unless they also contain an > expectorant. I take regular Zyrtec and add non drying formula > pseudoephedrine when needed (during colds). I don’t think the > combination anthistamine/antidecongestants have the non-drying > feature, which is an important one. > Susan
All the -D does is add pseudoephedrine, so taking Allegra-D and Zyrtec-D is the same as taking Allegra or Zyrtec plus pseudoephedrine. I’ve been taking the -D seasonally for years and have had no problem.
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Susan <neverm…@nomail.com> writes: > It may help, but in terms of my chronic sinusitis, it wasn’t nearly > effective enough til I got aggressively desensitized. Any allergist > that tells you you must have weekly shots for a year or more isn’t > going to help, though that’s become the standard convention, based > upon about 26 deaths in 40 years of practice. I got dramatic > improvement with 12 weeks to desensitize.
Thanks for posting your experience. What form does "aggressive desensitization" take? Is it just higher-dose allergy shots? I got allergy shots for about a dozen years and didn’t find that they did much for me, but I recognize that treatment methods may have improved. NSCEO posted: >>>If he’s on an antihistamine, like Zyrtec or Allegra, he may want to >>>ask his doctor if he can try Zyrtec-D or Allegra-D, which has the >>>decongestant added.
Susan continues: > I don’t advise such preparations unless they also contain an > expectorant. I take regular Zyrtec and add non drying formula > pseudoephedrine when needed (during colds). I don’t think the > combination anthistamine/antidecongestants have the non-drying > feature, which is an important one.
How do you tell non-drying decongestants from drying ones? — Alison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Predators fail often; prey fail only once. — Tom Evslin
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Alison, I was in a similar situation as you described. I tried a couple of courses of antibiotics over 6-8 months and nothing worked. I was getting progressively worse but I was afraid of the surgery. Over that time, I got two ENT opinions and also visited my allergist for his opinion before agreeing to the surgery. (also had new round of allergy tests which showed new allergies had developed). It is very important to know what kind of surgery they will do. Next I found the doctor with the best reputation in the area. The doctor who performed my surgery showed me exactly on the CAT scan where there were polyps and blockages. He showed me what areas they would open up. I had version of FESS called MIST (at a Boston area hospital) which does not remove turbinates or bone or the mucuous membraines. Once the sinuses were opened I feel about 95% better. I still have some allergy symptoms and irrigate twice daily with the grossan irrigator to keep things healthy. If you are near a major medical center try to go there for an opinion. Not to scare you (just a warning), there are some ENTs still performing an older sinus surgery where they take out too much sinus tissue and the patient can be left with more problems (called empty nose syndrome). Check the FAQ posting for this group. There is a lot of good info on books to read and things to do to help this condition especially irrigating which has been a salvation for me.
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"00doc" <00…@comcast.net> wrote in message
news:m6OdnYYadLFNZqLeRVn-vA@comcast.com… > "NorthShoreCEO" <NorthShore…@aol.com> wrote in message > news:1e2dnXOFOpF5a6LeRVn-gg@comcast.com… >> Sudafed, a decongestant, is probably clearing him of mucous >> that may be causing him to breathe through his mouth, or may >> be creating post nasal drip, which can exacerbate asthma. If >> he’s on an antihistamine, like Zyrtec or Allegra, he may want >> to ask his doctor if he can try Zyrtec-D or Allegra-D, which >> has the decongestant added. > That would work if he is old enough. The problem is that the > kids have to get to be a good isze before they can take the > 240mg of Sudafed that is in the tabs (I think it is about 12 > years old but always have to look it up).
Hmmmmmm……I assumed she was talking about her partner, her main squeeze, her manly man. I don’t think Alison has kids, so I think when she writes of her "loved one", it’s her guy. And let’s hope he’s older than 12. Which means the real advice we want to give her is to let him stand in line for his own drugs! ;-P
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"Steven L." <sdlit…@earthlinkNOSPAM.net> wrote in message
news:GdA1f.7926$zQ3.3126@newsread1.news.pas.earthlink.net… > My advice: Do the surgery just for the heck of it. > > — > Steven D. Litvintchouk > Email: sdlit…@earthlinkNOSPAM.net
I don’t think anyone should ever have surgery "just for the heck of it". It should be the final solution after exhausting other options.
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- Hide quoted text — Show quoted text -Steven L. wrote: > Alison Chaiken wrote: >> Susan <neverm…@nomail.com> writes: >>> In my case, anything that stops the constant nasal dripping stops me >>> from having asthma symptoms. >> I don’t really understand the connection between PND and asthma. >> Normally mucus goes from the back of your sinuses into your digestive >> system. With PND the cilia are weak and the patient is more conscious >> of mucus in the throat, but it still goes on the normal path into the >> stomach, right? > No. > Especially at night, PND can drip all the way down thru the trachea, > right into the bronchial tubes. If the PND is infected, the infection > can spread into the bronchial tubes, causing bronchitis and the > inflammation can trigger asthma. > I often get acute bronchitis as a consequences of a bad cold or sinus > infection. >> Your comments get to the crux of the matter, which is: is the sinus >> congestion allergy-related or the result of an infection? He has had >> a stuffed nose continuously for months except when he’s taken big, >> continuous Sudafed doses. Since the nasal discharge is clear and he >> has no sinus pain, I’m quite doubtful that he has an infection. The >> CAT scan shows heavy congestion but no mechanical problems with the >> septum, etc. It’s consideration of all these indicators that makes me >> dubious about the surgery. Perhaps Susan has hit the nail on the >> head: we need not a new ENT but an allergist! > No, I was in the same boat. > The CT scan showed no evidence of sinus infection. > I suffered for years until I found an ENT willing to operate on me > anyway. And when he did, he found sinus blockages that hadn’t showed up > on the CT scan. > CT scans aren’t perfect. They have a finite resolution and they can > miss tiny pockets of infection. > My advice: Do the surgery just for the heck of it. Don’t make the same > mistake I did.
I had a inf in my sinus for over 15 years that *never* showed on a CT scan. This year I got another inf on the other side, and the CT scan picked it up! The dr decided a FESS was the best way to go. While in there, he found the other inf that I always knew was there. Though I tried and begged through the years, I was never able to get an ENT willing to operate without proof that something was up there. I’m not saying I blame the ENTs, or that surgery is the answer for everyone’s problems. I just believe there should be another type of test, or even an "exploratory-type" surgery that could be done in the event a person continues to be sick, but the CT scan is negative. As for asthma, I would wake up gagging from PND and had a chronic asthma cough for months prior to the surgery. A pulmonologist dxd me with asthma about a year ago. The actual day of my surgery it was already better. Now I have very little to no PND , and no cough at all. I’m so grateful! I hope telling my situation will help someone else. Lily
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On 10/2/05 10:06 AM, in article 86psqndf1r….@capsicum.wsrcc.com, "Alison Chaiken" <alison+gnus20051002T093…@dailyplanet.dontspam.wsrcc.com> wrote: > I don’t really understand the connection between PND and asthma. > Normally mucus goes from the back of your sinuses into your digestive > system. With PND the cilia are weak and the patient is more conscious > of mucus in the throat, but it still goes on the normal path into the > stomach, right? So how does PND exacerabate asthma? Does mucus leak > into the bronchial tubes or does its slower transit cause a > generalized inflammatory response?
There is a chapter in Emedicine on sinusitis and asthma. Any product, bug, radioactive tagged bug, appears in trachea form the sinuses in about 16 hours. PND is a common trigger for asthma, but is not the cause of asthma.
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On Mon, 03 Oct 2005 14:34:17 -0700, Murray Grossan <hydro…@adelphia.net> wrote: >There is a chapter in Emedicine on sinusitis and asthma. >Any product, bug, radioactive tagged bug, appears in trachea form the >sinuses in about 16 hours. PND is a common trigger for asthma, but is not >the cause of asthma.
Would it be correct to say that t he underlying cause of the asthma is probably the same as the underlying cause of the PND and sinusitis – allergic inflammation?
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Alison Chaiken wrote: > Susan <neverm…@nomail.com> writes: >>In my case, anything that stops the constant nasal dripping stops me >>from having asthma symptoms. > I don’t really understand the connection between PND and asthma. > Normally mucus goes from the back of your sinuses into your digestive > system. With PND the cilia are weak and the patient is more conscious > of mucus in the throat, but it still goes on the normal path into the > stomach, right?
No. Especially at night, PND can drip all the way down thru the trachea, right into the bronchial tubes. If the PND is infected, the infection can spread into the bronchial tubes, causing bronchitis and the inflammation can trigger asthma. I often get acute bronchitis as a consequences of a bad cold or sinus infection. > Your comments get to the crux of the matter, which is: is the sinus > congestion allergy-related or the result of an infection? He has had > a stuffed nose continuously for months except when he’s taken big, > continuous Sudafed doses. Since the nasal discharge is clear and he > has no sinus pain, I’m quite doubtful that he has an infection. The > CAT scan shows heavy congestion but no mechanical problems with the > septum, etc. It’s consideration of all these indicators that makes me > dubious about the surgery. Perhaps Susan has hit the nail on the > head: we need not a new ENT but an allergist!
No, I was in the same boat. The CT scan showed no evidence of sinus infection. I suffered for years until I found an ENT willing to operate on me anyway. And when he did, he found sinus blockages that hadn’t showed up on the CT scan. CT scans aren’t perfect. They have a finite resolution and they can miss tiny pockets of infection. My advice: Do the surgery just for the heck of it. Don’t make the same mistake I did. — Steven D. Litvintchouk Email: sdlit…@earthlinkNOSPAM.net Remove the NOSPAM before replying to me.
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Recently my loved one’s asthma and sinus congestion has been getting worse. He tried azithromycin (sp?) for about a month, but it didn’t seem to help. Perhaps this is not surprising given that his nasal discharge is clear. A CAT scan showed congestion consistent with his symptoms. He went to see an ENT who was only interested in doing surgery and refused to perform a sinus culture or endoscopic examination. Obviously we need a new ENT. Surprisingly the only thing recently that has helped his asthma (or nasal congestion) is Sudafed. Has anyone heard of sudafed being effective for asthma? What does the alleviation of the asthma symptoms by Sudafed mean? Of course Sudafed is no longer available from shelves in our area, and I have to wait in line at the prescription counter to purchase it. — Alison Chaiken "From:" address above is valid. (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ Predators fail often; prey fail only once. — Tom Evslin
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- Hide quoted text — Show quoted text -Alison Chaiken wrote: > Recently my loved one’s asthma and sinus congestion has been getting > worse. He tried azithromycin (sp?) for about a month, but it didn’t > seem to help. Perhaps this is not surprising given that his nasal > discharge is clear. A CAT scan showed congestion consistent with his > symptoms. He went to see an ENT who was only interested in doing > surgery and refused to perform a sinus culture or endoscopic > examination. Obviously we need a new ENT. > Surprisingly the only thing recently that has helped his asthma (or > nasal congestion) is Sudafed. Has anyone heard of sudafed being > effective for asthma? What does the alleviation of the asthma > symptoms by Sudafed mean? > Of course Sudafed is no longer available from shelves in our area, and > I have to wait in line at the prescription counter to purchase it.
Hi Alison, I wonder why they jumped on the "surgery" wagon so quickly. Did they say there was blockage that was causing the congestion? If that’s the reason, that may be why they want to do surgery. My sinus was so blocked up that when they tried to do an endoscopic exam, they couldn’t see around many of the blockages. Now, after FESS, they can look all around up there. I wonder if your loved one’s asthma is a result of the sinusitis. This is true in my case. For me, something that helps clear my sinuses, also clears up the asthma. As a matter of fact, before I had the FESS surgery, I was coughing horribly and barely sleeping. The day of the surgery my husband could tell a difference in the cough. Today, 2 months later, I don’t cough at all. Best wishes to you and yours, Lily
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"Alison Chaiken" <alison+gnus20051001T094…@dailyplanet.dontspam.wsrcc.com> wrote in message news:868xxdgoqv.fsf@capsicum.wsrcc.com… – Hide quoted text — Show quoted text -> Recently my loved one’s asthma and sinus congestion has been > getting > worse. He tried azithromycin (sp?) for about a month, but it > didn’t > seem to help. Perhaps this is not surprising given that his > nasal > discharge is clear. A CAT scan showed congestion consistent > with his > symptoms. He went to see an ENT who was only interested in > doing > surgery and refused to perform a sinus culture or endoscopic > examination. Obviously we need a new ENT. > Surprisingly the only thing recently that has helped his asthma > (or > nasal congestion) is Sudafed. Has anyone heard of sudafed > being > effective for asthma? What does the alleviation of the asthma > symptoms by Sudafed mean? > Of course Sudafed is no longer available from shelves in our > area, and > I have to wait in line at the prescription counter to purchase > it. > — > Alison Chaiken "From:" address above is valid. > (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ > Predators fail often; prey fail only once. — Tom Evslin
Yes, and you hijacked my thread becaaaaaaaaaaaaaaaaaaaaaaauuuuuuuuuuusssssssseee………..??????????????
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On 10/1/05 1:36 PM, in article spC%e.62$9K2…@bignews1.bellsouth.net, – Hide quoted text — Show quoted text -"Lily" <smor…@nospambellsouth.net> wrote: > Alison Chaiken wrote: >> Recently my loved one’s asthma and sinus congestion has been getting >> worse. He tried azithromycin (sp?) for about a month, but it didn’t >> seem to help. Perhaps this is not surprising given that his nasal >> discharge is clear. A CAT scan showed congestion consistent with his >> symptoms. He went to see an ENT who was only interested in doing >> surgery and refused to perform a sinus culture or endoscopic >> examination. Obviously we need a new ENT. >> Surprisingly the only thing recently that has helped his asthma (or >> nasal congestion) is Sudafed. Has anyone heard of sudafed being >> effective for asthma? What does the alleviation of the asthma >> symptoms by Sudafed mean? >> Of course Sudafed is no longer available from shelves in our area, and >> I have to wait in line at the prescription counter to purchase it. > Hi Alison, > I wonder why they jumped on the "surgery" wagon so quickly. Did they say > there was blockage that was causing the congestion? If that’s the > reason, that may be why they want to do surgery. My sinus was so blocked > up that when they tried to do an endoscopic exam, they couldn’t see > around many of the blockages. Now, after FESS, they can look all around > up there. > I wonder if your loved one’s asthma is a result of the sinusitis. This > is true in my case. For me, something that helps clear my sinuses, also > clears up the asthma. As a matter of fact, before I had the FESS > surgery, I was coughing horribly and barely sleeping. The day of the > surgery my husband could tell a difference in the cough. Today, 2 months > later, I don’t cough at all. > Best wishes to you and yours, > Lily
I can understand your concern when the doctor recommends surgery at the first visit. But what is the ethics here? . But understand the ethical dilemma I face every day. For example: I see the child with thick almost solid fluid behind the ear drum. She has a hearing loss. She has already had loads of treatment. I KNOW that the only treatment that will work is to drain the fluid, irrigate the ear at surgery and place a tube. I also know that if I recommend surgery at the first visit the parents will flee. Do I lie and say let’s try this and that and then if it doesn’t work, we will consider surgery? That way I can "sell " the surgery? Or do I tell the truth and say that surgery is the only thing that will work and have them flee out the door to a more caring doctor? This dilemma comes often and doctors have to choose what they believe is best for the patient.
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"Alison Chaiken" <alison+gnus20051001T094…@dailyplanet.dontspam.wsrcc.com> wrote in message news:868xxdgoqv.fsf@capsicum.wsrcc.com… – Hide quoted text — Show quoted text -> Recently my loved one’s asthma and sinus congestion has been > getting > worse. He tried azithromycin (sp?) for about a month, but it > didn’t > seem to help. Perhaps this is not surprising given that his > nasal > discharge is clear. A CAT scan showed congestion consistent > with his > symptoms. He went to see an ENT who was only interested in > doing > surgery and refused to perform a sinus culture or endoscopic > examination. Obviously we need a new ENT. > Surprisingly the only thing recently that has helped his asthma > (or > nasal congestion) is Sudafed. Has anyone heard of sudafed > being > effective for asthma? What does the alleviation of the asthma > symptoms by Sudafed mean? > Of course Sudafed is no longer available from shelves in our > area, and > I have to wait in line at the prescription counter to purchase > it. > — > Alison Chaiken "From:" address above is valid. > (650) 236-2231 [daytime] http://www.wsrcc.com/alison/ > Predators fail often; prey fail only once. — Tom Evslin
Peoples allergies have been really BAD this year – at least in Illinois. Not sure about where you are. Sudafed, a decongestant, is probably clearing him of mucous that may be causing him to breathe through his mouth, or may be creating post nasal drip, which can exacerbate asthma. If he’s on an antihistamine, like Zyrtec or Allegra, he may want to ask his doctor if he can try Zyrtec-D or Allegra-D, which has the decongestant added. My ENT has told me more than once, that most sinus infections that appear to be chronic, are merely under-treated, and they require a six week round of antibiotics. Find a new ENT, though, if all his current ENT pointed to was congestion as a need for surgery. Did the CAT scan show any mechanical problems, such as deviated septum, or enlarged turbinates that would require surgery in order to relieve him of congestion? If not, he sounds surgery-happy, and some ENTs are. Can you order Sudafed online, from someplace like www.drugstore.com? That might be your easiest bet, and it may even be cheaper in the long run.
Response:
"Alison Chaiken" <alison+gnus20051001T094…@dailyplanet.dontspam.wsrcc.com> wrote in message news:868xxdgoqv.fsf@capsicum.wsrcc.com… > Recently my loved one’s asthma and sinus congestion has been getting > worse. He tried azithromycin (sp?) for about a month, but it didn’t > seem to help. Perhaps this is not surprising given that his nasal > discharge is clear. A CAT scan showed congestion consistent with his > symptoms. He went to see an ENT who was only interested in doing > surgery and refused to perform a sinus culture or endoscopic > examination. Obviously we need a new ENT.
It is hard to comment on this without knowing more. Sometimes surgery is obviously required (either due to the anatomy or what has previously been tried and failed) and sometimes (contrary to a commonly expressed opinion here) the primary doc actually does do a good job of doing all the non-surgical stuff prior to referring. Of course, a second opinion if there is some doubt is never a bad idea. Endoscopy and culture is warranted if the problem is suspected to be a drug resistant infection. If that is not the case then it will not do much good. Usually prolonged courses of antibiotics are attempted first. If infection is not suspected then antihistamines with decongestants, nasal steorids, and nasal irrigation can help. A referal to an allergist may be helpful. > Surprisingly the only thing recently that has helped his asthma (or > nasal congestion) is Sudafed. Has anyone heard of sudafed being > effective for asthma? What does the alleviation of the asthma > symptoms by Sudafed mean?
It is probably being triggered by the sinus congestion and post nasal drip. Trying the above stuff may help. > Of course Sudafed is no longer available from shelves in our area, and > I have to wait in line at the prescription counter to purchase it.
You can thank the meth labs for that. — 00doc
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"Murray Grossan" <hydro…@adelphia.net> wrote in message
news:BF645820.22E4%hydromed@adelphia.net… > Do I lie and say let’s try this and that and then if it doesn’t work, we > will consider surgery? That way I can "sell " the surgery? > Or do I tell the truth and say that surgery is the only thing that will > work > and have them flee out the door to a more caring doctor? > This dilemma comes often and doctors have to choose what they believe is > best for the patient.
That is the art of medicine. Not only do you have to try to divine the best course but you then need to convince the patient to follow it. Often the second part is harder than the first. Since no treatment plan will work if it is not followed it is also the most important. Whatever has the best chance of getting the patient well is the ethical course. — 00doc
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"NorthShoreCEO" <NorthShore…@aol.com> wrote in message
news:1e2dnXOFOpF5a6LeRVn-gg@comcast.com… > Sudafed, a decongestant, is probably clearing him of mucous that may be > causing him to breathe through his mouth, or may be creating post nasal > drip, which can exacerbate asthma. If he’s on an antihistamine, like > Zyrtec or Allegra, he may want to ask his doctor if he can try Zyrtec-D or > Allegra-D, which has the decongestant added.
That would work if he is old enough. The problem is that the kids have to get to be a good isze before they can take the 240mg of Sudafed that is in the tabs (I think it is about 12 years old but always have to look it up). > My ENT has told me more than once, that most sinus infections that appear > to be chronic, are merely under-treated, and they require a six week round > of antibiotics.
I think this is definately true. If it is sinusitis then a longer course of a broad spectrum antibiotics can be helpful. The other way it is undertreated is that people don’t hit the medical ways of opening things up hard enough. They either treat allergic congestion as "sinusitis" and then wonder why it keeps relapsing or, even of there is a bacterial component, don’t work hard enough on getting the sinuses draining. Fluid will become infected whenever it sits around where it doesn’t belong (and sinuses that are open will not be infected no matter what bacterial may be present). If you treat the infection but not the drainage you have not really gotten to the root of the problem. > Did the CAT scan show any mechanical problems, such as deviated septum, or > enlarged turbinates that would require surgery in order to relieve him of > congestion?
Those are the relevant questions. Some things just can’t be fixed with drugs. — 00doc
Response:
. I like it as a complement to DAI. Holger 
) still have some hearing at higher frequencies. You might get your audiologist to give you a programme with more compression. This will make the music sound a little less ‘natural’ but the loud passages won’t be amplified as much and so may not sound ‘over loud’ as they do now. Any music with a wide dynamic range is going to be problematical – you need amplification to hear the quiet passages, but the same amount of amplification will make loud passages overly loud, and the more compression or limiting you introduce to to tame the loud passages, the more ‘unnatural’ things sound. > I hope some brand > is good for music. 