12) Friday Nite at the ER

Not that it is hugely important to this Blog... on February 23rd I was back on the road to San Antonio School of Nursing for my second Covid-19 Vaccine in the middle of the day for a 1:00 p.m. appointment... and worried about getting a debilitating nosebleed somewhere along the route.  The Gods were with me though and aside from a general sense of apprehension I made it to San Antonio, got my vaccine, and was back home before 5.

February 26, 2021: As is normally the case in my HHT situation, I have a few spotty nosebleeds after a major bleed that ends with a trip to one of the doctors who diagnoses an epistaxis helps me stop the bleed.

On that Friday night my nosebleed intensified and I was unable to slow it or stop it.  Finally Liz and I decided to return to the new Scott & White ER close to our house: since it is very new, the place was empty and we were taken right in to a treatment  room and seen by Dr. Tomar. With his guidance we flushed my nose about 6 times with Afrin and then he had me use the accepted Elsevier procedure (see below) for stopping nosebleeds.  

This procedure is basically 1) flushing and clearing the nose and sinus cavity with Afrin; 2) tilting head a little forward, and 3) pinching the nostrils using the tissues to the nose for 10 minutes. Then, 4) letting go of the nose, and 5) if there is still bleeding, repeat the process, and 6) repeat the steps until the bleeding stops.

After using this procedure around 4 times the doctor moved up the medical treat-ment scale to packing my right nostril, which seemed to be most heavily flowing.

Packing A Nostril: After messing around trying to get this bleed to stop, Dr. Tomar and I decide to pack it and leave it for a few days (5 days limit for this method due to change of infection).  Packing materials have evolved significantly since the year when I got packed the first time (c. 1996).  Over the past three weeks I've been introduced to two types, one that is lubricated and inserted and the other, which seems more technologically advanced and comfortable (a rapid rhino).  Here is a video showing the basic tools of this kind of procedure.  

Once the packing was set, it felt to me like a semi-hardened kind of packing peanut stuffed in my nose. This method comes with antibiotics and I got a prescription for some pain meds too, since it was apparent to me that sleeping was going to be uncomfortable for me.

March 3, 2021

Pulling the Plug: We went to Austin Regional Clinic to meet with Bryan Watabe, PA, who knows something about HHT, has worked with me before, and who may know some other Austin docs who use laser with HHT.  Dr. Levy had already left us a message that he thought the active spot was too far up in my sinus cavity for his interest.

Watabe easily pulled out the packing, with no pain at all to me!  Then we talked about some other ways to home treat the situation by again adding a humidifier, avoiding bending over from the waist, and he gave us a referral for and ENT group that has been using laser for spots rather than cauterizing. 

There are other actual bleeding treatments as featured in a Youtube with Dr. Terrell at U of Michigan.  Dr. Terrell thinks the absolutely most important treatment is keeping the nose moist! He goes on to review the ones he prefers. 

By the time we left ARC I was feeling better about the HHT episodes, even though I knew I had to really take it easy for a week so as to avoid restarting the bleeding 

March 4, 2021: So, the very next morning I get a 4 hour nosebleed starting when I sit up in bed at 6:00 a.m.  I am able to get this one to stop.  Then, on March 6th I get another one that also starts when I sit up in bed, and even though ER visits are expensive, by 7:15 we are deciding we are too worn out to fight this again, and by 7:30 am, we're  back at Scott & White talking to Dr. Wallace, who is ready to pack my nose again if needed.  

Then... voilà: the bleeding has stopped. We sit around waiting to see if it will start again.  Dr. W. is off to see another patient, drink coffee, or complete some other medical task and returns every 20 minutes or so to check on us.  By 8:30 we are NOT packed but happy to be going home, and I'm wishing I we hadn't decided to add another charge to our ER tab.

Liz went right out and bought a new humidifier and I've had no more late night or early morning nose bleeds!  So it goes.