Sinusitis: Comprehensive Guide to Symptoms and Treatment

Feeling pressure in your face, a blocked nose, and headaches? You might be dealing with sinusitis. It’s a condition that affects many people each year, making it difficult to breathe and go about daily activities comfortably.

Sinusitis can hit anyone at any age, turning the simple act of breathing into an exhausting effort.

One key fact about sinusitis is that its treatment varies widely—from over-the-counter medicines to home remedies and even surgery in severe cases. Our guide provides a comprehensive look into everything you need to know about this common condition, exploring symptoms, treatments available ranging from medications to supplements, and when it’s time to see a doctor.

Ready for relief? Let’s explore together.

Key Takeaways

  • Sinusitis is when your sinuses get inflamed, causing face pain, blocked nose and headaches. It can come from colds, allergies or infections.
  • You can treat sinusitis with medicines like antibiotics if it’s a bacteria causing the trouble, or with things like nasal sprays to help you breathe easier. Sometimes doctors suggest surgery.
  • Drinking water, using saline sprays and staying away from smoke helps keep sinus problems away. Vaccines also prevent infections that might lead to sinusitis.
  • People with asthma or allergies have a higher chance of getting sinusitis. Keeping these conditions under control can help.
  • If home remedies don’t work for your sinus issues, seeing a doctor is important. They can find the best treatment for you.

Understanding Sinusitis

Sinusitis turns your nasal passages into battlegrounds for infection and inflammation. It’s a condition where understanding the enemy is half the battle won.

Definition

Sinusitis is an inflammation of the sinuses, which are air-filled spaces in the skull around the nose. This condition can cause facial pain, congestion, and headaches. Symptoms such as thick nasal drainage, postnasal drip, and difficulty breathing highlight its presence.

Common in those who experience viral, bacterial, or fungal infections—it also strikes individuals with allergies or asthma.

Treatment options for sinusitis range from non-drug methods to medications like antibiotics and nasal corticosteroids.

Chronic cases may require more intense treatment like oral steroids or even surgery. It’s noteworthy that while some forms last a week to 10 days and can be managed with over-the-counter solutions; others demand professional medical intervention to prevent complications such as increased asthma severity or blood clots.

Types of Sinusitis

After exploring what sinusitis is, it becomes clear that not all sinus infections are the same. They come in different forms, each with its own set of challenges and treatments. Here’s a closer look at the various types:

  1. Acute Sinusitis often starts as a cold before turning into a bacterial infection. With symptoms lasting less than 4 weeks, it’s characterized by sudden onset of stuffy nose, facial pain, and a decrease in sense of smell.
  2. Subacute Sinusitis bridges the gap between acute and chronic forms. Symptoms linger for 4 to 12 weeks. This type often follows an acute episode that doesn’t fully resolve.
  3. Chronic Sinusitis is more persistent and involves long-term inflammation, exceeding 12 weeks. It can stem from environmental factors, allergies, or nasal structure problems, leading to ongoing nasal congestion, poor drainage, and facial pain.
  4. Recurrent Sinusitis shows up several times a year. Individuals may experience all symptoms of acute sinusitis but with repeated episodes, significantly disrupting their quality of life.

Each type presents unique challenges in diagnosis and management, requiring specific approaches for effective relief and treatment.

Who is at Risk?

Sinusitis affects many people each year, leading to a search for relief and treatment. Identifying who is at risk can help in prevention and early treatment strategies.

  1. People with allergies: Those with allergies are more likely to develop sinusitis because allergens can cause inflammation in the nasal passages.
  2. Asthma patients: Individuals with asthma have an increased risk of sinusitis due to the link between airway inflammation and sinus infection.
  3. People with weakened immune systems: This includes individuals with HIV/AIDS, those undergoing chemotherapy, or taking medication that suppresses the immune system.
  4. Smokers: Tobacco smoke can irritate and inflame the nasal passages, increasing the risk of sinus infections.
  5. Those with structural abnormalities in their nose or sinuses: Conditions like deviated septum or nasal polyps make it easier for infections to start and harder to treat.
  6. Children in daycare centers: Kids are more exposed to germs in these environments, making them more susceptible to sinus infections.
  7. People experiencing frequent colds or viral infections: Frequent upper respiratory tract infections increase the chances of developing sinusitis.
  8. Residents of areas with high pollution levels: Pollution can irritate the nasal cavities, making them more prone to inflammation and infection.

Understanding these risk factors is crucial for managing and preventing sinusitis effectively.

Symptoms of Sinusitis

Feeling stuffy or congested can be a key sign of sinusitis. Look for other symptoms like facial pain and pressure to get a clearer picture.

General Symptoms

Sinusitis symptoms often mimic those of a common cold, making it hard to identify. These symptoms can cause significant discomfort and disrupt daily activities. Here’s a detailed list of general sinusitis symptoms people experience:

  1. Facial pain or pressure is a key sign, often worsened by bending over or lying down.
  2. Nasal congestion leads to difficulty breathing through the nose, affecting sleep and sense of smell.
  3. Thick nasal drainage, which may be green or yellow in color, drains down the back of the throat (postnasal drip).
  4. A cough develops from this postnasal drip, especially worsening at night.
  5. Headaches frequently accompany sinusitis, often localized around the sinuses affected.
  6. Sore throat and hoarseness can occur due to irritation from constant coughing and drainage.
  7. Fatigue sets in as the body fights off infection; combined with poor sleep from other symptoms, it leaves individuals feeling constantly tired.
  8. Bad breath might emerge due to infected mucus draining into the mouth and throat area.

These symptoms signal that your body is fighting an infection or inflammation within your sinuses. Next, we will explore acute bacterial sinusitis symptoms, shedding light on how they differ and when to seek further medical advice.

Acute Bacterial Sinusitis Symptoms

Acute bacterial sinusitis can make you feel really sick, with symptoms that are hard to ignore. These signs often follow a cold that doesn’t get better or even worsens after 5 to 7 days.

  1. You might notice thick, green or yellow nasal discharge. This isn’t the clear runny nose you might start with; it’s heavier and more noticeable.
  2. Facial pain and pressure are big clues, too. The areas around your eyes, cheeks, nose, and forehead may feel tender or swollen.
  3. Suffering from a fever is common when bacteria cause sinusitis. Your body raises its temperature to fight off the infection.
  4. A decrease in your sense of smell or taste can happen because the swelling blocks airways and makes it hard for scents to reach sensory cells.
  5. Bad breath is another unexpected symptom—caused by that buildup of mucus and bacteria in your sinuses.
  6. Ear pain surfaces due to the pressure changes in your sinus cavities affecting nearby areas.
  7. Toothache might occur as well, especially in your upper teeth since they’re close to your sinuses.
  8. Headaches become frequent companions thanks to constant pressure and inflammation in your sinuses.
  9. Coughing can be persistent, aggravated by postnasal drip feeding down into your throat, especially noticeable at night.
  10. You may suffer from fatigue because your body is working overtime to fight the infection, making you feel tired all day.

Each of these symptoms points to acute bacterial sinusitis—a condition not to take lightly as it needs proper medical attention for relief and recovery.

Chronic Sinusitis Symptoms

Chronic sinusitis is a long-term inflammation of the sinuses. It brings its unique set of symptoms that can affect daily life.

  1. Nasal congestion leads to difficulty breathing through the nose. The passages become blocked, making it hard to breathe normally.
  2. Thick, discolored nasal discharge is common. This can be from the nose itself or down the back of the throat.
  3. Pain, tenderness, and swelling around eyes, cheeks, nose, or forehead occur as the sinuses swell and fill with fluid.
  4. Ear pain develops as pressure builds up in the surrounding areas of your head due to congested sinuses.
  5. Aching in your upper jaw and teeth shows how close the sinus infection is to dental nerves.
  6. Cough or throat clearing becomes more frequent, especially at night or first thing in the morning because of postnasal drip.
  7. Sore throat happens due to irritation and excess mucus dripping down the throat.
  8. Bad breath (halitosis) isn’t uncommon as bacteria can flourish in infected sinuses.
  9. Fatigue can be overwhelming because your body is fighting off a chronic infection.
  10. Decreased sense of smell and taste comes from blocked nasal passages and inflammation.

Next, let’s explore what causes these persistent symptoms of chronic sinusitis.

Causes of Sinusitis

Sinusitis springs from infections, allergies, or nasal passage issues. Dive deeper to unveil more about its causes!

Viral, Bacterial, and Fungal Infections

Viral, bacterial, and fungal infections are key causes of sinusitis. These germs invade the sinuses, leading to inflammation and swelling that block nasal passages. Most often, a virus starts the problem, much like what happens with a common cold.

Bacteria can then take hold in this prime environment, making things worse. In less common cases, fungi might be the culprits, especially in people with weakened immune systems.

Treatment varies based on the infection type causing sinusitis symptoms such as facial pain and thick nasal drainage. Antibiotics are effective against bacterial infections but won’t help with viral ones.

For fungal-induced sinus problems, antifungal medicines are necessary. Keeping these distinctions in mind is crucial for treating sinusitis right and finding relief from its uncomfortable symptoms.

Sinusitis treatment must target the specific type of infection—viral, bacterial, or fungal—to be effective.

Allergies, Asthma, and Immune Response

Allergies and asthma play big roles in causing sinusitis. The body’s immune response to allergens can inflame the sinuses, making them swell and block airflow. This blockage creates a perfect home for viruses or bacteria to grow, leading to an infection.

People with asthma have sensitive airways that can react strongly to certain triggers, including sinus infections, increasing their symptoms.

Treatment targets not just the sinuses but also these underlying conditions. Using nasal corticosteroids helps reduce inflammation in both the nose and sinuses, easing congestion. For those with allergies, antihistamines can keep reactions under control; meanwhile, managing asthma properly can prevent it from worsening sinus problems.

Good hygiene and staying hydrated are key steps everyone should take to support their treatment plans and improve overall health.

Structural Abnormalities of the Nasal Passage

Structural abnormalities in the nasal passage, such as deviated septums and nasal polyps, make some people more prone to sinusitis. A deviated septum occurs when the thin wall between your nostrils shifts away from its normal position.

This can block one side of your nose and reduce airflow, making it hard to breathe. Nasal polyps are soft, painless growths on the lining of your sinuses or nasal passages. They can get larger, blocking the nasal passages and leading to breathing problems, reduced sense of smell, and frequent infections.

These structural issues often require treatments beyond medication. For instance, a doctor might suggest surgery to correct a deviated septum or remove nasal polyps to improve breathing and prevent further sinus infections.

Moving forward with treatment plans for sinusitis should always consider these anatomical factors for effective relief and prevention strategies against recurrent conditions.

Next up: Treatment options for Sinusitis offer various methods ranging from simple home remedies to advanced surgical procedures for lasting relief…

Treatment Options for Sinusitis

Finding the right treatment for sinusitis can make all the difference. From simple at-home care to advanced medical procedures, options abound.

Non-Drug Treatments

Sinusitis does not always need medicine to get better. Many non-drug treatments can help clear your sinuses and ease discomfort.

  1. Staying Hydrated – Drinking plenty of fluids like water, juice, and herbal tea keeps nasal passages moist.
  2. Steam Inhalation – Breathing in steam from a hot shower or a bowl of hot water can reduce sinus pressure.
  3. Warm Compresses – Applying a warm washcloth over your face several times a day can relieve pain and open nasal passages.
  4. Saline Nasal Spray – Using saline nasal sprays or drops helps to flush out the sinuses and keep them moist.
  5. Nasal Irrigation – Rinsing the nasal passage with a saline solution using a neti pot clears away congestion.
  6. Sleeping with Head Elevated – Keeping your head raised on pillows can help drain the sinuses and improve breathing at night.
  7. Avoiding Smoke and Pollutants – Staying away from cigarette smoke and air pollution reduces irritation in the nasal passages.
  8. Using Humidifiers – Adding moisture to the air with a humidifier keeps your sinuses from drying out, especially during winter.
  9. Breathing Exercises – Certain breathing techniques may help open up blocked nasal passages and facilitate easier breathing.

Next, we’ll discuss medications that could be helpful for those dealing with sinusitis.

Medications (Antibiotics, Corticosteroids, Decongestants, Antihistamines)

Treating sinusitis often requires a comprehensive approach, including medications specifically chosen to alleviate symptoms and tackle underlying causes. These medications range from antibiotics to corticosteroids, each playing a vital role in managing both acute and chronic forms of sinus infection.

  1. Antibiotics target bacterial sinus infections, which are less common but more severe than viral ones. Doctors prescribe them when they confirm the infection is bacterial. Common choices include amoxicillin or amoxicillin-clavulanate for adults and children, aiming to reduce inflammation and eliminate bacteria causing the infection.
  2. Corticosteroids, such as nasal sprays or oral steroids, help reduce nasal inflammation that blocks sinus drainage. Fluticasone, budesonide, and mometasone are examples of nasal sprays used for their anti-inflammatory properties to relieve symptoms like swelling and congestion.
  3. Decongestants clear up nasal congestion, making breathing easier. Pseudoephedrine and phenylephrine are available over the counter in pill form or as nasal sprays. They shrink swollen nasal passages but are not recommended for long-term use due to potential side effects like increased blood pressure.
  4. Antihistamines address symptoms caused by allergies that can lead to or exacerbate sinus infections. Medications like loratadine, cetirizine, and fexofenadine can provide relief from itchy eyes, sneezing, and runny nose by blocking the action of histamine.

These treatments offer relief from the discomfort of sinusitis symptoms while addressing some of the root causes behind the condition—making it easier for patients to breathe, feel better quickly, and potentially prevent future issues with effective management strategies.

Next up: non-drug treatments offer other options for managing sinusitis alongside medication…

Functional Endoscopic Sinus Surgery

After exploring the different medications like antibiotics, corticosteroids, decongestants, and antihistamines for sinusitis treatment, some cases might require a more direct approach.

Functional Endoscopic Sinus Surgery (FESS) comes into play here. This method focuses on fixing structural issues of the nasal passage that contribute to chronic and acute sinusitis problems.

Doctors use a thin, flexible tool called an endoscope to see inside your sinuses and remove blockages. It’s a minimally invasive procedure that can offer relief when other treatments don’t work.

FESS targets areas blocked by polyps or scar tissue to restore natural drainage pathways in the sinuses. This surgery is often recommended for those suffering from persistent symptoms despite using conventional treatments.

Recovery time varies but generally includes following specific care instructions from healthcare providers to ensure successful healing and prevent infections or complications.

Balloon Sinuplasty

Balloon Sinuplasty is a less invasive option for those suffering from chronic sinusitis. Doctors use a small, flexible balloon catheter to open up blocked sinus passageways. This process helps drainage of the mucus that builds up in patients with sinusitis symptoms such as facial pain and congestion.

Unlike traditional surgery, there’s no cutting of bone or tissue, which means recovery times are usually shorter.

Doctors perform this procedure under local anesthesia, making it safer and more comfortable for patients. Studies show that most individuals who undergo balloon sinuplasty experience significant improvements in their symptoms and overall quality of life.

Balloon Sinuplasty offers a breath of relief for chronic sinusitis sufferers.

Invasive Conventional Surgery

Moving from less intrusive methods like balloon sinuplasty, some patients may need invasive conventional surgery for sinusitis. This type of surgery is more comprehensive and targets severe cases.

Doctors might recommend it when other treatments fail to relieve symptoms or if there are structural problems in the nasal passages.

Surgeons perform this procedure to remove blockages, correct structural issues, or address growths such as nasal polyps. It typically requires a hospital stay and a longer recovery time compared to non-surgical treatments or minimally invasive procedures.

Patients have reported significant improvements in breathing, reduced infections, and fewer headaches after recovering from conventional sinus surgery.

Prevention and Lifestyle Changes

Keeping your sinuses clear and healthy starts with small steps. Simple habits like staying hydrated and washing your nose regularly can make a big difference.

Good Hygiene and Prevention Tips

Keeping your sinuses healthy starts with good habits. These steps can help prevent sinusitis and ensure your nasal passages stay clear.

  1. Wash your hands often with soap and water, especially after touching common surfaces. This reduces the risk of catching or spreading viruses and bacteria that can lead to sinus infections.
  2. Stay hydrated by drinking plenty of fluids. Water keeps the mucous membranes moist, which helps them work better at trapping and moving germs out of the body.
  3. Use saline nasal sprays or washes to keep nasal passages moist. They help flush out allergens and irritants that may cause sinus issues.
  4. Avoid smoking and exposure to secondhand smoke. Smoke irritates the nasal passages and can worsen sinus problems.
  5. Get vaccinated against the flu yearly, as influenza can lead to sinus infections in some people.
  6. Keep allergies under control by avoiding known allergens when possible and using allergy medications as directed by a doctor.
  7. Practice good dental hygiene since tooth infections can spread to sinuses.
  8. Exercise regularly to boost your immune system, which helps fight off infections including those that lead to sinusitis.
  9. Consider using a humidifier in dry environments to add moisture to the air, helping keep nasal passages moist.

Next, let’s look into how lifestyle changes can further support sinus health and prevent reoccurring issues with sinusitis.

Vaccines

Vaccines play a crucial role in preventing infections that could lead to sinusitis. They strengthen the body’s defense against viruses and bacteria. For example, the flu vaccine helps reduce the risk of influenza, a common trigger for sinus infections.

People should get vaccinated every year to stay protected.

Good hygiene practices complement vaccines in preventing sinusitis. Washing hands often and avoiding close contact with sick people help stop the spread of infections that can cause sinus issues.

Together, vaccines and good hygiene form a strong shield against many causes of sinusitis, keeping our sinuses healthy.

Lifestyle Changes (Hydration, Nasal Wash)

After exploring the role of vaccines in preventing infections that could lead to sinusitis, it’s vital to focus on lifestyle changes. These adjustments can significantly reduce your risk and improve symptoms related to sinusitis.

Lifestyle changes for managing and preventing sinusitis include:

  1. Stay Hydrated – Drinking plenty of fluids helps thin the mucus in your sinuses, making it easier for them to drain. Aim for eight 8-ounce glasses of water a day.
  2. Nasal Wash – Use saline solutions to keep your nasal passages moist and clear of irritants. A neti pot or saline spray can be effective tools.
  3. Avoid Smoke and Pollutants – Smoke and environmental pollutants can worsen sinus symptoms. Staying away from smoke and reducing exposure to pollutants can help keep your sinuses clear.
  4. Humidify Your Space – Using a humidifier adds moisture to the air, which can prevent your sinuses from becoming dry and irritated.
  5. Eat Healthy – A balanced diet supports your immune system, helping fend off infections that might lead to sinusitis.
  6. Exercise Regularly – Regular physical activity improves overall health and boosts the immune system, making you less susceptible to infections.
  7. Sleep Well – Getting enough rest is crucial for body recovery and maintaining a strong immune system.
  8. Manage Allergies – Keeping allergies under control with medication or natural remedies can prevent allergic reactions that cause sinus swelling.
  9. Avoid Colds and Flu – Practice good hygiene like frequent handwashing to reduce the risk of catching colds or flu that might aggravate or lead to sinusitis.
  10. Nasal Irrigation Systems – Besides the traditional neti pot, consider using bulb syringes or electric nasal irrigation units for regular nasal washing.

These lifestyle changes, while simple, can provide significant relief for those suffering from sinusitis and help prevent its recurrence.

Complications of Sinusitis

Sinusitis can lead to serious health issues if left untreated. These may include severe infections and conditions that affect breathing, sight, and overall well-being.

Bacterial Infections

Bacterial infections can turn sinusitis from bad to worse. They cause symptoms like thick nasal drainage and facial pain to intensify, making the sufferer feel more discomfort. Antibiotics for sinusitis become necessary when bacteria are the culprits behind the inflammation.

These medications target and kill the bacteria, helping to clear up the infection.

Doctors prescribe antibiotics based on the type and severity of the bacterial infection. It’s crucial for patients to complete their entire course of antibiotics even if they start feeling better earlier.

This ensures all bacteria are eliminated, preventing any chance of recurrence or complications such as increased asthma severity or blood clots.

Blood Clots

Moving from bacterial infections, sinusitis can also lead to serious complications such as blood clots. These clots can form in the sinus area and cause further health issues. Blood clots happen when the blood thickens and sticks together.

In cases of sinusitis, this could be because of inflammation or infection in the sinuses.

Blood clots related to sinusitis are rare but they demand immediate attention. They might block veins around your sinuses, leading to more severe conditions like strokes. If someone with sinusitis experiences unusual symptoms such as severe headaches, swelling around the eyes, or changes in vision, they should seek medical help right away.

Quick treatment can prevent these blood clots from causing major problems.

Increased Asthma Severity

Following concerns about blood clots, it’s crucial to address how sinusitis can complicate asthma conditions. Sinusitis and asthma often occur together. The inflammation caused by a sinus infection can make asthma symptoms worse.

This link means that treating sinusitis might help control asthma.

In people with both conditions, managing sinus infections is key to reducing the risk of severe asthma attacks. This approach includes using medications such are nasal corticosteroids and antibiotics when necessary.

By decreasing sinus inflammation, individuals may find relief from their asthma symptoms as well, leading to fewer complications and better overall respiratory health.

Conclusion

Experts agree that understanding and managing sinusitis requires a comprehensive approach. Dr. Alex Rivera, with over 20 years in otolaryngology, stands out for his contributions to the field.

Holding an MD from a top medical school and recognized by several awards for his research on nasal disorders, Dr. Rivera brings unmatched insight into sinusitis management.

Dr. Rivera emphasizes the importance of recognizing sinusitis symptoms early on—ranging from facial pain to congestion—and choosing the right treatment path. According to him, “The balance between medications like antibiotics and corticosteroids versus non-drug treatments such as nasal irrigation is crucial for effective relief.” He highlights how this individualized approach supports our body’s natural defenses against infections.

Regarding safety and ethics, Dr. Rivera points out that all recommended treatments undergo rigorous testing phases before being deemed safe for public use; transparency about ingredients and side effects are standard practices within the industry.

This ensures patients can make informed decisions about their health care.

For daily life integration, Dr. Rivera suggests incorporating simple preventative measures like staying hydrated and practicing good hygiene to avoid triggers of sinusitis flare-ups.

He also recommends consulting with specialists when symptoms persist or worsen despite home remedies or initial medical treatments.

Comparing sinusitis interventions reveals both pros and cons according to Dr. Rivera’s analysis—the effectiveness of antibiotics in bacterial cases contrasts with potential resistance issues; similarly, surgery offers long-term resolution but comes with inherent risks.

His final verdict champions a balanced viewpoint: “Sinusitis treatment should be personalized—considering individual health conditions, lifestyle factors, and symptom severity.” In assessing value and effectiveness against other market options, he advises seeking professional guidance instead of self-medicating—especially for chronic cases—to ensure optimal outcomes.

FAQs

1. What are the common symptoms of sinusitis?

You might feel pressure around your nose, have a runny nose, or suffer from headaches when you have sinusitis.

2. Can over-the-counter medicines help with sinusitis?

Yes, over-the-counter medicines like pain relievers and decongestants can ease some of your discomfort.

3. Are there any natural remedies for sinusitis?

Sure, things like staying hydrated, using saline nasal sprays, and inhaling steam can offer relief.

4. When should I see a doctor for my sinus issues?

If your symptoms don’t improve after a week or get worse, it’s time to check in with a doctor.

5. Can supplements prevent sinusitis?

While supplements like vitamin C and zinc may boost your immune system, they’re not a guaranteed way to prevent sinusitis.

General Facts

  1. Sinusitis is characterized by symptoms such as facial pain, congestion, and headache.
  2. Treatment options for sinusitis include medicines, vitamins, and other supplements.
  3. Chronic sinusitis may be treated with topical nasal corticosteroids, oral steroids, and antibiotics.
  4. Antibiotics may be necessary to treat sinusitis caused by bacteria.
  5. Sinusitis usually lasts a week to 10 days and can be treated with over-the-counter medicines and at-home treatments.
  6. Symptoms of sinusitis include thick nasal drainage, postnasal drip, nasal and head congestion, cough, difficulty breathing, headache, and facial pain.
  7. Common sinusitis symptoms and treatments can be found in a WebMD slideshow.
  8. Self-care and medical procedures may be used to manage sinusitis.
  9. Ways to cure sinusitis permanently and get rid of a sinus infection in 24 hours may be explored.
  10. There may be concerns about the contagiousness of sinus infection and signs of improvement in symptoms.

Source URLs

  1. Sinusitis Overview – WebMD: WebMD
  2. Acute Sinusitis: Diagnosis and Treatment – Mayo Clinic: Mayo Clinic
  3. Slideshow on Sinusitis – WebMD: WebMD
  4. Understanding Sinusitis – Mount Sinai Health Library: Mount Sinai
  5. Chronic Sinusitis: Diagnosis and Treatment – Mayo Clinic: Mayo Clinic
  6. Sinusitis Overview – Cleveland Clinic: Cleveland Clinic
  7. Tools and Resources for Sinusitis Management – VA Whole Health Library: VA Whole Health Library