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Could really use some advice regarding an ongoing problem with recurrent nostril infections and pain for over a year...
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southerngrrl posted:
Hello -

About 15 months ago I came down with what seemed to be a bacterial infection in my left nostril which would not heal on its own. I had recently had a baby (2 months earlier) and so hadn't seen a doctor about it til it got pretty bad as I wasn't really looking after myself that well and not sleeping, breastfeeding around the clock, etc! The doctor gave me Naseptin and swabbed the inside of my nostril (which came back negative). The Naspetin did not clear the infection and so the doctor gave me a round of Penicillan and Bactroban and my GP sent me to an ENT as he thought there was some kind of cavity inside my nostril. The ENT said when he saw me (after examining and using the scope) that my nose looked fine, no polyps or anything, no cavity they could see and that it looked like it was healing from an infection and that I had a deviated septum (which deviated into the side I'd been having the trouble with). This seemed to clear it up, for a short while. It soon came back and I had another round of antibiotics and more bactroban. I got to where I would use Bactroban every day to try to keep the infection from getting too bad. I had a third round of antibiotics which seemed to clear the infection for another couple of months. It soon flared up again and this time started to affect my sinus in my cheek. I would get headaches and extreme tiredness and irritability. After more antibiotics it seemed to calm down. I had another ENT appointment then which unfortunately when my appointment came along there wasn't much to show him. He said for me to call him when it flared up again. The next time it flared I couldn't get an appointment with him and I had another round of stronger antibiotics designed to beat bacteria that penicillin doesn't, and it didn't clear the infection. I remember flying in an airplane around this time (May of this year) and feeling loads of popping in my cheeks and feeling some relief from the pressure. I continued using the Bactroban and for the first time it seemed to go away on its own and stayed away for about four weeks. I then got a cold and when the cold seemed to go away it all flared up again. Starts with tinging/burning in the tip of my nose which seems to also tingle in the top of the left front tooth. Soon after I would notice the septum would turn really red and raw with bit of mucous on it, some extremely sticky mucous but not a lot of it. Sometimes upon my own examination I could see spots of blood on the septum. I start using the Bactroban then about 4 times a day. The days then are all different, some days I'll have serious sinus pain and headaches, sometimes the pain will be restricted to my nostril, and sometimes it will be the nerve type pain in the tip of the nose and my tooth. I'm beginning to notice that I also tend to have random joint pain around the time that things flare up. I have had odd trouble with my joints over the past four years, in particular my knees. I have been tested for Rheumatoid Arthritis and Lupus and both came back negative. I have also been tested for diabetes which came back negative. About to go for another appointment with a new doctor but am so exhausted from trying to tell the whole story every time I go in. I also feel very stressed by the whole situation as I'm scared at what could be the underlying problem and have two small children to look after on top of all of this. My husband has Herpes which he will get on his face, not really on his mouth, but this has really been under control over the last few years. My mother has Fibromyalgia and has had several Squamous Cell Carcinomas removed from her face. I myself have had a non-cancerous cyst removed from under the skin of my lip (left side) 13 years ago, my tonsils removed 14 years ago and had Mono 14 years ago. Otherwise I have been pretty well. I would really appreciate if anyone could give me advice on things to mention to my doctor or routes to go down. I'm open to anything! Thank you!
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Rod Moser, PA, PhD responded:
I know that you tried to be very thorough with your posting, but it is not the same as seeing a person first-hand, taking my own detailed, medical history, reviewing your past tests, and of course, examining you myself. You have more than one medical problem, for sure, but it is very difficult for me to blindly get a handle on your case based solely on you posting. I hope you understand.

As I read your lengthy posting, herpes simplex did come to my mind since it can occur inside your nose, so the next time that you have a flair-up, you need to have a new bacterial culture and a viral culture for herpes simpex. This would be my only recommendation for you. While herpes cannot be cured, theres is no sense in taking antibiotics of it (it is a virus), but if you does does show up on the test, you can be prescribed ANTI-VIRAL medications that can control herpetic outbreaks.

Hopefully, you are seeing a good primary care provider who can put all of these things in perspective. Your nasal infections may have nothing to do with those sinus-related symptoms, those joint pains, etc. A person often has more than one medical problem going on at the same times and your symptoms are not necessarily related.
 
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southerngrrl replied to Rod Moser, PA, PhD's response:
Hi Dr Moser, thanks so much for your response. I was able to get an appointment today with another GP (we recently moved to a new city) and explained my whole situation to her. She did a swab (not sure if it was bacterial or viral) and said it will be sent off and I can call back in a few days for the results. I mentioned Herpes to her and she said although she wasn't completely convinced as it wasn't presenting how she would expect it to she gave me 200mg Aciclovir to be taken five times a day for five days. She has also put in a new referral for me to see an ENT doctor here (we live in Northern Ireland). So I suppose by the time I've finished the anti virals my swab test results will be back and we'll hopefully have a better idea. Otherwise I will be seeing the ENT again and hopefully getting some answers. I have to admit in the back of my mind I'm afraid it's cancer...but don't we always think the worst when we have problems that aren't easily solved?!

Thanks again-
 
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Rod Moser, PA, PhD replied to southerngrrl's response:
Cancer? Not very likely; rare in fact for it to present in this area and in this way. Put that out of your mind.

Herpes is notoriously difficult to culture, so just because it does not come back positive, it does not mean it still isn't herpes. Culture it again next time. Herpes has a nasty habit of (a) showing up periodically in the same area, and (b) causing those strange nerve-like symptoms/burning.

Sounds like you found a GP that listens and takes you seriously. Very good.

By the way: Ireland is beautiful. We hope to go back again soon.
 
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southerngrrl replied to Rod Moser, PA, PhD's response:
Hello Dr Moser,

Thought I would write to you with an update. I finished my course of Aciclovir and couldn't tell any difference one way or another. The problem has stayed the same on the left side and feels as though it has in fact moved to the right side of my septum/nostril for the first time since the problems began over a year ago. Also my right ear has been very stuffy since Friday with some pain from time to time in both ears. Also since around Friday my throat has started to become sore from time to time and looks red on the sides. The nose swab came back normal. I am planning on calling the doctor tomorrow to make another appointment as I am concerned by the new symptoms, especially the pain extending to the right side. Anything you could advise me on to mention to the doctor?

Thanks very much,

Holly
 
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Rod Moser, PA, PhD replied to southerngrrl's response:
Failure to improve on acyclovir....just one short course...does not necessarily imply that you do not have an herpetic problem. I think this should still be pursued. Perphaps your doctor should consider keeping you on acyclovir or another anti-herpetic drug for a longer period of time.
 
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southerngrrl replied to Rod Moser, PA, PhD's response:
Okay Dr Moser, I will mention that. Thanks for your response. What would be your thoughts be on fungus? Would that have come out on the swab?

Thank you!
 
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Rod Moser, PA, PhD replied to southerngrrl's response:
Never found fungus in the nose....That is not to say it can't happen, but fungus is not a common pathogen in this area.
 
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southerngrrl replied to Rod Moser, PA, PhD's response:
Hi Dr Moser,

Well I had another Dr appointment yesterday as I was having more pain in the nostril and it seemed to be spreading somehow to the right nostril. Also I had stuffiness and pain in my ears and pain in my throat. I've also had some chest pains on and off since Thursday last week. She took another swab of my nostril and put me down for a sinus x ray. I've never had an X ray on my sinuses before so was glad she recommended it. She said in some ways she's not sure if my septum is actually deviated as it looks straight from the front. So she feels perhaps the fleshy part of the septum is inflamed. So I had the X ray yesterday and can call tomorrow for the results. She said for me to stop taking the Bactroban as it was the treatment for MRSA and she was worried my body would get used to it and if I ever did get MRSA it would be ineffective in treating it for me. So I stopped using it and I have to admit I really don't like not using it...it was the one thing I've ever used that seemed to help treat my symptoms. But I will try it out and see what happens. More than likely I'll be going back in around Thursday to show her the state my nostril is in after not using Bactroban. She did give me a prescription for Co-Amoxiclav 500/125 to take for 7 days in case it is an infection. But I took this same treatment for the same symptoms in April of this year and it did nothing to help really. Just wanted to update you and to get any advice you might have.

Thank you!
 
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Rod Moser, PA, PhD replied to southerngrrl's response:
Sometimes, sinus xrays are not very diagnostic. The sinus CT scan is really the gold standard for imaging the paranasal sinuses. I certainly hope that you get some relief soon. Let me know how that xray turns out.
 
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southerngrrl replied to Rod Moser, PA, PhD's response:
Hi Dr Moser,

Thanks for replying. I got the results back over the phone for the swab and X ray both coming back as "normal". I'm not sure what normal means in the sense of the X ray, does it mean they can't see any infection? Does it mean my septum is not deviated? I'm not sure, will have to wait until I speak to the doctor. On day 5 of my antibiotics and they aren't doing anything. Waiting to get my ENT appointment, have another Dr Appointment on the 4th of August as well just to follow up. I haven't really noticed much difference of not using the Bactroban until today when I would have used it. But I suppose if nothing is growing on the culture I really shouldn't be using something that my body could get used to and be ineffective later.

Thanks again!
 
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Rod Moser, PA, PhD replied to southerngrrl's response:
Let me know what your ENT has to say. I would need to see those xrays to know what they mean by "normal", too. Ask to see a copy of the actual report.
 
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southerngrrl replied to Rod Moser, PA, PhD's response:
Hi Dr Moser,

Thought I'd give you an update on what's been going on over the past couple of months. After I took the antibiotics and had the X Ray come back "normal" a lot of my symptoms improved quite a lot. It wasn't until after I got a cold about two weeks ago that the symptoms started back up again. Strange nerve feelings from tip of nose to top left front tooth, burning septum, pain in left cheek, bridge of nose and in between eyes, tiredness and headaches. I also have some swollen lymph nodes in my neck, a couple that have been there for quite some time but the doctor doesn't seem concerned about them.

I had my ENT appointment yesterday. I honestly don't think I've ever met a doctor with less "bedside manner". When I tried to explain my symptoms he would stop me and say "That's not what I asked," and wasn't interested in hearing the history of my problems. He checked my ears, throat, and looked in my nose, then checked my neck and nerves in my face. He used a long metal instrument to look into each nostril. He said that I did have a deviated septum and the membranes looked inflamed. He wasn't sure about what was causing all of my symptoms. He gave me a prescription for Nasonex to be used two sprays each side once a day (the prescription had written by provisional diagnosis : allergic rhinitis) and has put in for me to have a "scan" of my head/sinuses. I don't know what kind of scan this is but I assume it is a CT scan. Will be waiting for the appointment to come through in the mail. (NHS in Northern Ireland...these things are free but you don't have much choice).

Yesterday evening I noticed a small white pimple like sore on the edge of my left nostril, right where the nerve is that bothers me sometimes and thought, could it be herpes? I went to the doctor today to show her in case it was something useful. She said she thought it looked like an irritated follicle or perhaps that the ENT scratched it when he was examining my nostril with his instrument. She gave me a swab to take home with me and said to leave it alone but if it started to get worse and/or crust over to swab it, put it in the fridge, and bring it in tomorrow or at some point this weekend bring it into the hospital if the doctor's office is closed.

I tell you things like this do a number on your psychological well being. The anxiety and worry is hard to keep at bay. I can't help thinking I have cancer or some kind of horrendous infection or autoimmune disorder.
 
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Rod Moser, PA, PhD replied to southerngrrl's response:
Thanks for the update....

What you described does appear to be a folliculitis. Our nose is filled with hairs, so this is not uncommon. Herpes in the nose can definitely cause all kinds of unusual " nerve" pains, but these lesions are more like a group of flat water blisters, not like an isolated pimple. It does appear your doctor may be culturing it, so don't be surprised if it comes back with a garden-variety Staph species. A herpes culture can be done, but this is a very special swab...I suspect this is not what yo have.

I am sorry that your ENT visit was with a person with poor bedside manners. He should change professions to one that does not deal with humans.

Yes, you probably do have a CT in your future, but it may not offer any profound diagnoses.

Stop worrying about cancer!
 
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southerngrrl replied to Rod Moser, PA, PhD's response:
Hi Dr Moser,

I've had my appointment come through for my CT Scan which is in a week and a half. I had to call after two weeks when I hadn't heard anything to find that somehow the paperwork hadn't gone through and they had to re-order the scan. The Nasonex I do think could possibly be helping a little but it certainly isn't helping completely. I've only missed one day and I do think I could tell a difference. I've had a couple of really bad headaches over the past couple of weeks, migraine style that stayed with me all day and no meds would touch it. The pressure was mainly in between my eyes and it felt like the bridge of my nose was going to break. I've gone to the optician to renew my contact lens prescription in case I was getting headaches from my eyesight. The swollen glands in my neck are all still there and do concern me, although both my GP and this ENT checked them and didn't seem concern. My neck will feel quite sore sometimes, when I reach to massage it I realise it's where the swollen glands are. I haven't had any more issues with the folliculitis although I have started since then I pretty stringent cleaning regime, including washing my hands more often and using towels only once before washing them in hot water, cleaning sheets more regularly,etc. I really am trying to do what I can to help myself, I just feel like I need medical help to help my nasal problems. It can't be sinusitis, most of the time I don't have any congestion or real drainage, just very thick, sticky mucous that sticks to the insides of my nostrils. I really hope the CT Scan shows something that can be helpful. I'm not sure what I'll do next if it doesn't. *sigh*


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