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Chronic Sinusitis: Functional Wellness Mindset

Updated: Dec 1, 2021

This is a great distinguisher between the functionally-minded and the conventionally-minded. Let me explain why. Chronic sinusitis is one of the most common reasons individuals seek medical care. It is currently the most common respiratory condition in the world. One in seven individuals suffer chronic sinusitis inflammation. It is second only to arthritis among the most common chronic diseases affecting women and the fourth most common chronic disease in men, behind hypertension, hearing impairment and arthritis. No surprise, the fourth most common chronic condition is allergic rhinitis, then asthma is the eighth, and bronchitis the ninth. When you combine sinusitis with allergic rhinitis, asthma, and chronic bronchitis (which one in three suffer at some point) you have the first environmental #epidemic. In the 1960s, none of these four respiratory conditions were among the top 10 chronic health problems. The conventionally-minded don't ask why, they ask for antibiotics.

Our modern day plague is pollution. Our toxic environment is destroying the respiratory tract. Sixty percent of Americans currently live in areas where the air quality makes breathing a risk to their health. Tens of thousands of Americans die each year from toxic air in their environment. People who live in highly polluted areas die fifteen percent earlier than had they been in a more clean #environment. This pollution may also include carbon monoxide, ozone, sulfur dioxide, nitrogen dioxide, hydrocarbons, and lead. Is part of our pandemic improvement or containment efforts addressing environmental pollutions?

Our First Line of Defense

Our respiratory system is our air filter. It humidifies and regulates the temperature of the air we breathe. This is in many ways our first line of defense. Bacteria, viruses, pollen, animal dander, cigarette smoke, dust, chemicals, automobile exhaust, and essentially anything you smell is potentially toxic to your health and wellness. Most of this regulation actually happens in the nose and sinuses, as it is the entrance to the respiratory tract.

Although the body is self-healing, and self-rejuvenating, it requires rest and recovery. The primary challenge in healing is not only do we remain within these toxic environments, but we continue to demand of the respiratory system while it tries to self-repair. We aren't able to rest our lungs as we would our broken leg. Air indoors is also dry and often more polluted than outdoors, so especially in the cooler months, we inflame and irritate our respiratory system which often leads to chronic inflammation. When chronically inflamed, we are weak and therefore vulnerable to cold viruses, the most common trigger for sinus infections. No wonder we are suffering a #COVID pandemic today. The mucosa then also becomes hyperreactive and more sensitive to a wide variety of allergens, foods, and chemicals.

Nothing is more important to optimal physical well-being than the quality of air we breath and our ability to breathe it. Pollutant-laden air often has far less than the optimal 20 to 21 percent oxygen or negative ion content, thus adding to its effect as a chronic irritant in causing inflamed and hypersensitive mucous membranes. Chronically inflamed mucosa often results in increased mucus secretion whether this presents as a runny nose, post-nasal drip, or head and nasal congestion, ev en headaches.

Are these Individuals Infected?

We often teach people that drainage means infection. Right, if your leg is oozing, seek medical care, expect an antibiotic. If your nose is oozing though, not necessarily the case. Sometimes, but not often. In fact, this is rarely the case. However, it does always indicate inflammation. Those who suffer the worst with chronic sinusitis often also have fungal #sinusitis. If you have a white layer on your tongue, you have yeast. If you have athlete's foot or jock itch, you have yeast.

There really aren't great laboratory tests for chronic sinusitis, although definitive diagnosis would be via CT scan with an otolaryngologist. A good history and physical exam however, is quite reliable for diagnosing and establishing an effective treatment plan, but of course, this is also dependent upon your mindset. For many, if not most of our country, this would include antibiotics, steroids, and ultimately surgery.

The functionally-minded though will want help understanding why they suffer in this way. What are the common triggers? They want support for their immune system and guidance in finding the root cause. As a clinician, we want ask a thorough history - environmental exposures, occupational hazards, cold air, dry air, emotional stress, allergies, lifestyle - and part of our physical exam will be to rule out polyps, cysts, and a deviated septum. Other issues may be dental, particularly root canals which are rarely recognized as infected and inflamed. Reflux should be addressed.

The optimal temperature for our respiratory effort is greater than 65 degrees and the optimal humidity is greater than 30 percent. Forced-air heating systems, air-conditioning (cars), oxygen therapy, and even wind can be troublesome. Automobile mechanics, construction workers, carpenters, painters, beauticians, firemen, airport personnel are often those with the greatest risk exposures.

Emotional stress is no joke though, but we completely gloss over this in our culture. This alone can wreck our nervous system and ultimately our gut where our biome is established, which our respiratory system is dependent via the mouth and nose. Repressed anger and grief especially impact the nervous system and vagal responsiveness which also impacts brain health. We can not continue to ignore this and push ourselves and expect to live healthy lives.

Food sensitivities as well, we live in a society in which most of our grocery store is packaged foods which resemble nothing similar to human food yet these products are consumed by the tons, in an almost addictive manner. If you shop on the inside isles of the grocery story, you are not eating real food. If you get your food on the run, you will eventually suffer dis-ease.

Fungal Sinusitis

The Mayo Clinic offers us an incredible antifungal regimen and the more challenging cases often achieve success via this plan. In fact, a landmark study in 1999 reported that an immune response to fungus, rather than bacterial infection, is the cause of most chronic sinusitis cases. Interestingly, it may be the response to fungi in these individuals who suffer chronic sinusitis, more so than the presence of actual fungus. The term, "allergic fungal sinusitis" was coined at the turn of the century to describe this clinical finding.

Having said that though, once one is labeled as a chronic sinusitis suffer, most likely, they've also endured multiple rounds of antibiotics. The profound disruption of the normal gut microbiome may certainly be part of the immune response among these individuals. Either way, chronic sinusitis is likely less about bacteriology or anatomical issues, and more about the dysfunction of the immune system mediated by a fungal issue.

There really isn't a great test for evaluating for presence of Candida, as most all of us have some level of fungus. Dr. Crook does offer us a Candida questionnaire and scoresheet however, which can be helpful in making this diagnosis.

Healing with a Functional-Minded Approach

Although antibiotics have been the mainstay of conventional medical treatment for chronic sinusitis, often followed by surgery if the issue doesn't resolve, these approaches are almost always temporary and really fail to resolve or cure chronic sinusitis. They often invite further issues as well, many of which may not even be related, such as gut dysbiosis and subsequent autoimmune concerns or mental health struggles.

The truth is that our professional groups recognize this. We have been told for at least a decade now not to prescribe antibiotics for sinusitis. There is no benefit in overall symptom relief or even duration of symptoms. There are no fewer days missed from school or work, and relapse is just as likely. Here's the sad reality though, as more and more corporations are using customer satisfaction surveys to measure the success of its practitioners, as more and more articulate their frustration with not being offered an antibiotic which is what the current television advertisements encourage, more and more clinicians are being penalized by their employers. I hate to admit, I did poke fun at a colleague of mine who was frustrated with feeling pressured into writing a script for such complaint, by saying, "Oh, come on, give her what she wants or you'll lose your Christmas bonus." What else can we do but laugh at the insanity of the situation.

Okay so here's the thing, integrative #holistic treatments can be very effective for chronic sinusitis. If we focus on the fire, the inflammation, and put that out then the body can heal the rest. Certainly if we can't eliminate symptoms entirely, we can at least mitigate them and improve overall health and wellness.

We can practice nasal hygiene with spraying, steaming or irrigation. We can really commit to a healthy diet, one which is anti-inflammatory and hypoallergenic. We can also offer anti-inflammatory and antioxidant vitamins and supplements, and some really big guns via intravenous infusion. Our air quality can be improved through a variety of measures. Treating yeast overgrowth is important, as well as a healthy detoxification program. Identifying food allergies and sensitivities is also critical for overall health and wellness. Then we can strengthen and restore balance in the immune system. We can't ignore necessary healing in our mental, emotional, spiritual and social lives either. Our practice can walk you through these steps and with just a few modifications and implementation of these strategies, significant improvement can be seen in just one to two months. If you are Functionally-Minded, a Respiratory Healing Program is what you eagerly invest in for true healing, even when that means some level of conventional healing modalities prove necessary. When we think integratively though, many of those modalities can be offered through botanical medicine, and again, most especially lifestyle behavior modifications.

No judgment though. As individuals, we can only juggle so much and sadly, we aren't often our own priorities. Convenience medicine is often the lowest hanging fruit and where we are familiar. No worries. This just isn't our mindset. While we can offer conventional medicine to meet immediate needs, our ultimately goal is complete healing. We seek to support the body with a goal of optimal health and lifelong vitality. This is our niche.

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