On the second day of Ob-Gyn rotation, we once again observed
Dr. Cao in the outpatient department. We saw many interesting cases today and I
have outlined some of them below.
Case 1: The woman with the rectocele
58 year-old female with an ATH (abdominal total
hysterectomy) presented with the chief complaint of stool passage issues. She
explained that it was difficult for her to pass stool and she has noticed when
she bears down to poop, a pouch protrudes from her vaginal canal. The only way
to relieve the problem was for her to physically insert a finger into her
vagina and push the pouch posteriorly. She also suffers from mild urinary
incontinence when she exercises. Upon examination, Dr. Cao showed us the
protruding pouch from her vagina and diagnosed it as a rectocele (a prolapse of
the rectum into the wall of the vagina). I was once again surprised by her
openness to discuss her issue in front of 4 people (Dr. Cao, the nurse,
Christine and I) and willingness to demonstrate exactly what she has to do in
order to pass stool. It was certainly an eye opener and I don’t think I will
ever forget what a rectocele is or what it looks like. Surprisingly, Dr. Cao
suggested that if it is not causing her any pain other than the inconvenience
during a bowel movement, she should just keep it the way it is. He explained to
her that even if she underwent surgical correction for the rectocele, the potential
side effects or results might cause her even more issues than what she has currently.
Case 2: The woman with Trichomoniasis and condylomas
24 year-old woman who presented with the CC of increased
white discharge, vaginal discomfort and foul odor in that region. Dr. Cao
examined her and discovered copious foamy milky white discharge in her vaginal
canal. In addition, he noticed 3-4 small condylomas (genital warts caused by
HPV-often a symptom of STDs) in her perineum. Dr. Cao prescribed her Flagyl,
which is an antibiotic for anaerobic bacteria and also Dafrin for the
itchiness. We actually saw this patient on Monday, but we saw her again today
because Dr. Cao scheduled her to get her condylomas removed. As a result, we
got to go into the surgical room to observe Dr. Cao remove the warts through electro-cauterization.
It was an extremely short procedure and we were out in less than 15 minutes.
In the afternoon, we observed a different physician named
Dr. Tung. Dr. Tung was the first female physician I’ve shadowed in this
hospital. She was incredibly nice and took twice as long with her patients as
Dr. Cao did. She was chattier and perhaps the patients were more comfortable
with her, they responded to her more eagerly than they did with Dr. Cao. We saw
several more pap smears, amenorrhea cases, and lower abdominal pain cases. We
were able to observe an X-ray performed on the uterus using dye contrast and
tomorrow, we are scheduled to observe a cone biopsy of the cervix. Though I
have realized Ob-Gyn may not be the right field for me, I am still intrigued
and excited for tomorrow. I was also glad to notice that there was MUCH more
privacy in the Ob-Gyn outpatient department than in heme-onc or pulm.
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