#$@^%^!ing allergies

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Nwbrewer
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#$@^%^!ing allergies

Post by Nwbrewer »

I don't have any history of allergy issues, but I've had really bad allergic reactions to whatever seems to be blooming this summer.

Saturday I felt pretty good, nose and ears seemed clear, and went for a dive over in Hood Canal. We took the descent nice and slow, but at 15' or so I could feel a little bit of a squeeze in my forehead. I cleared and it seemed to resolve, but after the dive I had a good amount of blood in my nose, and the area around the bridge of my nose felt swollen. I sat out the 2nd dive, but my sinus' haven't been right since.

So,

1) Any advice on helping the healing process?

2) How do others with summertime allergies prevent this sort of thing? (I don't want to become a winter time only diver!)

Jake
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Scubie Doo
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Re: #$@^%^!ing allergies

Post by Scubie Doo »

I use a Neti pot. The key is using it a few days before you dive. You may be too stuffed up now, but wouldn't hurt to try. You can get them at a supplements store.
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Desert Diver
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Re: #$@^%^!ing allergies

Post by Desert Diver »

I have never been free of allergies since I was small. They are not any better as I approach 60. I am using Flixonase, a nasel spray steroid right now and I pretty much don't dive without taking something with psuedoephidrine, Drixoral being my favorite, but I have to buy that in Canada now because of the battle between the meth heads and drug enforcement.
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60south
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Re: #$@^%^!ing allergies

Post by 60south »

Let's commiserate. I too am having bad allergies this summer. Usually it lasts for a couple weeks during the spring, but this year... yeesh! It's been constant.

I use Loratadine when I get too exasperated by it. A saline nasal spray also helps clean things out temporarily-- it's cheap and effective. Even so, I'm thinking of trying a Neti pot.

When diving, I sometimes take a Pseudofed PE a few hours beforehand. I also have a bottle of Afrin nasal spray, which works really well, however I only use that for 'emergency' because it also has a bad rebound effect later on.
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LCF
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Re: #$@^%^!ing allergies

Post by LCF »

Jake, by history, you had a frontal sinus squeeze. The blood after the dive tells me you ruptured capillaries from it, which means the sinus may be full of clot. This will take significant time to resolve and presents a real risk for infection (clot being a great culture medium, and no sinus is sterile) so watch for increasing pain or fever.

Sinuses in many way are more difficult than ears. It's harder to tell if you can equalize them, and they don't recover as fast as ears do when they have been injured. The ostia to sinuses can be quite small and are easily blocked with inspissated mucus or with nasal polyps, which are common in allergy sufferers.

Many people with sinus issues swear by Neti pots, and there is little risk to the procedure if you are careful about keeping everything clean. (And, having done it, I can tell you it isn't nearly as unpleasant as you might envision it being.). Long-acting, non-drowsy antihistamines are a quite reasonable strategy, so long as you take them a few times without diving, so you know how you react to the drug. Nasal steroids should be employed only after consultation with a physician, because they can have nasty side effects (nosebleeds!).

OTC decongestants are controversial, and it's important to understand the pharmacology of the drug. Pseudoephedrine, which is an effective decongestant, works the way they all do -- by vasoconstriction the blood vessels in the mucosa. The problem with that is that it is possible for the tissues to be sufficiently starved for blood during the max effect of the drug that they begin to send out all kinds of chemical signals to dilate the vessels, so that when the drug wears off, the congestion is worse than it was before. This is a bigger risk with the topical agents like Afrin or Neo-synephrine, but it can occur with all of them. Exactly when the dilating effect of the endogenous signals overcomes the constricting effect of the drug can be a bit unpredictable, which is why there is always a worry about reverse block. Reverse block in the ears can blow a drum, but reverse block in the sinuses can actually damage the very thin bone plates that form the walls of the spaces, and this can cause nerve damage, as well.

So I guess my advice would be to take the time out of the water that you need to, until your sinuses feel back to normal (no dull pain in the forehead). It may be several weeks, I am sorry to say. Then, if you are still reacting to the pollens, try a non-drowsy antihistamine and see if your symptoms abate (on land first!). If not, you can try a long-acting, time-release form of Pseudoephedrine, but again, do it first on land and make sure you tolerate the bitterness and palpitations the drug can cause. Also, be aware that there is anecdotal evidence that the drug may lower the seizure threshold, so don't push MODs when taking it.
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fmerkel
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Re: #$@^%^!ing allergies

Post by fmerkel »

As a sinus suffer for 19 years of diving I can tell you that you have gotten very good info.
Personally I'd start with the Pseudofed and a couple days of Afrin....NOW. You want to open up those sinuses and let them drain to prevent that possible infection. You'll feel better, recover faster, and start to get a handle on your personal reaction to the drugs.
Pseudofed recommends 2 x 30mg tablets. I take one.
Afrin recommends 2 sprays. I take one.
This minimizes side effects and seems adequate for me. Recommendation > start low, work up if needed.
I'm also a consistent Flonase user...since the beginning when I got reverse block (ouch). I could simply not dive without it. You need and Rx for that.
If you get good results from the OTC antihistamines (not Benadryl) go for it.

I prefer a Nelli-med squeeze bottle over the netipot but that's mostly a preference thing.
I recommend you get some Xylitol sweetener and add it to the saline nasal rinse. There is good evidence that the artificial sweetener screws up the bacteria and makes it more difficult for them to get established. Do some googling on [Xylitol + nasal rinse] and the like. I just add ~1/4t to the bottle mix, 30 second warm in the microwave, and snort it up.
I've had a couple roaring sinus infections (Columbia River water force-ably injected via windsurfing crashes) that I have cleared completely in 3 days with Afrin, Pseudofed, and multiple saline+Xylitol rinses.

On any dive you need to pay close attention to the area right above your eyebrows and below your eyes. ANY, and I mean ANY pressure at all means STOP, and HOLD, until it goes away. You are trying to feed a lager airspace through a tiny opening. It takes awhile. Abuse it, it swells up, and you get the results that concern you. This problem generally happens ~10'-15'. Descend very slowly. No deep water drops. Very controlled.
It's a good time to set up your camera or poke around for lumpies. Be sure to communicate this with your buddy and come up with a 'I have sinus squeeze' signal.
If the sinus is completely blocked of course it will not equalize and you have to abort the dive.
FWIW being able to BREATHE through your nose, vs. CLEAR your sinuses are not the same thing. I breathe fine, I have trouble clearing. And, you can't 'clear' the sinus like your ears. It just has to happen. There is no Eustachian canal to pop open.

Note-if it feels like the roof of your mouth is trying to push down a bit that's your sinus being plugged up and bulging (ugh). Sinus issues can also manifest as tooth aches, as the roots are in the same area as some of the sinuses.
You have a bunch of sinuses. Different people may have problems with different ones.
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Tom Nic
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Re: #$@^%^!ing allergies

Post by Tom Nic »

Great advice here! Can't beat the Doc's advice - just add my own story for what it's worth.

I've suffered from "hay-fever" all my life, typically starting in Marchish and not letting up until end of July 1st part of August. I always wondered why I didn't have those magical Summer memories.... yeah... :angry: I was typically miserable with my face running off when the sun came out and weed and grass sex exploded.

I now take over the counter Loratadine every day with my morning vitamins. Loratidine (main ingredient in Claritin) is non-drowsy, and does NOT help when (me) in the middle of an allergy attack. Let me repeat that, Loratadine does NOT help me when I am in the middle of an attack. It is only taken daily before and during allergy season that it makes a difference. (This is straight loratadine, not the one that also has decongestants. Costco has the generic version with 365 tablets for around 10 or 12 bucks. WAY cheaper than anywhere else.) Taken daily, well before my allergy season, I found the worst of the allergies greatly lessened and manageable. That combined with small doses of a low strength (and potentially drowsy) over the counter medicine when things got REALLY bad have helped my manage things quite well for a the last several years.

I can now enjoy Summer again! :partydance:

The key for me was getting ahead of the curve. The great majority of the time I have been able to prevent the slide into nasal / sinus oblivion, and function on all but the worst days of the season. Occasionally I'll take decongestant and ibuprofen if the swelling gets bad but most of the time I haven't had to.

If I'm mowing / weed eating etc in the middle of a pollen apocalypse, then it's just take a shower, take drugs, knock myself out and live to fight another day. If you immune system is hyper aroused and your sinuses are fried you just need to take it easy, do what you gotta do, and stay out of the water until you're better.

This is a HUGE improvement over past years for me, and I tell the story just for the nudge that in future years if you have a strategy to stay ahead of the pollen apocalypse it CAN be managed.

Good luck!
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60south
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Re: #$@^%^!ing allergies

Post by 60south »

fmerkel wrote:On any dive you need to pay close attention to the area right above your eyebrows and below your eyes. ANY, and I mean ANY pressure at all means STOP, and HOLD, until it goes away. ... This problem generally happens ~10'-15'.
This exactly describes what happened on my last dive. At 10ft it was like a nail was suddenly being driven into my eyebrow. Stopped and held the dive... waited... and it cleared up. The rest of the dive went well. No blood or pain later, happy happy.
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Nwbrewer
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Re: #$@^%^!ing allergies

Post by Nwbrewer »

60south wrote:
fmerkel wrote:On any dive you need to pay close attention to the area right above your eyebrows and below your eyes. ANY, and I mean ANY pressure at all means STOP, and HOLD, until it goes away. ... This problem generally happens ~10'-15'.
This exactly describes what happened on my last dive. At 10ft it was like a nail was suddenly being driven into my eyebrow. Stopped and held the dive... waited... and it cleared up. The rest of the dive went well. No blood or pain later, happy happy.
Yeah, I thought mine was pretty well gone when I stopped, but I guess not.

Thanks for all the info lynne. Sounds like I'm out for a bit and I'll keep an eye on my temp to make sure I didn't get an infection.
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Jeff Pack
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Re: #$@^%^!ing allergies

Post by Jeff Pack »

I take Allegra at the beginning of allergy season, PseudoPhed if I need additional relief, and the big fixer for me if I get a major allergy attack is Actifed. Downside with Actifed, is it turns me into a space cadet and total non functional, but it knocks down a bad bad allergy attack.
=============================================

- I got a good squirt in my mouth
- I would imagine that there would be a large amount of involuntary gagging
- I don't know about you but I'm not into swallowing it

CCR discussion on Caustic Cocktails.
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fmerkel
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Re: #$@^%^!ing allergies

Post by fmerkel »

The non-drowsy antihistamines are OTC now. Claritin (Loratidine) was the original so has marketing presence. Any medication may have different effects on different people so it's also worth investigating fexofenadine and cetirizine.
Many people think the later are actually more effective, but less well known.

This may be of interest -from Wikipedia:
[The original formula for Actifed contained pseudoephedrine hydrochloride 60 mg as the nasal decongestant and triprolidine hydrochloride 2.5 mg as the antihistamine. However, in response to widespread laws requiring products containing pseudoephedrine to be kept behind the pharmacy counter, Pfizer changed Actifed's U.S. formula in late 2006 to contain chlorpheniramine maleate 4 mg as the antihistamine and phenylephrine HCl 10 mg as the nasal decongestant.[2] Many users of the old formula have complained that the new formula is not as effective at relieving their symptoms. Other brands available behind the counter that use the old formula include Genac and Aprodine. The American pharmacy chain Walgreens produces a house-brand version of Actifed, Wal-Act, which uses the original pseudoephedrine/triprolidine formula.]

The non-drowsy antihistamines did so at the expense of actually being somewhat less effective. The GOOD antihistamines like Benadryl are sedating (often used in OTC sleeping medications). Pseudofed is an 'upper'. The combination often worked well together. People often get antihistamines and vasoconstrictors mixed up since so many of them were used as combos in 'shotgun' cold remedies. They are most definitely not the same medication. Understand well what medication you are taking, especially before diving.
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Scubie Doo
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Re: #$@^%^!ing allergies

Post by Scubie Doo »

Tom Nic made me think of another point. Hire a good landscaper. No mowing lawns for me :) seriously, as goofy as it looks wear as mask when doing yard work.
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renoun
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Re: #$@^%^!ing allergies

Post by renoun »

I've had seasonal allergies all of my life and have only found good strategies to manage them in recent years. Both Fritz and Tom have had very good suggestions.

What has worked well for me has been to take a non-sedating antihistamine (I'm currently using Costco's Aller-Tec Active Ingredient, Cetirizine) daily from March through September. It's what I consider a "maintenance" medication that handles most of the allergens that bother me and keeps me from having a constantly symptomatic. I use Diphenhydramine (Benadryl) as a "rescue" med a handful of times each year when something overwhelms me and I become symptomatic. It usually controls the dripping nose and itchy eyes but may still leave me congested. If I've been congested for any period of time and a couple of rinses with a neti-pot (I use the squeeze bottle myself) haven't been effective I'll use a dose or two of Afrin. I'm very wary about overusing Afrin because of the possibility of rebound congestion from over use. I always do a squirt in each nostril and wait a few minutes before giving myself a second squirt.

It's going to take some experimentation to figure out what works for you. If easy treatments with over the counter meds aren't working for you I'd suggest working with an Allergist to get sensitivity testing done to figure out what is bothering you. Understanding what allergens affect you will be useful in understanding what you need to avoid and when you need to treat yourself prophylactically.
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Re: #$@^%^!ing allergies

Post by GearHead »

I've given up on being self conscious while mowing my lawn. So I look like a dork with my red ear muffs and dual canister air filter mask, so what.

I was miserable with allergies when I lived in So California with all the local molds and pollens year round, plus two cats in the house. I used to be perma-stoned on 12-hour Drixoral. Moving up here in '85 was a life-saver, as the local trees didn't bother me and I was no longer living with my sister's cats.

When Claritin became OTC, that was another revelation, as I still had bouts of allergies when mowing the lawn. I discovered that getting ahead of the allergic reaction was very important, as mentioned above. Now I just use Claritin seasonally. It works well enough for me to be effective even after exposure. It works best, though, when I take it every day.
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Re: #$@^%^!ing allergies

Post by LowDrag »

Here is a pic of the NeilMed squeeze bottle rinse:

Image

Much better IMO than a Netti Pot. I found with the Netti Pot that I practically had to stand on my head to get the saline solution to pass through my sinuses. All I have to do is lean over a sink when I use the NeilMed squeeze bottle. I put it up under my nose and squeeze it. I use half of the bottle on my right side then the second half on my left side. Another nice thing about the NeilMed is that it comes with premixed packets of salt mix that I pour into the bottle then top off with DISTILLED water and you can get extra packets separately too. It is very important that you use distilled water because it is sterile.
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