116 of 122 people found the following review helpful:
5.0 out of 5 stars
This Book Should be on the Bookshelf of Every Sinus Sufferer, February 27, 2007
This review is from: Sinus Relief Now: The Ground-Breaking 5-Step Program for Sinus, Allergy, and AsthmaSufferers (Paperback)
If I could rate this book six stars, I would do so. Here is my review.
When I first started seeing an ENT specialist years ago for my sinus problems, I purchased a couple of books on the subject of sinusitis. When I mentioned this to my doctor and asked a couple of questions that showed a bit more knowledge of the subject than most people had, he frowned and had a worried look on his face. He then commented that having only "a little bit of knowledge was dangerous". I therefore appreciated the comments by Dr. Josephson in his new book entitled "Sinus Relief Now- The Groundbreaking 5 Step Program for Sinus, Allergy, and Asthma Sufferers". He stated: "If your
physician responds negatively to your newfound knowledge or is obviously uncomfortable working with a patient who is well educated about his or her disease, it's another clear signal that it's time to move on" (and find another doctor). I wish I had had this advice at that time, as the doctor eventually performed my first sinus surgery, caused me immense pain, and he didn't improve my situation at all.
It should be mentioned at this point that Dr. Josephson is a well known and highly regarded ENT specialist and surgeon. He has several times been on New York magazine's "Best Doctors" list. He has been an expert commentator on many local and national television programs, and he is the Director of the New York Nasal and Sinus Center. I personally believe this book should be part of the home library of anyone who suffers from what Dr. Josephson calls CAID, or Chronic Airway-Digestive Inflammatory Disease.
In the U.S. alone this includes about 70 million people who suffer from sinus disease, asthma, allergies, reflux diseases GERD and LRPD, as well as sleep problems like snoring and sleep apnea. Dr. Josephson believes that all these problems can be related for the simple reason that they all are associated with parts of the body which are directly connected together in the upper and lower respiratory and digestive systems. This is an interesting concept and is explained clearly and thoroughly in the early chapters of the book. Dr. Josephson discusses the symptoms of all these maladies and then offers a CAID test, which helps the reader understand which branch of CAID is causing his problems. He explains symptoms and possible treatment options in great detail for the various "limbs" of CAID, sinus disease, allergies, asthma, GERD and LPRD, and sleep disorders such as snoring and sleep apnea.
One point is made clear throughout the book: like high blood pressure, sinus disease cannot be "cured" in the sense that it is gone once and for all, but it can only be controlled. But with this awareness and being knowledgeable about one's problem, it is possible to control these health issues, and one can improve his or her life and not be forced to "just live with it".
There are a number of things I was pleased to see in "Sinus Relief Now":
1. Dr. Josephson is a sinus sufferer himself. He has undergone sinus surgery, uses the therapies he recommends, and "knows the feeling". I got the feeling when reading the book that this person has gone through some of the same pain I have experienced.
2. Dr. Josephson strongly emphasizes the use of nasal irrigation. He uses a sinus irrigation device every day, as do I. He also talks about using a neti pot for sinus irrigation, but I've used both and find the irrigator much more effective. I personally would not even recommend the neti pot method.
3. Dr. Josephson is a surgeon, and he pushes for a very conservative approach regarding turbinates. In the past many surgeons routinely cut out parts or even most of the turbinates in people. In recent years it is becoming apparent that this can have disastrous effects on patients over time, and there are many horror stories to read at the forum of the ENS Association web site. ENS stands for Empty Nose Syndrome, which is the term coined for this condition.
4. Dr. Josephson says that smokers with CAID problems simply must quit. He has some appreciation of the difficulty of quitting, however, and offers some guidelines for that as well.
5. Regarding surgery, Dr. Josephson was a pioneer in the procedure called FESS (Functional Endoscopic Sinus Surgery) which is now considered state of the art. This procedure uses an endoscope for both a diagnosis as well as during the surgical procedure. This gives the surgeon an excellent view of the area being worked on, and thus there is less bleeding, more accuracy, and packing is rarely necessary, which is very important. He says many of his patients simply go home and go to work the next day. I would have liked him to comment about endoscopic surgery using lasers as well, but he didn't make mention of that technique.
People have told me that this laser procedure worked exceptionally well for them. Dr. Josephson is obviously totally committed to FESS, however, and with the micro tools he uses, he apparently is able to keep bleeding and pain levels low for patients, as is the case for endoscopic laser surgery. He also makes no comments about a new surgical procedure called sinuplasty, which is similar in concept to angioplasty. I would certainly like to hear his opinion of that new procedure.
6. He wrote at length about new research developments, especially the remarkable work done by Mayo Clinic researchers regarding the effects of fungus on sinusitis. Although the results are still somewhat controversial, this team has shown that an atypical immune response reaction to fungus in certain people to common fungus might be the root cause of sinusitis. The theory is growing in popularity and new topical anti-fungal medications are being developed.
7. He emphasizes that eating the right foods can make a big difference, but he isn't totally dogmatic about it. I was turned off once by another book in which the author stated that one must simply give up certain foods if they wanted to get over sinusitis, and these included cheese, chocolate, wine and all other alcoholic beverages, among other things. For a person like me who lived for several years in France, this would be unbearable. I might mention that for a French person it would be unthinkable.
8. A clean living environment is also stressed, and the book has motivated me to break out the bleach bottle and give our bathroom the once over. Molds can apparently grow very rapidly on wet items, so one should be careful about having wet clothes or rags lying around, for example.
9. Also included in the book is a discussion about the validity of alternative therapies, like acupuncture, holistic medicine, and chiropractic, for example. I think this is useful, and in fact a niece recently told me she had acupuncture treatments for her sinus problems and she was excited about how much better she felt.
The five step plan that Dr. Josephson recommends is presented at the end of the book. The steps are:
Take care of your sinuses through proper irrigation.
Clean up your environment
Be vigilant about food choices
Take your medication (i.e., take the entire prescription)
Embrace life-altering changes and enjoy your health.
There has been a lot of progress made in the treatment of sinusitis in the past 5-10 years, and Dr. Josephson's book puts it together and brings us up to date. "Sinus Relief Now" is certainly a great reference for anyone with CAID problems. There are descriptions of just about every medication used in any of the treatments, both prescription and OTC. I learned several things I didn't know before. For example, I didn't know that antihistimines are only effective against allergies. I thought they would simply prevent excess mucus forming in any case. Also, Dr. Josephson feels that decongestants should not be used long term but only for a week at a time as he believes they can cause problems if used for long periods. In general the book is almost a reference work for any type of respiratory or digestive condition. All sinus sufferers would do well to read "Sinus Relief Now" and then to refer to it any time problems come up. It is the best sinus book I've ever read.
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24 of 28 people found the following review helpful:
5.0 out of 5 stars
Followup Q&A with Josephson, March 7, 2007
This review is from: Sinus Relief Now: The Ground-Breaking 5-Step Program for Sinus, Allergy, and AsthmaSufferers (Paperback)
This book is approachable by a layperson and which covers most of what a sinus sufferer should know before seeking treatment. It provides a good overview of the anatomy, a brief description of surgical evaluation and intervention, and detailed descriptions of medications and recommended lifestyle adjustments
I'm a patient of Dr. Josephson and he strongly encourages patients to read this book so I read it. Before reading my review, I recommend you first read the best review I could find, written by Walt Ballenberger who is founder of PostNasalDrip, "a resource web site for sinusitis sufferers like himself". You can find the review at the following links: [..] Ballenberger's review identified a number of questions which were unanswered in his book. By talking with Josephson in person, I was able to get answers for some of them.
LASER
The book doesn't explain the tradeoffs of laser vs. traditional cutting instruments. Before Josephson, I saw an ENT who recommended laser to lightly cauterize the turbinates in order to reduce their tendency to swell when inflamed (the scarification reduces the membrane's elasticity). Dr Josephson is not a proponent of laser except in certain cases. Although a laser is self-cauterizing and therefore reduces bleeding, it causes heat damage to surrounding tissue (more than the damage caused by a cutting instrument) and instrument setup adds time/cost to the procedure. Only where the decrease in bleeding outweighs these costs is use of a laser justified (e.g. when the patient has many small polyps). I didn't ask him but I'd imagine that the thermal heat injury would likely cause more damage to mucus-producing goblet cells and mucus-transporting cilia cells than cutting tools.
SINUPLASTY
This book doesn't explain the tradeoffs of sinuplasty® vs. traditional cutting instruments. Sinuplasty® is a proprietary tool made by Acclarent which uses a thin balloon similar to an angioplasty balloon to open the sinus passages. As in heart vessels, the balloon is placed into position and inflated, then deflated and removed. According to Acclarent's description, this results in permanent widening of the critical areas leading into the sinuses while leaving the nose lining unharmed rather than destructing this lining as occurs in typical sinus surgery. I would have to imagine that if the pressure applied expands bone than it certainly will crush the membranes and must do some damage to them and the cilia which are so necessary to remove the infection and mucus (mucociliary clearance) which is the whole basis by which the sinuses protect you. When I asked Dr. Josephson about what the pressure does to the membranes he said that he knew of no studies that showed what the effect of the balloons on the membranes and cilia were. It turns out that Dr. Josephson is trained in sinuplasty but relies almost exclusively on FESS (endoscopic cutting instruments, as described in his book). He pointed out that unlike angioplasty, which operates on only soft tissue and requires a stent to hold open the expanded tissue, sinuplasty expands a passageway or sinus by dilating bony openings and pathways--widening one passageway by crushing an adjacent sinus cavity. He speculates that such pressure fractured cells could result in a problem later such as mucocele formation--the procedure was too recently developed and long term studies were not available. In addition, while sinuplasty can open up a closed frontal, maxillary, or sphenoid sinus, it cannot open up the labyrinth of the ethmoid sinus. If the ethmoids are closed, functional FESS may be required in conjunction.
FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)
Josephson doesn't much describe his surgical techniques in this book, which makes it difficult to compare FESS with alternative approaches. Dr Josephson says Functional Endoscopic Sinus Surgery (FESS) uses microcutting instruments to remove bony partitions and to widen openings into the frontal, maxillary and sphenoid sinus when necessary. I asked how he expands the passages to closed sinus cavities. He explained that, in my case, he would remove the wall between the passage to a frontal sinus and an adjacent ethmoid sinus cell (rather than crushing the ethmoid cell as in sinuplasty). This would be more controlled than expanding a balloon (as in sinuplasty) and avoid creating a new closed cell which could become a cyst. While FESS changes the connectivity of the cavities, it avoids potentially closing off the adjacent cells. He claims that research shows that mucus transport from the now-opened frontal sinus to the ostiomeatal complex is preserved with this method. This book should include and expand on these descriptions. I also asked in what cases the membranes grow back which seems important when polyps are removed from sinus cells, leaving bare bone walls. He replied that they quickly grow back. This book should include pointers to research validating this claim.
SINUS ANATOMY
This book describes the sinuses as cavities which clean and humidify inhaled air. However, the diagrams show the sinuses as dead-end spaces off the primary airway connected only by tiny passages. Why does air travel through them except a small amt via turbulence? Although I suspect they do indeed clean and humidify inhaled air, it would be helpful to me if the book resolved this seeming contradiction.
CAT SCANS
The book includes a series of diagrams showing an idealized representation of the sinuses and other organs. I found it very difficult to relate my CT scans to these idealized diagrams even though I'm quite good at 3D visualization. It would be helpful if this book included a link to an online series of example CAT scans with annotation explaining what's what, how the structures relate to disease symptoms, and (assuming some patents get post-operative CT scans) what the structures look like after surgery. Josephson told me that he had a CT review in a draft of the book and Penguin Publishers needed to make the book shorter and insisted that he cut it out. Eventually he plans to put it on line.
Overall, an excellent book and highly recommended.
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