I'm back again! With questions

[Mikeb123]

So I have tried many methods to treat my anxiety/OCD and so far the only things I have seen any benefits from is Xanax. Not compete resolution but a great improvement.

 

Tomorrow I am getting bloodwork back for strep, myco, ebv (mono), and Lyme. If these numbers are going up that explains why my anxiety seems to only be getting worse by the day

 

My question for you all is what should I do from here going with the assumption all the numbers are up?

 

My first idea is to get a FESS (Functional endoscopic sinus surgery) that is basically where they remove bacteria and other things from the sinuses. I remember vaguely when I was younger having a pandas flair where there was strep in my sinuses. It sucks because my mom is no longer alive to confirm this, but I'm pretty sure that was an issue. It would also explain why the strep I have isn't going down (since its stuck in my sinuses) I am literally on an antibiotic my mom would swear by as being helpful in my strep flairs, but now it's not doing the trick...

 

The second option (the idea dr. L is encouraging) is to do ivig. The process scares me because it seems that for some people it makes people worse/they might see long term improvements but have a downhill battle first, and right now I feel like this is the longest I can possibly take.

 

The third and final idea (if you guys have any more id love to hear them) is steroids. I have yet to try this method but I am scared of this option too since I had wisdom teeth surgery in 2011 where I was given prednisone and while I was on it I had my first panic attack in over 10 years. At the same time though I truly feel that how I feel now is worse than how I felt during that panic attack since this has just been a 5 month constant downhill issue

 

If I could just see some more improvements I'd be happy.

 

Any suggestions/other ideas would help.

 

At this point I've basically given up on antibiotics.

 

Thanks

 

Mike B

[wisdom_seeker]

Hi Mike,

 

I take it from your message that you have a sinus infection -- and maybe have had for a long time. PANDAS stinks. Sinus infections hurt, they are exhausting, and if they drag on discouraging. You want to do whatever you can to get rid of it. I get it -- I'm not an MD, but someone who used to have chronic sinus infections, and with two kids who used to have chronic sinusitis (and eventually had FESS, but they're oddballs in many ways).

 

We go see two MDs who focus on nothing but complex sinus disease, and we've gotten much better. So what have I gleaned from my years of experience:

 

First, don't give up on antibiotics -- make sure you've got the right one!

Just because your "reliable" antibiotic isn't treating the infection this time doesn't mean that the current bacteria aren't sensitive to another one -- you just need to know which. Otherwise it would be like saying that you're giving up on foreign-language dictionaries because your German-English and Russian-English dictionaries haven't helped you translate some French text. You first need to see what language you're dealing with!

 

So you need to figure out what is the right antibiotic -- for that you need to go to an ENT who will do an endoscopically-guided culture, where they suction up some mucus, and culture it to see what specific bacteria (and or fungi) you have, and what antibiotics those bacteria are sensitive to.

 

In addition, a good sinus doctor should also recommend practical things to help your body rinse out the mucus that is a breeding ground for bacteria, namely

• guaifenesin w/ decongestant (Mucinex-D) along with
  • a ton of liquid to help you drain,
  • perhaps followed by a steaming shower.
• Second, we always do saline sinus irrigations to actively rinse out the mucus and moisturize with bacteria-unfriendly liquid -
  • my kids and I do these irrigations a few times a day when sick,
  • with a mild mucus-thinner (e.g. a few drops of listerine, or baby shampoo -- it sounds much worse than it is).
  • We use Dr. Grossan's salt for irrigation, for it includes Xylitol, which is anti-viral and antibacterial.
• Hopefully you've also been tested for allergies, to see if those are helping you make more mucus, keep your nose more easily colonized by bad bacteria.

Perhaps you've done all these, along with the right antibiotic? If so then....

 

Next, steroids.
A few times it has helped to add a few days of steroids to the antibiotics; the key benefit is that they really help decongest and drain them, with a short-term anti-inflammatory benefit. However, if you can open up your sinuses with decongestants and mucolytics, and then use a steroid nasal spray, you may not need them.

 

If you do need steroids, then I bet you can prevent the panic side effect: The Xanax itself might well be enough to prevent that. What does your doctor say? If you want secondary insurance, I've seen a few case reports of treating even severe steroid-induced panic attacks with SSRIs, e.g. this, so you could ask about pre-treating with a few weeks of SSRIs to be sure to prevent the panic.

 

Lastly, FESS.

I know nothing about your condition -- for all I know you've been recommended FESS for years. Also I'm not an MD; I only speak as a veteran of FESS, with two kids who've had chronic sinus infections and FESS. FESS in the right hands, for sinuses that need it, can be very effective -- but it is invasive, and the recovery is not easy, even though it is surgery on a small part of the body. How do you know if it's a good idea for you? If the right antibiotic, irrigations, decongestants, and a course of steroids have not helped and you continue to have infections, then an MRI will show if there's a structural reason why, and/or if there are thick diseased mucus membranes.

 

The thing is that FESS doesn't just remove bacteria -- it is used to increase the size of sinus drainage openings (the osteomeatal complex) and then to scrape away diseased tissue, scar tissue or to remove thin bones that prevent drainage. ( If there is a lot of fungus, then FESS is the right thing - but that's uncommon, and would be visible on culture or MRI too.) My kids had deviated septums with a concha bullosa that prevented drainage, and my 2nd grader had had a year of pansinusitis -- infection in most of his sinuses. FESS did help a lot. Still, If you can make the mucus membranes on your sinuses healthy with the other measures, you'll be better off.

[Mikeb123]

My situation is quite complex due to the number of things I am currently positive for. I have high antidnase, myco p, ebv (mono), and possible Lyme. I just know that when I was younger strep was my main issue. My current belief is that I got mono first and that that is what left me suseptiable to all these other problems.

 

The weirdest thing is that now most of my physical symptoms are gone but I would say my anxiety is at the worst it's been since getting sick back in October... I don't have much sinus pain or pressure. Maybe light stuffiness but that's really it. Lastly, and this is the weirdest part. Every time I've been checked by a doctor over the past 10 visits (in the past 4 months) they've always said my left nostril looked inflamed. Now they're saying it's my right one...

 

Anyways Monday I get the results from the nose swab. The CT scan just showed some blockage in my sinuses and a deviated septum. Hopefully the swab has more detailed diagnosis. I just want to see some noticeable improvements!

 

Anyways I appreciate all the advice/words you have to off wisdom seeker. I sent you a direct message if you're able to I'd love to get more details.

 

Thanks!

 

Mike B