Gay/20 something/Multiple fistula/Fixin'

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Gay/20 something/Multiple fistula/Fixin'

Postby SurgeryDelay » 03 Mar 2016, 06:18

If you've stumbled on this blog, I assume you're here of one of the following reasons:

1. You're curious about the topic of anal fistulas
2. You or a loved one has been diagnosed and you're looking for answers.

If you've made it this far into the post, I want to say stop. There's no need to anxiously read up everything for fear of the unknown. You'll be fine. It's the unknown that hurts us more. Your medical professionals are likely to be the best people to discuss this topic with you. Furthermore my experience with the info I found online has been characterised in rather dramatic tones, without much resolution. This will do nothing for recovery.

But if you insist, keep reading.

In this post I'll write a number of things relating to this affliction, discussing:

1. Who I am and how the fistula formed
2. How I ignored it for so long
3. What was the tipping point for me to change
4. The surgery experience
5. Recovery process

I am also sure you're really quite worried. You have questions. This builds anxiety. Which adds to the inflammation in your body already. Don't be. You're going to be just fine.
Last edited by SurgeryDelay on 03 Mar 2016, 07:05, edited 1 time in total.
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Re: Gay/20 something/Multiple fistula/Fixin'

Postby SurgeryDelay » 03 Mar 2016, 06:23

Who am I?

I'm a 28 year old gay man who lives in Australia.

Like most twenty somethings, I smoke and drink too much as part of the carefree lifestyle.

I'm sexually verse, topping and bottoming on regular occasions. SINGLE LIFE!!!!

Conversely I'm quite diet conscious and active, taking in two fruit and five veg a day, running 7kms two days a week, lifting 2 days a week and finishing off with a swim every Friday.

I'm a bit of a stress head, which doesn't help.

For those in Australia, I am a private insurance member. This will become important in time.
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Re: Gay/20 something/Multiple fistula/Fixin'

Postby SurgeryDelay » 03 Mar 2016, 06:38

How the fistula formed

In 2011, I had woken up after a one night stand with an older guy who had licked out my hole the night previously. His niceties aside, I feel a dull, but throbbing pain in the left cheeky of my ass as I sat down.... honestly I thought he fucked me while I was drunk.

Anyway that pain increasingly got worst over the next 6 days. At day 3 a red welt appeared, to which I had it checked out my local GP. His advice to take sitz baths to see if it would heal. By day 6, it was too late. I went back to the doctor's office, with a new guy who took one look and said "nope, you have an anal abscess."

"Sorry, there's nothing I can do for you here today,

"What you're going to have to do is go straight to the emergency room and get it seen to by a surgeon," he finished.

He then passed me a referral note to be handed to the nearest public hospital where I would undertake the surgery.

By now the pain was excruciating, making the drive to the hospital unbearable. On arrival in the triage area, I provided the nurse with the note, explained what I had and then had to lie on my side because the pain was so bad, I couldn't sit down properly.

Within 45 minutes, I was seen by a doctor who did a digital exam, recommending a surgical lancing asap.

Fortunately I wasn't able to be seen straight away, and spent an agonising night in hospital waiting for a surgeon. In this time, I took a photo of it. It was this raw, red, angry looking thing, with a bald head of white just begging to burst free.

I fasted. I bit my lips. I cried mercy. I took a lot of endone/oxy. But I got there in the end.

The next morning I was wheeled into the operating theatre and had the abscess lanced under general anaesthesia.

As post-op care, I had to see my local GP for 30 days to have the wound dressed and packed. I also took a course of antibiotics as well.

Once this healed, all that was left was an incision scar that tucked into itself. I didn't think much off it once the doctor stopped having to pack my wounds. Little did I know what I should have done next.
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Re: Gay/20 something/Multiple fistula/Fixin'

Postby SurgeryDelay » 03 Mar 2016, 06:54

How I ignored it for so long

It's 2016. Given that this story first started in 2011, the eager mathematicians in this forum will see that it took close to 5 years for me to have done something about. Before I continue, I say this. If you've had a perianal abscess, GET THAT SHIT CHECKED OUT FOR A POSSIBLE FISTULA!!!! IT WILL MAKE A DIFFERENCE IN HOW MUCH SURGERY YOU HAVE!!!!

Nonetheless I digress. With 4 months of having been treated for the fistula, noticed what looked like a pimple formed at the sight of the incision. It was painful in the way that skin acne is, and so I took a sterile needle and lanced it under my bathroom lights. No harm, not foul.

Part of me knew that this was connected to my treatment for the perianal abscess, but when you in your early 20s, you're kind of meh about your health. This was a continuous cycle that continued for about five years. I would see something come up, lance it, and be on my way.

Little did I know that it wasn't what I could see that was hurting me, but what I couldn't see.

Anal fistulas are tiny tracts that connect two parts of that body that shouldn't be. When I initially formed the perianal abscess, the anal opening of the tract was likely quite small, caused by the infection of a mucous gland. Overtime, that opening accumulates a raft of infectious fecal, weakening the tissue structure that surrounds it with each consecutive infection. Therefore it follows that he first time you identify that fistula, I looks like an innocuous skin condition that just needs to be lanced. By the 100th time, however, the cellular wall around the area has been weakened by consecutive infections, inflammation, the constant presence of pus and infectious material that two things happen:

1. You feel the entire tract shooting through your nerve system in pain.
2. What was a once every six month skin thing is now every week or so.
3. These fistulas discharge pus so regularly, you feel like you're damp in your crack all the time.

Don't do it. Don't wait. Get it seen to now!
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Re: Gay/20 something/Multiple fistula/Fixin'

Postby SurgeryDelay » 03 Mar 2016, 07:04

What was the tipping point for me to get this sorted

So anyway, like I said, I was having regular bum sex with this affliction. It wasn't until October of last year when I noticed a change in my bowel movements that I believe was caused my an irregular diet whilst travelling that I decided to do something. I had considerable pain from what I thought was a hemorrhoid (turned out to be a new abscess forming) that I knew I had to get this sorted.

Further, I could feel the pulsating nerves emanating from my hole. As I walked, I could feel this angry infection throbbing with every step. So I got it checked out by my local GP.

On inspection, his prognosis was that it was an anal fistula. There was nothing he could do, but he referred me to the best colorectal surgeons he knew in Melbourne at the St Vincent's hospital. I enquired with him about the wait time to see a specialist in a private setting and whether that would affect treatment. His clinical view was that it was fine to wait until then.

I later learned that it would take four months for me to see a specialist in a public hospital to avoid paying for an out of pocket consultation (roughly $400) with a specialist. You see, in Australia, the cost of seeing a specialist isn't covered by insurance unless it's referred from a public hospital setting. All proceeding appointments from then on are covered by the insurance company. In hindsight, I should have paid the damn money because what I did from then was the worst.

What I did while waiting for the colorectal specialist:
- read medical journals about the treatment and surgery process
- watched all the youtube videos about it
- tried to pre-empt the specialist's prognosis by trying to self-diagnose and assuming i would have either this or that surgery
- Got really anxious
- Had some sleepless nights
- Worried myself sick to all my friends and family about it.
- Assumed I had anal cancer
- Read all the blogs.

So this was a horrible time for me. If you've reached this far in my blog, it's at this point I recommend you stop reading if you're suffering from a fistula. After all, my circumstances are unique. My body is unique. As such my treatment is tailored for what worked for me as judged by my surgeon. You cannot read blogs like this and assume that what I'm going through will be some guide into what will happen to you. It's not your story. All this does is serve to make you anxious. But if you must, continue forward.
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Re: Gay/20 something/Multiple fistula/Fixin'

Postby SurgeryDelay » 03 Mar 2016, 07:23

Surgery - Initial consultation

When the wait to see the specialist was finally over, I felt a sense of relief that I had made it this far. By now, my hole felt angry and swollen. It had no business feeling like that. I had enough. I wanted it sorted.

Armed with the array of stories I had read online, the medical research I had conducted and the sense of confidence that I new better, I was certain of a number of things:
- I would let it be known to that specialist that I did not want a seton stitch because it would require follow up surgery
- That I was a gay man and it was important for me to get back on that sexual saddle
- That I knew everything.

So after my two hour wait in the public hospital, the specialist ushered me in to examine what was wrong. He stuck two latex gloved fingers up my hole during the inspection, confident that he could likely find the sources of the fistula as the indurated skin identified the tract for him.

He then went on to say that his approach would be staged: partial fistulotomy with insertion of a drainage seton, and then a fix up job 8 to 12 weeks later. When I protested, he said "Well I'm the doctor, not you. You can see another specialist if you like, wait back in line for another four or so months, or you can work with me. My first priority is to make sure you retain your rectal integrity. This is the best way I can do this."

With that, there was nothing left to say. So as he started scribbling down notes to refer me to a public system surgery, I informed him that I had private healthcare insurance and would elect to use that. All of a sudden, I noticed a change in his tone. It became a lot more lighter. I understood it for a number of reasons:
1. In Australia, the wait time for a surgery like this could be up to another 16 months in the public healthcare system. With private treatment, I could be seen when he was next available.
2. The way that surgery in a public setting works is the operation is performed by a general surgeon. This specialist's opinion was that while general surgeons were up to the job, specialists had specific knowledge that would allow them to make more informed decisions about the operation as it happened if anything unexpected popped up (in my case, it did)
3. The post-op care for these types of surgeries vary depending on how rationalised a public hospital setting is. As you won't have one practitioner seeing you all the way through, you might be seen at 8 weeks, or 10 depending upon appointment availability. Your immediate post op instructions will focus on the recovery post surgery, not the recovery from the ailment itself. As such, there won't be a specialist on hand to speak to about your case and you'll have to wait for how ever long it takes until your next appointment. With a private insurance funded specialist, the practitioner would see you all the way through.

Look, I know that everyone has the money for private insurance. And i know that there will be some people who don't have private insurance, but can pay the thousands for a procedure like this out of pocket.

I'll say this. Australia has a great healthcare system. No matter what you elect, there will be a good outcome. But for me, I had the opportunity to go private, so I did. To me, it was worth it because even though I had the option to be treated privately, I wanted this ailment treated as effectively as possible from the onset, I wanted one doctor throughout the process and I didn't want to wait any longer.

This initial consultation was on the 8 Feb. It would be operated on by the 25 Feb.
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Re: Gay/20 something/Multiple fistula/Fixin'

Postby SurgeryDelay » 03 Mar 2016, 07:45

Surgery Day

Prior to the surgery, I was keen to know a couple things ahead of time.

Private insurance

The private insurance you take out will have a big impact on how you're treated. For me, I had basic hospital cover that enabled me to be treated in a private setting for day surgeries. The excess for the calendar year was $450 and I was liable to pay for any out of pocket expenses incurred on the day if any of the medical staff charged above an agreed rate agreed to by the Australian Medical Association and Medicare. To date, I have not received any bills (fingers crossed) besides that $450 charge. It's important that you check with your insurance provider to get all the information about any out of pocket charges to avoid bill shock.

Post-op care

My specialist's advice was to maintain a high fibre diet. Regarding exercise, sex, life, etc, I could do anything I wanted so long as I didn't feel any pain.

Surgery

In 45 mins, the CRS performed a partial fistulotomy, Examination under anaesthesia and seton stitch insertion. Given the history I presented with, the specialist was surprised to find that I had in fact three fistula tracts rather than one.

He performed a full fistulotomy on one of them. He also placed setons in the other two to enable them to heal a bit before he would decided in 8 to 12 weeks whether I would need a mucosal flap, or whether he could perform another two fistulotomies on the other two.

My personal preference is the fistulotomy because they are the gold standard in treatment, but this isn't for me to decide. I would have to wait it out to see how the 8 weeks of healing eventuated. If the tissue walls around the the tract heal well enough to enable that option, then I'm sure he would go with that. Otherwise it's whatever he believes is the best treatment option weighted on the need to maintain rectal integrity and minimise recurrence.

Post-op care

I was prescribed some pretty hefty painkiller and an anti-inflammatory drug. I was told to be gentle when cleaning, using damp tissues or baby wipes to clean up. Sitz baths go without saying, though I haven't needed one thus far.
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Re: Gay/20 something/Multiple fistula/Fixin'

Postby SurgeryDelay » 03 Mar 2016, 07:52

Before I start doing diary entries, I want to lay out a couple pieces of key advice.

1. Don't stop taking the inflammatories for at least the first three days like I did. They are a good alternative to taking the stronger painkillers and do lot to dissipating pain and act as a good inflammatory.

2. Paracetamol is your friend.

3. It doesn't hurt as much as you think it will. It's just sore, you'll feel it in the first four days, but it'll go away.

4. The hefty opioids cause constipation. This is exactly what you don't need.

5. Don't be scared to poop. It won't hurt so long as you have fibre. Don't strain though. That'll hurt.

6. Take it easy for the first couple of days. Eat well. Rest up. It's crucial to getting you back on your feet.
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Re: Gay/20 something/Multiple fistula/Fixin'

Postby SurgeryDelay » 03 Mar 2016, 07:59

Day 1: Feeling fine. Post op anaesthesia hasn't worn off, so I don't feel much. When I have my first bowel movement, wiping down there with a wet wipe send a tingling nerve pain. I do feel it.

Day 2: Serious discharge, lay in bed watching tv. BM not so big as I've had an opioid. Not a good idea. Paracetamol should have been enough.

Day 3: bit of pain. Confident enough to go out and see some friends. Pus is present. Use gauze to soak it up.

Day 4: Still at home, lying on my back. Pain becomes a lot more pronounced. More paracetamol and gauze. Bowel movements going steady. Back to taking Naproxen to assist with the inflammation and pain.

Days 5: As day 4

Day 6: First day back in the pool. While I normally run, its too high impact for me. I'm following my specialist's advice in that if it doesn't hurt, i can do it. So I swam about 2km. Exercise is good, promoting bowel movements and improving circulation for healing.

Day 7: Pool time again. Lots o' pus. Gauze all the way up in there to soak it up. Not sure when it will end. Will be seeing specialist in about 5 days. Found out he took a biopsy to see if I have crohn's disease. Fingers crossed i don't. On the plus side, I feel confident enough and am pain free to wipe with dry toilet tissue. Huzzuh!!!
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Re: Gay/20 something/Multiple fistula/Fixin'

Postby Savaici » 03 Mar 2016, 13:09

GREAT posts! Just what is needed!! Be careful about wiping. DAB!
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