NASAL-DENTAL-DIET

• Nasal Irrigation (Last update 11 February 2010)
  • Why
    • Many patients have trouble with nasal crusting, during treatment, and even in when their vasculitis is remission.
      • Nasal irrigation once or more a day with an appropriate sterile solution seems to work well for some, to prevent crusting and clearing debris.
      • It is possible that cilia lining the nasal and sinus passages are not performing their function of moving out mucus along with bacteria and mold.
    • It's possible nasal irrigation may help prevent relapses (though there's no studies to show that).
  • What
    • Ask your physician before starting irrigation to make sure the method and irrigation fluid are approved for your use.
    • Do daily or more frequently, Flush the nasal passages, first on one side, then on the other side, or as instructed by your physician.
    • For "ordinary" nasal problems and especially as a moisturizer, Breathe--Ease XL Nasal Gel is one that may be useful.
    • A nasal emollient called Ponaris thins the nasal secretions.  It is made by Jamol Laboratories, Inc. in Emerson, New Jersey.
    • For a fairly extensive discussion of chronic sinusitis by a non-professional, see http://www.sinusitisfaq.org/
    • For a Mayo Clinic video on nasal irrigation, see http://www.mayoclinic.com/health/nasal-lavage/MM00552
  • How
    • Method
      • Never force fluid. The flow upward from the device shouldn't exceed 1 inch vertically.  Do not increase the flow volume.  If fluid is blocked, try the other nostril.
      • If flow is not established in a few seconds, discontinue irrigation on that nostril.
      • If irrigation isn't possible with minimal volume, pressure, and duration then use decongestants or other means and wait to irrigate until the nose is unblocked.
      • Hold head up.  See Devices below.  Irrigate one nostril at a time, allowing the water to flow out the other nostril.
      • Repeat as many times a day as ordered or required.
    • Fluid
      • Use a sterile isotonic solution without preservatives.  Isotonic means the same salinity as blood. Commercial irrigation fluids are available from many sources such as http://www.pharmacy-solutions.com/
      • Home-made
        • You can mix your own irrigation fluid by using distilled water, salt, and baking soda.
        • DON'T use table salt (contains additives) nor sea salt.  Use canning, pickling, or kosher salt as they contain fewer impurities.
        • The optimal salinity is obtained by adding one level teaspoon of salt to a U.S. pint of water (a U.S. pint is 16 ounces or 0.47 liter).               
          • Alternately, you can add one-quarter teaspoon of salt to 4 ounces (0.12 liter) of water.  This creates an isotonic solution.
          • Refrigerate and dump after three days.
      • Ringer's solution is an alternative that might prove better.
        • It is the latest development in saline solution for sinus irrigation,
        • Ringer's solution has been used intravenously for many years.
        • Along with sodium chloride (salt) and sodium bicarbonate (baking soda), Ringer's solution also contains potassium chloride and calcium chloride.
        • The chlorides seem to allow the solution to have less deleterious effects on cilia movement.
      • BreathEase
        • HydroMed, at http://www.hydromedonline.com/ or 800-560-9007, sells a product based on Ringer's solution called Breathe Ease.
        • It's convenient but somewhat expensive, costing $14.95 per package (2006), enough for about 30 irrigations, which makes the cost per irrigation about 50 cents.
      • Sinus Rinse
        • This is an inexpensive isotonic and non-irritating nasal irrigation available from various locations.
    • Antibiotics
      • Some physicians will prescribe antibiotics to be used in irrigation.
        • A water soluble formulation antibiotic formulation is probably preferable to oil-based formulations.
        • Some physicians recommend use of Bactroban nasally to prevent S. aureus and other infections.
        • An alternative might be use of chlorhexidine nasal gel to rid the patient of nasal carriage of MRSA (methycillin resistant Staphylococcus aureus).
        • Dilute hydrogen peroxide has been used by a few sinusitis patients, but should not be used without a physician's knowledge and approval.
      • Methicillin-resistant-Staphylococcus-aureus (MRSA) is a common infectious organism, readily infecting persons in hospitals and nursing homes.
        • It is not controllable by most antibiotics.  More recently a strain resistant to Vancomycin has become prevalent (VRE strain). It may take a combination of intravenous antibiotics to rid the patient of the infection.
          • For Methicillin resistant Staphylococcus aureus, Bactroban (prescription only) is probably superior to OTC BreatheEase XL Nasal Gel.
          • Generic Bactroban is perhaps as satisfactory as the more expensive formulation for "nasal use".  Check with your physician.
    • Devices
      • "Neti Pot" - An older method that some people find too messy and pressure is variable.
      • Bulb syringe - May be used but lends itself too easily to over-pressure.
      • Electrical devices
        • WaterPik - A commercial product with good pressure control.
        • Interplak oral irrigator - Needs the "Grossan tip"� to be used easily.  See http://www.conair.com/product_info.php?products_id=363&pcID=4_42
        • HydroPulse nasal irrigator.  See http://www.pharmacy-solutions.com/hydropulse.pdf (Requires Adobe Acrobat Reader)
      • Limitations of irrigation devices.:
        • Requires regular cleaning and disinfection.
        • Verify model numbers and adapter compatibility.
  • Mucus clearance
    • Some find Clear-Ease Sinus Enzyme Relief helps clear mucus.
    • There are a number of non-prescription mucolytics available.
    • See http://www.thoracic.org/sections/copd/for-patients/what-kind-of-medications-are-there-for-copd/what-are-mucolytic-agents.html for prescription mucolytics.
      • A brief entry on mucolytics is at http://en.wikipedia.org/wiki/Expectorant
  • WG patients
    • Nasal and sinus health are important to prevent infection,
      • For WG patients it is important to avoid carriage of Staphylococcus aureus ("golden staph, S. aureus").
      • It can be guarded against by common precautions, especially not touching one's nose, eyes, face, or mouth, and by frequent and thorough hand washing or use of a topical sterilizing fluid.
      • Presence of S. aureus has been shown likely to be a cause of relapses of WG.
        • There's some indications that S. aureus is involved in the initial development of WG, but probably not other AVs.
        • Most strains of S. aureus are easily controlled with antibiotics.
        • The risk for relapse of WG increases with the presence of tsst-1-positive strain of S. aureus.
          • Eradication of tsst-1-positive S. aureus in WG may help prevent disease relapse.
        • In the 1990s a strain of S. aureus was found that is resistant to Vancomycin (VRE), then the antibiotic of last resort for S. aureus.
          • This is a very dangerous situation and must be treated aggressively.
          • Treatment of that strain requires multiple intravenous antibiotics.
          • At one time, Vancomycin (Vancocin) was an FDA-approved drug to treat MRSA in children, and only one drug, linezolid (Zyvox) was approved in pediatrics for VRE.
            • Now, in mid-2007, there may be others approved.
    • The European Vasculitis Study Group (EUVAS) had an on-going trial (MUPIBAC) to determine the effectiveness of eliminating S. aureus from nasal passages using Mupirocin nasal ointment.
      • Click here to see the progress on EUVAS research programs.
• Teeth, Mouth, & Disease
  • There's considerable evidence that poor dental conditions can contribute to both infective and autoimmune diseases.
  • Brushing and flossing daily or more often can restrict gum disease (gingivitis or periodontal disease).
    • If gums bleed when brushing, it can lead to infection and possible autoimmune disease.
    • If gums bleed over a long period, they will recede, expose tooth roots, and lead to tooth loss.
  • Professional cleaning should be done perhaps quarterly or semi-annually as required.
  • Click here for information on maintaining dental health and preventing subsequent diseases, both infective and autoimmune.
  • Mouth ulcers can be caused by viral infections or as side effects of methotrexate or other medications.
    • A dental assistant volunteered the information that aqueous chlorhexadine gluconate .2% solution can be used as a twice daily mouth rinse.
• Food
  • Diet and inflammation
    • All changes in supplements, herbs, unusual foods should be reported to the patient's physician.
      • Most physicians have little training in nutrition and may be unaware of the effects of food on inflammatory condition.
      • Inform your pharmacist and naturopath of all medications, herbs, and supplements so that the combination can be evaluated for conflicts and contraindications.
    • Persons with kidney damage may have to follow a "renal" diet to avoid excessive demands on kidney functions.
    • It is important to know about inflammatory foods and follow good anti-inflammatory practices.
      • Food can powerfully contribute to inflammation.
      • Foods containing anti-inflammatory compounds can help reduce inflammation.
    • Any food that raises the blood glucose level is inflammatory
    • Virtually all foods will raise the blood glucose level sooner or later
      • To minimize inflammation, timing of meals is important.
        • Meals should be five times daily to avoid the blood sugar getting too low as that will cause overeating.
    • Each meal should contain both proteins and healthy carbohydrates in a healthy balance.
    • Proteins take longer to break down than carbohydrates, and so enter the blood stream more slowly, helping to avoid blood glucose peaks and crashes.
    • The best diet is a variety of foods consisting of adequate protein, sufficient complex carbohydrates and limited fats, but always in accord with physician's instructions.
    • Avoid excesses in any particular food group.
      • Particularly, avoid any foods or drinks with high fructose corn syrup (HFCS).  This is the result of many complex manufacturing chemical processes involving many reagents and enzymes.
      • See below for information on HFCS.
      • A recent Australian study indicated widespread HFCS use may be a significant part of the problem of obesity.
  • Processed
• Processed foods and fast foods almost invariably contain too many simple carbohydrates, and often too little protein.
• Processed foods contain many non-food chemicals and additives.  The cumulative effects are unknown in most cases
• Processed foods should be minimized in the diet.
• Proteins
• Protein requirement is best based on age, activity level, and metabolic rate.
• Most vegetable proteins don't have the saturated fat content of meat proteins so are to be preferred.
• Each day should optionally have meat in one meal, but preferably not always red meat.
  • Chicken, turkey and other non-red meats should be preferred.
  • Split protein into five portions for the five separate meals during the day.  The portions do not have to be equal
• Carbohydrates
• All carbohydrates, both simple and complex, are converted in the blood stream or in the liver to glucose.
  • Most people eat too much carbohydrate, and too much of that is simple carbohydrates.
    • Simple carbohydrates are all kinds of sugars and starches.
  • Complex carbohydrates are foods consisting largely of fruits, herbs, vegetables.
  • Fresh uncooked complex carbohydrates enter the blood stream more slowly than cooked ones.
    • Carbohydrate portions should also be split in five with the amount eaten at each of the five meals with the amount at each meal based on the amount of protein in the meal.
• Fats
• Following an anti-inflammatory diet based on correct selection of foods, proper number of meals daily, and avoidance of excessive red meat will generally provide adequate but not excessive fat content.
• Olive oil or other vegetable oils that contain mostly unsaturated fats should be preferred over oils from animal  sources.
• Saturated and transfats should be limited with the major portion of fats being unsaturated fats.
• Vitamins
• A balanced diet with lots of fresh fruits and uncooked or lightly steamed vegetables will supply most vitamin needs.
• Folic acid supplementation may be needed for persons on medications that deplete the body of folic acid.
• Anti-inflammatory vitamins C and E may be useful, but your physician should approve any use of those.
• People in northern climates and those who spend little time outdoors may need supplementary vitamin D.
  • Click here to view a file on the importance of vitamin D3, rather than D2 as commercially available in most vitamin D supplements.
• Some vasculitis patients have found supplementary vitamin B-6 and B-12 to be useful during certain conditions.
• Many physicians will put vasculitis patients on a multi-vitamin/mineral supplement, especially if the patient is older and eats little.
• Food Information
• Click here for information on anti-inflammatory foods, to view information compiled by Cyndi Olsen, a patient with an autoimmune vasculitis.
• Click here to see why high fructose corn syrup (HFCS) and table sugar should be avoided.
• Any proposed changes in diet, supplements, herbal remedies, or unusual items to be ingested should be reviewed in advance by your physician.
• Get and follow the guidelines in Dr. Barry Sears' book, "The Anti-Inflammation Zone"

THIS SITE

• Intent
  • To assist vasculitis patients in getting early diagnoses, effective treatments, and to advise of patient, organization, and scientific resources concerning vasculitis.
• Sources Used
  • The following information is derived from a variety of sources over some ten+ years and is not to be considered as medical advice, but merely the opinions or experiences or findings of the writer who is not a physician and has no medical training.
  • Much comes from Medline abstracts and medical journal articles on vasculitis.  Some is from autoimmune vasculitis patients and carers, some from newsgroups,  internet web pages, etc. that also deal with vasculitis.
  • The compiler has attempted to use only recent valid medical information regarding vasculitis, but cannot guarantee the validity nor the currency in every case
• Limitations
  • No medical decisions should be made on the basis of information on this web page or on associated linked documents and web pages unless those are from a recognized medical professional or professional medical publication.
  • Limits to this web page concerning vasculitis:
    • The author/compiler/editor of this web page and related pages has had NO medical training.
    • Only autoimmune vasculitides will be considered, not hypersensitivity vasculitis nor vasculitis as a result of an allergic reaction to medication or vaccine..
    • Most sections apply to most autoimmune vasculitides.
      • One refers specifically to Wegener’s granulomatosis.
• Terminology
  • Some abbreviations and equivalencies are:
    • Hereafter, “autoimmune vasculitis” may be abbreviated “AV” or “AVs” for plural.
    • The term “Prednisone” is sometimes used where it or a similar glucocorticoid might be prescribed to treat vasculitis.
    • “Immunosuppressives” used to  treat vasculitis are sometimes abbreviated “ISs”.
• Updates
  • This update was on June 1, 2009 and is a complete rewrite of the former web page at http://www.wegenersgranulomatosis.net that also dealt with vasculitis.
• Files & links – Vasculitis related.
  • Click here to view a web page listing all the links and files from this page.
• Tables & Figures – Vasculitis related
  • Click here to view a listing of the tables and figures in this web page.
• Disclaimer
  • ALL MEDICAL QUESTIONS, SYMPTOMS, CONCERNS AND PROBLEMS SHOULD BE DIRECTED TO APROPRIATE LICENSED MEDICAL PROFESSIONALS.
  • The writer/editor/compiler does not vouch for the accuracy, completeness, nor applicability of the information included on this site to any person, whether a vasculitis patient or otherwise. 

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