Info not question, comments welcome - Bleeding

[Jerry_NJ]

Here's a link to a reply I made today on Blood Disorders.  I went there because of a nose bleed problem aggravated by Warfarin.   The USA products I noted there may be among the "best kept secretes in medicine"

http://www.medhelp.org/posts/Blood-Disorders/clotting-/show/2068099

[Jerry_NJ]

I have a follow up with "my" newest doctor, the ENT who took the balloon out.  That appointment is February 5.  

I have had a congested nostril on the left, bleed side, since I left the office and I think it is mostly from whatever he put in my nostril at the first visit because the "too early" removal of the balloon left me with some seepage. I think he said "latex" and his nurse gave me a NasalCease packet to take home.  As it was Friday afternoon I was told to return to ER if the nose bleed started, it did not.  I feel some opening in my left nostril today and I think the ENT said whatever he  put in would be absorbed.  He did not mention cauterization - but the ER doctor said he'd have done it if the Afirin had stopped the bleeding and the area was "small".  

I started using Equate brand Vaseline in both nostrils from that visit and increased my use of saline spray and humidification - but the humidity is still very low in my house, due in part to supplementing heat with a wood stove when the temperatures get bellow 20 degrees, which have been common in NJ this January.  We're headed to single or even below zero in the next period, tonight I think.

I ordered a 5 pack of NasalCEASE from Amazon, I didn't see any at the Walmart pharmacy - and I didn't ask the pharmacist, it may be behind the counter even though no prescription is needed.  

[achillea]

Ah, the numerous delights of nosebleeds! I have a strong tendency towards this annoying business myself, and I do keep Afrin and NasalCEASE on hand for it. For me, though, the cause is not warfarin.  It is a constellation of little vessels moderately high up on the nasal septum, called Kiesselbach's Plexus.

In some people, this cluster of blood vessels gets pretty overgrown, so it's no longer safely embedded in the mucosa, but becomes quite superficial.  That means that anything can injure it and cause a nosebleed.  The leading cause in fact is the cold, dry air you mention:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096213/

When nosebleeds become chronic because these vessels are too numerous and fragile, a very effective treatment is cautery, usually via silver nitrate, although electrocautery is sometimes used.  I have to have this done about every five years, because although cautery is most effective, the nasty little vessels grow back eventually.

My ENT advises me to keep that area moist in dry weather.  There are various OTC saline-type nasal gels one can use, but the pharmacist told me that the best thing is plain old K-Y Jelly, because it's non-allergenic, non-irritating, and cheap.  Some docs recommend heavier ointments, and among them, a topical nasal antibiotic called Mupirocin or Bactroban is remarkably effective in preventing bleeding.  However, since it's an antibiotic, doctors don't want to prescribe it for long-term use.

Anyhow, for the nose-bleed crowd--as you point out--there are at-home measures the patient can take.  It can also be worth asking the doctor if you've got an overgrown Kiesselbach's Plexus and if so, could it be cauterized.

But there is another site, further back in the nose, that causes heavy, dangerous nosebleeds, and for those, packing and pressure such as you had are the treatment.  In these cases, the bleeding is so copious that I doubt that Afrin or NasalCEASE would be enough to stop it, but it could be worth a trial to see if it helps.

[Paderla Anitha, DNB]

Thanks for the info. Now the shift is towards 'patient centered medical home' and this could be a starter in that direction..:)

[skydnsr]

Good information.  Thanks, Jerry.  I'm on warfarin too.  I haven't had any bad nosebleeds yet, but you never know.