Stephen J. Schueler, M.D.

Overview Risk Factors Symptoms Evaluation Treatment questions for doctor specialist Home Care nosebleed taking control using a cane using crutches warning signs Prevention Complications Underlying Cause Anatomy Genetics

Factor 9 Deficiency Home Care

Home care measures for hemophilia B include:

  • Avoid aspirin.
  • Avoid anti-inflammatory medications.
  • Avoid herbal supplements.
  • Do not take additional medications without your doctor's consent.
  • Weight loss if you are overweight
  • Take prescribed medications as directed:
    • Don't skip doses of your medication. This makes them less effective.
    • Be aware of the common side effects that may be caused by your medication.
  • Apply direct pressure to control bleeding:
    • Use a gauze or clean cloth directly on the wound.
    • Maintain constant pressure for at least 10 minutes.
    • Do not interrupt the pressure, in order to look at the wound.
  • Nosebleed home care
  • Learn everything you can about hemophilia B:
    • The more you know about your condition, the easier it will be to participate with your doctor in making treatment decisions.
    • Ask your doctor about good sources for information.
    • Write down questions to ask your doctor.

Home care for joint swelling and pain include:
  • Rest the joint:
    • Use a walker.
    • Use crutches.
    • Use a cane.
    • Wear a sling
  • Apply an elastic wrap.
    • Re-wrap the joint every 6 hours.
  • Apply cold compresses:
    • Wrap ice in a moist hand towel. Do not apply ice directly to the skin.
    • Apply for 20-30 minutes, every 1-2 hours, for the first few days.
  • Acetaminophen for pain

Factor 9 Deficiency Nosebleed

How to stop a nosebleed in someone with hemophilia B:

  • Pinch the nose firmly for 15 minutes without letting go. Make sure you are pinching the bulb of the nose so that it is completely closed.
  • Spray decongestant nasal spray in each nostril prior to the nose pinch. Do not use a decongestant if you have heart disease or high blood pressure.
  • Sit upright, do not lie down.
  • Breathe through your mouth.
  • Drink cold water to clear blood from your throat.
  • Seek medical care if the bleeding does not stop within 15 to 20 minutes.

Additional home are includes:
  • Stop smoking.
  • Avoid hot liquids.
  • Do not take aspirin for at least one week.
  • Do not pick blood from your nose once the bleeding has stopped.
  • Do not blow your nose for 2 days.

Factor 9 Deficiency Taking Control

The successful treatment of hemophilia B requires your participation. Here are answers to some important questions.

Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.

How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.

How can you participate in your health care?
To participate you must:

  • Learn to take responsibility for your own health.
  • Learn to partner with your doctor.
  • Learn how to make active decisions about your health.

How can you learn what you need to know?
  • Educate yourself.
  • Be skeptical: Learn to separate fact from fiction.
  • Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
  • Be careful about where you get your health information.
    • Some of the best sources for health information on the web are professional societies and non-profit organizations.
    • Ask your doctor what he or she recommends.
  • Examine the credentials of the authors.
    • If you are reading about symptoms and disease, your best source is a licensed physician.
    • Pay attention to when the content was last updated.
    • Make sure the person is not just trying to sell you something.

Important questions you need to answer:
  • What things in your control can increase your risk for disease?
  • What can you do to decrease this risk?
  • What are vaccines and how can they help you?
  • How do your lifestyle choices increase your risk for disease?
  • How can you reduce stress?
  • What minor health problems can you treat at home?
  • When is a medical problem "serious"?
  • When should you call the doctor?

How can you find the right doctor?
Key points:
  • Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
  • Establish a relationship in advance with your doctor.
  • Make sure you are comfortable with your primary care physician.
  • The internet contains many resources where you can do research to locate the doctor that is best for you.
  • You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
    • Be open-minded, and allow your doctor to know you well. This will improve communication.

Important information you need to make your decision:
  • Physician credentials:
    • Internship and residency training is usually best from respected institutions, universities, and major hospitals.
    • Look for board certification in the specialty.
    • Ask about membership in medical societies.
  • Community and professional reputation are also important.
    • Are other patients happy with the doctor?
    • Has the doctor been disciplined by hospitals or agencies?
    • How long has the doctor been in practice?
    • In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
  • Does the doctor communicate well? Are your questions answered during busy times?
  • Does the doctor welcome you to help make decisions about your care?
  • Is the doctor available when you need care?
  • What is the doctor's after-hours coverage?
  • Is he or she a member of a large group?
    • Do the doctors' cross-cover one another?
  • Where do they admit patients?

What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.

For any recommended test, medication, or surgery, remember to ask:
  • How will this help me?
  • How much will it cost?
  • Is it covered by your insurance?
  • What are the potential side effects and risks?
  • What are my alternatives?

For tests, remember to ask:
  • Is it done in the office or at another facility?
  • Is it painful?
  • How will the results of this test influence my care?

For surgery or other procedures, remember to ask:
  • How long will it take to heal?
  • How many cases has the doctor done?
  • What would your doctor do if he or she were the patient?
  • Where is it done?
  • Who will perform it?
  • What are the doctor's qualifications?

What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.

The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
  • To be spoken to in words that you understand
  • To be told what's wrong with you
  • To know the benefits of any treatment and any alternatives
  • To know what a treatment or test will cost
  • To share in treatment decisions
  • To read your medical record
  • To refuse any medical procedure

What should you do before an office visit?
  • Bring all important medical information with you to the visit.
  • Make sure you can answer questions about the following:
    • Allergies and side effects to medicines
    • Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
    • Insurance information
    • Marital and sexual history
    • Past injuries and hospital stays
    • Past medical problems
    • Past surgeries and operations
    • Pre-visit questionnaires
    • Use of tobacco, alcohol and drugs
    • Work history

What should you expect from the visit?
  • You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
  • Bring along a book or toys for the kids. You may also have to wait during busy times.
  • Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
  • Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
  • Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
  • Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
  • If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
  • Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.

What should you know about your medications?
Every year many people become ill because of problems with medications.

Remember to ask:
  • What side effects to expect.
  • What drug interactions are possible.
    • Find out if a new medicine reacts with those that you are taking now.
    • Many over-the-counter drugs and dietary supplements can also cause serious side effects and drug interactions.
    • Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
  • Make sure you can drive or operate machines safely while taking a medicine.
  • Ask your doctor how much a prescription costs.
    • Is there a less expensive option or a generic version?

What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.

Three simple questions can help you get the most from your treatment plan:
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do these things?

Other important points:
  • Be sure you understand your treatment plan.
  • Stick with the treatment plan and allow time for improvement.
  • Don't stop medicines when you feel better; check with your doctor first.
  • Call your doctor if your condition is becoming worse.
  • Your doctor should tell you what to expect and when to follow-up or call the office.

Factor 9 Deficiency Using a Cane

Hemophilia B patients with bleeding into one or more joints of the leg or foot may benefit from using a cane.

Proper Cane Length
The handle of your cane should reach to the crease in your wrist when you stand upright and the end of the cane is resting on the floor.

Using a Cane
Hold the cane in the hand on the opposite side of the leg that needs support. With the cane, you can support some of your weight with your opposite arm. For example, if your left leg needs support, you should use the cane with your right arm. When you step with your left leg, the cane and your left leg should be on the ground at the same time, and you should support some of your weight with the right arm.

Follow these steps:

  • Position your cane one small stride ahead and step forward onto the bad leg. Place weight on your bad leg and the arm that is supported by the cane. Your elbow should be slightly bent as you support your weight.
  • Step forward with the good leg.

Climbing Stairs with a Cane
Climb one stair at a time and rest on one step before moving to the next step.

Follow these steps:
  • Grasp the handrail with the hand that is on the same side as the bad leg.
  • Place your weight on the bad leg and on the arm that is supported by the cane.
  • Step up to the next step with your good leg.
  • Transfer your weight to the good leg.
  • Move the cane and the bad leg to the step where you placed the good leg.
  • Support and stabilize yourself with your legs, the cane, and the handrail before moving to the next step.

Going down Stairs with a Cane
Go down one stair at a time and rest on one step before moving to the next step.

Follow these steps:
  • Grasp the handrail with the hand that is on the same side as the bad leg.
  • Place your weight on the good leg.
  • Place your bad leg and the cane on the step below.
  • Transfer your weight to the bad leg and the arm supported by the cane.
  • Move the stable leg to the step where you placed the cane and the bad leg.
  • Support and stabilize yourself with your legs, the cane, and the handrail before moving to the next step.

Factor 9 Deficiency Using Crutches

Hemophilia B patients with bleeding into one or more joints of the leg or foot may benefit from crutches.

Proper Adjustment for Crutches

  • The top of your crutch should be 1-1.5 inches below your armpit as you stand upright and the crutch rests on the floor.
  • The hand grips should be even with your hip joint.
  • Your elbows should bend as you use the hand grips.

Non Weight Bearing Technique
  • Stand on the good leg while using the crutches for balance.
  • Hold the bad leg off the floor.
  • Begin your step as if you are going to step on the bad leg, but do not place any weight on this leg. Instead, place both crutches in front of you and place your weight on your arms.
  • Your arms are supported by the crutches as you grip the crutch handles.
  • The crutches should be placed on the floor at an angle away from the side of your body, in a shape like the upright arms of the capital letter, "A."
  • Your elbows should bend as you support your weight.
  • Gently push off with your good leg after the crutches are firmly planted on the floor. Swing your body forward between the crutches.
  • Rest the top of the crutches tightly against each side of your chest and continue to support your weight with your arms.
  • Do not rest your armpits on the tops of the crutches. This can cause nerve damage.
  • Place your good leg on the floor and allow it to completely support your weight. Swing your crutches slightly away from your body and forward. Place the crutches on the floor to prepare for the next step.
  • Focus on where you are walking -- do not look at your feet.

Partial Weight Bearing Technique
  • Stand on the good leg while using the crutches for balance.
  • Begin to step on the bad leg, but do not place your entire weight on this leg. Instead, place most of your weight on your arms.
  • Your arms are supported by the crutches as you grip the crutch handles.
  • The crutches should be placed on the floor at an angle away from the side of your body, in a shape like the upright arms of the capital letter, "A."
  • Your elbows should bend as you support your weight.
  • Gently push off with your good leg after the crutches are firmly planted on the floor. Swing your bad leg forward between the crutches.
  • Rest the top of the crutches tightly against each side of your chest. Continue to support your weight with your arms and the bad leg.
  • Do not rest your armpits on the tops of the crutches.
  • Place your good leg on the floor and allow it to completely support your weight. Swing your crutches slightly away from your body and forward. Place the crutches on the floor to prepare for the next step.
  • Focus on where you are walking -- do not look at your feet.

Climbing Stairs with Crutches
When climbing stairs, you should climb one stair at a time, completely resting for a moment on one step before moving to the next step.

Follow these steps:
  • Start by supporting your weight with your good leg and both crutches.
  • Place your weight on both of the crutches and move your good leg up to the next step.
  • Transfer your weight to the good leg.
  • Lift the bad leg and the crutches onto the same step where you placed the good leg.
  • Support and stabilize yourself with both crutches and the good leg before moving to the next step.

Going down Stairs on Crutches
When going down stairs, you should go down one stair at a time. Stop and rest for a moment on one step before moving to the next step.

Follow these steps:
  • Start by supporting your weight with your good leg and both crutches.
  • Place your weight on the good leg and place both of the crutches onto the next lower step.
  • Transfer your weight to both crutches.
  • Place the good leg onto the same step where you placed the crutches.
  • Support and stabilize yourself with both crutches and the good leg before moving to the next step.

Factor 9 Deficiency Warning Signs

Continue to Factor 9 Deficiency Prevention

Last Updated: Mar 1, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
Copyright DSHI Systems, Inc. Powered by: FreeMD - Your Virtual Doctor

PubMed Factor 9 Deficiency References
  1. Dunn AL, Abshire TC. Recent advances in the management of the child who has hemophilia. Hematol Oncol Clin North Am. 2004 Dec;18(6):1249-76, viii. [15511615]
  2. Ettingshausen CE, Kreuz W. Long-term aspects of hemophilia B treatment: part I-role for prophylaxis. Blood Coagul Fibrinolysis. 2004 Jun;15 Suppl 2:S11-3. [15322452]
  3. Gringeri A. Long-term aspects of hemophilia B treatment: part II. Blood Coagul Fibrinolysis. 2004 Jun;15 Suppl 2:S15-6. [15322453]
  4. Leissinger CA. Prevention of bleeds in hemophilia patients with inhibitors: emerging data and clinical direction. Am J Hematol. 2004 Oct;77(2):187-93. [15389908]
  5. Plug I, van der Bom JG, Peters M, et al. Thirty years of hemophilia treatment in the Netherlands, 1972-2001. Blood. 2004 Dec 1;104(12):3494-500. [15308570]
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