IslandTractor
Super Star Member
- Joined
- Sep 15, 2005
- Messages
- 15,802
- Location
- Prudence Island, RI
- Tractor
- 2007 Kioti DK40se HST, Woods BH
roxynoodle said:
Sinusitis is one of the more difficult issues in this whole business. Your case is actually quite atypical due to your trauma so what I am about to say does not apply directly to you.
There are, as N80 mentioned above, a few factors that make sinusitis such an issue. For starters, it is actually very difficult to diagnose accurately unless it is fairly advanced. The reason for that is that the symptoms of early or even moderately advanced sinusitis are virtually no different than the symptoms of an ordinary common cold. There are no easily performed laboratory studies that help distinuguish bacterial sinusitis from a cold and even xrays are fairly useless. The xray of someone with early to moderate sinusitis look virtually identical to the xray of someone with a cold. (Bizarrely, radiologists have no diagnostic code for common cold as a cause of these findings so inevitably report such findings as "consistent with sinusitis" which puts further pressure on the doc to treat) This is a big part of the problem. Physicians are confronted with perhaps half a dozen or more patients per day during the winter months who are complaining of prolonged cold symptoms. The docs know that at most 10% actually have a bacterial sinus infection but they have no good way to distinguish those from the others during a single office visit. Ideally they would take the time and educate patients (patient patients
) and send just about all of them home without antibiotics but with the understanding that a few of them might need to be reevaluated in a few days, especially if symptoms are worse. Time pressure, economics and general patient expectations and even fear of malpractice conspire to convince the doc to prescribe an antibiotic "just in case". It is a slippery slope however as it soon becomes just "standard practice" to prescribe an antibiotic for just about anyone with cold symptoms (to a greater or lesser extent in many practices). There have been studies done in the US showing that up to half of all patients who have a discharge diagnosis of "common cold", a clearly viral illness, will leave the office with an antibiotic prescription. That's nuts. But, as pointed out, the way we got there was through a combination of factors that focus on both the doc and the patient being impatient and not wanting to wait for 90%+ of those colds to simply resolve with time. There was a very interesting study done on students at the University of Virginia about thirty or fourty years ago where a group was intentionally infected with a simple cold virus and then asked to keep a symptom log book. They almost all had typical cold symptoms for the first 4 or 5 days but what was really striking is that a full quarter of them continued to have cough and nasal discharge for up to three or four weeks before it finally resolved. So, it is actually "normal" to have those symptoms for much longer than any of us is happy about and they do eventually resolve on their own the vast majority of time. None of the students was treated for sinusitis and they all recovered without antibiotics but that was fourty years ago before "sinusitis" became a fad diagnosis (to be sure it is also a real dx but probably the vast majority of what is called sinsusitis is really just persistent cold symptoms in the USA). Today it is standard to consider someone with cough and runny nose for more than 10 days to have sinusitis. Clearly that set of criteria grossly overdiagnoses the problem but it is used and even shorter periods of time often applied in clinical practice. It's one of those connundrums where if you set the diagnostic criteria higher you'd miss some of the real cases and if you set it low (as we have) you end up "diagnosing" a lot of people with sinusitis who are really just getting over a cold.There is surprisingly little good science showing that antibiotics are important in the management of what is typically diagnosed as sinusitis. Clearly in some cases (the real bacterial ones) it is critical but for the "average" case it is not so clear and most patients simply resolve the symptoms over time just as the students from UVa did. Essentially that is because what is being called sinusitis is really just the prolonged normal resolution of viral common cold symptoms. There is a huge industry surrounding sinusitis however as the pharmaceutical companies especially but some practicitioners as well, depend on continued over reaction and over prescribing. The phenomenon of diagnosing and treating sinusitis is really only about 20-25 years old in the is country. Before that it was a relatively uncommon diagnosis so there is pretty good evidence that this whole "sinusitis" thing is largely unfounded. Kinda like how in the 1950's every kid had his or her tonsils out until years later it became clear that if you did not take them out they eventually healed anyway and you avoided surgery....today we still take them out occasionally but much less often than before. Similarly ear infections were over diagnosed and over treated in the 90's and 90's and are now being less agressively managed. It will be a while longer before both public and medical practitioners are reeducated about the sinusitis business so we can anticipate continued pressure to prescribe and over prescribing for a while longer. Patients can help by simply recognizing that common cold symptoms persist for weeks, not days and by holding off on trips to the doctor unless they are getting worse after the first few days of a cold or they have a new symptom such as fever a week after the initial symptoms. The other important thing you can do is to drive tractors as much as possible thereby staying out of contact with other humans and thereby lowering your risk of acquiring a viral infection.
