Just YouTube it.
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Explore This IssueMarch 2021
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As a rheumatologist who sees many patients with granulomatosis with polyangiitis (GPA), I have spent a significant portion of my life talking to people about neti pots.
Originally, the neti pot was part of the Ayurvedic tradition. Neti pots were used to flush the sinuses with water, milk and ghee, or to prepare the body for meditation.1
The neti pot would have remained an Ayurvedic footnote if it were not for a brilliant cardiac surgeon from Columbia University, Mehmet Oz, MD, MBA, who appeared on a television show hosted by a former Baltimore reporter. In 2006, Dr. Oz went on The Oprah Winfrey Show to extol the health benefits of using a neti pot on a regular basis.2 The rest, as they say, was history. Endorsement by both Dr. Oz and Oprah was enough to get neti pots on the shelves of every CVS and Walgreens across the country.
For patients with GPA, medications may not be enough to keep their sinus disease under control. For many of them, an epoxy of blood and mucous adheres to their sinuses and becomes a nidus for infection. Irrigation with a neti pot, two or three times daily, is often the only intervention that brings their symptoms under control.
Most patients try to give me the benefit of the doubt, but it’s a tough sell. Further, I know if their first time using a neti pot is a disaster, they won’t hesitate to abandon it. So I provide them with some additional instruction:
Buy a gallon of distilled water from the pharmacy. Wash out the neti pot, and fill it with water. Bring it into the bathroom with you. After a hot shower, which loosens the mucus, hold the neti pot in your dominant hand. Now breathe: nice, slow, deep breaths.
Do you remember jumping into a pool as a kid, and trying to keep the water from running up your nose? That’s the sensation you have to fight; you have to let the water up and in. After you have a nice breathing rhythm, bring the neti pot to one nostril, lean forward, and let the water flow. If the water seems to stop at your nose, put the pot down, and try again tomorrow. When you have mastered the technique, you’re ready to start adding the salt packets.
I don’t give this tutorial as often anymore. Nowadays, more often than not, I send my patients to YouTube.
The internet has a surfeit of instructional videos on how to use a neti pot appropriately. I tell my patients to watch a few of them before they decide to try it. In part, I want them to have a solid understanding of the technique before jumping in. But I also know the videos simultaneously encourage them to dip a toe in the water. Every video starts with a convert, pot in hand, praising the Way of the Neti. Nothing is quite as convincing as a patient with chronic sinusitis or allergies talking about how sinus irrigation has changed his life. Two or three testimonials are all it takes for most patients to be willing to take the plunge.
I know that asking my patients to self-educate is not ideal, but for this particular intervention, it seems to work well enough. It also gives me back 10 minutes in an appointment, which I can use to talk about other issues that are more firmly in my wheelhouse. But what about more complicated tasks, like injecting a biologic for the first time? What resources can patients use when YouTube videos are not enough?
Enter the nurse ambassador.