I’ve recently had recurring nosebleeds and I’m reluctant to leave the house in case they come back. How long will it take my nose to heal and will I be prone to them in future?
Name and address supplied.
Nosebleeds fall into two categories — anterior and posterior — depending on which blood vessel the bleeding stems from.
Anterior nosebleeds are the more common and less serious form. These start near the front of the nose in Little’s area, a point where three arteries converge in the septum, the partition in the middle of your nose.
They are best stopped by squeezing just above your nostrils (not the bridge, a popular misconception), for ten to 15 minutes, while leaning forwards slightly. (Don’t be tempted to tip your head back, as this will divert the blood down your throat.)
Nosebleeds fall into two categories — anterior and posterior — depending on which blood vessel the bleeding stems from
Posterior nosebleeds start further back and are more worrying. The bleeding normally begins in a branch of the sphenopalatine artery and can be rapid and severe. These nosebleeds can’t be controlled by pinching the nose and specialist care is required.
From the description in your longer letter, it sounds like yours are anterior nosebleeds — and you ask whether they were caused by exercise or leaning over when gardening, but I think this unlikely as bending is not usually a trigger.
A common cause is dry air — as occurs, for example, with central heating — as it can irritate the nasal lining. This is what you say your GP believes to be most likely.
Other risk factors include taking low-dose aspirin, warfarin and other drugs to prevent blood clots.
Some hay fever medication, particularly intra-nasal steroid sprays, can make nosebleeds more likely, possibly as steroids used long- term can thin the skin and nasal lining. And recent large studies have confirmed that high blood pressure can also be a factor.
A common cause is dry air — as occurs, for example, with central heating — as it can irritate the nasal lining. This is what you say your GP believes to be most likely
Recurrent nosebleeds can be distressing and I understand your desire to stay close to home. But it takes just 48-72 hours for the blood vessels behind anterior nosebleeds to heal, meaning it is safe for you to go about your life as normal.
To guard against a recurrence, I suggest the following home remedy to help prevent your nasal lining drying out. Mix a teaspoon of table salt and a teaspoon of baking powder in a pint of boiled water which has been allowed to cool (you can leave this in the fridge for up to 30 days).
Place a puddle of this solution in the palm of your hand once or twice a day and sniff it up into your nostrils, especially when you’ve had the central heating on. I hope this helps.
A recent blood test showed that I had a kidney function reading of 59 from a usual 76-ish (I’m 64). I am taking lansoprazole to counter the fact that I am taking prednisolone for vasculitis. I read that lansoprazole can exacerbate kidney problems. 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 being a disease in itself.
The steroid prednisolone is usually prescribed along with other immunosuppressive drugs to curb the inflammation. As this commonly irritates the gastric lining, medication to suppress stomach acid production, such as omeprazole or lansoprazole, can prevent further irritation.
These kinds of anti-acid drugs are associated with kidney injury — however this is exceedingly rare. So rather than the medication being the culprit, it’s more likely that untreated vasculitis has led to inflammation in the blood vessels supplying the kidneys, affecting how well they function.
A normal kidney function score — which measures filtering ability — is above 90ml per minute. The first level of decline, stage two kidney malfunction, is 60 to 89ml per minute, stage 3A being 45 to 59ml per minute. Yours is not a severe level of decline but it does show it is not normal. You need to discuss this with your consultant. I anticipate they’ll suggest continuing with your current medication for vasculitis to protect your future kidney function. This may sound unnerving, but be reassured you are receiving the right treatment.
Write to Dr Scurr
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In my view: Hidden risk of flings in later life
The incidence of sexually transmitted infections has increased recently, with a 20 per cent rise in cases among the over-65s.
The increased availability of Viagra, along with online dating, is opening new doors of opportunity. In itself, this is a good thing, however I would sound a note of caution.
Contraception is not the only reason to use condoms — they also protect against what is a rising tide of gonorrhoea, chlamydia, herpes and other infections of the genital tract. Syphilis and HIV are also on the up.
The focus of people of retirement age is on having a new and satisfying adventure, but I would urge them not to become blind to the risks of what can be very serious infections.