Day 3
Two surgeries, abdominal hystectomy for chronic pelvic pain for 49 year old Mario with chronic pelvic pain since her tubal ligation 20 years before. Hysterectomy for pelvic pain is always an iffy measure. Many women continue to have pain postop, suggesting other sources of pain (gastrointestinal, or muscular for example) or an esceptionally low threshold for pain. But studies have shown that most women who undergo hysterectomy for his reason (assuming that other sources have been investigated and exluded) end up having a better quality of life postop.
Maria's hematocrit (the percentage of blood that is red blood cells) was 51, reflecting her high altitude adaption. Normal range for U.S. is 36-45; for Riobamba 45-55.
The second case was bilateral removal of ovaries for a postmenopausal woman with a “complex” ovarian cyst. Simple cysts are like water balloons—thin walls and clear fluid contents. Complex cysts are everything else—thick walls, solid components. Simple cysts are benign; complex can be malignant. Martha's cyst appeared complex on ultrasound but intraoperatively was clearly benign.
A busy clinic showed just about the same grouping of presenting problems that I might find at home, with one exception: parasites. The other 19 included:
urinary tract problems: 2
reproductive counseling: 2
annual exams: 2
menopausal issues: 3
abnormal bleeding: 2
pelvic mass: 1
chronic pelvic pain: 7
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