Welcome to Running: A FEVER. My name is Michael Davis, and this is a show about fitness, diet, and medicine. My goal is to live a long, healthy, happy, active life right up to the very end. It's all about livin' long and lovin' life.
For the last two years I have been getting sick about twice a year, usually in the spring and late summer or fall. It's kind of like a cold, with congestion, runny nose, and sore throat, but usually no fever. This normally wouldn't be that big a deal, but it takes me about six weeks to recover, sometimes more, which is a pretty big deal. The last time this happened was March of this year. I went to my primary care provider. She didn't know if it was caused by allergy or something else, but it turns out I had a really bad sinus infection. Antibiotics mostly cleared it up, but even after I started breathing again weeks later, my voice was still affected and I could feel some congestion somewhere in my sinuses. It took about two months to completely recover.
I had complained to my PCP about the fact that this happened often and about the long recovery time. So she sent me for a sinus CT scan and referred me to an ear, nose, and throat specialist, also known as an ENT doctor. The official name is otolaryngologist (pronounced oh-toe-lair-un-GAWL-uh-jist). But I'm just going to say ENT. The VA had not sent him my CT scan, but fortunately I brought the report with me just in case that happened. I'm not sure if it helped. I explained how I was getting sick for three to four months out of the year and hoped he could help me do something about it.
He asked me a lot of questions. What had I tried in the past? Had I ever used Flonase and Astelin in combination? What other medications had been prescribed? Did I have seasonal allergies? Did I have sleep apnea or another respiratory disorder? Did I have acid reflux? After all that, he concluded that I probably had recurrent sinusitis. That means I experienced inflammation, which cleared up in a few weeks, and then happened again later — repeatedly occurring, then clearing up, then recurring again. This is opposed to chronic sinusitis, which would be a continuous state of inflammation, or acute sinusitis, which would be inflammation that came on suddenly and lasted a short period of time.
Having determined this, he prescribed what he called a regimen that consisted of three things to be done on a daily basis. The first is a salt-water rinse, using a product called NeilMed Sinus Rinse. I had actually used this a number of times before. It consists of a bottle with a top designed so you can hold it up to a nostril, squeeze the bottle, forcing water to go in one nostril, wash out your nose, then go out the other nostril. Then you repeat it with the other nostril. The water is mixed with a powder that comes with the bottle (and you can get refills) that, as I understand it, is mostly salt. He emphasized that I should use distilled water, which I had not done in the past. The other difference is that I had used warm water from the tap. Now I was pouring the distilled water from a gallon jug, and it's cold. It doesn't have to be, but I haven't gone to the trouble of heating up the distilled water. It is not very pleasant. If you've ever been in a swimming pool and somehow got water up your nose, you know what it feels like. I'm supposed to do this on a daily basis to keep my sinuses free of irritants.
The other two are easier: just nasal sprays. One may be familiar. It's called Flonase, or fluticasone. This common over-the-counter medicine is a corticosteroid that works by stopping your immune system from overreacting to allergens like pollen, dust, and pet dander. It reduces swelling. Flonase targets multiple inflammatory substances rather than just histamine, which many common OTC remedies are designed to block.
The other medication is Astelin, or azelastine hydrochloride. By the way, I noticed many medications, especially OTC nasal sprays designed to just clear up the nose rather than treat the underlying condition, have HCl in the name, such as phenylephrine HCl, also known as Neo-Synephrine. I always thought these were highly diluted forms of hydrochloric acid, but that's not the case. The HCl does stand for hydrochloride, but it isn't the acid itself; the drug is combined with hydrochloric acid to form a salt that is more easily absorbed by the body. Hydrochloric acid would probably be very harmful, even in diluted doses.
Astelin is one of those OTC antihistamine remedies I mentioned before. These medicines work by binding histamine receptors, preventing the histamine from attaching and triggering allergy symptoms such as sneezing, itching, and runny nose. But azelastine also exerts a broader anti-inflammatory effect by inhibiting the synthesis and release of other inflammatory mediators, including leukotrienes, kinins, and cytokines. I remember cytokines from discussions about COVID that mentioned a cytokine storm, which is a severe, life-threatening immune system overreaction.
Two sprays of each of those, along with washing out my sinuses with a saline solution, every day. A bit inconvenient, but a lot less inconvenient than being sick for a quarter of every year — making me tired, making it hard to sleep, and making it difficult for me to sing and even record a podcast. It remains to be seen whether this treatment works. Hopefully it does. Otherwise I would expect the problem to start again around the August–September timeframe. I will report back.
But in the meantime, I suggest that if you have a similar problem, see a doctor. Your situation may not be hopeless. Don't just chalk it up to allergies or being around sick kids or something. There may be a solution.
Well, I hope this topic helped you understand a little bit more about sinus problems. There are a few references connected to this episode, and as usual you can access them at https://runningafever.com/481. Please also like the episode on YouTube if you benefited from it, and subscribe if you'd like to hear more about fitness, diet, and medicine as I seek a more healthy life.
Thanks for listening/watching. If you've got the fever, keep it burning, and if you don't, catch the fever, and I will see you next time on Running: A FEVER.