Do you ever ask a question to yourself or the universe, kind of rhetorically, and then receive an answer you don't really want? My fistula is acting up, as if to say, "It ain't over, sucker!"
I feel so much better in my guts, my energy level, my arthritic knee, that I sometimes forget that I still have one issue that refuses to get better. Actually, it's doing quite the opposite.
My fistula nightmare began a year and a half ago. After life exploded in September of 2015 (read The End of the Days of Plenty for more), I was being sent for round upon round of tests to find out what was going on in my painful and swollen knee (which had been painful for a long time, started feeling better for a bit, and then the pain came roaring back). The first thing they wanted to rule out was bone cancer, and they began doing so aggressively with MRIs, Xrays and CT Scans. The fun thing about all of those tests were the summaries, which always went to the tune of, "Well, we can see that SOMETHING is wrong, we just don't know what." Cheers, Modern Medicine, and thanks a lot.
The time came when my folks were taking me to Grace Hospital for a full-body bone scan at an hour of the morning that just shouldn't exist. Well, I guess the strain of several months of my guts not feeling quite right, and having to Shiss* out my contents and fast prior to every test I had to take finally caught up with me. I started forming an anal abscess, which was surgically drained after a trip to ER in November of 2015.
*Shiss: the hilarious pet-name coined by one of my favorite homecare nurses, Practically-a-Doctor Richard, which basically means to expel liquid stool. I'm trying to be delicate because my Mom is reading, so just use your imagination for the etymology of the term.
So, what is a fistula? Google says: "an abnormal or surgically made passage between a hollow or tubular organ and the body surface, or between two hollow or tubular organs." Basically, the extent of my Shissues (haha) caused a fissure, or tear, in my rectum. If bacteria gets through the fissure, an abscess can form. An abscess is basically a pocket of trapped infection that has nowhere to go. It can kind of just sit and hang out in an uncomfortable way, or it can be so mind-numbingly and constantly painful that you go to the ER. Fun fact: my surgeon said he drained one of those little styrofoam cup's worth of pus out in that first surgery. Gross right? It didn't feel so great either.
After an abscess gets cleaned out, everything can heal up fine. In my case, however, the fissure hadn't healed (it never had a chance), and after one more cleaning out in February of 2016, a silk seton thread was inserted by my colorectal surgeon in April of 2016 and lo, a fistula was born. I've had the thread replaced twice since then (November 2016 and April 2017).
Maybe you're still having a hard time imagining what it means to have a fistula. Well, I wouldn't be a good teacher if I didn't provide you with a visual aid. Here is a diagram I sketched to help illustrate my point. And if you're thinking that I must have drawn this several times before, you would be right.
Seton threads are the most common and effectual way of dealing with fistulas at this time, which is unfortunate because it doesn't seem to be working so well for me. Basically, the idea here is that the thread allows for drainage (yay, do more laundry!), preventing painful abscesses. Gradually, the fistula is supposed to heal and close in around the thread, letting it break away when it's time. The seton only lasts 6-8 months though, so if the tunnel doesn't heal as it should, the thread is replaced and you start over again. My General Physician said that the worst fistula case he saw was a patient dealing with it for 8 years. Just think of that: 8 years of having an open wound, draining into your clothing, often painful and irritating (an itch you just can't scratch, you might say), preventing you from being intimate, sitting (man we do that a lot in a day), driving and sleeping. Not to mention the sky-high water bill because deep soaks are the only thing to give me some relief. It can all be very debilitating, though if it's healing right and everything is going smoothly, you may even stop noticing that you have it.
Fistulas can be very complicated, especially for people with IBD, refusing to heal, or getting worse by branching off. In this last surgery I had in April 2017, my seton was replaced and an offshoot abscess was cleaned out. I have strong suspicions that another abscess is forming and that I'll be looking at fistula #2 before long, but my Colorectal surgeon doesn't seem to think so (it is uncommon for another fistula to form when a patient is on a medication called Remicade, which I have been taking for almost a year). I have a follow-up with him in a week, and I guess I'll just go from there.
This is probably the issue that brings me down the most. So I stayed in bed most of the day, and I'll probably be laying low for the next little while for the nth time. I suppose things will heal eventually, but man, chronic pain sucks. It's so isolating and discouraging, but at least it gives me something about which to write!
On that note, I leave you with this comic that I found as I was rifling through old pictures I had saved. It put a smile on my face.
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