Stint for blocked frontal sinus?

[The Iceni]

Laurence Stein DDS once bubbled...
But, hey, Dr. Paul, help me out here.

Durrr? I'm the lowest of the low - a primary care physician. You're more of an ENT man that I am. If I remember correctly dental students spent as much time on the head and neck as we did on the whole body when we studied anatomy.

It never ceases to amaze me just how much anatomy most people do know but also how little they really know (and this is not meant to be any criticism of you, Grajan.)

My comment

Thus the frontal sinuses are seen at the top above the eye sockets (which do not connect with the nose and do not have a mucosal lining), and with the maxillary sinuses each side immediately below the eyes with openings pointing upwards into the nasal cavity.

was intended as a description of what is seen in the section to help decipher it, as I admit it took me a little while to identify the eye sockets, so I imagined most could find the diagram quite incomprehensible.

Yes indeed, Graham. While I am sure any embryologist would disagree to my simple mind the sinuses are an internal structure (in that they lie entirely within the skull in communcation with the respiratory tree and are lined with mucus membrane), whereas the orbit is separate from the nasopharynx. The nasolachrymal duct is a part of the "skin" and mostly lies outside the bones of the skull draining the external eye.

The tear glands are specialised sweat glands that continuously lubricate the eyeball. (Without tears the cornea dries out and can become scarred (which can cause blindness). An example of a deficiency in tear production is Sicca syndrome which requires the use of artificial tears.) Tears drain through the nasolacrymal duct, which starts at the punctum of the eye, the little bulge found at the medial end of the lower eyelid. This is why we have a runny nose when we cry (and why Graham finds fluid in his eye when he blows his nose). I am no ENT surgeon, so I am not sure how common the later finding is. The ENT man should be told, though.

A nasolalrymal duct is often blocked in babies, causing a "sticky eye" but it almost always clears with massage, lubrication and time.

By the way. Were you aware that the function of the sinuses is to lighten the skull as air is considerably lighter than bone?

You are so right to be frustrated with Joe Public's expectaion of HMOs. Larry. We have one big one over here. It is called the National Health Service.

"You can have every medical care you need as long as NHS bureaucrats consider you need it".

 

[Grajan]

Much wiser now - thanks.

As A Brit who became an Aussie and has now been in Texas for nearly ten years I will remain (fairly) silent on what is laughingly called a medical system here - might get me re-exported.....

It does have one major upside - with a bureaucracy not unlike the Indian civil service it plays a major part in keeping unemployment low - even through recessions. Pity so few of them are medical practitioners.....

Graham

P.S. Notwithstanding the relative merits of the overall 'system' I have always recieved the absolutely best possible care here. Living next door to the Texas Medical Center probably helps a bit.

I would HATE to be a doctor here. Pressured by HMO's to cut costs at every turn and then having drug companies sending patients 'information packages' with leaflets on "how to get the best out of your next doctor visit" - sends a chill down the spine it does.

 

[Laurence Stein DDS]

Grajan and Dr. Paul,

Thanks for you understanding to my diatribe on getting good medical care. Unfortunately, when one reads, intonation and connotation can be lost.

My frustration is both with medical care delivery when a non-medical entity get's in the way and the way medical consumers seem to want to blame the system they choose or allow to have forced on them. Bluebandedgoby really was not my intended target of frustration but her comments served as an example.

One of the docs on the board is often reminding members that when you take medications and they wear off during a dive AND you know that they only last a few hours, DON'T blame the medicine. Blame the user--they didn't follow the instructions. The same for medical care. If you are going to have mediocre care and are willing to accept it, don't blame it. If you need better, then don't complain, just go out and do what you have to.

It never ceases to amaze me how patients can manage to mess up the best advice. I got a bit testy today. I'm taking a long weekend and I get a call at home. A patient calls and says, "Remember me? I saw you about 3 months ago. You told me to get my wisdom teeth out then but I didn't. I lost the x-rays and the referral slip to the oral surgeon. Now I'm in a tremendous amount of pain--what do I do?" "I tried calling some surgeons but they were either working half days today or wanted a referral." I'm thinking Duh! I'm also thinking that here's a person shopping for pain medication.

So I call the oral surgeon I originally referred her to and gave them the phone number. The patient calls back and says that, 1) They need to take the x-ray again and do a consultation with a fee prior to an extraction and 2) they expect to be paid at that visit."

This office doesn't know this person from Adam and she already has a history of not taking medical advice seriously--except when she is hurting. She's wondering why they want to be paid up front----because they will never see her again!!!

I spent nearly two hours on the phone on my day off with a screwball patient who couldn't sleep all night because of a tooth she was told would do this three months ago. I didn't charge her a nickle.

She had all the information she needed to avoid this situation months ago and now she want everyone else to "own" her problem.

Let me tell you, I really felt bad for her but just what exactly was I going to do? She is a perfect example of someone who, despite any medical advice, goes and does exactly as she wishes--until the problems occur. Then she blamed the strange oral surgeons, a lack of medical records, the need for an exam and consult prior to an extraction, the requirement of payment for the service when performed. She blamed everything but the fact that she was her worst enemy.

And since I'm on a rant, right now. Has anyone ever gone to the food store and brought groceries up to the check out aisle and told the check out person, "I'll pay you when I have eaten them." Perhaps, you are able to get your car from the repair shop without payment in full. For reasons that are beyond me, patients expect to be billed for services rendered and if they have insurance, they expect to be billed AFTER insurance has paid--even if whe know exactly how much their balance will be.

So let's see...doctors should wait for at least a month to 3 months in an uncontested filing for insurance to pay and THEN bill the patient for the difference--for which they may wait another 3 months to receive the remainder of the fee.

Doctors (and I include dentists) do so much free treatment it would make your heads spin. But as soon as our staff asks for payment, we become money grubbing doctors who's only reason to work is the pay. Nothing is farther from the truth. For those of us in private practice, the treatment does come first, along with compassion but I can't pay my staff with compassion and when all is said and done, a medical or dental practice is still the doctor's business and must be run just like the auto repair shop or the grocery.

Geez, that patient really got me going today. Tomorrow I dive though so I won't think about it unless she calls me on the boat and tells me she couldn't keep the appointment!

Dr. Paul--you are not the lowest of the low...you might not sleep much but you seem to know quite a lot about just about everything. I enjoy reading your posts. Keep it up. BTW, I don't know if you read Scientific American buy this month's issue--it's great--It's about time, it's measurement, perception, misconceptions as a "4th dimension", worm holes, time travel, psychological and socialological implication of this ephemeral thing we percieve as Time. Interesting reading. It might also help you sleep on your bad nights.

Grajan, you're doing the right thing. Use the system to it's advantages. If something is not right, seek outside assistance--it's not free but it's worth it.

Bluebandedgoby--I still love you. It's that ##$&$%^$% patient that kept me going for two hours with total stupidity that really got me started. You had a valid question and my only point was that you "own" your own problem. You must solve it. The doctors--especially the caring ones are here to help but you must seek them out. The system is not necessarily willing to do so without a push from you.

Laurence Stein DDS