Complete Allergy Care For All Ages

Serving The Greater Hamilton Area, NJ

516393_15.jpg
516394_15.jpg

"Persian Cough Persistent cough for years. Have seen Ent, allergist and pullmonary.post nasal drip, mucous... plus help?" - Anonymous Patient

I disagree with your doctor, losartan may cause chronic cough though the mechanism of this is unclear (it does not affect substance P and the kinin system as ACE-Inhibitors do) but there are numerous case reports of chronic cough associated with losartan (cozaar) and even the package insert mentions about 3-4% incidence of cough with this medicine, If your cough can be described as an annoying tickle and a feeling that something is constantly stuck in throat and thus need to cough to clear it out, then I am very suspicious of the losartan (this is the classic description I have gotten from patients with ACE-Inhibitor cough and reports of losartan cough describe very similar symptomatology. Unfortunately, I do NOT recommend changing a medicine for your BP without the clear permission and involvement of your prescribing doctor, but I would suggest working with him/her to find an alternate class of anti-hypertensive medicine to take so you can stop the losartan for at least 4 weeks, as chronic cough associated with these medicines can sometimes take that long to fully resolve. In my experience and from papers I have read, you will usually feel SOME change in nature of cough and some reduction in sensations leading to cough within at least one week of totally stopping this medicine. I agree, losartan causing this cough is far rarer than a typical ACE-Inhibitor, but it is certainly a known cause for chronic annoying cough and before I would chase other less common causes, such as tic/habit cough which is next on my list of causes based on your limited cough description, I would certainly try changing this medicine. If the medicine is the cause, then no matter what else you take or do, in my experience, the cough will NOT respond. I wish you luck and good health.
 Aslam Lateef, MD

"Should deviated septum be repaired when ENT is doing sinus surgery? Saw ENT, ct confirmed unresponsive to antibiotics recurrent chronic sinusitis. Surgery to open cavities up etc was recommended. He was noncommittal on deviated septum repair, despite, 6 week previously his nurse practitioner was firm in stating they would, if nothing else, repair that (dependent on last month of antibiotics). I'm a bit confused. All I read suggests the septum should be repaired especially with them doing sinus surgery. Thoughts or suggestions please." - Anonymous Patient
Deviated septa are extremely common, my estimate is that more than 8/10 adults has one. We all walk into walls and bump our faces as we grow up. The big question is whether fixing yours will result in better nasal function (or at minimum a better cosmetic result if the deviation is visually obvious). Both questions should be clearly answered by your surgeon. Recovery from septum repair is certainly often more traumatic and painful than functional endoscopic sinus procedures. Ask about this as well. I respect any ENT that would not automatically repair a bent septum (which almost all of us have) during a surgery for the sinuses, though it may logically seem the two are related, practically speaking and in reality, they may not be and repair of septum may not be needed at all to clear sinusitis. I believe and studies are increasingly supporting the view that when it comes to sinusitis, less invasive and traumatic surgery is usually best. The structures are delicate, potential for bleeding very high, and the recovery is stunningly painful for many persons as the areas are very sensitive (deep surgery on YOUR FACE - this is essentially what is going to be done). Nasal obstruction is most often due to soft tissue swelling and fixing the septum (the center, hard wall between nasal sides) may NOT be the best answer for your nasal congestion or sinusitis. ASK THE QUESTION DIRECTLY - "WILL FIXING MY SEPTUM HELP ME BREATH BETTER AND HAVE FEWER SINUS RELATED PROBLEMS?" If the answer is not a very clear "YES" then think hard about getting this extra bit of major surgery done.
 Aslam Lateef, MD

"Why was I prescribed perdnisone my Dr. diagnosed me as having a sinus infection she prescribed augmenten and perdnisone. I also told her I had a cough she prescribed a cough syrup with codeine. Why did she prescribe s steroid for a sinus infection?" - Anonymous Patient
Sinus infections can only occur if there is abnormal blocking and impaired drainage of one or more sinuses. The prednisone (an oral steroid) will reduce swelling very effectively which will allow the infected mucous (essentially pus) to drain out. Without proper drainage, even the best antibiotics will likely fail as killing bacteria is helpful, but flushing bacteria out of the body is curative. I cannot speak to your specific situation, but there are many methods of reducing swelling and draining sinuses that work great without requiring steroid pills which are notorious for having potentially serious side effects. I begin with nasal sprays and/or sinus washes which often can directly reduce the swollen area in the nose and sinuses without affecting the rest of the body. In fact, there are methods for applying liquid steroids into even the deeper sinuses to effectively treat sinus infections without antibiotics or oral steroids. A basic principle all surgeons learn is that if you can drain an infected area and keep it clean, antibiotics are NOT needed. In the same vein, if we can keep your sinuses draining properly using well applied topical treatments then oral medicines should not be needed. Antibiotics for sinus problems are massively overused in my opinion (and according to many published studies). There are rare occasions where I may use oral prednisone (rare because I can almost always get the sinuses clear without ANY pills), but even in these cases I will NOT use any antibiotic because once we get sinus swelling down and get sinus openings unclogged (and prednisone is terrific for accomplishing both these goals) a simple sinus wash will flush out any infected material making an antibiotic unnecessary. Although this is clearly a massive oversimplification, there is so much truth to this saying I have often heard that I think it bears repeating here, "Sinusitis is not mainly an infection problem, it's really more of a plumbing problem, once you get the pipes unclogged and flowing, the problem is usually solved." I hope this helps answer your question. Best Wishes.
 Aslam Lateef, MD

"Coughing Cronic coughing" - Anonymous Patient
Cough is a symptom, not a diagnosis. While it is always a sign something is not working properly, many studies demonstrate that the vast majority of persons with chronic cough do NOT have major or life threatening illnesses. The most common cause is what academics call "upper airway dysfunction syndrome" which you may think of as an inflamed nose, inflamed sinuses and angry upper airway (throat and "big pipes" are inflamed/sensitive). While big pipes are inflamed, they produce mucous and swell, both these lead your body to think the pipes are blocking up which triggers the cough reflex (a reflex designed to clear obstructions in these pipes/airways). With chronic cough (a daily or almost daily cough lasting more than 8 weeks) it is often impossible to diagnose the cause with tests or history alone (though these may help a lot). It is through systematic treatment that an intelligent clinician can get to the exact cause. It saddens me when patients come to me desperate to finally find a cause after years of being treated periodically with what I call the "shotgun approach" - treating everything and not bothering to figure out what the cause is. These persons will typically be given allergy medicines, sinus medicines, inhalers, oral steroids, antibiotics, and even acid reflux treatment - very often all at the same time. This approach may alleviate symptoms for some and may even cure others, but it also leads to side effects and no insight into what is causing the patient's main problem in the first place. Identifying the cause is important as many cases of chronic cough will recur in the future and it is neither kind nor practical to use the "shotgun approach" time and again in the same person as it will eventually totally fail and often make them feel terrible well before this failure (as most of these medicines have powerful side effects). My methodology is outlined in brief here due to the inherent constraints of this media but step one is to treat the nose and sinuses (sprays and sinus washes, nasal moisturizers), step 2 to treat the upper airways (and also possible initial onset asthma) with high dose inhaled steroids for a very short time (special regimen using flovent 220 and a spacer), finally consider imaging of chest and atypical antibiotics to manage atypical lung/upper airway infection (mycobacterial or other odd infections). I have patient follow each step for about 5 days, then move to the next. Once cause is identified by seeing cough get better, I now know exactly what to do next time the person gets into this situation. Finally, a subset will have habit or tic cough which are often the most difficult persons to treat - they will have been to many experts and will have been coughing for months or even years (the record in my practice is a very nice lady coughing awfully for 48 years, every single day per her report!). For these special cases, I have developed an excellent behavioral modification regimen and throat spray combination which is very effective. This topic merits a much larger discussion but I hope what I have added is acceptable by way of an introduction. Best Wishes.
 Aslam Lateef, MD

"Can an allergy go away? I used to be allergic to Milk but just got tested and the test says I am not anymore. I had trouble with the inside of my ears swelling, which would cause pain. A Naturalpath was the only one able to figure out this problem when I was young." - Anonymous Patient
Milk can cause a legion of different adverse reactions and there is testing for only about 3 or 4 of these. That being said, the ultimate test of tolerating milk is to drink/eat some and be just fine. Milk rarely causes anaphylactic level allergic reactions, so I usually suggest doing a basic challenge, have a tiny sip, wait one hour then finish a full glass. If you have no adverse problems over the next 48 hours, then it is unlikely you have any severe type of adverse reaction to milk. That being said, as many noted below, milk tends to cause may longterm harms to people's health in general, especially their GI immune system. Milk is associated with GI imbalances, abnormal flora, increased tendency for skin rashes (especially acne), and more copious, and thick sinus mucous which aggravates sinusitis for many who suffer with this issue. All the perceived benefits of milk cvan be had with coconut milk or almond milk (rice milk is close but a little lighter on proteins, soymilk has other possible health problems associated). The only cow's milk product I cannot substitute is cheese, all "fake" cheeses I have tried so far in my life are terrible, so there is my compromise with milk (coconut yogurt and coconut ice cream is amazing, better than cow's milk ice cream IMHO). Best wishes.
 Aslam Lateef, MD

"Acne post taking MethylPREDNISolone I took a 6 day dose pack of MethylPREDNISolone after an allergic reaction to an antibiotic I was on. Now I'm broken out in acne all over my face, neck and back. Are these related? And how long will it last?" - Anonymous Patient
I was just curtious if the acne has cleared yet? If not, I can suggest a very safe topical facial cleanser that will reduce skin colonization of many of the organisms associated with acne (product called Cln facial cleanser, it is made of very dilute bleach and gentle foaming agents so it if antiviral, antibacterial and antifungal but also very gentle) - my patients with long standing acne have done terrific with this treatment (along with probiotics and short-term avoidance of ALL cow's milk products to see if milk sensitivity is a factor). I have had many other patients clear their acne with gluten free diets as well but this depends on the state of your stomach. You mentioned having a boil, recurrent boils can be traced to hypercolonization with specific bacteria or very commonly even fungus. This is why I love the bleach cleanser, it gets both of these. This cleanser should also prevent future boils if you use it in areas that are prone these. Best Wishes.
 Aslam Lateef, MD

"Alcohol allergy I'm a college student at Purdue University. When I go to a party and drink even an ounce of alcohol, my stomach hurts. If I drink maybe one beer, I sometimes get sick. I was just wondering what may be the issue?" - Anonymous Patient
The answers given already by other experts are all very good as far as causes for your problems but let me give you a suggestion as for making it better. The 2 main mechanisms I find for alcohol to hurt someone's stomach (there are others which are less common) are either by direct damage (alcohol is directly toxic, just try putting some on an open wound) or by causing a histamine-like or histamine-releasing effect from the stomach's immune cells. For dealing with first problem, your stomach lining is likely too thin (this often results from chronic stress, lack of sleep, antibiotic use, systemic steroid use, or alcohol use especially binge drinking), to thicken the stomach lining and help protect and heal the mucosa, I like to use a product called DGL (Deglycherrinated licorice), this is a very old natural treatment that works by covering over wounds/ulcers and generally thickening and protecting the stomach lining. It is taken by chewing thoroughly before every meal for several days (it tastes like licorice which many of my older patients love but younger ones get used to quickly - an acquired taste but certainly not terrible). It is widely available at most health food stores and I find most brands are just fine. I'd suggest avoiding alcohol for at least one week while taking this to give your stomach lining an ideal chance to thicken up and heal fully. If this does not work, then the second cause of histamine sensitivity and release abnormality is more likely your cause. This is tougher to manage - but basic things to try are loratadine 10 mg at 2 hours before planned alcohol exposure. I also suggest a product called "HISTAME," it is a little expensive but taking this before drinking can again help break down histamine and its byproducts which may be causing your discomfort. If these suggestions are partially helpful or not at all, then seeing an experienced natural leaning allergist may be helpful to look into some of the rarer causes or more aggressively treatments of these 2 very common causes (I personally have many other approaches but time and space limit their discussion here). Cheers.
 Aslam Lateef, MD

"Excess mucus in mornings I have never been diagnosed with asthma, but over the last few months, I wake up sometimes with shortness of breath and a lot of mucus/phlegm backed up in my nose and throat. Are there any over the counter medications you could recommend to control this or could there be more to this problem?" - Anonymous Patient
Good answers below, esp from Dr. Pakdaman who is right on with all his suggestions. I will add simply that having chronic sinusitis (full angry, poorly draining sinuses) will often cause a secondary bronchitis (angry large pipes in lungs) leading to sometimes pretty impressive and terrible persistent coughing (sometimes even whooping cough-like in severity), but if you've never had asthma before, the chance of developing this condition right now is extremely remote. More likely, the big pipes in your lungs are angry from the constant preceding sinusitis - the sinuses and lungs are very intertwined in their functions - studies have clearly shown that angry sinuses will cause a "sympathetic" inflammation and increased sensitivity of the lungs, even when nothing is otherwise bothering the lungs (how interesting is that!). Bottom line is if you fix the sinusitis, the cough and lungs will almost always take care of themselves. A few small suggestions on top of what has been said, AVOID sinus irrigation near naps or sleep (I suggest doing it only if you will be upright for at least the next 3 hours to prevent trapping of solution in the head/inner ears) and it is absolutely best done first thing in the AM when mucous accumulation from overnight is at its worst. 2nd, breathing through your NOSE is crucial (you'll probably notice that mouth breathing sets off coughing spells). Your nose does a lot of good for you - it filters, heats and humidifies the air going into the lungs, the quality of this "conditioned" air from your nose is far better than the air coming in from your mouth (dry, cold, unfiltered). To help use your nose to breath instead of mouth, I strongly suggest using NASOGEL brand nasal moisturizer as often as possible but especially right before sleeping (and also before exercise). These are times where nose breathing is more crucial (you'll notice soccer players constantly blowing their noses as they run, this is because they know nose breathing puts less strain on the lungs than mouthbreathing). I can say with confidence that your night time breathing problems, such as snoring, mouth breathing and coughing are worsened by dryness of your nose, this dryness leads to more congestion which naturally leads to mouth breathing. I suggest avoiding all other OTC nasal moisturizers as they contain alcohol based preservatives (I esp dislike AYR products and even NASOGEL brand nose moisturizing SPRAY - you want to stick to nasogel brand nose gel that you physically apply into nostrils with a q-tip or tip of finger). The other products (high alcohol content) tend to make noses MORE dry which is very counterproductive. If basic things do not get you better within 4 days, then seeing a doctor is worthwhile. I will again stress that if you can get the sinuses to drain properly and consistently, then even if you have the nastiest infection ever in your sinuses, antibiotics are NOT needed (the most basic rule every surgeon learns about infection treatment is that proper drainage and irrigation of a wound works better than antibiotics). if you can drain your sinuses properly and keep then clear, the infection will disappear. Antibiotics will help in the short term, but tend to cause larger disasters in the long term IMHO, but certainly follow the advice of your medical professional on this, there are always exceptions to all cases. Best Wishes.
 Aslam Lateef, MD

"What would cause swelling of both eyebrows and just above them for a couple months now? Headache, no cold or fever, traces of blood when I blow my nose but no infection, can breathe thru nose but feels obstructed" - Anonymous Patient
Is it itchy or any associated sensation with swelling? (urticaria/angioedema, hereditary angioedema, contact dermatitis, melkersson wilkinson syndrome). Does it come/go or is it constant? (systemic swelling like low protein, renal dysfunction, etc) How did it start? (irritant or allergic causes) Is swelling symmetric? (internal vs external causes, relation to hair) Any other skin issues at present? (manifestation of primary skin disorder like lupus, sarcoid, etc) You mentioned no meds, but any supplements/herbals you may be forgetting? (fixed drug eruption). Many other questions and possibilities come to mind, but above is most statistically likely off the top of my head with such limited info. Best wishes.
 Aslam Lateef, MD

"Sinus I've been hacking up, from my sinuses, green hard hunks. Seems like something builds up for awhile than I have to hack it out always about the same size." Anonymous Patient
There are about 14 physiologic factors (maybe more) related to the intricate and ideal functioning of the sinuses, if one or more of these finely tuned systems is off, then tendency for recurrent sinusitis (sinus inflammation, but not necessarily infection) can be the result. A discussion of subacute/recurrent/chronic sinusitis is beyond the scope of this medium so I'll focus on acute sinusitis. The defining feature of ALL sinusitis is the production of irritating, thick and copious mucous created within the malfunctioning sinus system and then draining out. As a quick aside, head pressure and pain without this copious mucous is almost never sinusitis. It is usually migraine or some other primary headache variant. Sinus headaches, i.e. head pain originating form the sinuses but with NO congestion/mucous is not a true condition (or is exceedingly rare). Treating such head pain with sinus medicines in this day and age is not justified. Anyway, back to sinusitis. Discussing sinusitis means discussing mucous. Sinus mucous drainage out a frontal pathway eventually leads to the nose where mucous irritates the nasal tissue, worsens nasal swelling and often requires blowing/sneezing to clear out. The rear passageway for mucous drainage is via the throat (so called "post nasal drip"). Many persons with sinusitis will drain from both places simultaneously, hence a feeling of head fullness and pressure. Healthy humans (adults) produce about 1-2 cups of thin, clear and very healthy mucous per day. This mucous drains through these same places in a pleasant and largely unnoticed fashion, this mucous maintains proper humidity within the respiratory system, forms a protective coat against pathogens, keeps pH in the respiratory and even GI system within proper ranges and does many other wonderful and under-recognized/appreciated things for healthy humans. When normal sinus mucous drainage is impeded (as in most viral upper respiratory illnesses) this leads to a profound change in mucous viscosity and consistency. This altered mucous is what we notice and are bothered by. The goal of a properly executed sinus treatment plan is to flush out the unhealthy mucous, open up all normal drainage pathways and re-establish normal and healthy mucous flow. Normal mucous is NOT our enemy and does not need to be killed or eradicated as some commercials imply, a major goal of treatment is to re establish healthy mucous flow. Coming back to your problem, the "thick chunks" are likely the end product of a poorly draining sinus system with trapped mucous inspissating into thick, unpleasant consistencies causing further blockage and a possible vicious cycle. Proper use of a sinus irrigation system to clean out unhealthy mucous and a nasal steroid to reduce swelling and allow for better sinus drainage are excellent first steps (both of these are now OTC- neilmed irrigation kit and nasacort spray). Using these devices optimally takes a lot of experience and instruction, using them incorrectly may make matters worse (It is regrettable that most directions on nasal steroid sprays' package inserts have incorrect directions on them!). Antibiotics are almost never needed for basic sinusitis, but are a kind of short cut that is often effective because most antibiotics have inherent anti-inflammatory properties that reduce swelling and achieve some of the goals I have described. In terms of benefit/harm ratios, I think antibiotics have no role in acute sinus problems as they can lead to future resistant bacteria, GI upset/flora disruption and many other well known problems associated with antibiotic overuse. Well done studies have demonstrated that about 97% of acute sinusitis (symptoms less than 7-10 days) is caused by viral infection and antibiotics do NOT kill viruses, though they may relieve some swelling. It is also well proven that about 99% of cases of acute upper respiratory infection with associated sinusitis will spontaneously improve with supportive care only (fluids, rest, motrin, etc). Chicken broth (2-3 cups/day) and honey (2 tbsp 3-5 times per day) have shown promise in relieving virally induced mucous production and attendant symptoms. It is cases lasting more than 14 days (sub-acute to chronic sinusitis) that require stronger interventions. Such cases, IMHO, should get specialty attention. Most allergists should be non-surgical sinus experts able to provide optimal medical management for your problems (as a bonus, recurrent sinusitis is often influenced by allergy which they can also help with). Unfortunately many allergists are terrible at treating non-allergic chronic sinusitis, the majority of persons with chronic sinusitis. Allergists (I am one BTW), usually do their testing and put persons with positive testing on shots. Unfortunately, studies of persons with sinusitis show a majority of such persons have negative or irrelevant allergy testing results. ENT doctors are a good option although they are primarily surgeons, for them medical management of sinusitis is often a prelude to sinus surgery (treatment begins with antibiotics+oral steroids+ct scan - if not better in 2 weeks then schedule surgery). There are notable exceptions to my awful generalizations in both specialties and certainly some primary docs also know what they are doing with regard to these situations. My basic advice is if the doctor immediately goes to allergy shots, antibiotics or a cat scan for symptoms that have lasted less than 10 days (unless they are extremely severe), I'd go elsewhere. Ideally, find someone who specializes in the treatment of non-allergic, non-surgical sinus disease which is the description that best fits the majority of persons who have your symptoms. I wish you good health.
 Aslam Lateef, MD