The ER, visit #2 for 2008 - LONG

Well friends, I've done it again...manged to visit the ER, as a patient rather than the care provider, for a second time this year. I mean really, does someone out there have a voodoo doll with my face on it or is this truly coincidental? So, I think everyone knows that my first ER visit this year was on Mother's day, which was also my Master's graduation day, when I fell and sprained my foot after tripping from wearing flip-flops, thankfully that's all resolved now. On to visit #2...

*~*~*~Warning.....please do not continue reading this post if the discussion of blood, pain or gory details might make you feel nauseous, light headed, or any other form of grossed out~*~*~*

Phew, okay, now with that out of the way, I will proceed to tell the oh so fabulous story of my epistaxic episode, otherwise know as a nose bleed....or in this case I feel very validated to say nose hemorrhage.

I think everyone has had a nose bleed once or twice in their life, and usually it's nothing woth blogging about, stops with a little pressure and then life carries on with no major issues. Well, for me nose bleeds have always been something much more severe. I don't get them often but when I do there is usually very heavy bleeding that goes on for over an hour and the weird thing is that these nose bleeds are brought on by very benign actions....blowing my nose, wiping with a kleenex or sneezing. I've had 4 other episodes of severe epistaxis in my life, once when I was about 10, again when I was about 18, then one about 2 years ago and then 3 months ago was my last one....until yesterday.

I was leaving clinical around noon, it was a half day in the office, and when I got out to my truck I had to blow my nose. As soon as I blew, blood started *pulsating* out my left nostril and down the back of my throat. So, I tried to stay calm, applied pressure by squeezing my nasal bridge and taking deep breaths. After about 10 minutes of this, it started to clot and the blood flow stopped, but when I swallowed the clot moved down the back of my throat, pulling the clot loose that was stopping the blood flow and everything started over again. This cycle of clotting, swallowing and re-bleeding continued for about an hour.

Since I had just had a severe nose bleed about 3 months ago very much like this, my PCP, Dr. House told me that if it happened again that I really ought to go to the ER to have it properly looked at and stopped. I hated admitting defeat, but I eventually had to call Cory at work to come get me (I figured it would be a bad idea to drive while all this was going on) and about 20 minutes later, Cory had picked me and my bum nose up and we arrived at the St. V's Carmel ER.

As soon as we got there, they rushed us right back to triage where the RN applied this really cool nose clamp, it didn't stop the bleeding (as I'm sure it does in normal people with normal nose bleeds!) but it was nice to not have to hold my nose anymore. While she was taking my VS and history, I felt it...that awful feeling just before you throw up, so I grabbed a basin nearby and just let it happen, and to my surprise I vomited a huge clot...now it takes a lot to shake me, and seeing this clot come out of my stomach really showed me how much I was bleeding. The RN reassured me that it's common and she sees it happen a lot, so while it didn't fix anything, it made me feel a little better.

After triage, we were taken to the "special" ER room set up for ENT procedures.....this meant a funky gurney to sit on, funny lights in the room and all kinds of special surgical packs laying around. At this point my anxiety is so sky high that my BP was 150's/90's...which I'm sure wasn't helping my nose to stop bleeding. Our ER doc, Dr. Young came in and he was awesome, very confident but very attentive. Since I had just come from clinicals, I was still in my scrubs and white coat, so he was trying to figure out who the heck I was...thanks to Cory for being my "voice". While Dr. Young was taking with Cory about my history and how this nose bleed started, the RN was drawing blood (I'm thinking great, even more blood loss!) and I vomited 4 more times, the exact same result as the first, huge blood clots coming out. Blood is very irritating to the stomach lining, so I guess better out than in!

After all the history taking, lab drawing and "discussing" the next procedure, I was a brave patient and let Dr. Young start messing around with my nose. The first thing he did was remove the nose clamp and squeeze out the clot that was blocking my nasal passage, then he did 4 or 5 huge squirts of Afrin, which is a great vasoconstrictor and helped the blood flow to slow down....yes folks, my nose was STILL bleeding at this point, total time so far 1hr 45min. Then, he saturated a huge cotton rod with topical xilocaine and as gently as he could inserted it up my nose until it wasn't visible anymore...my eyes were tightly closed the WHOLE time and I was light headed from all the deep breathing I was doing to keep from crying....yeah, crying and nose bleeding don't go well together, so I'm proud to say that despite my anxiety and general uber-emotional personality, I didn't shed ONE tear during this whole process!

He let the topical anesthesia sit for about 20 min and I was surprised by how well it was numbing everything....my cheek, lips and tongue included! So, he comes back in the room and starts setting up his mayo stand with all these scary looking ENT instruments, again I closed my eyes tight not wanting to see any of it. He removed the cotton packing with the numbing medicine and inserted a nasal speculum...yes, it was a speculum, just like what I use everyday...I have some patients who are thinking this is fabulous revenge for me! He was able to see the area that was bleeding and thankfully it was all on the anterior aspect of my septum. So the next thing he was size me for the appropriate nasal packaing, even though he had numbed me, I still felt a lot of discomfort as he was pushing what felt like a huge cotton tampon up my nose! Once he got the right size, he coated the packing with antibacterial ointment and told me to hold my breath and he shoved it in place. Then, in the center of the cotton packing there is a small catheter that allowed him to expand it with saline.

Finally! The bleeding stopped! It worked. Now, granted, I have this huge cotton packing sticking out my nose, but no more bleeding. So he had us stay for about an hour just to make sure that the bleeding was truly stopped and then we were discharged. Ironically, my labs came back great, most likely due to all the iron in my vitamins. When we got in the truck it kinda hit me...I had lost a lot of blood and I felt so exhausted. So, we had to run to the pharmacy to get some antibiotics (the ER doc felt like this would be a good thing to do since it had been bleeding for awhile and he had to manipulate the tissue so much) then I was able to curl up at home and rest. Our next door neighbor, Daniel, was so kind and drove Cory over to the office to pick up my truck. Then once Cory was back, he had the joyous task of making a bunch of phone calls to cancel some plans we had made for the week & weekend and to the office to let them know that I wouldn't be in today.

Sleeping was a challenge with this thing in my nose. I started being propped up on like 5 pillows, but I just couldn't fall asleep sitting up, so I laid down and by doing that a small clot that must have formed on the back of the packing came loose with gravity and I swallowed it.....I freaked out and thought that everything had started bleeding again. But thankfully, that was it. So, I ended up being able to sleep on 3 pillows and just had to be really careful when rolling from side to side to not touch it.

When we were in the ER we were instructed to follow up with an ENT on Friday to have the packing removed....so I'm thinking, 2 days with this in my nose, I can handle that. Well, Cory called the ENT who took out my tonsils in '02, Scott Hacket (yes, that really is his last name!) and they instructed us that they had received the ER documentation and that Dr. Hacket wanted me to keep the packing in until NEXT WEDNESDAY! Seriously, are you kidding me!?! So after the initial shock of having to keeping this in for a whole week I calmed down and started thinking just how grateful I am that it's been 24hrs with no bleeding. When we go in on Wednesday, he'll take the packing out and then he's going to cauterize the area where the bleeding was coming from, in order to take care of this once and for all. While I'm not looking forward to having silver nitrate sticks stuck up my nose and burning my sensitive nasal tissue, I just want this over for good. So, I'm praying that when he takes the packing out it doesn't start bleeding again, and that he'll be able to numb the area before he cauterizes it.

So, while I spend these next 6 days with this packing in, I'll probably be posting some interesting blogs from the perspective of someone with a huge tampon shoved up their nose! Talking is really uncomfortable because it makes the packing wiggle, so I'll most likely be doing a lot of emailing while this is going on. Cory took today off to stay with me and make sure that I got through the day without anymore bleeding episodes, but he'll return to work tomorrow.

If you've made it to the end of this incredibly long and gory post, I applaud you for your patience and appreciate your attention :)