One anal fistula patient to another

Welcome to my blog. I created this blog with the singular purpose of documenting 1) my struggle with rectal abscess and anal fistula and 2) my journey to seek a comprehensive treatment to completely cure this disease. This blog is not a medical advice. I am not a medical professional. I once was a patient who suffered from a rectal abscess and the resultant complex Trans-sphincteric fistula. I am now completely cured from this painful disease by an amazing surgeon, who practices an unique surgical treatment and from whom, many patients from all over the world are seeking this treatment. This blog is simply my experience with this awful disease and the eventual cure I received. Please do your own research and consult your physician before embarking on any treatment. I would also like to warn you that this blog contains graphic pictures of my wound in my naked tush.

How did it all get started?

At the time of writing this blog in June 2015, I was a 40-year-old male from USA. I didn’t then and still don’t have now, IBS or IBD. Basically, I was a healthy marathon-running individual. In November 2013, I noticed sudden onset of sharp pain after bowel movements. In few days the pain became unbearable. Suspecting a Fissure, I went to a General Surgeon. Going to a GS was a huge mistake – I should have gone to a CRS. The GS didn’t even do rectal exam. Instead, GS sent me to Radiology, who through imaging found out that I have a big abscess high up from anus next to my rectal wall. At this point GS should have referred me to a CRS, but he did not. GS decided to take matters into his own hands and put me on a powerful cocktail of intravenous AB using a PICC line for weeks. AB didn’t have any effect on my abscess. The abscess kept growing big enough to push against my rectal wall with a balloon like pus collection obstructing the rectal pathway. If  GS had done a simple rectal exam at this point, he would have realized that the abscess is only growing bigger and that AB is not the treatment of choice for rectal abscess. At this point, nearly 6 weeks have gone by. Finally on a fateful day, GS decided to operate on me – the wrong way. i.e. Instead of taking the knife to the abscess through the anus and opening it at the protrusion inside my rectum, he decided to go fishing for it by cutting open my gluteus muscles. He successfully created an external opening 3 to 4 inches from anus and 7 to 8 cm deep. Few weeks after the surgery, the abscess, which still remains un-drained, decided to form a tract to the external opening. The abscess also connected this tract with an internal opening on the rectal wall. Voila, I now have an anal fistula – a complex, Trans-Sphincteric one.

Finally, I got my act together and went to a nearby CRS. Let us call this CRS, CRS 1. CRS 1 was shocked at what was done to me by GS. CRS 1 told me that this was a very complex fistula + abscess, one he can not treat. So he asked that I find some other CRS who can do “LIFT” – the first time I ever had heard that word.

I then found an excellent second CRS – CRS 2. CRS 2 was super kind and was willing to take me as a patient. CRS 2 did a big I&D on me. CRS 2 had to “move” the external opening close to my anus. Note that the external opening was 3 to 4 inches from anus. CRS 2 cut laterally from the external opening toward the anus and stopped about an inch from anus. This resulted in huge gash in my butt, which was a very good thing since the abscess drained very well through the now enlarged external opening. CRS 2 also drained the abscess from inside the rectum and put in a Seton through the fistula track. The abscess drained beautifully through the large external opening. I was, at last, free of abscess pain. Months went by. CRS 2 and I waited for the abscess to heal “sufficiently” before a fistula repair surgery can be performed. But, with the internal opening still there and the external opening healing and closing to a smaller hole, the fairly deep abscess started to flourish because the pus didn’t drain properly. I went back to having lot of pain – a pain level of 7 or 8, everyday. There is merit to the wait a fistula patient has to undergo after an I&D and before a fistula repair. But if that wait is too long, the patient goes back to square one, like I did.  CRS 2 performed 3 more I&D. But I did not get any relief from pain. October 2014 was around the corner and I was nearing 1 year anniversary of this ordeal and had undergone 6 surgeries, multiple CT scans, and two MRI. I was helpless, felt dejected, and was staring into the abyss.

Below you will find three images – 1) MRI report 2) A diagram I drew in Oct 2014 of the anatomy of my fistula 3) Picture of my external opening with a Seton running through EO and anus.

MRI report

Anatomy of my fistula.

I found KshaarShutra.

Consumed by fear of not recovering from this condition ever, I searched online for measures outside the realm of conventional treatment, to obtain even a temporary relief from pain. I tried the ghee+milk routine. It didn’t move the needle in my pain meter. Oregano oil made it worse. It is then that I started to read about an Ayurvedic treatment called KshaarSutra (pronounced Shaar-Sootra). I had to go to the deep reaches of internet to find credible information on KS. After lot of research, I was able to locate and establish phone and Email communication with 6 patients – 2 from Australia, 4 from USA – who were are all successfully treated by KS. These 6 patients had undergone KS treatment in India under two different doctors. Learning about these patients’ experience of finding permanent cure led me to believe that KS may be the treatment of choice for my fistula.

Then I started the most difficult part of this research into KS – finding an excellent KS doctor. I had defined an excellent KS doctor as someone who had these three qualities – 1) Masters or PhD in Ayurvedic surgery 2) Teaching faculty in an Ayurvedic college 3) Over 1000 fistula cases treated. Finding an excellent KS doctor with all these three qualities proved to be very difficult as there was very little credible information online about KS. The KS doctors who advertised their services in forums like ibdsupport.org with testimonials, sounded commercial and greedy. It is then I learned that Banaras Hindu University in Varanasi, India has one of the premier Ayurvedic colleges. There, I found Dr. Manoranjan Sahu, a proctologist and a professor of Ayurvedic surgery. I also found a paper that Dr. Sahu had published on KS.

While Dr. Sahu met my criteria for an Ayurvedic surgeon, it was not practical for me to obtain treatment from him, since 1) Varanasi was far away from my parents’ place in India (I am originally from India, now settled in USA.) and 2) BHU’s Ayurvedic college did not have a private hospital.  So I kept on with my search for a competent Ayurvedic surgeon. During this search, I ran into a paper on KS published in a western medical journal. This paper is first of its kind in two aspects – 1) It was a rare case of anal fistula extending to foot. 2) It was among the first few KS publications to be accepted by a western medical journal. I then located the website of the author of this paper, Dr. Ramesh Bhat. Dr. Ramesh Bhat has a PhD degree in Ayurvedic surgery from Banaras Hindu University. He is a professor and chief of division of surgery at Sri Sri Ayurvedic Medical College in Bangalore. And, Dr. Bhat had his clinic in a private hospital in Bangalore – a city that was well connected with the rest of India and the world by air. Feeling positive that I found the right specialist, I had established Email and phone communication with Dr. Bhat. He sounded absolutely confident that he could cure me. I thanked God for finally guiding me in the right direction and started to plan my trip to India.

I started KS treatment

On Dec 8, 2014, my treatment started with a visit to a Radiologist with whom an appointment had already been secured by Dr. Bhat. The radiologist performed a Trans-Rectal Ultra Sonagram (TRUS). TRUS took all of 15 minutes and the radiologist sent me back to Dr. Bhat with the following reports on that same day.

TRUS report

TRUS report

Dr. Bhat saw me in the evening of Dec 8 and went over the TRUS report with me. In our first face to face meeting, Dr. Bhat realized that I was very nervous and worried. This is what he told me and I quote – “, I don’t want you to worry about your fistula anymore. Your fistula is now my problem. I have treated over 1500 cases of fistula. Your fistula is of medium complexity. Live your life and let me worry about you.” On that day, upon hearing these comforting-words, I surrendered myself to Dr. Bhat. Dr. Bhat took me to Surgery on Dec 9 at an area hospital there.

The surgery, a fistulotmy, was under spinal anesthesia. The surgery lasted little over 15 minutes. I was watching Dr. Bhat perform the surgery at an amazing speed, but didn’t know what exactly was happening down there. That night I had asked the nurse to take a picture of my wound. It was then I learned that Dr. Bhat had made a deep hole, totally opened up the track, and removed all unhealthy granulation tissues. The picture below was taken on the night of surgery.

The wound was big and deep, reaching my abscess which was nearly 7 to 8 CM inside. The painful process of wound healing started from Dec 10. Luckily, I had taken with me many Vicodin pills from USA. You don’t get these in India. The picture shows a thread hanging out of the wound. That is the famous and magical, KshaarSutra thread. The thread starts cutting through the fistula track while the wound starts to heal from top/inside/cephalad to bottom/outside/skin. The wound had to be packed three times a day. If I had been living close to Dr. Bhat’s hospital, Dr. Bhat or his nurse would have changed my wound dressing everyday.

I underwent weekly thread changes

As the wound healed, I visited Dr. Bhat’s clinic in Bangalore weekly for KS thread change. There are KS thread change videos in YouTube. In summary, Dr. Bhat tied a new KS thread to the old thread, cut the old thread and pulled one end of old KS thread which pulled with it the new KS thread. He then tied the new KS thread tightly around.

My treatment lasted for 6 months. I returned to USA fully cured. I had pictures of my wound. I have now removed them. Feel free to reach out to me if you have further questions.