what causes sinusitis

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Did you know that what’s living up in your nose could be a trigger for what causes sinusitis? The nasal microbiome is a vast new frontier and when things are out of balance, there is a ripple effect that can drive inflammation not just in the sinuses, but also in your body.

So yes, a dysbiotic or imbalanced nasal microbiome can be a trigger for chronic nose rash, sinus yeast infection symptoms, and even chronic skin rashes like eczema and psoriasis!

Now, I want to reiterate that it is normal to have bacteria and certain fungi as part of your sinus microbiome. Just like how you need diverse bacteria for a robust gut microbiome and oral microbiome!  It is when certain bacteria overgrow in the sinuses that you might start noticing problems, like chronic sinus infection, a sore throat that seems to have no cause, and even nasal thrush.

Similar to how a dysbiotic gut microbiome can cause digestive problems, and an unbalanced oral microbiome can cause eczema around the mouth.

And that’s what this episode is all about. Dr. Anastasia Stocker and I are diving deep into the sinus microbiome and the cascade of issues (some of these are REALLY surprising!) that can occur if the bacterial community up there becomes unbalanced.

Dr. Stocker is a Naturopathic Physician and Acupuncturist with clinical expertise in autoimmune diseases and digestive wellness. Her interest in autoimmune disease was born of her clinical observations that gastrointestinal dysfunction and environmental toxicity are a major contributor. Additionally, Dr. Stocker is the current Vice President of the Gastroenterology Association of Naturopathic Physicians and practices at Aria Integrative Medicine in Seattle, WA.

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In This Episode:

  • Hidden triggers of what causes sinusitis
  • Meet your sinus microbiome!
  • Candida overgrowth in the nose (aka. Nasal thrush)
  • Causes of imbalanced nasal microbiome
  • Could your sinus microbiome be to blame for nose rash or eczema around mouth?
  • Causes of facial pain and pressure (Is it a sinus infection or something else?)
  • How to test your sinus microbiome
  • Thoughts on whether probiotics, herbs, or essential oils are safe to use inside your nose
  • Suggestions to support your nasal microbiome

Quotes

“Just like in your gut or in your mouth, you have a microbiome in your sinuses and in your nose.”

“We're kind of coming to understand that changes in the microbiome can trigger autoimmunity in the nose. And then what are the implications of that systemically? So with things like psoriasis, and psoriatic arthritis, things like eczema, we see these all have connections with altered microbiome in the sinuses.”

Links

Find Dr. Stocker online | Instagram | Instagram

AirDoctor HEPA Air Purifier

Healthy Skin Show ep. 309: Ear Inflammation + Ear Infection (How To Get Ear Pain Relief) w/ Dr. Haley Overstreet

https://www.frontiersin.org/articles/10.3389/falgy.2021.737086/full

https://www.annallergy.org/article/S1081-1206(18)30375-2/fulltext

 

342: What Causes Sinusitis + Triggers Nose Rashes? Your Nasal Microbiome w/ Dr. Anastasia Stocker {FULL TRANSCRIPT}

Jennifer Fugo (00:11.286)

Dr. Stocker, it is so great to have you here. I watched your presentation at GastroANP 2023 and I was just like blown away because you talked about the sinus microbiome, which fascinates me, I have to be honest. And I shared about us having this conversation today with my community and they were like, I am totally all in for this, because I think we're so fascinated by the different connections of microbiomes in the body. So thank you for being here. I really appreciate it.

Anastasia Stocker (00:45.03)

Thank you for having me. I'm so excited to talk about this. I love talking about the microbiome, everything, nose to anus. I love it.

Jennifer Fugo (00:53.066)

Well, let's dive into what exactly is going on with the sinus microbiome. So can you talk to us a little bit about what it is, the makeup, and then when things go awry? Is it possible for us to have an overgrowth and sinus yeast infection symptoms?

Anastasia Stocker (01:08.398)

Yeah definitely, there definitely is a possibility of having an overgrowth and we see that quite commonly for people that have chronic sinus issues or even acutely with acute sinus issues that people have. So just like anywhere in your body, just like in your gut or in your mouth, you have a microbiome in your sinuses and in your nose. And there's a, we don't really know, there's new research on what this kind of looks like, but it's not really well-categorized. And that's because it's really hard to figure out what's going on in the nose because a lot of those microbes die once they're exposed to air. So we have to come up with technology that can kind of sequence them and figure out what the heck is going on in there without exposing these microbes to air, so we can get an understanding of what the composition should actually look like.

But what we do know is there is dysbiosis, or an imbalance, in the sinus microbiome, and we can see overgrowth. So we can see overgrowth of fungi, we can see overgrowth of Staph and Strep and Pseudomonas, and all of these things can cause a change in inflammatory cascades and activation of the immune system, and that's when we really see symptoms of chronic sinus issues.

Jennifer Fugo (02:28.206)

So when you said there can be fungal overgrowth in the sinuses and it could be part of what causes sinusitis, I was like, well, first of all, my inside voice was like, of course there can be. But then outside I was like, oh my gosh, someone is saying this. This is amazing. I know I get so excited by these little things. So can you talk to us a little bit for anybody listening to this who never thought that you could have fungal overgrowth in the nose, nasal thrush, and sinus yeast infection symptoms, tell us a little bit about that.

Anastasia Stocker (02:58.735)

Yeah. So this can happen for a variety of reasons. It can be from mycotoxins, so mold illness, right? We know that there's certain fungi that produce toxins and then those toxins can kind of create changes in the sinuses, they create biofilms, they create reservoirs of these other bacteria that help protect them. They're all about protecting each other, these kind of bad microbes protect each other.

It's also normal to have certain fungi in the nose as part of that normal community. And when something goes awry, like whether it was antibiotic use or another infection, like a cold or flu or COVID or something like that, it can allow for overgrowth of the more dominant organism, right? So like fungi or different bacteria.

Jennifer Fugo (03:53.663)

And you also mentioned something to me in the beginning before we started recording about nose rash and how there's this weird connection between, I think you said fungus and Staph?

Anastasia Stocker (04:05.846)

Yes. So what we have found through research is that they can coexist, and overgrowth of certain bacteria or fungi, what they can do is they protect each other, right? They protect each other in this biofilm. They cause disruption in the barrier. So this is a similar thing as leaky gut. It's like leaky nasal epithelial barrier. And this leads to colonization and overgrowth in biofilm formation.

And then what happens is there's an overgrowth and it changes the immune system response, and we can see more mast cells in the area and then they are releasing histamine, and that's when we get a lot of those symptoms of the chronic sinus issues, like the stuffy nose, the runny nose, all those like hay fever type symptoms that we kind of get and we think about.

Jennifer Fugo (05:05.654)

And so I just wanna double check that we covered this. So when we're talking about the nasal microbiome, it's not just inside the nose itself, it goes back into the sinuses, yes?

Anastasia Stocker (05:17.058)

Yes, they're in the sinuses. So our sinuses that we're kind of thinking about are maxillary sinuses right there like in the front of your face, that ethmoid sinus which is like the bridge of the one that's behind the bridge of the nose, and then the frontal sinus that you can kind of feel over your eyebrows, right? And generally when we're trying to assess these things and we're trying to do either a swab to kind of get an idea, we're trying to look at what's happening in the middle meatus, so it’s kind of the part of the sinuses when we swab it, it's not going up into the nose because that's not going to give us a good representation of what's happening in the sinuses, because we have we have different microbes in the nose than what should be in the sinuses themselves. So we're trying to get a sample from the middle meatus, and that's kind of like if you put your finger on your nose and your finger on your ear and we draw a straight line, that's where we're trying to sample and get a good idea of what's happening there.

Jennifer Fugo (06:14.634)

I had no idea you could even do this, like I find this so cool. And I know for those who've struggled with sinus issues, I know that I don't have these issues, but I can appreciate those who can be in a tremendous amount of pain, having pressure and all sorts of things. So with having an altered sinus microbiome, are there any other comorbidities or concerns either that we should be aware of that could happen, or maybe that there's a comorbidity. If you're like, if you have this, you're at a greater risk to have an altered sinus microbiome.

Anastasia Stocker (06:58.542)

Yeah, so, think about any autoimmune condition, okay, first of all. Lots of gut problems, so GERD, acid reflux, heartburn, IBS, are all comorbid conditions that can be implicated in chronic sinus issues. So in what we're learning, which, and this is like really interesting to me, and I think it's cool to understand this, is that we're kind of coming to understand that changes in the microbiome can trigger autoimmunity in the nose. And then what are the implications of that systemically? So with things like psoriasis, and psoriatic arthritis, things like eczema, we see these all have connections with altered microbiome in the sinuses.

Jennifer Fugo (07:49.226)

And I was gonna say too, I know from looking at research and working with clients that, for example, you mentioned H. pylori, and if we have that lower stomach acid level where we no longer have the chemical barrier we need to kill things, anytime we swallow, so if you've got a messed up microbiome in your mouth (which may be a factor in eczema around mouth), you're swallowing this bacteria down and it's making its way into the GI tract. So, and I'm just thinking out loud here, I would imagine we also swallow mucus. So that could be another route, correct, that you could end up getting organisms into the GI tract, yes?

Anastasia Stocker (08:29.85)

Yes, definitely. And I think for those of us that do a lot of comprehensive stool testing, this is like a pattern you probably see, is if you see overgrowth of Staph or Strep, I am always thinking like, what is happening in the sinuses, or what's happening like in the throat? So either I see a lot of Strep, I'm like, okay, are you a Strep carrier? Did you have a lot of Strep as a kid? Or are you having overgrowth in your sinuses? And then you're, yeah, you're constantly swallowing all of these secretions, and if they're not dying in the stomach from this like strong stomach acid they can get down lower into the gut and cause issues with your gut microbiome.

Jennifer Fugo (09:11.586)

Would nasal drip be a potential sign to you that there is something going on in the nasal microbiome or can that also indicate something else? Can it be what causes sinusitis or nose rash?

Anastasia Stocker (09:26.542)

Yeah, so when it comes to post-nasal drip, if it's actual post-nasal drip that's coming out of the sinuses, it definitely makes me think clinically what is happening in your sinuses. But we do have to make sure it's not GERD, like actual reflux getting all the way back up into the throat and causing irritation in the throat that kind of mimics post-nasal drip. But if it is post-nasal drip, and people know, if you have post-nasal drip, you know that feeling, even if you don't have it all the time, you know that feeling from being sick, that drip, drip, drip in the back of your throat. And it can get painful and you can have a sore throat, just like if you had acid reflux refluxing all the way up to the back of your throat.

Jennifer Fugo (10:07.934)

I didn't realize that, I don't know why, I guess because I don't work with a lot of really like more severe GI issues. So I didn't think about that idea that, and many people probably aren't, that it could be a sign of actual reflux that's getting up a lot higher than just having maybe some burning in the sternum area.

Anastasia Stocker (10:29.038)

Yeah, it can reflux all the way back up. And those are the people that complain of sour taste in the mouth or chronic sore throat that we're like, why do you have a sore throat? And it's not an infection. It could be just the acid reflux coming all the way back up.

Jennifer Fugo (10:45.598)

And so, we talked a little bit about the different organisms that could be overgrown in the sinuses that could be part of what causes sinusitis and nose rash, but there's also that issue where somebody's really stuffy, like the face feels like inflamed, you know, like the tissue of your face, you're like, oh my gosh, I just, I have so much pressure. So is it possible that inflammation driven by this, whatever is happening, an immune response, can you talk a little bit about that, of the immune implications of how or why somebody might be getting so much pressure in the face?

Anastasia Stocker (11:27.818)

Yeah, so anytime we have an infection or we have a dysbiosis, it's changing the immune response, so both the innate and the adaptive immune response within the sinuses. And so then we see more cytokines being produced by the immune system, the more pro-inflammatory cytokines. And that's when we can see the swelling, the signs of inflammation.

There also, like we had previously talked about, that mast cell response. So if we have high reservoirs of Staph aureus, we're going to see more symptoms of mast cells and we're going to see that histamine response, which are those classic hay fever symptoms that we kind of think about when we have allergies or when we have chronic sinus issues. You know, runny nose, itchy eyes, and then the swelling, because mast cells create swelling, just like, systemically, we see hives, right, a similar response is happening within the sinuses.

Jennifer Fugo (12:28.574)

Now, this is kind of something I think about from my dad who was an ophthalmologist. He always told me, look, whatever you put in your eyes, you could like taste it sometimes in the back of your throat, like eye drops and things. But he said,you know, when you blow your nose too hard, you can cause issues with the eyes. Like, it's kind of all connected in this area, right? So is it possible, and it's OK if you don't have any data on this, but just your thoughts. Is it possible if you did have say an infection, like Staph overgrowth, MRSA, something like that in the nose, do you think that could also impact the eyes or the eye? I mean, we have an eye microbiome. Do you think it could impact other areas beyond the nose and the face? Like, you know what I'm saying, further out.

Anastasia Stocker (13:19.278)

Yeah, probably, definitely, I don't have data on that. I don't know a lot about the eye microbiome, which I'm super interested in, right? Because I see a lot of patients that have rheumatological conditions, and so they have inflammation in the eye. So now I'm getting curious just from this conversation we're having about what is happening with their eye microbiome, and that's something I'm gonna look into more. But yeah, it makes sense to me that like, because what we know is like, if there's alterations to microbiomes anywhere, whether it's on your skin, whether it's in your mouth, in your gut, they all affect one another. So it makes sense to me that, especially being so close, that if we have alterations in the sinuses, something's gonna happen with the eye or vice versa.

Jennifer Fugo (14:06.382)

It's just my theory. My dad's no longer around to be able to answer this question. I'm sure he would have had an interesting answer with all of his research he did over many years, but it is a question now that I am searching for. But I'm so glad for this conversation because the truth of the matter is I never thought, aside from doing a swab, sometimes you can go to, sometimes clients can get their doctor to do a nasal swab or they'll get that MARCoNs test, but how do we test what's going on up in the nose and then the sinuses? Like if you wanted to go that route, how do you even do that?

Anastasia Stocker (14:46.402)

So traditionally we did a lot of cultures, but cultures aren't great at sampling the microbiome in the sinuses because so many things die once they're exposed to the air. I think the last data I saw, if we do a culture, it shows like 1% of the actual microbiome in the nose. So there's new ways of sequencing. We can either do PCR testing, which we do a lot for stool testing, but then we have to know the exact microbes we're testing for. So that gives us an idea if we're testing for like 15 or 20 microbes.

But what I think the future of testing is, and what I've been using a lot, is next-generation sequencing, which these companies have these libraries of like 50,000 microbes and they're able to test the sample against their libraries with like 99% accuracy. And that is really helpful because it helps guide our treatment plan because they're able to look at antibiotic-resistant gene markers, and to tell us really what is growing in the nose, if we need to target therapy using different antimicrobial agents whether they be antibiotics or antifungals or what will actually work. Because what I see so often is, people that have chronic sinus infection or chronic sinusitis, is they just get put on like a whole gamut of antibiotics, like antibiotic after antibiotic after antibiotic, and eventually they just like stop working or they run out of antibiotics and they have to be on the harsher ones that really affect them systemically.

Anastasia Stocker (16:26.538)

And that's just like a band-aid, right? They're kind of just like taking the load of the infection off, but it's not targeting and killing the cause of their imbalance. And they're also not doing things to reestablish the microbiome, right? Just like in like gut stuff, like if we use antimicrobials, like either antibiotics or herbs or whatever it is, we also need to do work to reestablish a healthy ecology and a healthy gut microbiome. So the same thing happens in the nose. We need to kill with more precision and then do things to reestablish a healthy balance.

Jennifer Fugo (17:06.414)

And can I ask you too, one of the pearls that I took from your talk at GastroANP was, I never thought of this before, that if you use a swab up the nostrils, you're really only getting that area. So what might be a better option if somebody's really limited right now and they're just trying to like, they can get a culture, like that's what they can get? What would be maybe a smarter workaround?

Anastasia Stocker (17:34.982)

So it depends on who you're going to, right? Like if you're going to an ENT doctor and they're doing swabs, they're really good at swabs because that's all they do. They're gonna get a good swab back there. But if you're just, you know, going to someone that maybe isn't comfortable doing a lot of those deep swabs, you can blow your nose. So what I have patients do is I will do a swab, but then I will also have them forcefully blow their nose, like really trying to get all of the mucus, all of the stuff that's in there, blow it onto a clean tissue, and swab that swab that baby. Get as good as a sample as we can, trying to get really like all the gunk, right, like all that stuff from way back in the sinuses and so we can sample that.

Jennifer Fugo (18:22.638)

I think it's fascinating to know that there are other options. And I think for the doctors and other providers listening to this, my hope is that this inspires some curiosity to start looking in other corners that could help you get much better results for your patients. Because I mean, ultimately, at the end of the day, I think all of us have a shared goal of helping people get better sooner. And my hope is when we can bring our information together and we can put our heads together, maybe we can start helping people in ways that like, I didn't think of that, you didn't think of that, but like all of a sudden we're like, oh yes, and it moves the process forward, you know, and helping people get answers sooner rather than later. It's always my goal. It's my dream.

Anastasia Stocker (19:13.378)

I love that. That's my dream too, is like, how can we get people feeling better so they can go and live their best life? Like, to do the things that they wanna do and spend the time that they wanna spend with the people that they wanna spend it with. Like, that's always my goal. And I think that's really well put. Like, exactly my same goal with patients is like, how can we just get you feeling better? And how can we figure out, like, with the microbiome or with whatever we're looking at, to decrease inflammation in the body so you can live just like a healthy happy life without having this burden.

Jennifer Fugo (19:50.694)

Exactly, because you don't get the time back. So let's talk about some treatment options because I think, in terms of the sinus microbiome, you mentioned a lot of times it's just antibiotics, I guess antihistamines, decongestants. I mean, that's like what I'm thinking might be pulled out of the hat.

What are some other things that people, obviously you should always talk to your provider first before taking action on things. The only reason I say that is my dad was the one who told me like your eyes are an extension of your brain, your nose and the nasal passage are close to the brain, so we always want to be careful what we put in those areas.

Anastasia Stocker (20:36.058)

Definitely. That is my cue to say, like if you do neti washes or anything like that, we're not using tap water, we're using distilled water, we're using water that's been boiled for at least 10 minutes and then cooled down. Just protect yourself from the weird stuff that can be in water because your sinuses are so close to your brain and we don't want to get any sort of infection that is bad, you know.

Jennifer Fugo (21:03.126)

Yeah. Well, if someone is to do that, let's just start with that sinus, sinus rinses, neti pot, lavages, that kind of thing. What about additives? So like there's, some people have asked me about probiotics. Is it okay to add probiotics to it for nasal thrush? What's your thoughts?

Anastasia Stocker (21:22.414)

Yeah, I think when we're thinking about probiotics, like I really like, because the mouth and the sinuses are connected, I like to do swish and swallow so it kind of gets up. Because our nose is draining into our mouth like we know, and we can kind of seed things up in there. I think it's also dependent on how inflamed you are, because if your sinuses are so inflamed and then we either put probiotics up into the nose or we swish and swallow them and they don't have a way to drain out, we can create a sinus infection and that's like the opposite goal, right? So yes, the probiotics can be helpful because they can out-compete those bad microbes but we need to make sure that things are open enough that it's not gonna create more of an issue.

Jennifer Fugo (22:08.95)

What about adding herbs to the water? Or we live in the day and age that essential oils are so readily available. What are your thoughts on those for nasal thrush and sinus yeast infection symptoms?

Anastasia Stocker (22:21.038)

I get a little cautious around essential oils, especially putting them on mucosa, right? Like very delicate skin because they are caustic and they can cause damage to that tissue. Another thing that I always really have to think about is this thing called mucociliary clearance, which is basically just the beading of those ciliated or hair-like cells that are clearing our airways. And if we put things that are gonna kill them, we're not gonna get things out, right? Because we need those cells to be beading and moving things out of our airway for us. So we're always trying to improve that mucociliary clearance to get mucus, to get microbes out of our sinuses, out of our nose. So if we’re killing them with essential oils or other what we call cytotoxic chemicals it's gonna be deleterious to our goal. So that's what I'm always thinking about with essential oils.

There are herbs that can be helpful, right? Antimicrobial herbs, and I do love herbs because they tend to be more broad spectrum than antibiotics so they have less risk of creating resistance, like antibiotic resistance, because they have more ability to kill a wide variety of microbes.

Jennifer Fugo (23:45.954)

What it sounds like to me is like perhaps stick with saline?

Anastasia Stocker (23:53.198)

I would say stick with saline. The over-the-counter ones that are already in the jar are super easy. I like over-the-counter nasal sprays that have xylitol in them or they have grape seed extract in them. They can be really effective for the inflammation and for killing off both the fungi and the bacteria that can overgrow. When it comes to adding herbs into a neti wash, then it's just really important to make sure there's no sediment in there, right? So if we're using whole herbs, you have to make sure you're filtering it really well so you're not just putting plant material into your nose.

If I have patients do herbs, I generally have them use tincture in, I have them put the tincture in a boiling water, because then it's going to get rid of the alcohol because we'll boil off the alcohol but then we still have the herb compounds in the water, and then we don't run that risk of having like floating plant material in our washes.

Jennifer Fugo (25:06.078)

It sounds like you just, again, I think it's always like we have to be, we have to be more cautious than when we're doing, say like sending something down the GI tract. I mean, certainly there's issues with that in terms of essential oils and such, but I think again, you have to remember this area of the face is so close to your brain. And like you pointed out too, there's critical cells here that we don't want to die because they're really important for helping the sinuses do what they need to do. So just a couple quick thoughts, like what happens if you actually have a sinus infection whether it's MRSA or Staph or something like that, is it still okay to do some sort of saline rinse or neti pot?

Anastasia Stocker (25:48.982)

Yeah, I think it's really helpful. So oftentimes if you're having a full-blown sinus infection, that's when we really need to work kind of as an integrative approach, right? We're using either a steroid rinse, but we're also doing a saline rinse and maybe using some sort of antimicrobial, whether they're herbs or antibiotics. And I think that kind of integrative approach is really effective in treating a full-blown sinus infection, so then we can hopefully, and you know it's not always possible, but hopefully avoid oral antibiotics for those people.

Jennifer Fugo (26:26.338)

For somebody who's just, they have chronic stuffiness and chronic sinus issues, how much is too much in terms of doing like saline rinses or the neti pot?

Anastasia Stocker (26:38.614)

I think doing it once or twice a day is totally safe. Doing it more than that is probably not beneficial. And we do run the risk of damaging those little delicate ciliated cells in there, which we really want to keep them nice and healthy.

Jennifer Fugo (26:57.666)

You want to keep them moving and doing what they're supposed to do. And do you have any tips for anyone listening where they're like, well, like me, I don't have sinus issues, generally speaking. If you wanted to support your sinus microbiome, any thoughts on what we could just do in general that you think, based on your research and working with your patients, might be beneficial?

Anastasia Stocker (27:27.354)

Yeah, I think it's really important to make sure your home or office or wherever you're spending time has a good amount of humidity, right? So we're looking for 50 to 60% humidity. We don't want much over that because then we run the risk of mold overgrowth, which is not what we want. But we don't want too dry of environments. We also wanna decrease the amount of smoke or other pollutants that we're breathing in, because that can damage those ciliated cells and it can alter the microbiome in the sinuses. So making sure you're breathing clean air and you're not exposed to different chemicals and volatile chemicals especially. So if you're doing any hobbies or working with any chemicals, you're using that personal protective equipment to really protect your nose and your sinuses and your nasal microbiome.

Jennifer Fugo (28:29.694)

I love it. I love all the things, and obviously this is an evolving microbiome science space. We will probably know more in like two, three years, I would think, but I think it's fascinating. And I just wanna make this final point because you're not an ENT, you work in rheumatology, and you shared with me that you at first didn't ever ask anyone about this unless they maybe mentioned something. But now, do you want to share your thoughts on that now? Being that you're in a total, like I just think it's an important thing to hear.

Anastasia Stocker (29:07.024)

Yeah, because of all the comorbidities of having sinus infections and because I work in rheumatology, so what I'm always doing is looking for triggers to the immune system. My goal is always trying to figure out what is triggering your immune system that is causing autoimmunity, and how can we remove or decrease those triggers. So at my first office visits, I'm always looking for reasons why we have infections, right? So UTIs, history of ear infections, Strep throat, any signs or symptoms of gut dysbiosis, right? Trying to figure out those triggers. And then eventually, people would be like, oh yeah, and by the way, I get six sinus infections a year. And then I started making these connections of like, well, if we're treating the oral microbiome, getting people to go see their dentist more, getting people to do better oral hygiene, they're kind of getting better, but they're also getting like this sinus thing. And then eventually I was like, I just have to ask everybody about their sinuses.

So that's part of my like first office call now is being like, do you have any sinus issues? What's going on with that? Because what was happening was like down the line, you know, like a few visits in, people are like, oh, or like it would come to fall. And they'd be like, oh man, I'm getting a sinus infection or the seasons change and the different, you know, allergens are in the air and they're like, my sinuses are acting up. And it was like, oh, we need to be looking at the sinuses as a potential trigger for their autoimmunity, and how can we try to balance this to remove that as a trigger for their autoimmune disease process.

Jennifer Fugo (30:57.024)

I love when people think outside of the box. I just love it. It excites me so much. I know that it's probably not exciting. It probably is exciting and yet not exciting for somebody who's dealing with chronic sinus issues because they're just like, can we get this to stop? But I think it's fantastic that we're starting to look at these different things and create connections where maybe we didn't even realize there might be one so that, like you said, we can better serve people and help people get better sooner. So I appreciate that about you. And we had your colleague, Dr. Jenny Bennett, on the show already. You also practice at ARIA Integrative Medicine in Seattle, Washington, and you are taking patients, correct?

Anastasia Stocker (31:41.85)

Yes, yes I am. Me and Dr. Bennett, we work closely side by side. We like to talk about cases. It's something we really enjoy.

Jennifer Fugo (31:51.11)

Awesome. Well, we'll make sure to put all of the links, especially for those who are interested in getting in touch with you into the show notes. And I so deeply appreciate you coming on the show and I hope we can have more conversations like this in the future.

Anastasia Stocker (32:02.126)

Yeah, thank you so much. Thank you so much. It was a lot of fun.

what causes sinusitis