A 'Delicate' one...

[Fliegenmong]

Suffered two Perianal abcesses (?) in the last 18 months....Docs thought I should be checked for an anal Fistula....there follows an MRI....and I had surgery today to treat an anal fistula....

So how the hell do you keep a gaping wound like that 'clean' everytime you go to the toilet?....I'm having 'sitz' baths after every bowel movement.....but still....!? ...it all seems super unhygenic??

[421dog]

Get a hand-held pulsing shower attachment, and clean up after each go.

Also, get some psyllium (like Metamucil) and take it a lot. It makes the faeces stick together and stay moist so that they don't tend to accumulate in the nooks and crannies left by your proctologist.

[wiggy]

Get a hand-held pulsing shower attachment, and clean up after each go.

Also, get some psyllium (like Metamucil) and take it a lot. It makes the faeces stick together and stay moist so that they don't tend to accumulate in the nooks and crannies left by your proctologist.

Oh boy...TMI for some but since I occasionally experience a fun and games after a re-section, well... put it like this I never ever really appreciated those hi tech Japanese loos until recently and now am thinking of putting one in at home.

Personally I found Psyllium didn’t work as advertised but I gather it’s a bit like Marmite....a personal thing and probably worth a go....:E

[421dog]

Tell you what, I won't offer you advice about how to fly widebodies, even though I've been a passenger in a lot of them that seemed like they weren't being flown the way I thought they should have been, and maybe you should reconsider giving tips on postoperative care to surgeons who do a fair amount of fistulous disease treatment...;)

[Mac the Knife]

'Tis a very civilised thing to have a bidet with a "shower-from-below" - makes perineal hygiene so much easier.

I ban "Sitz baths" for my patients - sitting in a dirty soup, disgusting!

Best thing a tap-water shower (running-water to wash debris away) and plain ordinary soap (L*x or Palm*live). A smudge of plain zinc-oxide ointment after stops things sticking and soothes. No need for gloves and all that folderol.

Wound care is actually simple, but big Pharma make it sound terribly difficult.
Rarely any need for their complicated and expensive offerings.

"If you can keep a baby's bum clean then you can look after a wound" is what I tell my patients.

Mac

:8

[obgraham]

Having “worked on” literally hundreds if not thousands of bottoms, all female in my case, I found that docs were of 2 minds on healing. Some wanted as little bowel action as possible “while it healed”, and others, me included found it was better to keep things loose, like 421dog is advising. The messies can always be cleaned up, but there’s nothing worse than driving a solid log past a recently repaired bottom.

Sorry if this is all TMI, folks. Some of us made a living from this stuff.

[gingernut]

From experience, they seem to heal well generally. I guess thats the nature of having an open wound, all the pus and crap can drain out. The positive pressure of the pack apparently promotes granulation (healing).


In the bad old days, they used to use "EUSOL"- Edinburgh Solution of Lime. (Basically bleach). The last time I packed one (many years ago), it seemed to be a little more gentle (seaweed or silver based dressings).

We used to try and time things around your bowel movement (rather the other way round!), and asked the patient to have a bath or shower prior to the dressing change.

Another tip is to make sure the nurse gives the pack a good squirting with sterile saline a few minutes before, the pack can sometimes dry up overnight.

Watch out for over zealous nurses "swabbing" the wound for laboratory analysis (it's a nursey thing)-shouldn't really be done unless there's clinical signs of infection. They all look a bit pussy and smelly, generally you only need to treat if inflamation is spreading to surrounding tissues or if you are unwell. (Unusual).

It is many moons since I repacked a moon, so check with your friendly DN.

[Fliegenmong]

"I ban "Sitz baths" for my patients - sitting in a dirty soup, disgusting!"

Yes, I agree, but after sitting on small pile of submerged epsom salt, I always have a shower afterwards, and after that a squirt of saline solution....seems the best way I think....

I won't be horse riding anytime soon....I can tell you!....was in agony this morning....actually sweating in pain....:{

Thanks all for your replies......very much appreciated! ... :)

[cavuman1]

Paradise Lost or It Ain’t Necessarily So

Ah! Paradise! I was twenty-nine years of age living in a large home we owned on the tropical island nirvana called St. Simon’s Island, Georgia, USA. I had my Cessna 152 and a Bertram 47’ yacht to enjoy. A beautiful, loving wife, an intelligent, innately curious, and well formed ten-year-old son, an obedient, affectionate Siberian husky, and Oceanus Atlanticus as our back yard were mine in which to immerse myself and have an enduring sense of uninterrupted marvel. Until THAT DAY...


I had awakened and taken my early morning swim in the ocean. The sun had barely arisen. I returned to the house and reveled in the scent of gardenia and hyacinth and the fiery beauty of azalea and gentle pastels of dogwood. Raz (Rasputin), our Husky, looked at me with his impenetrable and inscrutable blue-eyed gaze – he wanted to go for a run on the beach. As I leaned over to pat him, I noted a distinct focal pain erupting in my nether regions. “Great”, I thought, “An ass pimple! Just what I need! NOT!” Raz and I went for a run and returned to a sumptuous breakfast of scrambled eggs, sausage, waffles, and tomato juice with a generous squeeze of lemon juice. As I got up from the kitchen table, I winced with the pinching pain bedeviling my “Taint”. For the medically uninitiated, the Taint is that exquisitely tender and sensitive parcel of skin which separates one’s rectum from one’s genitalia. ‘T’aint neither, as the olde saying goes...


I went to my office and had a fairly successful day selling residential real estate to unsuspecting victims, errr, grateful clientele. The only downside of the day was the crescendo of pain proximal to my keister. I had to sit on a seat cushion to enjoy a dinner of rare roast beef, fresh asparagus, potatoes au gratin, and lemon meringue pie (my death row meal!) I went to bed glad to be alive but with a literal pain in the ass.


A well-aimed ray of sunshine and an intractable stabbing unpleasantness du derrière awakened me with unwelcomed promptness. I leapt from the bed and walked slowly and bow-leggedly to the bathroom. I may as well have won an Emmy for imitating His Dukeness, John Wayne: as I passed my wide-eyed wife in the hallway, I said “There’s only room for the one of us in this town, Pilgrim!” Our shared laughter failed to erase my pain. I felt sufficiently agued to return to bed and to take the day off. :\


When High Noon was chiming on our grandfather clock, my considerate Bride waltzed into the bedroom, bearing a plate and bowl of delectables. (You should know at this point that she was the Secretary to the Teaching Professional at the Sea Island Golf Club. Sea Island is the sole Five-Star resort on our East Coast. Everything they do, including cooking, is top shelf.) She had brought a feast of crispy butter and bacon grease-golden brown fried chicken and cooked-all-morning-with-meaty-ham-hocks collard greens. All with lotsa NaCl. Who cares at that age, right? There were lighter than air biscuits as well. Note well that I am certain that I am an octoroon: I cannot bypass collards; their pot liquor – likker – is the nectar of the gods and good for you in seven different ways!


So it came to pass that I consumed a breast, a thigh, and a leg of tender, juicy, and perfect free-range chicken and, oh, about a half-bushel of greens and, let’s say, a cup of collard decant. I felt a moment of preternatural satisfaction which was immediately shattered by the bounding pulse I could feel – in my bottom! CURSES! :{


My Bride suggested that I contact our friend Tom, who was a talented Urologist and good friend whom I whupped at backgammon at regular intervals. She dialed the number, handed me the ‘phone, and went back to work. “Dr. Frankenst**n’s office!” said Tom’s receptionist in her sexy voice, though she was sufficiently ugly to make a train take a dirt road. “May I help you?” “Yes. Yes you can!” I cried plaintively. “I have this pain in my, errr, ummm, and I can barely walk! I, aye, aye, aye!” I yelped as she broke into my pained rendition of Cielito Lindo, saying “Tom is free right now. Can you make it to the Mainland alright?” “I’ll be right there”, I exclaimed, moaning, groaning, and bitching, wishing that I had had unlimited access to NCC-1701 Starship Enterprise’s transporter. :p


I John-Wayne-Walked to my own Enterprise, a 1977 Oldsmobile 98 Regency (19’6” long! Curb weight 3 short tons!) with all the trimmings, including six-way velour seats and a tilting/telescoping steering wheel. Sitting was right out! I adjusted the wheel such that I could hold myself off the seat long enough to voyage the six miles to Tom’s office using cruise control without sitting into a vat of superheated radioactive lava. :mad:


I got a number of quizzical looks as I negotiated the causeway, but somehow made it to Tom’s office in one piece. Ringpiece, that is! Tom, who had obviously watched my clumsy exit from “The Enterprise”, met me in his anteroom. He said “Nice Wayne impression! Get your ass back to Exam Room #2!” I waddled back there. Tom commanded: “Drop trou!” I complied. “Bend over!” he said in Hitlerian tone of voice, as if my gluteus maximi were Austria and his middle name was Lebenschraum. After a cursory examination including a finger the size of the Empire State Building being inserted into an orifice the size of an Up Quark, Tom shrugged his shoulders as he removed his gloves, snapping them off one gigantic barbed wire wrapped digit after another. “You have a perineal cyst, mostly internal, the size of an orange. We have got to get it out NOW!” “Whuyut?” I asked in my finest I-really-don’t-want-surgery-today voice. “If that thing perforates, you’ll go into full-blown peritonitis. Best case: your plumbing, including John Thomas, never works again. Worst case: you’ll be taking a dirt nap!” Tom exclaimed. With a bony index finger which may as well have belonged to the skeletal Grim Reaper himself, he pointed in the direction of Brunswick Hospital, immediately across the street. He said “I’ll meet you there!” with the graveness, gravity, and financial depravity of an undertaker. There was, however, a twinkle in his eye. Perhaps he wanted me to pull his finger...


I duck-waddled like a platypus with cerebral palsy to the hospital and presented myself to the Emergency Room Admissions Nurse. I filled out enough bureaucratic paperwork to occupy several wings of the National Archives and presented my insurance information. The lovely nurse, who was obviously repressing the urge to say “I’m your biggest fan, Mr. Wayne!” asked if I had eaten anything over the last twelve hours. When I replied in the affirmative; she stated blandly “We’ll have to give you spinal anesthesia.” :eek:


And so it came to pass that I was curled up like a fetus on an operating table as a needle the size of a sawfish snout sought and found my L-3/L-4 intervertebral space. The anesthesiologist must’ve used blowfish poison; I was paralyzed and insensate from the waist down immediately. Ah! Blessed relief! By that time, I would have used a dull rusty axe to rid my hurting self from the intractable pain. Plus, there was the Valium being delivered via intravenous drip. I was thinking we should do this every day when I realized that my legs were being spread and my feet being clamped into gynecological examination stirrups. Uh Oh! Now they are taping my flaccid member and its two side vegetables to my right leg! Double Uh Oh!


Tom walks into the operating room, accompanied by an assistant surgeon, his nurse, and some stranger they probably found wandering around drunkenly on one of Sea Island’s numerous well-manicured golf courses. This makes a total of six people in the O.R., not counting me. They are all capped, gowned, and gloved and ready for action. (With a capital A! For Ass!) I am certain that they are barely able to contain their laughter regarding my plight. I don’t care. This benzodiazepine is sho’ ‘nuff de gude stoff, man!!! BRING IT ON! :ok:


Tom walks up to my right shoulder and asks if I would like to watch the procedure. I reply in the definite affirmative, hoping for an appearance in Grey’s Anatomy or America’s Most Wanted. A couple of staff members arrange overhead lights and trundled mirrors until I am rewarded with a clear view of a full blue/harvest/super Moon, which, when my visual focal length resolves, turns out to be the immensity of my back fanny! (Were they using fun house mirrors? I still don’t know the answer, but I dared not ask if my ass looked big in this.) :zzz:


Suddenly, Tom and two assistants appear at my rear. Tom looks at the clock and says “First incision 1400 hours.” He cuts me up like a mother on speed might partition a banana with an ultramicrotome for her beloved child! Blood and pus. Something brown and ugly. Brown 29? No pain. A tornadic swirl of sponges and clamps and gloved hands and fingers. The hot stench of Bovie electrocautery. A cold swab across my forehead. Someone asks if I’m alright. I say “Hell YES!” Who needs wives and sons and dogs and planes and boats and sunrises and night’s sparkling constellations and oceans when ya got somebody cuttin’ ya up, but good? ;)


Uh Oh! Look back a couple of paragraphs wherein I reference the paralytic effects of spinal anesthesia. See where it says that “I was paralyzed from the waist down immediately.” ‘S’truth. Every muscle group lower than my navel was on full autonomic autopilot. No voluntary control was possible. Including my rectal sphincter. :rolleyes:


With apologies to Clement Clarke Moore - And then from my ass there arose such a clatter, I was afraid for all humans the Earth I would splatter. A veritable cacophony resembling the tuba sections of every marching band ever assembled on the face of this fragrant home planet burst forth! Once in total control, the circlet of orbicular musculature which had, at least for the most part for my twenty-nine years, controlled the gaseous and fecal exudates of my lower intestinal tract with admirable composure, gave way in complete and explosive surrender to the flatulogenic and malodorous effects of collards, fried chicken, anxiety, and some curry I had eaten a week before. Think Hindenburg without the flames... CatASStrophe! :uhoh:


Tom and the operative team beat a hasty Dunkirkian retreat to the furthest corner of the O.R. Tom ejaculated “Good God, Ed, WTF did you eat for lunch?” Everyone was frantically fanning their faces with their hands, including me! (It was as if I were a child taking piano lessons and hitting only clinkers!) One of the nurses could be seen dry heaving behind her mask. Another ran away! As if they were the collective consciousness of Father Damien's mother in The Exorcist, they sent me the telepathic interrogative: "Why you do this to me Dihmee?" :=


A few minutes later, they re-approached the operative site with the same caution a mongoose shows a King Cobra during monsoon season in the parking lot of a convenience store. Their foresight was well-founded; I did not disappoint. Just as Tom was using an admirable “interrumpted” suture technique to close my surgical wound, I let loose with a contrabassoon version of my two favorite composers’ - Rimsky and Korsakov - master oeuvre “Flight of the Bumblebee”. For a radius of one half mile, suddenly exfoliated trees bent double in supplication. The U.S. Army approached me to see if they could patent the horrid aroma of my flatulence to paralyze enema/y troops on the battle field. Mr. Methane retired from the stage, eventually taking his own life by assphyxia due to inhalation of "Gaz de Cavuman." Skunks slunk away, outclassed, disheartened and beaten. :D


Thus are the ways of perinea and perianalia.


It hurts to laugh! :ok:

All Sympathy and Empathy, Herr Fliegenmong!

- Ed :p

https://imgc.allpostersimages.com/img/print/u-g-PQCSTE0.jpg?w=900&h=900&p=0

[captainsmiffy]

Cavuman, sorry for your suffering....but right now I am laughing so hard at your description of it.....

[obgraham]

Excellent report, Cavuman. Are you sure you are not a surgeon?

[cavuman1]

Aye, captainsmiffy, that's a fine lookin' cabin boy ya got thar, Cap'n. O'er, now be bringin' him on down to me cabin... Ooops, wrong story! I take immense pleasure in giving the gift of laughter to others and am genuinely glad that you got some out of my tail/tale. I, too, find it to be highly amusing, but(t) it was certainly not at the time. :bored:

Salutations, obgraham! I am given to understand that you have spent a number of years "fanny gazing" in your practice. I am therefore hugely complimented that you wonder if I am a surgeon. Unfortunately, the answer is no. I was accepted to Duke Medical School, but did not attend. Having become a father at the tender age of nineteen, I needed to make money, not spend it. (With the luxury of retrospection, I believe that to be the worst decision I ever made.) I do love medicine and consider it, along with flying, to be the favorite avocation to which I devote myself. My son is a physician; my first cousin a pathologist, my uncle an internist, and my grandfather, psychiatrist Dr. Edward Gayle, started the first privately owned sanitarium in the United States. No wonder I'm so crazy... When asked what she had done with her life, Dr. Gayle's wife, Annie, my favorite grandmother, would respond "I spent most of it in looney bins!" She wasn't lying! :eek:

Let's keep the laughter going, gentlemen!

- Ed :p :ok: :}

[obgraham]

Well, Cavuman, seems to me your family fulfills the old saying about physicians:

The internist knows everything, but can do nothing,
The surgeon knows nothing, but can do anything,
The psychiatrist knows nothing, and does nothing, and
The pathologist eventually knows everything, but is too late.

You’ve got them all covered!