The Medical Consumer's Advocate
Of nasal saline douches, leeches, and other
odd forms of torture
Q:
Back in '77, I was diagnosed
with sinusitis (oh, and a deviated septum, too.) There
was one part of the exam that still makes me shudder and
shall haunt me forever. I heard the doctor tell the nurse
to give me "the treatment". (He might have said
"water treatment"; it was a long time ago).
My chair was then positioned so that my head was
lower than the rest of me. The nurse then proceeded to
squirt water up my nose and vacuum it out again. Many
times. I thought I was drowning/dying. It was horrific.
(I don't swim, by the way, so maybe I'm overly sensitive
to have water in my nose.) The nurse ended up telling the
doctor that she couldn't finish "the treatment"
because I was being "a baby." (Good bedside
manner.)
Anyway, my question is, is this particular form of
treatment still used? I *think* they were
"irrigating" my nose to get a better look
inside, but I'm not sure. Is that the purpose of a CT
scan these days then, to prevent this medieval water
torture?
Thanks for taking the time to read this. And thanks
for an entertaining and informative site.
A: Thanks for the kind feedback.
In Mexican prisons, they allegedly
torture prisoners by opening a bottle of Coca Cola (you know,
the old style bottle with the sexy curves), adding a teaspoon
or so of cayenne, shaking it up, and unleashing it on the
nostrils of the unfortunate victim.
Count your blessings, you only got
the Saline Treatment.
Nowadays, we still recommend
nasal saline spray and even saline irrigation using a variety of devices (there are even
Water Pik-type attachments available that can produce a less powerful stream).
Key difference: you, the patient, does it -- not a nurse (was
she wearing black leather and spiked heels?) That way, you
can control the forcefulness of the treatment. If you blow
the back of your head off, you only have yourself to blame.
Trendier still (and one step closer
to the Mexican prison) is hypertonic saline, which is salt
water that is a bit more concentrated than regular
saline (AKA normal saline, which matches the salt
concentration of your blood). Hypertonic saline is a bit of
an irritant, producing a lot of mucus, which tends to flush
the nose of unwanted bacteria, dust, pollen, etc.
By the way, in some cultures, nasal
douching is as much a part of the daily routine as
toothbrushing is in ours.
The purpose of this douching is to
improve the environment within the nose, decrease
inflammation and thereby improve your sinuses' ability to
drain. There are caveats to this procedure, however. Aside
from the discomfort of douching, there are some organisms
which thrive on wet environments. Thus, by douching, you
could get rid of some bad bugs but make your nose a homey
place for different bad bugs.
Nevertheless, on the whole, I like
nasal saline irrigation, particularly in patients who have
had sinus or septal surgery.
(Note added 2005: You won't often see me endorsing a product, but I
do like the sinus rinse kit marketed by
NeilMed.)
Q: Thanks for your reply. I was hoping
nasal irrigation had gone the way of leeching, but no
such luck, I guess. :)
A: Sorry to disappoint you, but leeching
has NOT gone the way of leeching. Leeches are alive and well.
I should know, I was the leech keeper during my residency at
USC.
Leeches are used for a very
specific purpose: relief of venous obstruction in a
reattached bit of tissue. Typical example: man slices finger
off in a band saw, and the hand surgeon reattaches the
finger. Two hours later, the digit is blue. The problem is
usually not with the arterial supply, but with obstructed
venous outflow. Solution: attach a leech. Leeches
"inject" an anticoagulant. Not only do they suck
out a bit of venous blood, they create a wound which
continues to ooze for an hour or more.
We use only medicinal leeches,
which are leeches that are raised under very clean
conditions. Thus, you don't need to worry about acquiring
some bizarre parasitic disease from a wild-caught leech; the
leeches are quite clean, and in fact, make rather attractive
aquarium pets. But they will be quite deadly to the fish in
your tank.