Day 2:
Clinic: 14 patients
Surgery: With time and the effects of increased abdominal pressure (e.g., heavy lifting or chronic cough), vaginal supporting structures stretch and relax allowing the rectum and/or bladder to bulge into the vagina. Harmful, no; uncomfortable, even painful, yes. Anterior vaginal repairs (anterior colpopexy) begin with an incision in the vaginal roof that runs from the back to within about a half-inch of the urethra, and as it progresses, the underlying connective tissue is dissected away from the vaginal skin, extending one-half to one inch from the center. The freed vaginal skin is excised and the new edges are sewn together, thus eliminating the stretched, redundant vaginal skin that has allowed the bladder to drop. Two anterior repairs went well today, with one predictable complication.
At 46 and in good health Atienia should have recovered easily from this relatively simple procedure. But several hours postop, nurses found her weak, nauseated, syncopal. Her oxygen saturation level measured at 70%. Oxygen saturation is the percentage of hemoglobin binding sites filled with oxygen. Levels below 90% define hypoxia, the point at which organs don't function normally.
At Riobamba's 9035 feet, the atmosphere is still about 20% oxygen, but less gravity at higher altitudes means decreased air pressure, which makes it more difficult for oxygen to enter blood vessels. A number of physiologic changes help Riobambians maintain O2 sats above 95. But Atienia is from Guayaquil, a coastal city and arrived only yesterday to be seen by our team. By giving 100% O2 with a face mask, she did well.
At this level, 4 days is usually cited time required for altitude adjusment. On my first night in Quito (also 9000 feet), I ran 5km in the hotel gym and felt fine (tho at an admittedly wimpy 7km/hr).
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