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On the nose

MagazineDecember 2013 (Vol. 24 Issue 9)On the nose

Clever first aid and an array of alternative medicine can staunch nosebleeds and prevent them from recurringQMy son, Roger, is 13 and regularly goes to a boxing gym after school

Clever first aid and an array of alternative medicine can staunch nosebleeds and prevent them from recurring

Q

My son, Roger, is 13 and regularly goes to a boxing gym after school. He loves the sport because he is fast and crafty. In fact, I am proud to say, he is really good at it and, largely thanks to me, he models himself on the former world champion, Frank Bruno.

What worries me is that he often gets nosebleeds-and used to get them just as often even before he started with boxing. Fortunately, he doesn't seem to get them in the ring. Has his boxing got anything to do with that or is it perpetuating the nosebleeds? Will it make his tendency worse? Is it now like a delayed effect, of sorts-after the thumps on his head, or

just a general childhood thing that he

will grow out of?

J .K., London

A

'Traumatic epistaxis,' the medical expression for a nosebleed that results from some impact on the nose, which would occur if he got hit there, can be quite a serious matter. If there is ever any possibility that the flow may be a mixture of blood and spinal fluid, no packing or medication should be inserted into Roger's nostrils.Arnica montana 30CH should be given every 15 minutes, the injury should be treated as a skull fracture and Roger should be hospitalized without delay.

But this is an unlikely scenario, judging by your letter. From what you say about Roger's history, it doesn't seem as though the boxing brings on nosebleeds or is responsible for their frequency. The more likely picture is that you have a normal childhood nosebleed problem on your hands.

Nosebleeds are fairly common, particularly in children, and can often be treated at home. 'Non-traumatic epistaxis' is the technical term for a nosebleed that occurs for no obvious reason, when blood flows from one nostril or occasionally from both. The flow of blood can be heavy or light and may last from a few seconds to more than eight minutes.

The 'non-traumatic' ones are particularly common among infants, children and young teenagers, and it's often impossible to determine the cause. A number of factors are known to be associated with them, ranging from hypertension (yes, youngsters occasionally suffer from the condition too) to high altitude (climbing high mountains or flying in airplanes). While high blood pressure doesn't actually trigger nosebleeds, it can keep a bleed spurting.

Most nosebleeds, even frequent ones, are simple mechanical disturbances, from nose-picking, nasal-lining dryness or low humidity. An innocent scratch of the lining causes a tear and then a bleed. You can end this by keeping the house humidified and by regularly putting a light coating of Vaseline (petroleum jelly) inside Roger's lower nostrils. Gently suggest that he stop any nose-picking, to ensure that isn't the source of the problem.

Lack of adequate sleep is sometimes also associated with nosebleeds. If Roger watches television in his room or gets absorbed in a good book or on the internet, it might be worth checking whether he is staying up too late and losing too much sleep.

Surprisingly, one common cause, in my experience, is food allergy or intolerance. If you can't find any other obvious cause, you may want to place him on an elimination diet (see WDDTY November 2012) to find out if he is intolerant of any foods.

Other causes include a foreign body in the nose (with younger children) and cocaine abuse. Happily, neither situation would apply to Roger's age group.

A sudden unexplained nosebleed that persists (for longer than, say, fifteen minutes) or contains bright red blood may need surgical cauterization (heat-sealing of the blood vessels involved).

Sometimes the blood, instead of escaping in front through the nostril, runs into the larynx down to the stomach. This can induce nausea. To avoid that, when Roger gets a nosebleed, keep him in an upright position with the head tipped slightly forward to allow drainage frontward.

Other first-aid home remedies that I have found really useful include: applying pressure on the nostrils with the fingers; wedging a pad of gauze, cotton wool or rolled-up tissue paper between the gums of the upper teeth and the upper lip; reducing the temperature of the room; applying cold compresses to the upper spine and the neck-or, failing this, to the genitals;1 and gently irrigating the nasal cavity with a cool saline solution.

During any of these treatments ensure that Roger is breathing through his mouth and is not blowing

his nose.

If the bleeding continues, roll up a piece of tissue, saturated with tincture of witch hazel (Hamamelis virginica), and twist it into the bleeding nostril. Before inserting the plug, remove any clots of blood.2

Once the plug is in place, have Roger lie back. Do not use iodoform or any other medicated gauze to do this.3

Whenever non-traumatic nosebleeds keep recurring, my therapy of choice to prevent future bleeds is acupuncture, which is particularly helpful when combined with detection of food allergies. In my experience, the best combinations of acupuncture points include: on top of the head (Gv-23), at the tip of the nose (Gv-25), and in the groove leading down to the corners of the mouth (LI-20). If there is still a continuous nosebleed, your acupuncturist may add (SP-1), at the medial (inner) aspect of the big toe, or behind the knee (B-54).

For a nosebleed that causes spitting of blood, the acupuncturist may use a point on the back (B-20), together with a point between the pit of the stomach and the navel (CV-13).Acupressure can also be used at all these points.4

The most common homeopathic remedy for nosebleeds is Achillea millefolium-the common yarrow. Other, lesser used remedies include Belladonna if accompanied by a flushed face and headache; Nux vomica when there is a morning discharge of clotted blood; the non-metallic element Phosphorus, with a bright red flow of blood, frequent and profuse; and Ferrum phosphoricum,

when there is recurrent bleeding, with a steady flow.5

In herbal medicine you would use either Calendula officinalis for its mild styptic but effective antiseptic action, or Urtica dioica for its anti-haemorrhagic action.6

One word of caution. Since Roger is susceptible to frequent nosebleeds, it's more likely that he will be susceptible to vascular defects that might cause strokes or bleeding in the brain at some later stage, if his nosebleeds are caused by ruptured capillaries, as seems likely.

He might well have a tendency to have other small blood vessels rupture in his body, and if this happens in the brain it could result in a stroke or some other serious condition such as an aneurysm.

Consequently, I must advise you that boxing is not an ideal sport for Roger because of the regular impacts to the head. Hard as this may seem because of his enthusiasm for the sport, the safest future course is to gently steer him, particularly as he gets older, into another sport without such potential for head injury.

References

1

John Henry Clarke, The Prescriber, 2009, 9; 278

2

E Harris Ruddock, Homoeopathic Vade Mecum, New Delhi: Taj Off-Set Press, 1989

3

Thomas Flint Jnr & Harvey D Cain, Emergency Treatment and Management, W B Saunders & Co, now Elsevier, 1972, p 276

4

Shanghai College of Traditional Medicine, Acupuncture: A Comprehensive Text, Seattle, WA: Eastland Press, 1981

5

John Henry Clarke, The Prescriber, 2009, 9; 278

6

British Herbal Pharmacopoeia, Herbal Medicine Association: Cowling, West Yorkshire, UK, 1976; 1:39, 217

Harald Gaier, one of the UK's leading experts on alternative medicine and a registered naturopath, osteopath, homeopath and herbalist, practises at The Allergy and Nutrition Clinic, 22 Harley Street, London. Visit his website at www.drgaier.com.

If you have a question for our Medical Detective, write to us at the usual address or email
letters@wddty.co.uk.


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