the morning after

This morning, the Eldest woke up.

I'm just going to clean you off, said the Man, and gently wiped up the last of the dried blood from the night before.
Whaa?? said the Eldest, thoroughly confused.

Eventually, we realized that the kid doesn't remember the nosebleed from last night. He slept through the mess, through us holding a good 25 minutes of pressure, through 8 ml of Amicar (the nasty nose/mouth bleed medication), through the sheets being changed, through me trying to get the blood off his gunked-up eyelashes - he complained about it at the time, but still didn't wake up enough to remember it in the morning.

Dang. You've got to respect sleep that determined. On the other hand, I consider how much he's sleeping (only a bit more than usual), the dark circles under his eyes and the paleness of his lips. Yep, we've got some anemia going here.

So? WTF is going on here?

Well, Rix, it's not a growth spurt - we weighed him last week. Nor is it allergies, and nor, Lois (and I'm saying this with utter faith, only some of it blind) is it inhibitors. If that were it, he'd be having more bruises and the nosebleeds would fail to stop, or rebleed more frequently. I'm nearly certain of that. Nor is it air conditioning, which can dry out the nose. Alas and alack, but we are mostly a ceiling fan house. Mostly.

Nope, it's just lousy engineering. The Eldest has inherited my family nose - both my mother and my father were chronic nosebleeders, and even the wondrously clotting Toddles gets little nosebleeds. I have one, reliably, every day. There's just a couple of largish blood vessels that are close to the surface, and the placement makes them vulnerable. So, nosebleeds. And I know this cycle well - if you have too many nosebleeds, too close together, the tissues are fragile. Anything will pop the surface, and off you go.

Like tonight, when the Eldest burst into tears and sprayed blood on the pillow. It doesn't take much to set the nose off, and given the nose, it doesn't take much to set the kid off, either. Although, I'll note that me holding vicious pressure on the nose did distract him from his wailing. Either that, or he was too busy adjusting to life as a mouth-breather to continue wailing over who got the fatter pillow.

(The Toddles, sensing an opportunity, wailed also - but lacked that crucial element of drama to get my attention. Still, when I left the room, I took the plumpest pillow with me. It's one of the minor pleasures of parenting, this being fairly unfair, all 'round.)

Nighttimes are a tough time to be a kid. But if we're lucky, he'll sleep through the 1 am dose of Amicar (a PH adjusting medication used for bleeding in mucous membranes, like noses and mouths). And that's pretty much what we've got in the arsenal right now: I called the Hemophilia Treatment Center (HTC) today, and discovered that - naturally - they are all away. Back on Monday, pleaded the second year hematology fellow. Can you wait until then?

I considered the matter. Sensing an opportunity to get off the hook, the heme fellow explained that Amicar is safe to use indefinitely, and nosebleeds just aren't life threatening. I recalled an ENT who would pop a vessel of his own, should he hear this, and drew breath to argue. But the fellow beat me to it, filling the air with suggestions. Try this? (we're doing that, I said) Try that? (doing that, too, I growled) And what about this, this and those? (yes, yes, and yes, I said, holding on to my temper)

Truth be told, nosebleeds really aren't life threatening, unless they fail to stop when you give pressure, apply clotting oomph and readjust the pH of the mucous membrane to suit the clot's longevity. In short, they're only life threatening if they don't stop. And we're not there yet, and as frustrating and messy as this all is, we truly may not get there. It's just soul-wearying to pull the same tricks out, over and over, to create less effective results. But it'll buy us time, to get us past the weekend and the absent coagulation team, and hopefully keep us out of the hands of the new interns in the ER. It is, after all, July.

So, we wait for Monday. But, I warned the hematology fellow, if the kid pulls another really nasty bleed, and the this, this, this, this and that don't do the trick, I'll be in the ER and making her hold pressure on the child. Or she can do my laundry. Either one will do, really.

Note: the photo with this post isn't from this week - note the pinkness of the lips. But, after the drama-mongering of last post's photo, I felt I owed the blog a cleaner shot. So.