Tuesday, December 29, 2009

Fistulotomy - final

Goodness, it's been a while since I've blogged. I just got off the phone with Dr. Jahadi about my account and thought I'd close it out for those of you who have been following it. Those few, few of you. *chuckle

This will be short because since the most recent posting, things have been completely issue-free. No muscle problems back there, everything is healed and all's well. There is a scar, thought I can't see it because, well, unless I want to put a camera back there or some sort of polygramic configuration of mirrors, there's no need to. I'll trust the doctor's description as being true. BMs are smooth, minus the occasional clog (usual) and all's good.

I do want to say Dr. Jahadi did his job well. I have a friend who may be headed for some tailpipe work and I intend to recommend Dr. Jahadi for that. I think the hospital experience was average and I think we all could have done without the tornadoes that night, but hey.

So, onward, upward and best wishes for an anally peaceful new year. Yay, 2010!

Friday, June 26, 2009

Fistulotomy part 7

I haven't posted anything in nearly a week, though I've meant to keep the blog rolling all through the week.

The only things that have really been of mention over the past five days are the follow-up doctor's appointment with Jahadi. He said I'm still getting some discharge back there, and I should be wearing the cotton ball for a more speedy healing. However, it's very uncomfortable with it up there, so I've not worn it. BMs have come much easier and I just had one today. I was pretty much able to sit comfortably on the toilet, though I was hesitant to do that. I'm back to eating pretty normal food. The roommate and I went to P. Terry's, an Austin burger joint on Thursday and I had a regular burger and fries. I was wondering what it would do. The answer: very little. I didn't even have a BM until the next day, today.

I've not done any more sitz baths, not since Monday or so, and it's helped with some raw places 'down there' and I'm still healing. The only discomfort, if you can even call it that, is the feeling of the discharge. You can actually feel the movement of the droplets and it's annoying. I'm pretty sure it's not from any incontinence, but originating from outside the rectal canal. I've been careful to use bleach when washing whites and it's doing a good job of keeping my clothes clean, since I'm not wearing the cotton ball to catch any discharge.

It's Friday going into Saturday and ... back to work Monday. I think the extra time off has done some good, even though I thought I would be driven to the point of insanity during that.

I guess I can say there's not much more reason to blog until something earth-shattering happens, and that hasn't been the case in quite some time. Wiping is still only marginally painful, I'm still using the Fleet enemas, tap-water only, just to keep things moving back there, and get it all out in one fell swoop. The fistulotomy incision is almost completely scarred over now and I did encounter some intense itching two days ago. I was careful to make sure I didn't scratch it directly on the wound though, so no stitches would be endangered or anything like that.

As far as sitting upright, everything has been fine. No illness or anything, I'm off the meds completely and pretty much back to normal. I can get into and out of cars with ease, and best of all, the itching and burning I used to feel quite often are completely gone.

I guess I do need to say the chapping between my perineum and the rectum is also healing nicely. That only started happening yesterday, though. It was intense and was disruptive for longer than it should have been. But the sitz baths exacerbated it, I think.

I intend to blog again when the notion hits me. Until then...

Saturday, June 20, 2009

Fistulotomy part 6

Last night I didn't get to post anything, so I'm making up for it now. The pain from the fistulotomy is almost completely gone and things are nearly back to normal.

Two things of note from yesterday. I went out of the apartment for a while and upon returning, I was trotting down the stairs to the entranceway and I felt the most hellish combination burn-sting from deep inside the fistulotomy wound. It lasted less than a second, but it was worthy of note. I've been invited to go swimming with a friend, but I've turned down all invitations for now because of the potential for stinging by way of the chlorine, and the BMs.

The sitz baths have continued religiously. Three times per day, including one after a BM. Last night's BM was not nearly as unpleasant as those in the past, but the after sting was really tough to deal with for about 10 minutes. Over that time, mostly in the last five minutes of it, it was fading away. Laying down with the fan pointed at my fanny was not required. I'm still using plain-water enemas before each BM, however. Last night's was very full and shall we say "robust". I have a post-op appointment with Dr. Jahadi on Tuesday. I think he'll probably put me back to work soon after that.

At this point, I think the only recurring pain and minimal discomfort is coming via the hemorrhoidectomy wound and perhaps what's left of the chapping (not chafing, as I had described in many posts earlier). But life is almost completely back to normal.

I'm still afraid to eat anything that could remotely legally be construed as "spicy" though. That includes my dearly beloved chips and salsa.

Friday, June 19, 2009

Fistulotomy part 5

It is now the end of Thursday, one full week post-op. Today was a total breeze. Very little impairment to movement. It's hard to believe that it's been one week to the night that I was in surgery and recovery with gauze crammed up my butt and barely able to move.

Over the past week, I've done the sitz baths absolutely religiously, and I think the water had a lot to do with helping my skin to heal, even though so little is exposed in that area. I've experimented with rationing of the diet and sleeping on one side, etc, but I think time has just had to be the savior of it all. I did have another BM tonight and I was dreading it again, but I suspected it would be not quite as murderous as the previous ones, and I was right. The stinging afterward was definitely still there, but that's only because I've had to push to get the feces out of the hole. Three wetted, wedged piece of toilet paper later, I was laying on the side with the fan blowing on me again. I think the burning is now more on the part of the hemorrhoidectomy than the fistulotomy. The hemorrhoidectomy will take longer to heal, I think, even though the fistulotomy is what left me pretty much incapacitated for four to five days post-op. It feels as if the fistuolotomy incision has really begun to scar over.

Today I was able to sit up a lot more and concentrate on other things beside jockeying myself in and out of chairs. It was nice. I also started valuing just normal living.

I'm glad I was able to work just a teeny tiny bit from home this week. Keeping my presence felt at work was nice for me.

This blog won't be too long because it really doesn't need to be. I think the recovery process is pretty much past the tough part now, though complications could still arise. I'm not suspecting any. However, I've been wrong before.

I have mostly stopped taking the potentially addicting Hydrocodone pills. I woke up this morning and felt weird, and I thought my body might be going through a very minor form of dependency or something. But I went back to sleep and oddly, slept until 2pm! Way too late, but I figured, hey, I'm recovering, I'll let my body do what it needs to do. I'm still taking the anti-inflammatory meds (ibuprofen) just to make sure the wounds heal faster.

Wednesday, June 17, 2009

Fistulotomy part 4

What a difference a day makes. Yesterday I was cursing the surgery and wondering if I should not have just lived with the injury. Part of it is not knowing if at that early stage in recovery, if this is bad as it gets or if it gets worse.

I need to take a moment to clarify, though. In the first posting, I make clear that I had a combination fistulotomy/hemorrhoidectomy. That's exactly what this was; not just a fistulotomy. The hemorrhoidectomy, if I am able to feel its healing, it's unnoticeable as opposed to the fistulotomy incision.

Tonight is Wednesday, coming into one week since the procedure. Today was full of events, albeit minor ones. I woke up at 6am because I had fallen to sleep so early last night. It forged home for me that I am not a morning person. I was bored as it gets, with nothing to do with my day.

The chafing has subsided and I hope it's for good. I'm dabbing triple-antibiotic cream on there in hopes the raw place won't get any air to it and sting again. With those things, it's also a matter of stretching the raw skin which makes it sting really horribly. But tonight I am able to move around some and I don't feel the incision nearly as much. I even started to feel the twinge of some deep itching, which is a great sign! My sense is that the next several days, I will be going through some pretty intense itching back there because of the healing. Another trip to the drug store for some antihistamine may be in order.

Today I had an unexpected BM and I was dreading it, though not for long. I grunted it out and man it did hurt. It stung very badly, in addition to the burning. It took another three wads of paper, wetted and squeezed into a wedge, to get all of the residue out of there. I then had to lay on my side with my bum pointed at the fan for no less than ten minutes to help in alleviating some of that pain. This BM was really bad still, but nothing like yesterday and absolutely nothing like the first one. I don't know why the doctors say to not use Calmoseptine ointment on the wounds at first. Dear God the pain would have been completely unbearable.

It seems that the protein shakes and yogurt I've been eating either did not help the BMs or it was simply too late. So tonight, I ate some cream of chicken, whole wheat bread with margarine, a yogurt and a protein shake. I'm pretty sure starving is also not good for recovery, so I figured what the heck.

Not sure how long it will take before I'm feeling really good again, and it may be another month before this bum is really healed and good to go. Everything I have read said it will leave a scar. I figure it probably will, since a gash was removed from it back there.

Three sitz baths today, as recommended. The first was very slow in and out. The second was a bit faster and the third was within the past hour. I was in and out of there.

Fistulotomy part 3

I didn't get to blog any last night, mostly because I was pretty tired, oddly, before 11 p.m.

Yesterday sucked. That's pretty plain and simple. The chafing really did not help the healing process in the least. It made it tough to so much as move my legs, and climbing in and out of the tub was a pure hassle. It's not as if the chunk taken out of my butt was not painful enough. However, I got through it by coating that very tender, exposed pea-size spot with triple-antibiotic ointment. I have yet to mess with it this morning, mostly because I just do not feel like it. Managed to eek in a shower last night, which felt so good. When the chafing goes away completely, I'll resume using my sitz bath on the toilet.

Another bowel movement came at around 6:30 last night and it wasn't a pebbly one like the day before and on Sunday. This one was a full BM. It didn't hurt so bad, with the help of the enema and with the remaining Calmoseptine ointment I'd applied the previous day. Dr Jahadi said the Calmoseptine might help the chafing, but of course "don't apply any to the incision". Doctor, respectfully, that's the only way a BM could have occurred at all, was with the ointment. Otherwise, it would have been a fate almost as bad as death, I'm pretty certain. Or, just impossible. Still, I don't mean to minimize the pain of the BM. It was still excruciating. The sting, the burn, absolutely horrible. It took three wipes of wetted-down toilet paper, pinched into a wedge, to get it clean, and my hands were shaking and twitching, it burned and stung so badly. The pain felt just like that of the fistula, except in a much broader area of the anus. It was torture, but the pain did not last for maybe 10 minutes. It helped that I lay naked on the bed, butt pointed toward the fan, to try and calm it down some. It worked. But just like a bad rain storm (weather analogy), it didn't last and I was ok.

Three sitz baths, one about an hour after the BM. I knew there was no way to let it stay on my mind that I'd done a BM without bathing. That's just bad medicine. So I gutted it out and sat down. Was not that entirely painful. By then, the antibiotic cream was mostly shielding the chafing from the water and all, so that wasn't much of an issue. After about five minutes, I started swooshing some water back up into the "family jewels" area and hoping to wash some extra infection or dirt out of the wound. Went back to bed, aside from the intervals of getting up and making the milkshake and eating the yogurt.

My food regimen right now is sports protein drink and vanilla yogurt. I made that decision a couple of days back because I knew going to solids would be pretty tough this soon. But that can't last forever, because an overload of protein is no good, either. I need not forget that I've also been eating whole wheat bread with some butter on it. I make sure I chew the bread really well though. It is the only resemblance of solids I'm getting right now.

Today the wound doesn't seem to be as taxing on the muscle as it has been in days past. I have yet to really take care of anything back there, though. Part of me doesn't even want to.

I guess if I were to paint a picture, the recovery process seems like a piece of notebook paper, with each day its own line. For this procedure, the lines are definitely college-rule line spacing. This morning feels like perhaps, maybe, just maybe, my body has allowed me to skip maybe a half of a line or so. Yesterday, Dr. Jahadi said after five days, I should be getting a little more momentum with this. He even talked about returning me to work next Thursday. Given yesterday's mood, I nearly blurted out "are you on crack?! are you even halfway serious??". And he was talking about me moving around, going about my daily business. The cynic in me wanted to say "daily business for me is jumping in the car, going to job assignments, living pain-free, and when I need to poop, doing it without the same terror as being held with a gun to my head", but I politely changed the subject.

On a side note, in the past week I've watched my toe and finger nails grow and really need a trim. Why is it that I can never find my nail clippers without making it a side job? argh.

Tuesday, June 16, 2009

Fistulotomy part 2

There are days, like today, when I wonder if it was worth it. The chafing continued into this morning, with the antibiotic ointment. I called Dr. Jahadi and he scheduled me for an appointment for next Tuesday while he had me on the phone.

Today I am pretty dumpy because I just want it to be over. It isn't like having your arm operated on, or your feet. It's the inside of and the immediate opening of your rectum. That's where all the infectious stuff gets pumped out of your body. It is the part that's the most important to keep clean. I'm trying to make this thing heal and follow the rules, but then when I try to do that, the little chafing mark stings and makes me not want to do it anymore. The raw spot is exactly between my rectum and my perineum, just inside that little and very sensitive skin fold. The skin is really delicate right there and it's usually very pleasurable to the touch. I've wanted to use my sitz bath tub and the spray, which usually makes the swelling and pain pretty much disappear for a while, because of the water. The raw spot, the chafing, makes it sting like the dickens when it gets touched by water spray. Kind of reminds me an action adventure movie where the heroes are trying to save the day, and some terrorist is holding most of them at gunpoint, unable to be convinced that they will all die anyway if the heroes don't act soon.

It is today when I do wonder if living with the fistula and hemorrhoid would not have been so much easier than the recovery.

Monday, June 15, 2009

Introduction

Tonight is the fourth night after my combination fistulotomy/hemorrhoidectomy and I thought with everything going on inside my bottom and in my mind, I should jot some of it down.

The procedure was done by Dr. Kambiz Jahadi at St. David's Round Rock Medical Center on Thursday, June 11, 10 days before I turn 31. Tonight is Monday night.

I realized a year and a half ago, maybe two, that something was wrong. But I had never heard of a fistula before and knew I had hemorrhoids. After more than a year of dealing with that hemorrhoid that seemed to be worse than the others, I finally decided enough was enough and to go in for the procedure. But I had spent countless hours researching it, all of its symptoms, what is a fistula, how they are formed, what they mean and most importantly, why I had one at 30.

I'll spare you the gruesome details and if you would like to know more about a fistula, google it. It's basically a tunnel from the rectum to another part of the body, commonly the vagina or the anus and is formed by infection eating its way through muscle and issue. They commonly end in an abscess, which appears as a very painful bump on the outside of the rectal cavity. They resemble a hemorrhoid if you don't know just exactly what you are looking for.

In October of '08, I found Dr. Jahadi by googling proctologists in the Austin area. He first diagnosed me with hemorrhoids but I knew something else was up and so researched it and asked him about a fistula. He agreed, pulled out the probe, and confirmed it.

In March, I had a colonoscopy to rule out Crohn's, UC or colon cancer. The news that I needed a c-scope was enough to scare the hell out of me. But after I talked to Mom and then my big brother and realized he'd had a colonoscopy at my age, I thought, oh, ok, it's ok then! Scheduled it, got time off work, drank the absolutely awful 'alien snot' as I call it, went in for it, and it was over. Major nausea as the anesthesia was wearing off though. Chucked the grape juice on my front stoop before making it in the door. Was glad I'd never have to drink the alien snot "MoviPrep" ever again. A week later, I phoned Dr. Jahadi to proceed with fistula treatment. Met with him and thought it was a go UNTIL he wrote a note for 2 weeks off work. TWO WEEKS?!, I thought? So I met with the boss that day and he said to do it. But my trip home to Columbus was coming up within a month and I thought "no, let's wait". So, wait, we did.

June rolled around and I decided it was time. The company was very gracious to activate short-term disability and off we went. Wednesday before the surgery, roommate and I went for a meal. I was worried sick about what lie in store. The next day, I reported promptly to the hospital. Time for prep. She was sweet, but the pre-op nurse was pretty inept. She had to ask three times when was the last time I had urinated, twice when I ate last, and she had a devil of a time with my IV. Got into the OR, we had agreed on spinal anesthesia, they put the needle in there, I lay face down on the gurney, and out I went. I woke up just before the surgery was over, though, and could feel nothing, back there. I was overheating and was ready to chuck. Then I fell back to sleep. Woke up again in the holding room and my waist- down- was numb. That began wearing off, and they wheeled me to my room. The nurse told me I would be staying overnight, doctor's orders.

The pain at the time was nil. I was so numbed by the spinal that I felt nothing. They also had me on Percocet. Afternoon drifted to evening, I had the room to myself, and aside from the cords coming off me, I was ok. By 8 or 9, it was storming and they activated a tornado warning for Williamson County, and they evacuated us to the hall. Nothing like a little "we're all gonna die!!!" excitement right after the doc chisels a chunk from your ass. That was soon over and we were back to normal, no tornado. That night was long. Sleeping was tough. The cords hanging off me, the IV, the bed. Ugh. The confinement and lack of independence, the occasional pain, though nothing ferocious.

The next morning came news of the sitz bath. They did not teach me how to use it until Friday afternoon, which I thought was pretty bogus. The care was really good, but the wait for juice, pills and the like was way too long.

Got home at 5:30ish and they say I can eat solids, just high fiber and no spicy food. I decided solids would be a bad idea, so I remained on liquids. Went down to Walgreen's and picked up my prescription for Hydrocodone and came home. A couple of days went by and I decided the swelling had to go, so I looked up "NSAIDs" and researched it a bit. Asked the pharmacist at Walgreens if they would counteract, got the go-ahead and picked up some OTC ibuprofen, store brand.

It's Monday night. Yesterday, I craigslisted for a TV for this room. I've insisted on no TV in the bedroom -- until now! I also decided it might be time to switch to solid foods, so I ate two small homemade cheeseburgers, no spice. Yesterday or the day before, I super-glued the clear sitz bath feeder tube into its two-finger slot in the bottom because it kept flipping around and coming un-done. Six times in a row of trying to make that thing stay gave me a headache. Yesterday morning, I woke up with a nasty sting between my perineum and the anus. I figured I'd developed a chafe, but I let it pass.

First bowel movement after surgery came last night. I forced it, mostly because my muscle has been healing and adjusting, and lot allowing for much movement in that regard. Well, lo and behold, the good ole' chafe had to join. STING! Yeah, didn't need that so much. I'm not sure I'd been able to go through with the BM if I hadn't tapped some Calmoseptine cream on there first. I'm pretty sure the raw tissue of the fistulotomy would have been cruel and unusual punishment, but the cream pretty much shielded it all.

Today, I went to Wal-Mart and picked up some yogurt, protein drink and other supplies to stay off solids for a while longer. Got home and put the stuff away, and back to bed I went. Went to do a sitz bath and realized that second sting was being a troublemaker, but decided to let it go. I put some Calmoseptine cream on it too, after I took care of the fistulotomy job. Several hours later, the chafe was hurting worse than the surgery, so I decided enough's enough. I also felt a BM coming on, and that damn chafe was making it next to impossible. I did my business, which took no less than 2o minutes, then I had to use my laptop and webcam to examine back there, and the chafe had grown to about a pea size. No wonder it stung! Out came the triple-antibiotic ointment. I think that qualifies as a "complication".

We'll see what tomorrow brings, and I'll keep the blog running daily from now on.