Waterboarding Used as Treatment Not Torture
In last week’s article we discussed the various causes and treatment options for rhinosinusitis (RS). For treatment options, we touted saline nasal irrigations as front-line therapy no matter the cause of the nasal and sinus symptoms. Some readers responded with questions about why the procedure is so effective and requested more detailed information about the process.
A discussion about excessive respiratory mucus may not make a particularly pleasant topic; unless, of course, you are a teenage boy preparing to compete in a spitting contest or a rookie baseball player trying to appear fashionable with his spitting. Nevertheless, we will proceed.
The analogy with waterboarding may not be pleasant, but the term is used in place of irrigation or lavage to emphasize that to be effective, the procedure involves more than simply spraying a mist of saline into the nostrils. There must be adequate pressure and volume of the solution to clean out the nose and sinuses. Waterboarding is associated with interrogation and torture, but saline lavage certainly doesn’t fall into that category.
RS is simply inflammation of the mucosal lining of the nose and sinuses and there are a number of factors that can precipitate this inflammatory response. These were described in last week’s article. Two of the most common culprits are infection and allergens. Inflammation is a critical component of our complex immune system. When an irritant contacts the lining of the nose, blood flow increases to the area in order to transport immunologic defensive cells and other biochemicals to the area to fight off the offending agent. This increase in blood flow results in nasal mucosal edema (swelling) and thus a ‘stopped up nose’. Another component of the inflammatory response is stimulation of mucous glands that release large amounts of mucus causing a ‘runny nose’. This mucus causes aggravating symptoms with anterior and posterior nasal drainage, but we need to remember that “mucus is our friend” because it traps offending agents, like viruses and bacteria, and facilitates removing them from our body when we expectorate the mucus. However, many people can’t tolerate the congestion and drainage and are understandably embarrassed in public when constantly blowing their nose and clearing their throat to spit up mucus from the posterior drainage. People seeking immediate symptom relief turn to OTC cold and sinus meds-the wrong approach! These meds dry the mucus making it difficult to eliminate, and if infection is present, the bugs are somewhat protected by dry, crusty mucus. The mucous membranes also become dry, and this allows further penetration by the bugs prolonging the illness. This is one reason that a simple rhinitis, like a cold, can progress to sinusitis.
So, this information should make our treatment goals obvious: thinning and removing the mucus. To do so during an attack of RS, drink extra fluids and not just water. Use electrolyte solutions (sports drinks) and brothy soups. We have known for some time that chicken soup is helpful in treating a cold, but there is probably no magic in the chicken, it is the broth that liquefies the mucus. There is one OTC medication that is beneficial called guaifenesin (a well-known brand is Mucinex) that liquefies mucus and lubricates airways facilitating removal of the mucus.
Finally, but most importantly, is the use of nasal irrigation and lavage with buffered saline (therapeutic waterboarding). This procedure simply washes out the mucus and other foreign matter from the nose and improves sinus drainage. The saline reduces the swelling in the nasal cavity by drawing out the excess fluid from the mucosa as a result of a process called osmosis (take my word for it or check with Dr. Google for details). If the congestion is so severe that it interferes with instilling the saline, it is acceptable to pretreat with decongestant nasal sprays. However, do not use these longer than about 3 days.
Instead of a homemade system, we suggest purchasing one of the many kits available at most pharmacies. One of the best known is the Neti-Pot but there are other kits that are just as effective. The following points are important to remember: a) Rather than making the saline solution at home, we think it best to purchase commercial solution that is sterile, buffered, and contains the proper sodium concentration; b) Be sure to use adequate volumes of the solution, 6-7 ounces, that is warm but not hot; c) During acute episodes of RS, irrigations can be done 3-4 times daily. During times when respiratory infections are rampant or during pollen season, it is wise to use irrigations once daily as prophylaxis; d) When the saline is instilled into one nostril, it should pass to the other nostril. Some may enter the throat and this should be expectorated; e) If you are using prescription steroid or antihistamine sprays, their effectiveness is enhanced if they are used after a lavage; f) If you have a spouse or roommate, you might consider doing your waterboarding in the shower rather than over the sink!
Dr. Tippett is the founder of Comprehensive Quality Healthcare Providers located at 1210 Commerce Dr. Suite 106, Greensboro, Ga. 30642. He can be reached at 706-510-3659. Visit his web page at www.drtippett.com