Travel problems! Stitches and Credit Cards?

March 1, 2015 9:17 AM

I'm in Vietnam, soon to be India, and I have a medical problem and a credit card problem. (1.) How to treat stitches in my leg from an injury I got 17 days ago? YANMD, but you speak English. (2.) Credit card: My card is lost, where in Northern India should I get the replacement sent?

Issue 1: Injury
(Pictures attached are non-gruesome except for 'warned' one)
A car door opened directly onto my leg & shin while I was on the back of a bike (didn't hit the bike, just my leg). Luckily we were going very slowly, and I was wearing leather boots. I went to a Thai hospital, they cleaned the wound e.g. (car paint!), and I got 4 stitches, antibiotics etc.

It's quite a short cut obviously, but it went down to the shin bone.

It seemed to be healing well. When my foot got a bit swollen, I kept it elevated, and it went away. This was from Day 2 after accident - looking fine!

Day 7, I had the stitches out. If I knew what I knew now, I would have had the stitches in longer, because I really don't care about getting 'train track' scarring on my shin. Dr Google tells me that 'Pretibial lacerations' aka deep cuts on the shin should have stitches for 10 to 12 days.

Day 8, when I arrived in Bangkok, I walked around a bit too much, because it started bleeding (But, but - Chinese New Year! Walking street in Chinatown!). I held it together with my hands and then bandaids, as I had the worrying feeling it was trying to open ALL the way. Day 9 managed to get some steristrip things and taped the whole thing together. Yay! If I knew what I knew now, I would have bought several weeks worth, but... I didn't. Then I was in Cambodia - asked in pharmacy, showed box, no butterfly strips. Vietnam, no strips.

Day 14 from injury, took this picture to show my mother it was healing ok (last two steristrips!), then two hours later, did something really stupid - yanked my boot off, and busted it open again. :(

Tried pharmacies, then ended up at a Vietnamese Hospital in Hoi An (pretty tourist town by the way!). The doctors only spoke a couple of words of english, so I was using Google translate to say things like "Two weeks since injury. One week since stitches out", showing them pictures, including the one of it looking fine two hours earlier, and the box of steristrips.
They said "Infected!". They said "Stitches!". I figured stitches were probably a good idea, because they didn't have steristrips. I'm not a Doctor, but, does that last picture before I ripped it open really look like an infected wound?

So they opened it up again, swabbed it out with Iodine. I got to see deep inside the wound all over again. [Warning! The slightly gruesome one! NSFW!] Sorry, camera phone pic, so it's not initially clear how deep it is until you zoom a bit.
They stitched it up again with 5 stitches, and sent me home with two antibiotics - cefuroxim, ciprofloxacin, and something called alphachymotrypsine which google tells me is for edema (and taste like mints!).

I'm back at square one, except it is hurting just as much if not more so as straight after the accident. I think it might have got a little infected after being swabbed over. Day 17 since initial accident, 'Restitch:Day 3' and it is not as hot and red as yesterday, but I'm worried that the edges seem like it is connecting less than it did the first time it got stitched, and it's still weeping. My brain is just really, really not working, despite lots and lots of sleep. Maybe I'm just more stressed by now, but it seems like it hurts more than the first go round.

Mostly I'm just stressed out, in pain, in a foreign country without Drs who speak my language or access to things like steristrips.

In three more days I will be flying to Kuala Lumpur Malaysia, where I have 1/2 day there, then I fly to Delhi, in India.

What should my approach be from here?
My current plan is to buy a heap of steristrips in Kuala Lumpur. I don't know what other supplies I should get, or if I should try and visit a Dr there. I have one tegaderm waterproof bandage I could use. I'd tegaderm over the stitches right now (to protect it from infection, while I'm still on the strong antibiotics), but I don't think I should while it is still weeping? IANAD. I'm not sure how long I can or should leave the stitches in. As long as possible, preferably. I don't mind taking them out myself, either.

My current plan - once it stops weeping, tegaderm to keep out nasties, as it's a humid, unsterile environment, and the antibiotics are about to run out. Once I have steristrips, reinforce stitches with steristrips, and tegaderm over the top. Leave stitches in for 2 weeks, then remove, and steristrip and tegaderm. Keep it elevated above my butt when I'm not walking.

If anyone knows where to get a walking cane in Hoi An, that'd be aces too. :P


Issue two - I lost my credit card!
Luckily I have a someone travelling with me who is able to get cash out, but he only has 1 card, and given our calamities, I am worried about going the next 6 weeks, through India and Nepal, with only one card between the two of us.

Bank says it'll apparently take 7-10 days to arrive. At that point I will be either be in Delhi, just about to go to Jodhpur, then after a few days there, will be Jaipur (possibly 2 weeks for indian mail?!), then back (so could possibly stop in Delhi again instead of Agra).

My bank wants to know where to send it. Where do I send it?!?

I am staying in cheap backpackers along the way ($10 per night), but I don't have anywhere booked yet.
I'm not sure if it would be safe to send the card to a hostel?
Does India even have Post Restante?
I saw a suggestion to try sending it to a couch surfing host instead, but I'm not even signed up for couch surfing. Should I do that?
What budget would I need for a 'high end' hotel, to reliably get the letter to me?

Normally I would be very good at this kind of problem solving, but I just can't.


I think my leg will be ok enough for riding trains around India. I did Bangkok to Cambodia to Vietnam mostly ok. I could rest up in Delhi, however, I really would prefer to stick with my travelling companion due to money, having someone to help, and they are off to Jodhpur, Jaipur etc.

[The mods have very kindly let me post two questions in one]

posted by Elysum to Health & Fitness (21 answers total)

You should try to pick up hebicleanse. It's in a blue bottle with a white label, and it's a pinkish liquid used to clean wounds post surgery.

Instead of bandages look for nonstick pads and bandage tape. I went through a lot of those after my surgery.
posted by spunweb at 9:39 AM on March 1, 2015

Re: your credit card - I would contact your country's embassy in Delhi and see if they will allow you to have the bank send your card there.

Re: your leg - I'm unclear how long it's been since you started the antibiotics, but if I were you I would stay put and stay off that thing and if it's not noticeably better tomorrow go back to the doctor. Don't be messing around with that wound on your own. You need to be taking it way easy and taking the injury much more seriously than you have been. Slow your travel plans down for a while if you can. You need to get this thing healed up and if that means going back to the doctor repeatedly and losing money on an already purchased airfare ticket, well, that's better than getting sepsis.
posted by something something at 9:40 AM on March 1, 2015 [4 favorites]

IANYD. You are getting confused about wound healing principles. When it has been weeks since the injury, having it closed is not the best idea because bacteria from your skin will have inevitably gotten into the wound, and by closing it you are just sealing the bacteria inside. Wounds should generally be closed within 24 hours of when they occur, or not be closed and allow to heal by "secondary intention", especially if you don't care about scar. I don't think steri strips and Tegaderm are going to work well for you in a hot\humid environment on a gaping wound like that. Get rolls of gauze. Wash the wound well daily with bottled water, put on Bacitracin, roll on gauze and maybe an ACE wrap over top to hold it together. The antibiotics you are on are strange choices for skin infection BTW. I don't have full confidence in the docs you saw. See someone else. No, the picture you posted does not look infected but I did not examine you in real life and cannot judge.

Would you really trust a couch surfing host you've never met to receive a credit card for you? I love couch surfing but I think that's not a great idea, I wouldn't rely on mail in India at all. If you get stuck there's always Western Union.
posted by treehorn+bunny at 9:49 AM on March 1, 2015 [6 favorites]

India, especially in the major cities, has much better options for medical care than the SE Asian countries you've been visiting. The Embassy or Consulate will have a list (sometimes even on their website) of clinics and hospitals that cater toward tourists. While it will be more expensive, it sounds like you need a clean, well-equipped facility with well-trained English speaking doctors. That is possible in India.

As for the credit card, can you talk to your bank again? Sometimes they can rush these things, sending a new card via FedEx or similar at a minimum. Even if you have to pay extra, getting a new card quickly would take one worry off your plate, and you have enough troubles when you're supposed to be enjoying your adventure.
posted by zachlipton at 10:01 AM on March 1, 2015 [1 favorite]

Response by poster: treehorn+bunny:
I don't have any confidence in the docs I saw, and wish I hadn't ripped it open, or that the initial stiches had just been in for 12 days, rather than 7.

But, to be clear, it was closed, then 2 hours after that exact picture was taken, I accidentally ripped it open (by pulling my boot off too hard - I just forgot), then less than two hours after that, the Doctors at the Hoi An Hospital were opening it riiight up again. It wasn't 'gaping' until they "cleaned" it, and then they stitched it closed again.

I am here in Hoi An for another 3 days, and I don't know of any bigger hospitals or better Doctors I could go to. That's why I am resorting to using the internet. :(

Does it need to be unstiched? Can I wait til Kuala Lumpur and see someone there?
posted by Elysum at 10:03 AM on March 1, 2015

Erm... doctors in Vietnam... not the best reputation for proper medical help. As you have now experienced.

Listen to treehorn+bunny.

I would not plan on getting the new card while traveling. Call your bank and find out what other options you have for getting money through them in India. Could you withdraw in person at a bank somewhere, just having your account information? Can you wire money to yourself? Can you transfer money to your travel partner?
posted by zennie at 10:09 AM on March 1, 2015

Response by poster: Credit card - Embassy!

Ohhhhhhhhhh! Yes. That it super obvious and it didn't even occur to me.
There is a NZ Embassy in Delhi, I will ask to have it sent there!


Wound:
Above is an example, I'm really not thinking well.
I was partly worried about it being mildly infected because leg was hot, red, but that is already getting better, but mostly because I've been forgetful, weepy, full of suck. I thought I'd only stayed in the guesthouse 2 days, not 3. Had to be shown on a calendar before I believed. Kind of forgot the whole day after stitches.

Should I keep taking all these antibiotics? Only a day left now I guess, but maybe it's partly the meds that are making me loopy.

Is there anything I should do between now and Delhi, where I can go see a Dr?

(Have to say, other than stitches out too soon, Thailand also left me with much greater confidence in medical treatment than Cambodia or Vietnam).
posted by Elysum at 10:15 AM on March 1, 2015

zachlipton's suggestion for asking to use an express courier service for the card is a good one.
posted by zennie at 10:18 AM on March 1, 2015

I wouldn't arrange to have the card sent to the Embassy until you've talked to the people at the Embassy and have their OK. They may well be willing and able to help, but it's unlikely to work if they aren't expecting the card first.

I would contact them via email or telephone about both the credit card situation and your need for medical care. Ask them for their recommended medical facilities that meet international standards and have English-speaking doctors.
posted by zachlipton at 10:42 AM on March 1, 2015 [1 favorite]

As a non-medical expert, your leg doesn't look horrible at the moment. But you need to slow down your travel a bit, and make sure you get some rest, showers, food and stay off your leg for a few days.

Are you flying out of Hoi An, or another major city? There are better clinics in Ho Chi Minh City - I went to one that seemed to specialize in American/European expats and got really good treatment. Can you ditch Hoi An and go south to HCMC?

Don't send the credit card there before you've spoken to the embassy. There might be specific instructions on how they will handle it, or the address.
posted by barnone at 11:15 AM on March 1, 2015

A friend says they will have English-speaking staff at Pacific Hospital in Hoi An. You could see if they will inspect your wound and review your antibiotics, and discuss wound care. They may have a pharmacy with canes, but if you're in that much pain, you really need to be taking this whole thing more seriously, and change plans to ensure your leg heals.
posted by barnone at 11:21 AM on March 1, 2015

Response by poster: About to go to sleep, will check in later.

Credit card:
Emailed Embassy, will call when open, and confirm before sending anything there.

Will look into Western Union, hadn't used it before, but nice to know that's an option if we get stuck, we can transfer money to a friend who can send it via WU.


Doctors:
Flying out of Da Nang, unfortunately. A days travel by road from Hanoi or HCMC, will fly as a last resort, but I don't want to get stuck in Vietnam, honestly.

After I wake I will look into well reviewed (?!?) Doctors in Da Nang, or try Pacific Hospital. Before it got opened up, I was carrying a pack around, now I'm having to rest it after walking a few dozen meters, but it doesn't hurt if it's elevated. :P
posted by Elysum at 11:45 AM on March 1, 2015

I've successfully mailed a couple of things to India but I don't have enough experience to counter the rumors that mail service is bad. I unsuccessfully used FedEx. DHL has been consistent and was the carrier of choice for Indian colleagues. Indian health care is good in my experience but all the discussion about super-bugs would have me being very insistent on sterile procedures and very vigilant about their application. Good luck.
posted by firstdrop at 12:07 PM on March 1, 2015

I think you need to drop everything and get that leg attended to at a good clean hospital by someone you can communicate with asap.

Fwiw, I've cut my shin down to bone three or four times as badly as that (because I'm graceful and also surfing) and it's never been that painful or taken so long to heal.

I'd be very concerned about it being restitched so late, the appearance of the wound now and, mostly, about the pain level. It's a small cut, it shouldn't hurt that bad after 17 days. It shouldn't affect your ability to walk. You really don't want an infection that close to your bone.

I know you have travel plans but your leg is more important.
posted by fshgrl at 12:18 PM on March 1, 2015 [4 favorites]

family medical practice da nang speak English and are well reputed.
Don't mess about with an infection in the tropics. Seriously.
posted by grubby at 12:48 PM on March 1, 2015 [2 favorites]

I just responded to your Memail, but I think the confusion was that it's really the complete reopening of an old wound.

You say the wound (a super dirty wound from the sound of things) was closed and then reopened when you pulled off your boot, and you had it re-stitched 2 hours later, but your text above describes what sounds like an initial wound that never really fully closed and as soon as the suture came out, was bleeding and had to be held together with your hands and other bandages because it was coming apart - and that sounds like it was going on for a week before it fully ripped open again and got restitched.

Anyway, what's done is done - just take good care of it now. See my Memail for more details. You don't need alpha chymotrypsin, that appears to be something used by naturopaths and chiropractors, without any evidence base behind it. If they really thought the wound was infected they should have given you a course of antibiotics longer than 5 days, the typical course for cellulitis is (minimum 7 to) 10 days. Talk to your second opinion doctor about that, but don't stop taking antibiotics early if you're concerned about an infected wound!
posted by treehorn+bunny at 12:56 PM on March 1, 2015 [1 favorite]

If you're flying out of Da Nang, the Family Medical Practice is where some expats go - there is an English-speaking doctor there.

You should be able to walk a few dozen meters without searing pain at this point. If it's still bad in the morning, go to Pacific Hospital, or travel to Da Nang early and go to the Family Medical Practice.
posted by barnone at 1:07 PM on March 1, 2015 [2 favorites]

Yes, Pacific Hospital in Hoi An is fine, too. I've been there.
posted by grubby at 1:51 PM on March 1, 2015

I'm not sure that the embassy will be able to act as a post office for you - see the 5th bulletpoint under 'staff at embassies cannot', though they can provide advice on hospitals and can transfer money if there is no other option.

I seem to remember India's postal system being pretty good (I was there in the late 90s though). Lonely Planet has some advice:

To claim mail you’ll need to show your passport.

Ask senders to address letters to you with your surname in capital letters and underlined, followed by poste restante, GPO (main post office), and the city or town in question.

Many ‘lost’ letters are simply misfiled under given/first names, so check under both your names and ask senders to provide a return address.

Letters sent via poste restante are generally held for around one to two months before being returned.

It’s best to have any parcels sent to you by registered post.

posted by Pink Frost at 12:13 AM on March 2, 2015

How's your leg doing?
posted by barnone at 6:25 AM on March 3, 2015 [4 favorites]

Response by poster: Ok, my update from KL airport didn't go through, so quick update.

Credit card:
Embassy will accept the letter! Very kind of them.
Western Union also a great option, not something I had heard of as much in NZ, travel companion super relieved by that option also.


Wound:
I got to the other side of the pain hump.
Note, it was only since the Vietnamese Dr opened it up again that it had got increasingly painful, before that I was walking around mostly fine. Got briefly checked, probably not infected, and promise to sort it in Delhi (really wasn't keen to mess with stitches).

I think I may even have been having a weird reaction to the choice of antibiotics and non-western medical standard meds? Anyway, the achyness I was getting all over, started tapering off with getting off the meds (please always take recommended antibiotics for an infection, but maybe don't trust Vietnamese hospitals :P).
Just checked in with a western nurse yesterday, still looking not infected, and it finally feels like it is healing up ok.
posted by Elysum at 10:09 PM on March 7, 2015 [4 favorites]