How I Got Here

Author’s note: In the spirit of authenticity and candor — and in order for the story to make sense — I have to get pretty real in this post about symptoms and anatomy. If semi-graphic butt stuff if really not your thing, maybe wait for the next post. 🙂

First, I got a bit of good news today: The CT scan results showed a few very small spots on my liver but was otherwise clean. I’m getting an MRI tomorrow to get a closer look at those spots, but it sounds as though small spots like that (essentially too small to analyze with a CT scan) are commonly just benign cysts; we’ll see. Either way, it was a huge relief to rule out what was probably the most terrifying potential result (cancer everywhere).

Ok, so the back story. I’m sharing this because I think there’s a lot to learn for anyone who’s ever had (or will ever have) a weird symptom they didn’t think was a big deal. I certainly don’t mean to sow fear or to send people running to their doctors for every little bump and bruise. But when it comes to colorectal health, the stakes are high and it’s worth the minor inconvenience of a possibly unnecessary checkup if something just ain’t right.

At the end of 2018, I thought I had hemorrhoids. A friend of mine happened to be suffering from hemorrhoids at the same time, so as we commiserated, it was easy to jump to the conclusion that our affliction was shared. I had pain, pressure, and even some weird yellow pus. I still lived in San Francisco at the time, so I went to One Medical (I never had a primary care doctor there) and after taking a look, they sent me on my way with typical over-the-counter hemorrhoid remedies and recommendations: a cream, sitz baths, etc.

After a few months (yes, months; this is where I began a horrible pattern of dragging my feet on simple next steps, essentially neglecting my health because I was “too busy”), I’d had some periods of relief, but in general things weren’t much better, so I went back to One Medical. This time, they said, “Hmm, doesn’t actually look like hemorrhoids. You should see a specialist.” They referred me to a local colorectal surgeon.

By the time I sat down with the surgeon, it was pushing mid-2019. I liked him a lot. Before he examined me, he drew me a diagram explaining how hemorrhoids work, and it made a lot of sense. Then he examined me and said, “Well, this isn’t hemorrhoids. Time for a new drawing.” He sketched and explained what an anal fistula was: basically an abscess that turns into a tunnel through your butt. (Here is a better description.) Finally, an explanation for the pus!

I needed surgery — a fistulectomy — and again in classic foot-dragging style, didn’t actually get it done until August 2019. But it went well, and my surgeon did a great job (it’s evidently somewhat challenging to make sure not to damage the anal sphincter’s delicate muscles). The pain was gone, the pressure was gone — it was amazing!

But the pus wasn’t gone. For whatever reason, I didn’t think much of it. I was so happy to have some relief that I suppose I figured the very minor discomfort of a little lingering pus in your butt was a small price to pay to not be in pain anymore. We moved from California to Ohio, life got crazy, and I procrastinated.

Then finally in December, I happened to be back in SF for work and went to see my surgeon. I explained that I still had the pus problem. He said that sometimes the fistula doesn’t heal perfectly and there can still be a little opening or flap of skin where pus can collect. Without a full exam under anesthesia, he said, it would be impossible to tell what’s going on. But he didn’t seem alarmed, and for whatever reason, his guess was good enough for me. (Not-so-fun fact: After that appointment, I walked across the street to Peet’s Coffee, sat down to do a little work, and had my laptop stolen right out from underneath my fingertips. Crazy stuff. Important: If this ever happens to you, do NOT chase the thief like I did. I got lucky and didn’t get hurt; tragically, some others have not been as fortunate.)

Anyway, I did ask my SF surgeon to recommend a surgeon in Ohio — which he did, a very well known one at the Cleveland Clinic. After a few more months of procrastination, I gave his office a call in March of this year and got on the calendar. Then COVID hit, patients with non-life-threatening ailments were supposed to wait it out, and I had another foot-dragging excuse.

Finally, at the end of July, I got my butt up to Cleveland to see my new surgeon. He’s great. I explained my whole weird story. First thing he had me do? Go get a colonoscopy. If you’re keeping score at home, that’s a whopping 20 months from the first time I had a butt problem to my first colonoscopy. I have to assume that my 40-mm cancerous polyp took a heck of a lot longer than that to form.

So there you have it; that’s the story. It took longer to tell than I planned, so I’ll save the rest of my thoughts for a future post. More to come.

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