Patient 38

To: jackfaf6.arc.nasa.gov
Subject: An Anal Fissure Patient
Date: Sat, 1 Feb 2003 17:30:14 -0600

Dear Jack,

I am an anal fissure patient who found your website in November just after I was diagnosed. What you have done here is just what I needed to read at that time and for many days since. I applaud the professionalism and "real application" with which you have done this. How nice it would be to have this type forum available with many other health and life issues.

Just a synopsis of what occurred to me:

I am a 48 year old female executive, very active and healthy, who was diagnosed in October with osteopenia, the precursor to osteoporosis (I am tall and thin and this disease runs in my family). My gynecologist placed me on high doses (1200 mg) of calcium daily, along with the usual dietary calcium I was receiving....yogurt, skim milk, cheese, etc, and prescribed Fosamax. The plan was to build back the bone. My schedule is quite busy and hectic and it was one week before I realized that my normally well-functioning elimination system was in trouble...I was significantly constipated, though I had to do some research to know that was the problem. I did a quick internet search of the words "calcium + constipation" and was shocked to find such a substantial amount of information on the subject...though my gynecologist never mentioned constipation as a possible problem. I had some rectal bleeding at that time, assumed I might have a hemorrhoid (never had one though surmised that was what it was from the website info) and purchased over-the-counter Anusol. I quickly dropped back on the calcium from supplements and substituted more dairy for it. My regular bowel function returned for a week or so but the rectal bleeding and irritation never subsided. I called the gynecologist who referred me to a colo-rectal specialist. He quickly diagnosed my anal fissure and I was shocked. We discussed all the alternatives, including surgery, but he felt it would heal on its own. I liked that choice. He prescribed Analpram....which I did not tolerate at all....I was so sensitive to it that I felt over a period of time that it was causing me more pain. He told me about using nitroglycerin but said it would only work on the involuntary muscle spasms but would not aid in healing the fissure. I elected to forgo that choice, especially with the side effects he noted.

I felt I was getting better, some days of minimal pain but one or two a week with more pain, then my constipation returned for a day or two at a time. I have had weekly massages for years and have come to understand muscles and their function, so I felt that exercising the muscle when I had pain was a good thing. That worked most of the time but did not at other times...when the involuntary muscle was in spasms. My diet mistake at this time was that I was still trying to "heal the bone loss" and was ingesting more calcium than I could handle and cure a fissure at the same time. I spent one four day weekend in so much pain that I knew I could not handle it anymore. The Aleve that I had used would not cut the pain and I was spending 8-10 hours in substantial pain from the spasms. I was able to see the colo-rectal specialist on day 4 and he said that the fissure was wider and deeper and that he recommended day surgery. I scheduled it for the first opening, 3 days later. It was time to "get this over with" because I had had no quality of life for two months.

The surgery was brief and went well. The recovery was another story. I have never had surgery, never taken prescription narcotics and have been in excellent health for years from working out on a regular basis. I did not tolerate the anesthesia, Demerol and Vicodin that I was given. The recovery room staff all told me that "the healthy ones are the ones with the problems when given these drugs." I lost consciousness 3 times over 6 hours, had my blood pressure go to 87 over 32 (normal blood pressure for me is 122 over 74 or so) and ended up admitted to the hospital for 36 hours until I stabilized. My pain medication was switched to Darvocet along with Vioxx, an anti-inflammatory. With all the drug reactions, I will tell you that I never had any pain! Not one moment. I took the last Darvocet about 30 hours after surgery.

I spent one week at home recovering....not so much from the surgery I suppose as the drugs' impact on my system. I followed post-surgical guidelines to the letter by having a high fiber diet (I had one already) with no dairy at all (bold letters on the instructions: DAIRY CAUSES CONSTIPATION AND IS TO BE AVOIDED COMPLETELY), sitz baths three times per day, lots of water and using psyllium and stool softeners. My greatest fear was handling the first bowel movement. It was a non-event! I have had no problems at all. I was driving myself without pain or problem within one week of the surgery.

The issue I face now is what to do for building bone and halting and reversing the osteopenia.

Jack, let me know if this is helpful. And, of course, please do not use my name.