Sudden significant, difficult to control nasal bleeding

There is always an underlying reason for nosebleeds that are as copious as everyone has experienced. It just takes the right physician to take the time to work through a diagnostic differential. Therein lies the problem!

My primary and I had a Virtual Visit the day after the second episode. And I wrote a note that I dropped off yesterday at her office. In it, I informed her that 4 days after that Virtual Visit, a third episode occurred, but we were well prepared with the items that she had explained to do (as had the otolaryngologist who had cauterized and treated me with the first episode). Saturday's sudden nasal bleeding was much less intensive than the others, but still disturbing because I concur that there has to be a REASON. I have never had nose bleeds before! My primary (whom I absolutely trust and respect) had sent a script to my patient file for blood work, but in the note I shared with her what a couple of mayoconnect members had suggested regarding blood factors to test. I am more concerned that the source of my nasal bleeding lies deep within the nasal cavity. I had a CAT scan 2 years ago, because I was having such problems with breathing through the very nostril that squirted blood three weeks ago! The scan showed no problems other than my deviated septum. The doctor who took care of me with the first nasal bleed is incredible, but it's imperative to have an otolaryngologist who is not an 80 minute round trip drive. In the past 6 years, I've been brushed off by 4 ENTS that I turned to for help. All I've been told is a litany of "...saline spray, a prescription spray, etc., etc...." Not surprised, now that I think of it, that the left nostril that barely allows air in/out, (and the reason that I sought help from those 4 ENTs) is the very one from which blood flowed and squirted and scared the heck out of my husband and me. ALL 4 doctors told me "...can't find anything wrong with your left nostril..." Riiiiggghhht! And look at me now, with that very nostril having suddenly upending my world...

I'm keeping notes on whatever I feel in my nasal passages/eye pain/nerve pain/even the slightest headache. Today is Tuesday, four days since the latest episode. Let's see what transpires over the next few days...
One member took the time to write to me in detail how her husband had developed nose bleeds, but he was lucky that he lives in an area where ER departments have doctors that will attend to nasal bleeding. He got appropriate, attentive medical care in that ER. I didn't. He had his situation attended to, and astute medical professionals in that city finally found the source of his problem. I've been told "...there's nothing there..." Unfortunately for him, it was a growth that had to be excised and then receive treatment. I pray that he escapes the diagnosis of cancer. Therein lies my own fear, my concern about the source of my nasal bleeding. My primary has not tsk-tsk-ed me, and I'm grateful to have her on my medical team, as well as my wonderful vascular cardiologist (whom I'll be seeing also).

Thank you for taking the time to write to me. I do appreciate it.🌺

Thank you for taking the time to reply. Your experiences resonate what I've undergone.
Yes, Afrin sprayed cotton inserted into the left nostril (the one that literally pours out blood) absolutely helped. Ditto to the squeezing (which I did for 90 minutes this past Saturday when I had episode #3!).
We've had air purifiers and cool mist humidifier stationed strategically throughout the house, and most definitely in the bedroom. And yet I experienced what I call "nasal hemorrhaging" episodes.
I'm looking to be seen by the incredible otolaryngologist who cauterized the nostril with the first episode. She also removed sizable blood clots that had lodged in my throat (making it difficult to breathe and swallow). I'm so worn out and stressed with this additional "condition" placed on my already seriously filled medical plate. Doesn't do much for my ongoing depression either, and adds more to my husband's intense heart issues.

Gracias for your input. Deeply appreciated.

I'm so sorry for what you're going through, and for the agonizing uncertainty. My 81 year-old husband started having copious nosebleeds (no history) in mid-2022. Maybe an average of once per month. An urgent care visit resulted in a cauterization of some kind and taking Afrin home with us. It worked well for a long time. No bleeding. Then last fall 2023 he started getting a severe headache (he's not a headache person AT ALL) that grew more painful over about a week, and the nosebleed situation came back with it. We figured it was time for the ER. They saw a nasal mass in one of their scans. After consulting with an ENT surgeon the next week (the result of an ER referral), a biopsy was done shortly after and the result was a malignancy, either a carcinoma or sarcoma, (it was never determined for sure). Scans showed no spread. In December the tumor was cleanly removed endoscopically (through the nostril, no cutting) in a long operation by that same ENT and a neurosurgeon standing by. The location of the tumor was close to the brain. It all went very well, with a one-week stay in the ICU to watch for spinal fluid leaks. My husband is now in his final week of chemoradiation (once per week), and we won't know for about 3 months from now (summer 2024) if there is any cancer remaining, when they do all the scans again. Chemo has been more or less tolerable; the radiation has caused more of the discomfort to the targeted area, but compared to many others he has fared well. That's a lot of detail just to tell you that going to the ER was ABSOLUTELY the key to finding and treating his problem, which started as copious, unpredictable nosebleeds, followed by a debilitating headache. I send my encouragement!

I just tried sending a rather lengthy response but it didn't work, so I'm going to attempt to do so by DIVIDING it and sending each section SEPARATELY. HOPE IT WORKS!!!

Here's Part A....

A belated thank you for your having made time to write to me about your husband's experience. I "lost" your post and found it difficult to locate, and was delighted when I found it this morning! I experienced yet ANOTHER nose bleed episode on April 5th. I wrote about it within another response here.
You are fortunate to have great emergency services. We live in a desirable area of Westchester County but the ER department of a hospital just 14 minutes or so from our home FAILED ME MISERABLY. Not only was I left alone in a corner along a heavy trafficked passageway, but I had the misfortune of having an obviously inexperienced, insecure (and yes, inept) PA be assigned to "attend" to me. He would disappear for up to about 15 minutes or so at a time, spoke in a way to low-voice within the din in that ER, but also did not ask ANY questions about my situation or my medical history! I had to call out for help when I began to gag and warm blood rushed out my mouth up blood along with clots onto a towel. Not one glance in my direction! I took a deep breath after puking up blood (with blood rushing out the left nostril and down back of the throat) and YELLED "I need help!!" Only then did someone who was not a nurse place a plastic basin in my lap (and another towel), but then took off! I had to call out in a LOUD voice to the nurse sitting behind the desk, who was tapping away in front of her computer. She did not come over but did glance (looking a bit annoyed) in my direction. "Where is the PA assigned to me?" I loudly asked. A bevy of staff walking past me and down the corridor to my right obscured the nurse and the nurses station. Finally a nurse (I presumed she was nurse or possibly a NP) came and took my vitals, then she also disappeared. I continued gagging on the warm flow of blood down my throat. I gagged blood into the basin, along with nasty blobs of blood clots. I was so scared! I had NEVER had nose bleeds in my 7 and a half decades of life, and no one appeared at all concerned that a senior was in the condition that I was in....FINALLY the errant PA came and told me he was going to insert "something" in my nostrils (yes both, not just the gushing left one) to stop the bleeding. No explanations, no questions about any medical info/situation that he should be apprised. ¡NADA! All I clung to were his words "...to stop the bleeding..." so I was prepared to be cooperative, but NOT prepared at all for the excruciating pain the he inflicted while SHOVING a nasty object into my right nostril. It hurt!! I yelled out "You're hurting me!" but he continued, even as I moved my head and entire body AWAY from him. "Stop!" I demanded, but he didn't, so I screamed "STOP ALREADY!" He finally did so, then disappeared again! My one consoling thought was that he was hopefully getting advice/direction from one of the ER doctors. I continued gagging and bringing up blood and clots, with not one medical personnel coming near me, not one staff member at all interested. My husband had not been allowed into the ER for whatever inane reason so I had NO ONE to advocate on my behalf. I felt so alone, and damned scared.

----------------Part B to follow--------------

pretty flower PART B RESPONSE
FINALLY the PA and one other person (possibly the one who had taken my vitals --- and she had announced "Wow! Your numbers are really high!") appeared in front of me. Made me more apprehensive after what the PA had attempted to do to my right nostril. With no word of apology for what had transpired, he said that perhaps the blocker that he had tried in the right nostril was "too large" so he had with him a "much smaller one" for the left nostril. "It WILL stop the bleeding" he urged. I told him that my left nostril has ALWAYS been sensitive and painful and said I'd cooperate as well as possible but that if told him to STOP that he had to do so IMMEDIATELY. He agreed, then started the insertion, which got blocked by my deviated septum. I clenched my fists as he attempted to re-direct and insert it and FINALLY IT WAS WHERE HE EVIDENTLY WANTED IT TO BE. He explained that he was going to "pump air" to inflate the "balloon." The idea chilled me but I consented. I soon felt intense pain as the "balloon" pressed against sinus cavity tissue and in turn that set off the nerves in my face and left eye. Since he had not asked questions about anything he should be aware of, he didn't know that he had ignited nerve pain in my face and eye, also into my temple area and into my left ear. I told him to remove it, to get it OUT, but he said he couldn't. The "nurse" evidently had reached the end of her rope at this point and told me I was going to be sent by ambulance to another hospital. "NO! I'm leaving with my husband and HE will take me to N---- Westchester Hospital ER where I can get help!" So she placed a form in front of me and asked me to sign. I told her I couldn't read the form (which had sentences followed by lines and "blanks") because I did not have my readers. In a terse, nasty tone, she pointed to a line and said "Just sign here!" Against my better judgement, I did so b/c I wanted to LEAVE the incompetency and what I was being put through. (I later found out that my signature indicated that I was signing out "against medical advice" which not only was a LIE but also ILLEGAL since I'd had no idea what I was signing, AND also NO "advice" had been given, I just got the cold impression that she wanted me out of their ER). I was wheeled out in silence, where my very worried husband had sat for the 3 1/2 hours that I'd been in the ER area. (He had repeatedly asked to be let in but kept being denied entry, with no reason offered.) Without a word, she stomped off, leaving me in the wheelchair unattended while my husband went to bring his car to the area in front of the exit/entry. Despite my pain, I sensed that she was glad to be rid of me...and she was indeed in a nasty, haughty mood. My husband took me to the other ER, where I was attended to IMMEDIATELY and attentively. Unfortunately, the PA there could not remove what I later learned is called a Rocket, from my throbbing left nasal cavity, and there was no ENT available BUT she called one in private practice who agreed to see me immediately. My husband drove me there (a 40 minute drive one way) and the otolaryngologist was wonderfully calm, patient, CARING, and not only removed several medium to large blood clots from my throat and nasal-pharangeal area (they had been obstructing my breathing and swallowing), but she also extracted the Rocket!!! Then she cauterized the area in my left cavity. I was so happy and relieved that I cried tears of joy. She comforted me and then gave me clear instructions on how to deal with any possible other bleeds, giving me the spray required; taught me how to make a "nasal dam" and placed one one me; then told me that I need not worry because she has indeed encountered situations like mine before.... We left her office feeling grateful not only to her, but also to the PA in the second hospital ER that had made the arrangement for being seen the SAME DAY by this amazing doctor....Evidently ONLY an otolaryngologist can remove a Rocket because significant trauma/damage can occur if done without competency and knowledge (thus a PA can insert one but cannot remove it, and this doctor had concerns about the PA having inserted one into my obstructed nostril).

----PART C TO FOLLOW------------

pretty flower PART C (AND LAST SECTION) RESPONSE

I've since had three more episodes, but was better prepared for dealing with each. Scary and unnerving just the same. For the last one (the 4th, this past Friday evening) my husband drove to the county trauma center just before 10 PM, and I was attended to by an experienced, knowledgeable PA, and given the phone number for the Dept of Otolaryngology at that teaching hospital. This morning (Monday) I am placing the call, happy to have that avenue because not ONE of the ENTs in our town and surrounding area was willing to see me, telling me "....you need to be seen by a trauma specialist..." Well, that's what happened Friday night! And that hospital is rated the TOP trauma center in the county...

I am appalled that not ONE doctor within the ENT departments of medical groups within my town and surrounding areas is interested in dealing with the kind of situation that has happened to me. What does that say about them?.....And where does that leave people like me, faced with such frightening experiences? I cannot travel to another state or into NYC so that seriously leaves me with little to no options. I'm praying that the teaching hospital whose trauma ER attended to me on Friday night will prove helpful. I had actually been informed that no, would not see me UNLESS I WAS NOT BLEEDING....But my past experiences with several ENTs had left me underwhelmed, with my nasal issues not addressed...

I still worry about a possible growth of some kind, just as what happened to your husband. He is so fortunate to have had knowledgeable PROFESSIONALS who take responsibility instead of shrugging a patient off to someone else. Trust me when I say that the survey that I was sent to fill out for that 1st nasal bleeding episode, had my entire focused account of how incompetently and unprofessionally that ER had treated a 75 year old woman who was left unattended for periods of time and not allowed to have her husband to be with her..... Yes, I filed a complaint with the head of the ER department, along with a copy to the head of the hospital.

I have included your husband in my prayers, that he may get wonderful news this summer!

God bless you both, and again mil gracias for making time to write to me. You are appreciated, just as are the other members on this incredible site. 💝🙏🏽

Thank you so much for responding and sharing your experience. 🌺

At least I was ready when I had the repeat performance of my scary nose bleed yesterday.
I hated waking up my husband since he has sleep interruptions due to severe neuropathic pain in his feet but I needed his help with doing what I had been informed would stop the bleeding (and avoid yet another event like the first one on March 18th).

The plugs that he helped me shape from small cotton square rolled into "plugs" sprayed with Afrin absolutely did work! My doctor had suggested cotton balls but the little square pads were great. Took about hour with them in place, and having to replace them twice before the bleeding stopped (as did the disgusting warm blood down my throat and gagging!) and I was able to kinda sleep sitting up, propped by many comfy pillows on the family room sofa. It was difficult having to breathe through my mouth because I'd keep jerking awake whenever my mouth would close and I guess my brain registered "Wake up! No oxygen getting to me!" After getting up, showering, and having a light lunch, I actually was able to go over to our older daughter's home (she lives about 5 minutes away in same town) and do a laundry. Yeah, our washer chose to just stop working this week, to add to my stress level. And you are absolutely spot on when you indicate blood pressure being a factor! Despite metoprolol succinate extended release and losartan, my BP was elevated this week due to the stress of the unknown etiology of the sudden nasal bleeds but also brought on by dealing with a dead washer (that had clothes in it when it chose to stop working), getting a repairman to the house and then learning that the mother board needed replacement so it was not worthwhile saving the 12 yr old appliance, and then coming to grips that I would replace BOTH appliances so that they would both have a distal demise...the dryer had been "hiccuping" for the past month also, with at times extending a dry time of 28 minutes to over an hour and then upping it again by 47 minutes, which meant that I had to keep an eye on the dry cycle...so yes, the stress of facing a major output of money for new appliances had my heart palpitating (I also have irregular beats but not atrial fibrillation thank God).

I did have blood drawn at the second ER that I was in on the first nose bleed event (March 18). And all those tests were normal, no low or high readings of crucial items. But of course it did not include specifics that you indicate your primary ordered. I had a Virtual Visit with my outstanding primary this past Tuesday (day after the second nasal episode) and she had the blood work results done on the 18th so she was pleased to see that all had been fine. Of course I will drop off a note at her office here in town (literally 4 minutes from our home) regarding what you indicated. I drop off notes rather than email via the patient portal since the portal does not always work for me. It's a new system for the medical group and still is quirky, so dropping off a note is way more efficient and direct since her nurse attends to it right way, making sure that my doctor reads it. Her nurse is amazing and she is the one who gives me my monthly B12 shot. So I'll drop off a note tomorrow (she's in the office on Mondays which works out great), asking if she might consider having those specific levels tested. She will definitely be concerned that after speaking with her on Tuesday via Virtual Visit that I had yet another event just 4 days later. The lab is within the same building so it will be easy to get blood drawn.

I do know that I have osteopenia but not osteoporosis. I have fallen several times and thank God no breaks or fissures of any kind. I've had balance issues for over 9 yrs now, and just recently got a diagnosis that explains why, but I can't share that just yet...still wrapping my head around it and the impact on our lives...

Your reply and that of another member have both been very useful and appreciated. The fact that you experienced a similar situation at least relieves a bit of the stress of thinking it could be a vascular issue (although I will be contacting my vascular cardiologist this week to get his input as well). Two otolaryngologists have indicated that the problem lies within the nose passages itself. I will be making an appointment with the one that cauterized the left nostril (the one that literally pulsed and gushed warm blood out the opening as well as flowed down my throat). I vetted her and learned about her incredible education and experience, and that she is also an outstanding surgeon (just in the event that it should be required). The doctor at my medical group pales in comparison, so of course I'd choose her!

Can you share how you are doing now, since having had the parathyroid tumor addressed? Was it excised or treated by another means? It would be helpful for me to know.

Be well, and thank you again💖.

Read your message. Thanks for mentioning parathyroid tumor. I will research it. When I was age 16 I had blocked eustachian tubes. The doctor inserted active radiation rods through my nose into my Eustachian tubes to get rid of the blockage. Letting you know this about my medical history. I will get back later to continue our discussion.

@delia74 I really appreciate your updated account and can't believe the first "outfit" you went was even able to be called an ER. Wow. But you have finally gotten some proper attention, and what a stress reliever! As to the question of what's behind this -- have you had any scans or ultrasounds done? That's what our ER did for my husband and a mass was seen immediately, leading to the ENT surgeon referral.