Running with Crohn’s: Fistula Post-op

Running with Crohn’s: Fistula Post-op

I am once again NOT talking about the drugs I have used so far (although I have started writing that), because I want to slip in this fistula post-op report.

The following contains graphic detail, biological functions, and very personal experiences; some may find it offensive:

I developed a fistula probably around November of 2012.  I did not actually see the doctor about the symptoms because “I wasn’t positive” that I had a fistula.  However, in April of 2013, I exhibited unambiguous symptoms that I had a fistula (blood and pus in my underwear).  Since then I have had three surgeries.

The first surgery just drained the giant abscess that had developed (roughly the size of an extra-large egg).  This allowed most of the infection to drain and the inflammation caused by such a massive infection to recede.  Since it involved cutting, it was a painful experience.  On the other hand, the draining of the abscess relieved a lot of pain caused by it.  On balance, I felt better than I did before the surgery and I bounced back quickly.  By the time the doctor permitted me to resume running, I was extremely eager to return to the running.  However, I took it easy and began by running just two miles.  In the two weeks, I had between this surgery and the next, gradually worked my way back up to running six miles.

In my second surgery, the doctor found the track of the fistula (he was not able to do this in the first surgery because I had such a bad abscess), placed a rubber band like object (called a seton) through the fistula, and irrigated the track to help flush out any infection.  This surgery was even less painful than my first for this fistula.  Do not get me wrong, I was sore; it just was not as bad as I feared it might be.  It took several days after the seton placement for my inflammation around the fistula continued to recede.  Similar to my last surgery, I was able to work my way back up to six miles prior to my third surgery.

I had my last surgery on Wednesday (7/31).  This surgery was the doctor’s first attempt to heal the fistula.  In prior surgeries, the fistula was too infected to attempt to close it.  The doctor removed the seton, irrigated the whole track of the fistula, and then glued the entire fistula track closed with glue (called “fibrin glue”).  My pain upon getting home was (and still is minimal).  I suffer from occasional stinging sensation and general discomfort from having the doctor poke around.  Even though the pain is minimal, I am attempting to restrict my activity.  Too much activity could rip open the glued fistula.  The doctor did permit me to resume running 4-5 days after the surgery, so I plan to perform a trial run on Monday.  I will perform a two-mile run on a half-mile loop so I am no more than ¼ from the car at any time.  Until then, I will take Beth on short walks on the Greenfield walking trail.

This illustration shows several possible fistula tracks.  My first fistula followed the innermost track (just going under the skin but not penetrating any muscle).  My latest fistula follows the transsphincter fistula track which penetrates both muscle groups.  The first type of fistula is easy to heal.  My latest fistula is much more difficult to correct.

For any of you who might require a fistula surgery in the future, I will describe my experiences here.

My surgeries begin with checking into the surgery center (an outpatient surgery facility).  After waiting for a while, the center personnel call me back into a changing area.  After changing into the surgical gown (a typical hospital gown), they have me hop onto a gurney.  It usually takes about an hour of prep to get me ready.  Most of this time they ask me question and fill out forms.  They then place gauze soaked in numbing gel onto my fistula opening (read that as “butt crack”) and put an IV into my arm.  They inject sedation medications as the wheel me into the surgical suite.  The drugs include versed (an amnesiac and anti-anxiety medication), fentanyl (a strong painkiller), and propofol (a hypnotic, or sleep agent).  The procedure usually last 5-15 minutes and it usually takes about 30-45 minutes for me to recover sufficiently to walk out of the surgery center.  My perception of the time is that I wake up about 30 seconds after being injected with the sedation medicine.

While I am unconscious, the doctor injects a nerve block to numb my rectum and urinary track completely.  The numbness can last for many hours (up to 12 for me on one occasion).  It obviously helps with surgical and post-surgical pain but can also cause unpleasant side effects.  One that the doctor has warned me about but I have never experienced is the inability to urinate (I have not had any problems urinating).  A side effect the doctor did not warn me about but I have experienced is incontinence.  After my second surgery, I experienced severe abdominal cramping and pressure.  I tried to hold this as I slowly made my way to the restroom and thought I had succeeded, however, when I got onto the toilet I discovered I had failed :( .  After recovering feeling, I regained control of bowel movements.

Upon waking from surgery, I usually feel a bit wobbly.  On the day of surgery I make a point of taking the maximum prescribed dose of pain medicine until I get a better idea of how much pain I will be in.  Usually on the second day I begin weaning myself off of the prescription pain killers.  With these three surgeries that meant using only 1/2 of the pain pills.