Report on First poop after LIS (lateral Internal Sphincterectomy and Fissureotomy):

Questions are dribbling in, asking how I am doing and I dribble out responses, and after a while, I forget to whom I told what, so I am writing ONE report now.

It’s still less than 72 hours since my LIS surgery. Less than 3 days, and considering how long I was told it would take for me to recover, I would appreciate some patience in your expectations for me. (It actually makes me sad when your hopefulness is out of line with reality, and I feel as if I have failed you or that I am bad or incompetent at healing or something.) On the other hand, healing energy, loving thoughts and prayers are all appreciated very much. What I prefer is a realistic (not pessimistic) approach. And stories and anecdotes from YOUR LIFE to that all my attention is not focused on the surgery site.

I was feeling significantly better (improved) earlier today, better than yesterday which was better than the day before, AND better than before the surgery. NOT WELL, mind you. I still had pain and felt “delicate” there, at the surgery site. I was unable to do my exercises or walk far.

All that has changed now, and I feel worse again.

The reason I feel worse is that I have pooped now, twice. Pooping was not only very painful during the course of evacuation, but for hours afterwards. I am trying to avoid taking the heavy-duty painkillers, since they cause constipation, but I may have to break down and do so. So far, I have only had ibuprofen for the last 3 days, counting today.

So currently, I am still bleeding and I am having an unpleasant and beyond uncomfortable amount of pain. I also slept very poorly and am exhausted. Worse yet, I feel as if there is more poop waiting to descend. I may have to give up and take the Tylenol 3 with codeine.

Just about 72 hours from right now, I was finally entering surgery after a LONG LONG WAIT.

Small solutions: Finally able to take a Shower!!!

I've been unable to take a shower for more than two weeks, because it hurts too much to stand (my anal fissure.)  We finally solved the problem.

I had thought earlier of a chair or stool for the bathtub, but couldn't think of one that would work, and the brainstorming got us going on it and Keith came up, after other ideas by both of us, including my camp stool, with the bench for Graham's keyboard. That seemed perfect!

 So this morning, we tried it, and it worked GREAT! Keith put a plastic kitchen garbage bag over it to protect the stuffing, as I was afraid water would would get in through the stitching holes and rot the stuffing. I was able to shower. I washed my hair twice. I cut my nails, finally, they were getting really long. YAY! (It feels great, except now my skin is peeling off hugely and I will need another shower to get rid of all that dead skin!)

Botox Tomorrow

Botox Tomorrow

Tomorrow, I will have botox shots in my anus for my anal fissure.

Ironically, since I've been fasting, the anal fissure seems to be healing.  I am afraid he'll get in there and say it doesn't need botox shots.  I called twice to warn him.  (See below).

I start the fleet enemas tonight after dinner (2), and tomorrow morning before the procedure (1).

I will have stool in there.  When you don't eat, the stool that is already in there just sits there, and as it sits there, it hardens, because water is drawn out of it in the intestines.  It gets rock hard and dangerous.  This is why fasting is not considered a viable option for treating fissures.

It would have to be done under careful doctor supervision, perhaps by totally emptying the entire colon first, as they do before a colonoscopy with the oral stuff.

Since I have done this before with fasting (four days of fasting before my colonoscopy), I know what to expect:  the insertion will be very painful the first time because of the fissure.  A bunch of terrible burning stuff will come out, including lumps (I hope they aren't too hard).  The second time, of course, if will hurt worse, and the third time, worse yet, since the enema nozzle and the burning shit and enema mixture will damage the fissure area.

I think, if I could fast long enough with doctor supervision and assistance, I could heal without the botox.  However, I am now committed to the Botox.  I'm afraid now that the doctor will say it's not bad enough for botox shots!  It has been getting better every day.

I tried yesterday to call and talk to the doctor.  I got Catherine, who's intelligent and sensible, but Barbe wasn't available and Catherine was with a patient.  She gave me to Yvonne, who seemed like and must be a total moron--she delivered the WRONG MESSAGE, the exact Opposite message, to the doctor, who was then wanting to switch me to having the OPERATION tomorrow!!! (AS reported later by Catherine when she called me back).  NO NO NO!!!  I told her NO, that wasn't what I said.

I called Catherine back again today to reiterate that I am IMPROVED, not worse. (Thank God I didn't get Yvonne). I asked Catherine to PLEASE tell the doctor, as I was worried he might actually be upset by the fact that I'm so improved.  However, after three Fleet enemas, I might be back to ground Zero.  Also, of course, he will be also shoving that sigmoidoscope up in my butt, which has the potential for tearing and damaging the fragile healed parts.

I'm likely to come away feeling MUCH WORSE than I feel now, between the enemas, shots and sigmoidoscope.

I wish I could talk directly to the doctor, but he's never available when I call.

I am trying to be practical and realistic in my expectations.  I am willing to have things turn out better than I fear.  I just don't want them to turn out worse.  

I hope they give me something for pain.

Answering Questions about Bearing the Acute and Difficult Pain

A friend (Pam) asks:  What do you do when in such severe and protracted pain?  Can anything distract?   Temporarily?  What do you do physically?  Damn, I wish I could help.  Also wish they'd DO MORE for the pain!!!   Pain amelioration is not an advanced science, for sure.  More damn !!!!!!!!!!!!!!!!!!!!

I answer:

During the super acute phase of the pain, I stand in the bathroom applying hot compresses to my butt leaping around crying.  This lasts like 40 minutes (or more) after every poop, and though the hot compresses seem to help a little, they do not help enough.

Nothing distracts.  The pain is too intense--It is all there is.  It seems unbearable.  (But I am, of necessity, bearing it).  I stand by the sink, apply a hot compress with one foot up on the toilet and then repeat over and over.  I leap about, run back and forth, sweat profusely, cry and scream.

Eventually, hopefully, the pain fades a little to semi-acute stage.  During this stage, I run back and forth from the heating pad to the bathroom to repeat above, only with groaning and moaning instead of screaming and crying.  Sometimes, during that stage, I can walk around the house or even outside BRIEFLY, before returning to the hot compresses.  I am having pain, which is pretty bad, but the walking helps some. 

That stage usually doesn't last more than about 20 minutes.

The next stage is the sitting on the heating pad stage, which at first hurts so much I can hardly sit, but then the pain gradually fades after 15-20 minutes and I can sit and work on the computer.  It still hurts!  The distraction of the computer helps.  At this point, there is still too much pain to say, cook or prepare a meal or do anything away from the heating pad.

With every poop, the whole cycle repeats again.  Depending on the timing and severity of the poops, I may never get past the acute or semi acute stage before the pain is ramped up by the next poop.  Each poop is progressively worse and I've been averaging 3-4 a day (which the doctor says is NORMAL.)

Another thing the cycle the pain is the pain meds.  I am taking both Ibuprofen and acetaminophen and trying to do it so they overlap each other.  It’s a complicated schedule, but as the various doses wax and wane, so the pain, to some extent.  Even if I am on a FULL DOSE of BOTH MEDS, the pain during and after pooping is still nearly unbearable.  And the poops seem to like to schedule themselves at one of the waning points of meds.

If I am lucky, the pain fades to the point where I can stand long enough to prepare a meal or maybe take a walk or do some exercises, or some small chores.  Yesterday I never got that good.  So far today, I have not had breakfast.  I am on the heating pad, but the pain is fairly bad and I am thrashing around.  I have not been able to do anything yet today.   Yesterday, as I was trying to relieve the pain on the heating pad, by shifting one way and then the other, I knocked the chair over with me in it.

The doctor (Barbe) tells me there are no stronger pain meds that do not cause constipation (or, all stronger pain meds cause constipation).  (Earlier today, I wanted to go to the hospital and beg for morphine.)

Always, there is the fear of the next poop. 

Jiggling (Pain Remediation)

I've discovered jiggling as a pain remediation for my "anal fissure.".  I discovered it by accident, by doing it inadvertently.

Sometimes, the very warm/hot compresses do not help.  Sometimes, they make it feel worse.

Sometimes, I can't sit on the heating pad.  It's weird when the one thing that usually helps the pain doesn't.

But lately, one thing that is currently helping is jiggling.  There are different methods for jiggling.

• on the toilet, with the toilet paper, gently pressing and jiggling the anus
• using warm washcloths pressed against the anus and gently jiggling them
• jiggling the butt cheeks gently. 
• jiggling the legs back and forth very quickly to produce a jiggling in the anal area
• walking

Depending on the level of the pain, jiggling can make it lesser or almost gone.  But the minute I stop jiggling, the pain returns full force.  I think that it relaxes the sphincter, but this is only a personal theory.  I have yet to read anything about this anywhere else.

NOTE:  GENTLY is the operative word here.  too much, too fast, too hard makes it worse rather than better.

Problems with jiggling:  When the pain is bad, jiggling works best in the bathroom by the sink with warm but not too hot water.  I have to keep replenishing the washcloth with just the right temperature water, and applying it to the anus and jiggling.  When the pain is bad, I may be doing this for 45 minutes.  Unlike sitting on the heating pad, where I can use the computer or paint or something, or having a sitz-bath, where I can read, I cannot do anything else.  And it's tiring.

Another thing is, I don't know if it does anything positive toward healing, or whether it just alleviates the pain a little.  This is in addition to Ibuprofen and acetaminophen.  (Which, by the way, I took some of BOTH today because the pain was so bad.)

LATER:  I've stopped jiggling as much as possible.  I was thinking the jiggling was helping to relax the anal sphincter, but I worrying that it may damage the torn flesh.

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.

Jogging in Place in the Shower

Jogging in Place in the Shower

I want desperately to take a shower.  I haven’t been able to take on in a number of days because of the pain.  It’s been hot, and I’ve had to use a heating pad nearly continuously, and that causes sweatiness.

But the pain makes it hard to stand.

Some of the things that help the pain include:

• Ø  hot water, hot baths, hot compresses
• Ø  walking, running or leaping about, depending how bad the pain is
• Ø  hugs and touch, massage
• Ø  ibuprofen (takes the edge off a little)

No one is here to hug me.  I’m an hour and a half into this round of ibuprofen.

The hot water helps some.  When it doesn’t help enough, I march in place under the water.  When it still hurts too much, I jog in place.  The washing and shampooing become hurried and urgent.  Luckily, no one is here to see me. 

I wonder how far I’ve run, if I were going forward.  Three quarters of a mile?  I‘m going pretty fast and that’s about how much ground I’d cover on foot in the time it takes to wash up, shampoo, shave my legs.  Shaving my legs at a dead run is pretty tricky though, I have to slow down to easy jog for that, then quick speed up to knock the pain down.  Owy.  Well, I did it!  I'm clean!

During the high-pain phase of the flare-up, I ran around the house (upstairs only, for the most part) reorganizing things because it hurt too much to sit.  Moving rapidly around seemed to help.

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.

RECTIV

How to use RECTIV
from here.

Rectiv, or nitroglycerine ointment, "is the first and only FDA-approved medicine for the treatment of moderate to severe pain from chronic anal fissure."  There is a limited amount of somewhat useful information about anal fissures relatively easily found on the site using tabs.

However, this ointment's sole task is to treat pain.  Symptomatic relief.  I want something that will heal the problem, make it GO AWAY!  I DO want the pain to stop.  But jamming a finger up my butt and wiggling it around when it's in so much pain already doesn't seem like a good way to heal it.  :-(

I read that some people can't take the side-effect headaches.  (I have not tried this, so I cannot report about the headaches.)