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Bill,

Thanks so much for taking the time to write me about your experiences with this in regard to Joey. It helped a lot to feel like there were others this had happened to, and also your explanation about the different sorts of blood.

We did go see Dr. Mallory, our pulmonologist at Tx. Children's. He had Becky get a chest x-ray, examined her, listened to her breathe, asked questions, etc. He said her x-ray looked different from the last time, but that he couldn't see anything definite on it that was wrong. His belief is that given that she has a respiratory infection, combined with being on Coumadin which thins her blood, all the coughing and her having PH and he says the blood vessels in lungs with high pressure in them are more fragile than those of normal people.

He said that he could have her admitted to the hospital, but that she didn't seem to be in breathing distress even though she is breathing with more difficulty than usual, and the bleeding had slowed down some at the time we were there (and is still that way now). So he said given that he knew Becky and I both well, and knew that I would call if anything worsened, that he was willing to send her home, and have her continue to take the antibiotic, and he prescribed such Vicodin which he said would relieve her chest pain and also has the side effect of suppressing coughs so she won't cough as much and he is taking her off Coumadin temporarily. He said for me to call him on Monday and let him know how she is doing. And that if she gets worse I am to call the pulmonologist on call at night if needed.

It is strange that Becky has had this wretched disease since she was 6 and is now 17 and almost 18, and yet we've never dealt with this issue of coughing up blood until now. Perhaps because Becky doesn't seem prone to get maladies that she coughs with very often.

Pam
Bill Nelson <dgccandwrr@...

Pam,
Joey coughed or vomited up a lot of blood in his
time with us, and there are several serious distinctions
that need to be made. The first is is this old blood or
new blood. old blood is dark rust brownish, which Jennifer
refers to as coffee grounds. Old blood is less worrisome,
as it is old and the source may already be healed up .
Bright red blood is new blood, and more worrisome.
The next variable is where is the blood coming from.
Joey had a lot of nosebleeds, to the point where it wasn't
considered serious until all of his clothes and half of
mine were in the washing machine. sometimes the blood would
come out the nose, and other times it would go down the
throat, to be coughed up or thrown up later. with a sore
throat there is also the possibility of bleeding in the
throat.
a
more serious concern is a pulmonary bleed, where the
little sacks where the oxygen is transferred into the blood
in the lungs pop from the high blood pressure.
So you have a lot of possibilities concerning the
source, and seriousness of this blood being coughed up, it
may become another frightening thing that you learn to live
with one you know where it is coming from, but it is
something which may be serious, and should be evaluated by
a doctor. So it is a good thing Becky has a
pulmonologist who can see her asap, cause when you go to
the emergency room with something like this, nobody there
will know anything about PH. I hope this turns out to be
one of those things that is more of a scare than a
serious set of new problems. Seeing the Pulmonologist is the
right thing to do. Jennifer has just got home from a
long day @ clinicals, so this letter has been run by an
editor, and is a little better than my normal ramblings.
Please keep us posted , Yall will be in our prayers.
Bill Nelson, Jennifer's Husband Joey's dad