Sorting out sinusitis

This post has been updated November 7, 2018

After my recent series about antibiotic use a reader asked a question about sinus infections.

“How do I know if I need an antibiotic for a sinus infection?”

It’s really a 2-part answer, so I’ll answer the second part first, it’s easier.

If you have a bacterial sinus infection with more than mild symptoms, an antibiotic may relieve symptoms and help you recover sooner.

So, you’re probably asking-

“How do I, or my doctor, know that I have a bacterial sinus infection?”

That is the more difficult question. Like so many things in medicine, maybe even most, figuring out what is wrong is the hard part. Once we know that, choosing one or more possible treatments is often rather straight forward.SORTING OUT SINUSITIS -www.watercresswords.com

 

 

Your symptoms may be one of these  diagnoses, not sinusitis

The common cold, the most likely diagnosis- this is more correctly called acute viral rhinosinusitis. The medical prefix “rhino” refers to the nose, for obvious reasons.

a rhinoceros carved into a rock
photo by Dr. Aletha at Disney’s Animal Kingdom in Florida

 

 

Allergic rhinitis, commonly called just “allergies” or hay fever; again, a more correct diagnosis is allergic rhinosinusitis

Since the nose and sinuses are directly connected, problems in one part affect the other.

diagram of the nose and sinuses
small passageways connect the nose and sinuses

 

 

An abscessed tooth, or other dental problem

Cellulitis, an infection of the deeper layer of the skin

Zoster, known by its common name shingles; prior to the onset of the rash, there may be pain alone

Migraine– the headache of migraine can cause pain in the sinus area

Angioedema – You may not be familiar with this, it’s an uncommon type of allergic reaction characterized by swelling, mostly in the facial area. Once a patient called me requesting an antibiotic for a sinus infection. My office nurse wisely scheduled an appointment for her to see me. Rather than a sinus infection, she was experiencing angioedema from her blood pressure medication. These reactions can progress into life threatening swelling of the throat; I’m glad I didn’t try treating this with an antibiotic.

How do doctors diagnose bacterial sinusitis?

The gold standard for diagnosing any bacterial infection is to identify the bacteria by growing it in a lab, a test called a culture. For that, we need a sample of the tissue or fluid from the infected area. Since the sinuses are deep in the face, there is no easy way to do this. So most of the time we rely on symptoms and exam.  We look for

We consider prescribing an antibiotic for sinusitis when

  • Symptoms have been present 10 or more days, and/or are worsening
  • Severe symptoms, such as pain not relieved with mild pain meds or persistent fever,
  • People with conditions that impair their immune systems, like cancer and its treatment, or people with diabetes
  • People with allergic rhinitis often seem to be more prone to bacterial sinus infections or take longer to get better

These of course are all general guidelines; every patient, every illness is different, so different approaches may be needed. This is a framework for us to work from, not hard and fast rules.

a rhinoceros
We encountered this rhino during a ride through Animal Kingdom, Disney World, Florida.

 

 

Other ways to feel better when treating sinus infections as well as colds,  allergic rhinitis, bronchitis and influenza include rest, increasing oral fluids ,and moisturizing the nose and sinuses. (The following includes affiliate links that may pay this blog a commission at no additional cost to you. )

Portable humidifiers are an easy way to relieve dryness in the nose and sinuses.

A Neti pot or sinus rinse bottle are safe, easy ways to relieve dryness, congestion and clear out excess mucous from the nose and sinuses. Always use distilled or boiled water and ask your doctor before using.

 

 

 

 

 

 

Learn about sinusitis from an expert in otorhinolaryngology

Dr. Deborah Burton, a pediatric ENT-ear, nose, throat- specialist blogs at Dr. Momma Says. In her companion podcast she explains-

WHICH SINUSITIS TREATMENT OPTIONS ARE THE BEST?

 

Thanks for joining me and Dr. Burton to explore options for sinus problems. Please share and stay well.

Dr. Aletha – sharing the HEART of health 

From bullets to blessings-one man’s journey to recovery from war

On April 30, 1975  the United States withdrew from VietNam after many years of involvement in that country’s war. That conflict remains a part of American history- and also a part of the personal history of the men and women and their families who served the military in any capacity during those years. Here is  a perspective on that history from my husband Raymond Oglesby.

in country, 1970
in country, 1970

Finding My Way Back

By Raymond Oglesby

I didn’t want to ever go to Vietnam again when I came home in 1972 after a one-year tour of duty with the United States Army. I was stationed with the Americal Division, 3/18 Field Artillery Battalion near Tra Bong, a major village located about 25 miles west of Chu Lai, the headquarters of the Americal Division, on “China Beach” at the South China Sea.

Tra Bong was an artillery base and housed two 8 inch and two 175 self-propelled howitzers. Each gun was capable of launching a 90 to 100 pound projectile 20 to 30 miles. The “fire base” was home to about 120 soldiers. Day and night, we fired the guns.

The US Army trained enlisted men to use weapons to destroy the enemy. Our mission was to route the NVA (North Vietnam Army) and VC (Viet Cong) from South Vietnam. I served as team leader of Fire Direction Control (FDC). We were responsible for working up fire missions and passing them to the gun crews via radio.

RAymond on duty at the firebase.

Killing the enemy, Vietnamese soldiers, didn’t bother me then because I did not see them as human. They would intercept our radio transmissions and curse us in English. We called them Charlie, VC and gooks. Without real names, they did not exist. Despite our superior air, sea and land capabilities the United States military lost the war, the first war our country has ever lost.

When I came home, I did not talk about my involvement in the Vietnam War for over fifteen years. I only told two or three people what really happened. I thought only  another Vietnam vet could understand.

After the Vietnam Veterans’ Memorial was erected in Washington D.C. (1982), I began reading and watching videos about that time in our nation’s history. In Vietnam, we heard nothing about the anti-war demonstrations back in the States. Now I realized that our country’s involvement there had been a misguided effort. The more I learned, the more I wanted to go back to Vietnam, not to feel sorry for myself but to help the country I tried to destroy.

a replica of the Vietnam Memorial Wall with an American flag and a wreath of red, white, and blue flowers
a replica of the Vietnam Memorial Wall in Washington, D.C. visits towns throughout the United States

 

For Christmas, my wife gave me A Missing Peace, a book written by a Vietnam veteran, Robert Seiple. From it, I learned I was not the only veteran haunted by his war experience. Others sought healing from their shame and anger.

A MISSING PEACE-BOOK
A MISSING PEACE by Robert Seiple (affiliate link)

And I discovered how much the Vietnamese people had suffered and still did. Unlike other wars, no restitution was made to rebuild the nation so Vietnam steadily declined economically. He described efforts to help rebuild Vietnam and said anyone can make a difference. He issued a call to “reconciliation”, both within ourselves and between the two countries.

I decided to contact Vets with a Mission (VWAM), one of the agencies listed in the book. VWAM is a non-profit, non-political organization that works to bring healing and reconciliation between our countries. Since 1988, VWAM has taken  teams of veterans and other volunteers into Vietnam. At their own expense they travel to Vietnam to build rural medical clinics, support orphanages, care for homeless children and work with hospitals.

I began planning a trip there myself, wondering what I would find and how I would feel. I did not understand why God was stirring my heart for the people of Vietnam. Was I a traitor for wanting to aid a former enemy? Some of my friends thought so, saying “Since you were dying to get out, why would you go back?”

In January 1994 I arrived in Vietnam for my first visit after twenty-two years. I was so excited I couldn’t sleep. I ran whenever we stopped to visit a site, especially if I had been there during the war. I empathized with the Vietnamese who were still living in poverty. I no longer saw them as enemies but as fellow humans. They treated us kindly and welcomed us wherever we went.

At Tra Bong a crowd of people followed us around, since few Americans have been there since the war. For me the highlight of the trip was a visit to the site of the old firebase.

After walking around the now deserted site, I felt I should kneel to pray for the village people around me. They did not understand what I was doing or saying. Right then, my heart was broken for the Vietnamese people.

As we left, children from the nearby school mobbed our van. My eyes misted with tears as I felt the Lord drawing me back. “You must reach these people for my Kingdom.” I knew then I would go back.

making friends with children during his trip back
making friends with children during his trip back

 

 

I have served on several Vets with a Mission teams, teaching computer applications in schools and hospitals. I have made Vietnamese friends. Some people think I am a traitor by giving aid to a former enemy. I’m not offended or resentful toward them. I only know that God has given me a burden and compassion for the people of Vietnam.

 

In 1970, I went on a mission of destruction, now I go on a mission of reconstruction. We failed to win the minds of the Vietnamese by bullets, but we are touching their hearts through the love of God.

 

 

Update November 2018

Raymond has written a detailed account of his service at Fire Support Base (FSB)/Landing Zone (LZ) Cindy near Tra Bong Vietnam. The firebase fought a major battle in September 1970. That battle and how it impacted the war in general and one soldier’s life specifically is the subject of his book.

We who served on LZ Cindy in 1969 and after when the unit left in 1971 did a job that had to be done to save more lives than were taken by the enemy. All of us were there because we were asked or drafted to serve this country and help the people of Vietnam survive.

Those of us who did the job on LZ Cindy did the best we could to survive and help those who served with us. It is unfortunate that some of those did not survive, but in war people die, and there is nothing we can do about it.

Find Battle for Tra Bong Vietnam on Amazon (affiliate link)

Expert advice to sleep well every night

If you live somewhere that observes Daylight Savings Time, you will get an “extra” hour of sleep Sunday morning November 3- remember it’s “fall back” (Next March we will “spring forward”.)

But just like the jet lag from travel, these time changes can interrupt our sleep schedule for a few days. And if you already have trouble sleeping, it’s even more of a problem.

Here’s a review of what sleep professionals recommend to help. But for persistent or severe problems, see your own doctor to get started.

person sleeping on a couch
Sometimes getting a good night’s sleep can be a challenge.

(Affiliate links are used in this post.It costs nothing extra to shop through these links and this blog may earn a small commission, which funds its existence. )

What is Chronic Insomnia ?

Most of us have trouble sleeping occasionally, but if you persistently have difficulty with sleep, you may have a medical condition associated with sleep disturbances. These include

  • sleep apnea
  • restless legs syndrome
  • depression and/or anxiety
  • post-traumatic stress disorder

Some people have true chronic insomnia, meaning persistent sleep difficulty alone. There are various criteria to diagnose chronic insomnia but in general include

  • difficulty falling or staying asleep
  • at least 3 nights per week for at least 1-3 months
  • with impairment of daytime function, such as fatigue/sleepiness, poor concentration, irritability, school or work dysfunction

 

EXPERT ADVICE TO SLEEP WELL EVERY NIGHT

 

 

 

How is chronic insomnia managed ? 

First step in treatment of chronic insomnia as well as occasional difficulty sleeping  is identifying and treating any underlying medical issues that might contribute to poor sleep. In addition to the ones mentioned above these include

  • pain, of all kinds
  • heartburn (gastroesophageal reflux)
  • congestive heart failure
  • lung diseases like asthma  causes nighttime breathing difficulty
  • menopausal night sweats

 

 

Sleep specialists recommend non-drug management of chronic insomnia and reserve sleep medications for more resistant cases. 

Sleep meds were one of the 7 drugs that are overused in my previous post.

a bed with ornate headboard
photo by Dr. Aletha- at the Hemingway house, Key West, Florida

(Read more about Ernest Hemingway’s preserved Florida home at this previous post)

Hemingway’s study- chaos and creativity

Sleep hygiene management

Experts recommend sleep hygiene , basically lifestyle changes, as the initial treatment. Some people have developed bad habits in regards to sleep that need to be unlearned and new behaviors put in place.

For optimal sleep you should

  • Engage in regular exercise- moderate intensity , tai chi , yoga and low-impact aerobic exercise
  • Avoid evening large meals
  • Limit caffeine, tobacco and alcohol
  • Use the bedroom only to sleep and for sex
  • Maintain a regular bedtime-awake schedule
  • Avoid daytime naps
  • Avoid distracting stimuli at bedtime-watching television, using electronic devices, talking on the phone
  • Stay in bed only while sleep

 

 

How to dim the lights

The light from electronic devices- clocks, thermostats, televisions, monitors-can disturb your sleep even after you turn off  your phone and tablets. This light can be blocked by stick on light blocking covers than can block out the majority of it.

affiliate link

Light from my clock made it hard for me to fall asleep before I discovered these products. With them I fall asleep easier, and can fall back asleep if I wake up.

 

 

 

Maintaining a regular schedule helps to set or reset your  sleep/wake cycle. So go to bed at the same time every night and wake up at the same time every morning.

However, if you can’t  sleep, rather than lie in bed awake, you should get up, do a non-stimulating activity, then return to bed when sleepy.

woman typing on a laptop keyboard.
Using a computer, laptop, or tablet before going to bed can impair sleep.

 

 

 

If you have persistent sleep loss, consider more intensive therapy by a professional.

Cognitive behavior therapy for insomnia , CBT-I , significantly improves chronic insomnia and daytime functioning and is recommended as first line therapy.

CBT-I combines cognitive therapy with sleep restriction, relaxation training and stimulus control.

Treatment typically requires 5-8 sessions conducted by a health professional trained in its use. Patients need to participate by keeping a sleep diary and writing down daily thoughts in a journal, while continuing with the sleep hygiene practices mentioned above.

person writing in a spiral notebook
Writing thoughts in a journal is often encouraged in cognitive behavioral therapy. (photo from the Lightstock.com collection)

 

 

Insomnia sufferers can also get help from an online web-based CBT-I, Sleep Healthy Using the Internet , SHUTi.

One study found 70% of those participating improved their sleep, compared with 43% who received education only.  If you  can’t find a trained therapist or don’t have time for office based therapy, this may be a good option.

SleepPhone by Acoustic Sheep

A physician, Dr. Wei-Shin Lai had trouble falling asleep after being awakened at night by calls from the ER. Her husband suggested listening to relaxing music to help her fall asleep.

She designed a comfortable headphone for her own use, and eventually started a company to make and sell them . You can try her SleepPhone  made by her company AcousticSheep.

SleepPhones

 

 

Manage stress, learn to relax

If you have  occasional trouble sleeping due to stress,  relaxation techniques can help you.  Techniques include  meditation, yoga, imagery, abdominal breathing and muscle relaxation techniques . These can reduce tension and anxious thoughts that inhibit sleep onset and maintenance.

You may find these ideas from a previous post helpful .

5 steps to manage stress and strain

 

man with hands folded over a book

Expert advice from physicians

Think alcohol will help you sleep better ? Read this advice from a psychiatrist, Dr. Melissa Welby.

The truth about alcohol and sleep

Curious about sleep apnea? Dr. Deborah Burton offers this review of another common sleep problem.

EVERYTHING YOU NEED TO KNOW ABOUT DIFFERENT SLEEP APNEA TYPES

 

 

 

 

Please share on your social media sites and follow Watercress Words as we continue to explore the heart of health. My goal is to bring health and wholeness to everyone who seeks it and hope you will join me.  Please visit my resources page.

Dr. Aletha 26952564_10213093560871954_4239554644472378905_o

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How smoking and sun affect your skin’s look and feel

 

Skin health and beauty- big business

Browse social media or news sites online and you notice skin health and appearance is a priority for most people. Sales for skin care and appearance products and services is a multi-billion dollar industry. If you’re on social media, you’ve probably seen posts from friends who are involved in direct selling companies for skin care, maybe you are also.

(By way of disclosure, I am a consultant for a direct selling company offering skincare products and makeup but will not discuss any of those products in this post. However there will be other affiliate links through which this blog can earn a commission if you make a purchase through them.  )

In my work as a family physician, I treat skin problems frequently. Some of these are primary skin problems, but some are the result of lifestyle habits, other medical conditions, and even medical treatments. While some of these may be unavoidable, others are preventable.

This post will look at two avoidable risks to skin health and appearance-smoking and ultraviolet light. 

HOW SMOKING AND SUN AFFECT YOUR SKIN'S LOOK AND FEEL

 

 

 

Skin Deep- cells and layers

First let’s take a deeper look at our skin, it’s more complex than you may realize.

Layers of the Skin diagram
The layers of the skin (epidermis and dermis), as well as an inset with a close-up view of the types of cells in the skin (squamous cells, basal cells, and melanocytes). Source: National Cancer Institute Creator: Don Bliss (Illustrator) This image is in the public domain and can be freely reused. Please credit the source and, where possible, the creator listed above.

 

 

Skin disease and trauma involve damage to one or both layers of the skin- the dermis or epidermis, or to the individual cells- squamous cells, basal cells, or the melanocytes-the cells with pigment that give our skin color.

Cancers can develop in any cell of the skin. Melanoma is cancer of the melanocytes.

(This photo is for illustration only and should not be used to diagnose a skin lesion. See a physician if you have a skin lesion that concerns you. )

photo of melanoma skin cancer
a melanoma skin lesion-Source: National Cancer Institute Creator: Unknown Photographer- This image is in the public domain and can be freely reused. Please credit the source

Smoking

I’ve previously discussed 7 reasons to be smoke free. One of those is skin health.

By decreasing circulation, smoking robs skin of nourishment and oxygen; this weakens skin , making it susceptible to infection, cancer, and aging.

Skin experts wrote in the Journal of Dermatological Science

“Smoking is associated with many dermatological (skin) conditions, including

  • poor wound healing,
  • premature skin aging,
  • squamous cell carcinoma and melanoma,(cancers)
  • acne,
  • psoriasis, and
  • hair loss

Tobacco’s effect on  skin appearance include

  • Facial wrinkles and furrows (eg, crows’ feet at corners of the eyes,  smoker’s lines around lips)
  • Baggy eyelids and slack jawline
  • Uneven skin coloring: grayish, yellow with prominent blood vessels (telangiectasia)
  • Dry, coarse skin.

 

 

Long term, the skin of a 40-year-old heavy smoker will resemble that of non-smoking 70-year-old. !

 

Other potential hazards from tobacco use include

  • increased risk for bacterial, yeast, and viral skin infections
  • impaired circulation increasing the risk of frostbite, Raynaud’s syndrome, and blood clots (thrombosis)
  • thrush and gingivitis

 

 

 

DermNet NZ offers this gallery of photos illustrating these ways tobacco use can damage our skin.       ALERT: These photos are graphic.

No Smoking sign with pumpkins
Ask your doctor about safe and effective ways to help you stop smoking.

 

 

 

 

 

 

 

 

A woman lifts her arms in praise at sunset
Lightstock.com photo (affiliate link)

Ultraviolet light

Basking in sunlight may enhance our mood, but too much of it can damage our skin.

The signs of photo-aging are obvious to physicians-

  • yellowing or sallowing of the skin complexion
  • dry and rough texture with wrinkling,
  • unevenly pigmented skin tone with dilated blood vessels.
  • stretched out
  • easy bruising

Photoaging is premature aging of the skin caused by repeated exposure to ultraviolet radiation (UV), primarily from the sun but also from artificial UV sources, such as tanning beds. Besides aging, excess sun exposure can cause

  • Burns
  • Rash due to increased sun sensitivity when taking certain medications
  • Cancers- skin cancers are the most common type of cancer.

 

How to limit UV light exposure 

  • Use a broad spectrum sunscreen, SPF 15 or higher
  • Wear hats, sunglasses, sun protective clothing
  • Avoid sun exposure, especially from 10 am to 4 pm
  • No tanning bed use.

Learn more about the effects of sun exposure from familydoctor.org at this link.

What sun exposure does to our skin.

 

 

 

In future posts, I’ll talk more about what hurts our skin, and what helps our skin.

As always, I appreciate your time and interest in exploring and sharing the HEART of health with me.

Dr. Aletha

 

a cute monkey checks out his face in a mirrow
We all care about our appearance, including this cute monkey. Photo by Andre Mouton on Pexels.com

a blog by Dr. Aletha Cress Oglesby

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