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Vaginal bleeding, 80 years - Online Doctor Chats

Date : 21-Feb-2012
User rating for this question
Excellent Posted in: Cervical and Ovarian Cancer
Answered by

General & Family Physician
Practicing since : 2005
Answered : 1706 Questions
User :   My mother is 80; she has experienced vaginal bleeding this week (previously experienced this once in June). The bleeding has worsened today. (not heavy but heavy spotting). Her ultrasound is not scheduled until mid December. Should we accelerate her appointment, and should I take her to the doctor on Monday?
Doctor :   Hi
Doctor :   How can I help you?
User :   Please refer to my earlier question regarding my mom's bleeding. Thanks,
Doctor :   Does she have any other symptoms along with vaginal bleeding - abdominal pain, discharge pervagina?
User :   No ab pain, what is discharge pervagina?
Doctor :   I mean do you notice any discharge?
User :   No, the spotting appears as if it is a menstral cycle.
Doctor :   Does she have any other medical illness?
Doctor :   Is she on any medical drugs?
User :   Also, given the extensive delays in HC testing in Canada, we brought this to the attention of our family physician in June. The ultrasound is not scheduled until Dec. 14, do you think I should try to have this rescheduled or get the test in the United states?
User :   Only high blood pressure, treated with Micardis.
Doctor :   Was a pap smear done for her?
User :   No pap smear in June, also she had a physical 2 weeks ago, no pap test.
User :   Please advise on the timing of the ultrasound - should we accelerate? thanks,
Doctor :   Ok
Doctor :   I would like few more details before I give an opinion.
User :   Also, Mother had breast cancer - full masectomy in 1994.
Doctor :   May I know, if she is losing weight without any cause?
Doctor :   Does she have reduced weight?
Doctor :   * Does she have reduced appetite?
User :   She has not lost weight recently; over the last 2 years, she has lost about 15 pounds. She is very fit; does 30 minutes of cardio with me at the fitness center 2-3 times a week. She is losing her memory, and the physician indicated that she would like to to a test on this.
User :   Yes she has a reduced appetite - and only eats when reminded to eat.
Doctor :   Ok
Doctor :   Let me brief you.
Doctor :   Without a physical examination, it is difficult to predict what is the reason for the bleeding is, however based on what you describe, the following conditions have to be looked for.
Doctor :   1. Cervical tumours
Doctor :   2. Pelvic inlammations/infections
Doctor :   3. Genitourinary infections
Doctor :   4. Ovarian cysts or tumours.
Doctor :   These conditions can be diagnosed by tests and physical examination.
User :   When you indicate physical examination - do you mean ultrasound? And what other tests could be done?
Doctor :   Pap smear, vaginal smear, urine analysis, culposcopic examination are better diagnostic tests, than ultrasound alone.
User :   What is coposcopic examination? Is this performed by a family GP?
Doctor :   Culposcopic examination is an visual examination of cervix and vagina, through an instrument.
User :   Thanks - what is the urgency? Do we need to expedite, and book an appointment with our GP on Monday.
Doctor :   This is one among routine examination done by a gynaecologist.
User :   Oh no, not a gynaecologist, in Canada that could take months.
Doctor :   Watch out for few symptoms such as
Doctor :   abdominal pain or discomfort, profuse bleeding, fever, difficulty while urination, presence of blood in urine.
Doctor :   If such symptoms, you may have to report to your doctor immediately.
User :   So far, none of the above. What does her loss of appetite suggest? I'm worried she has cancer.
Doctor :   Else, you can go with these tests through your GP.
Doctor :   I mean get an appointment with a gynaecologist through your GP.
User :   When you indicate profuse bleeding, do you mean very heavy bleeding (1 pad per hour)?
Doctor :   Sudden loss of appetite and with unexplained loss of weight, with or without frequent fever are signs of malignant cancers,
Doctor :   By profuse bleeding, I mean if there is more than 2-3 pads per day,
Doctor :   presence of clots in the bleed,
Doctor :   or if there is bleeding following sexual intercourse.
Doctor :   If these symptoms are noted, then you may have to get these tests as early as possible.
Doctor :   Have you followed what I have suggested?
User :   No clots present. How would infection be detected?
Doctor :   The signs of infection are very mild in an elderly.
User :   I believe that I understand that we should accelerate the tests. I intend to contact our GP on Monday, and see if there is any way to accelerate the ultrasound or other tests. If not, I will look into scheduling the tests in the US, as there are clinics which take Canadian patients. Is there anything else that I should watch for over the next 2-3 days?
Doctor :   Yes,
Doctor :   Watch out for these symptoms
Doctor :   1. Drowsiness or reduced activity.
Doctor :   2. Further reduction in the appetite
Doctor :   3. Fever
Doctor :   4. Discomfort or difficulty in passing urine.
Doctor :   5. Feeling of weakness
Doctor :   Watch out for these symptoms.
User :   She has drowsiness, but not increased signs thereof. I will continue to watch for these symptoms. Anything else I should ask the GP at the next appointment? Would blood testing help?
Doctor :   Good and improved diet, monitoring of blood pressure are other few things that you can do.
User :   If the bleeding worsens this weekend, should we go to a walk-in clinic?
Doctor :   Blood test can help, but the pap smear, vaginal smear and the colposcopic examination are more essential.
Doctor :   Yes, if there is worsening of the bleeding you can get either to an ER or walk - in- clinic.
Doctor :   Have you followed what I have suggested?
User :   I've exhausted my questions....I really appreciate the information. Is there any other advice that you might provide?
Doctor :   I can give a better opinion, if I had the reports of those test. Hence my suggestion is that you get these tests. Things will be much clearer following the reports of the test.
Doctor :   Have you followed what I have suggested?
Doctor :   Do you have any other query?
User :   Very good - I understand your suggestions. No other query at this time, thanks again.
Doctor :   Thanks for consulting me. Bye for now
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