Hi. A month ago, my piles flares and subsided after given daflon but it left a piece of skin there. Then this month I started to have constipation again despite eating plenty fruits and vege, so I tried probiotic and got bowel movement again - very nice everyday. Then on 3rd day the hemorrhoid flares again, this time not too swollen but I got sore pain and terrible itch in anus. Went to kpj to see if they will remove the pile but they said it s very small only and its not bleeding. I was given medication and fibers. The piles/skin tag is small most of the time but the itch and soreness especially after bowel movement and at night is terrible. It will swell after I went to toilet, whenever I squat down and when I walk a lot, sometimes have wetness on it. 2 weeks have pass and I have been on vege, rice and fruits diet, but the condition still the same. Are there any good colorectal in klang valley area to recommend? I had been to kpj 3 times seeing a general surgeon, so I am thinking to see colorectal specialist.

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This post has been edited by momusu: Dec 7 2013, 08:20 AM

Are they sure it is just a skin tag ?

It may be an external pile. That's what I have now, after surgery to remove
some pretty huge internal hemorrhoids in 2003.

An experienced and reputable colorectal surgeon is Dr Akhtar Qureshi in
Sunway Medical Center.

Dr Anantharachagan is a general surgeon in Sentosa Medical Center, but
quiet experienced in hemorrhoids and colorecal surgery too.


Rubber band ligation, or banding, is not suitable for external hemorrhoids,
because they lie below the dentate line, where it is full of nerves and will
cause excruciating pain.

Dr Mohd Anis, who practises in SJMC as well, ligated me there a couple of
times over two decades ago, and the pain was horrendous for a couple of days.
I could barely sit down and felt as if someone or something was grabbing my
skin there all the while.


The latest treatment for internal ones appears to be HAL, or hemorrhoid artery ligation.

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



http://www.youtube.com/watch?v=H6NVQzfQzkQ


Otherwise, if surgey is required, these are newest cutting devices :

1. Starion thermal welding
2. Ligasure bipolar diathermy
3. Harmonic scalpel
4. Laser


Make sure you don't go for the staple method (which I had), or else you
may end up with lots of problems.

Dr Samuel Tay in Sunway also uses Ligasure.


This clinic in PJ also appears to have Ligasure.

http://klinikbuasir.com/index.php/hubungi


Starion is now known as Microline.

http://www.microlinesurgical.com/company/a...roline-surgical


Ligasure.

http://surgical.covidien.com/products/vessel-sealing


http://www.youtube.com/watch?v=x9e4ArimjVU

http://www.youtube.com/watch?v=gDNyKfG9Bug

http://www.youtube.com/watch?v=6BWscApj-d8

http://www.youtube.com/watch?v=qcaP58wOses



Randomized Trial Comparing a Starion™ and
a Harmonic Scalpel™ Hemorrhoidectomy.

http://www.coloproctol.org/search.php?wher...vmode=PUBREADER



Prospective, randomized, controlled trial of Starion vs Ligasure
hemorrhoidectomy for prolapsed hemorrhoids.


http://www.ncbi.nlm.nih.gov/m/pubmed/17587087/



Comparison of Ligasure Hemorrhoidectomy with
Conventional Ferguson’s Hemorrhoidectomy.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002768/




This post has been edited by Tham: Nov 28 2013, 08:41 PM

No, I didn't push it. Since I went to KPJ 2 weeks ago, I have been faithfully taking the psyllium husk fiber they prescribed. I have bowel movement everyday since then (I used to be able to have bowel movement after 4 or 5 days). I even googled for the correct way to bowel movement - suck in breath, hold it and let it come out by itself. Still that piece of piles still comes out, slightly swelling and very sore. After washing, it popped back 'inside' but carry with it the terrible itch. The itch is no joke, so terrible that (sorry for the graphic) that all I wanted to do it stick my finger inside and scratch it! I have been sleeping in sitting position for days because sitting position seemed to help with the itch a little.

At first, I was put on Daflon 6 pills per day, until the 5th day, I got hives all over my body probably because of allergy. I stopped taking it now cause even when I take it, the itch is still there. Oral steroid and anti histamine doesn't help too.

On the other hand, the stool seemed to contain lots of undigested food, very wet and 'burn' my anus even though I am not eating spicy food.

It's confirmed a hemorrhoid. Problem is it flares, pains and itch but will not be swollen enough for the surgeon to help me remove it. Worse, it always went 'inside' whenever they checked me. The surgeon at KPJ and the GP I went, both said it's because my skin near the anus is too dry. But I have took all the precaution not to irritate the skin - no scrubbing, no toilet paper, just wash with flowing water, sitz bath, wear cotton pants but still the itch is there. I woke up once or twice at night just to sit in the sitz bath to ease the itch.

Dr Akhtar Qureshi is good? I see his schedule in Sunway Medical site and he's available tomorrow. Maybe I'll go to him tomorrow. I just hope he's willing to do something about that hide-and-seek piles.

Seriously, I am considering to just gulp down chillies and hot stuffs to make it swell and bleeding so they will cut it off

This post has been edited by lowlowc: Nov 28 2013, 09:26 PM

Hemorrhoids will tend to itch sometimes, even mine.

You also probably have some mild eczema there.

Yours prolapses, then goes back in spontaneously, so you probably
just have second degree internal hemorrhoids, quite mild.

If you see Akthar Qureshi, he will probably just give you Xyloproct
or Proctosedyl cream, something you can buy yourself anywhere.

These contains some mild steroid like hydrocortisone to reduce the
inflammation and itch, plus aesculin (from horse chestnut) to improve
the venous blood flow there a bit, and thus shrink it a litle.

Otherwise, go down to TM Shafi, a small homeopathic shop at the
row of shophouses opposite YMCA in Brickfields. They have homeopathic
pile creams which are usually quite moisturising, so may reduce the
dry skin and itch.


Another time and tested remedy is salt, i.e. sitz baths. Buy Cosway's
Zara Dead Sea Salts, blue in color. Sprinkle say two tablespoonsfuls in
a small tub which just about fits your toilet bowl, add in fairly hot water,
then sit there for at least 15 minutes.

I am sure that will relieve the itch and pain somewhat.

That was what I did way back in December 2003, when, coming home
after the surgery (stapled plus diathermy), I was in really bad pain.

So my sister came over, prepared the above sitz bath, and luckily the
pain subsided after that.

If you can't get the salt, ordinary table salt, or those cheap rock sea salts
from the supermarket will do.

Dr Anantha also advised my father to do that after he had removed his
piles many years ago. Surprisingly, my father said he had hardly any pain
from the surgery, while mine, like many others, was like the end of the world.

I think those brownish colored Himalaya rock salts are also suitable.


My elder brother had an acute attack too not too long ago, after I thought
all the while that he was one of the lucky ones with no hemorrhoids.

He surfed the net, then made an ice pack and placed it there.

Also bought Daflon, took a loading dosage of 6 tabs the first day, then 4
the next two days, then 2 daily.

It subsided.




This post has been edited by Tham: Nov 28 2013, 10:41 PM

Thanks for the info you gave.I did sitz bath every day with rock salt, it did took away the itch but not for long.

I had tried Protosedyl for 2 weeks now, sometimes it works a little, sometimes sting my skin. I really hope the doctor won't be giving me anymore medication, cause they just slighly easen the itch, not cut off the problem.

Now thinking back, is it possible that the itch reaction on my pile is triggered by probiotic I first took before the pile flares up? Also I noticed the itch has worsen today after I ate a spoonful of plain yogurt. Possible?

Yes, it's quite possible.

Probiotics are after all bacteria, and just like antibiotics,
can trigger off allergies or other reactions in some people.

Just stop them for a couple of weeks and see how it goes.

Even fiber doesn't agree with me very well. If I take Metamucil,
I will get cramps the whole night long.

Finally someone agrees with me that probiotics can trigger adverse reaction. I have been searching long for connection between itchy anus and probiotic but nothing come out. Only today I tried the keyword allergy and probiotics and now it seemed clear. It does trigger itchy skin and hives, just too bad of all the places to itch, it has to be that part.

I didn't ended up going to Sunway because of the price, but went to Tung Shin. I was asked to lie sideway and tried to push out the piles. It was diagnosed as almost level 3. Unlike previous surgeon, he recommend removing it if it's hindering my daily activity, so I agreed. Will be doing both colonoscopy (to see any underlying answer to why I can't get normal bowel movement) and surgery on Monday. Somehow, I feel very gan cheong now.

So which surgeon did you see there ?

Was it Lim Chwen Loong or Muthu ?

Did you ask him which device he is going to use ?

I see Dr Lim. He showed me a diagram of the process. Something like this but I cannot be sure.



I'm so sorry, I woke up early in the morning, not enough sleep, straight away went to hospital, happy that he's going to operate it and totally forgot the instruments you recommended to me.

This post has been edited by lowlowc: Nov 29 2013, 05:53 PM

Staple method.

If he does a good job, then good. If not, you'll have problems - bleeding,
intense pain, stenosis (narrowing of your anus).

The staple is made by Johnson & Johnson ...... in Mexico.

Looks very flimsy, plastic, like a kid's toy ray gun.

Costs at least ...... $1,000.

You should have asked for the harmonic scalpel, Starion or Ligasure,
but anyway, it's already scheduled.

How much is he charging you ?

I'll call back the doctor's assistant tml to ask what's the method because after looking at the video you gave it looked la bit like HAL pulak. I do remember him mention the surgery takes 20 minutes only.

As for charges, I did not ask, going to let my company insurance settle it and have taken the letter of guarantee.

One thing though, is there anything I should do after the surgery to speed up the healing. My mum told me to drink pati ikan haruan, or eat the fish for faster healing of the wound but I'm skeptical since a lot of food seemed to trigger my itchy anus recently.

Another colleague who had surgery to remove a few 3 and 4 degree piles 2 years ago, swears applying Gamogen/minyak gamat to that wound speed up her recovery.

After reading more info, a lot of people introduce sitz bath. I am thinking to buy a proper sitz bath (currently using pail and sea salt) and Epsom salt. Is Epsom salt better than rock salt. I know they're different properties and there's mixed review for both. Or the Cosway one is better?

As for the probiotic reaction, I had stop it the moment the symptom appears, it's been more than 2 weeks now but do you think it still need more time to clear the allergy symptom?

This post has been edited by lowlowc: Nov 30 2013, 02:21 AM

please do check how much it is...i would like to know

My uncle just discharged from Sentosa about a month ago and it cost 3K++.

Not sure the method of his surgery though.

Shit! I called back and they said it's stapler method. Tham, the staple method you had previously is in 2003, right? What are the complications you have after that, other than the pain? Relapse?

Andrekua, how's your uncle now?

Abubin, will let you know when I see the bill. For now, I don't bother. I just let my company insurance settles money matter and I'm now worried about the procedure only.

Yes, the snakehead fish, Haruan, Channa striatus is documented
to have wound healing, pain reducing and energy-boosing properties.

It would also be a good idead to take it to reduce high blood pressure,
depression, prevent/treat Alzheimer's and as an adaptogen.

This means that the fish would be a good antiaging food.



Therapeutic potential of the haruan (Channa striatus):
from food to medicinal uses.

'' This review updates research findings on potential uses of Channa striatus,
beyond the traditional prescription as a wound healer, pain reliever and energy
booster to include its properties as a ACE-inhibitor, anti-depressant and
neuroregenerative agent. The fish appears to have wide-ranging medical uses
and should be studied more intensively to unearth its other properties and
mechanisms of action. ''


http://www.ncbi.nlm.nih.gov/pubmed/23713236




Wound healing effect of Haruan (Channa striatus) spray.

http://www.ncbi.nlm.nih.gov/pubmed/21722317



The wound healing properties of Channa striatus-cetrimide cream
- wound contraction and glycosaminoglycan measurement.

http://www.ncbi.nlm.nih.gov/pubmed/11025135




Antinociceptive activity of Channa striatus (haruan) extracts in mice.

http://www.ncbi.nlm.nih.gov/pubmed/9254114




Fatty acid and amino acid composition in haruan as a
potential role in wound healing.

http://www.ncbi.nlm.nih.gov/pubmed/7835642

Intense pain and heavy bleeding the first night. The pethidine injection
lasted me only an hour. Had to bear with the pain the rest of the night.

I had stenosis for the first two months. The stools which came out
were pencil-thin.

I also had fecal impaction twice the first two months. Had to dig it out
with my fingers.


Luckily, improved by the third month.

The surgeon was probably not too skilled nor experienced enough in
the use of the staple.


The staple also has a high rate of relapse.

Within two years, an external hemorrhoid came back.


But is Dr Lim is skilled in this method, you should have no problems,
reduced pain and faster recovery, I guess.



Reinterventions for specific technique-related complications of
stapled haemorrhoidopexy (SH): a critical appraisal.

http://www.ncbi.nlm.nih.gov/m/pubmed/18766410/



Stapled hemorrhoidopexy is associated with a higher long-term
recurrence rate of internal hemorrhoids compared with conventional
excisional hemorrhoid surgery.

http://www.ncbi.nlm.nih.gov/m/pubmed/17665254/




Obstructed defecation after stapled hemorrhoidopexy: a report of four cases.

http://www.ncbi.nlm.nih.gov/m/pubmed/20583519/?



Agraffectomy after low rectal stapling procedures for hemorrhoids and rectocele.

http://www.ncbi.nlm.nih.gov/m/pubmed/21695440



Obliteration of the rectal lumen after stapled hemorrhoidopexy: report of a case.

http://www.ncbi.nlm.nih.gov/m/pubmed/18670815/






This post has been edited by Tham: Nov 30 2013, 01:37 PM

I think I will try to seek if any restaurant in my area has Sang Yue dish. I don't think I can cook for the time being and my family is in Johor.

Fecal impaction. I had that before when I have to dig, a very bad experience. Will pharmacy bought enema help?
Did you change the diet after that, or the relapse still happens after the change of diet?


This post has been edited by lowlowc: Nov 30 2013, 02:42 PM

Maybe you can try this.


http://www.rakuten.com.my/shop/caringpharm...HF0005_0191081/



Enemas may help, or maybe Dulcolax (bisacodyl), but if the impaction
is really bad with the stools already hard, that won't work.

This is why doctors have to do it for patients who come in with fecal impaction
- if the stools are way too far in the rectal area, obviously you can't dig it out
yourself.

Dr Anantha in Sentosa says he has to do it such patients who pay him an
emergency visit sometimes, even young people.

I didn't really change my diet, but as it is, everyone tends to get hemorrhoids.
I can't really tolerate fiber anyway, as I have IBS.

Stresses in life, including lack of sleep, can also cause or aggravate them.
The Chinese believe that lack of sleep (as in my case too) causes heatiness
to form in the liver ( ''kah foh'').

Lack of sleep can also result in a low ''Chi'' (life force), so your anus will
tend to drop out.


The staple method doesn't really cut away the hemorrhoids, rather it retracts
them further up the rectum, so that would explain the high relapse rate.

How is it that you never even asked what device he is going to use when
he examined you and advised surgery during the whole consultation, after
I had given you all that info ?

Akhtar Qureshi uses the harmonic scalpel, and I think he also has Starion
and/or Ligasure. That was why I advised you to go to him. He also uses the
staple, but he said he is very selective, due to the high relapse rate and risk
of complications.

Otherwise, Samuel Tay in Sunway also has Ligasure, as mentioned earlier.
I enquired from the Ligasure distributors here some years ago, and they
mentioned that he was one of the doctors with this device.

I did not select Anantha at that time, even though he did an almost painless
job on my father with diathermy alone, because he did not use the staple,
which I thought was the ''in thing'' at that time. Sentosa was poorly equipped
too then, with no harmonic scalpel. They probably have now, as well as the
other devices.

Sea Cucumbers Fast Track Organ Regrowth By Healing Their Wounds.

http://www.sciencedaily.com/releases/2007/...71017194617.htm



Regeneration of the radial nerve cord in the sea cucumber Holothuria glaberrima.

http://link.springer.com/article/10.1186%2F1471-213X-9-3



Regeneration of the enteric nervous system in the
sea cucumber Holothuria glaberrima.

http://www.ncbi.nlm.nih.gov/pubmed/10205023

Hi, I've just go discharge from hospital. All fees including gastroscopy, colonscopy and the surgery is around 1,500. My insurance pays 1,400 something, I paid 70 because I upgrade to single room plus other things. I stayed in the hospital for one night. They almost tahan me for another night because I was having slight fever.

For now the pain is still endurable but I have not bowel movement yet, so maybe will be worse later.

Dr Samuel Tay is actually my first choice, but he's on leave for 2 weeks. And I'm afraid Akhtar Qureshi will probably put me on medication too, so I decided to go to Tungshin. At least if I was put on medication again, it wouldn't be too expensive. Last time I went to Sunway (for other illness) my outpatient bill was 400 something. Also, I had spent almost 600 in the past week in and out KPJ. I'm broke now.

Tham, the stapler used on me is worse than yours - Made in China. As you said "The staple method doesn't really cut away the hemorrhoids, rather it retracts them further up the rectum, so that would explain the high relapse rate." But Dr Lim did cut away the hemorrhoid. They showed me the sample after the surgery. Quite big, the lump.

My colonscopy and gastroscopy found some burnt marks due to my previous gastric problem. The anesthesia brings the worse effect on me. I could not eat or drink for the whole day on yesterday. Very dizzy and puke out everything they gave me to eat. Can't even handle plain water.

The hospital staffs are all very professional and caring, so I have no complain. Let's hope my bowel movement will be not too painful. I am very afraid now...

This post has been edited by lowlowc: Dec 3 2013, 06:12 PM

It's good to know you had no major problems throughout and after the
surgery, that means Dr Lim did a professional job.

Are you sure it's $ 1,500 or $ 5,500 ?!?!

Colonoscopy, gastroscopy and stapled hemorrhoidectomy for just $ 1,500
in total, plus rental of the operating theater, anesthesiologist's fees, room,
supplies, medication and nursing ?!?!

A gastroscope alone these days, even in Tung Shin, should be easily $ 1,000 !

And as I said, do you know how much the stupid staple gun alone costs,
when I was quoted exactly 10 years ago in November 2003 ?

Tung Shin - $ 1,000
Pusat Rawatan Islam - $ 1,500
Pantai - $ 2,000

And the colonoscope would easily be another $ 1,000 !

Dr Ashim Nandy, general cum hepatobiliary surgeon, in Tung Shin (also
goes to Pantai) at that time quoted me $ 3,000 for the harmonic scalpel.
If I wanted the staple, it would be an extra $1,000 for that device.

Which would be around $ 4,000 for staple surgery, in 2003 !

Dr Lee Hock Bee in Pantai quoted me $ 7,000 for the staple at that time.


So how did it cost you only $ 1,500, moreover plus those two extra scopes ?



And a bronchoscope plus a chest drain for a pleural effusion in my right lung
in November 2011, done in Tung Shin by my schoolmate, Yap Boon Hung
came to some $ 3,000. Total cost of a one week stay there, $ 8,000.


Maybe take a photo of your excised hemorrhoid and post it here if you would like.

You're right. The payment clerk did mistake. She pointed at first page (which she mistook as second page) of the receipt and told me 1400 covered by insurance. I have to pay my own RM76. Actually 1400 is only for scopes procedure.

The instrument alone is 1200, anaesthia = 1100, surgery = 1800. Total including medication, pathlab (for the stomach sample) etc =8200. Strange.. I thought my GL only covers 5000, any more than that have to go through another GL.
They sent the hermorrhoid to lab, and it's all bloodied, so I didn't ask to give me back. The painkiller is to be taken in the morning only, now it's wearing off and I'm starting to feel sore.

Did you woke up immediately after the surgery in the surgery room? I heard them all calling me, calling me to wake up, but I could not open my eyes. I can only make noise through my throat.

How long did you MC last time? Dr gave me MC until next Monday only.

Going to buy Gamogen tomorrow so the wound can heal faster.

This post has been edited by lowlowc: Dec 3 2013, 10:11 PM

$ 1,400 for both scopes ? That's still very cheap.

I selected epidural anesthesis, which was a mistake, so I was already
awake by the time they were wheeling me out of the operating theater.
The anesthesiologist just gave me a sedative to knock me out.

No bleeding in your case ?

I must have bled a lot after he had used diathermy to cut off one of the hemorrhoids
which was too big to be grabbed by the staple.

That night itself, I started bleeding, and those lazy Malay nurses wouldn't answer
my calls. I had to call the surgeon, Zain Al-Rashid, who in turn called those lazy
b****es to screw them up.

The next morning, going to the toilet for what I thought was a bowel movement,
a big mass of clotted and dark blood stained whole bowl red.

On discharge, I ended up with a high fever a few days later, and my brother admitted
me to Sunway for four or five days. My hemoglobin had dropped to 10 grams/dL, but
the chest physician there, Usha Rani, didn't note it either.

In the end, plus the duration of the two hospital stays, I was out for a whole month.

1,400 just the procedure and there are other charges for medical supplies etc...

Two months? That means you have very bad inflammation after the surgery? Did the first doctor give you antibiotic to take at home? Actually your doctor is Dr Zain or Dr Mohd Anis? I see their biodata, they are general surgeons. Dr Akhtar, Dr Samuel and Dr Lim are general surgeons with specialty in colorectal surgery.

As for bleeding, I think got but the doctor stuck a bandage inside my anus plus another bandage outside my anus, so I think the bandage absorbed the bleeding for the first night. There's not much stain on my bed. But the bandage is very uncomfortable, it made me wriggle here and there on the bed. They removed the bandage yesterday morning before prepare a sitz bath for me. I found it very hard to urine for the first few time.

Nurses came into my room every 2 hours to check my blood pressure and temperature.

I had bowel movement yesterday night and this morning but very little and watery. Yes, there's a blood clot coming out but already coagulated, and some bleeding after the bowel movement. Doctor said it's normal. I clean up using bidet and immediately do sitz bath.

I experience on and off pain like suddenly pricked by razor but lasted for seconds only. Taking deep breath helps. This morning I notice I was given painkiller for 3 days only.. now I'm very worry

This post has been edited by lowlowc: Dec 4 2013, 10:02 AM

I think you will have a bowel movement in a few more days, nothing
to worry about.

The bowel has naturally gone into spasm after being cut, so will take
some time to relax again.

Moreover, the scarring part there will narrow somewhat (stenosis), so
the stools will have trouble coming out initially.

My case is worse than yours because I had both diathermy and staple,
the diathermy causing the major scarring and stenosis.

That is why I said I made a mistake and should have chosen Ashim Nandy
in Tung Shin with the harmonic scalpel.


My surgeon was Zain Al-Rashid, attached to Pantai and Pusat
Rawatan Islam, where I went.

Mohd Anis was a general surgeon at Subang Jaya, but I think
he's probably retired by now. He ran a clinic at Taman Pertama
in Cheras in the late 1980s to early 90s. He just did the rubber
band ligation for me twice, the first time in Lady Templer nearby,
in 1986, where he was also attached.

Not inflammation, I had a high fever and URTI infection after the surgery,
as I had lost so much blood and immune system had plummeted.
Both Usha Rani, the chest physician, and Akthar Qureshi attended
to me in Sunway.

I had no insurance at that time, and had to borrow money from my
brother to pay for both hospital stays.

I was conned by AIA, which I had ''credit card shield'' insurance with,
''guaranteeing'' to repay your monthly card payments for the client in
case sickness kept him out of work.

They only compensated me a few measly dollars, after I had to pay
the surgeon $80 for the medical report, twisting their story around
that they would only pay for the period of medical disability AFTER
ONE MONTH. How many people will go on MC more than a month ?

I cancelled their fake policy immediately, and lodged reports with the
Finance Ministry, the Domestic Trade Ministry for mispresentation of
products under the Trade Description Act, 1972, as well as a police report.

Not only that, I shot a letter to the Inland Revenue's Investigation Unit
suggesting that they check out their entire board of directors' previous
years' tax background for possible evasion (I'm in the tax line).

AIA is not an American company, as I was under the impression all the
while, but run by a bunch of conman Honkees.





This post has been edited by Tham: Dec 4 2013, 05:25 PM

I had bm this morning, and it's no fun. It feels like something is blocking and and I have not clear everything yet. And I know I cannot push or it will exaggerate the wound. It was not awfully painful but the fear of going to toilet itself, is horrible. I hate seeing the blood clots and i keep imagining blood will come gushing out, although it's not. I cannot be sure whether I have totally emptied my bowel or not. I fear Monday when I will have to go back to work and probably need to BM there.

Tham, I'm sorry about your AIA insurance. Do you know that they're still selling this scam when people applying for credit card these days? When I applied a credit card last year, they really hard sell this to me. I told them I don't really spend much on CC so this is unneccesary. I'm not sure it's under AIA or not.

A little question; how much salt did you put for your sitz bath? I put half tablespoon only for a 50cm diameter pail, half full of water. Should I put more? Is it normal for the skin around anus to be irritated?

2005 had a heated cutlery surgery for mine, and a small banding on the other.

I did not go for the stapled as Tham (who might have forgotten me), provided his advise to me via email some years back then.

Appreciate him for his medical inputs as always.

For TS, the first few months would be a challenge. Whilst if you are younger at age, the healing would be faster, and depending on how good the surgery went.

I had blood stained almost on every BM, and some anal stricture feel. Nevertheless... I say this...Life needs to go on.

What you can do it get yourself Sitz Bath. Which I assume you might know this. Do it 3 times a day perhaps, get some gauze and replace them during the time of healing, as there might be pus during healing, and slight bleeding as well.
I usually put about 5 tablespoonful , enought to soak me to the waist.


If require to go outside...wear those women's sanity towel.

As for diet...I had loads of papaya, water and other fruits that reduce the hardness of the BM.
Prunes (don't go for the juice...it's rubbish), would help reduce any constipation.
Have a bigger fiber intake.

The work for me was timely, as I was a contractor back then...so, I was to be renewed the next 2-3 months...and that gave me time to do the surgery...and that was also timely, when the clot was bleeding, and I had them done overnight.

I wish you speedy recovery TS. Brave it, and don't rush things....
It will be a 2-3 months healing at least ...sometimes perhaps more...but honestly...DIET is everything.

Thanks finkl1 for your encouragement. It's really great to have people who have the same problem and surgery to come together and give advises in this forum. I have not have fruits yet since I discharged, just oat, vegetables and rice, and today I had snakehead fish porridge to see if it can heal the wound faster. I will start adding papaya to my diet tomorrow but the rest of the fruits I do not dare, as I was afraid will trigger itchiness which I had prior to the surgery. I had papaya in the hospital, so I think it's okay.

5 tablespoon? Then I think I'm not putting enough for my sitz bath, i will put more. Actually I am doing 15 minutes sitz bath for twice a day, and additional 5 minute sitz bath for every bowel movement.

Now I have another problem. The medication makes me sick. As always, antibiotic make my stomach turns , dizzy spell and itchy dry skin for me. I still have another 2 days of antibiotics to go, so hopefully I can make it through. Dr Lim told me surprisingly most of his older patients recover faster than younger patients probably because the muscles doesn't constrict that much in older people.

Now I am thinking whether to go back to doctor and ask for extra MC. My office's toilet hygiene level is and I'm afraid to use its dirty bidet. And I can't imagine no sitz bath after bowel movement.

This post has been edited by lowlowc: Dec 5 2013, 11:14 PM

You said you had your surgery in 2005 - perhaps you could refresh my
memory - did I meet you on another forum then, as I joined this one only
in 2007 ?

Anyway, it's good you had your surgery and fully recovered. Hopefully
you had no complications then, and no relapses after that.

You mentioned ''heated cutlery surgery''. Did the surgeon use diathermy,
Ligasure, Starion or bipolar scissors ?

Half a tablespoonful is way too litle, I mentioned two tablespoonfuls.


As Finkl1 also said, he used 5 tablespoons, but that was to soak up
to waist up, so maybe he used a large basin or sat in the bathtub.

If you are using enough hot water just to cover and a bit above the
bum area, so that your anus is fully immersed, then two to three
tablespoons should be enough.

Use Cosway's Zara sea salts as I advised. It's really soothing, and
does have healing and pain reducing properties. Costs about $19,
but they usually give you the 20 % member discount, even if you
are not a member. Just tell them you have just been discharged
from hospital after surgery.

Use one of those shallow baby's tubs about a foot across, just
enough to sit on top of the opening of your toilet bowl. The water
would then be above 4 inches high, just enough to cover your bum.

Try taking dragon fruit and/or beet root juice - that will be sure to make
your stools watery or at least much softer. I tend to get some mild diarrhea
within two hours after drinking mixed beet root/carrot juice. Papayas don't
really help much for me.

Your stools will just turn dark after dragon fruits and beet roots.

Another juice which will make me run to the toilet shortly is yellow pear.


I think you should ask the doctor for at least another week's leave.
Otherwise, I am sure your employer will let you have extra compassionate
leave, if you explain that you are having some post-surgical complications
with bleeding, much pain and still can't pass out anything due to rectal
stenosis.


If you email your boss and show him this was how much the surgeon's
''grenade launcher'' streched your anus, I am sure he will understand.

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

HI Tham, we just emailed around 3-5 mails to each other.
I just read your experience from another webpage, and got in touch with you.

YEs, I had a bipolar scissors, the heated ones, that seals and reduces any blood lost.
Back then, laser was only available in Pantai, and it was expensive. Almost 3-5k i believe.
You told me about your staple experience...and I decided to forgo that procedure.


TS,

Please do not use the "consumer" sugar that you buy from sundry shop. Get those sea salt , that cannot be consumed by human, but used for other means....

After the healing starts...around 1 month or so...buy some antiseptic cream....

Also maintain cleanliness in that area....ie: dry.

Try not to push stools...I know it's difficult, so, drink lotsa water, and maintain a good diet.

Oats and cereals bulk...so be careful....Have to test a bit.
I forgot the diet I took , but mainly lotsa papaya alternate days....





Well, now I am plagued by H.pylori....and after a few rounds of antibiotic therapy failure, I decided to do some home treatment.

Life's ups and downs... Even through good diet..and being a workforce... we cannot control much of the food we eat outside....regardless if it looks clean and cooked hot.

Today, I'm feeling a bit weird sensation there. The anus feels like tightened a bit, some little tingling pain, swelling a bit (but no pus or bleeding) and my buttock feel a bit numb.

I'm using organic sea salt (unrefined, unbleached) right now (but it's food grade)because previously the cosway branch I went, is out of stock for the Zara sea salt. Will try another branch soon since the salt is finishing soon anyway. I also have Epsom salt at home but I decided not to use it in the end after reading mix reviews online.

"Your stools will just turn dark after dragon fruits and beet roots."
This reminds me, is your yellow and contain undigested food (in my case, vegetable leaves) after the surgery or colonoscopy?

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

Holy crap.. this is what happened to me in the surgery room? I didn't search for the actual picture prior to the surgery, in order not to get chickened in the last minute. But now looking back, it still .. urgh
I'll call up the doctor tomorrow to ask for another MC.

Finkl1, I can't have antiseptic cream, because the skin there is already seriously irritated prior to the surgery. Right now... ahem.. I don't think you and Tham might approve of this but I dab some coconut oil (organic, pure, unrefined type) that I bought from pharmacy. I decided to try this last week (2 days before the surgery) since the itch was awful and preventing me from sleeping. This was recommended by "itchy hemorrhoid" and "post hemorrhoidectomy" forum. I did not apply it directly to the anus but the skin around it in very small quantity. It seemed to work but very slowly. Prior to this, I was prescribed protosedly, zarticorn (anti fungal), steroid cream but all works for only 1 day then worsen the condition.

that's fine. There is naturally no right and wrongs as each body reacts differently.

As long as you don't develop any rashes, excessive pus and infection.

That will set you to more long term healing. ...

The "stricture" feeling is normal for me. Because it;'s tightening....hence, stools should not be entirely liquid, but still having some "form", but soft for you to pass through.

This is to allow your "muscles" to not completely close. ( As Tham puts it in term stenosis)

I know it sounds worrying, but it's NOT.
Healing will take place , just need some light exercise...walking a bit, less sitting...and more warm sitz bath.

Speedy recovery to you.

Which hospital did you go to, and which surgeon did it for you ?

Yes, I think only Pantai had the laser then, Lee Hock Bee there said
he normally used it for first and second degree hemorrhoids. He was using
the harmonic scalpel for third and fourth degree beforehand, but had since
switched over to the staple when I called him at the end of 2003, for which
he quoted me $ 7,000.

$3,000 - $5,000 for the laser isn't really expensive for Pantai, even at that time.
Ashim Nandy quoted me $3,000 for the harmonic scalpel in Tung Shin.

Zain Al-Rashid, attached to both Pantai and Islamic Medical Center, did the
staple for me in the latter hospital for $4,500. He didn't even realize that Pantai
had the laser !

Actually, I wonder why you didn't select the harmoic scalpel ?

Which grade were yours, by the way ?

Mastic gum and zinc l-carnosine (Pepzin GI, Polaprezinc) would be
the supplements for you.


Zinc l-carnosine was developed in Japan and marketed as a drug (Polaprezinc)
there, but licensed to supplement manufacturers in the States as Pepzin GI.

It can also be used for bed sores, or pressure ulcers, although l-carnosine
itself is also effective.


http://pepzingi.com


The development of Polaprezinc research.


https://www.jstage.jst.go.jp/article/yakush..._3_271/_article



The effect of polaprezinc on gastric mucosal protection in rats with
ethanol-induced gastric mucosal damage: comparison study with rebamipide.

http://www.ncbi.nlm.nih.gov/m/pubmed/23743168



Polaprezinc (Zinc L-carnosine) is a potent inducer of anti-oxidative stress enzyme,
heme oxygenase (HO)-1 - a new mechanism of gastric mucosal protection.

https://www.jstage.jst.go.jp/article/jphs/1...9056FP/_article



inhibitory effect of polaprezinc on the inflammatory response to Helicobacter pylori.

http://www.ncbi.nlm.nih.gov/m/pubmed/12464972/




Applicability of zinc complex of L-carnosine for medical use.

http://protein.bio.msu.ru/biokhimiya/conte...l/65070961.html



Effects of L-carnosine and its zinc complex (Polaprezinc) on pressure ulcer healing.

http://www.ncbi.nlm.nih.gov/m/pubmed/23835365/



Studies on anti-ulcer effects of a new compound, zinc L-carnosine (Z-103).

http://www.ncbi.nlm.nih.gov/m/pubmed/2113032/




Mastic Gum Kills Helicobacter pylori.

http://www.nejm.org/doi/full/10.1056/NEJM199812243392618



The effect of mastic gum on Helicobacter pylori: a randomized pilot study.

http://www.ncbi.nlm.nih.gov/pubmed/19879118




Now's Ulcetrol.

http://www.iherb.com/Now-Foods-Ulcetrol-60...=6&sr=null&ic=1



Natural Balance's Peptic Soothe.

http://www.iherb.com/Natural-Balance-Pepti...4&sr=null&ic=15


Jarrow's mastic gum.

http://www.iherb.com/Jarrow-Formulas-Masti...44&sr=null&ic=4



Doctor's Best PepzinGI.

http://www.iherb.com/Doctor-s-Best-PepZinG...44&sr=null&ic=6

Dark, virtually black, presumably from all the bleeding.

As mentioned earlier, pencil thin, due to the stenosis. Gave me quite
a shock - I thought the stenosis would be permanent.

That was how it was for the first month after the surgery.

Beet root is good not only as a laxative, but a blood builder, high in iron.

I was taking this after an I & D (incision and drainage), by an orthodedic
surgeon in Sunway December 2004 (one year after the hemorrhoidectomy !)
to drain out a cellulitis abscess in my left big toe.

http://www.iherb.com/product-reviews/natur...-capsules/1842/


Reduces blood bressure, improves stamina, due to the nitrate content,
converted to nitric oxide in the system.



'' .... as little as one cup of beet juice has dramatic effects and may be a natural
alternative to blood pressure medication for some people and just 2-3 ounces
per day can be a natural approach to preventing constipation. ''

http://www.webmd.com/food-recipes/features...-beetroot-juice



Acute ingestion of beetroot bread increases endothelium-independent vasodilation
and lowers diastolic blood pressure in healthy men: a randomized controlled trial.

http://www.ncbi.nlm.nih.gov/m/pubmed/23884387


Inorganic nitrate and beetroot juice supplementation reduces
blood pressure in adults: a systematic review and meta-analysis.

http://www.ncbi.nlm.nih.gov/m/pubmed/23596162



Effect of beetroot juice on lowering blood pressure in free-living,
disease-free adults: a randomized, placebo-controlled trial.

http://www.7ncbi.nlm.nih.gov/m/pubmed/2323177



Blood pressure-lowering effects of beetroot juice and novel
beetroot-enriched bread products in normotensive male subjects.

http://www.ncbi.nlm.nih.gov/m/pubmed/22414688



Nitrate supplementation's improvement of 10-km time-trial performance
in trained cyclists.

http://www.ncbi.nlm.nih.gov/m/pubmed/22248502




Another good blood builder and laxative is blackstrap molasses.


'' Molasses Health Benefits and Natural Cures ''

http://www.earthclinic.com/Remedies/molasses5.html



'' Constipation Remedy – Blackstrap Molasses ''

http://www.poopdoc.com/articles/constipati...natural-way.htm



'' It’s best to eat or drink blackstrap molasses in the morning, as it makes
a good laxative and will give you energy.

This black goo, the bi-product of unhealthy white sugar, has ironically one
of the highest mineral contents compared to other foods. Blackstrap molasses
is quite extraordinary, containing these excellent sources of iron, magnesium,
calcium and potassium and other trace minerals and vitamins. I think it’s so sad
that this fantastic healthy sweetener, is used as the bi-product, and the
unhealthy sugar lines our supermarket shelves. ''

http://www.2baware.net/healthy-foods/blackstrap-molasses/




http://whfoods.org/genpage.php?tname=foodspice&dbid=118

http://spiritfoods.net/health-benefits-of-...strap-molasses/

http://whfoods.org/genpage.php?tname=foodspice&dbid=118




Total antioxidant content of alternatives to refined sugar.

'' Dark and blackstrap molasses had the highest FRAP ''

http://www.ncbi.nlm.nih.gov/m/pubmed/19103324

Thanks Tham.
I did mine in Assunta, under Mr.Liew Fah Kong.
I believe the equipment is harmonic scalpel...and the cost was about 1.5k -2k range, adding the rest, brings up to around 2.8k range.

1x 4 degree, prolapsed external
1x 3 degree, prolapse external
1x 1 degree, banding.

The 4th was bleeding, before he decided to cut me the next day.
I was LUCKY I believe, that he did it well, and less complication, and less pain since I had a strict dieting regime before the surgery.

This post has been edited by finkl1: Dec 8 2013, 01:26 PM

Will you describe the kind of itch you encounter during healing? Inside or outside? Prickly or wriggly itch? Yesterday night I had a very bad itch that I am now paranoid that I might have worms. The skin around the anus (I don't know if it's eczema or what) is still irritated that I've become very depressed now. Plus I'm very concerned about the undigested food in my stool.

My friends advise me to just go to work if it's not painful because I've been thinking too much.

This post has been edited by lowlowc: Dec 8 2013, 03:47 PM

You had four hemorrhoids ?

But overall, not that bad. All three of mine were virtually 4th degree, and the largest
one was too big to be grabbed by the staple, so he used diathermy to cut it.


It's good he used the harmonic scalpel. Seals the blood vessels, as well as nerves,
as it cuts. Thus, much less bleeding and pain than a normal diathermy, or bipolar
diathermy.

The healing period is difficult for the first one to two months, as with any form
of hemorrhoid surgery, but there are normally no complications with the
harmonic scalpel, apart from temporary stenosis or narrowing of the anus.

This is evident, as you had no relapses after 8 years. Dr Liew must have done
a good job.

If it is itching, that means the wound is healing. Usually a kind of wriggly itch,
somewhat prickly too. Do not worry, quite normal. It will last a week or two.
I had that sometime towards the end of the second month.

Moreover, there are staples left inside your rectum, grabbing and retracting
the hemorrhoids up. That is why they call it the staple method. So there will
be bound to be some itching and irritation.

Dr Akhtar Qureshi saw my staples when he examined me in 2004. He said they
will be there for life.

The itching will go away or at least reduce after one or two more weeks, I am
sure it will, do not be depressed.

Have you bathed it with Cosway's Zara Sea Salts yet ?

Did Dr Liew also give you some lidocaine gel, or Xyloproct cream, which has
a mild steroid to reduce the itching ?

I think all the spasm from the trauma of the procedure has affected your digestion,
so there might be some undigested food. Why don't you get some good digestive
enzymes from the pharmacy ? A good one is by Bio-Grow, chewable. Chew two
at each meal.

http://www.rakuten.com.my/shop/caringpharm...H00023_0163321/


Ask the doctor to let you have one or two more weeks of rest. When are you going
to see him for a review ?

If the itch and irritation is unbearable, maybe you should see Dr Liew again tomorrow.



Talking about depression, I'm the one who is even more depressed now, having to
put up with a schizoid and narcissist younger brother, whom I live with. I have far
more problems than you, and mental trauma kills faster than physical ones.

If you're not sure what narcissistic personality disorder is, just seach Youtube and
there will be countless videos describing one. Hitler was definitely one. Combine
that with schizoid and paranoid personality disorders, and you virtually have a
lunatic on your hands.

I'm amazed that such a mentally unstable person has managed to rise to the level
of a $ 20,000 a month Principal Engineer in Western Digital. I've received feedback
that nobody there likes him.

I received another sick SMS from him today.





This post has been edited by Tham: Dec 8 2013, 08:18 PM

Nope. It's 3...only 3 blood veins in the anus...should NOT be more. I just mentioned them each by the degree they were in.
Touch wood...no relapse, and hopefully not ever.

It is genetic for mine. Grandfather, father, brother and me...all the males in the family has them.

This post has been edited by finkl1: Dec 8 2013, 09:31 PM

Thank you Tham for your encouragement. Narciscism, although I may not be able to spell it correctly, I certainly had encounter enough of narcisist in my life to know how terrible it is. I'm sorry that you have to deal it at home.

Today is my second day at work and I am glad I did that. Sitting at home alone makes me think too much and depressed. Also at work, my colleagues encourage me not to think too much about the itch.

My bowel movement changed from twice a day to once only, so I don't have to go in the office. Now the fiber is finished, I need to eat more fruits and vege to make my stool softer. I had some bleeding today during bm.

I think I know now why I have frequent constipation. My body have problem with animal protein, even fish's. My stool became harder since I added fish to my diet. Need to buy pears and dragon fruit later.

As for the wriggly itch, I need to pantang like women in confinement. This lessen the itch.

This post has been edited by lowlowc: Dec 10 2013, 09:05 PM

My follow up with dr lim is next week. Hopefully my bleeding during bm is solved by that time. Going to ask him why stapler method yet there's a piece of hemorrhoid being cut out. I hope he'll have something for my irritated skin. So far he have not prescribe any cream for me.

There is a possibility the staples will be in there for life? I thought I will loose itself and come out in stool. What's the staples made of?

This post has been edited by lowlowc: Dec 10 2013, 09:03 PM

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

"Persistent pain and faecal urgency after stapled haemorrhoidectomy."

I do have feacal urgency now, always hit me very sudden and I have to stop everything and rush to toilet ASAP. Sometimes after rushing to toilet just to find out it's gas only. I do hope it's not permanent. I don't really like having bowel movement for 2 or 3 times a day. I am now trying to 'train' myself to empty bowel every morning after waking up by drinking a large jar of water. Sometimes works, sometimes no. Hope I can succeed.

I seemed to have more bleeding today. Although not painful, doesn't feel good either to see bloodied stool.Now that I finished all the fiber they prescribed to me, I am using psyllium husk + 3 portion fruits. Maybe I really need to banish fish from my diet.

My incised piles doesn't look like doughnut. If anything, it looks more like mini curry puff .

double post

This post has been edited by lowlowc: Dec 12 2013, 10:27 AM

Bad news. I think I may have stenosis. I feel the urgency to go toilet, but when I m there it wont come out,it took me 30 minutes in toilet just to have a few small thin stool to come out. I cant seem to clear the bowel 100%.

What can I do? I know I cant push but I had push a little because it s stuck. The opening there seemed to be a little swollen.

Cosway sea salt is finally in stock but they no longer carry the plain type, only those with lavendar fragrance. I dont thik my skin can handle perfume right now. So I tried epsom salt this morning. The irritated skin seemed to be less itchy now.

This post has been edited by lowlowc: Dec 12 2013, 02:28 PM

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

Dr Ting will do that for me? Somehow the last time I was there he wasn't very helpful when I asked question.

I'm in confused state now. I have very bad flatulence yesterday, a bit symptom of diarrhea yet I can't fully empty my bowel. I ended up going to the toilet a few times and the skin is itchy again. Sometimes I went to toilet to pee but ended up have bm.

I stop taking psyllium husk and called Tungshin for the brand of fiber they gave me. Found it in Caring pharmacy and drink it back again. Flatulence is much lesser but still some symptom of diarrhea, but very little at one time. Right now, maybe is not the time to visit GP to dilate for me because I may leak. I read some health forum that some people will experience stenosis and leaking during the course when the splinter (not sure i got the spelling correct) is contracting/having spasm while healing. This morning, it does feel like the hole is having spasm. Hopefully will be gone by next week. Right now, I don't know whether to soften the stool (to cure stenosis) or not to soften (to prevent leakage).

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 !

Will artichoke extract make us dependent on it?

I haven't seen Dr Lim yet until another 2 days. Going to ask him whether it's stenosis or swelling down there. I keep on feeling the urge to go but when I was in toilet, just can't get them out despite eating vegetable, rice and fruits only + 3 liters of water. Today I feel the 'real pain' for the first time when I try to get them out but fail. Miserable... This is a big setback for me, since I didn't experience much pain during the first week, not even during bm so I thought it will continue like this until totally healed. No doubt the itchiness returns again. Alas..

The fiber they prescribed to me is Total Fiber. Apparently it has both soluble and insoluble fiber in a ratio that will decrease flatulence. I drank 1 sachet this morning and managed to BM. But after lunch and dinner, I feel the urge again but very little come out. I drank another sachet again but no bm. I'm starting to worry of overloading myself with fiber will make the 'constipation' worse. Maybe the swelling is making me feel like wanna bm but actually not?

Thinking back, this is what always happen to me and gradually constipated. Went to toilet but lose all the urge after settling down and no matter how hard I tried, I can't get it out.

I started to have some kind of swelling at the old place of hemorrhoid, I freaked out because I was afraid the hemorrhoid was not completely removed. Went to a few hemorrhoid discussion forum, most mentioned it's normal and the swelling can easily be mistaken as another hemorrhoid.

Maybe will consider Dr Anantha only if it's not healing by another 2 weeks time.

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

35 only? That's really cheap because I understand at very least the consultation alone is 60 or above.

I went to Dr Lim today. He inserted finger and moved around but there's no pain, so it means no stenosis. Just swelling and (unfortunately) I was given Daflon again for the swelling. Plus the Daflons I got from KPJ and Mediviron, I think I have half year supply already if I eat 2 each day. Luckily my Guarantee Letter is still in effect, so I don't have to pay. The swelling causing the urgency to move my bowel.

I am trying prunes now despite the experience with cramps from it. If possible, I am trying to swear off whatever packaged fiber or laxatives cause I read somewhere in lowyat, a girl depending on a certain supposedly natural laxative/fiber (based on her doctor recommendation) and ended up with very inactive colon. She had to remove part of her colon. Prunes seemed to bring a little diarrhea effect on me so I'm going to cut down on it (yesterday I ate around 6-7 pieces of them). If still having diarrhea from it, I may move on to try figs. I am a bit worry to try out the artichoke since you mentioned it's not recommended for ppl with bile stone. I don't think I have bile stone, but since I've never got there checked, I'll never know for sure.

The bad news is, I have developed a skin tag and I may probably have to live with it for the rest of my life. I am very saddened by this, because the first week after the surgery, the place where the hemorrhoid used to be, was healing fine, no tags nothing. I thought I had got rid of that ugly irritating thing for life!

As for the sensitive skin there, no one seemed to be able to give me a solution. I think I may try natural healing like some i read on other pages - to restore the PH balance for the skin down there and see if anything works. Any idea where can I buy PH litmus paper?

Sentosa Medical Center is now KPJ Sentosa (as I searched online)? Does he has clinic outside? Can't find Dr Anantha in the list of General Surgeon.

Did you ever fully recover from the cellulitis drainage you did? My friend did such drainage before 5 years ago, and never really recover from that. He ended up couldn't stay on any job for long (as he can't walk much). Every time he work for a few weeks, the symptom came back and he has to resign and rest at home. I feel very bad for him.

This post has been edited by lowlowc: Dec 16 2013, 05:49 PM

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 ?

Other than Dr Anantha is now retired, another bad news is my burning itch has return. This is definitely not the wriggly kind of itch when the wound heals. This is the itch I had since more than a month ago, long before my surgery, the reason why I made so many trips to hospitals, the one that cause me to decided to have hemorrhoid remove. I do not know anymore who to seek help. I am thinking hard what causes the itch to come back and there's many suspect:

Prunes that I started to eat yesterday.
Diarrhea caused by prunes irritates/burns the inside of my anus.
The Lui Cha I ate this afternoon that contains "chai bok"
The gel the doctor used when he inserted his finger to anus
Daflon that I started on. Prescription is 2 X 2 times a day, but I started with 1 this afternoon and later 2 after dinner.

I am seriously depressed now, I do not know where or who to consult anymore. I even try assuming I am having yeast infection and sit myself in water with Apple Cider Vinegar, but nothing works miracle. Heaven knows whether I can sleep tonight with the burning itch. I pity my co workers who have to handle my job because of my frequent absence from work, my hubby who has to take leaves to accompany me to so many trips to clinics and hospitals.


Tham, I didn't know if my friend has the exact problem as you (cellulitis) but the draining concept you mentioned certainly rings the bell. I did a search and from Webmd

"Cellulitis is a skin infection caused by bacteria. Normally, your skin helps protect you from infection. But if you have a cut, sore, or insect bite, bacteria can get into the skin and spread to deeper tissues. If it is not treated with antibiotics, the infection can spread to the blood or lymph nodes. This can be deadly."

Yes, my friend started out with something like skin infection on legs, then spread deep within with fluid buildup. Went to SJMC and the doctor (I do not know which one) suggested the procedure just like the one you did. Pain was reduced but not for long, everything became worse. He can't walk and leg swollen, has to quit his job and rest at home. I know he went to a few hospitals but all treatment doesn't work. In the end went for Chinese medicine, improved a little. Just when he thought he can start working again, symptom came back again. The only thing (I don't mean this sarcastically) I really thankful for him is he came from a generation of landlord family so he succeeded his family tradition of collecting rentals for livelihood, no need to work while with the illness.

Hello guys. Luckily I came acroos this thread, so I have someone out there to share my problem with. I suspected that I might have hemorrhoid, based on these few symptoms; my butt itch most of the time, and whenever I'm defacating, feels like fire coming out from my anus, and even after that, its still feels hot and itchy. Sometime it get wet, and by the time it get wet, the itchiness is unbearable. Few times I scratches my anus until it bleeds. I think it might get worst now, I can't sleep at night because of the hot feeling and itchiness of my anus. The thing is, I'm still young, 24 to be exact. I never share my problem with any specialist before, but I think its time to do so. From what I read, I should not squat always. The thing is, I'm an MMA fighter, and I did squat a lot for training. I stop training for one month already because I can't stand the itchiness. Its really troublesome to stop in the middle of the training, take of my glove, run to toilet and scratch my anus. I did took a lot of fiber recently, but doesn't seems to work. The hotness, the ithiness is there. And yes, I think some of my intestine is out too.

So before I go for checkup, wanna make something clear first. Is the checkup and the surgery is covered under insurance? Do I need some kind of recommendation letter, or I can just come to the hospital? I would like to do my surgery at Sunway Hospital.

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.

Sorry anak kenyalang, I m using mobile now and the reply button is missing. I m not sure whether if u have hemorrhoid or not. Do u constipate a lot all theses years, pushing stool a lot? Bleeding when bowel movement? Any protruding flesh, swelling there (means u have external one). And one thing very important is to know whether the itch is started by hemorrhoid or the other way round. Mine is sonething causing the itch and flares the hemorrhoid. In my case, the surgery did not solve my problem.

Usually for your first consultation u have to pay by yourself, if doctor suggested surgery, only after admission for tge surgery, insurance will cover. Insurance requires u to be hospitalisee in order to use insurance guarantee letter to pay. After hospitalisation normally follow ups within 30 days are paid by insurance too.

I hope u are not having the same symptom as me, but we do have commons here, burning and itch after bowel movement, uncontrolable itch. Did the itch stop when u r in sitting position? No one should suffer this, I wouldnt even wish it upon my worst enemy.

Tham, sorry I never mentioned I m a female. The probkem is only at anus area and inside it, never went to the genital. I had zaricort and used it for 2 days stopped using it because it s time for my surgery. Maybe I ll try it again, but how about the itch inside? The cream does not come with tube for insertation and is it safe to use it after the surgery?

As for my friend case, no doctors can give him definite answer what s his illness.

I ve stopped prunes and everthing acidic now.

Tham, sorry I never mentioned I m a female. The probkem is only at anus area and inside it, never went to the genital. I had zaricort and used it for 2 days stopped using it because it s time for my surgery. Maybe I ll try it again, but how about the itch inside? The cream does not come with tube for insertation and is it safe to use it after the surgery?

I only reason I self assume I have yeast is from itchy anus forums that discuss candida yeast causing anus infection.

As for my friend case, no doctors can give him definite answer what s his illness. Now I know that feeling.

I ve stopped prunes and everthing acidic now.

I'm 80% posirive that I might have a hemorrhoid. I seldom have constipation, and blood never comes out when there's bowel movement. And yes, its flaring upo there, and there is protuding flesh, something that comes out. Bad news is, I might suffer the same thing as u. Unbearable itch and flaring feeling on the anus after bowel movement. And plus, its always feel like kinda tight down there. I'm not comfortable when I'm in sitting position either. The protuding flesh seems jellyish whenever I sit on it. Its getting worst mow, I can't fall asleep last night because of the ithiness, and have to take MC today. I think I might see a local clinic first, and under their recommendation letter, I will go to hospital.

Yes, get a letter from clinic and maybe see specialist in govt hospital, maybe can get a totally different opinion from me. I heard the specialist in govt hospital can be very skilled. Unfortunately the clinic I initially went refuse to issue letter for me, so I went to private

Remember to point out just how itchy and burning it is, or they wont take the word 'itchy' seriously, just brush it as normal hemorrhoid.

Can we compare a few more symptom? Did u started on new food or supplement when this happen? How long has it been? Itch first or the hemorrhoid protude first? Is it wet but it s not pus, more like no color secretion? The burning itch is more worse when something touches it, like clothing or even just the touch of hand?

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.

The itch is inside near the anal entrance and outside the surrounding skin. The itch is burning kind of itch, the one I had before the surgery. After the surgery in first week I had wriggly itch which many told me it s healing itch. I believe so.

Now I am having the burning itch just like before I had the piles remove. So I tried using the anti fungal zarticord yesterday (issued by mediviron previously). it burns and stings like crazy that I cannot sleep. I don t remember it stings that much when I use it before my surgery. Is it normal?

I truly sympathize with your condition and pain. I have been following your case closely,
hoping that you will find a solution as soon as possible.
And I can understand your serious depression after not really getting your problem solved.

Please hear me out, especially when you are running out of options:-

This is my suggestion & recommendation:-

Recently, I came to know of this doctor in Pudu-KL, by the name of Dr. A.K. Ng who
has been practicing "Natural Preventive & Curative Healthcare for the past 40 years.
(Note & Disclaimer: He is not a Sin - Seh and does not practice any form of chinese medicine
or chinese healing theraphies)

He uses Natural Approach methods, avoiding drugs where possible.He treats his patients
with these alternative methods. Patients with heart disease, stroke, diabetes with complications,
chronic recurrent pain, dengue. chicken pox, etc have been treated successfully without drugs.
He has also successfully treated non-wound healing cases, especially post operation wounds that
does not heal.

He mainly uses a natural product containing Xanthones, Catechins, Polysaccharieds, Proanthocynadins.

If you google Xanthones or search PUbmed on Xanthones, you will find tons of info there.

But let me not bore you with these details (which I can email you later if you PM me)

The good news is Dr A.K. NG (MBBS Adelaide) is currently offering FREE consultation
for any disease (Preventive & Curative) and to anyone.

Why? Because many of his patients come to him as a lst resort after trying many other options
whether natural or pharmaceutical and spending so much money & time in the process.

So he does not want to burden his patients with the consultation fees which may stop
people from seeing him in the first place.

So I hope you decide to see him, and call me and I will inform him about your case.
You can see him from Mon-Fri @ 10am to 4.30pm / Sat : By Special Appt Only
You can come alone or with your husband
(If you walk in directly, you have to pay the consultation fees)

My adivise is, you have tried so many options, what have you got to lose
since you pay nothing and there is no obligation.

I sincerely hope to see your problem solved.

Thank You
Simon Jayadevan (019.220.1530 / 018.2562.747)
Health Advisor
NATURAL HEALTH & WELLNESS CENTER SDN BHD
345 & 347, Jalan Pudu,
55100 Kuala Lumpur