When osteopath Dr. Rob Ivker moved to Colorado in the 1980s to set up his family practice, he had no idea that when he stepped off the plane he’d succumb to symptoms of chronic sinusitis that just wouldn’t go away: stuffy nose, thick mucus, pressure behind his cheekbones and above his eyebrows, dull aching headache, and thick goopy drainage in the back of his throat.
He began treating himself as he’d been taught during his residency and made little progress.
Dr. Ivker then went to ENT (ear, nose, throat) specialists and was discouraged to learn that there were exactly two approaches to chronic sinusitis: surgery and medication (allergy shots, antihistamines, antibiotics). The long-term success rates of both were pretty poor. Surgery was rarely a permanently fix because any nasal obstruction, once cleared, simply grew back. Sinus infections treated with antibiotics become ever more resistant to them.
So in the 1980s Dr. Ivker wrote Sinus Survival, which summarized all the alternative approaches to chronic sinusitis. The book took off like a rocket, possibly because it was the first real US exposure to what are now fairly common approaches to sinus troubles: diet changes, neti pots, acupuncture and homeopathy, treating chronic candida infections, and a slew of nutritional supplements.
And yet, even following everything in Sinus Survival, the miseries of chronic sinusitis continue to plague us. A friend of mine (not a patient) once remarked that he’d been through both heart surgery and cancer surgery, but for sheer day-to-day misery, chronic sinusitis topped them both.
So let’s label the antibiotics/surgery route of conventional medicine Plan A. The smorgasbord of lifestyle changes and alternative therapies will be Plan B.
Could there be a Plan C?
Yes. Over the past few years, ENT surgeons took a second look at two organisms that had appeared in sinus cultures taken from surgical patients. The organisms had been previously considered non-pathogens, meaning, yes, there they are, but they don’t cause problems.
One of these was good old Candida albicans (C. albicans), a yeast that often emerges after patients have taken one antibiotic after another. The second was something called coagulase-negative Staphylococci. Understand that coagulase-positive staph can be vicious, the most dangerous of the staph infections—causing everything from serious skin infections and heart valve disease to bone and kidney abscesses.
But coagulase-negative Staphylococci? Harmless, so was the gospel.
But then researchers started connecting some very interesting dots.
Over the past 20 years, more and more articles from around the world began to appear about a condition named chronic inflammatory response syndrome (CIRS). In patients with CIRS, there was evidence of widespread, low-level inflammation producing a broad range of seemingly unrelated symptoms (fatigue, muscle/joint aches, brain fog, and often chronic sinusitis).
CIRS was appearing in two groups of people: those who had been exposed to a water-damaged building where black mold had been known to grow and those who had blood test evidence of a tick-borne illness, mainly Lyme, sometime in their past.
Not all people exposed to black mold become ill. The mold produces a toxin (called a biotoxin or mycotoxin) that triggers CIRS. Your susceptibility to this is genetic. Only 25% of people exposed to biotoxins are made sick from them.
However, the chronic sinusitis triggered by mold biotoxins is none other than the formerly-considered-harmless coagulase-negative Staphylococci (CNS).
So where does chronic sinusitis Plan C come in?
Okay, here goes. You’re miserable with chronic sinusitis. You’ve been through the Plan A antibiotics/antihistamines and you’ve had one or more sinus surgeries (or you’re planning to schedule one).
You’re still miserable with chronic sinusitis, especially during flare-ups (like after a cold or during allergy season). You’ve tried just about everything in Plan B. You have gone gluten-free and dairy-free. You steam with eucalyptus and neti pot rinse until you feel your eyeballs popping. You’ve tried acupuncture and cranial osteopathy and your kitchen counter is littered with expensive supplements.
You’re ready for Plan C:
1–Get tested for the possibility of CIRS. The tests are described in this Health Tip and are generally covered by insurance.
2–Get a nasal swab test specifically for MARCONS (multiple antibiotic-resistant coagulase- negative staph) and fungi (especially C. albicans). Unfortunately not covered by insurance.
If the CIRS tests are suggestive of black mold toxicity, have your home/workplace tested for mold and get a urine test called Mycotox from Great Plains Lab, which will measure the levels of biotoxins in your body. If you have high levels of mold toxins, you’ll need to be detoxed, a fairly simple treatment I described in this Health Tip.
If the mold tests are negative for biotoxins, get tested for Lyme.
If your MARCONS test returns positive results, you’ll need a specially compounded nasal spray called BEG, made up of two antibiotics and a substance called EDTA to weaken the bacteria. It’s called BEG because of the ingredients: Bactroban+EDTA+Gentamicin.
If your swab shows candida, BEG is replaced with itraconazole spray.
Many people need both BEG and itraconazole, with the spray treatment usually lasting two months.
BEG spray will definitely be enhanced by adding nasal ozone treatments. This might sound more dramatic than it actually is. To get an idea of what’s involved, watch this video of someone getting a treatment. A syringe is filled with ozone (the three-atom oxygen, remember?) and you take a deep breath and hold it as the ozone is infused up one nostril. You pinch your nose closed for ten seconds and then blow it out before repeating with the other nostril. The whole procedure takes just a couple of minutes and the only necessity is holding your breath because breathing in pure ozone will irritate your bronchial tubes.
To paraphrase the little boy writing to his aunt to thank her for her gift of a book on penguins (“Thank you, auntie. The book told me more about penguins than I really wanted to know”), I feel I’ve done the same here regarding chronic sinusitis.
If you’re not a WholeHealth Chicago patient but are interested in mold and MARCONS testing, schedule an appointment with any of the following: Katie McManigal, A.P.N., Alaina Gemelas, D.C., or Caley Scott, N.D.
If you’re already a patient and you want any of these tests, call and schedule a lab-only.
If you want to move right to ozone therapy without actually becoming a WHC patient, simply schedule nasal ozone with Katie McManigal.
David Edelberg, MD