The trickle down of postnasal drip
DEAR DR. DONOHUE: I have the worst case of postnasal drip, and it’s driving me crazy. I have a neverending “ahem, ahem, ahem” throat-clearing. Phlegm is constantly in the back of my throat. Sometimes I clear my throat a thousand times a day. Two-thirds of my garbage is used tissues. What can be done? — J.B.
ANSWER: I apologize for condensing your letter. I got the idea, and I believe readers will too.
Three or four conditions account for most postnasal dripping. One is allergies. You’ve seen an allergist, and the only allergic reaction you demonstrated was to dust mites. Can you leave your home for a week or so — visit a relative? If dust mites are the cause, your symptoms should subside in a new environment.
Vasomotor rhinitis is second on the list of drip causes. It’s a more-or-less permanent dilation of blood vessels in the nose, and those dilated vessels leak fluid. Throat-clearing is part of the picture.
Sinusitis is another important cause. An infected sinus pours out thick mucus that drips into the back of the throat. Chronic sinusitis is best left to the treatment of an ear, nose and throat doctor. Nasal polyps provoke mucus production and dripping. An ENT doctor is equipped to deal with them, should they be found.
Medicines — beta blockers, Catapres for high blood pressure, aspirin and NSAIDs — are examples of drugs that cause the nose to leak fluid down into the throat.
Let me provide some general treatments that help most of these causes. You must stop clearing your throat. Sucking on throat lozenges or frequently sipping from a cup of hot tea with some honey in it will clear mucus from your throat and stop the irritation that throat-clearing causes. Flush your nose with a saltwater solution three times a day, one of those times being right before bedtime. You make the solution by adding one teaspoon of salt and half a teaspoon of baking soda to a quart of boiled water. Add the ingredients when the water is still hot. When the water cools, lean over a sink and flush each nostril gently with a bulb syringe, obtainable in drugstores. Cortisone nasal sprays — Nasarel or Rhinocort Aqua — soothe the nasal lining and reduce mucus production. If you still are afflicted after all this, do see an ear, nose and throat doctor.
DEAR DR. DONOHUE: I am a 74-year-old woman who exercises and maintains a healthy lifestyle. My OB/GYN doctor referred me to a colorectal surgeon for evaluation of a rectocele. The surgeon thought surgery was not needed at this time, but he wanted me to have a defecography to check “something” in the colon. I have had three colonoscopy exams. What does this test do that a colonoscopy doesn’t? I opted not to do this procedure. I wonder if it was a good choice. — M.S.
ANSWER: Defecography is an X-ray procedure in which barium paste is inserted into the rectum. The patient then drinks a watery contrast material that stimulates the urge to defecate. The radiologist sees how much the rectum holds, how well the person evacuates the rectum, if there is any involuntary loss of stool from it, and how extensive is the rectocele. Colonoscopies do not furnish such information. A rectocele is a bulging of the rectum into the vagina. Both rectum and vagina lie in close proximity to each other.
Not having the test done isn’t a threat to your life. It does provide information for the surgeon as far as judging the issues I mentioned. It’s not a test that you have to rush to have done unless you’re having symptoms. Apparently, you are not.
DEAR DR. DONOHUE: You refer to a question about a neuroma by saying that a podiatrist can pad the foot, yet you say a doctor can remove the neuroma surgically. I have been married to a podiatrist for a very long time. A podiatrist is perfectly qualified to remove a neuroma. Why would you say that a podiatrist can give palliative care but a doctor is needed for surgical treatment? — T.J.
ANSWER: I used “doctor” to refer to the podiatrist. Since you’ve lived with one for so long, I take it for granted you do the same.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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