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.

Support in an email

I am up in the night because my pain in the butt hurts too much to sleep.

I just received this nice note from my friend Pam, which while it doesn't take the pain away or help me sleep, it does help my heart:


Your pain is unfair --and dreadful. May the procedure go well, and act faster and more swiftly than anticipated.

In spite of it all, you add to the world's beauty, with an artist's eye and hand, and your courageous spirit that keeps rising every time it's smacked down.

You are loved and admired.

Mary is one very intelligent, brave, beautiful person, with talent and gifts. May this current curse be the last one you have to endure before the blessings rain upon you

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. 

Loneliness and Isolation

I read that isolation and loneliness contribute to depression and that isolation and depression contribute to dementia.  In any case, isolation isn't fun.

I'm home alone all day.  Keith comes home, and then, leaves again as soon as possible.  Today, he went to Home Depot, and then R'dale to do some work.  The work does need to be done.  AND he probably doesn't want to be with me when I am miserable.  I do not blame him.  I am miserable when I'm miserable.

I am also lonely.

And no one can come visit.  And really, no one can call.  Scott called this morning to be supportive, and I was in so much pain I couldn't concentrate or make good conversation or even be a good listener. I am stuck.  Alone.

I can read Cowbird stories, theoretically, or send emails, or go on facebook, but most of the day, I was in too much pain to sit and read or type.

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 May 19, 2013

Butt Report for May 19, 2013

I actually did have an incrementally better day today than two previous days. A slightly “less-pain” day.

What exactly does that mean?  

I didn't have to take any "extra" Ibuprofens (the day before I took 7 instead of 6--and one day I took 8) and I didn't have to supplement with Acetaminophen (The day before I took 6 of those in addition to the ibuprofens).  And I didn't have to get up twice in the night because I was in too much pain to sleep and take more pain meds and apply hot compresses.  

But I also don't consider missing my own featured poetry reading and leaping about in pain and having to sit on a heating pad all day a "good" day.  

I took exactly 6 Ibuprofens yesterday.  It doesn't stop the pain, but it does take the edge off a little.  That is a slightly improved day.  

I have 9 days left before I can speak with the doctor again.  9 days before I can call for an appointment, then if there is to be a botox shot, there are several days of prep required.  And I don't know how quickly they schedule you.  Then 72 hours before the botox takes effect, and then the thing still has to heal on its own.  I am not eager to do the botox, but this is wearing and exhausting.   :-(

Risk factors for Anal Fissures

• Risk factors in the development of anal fissures include chronic constipation, passage of hard and/or large stools, straining during defecation, and prolonged diarrhea.

• Diets low in fiber and water may increase the risk of straining during defecation and constipation and thus may increase the risk of anal fissure development.

• Diets high in agents that may increase the risk of constipation, including caffeine, may increase the risk of straining during defecation and of constipation and thus may increase the risk of anal fissure development. Spicy foods may aggravate symptoms of anal fissures.

• Aging is a risk factor for anal fissures. Aging is often accompanied by decreased blood flow to the anus, increasing the risk of nonhealing wounds.

• The potassium-channel activator nicorandil may increase the risk of anal fissure. Use of this agent is associated with increased anal ulcerations. However, the available research is limited.

• Pregnancy and childbirth may increase the risk of anal fissures. In pregnancy, up to one-third of women develop anal fissures and external hemorrhoids. Constipation and dyschezia (retaining stool in the rectum) during pregnancy may be the main risk factors during pregnancy.

• In infants, risk factors include infrequent diaper changes and constipation, often due to inadequate fluid intake. Infants with a previous episode of abscess or pus at the time of surgery were more likely to have recurring anal fissures. Early introduction of cow's milk may increase constipation and therefore the risk of anal fissures.

• Other risk factors in adults include harsh anal hygiene (rough toilet paper), chronic wetness around the anus, rectal irritation, bariatric procedures for obesity, constant saddle vibration (in professional mountain bikers), the use of bidet toilets, sexual abuse, and inflammatory bowel disorders such as Crohn's disease.

from here

Note:  Other risk factors in adults include chronic wetness around the anus.  What about sitz baths and all the hot compresses I've been using to alleviate the pain?  The more pain I have, the wetter I've been keeping my anus--is that making things worse?