Patient 14

Date: Thu, 13 Nov 1997

I am a 32 year old white male with a strong A-type personality. By the fall of last year (1996) I had already a) spent 7 1/2 years active and reserve duty as a military officer; b) run for the US House of Representatives (nominated, not elected); c) served 3 years in the minister's position of my church; d) been CEO of several small businesses (along with sitting on the Board of Directors for various charities, organizations, Chamber of Commerce committees, etc. etc.); e) had only four weeks of vacation (total) since April 1992.

It goes without saying that a low stress lifestyle was essentially unknown to me (over the last few years it had become common for me to average 4-6 hours of sleep per day). Now follow those facts with a really horrible, and I mean HORRIBLE diet regimen (which I thought I was making up for by four days of strenuous working out every week) and you have just about got all the pieces for disaster put in place.

I first developed hemorrhoids while in college (around age 18-19). Over the years they recurred from time to time (in varying degrees of persistence and pain) and my principal solution was to ignore them. It never occurred to me that my diet and lifestyle might be affecting my internal biology.

Then late last year (early this year), one of my businesses failed, and failed big (losing four years of profit in 90 days). In its aftermath I had to fend off a frivilous lawsuit while reorganizing and restructuring existing businesses (including selling off whole businesses and laying off employees). When that finally settled down (right about the time my hemorrhoids really began flaring up), my marriage ran into its first big bump in 8 years. Coming out of that, my hemorrhoids turned into a full blown fissure somewhere around late August/early September.

Now I should mention that, through all of this, I was eating at least one fast food meal per day, lots of red meat and maybe a helping of vegetable or fruit once a week.

Surprised my bowels and colon had a full bore meltdown? Neither am I (at least not now anyway).

I had no idea what a fissure was (or that I had one) until my research on the Net told me that pain on bowel movements was NOT normal for hemorrhoids and more likely a fissure. The descriptions of a fissure fit my symptoms exactly. I hit your site from Yahoo (as well as others) and started reading/learning. I learned a lot, mostly that I had been essentially begging for this to happen to me.

I'm not going to discuss the pain. If you're reading this letter due to similar experience, you know all about that (it only hurts when you're conscious right?), and if you haven't, you can't understand anyway. Instead I'd like to focus on how it has been healing.

The very first thing I did was change my lifestyle. Getting well became the focus of my life. I spent a portion of each day in prayer (something I'm a little embarrased to say I spend more time on today than I did when I was in the ministry). During the first few weeks I sometimes combined that time with time in the tub (the baths, particularly right after painful movement as suggested by Patient 6, seemed to make a really positive difference ... oddly enough though, towards the end of healing the baths seemed to hurt more than they helped and I stopped them). And I made every effort to reduce the level of stress in my life (I can't really describe how to do reduce stress; each time I started to stress out or lose my temper I simply stopped and reminded myself that my mental state was killing me ... that seemed to help allow me a greater perspective and made it easier to maintain calm).

I also changed parts of my diet. I started eating breakfast again for the first time since I was a child (I mean something other than Pop Tarts). Shredded Wheat with fruit and 2% milk. You want to know what's in Shredded Wheat? Here's the whole ingredients list (I memorized it), "whole wheat, wheat bran." That's it! I called it "twigs in milk" but eventually found that it wasn't that bad (perhaps because I knew it was good for me, perhaps because my body was that desperate for something good for it). I even decided I didn't need sugar with it since the fruit usually provided enough natural sugar to keep me eating. One piece of advice, if you eat this stuff, eat quickly; like most high fiber cereals, it tastes like wallpaper paste if you let it get soggy.

I eventually switched from Shredded Wheat to Quaker Oatmeal for two reasons; first, it was getting cold and a warm breakfast with fresh fruit seemed better; and second, I noticed that Shredded Wheat was high in insoluble fiber, which is supposed to be good for adding bulk to stools, while oatmeal was high in soluble fiber, which is supposed to aid in digestion. I decided that bulky stools were more a part of the problem and that I needed more soluble fiber than insoluble fiber. A good explanation of the difference and why either or both are good for you would be a welcome addition to any web site on this topic (I searched and found definitions galore, but no explanations).

Important Update for Patient 14.
Date: Mon, 01 Dec 1997

I wondered in my original note about the difference between soluble and insoluble fiber, and I guessed that soluble fiber was better. After discussions with Doctor of Internal Medicine, I can categorically say that I was INCORRECT!

This is VERY important. My substantial increase in soluble fiber and simultaneous decrease in insoluble fiber was, in all likelihood, directly related to making me a bit diarhetic (sp?) a few weeks back (very painful in recovery).

Insoluble fiber is necessary during recovery as it soaks up so much moisture and helps keep the inside of the bowels clean (as well as it's aid in "sweeping" out your system).

So, if you read my note looking for advice, please disregard my assumption about soluble fiber. It IS good for you, but you should balance it with insoluble fiber.

I also stopped eating red meat, finally (yea!) kicked caffeine out of my life for good and, as suggested here, massively increased my water intake.

A word about that (water intake) which no one else seems to have commented on. It's a bit obvious but readers should be aware that, when you sextuple or octuple your water input (as I did, up to 2 litres a day at one point), you also sextuple or octuple your water OUTPUT. You will make substantially more trips to relieve your bladder, and by the end of the day you'll be peeing near Culligan quality water right back out of you ... but I can't deny that it does seem to help.

The difference was immediate and substantial. The pain became less pronounced and started lasting only until the evening, then mid-afternoon, etc. The bleeding lessened and began to disappear. Over the next few weeks I became a complete vegetarian and was amazed to discover that you can give up meat and still have some REALLY good food (I have discovered some vegetable dishes I'd be happy to share ... that's something else this site needs, "the fissure recovery cookbook"). I had at least two pieces of fruit per day and usually a vegetable dominated main meal.

A warning for those like me (switching from an amazingly bad diet to a healthy one). One of the medical databases on the Net warns that, when changing to a healthy diet (particularly when reintroducing fruits and vegetables), it is normal to be a little extra flatulent while your body makes the transition. True! If I might break into a moment of stand-up comedy, at one point I was farting through a pair of pants per day (no kidding). The first week I had a government Hazmat team do my laundry (alright, maybe I just *wanted* them to). I actually blew holes in several pair of underwear (OK, *that's* an exaggeration). You get the idea. If you experience these symptoms, relax, they're normal and should disappear in a few weeks (it took me about two weeks).

By the third week of October I felt well enough to go back to the gym and at least do some light working out (cycling, rowing, situps ... I had stopped working out as I thought it might be contributing to the problem). No problems. On Halloween, after a grueling two day conference in another city, I rewarded myself for my progress with two pieces of my one great food weakness, Popeye's fried chicken (followed by an apple, lots of water and a dose of Metamucil when I got home). The next day I had no problems. That weekend I decided I was well enough to return to my more strenuous workouts. After three days, I was already feeling my muscles start to return to their form of a month or so back and my body answering the call from the demands of my mind. I returned to a more normal work schedule as well (working on weekends, later into the evenings etc.). On the fourth day (a week ago yesterday) I found a small amount of blood with my stool for the first time in weeks. The term panic just doesn't cover my reaction. Further research on the Net indicated that strenuous exertion can cause a fissure to reopen. Two days later, a little blood again.

I decided to attack full force. That weekend I ate nothing that didn't grow from the ground (fruits and vegetables). I involved myself in no strenuous activity (I forced myself to watch football all weekend ... I mean how often can you do that and claim you're helping your health ). I vigilantly took the recommended three doses a day of Metamucil (I had purchased it sometime in mid-October, but had used it only intermittently as I seemed to be getting better without it). The bleeding disappeared again immediately and I found myself in less pain than I'd been in since ... well, I don't honestly remember when ... but a long time.

Yesterday I needed to chop some wood for our fireplace. I knew it was physically strenuous, but it had to be done. I'd also gotten back to a regular work load again. This morning, blood, but hardly any pain at all (as I write this, at 10AM, I am already feeling completely normal). At this point, I'm assuming that I am pretty much on the right path to a full healing and that if I continue adhering to my new lifestyle (time for prayer, time to eat correctly, no time for stress), as long as I avoid strenuous activity until I'm completely healed, I ought to be OK.

I may never go back to red meat, absolutely won't EVER go back to caffiene and never touched alcohol anyway, but I will probably want to reintroduce at least fish and chicken back into my diet sometime next year. Sometimes I miss fast food (when I smell it), I definitely miss things like french fries and popcorn (which I've also cut from my diet because they are fat intensive and don't digest well respectively).

That's my story to date. Now I'd like to make some conclusions/observations:

• This site (or some form of "bowel education") should be mandatory reading for nearly all Americans. Sound bombastic? My research on the Net shows that at least *50%* of Americans will experience symptoms which COULD lead to a fissure before age 50. Still think I'm nuts? Bless you, people need this site and the information it contains!
• It is shocking, amazing and truly unbelievable that something this painful is 100% preventable and yet hardly anyone knows what it is or how to prevent it.
• Given our culture and average diet, it's amazing to me that fissures aren't substantially more common than they are.
• I found that, the more I adhered to a vegetarian diet, the better the food seemed to me. I've actually developed a genuine appetite for vegetables like broccoli and especially asparagus (cook it normally, dip it in a small amount of mayonaise ... you're welcome). I actually enjoy salads now (used to hate them), think non-fat dressings taste good and agree that spinach and broccoli are in fact legitimate pizza toppings.
• If you really miss meat, mushrooms (cooked and uncooked), feel and taste more like meat than any other vegetable I've found (my wife has a way of cooking them with butter and parmesan ... I'll try to get you the recipe).
• Nowhere on the Net is there a "Fissure Recovery Cookbook" ... and there ought to be .
• Nowhere on the Net is there a breakdown of specific foods and a representation of their relative "colon friendliness" factor ... and there REALLY ought to be (geez, it must be lunch time ... I'll get off food now).
• Most medical professionals (on the Net at any rate) will recommend surgery (including the ones reachable from this site). In a way, I see their point: they're licensed medical professionals being asked to make a diagnosis without seeing the patient. Given our amazingly over litigious society and the paranoia that must surround physicians regarding malpractice, imagine the risk a physician would take by telling you over the Net that you might not need surgery. If it turns out you do, they're potentially in big trouble.
• In any case, surgery may fix the problem, but it doesn't *solve* the problem. In any case like mine, I could have had the surgery, and then wound up with another fissure in a few years. What's most needed is a change in how we LIVE; to remove what *causes* a fissure to happen. Always follow you doctor or practitioner's advice (as opposed to mine), but if you haven't tried to solve the problem and are looking to "fix" yourself like a machine, in my opinion you may only find temproary relief.
• Along those lines, I feel very much like Patient 6 in many respects and wonder if there isn't a sort of "prototype" of people who are more prone than normal to fissures (I'm sure there's a good research grant in it for any proctologist wannabe out there). Like her, I'm a 30s, A-type, pro-active personality with (apparently anyway, as I'm about to speak for her and don't know her) little concept of what the word relax really means. Like her condition early on, I feel that no competent physician on Earth would have recommended anything but surgery for me six weeks ago, and that today no competent physician would recommend anything but staying the course to final recovery.
• I would be very interested to see research (particularly "unofficial" research like the kind which can be generated here) on commonalities. For example, I've noted above that I've had three recurrences of light bleeding in the last fourteen days (counting back to when I restarted hard workouts). I noted one other person on this site who was helping a friend move and reaggravated a fissure through heavy strain. I also wondered if, as fissures heal, just like external skin, some tearing of "scab" tissue in the stretching and moving of bowels isn't normal and isn't any reason to panic about the progress of the healing process.
• This may sound very strange, but in a very real way, I'm somewhat grateful to have had this experience. Like the one of my businesses that collapsed, I'm happier to have learned those lessons now, at 32 with no kids and containable, survivable financial damage, than at 42 when the loss might have cost me a kid's college education or our home. Similarly, if I had to learn to live a more harmonious life with a more sensible diet, I'd rather learn that now and minimize the physical damage I've done to myself at this point than later, when the damage might have been substantially more severe and perhaps permanent.

Thanks for letting me tell my story. :-)