Ooey, Gooey: the Revenge of the Nosebleeds

Today, the cliff shall be unhanged! It's a little anticlimactic, since we're not talking about horrible tumors or immanent death, but it's kind of gross.

As I wrote on the night of the 12th, I was to see the amazing neurosurgeon who had tried to plug my nosebleeds and then see a very well-respected neurologist and stroke expert whom I will call Lord Strokes (This is not at all fair. He's a very nice guy who, in no way resembles the evil overlord of the First Order.)

So, on Friday, the 13th*, Kathleen and I drove downtown to the O'Hair Medical Center for the appointments. First, we saw Lord Strokes.


Meeting with Lord Stokes

I hadn't seen Lord Strokes since 2006 when I had my first stroke, so we had a lot of catching up. I had sent him one of my own patients recently, and we discussed that too. The good news is that there has been a big study comparing doses of aspirin from 50 mg to 1300 mg per day for the prevention of stroke. There was NO difference except that the incidence of stomach ulcers and kidney damage increased with dose. So I can get by on a low dose which will cause less of a risk of nosebleeds.

Then, it gets complicated. There are two likely causes of my strokes.

One of them is absurd amount of radiation to my head I got for my cancers. Sadly, this was not ruled out when the neurosurgeon found no narrowing of the arteries of my head. The effect of the radiation is on microscopic vessels called arterioles. This is not visible until you cut the patient's head open and collect some tissue. I'm not really up for that. But I think this is the most likely cause. I received so much radiation that radiation oncologists practically faint when they hear about it. Also, the two strokes were located close together within the radiation field.

However, that still leaves the issue of the little hole between the top two chambers of my heart (patent foramen ovale, or PFO).** It is possible that a small blood clot found its way from the right side of my circulation, through the PFO, into the left side of my circulation, and to my brain. Even if it's not the case, with a PFO, my risk of stroke is 1.5 % a year. If I get the PFO closed, that risk drops to half a percent per year.

Closing the PFO is relatively easy. They spike my crotch again (which is getting to be routine), and another catheter is threaded up, this time through the veins, and into the the right side of my heart. There, they would open a little umbrella-like device which would block the hole. I am in no hurry to get this done, but I expect I will get it some day.


Meeting with the Neurosurgeon

So, finally, the time came for the follow-up with Dr. Crotch-Spiker (provisional, inappropriately disrespectful nickname for a doctor who is at the very top of his sub-sub-subspecialty and is a good man). We told Dr. Crotch-Spiker (whose parents' last names were Crotch and Spiker) that I was still having nosebleeds. He shook his head sadly. The intense headaches and fevers I had after the procedure meant that he could not repeat it without risking permanent damage to the tissues. I am going to have to live with the nosebleeds.

That said, it's not so terrible--a lot better than it was before the procedure. Instead of erupting with gushing bleeds in the middle of patient appointments and having to rush to ENT for cauterization, I have a slow trickle that does not even come out until I have gone a few hours without rinsing my nose.*** I just have to remember to rinse in the middle of the day to avoid sneezing bloody goo in the afternoon.

And that's the end of this particular adventure. Another annoyance, but not the end of the world.


Be well,

Tom


* No, I don't believe that means bad luck. If there were truly an unlucky date/day-of-the-week combo, it would be Monday, the 13th, wouldn't it?

** See Tumoriffic, original blog, August 7, 2007 for more on that: http://www.tumoriffic.org/Part%20III.htm

*** Technically, this procedure is known as a 'nouche,' for nasal douche. It is done with a squeezable 8 or 16 oz bottle filled with salt solution. I do it at least 4 bottles at least twice a day and a lot more when I have an infection.

You too can nouche. I strongly recommend it for anyone with sinusitis or cold. The bottles, made by Neilmed, are available at most drugstores. You should use distilled or boiled water and mix it with a little bag of salt and sodium bicarbonate formulated to match the salt in your own blood and snot. (That way, it doesn't sting when it goes in. Pure water really hurts.) Neilmed makes these bags, but CVS, at least, now sells their own bags, which are much cheaper. You don't have to do it as much as I do, but it should help with cold symptoms, help prevent colds from becoming bacterial sinusitis, and make your bacterial sinusitis go away faster. Happy nouching!

This bird never gets bloody noses.