How are you doing @matrixgotme??? Been wondering post your surgery….

Hey guys just thought I should give you an update. Unfortunately, the worst possible thing has happened. I had a new fistula tract form from the same internal opening. Everything was going ok, my bowel movements were very smooth and almost pain-free, still had discharge and pain throughout the day but slowly improving. I went in for my 1 month follow-up with Dr Arun. He asked how I'm doing and I said slight improvements but had pain in the posterior where my muscle was cut and repaired. I told him I'm still seeing pus on my gauze and it still had a bad smell. He then examined me and inserted his finger and pressed SOOO hard against my wound and I felt a tearing feeling. I screamed in pain and told him to stop. He said I shouldn't have so much pain and gave me isosorbide dinitrate ointment which is a muscle relaxer like nitro/nifedipine/dilitiazem. About a week later I felt massive swelling going from my anus up to my tailbone. It felt like a snake under my skin and a hard lump close to my anal verge/tailbone area. I went back to him again and he said I need to go back in for another surgery. I told him I believe he reopened the internal opening as it was just barely starting to heal and he put so much pressure on it during my follow-up. He said its unlikely as he's examined thousands of peolple and had no issue but I know what I felt. Anyway, I tried antibiotics for a few more days and I just felt even worse. I went back again to see him on Dec 27 and he looked again and pinpointed where the new abscess had formed just by looking from outside. He said surgery is the only option now and he can get me in the following day. So my mom and I thought about it and decided at this point we had no choice but to continue. He waived his doctor's fee and other fees this time so it was only $3000 CAD. I got the hospital to pick me up and drop me off this time. I got to the hospital and 5 am and surgery was at 8. The nurses did an enema for me and it was so painful. I felt even more swelling immediately after going towards the front left where my original fistula was.

After the surgery the doctor came to see me in my room. He said it was a simple fistula and he performed a fistulotomy and repaired my external sphincter, he also put stitches alongside the abscess to hold it open and allow it to drain. He said this is it and everything should be good now. Im still in Thailand, I came in mid-November, and it's now Feb 6. Its been about 5 weeks since the second operation. Im feeling improvement again and I went for a couple of follow-ups. I did not let him insert his finger at all but just look. He said everything looks good and I will have a full recovery now. I'm super scared and anxious now. I'm trying to take it easy, I have a daily plan of exactly what to eat and when. I go for 1-2 walks a day, sometimes on the treadmill and the hotel's gym. He said no more follow up required but I can come anytime I want. I've called him many times with questions and he does a good job of calling me back but usually brushes off what I say and says not to worry.

So now what's bothering me is that my muscle has been cut twice although he repaired the internal and external sphincter the first time but only repaired the external the 2nd time. I have a linear scar going to the left about 2 cm, its a very thin line and has improved a lot since it was stitched closed from the first surgery. I also have the fistulotomy scar going from the anus up towards my tailbone and where the abscess was. That one is still a bit inflamed and I can feel the stitches dissolving. I just really hate that I had a reoccurrence and it went in a different direction and created a bigger damage area. He says the scars and very small and will fade almost to where I won't be able to feel them anymore but now I've lost trust in him. My fistula was 1 tract and stable for 2 years so obviously a mistake was made. It could be when he examined me roughly which is the most likely scenario, or the seton I had placed in Canada had left some weak point or damage, or when I got fed up and tried to go on a liquid diet to speed things up and had a hard uncomfortable bowel movement the next day. But I got fed up and did that because I was in so much more pain after going to see him for a follow-up. He inserts his finger every time which is insanity for someone just recovering from a surgery. So it's hard to say why this happened but I'm not in a good place right now.

After my reoccurrence, I started to scavenge the internet again like a madman. I came across Dr Ashwin Porwal in Pune India who does a procedure called DLPL, Distal Laser Proximal Ligation. He claim 99% success rate even in patients with complex reoccurring fistulas. He also has a 3d endo imaging camera that he invented to see the internal openings and any tracts or branches in real-time. He uses this to diagnose and to confirm complete healing afterward during follow-up care. There are tons of Youtube videos on his channel, the clinic is called Healing Hands. There is many people on Facebook, Reddit and other platforms swearing by Dr Porwal and the DLPL. The surgery closes the internal opening, opens up the skin from outside, drains the fistula and lasers the tract to collapse it and does not involve cutting the muscles at all. It seems too good to be true but tons of people are saying it worked for them and they are 100% healed. I briefly saw some of his videos probably a year ago when I thought all I had was a fissure. I was still hopeful that I would get help in Canada at that time and didn't look further into Dr Porwal. I'm kicking myself now thinking maybe I should have gone to India instead but I forgot and was desperate. Had I known all of this I would have strongly considered that. I thought Dr Arun would do some type of special surgery for me but he's very old school. I've also heard the aftercare at Dr Porwal is very good with eating plan, supplements, wound cleaning and care, debridement to improve wound healing, probiotics, and the 3d endo camera to confirm healing. All I got here was antibiotics and painkillers. I had so much on-and-off diarrhea and when I still had pus Dr Arun would just give me more antibiotics which caused more diarrhea. I eventually bought my own probiotics and that helped stop diarrhea. I had 4-5 rounds of antibiotics since I've been here. We've spent over 30k here now between fight, hotel, hospital, food etc. I've had many breakdowns and brought up that I may have made a mistake and should have researched more and maybe India was better but that hurt my mom. She's fed up as well. It's too late now and I have to just wait it out and trust Dr Aruns skill and experience. I really hope I don't have long-term issues with pain or scar tissue.

Now some people on Reddit and Google reviews say Healing Hands is not all it's cut out to be. There was one person who went and said DLPL only works in certain cases, repeat surgery may be required and he saw some people get sent home being told they are 99% healed but still have symptoms months later. There are people on Google saying they had multiple surgeries mostly for piles but I found one for fistula and they are still having issues. Also it's not just one clinic, its a chain of clinics around India. Its rare to get Dr Porwal to do the surgery himself, its various doctors for surgery and follow-ups. Also one person on Google said he was told that he does not have a fistula at Healing Hands after they used their 3d endo camera, but he went home to UAE and got an MRI which revealed that he did in fact have a fistula. So maybe its a grass is greener situation for me but since I had a reoccurring fistula weeks after surgery my mind is going there. Dr Arun said he treats 30-40 people a month and right now only 2 people are having issues and I was one of them. I met the other gentleman, hes had 5 surgeries, 3 at home and 2 here in Thailand and he still has an infection. He's giving up for now and going back home and will try again later, I told him to check out Dr Porwal in India and maybe that's the answer he needs. I mentioned DLPL and the 3d camera to Dr Arun and he said Laser is not as effective for complex cases and a skilled surgeon doesn't need fancy cameras. But I don't think he knows about DLPL, he was probably thinking about FILAC which is a different type of laser but DLPL is a modified version of FILAC developed by Dr Porwal.

My concerns now are

1. I hope to heal fully with no symptoms. Without a clear 100% healed answer that leaves me with concerns. That's why Dr Porwals 3d camera sounds like a great tool to give patients peace of mind. I asked Dr Arun how we can verify 100% healing and he said if you feel better then you are better. I asked when an MRI would be a good idea and he said at least 6 months to let everything heal. I had another MRI booked in Canada and moved it to 6 months from my last surgery so maybe months from now I can go for that MRI to know 100% that I am healed.

2. I hope that cutting my muscle and scar tissue doesn't leave me with long-term issues or a weak point that is susceptible to further issues, I really can't go through this again in my lifetime. I don't know if Dr Porwals method has more or less scarring. Some of his videos he really opens up the tract externally to let it drain, but in my case Dr Arun made a 2cm incision on the left side and excised the tract from under the skin. I was happy with that but the second surgery is what really tripped me up. Every case is different and when I watched videos of surgeries where some people got way more skin damage than me and some got less I don't really have a clear answer here. But for sure my muscle was cut but luckily my skin usually heals very well with little to no scarring. Time will tell.

3. I hope to eat and be normal again at some point and regain confidence in my body and rectum that it functions correctly

4. I have these little redish/pink lumps around my anus that have been there since the begging of all this 2 years ago. I thought they were related to fistula and all doctors brushed them off when I tried to show them. I don't think they hurt but I don't know yet as I still have surgery pain. I sent a picture to my uncle who is a natural path doctor. He says they are from trauma to the anus from surgery, infections, fissure etc. He says they will heal eventually if they stay trauma free and I can use castor oil now to heal the skin around the anus, reduce inflammation, and its also antiseptic. He also has a treatment plan for me afterward to help heal my intestines and rectum with supplements and a salve ointment for the rectum when I'm back in Canada. I'm very lucky to have him as well since doctors alone only cut you up and send you home. I need all the help I can get.

5. The day of the surgery the enema really hurt me after my bowel movement, it was so early in the morning and I wasnt ready to go yet. The front left got a bit swollen again where my original tract was which freaked me out. I told Dr Arun about this and he said he doubts any other tracts and that this swelling was related to the 2nd tract that had formed and will subside. It has gotten better and sometimes feels completely normal but sometimes still feels a bit harder than the front right of my anus which is untouched healthy tissue. I hope all issues go away.

I've spoken to some people on Reddit who are sending me good wishes. They also said healing takes a while, normally 3-4 months for full recovery so I'm still early. Dr Arun says 1-2 months, but his nurse said 4-6 months for full recovery based on what she has been. There is so much varying info that it's driving me insane. My mom is leaving at the end of this month because her business really starts to pick up and she needs to be home. I'm staying until April 2nd, I'm praying to god that I'll be ok by then and can sit on 2 long flights back home. My best friend may come here in March for a week or two. He doesn't know exactly what I'm going through but he figured it was for something medical.

So as of now, I'm just waiting it out in Thailand, speaking to Dr Arun and my uncle. I just need more time and keep my fingers crossed. My life is a mess over this and I hope I can be a normal human again. I don't even remember who I was before all of this. I for sure have some serious mental health issues now but I need to be physically good 100% then figure out what else needs to be done. If anyone has a positive success story please share it as I really need hope right now. Please share what happened, surgery, or surgeries. and complete 100% healing time.

Hang in there matrixgotme. Hoping you will be fully healed by April and won't need anymore surgery.