Kenalog Procedure for Anal Fissure

Dr Daniel Feingold - Columbia, NY

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Kenalog Procedure for Anal Fissure

Postby jeffv » 12 Mar 2014, 22:00

Hello Folks,

I have read a lot of forums getting up to my point of surgery and thought for me and everyone, this would be good to share.

Today, I had fissure surgery using what I believe to be a relatively unknown method, Kenalog injection.


First, how I got here (which is traumatic and interesting in itself)

I have been suffering with a fissure for at least 10 years. (maybe 20) At my latest colonoscopy, the Doc said that it was the worst fissure he has ever seen in his years of practice. The fissure and I got a long for a long while, but after that colonscopy (which made it worse), we kind of decided together that we couldn't live with each other well.

The only things that work for me are hot baths (only during the bath) and tons of ibuprofen and the following:

One tip I think people should try. Switch your breakfast to a cereal called "Mesa Sunrise (raisin version or not) by Nature's Path". Bonus, it is gluten free for gluten free folks. I swear, in much of the time I had the fissure, making this my breakfast helped pain dramatically within only a few days of starting to eat it all the time. It has flax, Vitamin E in it etc and just seems to work miraculously. I would love to see if making that your breakfast cereal helps anyone with moderate fissures as much as it helped me or really bad fissure some. It even just seems easier than just taking flax and easier to make routine. I ate 2 to 3 bowls daily. Might want to drink a lot of water after eating it.



Ok.. so.. Two weeks ago, I was scheduled for LIS surgery and hemorrhoidectomy. It was a rush surgery (hoping to help me) and I had no time to really research it. I got to the hospital in the morning a nervous wreck. Doctor told me amazingly that I was so nervous that i was making him nervous and he basically said he didn't want to do the surgery! Unbelievable. At that point, once he said he was nervous, I backed out. I mean, if a surgeon can't handle a nervous patient, I don't want him cutting!

After recovery from that trauma of an experience, I decided, I am calling up Columbia in NY. Every time I have ever met a doc their, they have been a genius and fantastic. I was given an appointment within 2 days with Dr Daniel Feingold and went to see him. After hearing the story, he was amazed the surgery wasn't done that day. He said if has nervous patients, he just gets them into surgery faster. He looked at my condition and diagnosed an anal fissure but no hemorrhoid. He said it was likely a papilla and doctors often confuse this. If it turned out to be a hemorrhoid, he would not cut it out but instead, he would tie it off a stitch it up to keep it from "coming out". He said he sees no reason to create an additional wound in someone that already has a wound. (which to me just totally makes sense).

So back to the fissure. He said he does not do traditional fissure surgery. Even though the risk of incontinece is low (higher in women), he doesn't want to risk it.

Instead, he does this: He seals the fissure to a degree with something electrical (don't remember exactly what), stretches the area with surgical tools a relatively small amount compared to older, traditional, dangerous British methods and then injects it with Kenalog (a steroid). He has done this surgery a large number of times and has almost always been successful. (like 99+% of the time) After some debate back and forth with him, I decided to try his procedure. He has unbelievable bed side manors and quickly returns all emails patiently and calmly. I sent him I think 5 emails with different questions over time and he quickly answered every question. As for outcome, worst and very unlikely case is I just end up in LIS surgery later.

I took Klonopin the last few days to kill the anxiety (at his recommendation) and I calmly went to surgery today. Dr Feingold was absolutely wonderful to deal with today also and everyone on the surgical team was also. The whole surgical team introduced themselves to me before taking me to surgery and kept me laughing.

The surgery itself was a blink of an eye and I was back in recovery. I think there should be a rule they have to count down from 10 as that is the "fun" part. I didn't even know they gave me the meds to put me out.

In recovery, I had some food I brought (banana, pear, apple sauce) and took plenty of ginger lozenges. Rumor has it that you should actually take 1,000-2,000mg (see Mayo Clinic site) of ginger an hour before surgery but I didn't know that until tonight. Oops. No pain higher than 5 after surgery today and none now although I am still quite numb. All I took today was advil although I picked up Vicodin. (Doc prefers Toradol but I couldn’t find a gluten free version). I do have some nausea even though they gave me nausea meds before and after surgery. Nothing bad.


Doc says most people have pain for 3 days to 6 weeks with likely pain 10 days to 2 weeks. He said to expect tomorrow to be MUCH worse than today. (when the local wears off).

I will continue my blog over the next few days and let everyone know how things go with this Kenalog procedure. If you have any suggestions or if anyone has had this procedure, let me know. I believe he is the only person in the country doing it right now and is just writing papers on it now.

Jeff
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Re: Kenalog Procedure for Anal Fissure

Postby jeffv » 12 Mar 2014, 22:01

Oh.. by the way.. He found it wasn't a hemorrhoid but was a papilla so I think he cut it out. Not sure if that is good or bad.
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Re: Kenalog Procedure for Anal Fissure (Day 2)

Postby jeffv » 13 Mar 2014, 20:57

Day 2 after the procedure. Mostly spent the day lying in bed watching my iPad. Generally, I find a non-moving position lying down to be the most pain free. Left side is best as it helps get the gas out. Took Colace, Citracel, ate fruit and vegetables , tons of water, etc. Taking 3 ibuprofen and inflammation but honestly, I was off meds about 4 hours today and had no real pain. Area is very inflamed on outside looking like hemorrhoids. I feel like I read somewhere else that was normal after surgery in this area. Sent an email to Dr Feingold just to get his thoughts but haven't heard back yet. A little anxious about how this first BM is going to go but haven't gotten there yet. I am hoping it can't be worse than the excruciating pain I was getting for 10 hours from the fissure itself after BM.
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Re: Kenalog Procedure for Anal Fissure

Postby owmybum » 14 Mar 2014, 04:34

:wel:


Welcome to the forum jeffv........

Very interesting, I've never heard of kenalog injections before!

I hope you have a speedy recovery, and I will be reading your diary with interest! ( off to google it now!! Lol )

Good luck with that first bm

OMB x
fissure after hem banding and tag removal feb 11
Pelvic floor therapy
Diltiazem
Botox June 13
Nitro
Internal flap July 14
EUA and polyps removed Nov 14
Diagnosed with neuropathy Jan 15
Diagnosed with HS EDS type 3 (causes poor wound healing )
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Re: Kenalog Procedure for Anal Fissure

Postby owmybum » 14 Mar 2014, 04:38

fissure after hem banding and tag removal feb 11
Pelvic floor therapy
Diltiazem
Botox June 13
Nitro
Internal flap July 14
EUA and polyps removed Nov 14
Diagnosed with neuropathy Jan 15
Diagnosed with HS EDS type 3 (causes poor wound healing )
User avatar
owmybum
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Posts: 2826
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Mood: UGH !

Re: Kenalog Procedure for Anal Fissure

Postby asdf123456 » 21 Mar 2014, 11:33

Hi Jeffv, I'm just wondering if you've felt any better? I actually made an appointment to talk to this guy for next week, so any input you could provide would be helpful.
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Re: Kenalog Procedure for Anal Fissure

Postby vhaas » 31 Mar 2014, 18:49

Dear Jeffv. I would also like to know what happened and if you feel better.
thanks
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Re: Kenalog Procedure for Anal Fissure

Postby Apes » 15 May 2014, 12:00

Jeffv, Any update, you seem to be the only one who has had Kenalog on the forum. i'm sure we would all love know the progress.
Fissure 2/13/14 from Colonoscopy
Nitro no help
Nifedipine no help
Botox 5/5/2014 work in progress
HEALED 10/2014
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Re: Kenalog Procedure for Anal Fissure

Postby Apes » 26 May 2014, 08:20

Try to bump this... Jeff any update, the forum people want to know.... What do we think happened to Jeff???
I would say healed since he left us....
Fissure 2/13/14 from Colonoscopy
Nitro no help
Nifedipine no help
Botox 5/5/2014 work in progress
HEALED 10/2014
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Re: Kenalog Procedure for Anal Fissure

Postby asdf123456 » 26 May 2014, 08:46

I would have to agree Apes. If he hadn't healed, I'd imagine he'd be on this website venting his misery like the rest of us. Feingold explained that virtually all of his patients have healed from the procedure, and I think the only 2 who did not, chose to have LIS very soon after, so they may have actually healed anyway if they had just waited a little longer.
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