You can read more about Dr. Tolan’s impressive credentials below.

To summarize, Dr. Tolan is the real deal, and is perhaps the best-qualified person to answer my question:

Will nasal saline rinses result in death from brain-eating amoeba??

The main points from that conversation are these:

• Using a Neti pot or other methods of doing nasal saline rinses won’t cause your death by brain-eating amoeba.
• Just to be safe, for nasal saline rinses, simply use boiled tap water, or simply buy a jug of distilled water.

There you have it. For the rest of what Dr. Tolan had to say, read on …

Image: Brain-eating amoeba, N. fowleri (image credit: CDC). The central B&W image is a "phase-contrast" from under the microscope; the pics on either side are stained brain tissue showing infection with amoeba ("Amoebic Meningoencephalitis")

As a world-renowned expert on infectious diseases of the central nervous system, I called Dr. Tolan to ask his opinion about the recent cases in the media, specifically cases of “brain-eating Amoeba” – Amoebic Meningoencephalitis (AM), linked to use of a Neti pot.

I wanted to get to the bottom of this because I have colleagues, patients and their families (and readers of this blog), asking me whether it’s safe to be doing nasal saline rinses at all. Are we risking Amoebic Meningitis by doing nasal saline rinses??

There are two reports that I am familiar with, and both have received a lot of attention on the web, in social media like Facebook and Twitter.

Here is what Dr. Tolan had to say:

Boogordoctor: Dr. Tolan, thank you so much for taking time to offer your expert opinion about Amoebic Meningoencephalitis, from Neti pot use.

Dr. Tolan: My pleasure, Dr. Faust, glad to help.

Boogordoctor: Are you familiar with the recent cases of AM linked to Neti pot use?

Dr. Tolan: I am not, since they have not yet been confirmed by the CDC (Centers for Disease Control and Prevention). I have not seen them reported in the MMWR (Morbidity and Mortality Weekly Report). Don’t believe everything that you read on the internet. Many things are sensationalized to boost readership.

On the other hand, there are some important points to make using these examples.

Boogordoctor: Such as?

Dr. Tolan:

• The first point for your readers to keep in mind is that AM is incredibly rare. There are usually about 3 cases per year in this country annually.
• Most of those cases occur after swimming in ponds in warm environments – Southern states.
• The next point to keep in mind is that the organism responsible for those cases is usually Naegleria fowleri. It is important to point out that N. fowleri is EVERYWHERE in our environment, including our municipal water supply. It is ubiquitous.
• N. fowleri is difficult to kill, especially in environments where it is happiest – in the South, for example. There is simply no way to chlorinate our water supply in the South to levels that will eliminate all N. fowleri. The farther South you go, the warmer the water, the greater the risk of having N. fowleri in your tap water (and ponds, lakes, etc.).
• My recommendation is, for people using Neti pots or other methods of nasal saline irrigations, USE DISTILLED WATER, or BOILED tap water. Distilled water is not absolutely sterile, but will have much lower risk of containing amoeba species than tap water.

Regarding these cases of AM related to Neti pot use that are reported online, I will be interested to see what the CDC investigators tell us. Regardless, it is important to emphasize how rare these cases are in this country.

Boogordoctor: Dr. Tolan, that is great advice, and supports what I have been telling people: use distilled water for your Neti pot or squeeze-bottle for nasal saline rinses – whether you use a store-bought salt preparation or make your own from a recipe.

Again, thanks so much for lending your expertise.

Dr. Tolan: You are very welcome, call any time.

My take on this: if you are doing nasal saline rinses, you have little to fear from Amoeba, as long as you are using distilled water or boiled tap water. You have a much (much) higher risk of exposure to N. fowleri by swimming in lakes or ponds in Southern states.

Conclusions

• It’s not about the Neti pot, or even about nasal rinses.
• It’s about the water.
• Just be sure your water is safe. How?
• Use distilled or boiled water for your nasal rinses!

The Life-Cycle of N. fowleri

The image below shows how N. fowleri (and some other amoeba species) get into our brains: simply swimming in ponds or lakes with high concentrations of amoeba (think warm, Southern states), can result in amoeba reaching our noses; they crawl through our “olfactory neuroepithelium” – that part of our noses that give us the sense of smell), and enter our brains that way. Bad news!

Image: Life-cycles of amoeba

Please leave a comment / reply and let us know how you are doing nasal saline rinses.

And thanks for visiting!

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About Dr. Robert Tolan

Dr. Tolan is a world-renowned expert on infections of the central nervous system.

He is currently Chief, Division of Allergy, Immunology and Infectious Diseases, The Children’s Hospital at Saint Peter’s University Hospital, New Brunswick, New Jersey and Clinical Associate Professor of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania.

He earned a Master’s Degree in Microbiology before earning his Medical Degree at Washington University School of Medicine. Following his training in Pediatrics, he pursued advanced training and research in Infectious Diseases at Washington University/St. Louis Children’s Hospital. He is board certified in Pediatrics by the American Board of Pediatrics, and also the Sub-Board of Infectious Diseases. He teaches at Drexel University, where he is Associate Clinical Professor.

Dr. Tolan’s research is funded by the NIH; he studies various infections in children and infants, and his list of publications is longer than I am tall.

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Resources:

http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2332

http://www.medicalnewstoday.com/articles/239422.php – be sure to read the comments: this isn’t about Neti pots! It’s about the WATER.

http://health.yahoo.net/articles/flu/neti-pot-deaths-linked-brain-eating-amoeba-tap-water

http://phoenix.about.com/od/health/qt/Ameba.htm

http://www.wwltv.com/news/health/Doctors-explain-cause-of-brain-eating-amoeba-128043523.html

Image Credit:  All images from the CDC (Centers for Disease Control and Prevention) Image Library, in the Public Domain.

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

First, thank you for entrusting the care of your children to me. I see this as a great privilege, and a huge responsibility. And as a parent, I know how difficult it can be to put the health of my children in the hands of a stranger, especially for surgery. Again, thank you for your trust.

Second, I regularly make recommendations in my clinics, and on this website, for certain products that I use personally, and that I use for my own children. Usually, I provide a website link for where to purchase those things – usually the same site where I purchase them.

Well, most of you don’t know that this site has an affiliate link to Amazon.com, where I have placed links to some of these products.

Many of the things that I use were not available through Amazon when I started this site 1 ½ years ago. Now they are. I have never mentioned it because I have an aversion to the notion of doctors selling things. What has changed? Well, these are the best prices that I have found for these products, and they are the products that I use myself, and my patients ask where to get them. So I wanted to share. Here they are.

You can find these products on the boogor doctor’s Amazon Store. The newest additions are on a new page on the boogor doctor’s Amazon Store, called “Evidence-Based Cures”.

Evidence-based remedies selected just for you!

Evidence-Based

All of these products have been found to have significant benefits through the best clinical trials available, the “gold-standard” of modern medicine: prospective, randomized, controlled clinical trials. “Evidence-based.” As a PhD scientist before going into medicine, I need to see the data to be convinced.

Things like Nasal Saline Rinses, Manuka honey, Probiotics and Xylitol, all proven to significantly reduce upper respiratory infections (URI’s), sinusitis, otitis media (ear infections) – the things that our children struggle with. The things that my clinical patients struggle with.

It is interesting that these two examples, Probiotics and Xylitol, were brought to my attention, not from the medical literature or expensive ad campaigns from drug companies, but from mothers of patients.

Moms that were frustrated by needing to take their child to 6 different specialists who could not agree on a diagnosis or on a remedy. Moms who figured it out on their own. Amazing. Yet, when I searched Medline on these topics, the research is there. The clinical trials have been done, with astonishing results. In the case of Xylitol, we’ve had the results from clinical trials beginning in the 1970’s!! So why aren’t these remedies recommended by EVERY pediatrician?!?

Don’t get me started.

Well, I just discovered that Amazon has these evidence-based cures for less than I have been paying from some other online sources. So that you can save money too, I have just added them to the boogor doctor’s Amazon Store.

You may not be aware of my Amazon Store. It’s over in the right-hand column on this page, just a small “widget” box. If curious, just click on it and check out the things that I endorse. These are products that we use in our family.

Readers of this site know my aversion to plastics (BPA and other harmful chemicals), and I include some alternatives to using plastic containers for our children’s lunches; and I use various natural products like Xylitol (a naturally-occurring sugar that is antimicrobial) and Manuka honey (nature’s strongest antimicrobial). Read this article on the antibiotic properties of honey.

At this time of year, a good Steam Vaporizer humidifier is needed to minimize the risk of nose bleeds. The one we use in our home (we have five (yes, 5) of them!) is the Vick’s Steam Vaporizer. The Nasopure nasal saline rinse system is the best available, and the one that I use.

If interested, this is the best price for Manuka honey that I have found, and this is where I purchase mine from. It is also the best price for Children’s Probiotic Pearls (Integrative Therapeutics), the probiotic preparation that has made such a huge difference in reducing the frequency of colds in my own children (hallelujah!).

So there you have it. Nothing profound. Just the best prices that I have found for the things that I use to help keep me and my own children healthy, and my patients. Some great products!

Transparency: Yes, that boogor doctor’s Amazon Store is an “affiliate link.” That means that anything you buy through that link brings a few pennies (literally, pennies) back to this site. It doesn’t even come close to paying for having the site hosted, and it’s pretty inexpensive hosting – about a hundred dollars per year. So no, I’m not getting wealthy on this Amazon Store affiliate thing. I wish. If you want to avoid any pennies coming back to this site, simply note the products, and log into Amazon from a separate browser page to make your purchases.

I do have one complaint: I have not been able to figure out how to search for other products once I am in the boogor doctor’s Amazon Store. If any of you tech wiz-kids reading this know how to do that within the Amazon Store system, please let me know.

I hope these products help you as much as my family and I have benefited from them.

Please leave a comment / reply and let me know about some of the things that YOU are using to stay healthy, so that I can add them to this Amazon Store!

And thanks for visiting!

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Dr. Faust and friend

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

According to the Americam College of Allergy, Asthma, & Immunology:

• More than 50 Million people in the US have allergies
• Adults and children of any age can be tested
• Testing options include Skin tests, or Blood tests
• 2 types of skin tests:
  • Drop of suspected allergen is scratched on the skin surface, usually on the back or forearm; can test many possible allergens at same time
  • Tiny amount of suspected allergen is injected just under the skin (“intra-dermal”); intra-dermal allergy testing is restricted to testing for allergy to insect stings or penicillins
  • For skin tests (both types), positive reactions usually appear within 20 minutes
  • Both types of skin test have little or no pain; positive reactions can cause annoying itching red bumps, like a mosquito bite
  • Note that some medications interfere with allergy testing – especially allergy meds like antihistamines
  • Both kinds of allergy skin tests are thought to be mediated by a type of antibody (IgE) that we make against the allergen
  • Allergy Blood Tests detect the presence of IgE that is made against an allergen.
    The Allergy Blood Tests can be used when: 
    • Patient is taking a medication that can interfere with skin testing, but the medication cannot be stopped for a few days
    • The patient suffers from severe skin condition such as eczema or psoriasis that would either be exacerbated by the testing, or interferes with interpretation of the results
    • Testing with a strong allergen might cause an extra large positive reaction
    • For babies and young children, a single needle stick to draw a small amount of blood to be used for allergy blood testing may be better tolerated than several skin tests
    • Allergy blood tests can take many days to get results
    • Allergy blood tests are generally less sensitive than skin testing methods

Which Test is Better?

Each test type has pluses and minuses.  Using either type of test, the results alone do not diagnose allergies.  Like all test results, they must be interpreted with the medical history.

The Benefits of Testing:

Some people with severe allergic rhinitis, sinusitis, otitis, or asthma (think Unified Airway Disorders), that is not controlled with standard therapy may benefit from allergy testing, if test results enable allergen avoidance or help guide allergy treatment using immunotherapy – either sub-cutaneous or sub-lingual immunotherapy (SCIT or SLIT).

If you enjoy these articles, please share them with others: scroll to the bottom of the page and click on one of the “Be Sociable, Share” buttons – send the link to your Facebook page, or Tweet it, or even just email it to a friend that you think may benefit from the information here! Thanks.

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For More Information on Allergy Testing:

• Allergy Testing. A Review by JAMES T. LI, M.D., PH.D., Mayo Clinic; Published in:
  Am Fam Physician. 2002 Aug 15;66(4):621-625:
  http://www.aafp.org/afp/2002/0815/p621.html
• Allergy Testing, According to the American College of Allergy, Asthma, & Immunology:
  http://www.acaai.org/allergist/allergies/Treatment/diagnosing-allergies/Pages/allergy-testing.aspx
• From this blog: How Rhinitis, Asthma, Sinusitis, Tonsillitis, Otitis, Are All Connected – the Unified Airway:
  http://www.boogordoctor.com/wp-admin/rhinitis-sinusitis-otitis-laryngitis-adenoiditis-tonsillitis-are-all-connected

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Image Credit:

Wolfgang Ihloff: http://de.wikipedia.org/wiki/Benutzer:Wolfgang_Ihloff

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

An object that does not belong there – a “foreign body”.

Or, your 2-year-old has a foul smell, a bit like a piece of old fish, and there is some foul drainage from one side of her nose. Further investigation reveals that she has stuffed some upholstery foam into one side of her nose, resulting in rhinitis and sinusitis on that side (yuk!).

Common Nasal Foreign Bodies

Things (“foreign bodies”) that little boogorheads might put into their noses include:

• Beads,
• Buttons,
• Toy parts (shoe from Polly Pocket, for example),
• Pebbles,
• Food,
• Crumpled paper,
• Small disk batteries.

Don’t ask “why” – they just do.

Not an Emergency – Unless

Here is the important thing to keep in mind: this is not an emergency, UNLESS the foreign body is a disk or “button” battery.

A Disk Battery IS AN EMERGENCY.

If you suspect that your infant, toddler or child has placed a disk battery into their nose or ear canal, or that they may have SWALLOWED a disk battery, take them to the Emergency Department of your local Children’s Hospital.

Right Now.

Image: Nasal Foreign Bodes

The figure shows the most likely places for a bead or other foreign body to lodge in the nose – either high in the front of the nose (at the front of the “middle turbinate”, site #1), or against the “inferior turbinate” (site #2).

Things to DO

• Once you identify which side is affected, gently press the other nostril closed and have the child blow gently; this may blow the object free

Things NOT to DO

• Do not search the nose with cotton swabs or other tools – that may push the object further into the nose, where it may be aspirated (site #4 on the figure)
• Do not try to remove an object that you cannot see or grasp
• Do not use tweezers or other tools to attempt removal – you may create nasal trauma

Seek Professional Help If

• Bleeding develops or continues
• There is a foreign object in both nostrils
• You think that an infection has developed

Prevention

• Discourage your little boogorhead from putting objects into any body openings
• Keep small objects out of reach of infants and toddlers – especially button batteries

Treatment

Most of the time, your pediatrician or, more likely, your pediatric boogor doctor (Ear, Nose & Throat surgeon) will be able to remove an object from the nose in the clinic. Occasionally, due to a very wiggly, strong, or uncooperative child, this may need to be done in the operating room with the child sedated.

Your child may require surgery – general anesthetic – for removal of a nasal foreign body if the object is lodged securely, or if it is very deep. Anesthetic will keep your child comfortable and still, and help prevent further nasal trauma. If the object has caused a laceration to the lining of the nose it may require repair.

Emergency

To repeat:  if you think that your child may have placed a disk battery into their nose or ear canal, or may have swallowed a disk battery, take them to the Emergency Department of your local Children’s Hospital NOW.

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Hi, I’m Russell Faust, author of this medical education blog.

Image: Russell Faust

Let me know what topics are important to you and your child’s respiratory health. Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later – we will be going into more detail on how to rid your children of allergies, rhinitis, sinusitis, and other chronic aero-digestive inflammatory disorders on this site.

If you are interested in these topics, please click here to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-t0-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)