[Resolved] Post-OP injury after returning home. Not sure how to handle.

[LifeInLimbo]

Within the first week of coming home from Thailand (Dr. Suporn), I have two cats that have a habit of using me for a jump pad. Unfortunately for me, one jumped off of me, and it's back paw pushed DOWN and OUT (while I'm in a laying position) on the top of the clitoral hood and across the front of the clitoris itself. This caused extreme short term agony considering I'm still recovery and have stitches there of course.

I commented to Sophie about the discharge being tinted green and strong smelling to which she replied it was normal and that the injury shouldn't have caused any damage to the clitoral area. Since then I've been having worsening pain on the left side, in between the fold and the very left side of the clitoris, along with the oddball feeling of it 'moving' as it it popped into or out of place. Colour is normal of the skin is normal but been getting additional discharge from that area specifically (as determined by smell and the fact there is always a line from that area down the pad since then). Pain relief there was always found when just lightly wiping around the inside and around that side of the clitoris with a betadine soaked swab tip for several hours until it returned soon after.

Now, after closer inspection tonight - I at least now know where that nylon stitch through the clitoral hood went. It goes in and around through the side of the labia, into the right side of clitoris, and out the other side to I'm supposing it would have continued into the labia on the other side to 'fix the clitoris in place'. Closer inspection reveals that that part of the stitch on the other side is just sitting there and the side of the clitoris and the labia wall are separated which would explain the pain and discoloured discharge with a strong odour (infection?) as the loose stitch tip is now just aimlessly poking that section of the labia wall.

So the question is, since I'm already home in the states what more can I do about this and the stitch aside from constantly flushing it with a betadine solution and continue dealing with the pain from that stitch?

[Vicky]

As quickly as you can, get in touch with a Gynecologist in your community and or your health plan and have this put under their care.  I had stitches that came loose in my surgery too, but that was simply when they had dissolved for whatever reason they did.  The fact that the cat's claws tore your skin is the issue since your immune system has taken a general hit by the surgery itself.

[LifeInLimbo]

As quickly as you can, get in touch with a Gynecologist in your community and or your health plan and have this put under their care.  I had stitches that came loose in my surgery too, but that was simply when they had dissolved for whatever reason they did.  The fact that the cat's claws tore your skin is the issue since your immune system has taken a general hit by the surgery itself.

Aye, I contacted Sophie with more details about it and will be calling my psyche for a referral to a gyn that can look into it. The cats claws did no damage.. in actuality.. it was purely the weight and pressure from her back paw itself (with the claws retracted so not out) that tore the stitch and that section out of place.

I have been managing it since the 23rd of Sept but it isn't getting any better pain-wise so something definitely needs to be done.

This is the mailing I sent her way which was more clearly revised than the frantic post I put up while gathering my thoughts.

To touch on the issue of the cats jumping on my clitoral hood from an earlier reply.. I think there was, in fact, some damage caused. Since then I have been having pain to the left side of the clitoris and top of the clitoral hood and a mild wipe with a betadine swab and flush relieved that pain for a few hours. There is extra discharge from the clitoris/hood specifically happening as evidenced by a greenish streaking discharge down the pad from that area only. That area is as seems to have been the original source of the strong smell and green colouring despite no more coloured discharge from the vagina itself (very little of it infact). This would explain why lightly wiping and cleaning that area with a betadine swap relieved it for a short period.

I took a closer inspection last night and made a small assessment from what I can gather from how the area was normally stitched.

The nylon/clear stitch starts at the top of the clitoral hood and runs along the inside and exits through the labia Minora into the side of the clitoris to fasten it in place. It then continues through the other side and into the other labia minora wall then continues on back through and meets at the top in a knot.

My assessment revealed the following from tonights closer investigation with a magnified mirror.

The nylon/clear stitch starts at the top of the clitoral hood and runs along the inside and exits through the labia Minora into the side of the clitoris to fasten it in place. It then continues through the other side... as a long excess piece with nowhere to go. This side of the clitoris is separated from the labia wall on the other side with the long piece of stitch aimlessly poking at it causing further irritation and seemingly the cause of the odour and possible infection as the pain subsides after a cleaning. There is no longer any secondary section of stitch at the top of the clitoral hood where there would have been a knot... just one piece of nylon. The result is the clitoris being fastened in place from only one side with a bit of uncomfortable movement and popping out of place as the clitoris and labia wall on the other side constantly heal and separate from regular movements such as sitting. I will see if I can borrow a camera to provide photo's as I'm sure this situation will warrant it. This one doesn't seem like something that will heal on it's own and has been the primary cause of worsening discomfort lately since the incident both with pain and a very strong burning sensation. Sometimes the pain gets to the point I can barely walk around at times without holding that area to apply pressure.

[Monkeymel]

If nothing else a principle care provider to get some creams to help with disinfecting and possible bacterial infection. Are you still taking antibiotics or anti inflammatories?

Lalugen is a runny cream which helps clean wounds and stimulate skin growth
Fucidin is an antibacterial cream which can help with any mild bacterial infection

[LifeInLimbo]

If nothing else a principle care provider to get some creams to help with disinfecting and possible bacterial infection. Are you still taking antibiotics or anti inflammatories?

Lalugen is a runny cream which helps clean wounds and stimulate skin growth
Fucidin is an antibacterial cream which can help with any mild bacterial infection

The only inflammatories I have are just the usual NSAID's they provided me (Idarac.. which is just ibuprofen of the same dose). I was provided with plenty of Silvex however as a cream for the purpose which is 1% micronised Silver Sulfadiazine. That's about it aside from the usual Povidine/Iodine solution. I was taken off antibiotics a week before returning home (was a wide spectrum antibiotic.. name escapes me at the moment).

[Jenna Marie]

Yowch!! I winced just reading that.

I would try to get a local GP to take a look even if the surgeon's office reassures you again that it's fine; the pulled/popped stitch may not be a big deal, but the color and odor of the discharge sounds a lot like infection. If so, you don't want to let it get a foothold.  Thank goodness the cat's actual claws didn't make contact - I love cats, but their feet are full of bacteria. We were actually banned from having pets in the bedroom for a month after we got home, and I can see why...

(I was on a broad spectrum antibiotic for a month post-op just in case, as it sounds like you were, but once you stop taking it you're fair game for infection again.)

[LifeInLimbo]

Ended up going to the ER yesterday which was probably just in time too since no gyn I could contact as a referral from my psychologist would see me till next week (one even wanted a $100 consultation fee up front beforehand!). For the past few days I was slowly feeling more nauseated,dizzy, whole body feeling hot but no fever, worsening headaches to the point of migranes, lack of appetite, etc. From what I find out the infection was beginning to go septic based on the symptoms. Got to the point I had to barely drive myself there to get this taken care of.

Prior to the ER visit a day prior I realized the stitch was one of the two on the sides of the clitoris clamped down with a tiny loop. Stitch with the stiffness of fishing line (resorbable monofilament stitch) that was on the outside for over a month. The other one that matched (this one still butterfly tied unlike the problematic one) was attached by a thin layer of skin necrosis and was a perfect example of what the other stitch was exactly like.

However, the ER wasn't helpful at all at the hospital locally I went to. I described an abscess with excessive puss and excessive pain from the stitch stating I needed the stitch excised. They looked and saw how much drainage there was from that area and sent me to Triage. Needless to say, they took a blood test and a culture swab of the area.. and an hour later told me I'm going home with strong antibiotics only (Keflex and Bactrim for 10 days nonstop) and they weren't going to do anything about the stitch. This left me puzzled as the stitch is the source of this trouble and incredible pain and was told that 'they didn't want to touch it due to not knowing what the past surgeon was using it for'. This all despite my explaining what it was, why it's like this, and what it was/wasn't attached to or for. Was also told that 'the stitch will have to stay as it is until it dissolves... sorry' which would take over a year.  I haven't dilated in 2-3 days because of the infection, symptoms, and pain... I didn't want to go a year until that stitch dissolved before I can continue on unless I was on severely strong painkillers and antibiotics 2/47 due to the source being left in there. Might as well tell a person that the rusty nail in their foot must remain till it dissolves but to take 10 days worth of strong antibiotics in the meantime.

All it would have taken to resolve the stitch excision was a 1-2mm cut parallel along the short part of the exposed stitch numbed with lidocane, the knot pulled out, and undone with the rest of the stitch pulled away. All this trouble being caused by a couple centimeters of untied stitch snaking it's way through the labia minora, stabbing everywhere it went and causing the infection in the same exact way an ingrown hair would. I'm guessing they refused to 'treat' me because it would have been considered a possible 'liability'.

So.. my solution ended up being treated by the 'backalley surgeon' (jokingly stated of course). A couple family members helped instead with my guidance and half a low-dose oxycodone pill to take the edge off (the side effects weren't pleasant after it wore off - never again taking that!). We then proceeded with a sterilized needle, flat-blaze razor, and tweezers and was able to make the small cuts needed to expose the stitch and work it out. It was rather crude but it did the trick and did what the hospital could/should have done for me to begin with.

Immense relief was felt afterward.. but I feel like I got kicked in the left side of my crotch due to the soreness due to the small cuts and pulling to expose the stitch knot and the infection starting to go down some now that the source has also been removed. It just feels good to finally sit down and sleep without feeling like I'm being repeatedly stabbed with a knife down there and feeling overall worse by the day. Was rather sickening how much green foul puss was trapped inside where the stitch was. Antibiotics can cure an infection but it won't cure an infected stitch that isn't removed.

The day after (earlier today) is when the symptoms hit me full force. I couldn't even lift my head without feeling dizzy and feeling I needed to vomit from the nausea. Was feeling hot everywhere, aching everywhere, migrane worse than I could ever imagine. Was feeling fine for a short bit wen we all went out to get breakfast only for me to eventually feel faint, go pale, and end up heavily nauseated so had to lay down in the vehicle instead. Ended up laying back down at my brothers house for a bit while they went out and started to feel a bit better. Tylenol, Nyquil, and antibiotics later I'm feeling able to actually get on with my day and feel normal again. Pretty much most of the symptoms have started to wear off... but leaving that stitch in like the hospital suggested wasn't going to make it get better in any form.

Now there is far less discharge from the affected area and far less trouble. I honestly feel like the hospital just wanted to get rid of me without actually fixing anything as if sticking gum in a widening crack of a floodgate. It may work for a very short term but it won't solve the problem.

[mrs izzy]

This is why i say make sure you have talked to a doctor or gyn before anyone has GGS.

It happens to often that there is no acceptable care in emergency care. They have no clue what to do.

Who to think, infection is a infection.

Hope you feel better and you can get back to healing and dilation.

[LifeInLimbo]

This is why i say make sure you have talked to a doctor or gyn before anyone has GGS.

It happens to often that there is no acceptable care in emergency care. They have no clue what to do.

Who to think, infection is a infection.

Hope you feel better and you can get back to healing and dilation.

Thanks - giving myself another day for the soreness and sickness to wear down then to catch up on a few days of lost 'duty'. Going to be hell I tell ya!

I did contact a couple prior - don't get me wrong! The issue is that by the time I needed to actually see one I find the surgeon/doctor that could perform the task wouldn't be in that day or was already booked. So had to get other contacts/referrals from my psych on short notice to try hunting around for another in the meantime only to get no luck in that department with worsening results. Couple even told me that the 'ER is probably my only hope at this point' or that they won't accept patients without insurance. Can't sign up for a health plan either until 'enrollment' opens up come November.. since I tried to apply for one months ago only to be pushed away because I wasn't already transitioning from one provider to another.

[JessicaH]

There is no requirement from the surgeon to line up a local provider ahead of time in case their are problems?

[Jenna Marie]

Oh, wow, what a nightmare. I'm sorry you had to go through all that, and especially that you ended up having to get it handled *yourself* after the ER turned you away. Hopefully this will be a fast track to healing now, but that's horrible.