wtf sinuses? chronic sinusitis and me

An Evil Six-Week Cold

As of today, I’ve been suffering with a variety of evil cold and flu like symptoms for a hellish six weeks. Twice already, the symptoms have been so bad that I’ve visited my doctor; first back on Halloween and again this week.

Both doctor visits resulted in an antibiotic prescription, even though there was no clear evidence of bacterial infection. Normally, I would resist taking antibiotics in such situations (it had been at least 17 years since I had done so in response to sinus/throat/lung type symptoms). This case felt different. More difficult to deal with. So I have taken the antibiotics. They haven’t made any difference so far.

Part of my frustration, and what has driven me to the doctor’s office, is that during both of these weeks I’ve been too sick to train. Training has been hampered by weakness, lightheadedness, and painful episodes of coughing and hacking balls of phlegm. And for the past six weeks, after every even moderately intense workout, my recovery has been difficult, to say the least: DOMs is dramatically increased, and accompanied by fever-like symptoms. And the general sinus and throat symptoms have dramatically worsened after a number of these sessions.

Diagnosis: Sinusitis

Well, to my GP, whom I saw on Tuesday, I likely have an emergent case of “chronic sinusitis,” by which is meant: I have severe inflammation of the sinus passages, the result of an infection or other factors, which, if left untreated, will likely continue for weeks or months longer. On this theory, the inflammation of the sinuses is the root cause of the nasty mucousity of my entire upper respiratory tract. Technically, it’s not chronic unless it has persisted for 12 weeks or more. But such symptoms transcend the usual viral or bacterial infection when then hit about 6 weeks. So from 6-12 weeks, you have a grey area. Not technically chronic, but on its way.

His diagnosis for me did not come as a surprise, even if I am not entirely convinced by it (the symptomology of chronic sinusitis fits my complaints, but not entirely). That is because I have been diagnosed as having chronic sinusitis in the past. About 17 years ago, in fact, when I was about 26 years old.

Previous History with the Chronic

Back in 1995, I was 26 years old and living as a graduate student in Chicago, I had a similarly persistent and ridiculous case of upper respiratory distress that led me to the doctor. It wasn’t the first time I’d had extended periods of stuffy/runny nose, post-nasal drip, difficulty breathing, sore throat, productive cough, etc. In fact, you could say I had learned to count on at least one extended cold during most seasons.

I grew up with such problems. As a child, I had a striking tendency to get strep throat and tonsilitis. I never knew why. My parents would culture my throat (my dad is a physician), confirm the diagnosis, get me a scrip for arithromyacin and that was that. I didn’t think much of it. But as a teenager and a young adult I had outgrown my tendency to get strep; instead, I would just get these bad colds and short-term sore throats.

But this time was different, so I saw my doctor. Dr. Roach. He was a cool guy, an athletic runner and holistic thinker about medicine and health. Anyway, he diagnosed me with Chronic Sinusitis, suggesting that something about my sinus architecture might predispose me to frequent infections.

After a botched attempt to clear the current infections with a sulfa antibiotic (I turned out to be allergic), we succeeded in curing my symptoms. He prescribed exercise, weight loss, and breathing exercises. Which seemed to work.

The Architecture of My Sinuses

Dr. Roach’s suggestion, that something was wrong with the architecture of my sinuses, resonated. My dad has terrible problems with loud snoring, sleep apnea, and family lore blames this on a “deviated septum.” Like my dad, I have trouble breathing through my nose, and I am a “mouth breather” at night; it was always assumed that I had a deviated septum too.

Well, it turned out that I do. I had found this out out in 1990, at New York’s St. Luke’s/Presbyterian hospital, during a stay in the hospital for Spinal Meningitis. (Another, even longer story). Short version is: I had to have an MRI or scan or something because of my spinal infection. Afterwards, an ENT specialist showed up in my room, explained he had routinely examined my scan, and did I know that I have screwed up sinues? Not only had he seen that I have a deviated septum, explaining the near non-functioning of my left nostril, but he also found evidence of one or more nasal polyps back in there. Call me, he said, if you want these removed. I got out of the hospital, and never did call.

But here I was, six years later, suffering from a chronic infection, and being told that nasal architecture was to blame. So, what I did was, I got a referral to an ENT surgeon, and had a scan and a consult. What he told me was yes, I had polyps and a deviated septum, and that surgery was a possible route of treatment for me. He would recommend it, he said. But when I listened to his report on the outcomes, and on his explanation of possible complications, I decided, wisely I think, to skip surgery on my nose.

It turns out that only about 40% of patients (at that time) were reporting relief of symptoms of chronic sinusitis, snoring, sleep apnea, etc., after such surgeries. In other words, the majority of patients underwent the procedure and experienced no benefit. Some even had a worsening of symptoms or other new and unexpected symptoms.

And the complications? They are rare… but they are as obvious as the nose on your face. Deep in the sinuses, back up between the eyes and near the brain, the risks included possible damage to the optic or olifactory nerves. No thanks.

How I Dealt

At my doctor’s suggestion, I started working out more. Mainly running. And a little bit of ineffective, broscience driven, skinny boy weightlifting. Also, I took up a bit of Yoga, and learned some breathing techniques. I lost a little weight. Got fitter. Later, I lost quite a bit of weight and even got a bit shredded. Eventually, I gained all that weight back, and then some (before I hit my CrossFit phase… from that point, the rest of the journey is recorded in this blog); but even so I retained my running and Yoga.

And you know what? During that whole time I was better. A lot better. My sinuses cleared up and didn’t bother me again in a serious way for about 15 years. My theory was that regular outdoor exercise, aerobic exercise, and the high impact activity of running, 3-5 days per week, literally shook out the sinuses and helped me keep them clear. Besides whatever stimulation was offered to my immune system. I never ran the kind of mileage that was a serious challenge to recovery, so I think I mainly benefited from the endocrine stimulation. And the techniques of breathing that I learned in Yoga, especially once I’d moved to Asheville, they offered me ways of working on my sinuses in a practical way. I learned that meditative patience, focus, and other tricks could actually cause my sinuses to relax, and let go, and allow air through.

So What Happened?

Weight gain. Over the past year I have gained at least 15 pounds.

No more endurance/aerobic exercise. I have also stopped running, and have done very little in the way of metabolic conditioning.

Recovery from a broken arm. Both of these situations have been exacerbated by my period of recovery from the broken arm (now in week 17).

No more Yoga or meditation. Aside from a brief flirtation with meditation in September of this year, I’ve done no conscious sitting or breathing, and haven’t taken a Yoga class or done a home practice in months.

No more Paleo Diet. Yes, I am SAD to report that, over the past 8 months, I have pretty much allowed a huge window for foods in the Standard American Diet. It’s not as though I am eating sandwiches, soda pop, and sugar cereal or anything. But I have allowed plenty of ice cream, dairy, pizza, hamburgers, french fries, desserts, candy, alcohol, and other American goodies back into my life during this period of weight gain. Besides the obvious impact on my waistline, the dietary change has meant the addition of many many pro-inflammatory foods in my diet. Chronic sinusitis is an inflammatory condition.

Bottom line is: I have done this to myself. I have sown the wind, and reaped the whirlwind.

My Solution

I think that the solution to my current situation is obvious.

1) Return to Paleo or Paleo-ish principles in my eating. Avoid inflammatory foods. Cut back on dairy, grains, sugar, and alcohol in particular. Watch my O6/O3 ratio, supplementing if necessary. Bring back the veggies and lose some of the starchy carbs, especially the processed ones (like, e.g. Bob’s Red Mill Brand Gluten Free Pancakes… how I love thee!).

2) Take eating for recovery more seriously. Do more nutrient partitioning: more fruit and starches in the post exercise window, and less in the afternoon and evening.

3) Don’t confuse binge eating with eating for recovery. This is a particular problem of mine. It is one thing to make sure you eat enough protein and get some good carbs in the days following a serious lifting session. It is another thing entirely to “feel hungry” and so drink three milkshakes.

4) Lose some fat. Besides the fact that I will look better with less body fat, my personal experience and epidemiology supports the notion that I will be and feel healthier (and breath better, and snore less) with less body fat. I am not talking about losing weight. I am talking about losing body fat. In my case, this can be tracked roughly with an umbilical measurement. I don’t care what my body weight is. But I do need to stop accumulating excess fat.

5) Walk more. Even run some. Get outside. I need to take time to do some longer, slower, outdoor sessions, in all seasons.

6) Do Yoga and/or meditate. Some time spent in focused practice of Yoga is necessary for my spiritual and physical health. I knew this before. Why did I forget it? It’s time to bring myself back to reality and embrace the practice.

Bring yourself back to reality and embrace the practice.

Practice reality.

Let me know what you think...