Dr. Zorba Paster: When sinus problem persists, time for a second opinion
Dear Doc: Six months ago, I had deviated septum surgery. Since I’ve had the surgery, my nose feels plugged up. I go to blow it, and I get air out but no snot. If I snort my nose, I can hack it out. I do this all day, spitting it out into Kleenex. My nose is dry, and I have little taste or smell. I breathe through my mouth now, especially if I am doing any activity. I have gone back to the ear, nose and throat doctor. The first visit, he said everything was fine and I couldn’t have those symptoms. The second visit, he loaded me up with antibiotics, prednisone and nose spray.
It was no better when I went back for a third visit. He did a scan and said everything looks fine. On that visit, he told me to add Alkalol nasal wash to my twice-a-day netti pot rinse. I still snort and hack all day. I have lost all quality of life and am physically worn out.
Do you have any suggestions or know of anything that will help me. Thank you so much. Love you on NPR and in The Spokesman-Review newspaper. – C.W., from Spokane Valley, Washington
Dear C.W.: Whew. You are clearly suffering, and those extra visits to your doctor didn’t seem to help at all. Looks to me like you’ve tried the whole nine yards – antibiotics, steroids, nasal sprays, scans – and you’re still having problems.
Unfortunately, this can be the case with nasal and sinus symptoms, where you’ve done everything but nothing seems to work. In these situations, I ask myself: What would I do if it were me or one of my family members?
I would get a second opinion. I would go to a research institution, where problems like this are vetted out.
And you have that in Spokane with the Elson S. Floyd College of Medicine, which is part of Washington State University. It’s a good place to start. Your problem is not a simple one, so that’s where a tertiary institution comes into play.
Dear Doc: I’m a 50-year-old guy who needs a colonoscopy, at least that’s what my doctor and my wife say. I exercise, I eat right, I have no family history of colon cancer. I hate the idea of drinking all that stuff. Any suggestions? – B.C., from Manitowoc
Dear B.C.: Yes, drinking all that stuff to prepare for a colonoscopy is a drag, but having colon cancer is a bigger drag, believe me.
The present recommendations are to have this test every 10 years, but that might be too often. A landmark study published in the Annals of Internal Medicine showed that having a single negative screening colonoscopy was associated with a 90% reduced in death from colon cancer for as long as 17 years. The new study was a biggie – it followed more than 165,000 patients over time. This is strong data.
Current guidelines recommend a 10-year interval between negative screening colonoscopies for average-risk adults. This recommendation is based on estimates of time between the development of a pre-cancerous adenoma and cancer. It migth be time to make changes in the colonoscopy recommendations to once every 17 years for normal risk adults with one negative screening. Now that would be nice.
Now, if you don’t want a colonoscopy, you can do a fecal immunochemical stool test. The FIT test, when done yearly, is nearly as good as a colonoscopy in normal risk individuals. Then there is the Exact Sciences Cologuard test, a DNA test done on your stool. At present, the recommendation is to do it every three years.
There is something else on the horizon – a blood test called CellMax. Preliminary research shows that testing blood for three distinct cancer markers had a 90% sensitivity for picking up colon cancer. The test involves detecting gastrointestinal cancer cells that are circulating in the blood. Clearly this would be a game changer.
My spin: There are many ways you can test for colon cancer. What’s important is to get off your butt and get it done. Stay well.
Dr. Zorba Paster is a family physician and host of the public radio program “Zorba Paster on Your Health.” He can be reached at askzorba@doctorzorba.com.