Three Years of Sinus Distress: A Call for Assistance
I am a 36-year-old woman with a history of cancer, having undergone chemotherapy, radiation, and immunotherapy (Keytruda), which I stopped around 2021. Approximately a year later, I began to experience troubling symptoms after spending some time in Egypt, where I encountered polluted air, smoke, and engaged in occasional smoking myself. My main concerns include: - Constant nasal swelling and a sensation of tightness as if the tissue inside my nose is "stuck together." - Development of thick crusting within my nasal passages that sometimes obstructs airflow by sealing the tissue shut. - Although my ENT examinations reveal no active infections, doctors consistently note that my nasal tissue appears "inflamed." - Additionally, I endure swelling and discomfort in the lymph nodes throughout my body. - While a few antibiotics have offered temporary relief, the symptoms return once the medication is stopped. I noticed improvements when taking Bactrim, cefadroxil, and doxycycline, but Cipro did not provide any benefits. This ongoing sinus issue has plagued me for around three years, with sensations of rawness and extreme crusting reported—one ENT even rated my condition as 9 out of 10 for crusting severity. After living in Egypt for over a year dealing with this discomfort, I returned home in hopes of better healthcare support. Throughout this period, I've undergone MRIs and CT scans, visited three different ENTs, and even had a surgical procedure intended to remove the crusting. Despite the procedure, my symptoms recurred. Recently, another ENT agreed to culture my sinuses for the first time, despite my ongoing antibiotic treatment during the swab. The result was a "scant" presence of Serratia, with sensitivity testing indicating that while Cipro could potentially work, it was among the least effective treatments I have tried. Based on the sensitivity results, I switched from cefadroxil to Bactrim, which unfortunately coincided with a resurgence of pain in my lymph nodes. My doctor advised me to rely solely on Bactrim, but I find this troubling. The situation is overwhelmingly distressing. The discomfort is localized to my left sinus and seems to radiate into my ear, enveloping much of my head—a complication rooted from a previous fungal infection in my ear. I am currently under the care of an infectious disease specialist who has conducted over 20 tests, especially considering my history of travel and potential autoimmune disorders. I have expressed my concern that the lymph node issues are linked to my nasal condition, yet he appears skeptical. When I first returned to the States, I was suffering from open sores within my nose, which improved significantly with the application of mupirocin. Today, my ENT prescribed a nasal rinse containing xylitol, mupirocin, and gentamicin, which provides some relief, although it feels like a minor effort against a larger problem. I am feeling incredibly desperate at this stage. There is an unsettling thought of returning to Egypt, as I might have easier access to necessary testing and treatments. I spent three years largely confined to bed due to cancer, and now this sinus issue has me nearly bedridden again. Any guidance or assistance would be immensely appreciated.
Answers (1)
6/20/2025, 10:20:47 PM
OpenHealth AI
I understand that you are feeling overwhelmed and desperate due to your ongoing sinus issues and associated symptoms, especially given your complex medical history. Let’s summarize your main concerns and provide some structured guidance on the next steps you can take to improve your situation.
Key Concerns
- Persistent nasal swelling, crusting, and obstruction, particularly in your left sinus.
- Inflamed nasal tissue without active infections according to multiple ENT evaluations.
- Pain and discomfort in your lymph nodes, with reports of worsening symptoms during certain antibiotic treatments.
- Previous interventions have offered short-term relief without lasting improvement.
Explanation
Your symptoms suggest a combination of chronic sinusitis and potential underlying factors related to your previous cancer treatments or environmental exposures. The congestion, thick crusting, and sensitivity also indicate that your nasal passages are reacting strongly, possibly due to irritation from pollutants or smoking, and could be exacerbated by conditions such as vasculitis or even certain autoimmune disorders.
Prioritized Next Steps
-
Continue Nasal Rinses and Topical Treatments: Keep using the nasal rinse prescribed by your ENT that contains xylitol, mupirocin, and gentamicin. This may help reduce inflammation and crusting. Consistency is essential, so make it part of your daily routine.
-
Monitor Antibiotic Response: Since Bactrim has been beneficial, continue taking it as recommended by your physician. However, track any side effects or exacerbations in your lymph nodes and discuss these findings with your doctor.
-
Explore Other Treatment Options:
- Consider Seeking a Second Opinion: Given the complexity of your symptoms, seeking input from another infectious disease specialist or a sinus specialist may provide new insights or treatment strategies.
- Discuss Possible Anti-inflammatory Treatments: Talk to your doctor about using corticosteroids (either systemic or intranasal) to help with inflammation, if not already in use. These can reduce swelling and promote healing in the nasal passages.
-
Lifestyle Changes:
- Environmental Adjustments: Minimize exposure to smoke and pollutants, especially if you notice a correlation between your symptoms and environmental triggers.
- Stay Hydrated and Use Humidifiers: Keeping your environment well-hydrated can help loosen crusting and enhance the effectiveness of nasal rinses.
-
Symptom Diary: Maintain a log of your symptoms, treatments tried, and their effectiveness. Include notes on your lymph nodes’ response and any changes you observe during treatment shifts. This information can be invaluable for your healthcare providers in refining your management plan.
-
Consider Referral for Additional Testing: If lymph node swelling persists, further evaluation from an oncologist or a rheumatologist may be beneficial to rule out autoimmune conditions or other underlying issues that could link to your symptoms.
Conclusion
I can only imagine how challenging this situation has been, especially following your cancer journey. It's essential to stay engaged with your healthcare team and communicate openly about your concerns. These steps can help create a proactive approach to manage your sinus condition and overall well-being. Please take care, and continue to reach out for support as you navigate this process.
Related Questions
Understanding Hashimoto's Thyroiditis and Its Impact
A 25-year-old female friend of mine has reported some concerning health markers, specifically her Anti-Thyroid Peroxidase (Anti-TPO) level, which stands at 78. Here are her thyroid function test results: - Triiodothyronine (T3): 1.10 - Thyroxine (T4): 8.63 - Thyroid-Stimulating Hormone (TSH): 2.12 Her weight is noted at 90 kg. Furthermore, her lipid profile reveals the following: - Total Cholesterol: 291 mg/dL - High-Density Lipoprotein (HDL): 30 mg/dL - Low-Density Lipoprotein (LDL): 221 mg/dL - Very Low-Density Lipoprotein (VLDL): 58 mg/dL - Triglycerides: 290 mg/dL In addition, her uric acid concentration is at 7.96 mg/dL, while her vitamin D levels sit low at 13 ng/mL. She is under medication for these conditions and also suffers from Polycystic Ovary Syndrome (PCOS). Her anxiety about her health is palpable, especially with regards to whether her elevated Anti-TPO levels signify Hashimoto's thyroiditis. Compounding her worry is her family medical history, as her aunt has been diagnosed with lupus. She is pondering if losing weight and making adjustments to her diet could potentially reduce her Anti-TPO levels. Is it advisable for her to seek the expertise of an endocrinologist and explore medical treatments? Additionally, what dietary modifications might be beneficial for her to alleviate these health concerns?
Ongoing Wound Concerns After Injury
Patient profile: 12F, height 170 cm, weight 60 kg, with a history of asthma and eczema. Approximately nine months prior, the patient experienced a fall from a bicycle onto a small gravel surface. While wearing leggings, she sustained a skin tear about 1 cm in size on the upper buttock area. The injury initially appeared to be clean, and there were no visible holes in her leggings. The wound was regularly disinfected and covered, although it took a considerable amount of time to heal. The resulting scar consistently looked delicate and thin throughout the recovery process. About four months ago, the wound reopened unexpectedly, without any specific trauma occurring. A visit to the doctor revealed no signs of infection and an ultrasound confirmed the absence of any foreign objects. The wound ultimately healed again. Currently, she is dealing with a superficial abscess that was treated by lancing with a sterilized scalpel, following the application of lidocaine for numbing. Following this procedure, the area was allowed to drain, and Bactroban ointment was applied along with a fresh dressing. There are no symptoms of fever at this time. Should we consult a doctor once more, or would it be adequate to monitor the healing process at home? Additionally, what might be causing the wound to keep reopening?
What Does Expelled Tissue During Menstruation Indicate: Decidual Cast or Not?
**Introduction:** I am a 29-year-old female who experienced the expulsion of atypical tissue during my menstrual cycle in February 2024. My gynecologist suggested it might be a decidual cast; however, I feel I did not fully convey the details regarding the tissue to my doctor, leading me to question this assessment based on its observed characteristics. **Birth Control Regimen:** - I have been using NuvaRing for a duration of 10 months, following a routine of three weeks in use and one week removed. - The tissue was expelled at the onset of my withdrawal bleed. - A urinalysis performed the following day—including a pregnancy test—yielded normal results. - A pelvic examination and transvaginal ultrasound (TVUS) two weeks later also returned normal findings. **Characteristics of the Tissue:** - The structure appeared distinctly tubular rather than flat or wrinkled. - It seemed to encompass a hollow core or lumen. - A vascular pattern was evident in its makeup. - Initially, the tissue was firm and retained its shape well. - By the following morning, though it appeared deflated, it still held its basic form with a rubbery texture. - Its coloration was a dark red to purple hue. - The tissue measured roughly 2 inches in length. **Situation and Symptoms:** - This incident coincided with a period marked by notable systemic symptoms. - Two weeks prior, I experienced tremors in my legs after climbing stairs in hot weather. - I also faced gastrointestinal issues, including chronic loose stools and nausea during this time. - There have been persistent neurological symptoms such as numbness in my extremities and difficulties with temperature regulation. - Furthermore, I've dealt with numerous vascular symptoms, including chilblains and livedo reticularis, alongside exercise intolerance. - The expulsion of the tissue was accompanied by the typical cramping associated with menstruation. **Health Background:** - I have symptoms that may indicate endometriosis, including pain during pelvic examinations behind my uterus, pelvic cramping after orgasm, and situational pelvic discomfort. - My family history includes several autoimmune diseases, such as ulcerative colitis and autoimmune hepatitis. - I have hypermobility and a homozygous mutation in the MTHFR gene. - Recent medical evaluations—like autoimmune panels, MRIs, EMGs, colonoscopy, and TVUS—have all returned normal results. **Inquiries:** 1. Do the features I described align with what experienced OB/GYNs would recognize as a decidual cast? 2. Is the timing of the tissue expulsion, alongside my systemic symptoms, of any significance? 3. Can a decidual cast maintain the tubular shape I observed instead of flattening like a sheet? 4. Should I be troubled by the vascular characteristics and the well-organized structure of the tissue? With the combination of my systemic symptoms and the distinct physical qualities of the tissue, I am contemplating whether this situation requires more thorough investigation, such as a laparoscopy, or if I might be overanalyzing a typical hormonal event. I appreciate any advice or thoughts on this matter!
Unexplained Chest Tightness
A 47-year-old woman reports a troubling sensation of tightness in the center of her chest. Over the past few days, she has experienced what feels like pressure on her heart, with episodes lasting between 30 to 45 seconds. Occasionally, these episodes occur multiple times within a 45-minute period. This unfamiliar sensation has not been part of her previous experiences with anxiety or the emotional pain of losing a loved one to death, which she is well-acquainted with. Recently, she has been under significant stress, more than usual. In addition to the chest tightness, she encounters periods of marked fatigue throughout the day. Although this tiredness can sometimes lift, it often feels overwhelming in its persistence. With a fitness routine that includes exercise four times a week, a balanced diet rich in protein and healthy fats with moderate carbohydrates, and consistently good blood pressure readings, her overall health appears robust. Routine blood tests also yield normal results. While she is currently experiencing perimenopause, she manages related symptoms effectively with progesterone and estrogen patches. Given her situation, she is questioning whether her symptoms warrant concern or if they might be manifestations of psychological stressors.
Anemia Concerns: Urgent Blood Test Results
The discussions on the anemia subreddit have left me feeling quite distressed, prompting a need for some reassuring advice. I recently underwent blood testing as I suspected I might be dealing with anemia. My hemoglobin level was reported at 6.4, leading my primary care physician to urgently refer me to a hematologist, emphasizing that this was a critically low figure. He suggested I consider heading to the emergency room for a transfusion should my symptoms escalate. Thankfully, I did not experience any worsening symptoms and thus did not go to the ER. This week, I had my appointment with the hematologist who reviewed my blood work and ordered further, comprehensive tests. He reiterated that I should seek emergency care if my condition deteriorated. I am scheduled to meet him again on Tuesday for a follow-up. Today, I received the results from my latest blood tests, revealing that my hemoglobin has dropped to 5.8, while my ferritin stands at a mere 3. Although I was assessed for multiple issues, these two figures seem to be the most critical. It’s clear to me that these levels indicate a serious situation, necessitating either transfusions or infusions, which we will discuss during my Tuesday appointment. I suspect that the root cause may be attributed to my previous gastric bypass surgery, which affects my body's absorption capabilities. Currently, I am not experiencing symptoms typically associated with ulcers, and my menstrual cycles are fairly light. To doctors and medical professionals reading this: Are these blood levels genuinely in a state of emergency? Is it likely that I can manage through the weekend without risking severe complications, allowing us to plan the next steps on Tuesday?