Scheduling EUA and possible LIS

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Scheduling EUA and possible LIS

Postby Luka » 19 Jul 2016, 11:44

Hi everyone,

Well, I've reached the end of my rope with this fissure and I'm out of other options. I'm just plain tired from dealing with this fissure, which I've had for the past 3 years. It improved for a while with Diltiazem ointment and I was able to function decently for about a year or two (with flare-ups... I could always feel it was still there and never healed), but once I became allergic to that medication, everything just went south again and I've been in pain ever since. I just can't take it anymore. :( That muscle is just too tight and needs to be fixed.

I saw my CRS yesterday (the first one I saw in the beginning) and since he can't see my fissure at all (which is internal) because of how tight I am and how much pain I'm experiencing, he wants to do an exam under general anesthesia at a surgery center. He said if he finds a fissure, he will perform the LIS and a fissurectomy to clean up any scar tissue that is preventing it from healing properly. All I have to do is schedule the EUA/surgery. I don't need an enema beforehand (thank God!) and probably just a laxative to clear me out the night before, and they will be using Propofol with LMA (no endotracheal tube, apparently, because the procedure is so short).

I am absolutely TERRIFIED of surgery. I have always hated medical stuff and hospitals and have a history of anxiety, depression, panic attacks and stress-induced fainting spells, which makes all of this even more difficult for me. :( It just runs in my family. I take Prozac (I have since middle school) and that helps to some extent, but my anxiety tends to lead to pretty bad panic attacks when I'm under a lot of stress. I really need the help and support of people on the forum who have been through this procedure.

I am scared out of my mind, but I know I don't have a choice since I just cannot live my life like this anymore. I want my life back! I want to be able to make plans without worrying about how I'll be feeling later in the day when sometimes I get horrible spasms. I want to be able to go out with friends, work a normal job, and travel again. I hate being home all the time. I'm just miserable this way.

I think what scares me most is just not being able to control my anxiety when I get to the surgery center on the scheduled day. I want to be able to go through with it and not have a major panic attack. I will probably need some sort of medication to take beforehand to hopefully control it. I don't want to chicken out on this because I know I need it and I just want to be knocked out once I get there! Actually going through with it is going to be the hardest part for me and will be the hardest thing I will ever have to do in my life (so far). So I think I'm most afraid of just being afraid to the point of freaking out/fainting/having a major panic attack. Fear of being afraid and out of control, I guess?

I also worry about the recovery and how painful that will be, too, as well as the incontinence risk. Recovery stories are so mixed on this forum. I just hope and pray I get some relief. My CRS said 70-80% of his patients feel better right after the surgery. I hope I am one of them.

I wanted to ask my CRS for some sort of anti-anxiety med (like Valium or Ativan) I could take to help me get through the upcoming weeks before my procedure in case I have panic issues and for the night before the procedure, but forgot to ask. I had already asked him for some Vicodin just in case I had horrible pain I couldn't stand before the procedure (I know it's constipating, so I avoid it like the plague in case I need it), so I didn't want to ask for something else potentially addicting. : ( Should I ask my regular doctor for something to calm me down since he knows I have anxiety issues?

Thank you for listening and sorry for the huge wall of text; I'm just trying to get my feelings sorted. Now I just have to schedule the date. Please pray for me that I get the courage and strength to go through with it. I just really want to be on the other side already with the procedure done and focusing on healing and getting better, because with the way I am now on this rollercoaster, nothing is helping or healing. : (
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Re: Scheduling EUA and possible LIS

Postby thedude » 19 Jul 2016, 13:21

Luka,
I shared some of your same thoughts prior to my surgery. I had never had surgery before and I was scared / nervous about things such as what happens if things go wrong. What if this makes it worse. What if the pain is unbearable.
Let me re-assure you that everything will be perfectly fine! I'm so glad I did my fissurectomy, fistulotomy and abscess surgery. Best Decision I ever made. So let me hit on a few points for you:

1.
I was super nervous..so nervous and stressed out in fact that my blood pressure at the outpatient surgery center was 181/83 while they had me in the pre-op waiting room! Super high just because of how stressed out I was. But I stuck with it, and like I said I'm glad I did. My experience is this: They take you back to pre-op, have you change into a gown, take your vitals, and setup an IV in your arm to start giving you saline to hydrate you (expensive gatorade as my nurse said). The anesthesiologist and my CRS came to talk to me and answer any questions / alleviate any fears I had, and to also do their own little check up. The Anesthesiologist was the one who spent the most time with me just to make sure that from his end everything would go smoothly. Then the nurses wheeled me back to the OR and the nurse anesthetist gave me 2 shots in my IV. She said this ones to make you feel good, and this ones to make us friends. I heard another nurse asking if they needed more KY jelly, and I cracked a joke about that being something I didn't really want to hear in the OR, then that was it. Next thing I remember is waking up in the recovery area with a ton of gauze up my butt. That was the procedure for me, didn't even ask me to count to 10, just one minute I was awake and the next minute I was waking up. I don't remember going to sleep or even feeling tired. Can't believe I was so nervous about the procedure, it really was simple. I stayed in the recovery area for about an hour then they released me to my wife, gave me a ride in a wheelchair to the car and that's that.

2.

As far as pain, there was some discomfort / minor pain after surgery, but nothing crazy. They gave me Tramadol and ketorolac for inflammation. I only took the tramadol for a few days. The ketorolac I had to take for 7 days to keep the inflammation down. Overall though the pain was nothing like I was afraid of. My first BM came 2 days after surgery (though I had enema's and all the laxatives and what not prior to surgery so yours may be different). My first BM was not scary at all. I was terrified it was going to hurt, but you know. It wasn't all that bad. Even less painful than it was before surgery. I would have some burning sensation after a BM, but I would hop in a bath I had gotten ready prior to using the bathroom and that would almost immediately relieve the pain. I had that burning sensation after a BM for about 5-7 days after surgery and then it gradually went away all together.

3.

For your anxiety I would call your doctor and ask if they can call you in 1 or 2 pills to help with that, I know some doctors will do that prior to surgery. If not, when you get to the surgery center, ask the nurse for something they can give you something to help keep you calm.

Bottom line is don't stress about this..I know it's stressful but it shouldn't be.

I had my surgery on Wednesday, for the rest of that day, and through Monday the following week (monday was a holiday), I laid on the couch, binge watched TV shows / movies, and ate soup and salads. Nice little mini vacation lol. Tuesday I went back to work without issue. Get a small water bottle that you can take with you into the bathroom at work so after you have a BM you can spray off down there. Using toilet paper will be to painful for the first 2-3 weeks though I'd say between 2 and 3 you can start to dab down there if you need to, but I'd recommend giving it as much time to heal. When at home, showering off down there after a BM or taking a bath will be your best option.
If you have any other questions please let me know, but do go through with this. It's not as a bad as our minds make it out to be. I promise.
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Re: Scheduling EUA and possible LIS

Postby Luka » 20 Jul 2016, 08:36

Hi thedude,

Thank you so much for the detailed account of your experience with surgery. : ) It really helps to know your experience and that the surgeries helped you. I'm assuming you didn't get LIS since you didn't mention it, but just the fissurectomy for the fissure issue? Since I'm so tight down there, I know I will have to get LIS.

It's weird because when I'm really freaked out, my blood pressure goes down and I eventually pass out. : ( So, I have that to worry about. The last time it happened I was just getting an eye exam! The part where they shine that really bright light in your eyes and barely tap it to check the pressure. Well, I passed right out. Super embarrassing. I'm such a wuss about this stuff and that scares me going into a procedure like this. : (

I will definitely ask for something from my doctor before the procedure. I know they can give you Versed through your IV to relax you before they give you the Propofol, so I'll ask for that.

How much gauze did you have up there and when did it come out? Are you supposed to pull it out yourself or just leave it in there until you poop it out? Sorry for asking, but that sounds really uncomfortable and painful to me.

Wow, you had a lot of procedures done, so I'm surprised you didn't have more pain. I'm worried I'll be in excruciating pain and go from the frying pain into the fire, so to speak. : ( You're very brave to go through with all that and I hope I can have just as much courage and just as good as an experience as you.

All of this still hasn't hit me yet, so I'm still not totally freaking out, but I know I will eventually. Since my CRS is on vacation for the next 2 weeks, I have to wait, which really sucks. But I know I will be scheduling the surgery for next month, September at the latest, since I'd prefer to get all this done before summer is over. I will update with my plans when I make them. Please wish me luck!
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Luka
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Re: Scheduling EUA and possible LIS

Postby Luka » 20 Jul 2016, 08:49

Also, I have another question: did anyone have to get any blood work done before surgery? Like basic blood panel work? My CRS says it's not necessary. I looked it up and since I'm still relatively young (32) and don't have any major health issues besides bad acid reflux/GERD, it doesn't seem necessary.

My regular doctor (not covered under my Medi-Cal insurance) actually ordered some blood tests for me the last time I saw him, but my insurance will not cover them because he's not a doctor in their system. : ( So, even though I want to get the blood tests anyway, I can't because they'd be too expensive out-of-pocket.

Just wondering if anyone else needed tests before surgery.
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Luka
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Re: Scheduling EUA and possible LIS

Postby thedude » 20 Jul 2016, 11:40

Luka,
I did not get LIS but at the same time I sort of did. My CRS said that when he went in there to do the fissurectomy, the fissure had gotten deeper and started to burrow under my muscle there, so he did cut part of it, just not all the way through like they would with LIS. I think he said he did a partial LIS.

I had enough gauze up there that they ran 2 pieces of tape across my butt cheeks to keep it all in there lol. For the first little bit after surgery and the first day or so you'll have some bleeding still occurring. Really for that matter you'll still have some residual spotting for even a few more days. I think I had some light bleeding for a week or so after surgery. When I said I had a good bit of gauze up there, I don't necessarily mean inside of me, just quite a bit of gauze on and around the wound / anus. As far as it coming out, they told me to remove it with the first bowel movement, or the following day. As I said before I didn't use the bathroom for 2-3 days after surgery so what I ended up doing at the advice of my doctor was taking a bath and then removing the gauze in the bath. Most of the gauze comes out easily, but the ones closer to / on the wound tend to stick to it due to dried blood. Taking a bath let's all that soften up quite a bit and makes it easier to remove. Also when you do use the restroom don't be afraid if your still leaking blood some..especially after a BM. That will happen for a little bit, hence why they want you keep using gauze.

While you have the gauze up there from the surgery, you do feel it there, but I wouldn't say it's uncomfortable, just more annoying really. Really for the 4-6 hours after surgery you don't feel much just because you still have all the numbing medicine and pain killers in your system. I recommend at least taking 2-3 days of doing nothing by laying down and bing watching some TV shows you've been wanting to catch up on. If you have someone that can be there with you or swing by every now and then it's helpful, but for me wasn't 100% necessary. I did have my wife with me, but honestly I was able to get up and move around on my own if I wanted to.
When i type out the procedures yes it does seem like a lot, but it really didn't feel like it. 2 of those procedures were because of developing an abscess.

At the time of surgery I was 31 and my doctor did have me get labs done, but I suppose everyones different. I also had to get an EKG done, but that's only because I take blood pressure medicine. If it wasn't for that medicine I wouldn't have had to have an EKG.

Honestly the biggest thing for me to remember after surgery especially for the first 1 week was no wiping! Just use the sitz bath to clean up afterwards or a regular bath. Any touching of the surgical site can give you a decent burning sensation for a minute that will make you not do that again lol.

You'll be fine through all this. Just follow the doctors advice and there's nothing to worry about. These guys are one of the top paid doctors for a reason.

Keep us posted on how things go for you!
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Re: Scheduling EUA and possible LIS

Postby chachacha » 20 Jul 2016, 15:23

I did not have bloodwork done before LIS because my doctor said that only people with pre-existing conditions, or the elderly needed to do so.
Fissure since about 2007
Fissure diagnosed in 2011
Diltiazem for two years - didn't work well
LIS January, 2015
Hemorrhoidectomy December, 2017
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Re: Scheduling EUA and possible LIS

Postby thedude » 20 Jul 2016, 20:30

Yeah I think it just depends on the facility your doctor uses. Mine did basic tests for diabetes and anemia.
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Re: Scheduling EUA and possible LIS

Postby Luka » 21 Jul 2016, 08:23

Thanks for the replies, guys. I really appreciate it.

thedude: Thanks for the reply about the gauze and other stuff. Your experience has been really helpful to me. : ) I know I will be absolutely terrified of the first BM, too, but I'll cross that bridge when I come to it. The first hurdle for me is actually going through with the surgery, so I'll focus on one scary thing at a time.

Guess I won't worry about the bloodwork stuff, then. I have enough to worry about as it is.

Now I just need to schedule the EUA/surgery date. I'll keep everyone updated. Wish me luck and the courage to go through with it!
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Luka
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Re: Scheduling EUA and possible LIS

Postby Luka » 03 Aug 2016, 08:22

Well, my EUA/LIS is scheduled for August 26th. I'm scared out of my mind. : ( There was an appointment available next week on the 12th, but I was just too chicken to take it even though I'm currently in pain. I feel like I need some more time to mentally prepare myself and hopefully get some anti-anxiety meds for those days that I just can't function.

I'd appreciate any support I can get. This forum has always been a great support platform for me. So many helpful people. I need that support now more than ever as I'm such a wuss at dealing with medical stuff. Please wish me luck and pray for me, if you do that. Thank you everyone. : )
January 2013 - Diagnosed with fissure. Eventually turned chronic.
History of IBS and anxiety disorder, along with fear of using bathrooms other than my own caused it.
Tried Diltiazem, but eventually developed a rash.
LIS surgery scheduled August 26th.
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Luka
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Re: Scheduling EUA and possible LIS

Postby thedude » 04 Aug 2016, 23:41

Congrats on taking the step to schedule the surgery!

I was the same way..they offered me an appointment for the very next day after they said I needed surgery, but I felt to rushed and needed more time, so I took one for a week later. Best of luck to you Luka, you will be fine!
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