I’ve recently had recurring nosebleeds and I’m reluctant to leave the house in case they come back. How long will it take for my nose to heal and will I be susceptible to it in the future?
Name and address provided.
Nosebleeds fall into two categories — anterior and posterior — depending on which blood vessel the bleeding originates from.
Anterior nosebleeds are the most common and less serious form. These begin at the front of the nose in Little’s area, a point where three arteries meet in the septum, the septum in the center of your nose.
They are best stopped by squeezing just above your nostrils (not the bridge, a popular misconception) for ten to fifteen minutes while leaning slightly forward. (Don’t be tempted to tilt your head back, as this will force the blood down your throat.)
Nosebleeds fall into two categories — anterior and posterior — depending on which blood vessel the bleeding originates from
Posterior nosebleeds start further back and are more concerning. Bleeding normally starts in a branch of the sphenopalatine artery and can be rapid and severe. These nosebleeds cannot be controlled by pinching the nose and specialist care is required.
From the description in your longer letter it sounds like your nosebleeds are frontal – and you ask if they were caused by exercise or leaning forward while gardening, but I think this is unlikely as bending over is not usually a trigger.
A common cause is dry air – such as with central heating – because it can irritate the nasal lining. This is what you say your GP considers most likely.
Other risk factors include taking low-dose aspirin, warfarin, and other medications to prevent blood clots.
Some hay fever medications, especially intranasal steroid sprays, may increase the likelihood of nosebleeds, possibly because long-term use of steroids can thin the skin and nasal mucosa. And recent large studies have confirmed that high blood pressure may also be a factor.
A common cause is dry air – such as with central heating – because it can irritate the nasal lining. This is what you say your GP considers most likely
Recurrent nosebleeds can be distressing and I understand your desire to stay close to home. But it only takes 48-72 hours for the blood vessels behind the anterior nosebleeds to heal, meaning it’s safe for you to live your normal life.
To prevent recurrence, I suggest the following home remedy to prevent your nasal mucosa from drying out. Mix a teaspoon of table salt and a teaspoon of baking soda in half a liter of boiled water that you have allowed to cool (you can leave this in the refrigerator for up to 30 days).
Once or twice a day, place a pool of this solution in the palm of your hand and sniff it into your nostrils, especially if you’ve had the central heating on. I hope this helps.
A recent blood test showed I had a kidney function reading of 59 from a usual 76-ish (I’m 64). I take lansoprazole to counteract the fact that I take prednisolone for vasculitis. I read that lansoprazole can make kidney problems worse. Is there an alternative?
Crispian Watson, by email
Your concern about the lansoprazole may be misplaced.
Vasculitis, inflammation of the blood vessel walls, is a symptom of other diseases such as rheumatoid arthritis rather than a disease in itself.
The steroid prednisolone is usually prescribed along with other immunosuppressants to curb inflammation. Since this often irritates the gastric mucosa, medications to suppress stomach acid production, such as omeprazole or lansoprazole, can prevent further irritation.
These types of antacids are associated with kidney damage, but this is extremely rare. So rather than the medication being the culprit, untreated vasculitis is more likely to have led to inflammation in the blood vessels that supply the kidneys, causing them to function less well.
A normal kidney function score – which measures filtering ability – is above 90 ml per minute. The first level of decline, stage two renal failure, is 60 to 89 ml per minute, stage 3A is 45 to 59 ml per minute. Yours is not a serious level of deterioration, but it does show that it is not normal. You should discuss this with your advisor. I expect they will suggest continuing your current vasculitis medications to protect your future kidney function. This may sound nerve-wracking, but rest assured that you’re getting the right treatment.
Write to Dr. Scurr
Write to Dr Scurr at Good Health, Daily Mail, 2 Derry Street, London W8 5TT or email [email protected]. uk — add your contact details. Dr. Scurr cannot respond to personal correspondence. Answers should be taken in a general context and always consult your own GP if you have any health concerns.
In my opinion: Hidden risk of excess later in life
The incidence of sexually transmitted diseases has increased recently, with a 20 percent increase in those over 65.
The increased availability of Viagra along with online dating opens up new opportunities. In itself this is a good thing, but I would still like to be careful.
Contraception is not the only reason to use condoms – they also protect against the rising wave of gonorrhea, chlamydia, herpes and other infections of the genitals. Syphilis and HIV are also on the rise.
The focus of people of retirement age is on having a new and fulfilling adventure, but I would urge them not to become blind to the risks of what can be very serious infections.