247. Nepal Day 14

Difficult day on the postop ward. One young patient with a simple tightening of the posterior vagina (the vaginal floor) reported postoperative abdominal pain, back pain and and/or headache. No vaginal pain was reported. All of my previous U.S. patients with this procedure go home after a few hours, many reporting report zero pain.  

Concerned about a “white” vaginal discharge she was reassured, with the caution that a vaginal discharge becomes a concern only if associated with pain or itching or malodor. Yes she promptly reported, she was experiencing all three. But an exam showed only a slight blood-tinged discharge that one would expect in this postop setting. 

Nepalese nurses and doctors spent much time with her, eventually discovering that she hadn't taken thyroid medications for four days—but it turned out that it was such a low dose that even four days missed should not elicit the symptoms she reported immediately postop. Questionable use of thyroid supplements for fatigue and weight gain among other complaints has a long history in the U.S., and it would be not unexpected to find the similar prescription patterns here. She ended up staying three days.

"They all want medications" I was told by a local nurse using “antibiotics” as the generic term for any pharmacologic cure. But then again, so do I with my tumeric, vitamin D ibuprofen for arthritis, along with thyroid and HCTZ, which is another story (osteodude.blogspot.com).