Guns n' Roses Rocker Duff McKagan Underwent Sinus Surgery

Duff McKagan, the bassist of Guns n' Roses, apparently underwent sinus surgery back in December 2010.

According to media reports, his sinus cavities developed significant scar tissue due to years of cocaine abuse.

Sinus surgery due to scar tissue is a relatively rare indication for surgery, but required if they block sinus cavities leading to recurrent sinus infections.

Cocaine abuse more typically causes other sino-nasal abnormalities especially septal perforation.

Exactly what type of sinus surgery Duff McKagan underwent is unclear, but for sinus scar tissue, balloon sinuplasty is typically the route taken and can be performed in the office.

Balloon sinuplasty is when the sinus openings are enlarged using a balloon and can potentially be performed in the office assuming no anatomic contraindications (significant deviated septum, nasal polyps, etc).

However, before sinus surgery is considered in a patient who is suffering from recurrent sinus infections whether scar tissue is present or not, a workup is typically required followed by maximal medical management.

A typical workup includes a CT sinus scan, allergy testing, and nasal endoscopy. If allergy testing is significant, aggressive allergy management is required prior to surgical consideration.

Depending on the CT scan and endoscopic findings, there are two "flavors" of sinus surgery: traditional and balloon sinuplasty.

Traditional sinus surgery, otherwise known as functional endoscopic sinus surgery, is when all sinus disease is physically removed endoscopically from the nose and sinus entrances are enlarged.

Source:
Duff McKagan explains sinus surgery. SFGate 12/17/10

Cocaine the Soft Drink Being Sold in the United States

It was a little bit disturbing to me when I found out there is a soft drink being sold in the United States called "Cocaine". Made by Redux Beverages, LLC, they have a very aggressive marketing campaign using the tagline "Cocaine is a hell of a drug!" with a website DrinkCocaine.com, YouTube channel, Twitter feed, and a Facebook page (over 3500 fans).

It is marketed as an energy drink high on caffeine and packs 750 grams of taurine like most energy drinks. Unlike Four Loko (pulled off the market), it contains no alcohol.

Even in spite of the warning label on the can:

"WARNING: This message is for the people who are too stupid to recognize the obvious. This product does not contain cocaine(duh). This product is not intended to be an alternative to an illicit street drug, and anyone who thinks otherwise is an idiot."

What's next?

An orange juice called "Marijuana"?

Bottled water called "Roofie"?

Labeling benign food/drink items with illicit drug names is a travesty and should be banned. In essence, such illicit drugs are receiving free advertisement and can desensitize children to how dangerous these drugs are given the sugar-coating and flippant warning and potentially lead them to become users later in life.

Given the restrictions on cigarette ads imposed by law, I shudder to think when cigarette companies get wind of this marketing ploy and start producing water called "Malboro" and a candy bar called "Camels" as a form of indirect advertisement to get around the restrictions.

Remember the cigarette candies of the 1970s - 1990s now banned in many countries?

Illicit drug names should go the way of the Dodo as well...

Cocaine As A Medically Approved Medication

Many people are already aware that marijuana is now legal in some states in the US with a medical prescription.

What many people may not realize is that cocaine is also used in medical care, especially in the ENT world.

Cocaine is one of the most potent anesthetic AND vasoconstrictor. These two characteristics make it an ideal medication for use during sinus surgery as well as any nasal procedure where bleeding and pain may be an issue.

Many physicians will use cocaine to help stop nosebleeds (I do not).

Many surgeons use cocaine during sinus surgery to minimize post-operative pain as well as minimize intra-operative bleeding. Use of cocaine also significantly decreases risk of nosebleeds after sinus surgery as well as minimize need for nasal packing.

Cocaine when used for illegal recreational purposes by snorting puts a person at risk for septal perforation due to its vasoconstrictor properties. In essence, the cocaine puts a chemical tourniquet on the blood supply to the septum leading to mucosal necrosis and eventual perforation. Afrin does the same thing, but on a much smaller scale.

Before anybody asks... Cocaine is NEVER prescribed to a patient. It is only ever used in a hospital/office setting and heavily controlled under lock and key. (It is never used in our office.)