tag:blogger.com,1999:blog-30499448.post694733787622468584..comments2024-02-18T13:53:30.168-08:00Comments on Surgeonsblog: Pain in the AssSid Schwabhttp://www.blogger.com/profile/14182853083503404098noreply@blogger.comBlogger331125tag:blogger.com,1999:blog-30499448.post-81452429156458046722010-10-23T11:39:40.209-07:002010-10-23T11:39:40.209-07:00P.S.: Thanks to the last two commenters (excluding...P.S.: Thanks to the last two commenters (excluding voon) I'm closing comments in this thread. <br /><br />To those AF sufferers who stop by, if you wade through the many previous comments and my answers, it's likely you'll find something that relates to your issue. If not, I'm sorry; but I really can't offer much but general information, most of which is already here in the post and in the comments. <br /><br />If you are suffering before or after surgery, the best and only advice is to keep letting your doctors know what's going on, and to seek other opinions if you remain unsatisfied. <br /><br />Sorry it ends this way.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-30851167373169046302010-10-23T11:37:12.923-07:002010-10-23T11:37:12.923-07:00Yes, I admit that person's claim that it's...Yes, I admit that person's claim that it's all about the money, and that since I'm retired I don't know what I'm talking about annoyed me. Especially because I keep giving helpful answers here long after I've stopped making new posts on this blog. <br /><br />Yes, I find it frustrating that people are as gullible as they are; and that people would stop by this entirely voluntary thread to insult me. <br /><br />As to the comment about the operation being a pain in the ass to surgeons: it was in response to that person's claim that it's all about the money. For that two minute operation, for which the reimbursement is a few dollars, we have to do a history and physical, schedule it at an operating room (in my case, I usually did it as an urgent procedure, interrupting my schedule and, since it wasn't a true "emergency," taking an OR time late in the afternoon), get there ahead of time, meet again with the patient, do the procedure, dictate an op note, write orders, see that they recovered okay, and follow up with subsequent office visits: all of which adds up to several hours and all of which, including subsequent visits, is included in the surgical fee. <br /><br />So it's the opposite of a money-maker. It's a service to those in need, which I was always glad to do. But when dumped on by someone suggesting we withhold better treatment to line our pockets, it makes it hard to be nice in response. <br /><br />I invite people who are angered by what I'm doing here, for the benefit of those who are suffering, to stop stopping by. <br /><br />And if I'm human enough to get pissed off when this entirely voluntary effort is used as a way to insult me and all surgeons, well, that's the way it is. The fact is, I spent more time on the answer than the comment deserved. The P.S.? Well, it is what it is. Probably I should pretend not to be ticked off by such claims. I could delete it, but I won't.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-51322967041765670272010-10-23T10:18:50.776-07:002010-10-23T10:18:50.776-07:00I was enjoying the helpful stories... until LAF se...I was enjoying the helpful stories... until LAF seemed to get under your skin, in your P.S. reply. I thought you were a little harsh to say the least. Not only to her, but all AF sufferers, and possibly your future AF patients, if you have any after reading those remarks. At the beginning of this site you state what an embarassingly simple operation this is and only takes a minute or two at most. I'm sure you are paid extremely well for your competency as a great surgeon as you should for having to suffer through those 2 grueling minute. Using your own words, those 2 minutes are a pain in your own ass. Excuse me...your insult was felt by all your bloggers that are AF sufferers. I think your beef is more toward the holistic medicine. The 2 field of medicines seem to clash and it's my opinion your snide remarks only proved her assumption right... it is about the holistic field taking money out of the Medical Doctors pockets. It is a shame because there is a place for both fields of medicine. I know your not going to post this, but I got pleasure in knowing you will read this...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-40237540631972838672010-10-22T08:30:30.738-07:002010-10-22T08:30:30.738-07:00voon, I can't give better advice than someone ...voon, I can't give better advice than someone who's actually examined you. Given varying opinions, you'll have to decide whose to follow, and then stick with that person long enough to see it through.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-36739730702568776372010-10-22T00:43:42.874-07:002010-10-22T00:43:42.874-07:00Hi Sid
Voon here again. After my posting on 10/15,...Hi Sid<br />Voon here again. After my posting on 10/15, I did seek a second opinion from a CR surgeon.(My first surgeon is also a CR surgeon)<br /><br />After reviewing my case, he told me that my pain is due to my sphinter muscles "working overdrive" to expell the load of fibre and stuff from my body.I have to lessen the burden on these muscles to ease my pain. He told me to stop eating fruits (juices are ok), vegetables, oats and fibre I have been taking to smoothen my stools for a easier bm. He assured me that I won't get constipated by drinking plenty of water and 20ml of Lactulose a day. I have to do that for one week before the next appointment. I am totally confused because what he advised go against all that I know about AF. He told me that my fissure has healed after examining with his finger only. He is a leading CR surgeon and in fact one of his papers on "advanced flaps" was actually cited by you in this very blog last year. I am still in shock. What is your advice to me?Anonymoushttps://www.blogger.com/profile/12337366962548838286noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-5883171436475587352010-10-21T11:48:04.599-07:002010-10-21T11:48:04.599-07:00P.S.: I don't know any general or colorectal s...P.S.: I don't know any general or colorectal surgeon who wouldn't LOVE never to see another fissure. It's not just a pain in the ass for the patient. So go out there and gather ye your laser hypers and take every last fissure patient with you. You'd have the undying gratitude of everyone. <br /><br />So, go for it. And thanks for stopping by with your insults. It's why I keep doing this.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-30722819762035085822010-10-21T11:42:23.836-07:002010-10-21T11:42:23.836-07:00Oh, how I love these "it's all about the ...Oh, how I love these "it's all about the dollar" comments.<br /><br />Laser is all about the hype. <br /><br />Okay, it's not always. But the laser is a way to cut or to coagulate tissue or otherwise to destroy tissue. It's not magic. A cut is a cut. Whether by laser, cold knife, electrocautery, a cut is surgery. It's not "non-invasive." It'll hurt as much as a cut by a knife. I have no idea what an ER doc would do with a laser for an anal fissure, but I can tell you that whatever it might be, without anesthesia, it'd hurt like hell.<br /> <br />Laser is not a magic ray. It doesn't have healing powers by itself. It's a very hot beam of light. It has certain advantages in the ability to use it in hard to reach places, since you can bend it via fiberoptics. And it's good on tattoos.<br /><br />In and of itself it's neither invasive or non-invasive. It's the technique by which it's used. On skin, yeah. Non-invasive. On a gallbladder, after punching holes in the belly wall, it's exactly as invasive as electrocautery, but slightly less easy to control. <br /><br />Want to know all about the dollar? Find out how much a laser unit costs compared to standard electrocautery. Read how many laser machines were sold to hospitals because "that's what people want." Check out how many of them are gathering dust. <br /><br />Or, <a href="http://surgeonsblog.blogspot.com/2008/02/zap.html" rel="nofollow">read this</a>. <a href="http://sidschwab.blogspot.com/2008/12/ay-yi-robot.html" rel="nofollow">Or this</a>.<br /><br />So, yeah, I guess you're right. It's about the dollar: the ones collected by companies that make lasers, hype then to a gullible public, and sell them to hospitals who don't want to get left behind. Or so they thought.<br /><br />Sure, there are hucksters out there selling some sort of laser technique or other for just about anything (some of which aren't even using lasers.) And there will always be people who fall for it. Like magnets, homeopathy, and manipulation of the spine for asthma.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-35237728289385152852010-10-21T10:52:14.305-07:002010-10-21T10:52:14.305-07:00Short version, 52 year old female, fissure pain fo...Short version, 52 year old female, fissure pain for 2/12 months, saw a CRS , diagnosed with a chronic stage fissure in the 6 o' clock position not far into the rectum, using diltiazem 2%. Getting some relief. Not at the "kill me or cure me" stage... yet. The info on your web sight has been enormously helpful. Question...Why do we not hear more about the use of LASERS for this hideous condition?? I have read other stories on other websites where LASER has been used very successfully on AF sufferers.(some by emergency room dr.s) Lasers have been proven to be very effective on a number of conditions lately, is very safe, non-invasive, short recovery time, and hardly any side effects, AND significantly cheaper than surgery. To an average person like me, if this is true, then it seems to make sense, the only barrier to this new procedure to be furthered studied, used, suggested and/or promoted is the fact that it is so much cheaper than surgery. With all due respect, Dr.Sid, we all know its about the dollar, and CRS and GS would take a monetary hit if this procedure proves to be successful for AF sufferers, especially those less chronic. I understand you are retired and that may be a reason you don't know a lot on this subject, maybe you do, but would you please find out more if you could?? Opinion, please???LAFnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-62919029276726536392010-10-20T17:53:36.741-07:002010-10-20T17:53:36.741-07:00I am the one who posted about the cream - I am not...I am the one who posted about the cream - I am not affiliated with the company nor would gain anything from promoting their products. I just know that so many people keep posting what they have done that doesn't/didn't work and my husband and I were so surprised that this cream worked better than the prescriptions I was using for the past 3 months (which also cost a lot of money, especially for the compounded creams) that he told me to let others know about it. I noticed that with a lot of chronic conditions you usually find more people actively posting on blogs looking for answers or complaining about symptoms, rather than people who have successfully overcome a condition, so I figured it may behoove someone to at least know that the product is out there. I was going to just go about on my merry way singing a happy tune with a healing fissure but wanted to re-visit the site and share my experience. I would leave my name but with a malady such as this and having a unique name and the internet being so public I would prefer to stay anonymous. But please don't think I was in any way hawking it, also as you can see I am doing 10 other things in tandem - it is a constant battle to keep myself on the road to recovery since I am opting to not go the route of surgery. I know that many physicians are skeptical of any treatments not approved by the FDA etc. (as members of my family are doctors) but sometimes natural remedies work wonders. Ten years ago I was suffering with a lot stomach issues (constipation mostly) and went to numerous physicians and had numerous tests done and found no relief. After doing a lot of research on-line I read that taking Magnesium Glycinate (just a mineral not a branded product) can help alleviate constipation. I started taking the MG and after some trial and error of when to take it and how much I have been almost constipation free for about 8 years. I certainly understand your concerns Dr. Schwab as when I researched the cream myself I was very skeptical as well. I appreciate that you did post my post nonetheless and if it helps even one other person I know it was worth sharing.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-57950495135505707222010-10-17T19:52:37.235-07:002010-10-17T19:52:37.235-07:00In general I don't publish comments that seem ...In general I don't publish comments that seem to be thinly-veiled commercials. In the above case, I can't be sure, although the mention of the name several times is suspicious. <br /><br />However, if people want to spend a lot of money on a cream of questionable medicinal value, I doubt it'd cause harm to anything but the pocketbook; and if it works, that's great.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-8562833216415949262010-10-17T18:24:56.064-07:002010-10-17T18:24:56.064-07:00I am the mom who left some comments about 2 weeks ...I am the mom who left some comments about 2 weeks ago (10/3). Since my re-occurance recently I have tried to do what another person on this blog recommended - sitz baths and heating pads and I feel like I am on my way to healing. I also add epsom salt to the bath. I know I read somewhere about a product from "Dr. Wheatgrass", I found it and tried it. Some people on the site said they felt better after 1-2 days of using it. I was very skeptical since I had tried hydrocortisone, nitroglycerin etc - all the perscription creams you could think of. Well I am happy and surprised to report that after using the cream for a day and half I felt like I was 150% better!!!! I just wanted to share what worked for me - I drink a lot of water, take a sitz after each BM and before going to bed, Whenever I am sitting down I am sitting on a heating pad, I take 4 stool softeners each night, I take 2 magnesium glycinate pills every night (I have been taking these for years for constipation and use them religiously) and I apply the Dr. Wheatgrass skin recovery cream every morning, every night and after each BM. Also I try to inject vaseline before each BM to lessen the likelihood of a hard stool aggravating the area. I also make a batch of the lentil/okra stew recipe that someone posted on here to aid in keeping me regular. But I would highly recommend the Dr. Wheatgrass skin recovery cream - again I was extremely skeptical but desperate to find something that would work and it does!!! I just wanted to share my experience in the hopes it can help someone else with this life consuming malady!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-12276496980535901372010-10-17T07:33:52.083-07:002010-10-17T07:33:52.083-07:00voon: it doesn't seem right that you had that ...voon: it doesn't seem right that you had that much pain after the procedure and that you still do. I'd seek another opinion, preferably from a colorectal specialist.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-26512805421210728622010-10-16T18:38:19.820-07:002010-10-16T18:38:19.820-07:00Sid
Had a lateral sphincterotomy done on 9 Sept. ...Sid<br /><br />Had a lateral sphincterotomy done on 9 Sept. No change in my severe pain. Seen my surgeon 3 times after surgery. On my last visit one month ago, I was warded by him for pain treatment. Was in hospital for 8 days treated mainly with different painkillers but my pain worsens because the painkillers constipate me. Was discharged 2 days ago. Very little answers from my surgeon who gives me the standard answer "Is healing"<br />The pain does not come from the wound but the same spasm pains that I am experiencing for the past 6 agonising months. The only difference is that after surgery,no more bleeding after bm. He seems unsure what to do and prescibed more painkillers. Should I seek another opinion? My pain is driving me crazy. Help!!Anonymoushttps://www.blogger.com/profile/12337366962548838286noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-21783848052630619622010-10-15T11:58:57.824-07:002010-10-15T11:58:57.824-07:00SMR: I don't know of evidence that those activ...SMR: I don't know of evidence that those activities retard healing, but they certainly can add to discomfort.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-86788842091078165262010-10-15T11:11:13.166-07:002010-10-15T11:11:13.166-07:00thank you, thank you, thank you for taking the tim...thank you, thank you, thank you for taking the time to offer your expertise and to establish a forum for AF sufferers to share. Here's my story in brief: During birth of my last child (21 years ago!) I developed a fissure. Thought it was hemorrhoids for about 12 years. Had surgery scheduled once but got scared and canceled. Been able to keep the demon-down-under at bay with stool softeners until recently. Here's the question: When the AF acts up, are there things that exacerbate the condition? Such as lifting, exercise, car trips, etc. I am scheduled to go on a three-hour-car trip this weekend and I am NOT looking forward to it. Wondering if it will just bring pain or if will actually hamper the healing. Again...thank you for so generously sharing your knowledge.SMRnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-14071841473264393862010-10-11T14:37:50.293-07:002010-10-11T14:37:50.293-07:00It works mostly topically. There may be some effec...It works mostly topically. There may be some effect by taking nifedipine by mouth, so absorption could be part of it, too. It should be applied twice a day. I'd suppose that by the time two hours is up, it's been taken into the muscle so I'd guess it doesn't need to be reapplied after a bm two hours later. But I don't know for sure.<br /><br />It's to be expected that there'd be stinging or burning for a while after application. It doesn't work immediately. You could try lidocaine, I suppose, but I'd not want to dilute the nifedipine.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-51958648152440414442010-10-11T07:45:03.990-07:002010-10-11T07:45:03.990-07:00J here again. Thanks so much for your reply. I g...J here again. Thanks so much for your reply. I guess I have a few more questions about Nifedipine. If you apply it first thing in the morning and then have a BM 2 hours later, should you reapply it? Does it work topically or is it absorbed into the blood stream and work that way?<br /><br />Is it supposed to relax the spasm instantly (I'm don't think it is in my case) or does it take a bit to do so?<br /><br />Is it normal that is sometimes stings/itches for a bit after using it? Anything I can do to make it not? My version doesn't have any lidocaine or anything like that in it.<br /><br />I am so ready to start feeling better!!!<br /><br />Thanks again for all you do!!!<br /><br />JAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-55501801191062143882010-10-09T13:02:32.986-07:002010-10-09T13:02:32.986-07:00A sentinel pile is easy to remove, and any general...A sentinel pile is easy to remove, and any general surgeon could do it; it needn't be a CRS. I doubt an OB/GYN would want to, for generic reasons, but it's simple. Depending on pain from the fissure, it can be done in the office. The area of the pile is painless, so there's virtually no discomfort -- other than getting there when there's an active fissure.<br /><br />Nifedipine works best when applied directly onto the fissure, which means putting some on a finger tip and gently inserting it a little way in. Same with nitroglycerin, which also can work.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-13347618908853619572010-10-09T09:20:22.437-07:002010-10-09T09:20:22.437-07:00I am so thankful for you site. I'm doing all ...I am so thankful for you site. I'm doing all the self help measures - several warm baths per day, increased fluids, increased fiber (slowly), citurcel 2x per day, colace stool softener 2x per day. My OB/Gyn rx'd Nifedipine for me. I had asked for it and he didn't really know much about it. I was just told 3x per day "for external use only".<br /><br />What is the most effective way to apply Nifedipine gel. I am dedicated to getting better!! Does it need to go inside the anal canal?<br /><br />Also, I have an annoying "sentinel pile" to go along with my fissure. Could I have it removed without having the LIS surgery? Could any doctor (my OB/Gyn) do this or would it need to be a CRS?<br /><br />My heart goes out to all that are suffering with this type of issue!<br /><br />Thanks for your site!!!<br /><br />JAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-70712733685797416552010-10-07T08:15:33.348-07:002010-10-07T08:15:33.348-07:00My first thought is to feel bad that you're so...My first thought is to feel bad that you're so miserable. The second is that you're out of the norm for expected post op course, and you should see your surgeon again; if he/she isn't of help, then another opinion is reasonable.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.comtag:blogger.com,1999:blog-30499448.post-6807430744651327352010-10-07T05:03:46.702-07:002010-10-07T05:03:46.702-07:00Hi Dr. Sid,
PITA here. It's just after four i...Hi Dr. Sid,<br /><br />PITA here. It's just after four in the morning and I'm laying awake contemplating my pain and doing exercises to try to get relief. I'm six weeks post op two days ago. I go once a day but always have bleeding, sometimes so much that I can't see my stool. Is there a risk of anemia from this level of bleeding? Also, each bm brings on hours of severe anal and abdominal/intestinal pain that is certainly life-changing. I feel myself sinking into depression. <br /><br />I cannot sit, experience tailbone pain as well, and yet still keeping the Norco/Valium to one per day (unless absolutely out of my mind with pain) wherein I will take two Norco hours apart. I am a humor writer by trade and I haven't been able to write because of the pain and not being able to sit at my computer. <br /><br />It does NOT hurt to go to the bathroom even with the bleeding.'the pain starts ten minutes later and "blooms," if you will, steadily ratcheting up to sometimes unbelievable proportions and lasting hours and hours. It makes me SO afraid to go to the bathroom again that I sometimes don't eat all day just so I can avoid pain meds, drive, and do for my family what must be done. This has me eating dinner only, though I still drink 100 oz. of water through the day. Then I wake up half-an-hour after going to sleep to go.<br /><br />I'm still doing sit baths and hot packs but not feeling very hopeful. Any thoughts?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-66101386861439626322010-10-03T11:53:08.485-07:002010-10-03T11:53:08.485-07:00I am a 37 year old woman and had my first child a ...I am a 37 year old woman and had my first child a coupe of months ago. When I was having pain going to the bathroom I just assumed I had Hemorrhoids but it never got better with any of the common treatments. My Mom then said that it might be a fissure (she has unfortunately suffered with them for 25+ years poor woman). So I went to a Dr. and I did in fact have 2 anal fissures. I tried everything the first 6 weeks, creams, sitz baths, heating pads, more water, more fiber (did not work for me at just made my BM too voluminous) and nothing seemed to make a difference. Then I had a thought that perhaps the fact that I was still breastfeeding may be making a big difference in how much hydration was being used to produce milk. So I made the very difficult decision to stop breastfeeding earlier than I was planning to. Within 2 weeks I was feeling much better and although I still have to use Vaseline before each BM and I still use creams and baths it was becoming much more manageable. It has recently gotten worse again (I think due to taking some diet pills that make me really thirsty and not keeping up with drinking enough water) but I am trying to stay positive, although that is very hard and I see from all posts I am most definitely not alone. My main reason for posting was for any new Mom who is having this issue to consider stopping breastfeeding to see if that helps to speed your healing as it did for me. Again hard decision but in the end it was the right one for me. I truly wish everyone who suffers with this the best of luck, this is perhaps one of the hardest things to deal with (I know it gets me depressed more often than I would like to admit) and not the easiest thing to talk about so it's nice to have a forum to do so, thank you!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-23714810056883956572010-09-25T10:54:18.823-07:002010-09-25T10:54:18.823-07:00P.S. Sorry, that was me, PITA. :)P.S. Sorry, that was me, PITA. :)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-30757660219306760262010-09-25T10:50:18.197-07:002010-09-25T10:50:18.197-07:00Hey Dr. Sid,
Thanks for the encouragement. I'...Hey Dr. Sid,<br /><br />Thanks for the encouragement. I'm still doing the tub soaks a couple of times a day and realizing I was getting a little lazy about water. Please people: drink a LOT of water. I have to do a minimum of 100 oz. a day or no matter what, I can't keep my bm's soft. <br /><br />The bleeding continues but is a little better. My husband remembers the doc saying if could be from a new hemorrhoid that formed with that bm 8 hrs after surgery. PLEASE everyone ask for an enema before surgery ( or do it yourself) so you don't have to go right away. That area needs a LITTLE rest.<br /><br />Still "movin'" along. I'll let you know when I'm all well. Can't thank you enough for being here!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-30499448.post-28246877712019917692010-09-24T15:59:33.413-07:002010-09-24T15:59:33.413-07:00Yes. I'd say by far most do. On forums such as...Yes. I'd say by far most do. On forums such as this and many others, no matter the disease or operation in question, one tends to hear from those who have problems. The denominator, however, is unknown. In other words, forums give voice to those who chose to post about problems. <br /><br />The vast majority, who do just fine, whether it's this surgery, or gallbladder surgery, or whatever, don't speak up because they're happy and don't need to.Sid Schwabhttps://www.blogger.com/profile/14182853083503404098noreply@blogger.com