The Connection Bridgewater-Somerville Edition Feb/Mar 2019

www.theconnectionsnj.com NOSE BLEEDS By: Todd A. Schneiderman, M.D. F.A.C.S. It is nose bleed season and every year many go to the doctor for this problem. It happens frequently and often for no definite reason. Sometimes nasal trauma, allergies and nose picking may cause this but many times it is hard to tell why it starts. A typical patient may come in with no definite reason other than needing a blood thinner for atrial fibrillation. Many people are on blood thinners for different rea- sons, sometimes with cardiac arrhythmias like a fib and cardiac stents, and this makes nose bleeds more likely. The issue is that an injury to the nasal lining occurs, and that the bleeding does not stop easily. The injury may be trauma from sports or an accident or just nasal dryness. This happens in the winter, when heating dries the home. The clot- ting is impaired by a blood thinner and one is at risk for significant bleeding in this situation. The way to stop bleeding would usually be to put pressure on the injury but with nose bleeding the site may not be obvious. Nose bleeding, while definitely inconven- ient, is concerning because it is hard to tell how much blood loss there is and where to press to stop the hemorrhage. How to stop a nosebleed Step 1-Pinch the nostrils together for 5 minutes with the head for- ward, so blood does not run down the throat. If this does not work: Step 2-Blow any clots from the nose gently, and spray 2 puffs of over-the-counter Afrin nasal spray into the bleeding nostril, and pinch for another 5 minutes. You should check with your doctor to make sure this is safe. Do not use Afrin nasal spray if you have a history of heart problems, such as a fib or high blood pressure. Step 3-If this does not work, spray the Afrin on a cotton ball, place the cotton ball in the bleeding nostril, and pinch to apply pressure over the cotton ball. If these steps do not work consider going to the emergency room. Bleeding may still occur if cauteri- zation or packing is needed, if this happens, follow the above steps. If packing is placed, take antibiotics and pain medications as directed. How to prevent nosebleeds Salt water spray may be used to clear crusting, 2 puffs/nostril two or more times a day, blowing the nose gently. After use of nasal saline spray, nasal saline gel may be used to keep the nasal lining moist. Do not use q tips. Place 1/2 tsp. in the nostril directly from the tube, then pinch the nostrils to distribute the gel. This is also sometimes available as a spray gel. If you take a prescribed blood thin- ner, do not stop this unless directed to by the prescribing doctor. Med- ications such as ibuprofen (Motrin, Advil) may also make this worse. Packing may be needed, and this is left in for 3-5 days. In severe cases, surgery may be needed. PAGE 23 Health & Wellness