Butt Report for 9:30 AM Tuesday May 14, 2013

The Dire Wolf of Pain among the Posies
Pain, and the efforts of others to pretend the pain
is something less than it is
click image to view larger.

About half an hour ago, I had to urge to use the toilet.  I'd already gone twice.  (The doctor says that's normal for anal fissures--the pain causes the sphincter to tighten).

poop #1--painful, no visible blood, painful afterwards.  Applied hot compresses.
poop #2--very painful.  Some blood, not too much.  Quite painful afterwards, still hurting from poop 1.
poop #3:  VERY PAINFUL.  FRESH red blood.  HURTS A LOT!!!  right now.

Most days I sit on the heating pad until 3:00 or later.  Sometimes until bed.  The heating pad relieves the pain, but I can't do much of anything.  Some days I can't even get up to prepare myself breakfast until after noon, even after 2 PM.  Some days, Keith has to make dinner because I'm in too much pain.

I don't see any light at the end of the tunnel.  It's easy for other people to say "things will get better," but I've had this since March, nine and a half WEEKS, every single day, day after day, and it is VERY PAINFUL!  Sometimes agonizing.  Sometimes I scream and leap around, it hurts so much.

The pain never goes away.  NEVER.  Sometimes, in the LATE afternoon and evening, it subsides to a burning pinch.  When it reaches this point, I can tolerate it enough to do certain things, walk, cook, eat, paint.  If I am doing something that really engages me, I forget about it, sometimes, and then I feel it again the minute I stop concentrating (on painting, for example).

I feel it all night long, whenever I wake up.  (I wake up a lot.)

The pain is exhausting.  It makes me tense, tired and cranky.

I don't like taking so many Ibuprofens.  It's bad for me!  But it is all I am allowed to take and I can't tolerate the pain without it. It doesn't help that much, but it does help some; it take some of the edge off.  Also, I stopped taking half-aspirins as a blood thinner because I was bleeding so much.  So any benefit I might get from taking the half-aspirins is lost.

The doctor says these things can heal by themselves.  He also says the operation is VERY painful.  AGONIZINGLY PAINFUL.  WORSE than the fissure itself.  He says the pain lasts 2-3 MONTHS, and that during that time, one is totally incapacitated.  He had the operation himself, so he knows what he's talking about.

But the fact that fissures can heal by themselves doesn't inevitably mean that they will.  MANY people require operations.  And the fact that it has healed in the past does not necessarily mean it will heal by itself this time.  The tear causes scarring, and each time you get it, the scarring gets worse.  Which means that the sphincter is shrunk slightly and ripping is more likely to occur.  It keep tearing it open every time I defecate. That's what the bleeding is.

I am sorry this is so gross to talk about.  But it is even grosser to have it, and sad/difficult not be able to talk about it.  It's depressing to be in pain every day.

(I have been talking about it, more than last time.)

The botox shots are a temporary fix, and the doctor says they are 70% effective.  They wear off in three months.  What they do is loosen the sphincter so that hopefully, the poop can come out without tearing it.  It still has to HEAL on its own.

If, in two weeks, I'm still not improved, I will talk to the doctor about the botox shots.  This is a hospital procedure which requires anesthesia.

Right now, as I am writing this, I am in quite a bit of pain.  I keep leaping up and running in the bathroom to apply hot compresses to my butt.  And then I sit on the heating pad.  I have not had breakfast.  I have not done my exercises, I have not washed up or gotten dressed, my entire morning so far has been pain and pain remediation.

There is a small amount of incremental improvement, however.  The pain, while bad enough to make me cry during and immediately after the third poop today, is not so agonizing that I leap around and shriek in agony (nearly unbearable pain).  I had some of that, early on.

I had two bad about three day days ago, and those were BAD, but not AS BAD as some I'd had earlier.  Those two bad days were followed by three incrementally improved days.  I would NOT say good days, considering that I am still incapacitated, essentially, and still suffering from a great deal of pain.

The other incremental improvement is that I could begin to function (do things) slightly earlier in the day the last couple days.  Like maybe 2:30 in the afternoon instead of 3.

The last time I had some incremental improvements, I was hoping for healing, gradual day-day-improvements.  Instead, I got worse again.  :-(

*

On a totally different not, we had 4-5 days of very hot weather (which, sadly, pushed the the flowers past very quickly), and Keith turned off the heat in the house.  It's FREEZING in here.  I am wearing 6 layers of clothes, a scarf and a hat and am still cold.

Suicide

Tulip Collaboration
with Gail Slaughter
(She took the photograph; I painted it)

This first section is copied from the New York Times and is only part of the total story there:

Suicide rates among middle-aged Americans have risen sharply in the past decade, prompting concern that a generation of baby boomers who have faced years of economic worry and easy access to prescription painkillers may be particularly vulnerable to self-inflicted harm.

More people now die of suicide than in car accidents, according to the Centers for Disease Control and Prevention, which published the findings in Friday’s issue of its Morbidity and Mortality Weekly Report. In 2010 there were 33,687 deaths from motor vehicle crashes and 38,364 suicides.

Although suicide rates are growing among both middle-aged men and women, far more men take their own lives. The suicide rate for middle-aged men was 27.3 deaths per 100,000, while for women it was 8.1 deaths per 100,000.


“It’s vastly underreported,” said Julie Phillips, an associate professor of sociology at Rutgers University who has published research on rising suicide rates. “We know we’re not counting all suicides.”


Another factor may be the widespread availability of opioid drugs like OxyContin and oxycodone, which can be particularly deadly in large doses.

*     *     *     *

I've written about suicide before.  More than once.  It may be a real option for me, later.

Last time I had this condition, I began to seriously consider suicide.  The unrelenting nearly unbearable pain, the worst pain of my life, went on and on and on.  How would I do it?  Sleeping pills, of course.  I guess.

So now, I'm reconsidering.  Thinking about suicide again.

I'm not ready to do it--I generally like being alive, except for this pain.  And, I'm afraid of the pain of dying and afraid of death itself.  I keep hoping for healing.  For some relief from the pain.  But when it's bad and I consider the options, suicide seems like one of them.

I recently threw away eleven bottles of sleeping pills.  I should have saved them.  If I do do it, I want to do a good job, not a half-assed one.  I do have more, and the others were expired.  I don't take sleeping pills any more.

*     *     *     *

Tulips, on the other hand, are one reason to stay alive.

Pain Remediation

1)IBUPROFEN (barely cuts the edge when it's bad)(but helps some otherwise)
2)HOT COMPRESSES (washcloth), applied GENTLY to the injured part.
3)HOT BATHS or sitting on hot WET towels on a heating pad (protected by plastic and a dry towel)
4)WALKING--walking helps, but only if it's not to agonizing to begin with.
5)TOUCH, MASSAGE helps when the pain is not too terrible--relaxes.  Pain tends to cause me to tense up.  This makes the pain worse.
6)ENGAGEMENT/DISTRACTION: doing something deeply engaging helps with the pain isn't too bad.  When the pain gets too bad, I am unable to do anything else, including read.

These things help with the pain.  I hope they also help with healing.  I'm not sure about that, though.

NOTE:  If possible, take the ibuprofen and sit on a hot pad for half an hour BEFORE pooping.  This is not always possible.

I read that fish oil helps to reduce inflammation and that helps with pain reduction, but I do not know if this is true.

I also read that "bad food" (candy, sweets, snacky things etc, and red meat, especially fatty red meat), exacerbates pain.  I don't know if this is true either, but it seems that healthy food is more likely to improve healing than crap food.  However, different people have different ideas about what is healthy and what is not.  Sometimes, it's hard to know.  Food that is close to nature seems like what we evolved to eat, but that includes red meat.

I am sure getting good sleep helps heal, and here I am up with insomnia.

Waiting

Here is why my doctor wants me to wait:  

Surgical therapy is usually reserved for acute anal fissures that remain symptomatic after 3-4 weeks of medical therapy and for chronic anal fissures.

it's BEEN 3-4 weeks already, though.


A newer therapy for acute and chronic anal fissures is botulinum toxin (BOTOX®). The toxin is injected directly into the internal anal sphincter and, in effect, performs a chemical sphincterotomy. The effect lasts approximately 3 months, until the nerve endings regenerate. This 3-month period may allow acute fissures (and sometimes chronic fissures) to heal and symptoms to resolve.[7] If BOTOX® injection provides initial relief of symptoms but there is a recurrence after 3 months, the patient may benefit from surgical sphincterotomy.[8, 9]

In a review of 4 prospective, randomized, controlled trials, Shao et al concluded that surgery, specifically, lateral internal sphincterotomy (see Intraoperative Details), is more effective than BOTOX® treatment for healing chronic anal fissures.[10] In their analysis of the studies, which involved a total of 279 patients, the investigators found that the absolute benefit increase rate was 23% for the surgical patients in comparison with the BOTOX®-treated patients, with BOTOX® therapy associated with a lower fissure healing rate and a higher recurrence rate than was surgery. However, minor anal incontinence occurred more frequently with lateral internal sphincterotomy than it did with BOTOX®.

I read that the people who suffer the most are those whose sphincter muscles spasm, which I think is what happens with me.



It doesn't happen with everyone, and I do not know what makes the difference.

This information (minus my comments) came from here.

What the doctor said

I had my poetry class tonight and waked at St. Clair Park between the doctor and the poetry.  

So I didn't have time to write about what the doctor said.

I was disappointed in what he said.  I was hoping for an easy solution.  Nope, no such luck.

I wrote about this in more detail on the Psion, which I will download as soon as I can, but not tomorrow, maybe, because Keith has his colonoscopy.  I have to be there to drive him etc.

Here are my options, briefly:

1)continue to endure and hope for the best.  No heavy duty painkillers.  The body, he says, will heal.  But when?  It's been a month.  

2)get shots of botox in the anus. 70% chance of solving the problem.  Must be done at hospital under anesthesia. 1% chance of anal incontinence.

3)have an operation.  95% successful.  1% chance of anal incontinence.  VERY PAINFUL, long recovery time (2 months of pain, no heavy duty painkillers allowed.)

I opted for part one.  If it continues to worsen or becomes unendurable, I will try 2. If that doesn't work, then 3.  Like I said, I was hoping for something better.  A better medication, for example.  Something more healing.

My pain was bad this morning, subsided some in the afternoon (with ibuprofen) and subsided more in the evening (with more ibuprofen) and right now hardly hurts, only a little.  BUt the cycle starts over every time I poop--and I only pooped once today, very early.

I saw baby owls in the wild at St. Clair park today, got a very good look at them, no camera though.

Not and not, "A Tear, not a Fissure"

This is about my walk back from the doctor this noon.  And what the doctor said about my "pain in the butt."  It is also about attempting to use the iPad to type on while walking.

I am walking down Kercheval with iOla after seeing Beeai about my “bottom” (anus and rectum).  I was also trying to carry a bag and separately, loose papers, prescriptions and appointment cards while typing on iOla.  That wasn't working.  However, I now how the papers in the bag and the bag over my shoulder and am trying to type with iOla in landscape,  I can see the test slightly better this way, but the keyboard is so large it is hard to reach the center keys. I have to suspend the iPad from my bent fingers and this could get quite tiresome.

Dr. Beeai said that I do not have hemorrhoids.  She said this as if it were a good thing.  I also do not have an actual anal fissures, which is also a good thing,  I guess, from her attitude.  What I do have is "a tear in the anus and rectum, an injury from a too large, too hard poop.  This takes time to heal and it is essential not to allow constipation to occur again," she says.  Does she think I want to be constipated?  That I choose to be?  No, she simply wants me to take extra precautions.

She gave me two prescription, but I could only get ONE of them filled at the Kerchival pharmacy.  So I have to drive CVS and leave the other one and go back for it, probably.

Meanwhile, this has taken the whole morning and will take more time before it is over.  And I am supposed to be packing for trip.  K told Sam and Joan that we do this every time.  We are often, but not always late, but I almost always start like week ahead planning and making various preparations, shopping, etc.  The fact that K himself does little until the last minutes doesn't mean WE "always wait until the last minute." I was sad that he would say that; it means he doesn't notice or appreciate or care about the effort I put into shopping and preparation, and doesn’t care if Sam and Joan think I’m a lazy piece of shit. This time, I have NOT done much because I was NOT sure we were even going or how long we'd be gone and I’ve been VERY under the weather.

Keith is wrong about the fact that we "never" do anything to get ready, that it's always like this.  We are often later and slower leaving than we ought to be, or than we want to be, but this time it's much worse.  MUCH WORSE, as I've been unable to do much of anything.  And yes, normally, I would have shopped once for staples and once for perishables by now, and had them all organized.  Grr, Keith.  You mean bad man-- you make me feel bad.  I feel unloved when you say things like that.
Keith was right, though, about Lidocaine ointment.  I didn't like the idea of it, but Dr. Beeai prescribed it.  so it put some on--but it only helps on the OUTSIDE, and it also hurts on the INside.  she gave me some suppositories which I’ve been afraid to try.  I’m afraid they will hurt going in.  But--I guess I will try them--now.

            I am back at my car—I drove halfway there and walked the rest of the way—I wanted to walk the WHOLE way, but I didn’t have time from the time I called to the available time slot.  And I was able to write this on the iPad, iOla.  It was a little slower but might improve as I get used to it.  In many ways, I like the Psion better.  But LOOK, I downloaded this—with a bit of effort—to Leo and will be able to print it.  It SHOULD be easier.  But since the Psion’s software won’t download on Leo, I guess it is better than nothing.  I’m still not sure how well it will all work, but hey--