Simple Fistula Surgery 2014, Now Fissures :-(

My journey -

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Simple Fistula Surgery 2014, Now Fissures :-(

Postby Manitourose » 23 Jun 2014, 15:12

Several years ago I suffered very severe food poisoning.... Christmas day, fantastic! It was miserable. It took about a month to really recover from, but I thought the worst was over. After this, I seemed to suffer from what I thought was hemorrhoids. Welcome to my 30's I thought. Knowing these were normal, I did not think twice. Fast forward to last summer, 2013, I get a nasty GI bug. Working in healthcare you pick things up and I didn't think about it. After this GI virus, I notice anal tags and again what I considered hemorrhoids. To be safe I schedule a rectal exam at the end of summer of 2013. The PA nearly looks at me like I am crazy for being so cautious and sends me home with Anusol cream for hemorrhoids. No info about how long to use, if I had hemorrhoids... Just on my way.

Fast forward to March 2014. I notice light bleeding and discharge. Hemorrhoid cream never worked, I used it like crazy. But I'm under immense stress in my grad program and in life. I brush it all off to internal hemorrhoids which they say can have discharge. I notice a "tiny hole" when checking things out, but given the fact a fistula was not on my radar.. I thought nothing of it. Get to beginning of May, still on and off very light discharge and bleeding and my "tags" seem inflamed. No pain, though I do have a tender tiny lump. Again, I'm all about hemorrhoids. Finally, I email my general doctor and ask him for a referral as I want to feel human again! He agrees and scared, I make my 1st appointment with a colorectal surgeon.

Early May, see the colorectal surgeon with over 8 years experience. At this point through my anxiety & nerves, I have researched the heck out of many rectal conditions and learned about fistulas, fissures and so on. Go to this CRS, he performs a digital rectal and a rigid sigmoidoscopy. Consults with me and states "that little dot looks like a fistula but is NOT one". Errr OK?! He informs me because he knows I deal with anxiety and am in a busy grad program he thinks I am "wiping too much" and this "not a fistula" he tells me is simply an abrasion. Surely he can't be serious, but I am relieved. He said my hemorrhoids were pretty much two tiny internal ones. Everything looks normal. Sends me on my way with new cream: Analpram, tells me to use Desitin on this tiny spot that is NOT apparently a fistula, and gives me Bentyl (for undiagnosed IBS?aka my nervous stomach).

2 weeks in, nothing is changing. I'm very particular at checking down there now and my fiancé kindly offers to help with the creams. I am convinced its a fistula, he is unconvinced as it isn't common. Until one day, he finally states "that is interesting" and says he saw everything he read about online with fistulas happening with my "spot". Call the original CRS, tell him what we see, he NOW agrees he thinks its a fistula. Hello!?? I appreciated his kindness overall in the office and the phone call. But the lack of diagnosis from the get go = frustrating!


End of May, decide to go after this "fistula". Make multiple 2nd opinion appointments, including one in a major city well known for medicine and schedule to see a top CRS. Can't get in till June 9th. In the meantime, JUST before my 2nd opinion appointment I get a UTI... why? Due to the Analpram according to the doctor who sees me... Yep steroids in the cream breaking down my ability to fight bacteria. Awesome, a cream that I should have never gotten gives me something else to deal with. Tack on another co-pay for insurance and $$ for a prescription. Nothing like a 3 hr trip to see the new doctor having to go to the bathroom constantly!

Finally we go = Doctor immediately and easily confirms fistula diagnosis with external exam, digital rectal exam and anoscope.He sees internal and external opening. He reviews the notes from the 1st CRS and is utterly confused how it was missed. (Later my primary care doctor reviews the same notes and states the same... the notes show everything for fistula). We ask about doing surgery now or waiting. Issue: I have to be in another state on the east coast ready to begin my own clinical rotations by June 30th. No flexibility can be made to help me adjust for recovery due to the nature of my program... Either take a full medical leave, risk hoping you recover in time or wait on surgery. He firmly believes based on his diagnosis: simple superficial anal fistula that he's 95% sure it would be a straightforward fistulotomy and he would not have to cut much of the sphincter muscle. Surgery would be June 18th. If I wait till when I am done with my program, I'd be in yet another major city, but well known for medicine. He offers up a colleagues name and states he thinks the chance of it getting more complex is low. BUT in order to keep it basic, I have to keep up sitz baths twice a day, expel the "stuff" from the hole and use Neosporin internally to keep the risk low for infection.. abscess... so on.

He's a fabulous doctor, very kind, and I have confidence.. I just don't know if I can make it all happen and move, and be ready/recovered! We spend the next few days back and forth about options. Lots of tears, fears, posts on here. Lots of research (probably too much), consulting by email with my very supportive primary care doctor and speaking to my program about the many "what if's"....

Deciding factor: It will cost much more in the state I finish up my program clinicals in to have this surgery, his colleague is not on my insurance (sigh), the BIG what IF it gets worse, and finally... this will be hanging over my head and I'm already anxious.

Decision = After 8 weeks of trying to get answers, lots of tears, lack of sleep, panic attacks, diagnosing myself, being angry, the why me's... I schedule and decide to have surgery on June 18th. Here goes NOTHING!

Sorry for the long story of how I got here... But here is my journey.
Last edited by Manitourose on 19 Nov 2015, 10:45, edited 1 time in total.
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Re: Simple A-Fistula, Fistulotomy - My Journey

Postby Manitourose » 23 Jun 2014, 16:39

Pre-op day before ---
• Does stress make it worse? Bleeding a bit after BMs... increasing anxiety regarding "what will they find?!?"
• Field tons of calls from pre-admission at the hospital. Agenda: health history in depth....details about surgery....confirmation of insurance .. finally the "surgical time" call. Show up at 11:45am, surgery at 12:45pm. Confusion over when to stop eating.... surgeons office calls and says 6 hrs prior. Hospital nurses calling saying midnight. Go with midnight.
• Begin 3 hr trek to the city where surgery is being done.
• EVERYTHING imagined packed and ready.
• Be the person who orders room service French fries at 11pm because I might as well enjoy something I rarely do before I am cut off. Besides I am scared to do the enemas in the AM and fries distract me. :)
• Use a calming sleep app meditation by Glenn Harrod to calm my nerves..... Shockingly, I sleep!
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Re: Simple A-Fistula, Fistulotomy - My Journey

Postby Manitourose » 23 Jun 2014, 17:51

Thursday June 18th -- Fistulotomy time.

I slept reasonably well, which was a lovely surprise. Allowed to have straight black coffee, tea, apple juice or water until 8:45am. Don't usually care for black coffee but so grateful that I can have it so I enjoyed it! A slice of normal life, that's until I contemplate the fabulous enemas I am about to do. Instructions 1 2 hrs before I show up (11:45am), 2nd one 1 hr after the first.

Enemas times 2: I cry, I laugh. This is a hotel, what is going on in my life. The pharmacist while politely laughing said "really stay very close to the bathroom".. I ponder... how close... do I do this in the bathroom? We decide to do this lovely experience just outside the lavatory, pillow on the floor.. make it as comfortable as possible. Go time! Box says should have effect in 1-5 mins.... 20secs later... yeah, said effect occurs. I cry on the loo. Why? Because I forgot saline mixture may just burn a bit with a fistula, more of a shock than anything. Survive the 1 minute experience. Laugh about it and prepare for repeat.
-Fastest hour of my life, go time #2. This time I am more prepared and its fine. I'm just grumpy, laughing and crying about the whole experience. Shower and feel 1000x better. Time to get ready!

-Off to the hospital. Dressed comfortable and feel the best I can. The hospital staff is incredible, with volunteers directing you everywhere. Nerves set in as I am lead to the ambulatory surgery waiting room. I say "I know my surgeon is going to be behind, I just feel it"... And I was right. Intake on basic BP, weight, height at what should have been my procedure time of 12:45pm.

-Wait another 45 minutes and finally am lead back to provide a urine sample, get gowned up, and get m IV from my pre-op nurse.
For those nervous about the IV, it was easy... a little lidocaine to numb the area and IV is then put in. IV is great because it starts to hydrate you after not drinking since early in the AM.

- Informed who I will meet: Surgical resident to my CRS... oh wait, I forgot there would be a resident!? Wait is he doing this procedure? I meet him, he's super nice and I feel at ease. My CRS, the anesthesiologist and the OR nurse. They all pop in, everyone is supportive. I advise everyone going through this to be honest about your concerns and fears. They are there to support you and walk you through the nervous day.
- See my CRS, he's so relaxed and confident. When I re-assert my worries about being ready to be out on my own clinicals by end of June he states "no problem, you will feel much better by Monday".. I am not so sure about this, but his confidence is inspiring me to stay calm.

-As we wait, we listen into the other areas.. Lots of individuals waiting for surgeries. We overhear people not being honest about what they had for breakfast and how this could postpone their surgery. We see people wheeled off, they look calm and relaxed.

-Anesthesiologist tells me she will give me Versed to relax me since I deal with anxiety. She brings it in about 2 minutes before I am taken for surgery. She also informs me because I once had nausea after my wisdom teeth were pulled she'd give me anti-nausea meds in my IV too.
-Wheeled away, the OR nurse is kind and compassionate. We get to the surgical suite, it looks wide open, not intimidating and they are playing music. The anesthesiologist asks if the Versed meds have kicked in, she is surprised they haven't.. its been 3 minutes since I got it. They took a good 10 minutes last time I had surgery. But at this point it doesn't matter, I'm here and they are ready. Everyone is so wonderful I am not so nervous (or maybe the meds did help). Given the general anesthesia... she walks me through everything, never have to move off my gurney, and I'm out.

-Wake up on the same gurney in the OR and am rolled off to 1st stage of post-op. Again, they talk me through it all, as you wake up a bit confused where you are. NO PAIN! Feel pretty awake and the nurses all are impressed. I get ice chips and immediately ask when I went under and what time it is, I am calculating what was done in surgery this way. Find out it was simple as expected and anal tag removal which he said he would do if it was in the same incision area.

-Went under at about 3:20pm, surgery started at about 3:40ish or just before, by 3:53pm my fiancé is given an update all went well. They clearly inspected things, examined under anesthesia (there is a CPT code for that.. haha), did ultrasound and so forth 1st. No doubt the surgical resident learned during this time or got to do some stuff. I wake about 4pm.

-Post-op overall: Pretty easy, they check vitals, continually check your "dressing" (gauze), and check on your pain. Moved to post-op part 2 and family (fiance) can come in. I get my choice of drink and food. In a private area with reclining chairs and remote control TV. Not bad. Given discharge instructions, med info if I choose to take it (Colace 2x a day, Norco 2 pills every 6 hrs as needed) and I can ask questions.

Questions I asked and their answers:
-Should I take fiber supplements? Nope, just add fiber and water into diet. Use Colace as stool softener, especially if taking the Norco, pain killers (with narcotics in them) can cause constipation.

-Should I use wet wipes...how do I wipe??? No wet wipes, the doctor doesn't like them on the wound due to the chemicals that can be in them. Hop in the bath. Water will help keep you clean.

-When do I take off the gauze? With your 1st bowel movement. Um, there is a lot on me, but not packed and no tape. She informs me the outer layer will fall off and whats left will either fall off in the toilet or come off after a bath. Let it happen naturally. If it is when you have a bowel movement, she said some people slightly wet the gauze down which helps loosen it if it has dried to the skin.

-What can I do? Just don't mow the lawn. Okay, she said it as a joke, but she said, go about your life. Rest today, take each day as it comes. Movement is ok and gets the blood flowing. Listen to your body and needs.

I leave the hospital by 5:20ish feeling fairly good, wheeled out and then I see the car. Hmmm, the 3 hr drive back will be fun. Glad I brought pillows. Stashed in the backseat, a kids swimming inner tube, but we forgo this. I remain in the front seat and keep adjusting myself and pillows as needed.

-Surprises after surgery:
I can sit! Yes I have tons of gauze up me, but I am shocked really. Uncomfortable in an odd way, but not really painful.
I want a decaf coffee and croissant. Happy to eat, just happy to be on the other side. Get both and of course drink tons of water.
We spend the night with family about 1 hr from home. I eat a light dinner at 9pm and don't tell anyone, enjoy a glass of wine. Again just happy for a slice of normal.
Decide to not take any pain pills.
Can't sleep, huh??? I should be exhausted, but I'm overwhelmed by the day. I barely fall asleep and look forward to going to our own place in the morning. Just in case that first BM makes its appearance!

My fiancé said he'd like his own blog for his side. He was nervous too, but states "its all a lot less than you think". Point is, its surgery in a sensitive area. There is not tons of info out there about it to rely on. You can't just ask anyone about it and who you do tell has NO clue what it is.

So in saying that above, this is why I am writing so much. People deserve to know they are not alone and this site provides that. I hope others along the way will share their experiences because this forum helped me as I read stories, worries, and questions. We can help those after us even more! Onto recovery, surgery is over!
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Re: Simple A-Fistula, Fistulotomy - My Journey

Postby Savaici » 23 Jun 2014, 18:18

Great read! Keep it up. Hope you are doing GREAT!!! :smilyhug:
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Re: Simple A-Fistula, Fistulotomy - My Journey

Postby Manitourose » 23 Jun 2014, 18:34

Post op day 1: Friday

Didn't sleep a wink really but feeling fairly good still. Fiancé's supportive family encourages me to go ahead and get ahead of any pain and take the Norco. I decide to give it a shot and make sure I drink tons of water, eat tons of fiber and Colace it up! Happy I chose to take the pain meds. While not exactly in "pain", I am overall uncomfortable and when it kicks in I feel more normal.

1st bath: I cry before I get in, fear, worry, and how will it feel. Shockingly, its not bad.. a small sting but it is infact SOOTHING. I set a timer, need to get into this routine. 15-20 mins, 3 x a day (at least) and after a BM. Each bath there after is really helpful. It truly does feel better, keeps the area clean, brings blood to the area for healing and relaxes the muscles. Noticeably, after several hours of not having a bath I get uncomfortable and am happy to get back in.
-I set up a little tray by the bath and my Kindle (sometimes the laptop -- just avoid getting it wet) and watch movies and TV shows. I need and everyone needs whatever makes them comfortable with this because having to do it so much changes your normal routine, emotionally you can get a bit annoyed! Candles, music, whatever works.

I begin keeping track of my meds and *hopeful* future BMs on paper. Glad I did this. It gives me a sense of control in this crazy situation.

Set up a place in the bathroom or somewhere convenient with everything you need. I place a clean towel and on top are my meds, extra gauze, feminine pads, latex gloves (we never knew what we were going to need so bought too much ahead).

Washing things so often is such a pain. But again, I feel good knowing I have rotating clean towels and definitely clean hand towels for pat downs after each bath.

Positives: I want to eat and am eating well, lots of fiber. Tons of water. Teas (lemon/ginger/peppermint/licorice). I make it out to the store with my fiancé, a little doped up and walking funny but I get to choose foods and items I feel I need.
Don't tell the doctor (he didn't say I couldn't), we stop by a get together I had been waiting to go to. Not for the social/get together aspect, but more for preparation before my clinicals by chatting with former colleagues and trying to boost my collapsed "how will I start by the end of June" confidence.... It feels good to get out, though no one (but my department chair) knows I had surgery. Ready to go home pretty soon after getting there, after a short bit of standing. I'm beat but happy I gave the effort because I feel emotionally better for now.

Negatives: I haven't really slept and am dreading my first BM. :poop: Researching these boards like crazy for advice.

One step closer to being better...
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Re: Simple A-Fistula, Fistulotomy - My Journey

Postby Manitourose » 23 Jun 2014, 18:53

Savaici wrote:Great read! Keep it up. Hope you are doing GREAT!!! :smilyhug:


Thanks so much Savaici. I hope to provide support to those who look for it. :)
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Re: Simple A-Fistula, Fistulotomy - My Journey

Postby Manitourose » 23 Jun 2014, 19:04

Post-op day 2: Saturday

Didn't sleep again. Losing track of what day it is by this point. In tears, lack of sleep leads to tears. What I did wake with at 4am, a belly that feels strange... sort of nauseated, sort of crampy. Just go to the bathroom and back to bed, feel dizzy and have that horrible hot flash feeling. By 7:30am I awake, for fear of what is to come.... my 1st BM.. Yes my anxiety, coming off anesthesia, food moving in my digestive tract and painkillers are responsible for my cramping-not so happy belly.

1st BM - I make my fiancé get up and no I'm not usually high maintenance but given the dizzy feeling I had at 4:30am I worry I will have this BM, get in the bath and faint or something. News flash!! It was much easier than that. I finally went, small but smooth and I lived. Not much pain. Feel a bit awful about dragging him out of bed due to my fear. I learn from others, this fear is normal!

Rest of the day -- I lazy around. So physically and emotionally exhausted, I can't rest well or get comfortable. Keep up with baths and meds. The meds are beginning to be useful, I can tell when they wear off. Although the doctor didn't think I would need them when we met for our 1st appointment, I recognize the chaos in my life is placing a lot more stress on my body than normal and staying up with feeling "comfortable" is important. He prescribed them exactly for this.

Dread going to sleep..... and I should. I again don't sleep. I lay on the couch at 1am face down. As the anesthesia has worn off and I begin to heal, I just can't get comfortable. Not so much pain but plain uncomfortable. I am also very itchy, but I assume this is likely due to the increase in the baths... dry skin.

Not a great day, but one more day past surgery and hey, my bowels work for now!
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Re: Simple A-Fistula, Fistulotomy - My Journey

Postby Manitourose » 23 Jun 2014, 19:17

Post-op day 3: Sunday

Fell asleep from 2am to around 6am on the couch in an awkward position. Oh, please someone let me SLEEP! We try to make my room comfortable and I watch some shows, read some of these sites, and play around. Still can't fall asleep though I am so exhausted. The slightest noise and I jump. Overwhelmed, I am crying. Learning this too is normal.

Stay up with the baths... Again they are everything so incredibly important. Stay up with meds, water and fiber. I have eaten so much, I'm hungry often which is good, but I'm feeling so bloated I worry about the next BM... or am I constipating myself with the pain meds.?

What do I do? I try to stick to exactly what was prescribed. I do not add in any fiber supplements, let nature do its thing despite feeling huge and crampy as my digestive system works again.
- Increase herbal teas and water.
- Add in spoonfuls of Manuka honey.
- I may be crazy (and its gross) but a spoonful of ghee butter. Yes, some random stuff I read before surgery said it helped with fistulas. No I know now it doesn't "fix them" as some may try and tell people. But ghee butter does help for smooth "moves" so why not.
-Keep up with my life: Take a short walk. Run into neighbors who are moving in and we get their boxes for our move out. Win! Watch US soccer like the rest of the world. Watch some Game of Thrones... Keep life light, despite being uncomfortable in the gut and getting gassy.

Changes:
Reduced pain meds. Notice change in bleeding, its less and more discharge mixed with blood. I'm healing.....I mean I think I am. Allow kind fiancé to take a peek at the wound as he asked. He says its looking good but yep, definitely an incision down there. :-)
Finally, I have anti-anxiety medication and was ok'd to take it. So I give in and take a low dose. Smart choice, I am calmer physically and emotionally. I do this again before bed as well with hopes of sleeping. Because rest = healing! That's the goal!
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Re: Simple A-Fistula, Fistulotomy - My Journey

Postby Manitourose » 23 Jun 2014, 19:34

Post-op Day 4: Monday (the day calm and confident CRS doctor said "you'll be good" by)

I'm not quite "good" as he suggested. But better than yesterday. Interesting, more uncomfortable as I believe the healing is happening. I did sleep, thankfully! I walked around in the AM with hopes another BM would come, because I've been eating don't want to end up ruining the healing by being constipated. After relaxing a little (a lot!) -- success. Finally, what I would consider a real BM. As they said, I would bleed slightly, and I did. Nothing too horrific or painful. But I was happy to get into my routine bath right away.

So then I wonder, I know bathwater helps, but how does one keep clean? I'm not supposed to wipe...... yet. So? Well I let the bath water do its best, on the 2nd bath of the day I gently clean the area... gentle at the end of the bath is important because anything that needs to "move" moves off easier. Seriously, when did my life become a diary about my bum and poo?

Now nearly 9pm, have fit another bath in and feeling better. Have cried a few times today, but rebounded as well. I share this because its okay to feel defeated and have good cries. This is a process being able to emotionally heal/process is just as important as physically.

Changes:
Definitely more sore today after that "real" BM. Again reducing the pain meds to 1/4 of what is prescribed every 6 hours, but also not afraid to take a little more if I am more comfortable.
Feeling a lot less nauseous and crampy! Amazing with all the food I have had and only 2 BM's really since surgery day, its clear my body is using the food for fuel and recovery.
My whole body is not as sore, which is nice. Still uncomfortable with this and that but progress that I don't feel as beat up.

New today:
I have never had a fig, today I tried them for the fiber. Not bad!!
I started this diary. Sorry its long but its been cathartic as well. I hope it helps someone else.
I feel I just may be able to start the moving process tomorrow.... Suppose I need to, we leave Thursday.

Another day towards healing, hope the next one is better.

** Update**
Another BM... Okay fantastic digestive system, you are working. However, I totally tense up. Can't tell if its being tense b/c I don't want to strain but have to slightly, or that my stool is slightly hard. I felt like I didn't have the full BM I needed.
-Took a 3rd Colace (says its ok on the normal over the counter bottle to take 1-3 daily) and hopped in the bath. I'm so worried about screwing things up and too anxious to be normal again that its likely affecting things. Yes folks, a :poop: update. Boo! :(
Last edited by Manitourose on 23 Jun 2014, 21:40, edited 1 time in total.
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Re: Simple A-Fistula, Fistulotomy - My Journey

Postby Savaici » 23 Jun 2014, 20:28

I have not had surgery, but do find that dabbing (never wiping) with a dampened Johnson & Johnson sterile gauze pad is fantastic. I get through quite a fair amount of them, but I am content. Also, I never use soap, or anything impregnated with anything (such as wipes) to clean. I also invested in a Sitz Bath and find I can much easier relax with my rear soaking for a little using this than taking a bath. A question of preference. I used to live in Scandinavis and that might have something to do with me feeling more relaxed in a shower when I bathe.
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