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Heart Matters: Father-Son Heart Surgery Strengthens Bond

When the need for surgery arose, this close-knit family made the decision to travel to St. Louis for a second opinion and care at Missouri Baptist Medical Center (MoBap). However, Matt and Bill never expected to be in the hospital at the same time, much less have heart surgery on the same day.

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Glen's life took an unexpected turn one afternoon while working in his shed. He received specialized care at Missouri Baptist Medical Center, helping him to a path of recovery.

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Michelle Mondello was breastfeeding her youngest child of three when she noticed a lump in her breast. Michelle was only 35 years old and had no family history of breast cancer. Because of her age and background, she wasn’t a candidate for regular mammograms. But after a biopsy at the Breast HealthCare Center at Missouri Baptist Medical Center, Michelle was diagnosed with triple-negative breast cancer (TNBC), an aggressive form of cancer that accounts for 10 to 15 percent of all breast cancers.

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Get the care you need, when you need it

Knowing where to get medical care is important, especially for sudden injuries or illnesses. For health concerns, Peter Fletcher, MD, Washington University emergency medicine physician and interim medical director of emergency medicine at MoBap, advises contacting your primary care provider first unless it’s an emergency.

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Is it a sinus infection or just allergies?
James W

Is it a sinus infection or just allergies?

Patients with congested nasal passages often assume they have a sinus infection or 'sinusitis." Inflamed nasal passages actually can be caused by allergies or viral colds. Physicians, therefore, generally limit the definition of sinusitis to bacterial infection of the sinuses.

There are four pairs of sinuses. These include the frontal sinuses above the eyes, the maxillary sinuses under the eyes and behind the cheeks, the group of small ethmoid sinuses between the eyes, and a pair of sinuses deep behind the nose at the base of the brain known as the sphenoid sinuses.

The mucus membrane lining of the sinuses is a very specialized layer of cells characterized by microscopic fingers known as cilia. The cilia trap bacteria, viruses and other particles and propel them in a mucus blanket from the sinuses into the nose for clearance. The average person secretes 1 to 1 ½ liters of nasal and sinus secretions per day. Secretions in excess of this amount should be evaluated.

Many people believe that any sinus drainage is abnormal. This, of course, is not true and we rely on a steady flow of mucus from our nose and sinuses to keep these structures clean and relatively sterile.

Sinuses drain into the nose and circulate air from the nose into the sinuses through a series of holes known as ostia. Anything which obstructs this airflow, including mucus membranes, swelling, bone derangements from injury or inherited conditions, or polyps will result in impairment of ventilation and drainage, and ultimately sinusitis.

The symptoms of sinusitis differ between the acute and chronic phases. Acute sinusitis — usually the first four weeks — is characterized by nasal discharge, headache, facial pain, fever, tooth pain, decreased sense of smell and cough.

Chronic sinusitis — when the condition persists for 12 or more weeks — is less localized and presents with a dull headache, chronic nasal congestion, thick posterior nasal drainage and often eustachian tube dysfunction with ear blockage.

The treatment of sinusitis typically includes antibiotics prescribed for 10 to 21 days, decongestants and mucolytics, topical vasoconstrictors such as Afrin or Neo-Synephrine, and in selected cases systemic steroids.

Unfortunately, bacteria are becoming increasingly resistant to antibiotics and stronger antibiotics are more often required than in the past.

In cases of recurrent sinusitis, the physician looks for underlying causes, like septal deviation, allergies, nasal polyps, an immunocompromised state, tumor and foreign body (particularly in children). This search will include very likely an endoscopic exam and imaging studies, often in the form of a CT scan.

An uncommon, but well recognized variant of chronic sinusitis includes fungal sinusitis, caused not by bacteria but by fungi. This form of sinusitis is more difficult to treat, and usually requires surgery.

Over the years the medical community has become aware that the sinuses are not an isolated organ system, but one end of the respiratory system. Sinusitis, therefore, can impact our pulmonary health and aggravate asthma and other lung conditions. Therefore, treatment of sinusitis may be necessary before lung conditions can be brought under control.

Dr. Barry Rosenblum, Fellow, American College of Surgeons, is an ear, nose and throat specialist who is board certified in Otolaryngology and Facial Plastic/Reconstructive Surgery. He is a member of BJC Medical Group and on-staff at Missouri Baptist Medical Center. He received his medical degree from University of Missouri-Kansas and did his internship and fellowship at St. Louis University School of Medicine.

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