Follow up on concerns after a hysterectomy
Dear Dr. Roach: I am a 78-year-old woman who would be embarrassed to go to a doctor with my complaint. I have been having a brown vaginal discharge for a couple of months. I did have a complete hysterectomy about 14 years ago, including some of the cervix because of pre-cancerous cells. I followed up for five years to make sure that all was well. There is no pain and no odor with this discharge.
I tend to think it’s just one more old-age occurrence, like thinning of the skin, wrinkles and other things that pop up in old age. The Internet seems to suggest that it is a natural thing in older women, probably caused by the drying up of the cervix.
What do you think?
Dear L.: Some degree of vaginal discharge can be normal. The appearance of vaginal discharge is highly variable, so I can’t really make a diagnosis based solely on your description. The three most common causes are yeast overgrowth, bacterial vaginosis and an infection called trichomonas, which is the only one of the three that is transmitted sexually. In older women, vaginal atrophy is common due to decreased estrogen production, and this can have an associated discharge.
However, any woman with a history of cancer or pre-cancer in the cervix should continue to follow with her gynecologist. There has been recent discussion about whether routine gynecologic exams are worthwhile: There are two sides to that debate, but NOT in a woman with a history of cancer.
Get over your embarrassment. You need to get this evaluated by your doctor. The odds are that everything will be fine and that a simple prescription will take care of a problem, if there is one. But only your doctor, nurse practitioner or physician’s assistant can evaluate it.
Dear Dr. Roach: I woke up in the early morning with a pain in my left calf. There was clearly defined swelling, and I felt a small nodule. I immediately thought of a blood clot and saw my primary doctor, who ordered a Doppler ultrasound, which was negative. This was followed by an MRI scan and bone density test, and the nodule was diagnosed as a fatty tumor. It’s almost a month later, and it is still swollen and firm to the touch.
Dear N.H.B.: Sudden swelling in the leg should indeed raise suspicion for a blood clot in the deep veins in the leg (deep venous thrombosis). An ultrasound test is a good way to make the diagnosis, but it isn’t perfect. If suspicion is high for DVT, then the test should be repeated or a different test done.
A fatty tumor (lipoma) can cause a soft nodule, but usually not sudden pain and swelling. Other possibilities include a superficial blood clot, infection and calf-muscle tear. A month is a long time for any of these conditions.
Go back to your doctor.
Email questions to ToYourGoodHealth@med.cornell.edu.