My cordless hedge trimmer blades got dull and needed replacement. In retrospect, for an extra $20 I could have gotten a new trimmer and avoided the hassle of blade replacement. Instructions didn't come with the blade, and I couldn't find anything helpful in a quick Google search.
He are my tips
https://docs.google.com/file/d/0B_kuFlF9ob4GODBLTHBYY2U3aDQ/edit?usp=sharing
Sunday, September 22, 2013
Tuesday, December 18, 2012
Update on Allergies and Sinuses
I haven't had an allergy flare-up or sinus infection in more than a year now. Here are my latest thoughts in approximate order of importance:
Antibiotic Nasal Spray
I think this is the best thing I've tried lately. It goes along the same lines as the Betadine rinse (mentioned below), trying to kill/prevent bacteria without requiring a systemic antibiotic and the associated side-effects.When I feel a cold coming on, start getting nasal congestion, start noticing yellow mucus, etc. I'll use this spray for a few days. I haven't had a sinus infection since doing this. I've been using it more as a preventative measure, which is better than waiting for a full-blown sinus infection and then taking oral antibiotics.
I found some information online and spoke with my ENT.
The suggested grams of Bactroban per milliliter of saline vary from 0.0075 to 0.27 depending on the reference. I start with a 3 fluid ounce saline nasal spray bottle. This includes some preservatives, which I think is important for shelf life. I'll then squeeze a couple inches of Bactroban into the saline, either in the 3 oz. bottle, a smaller mixing bottle, or a spray pump bottle. Ultimately I want to use a pump spray (e.g. an old decongestant spray bottle) since I prefer these to the squeeze bottles usually sold with saline. They resulting concoction should be creamy white and not too thick. You don't want to clog the sprayer.
I then use three pumps per nostril twice a day. Some of it runs down the back of my throat; I try to spit this out rather than swallowing it. I'm trying to keep the antibiotic from getting into my stomach and possibly creating side-effects. I'll wake up with a little congestion and a scratchy throat from spraying just before bed. When the mucus has been clear/white for a day, I'll stop the spray.
Bactroban could also be mixed into a Neti bottle. I thought this would be really good, if my sinus passages were open, to squirt into and then leave in my sinus sloshing around. However, I don't think it is as effective as just doing the spray twice a day. It also take a lot more Bactroban cream to mix in with the Neti bottle.
Kids and Immunoglobulins
I believe my particular problem is a combination of allergies, low immunoglobulin levels, and young kids.
I've been tested every year for immunoglobulin levels since 2009. My results are always right at the low threshold for total IgG and some of the subclasses. I believe this makes it harder for me to fight off bacterial infections such as those associated with sinusitis.
I've turned up Moraxella Catarrhalis bacteria on a couple of sinus cultures. Doing some research, kids' immune systems develop by about the time they're 2 years old. Before that, they might harbor more bacteria plus they are getting viruses from other kids. It seemed like my combination of low IgG's and young kids (born in 2006 and 2008) may have led to worse sinus problems.
Had a I known what I know now (especially if the Bactroban is really effective) I think I could have saved a lot of misery back to 2006.
During Spring and Fall allergy seasons
I'm still using Nasalcrom and Ceterizine during allergy seasons, but I stop when the pollen count goes down.
Baseline Maintenance
I'm still doing allergy shots (every three weeks). I'm also back on Monelukast (Singulair) after trying to go without it for a few months. When I'm on it I have no wheezing. When I was off it I had some wheezing and wanted to use an inhaler a few times. Now that it is generic and cheaper, it'll stay in my maintenance meds.
Zinc Lozenges
I've been taking these as soon as I feel a scratchy throat coming on. They seem to be making colds shorter and less intense.
Omeprazole Antacid
I was on this for more than a year after I asked and my ENT scoped me for reflux. I then became concerned with side-effects like mineral depletion and some GI issues I was having, so I tapered off. Tapering is important (search online) because there's a risk of getting really bad acid reflux when the medicine is taken away. I tapered off 40 mg/day over a few weeks and didn't have any issues. I also haven't had any problems since.
Betadine and Baby Shampoo
This has been superseded by the Bactroban spray mentioned above. Bactroban is much less irritating and seems much more effective than Betadine. I remember one case with Betadine where it was just slowing the onset of a sinus infection. Bactroban has prevented or stopped several.
Antibiotic Nasal Spray
I think this is the best thing I've tried lately. It goes along the same lines as the Betadine rinse (mentioned below), trying to kill/prevent bacteria without requiring a systemic antibiotic and the associated side-effects.When I feel a cold coming on, start getting nasal congestion, start noticing yellow mucus, etc. I'll use this spray for a few days. I haven't had a sinus infection since doing this. I've been using it more as a preventative measure, which is better than waiting for a full-blown sinus infection and then taking oral antibiotics.
I found some information online and spoke with my ENT.
- http://www.mmpc.com/files/bactrobanrecipe.pdf
- http://www.disease-treatment.com/showthread.php?t=9699
- http://www.disease-treatment.com/showthread.php?t=9722
- http://www.midwestsinus.com/treatment/nasal_washes_rinses/types_of_nasal_rinses
The suggested grams of Bactroban per milliliter of saline vary from 0.0075 to 0.27 depending on the reference. I start with a 3 fluid ounce saline nasal spray bottle. This includes some preservatives, which I think is important for shelf life. I'll then squeeze a couple inches of Bactroban into the saline, either in the 3 oz. bottle, a smaller mixing bottle, or a spray pump bottle. Ultimately I want to use a pump spray (e.g. an old decongestant spray bottle) since I prefer these to the squeeze bottles usually sold with saline. They resulting concoction should be creamy white and not too thick. You don't want to clog the sprayer.
I then use three pumps per nostril twice a day. Some of it runs down the back of my throat; I try to spit this out rather than swallowing it. I'm trying to keep the antibiotic from getting into my stomach and possibly creating side-effects. I'll wake up with a little congestion and a scratchy throat from spraying just before bed. When the mucus has been clear/white for a day, I'll stop the spray.
Bactroban could also be mixed into a Neti bottle. I thought this would be really good, if my sinus passages were open, to squirt into and then leave in my sinus sloshing around. However, I don't think it is as effective as just doing the spray twice a day. It also take a lot more Bactroban cream to mix in with the Neti bottle.
Kids and Immunoglobulins
I believe my particular problem is a combination of allergies, low immunoglobulin levels, and young kids.
I've been tested every year for immunoglobulin levels since 2009. My results are always right at the low threshold for total IgG and some of the subclasses. I believe this makes it harder for me to fight off bacterial infections such as those associated with sinusitis.
I've turned up Moraxella Catarrhalis bacteria on a couple of sinus cultures. Doing some research, kids' immune systems develop by about the time they're 2 years old. Before that, they might harbor more bacteria plus they are getting viruses from other kids. It seemed like my combination of low IgG's and young kids (born in 2006 and 2008) may have led to worse sinus problems.
Had a I known what I know now (especially if the Bactroban is really effective) I think I could have saved a lot of misery back to 2006.
During Spring and Fall allergy seasons
I'm still using Nasalcrom and Ceterizine during allergy seasons, but I stop when the pollen count goes down.
Baseline Maintenance
I'm still doing allergy shots (every three weeks). I'm also back on Monelukast (Singulair) after trying to go without it for a few months. When I'm on it I have no wheezing. When I was off it I had some wheezing and wanted to use an inhaler a few times. Now that it is generic and cheaper, it'll stay in my maintenance meds.
Zinc Lozenges
I've been taking these as soon as I feel a scratchy throat coming on. They seem to be making colds shorter and less intense.
Omeprazole Antacid
I was on this for more than a year after I asked and my ENT scoped me for reflux. I then became concerned with side-effects like mineral depletion and some GI issues I was having, so I tapered off. Tapering is important (search online) because there's a risk of getting really bad acid reflux when the medicine is taken away. I tapered off 40 mg/day over a few weeks and didn't have any issues. I also haven't had any problems since.
Betadine and Baby Shampoo
This has been superseded by the Bactroban spray mentioned above. Bactroban is much less irritating and seems much more effective than Betadine. I remember one case with Betadine where it was just slowing the onset of a sinus infection. Bactroban has prevented or stopped several.
Tuesday, May 24, 2011
Spring Allergy Avoidance
I made it through spring allergy season without a flare-up for the first time in at least 4 years. I'm not sure which of the following made the difference, but here's what I'm thinking.
These first few seem the most likely, since I've introduced them new for this season:
1) Windows closed in our house. Last year was our first back in FL, and I didn't remember having springtime allergy problems here. So we kept the windows opened and enjoyed the fresh air. In retrospect, I was waking up a little stuffy in the days before the flare-up.
2) No outdoor exercise when the pollen count is above 8. (See below for indoor treadmill workouts.) Last year's flare-up happened after a 1-2 hour road bike ride when the pollen count was >9. That, combined with the widnows being open, was probably just too much to handle. In retrospect, I've been getting a runny nose and red eyes during workouts in the spring and fall pollen seasons. This year, I've been doing yard work outside for several hours a day on the weekends, but I think the rapid and deep breathing associated with vigorous exercise is much worse for pollen inhalation. At least one other flare-up in the spring happened after a hard run outside.
3) Nasalcrom - I've been taking it 2-4 times a day for a few weeks. In early February it seemed to hold off allergy problems when the pollen count was first starting to get high. I also used it in North Carolina when I did a mountain bike ride when the pollen count was >8.
4) Omeprazole. Dr. Witten seems to think this is helping to reduce inflammation.
Here are some other one which might be helping:
5) Allergy shots at maximum maintenance dosage every 3 weeks. I've been on shots since 2008 and reached maximum maintenance dosage in late 2008. However, after moving back to FL in 2009, the local Dr. kept me at the minimum dosage of the highest concentration in 2010 until I pressed him to ramp back up last summer. Perhaps now that I've been on shots for a few years they're working. I'm also thinking it helps to not be ramping up or getting shots every week. I think my summer/fall was worse than usual because I was ramping back up again.
6) Betadine / shampoo sinus rinse mentioned in a previous post. I was using a saline rinse a lot last year to flush out the pollen but still had a problem. Maybe the new rinse is helping to reduce inflammation, bacterial load, etc.
7) Zyrtec/ceterizine nightly. I did this last year and still had problems.
8) Omnaris 2x per nostril in the morning. I've been on a nasal steroid for a few years and still had problems.
9) Avoiding MSG. The past two flare-ups in spring and fall had at least 2 things in common. The first was lots of outdoor exposure either on a bike ride or at a football game. The second was eating a lot of snack food containing MSG (cheesy puffs, Chex mix). At this point I'm going to try everything I can to avoid a flare-up.
10) Zinc lozenges. There's been some recent research showing they help to reduce the duration and intensity of colds. I've tried them when I've been exposed to people with colds, and they seem to be helping.
Indoor Workouts
Doing no outdoor exercise in pollen season seemed like a substantial tradeoff to avoid a flare up. When the weather is nice in the spring and fall is exactly the time when I want to be outside running, riding my bike, etc. Here are some things to try inside:
1) Treadmill hill repeats. I checked the elevation change and distance for several climbs I like, e.g. Dark Mountain Trail in NC, Acost Bridge, Usina Bridge, etc. From this data I calcualted average grades. I then experimented with these on a treadmill. The average grades were around 4-5% for 0.3-1.0 mile distances. Of course, the instant grade varies throughout the climb and is usually steeper at the beginning and end. Just doing 4% on the treadmill didn't seem as challenging and didn't seem to stress my leg muscles in the same way. 6% was closer. Starting at 8%, then going to 4%, then back to 8% also seemed pretty good. 10-5-10% seemed a little too much.
2) Treadmill speed repeats. I like getting loose at an easy run pace, then doing 1/4-mile repeats in the 8 mph range, then doing 1/8-mile repeats in the 9-11 mph range.
3) Long treadmill runs - I put in a DVD and watch a full moving. Otherwise long treadmill runs are agonizing.
4) Speed ramps - Especially when I've getting back into running, starting out at 6 mph and increasing by 0.2 or 0.3 mph every 1/4 mile lets me get in a good workout without starting too fast. I can stop the ramp based on how I feel or heart rate.
5) 5K time trials. To see the effects of the speed and hill work (done during the week) I did 5K time trials on the treadmill on the weekend. I decreased my time each week for several weeks in a row and set a new indoor/treadmill personal best this year. At first I tried increasing speed like the aforementioned speed ramp run, then I came up with some more structured speeds. I do better with varying speed than just running the same page for a 5K.
These first few seem the most likely, since I've introduced them new for this season:
1) Windows closed in our house. Last year was our first back in FL, and I didn't remember having springtime allergy problems here. So we kept the windows opened and enjoyed the fresh air. In retrospect, I was waking up a little stuffy in the days before the flare-up.
2) No outdoor exercise when the pollen count is above 8. (See below for indoor treadmill workouts.) Last year's flare-up happened after a 1-2 hour road bike ride when the pollen count was >9. That, combined with the widnows being open, was probably just too much to handle. In retrospect, I've been getting a runny nose and red eyes during workouts in the spring and fall pollen seasons. This year, I've been doing yard work outside for several hours a day on the weekends, but I think the rapid and deep breathing associated with vigorous exercise is much worse for pollen inhalation. At least one other flare-up in the spring happened after a hard run outside.
3) Nasalcrom - I've been taking it 2-4 times a day for a few weeks. In early February it seemed to hold off allergy problems when the pollen count was first starting to get high. I also used it in North Carolina when I did a mountain bike ride when the pollen count was >8.
4) Omeprazole. Dr. Witten seems to think this is helping to reduce inflammation.
Here are some other one which might be helping:
5) Allergy shots at maximum maintenance dosage every 3 weeks. I've been on shots since 2008 and reached maximum maintenance dosage in late 2008. However, after moving back to FL in 2009, the local Dr. kept me at the minimum dosage of the highest concentration in 2010 until I pressed him to ramp back up last summer. Perhaps now that I've been on shots for a few years they're working. I'm also thinking it helps to not be ramping up or getting shots every week. I think my summer/fall was worse than usual because I was ramping back up again.
6) Betadine / shampoo sinus rinse mentioned in a previous post. I was using a saline rinse a lot last year to flush out the pollen but still had a problem. Maybe the new rinse is helping to reduce inflammation, bacterial load, etc.
7) Zyrtec/ceterizine nightly. I did this last year and still had problems.
8) Omnaris 2x per nostril in the morning. I've been on a nasal steroid for a few years and still had problems.
9) Avoiding MSG. The past two flare-ups in spring and fall had at least 2 things in common. The first was lots of outdoor exposure either on a bike ride or at a football game. The second was eating a lot of snack food containing MSG (cheesy puffs, Chex mix). At this point I'm going to try everything I can to avoid a flare-up.
10) Zinc lozenges. There's been some recent research showing they help to reduce the duration and intensity of colds. I've tried them when I've been exposed to people with colds, and they seem to be helping.
Indoor Workouts
Doing no outdoor exercise in pollen season seemed like a substantial tradeoff to avoid a flare up. When the weather is nice in the spring and fall is exactly the time when I want to be outside running, riding my bike, etc. Here are some things to try inside:
1) Treadmill hill repeats. I checked the elevation change and distance for several climbs I like, e.g. Dark Mountain Trail in NC, Acost Bridge, Usina Bridge, etc. From this data I calcualted average grades. I then experimented with these on a treadmill. The average grades were around 4-5% for 0.3-1.0 mile distances. Of course, the instant grade varies throughout the climb and is usually steeper at the beginning and end. Just doing 4% on the treadmill didn't seem as challenging and didn't seem to stress my leg muscles in the same way. 6% was closer. Starting at 8%, then going to 4%, then back to 8% also seemed pretty good. 10-5-10% seemed a little too much.
2) Treadmill speed repeats. I like getting loose at an easy run pace, then doing 1/4-mile repeats in the 8 mph range, then doing 1/8-mile repeats in the 9-11 mph range.
3) Long treadmill runs - I put in a DVD and watch a full moving. Otherwise long treadmill runs are agonizing.
4) Speed ramps - Especially when I've getting back into running, starting out at 6 mph and increasing by 0.2 or 0.3 mph every 1/4 mile lets me get in a good workout without starting too fast. I can stop the ramp based on how I feel or heart rate.
5) 5K time trials. To see the effects of the speed and hill work (done during the week) I did 5K time trials on the treadmill on the weekend. I decreased my time each week for several weeks in a row and set a new indoor/treadmill personal best this year. At first I tried increasing speed like the aforementioned speed ramp run, then I came up with some more structured speeds. I do better with varying speed than just running the same page for a 5K.
Sunday, February 27, 2011
Visio printing defaults
Visio 2007 was causing a maddening problem where it would insist on printing to the rear tray (manual feed) on my Canon MX860 rather than the bottom cassette. It was the only application doing this. Setting the print options through the usual File...Print...Properties... had no effect. Setting the printer defaults through start...Printers and Faxes...[printer name]...Printing Preferences... also didn't help. It was getting to be a "PC LOAD LETTER?! WTF?!" situation.
I found similar questions/complaints in several online forums but no answer. Rather than registering for each forum with my solution, here's what worked for me:
On each worksheet,
select File...Page Setup...
Setup...
Source = Cassette
Verify this setting by checking File...Print...Properties
I found similar questions/complaints in several online forums but no answer. Rather than registering for each forum with my solution, here's what worked for me:
On each worksheet,
select File...Page Setup...
Setup...
Source = Cassette
Verify this setting by checking File...Print...Properties
Thursday, February 24, 2011
Allergies and Sinuses
Quick History
I've had nasal allergy problems for pretty much my whole life. When I was young this was probably a big contributor to many ear infections and subsequent surgery for ear tubes and removal of my tonsils and adenoids. When I was probably 8-12 years old I had constant stuffiness, runny nose, etc. In retrospect, it was really nasty. Then I did allergy immunotherapy shots and was introduced to the first non-sedating antihistamines - these let me get through most of high school and college with few issues. But things started getting much worse again about 4 years ago due to a number of reasons.
I'll go into more detail later but wanted to provide some initial advice. The usual disclaimers apply about me not being a Dr., you seeking the advice of your Dr., etc. But I've been through a lot and hopefully this can help someone.
Control Allergies
It seems that allergies which are out-of-control, with frequent flare-ups that cause inflammation, mucus, etc. can lead to sinus problems that become chronic. One example seems to be sinus and nasal polyps - these are non-cancerous growths in mucus membranes. Eventually they can get big enough to cause problematic obstructions which lead to infections and misery.
Start with antihistamines like Fexofenadine (Allegra), Loratadine (Claritin), and Cetirizine (Zyrtec). If these don't clear up sneezing, runny nose, itchy red eyes, etc. try Diphenhydramine (Benadryl). If these don't work, talk to a Dr. In my case, something (usually visits to NE Florida) was triggering flare-ups so bad that even Benadryl wouldn't really stop the syptoms, it just let me sleep. This was an example of not controlling my allergies.
Establish a relationship with an allergist and get tested. Skin prick testing is the gold standard. For me this highlighted allergies to many animals, trees, grass, dust mites, etc. This information will help you avoid triggers. It is also necessary to start allergy immunotherapy. I believe the shots worked well for me as a kid. They also seem to have worked well lately for controlling the histamine-related symptoms (sneezing, runny nose, itchy red eyes) but not necessarily the nasal and sinus inflammation.
Sinusitis
My problem became sinus inflammation, triggered by allergies or a cold (more common with two young kids), which interrupted the natural ventilation to my sinuses and resulted in sinus infections. The pattern became very repeatable over 3 years every few months:
1) Initial trigger
2) A few days of initial symptoms (sneezing, runny nose, itchy red eyes, perhaps a low fever and aches, feeling tired)
3) Initial symptoms subside but are replaced by sinus inflammation (congestion, headache, yellow post-nasal discharge, irritability)
4) Inflammation and related symptoms persist until an oral antibiotic is prescribed. This could be 10-20 days.
5) Within a few days the symptoms clear up. Within 10-14 days everything is fine.
Otolaryngologist "ENT"
My multiple sinus infections and history of childhood problems pushed me towards an ENT. ENT's are useful for a number of things, but you need to find a good one. I've seen at least 5 in as many years due to moving and having trouble finding good help. There are basically two types. One type is primary interested in screening for surgical candidates. My experience with these has been very negative. Since my anatomy isn't quite bad enough (but still problematic), I do clear up between episodes, and I have a history of allergy and borderline-low immune tests, I'm not a surgical candidate. This is actually good - I'd rather not have unnecessary surgery which may not help my problem or may need revision later. However, at least two of these types of ENT's have been totally unhelpful after determining that I'm not a candidate for surgery.
The second type of ENT's are better defined as people who really care about patients and just happen to focus on ENT. Two examples are Dr. Witten in St. Augustine, FL and Dr. Yetter in Winston-Salem, NC. The can do helpful things like:
Order and read CT scans to look for anatomical problems, polyps, infection, etc.
Swab nasal passages near the sinus openings, send the mucus off for culture, and try to determine what's causing the infection. For me it was Moraxella Catarrhalis, for which there isn't a vaccine and which apparently is common on young kids (correlates with the infections popping up after my son was born) and the 3rd leading cause of sinus infections.
Prescribe appropriate antibiotics, even give you a supply to have on hand in case of a flare up so you don't have to make an appointment. GP's and allergists can also do this. After I built a history backed up by lab tests, Dr.'s were much more receptive to meeting my needs. I was concerned about reducing the time to feel better and also the potential to have a flare-up while on travel.
Endoscopic evaluation to look for anatomical problems, evidence of acid reflux, etc. In my case, we (my ENT and I) began to suspect acid reflux was a contributor. I've been on opeprazole for a couple of months now, and it seems to help.
Provide a 2nd opinion on allergy medication
Prescribe prednisone to (hopefully) reduce allergic inflammation
My main point is, if you have sinus problems, find an ENT who will work with you. It may take a few tries. Treat your initial appointment partially as you interviewing the Dr.
Sinusitis Suggestions
1) Advil and caffeine help with headache and malaise.
2) Oral decongestants like pseudoephedrine and phenylephrine may help a little but certainly didn't help enough. I was hoping some combination of oral and nasal decongestants would reduce the swelling, open up my sinuses, and allow the to drain normally but this never happened. Be careful of pseudoephedrine. For me it caused my blood pressure to go up by 10-20 mmHg, insomnia, worse irritability, and weight loss if taken for many days. I also think it contributed to some very bad headaches.
3) Nasal spray decongestants never seemed to help enough either, plus I was always trying to avoid using them because of the rebound congestion problems associated with use for more than 3 days.
4) Neti pot / sinus rinse bottle. Some people swear by these. They were never enough for me, perhaps because if the nasal and sinus passages are so swollen, nothing will get in/out. The bottle was better than the pot because it has positive pressure, more than just gravity.
5) One thing that does seem to help with the sinus rinse bottle is adding 4 drops of Johnson & Johnson Baby Shampoo along with 10 drops of Betadine. The idea is that the shampoo acts as a surfactant to break up any biofilms where bacteria form a protective layer around their colony. The Betadine is an antiseptic which shold help reduce infection. Only about 10 drops (very slight reddish color to the saline) of Betadine can be used since it irritates mucus membranes in higher concentration. For me, this mixture seems to keep my sinuses healthier between flare-ups. It may have allowed one flare-up to clear without an infection. It seemed to reduce the severity of another infection but didn't totally clear it.
6) Establish a relationship with a GP, allergist, and/or ENT to have antibiotics, prednisone, etc. on hand for flare-ups. I often had to wait a couple of weeks to start antibiotics. After a couple of years it was just a waiting game. Now I have something on hand and can start when I'm convinced an infection has set in, saving days/weeks of misery. I am also trying this with prednisone now to see if I can avoid an infection setting in.
Wheezing and Chest Symptoms
In addition to the nasal problems, I also have a history of some wheezing and lung problems. My childhood ENT, upon my coming back to him 20 years later, remarked, "Yeah, I can remember you had a lot of problems...breathing." I vividly recall 2 incidents as a kid, once when my lungs totally seized up from exposure to polyurethane vapors resulting in a rush to the ER and another when I ended up in an oxygen tent in the hospital from some kind of bronchitis. For me it seems to be allergy-induced wheezing and tightness, not necessarily classical asthma. When not symptomatic, I pass lung function tests just fine.
I ended up with asthma-like symptoms in college when exercising outdoors, especially when the air was cool and dry. This is classified as exercise-induced asthma. For a few years I used an albuterol inhaler which did a pretty good job. Then I tried Singulair. It didn't seem to do anything for my nasal/sinus symptoms, but it seems to have totally solved my exercise-induced asthma.
What didn't work for me
The following were ideas I found while searching the net or in the pharmacy, often when I was slammed with another sinus infection, but which didn't seem to work.
Colloidal silver, grapefruit seed extract, and other sinus rinse additives
Steam, tea, soup, etc.
Sinupret
Switching steroid nasal sprays (Beconase, Veramyst, Omnaris, Nasonex)
Vitamin C in various forms
Reducing the duration, intensity, and/or frequency of exercise
Post-exercise recovery drinks
Distilled water for sinus rinse
Mucinex
Dust mite bedding spray
Xyzal (vs. generic ceterizine)
Astelin, Astepro (doesn't help inflammation, caused drowsiness)
Omega-3 / fish oil
To discuss later
Food allergies, sensitivities, MSG
Limiting outdoor exercise in pollen season
Immune tests and pneumovax
Sinus irrigation, sloshing, and draining
Monitoring pollen
I've had nasal allergy problems for pretty much my whole life. When I was young this was probably a big contributor to many ear infections and subsequent surgery for ear tubes and removal of my tonsils and adenoids. When I was probably 8-12 years old I had constant stuffiness, runny nose, etc. In retrospect, it was really nasty. Then I did allergy immunotherapy shots and was introduced to the first non-sedating antihistamines - these let me get through most of high school and college with few issues. But things started getting much worse again about 4 years ago due to a number of reasons.
I'll go into more detail later but wanted to provide some initial advice. The usual disclaimers apply about me not being a Dr., you seeking the advice of your Dr., etc. But I've been through a lot and hopefully this can help someone.
Control Allergies
It seems that allergies which are out-of-control, with frequent flare-ups that cause inflammation, mucus, etc. can lead to sinus problems that become chronic. One example seems to be sinus and nasal polyps - these are non-cancerous growths in mucus membranes. Eventually they can get big enough to cause problematic obstructions which lead to infections and misery.
Start with antihistamines like Fexofenadine (Allegra), Loratadine (Claritin), and Cetirizine (Zyrtec). If these don't clear up sneezing, runny nose, itchy red eyes, etc. try Diphenhydramine (Benadryl). If these don't work, talk to a Dr. In my case, something (usually visits to NE Florida) was triggering flare-ups so bad that even Benadryl wouldn't really stop the syptoms, it just let me sleep. This was an example of not controlling my allergies.
Establish a relationship with an allergist and get tested. Skin prick testing is the gold standard. For me this highlighted allergies to many animals, trees, grass, dust mites, etc. This information will help you avoid triggers. It is also necessary to start allergy immunotherapy. I believe the shots worked well for me as a kid. They also seem to have worked well lately for controlling the histamine-related symptoms (sneezing, runny nose, itchy red eyes) but not necessarily the nasal and sinus inflammation.
Sinusitis
My problem became sinus inflammation, triggered by allergies or a cold (more common with two young kids), which interrupted the natural ventilation to my sinuses and resulted in sinus infections. The pattern became very repeatable over 3 years every few months:
1) Initial trigger
2) A few days of initial symptoms (sneezing, runny nose, itchy red eyes, perhaps a low fever and aches, feeling tired)
3) Initial symptoms subside but are replaced by sinus inflammation (congestion, headache, yellow post-nasal discharge, irritability)
4) Inflammation and related symptoms persist until an oral antibiotic is prescribed. This could be 10-20 days.
5) Within a few days the symptoms clear up. Within 10-14 days everything is fine.
Otolaryngologist "ENT"
My multiple sinus infections and history of childhood problems pushed me towards an ENT. ENT's are useful for a number of things, but you need to find a good one. I've seen at least 5 in as many years due to moving and having trouble finding good help. There are basically two types. One type is primary interested in screening for surgical candidates. My experience with these has been very negative. Since my anatomy isn't quite bad enough (but still problematic), I do clear up between episodes, and I have a history of allergy and borderline-low immune tests, I'm not a surgical candidate. This is actually good - I'd rather not have unnecessary surgery which may not help my problem or may need revision later. However, at least two of these types of ENT's have been totally unhelpful after determining that I'm not a candidate for surgery.
The second type of ENT's are better defined as people who really care about patients and just happen to focus on ENT. Two examples are Dr. Witten in St. Augustine, FL and Dr. Yetter in Winston-Salem, NC. The can do helpful things like:
Order and read CT scans to look for anatomical problems, polyps, infection, etc.
Swab nasal passages near the sinus openings, send the mucus off for culture, and try to determine what's causing the infection. For me it was Moraxella Catarrhalis, for which there isn't a vaccine and which apparently is common on young kids (correlates with the infections popping up after my son was born) and the 3rd leading cause of sinus infections.
Prescribe appropriate antibiotics, even give you a supply to have on hand in case of a flare up so you don't have to make an appointment. GP's and allergists can also do this. After I built a history backed up by lab tests, Dr.'s were much more receptive to meeting my needs. I was concerned about reducing the time to feel better and also the potential to have a flare-up while on travel.
Endoscopic evaluation to look for anatomical problems, evidence of acid reflux, etc. In my case, we (my ENT and I) began to suspect acid reflux was a contributor. I've been on opeprazole for a couple of months now, and it seems to help.
Provide a 2nd opinion on allergy medication
Prescribe prednisone to (hopefully) reduce allergic inflammation
My main point is, if you have sinus problems, find an ENT who will work with you. It may take a few tries. Treat your initial appointment partially as you interviewing the Dr.
Sinusitis Suggestions
1) Advil and caffeine help with headache and malaise.
2) Oral decongestants like pseudoephedrine and phenylephrine may help a little but certainly didn't help enough. I was hoping some combination of oral and nasal decongestants would reduce the swelling, open up my sinuses, and allow the to drain normally but this never happened. Be careful of pseudoephedrine. For me it caused my blood pressure to go up by 10-20 mmHg, insomnia, worse irritability, and weight loss if taken for many days. I also think it contributed to some very bad headaches.
3) Nasal spray decongestants never seemed to help enough either, plus I was always trying to avoid using them because of the rebound congestion problems associated with use for more than 3 days.
4) Neti pot / sinus rinse bottle. Some people swear by these. They were never enough for me, perhaps because if the nasal and sinus passages are so swollen, nothing will get in/out. The bottle was better than the pot because it has positive pressure, more than just gravity.
5) One thing that does seem to help with the sinus rinse bottle is adding 4 drops of Johnson & Johnson Baby Shampoo along with 10 drops of Betadine. The idea is that the shampoo acts as a surfactant to break up any biofilms where bacteria form a protective layer around their colony. The Betadine is an antiseptic which shold help reduce infection. Only about 10 drops (very slight reddish color to the saline) of Betadine can be used since it irritates mucus membranes in higher concentration. For me, this mixture seems to keep my sinuses healthier between flare-ups. It may have allowed one flare-up to clear without an infection. It seemed to reduce the severity of another infection but didn't totally clear it.
6) Establish a relationship with a GP, allergist, and/or ENT to have antibiotics, prednisone, etc. on hand for flare-ups. I often had to wait a couple of weeks to start antibiotics. After a couple of years it was just a waiting game. Now I have something on hand and can start when I'm convinced an infection has set in, saving days/weeks of misery. I am also trying this with prednisone now to see if I can avoid an infection setting in.
Wheezing and Chest Symptoms
In addition to the nasal problems, I also have a history of some wheezing and lung problems. My childhood ENT, upon my coming back to him 20 years later, remarked, "Yeah, I can remember you had a lot of problems...breathing." I vividly recall 2 incidents as a kid, once when my lungs totally seized up from exposure to polyurethane vapors resulting in a rush to the ER and another when I ended up in an oxygen tent in the hospital from some kind of bronchitis. For me it seems to be allergy-induced wheezing and tightness, not necessarily classical asthma. When not symptomatic, I pass lung function tests just fine.
I ended up with asthma-like symptoms in college when exercising outdoors, especially when the air was cool and dry. This is classified as exercise-induced asthma. For a few years I used an albuterol inhaler which did a pretty good job. Then I tried Singulair. It didn't seem to do anything for my nasal/sinus symptoms, but it seems to have totally solved my exercise-induced asthma.
What didn't work for me
The following were ideas I found while searching the net or in the pharmacy, often when I was slammed with another sinus infection, but which didn't seem to work.
Colloidal silver, grapefruit seed extract, and other sinus rinse additives
Steam, tea, soup, etc.
Sinupret
Switching steroid nasal sprays (Beconase, Veramyst, Omnaris, Nasonex)
Vitamin C in various forms
Reducing the duration, intensity, and/or frequency of exercise
Post-exercise recovery drinks
Distilled water for sinus rinse
Mucinex
Dust mite bedding spray
Xyzal (vs. generic ceterizine)
Astelin, Astepro (doesn't help inflammation, caused drowsiness)
Omega-3 / fish oil
To discuss later
Food allergies, sensitivities, MSG
Limiting outdoor exercise in pollen season
Immune tests and pneumovax
Sinus irrigation, sloshing, and draining
Monitoring pollen
"Mountain Biking" in NE Florida
OK, there simply isn't mountain biking in NE Florida. With the exception of dunes, this area is totally flat. Getting any kind of hills means going west or riding a bridge. Here are the closest good things I've ridden:
Graham Swamp near Palm Coast
http://www.sjrwmd.com/recreationguide/grahamswamp/index.html
Who would have thought the best nearby trail would be in Flaglar County? Apparently the hilliness is the result of limestone excavation. Park off Colbert Road. The climbs and downhills are short relative to what I like from North Carolina. The sand can be annoying. But if ridden fast this is actually a decent trail. Thanks to the folks who built and maintain it.
Belleview / Santos near Ocala
http://omba.org/index.php/Trailhead-Locations.html
The hilliness on these trails is from a combination of slight elevation changes in the middle of the state plus quarries. I haven't ridden there recently, but it was good a few years ago.
St. Augustine and Jacksonville bridges
Good thing I took up road biking a few years ago.
The Acosta (State Road 13) bridge in Jacksonville gets steep enough (6% maybe) to be a good challenge for running or biking. The climbs are about 0.35 miles. The climbs start steep, taper off a bit in the middle, then pick up again near the end. Parking near the Museum of Science and History works well. There's a disorganized group ride here on Thursday nights in the daylight saving season.
The Usina (A1A) bridge linking St. Augustine to Vilano Beach is also a decent challenge. It has about the same grade as the Acosta but it slightly longer. The views of the intercoastal waterway and ocean are very nice. The seabreeze can add an additional challenge and one direction.
Graham Swamp near Palm Coast
http://www.sjrwmd.com/recreationguide/grahamswamp/index.html
Who would have thought the best nearby trail would be in Flaglar County? Apparently the hilliness is the result of limestone excavation. Park off Colbert Road. The climbs and downhills are short relative to what I like from North Carolina. The sand can be annoying. But if ridden fast this is actually a decent trail. Thanks to the folks who built and maintain it.
Belleview / Santos near Ocala
http://omba.org/index.php/Trailhead-Locations.html
The hilliness on these trails is from a combination of slight elevation changes in the middle of the state plus quarries. I haven't ridden there recently, but it was good a few years ago.
St. Augustine and Jacksonville bridges
Good thing I took up road biking a few years ago.
The Acosta (State Road 13) bridge in Jacksonville gets steep enough (6% maybe) to be a good challenge for running or biking. The climbs are about 0.35 miles. The climbs start steep, taper off a bit in the middle, then pick up again near the end. Parking near the Museum of Science and History works well. There's a disorganized group ride here on Thursday nights in the daylight saving season.
The Usina (A1A) bridge linking St. Augustine to Vilano Beach is also a decent challenge. It has about the same grade as the Acosta but it slightly longer. The views of the intercoastal waterway and ocean are very nice. The seabreeze can add an additional challenge and one direction.
Kerr Scott Mountain Bike Trails
Here's some really good singletrack in North Carolina.
http://www.bmcc.us/kerr_scott.htm
I used to ride the Dark Mountain trail when I lived in NC and then rode the Overmountain Victory Trail as it was being built. After moving to FL in 2009, I got the chance to ride these trails again last weekend. The Warrior Creek Trail was new to me and really impressive. The trail builders have done a wonderful job of building and maintaining the trails. I regret that I've never helped them
There are three things I really like in a mountain bike trail: a good rhythm, sustained climbs, and challenging but not ridiculous downhills. By rhythm I mean that the trail isn't obstructed to the point that I have to stop a lot and get off my bike. A 5-7 mile loop is perfect. The combination of sustained climbs and a challenging downhill mean the trail is distracting enough that my mind isn't wandering onto topics like work while I'm riding - I'm really focused on the ride and getting a good workout. The trails at Kerr Scott meet my needs.
The Dark Mountain trail feels a lot like the trails I used to ride in Greensboro/Winston-Salem, e.g. Hobby Park, Country Park, and Owl's Roost. Dark Mountain is just better - longer climbs, longer downhills, and almost no annoying roots.
Warrior Creek reminds me a lot of Tsali, probably because it follows the lake shoreline much like Tsali.Warrior Creek had some steep, short undulations outside of the long climbs which made it more challenging than Tsali
Since there are about 26 miles of trail now, wrapped around a lake, with campsites, a comparison to Tsali seems reasonable. There are a few things more appealing about Tsali vs. Kerr Scott. All four of the Tsali trails can be ridden right from the parking lot and campsites. I don't see how this is easily done at Kerr Scott, but the Overmountain Victory Trail could be used to get from camping to Dark Mountain. Tsali also has some longer climbs and descents, and better views.
http://www.bmcc.us/kerr_scott.htm
I used to ride the Dark Mountain trail when I lived in NC and then rode the Overmountain Victory Trail as it was being built. After moving to FL in 2009, I got the chance to ride these trails again last weekend. The Warrior Creek Trail was new to me and really impressive. The trail builders have done a wonderful job of building and maintaining the trails. I regret that I've never helped them
There are three things I really like in a mountain bike trail: a good rhythm, sustained climbs, and challenging but not ridiculous downhills. By rhythm I mean that the trail isn't obstructed to the point that I have to stop a lot and get off my bike. A 5-7 mile loop is perfect. The combination of sustained climbs and a challenging downhill mean the trail is distracting enough that my mind isn't wandering onto topics like work while I'm riding - I'm really focused on the ride and getting a good workout. The trails at Kerr Scott meet my needs.
The Dark Mountain trail feels a lot like the trails I used to ride in Greensboro/Winston-Salem, e.g. Hobby Park, Country Park, and Owl's Roost. Dark Mountain is just better - longer climbs, longer downhills, and almost no annoying roots.
Warrior Creek reminds me a lot of Tsali, probably because it follows the lake shoreline much like Tsali.Warrior Creek had some steep, short undulations outside of the long climbs which made it more challenging than Tsali
Since there are about 26 miles of trail now, wrapped around a lake, with campsites, a comparison to Tsali seems reasonable. There are a few things more appealing about Tsali vs. Kerr Scott. All four of the Tsali trails can be ridden right from the parking lot and campsites. I don't see how this is easily done at Kerr Scott, but the Overmountain Victory Trail could be used to get from camping to Dark Mountain. Tsali also has some longer climbs and descents, and better views.
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