Obviously they would be there permanently fixed to the rectal wall,, otherwise
how are they going to pull up the lumps of hemorrhoids ?

This is not like ligation or banding, where the rubber band falls out after it
has cut off the blood supply and the hemorrhoid shrinks.


As Dr Qureshi told me : '' ...... they (the staples) will fall down to the grave with you. ''


I believe they are made of stainless steel. Can't be cheap iron which can rust, like
those office staples.


The correct name is actually stapled ''hemorrhoidopexy'' or ''anopexy'',
not hemorrhoidectomy.

Any surgical procedure ending in '' - tomy '' normally means removal of tissue.


As mentioned here :

'' The procedure causes internal hemorrhoids to pull up and retract. It also severs
the blood supply to the hemorrhoids which may encourage a reduction of size of
the external hemorrhoidal component. ''


http://www.sages.org/meetings/annual-meeti...morrhoidectomy/




You can also see a piece being cut out as ''tissue specimen'' in the last photo of
the above link.



As this surgeon says :


'' I was so excited about stapler hemorrhoidectomy at first .… especially because it
caused only little pain postoperatively until I found out that it can be done on really
a small portion of patients... Only those with pure Prolapsing Internal Hemorrhoids .…
( most of these patients in real life they have advanced mixed hemorrhoids by the
time they reach this stage ) and it leaves - the stapler method that is - half of the
hemorrhoids behind, making long term recurrence of symptoms a problem, and then, c
ame the reports of increasing rate of postoperative pelvic infections to add to my fears
..... so I decided to leave it for only a small number of selected cases. ''

http://www.apcourse.org/template/tools_and_techniques.htm



'' ..... having recurrences after your stapler “Hemorrhoidopexy” - not Hemorrhoidectomy
- because you’ve barely removed 20 % of their Hemorrhoids and left the external elements
up for grabs ( because they ‘re not addressed by PPH alone) ? ''

http://www.apcourse.org/template/for_gener...al_surgeons.htm



I think the surgical specimen which you had cut out was the above 20 %, which
would also be the ''strip of mucosa'' mentioned below, the so-called ''doughnut''.

Does yours look like a doughnut ?



'' PPH employs a unique circular stapler which reduces the degree of prolapse
by excising a circumferential strip of mucosa from the proximal anal canal.
This has the effect of pulling the hemorrhoidal cushions back up into
normal anatomical position ''


http://en.wikipedia.org/wiki/Stapled_hemor...opexy#Procedure



Hospitalised a second time in Sunway after the surgery, under Usha Rani, a
chest physician as well as Akhtar Qureshi, I kept running to the toilet for one
bowel movement after another, and the stools were pencil thin and black.

The nurses noticed this, informed Dr Qureshi. Luckily, the activated charcoal
he gave me reduced it.


Persistent pain and faecal urgency after stapled haemorrhoidectomy.

http://www.ncbi.nlm.nih.gov/pubmed/11085693



Adverse Effects Following Stapled Hemorrhoidectomy.

http://www.aafp.org/afp/2001/0201/p550.html






This post has been edited by Tham: Dec 11 2013, 02:30 AM

There is a plain type ? They stock only one type of the Zara's salt, blue.

Quite idiotic of them to add fragrance to it, I know, since they know very well
that Dead sea salts are meant to be used by eczema and psoriasis sufferers,
which is just why they had that product in the first place.

But I think it should be alright. I've used it many times on my legs as well as the
anus, and the fragrance isn't really irritating. Just go ahead and try it.

But if you find the Epsom's salts work, then use that first. Everything
is money these days.


You had better visit Dr Liew. One way of correcting stenosis is to insert his finger
inside and move it around to try to dilate it.


Otherwise, you can go to your company's GP, or any GP near your house,
and he could also try doing this finger dilation for you.


Once, visiting Dr Ting, my usual skin specialist in Imbi Road for eczema a few months
after the surgery, I requested him to check me out there to see if things had improved.

He put his glove on, inserted his finger and moved it around, and he said
it look alright with no stenosis.




This post has been edited by Tham: Dec 12 2013, 06:15 PM

If there's a good supplement for constipation, it's artichoke extracts.

It works by causing extra bile secretion from your gall bladder.

There will definitely be more stools, but softer and yellowish.

Improves digestion, reduces flatulence, knocks down triglycerides.

Liver protector and detoxifier.

The cynarin in artichokes is also a cancer fighter.

http://www.lef.org/protocols/gastrointesti...isorders_05.htm


I think it is far more useful for the liver than milk thistle.

Here's one which I used to order.

http://www.healthspan.co.uk/products/artichoke-extract


I have this in my office now, almost finished.

http://www.iherb.com/Nature-s-Way-Artichok...0-Capsules/1824

Yes, Ting can be extremely busy, and doesn't say much either, at times.
He shuffles between two consultation rooms when seeing patients.

He probably sees easily 200 patients a day.

I asked him once how he managed to take the pressure, adding that
I could never handle the kind of pressure he faced day in, day out,
resting just a day and a half a week.

Once, I was describing to him a particular symptom. Before I could finish, he
was already walking to the other room, and I had to raise my voice a little so
he could hear what I was saying as he went over the other side !

What fiber did Tung Shin give you ?

Maybe you could try this, which is glucomannan. I tried it once and it seemed
to be quite pleasant to take, caused little flatulence and no cramps, unlike psyllium.

Also increased quite a bit of soft stools. About $2 a sachet.

http://www.youtube.com/watch?v=ceaYCZQqrBc

http://www.rakuten.com.my/shop/caringpharm...TC0006_0209031/


http://www.thestar.com.my/story.aspx?sec=c...ntral%2f7719099



The above, as well as psyllium, are all bulking agents, and just help to make
the stools bulkier.

If you can't push, that will make things worse.

I think what you need is to improve peristalsis in your intestines, i.e. stimulate
the colon's muscles to move the stools.

For that, try taking a small dose of senna (Senokot), maybe half a tablet. Don't take a full
tablet for a start, can cause spasms or cramps - that's how it makes the colon push.

Another one is Skilax liquid - I still have a bottle in my office, which is sodium
picosulfate, similar to bisacodyl (Dulcolax).

I prefer that because you can control how many drops you want to take.
Try just 3 drops into a glass of water for a start. About $11 a bottle.

http://www.globalnapi.com/PR_Consumer.asp?ID=26

http://www.ubuy.com.kw/images/productImage...32012123254.jpg


http://parenthots.com/q_a/panel_of_experts...x?c=0&q=145&p=1



Multicenter, 4-week, double-blind, randomized, placebo-controlled
trial of sodium picosulfate in patients with chronic constipation.

http://www.ncbi.nlm.nih.gov/pubmed/20179697


Laxigal effectiveness in constipation of various etiology.

http://www.ncbi.nlm.nih.gov/pubmed/11210355



Psychological well-being and symptoms in women with chronic
constipation treated with sodium picosulphate.

http://www.ncbi.nlm.nih.gov/pubmed/15738724



Randomised, placebo-controlled, double-blind study to investigate
the efficacy and safety of the acute use of sodium picosulphate in
patients with chronic constipation.

http://www.ncbi.nlm.nih.gov/pubmed/17504357

Why don't you go see Dr Anantha at Sentosa for a review ?

I went to see him about two months after my surgery. He was very nice
and accomodating, even though I had not selected him as my surgeon.

He's quite experienced and skilled. If Sentosa had the harmonic scalpel
at that time, I would have chosen him. He only had diathermy.

As mentioned earlier, he had done the hemorrhoidectomy for my father
some time in 1994. Despite using diathermy, which is supposed to be
quite painful, my father, who had very big, bleeding piles, said he had
pain like just ''ants biting'', recovered quite soon with virtually no
complaints of contipation, diarrhea, bleeding, gas, stenosis or any
other problems !

Before the surgery, my father, who had delayed surgery because
people told him he would ''lose control'', bled so much many times
(never told us because he was an introvert) that he ended up being
hospitalised in Damai Hospital with five pints of tranfusion !

This neighbour woman near my house told me that Dr Anantha had
done five surgeries on her !

Just go and see Dr Anantha to check you out properly for a second opinion,
regardless of how you are next week.

His charges won't be very high, and his assessment would be well worth it.

I don't know his consultation fees these days, but the last few times I saw him
maybe five years ago, it was just about $ 35. He's also very considerate, and
asked me if I wished to buy the medication he prescribed for me outside, since
the cost would obviously be higher at the in-house pharmacy.

After that, you could always follow up with him on this, or any other future
problems. He's really an experienced and reassuring surgeon.

He's the surgeon I should have gone to in December 2004 for the cellulitis infection
at the bottom of my left big toe, but my elder brother took me to Sunway instead
because it was nearer, where an orthopedic surgeon, Lee Chong Meng, did an
extremely painful I & D (incision and drainage) surgery on it to drain out an abscess
there. I was left hopping about for two months with a one and a half inch OPEN
wound there, which looked like a huge gunshot wound.

I also saw Anantha to assess that after I came out from Sunway.

I intend to see him one of these days too, for this persistent pain on the right side
of my right lung, after the chest drain for the pleural effusion done by my schoolmate,
Yap Boon Hung, in November 2011.

You may have fecal impaction. You can't be drinking too much fiber as I said.
You'll just be causing more stools to form inside with no means of pushing it out.

It's like pouring more rubbish down a clogged drain.

And what do you think will happen if the opening of the drain has narrowed too,
as with rectal stenosis ? How are you going to push it out a pencil-thin opening ?


There are two main types of laxatives :

1. Bulking agents, which is fiber. Lactulose and probiotics would also cause more
bulk (and gas) to form, but without any assistance of peristaltic effect.

2. Peristaltic agents, which stimulate your colon to propel out the stools.
Senna, bisacodyl, sodium picosulfate.


The elderly, for example, need the second type, because their colon have become
immotile with age.

Obviously you won't become dependent on artichokes. It's just a vegetable.
It stimulates bile movement from your gallbladder, which accounts for the
yellowishness of the stools passed out.

Thus it is not recommended if you have bile stones, because the flow of bile
may cause the stone to move and get stuck at the bile duct opening. I have
long wanted to give it to my father, but was afraid this might happen because
I know he has a small stone in there, from an ultrasound done at Tung Shin
about 15 years ago.

In a sense, it is also a bulking agent, causing the formation of more stools, but
safer than fiber, which just attracts water to the stools, causing them to swell up,
which are obviously going to make things worse if your colon is obstructed
with fecal impaction, or stenosis at the end of the rectum.






This post has been edited by Tham: Dec 15 2013, 01:07 AM

Well, disappointing news, my worst fears confirmed. I called Sentosa and
Dr Anantha has retired. Hopeless operator service, nobody seems to answer
most of the time.

Before I could ask her when Dr Anantha had retired, she put the receiver down.

http://www.nsr.org.my/list1viewdetails.asp?Account=1073


From the year he obtained his MBBS, he would be about 62 to 63 now. Hard to
find another surgeon with his level of experience, skill and etiquette.

Why do you have so many unfounded fears ? The case you mentioned of some
girl having to resect her inactive colon is a very rare, extreme one. You are not going
to end up with an immotile colon just because you took sodium picosulfate for a
few weeks, at a low dose, let alone artichoke extracts.

I don't think you have bile stones, so just go ahead and try it. If you wish to be
even more cautious, pour out half or two-thirds of the capsule to another empty
one, and take the rest.

I also have a few small skin tags there, a bit painful in fact if you touch it, and itches
at times too. Started with one, Dr Anantha examined it, I asked him to cut it away
but he said no, might cause infection.

No, never fully recovered. There is still some pain there when I walk or put a bit of
pressure there at times. I am wondering if it was due to that stupid, irresponsible
staff nurse called Juliana who did the initial cleaning of the dressing after the surgery
- she kept poking away with her tweezers at the open wound without a care in the world,
causing me to scream repeatedly in front of many visitors at that time. She must have
damaged some of the nerve fibers there permanently.

I wrote an email to Sunway some time ago, threatening to sue them because of that
dumb b****.

Worse, the scar is at the outer edge of the toe, so forms a callous when I walk.
I have to file it away once a week.

Dr Ting said some time ago he could use liquid nitrogen to burn it off.

Which part did your friend have that incision and drainage ? Was it due to cellulitis ?
Did he not try other treatments or procedures to lessen the pain ?

You never mentioned you were a woman. I was under the impression you
were male all the while.

I'm guessing you have a fungal infection from your vagina to your anus.
In your gender, your anus and vagina are just about an inch apart, virtually
a hop,skip and jump for any bacteria or fungus from one opening to the other.

Well, go see a gynecologist or dermatologist and see if he/she can check that out.

Otherwise, go to your friendly pharmacy, ask for miconazole + hydrocortisone cream
to apply around your anus. Some generic brands around, like ''Micort'', ''Zaricort'',
''Decocort'' for example. The pharmacist would know what to give you.


Kotra Pharma's product, Axcel Fungicort, which is in micronized form, looks
a superior cream.

http://www.kotrapharma.com/search.asp?by=b...atological+Care


Plain miconazole cream (''Daktarin'' or generics) may also be used.


In fact, I applied Decocort around my ass today. Dr Ting had given me the
same type of cream years ago after checking out my itch there, so I have
followed up with it since.


The other antifungals typically used for vaginal candida infections are :

Clotrimazole
Econazole
Nyastatin


So you can also apply those on your ass or vagina, with or without steroids.



Secondly, stop the prunes for at least two weeks, plus whatever ''lui cha''
you are taking.

The ingredient in prunes which account for its laxative action is phenolphthalein.

Not only is that an irritant, it is carcinogenic.


Phenolphthalein-induced toxic epidermal necrolysis.

http://www.ncbi.nlm.nih.gov/m/pubmed/9337441



Subchronic (13-week) toxicity studies of oral phenolphthalein
in Fischer 344 rats and B6C3F1 mice.

http://www.ncbi.nlm.nih.gov/m/pubmed/1601209/



The Toxic Powers of Phenolphthalein.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC402437/



It is also the ingredient used in the antique laxactive, ''Brooklax'',
long taken out from the market. My father used to take this in the 60s.


http://www.oldshopstuff.com/Shop/tabid/124...ve/Default.aspx



Phenolphthalein Poisoning.

http://archive.samj.org.za/1976%20VOL%20L%...SE%20REPORT.pdf

What are some things to know about phenolphthalein before pranking with it?



http://answers.yahoo.com/question/index?qi...25131318AAM8Xws

I don't think your friend's case was cellulitis.

The incision and drainange surgery is to drain out the abscess
caused by the serious bacterial infection.

Once the abscess is drained out, and strong antibiotics are given IV,
the infection usually subsides, and with it the swelling.

Usually any physician or surgeon should be able to treat him.

The wound has to be left open, unstitched, after the surgery,
otherwise another abscess would form again, as the bacteria
are still active inside.

Mine took a week to subside after the drainage. I was on one of the
strongest antibiotics IV, imipenem ($ 250 a bottle), followed by
ciprofloxacin ($ 100 a bottle, usually given for anthrax).

If his leg is still swollen, it may be due to something else. Congestive
heart failure, diabetes, arthritis ?

If it is really cellulitis and the infection is not cleared, it would go into
the lymph nodes and cause lymphagitis (as mine did right up to the groin),
and then on into the blood, as you had read. The end result is septicemia,
which can kill.

Celllulitis is usually caued by Staphylococcus aureus, the bacteria normally
found on our skin.

I thought you said your itch was just at the anal entrance.

Didn't you discuss with Dr Liew about this ? What did he
say ? Didn't he give you some Xyloproct or Protosedyl cream or
suppositories for it ?

As mentioned earlier, I still think the itch is a symptom of the wound healing.

You could visit Dr Ting or other dermatologist and let them assess you further.


Otherwise, go to a Chinese medicine shop, ask for ''Musk Hemorrhoid Ointment''.

Me and my parents used to apply a lot of it, Quite cooling and soothing, so it
may reduce the itch. Apply a small amount externally first to see how it feels.

It was a yellowish/green tube and box, and the cream was yellowish/brownish.
Smells a bit.

I think it was a different brand from this one here.

http://myhemorrhoid-treatments.blogspot.co...01_archive.html



I also tried these ''Fargelin'' tablets in those days, but didnt' really help me.

He also says here that his piles itched when they were healing.

http://myhemorrhoid-treatments.blogspot.co...argelin-36.html

As for your friend's case, with a symptom like leg edema, how can
it be that no doctor was able to tell him as to what might be the cause ?

Surely they can find out with proper investigations ?

Well, tell him to try my schoolmate, Yap Boon Hung, a physician and
rheumatologist in Tung Shin. I'm sure he can figure out what's wrong.

If it stings, then you should stop using it.

As I have suggested, go get that Musk ointment from Chinese medicine shops.
It's quite common and costs just a few dollars.

The cool and soothing effect of the ointment would reduce the itch.


There can only be three causes for your itch :

1. The staples fixed on the inside of your rectum, grabbing the muscle there,
is causing some spasm and irritation. This would also likely be the cause
of the fecal urgency.

2. Your wound is healing, and hemorrhoid shrinking.

3. There is some candida infection there, likely spread from your genital area.


You haven't answered if you had asked Dr Liew about this and what he has
said about this.

If you have and he has not been able to help you there, then go see Dr Qureshi,
since Dr Anantha has retired. He should be able to give you a proper assessment.

Or go and see a good dermatologist like Dr Ting, or Dr Koh Chuan Keng in Damansara
Utama.

You could also try taking an antihistamine like Claritine or Atarax before bed
and see if it reduces the itch.

The old phenothiazine-class drug, Vallergan (trimeprazine), is actually quite effective
for itching. Dr Ting used to give it to me for my eczema when I first started seeing him
over a decade ago.


However, I don't think it is available in the market here anymore. The alternative, and
related drug, is promethazine (Phenergan), usually found in cough syrups and
anti-seasickness pills.



Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree
hemorrhoids: a randomized, clinical trial and review of the literature.


'' Persistence of itching was reported in six patients in the stapled
group and in one of the diathermy excision group. ''

http://www.ncbi.nlm.nih.gov/pubmed/15785901




'' One of my symptoms, post op, is an urgent need to go. Two and a half years
after the op, I still need to get to the toilet in a hurry. I cannot hold it in and
apparently my sphincter muscle was NOT damaged in the op. Extreme urgency
has been noted in some people after PPH surgery. ''


'' I do remember however, the awful internal itch which lasted for about
20 minutes after every BM. If I could have reached inside I would have
ripped out those staples. ''


http://www.healthboards.com/boards/bowel-d...urgery-pph.html




Some studies report less itching with the staple than excision, but actual
experiences, as in the above forum, reveal the reverse is true.


Hemorrhoid Stapling Has More Long-Term Risks Than Surgical Removal.

'' In favor of stapling, results were better in terms of less pain, itching or bowel-movement
urgency; however, these were data "trends" that did not reach the level of significance.
All other clinical outcomes favored excisional surgery. ''


http://www.sciencedaily.com/releases/2006/...61018094723.htm






This post has been edited by Tham: Dec 20 2013, 10:20 PM

Treatment of hemorrhoids with individualized homeopathy:
An open observational pilot study.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061475/

Ah, another skeptic who thinks homeopathic remedies are "nonsense"
or "snake oil" ?

I always love challenging such skeptics.


Do this :



Go to TM Shafi's, the small homeopathic store in Brickfields, just
opposite the YMCA.

https://www.facebook.com/syarikattmshafi/


Ask them to prepare for you SULPHUR MMM.

Pellets or water, your choice.


MMM = 100 to the POWER of minus ONE BILLION.


That means Sulphur has been potentized, or "diluted" down
to 100 to the power of one billion times.

If you use your scientific calculator :

100 ^ 1,000,000,000


The display will show infinity.


Guaranteed to be nothing more a totally inert, worthless, placebo
- i.e. sweet little empty sugar pills or distilled water, right ?


Take one tiny pellet, or one teaspoonful of the "distilled water",
twice daily, for two weeks.


Then come back and tell us what happened to you.


I think you'll change your mind about homeopathy after that.





( Incidentally, TM Shafi also sells homeopathic creams for hemorrhoids,
if you do change your mind. )



( You may also ask them to custom prepare for you pellets infused
with the following remedies for oral intake :

Nux vomica 6x
Millefolium 6x
Collinsonia 6x
Rathania 6x
Paeonia 6x
Aloes socotrina 6x )



This post has been edited by Tham: Mar 14 2017, 10:47 AM

Since you feel homeopathy is "nonsense", then
don't try the medication, right or not ?

And as I have challenged you, try the Sulphur MMM,
and you'll definitely change your ridicule of homeopathy,

You are referring to Dr Samuel Tay.

At that time, I told you that Dr Akhtar Qureshi is also quite experienced
as well as a colorectal surgeon. but you did not want to see him, as
well as not opt for the staple as I had advised.


Akhtar Qureshi uses both the harmonic scalpel and staple. If they
have the laser there, he probably uses it too.

He said he is quite selective with the staple, as :

1. It can give rise to complications if not done properly
2. Has a high relapse rate
3, Cannot be used for really big hemorrhoids (like one of mine !)


Even Dr Ashim Nandy (Pantai and Tung Shin) said the staple
is "not troublefree".

The laser is more for smaller hemorrhoids.

This new Thunderbeat device seems quite good.

Ask the surgeon if he has it.

Combines the harmonic scalpel (ultrasound) and Ligasure
(bipolar heat cutter).


http://medical.olympusamerica.com/products/thunderbeat

http://www.olympusvideocenter.com/videos/t...emorrhoidectomy

https://www.youtube.com/watch?v=5gvm9sNVW4o

https://wn.com/hemorrhoidectomy_surgery_thu..._frederick_lane


https://www.laparoscopyhospital.com/article...thunderbeat.pdf



Lasers are more for smaller hemorrhoids.


Pantai KL has had the laser for many years.

Way back in 2003, I called Dr Lee Hock Bee there to enquire
about the staple.

https://www.pantai.com.my/kuala-lumpur/doct...dr-lee-hock-bee


He said he had switched over from the harmonic scalpel to
the staple for most hemorrhoid surgeries.

He used the laser for first to second degree hemorrhoids.

You can try calling him to ask if he still uses it if you want to
try the laser.

Luckily the stenosis largely improved, about 70 percent,
after a few months.

Whenever you cut any part of the body, the scar which
forms back is usually harder than natural skin, so there
will be bound to be some stenosis or narrowing

Your anus is obviously not as elastic or can
stretch as when it was new.

The external hemorrhoid is still there, and at times
does bother me, especially when I have diarrhea
or constipate (I have IBS since my young days).

One of these days, I think I will have to get it removed.

If you are planning to have surgery, ask the surgeon
to use the harmonic scalpel, Ligasure or one of the
new generation thermal scissors. Do not choose the
staple.

My ex-schoolmate's (Dr Yap Boon Hung in Tung Shin)
late father had hemorrhoidectomy three times.