THD and Me

Well, I woke up and the urge hit. I ran and slammed my 20mg of Norco, a .5mg xanax, and an alieve. I went to the bathroom, and to my surprise was able to hold the urge pretty well. Noticed for the first time since the surgery my underwear were soiled overnight, even though I cleaned up with a sits bath before bed. I applied some lidocane to the diaper rash, and when that settled down I was able to administer two good sized doses to the anal canal.

 I'm currently sitting, holding it in trying to make sure the lidocane kicks in, and then I'm going to go in there and drop some nukes in the toilet! Positive attitude, right??  Will report back!

- Evan

Hey, it's the OP here. I'm sorry for not keeping everyone updated -- but I figure I'll record what happened for posterity and hopefully help others in the process.

After the events above, I continued to have somewhat painful BMs for the next couple weeks.  However, every so often, I would have bouts of extreme constipation and the resulting BM would be very bad -- almost taking me back to square one pain wise.

Eventually I learned that the healing process had changed the shape of my anus -- My stools, when they were soft, would come out in the shape of a ribbon.  If they were more of a normal consistency they would be difficult to pass, causing pain and bleeding, but coming out round.  Usually the first stool would be round and hard, and then I'd have 'normal' ribbon shaped stools after that.

After a few months, my rectum had stretched out sufficiently that I was having regular round stools pretty much all the time, with minimal pain.

-- However --

The process of all the difficult BMs over a period of three months had left me with three new external hemorrhoids, and at least one internal.  I was worse than I had ever been, even before the surgery.  I was entirely dependent on prep-h and witch hazel wipes to function as a human, and had to apply it after each and every BM -- no exceptions.   After a month or so of that, the skin around my anus started to break down, and I developed 10-15 "sores/ulcers" from skin that was continually saturated with moisture.  This necessitated more cream to dull the pain.  Vicious cycle sort of thing.

I made an appointment to follow up with my surgeon, and started using my own special blend of butt-cream, that I created a long time ago to improve my hems before a vacation.  Not for long term use, but, helpful:

1. prep-h (pain relief kind)
2. antibacterial ointment (neosoporin)
3. anti-fungal ointment (azole-based)
4. hydro-cortisone cream
5. zinc-oxide based diaper rash ointment

If you decide to use that -- be extremely careful with it.  Prolonged use of steroid creams on the skin causes it to thin -- and this will greatly exasperate your issues.  Use for a few days, max.

My sores had already cleared considerably by the time I saw the surgeon -- he was amazed at the before and after (I showed him a picture I had taken two days before).  Based on my history, we decided to do a repeat surgery scheduled for yesterday.  We given that there had already been one THD attempt -- I told the doctor that if he didn't find Doppler signals to correspond to the new hems to go ahead and excise them with a traditional surgery.

Since I knew what to expect -- I did some things differently:

1. Complete colon cleanse with SUPREP vs the Fleet Enemas we had used before hand.
2. Clear liquid diet two days before the surgery.
3. Stool softeners two days before the surgery.
4. Fiber, pain pills, stool softener, water all on hand
5. No activity right after surgery
6. before I went under, I requested an IV of torodol (high-power NSAID) be on hand when I was woken 'just in case'
7. Started Alieve (NSAID) the night I came home to help reduce swelling.  This is tricky because it can worsen bleeding -- but I decided I'd rather have bleeding than swelling.  Definately discuss this with your doctor if you decide to do it.  My research seemed to indicate that Alieve was the least likely of the NSAIDs to cause bleeding.

My after surgery experience was much better.  Just like before, the spinal was already worn off when I woke up from the general -- the doctor actually had to bring me out of the general while I was still in surgery because my blood pressure was too low. I could feel my doctor moving the THD device around for the last 5-10 minutes of the surgery.  I was starting to feel pain towards the end so I asked my anesthesiologist to administer the torodol.  Thank god I made sure it was on hand, because with my low blood pressure, narcotics were out of the picture.  Honestly, that shot made all the difference.  I was "in pain" but it was more of a discomfort than excruciating pain.  The doctor found three additional Doppler signals and didn't end up excising any hems.  He did suture one of them up inside the rectum.

When I came home, I started on the fiber supplements, Alieve, and slamming water like it was my day job.  To be honest, I had planned on avoiding solid food for a couple days -- but since already hadn't eaten in two and a half days -- I couldn't help it.  I had a bowl of Chicken Noodle soup and a footlong subway (on wheat of course).  I have to say, that was the best subway I've ever had, even though I had to leave the bananas peppers off (for obvious reasons).  I went to bed (that was last night).

This morning my cat woke me up at about 4AM wanting food.  I realized that in my rush to get prepared for the post-op recovery, I had forgotten to buy cat food... so I had to make a trip to walmart.  I was hungry so I ended up getting an Egg-White-Delight from McDonalds (5g of fiber at least) and took it with a helping of fiber.  With lunch I took 4 fiber pills with senna extract that my doctor had given me.  I continued slamming water like it was my job.

I have to say that knowing my bowels were COMPLETELY empty from the SUPREP was an amazing relief.  Knowing that the feeling of needing to go was just pressure from swelling makes it a lot easier to ignore.  Spending time on the toilet trying to push out stool that isn't there didn't help last time.  That made what happened next even more surprising:

About six hours after lunch -- when I took those senna laced fiber pills -- I had a very small BM.  It was very soft and just slid out with no pushing.  I've actually had two more, slightly larger BMs since.  I'm not sure if it was the additional fiber or the senna laxative -- but it was amazing.  I'm planning on taking the other set of fiber pills from the sample my doctor gave me tomorrow at lunch.I can't say that this is a good idea for everyone -- I hesitated taking a stimulant laxative.  Also keep in mind that this round of THD was a lot less invasive than the last one (3 vs 7 arteries, 1 vs 2 hems sutured up).  But if you can get the stool out of you while it is still very soft early in the process -- before you have a bunch of pressure built up -- it makes all the difference IMO.

I'll post back in a few days to let you guys know how it went.  At this point last time I was doing "quite well" also -- I didn't start to go down hill until I had to have a BM.  At least that's behind me this time.

Well, so far so good.  This time around I'm in a lot more pain.. sitting is difficult and walking is more like a penguin waddle -- but I'm passing stools with regularity.  Actually, today, 4 days post-op I've had 4 decently large BMs separated by about 45 minutes.  So it seems like my system is getting flowing again.  I remember having a day like that last time as well -- although it was much later in the process.

Although this morning I've been feeling like I may have over done the fiber a touch the last 4 days :-p

I had to go to the ER last night because of a Spinal Headache.  Worst pain I can imagine -- but they did a blood patch and I was better within an hour.  Pretty amazing.

- Evan