Case # 1 of case solving contest: ‘A Ton of Mucus Comes Out’

Ms. SN, a 34-year old teacher, tall and thin with strawberry blonde hair and a little dimple in her chin, came to see me for chronic sinus infections and polyps in her sinuses so severe, that she had been forced to stop teaching. She had had two recent sinus surgeries to remove the polyps but said the polyps would grow back within six months. Her ENT doctor says her sinuses are “packed with polyps.”

Her doctor has put her on various antibiotics, but then she always gets yeast infections. She also has severe environmental allergies, especially to molds, and has constant postnasal drip. “I remember sniffling constantly as a child.”

She also had a urinary tract infection at the time she came to see me, with a history of recurring UTIs in her 20s. She reported occasional vulvar discomfort and hoped to be healthy enough to start a family. In her past medical history, she reported:

• warts on her hands, feet and nose frozen off at age 8
• her adenoids removed at age 10
• an intestinal blockage due to an abdominal adhesion, age 14. “I still feel as though something is kicking around in me” – gesturing to abdomen.
• ongoing acne since puberty, with a very greasy, oily complexion

She also reported many vaccinations in recent years, because of those required for teaching and those required for international travel.

“I started feeling more ill when I began teaching high school a year and a half ago. I believe my sinus infections started getting worse last year. I was catching every cold then. I became pregnant around Christmastime, then in January my sinuses were insanely swollen. I felt bad because I had to take Sudafed. I tried going off my medications but I got very sick and my doctor said I had to take them. I miscarried in February and felt guilty about the medications.

“In addition to beginning a teaching career, my personal life was very stressful. I had just gotten married the previous September, and we had to rush the wedding due to my husband’s overseas travel schedule. My job was exhausting, and in August I found out my uncle had molested his two sisters. I told his ex-wife because I was afraid for the safety of their young daughter. This was very traumatic for my family. Then my father refused to come to our wedding. He didn’t tell us, he had my grandmother tell us. I became much more distant from my family after all these conflicts”.

“My sinuses tend to get worse as the day goes on and are at their worst around 8 pm. I have mild face pain; headaches; swollen sinuses that make it uncomfortable to speak. When I learn forward to pick something up, it feels like my sinuses are falling forward in my face. Lots of mucus – very dense, not runny – pools near the bridge of my nose, so I have to blow my nose regularly to remove it. A ton of mucus comes out, it’s a deep golden yellow. There are pieces of stuff that look like rubber cement. I can often see the swelling in my face. The bridge of my nose and sides of my nose look swollen”.

“I have a huge amount of stress right now around not being able to work as a teacher. It took me so long to figure out what I wanted to do with my life. Now I’m being told I can’t teach, for health reasons. I have lost my whole identity, my sense of self-worth. Plus it’s creating financial stress”.

“When I was 19 I went to the emergency room with a UTI. The doctors made me feel filthy, told me I had pelvic inflammatory disease. I did not respond to the antibiotics and developed a kidney infection. From then on I experienced painful sexual encounters and later experienced vulvar pain and burning, along with frequent UTIs, until I was 29.”

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See “Student Case-Solving Contest Guidelines” for how to enter.