Browsed by
Month: October 2023

Dear Dr. K;  I read something that indicated chronic sinusitis can predispose to stroke.  It scared me.  Is it true? 

Dear Dr. K;  I read something that indicated chronic sinusitis can predispose to stroke.  It scared me.  Is it true? 

The short answer to your question is yes. But, the best answer to your question is maybe.  First of all, it is important to know that vascular problems in general whether due to blockage from plaque or due to a clot have inflammation as a common denominator.  Whether you’re talking about a coronary artery or a carotid artery or an intracranial artery its arterial inflammation that sets the stage for the problem.  By way of example, its arterial inflammation that acts as the “Velcro effect” enabling cholesterol plaque to build up.  As it turns out any repository of inflammation in the body can contribute to this “Velcro effect”.  Thus, chronic sinusitis has this potential.  But what is important to understand is that its untreated, smoldering chronic sinusitis that has this potential. 

There is some evidence that the proximity of the sinus inflammation to the carotid arteries and the intracranial arteries gives this a more potent negative effect in terms of stroke initiation. 

In your particular case you treat the chronic inflammation with your allergy shots, your Singular (a non-steroid respiratory anti-inflammatory) and your topical nasal steroid spray.  However, some people choose not to treat a chronic sinusitis and therein lies the potential mischief. 

The worst case I have personally seen was a patient of mine who had chronic infected sinuses producing yellow and green mucus who declined therapy from me, her PCP and an ENT.  She suffered both a stroke and a brain abscess from the condition.

Another way that chronic sinusitis might lead to stroke is due to self-medication with either topical or oral decongestants.  Both have the potential to raise blood pressure and pulse and

if used as a chronic therapy (as opposed to brief and occasional use) they can add to the hazard of stroke.  

Bones and Alzheimer’s

Bones and Alzheimer’s

Whoever would have thought that bone health could impact the development of dementia?  Until I learned about new research in this regard, I wouldn’t have connected the two.  The operant word here is “health” and that is a function of exercise.  Now, if you’ve read these newsletters in the past you’re probably thinking; Oh boy, here comes another sermon on the value of exercise.  And guess what?  You’re right!

The research connecting the two is from the fields of neuroscience and endocrinology.  It turns out that our bones are an endocrine organ that produces a hormone called osteocalcin.  Osteocalcin acts on many organs in the body including the brain but also on gene expression (the functionality of genes).  Regular exercise promotes bone mass (helping prevent fracture) and the increased mass leads to higher output of osteocalcin. 

At a brain level osteocalcin improves the production of serotonin, dopamine, GABA and other neurotransmitters.  These chemicals are vital to establishing new memories and maintaining previous memories. 

At a genetic level osteocalcin ramps up gene expression (function) of RbAp48.  This gene is critical for protein formation that allows the brain to convert short term memory to long term memory. Research in mice demonstrated that a normal part of aging is reduced osteocalcin production which is also true in humans hence the usual “benign senescent forgetfulness” which is not dementia.  But in mice, experiments knocking out the RbAp48 gene led to very early and rapid onset of dementia.  Injecting RbAp48 into these young, demented mice allowed recovery of memory function.  The next step will be to extend these findings to humans

The T(r)OOTH of the Matter

The T(r)OOTH of the Matter

By:  Sasha Klemawesch, MD

During residency, we had a DDS come do a grand rounds lecture. During it, he advised not rinsing after brushing. I paid no heed to his recommendation at the time since the idea of not rinsing your mouth out after you brush your teeth seemed so bizarre and gross (also probably I was too busy passing notes w my coresident to listen all that closely to a dental lecture – snore!).

The American zeitgeist writ large tends to reinforce the “normality” of swishing and spitting after brushing; picture every couple in every movie you have ever seen standing at the vanity together getting ready for bed; all of them brush, rinse, spit and then smile lovingly at one another (or glare daggers depending on the film).

However, apparently Hollywood and I have gotten it all wrong for decades. My personal dentist recently prescribed fluoride toothpaste and told me to not rinse, eat or drink for at least 15 min after brushing with it, preferrable 30, explaining that were I to do so, I would be giving the fluoride a few mere seconds to try and act before washing it away. You wouldn’t shell out 20 bucks for topical steroids or pain relievers to just immediately scrub them off post-application, would you? When he put it that way it made sense, but I was still Super averse to the notion of not rinsing after brushing; it just seemed so sticky and foreign! However, I assure you, in less than a week, not only did I get over the lack of rinse, but my mouth actually came to feel good and fresh by doing so, and now it’s second nature.

Two other tidbits related to teeth-brushing but non-dental in nature:

(1) Try using your non-dominant hand when brushing next time. Doing so will force your brain to work to establish novel neural pathways which can be especially helpful in delaying cognitive decline as you age.

Second, while the hand swap will benefit brain health, standing on one leg will help your physical health. While seemingly insignificant, if you really force yourself to balance on one leg at a time even for the minute you are brushing your teeth, you are working on balance, core, and leg strength, and those daily minutes will add up. 

I confess, the latter two are coming much more slowly and with greater difficulty than the no-rinsing thing, but I keep trying.

Finally, last teeth-related item; when you finish reading this article, look up and whoever the first person you see is, flash them a big toothy grin. I guarantee both you and they will immediately feel happier by doing so!



TEWL stands for trans epidermal water loss.  It is the “unperceived” loss of water through our skin, in distinction to the “perceived” loss of water when we sweat.  It is also sometimes called insensible water loss.  It has been known for quite some time that children and adults with eczema have a greater TEWL than normal, but the difference has never been carefully measured.  The Allergy and Asthma Proceedings recently published new research doing just that. 

The measurements were adjusted for body surface area and were 2 ½ times greater in people with eczema than those without.  This water loss leads to excess dryness of the skin which disrupts the barrier function of the skin.  Think of the cracks in the bottom of a dry lake bed.  These micro-cracks in the skin allow ingress of both allergens (such as pollen, dust mites, animal dander) and irritants (such as soap, preservatives in personal care products including their fumes) to get “under the skin” and therefore potentiate the eczema. Two simple strategies work: maintain good hydration and always apply a moisturizer after bathing.



PLE stands for protein losing enteropathy and was the subject of a review article in a recent issue of The New England Journal of Medicine. PLE is a syndrome not a specific disease and can occur for a wide variety of reasons.  The problem is caused by the loss of plasma proteins through the intestines (they “leak” out).  In general terms it is caused by illnesses that damage the intestinal lining or that block the intestinal lymphatic drainage.

The resultant loss of proteins causes a drop in oncotic pressure which lead to edema. The loss of immune proteins causes a greater predilection to infections.  The most common cause for PLE is inflammatory bowel disease such as regional enteritis or Crohn’s disease.  But for our purposes, food allergy, eosinophilic enteritis, and gluten sensitivity are all potential causes.  All three of these conditions can cause inflammation in the GI tract and if its is severe enough to cause disruption of the GI tract mucosa and PLE.  Clues to this possibility include “GI tumult”, edema in the ankles/legs, and a low albumin and/or globulin on blood work.  Correcting the cause of inflammation fixes the PLE.