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Dr. messed up on Aftercare instructions

By cauterization versus banding | 5 posts, last post
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cauterization versus banding

Hello everyone,

   Has anyone heard of cauterization as an alternative to banding? My doc said that my thrombosed internal hem was too large to band, so she cauterized it.  The needles for the anaesthetic and the cauterization hurt like hell.  After, she said to go ahead and :

EXERCISE ALL I WANT, including hiking and rock climbing

NO FOOD RESTRICTIONS--just eat high fiber (she didn't say what NOT to eat)

NO SUPPOSITORIES

NO PAIN MEDICINE

NO NUMBING CREAM

NO RECOMMENDATIONS REGARDING SITZ BATHS

    That was a week ago.  Within a few days, I developed severe interal swelling and two very large external hems. I called, but she said that was "part of the healing process".  I couldn't empty my bladder without practically doing a handstand, or sit, or stand without constant pain.  It bled, but not to an extensive degree.  I went to Urgent Care and they said they could do nothing but give me suppositories, and to REST, NOT EXERCISE, and take sitz baths.  WILL THE REAL DOCTOR PLEASE COME FORWARD?

  I DON'T KNOW WHAT TO DO: I HAD TO TAKE A DAY OFF WORK BECAUSE OF PAIN --should I exercise, fast, liquid diet, high fiber?  I have Vicodin but don't want to use it.  I want to be active again ASAP--when do I know that I can? My doc didn't schedule a follow up for a month, and I have things waiting for me to do.... any suggesetions?  My best to you all!!!  p.s. is there a difference between LIGNOCAINE gel and LIDOCAINE gel? Someone recommended a 2% of Lignocaine and I can't find it.

CLIMBER LADY232598

Just so everyone knows, that was ME who posted the above--I hadn't registered yet...thank you
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oceanarcher226083

climber lady,

welcome to these boards. most of us aren't docs, so our advice can't substitute for a trained professional. However, a lot of us have actually endured these procedures while docs have not. lots of difference between what medical text tells you a patient will feel and actual experience. 

Before accepting ANY actual 'medical' advice here, please consult your doc first. 

There's no lignocaine. That was probably a typo. For topical analgesics, the popular ones are benzocaine and lidocaine. They both work to numb the skin, especially for burns. However, there are different types of hemorrhoid tissues: Internal and External. You can google them, so I won't go into detail. You can NOT use topical solutions on internal hems. Not only will it irritate the hems more, it is very dangerous.

External hems START from the outside of the anus, so they're surrounded by skin. Topical solutions will soothe the external hem, but will not absorb through the skin. Internal hems are surrounded by mucosa, not skin. If they get big enough, they will protrude (prolapse) through the anus. Even though they're on the outside, they are still technically internal hems. This tissue absorbs medication very easily. So if you put lidocaine on internal hem tissue, it'll be like shooting the drug directly into your veins. Very dangerous for your heart.

However, the procedure you described sounds like it was for external hems, not internal. You may want clarification from your surgeon. The others 'hems' that developed later might be general post-op swelling in the area, which will turn into things that resemble skin tags, then hopefully will continue to shrink and disappear within a few months.
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CLIMBER LADY232598

Thanks Oceanarcher,
The procedure was actually for a large, internal, prolapsed hem. The ones that developed as a result of me not taking it easy right after the procedure are external ones; she was going to give me NOTHING for the pain, and I only got suppositories and cream from Urgent Care. I don't have any idea when they'll go away, and the doc can't fit me into her schedule for weeks. It was a different doctor who suggested lignocaine, which is a derivative of lidocaine, but I discovered it's very expensive and usually only doctors or vets can get it. Thanks for the warning; will not be putting any cream on anything other than the external hems. Problem is, there's so much swelling inside still, and it's been a whole week ????? I'm getting tired of taking sitz baths that hurt (because it hurts to sit) and just don't know what to do about these external hems that refuse to go away. And my doc was not a surgeon--I wonder if that makes a difference. Thanks for the advice--I do think there's a lot of post-op swelling, but I don't understand why she said to go ahead and exercise all I want and eat what I want, when other doctors and Urgent Care said just the opposite. I don't think I'd be in this situation with the bleeding external hems and other swelling if she had given me correct instructions. ??? Don't know, just so angry that I have nowhere to turn. Thanks so much for your support though, and advice!
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oceanarcher226083

wow, that's really bizarre. I didn't realize in-office cauterization was possible on grade 4 internals. Can you go see a colo-rectal surgeon? I don't have insurance, and my initial consultation with the surgeon was $65. Pretty reasonable. It doesn't sound like your doc was very qualified to do that procedure, especially since s/he told you to not change your diet habits or daily activities. 

Typically hemorrhoidectomy is the only option for grade 4 thrombosed. Your recovery time would have been much longer than 1 week, and you would have been in a lot more pain than what you have described (based on my own experience and others on this forum). So if this procedure got rid of your hem, then consider yourself fortunate :-)  Maybe your doc was qualified after all o.O but s/he has obviously never had to undergo this procedure his/herself based on the post-op advice you were given.
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CLIMBER LADY232598

I guess I should contact my primary care doc and get him to recommend a real surgeon--Maybe I didn't have a grade four, but it was big enough that she couldn't band it, and yet she had to do SOMETHING because it was already out. The procedure may have gotten rid of the one hem, but it seemed to result in a lot of swelling and now external ones that won't go away. Thanks for the advice--I think I will get in to see a real surgeon and maybe he can give me some relief for these x's! :)
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