Up your nose with a rubber hose (to fight Covid)

October 23, 2024 5:22 AM

"Our results support that pressurized nasal irrigation reduces the likelihood of hospitalization in high-risk COVID-19 outpatients, suggesting a safe and over the counter measure with potentially vital public health impact."

Abstract

Objective: To determine whether initiating saline nasal irrigation after COVID-19 diagnosis reduces hospitalization and death in high-risk outpatients compared with observational controls, and if irrigant composition impacts severity. Methods: Participants 55 and older were enrolled within 24 hours of a + PCR COVID-19 test between September 24 and December 21, 2020. Among 826 screened, 79 participants were enrolled and randomly assigned to add 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240 mL of isotonic nasal irrigation twice daily for 14 days. The primary outcome was hospitalization or death from COVID-19 within 28 days of enrollment by
daily self-report confirmed with phone calls and hospital records, compared to the CDC Surveillance Dataset covering the same time. Secondary outcomes compared symptom resolution by irrigant additive. Results: Seventy-nine high-risk participants were enrolled (mean [SD] age, 64 [8] years; 36 [46%] women; 71% Non-Hispanic White), with mean BMI 30.3. Analyzed by intention-to-treat, by day 28, COVID-19 symptoms resulted in one ED visit and no hospitalizations in 42 irrigating with alkalinization, one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths. Of nearly three million CDC cases, 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. Age, sex, and percentage with pre-existing conditions did not significantly differ by exact binomial test from the CDC dataset, while reported race and hospitalization rate did. The total risk of hospitalization or death (11%) was 8.57 times that of enrolled nasal irrigation participants (SE = 2.74; P = .006). Sixty-two participants completed daily surveys (78%), averaging 1.8 irrigations/day. Eleven reported irrigation-related complaints and four discontinued use. Symptom resolution was more likely for those reporting twice daily irrigation (X2 = 8.728, P = .0031) regardless of additive. Conclusion: SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate


Citation:

Baxter, A. L., Schwartz, K. R., Johnson, R. W., Kuchinski, A. M., Swartout, K. M., Srinivasa Rao, A. S., ... & Schwartz, R. (2024). Rapid initiation of nasal saline irrigation to reduce severity in high-risk COVID+ outpatients. Ear, Nose & Throat Journal, 103(1_suppl), 30S-39S.


I'm posting this article after a discussion with friends recently about neti pots and their value, with many we know (U.S., East Coast) having had some sort of flu, cold, bug, or Covid the last few months. I thought it would be of interest here, but be advised:

1. This is a small cohort study, like (I believe) most other similar studies with strong beneficial results for participants.

2. A number of studies take a more conservative "this seems potentially good and non-harmful, but further study is needed" approach (example).

3. I am not a doctor.

4. The title of this post is a referential joke. I am not encouraging anyone to put a rubber hose up their nose.

posted by cupcakeninja (52 comments total)

Ugh! Mods, I checked and double-checked but I put the WRONG ABSTRACT in the extend above. This is the correct abstract:

Abstract
Objective: To determine whether initiating saline nasal irrigation after COVID-19 diagnosis reduces hospitalization and death in high-risk outpatients compared with observational controls, and if irrigant composition impacts severity. Methods: Participants 55 and older were enrolled within 24 hours of a + PCR COVID-19 test between September 24 and December 21, 2020. Among 826 screened, 79 participants were enrolled and randomly assigned to add 2.5 mL povidone-iodine 10% or 2.5 mL sodium bicarbonate to 240 mL of isotonic nasal irrigation twice daily for 14 days. The primary outcome was hospitalization or death from COVID-19 within 28 days of enrollment by
daily self-report confirmed with phone calls and hospital records, compared to the CDC Surveillance Dataset covering the same time. Secondary outcomes compared symptom resolution by irrigant additive. Results: Seventy-nine high-risk participants were enrolled (mean [SD] age, 64 [8] years; 36 [46%] women; 71% Non-Hispanic White), with mean BMI 30.3. Analyzed by intention-to-treat, by day 28, COVID-19 symptoms resulted in one ED visit and no hospitalizations in 42 irrigating with alkalinization, one hospitalization of 37 in the povidone-iodine group, (1.27%) and no deaths. Of nearly three million CDC cases, 9.47% were known to be hospitalized, with an additional 1.5% mortality in those without hospitalization data. Age, sex, and percentage with pre-existing conditions did not significantly differ by exact binomial test from the CDC dataset, while reported race and hospitalization rate did. The total risk of hospitalization or death (11%) was 8.57 times that of enrolled nasal irrigation participants (SE = 2.74; P = .006). Sixty-two participants completed daily surveys (78%), averaging 1.8 irrigations/day. Eleven reported irrigation-related complaints and four discontinued use. Symptom resolution was more likely for those reporting twice daily irrigation (X2 = 8.728, P = .0031) regardless of additive. Conclusion: SARS-CoV-2+ participants initiating nasal irrigation were over 8 times less likely to be hospitalized than the national rate
posted by cupcakeninja at 5:27 AM on October 23, 2024

(Apologies, folks -- I flagged this and requested a swap of abstracts)
posted by cupcakeninja at 5:28 AM on October 23, 2024

The primary outcome was hospitalization or death from COVID-19 within 28 days

Not much of an endorsement for saline rinsing, then.
posted by stevil at 5:45 AM on October 23, 2024 [2 favorites]

In this case, I believe "primary outcome" means "the thing we're checking the numbers for," not "the thing that this intervention caused."
posted by humbug at 5:48 AM on October 23, 2024 [11 favorites]

That was also my understanding.

Definitely not posting this to make strong, unwarranted claims. My one encounter with Covid thus far was highly unpleasant, and I didn't fully recover for some weeks. I'm sharing this as one more possible tool in the toolbox for symptom alleviation and possible beneficial effects vs. hospitalization and/or severe illness for those who don't already know about it. I don't suspect there are many Covid-interested MeFites who haven't already considered this, but on the off chance...
posted by cupcakeninja at 5:55 AM on October 23, 2024 [2 favorites]

Mod note: Abstract text corrected!
posted by Brandon Blatcher (staff) at 5:56 AM on October 23, 2024 [5 favorites]

You might also find it useful to know that:

In addition to human angiotensin-converting enzyme 2, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can utilize alternative cofactors to facilitate viral entry. In this study, we discovered that histamine receptor H1 (HRH1) not only functions as an independent receptor for SARS-CoV-2 but also synergistically enhances ACE2-dependent viral entry by directly interacting with ACE2. Further studies have demonstrated that HRH1 facilitates the entry of SARS-CoV-2 by directly binding to the N-terminal domain of the spike protein. Conversely, antihistamine drugs, primarily HRH1 antagonists, can competitively bind to HRH1 and thereby prevent viral entry. These findings revealed that the administration of repurposable antihistamine drugs could be a therapeutic intervention to combat coronavirus disease.

... which given how inexpensive antihistamines are in bulk could also be a good way to mitigate risk. Dollar for dollar nothing's gonna beat masking though.
posted by mhoye at 6:12 AM on October 23, 2024 [7 favorites]

Anecdotally, I did nasal irrigation twice a day through COVID because my ENT has previously prescribed that for my allergies and save for the first two days when I felt too shitty to stick to my routines I kept that up through COVID so that I wouldn’t get a double whammy of COVID and allergy congestion, and my symptoms were much more mild than my partner who does not do this. Fatigue was still bad, but basically everything else was much more minimal and went away faster than it did for them.

On preview: …and I’m also on daily fexofenadine, which my partner is not.
posted by brook horse at 6:19 AM on October 23, 2024 [4 favorites]

We love our Nielmed saline rinses in this house but this isn't a very convincing study, at least based on the abstract and a skim of the paper. They screened and enrolled from a specific university hospital but didn't assign anyone who agreed to a screening to a control group. Then they compare their screened patients to national outcomes. They do talk about how their sample set compares to the national averages, but they don't seem to realize there might be a correlation between good health outcomes and people who are willing to participate in a study, easy to contact, willing to follow up with doctors multiple times a week, and irrigate nasally a few times a day.
posted by muddgirl at 6:21 AM on October 23, 2024 [14 favorites]

+1 muddgirl.

The lack of 80+ year old folks in the experimental group (4, or 5%) compared to the CDC dataset (330k or 11%) is noticeable too. It's worth quoting from The story of VaccinateCA:

It is a biological fact about Covid that some people are vastly more at risk from it than others. In particular, risk of death goes up with age. The magnitude of this effect is so large that it breaks many people’s intuitions about risk, including those of whom work in public health and in medicine. You know how smoking causes lung cancer? The relative risk of a smoker developing lung cancer is about 25 times that of a nonsmoker. The relative risk of death for a 55-year-old from Covid compared to an 18-year-old is . . . roughly the same, 25 times. The relative risk of an 85-year-old compared to an 18-year-old is . . . roughly 350 times. These are staggering disparities compared to most risk factors in healthcare, including other commonly identified risk factors for Covid.

posted by daveliepmann at 6:40 AM on October 23, 2024 [8 favorites]

I wonder if the original aim was solely to test the iodine nasal rinse with saline rinse as the control, but when the results were equal with low power due to under enrollment they combined the results to salvage the study.
posted by muddgirl at 6:47 AM on October 23, 2024 [13 favorites]

> I wonder if the original aim was solely to test the iodine nasal rinse with saline rinse as the control, but when the results were equal with low power due to under enrollment they combined the results to salvage the study.

Some days I find it soothing to see the speech of my people written out like this.
posted by Aardvark Cheeselog at 7:08 AM on October 23, 2024 [11 favorites]

Part of me thinks that this is mildly interesting and more study should be done.

The other part of me thinks STOP TRYING TO MAKE NETI POTS HAPPEN. THEY AREN'T GOING TO HAPPEN.
posted by AlSweigart at 7:11 AM on October 23, 2024 [2 favorites]

In fairness it doesn’t have to be a Netipot, squeeze bottle nasal rinses work just as well and are less horrible. I’ve had many ENTs suggest those, zero suggest Netipot. Lots of people with allergies do nasal rinses, many fewer use Netipots and I don’t think the study did either from what I can tell.

But yeah reading the study it does seem like it’s in the “area worth exploring but little actual evidence it works yet” stage.
posted by brook horse at 7:23 AM on October 23, 2024 [3 favorites]

Neti pots are never going to happen, but they're also never going to go away completely, because fundamentally, they are funny.

also if you use neti pots please do boil your water do not screw this up
posted by phooky at 7:38 AM on October 23, 2024 [4 favorites]

I definitely felt that using a neilmed squeeze bottle helped my covid symptoms. That said, I think there's a real market niche for a device that boils the water for you and then cools it to comfortable temperature and keeps it there. Basically like a fancy electric kettle but for your nose squirt bottle. When I'm sick the annoyance of having to do all the water stuff seems insurmountable.

I just ordered a big bottle of distilled water to use, and did the rinse with cold water. But I know warm would have felt better, I just didn't have the energy.
posted by potrzebie at 8:00 AM on October 23, 2024 [6 favorites]

Yeah, I just use distilled water now. I feel like I need to stick it in a towel warmer or something though.
posted by brook horse at 8:02 AM on October 23, 2024 [2 favorites]

Neti pots have apparently been in use for over 500 years. I think that counts as THEY HAPPENED.
posted by achrise at 8:07 AM on October 23, 2024 [10 favorites]

Distilled water and 10-15 seconds in the microwave makes it a ton more tolerable. It's in the Nielmed instructions for the squeeze bottle so it should be OK.

I'll also say there is a real difference between the Nielmed saline mix and the store brand, especially if you are rinsing 2+ times per day.
posted by muddgirl at 8:20 AM on October 23, 2024 [5 favorites]

(do test the temp on your wrist though)
posted by muddgirl at 8:22 AM on October 23, 2024 [1 favorite]

I wonder if the original aim was solely to test the iodine nasal rinse with saline rinse as the control

My immediate thought seeing this post was, "whatever happened to those studies of people nose-douching with povidone?"

Regardless of whether it works on a biochemical or simply physical level, a treatment that the majority of people won't do is no treatment at all. Might as well tell people to eat rice right while getting enough sleep and exercise.
posted by Panjandrum at 8:57 AM on October 23, 2024 [1 favorite]

I'll also say there is a real difference between the Nielmed saline mix and the store brand

Unfortunately the difference in my most recent batch is about 20% of the Neilmed brand packets are completely, entirely empty. I haven’t had the energy to call and complain about it. I haven’t noticed a difference with store brand in comfort, but not sure about effectiveness. (They have, however, actually contained the mix so far.)

Thanks for the tip about the microwave, though!!
posted by brook horse at 9:38 AM on October 23, 2024

Neti pots are fine (although optional - when I'm too dry I just use the palm of my hand, a la Mr Boats) but "pressurized nasal irrigation" is going to be a tough sell.
posted by Rash at 9:47 AM on October 23, 2024 [1 favorite]

This seems highly unconvincing. I think the big disparity between the the CDC data set and their data set is who got tests. I think it is fairly certain that ~10% of infected 55+ people did not get hospitalized, which suggests that many more of the people in the CDC data set were already severely ill or hospitalized when they got the test compared to this data set. We know this was true in 2020, of course. In other words, they are trying to fake a control group by using the CDC data and that clearly doesn't work.

but "pressurized nasal irrigation" is going to be a tough sell

It was just those Neilmed spray bottles or the Navage thing. More pressure than a neti pot, sure, but not pressurized in any significant way.
posted by ssg at 10:04 AM on October 23, 2024 [2 favorites]

I have been prescribed to use a neilmed bottle twice a day and there has to be a better way. Ok, so I'm supposed to use distilled or boiled water because apparently there are amoebas in tap water? OK, but I'm supposed to wash the bottle with tap water and dish soap and then rinse it with tap water. Aren't there rinse-water amoebas in my bottle now? So now I pour in the distilled water aren't those amoebas going up my nose? This doesn't make any sense so even though I"m only supposed to sterelize it in the microwave once a week I do it before every use because didn't I just rinse it in tap water? But now this is a giant PITA so I'm not actually doing it twice a day. And just for added lolz, I have accidentally melted 3 bottles in the microwave if I get distracted and don't pull them out in time (because my microwave control panel is broken so I have to set it for a full minute and then stand there and pull it out).

And warm water? Forget that. The jug of distilled water is on the counter. It's room temperature. That's the temperature I'm using.

So yes please, somebody invent a machine that gives me a sterile output system ready to go at the touch of a button, please.
posted by If only I had a penguin... at 12:12 PM on October 23, 2024 [3 favorites]

I love my neilmed. I use water filtered with a brita filter and then boiled, pour it into a measuring cup to cool down, and then use that. I have not yet gotten brain amoebas and I must admit to rarely doing more than rinsing the bottle itself (and replacing it roughly every 3-4 months). I'm sure this depends on the tap water where you live but I think brita filter + boil is good enough; boil alone makes it safe but the water where I live will still have gross sediment in it that means it doesn't as effectively solve the problem I need (preventing seasonal sinus infections mostly).

Also, if you let the water cool for too long and want it warmer, you can always put the filled neilmed in a bath of warm water to bring the temperature up to something more pleasant than room temp. Same goes for cooling the water down, putting it in a bath of cool water or running a cold tap over the outside of the bottle will cool it quickly (just don't get tap water in the spout).
posted by ch1x0r at 12:46 PM on October 23, 2024 [1 favorite]

Amoebas die off when the bottle dries out after washing and rinsing.
posted by muddgirl at 12:50 PM on October 23, 2024 [1 favorite]

Also getting sick from amoebas is very very rare, much more likely is to spread illness between family members through sharing instruments. Or spreading an illness from your hands to the bottle to your nose.
posted by muddgirl at 12:51 PM on October 23, 2024

If you just need warming and not sterilization baby bottle warmers would do.
posted by Mitheral at 1:45 PM on October 23, 2024

Point being, this could definitely be easier! A device where you pour tap water in, it boils it and then maintains it at a comfy temperature, mixes in the salt packet, and shoots the water up your nose at a pressure level you choose with a cool clicky knob actually seems like it would sell really well and I think Navage should make one. I would have paid like $400 no questions asked to get my hands on this hypothetical device same-day when I had covid in June. I was isolating in a space without a microwave so it was cold water or nothing at all.

Heck even if the Navage did nothing but warm the water I poured in there to a preset temperature I probably would have paid $$$ for it. So weird this isn't a thing.
posted by potrzebie at 4:29 PM on October 23, 2024

I use a squeeze bottle with a filter on it that I bought at CVS, and don't sweat the distilled water thing. Makes it MUCH easier to do my nasal irrigation.
posted by suelac at 6:38 PM on October 23, 2024 [1 favorite]

guys you're overthinking it just fill a keurig cup with salt and
posted by mittens at 6:49 PM on October 23, 2024 [1 favorite]

Are there really any cases of brain-eating amoeba infection via neti bottle and tap water, where tap water has been through a municipal treatment system?

I use boiled water myself, and guys this is not rocket science. Boil a kettle (ok, a saucepan, if you're the kind of philistine who has no kettle) of water, put it on a trivet to cool, and then fill up a carafe that has a lid. Later, you fill your Neil Med bottle from that and microwave it for like 11 seconds. Swirl the bottle to mix it up and then nuke it again for about as long, then add 1/4 tsp of USP NaCl (carbonate buffering is for wimps), swirl again to dissolve, and proceed to rinse out your head.
posted by Aardvark Cheeselog at 6:16 AM on October 24, 2024 [1 favorite]

> guys this is not rocket science

I don't think the sticking point is technical complexity. Adding a multistep task to an already full daily routine is hard for many people. Brushing and Flossing my teeth is not technically complex. I manage to do it most nights. But if I had to cook the toothpaste first and then sterilize the floss each time, I know I would skip much more often.
posted by mrgoldenbrown at 6:38 AM on October 24, 2024 [2 favorites]

Yes, there have been cases in the US where tap water via nasal irrigation was the likely source of amoeba infection.
posted by ssg at 6:53 AM on October 24, 2024 [2 favorites]

Yes, thank you, we are all very aware of how to complete the ten step process. We are complaining about it taking ten steps, not too stupid to know what the steps are.

Anyway this dyspraxic chronically ill autistic has enough ten step medical processes in their routine and would love if someone cut this one down to like, five.
posted by brook horse at 6:55 AM on October 24, 2024 [1 favorite]

"Acanthamoeba and other biofilm-associated amebae have been detected in >50% of US tap water samples" (from the link above). So it's not that amoeba are rare in tap water, it's that they usually don't infect you (most, but not all, of those infected were immunocompromised in some way).
posted by ssg at 7:00 AM on October 24, 2024

would love if someone cut this one down to like, five.

I used to have a multistep process that involved sterilizing bottles, heating water to the right temperature, measuring out salt, etc., but now I just get a can of slightly pressurized Simply Saline (either the real thing or the store brand) and my life is so much easier. At least, that part of my life which involves sticking things up my nose. No amoebas, no microwaves, no measuring.
posted by mittens at 7:00 AM on October 24, 2024

My understanding is that nasal sprays are less effective for allergens, which is my use case—but it would be a good idea for me to keep that around for the busy mornings or late nights where I have to skip the rinse for time. That way I’d still get something instead of nothing. Thanks for the suggestion!
posted by brook horse at 7:08 AM on October 24, 2024 [1 favorite]

Yes, there have been cases in the US where tap water via nasal irrigation was the likely source of amoeba infection.

FTA: Ten patients reported nasal rinsing before their Acanthamoeba diagnoses. Infections occurred during 1994–2022, but 9 cases occurred in the past decade.

So 10 people in the US (population 320,000,000) people got an infection bad enough to go to the hospital in the 28 year study period. That's like getting stuck by lighting while accepting your billion dollar lotto ticket. Go ahead and rinse.
posted by The_Vegetables at 8:14 AM on October 24, 2024

Neti pots have apparently been in use for over 500 years. I think that counts as THEY HAPPENED.

Not to mention they're currently being sold in every CVS/Walgreens/Rite Aid etc. They're very much already a thing.
posted by ultraviolet catastrophe at 8:23 AM on October 24, 2024 [2 favorites]

Boil a kettle (ok, a saucepan, if you're the kind of philistine who has no kettle) of water, put it on a trivet to cool

Ahem, your use of a trivet suggests that you are the kind of philistine who boils a kettle on the stove instead of plugging it in. You are cousin philistines.
posted by If only I had a penguin... at 8:35 AM on October 24, 2024 [1 favorite]

So 10 people in the US (population 320,000,000) people got an infection bad enough to go to the hospital in the 28 year study period.

All Naegleria fowleri infections are bad enough to go to the hospital.

Between 1962 and 2023, there were 164 reported cases of PAM in the United States. Only four have survived.

Those are some bad fucking odds.
posted by hydropsyche at 1:34 PM on October 24, 2024 [1 favorite]

ok wait that is terrifying. I realize that though the odds are bad, the incidence is rare, but still...the odds are bad. And most people don't do this twice a day forever, so the population at risk on any given day is not the population of the U.S. it's much smaller. So the amoebas die when it's dry. But like how do you know it's fully dry? And like you shower in the bathroom. Water vapour gets in there. Condensation. It gets wet again. Was it dry? How long does it have to stay dry or the amoebas to die?

Why don't they make one out of medical grade silicone like a haaka pump so you can stick the whole damn thing in some sterilizing machine like a baby bottle sterilizer (which I realize is not necessary for baby bottles but might actually be a good idea here).
posted by If only I had a penguin... at 7:14 PM on October 24, 2024

Been doing the daily nasal rinse for many years now to manage sinus and allergy issues. Highly recommend it.

Don't waste your money on the 'special' commercial powders, even buying them in bulk. I use 1/8 tsp of non-iodised salt and 1/16 tsp sodium bicarbonate per 200ml (1/3 pint) of sterile water (i.e. boiled or distilled). Strictly speaking you can ditch the bicarb, but I find it helps with loosening the mucous. Using non-iodised just reduces the stinging, and according to the headline study it doesn't affect efficacy.

I use the Flo brand squeeze bottles (200ml capacity, hence the rates in the recipe above). Cheap, readily available, do the job, and I get 6-12 months from each one. At $11 a bottle the cost amortises to barely measurable, let alone significant.

Tried a Neti pot early on, but the extra pressure from a squeeze bottle provides a more effective flush, and you can control the pressure and hence flow rate to suit your comfort level.

Also tried the saline sprays, and while they do work and are convenient for when away from home, they are not as effective as the more robust flushing with bulk liquid technique.

Only downside, besides being undignified, is avoiding amoeba infection. Not a trivial matter, I grant. But easy enough to deal with, I think.

Ok, so I'm supposed to use distilled or boiled water because apparently there are amoebas in tap water? OK, but I'm supposed to wash the bottle with tap water and dish soap and then rinse it with tap water. Aren't there rinse-water amoebas in my bottle now? So now I pour in the distilled water aren't those amoebas going up my nose?
posted by If only I had a penguin...

Anyway this dyspraxic chronically ill autistic has enough ten step medical processes in their routine and would love if someone cut this one down to like, five.
posted by brook horse

I can give you six, for the Flo bottle:

1. Boil water.
2. Add the salt & bicarb to the bottle, while water is coming to the boil.
3. Pour just off boiling water into bottle.
4. Stick the tube into the hole in the bottle cap and place the assembly loosely on the top of the bottle, so those components are either in the hot water or getting hot steamed immediately above it. Wait until cool enough to use.
5. Screw on cap fully, and use.
6. Disassemble and rinse/wash bottle, and place components somewhere to fully dry out before next use.

I do steps 1-5 with the bottle sitting on the sink, because there will be spillage, mainly when screwing the cap on in Step 5, but also as a precaution if you overfill or the bottle gets knocked over, as you are using very hot water.
posted by Pouteria at 9:36 PM on October 25, 2024

> I don't think the sticking point is technical complexity.

Thanks to all the people who chimed in basically to say or agree with this. You have my compassion for the difficulties you face.

I was not addressing you. I was talking to the people who think it's necessary to buy distilled water to complete the steps. Of which there are not 10:

1. Add water to nose bottle
2. Warm briefly in microwave
3 Add 1/4 tsp USP salt to bottle, swirl to mix
4 Put cap on bottle
5 Rinse sinuses
6 Rinse bottle with more boiled water
posted by Aardvark Cheeselog at 8:24 AM on October 26, 2024

Well, yes, if you leave out all of the boiling water steps then there are no longer ten steps. The boiling water part is the complaint. Which, again, isn’t a problem of “rocket science” but of tedium. Your response doesn’t address why people buy distilled water at all.
posted by brook horse at 8:42 AM on October 26, 2024

Boiling water is a tedious process? I guess if you want to break it down into micro-steps, you can make the algorithm for any activity as complex and/or tedious as you want. Shades of Zeno's paradox.

I also don't see how organising the buying and storing and use of distilled water is any less so. Certainly isn't cheaper.

If you are making coffee or tea you can use boiled water from that for the nasal stuff. Just add a little extra when filling the kettle. Which is what I do. So the boiled water is not actually any extra work for me. Just part of my morning ritual anyway.

Not sure how much simpler it can be made.

However, to each their own.
posted by Pouteria at 8:14 PM on October 26, 2024

Boiling the water at minimum requires pouring water into the kettle, letting it boil, waiting for it to cool, and then pouring it into the nasal rinse bottle, which is four basic and obvious steps without any “breaking it down into micro steps” like turning on the sink, etc. If you’re dyspraxic and in chronic pain, that’s a significant amount of motor coordination that does in fact make the process more tedious, and you also have to make sure you boil it at the right time or it won’t cool by the time you need it (or you’ll have to do another fancy song and dance such as putting it in an ice bath). And you have to do it every single day. I have enough trouble getting my morning routine done as it is and it is frankly stupid to add more steps to it that don’t need to be there.

Distilled water is literally just bought once a month with groceries and is then on or next to the counter immediately when I need it every single day with zero extra work outside that one (1) day a month. It costs $1 for a gallon and 2 gallons last me a month. $2 a month is worth not having to fuck around with the time management and motor coordination when I have more important and less outsourceable medical shit I have to fuck around with, like giving my cat subcutaneous injections daily, putting on compression clothing for each of my hypermobile joints, completing my PT regime for my chronic pain, etc. But if there were something that would sanitize the bottle/water without all of the extra pouring into a heavy kettle and waiting around for it to cool before pouring it into the tiny bottle from the big heavy kettle (which is basically designed to torture dyspraxics), I’d totally ditch the distilled water.
posted by brook horse at 6:17 AM on October 27, 2024 [1 favorite]

Might be too much trouble emptying the unit however counter top stills are a thing. Could be filled a more manageable cup/quart at a time and if set near the sink could be just tipped to pour the waste into the sink. Time how long it takes to produce a cup or two and you could set that time everytime you filled your rinse bottle and it would be ready for the next day. That way you wouldn't have to lift the gallon container.
posted by Mitheral at 6:18 PM on October 27, 2024 [1 favorite]

Oh, huh, had no idea those existed! Thank you for the suggestion.
posted by brook horse at 6:28 PM on October 27, 2024

OK, so now having re-read the instructions I see that the answer to my question about amoebas after washing with tap water is that I'm not supposed to be washing with tap water (so good thing I was microwaving every time!). You're supposed to also WASH the bottle with distilled or boiled water.

So ok, now this is no small thing. It take a lot of water to rinse the dish soap out of the bottle. How many times am I going to have to boil and cool water to make this happen? Who knows? But let's give it a shot. I boiled a kettle full of water. Now here's the problem, it's been like two hours and the water still isn't cool enough that I can use it to wash the bottle (like I feel like it's not going to burn my hands exactly, but it's not going to be comfortable either.

Now that would all be fine. It's not like I need to wash the bottle right this second. Except, wait....My kettle is full of this water that I'm waiting to cool. I can't make tea. Probably at least for another hour. Maybe two. And of course I thought of this and made a cup of tea just before boiling the water, but that tea is gone now and what am I supposed to do? Am I just supposed to go hours every day without tea?

I feel like this is yet another area where doctors tell you to do something like it's so simple but don't give any thought at all to how this supposedly simple thing would possibly work in reality. And then they turn it on the patient for non-compliance. I have nightmares wondering how I would possibly do nasal rinses if I were camping. I suppose I would have to buy a bunch of those pre-filled bottles.
posted by If only I had a penguin... at 7:38 AM on November 3, 2024