Recurrent epistaxis represents the most common and, frequently, the initial symptom of the disease, affecting more than 90% of HHT patients. It begins by the age of 10-20 years and becomes more severe over time. These episodes may be so mild as to never suspect the presence of HHT, or so severe as to require iron supplementation and multiple transfusions. Although nose bleeding usually does not represent the prevalent cause of death in HHT patients, it significantly compromises the quality of life of the affected persons, thus justifying the multiple efforts to find a definite therapy for this symptom.
Epistaxis treatments include cauterization, septal dermatoplasty, laser ablation, and transcatheter embolother-apy, but unfortunately, results have been controversial. Medical therapy includes estrogens, inducing a metaplasia in the nasal mucosa, and antifibrinolitic drugs. Anti-
fibrinolitic drugs are administered as a nasal ointment or orally, leading to less-frequent epistaxis episodes.
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The use of dumbbells gives you a much more comprehensive strengthening effect because the workout engages your stabilizer muscles, in addition to the muscle you may be pin-pointing. Without all of the belts and artificial stabilizers of a machine, you also engage your core muscles, which are your body's natural stabilizers.