Well I'm finally on here. I'm blowing up inside and need to connect with people who can understand.

2014 Anal pain, no idea what was wrong, went to the doctor, got a colonoscopy and nothing was diagnosed. No crohns no IBS luckily.
2015 Still in pain, finally met a Colorectal Surgeon, Dr Ken Woolfson in Oshawa Ontario Canada. Put in a scope and right away diagnosed and Anal Fissure. Perscribed Diltiazem which did absolutely nothing.
2016 I met with Dr Woolfson again and asked for the LIS surgery, he discussed the risks and we moved forward
2016 Horrible recovery pain, took 2 months to heal but after no more pain and life was good. Only a small difference in control but no real issue, the odd time I need to wipe maybe a drop of stool here and there but never any real "accidents". Dr Woolfson is an angel from heaven and saved my life.

Fast forward to 2022 January. I'm reckless and stupid and cause another fissure, but this time its much worse and my mental breakdown begins, the nightmare is back and it's completely my fault. I had left my 300K a year finance job to start a company, build a product for a year and just before launch this happens. My life is destroyed again and i just need help.

Months later I finally get to see Dr Woolfson again, he finds another fissure, perscribes diltiazem again says to give it another try for 6 months. Again no real improvment, i feel it getting better but tearing again. I then ask for botox which he admisters in the office months later. He also sends me for an MRI which i waited about 6 months for. After about 2 months I feel the fissure is gone but I still have pain and swelling with random bumps, no idea why. I suspect an abcess and fistula after doing some reading. Dr Woolfson no longer has hospital priveleges since he's retiring soon and says if I need a surgery he won't be able to do it. This is news was my worst fear and I knew it was going to be a whole journey to find help.

The MRI comes back and BOOM, there is an abcess in my left cheek and a fistula tract going from where my last fissure was at the back (posterior) and wraps around the left side towards the front perenial area. Im sore with sharp shooting spasms all day, this has ruined my life and I'm not dead, but not living either. All I can think about is the company that I wanted to start which is all a memory now, im broke, no job, no company, just pain and lots of it.

Dr W calls me and says I need to find another surgeon so he can send my file. He has another doctor in his office but I no longer live in Oshawa so my mom says to find a doctor close to my new house. I find another surgeon after going to the hospital, then the RUDD clinic in downtown Toronto, then to the michael garron hospital in east Toronto, months of waiting. I meet with DR Amandeep Pooni, he basically brushes me off and says I'm not dying and he deals with colon cancer, I see him back at the RUDD clinic where he does a sigmoidoscopy. I wake up bleeding from my anus and the whole staff is telling me to calm down and wait. Dr Pooni says he doesnt see why I'm in so much pain and the only thing he can do is an EUA (examination under anasthesia) in the hospital. He says the MRI is meaningless to him and radialogists don't know what they are talking about. He suspects a small internal opening a the back but needs me to do the EUA. Weeks and weeks go by and I keep calling his office, they don't usually answer and tell me they will call me back. I go in and speak with reception in the dirty broken down building off of Mortimer in east Toronto, she says Im on a waitilist and its at least 6 months or more and that DR Pooni is busy with Cancer patients. That was the end of it, havent heard back since. During this time I go to the Hospital again and get referred to Dr Thomas Gilas. A nice man but unfortunately once he saw the MRI he said hes not a specialist and cant help me. I don't know why the hospital reffered me to him, I specifically said a Colorectal Surgeon, he's a general surgeon.

So all of that was like a year of pain and suffereing, so I go back to Dr Woolfson. He sends a referral to Dr Andrew Yuen in Oshawa, a younger CRS who just started his own practice. I meet with him, he looks at my file and books me in for an EUA 6 weeks later. He places 2 setons right in the posterior area and pokes a hole for them to pop out. So he created a small fistula in hopes that most of the infection will drain out before the next surgery to finalize the healing. That was about 2 months ago, I'm still in a lot of pain but I feel the swelling around the left side coming down and the abcess feels like its pretty much gone, no hard lump anymore. He says he wants to leave it for at least 6 months, get a 2nd MRi and come up with a plan to fix the fistula either a fistulotomy or a LIFT surgery. He prefers the fistulotmy since it has better success rates but I had an LIS in the past so Its a bit more risky than a LIFT. Dr Woolfson initially said he would do a LIFT since its safer and even if it fails the fistula will be smaller then he can do a minor fistulotmy. So now im still in pain, waiting for the next step, its been almost 2 years of pain now and my life has fallen apart. I just got my MRI date for March 2024, the Canadian health system is awful. Wait times are months if not years to get help. After all of this I'm moving the the USA however I can. I'm done with Canada for my sake and for that of my future children, if I even make it that far.

Side note- I found a free website to view MRI files, get the dicom image files from the MRI clinic and click and drag them into this webpage. It will open up all of the angles and you can select the drop down box to see the different views. If you scroll your mouse wheel you can move the depth back and forth to see the full tract. I had this open on my laptop to explain my issue to Dr Woolfson and Dr Yuen, it was essential that we looked at it together. Most doctors never actually look at the MRI, they just read the radiology notes. Its not hard to see the fistula and abcess, you don't need to be a radilologist. I hope this link can help some poeple get a more clear answer.

https://www.imaios.com/en/imaios-dicom-viewer

I feel the left side is swelling up again. Now I have two setons tearing up my rectum and swelling again. Its like I'm back to square one. The next MRI is in March which is in 5 months from now!! I think about killing myself every day to be done with this awful pain. I'm only 33 years old and I hate Canada, the system is so broken here. I've spoken with the Bumrungrad Hospital in Thailand, they've started a file for me. The first time I messaged them they responded minutes after. In Canada you're lucky to even get a response. Now my plan is to see if my Doctor can call the hospital he sent the MRI Req form to to see if they can bump it up, I called another MRI clinic in Ajax Ontario that has availability next month. I need the MRI asap to see what's happening. Right now I think the stupid setons are just torturing me and dragging this on and on until I jump off a bridge. Bumrungrad in Thailand just wants to do a full Fistulotmy in one shot, no setons, no waiting, no-nonsense. I may end up just flying to Thailand and getting this done there. If that's the case I will have deep hate in my heart for Canada, the country I was born in. I've already decided to move the the USA after all this, but I still need to get help and be a normal man again. I hope someone is reading this, either way, it's a journal of my nightmare.

Hey Matrix
I’m so so sorry for your pain and the terrible way you have been treated by the Canadian healthcare system. I’m in the uk, we complain here but we are lucky in comparison. Altho one surgeon did say to me that fissure sufferers complain more than his cancer patients! Just because we are not actually at risk of dying from the disorder, it is life changing in its misery. My husband had a fistula and had I think a fistulotomy (he had this before my fissure issue) he healed really well after and never had any further issues. I didn’t realise at the time how fortunate that was! I would be wary of going to Thailand just because you can’t be followed up by your surgeon after your procedure, which is not ideal. However your situation in Canada sounds awful. I really hope they can bring forward your mri and you can get sone help. You are not alone and you will recover. You are young and it’s not the end of everything. Even tho sometimes it feels that way. Sending you luck and best wishes to resolve this

Thank you so much Hazey. I went to get my MRI form and Dr Yuen said he would most likely place a 3rd seton and I would have to wait another 6 months again! Anyway, i got my sheets and left. I got to the MRI place that books sooner and realized THEY GAVE ME SOMEONE ELSES MEDICAL RECORDS! A 37 y/o male whos been dealing with 3 Fistulas for 4 years! I have all of his info, name, address, health number, records etc. Of course the doctors office won't answer when I call. I drive back 2 towns over again and my mom starts filming. The receptionist's face turns red when I tell her she gave me someone else's records! She texts the doctor who left and he tells her to give me the correct forms. I go back to the MRI place again and a lady whos seen me 3 times decides to help, calls a patient to confirm a cancellation and gets me in for the following Monday, so i went from 5 months for an MRI to 5 days.

I video chatted with a doctor at Bumrungrad in thailand, they are so advanced. I requested a teleconsultation and spoke with Dr Navara Dusitanond within 1 day!!! . I tell him everything, hes so understanding and says I should see DR Arun Rojanasakul. He is world-famous, and specializes in abscesses and fistulas. He's an honorary fellow of colorectal surgeons in The philipines, india, singapore and the USA. He does another type of surgery where they drain the tract, clean it and close the internal opening so the body can heal from inside out. Its all in one shot! It's think its called primary closure with suction drainage. It does not involve cutting of any muscle! A vacuum will pull the infection out and apply negative pressure to close the tract. He said setons are for very complex cases and most fistulas don't need them. He said there is a one-week follow-up after and full healing can be a month or so. I will stay in Thailand until I am completely healed if I need to. I will also get my records and operative notes in case I need them in the future. My mom is coming with me, the surgery is 5000-6500 USD, plus flight and accommodations maybe 10k USD which is a bargain at this point. I'm sure to have travel insurance with trip interruption. They said bring all your files and MRI, I may still get another MRI at Bumrungrad, I'm sure their machine is way better than our ancient ones in Canada. I mentioned the other type of surgery to DR Yuen and he said they don't do that in Canada. So not only is our system broken, we don't even offer solutions that are available abroad. In Canada this will easily take another year or two minumum and they will cut me via fistulotomy or LIFT. Plus months of Seton torture beforehand. I now have a teleconsultation with DR Rojanasukul next week and hope to land in Bangkok in 2 weeks. They said they do surgery a day or two after consultation. So far my experience with Bumrungrad has been unbelievable. I can totally see why they are world-famous and people have nothing but positive things to say about them. I'm probably going to make a video series about this whole situation to help and educate people.

Wow Matrix this sounds very positive and it’s great they are being so helpful and can hopefully sort out your issues. In fact when my daughter was a baby we took her from the UK to LA for eye surgery because they couldn’t help her in the uk with a rare disorder. The surgery was amazing and I’m thankful always that we took this (educated) leap of faith. Sometimes you have to be brave and if you’ve done your research thoroughly then it could be your best option. I cannot believe they gave you someone else’s notes at your Canada clinic. That’s terrible. And that poor man suffering for so long. Awful. Definitely keep a diary/vlog and most importantly keep US posted on how it all goes!!

Thanks Hazey.

I had my video call with Dr Arun Rojanasakul. He basically said come here and we will fix whatever issue you have. I watched a lecture of his on Youtube. He is so smart it's insane. He's a professor and teaches colorectal surgeons across the globe. If you look up the LIFT surgery on Wikipedia he's actually the doctor who invented it in 2007 and published a paper on it and doctors all over the world perform that now. Plus he's developed even better procedures since then. In my teleconsultation with him, I told him that they put 2 setons in me and I saw the pain in his face. He said he teaches doctors to stop using setons, they usually just end up creating a false tract and make things worse which is exactly what has happened to me. These awful things are like fish hooks in my rectum and are driving me crazy, they are causing me so much pain I just want to rip them out. I'm just sleeping all day and night now until this Thursday when I leave for Bangkok. The trip there is going to be rough, I have a 8-hour stop over in Germany. I'm going to pop a bunch of Tylenol and Advil to make it through the flights. Im leaving Thursday and arriving in Bangkok on Saturday. I meet with Dr Arun on Monday at 1 pm and he said we can do all the necessary testing that day and then my surgery is on Tuesday. So next week I should be in my hotel room on the road to recovery and getting my life back. I'm bringing my gear to film the hospital and make a 2 part series about this nightmare in Canada and then hopefully the solution in Thailand at Bumrungrad. I still can't believe that this is real life. I'll attach some relevant links below.

Dr Arun's profile on Bumrungrads website
https://www.bumrungrad.com/en/doctors/Arun-Rojanasakul

LIFT Technique on Wikipedia mentions Dr Arun Rojanasakul's findings in 2007
https://en.wikipedia.org/wiki/LIFT_technique

Dr Arun Rojanasakul lecture where he talks about everything and anything regarding fistulas and abcesses. I'm confident that hes easily one of the best if not THE best colorectal surgeon on the planet.
https://www.youtube.com/watch?v=ACPrL6Q3v0Q&t=3662s

Wishing you loads of luck Matrix I hope the flight is ok and remember to take your miralax/Movicol after surgery… crossing everything for you. What a journey! I hope it’s a success xx

How are you doing @matrixgotme? Did you make it to Thailand safely?

Wishing you the best of luck Matrixgotme!

I'm in Bangkok baby! People are so respectful here it's amazing. Everyone bows to each other, and now I do as well. I went to Bumrungrad today and here's what's happened so far. It's the most beautiful and efficient hospital that I have ever seen. I'll attach screenshots from videos that I've been taking below.

We explored the hospital a bit and then went to the clinic. There was maybe 5-6 people waiting. The nurses called me to measure my weight and height. They then called me to meet Dr Arun exactly at 1:30 not a minute later. He had very kind and confident eyes. He physically examined me first, no poking or prying or inserting anything. Just a 2 seconds look then told me to sit with him at the computer. He immediately pulled up the MRI images that I sent him. Finally a doctor actually looked at my MRI and not just the radiology report. He drew out the fistula tract and it matched exactly what I've said the entire time. It starts at the backside(posterior) wraps around into my left glute and towards the front left. He explained that the doctor in Canada placed the setons in the right place but only partially through the tract which has created a false tract and is why he doesn't use that method, it requires multiple surgeries and wastes time and money. They go in the beginning of the tract but come right out at the back (posterior) leaving the majority of the tract untouched so it wont drain properly plus they feel like fish hooks tearing me apart. So his plan is to make a small hole in the left glute and drain out the infection and remove any bad tissue and then he will cut where the setons are from the inside out but then repair the cut so my muscle heals back together and the whole fistula has been cured and my muscle control will return to normal. He said this method has a high success rate and little to no change in muscle control plus it's all done at once. Healing time is around 2 weeks, I will follow up with him a week after and he said his patients don't need to stay long. He checks after and knows when it has been a success and will heal fully within a week or two, even if it is still not fully healed yet. The cost is $6300 Canadian, I get 1 night stay at the hospital in my own private room that includes food. They also got my hotel address and will drive me directly to my hotel once I'm discharged. He sent me for bloodwork, chest xray, patient admission and then cashier to pay. The appointment and testing was $145 Canadian and it all was done in less than one hour. I just went step by step to each clinic and they took me in immediately or within a few minutes. We paid in full for the surgery and then they gave me instructions on what to eat and when to stop. I return to admissions at 7 am to get prepared and then the actual procedure is at 10 am, its 1 hour then I stay for recovery for about 2 hours. After that they take me to my private room for the night.

My doctor in Canada wanted to bring me back in for 2 more surgeries. He wanted to place a 3rd seton now to try and cover the remaining part of the tract that was missed and that would be 2 months from now. Then he says to wait 6 months to see if it drains, then perform a fistulotomy which is basically where they cut and lay open the full tract to let it heal from the inside out. That doesn't include any repairing of the muscle, leaves a big scar and has a high chance of causing incontinence which means the patient can no longer control the sphincter muscle properly. No other doctor has mentioned repair of the muscle. In Dr Aruns lectures that I have watched he says that repairing the muscle requires a lot of experience and skill but greatly reduces the chances of long-term complication. He recommends that most doctors do not perform surgeries that require repair which is why most doctors don't do it at all. They just cut and hope for the best and let the patient know of the risks.