Re: Working on Recovering

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Decadron is dexmethasone, a classic, powerful corticosteroid. Whatever the steroid you use, side effects depend on the dose, but some have more side-effects than others. If you happen to use a strong dose, watch out if you experience any weird effect, like modified vision or anything suspicious, and report it to your doctor. If any loss of hearing happens, also report it (may be linked to gentamycin, although I understand this happens essentially under IV perfusion and without steroids). This being said, don't worry particularly : irrigating with steroids and gentamycin for a definite amount of time is not uncommon.http://en.wikipedia.org/wiki/Dexamethasone Biaxin is clarithromycin, a macrolide antibiotic, and the reason he put you on a low dose is that he wants to try a treatment option called "Long-Term, Low-Dose macrolide therapy", in which low-dose macrolides (or at least some of them) are supposed to have an anti-inflammatory effect when used like this. It is also often tried with azythromycin instead of clarithromycin. Normally, you are supposed to wait at least 2-3 months before seeing any effect. It may or may not work, and you will tell only by trial.see among others : Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2010 Dec;154(4):327-33.Influence of allergy on the immunomodulatory and clinical effects of long-term low-dose macrolide treatment of nasal polyposis.Peric A, Vojvodic D, Baletic N, Peric A, Miljanovic O.SourceDepartment of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia. alexneta@...AbstractAIMS:Cytokine levels in nasal secretions reflect the inflammatory status of the nasal and paranasal sinus mucosa and the development of mucosal disease. The results of previous investigations suggest that macrolide antibiotics can be effective in treatment of chronic rhinosinusitis and nasal polyposis. The aim of this prospective study was to compare the immunomodulatory and clinical effects of long-term low-dose macrolide treatment of nonatopic and atopic patients with nasal polyposis.METHODS:Forty (n = 40) patients with nasal polyposis, 22 allergic and 18 nonallergic were administered clarithromycin (CAM) 500 mg/day single oral dose for eight weeks. We measured the levels of proinflammatory Th1 cytokines TNF-α and IL-1β, Th2 cytokines IL-4, IL-5 and IL-6, and chemokine IL-8 in the nasal fluid samples, before and after treatment, using flow cytometric method. We also scored each of the 40 patients before and after therapy according to nasal symptom score and endoscopic score.RESULTS:Following treatment, we found significantly reduced levels of IL-8 (p<0.01) and TNF-α (p<0.01) in nasal secretions in nonallergic patients. In subjects with nasal polyposis and allergy, we found decreased levels of IL-8 (p<0.01), IL-6 (p<0.05) and IL-1β (p<0.01). Macrolide therapy decreased the size of polyps in 45.45% of nonatopic and in 50% of atopic patients. After macrolide treatment, we found 67.83% patients in nonallergic group and 55.55% patients in allergic group with improved nasal symptoms.CONCLUSIONS:Long-term low-dose treatment with CAM was effective in the management of nasal polyposis. Our results showed that macrolide treatment of nasal polyposis have different immunomodulatory and similar clinical effects in allergic and nonallergic patients.Regarding steroid use after surgery, it is actually supposed to improve healing ; if something burns, it will be the baby shampoo and the gentamycin, not the steroid, which on the contrary alleviates the inflammation they produce.Rhinology. 2009 Sep;47(3):280-6.Effect of corticosteroids on wound healing after endoscopic sinus surgery.Jorissen M, Bachert C.SourceENT Department, HNS, University of Leuven, Leuven, Belgium. mark.jorissen@...AbstractBACKGROUND:Approximately 20% patients with chronic rhinosinusitis undergoing Functional Endoscopic Sinus Surgery (FESS) experience impaired wound healing, leading to recurrences of sinusitis and polyps.METHODS:We investigated the efficacy of oral+ local steroids in wound healing, following FESS in subjects with a chronic rhinosinusitis with/without nasal polyps. Ninety-nine subjects were randomised to receive 6 months' treatment with mometasone furoate nasal spray (MFNS) 200 microg bid or placebo in double-blind manner approximately 2 weeks after FESS. Postoperative mean total score for several endoscopic parameters scores assessed at 6 months was calculated as the primary efficacy end-point. An endoscopic combination score (for inflammation, oedema, and polyps), a total symptoms score, and percent subjects requiring rescue medication, were assessed as secondary end-points.RESULTS:MFNS led to greater, although not significant, reductions in total endoscopic scores in all subjects, compared with placebo. The combination scores, however, indicated significantly improved healing with MFNS than with placebo for all subjects (median scores: 0.0 vs 2.0, p = 0.02), and particularly for subjects with nasal polyps (median scores: 2.0 vs 4.0, p = 0.03). The total symptom scores and percent subjects requiring rescue medication were similar in the two groups. MFNS was well tolerated.CONCLUSIONS:These results suggest that treatment with MFNS following sinus surgery may improve wound healing, particularly in subjects with nasal polyps.Regarding the amount of liquid to use, follow your doctor's directions, but also see what effect it has after a few tries. At 15ml, the idea is to fill your entire nasal cavity, to the point that it will overflow - otherwise there may be some areas that will not be treated. Of course, you are not supposed to swallow the irrigation liquid, but to spit it. After irrigating, you can also bend over forwards, face parallel to the ground, for a couple of minutes (or more) to drain any residual liquid from your sinuses.>> asfy,> > Thank you for that. I will ask my doctor again about his directions. Unless I misunderstood everything he told me, this rinse is a long term thing. I mis-quoted on the baby shampoo concentration. It is 10 ml shampoo in 1000 ml of saline. So 1% not 10. I did ask about budesonide rather than decadron but he didn't give me a clear answer. Other than, this is what has been working.> > He also put me on a low dose of Biaxin long term. I don't know how long that means, but I did get 90 days worth in the first prescription. > > I am also a little unclear about using a steroid directly on a new surgery. Won't the steroid iritate the area since it isn't healed yet? And one other question if anyone knows: How much of this solution should I be putting in my nose with my head upside down? The directions on the bottle says 15 ml per side. What? That makes me feel like I'm being water boarded Does that sound like a normal amount?> > Thanks again for the help.> > Crusher> > > From: asfy asfyso@...> samters > Sent: Saturday, April 23, 2011 9:45 AM> Subject: Re: Re: Newbie> > > > Crusher,> > 's solution (or rather, the modified 's solution that was prescribed by your ENT, because I think standard 's is just gentamycine and saline) is fine for a limited time period, such as the time it will take for your mucosa to heal from the latest surgery. You are not supposed to keep irrigating indefinitely (like, months on end) with it because : > - gentamycine will eventually select gentamycin-resistant germs,> - the corticoid will worsen the thinning of your skull bones,> - 10% baby shampoo is a high concentration of shampoo (1% is the norm) and is likely to irritate (burn) after some time.> > You may still have some bone separation between the olfactory area and your brain, but it may just be hidden between two CT scan "slices" because it is thin.>

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And thank you again for this useful information. I appreciate your helping me to understand exactly what is going on here.

This group is a treasure.

Crusher

From: asfy <asfyso@...>samters Sent: Saturday, April 23, 2011 4:02 PMSubject: Re: Re: Working on Recovering

Decadron is dexmethasone, a classic, powerful corticosteroid. Whatever the steroid you use, side effects depend on the dose, but some have more side-effects than others. If you happen to use a strong dose, watch out if you experience any weird effect, like modified vision or anything suspicious, and report it to your doctor. If any loss of hearing happens, also report it (may be linked to gentamycin, although I understand this happens essentially under IV perfusion and without steroids). This being said, don't worry particularly : irrigating with steroids and gentamycin for a definite amount of time is not uncommon.

http://en.wikipedia.org/wiki/Dexamethasone

Biaxin is clarithromycin, a macrolide antibiotic, and the reason he put you on a low dose is that he wants to try a treatment option called "Long-Term, Low-Dose macrolide therapy", in which low-dose macrolides (or at least some of them) are supposed to have an anti-inflammatory effect when used like this. It is also often tried with azythromycin instead of clarithromycin. Normally, you are supposed to wait at least 2-3 months before seeing any effect. It may or may not work, and you will tell only by trial