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Is Surgery The Best Treatment For The Polyps?
Question: Dr. XXXXXXX I took your advice and had a CAT scan of my sinuses. There were 4 mucosal polyps or cysts in the R maxillary sinus the largest 10X13mm and 3 in the L maxillary sinus the largest is 17X 20mm. The only symptom I have had is post nasal drip and feeling horrible with weather pressure changes. Mucus is clear, there is never been yellow or green mucus. There is no air-fluid level or bony destruction. As you can remember I do have tinnitus in my left ear with occasional pain. I am scheduled for FESS ( sinus surgery) on the 11th of
march. Is surgery always recommended for the polyps.? Could infection be present in the maxillary sinuses? Could the Eustachian tubes be closed due to the sinuses. Is surgery the only way to treat this condition? Could my low state of health be due to the sinusitis? The surgery looks pretty gruesome on film? Dr
XXXXXXX
Brief Answer:
Get surgery done if fit for anaesthesia
Detailed Answer:
Hello Dr XXXXXXX
Sir i do remember you very well.
It is good that you had CT scan done.
Whenever there is mucus then there are chances of infection.In the mucus the bacteria get adhered and form biofilms , that is a protective layer on bacteria for there own protection .until the biofilm is not broken the bacteria doesnot go or get killed .Even the antibiotics are not able to cross this barrier.
First line of therapy is medicine ie nasal sprays and antihistaminic .Nasal sprays are both steroid and normal saline nasal sprays. Which act directly on the nasal skin and decrease the inflammation ,decrease the allergic response and so decrease the mucus production.Nasal normal saline wash helps in cleaning and washing the mucus and tries to break these biofilms . For that even hypertonic nasal normal saline nasal sprays are used.
If there are no contraindications for general anaesthesia or surgery , surgery is a better line of treatment as it will manually remove the biofilms and clean the sinuses open the normal drainage pathway of the sinuses.
After surgery also you will be advised to use nasal sprays for some time, like few months.
In doubt do reply
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dr XXXXXXX In a book," Living With Chronic Sinusitis." by XXXXXXX XXXXXXX M.D. he of course mentions first a good trial of a full antibiotic course ( based on nasal or sinus culture), topical steroid preparations, and environmental control. He states that endoscopic surgery will not be helpful to someone who has uncontrolled environmental allergies unless the inflammation has become so severe that it is making the allergic reactions much worse. If this procedure is performed on someone who only has mild inflammation and is still exposed to tobacco smoke or environment allergens, there is the potential to make the rhinosinusitis worse by exposing new areas of relatively normal mucosa to the same irritants that initially caused the problem. At the present moment, I discovered during allergy testing my reactions to Bermuda and Kentucky grasses. All other tests to dust, molds and inhalant allergens were neg. or non-reactive. I wish I could establish the causal factors that are initiating the polyp growth and swelling of the nasal mucosa in order not to have continued problems in the future. The surgery might turn out to be a short term remedial solution, or possibly make the condition worse. What is your opinion? Do you perform endoscopic surgery (FESS)? Dr. XXXXXXX
Brief Answer:
Do not be afraid of surgery , it will surely help
Detailed Answer:
Hello Sir,
Sorry for the late reply.
Yes i do perform Endoscopic sinus surgery. And people do get benefit out of it .
As i said already it is the concept of biofilms which is causing the problem.And the biofilms need to be broken , and that can be done by surgery.
In sinus surgery what we do is that we just open up the sinus opening which are blocked because of the edema of nasal mucosa ie nasal skin . Because of the blocked opening the sinuses are not ventilated and so there is collection of secretions in it, and which drains at the back of nose and cause problems.
After sinus surgery you will be advised to take nasal sprays .
At present the nasal sprays alone will not help , sprays will act on the nasal skin and will decrease the allergic part, but as the secretions in the blocked sinuses will not drain problem will not be solved , once sinuses are drained by surgery then sprays will take over and be useful for decreasing the allergic part.
Do not be afraid of surgery , it will surely help.
Regards
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dear Dr. XXXXXXX Thank you for your most encouraging words, I intend to have the surgery as planed on the 11th of March. My question is, will the surgery improve the tinnitus due to closed and inflamed Eustachian tubes.? Can I expect this to be the case, since the problem area is the constant post nasal drip. I'm not sure if taking the Augmentin is doing any good. Is it important to take it up to the day of surgery. There was never a culture made of the nasal fluids! Also, my health has been weaken due to the chronic sinus condition. My Lab tests have been WNL up till now and I will repeat these tests before the surgery along with a chest film. My job now is to get as much rest as possible and deal with the constant ringing in my left ear along with swelling of the nasal mucosa. I use normal saline spray, neti pot, and Flonase. For pain the Eustachian tube I use a hot pack, 400mg of Ibuprofen, and saline gargle. The mucous continues to be clear to milky color and I've been afebrile. Dr. Sparks, my ENT, uses the insertion of trumpets into the nares, instead of packing, and these are removed 24 hours post surgery by the patient. The stents for septoplasty are removed after 5 days post op. The surgery is done as an outpatient procedure. Is this also the way you perform endoscopic surgery? I understand that the trumpets allow some nasal breathing when they do not clog, once removed one can resume some nasal breathing. Also, I expect the neck pain and crepitations will improve post surgery.
I appreciate our communication since my ENT, who is a very experienced surgeon, is always in and out, and not all of my questions are answered. Dr. XXXXXXX
Brief Answer:
do not worry for the surgery ,it will help.
Detailed Answer:
Hello Dr XXXXXXX ,
Sorry for the delay,
After surgery once the mucus settles down or decreases the inflammation in the upper respiratory tract will decrease and so the inflammation around the eustachian tube.
Augmentin is a good medicine and if possible should be taken for its complete course like for 10 days.Antiniotic decreases the infection part and so during surgery the chances of bleeding is less and unnecessary removal of normal tissue is also prevented,to conclude the surgical result improves .
Cultures need not be taken for the nasal fluids until and unless some uncommon or resistant bacteria is suspected which is not getting treated by regular antibiotics . The organisms most commonly are streptococcus or staphylococcus which responds nicely with augmentin and for which it is the drug of choice.
I hope you are taking a antihistaminic in addition , like cetrizine or loratidine or fexofenadine or ebastine .
It is based on surgeons preference what kind of packing needs to be done.I do merocel packing for 2 days , patient has to breath by mouth during that period and then after pack removal ,can breath through nose. After pack removal from nose there is rebound blockage of nose because of edema but that settles down in 3-4 days .I do not put stents , its the cost factor ,patients are not ready for that.
I perform sinus surgery in general anaesthesia , its surgeons preference .
I am more comfortable in general anesthesia.
Nasal sprays are good and should be continued .
Do not worry for the surgery .
If possible go for morning walk daily, it secretes adrenaline in body which is natural decongestant and will help in opening up the sinuses and the eustachian tube .
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Dr. XXXXXXX I know how busy you must be and your answers have been very supportive. As a physician of Acupuncture and Oriental medicine I have little experience in your area of specialty. My only problem at the moment is dealing with afternoon sinus and cervical headaches, which are also related to barometric and other weather changes. I treat this with Ibuprofen 400mg-800mg which along with a heating pad, rescinds in about 1 hour. I expect this to change once the surgery is over. Ibuprofen is not permitted 1 week before and 1 week after surgery, I assume this is due to increased possibility of bleeding? My next visit will be to my internist, who is also a pulmonologist, to review my health status in preparation for surgery. Thanks for the advice about walking in the a.m. I will start today. Namaste' Dr XXXXXXX
Brief Answer:
brufen does increase chances of bleeding
Detailed Answer:
Namaste Dr XXXXXXX
So nice to know that i could be of some help to you despite being so far.
I would love to meet you some day.
Yes brufen should be avoided because of chance of bleeding.It is actually any NSAID ; they also increase the chance of asthma.
Do start the morning walk.
The headaches should get releived by surgery.
But now you are on antibiotics you should not have so much of headaches.YOu can use paracetamol when required instead of brufen .
For headaches steam inhalations will help.Steam inhalations can be done 3 times a day. Yes exposure to cold breeze does cause headache ,if possible try to prevent from exposure .
I personally do not advice any pain killers to my patients .i do advice paracetamol tablet to be taken if required.
Regards
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dr. XXXXXXX I thought I was complete with my questions but something else has arisen. I now have oral thrush. I was given Nystatin mouthwash yesterday. It does not seem to be in eosophagus, but coates my tongue. I suspect the nasal steroids and maybe the antibiotics caused this. Since I am a diabetic, I would be more prone to fungal infections. My energy level is low. Should this be a concern with the surgery and anesthesia? What type of anesthesia do you use with your patients? Are there less aggressive or less intensive anesthesia that can be used? Should I be concerned about systemic fungal infection? I'm trying to avoid any unforeseen mishaps. I still intend to go forward with the surgery, but am concerned the problem may be more fungal than bacterial. Dr. XXXXXXX
Brief Answer:
Consult for starting Insulin for Diabetes
Detailed Answer:
Hello Dr XXXXXXX
Do you have a controlled blood sugar?
In uncontrolled diabetics there are more chances of getting oral thrush.
I do Surgery in general anaesthesia, even with diabetics.
What i prefer is that i admit my patient a day or 2 days before surgery and start insulin injection for diabetes and stop oral hypoglycemic tablets .After adequate control of diabetes only then i operate.
You should get your blood sugars checked and consult your physician or endocrinologist for start of insulin injections if required.
The insulin can be stopped after 2 weeks of surgery.
If the sugars are controlled then fungal infections will not occur.
Nystatin mouth wash is good for oral thrush.
You also need to get operated because there is good sugar control if there is no infection in the body.By surgery the infection part will be taken care of.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Dr. XXXXXXX I have been on insulin for over a year ( Humalog, flexpen 10-12 units 5-10 units before I eat. My AIC is 7.7, my morning glucose can range from 140-180 I.U. The thrush is thin on my tongue and the roof of my mouth feels pasty. I use the nystatin 1x in a.m. and rinse with yoghurt. I stopped the nasal steroids and amoxicillin. Due to a warm winter weather the pollen count is up and my sinuses are blocked. The post nasal drip is continuing. I have problems falling asleep and need to take Zolpiden 5mg. My pre-op blood work was WNL and the chest film was clear. I have night sweats, but no fever. Because of the post nasal drip and weakened state of my body I am concerned about post op pneumonia.
My ENT is on vacation but should return the beginning of March. Yes I quess I am worried about the anesthesia and will make an appointment with her to address the situation. Also, I have severe sleep apnea. I would feel more secure if they would admit me to hospital especially post op. The FESS and Septoplasty are done on an outpatient basis and I live alone. So Dr. XXXXXXX you can see my concern. In this Country they are now reluctant to admit patients to hospital due to insurance reimbursements. You have been the only one who takes the time to answer my questions. This problem has been one of the most difficult health issues of my life. I want the surgery now to improve the sinusitis, but I feel several other issues have arisen. Please help me to sort things out. Dr XXXXXXX
Brief Answer:
Get diabetologist consultation for insulin dosage
Detailed Answer:
Hello,
I apologies for the late response. I have been busy with my own patients these days.
Your HbA1c is high it shows that there is poor sugar control. In my opinion you should consult a diabetologist for modifying insulin doses. Please monitor your blood sugar levels so that insulin can be given accordingly.
Steroid nasal sprays are not absorbed much ,so you should continue with it.
I can understand you are tensed, but my suggestion is you should not worry. Once the diabetes is under control it will be fine . It is just the dose of insulin your doctor needs to set.
For gargle dilute Betadine can also be used.
Weather is a problem but if possible try to go for walk daily.
Your blood tests are normal and chest film is clear, so no need to worry . I am not able to understand why you are worried about post operative pneumonia. Just post nasal drip can not cause any such condition , and post nasal drip will definitely decrease after surgery.
If you are too much bothered about surgery then you can plan to postpone it as nasal sprays can take care of the post nasal drip and the eustachian tube blockage. If the present spray does not work then you can change the salt. In addition use antihistaminic medication ,it will help to dry up the secretions .
You main issue seems to be deranged blood sugar level which should be taken care of first.
If there is any doubt do reply
Regards
Above answer was peer-reviewed by :
Dr. Prasad
Dr. XXXXXXX you are correct about stabilizing my glucose. My internist wants me to take Lantus, but since I live alone, I've have several extremely low levels of BG during the night ( Lantus ) is usually taken at bedtime. The Humalog Flexpen allows me to dial in the estimated units of insulin before I eat. But you are correct, I need to search out a diabetologist in Las Cruces. The increased glucose is feeding the bacteria in the sinuses and nasopharynx. Tomorrow I consult with another ENT specialist in Las Cruces (2hours from here.) I am not satisfied with the lack of information and shortage of time spent with me here in Silver City. The fact that I needed to suggest a CAT scan, ( which was your suggestion) makes me a bit skeptical about her diagnostic neb. I will keep you informed about my consultation. I am not adverse to the surgery. I am taking Loratidine Claritin 10mg qd. I could increase this. I do not do well with nasal decongestants and the side effects (pseudoephedrine). There are also antihistaminic nasal sprays. The neck pain also comes and goes. Anyway, I appreciate the time you take, you are very busy and this is good, helping lots of people. Namaste' Dr. XXXXXXX
Brief Answer:
Continue with nasal wash.
Detailed Answer:
Hello Dr XXXXXXX
I have less idea about Lantus but to my knowledge it does not cause much or frequent decreased blood sugar.It maintains and has effect all day.
Are you taking oral hypoglycemics like Metformin , in addition . Metformin is very safe drug and does not cause hypoglycemia or decreased blood sugar.
But i should not speak on this being ENT specialist .It will be better to have diabetologist consultation.
Continue with Loratidine two times a day.
I would suggest not to take oral decongestants .If you take nasal steroids then it will take care.
Amongst nasal steroid spray Mometasone is the one i prefer most.
Do continue with daily walk and steam inhalations. and also nasal saline wash.
There is a nasal wash which i suggest to my patients to make it at home and use it 3 times a day. It might turn out to be helpful to you as well. It is as follows--
Take half litre water and add Half tea spoon full of salt (table salt) and 2 tea spoon full of Baking Soda in it and mix it and to be used for nasal wash. You can do the nasal wash with it using a syringe (plastic syringes used for injections , without needle ) or nasal douche bulb if available .
I hope this will help.
In doubt do reply
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dr XXXXXXX Tomorrow I have an appointment with an ENT Spec. in Las Cruces. I discovered that M.D's are given a "grade" by survey of their. The ENT that I will see tomorrow has a "poor" rating by "RateMD's.com" I will still see him tomorrow with but keep my appointment for 11 March with Dr, Sparks here in Silver City. She always seem to perform rhinoplasty with the FESS surgery. I'm not sure if this alllways necessary. Her rating is considered good at 2.5 out of 4. Todayptomsm was a painful day with lots of phlegm in left ear, neck pain, tinnitus heavy head. I did Simple Saline spray. ( NaCl+NaCOon with2) without preservatives, steam inhalation with eucalyptus oil and heatint thg pad on neck. I really want the surgery to relieve these symptoms. I still take amoxicillin daily. Perhaps I should bite the bullet and let the ENT surgeon here do her work. Do you always do a rhinoplasty with FESS? Dr. XXXXXXX
Brief Answer:
Avoid amoxycillin
Detailed Answer:
Hello,
You are so very troubled.
Are you not taking steroid nasal sprays regularly.? steroid nasal sprays can help in decreasing the secretions and decreasing the allergic response.
With saline douche there is good relief to many people , i feel so sorry that i am not able to help you out.
Do not take amoxicillin for more than 10 days , its not required.
Only Antihistaminics can be used for long otherwise avoid other oral medicines for long time.
Nasal sprays should be continued.
Is your blood sugar under control.?
I do not do rhinoplasty with Fess .
I do rhinoplasty only when the patient has cosmetic problem otherwise not.
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dr. XXXXXXX I was troubled since I listened to what the ENT physician was telling me here is Silver City and had already scheduled me for surgery next week. You see I live in a very small city. Yesterday I scheduled a consultation wit Dr. Gallihan in LasCruces. I gave him a copy of the CT scan and he examined it carefully, noting some small problem areas. He examined me and then said, YOU DO NOT NEED SURGERY! Your septum is slightly deviated but does not need repair. The. . He said the 'maxillary sinuses do have a few small polyps but none that block the openings. The sinuses are clear without fluids, the nasal conchae were not swollen and clean. He said if you had first come to me, I never would have recommended surgery. He also recommended Flonase to be used constantly during the allergy season and a hypertonic saline solution. He felt the amoxicillin was a waste for he could not identify and infection. He also recommended to get my BG better under control. All of this sounded like Dr. Sharma!!!!!!!!! I quess I learned the necessity of getting second opinions. He will do another CT scan in a year to see if there are any changes. The big job for me. like you said, is to control the allergy reactions with antihistamines and nasal sprays. Dr. Sparks here in Silver City has been ( past tense) a friend and I trusted her conclusions, but my inner voice kept doubting her treatment. Then Dr. XXXXXXX came alone and guided me in a more honest and medically correct advice. I am trying to get Nasonex ( the steroid you suggested, but the pharmacy charges $95.00. ). I will try to purchase it in Mexico. We are so materialistic in this Country I sometimes feel like going back to Europe or maybe visit India, after all I am a student of the Buddha. Thank you again for all your advice, your were right on the button. Dr. XXXXXXX
Sorry, I reread your information and I had one more question. If I have polyps in the maxilliary sinuses does this automatically preclude that I have biofilm bacteria stored up in the sinuses. He showed me that cavities were dark and aside from the polyps, did not demonstrate any infective mucous. He claimed a lot of people have polyps but do not suffer from sinusitis. I would expect that the sinus meatus was large enough. This was his rationale for not wanting to do FESS. He felt the risks i.e. optic orbit problems etc. were greater than what I presented to him.
He said the sinuses had air in them and no sign of cloudy mucous. Is my post nasal drip a product of the nasal turbinates? In this case the saline sprays, antihistamines and steroid sprays should diminish my symptoms. He felt my cervical headaches may be the result of cervical spondylitis as I do have several arthritic vertebrae in my nack? It is so easy to be objective when treating other people. Dr. XXXXXXX
Brief Answer:
You can avoid surgery.
Detailed Answer:
Hello Dr XXXXXXX ,
Thankyou for such great reply.
I am so very happy that your sinuses are mostly clear with some small collection.? Polyp.
If the sinuses are mostly clear then you should continue with sprays and antihistaminics .
"Blood sugar" ,yes a big problem should be taken care off.
I will try to explain for the nasal mucus ----
The sinuses are hollow cavities in skull , you know very well.The god has made nasal skin to spread over the inside of nose , turbinates and sinuses. The whole of nasal mucosa can secrete mucus and it does. If allergic condition then secretes more of mucus.
Mucus is secreted from all nasal mucosa, sinus mucosa , turbinate mucosa.
The mucus from the sinuses drains through their openings in the nose and then to the throat eventually.
The nose is air conditioner and humidifier of the body so this mucus is helpful , but if mucus is in excess it causes problems as you have.
If the mucus stays for long in sinus then there is bacterial growth as nose and sinuses are open to environment. This bacterial growth leads to biofilm formation and which is sometimes difficult to break medically.
But, in your description of the CT scan there is not much collection in the sinuses so less chances of such infections or biofilm formation .
I could now suggest , you can avoid surgery , and continue nasal sprays.
I must say i did mistake by not asking for the CT scan report in the beginning , actually i believed that your doctor (who suggested surgery) must have noticed a lot of disease in the sinuses.
Cervical spondylitis does causes pain. You could try to change your pillow ,or even the mattress sometimes this also helps. But i do not have much idea on spondylitis treatment .
India is beautiful country , so very lively. Many festivals, 4 different seasons ,,,,,,and so on , many things to say. Holi festival is approaching , have a look on internet pictures ,its full of colours.
Last but not least i would still say , do go for a walk daily, it will be good for both diabetes and nasal problems.
Hope you get better soon.
Regards
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dr. XXXXXXX I may have doing too many things to clear the sinuses all at once I steam.e. eucalyptus steam, simply saline, neti pot etc. I will stick with occasional saline and the steroid spray. Also, work hard on my diet and diabetes. Obviously my immune system is not functioning well or the sinus problem would have been resolved along time ago. This last ENT I visited mentioned that many people have polyps in nose and also sinuses but it does not cause them problems. He show me pictures of sinuses filled to the top with mucous, but mine only showed a few polyps at the bottom of the maxillary sinus. Anyway, we are having heavy pollen counts here and many people have acute sinusitis. Thanks for your help, Namaste' ////Dr. XXXXXXX
Brief Answer:
Prevent exposure from pollens
Detailed Answer:
Hello Dr. XXXXXXX
Prevention is better than cure.
You should prevent exposure from the pollen grains.
Take multivitamins and good protein diet ,it will help to fight against allergy. Otherwise prevention is the best remedy.
Rest Continue with the sprays. Steroid sprays will take care of the allergy part . And saline wash will not allow the pollens to stay in nose and stimulate allergic response, a mechanical way to clean the nose.
In doubt do reply,
regards
Above answer was peer-reviewed by :
Dr. Prasad
Dr XXXXXXX Sorry to say, I'm still feeling really badly. Last night I had a temporal/ occipital headache, tightness in bronchials, shortness of breath, stuffiness in maxillary sinuses, and slight fever. ( 99.6), sweating. Dr. XXXXXXX I stopped the amoxicillin. Recently I read about the rise of fungal infections invading sinuses and the use of antibiotics and steroids precipitating the growth of more fungi. Since I am a diabetic could I have fungal growth which are causing the polyposis? Could this be the reason that I am still having syptoms? I know you must think, XXXXXXX is a real hypochondriac! But when I still feel weak and horrible,I search for answers. Are you familiar with balloon nasal therapy in treating chronic sinusitis? Dr XXXXXXX
Brief Answer:
get blood pressure checked
Detailed Answer:
Hello Dr XXXXXXX
The sinus position you wrote earlier doesnt match with such severe symptoms. Either you are not taking the nasal sprays properly .
Let me just revise for the dose ---The steroid nasal spray comes in metered dose of 50 microgram in one puff. and should be used Two puffs both nostril two times a day.
Secondly the saline nasal sprays two puffs both nostril two times a day.
If using nasal douche then two times a day.
Fungal infection occurs when there is severe sinus infections ,
but as you said the position of your sinuses the openings seems to be patent.
Yes in diabetics there are more chances of fungal infection , but in your case doesnt seems to be like that.
I would suggest to get --Blood pressure checked for headaches and get your lungs examined by physician . Due to allergy there could be asthma like features.And which could cause snoring and sleep problems which could cause tierdness and day time sleepiness and difficulty in respiration in night. so there can be decreased oxygenation and so headaches.
Take medicines for reflux disease like domperidone especially .
We do Balloon Sinuplasty regularly, but in your case the condition seems to be more of allergic , and widening the sinus opening will not help much .
Regards
Above answer was peer-reviewed by :
Dr. Shanthi.E
1.am following therapy as suggested! 2. B.P. 127/80 take lisinopril 20mg qd. 3. have severe sleep apnea, started CPAP again, consulted with pulmonologist, no asthma, 98%O2Sat. Chest film clear, resting EKG wnl. 4. CTscan shows multiple degenerative processi in cervical spine. ( am72 yo.) , no upper arm paresthesias, get massage and chiropractic. Symptoms: headaches in suboccipital region, seem to be connected to pain in sinuses and weather changes. Generally occur in the late afternoon after last patient. Need to take 400mg Ibuprofen to relieve pain. Could maxillary sinuses cause these headaches, since pressure and stuffiness accompany the neck pain. Interesting phenomenon is that the headaches appear in the late afternoon? I do not have a history of headaches!
Brief Answer:
this could be tension headache
Detailed Answer:
Hello Dr XXXXXXX
Your sinuses were not that very infected to cause such severe headaches.
Your headache could be tension headache.
Have you started walk daily.
You also need to take rest daily in between your consultation .
And most importantly do not worry of the sinus problem , yes you have problem but try to get over it. and take it bit lightly.
Your problem is not such which is not treatable.
Watch television , read some jokes try to be happy. you know about laughter therapy.?
Seriously all this increase the level of adrenaline and which is a natural decongestant and which will help in opening up the eustachian tube and decrease the nasal congestion.
Regards
Above answer was peer-reviewed by :
Dr. Shanthi.E
Dr. XXXXXXX Thank you for such good advice. I am also a XXXXXXX Buddhist Priest but have been lax in my meditation practice. I spoke about it this a.m. to my community and how suffering can lead to spiritual growth, if you don't attach to it.
For some reason I've been attaching to it and stress in my medical practice is one of the causal factors. It is not easy to wear two hats, but my spiritual practice is most important and I've neglected it. The only symptom I have at the moment is pastiness in the mouth which could be due to candida overgrowth, I do drink a lot of water. My neck does have a lot of degenerative changes and I will get more neck therapies i.e. physical therapy, massage and chiropractic. The tinnitus has decreased since the beginning of our discussions and only increases briefly at times. I had broken the 2nd metatarsal of my left foot and wear a special boot.
In a few weeks this will be removed and I'm back to walking again. I try to walk my dog everyday. I had been very healthy all my life and had my diabetes under control. I climbed the Alps in Germany when I was a student. I'm taking your advice seriously, watching my diet ( no dairy or wheat,) except goats milk yogurt. So my outlook is improving and I'm planning a trip to California to be near the ocean ( no allergies!) Thanks again. Dr. XXXXXXX
Brief Answer:
happy to see you are recovering
Detailed Answer:
Hello Dr XXXXXXX
So happy to see the positive energy, do keep it up.
So Sorry for the fracture , may god heal it faster. If possible take calcium and vitamin d3 tablet it will certainly help.
We have a common point of interest "trekking". Alps are big .
I have climbed most of the Aravali range, in school days . And we do not need anything to take as they are small ranges and without snow .
I am planning for the Himalayas but have a very busy schedule and in medicine, you know , patients do not allow you to go for holidays.
Do continue betadine gargles for the oral cavity candida.
Hope to meet you some day.
Regards
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Above answer was peer-reviewed by :
Dr. Yogesh D
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