Ok friends, so there are indeed more fans of the fire hydrant nasal irrigation than just Wendy. Many thanks to those who wrote with their voices clearly in the camp of "this is not some weird torture." My brother is now even more smug than usual.

The best and most hy-STER-ical advice came from Kim who recommends that after you irrigate you need to bend over and touch your toes to get "all the drainage" (yuk) out or else you never know when it will surprise you and come dripping out when you least expect it.

Ahhhhhh, what shall we talk about next?

Email me and let me know.

Today I want to talk about one of my very very best friends. Let’s call her "Wendy” (because that’s her name). There are a few things I want you to know about her: she’s one of the best mothers I know, she's got a great sense of humor and doesn’t mind when we overshare everything (sorry Joe and Peter), and she’s got bad sinus disease. Over the past several years she’s been on a million different types of antibiotics, steroids, and nasal sprays; she can discuss nasal secretions in intricate detail, including color and consistency (ack); heck she’s even been roto-rooted out a couple times (endoscopic sinus surgery for all you sticklers out there). But the thing she swears by is a brisk, invigorating nasal wash. What is this? Depends on whom you ask. If you ask her, or my brother and father who are both Ear Nose and Throat surgeons, they will say that this nasal wash is cleansing, calming, and clarifying, soothing an irritated upper respiratory tree. If you ask me, it is something slightly worse than one of my early embarrassing waterskiing wipeouts on the South River where I landed face-first into the wake while I was in the fast part of a turn. On a slalom ski.

But I digress. Let’s start at the beginning, and then I’ll get to the sinus wash. Sinuses are tricky little useless spaces that are to bacteria, viruses, and fungus what Las Vegas is to gamblers. Once those germs set up shop there it can be extremely hard to evict them and can cause especially gross symptoms like a constant nasal drip or congestion, headache, or the worst: bad breath. (Now you can see one of the main reasons I didn’t follow in the family footsteps of ENT: am not mature enough to handle discussing snot while maintaining reasonable composure).

Sinus disease can be chronic and incapacitating and is a bajillion times worse if you smoke. If you are congested all the time and get frequent headaches, you definitely need to have your sinuses checked out. Sinus disease can be diagnosed by your doctor either by just examining you or by getting a simple CT scan. Sinusitis can be caused by viruses, allergies, bacterial or fungal infections. Unlike what most people think, antibiotics aren’t a cure-all. You may need that for flare-ups but the big thing I want to talk about is the importance of maintaining a minimally inflamed sinus zone. For this, your doctor may give you a steroid nasal spray and recommend that you perform these daily nasal rinses.

Here’s the highlight of this post: These nasal rinses involve (I am not kidding) squirting a bottle-not just a spray- of saline all the way up your nose with a similar force as water coming out of a broken fire hydrant. The wash goes in one nostril and comes out the other. Can you imagine! For all you naturalists out there, you can use the “netty pot,” a little teapot-looking contraption that works in a similar manner, just has better feng shui than the utilitarian plastic irrigator. Wendy is equipped with both contraptions, and although she swears by them, she looks equally frightening regardless of the chosen instrument. But ok, the last laugh is on me because since starting this “maintenance” regimen she has been sinus disease-free for a few years. Can anyone out there let me know your experience with this? And do you enjoy it as much as Wendy?

You would not BELIEVE the number of people who come to the Emergency Department (it's not just a room) complaining of a rash. "Skin bumps", you say? "An Emergency?" I don't know about you but the last time I had those two phrases together it was in reference to an enormous cheek zit the afternoon before my senior prom, which I knew up to that point had all the makings of a magical night for my date and me.

I know you are thinking in your head, "Why would anyone ever come and wait all those hours just for a rash?" Let me tell you, I and the majority of all my colleagues are thinking this too. Believe me, I understand that rashes can be a pain (literally and figuratively) and quite visually dramatic, but I can count on one hand the number of rashes that are true emergencies. So let's make a few categories and we'll see if this helps anyone's judgment:

Rash category 1: Run, don't walk (time warp yourself if you can) to your nearest Emergency Department
Rash category 2: Well, I guess it was worth the 4 hour wait, maybe
Rash category 3: Why did that doctor look at me in disbelief like I was really there trying to get narcotics?

OK, the diseases that make up category 1 are true emergencies. If you have a purplish non-itchy rash that is rapidly spreading accompanied by fever and neck pain, call 911. You need to be seen fast. Likewise if you have a non-itchy rash with lots of bruises all of a sudden or some gum bleeding.

Category 2 is for things like an itchy, red, poison ivy type rash around the eyes or in the groin area (the swelling from poison ivy in these areas can really be a problem- just ask Luke, my 3 year old) or a painful boil- non-life threatening, but clearly can't wait.

Category 3 is for non-spreading, isolated itchy red plaques or bumps like insect bites. And yes, more people than you would think come to the ER for mosquito or flea bites.

As a rule, I am happy to examine and treat anyone who comes to see me in the ER, but I just don't want you to be totally let down when I don't give you some fantastic emergency miracle cure for your red itchy skin bumps. For rash categories 2 and 3, it's important to check in with your primary care doctor before heading out to seek emergency care, and it's not unreasonable to try some over the counter hydrocortisone cream at home. I recommend trying that in conjunction with some Benadryl and an oatmeal soak bath (warm water, never hot since hot water releases histamine, one of the major "itch" factors)- these can really save you from adding to an emergency doctor's daily category 3 tally, and most importantly, you may actually get better on your own. Doctor you.

So often health news is made to sound about as exciting as cleaning the lint trap in the dryer. It's frequently packaged in small tips that are mostly impractical for an actual human being or disguised in so much "official-ese" that it feels as relevant to our lives as Rule 462.1.b in the federal government's General Accounting Office (I am totally making that up). Our bodies are wonderful and important, and typically we only get one, so we should make the most of it. I am going to do my best to deliver some simple thoughts on health that celebrate, point out, explain, and laugh at that awesome collection of cells, tissues, and organs, otherwise known as the human body. And I'll probably be a little snarky (general disclaimer) along the way. I am granting myself complete dispensation to be like this since sometimes I think that's what it takes to practice Pediatrics (kids are always a crack-up) and Emergency Medicine (not always a crack-up).

Now that THAT's out of the way, I found it interesting that there was so much news made about the recent study published on the amount (very little) of exercise children get in a day at varying ages. It should be a surprise to NO ONE in this country that our kids aren't exercising enough. Don't get me wrong, it's great that the news is highlighting this epidemic. Our fat kids are one chalupa closer to having chronic illnesses like diabetes and high cholesterol in their teens rather than in middle age or later. Sad. I'm disappointed in the large number of people who blame their family's bad eating and exercise habits on their work schedule or other time demands. I'm not going to get on my doctor soapbox and talk about exercising 30 minutes a day, steamed vegetables, a handful of almonds, or anything like that. Here's my simple advice on a manageable way to get the healthy ball rolling:

1. Eat less crap. In my household we have 2 well known junk nights per week. Neighbor kids come far and wide to partake. The other nights we eat reasonably. I don't believe in complete denial. I had a friend growing up whose dad was a cardiologist and they had no salt in their house. Whenever she came over she would pour the salt shaker right into the palm of her hand and lick it directly. More recently I saw a 142 lb. 7 year old in the ER a while ago who had to be evaluated for a heart attack because based on her weight and resultant blood pressure we couldn't say her chest wall pain wasn't a heart attack. This involved EKGs, blood tests, xrays, and observation of the child plus plenty of anxiety for her mother. Are you with me on this?

2. Move your body. I'm not saying go on fabulous 30 minute brisk walks during the time you don't have. Take note of what you are currently doing and then do a little more, just in your every day routine. The same goes for your kids. I smugly congratulate myself every time I carry a full laundry basket up the stairs at home or I breathe heavily from vacuuming because I'm trying to get it done quickly before my 6 month old gets bored of looking at the 1/3 cup measure (although it is a nifty translucent red). Before long, you'll find everyone doing more and more, and since you've limited your junk nights to 2 per week, the healthy bug has bitten you.

Just by doing those 2 things I give you permission to officially declare yourself "part of the health and wellness initiative" and you won't have changed much about your life. But I'll bet you, dollars to dried apples (ok fine, doughnuts), that your doctor will be able to tell. Whether it's in your blood pressure, your bloodwork, or your weight, you're no longer contributing to the lead health story on the network news. And let's meet someplace other than my ER, shall we?