Why We Actually Want to See You When You Feel Your Worst

Short answer: When you call to reschedule because you are in the middle of a sinus flare and feel too sick to come in, our answer is always the same: come in now. Seeing you on your worst day gives us information we simply cannot get on a good day — active mucopus for genetic sequencing, a CT scan that reflects your true disease burden, an endoscopy that shows inflammation and obstruction that will disappear once you recover. The bad day is not an obstacle to your evaluation. It is the evaluation. Coming in while you are symptomatic may be the single most important step toward getting you a definitive treatment plan and putting this behind you for good.

By Dr. Franklyn R. Gergits, MBA, DO, FAOCO · Board-Certified Otolaryngologist · Fellowship-Trained Otolaryngic Allergist · Clinical Focus in Rhinology and Airway Disorders · 30+ Years of Experience · Founder, Sinus & Allergy Wellness Center of North Scottsdale

The Call We Get All the Time

A patient calls the office. They have an appointment scheduled. They feel terrible — facial pressure, thick drainage, congestion that has not let up in two weeks. And they want to reschedule. They do not want to travel when they feel this bad. They figure they should wait until they feel better so the visit is more useful.

We tell them the opposite: come in now. Come in today if you can.

This surprises most patients. The instinct makes sense — why go to a doctor when you are at your worst? Would it not be better to feel human first, then have a thoughtful conversation about what is going on?

The answer is no. And understanding why changes how you think about your care.

What a Bad Day Gives Us That a Good Day Cannot

When you are in the middle of a sinus flare, your body is showing us exactly what we need to see. The sinuses are active. The inflammation is present. The infection — if there is one — is producing the organisms and the mucopus that allow us to identify precisely what is happening inside your nose and sinuses.

The most valuable thing we can do on a bad day is perform nasal endoscopy and obtain a specimen for MicroGenDX next-generation genetic sequencing. When you are symptomatic, the endoscopy shows us active mucopus — visible, accessible, collectable. That specimen goes to the lab for next-generation molecular sequencing — advanced molecular pathogen identification that goes far beyond what a standard culture can detect. It tells us exactly what bacteria are present, whether they carry resistance genes, whether there are fungal components, and what biofilm signatures exist. This is not a test of your human genetics — it is a test of the organisms living in your sinuses at their most active moment.

When you feel better — when the acute flare has resolved and you come in on what feels like a good day — the mucopus is gone. The specimen is gone. We can look at your sinuses and see the aftermath of the inflammation, but we cannot capture the active organisms. We cannot get the same quality of culture-directed information. The window has closed.

The same principle applies to imaging. If we repeat a CT scan during an active flare and compare it to a prior scan taken on a good day, we can see exactly where the disease is most severe, how the inflammation has progressed or shifted, and whether structural blockage is contributing to the acute event. That comparison tells a story that a single scan on a good day cannot tell alone.

The SNOT Score — Why Symptom Burden Matters in Real Time

We also use validated symptom scoring tools — the SNOT-22 is the most common — to quantify how severely your sinus disease is affecting your quality of life. A SNOT-22 score taken during an active flare reflects your true disease burden. A score taken on a good day reflects your baseline — which in CRS patients is already abnormal, but which significantly understates the impact of acute flares.

For insurance authorization, for documentation of medical necessity, for establishing the severity that justifies procedural intervention — the bad day score is the one that tells the complete story. Your insurance company needs to understand not just your average experience but your worst experience. We need to capture that while it is happening.

We cannot reconstruct a SNOT-22 score from memory on a good day. We cannot ask you how bad it was last week and reconstruct the same validated score. The SNOT-22 score has to be captured in real time, while you are living it.

The Message to the Patient Who Wants to Cancel

When a patient calls and says they feel too sick to come in, here is what we tell them — and I mean every word of it:

We understand how you feel. We know the last thing you want to do when your face hurts and you cannot breathe is get in a car and come to a medical office. We hear that. But if you can get yourself here today, we can do something that a visit next month when you feel better simply cannot accomplish. We can look inside your sinuses right now, while the infection is active. We can collect a specimen and find out exactly what is growing — not what we guess, not what the last culture showed, but what is there right now. We can capture your symptom score while it reflects your true experience. We can get the imaging that shows your insurance company what you are actually dealing with.

All of that information — taken together — gives us and your insurance company everything we need to build a complete, finalized, potentially potentially definitive treatment plan. Not another course of antibiotics. Not another temporary fix. A real plan that addresses the root cause — one aimed at significantly improving or resolving your symptoms, not just managing them temporarily.

That is what the bad day visit can do. The good day visit cannot come close.

What We Find on Endoscopy During a Flare

On nasal endoscopy during an active sinus flare, we typically see things that are clinically significant and immediately actionable. Mucosal inflammation and swelling that narrows or obstructs the drainage pathways. Visible mucopus — the thick, sometimes colored secretions that represent active infection or significant inflammation — accessible for specimen collection. Sometimes we can see the origin of the infection — whether it appears to be coming from a specific sinus, whether the pattern suggests a dental origin, whether the consistency and character of the secretions suggests fungal involvement alongside or instead of bacterial.

We can identify whether there is obstruction contributing to the flare — turbinate swelling, swell body enlargement, or polypoid changes that are preventing adequate drainage and creating the conditions for repeated infection. These findings, combined with the genetic sequencing results, give us the most complete picture of your individual sinus disease that it is possible to obtain.

On a good day, the mucopus is gone. The swelling has partially resolved. The endoscopy shows us the anatomy — and the anatomy is important — but it does not show us the active disease in the same way. We see the aftermath, not the event.

Dr. G’s Pearls

▸ The visit you want to cancel may be the most valuable one we can do. Seeing you on your worst day gives us diagnostic information — active mucopus, real-time SNOT score, active CT findings — that disappears when you recover.

▸ MicroGenDX requires active infection to yield its best results. The specimen we collect during a flare tells us what is actually growing — bacteria, resistance genes, fungal elements, biofilm signatures. That window closes when you recover.

▸ Your bad day SNOT score is the one that reflects your true disease burden — and the one your insurance company needs to see to authorize definitive treatment. We cannot reconstruct it from memory on a good day.

▸ Come in during a flare if you possibly can. If you are symptomatic and have access to a specialist, that is the moment to be evaluated — not after the antibiotics have suppressed the infection and the window has closed.

▸ One visit on a bad day can accomplish more than three visits on good days. It is not about how you feel when you walk in. It is about what we can find and document while the disease is active.

Want to Understand More?

What Is MicroGenDX and Why Does It Change Everything About Sinus Treatment?

Why Antibiotics Keep Failing Your Sinus Infection

What Is Balloon Sinuplasty — And Are You a Candidate?

My Doctor Recommended Multiple Procedures — Is That Too Much for One Visit?

Is It Possible to Have Sinusitis Without a Cold?

About the Author

Dr. Franklyn R. Gergits, MBA, DO, FAOCO is a Board-Certified Otolaryngologist and Fellowship-Trained Otolaryngic Allergist with a Clinical Focus in Rhinology and Airway Disorders and over 30 years of clinical experience. He is the founder of the Sinus & Allergy Wellness Center of North Scottsdale, where he performs in-office balloon sinuplasty, turbinate reduction, NEUROMARK® posterior nasal nerve ablation (Neurent Medical, FDA-cleared radiofrequency ablation system), and Eustachian tube dilation under local anesthesia. He performed the first balloon sinuplasty in Pennsylvania and holds dual Entellus Centers of Excellence certifications. Dr. Gergits is the originator of the Posterior Sinonasal Syndrome (PSS) hypothesis — a clinical framework identifying pepsin-mediated posterior nasal mucosal injury as an upstream driver of chronic rhinosinusitis. Preprint available at Preprints.org (DOI: 10.20944/preprints202603.0858.v1). ORCID: 0009-0000-4893-6332.

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This content is for educational purposes only and does not constitute medical advice. If you are experiencing an acute sinus flare or recurrent sinus infections, please consult a qualified otolaryngologist for evaluation. Do not delay care because you feel too sick to be seen — that may be exactly the right moment to come in.