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View Full Version : new member from Philadelphia with nasal crusting (aka: life of the party)



jlove
04-19-2014, 02:16 AM
I guess my GPAstory started 8 years ago now. I was 16 and came home from a weekend ski trip with a cold that made me lose my voice. After a few weeks, my voice still had not come back and my right eyelid was drooping. I didn't think these things were related at all. Come to think of it, I don't remember what I thought about losing my voice but we thought the eyelid drooping was from a stye in my eyelid. After seeing a few opthamologists, one noticed my right pupil was slightly lower than my left. I had a scan (MRI, CT... I don't remember) and it showed a mass between my eye and brain in my right orbit. I had a biopsy done at CHOP in Philly and they said it was a sclerosing pseudotumor. It went away after a heavy dose of Prednisone, which effectively crushed me for 5 months, being that I was a 16 year old girl in high school. My face blew up, I had acne, I gained 50 pounds. I started my Junior year of high school looking and feeling terrible but I didn't really have any idea why. I was also experiencing subglottal stenosis (narrowing of my airway) and I was seeing a rheumatologist but my bloodwork was inconclusive and no one could make a diagnosis at that point.

I started running and I joined a dance team and lost all of the weight I put on. I finished out high school feeling fairly aside from my lost voice. I got used to hearing, "are you sick? you sound hoarse" and, "wow were you at a concert this weekend?" It took some time to learn to be okay with my new voice, especially since I was a singer my whole life and I had to give that up. I had an evil choir teacher in high school who picked on me for switching from singing soprano to alto. It still makes me angry to think about it. Other teachers were great about it, though, so it wasn't all bad. I missed a week of school Junior year of high school to have surgery to open up my airway. My ENT lasered the area and treated it with a steroid, I believe.

I went to college at Penn (in Philadelphia), where I was already seeing my ENT and rheumatologist regularly. My voice became status quo at college because people didn't know me before the lost voice. I had another surgery to open up my airway Sophomore year of college (and more steroids and more weight gain). Junior year I started walking a ton and lost all of the weight I put on again. By the end of Junior year I was really happy and feeling almost totally normal (aside from the lost voice). Around March of my Senior year, however, I started feeling very congested and experiencing nasal crusting. I thought it might be allergies but I saw an allergist, who found nothing unusual. I saw my ENT soon after and she seemed alarmed. She said the nasal crusting could be the third strike that would officially diagnose me with GPA. My dad works at the Hospital of the University of Penn and he knew there was going to be a new chair of Rheumatology who was an expert in Vasculitis, Dr. Merkel. I was sort of seeing another Rheum at Penn but I really didn't like him. In October 2013 I became one of Dr. Merkel's first patients in Philly and he more or less diagnosed me on the spot after an hour of telling him my story and his reviewing my medical history. I started a low dose of methotrexate and am now taking 25 mg a week plus folic acid.

So after 7 years I finally had a diagnosis. Dr. Merkel says he doesn't think I have active disease, which I am very grateful for. Now I struggle with the nose crusting from the scarring that occured in my nose as a result of GPA. I rinse with saline three times a day. I'm constantly applying saline gel in my nose. I need to drink more water to keep from drying out. I know things could be worse for me but it has been a struggle to accept the fact that this is my reality now. I need to think about bringing saline with me on trips and having gel with me in my clutch if I go out to a bar (I'm 24). Drinking alcohol is not so much fun anymore as my stomach is very sensitive and I hate feeling so incredibly dried out by booze. Bloody tissues make up 90% of the trash in my house and I never have enough air. Between the blockage in my throat and the crusting in my nose, I have to really think about my breathing sometimes. I don't want it to be loud (a girl I work with said I was Darth Vader breathing once. rude.) but I also need to make sure I get enough air. My apartment is only reached by 5 flights of stairs and I often have to stop halfway through to regain control over my breath. I get really annoyed when people ask me if I have athsma or something. I like to think people don't notice but I have had several people close to me say something about my breathing. It makes me feel sick and damaged.

Another thing I struggle with is talking to my friends about this. Like I said before, I like to pretend there's nothing wrong with me and my breathing but sometimes I just want them to understand that I'm doing the best I can. I feel like they think I'm out of shape because I lose my breath on the stairs but breathing itself is just a lot more difficult for me than it is for them. I think when people aren't sick like this, it's easy to take something so simple as your breath for granted. But then, I don't want them to treat me like a sick person. I'm sure this is something others have dealt with... if you have any advice, please share!

I'm also seeking advice from people who deal with nasal crusting. My ENT just told me to try lanolin in my nose and adding baby shampoo to my saline rinse. Are there any other tricks people use? I'm hoping if I can really get a handle on the crusting that I can improve my ability to breathe. I really miss being able to run. In the past year I have taken up yoga and have found that extremely beneficial to me in many ways. I have learned how to command my breath and I'm also getting stronger. At this point, I guess I know the GPA isn't going away so I need to really take care of my body to reduce the amount of stress I put it through. I'm trying to eat more vegetables and less processed food. From what I've read lately, it seems your diet can really affect inflammation in your body.

While I would never wish this on anyone, I'm not sure I would have learned this early on how important it is to take care of myself. At least there's a silver lining to this, maybe?

Anyway, sorry for the wall of text. Most people I encounter have no idea what GPA is. I'm really looking forward to connecting with others who share similar struggles with me. I have a strong support system in my life but there are times when I feel like I either can't open up to people or I don't want them to see me in a certain way. Not everyone has had to deal with problems like this so I can't expect them to really understand what I'm going through. And in some ways, I feel like this because I don't want GPA to be the defining factor of who I am. It is certainly part of who I am, but it's not everything.

Aaaand I'm done. I swear I'm not usually such a serious person. I promise I won't always post epic novels on here! :cool1:

Dirty Don
04-19-2014, 03:20 AM
Welcome Jess, such a story and at a young age...sheesh. I don't mind old guys like me getting this stuff, but not fair to you young'uns. Anyways, ask lots of questions on here...lots of knowledgeable, experienced, and caring peeps on here...we all have different stories centered around this wonderful lil disease. Your docs sound on top of things as they should be! I like your attitude towards WG...it is simply another part of whom we have become...best to you!

MikeG-2012
04-19-2014, 04:45 AM
I'm also seeking advice from people who deal with nasal crusting. My ENT just told me to try lanolin in my nose and adding baby shampoo to my saline rinse. Are there any other tricks people use? I'm hoping if I can really get a handle on the crusting that I can improve my ability to breathe.

Hi Jess, a fellow cruster here! LOL! (-8

My crusting used to be HORRIBLE. I've learned that VOLUME and FREQUENCY are the two things that helped me. Lots of water/saline at least twice a day. I run 3 liters of saline through a Waterpik twice a day. Yes, that is over 2 gallons a day!! The past two months, I've discovered a new method of loosening the crusts. Using the Waterpik on the lowest setting, I put it in one nostril and pinch the other one shut. I let my nose and sinuses fill with the warm saline, and when I feel it tickle in the back of my throat, I stop the water flow. I then hold the saline in there for 30-45 seconds and then blow it out fairly aggressively. This method, I also used when I had an antibiotic rinse. My ENT says this technique is really great, and he wished he'd thought of it. My sinuses have taken a remarkable turn for the better in the months that I've been using the flooding technique. I am the only patient my ENT has that is doing such an aggressive rinsing routine. Others use maybe one 8oz NeilMed bottle a day, but that's it. Quite frankly, I would love to go back to those days, but if I do, the crusts would build up so heavy that I would not be able to breathe--just like you.

Another thing to consider is what I found out lately. You can have a flare up and it will stay in the sinuses and not register anywhere on the ANCA test scale. My sinuses were/are my trigger/indicator of when I am flaring.

One other thing that helped me when I was a crusted up mess was a good nose picking by my ENT at every visit. He went in with suction and forceps and removed as many as he could until I couldn't stand it any longer. Basically, he would work until the numbing spray wore off. An endoscopic procedure at every visit can get expensive if you have to pay a percentage of it. I have great insurance and a really low max out of pocket, so insurance paid for the endoscopy procedures without question.

I've done baby shampoo in the rinse, liquid nebulizer steroids in the rinse, Alkalol nasal wash diluted in the rinse, and have had decent luck with all of them when I was using them. Now, I am just using saline, but the last rinse I do with the Waterpik, I add about 1/4 cup of the Alkalol solution. It helps to keep the sinuses and nose open for a little while after rinsing.

Good luck, and feel to ask any other questions, either here or via private message.

renidrag
04-19-2014, 05:18 AM
Welcome Jess, no crusting here only the loss of Dr. Merkle, I had an appointment with him and when I went to see him, he was gone. He was at Boston Medical and left for Philly. Any way we now have Dr. Monach. You have one of the best Weg Doctors in the country, you're in good hands. Best of luck going forward.
Dale

annekat
04-19-2014, 05:14 PM
Welcome to the forum, Jess. And don't worry about the wall of words.... many of us have done it, and yours was well written and interesting. You have been through a lot in the last 8 years. All the above advice is good, especially Mike's on the crusting. It sounds like you have a good handle on how to take care of yourself and it's great that you have such an excellent doc overseeing your case. I hope you will continue to read and participate on the forum. It is really an excellent group of people with a lot of knowledge and support. Cruise the archives, too, to see past posts on various topics. I'm glad you found us.

Alysia
04-19-2014, 07:20 PM
thanks for sharing your tough and so touching story, Jess :hug2:
welcome to the family. we understand what you are going through and hold your hand.
please continue to write.

mishb
04-19-2014, 09:17 PM
Hi Jess and welcome to you, from me all the way from Australia.

Yes we hail from all over this great world and therefore someone is on here anytime you may need to ask questions, have a yell, share a laugh etc.
We all certainly know exactly what you are going through :crying:

A couple of things that caught my eye, in your lovely written post, were:
- Dr Merkel doesn't think you have active disease
I'm sorry, but if you are still filling the rubbish bin with bloody tissues, and if your nose is still crusting, and if you still can't breathe properly or walk the stairs,
then your GPA/WG is not yet under control, but it is certainly not in full swing.....which is something to be thankful for.

- Going to a bar and drinking alcohol
You really shouldn't be drinking alcohol whilst on Methotrexate (MTX).
MTX may cause liver damage if taken over a period of time and drinking alcohol can speed up/double the risk to your liver.
You can have the occasional drink, every now and then, but it is not recommended.......but people do
This could be the reason your stomach feels so bad.
It is easy to say NO and just have water or soft drink.
I used to tell people that I was a reformed alcoholic and now I don't touch the stuff :razz:

All the best of wishes to you and we look forward to many more posts

pberggren1
04-20-2014, 09:52 AM
Michelle, I am in remission and always have bloody nose with crusting. And also have trouble breathing and can't do stairs. I have to disagree there. Just because one has these symptoms does not indicate active disease.

And welcome Jess. Glad to hear you have Pete as your doc.

jlove
04-20-2014, 09:56 AM
Thanks so much for this! I tried the flooding technique and it was awesome. I do think the crust needs a little time to soften up before it will come out. I'm feeling better today than I have in awhile! Also, I just picked up lanolin last night from Target. It took me forever to find it... I guess I should have checked the breast feeding section first haha

pberggren1
04-20-2014, 09:59 AM
Good luck on getting that crust out Jess. Just irrigate lots with a Waterpik and like Mike and I do.

MikeG-2012
04-20-2014, 11:31 AM
Thanks so much for this! I tried the flooding technique and it was awesome. I do think the crust needs a little time to soften up before it will come out. I'm feeling better today than I have in awhile! Also, I just picked up lanolin last night from Target. It took me forever to find it... I guess I should have checked the breast feeding section first haha

I am so glad you tried it Jess!! I think the flooding technique is the cause of the rapid changes to my sinuses these past two months. My ENT would agree with that too. Keep up the good fight, and eventually you will get ahead of the crusting!

mishb
04-20-2014, 02:44 PM
Michelle, I am in remission and always have bloody nose with crusting. And also have trouble breathing and can't do stairs. I have to disagree there. Just because one has these symptoms does not indicate active disease.

And welcome Jess. Glad to hear you have Pete as your doc.


Sorry Phil & Jess, I didn't know that.

So this means that I could also be in remission with my bloody noses, my difficulty in climbing stairs and my aches and pains

I will take that :thumbsup:

pberggren1
04-20-2014, 03:06 PM
Definitely Michelle. I find most people do not understand the term remission.

Alysia
04-20-2014, 03:33 PM
according to my doc (which is far from being a wg specialist, but still it makes sense) any blood is an indication to wg activity. maybe smoldering. but still something which needs attention and correct treatment.
Dear Dr. Phil, with all respect :love: , I think that blood is an "alert" sign....

annekat
04-20-2014, 03:41 PM
So, Phil, how do we understand the term "remission" ? I am confused. If there is bleeding and crusting, what is that if not disease activity? Is it just residual bleeding and crusting from all the damage done to the sinuses? Stuff that hasn't healed, despite no disease activity? Will it stop if the person is in remission long enough or cleans their sinuses well enough? Not challenging here, just asking because I do not know.

jlove
04-20-2014, 03:52 PM
Hi Alysia,

I've told Dr. Merkel about the blood but I will talk with him again about it at my next visit. I think the way he sees it now is that my nose is just very raw on the inside from lots of abuse thanks to my Wegeners. The crust seems to be very very dry and if I try to blow it out without it being properly softened, it takes my nose tissue with it, resulting in scabs and nosebleeds. These scabs really haven't had a chance to heal because my nose is constantly being poked and prodded. I think that this will get better with the lanolin. Even just today it made a big difference. Saline gel wasn't really cutting it for me. It didn't seem to last long enough and coating my open nose wounds with salty gel was so painful because it burned. I think Mike's technique of flooding my nose will help me get the crust out without hurting the inside of my nose as much and the lanolin is definitely preventing my nose from drying out so quickly. I have a humidifier at home but my office is very dry. Dr. Merkel suggested I get a small humidifier for my desk but I haven't done it yet. I guess I've been avoiding all of the questions and odd looks that might come with a desk humidifier but maybe it's time to suck it up and get one.

Alysia
04-20-2014, 04:02 PM
the only thing that stopped my nose's bleeding and crusting (which lasted 4.5 years and caused a saddle nose), was the rtx.
I find a correlation between nose "productions" and other wg-activity, like aching joints, ears, or even the anca test.

mishb
04-20-2014, 04:15 PM
according to my doc (which is far from being a wg specialist, but still it makes sense) any blood is an indication to wg activity. maybe smoldering. but still something which needs attention and correct treatment.
Dear Dr. Phil, with all respect :love: , I think that blood is an "alert" sign....

Thankyou, my doctors also lead me to believe that this is the case.
........but hey, I will take remission - my husband and I both agree that this sounds good.

Then my husband said - terrific, now stop the pred ........ummm, arggh :unsure::crying:

jlove
04-20-2014, 04:16 PM
Anne, at least in my case, I think the bleeding is stuff that hasn't healed inside my nose. I've also always had post nasal drip (I remember my doctors noting it quite a bit when I was a kid) and Dr. Merkel says my latest CT scan showed a polyp in my sinus but he said it was nothing we should act on (it might do more harm than good given the state of my nose and sinuses). I have noticed, since being diagnosed, that some people are "mucusy" people. My roommate is a healthy 24 year old man and he can produce a hearty phlegm rattle, especially in the morning. Also my dad and his sister both are tissue people. Lately, I've noticed that they blow their nose more than the "normal" person. This is what I do with my time, apparently.

Last time I saw Dr. Merkel I asked him why he thought I had nose crusting even though he said he thought I had no active disease. I will try to repeat what he said as best as I can:

Dr. Merkel: So say I took a wire brush and I jammed it up your nose a bunch. That would do some damage and it would hurt right?
Me: Yes, yes it would.
Dr. Merkel: So that's going to leave some scarring.
Me: Yes, I would imagine
Dr. Merkel: And where there's scarring there's mucus. And you have mucus you need to clean out. But you also have scabs. And you are disturbing your scabs with water and picking when you are trying to get out that mucus.
Me: Sorry, scabs.

Basically, Wegener's jammed a brush up my nose and left me to deal with the consequences.

I do want to ask him about this again, though. He loves methotrexate for me. I don't have any joint or ear pain right now although every now and then my right ear will ring for maybe 30 seconds. This is a new development and I will be sure to share it with him. I don't know if it means much but I usually tell him every little thing I notice and see if he thinks they are problems.

Alysia
04-20-2014, 04:17 PM
how can we ever leave our precious pred :rolleyes1: ? impossible....

annekat
04-20-2014, 06:08 PM
Jess, what you say makes sense. Damage done in the nose has a hard time healing as long as the crusties keep jabbing at it and irritating it and causing more crusties, a never ending cycle. Humidification is probably the key, all right, and I wouldn't worry about what others think about a desktop humidifier.

Alysia, I have a hard time thinking that bleeding and crusting cause a saddle nose. As I understand it, the saddle nose is caused by erosion of the septum, from Wegs eating away at it. The bleeding and crusting are a symptom of similar destructive processes taking place in other tissues of the nose and sinuses. I would think that both things were happening independently over that long period of time that you weren't properly treated, and when enough septum erosion had taken place, the saddle nose went. That is what happened with me, too, only it was only 2.5 years. I had lots of sinus discharge but didn't notice much crusting or bleeding until after the saddle nose dropped and I was already being treated for Wegs. Lung issues were what got me in for observation but the saddle nose was what made it clear I almost for sure had Wegs. Everyone's case is a little different, as we know. In both our cases, if we'd been treated earlier in the correct way, we wouldn't have saddle noses today.

pberggren1
04-21-2014, 12:37 PM
The bleeding and crusting can be from damage from the disease. Mine has never stopped completely. I have to rinse with the Waterpik at least 2 times a day. It is what it is.

drz
04-23-2014, 11:45 PM
My Wegs started with nasal crusting and bleeding which greatly improved with aggressive treatment for the Wegs. I found I had to learn to leave the scabs alone till they healed and sloughed off naturally during a mild nasal rinse. Otherwise they just continued to bleed whenever i removed them and never healed up. Removing the mucous buildup frequently also helped me since otherwise the mucous dried onto my nasal passages like a hard plaque, and then its removal could also cause bleeding. I still have spots of blood at times in my nasal rinses but little scabbing or heavy crusting.

My breathing is much better now. I also found pulmonary rehab very helpful in improving my breathing and general endurance even though I am still very impaired compare to a normal healthy person.

MikeG-2012
04-24-2014, 12:55 AM
My Wegs started with nasal crusting and bleeding which greatly improved with aggressive treatment for the Wegs. I found I had to learn to leave the scabs alone till they healed and sloughed off naturally during a mild nasal rinse. Otherwise they just continued to bleed whenever i removed them and never healed up. Removing the mucous buildup frequently also helped me since otherwise the mucous dried onto my nasal passages like a hard plaque, and then its removal could also cause bleeding. I still have spots of blood at times in my nasal rinses but little scabbing or heavy crusting.

Good points Dr Z! Aggressive rinsing with lots of volume of saline, but go easy on the blowing out the crusts. That has been my method for these past 24 months. I really like the less pressure and more volume that rinsing with a Waterpik allows. It lets me run more saline through the sinuses with less ferocity than the squeeze bottles, but lets me run the water through longer. Combine that with my new method of holding the saline in the sinuses and nose, and the crusts stay softened and come out a lot easier--without ripping loose and bleeding.

I have noticed that since my RTX infusions in November, my crusting has been less, but I still continue my twice daily rinsing routine. It just lets me breath better and keep the small stuff from needing to be blown out during the day. I rarely blow my nose during the day now. I get most of the offending gunk out every morning and evening with the rinses.