Picture this scenario. You’re the doctor. Your patient has waited an hour to see you. He complains of congestion, headache, sinus pressure, and post-nasal drainage. Yes, the drainage is yellow. No, he hasn’t missed work. He winces when you tap his sinuses. He wants you to know how miserable he is. You gotta do something, Doc.
Is it sinusitis or is it a cold?
Sinusitis means inflammation of the lining of the sinus cavities. It does not always mean infection. From what I’ve seen in primary care medicine, doctors often – quite often – use the diagnosis “sinusitis” as an excuse to give antibiotics. It’s what our patients want after all, at least most of them. Whether antibiotics work or not, patients believe in them.
But colds are much more common than sinus infections, and allergies can cause similar symptoms.
It’s just a cold, you tell the patient. No antibiotics are indicated.
Your patient glares at you. He knows what he needs. The next day he calls your partner and demands an antibiotic – and gets it. No sense getting sued over amoxicillin.
Here’s the point. Unless the situation is bad enough to make you feverish, or to make you miss work, or to make you look sick enough for an x-ray, it’s probably just a cold – sinus irritation caused by a virus.
Here’s 7 tips to save money on sinusitis:
1. Ask your doctor if it’s truly bacterial sinusitis. If he makes a convincing argument, then ask for a $4 antibiotic. Rarely do you need something more expensive. The $4 antibiotics include amoxicillin, sulfa drugs, doxycycline, erythromycin, cephalexin and ciprofloxacin. Of these, the first four are considered first-line antibiotics for respiratory infections.
2. Otherwise, what you want/need is symptom relief. We’ll start with pain – facial pain, head pain, or even sometimes tooth pain. You’d be surprised how often a patient hasn’t considered standard pain relievers such as Tylenol®, aspirin, Advil® or Motrin® (ibuprofen), or Aleve® – they all provide effective relief for most patients – for under $5.
3. Mucus. Snot. Phlegm. Take your pick. If you have excess mucus you’ll either want to dry it up or make it run thinner, like maple syrup in the spring (see #5). Tasty metaphor! Antihistamines such as Benadryl® (diphenhydramine) and Zyrtec® dry up mucus. This can be good or bad. For some people it provides real relief. For others, it makes them feel worse – they can’t get the snot out (see #4). OTC medications are as good as prescription medications – most were prescription some time ago anyway – and cost under $10. And by the way, whereas Claritin® (loratadine) works great for allergies, the above work better for infections.
4. If you can’t get the snot out, try nasal douching. Fancy words. If you have a clogged pipe, run water through it. Same goes for the nose. Use a penny’s worth of warm salt water and run it through from one side to the other. This flushes out germs, mucus, chemicals, allergens (things you’re allergic to) and sometimes paper clips. Here’s a video from the Mayo clinic that shows you how to perform the irrigation: http://www.mayoclinic.com/health/nasal-lavage/MM00552.
5. If you can’t beat ’em, join ’em. Rather than dry up the mucus, many patients feel better if the mucus is allowed to run more freely. Mucolytics – primarily guaifenesin, the active ingredient in Mucinex® and some cough medicines – make mucus more watery. Then it feels like you’re swallowing saliva rather than snot, just like you’re supposed to. Don’t spend $40 on a fancy product. Just get a $7 store brand.
6. And now my personal favorite, pseudoephedrine. In the good old days, a few years ago, you could buy pseudoephedrine over-the-counter. Now you have to ask a pharmacist for it, thanks to the meth labs. The new Sudafed PE® contains phenylephrine, not nearly as effective in my experience. Pseudoephedrine opens the nasal/sinus passages, allowing mucus and air to flow more freely. It also has a bit of a drying effect. If I could choose only one therapy, this would be it – relief for under $10. Even though the medication is OTC, prescription plans often cover it, even cheaper than OTC! Common side effects include insomnia and palpitations, much like excess caffeine.
7. Ask your pharmacist for free advice. Tell your pharmacist your symptoms and she can tell you what medications will help you most. They deal with this stuff everyday – skip the doctor and save 50 bucks. Since you’re seeking symptom relief, be as specific as possible. If you have multiple symptoms, a multi-relief medication may be your best bet.
Every year Americans make over 10 million office visits for sinusitis. I’d say, at least half are unnecessary, and could be treated with the above guidelines.
Potential annual savings on unnecessary office visits for sinusitis:
5,000,000 patients x $50 = $250,000,000
Copyright © 2011 Cynthia J Koelker, MD – All Rights reserved