Katherine Price was 10 when she had her first chronic nose bleed. More than 20 years would pass before she knew why.

"They can come on when sleeping, knitting, sewing, doing nothing," Price said.

She has a rare disorder known as Hereditary Hemorrhagic Telangiectasia or HHT. Her father has it. So does her brother, as well as her nephew and both of her children. Even a grandfather had it, and his death certificate shows he died after bleeding from his nose for nine hours.

The disorder causes capillary vessels, which connect arteries and veins, to break open. It can happen anywhere in the body, such as fingers, lips and tongue, or internally, such as the stomach or brain.

Price loses up to four units of blood each time a vessel rupture happens.

"A nose bleed usually last 20 minutes. Mine are an hour and half," she said.

There are many causes of chronic nose bleeds. The disorder Price has is only one of them.

How much blood she loses depends on how badly she's bleeding. Besides her nose, she's had vessels break open on her fingers, on her tongue and even in her stomach.

"I just deal with it," she said. "The hardest to stop is the tongue."

Her nose bleeds daily. If she's sleeping, she doesn't get up unless it's bothering her, she said.

She's found that not all paper towels are created equal, when trying to staunch a nose bleed. So far, Viva paper towels hold up the best.

If she can't get the bleed to stop, she puts in a sponge-like device called a Rhino Rocket. At this point, she'll need to see her doctor to get the packing taken out.

She started seeing Dr. Sue Karen Wink, an otolaryngologist at Medcenter One, after she spent all but six hours over 16 days without her nostril packed.

"It doesn't take much, even a sneeze," Wink said, to get a vessel to burst. "There are not too many ways to get it to stop. You pack it and cauterize it."

When she sees the doctor, she has the blood suctioned, and the doctor cauterizes the vessels. She's been to the Mayo Clinic three times because of the bleeding.

Twice, she's had an embolization in her nose. It's a "last-ditch" effort to treat nose bleeds, Wink said. It is a procedure that shuts off the blood supply to a vessel. Last summer, Dr. Wink referred her to Dr. Brent Herbel, an interventional radiologist at St. Alexius Medical Center.

Using a catheter, Herbel went through the external carotid artery, which supplies blood to the face and scalp, in order to inject a substance that blocks the vessels, he said.

"Basically, you shut down the blood supply," he said.

He has to be careful where he stops the blood flow and that he doesn't do so much that it causes the cells in the area to die. This procedure can also be used for bleeding ulcers and ruptured blood vessels in other parts of the body.

Since her last embolization, she still has nose bleeds, but they are not as severe.

"I still have them, but they're not gushers," she said.

She lost a couple jobs because of her bleeding nose. She's driven trucks, worked in a nursing home and worked on a road crew. Each occupation produced some kind of trigger for her nose bleeds. Primarily, bending down to lift items or move people, as with the truck driving and nursing home jobs respectively, placed too much pressure on the vessels in her nose, causing them to burst. The dust blowing on the road made her job as a flagger difficult.

Many of her employers were sympathetic to her needs, and tried to accommodate her as they could. Her last full year of work was in 2001. She now receives disability and is on Medicare.

She makes adaptations in life to accommodate the disorder. When playing with her great-grandchildren, for instance, she sits on the floor to play.

"You can't sit and dwell on what if's or if only's," she said. "You live each day to its fullest."

(Reach reporter Sara Kincaid at 250-8251 or sara.kincaid@bismarcktribune.com.)