Firstly, let of course disclaim that I’m not a medical professional. I have no professional medical training, and my advice is probably terrible. That said, it worked for me. The impetus for writing this article is actually because, I have a sinus infection right now. You’re probably wondering why the hell should I listen to this guy if he’s suffering right now? Well, because this is the first one I’ve had one in six months. So long in fact that I forgot some of these lessons that actually have kept them at bay. I hope the lessons that I have learned on this journey can help some other people avoid some of the suffering I went through to learn them, and potentially avoid a few unnecessary surgeries.
Firstly, most of the things I used to gain the upper hand on my allergies, did not require a doctor. But a few did. One of the biggest lessons I learned during this experience is exactly what medical professionals are for. I learned how to be my own advocate and how to best make use of their professional experience. Some allergy sufferers are pretty disdainful of how the medical community handles allergies. I’m strongly of the opinion that ENTs, Doctors and other medical professions work best when you already know what you want. Each human body is very different, and an ENT has 15 minutes of time to understand you. If you understand your own body, you can make maximum use of those 15 minutes.
A little backstory, I’ve had sinus allergies since I was a little kid. I was that snot nosed kid who blew his nose ceaselessly. I had an adenoidectomy and tonsillectomy when I was very young and it helped stop a lot of the most egregious symptoms. That said, the underlying allergy of course, never went anywhere. Most of my swelling and discomfort happens because of my very deviated septum, and turbinates that are prone to swelling. You haven’t already read about your what your sinuses look like, you definitely should. The turbinates or nasal concha are more or less located directly behind your nose. Everyone’s allergies are different, unless you have the same exact problem as me, your results will probably very. That said, what worked for me will probably work for many others
1. Know your enemy
The very first thing you should do, is get an allergy test done. The biggest mistake you can make is to think that you just “have allergies”. You don’t need to go to an ENT for this test, and your GP can order it. You don’t need to take the prick test, it can now be done just as accurately through a blood test. I in fact had my most recent one done at the same time as my annual physical and blood work. Until you know exactly what you’re allergic to, it’s very hard to properly anticipate it. At the end of the day, most of us with chronic sinusitis are in fact just unfortunate enough to be allergic to something quite common. For me, it’s dust mites, I’m really allergic to dust mites. If you’re allergic to certain seasonal plants, google them and find out exactly when they bloom. Be prepared for their season and anticipate them. Many people falsely believe that cigarette smoke is an allergen, it’s actually just exacerbates all allergies regardless of your underlying allergy. If you’re an allergy sufferer, you should not ever be exposed to cigarette smoke. The biggest part of fighting chronic sinusitis is preventing the infection from occurring in the first place.
2. Know your tools
Some of the most effective tools available to you are OTC. I in fact only use one prescription product, and even then only when I know I’m about to get into an environment that I’m going to regret. The trick to over the counter medication is knowing what exactly you’re buying, and what’s in it. Medication marketing is designed to tie a set of symptoms to a magic pill. But in reality all your buying is the two generic ultra cheap products on either sides of it, at twice the price. An example of this is Clariten-D. You can buy psuedophedrine (the D) and loratadine (Clariten) for a fraction of the price as the combined Clariten-D product. Most of the products that you should have around fit into three categories. Vasoconstrictors, antihistamines, and..other.
Antihistamines work by actually stopping or mitigating the bodies release of histamines. Histamines are the chemical compound your body gives off in the presence of an allergen which cause inflammation. Once your sinuses respond to histamines we’re mostly playing catch up by then, so our goal is to either prevent us from needing them by preventing exposure, or by mitigating their effect by using antihistamines. Regardless, once you already have a sinus infection, antihistamines are more or less ineffective. The sinus infection itself is usually a result of inflammation preventing the natural flow of mucus. There are a few different types of antihistamines, most of which are OTC.
a. First Generation Anti-histamines: Benedryl (diphenhydramine) actually works be depressing your entire body. Using it exclusively would be like keeping only a sledgehammer around. I keep benedryl around but the only time you should use it is if you’re having a really bad reaction. An example would be when someone opened a vacuum bag in front of me. I knew that bad things we’re about to happen, and I also knew that either way I wasn’t getting much more done that day.
b. Second Generation Anti-histamines: Zyrtec (cetirizine) and Clariten (loratadine) both function very similarly, most people swear by one or the other. Personally, I don’t notice much difference between them. Because these antihistamines are so generalised when taken orally, I honestly never have seen any positive effects from either of them. I have however seen amazing results by delivered nasaly. Astelin (azelatine) is a second generation antihistamine that can be prescribed (make sure you don’t get astepro, yes it’s not as bitter but it’s incredibly expensive compared to the astelin generic). Maybe because my turbinates are where a lot of my problems start, but it’s the only antihistamine that I use regularly
c. Third Generation anti-histamines: Allegra (fexofenadine) is more or less a second gen, with some tweeks. If I do take an oral antihistamine it’s usually fexofenadine.
Vasoconstrictors act by causing your blood vessels to constrict. The idea is that by treating inflammation you can relieve some of what is inhibiting proper mucus flow. Once you’re already showing symptoms is when vasoconstrictors should be used. It’s very important to use them very very soon. As the longer you wait the longer the problem with compound.
a. Oxymetazoline: Commonly known as Afrin. This stuff is addictive. Literally. It’s probably the most effective tool in my toolbox, and I keep it everywhere. It’s incredible fast acting and effective. However, under no circumstances should you use it more than 3 days in a row. It is habit forming, and if you google “afrin addiction” you can read some pretty crazy stories about people becoming dependent. That said, when used preemptively or very early on, it will prevent many reactions from spiraling out of control into infections.
b. Psuedophedrine: Commonly known as sudafed. Lately because of laws that prohibit pharmacies from selling psuedophedrine in front of the counter, many drug companies have started using Phenylephrine. Unfortunately, Phenylephrine is not much more effective than a placebo. You have to go and wait in line at the pharmacy and get the real psuedophedrine if you want any real results. If you’re swelling or pain is further up in your sinues, or you’re dealing with a full on sinus infection. Oxymetazoline is not going to be satisfactory, and you’re going to need a more generalised vasoconstrictor like psuedophedrine. Notice, psuedophedrine is also what they give men suffering from priapism. So if you’re a man beware of that unintended side effect.
I don’t like steroids. They take a while to build up, and create a dependence that I’m not a fan of. They might work great for you, but for me, they just became an ineffective headache.
Whenever buying any allergy medication, never buy the brand name. These products are almost all non longer patented. In fact many times the same manufacturer makes both the generic and the brand name. Typically the brand name product will provide you half the quantity as twice of the cost. Especially if you’re a chronic sufferer that can really add up.
Tylenol and Guaifenesin are helpful to keep around. One for treating sinus pain, the other to thin out thick mucus. By the generic and have them available. Guaifenesin is not nearly as effective in the scheme of things, but if mucus is getting very thick and nasty it’s incredibly helpful to keep around just in case.
3. Know how to use your tools
Alright, at this point you’ve read a bunch of chemicals and you’re probably ready to get to the good stuff. The trick to limiting you sinus infections is three fold. 1. Prevent exposure to allergens 2. Mitigate the effect of that exposure 3. Treat symptoms aggressively and early.
a. Once you know what you’re allergic too, you need to accept that if you’re exposed to it, you’re going to have a problem. I know, it sucks. If you have even the slightest allergy, cigarette smoke will exacerbate it 100 times over. You need to spend as much time as possible allergy proving your house. To mitigate specifically whatever you’re allergic too. Don’t waste money on items that won’t specifically help you with your allergy. For example, allergy proof pillow cases and bed covers aren’t going to help much if you’re allergic to dogwood flowers. But for me, it literally represents the single biggest contribution to my recovery.
b. Anticipate exposures and load up on antihistamines early. Keep a bottle of a nasal antihistamine around at all times. Reacting quickly can mean the difference between 3 days of misery and a little sneezing.
c. Once you’ve been exposed and you can feel or sense swelling in your sinuses, take a vasoconstrictor immediately. Don’t wait until you’re already blowing your nose. By then it’s probably already too late.
Here’s an outline of what worked for me:
1. Bought a vacuum with a HEPA filter, use it to stay on top of dust accumulating
2. Bought an inexpensive HEPA filter from amazon, I run it 24/7, prevents from the dust from floating and settling
3. Bought dust mite proof bed and pillow covers (BY FAR THE BEST PURCHASE I HAVE EVER MADE)
4. Nasal antihistamines and oxymetazoline in my bag at all times, I usually use one of the two once a week, rarely more than once
5. Psuedophedrine 12HR I keep in the medicine cabinet. Psuedophedrine will keep you awake and I try to avoid it whenever possible. But it solves a very key problem. Usually if my turbinates are swollen before bed, and I lay down, they’ll stop flowing properly. By the time I wake up, it’s already too late. The mucus has dried and become infected. Psuedophedrine does a good job of keeping things flowing while I’m sleeping. Which can prevent a small inflammation from getting out of control.
Now, I know many people swear by allergy shots, and surgery. But personally, I try to avoid unnecessary surgery. It takes a lot of prudence and attentiveness to stay on top of symptoms. But now that I know what to watch for, I’m very rarely suffering. I’d like to quote a friend of mine, who responded to my question “How was the turbinate reduction surgery?”, his reply was “I’ve been shot, I’d rather be shot again than go through another turbinate reduction”. I hear a lot of people have easy surgeries, but this opinion convinced me to exhaust other options first.