Apr 13, 2011

golden rules

there are several golden (simple, made for idiot like me to remember) rules in gynaecology.

abnormal per vaginal bleeding in
  1. pre-menarche girls is sexual abuse or foreign body until proven otherwise
  2. fertile ladies (in reproductive age) is complications of pregnancy (miscarriage, or ectopic pregnancy) until proven otherwise
  3. warga emas (more than 40years old) is cancer until proven otherwise
I think this is the bare minimum that any medical graduates should understand.

solution: vaginoscopy, to check for foreign body and removal without compromising the hymenal integrity.
prevention: ...


Anonymous said...

Are u 100% sure rule no 3 applies coz the two gynaes who checked me (yes I'm 40something warga emas) said my abnormal bleeding its 99.9% pre-menopausal symptom and it normal not cancer & instead of checking me for cancer when I complained 2X and then months later it turns out they were wrong and I had the fucking BIG C. And these 2 gynaes are all in their 40's & 50's and one of them is a gynae oncologist!

pilocarpine said...

it is not in my place to comment on the experience that's beyond my seniority.

but it's still a possibility of 0.1% of cancer, and therefore some test is warranted to exclude it.

however, given their seniority and experience, they tried their best not to overdo tests on every patients.. so tests can be painful, annoying and come with risks.

i hope your cancer is being caught up in the early stages, since you're under the care of a gynaeoncologist, and the best treatment can guarantee a better 5 years survival.

i will try to help out if you have any further enquiries. Anger is the worst way of battling a cancer, Understanding is the best.

Not all cancers are death sentences.

May you be well and happy

Anonymous said...

"however, given their seniority and experience, they tried their best not to overdo tests on every patients.. so tests can be painful, annoying and come with risks"

As a woman, we know when something is wrong therefore we run to the doctors to check what is wrong, but when they pooh pooh & say don't worry without even bothering to look at medical history, the symptoms did not happen overnite, but over a period of months ! And because warga emas (in their 40's) also fall in pre menopausal group, the gynaes ASSUME I fall in that category. This also happened to my late aunt who was unfortunate as she was nearing 50, with a history of birth control device but the gynae also pooh poohed & say PRE MENOPAUSE. And both our doctors are attached at very well known private hospital in Klang Valley.

The same gynae onco who I consulted months before said DONT WORRY my type of cancer is easiest to treat. He has no idea what the fxxk BigC word means.

The tests can be annoying, painful & come with risks YES... but the PAIN that comes with cancer is 100x worst.

Yes I'm angry but has managed to overcome the sadness & anger but I'm super angry when I read in your blog post that No3 Golden Rule for medical ppl that abnormal vaginal bleeding for warga emas is cancer until proven otherwise ! That is what makes me angry when I think of my experience.

pilocarpine said...

my condolence for your late aunt.
if it will help, maybe i should retract this blog entry.

Anonymous said...

don't retract this blog entry, let this be a lesson & reminder to all esp to gynaes not to under treat women patient in future.

Fyi, this is not an isolated case. Google Fran Drescher aka The Nanny actress, she went thru the same experience as me & was she furious with all the gynaes. She once gave a speech at one gynae conference (US) some 2-3yrs back about her experience.

take our personal experience as a learning process. tq for listening

pilocarpine said...

thank you for reading my blog... it would be better if you're not anonymous.. n there is a person dat i can relate to...

Anonymous said...

hint ... i read from malaysian medical resources, maybe one day I'll tell or email who I am, occasionally I pop by here :D

pilocarpine said...

dat's an extremely non-specific hint.. =)
alrite, i will wait for that one day..