If patients are taking herbal supplements, safety issues arise. Many herbal remedies possess significant pharmacological activity and can cause potential adverse effects and drug interactions (Arch Facial Plast Surg. 2001;3:127-132). Dr. Seidman points out that St. John’s wort, commonly used to treat mild depression, is especially dangerous with inhalation anesthetics. Dr. Harvey follows the recommendations of the American Society of Anesthesiologists, which advises discontinuation of any herbal products two weeks prior to surgery (see “CAM and Endoscopic Sinus Surgery,” p. 16).
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April 2010Jordan Josephson, MD, FACS, director of the New York Nasal and Sinus Center in New York City, thinks it behooves physicians to take their patients’ preferences into consideration. “Whether we like it or not,” he said, “patients are going to continue to pursue alternative therapies. Patients will not tell you that they use CAM therapies if they think you will not approve. This puts you and the patient in jeopardy, because there might be interactions between those therapies and the ones you are offering. We really all need to join forces and try to educate patients,” he said.
Gretchen Henkel is a medical writer based in California.
ONLINE EXCLUSIVE: Treating Allergic Rhinitis: A Patient Experiment
Berrylin J. Ferguson, MD, FACS, FAAOA, associate professor of otolaryngology and director of the Division of Sino-Nasal Disorders and Allergy at the University of Pittsburgh School of Medicine in Pittsburgh, Pa., uses the following form to help determine which allergy treatments will work best for each patient.
“Every patient potentially responds differently to a medication,” Dr. Ferguson said. “So we have patients experiment by only changing one variable at a time, that is only change one medication they are taking at a time, and monitor themselves to see if the medication improves their nose or allergy symptoms.”
| Try each medicine in order indicated | Medication | Dose | Number of times a day | Symptoms which should improve and how long it should take to work | Check if sample given |
| Nasal steroid spray: Generic Flonase, Nasocort, Nasonex, Rhinocort AQ, Veramyst, Omnaris. If any of the above are effective, let us know which is on your ormulary. | 1 to 2 puffs each nostril. Direct spray using right hand to spray left nose, and vice a versa to maximize delivery laterally | 1 to 2 times, use lowest dose that relieves symptoms | Nasal congestion, drainage, allergy symptoms. May take a week to work SLOW |
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| Antihistamine nasal spray: Astelin, Astepro, Patanase | As above. Lean forward and do not sniff x 1 minute to minimize bad taste | 2 times, take first dose before bedtime, to see if it makes you sleepy | Nasal congestion, drainage, itch. May work in less than 1/2 hour FAST | ||
| Singulair | 10 mg pill | 1 time | As above plus cough, FAST |
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| Antihistamines: Loratadine OTC, Allegra, Xyzal, Zyrtec | 1 time | As above plus cough, FAST |
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| Guaifenesin (Mucinex) | 600 mg | 2 pills 2 times | Over the counter, less expensive as generic on the internet | ||
| Proton Pump Inhibitor | Take ½ to 1 hour before a meal | ||||
| Antibiotic | Eat yogurt, Kefir, or take probiotics or acidophilus tablets (OTC, health food store) while on an antibiotic to replenish good bacteria in your system | ||||
| Saline nasal rinse: Neil Med, Simply Saline | Use saline rinses BEFORE applying prescription nasal sprays | ||||
| Queen Helene’s Cocoa Butter Cream | Apply to front of nose | As needed | Available at Rite-aid; Wal-Mart and on the Internet. |
Source: Berrylin J. Ferguson, MD, FACS, FAAOA
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