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Fistula Surgery @ the Research Institute: Part 2

Read Part 1 first

We arrived at the Garg Fistula Research Institute, attached to Dr Garg’s house, and went in to meet him and his team.

Even though I had sent them emails before, I still ran over my history and everything that they might need to know regarding the fistula surgery and everything related to it. He asked about my Crohn’s history, and because I wasn’t on any medication and didn’t have any symptoms he said that it wouldn’t affect his job.

He gave us so much time and answered all our questions. Already I was getting the feeling that this was a man I could trust, who was passionate about his work, and who really knew what he was talking about. All he treats is fistulas, fissures and piles, and he travels around the world talking to other surgeons about his research.

The following morning I was booked in for an MRI at 8.

Shankar picked Harlan and I up at the hotel. When we reached the MRI clinic it looked like a little shopfront, and we were very glad that we had Shankar with us to speak Hindi to the people at the front-desk. It was quite different to any other MRI I’ve had, but I was relaxed and I’m sure the machine was slightly wider so it felt less cramped in there.

Once the images were ready we took the CD off to the clinic for Dr. Garg to check and give us the verdict. He is concerned that most surgeons and radiologists seem to have a hard time properly reading MRIs in relation to the anal area, and so many times he has people come to him as a ‘last resort’ from top surgeons around the world where fairly simple and obvious things have been missed. I didn’t realise I would be ‘one of those’ people.

He began scrolling through the images on his computer. We could see where the seton was and all the inflammation around that area. He kept scrolling higher through the slides and talked us through, in detail, how there was actually another, previously undiscovered, abscess higher up. He explained to us that there is an internal and external sphincter muscle, with an intersphincteric space where abscesses can often form with a fistula, and mine had horse-shoed around in this area. This meant that my case was complex, and my heart sank.

I had so hoped it would be a simple fix.

Being my first day in India I suddenly wondered if I would have to stay longer than three weeks, healing away from the comfort of home. Long story short, he told us what procedures he was going to carry out on the various areas and said that with the higher complex fistula/abscess it would reduce the success rate slightly to the 80% range , but he was still confident that it wouldn’t take longer than 40 minutes to sort it out in hospital.

The colour and choice is never-ending!

That afternoon I squeezed in some market exploration with all of us, knowing that in the next few days I would be too sore to go around in the car site-seeing. I was quite nervous about the following day – my second day in India, driving to a new town, being operated on in a hospital in India, having to spend the night, and being so far from home with what was happening. I was so relieved and grateful that Harlan was with me and would be able to stay the night in the hospital alongside me.

The next morning Shankar picked us up bright and early and we had an entertaining drive to the Indus International Hospital in Derra Basi. He dropped us, wishing me well, and again, being the only Westerners, we had to use a combination of sign language and help from some very kind people who would call in others who knew some English. Needless to say, we were allowed to skip parts of the forms.

We were led to our room on the 3rd floor, overlooking dry fields, where the cows were grazing, and waited to be called in for surgery. I had begun fasting that morning and Dr Garg also told me that I couldn’t eat for 5 days after the surgery – not having a bowel motion would greatly reduce the pain. That in itself was rather daunting, especially when everyone was so excited to be surrounded by delicious Indian food!

I was in my green gown, net hat on and the nurses came to get me with a roller bed and off we went. It was quite surreal really, waving Harlan goodbye and disappearing with people I couldn’t communicate with into the depths of this hospital. Even though it’s an international hospital it is still very different from what we are used to here in a first world country, but I had been mentally prepared and had a deep sense of underlying trust in the whole process.

In a nutshell, I received a spinal block, which meant that although I couldn’t feel the surgery I felt the pressure and discomfort of being prodded and poked with my legs up in stirrups. Luckily Dr Garg had given me the green light for taking in my head phones (with guided imagery and meditation music on), which really helped. Plus a lovely, young caring anaesthetist who told me a little bit about his life. After the procedure, I was wheeled into recovery and a few minutes later began shivering. At first I let my body go with it, because I believe that body movement after trauma can help shift it through your system faster (like with dogs shaking). However it became stronger and stronger. I tried to consciously stop it every time a nurse came in because I was desperate to get back to the room to see Harlan and I didn’t want anything holding up the process.

Eventually I was taken back to our room where I was overjoyed to see Harlan.

He was very concerned about my shaking and called for our Kashmiri doctor. She checked my vitals and covered me with lots of blankets because I had gotten cold in the theatre. With rescue remedy, lots of blankets, and Harlan by my side, I eventually calmed down and was able to doze. I was not allowed to move for the next 6 hours, and it was a long drawn out, uncomfortable time. I made it of course, and then I also made it through the night on minimal pain killers.

The next morning, I had to walk about 500m – Dr Garg’s orders – and so off we went, me holding onto Harlan’s arm in my faded green gown, limping slowly next to him. We found a way to get out of the building and did laps up and down the ramps in the steamy hot morning air. I wasn’t as sore as I had expected!

Near mid-day Shankar picked us up and took us back to the clinic so that they could look at the wound and begin the dressing change process that was so vital to healing.

The procedure was as follows:

• the fistula on the outside (where the seton was) was laid open because it only touched a small part of the sphincter
• another little tract was cauterised at the opening (PERFACT procedure) – internally
• on the horse shoe abscess, he performed a TROPIS procedure by creating a cross opening, draining it, and cauterising any openings (internally)
• the ‘dressing procedure’ for my particular case was someone making sure that these wounds heal from the bottom up/inside out and don’t close prematurely, leading to the possibility of another fistula/abscess.

For the next three weeks in India we had to go morning and evening to the clinic to have the dressing changed. The first few days Harlan just watched while they explained what they were doing, and then he had to start practicing.

Dr Garg believes that there are two very important reasons why his simple procedures have such a high success rate:

a) he knows how to properly diagnose exactly what’s going on (reading MRIs) and then has a range of procedures to choose the most suitable from, and
b) he says that aftercare is at least 50% of the successful healing.

Where with other surgeries you are sent home, mostly to fend for yourself with maybe a couple of weekly check-ups, with Dr Garg you see him and his expert team twice a day for the duration of your stay in India.

If I hadn’t had Harlan with me to learn the dressing procedure, or if it had taken him longer to gain confidence, we would have had to extend our trip. Luckily for us all he picked it up quickly and confidently, and within the last week Dr Garg was happy for us to leave on our planned date. He is reluctant to let his patients go unless he is confident that your support person will carry out the dressing changes as he and his team would, for the duration of the healing process.

For the first time I felt that I was really able to trust and hand over the whole process to a true expert.

Harlan, me and Dr Garg – two of the most expert men when it comes to fistulas!

He was always kind, caring and the amount of things that we learnt while there were phenomenal (I could write a booklet just on that). My other options up until then had pretty much been – live with a seton, go onto heavy immune-suppressant drugs, and keep trying a different surgery every year or so.

During the surgery, he took two tissue samples for a PCR tuberculosis (TB) test. He told me that it is routine for him to test for this, because if it goes undetected in the tissue it can cause a recurrence of an abscess or fistula because the TB cells multiply so slowly. About 5 days after the surgery the results came back positive. Since I was born and brought up on a farm in South Africa, where a lot of the workmen and their families had active TB, it wasn’t the biggest surprise.

The treatment for TB is a 6 month course of a combination of anti-biotics.

He told us that it was very lucky that the test had showed up positive, because often it can hide in an area of the body, and unless a PCR test is done on that particular tissue you can show up as negative. The things you never knew you never knew! I went on quite a Google mission after that to see if it might tie in with any of the other health-related issues that I’d experienced in my life!

Just to backtrack, for the last 5 years, since August 2012, I hadn’t been able to sit on my bum properly because of the pain. Whenever I needed to maintain a sitting position I would either sit with my knees bent and calves underneath me or I would sit twisted and sideways so that there was no pressure on the right-hand side of my bum.

The second day after surgery when I came into Dr Garg’s office and went to kneel on the chair he asked me why I wasn’t sitting.

Because it’s too sore and there is a gaping wound that I don’t want to sit on, I replied, wondering how he could even ask such a silly question.

You need to sit, he replied. Go on, try it.

I gingerly lowered myself very slowly onto the seat and allowed a little bit of weight to bear down. It wasn’t as painful as I had expected, but I still held some of my weight off.

Your new assignment, he said to me, is to sit as often as you can. It will give you that sense of normality that you haven’t had, and it will also allow you to feel any areas that may not be healing as they’re supposed to and you can report back.

Being dropped in Delhi for our last night in India. Shankar (middle) made our trip! He was the best driver EVER and became a great friend!

And so I began sitting normally on our drive to and from the clinic. At first I couldn’t believe that with such a huge wound I was able to do this when I hadn’t been able to sit for the last five years. However, it just became easier and easier until, on our last day we drove for 5 hours, from Chandigarh to New Delhi. Half way through the trip it started to get uncomfortable, but I could handle it, whereas before I arrived I couldn’t even have even sat for 10 minutes like that!

These were the small victories.

The big victories were that the wounds, both inside and outside began to noticeably heal before we left, and now, just over 3 months after my surgery, both the internal and external wounds are about 90% healed! Harlan still attends to them twice a day and will do so until everything is 100% healed. We now completely and deeply understand why the aftercare is so vital to wholesome healing after a fistula surgery. The other great victory is that I also have more energy because my body isn’t constantly fighting infection either!

My other offers regarding fistula surgery:

So, just to summarise, the procedure I was offered by the expert here in New Zealand, was to place a seton for about 6 months to a year, to allow inflammation to reduce and then possibly look at the option of an advancement flap. Inflammation would never have fully reduced because of the undetected abscess higher up, and even if it had and 6 months later the lower tract had been healed, I still would have been in a lot of pain from the hidden abscess. When this found another way to exit my body as another fistula, the explanation would probably have been that I was just prone to them and they were ‘unfixable’.

In Australia, even If the VAAFT procedure or the collagen plug had sealed the lower tract, exactly the same thing would have happened. I still would have been in pain, and weeks or months down the line, a new tract would have formed to allow the abscess to drain and I would have believed that I was incurable.

I had also thought of going to India for a kshara sutra treatment (before I found the Garg Fistula Research Centre), and had I done that, it would have at first seemed like a success and just like all the other options it wouldn’t have stuck.

Luckily for me I didn’t take the New Zealand option…

Enjoying the relatively cooler temperatures on a day trip up into the foothills of the Himalayas on our last few days.

…and the Australian option didn’t work, otherwise it might have taken me another year to get to India where I was able to find such amazing, expert, wholesome, caring treatment. I will be forever grateful to India, Dr Garg and his decision to keep learning more and more about treating fistulas, his amazing team, and all the growth and stretching I have done to get to the point where I never gave up and was ready to open myself up to fully trusting, even when it sounded like a ‘mad idea’ to others.

So many things led me to this place in my journey – EFT, learning to love myself more deeply and whole-heartedly (and all that encompasses), the incredible love and support from those human angels around me, and learning to surrender, let go and trust.

If you have, or know of anyone with a fistula please share this knowledge with them because it could change their lives! And even if it helps just one person to end the pain and struggle that they are experiencing as a result, that would be AMAZING!

India: I am ready

I step off the precipice and fall
for a moment I’m dropping
hurtling towards the hard ground

then I remember I have wings
I open them
they creak
stretch and the blood flows through them
my wings

it’s been a while
let them fly
let me fly
into the big unknown that beckons me
calls to my heart strings

and then there is vastness
openness above me
below me and all around me
I am free to journey

how did I forget my wings?
these beautiful light feathers
for soaring through the air
simply waiting for the words

I am ready.

And so I am. For another exciting chapter on this journey called life. In under two weeks I fly to India. A country that both scares me and intrigues me. A place where the Goddess Kali resides in many places. And I will meet her, even though I may not at first know it. I will feel her presence in the dirt and in the sunsets, in the poverty and in the wealth, in the rivers and in the temples dedicated to her.

I am going to the Fistula Research Centre in a city north of Delhi called Chandigarh. I am going to seek advice and treatment from a world expert in fistulas. There are not many of those around, and to be honest this colorectal surgeon, Dr Pankaj Garg, is the first such person I came across last year after 4 years of trawling the internet at regular intervals. I stumbled across his site about 8 months ago, and back then the idea of going to India with a sore bum and a tummy on the sensitive side scared the living daylights out of me. Australia seemed like a good first option. It did not pan out as expected though, so India came back onto the radar.

It is currently 40 degrees there in the height of summer and in July the monsoons arrive. However, this is the time Harlan can come with me and leave the bees to quietly and cosily winter in their sunny bush sights. Two dear friends are joining us too, and between the four of us there will be adventure.

Where there was fear and trepidation before, there is now excitement, anticipation and a feeling of adventure running through my veins.

You see I realised a few months ago that physical adventuring has been minimal through this healing journey of mine, and that I’m craving it. My soul needs it. It feeds me in ways that nothing else can. When I first got back from Australia I knew that when the pain settled we needed to explore, even if it was in tiny ways, we would do it.

And then one day last month, with the desire of healing my bum, the idea of India was reborn. It started out as a spark with only tiny flashes of light. But it very quickly grew into something more. The flight is 17 hours, which for someone who doesn’t even drive at the moment is very long! It’s hot! Some people experience Delhi Belly….

We all spent the first week almost reluctantly committing. Knowing we desired adventure, and me that and healing. However, as the days have passed, and more links and pictures have been shared between us, there has been a growing excitement and anticipation. What started out as a trip purely for healing my bum, has turned into so much more.

This time thinking about India, underneath the wildness of the idea, I feel a great sense of peace and calm. I am ready. The time is now.

It will be a pilgrimage. Me journeying to far off holy lands. Since I was named Kali, after the Hindu Goddess, I have always known that I will visit India at some point. I just hadn’t planned for it to be so soon. Lucky I’ve never been a big one for plans and so I can flow with the currents and go where I need to go at the time. I am ready. I am ready to adventure on all levels – physically, spiritually and emotionally.

I have opened my wings and my Inner Wisdom is guiding me.

I am ready.

I Can Heal Myself – Can’t I?

Can I heal myself?

I had an epiphany of sorts today! When you hear the words “you have the power to heal yourself“, what does that mean to you? Do you feel empowered or guilty? You don’t have to look far to find those words. When you google, listen to podcasts, join summits, pick up a book, you may come across a variation on that phrase. Maybe they just jump out more at me, because I have often attached guilt to them.

I have usually interpreted those words as: I should be able to heal myself. And if I can’t then there is something inherently wrong with me. I’m doing something wrong. Eating something wrong. Thinking the wrong things. Not meditating enough, or not doing enough yoga. I think this actually says a lot more about my journey with self-blame than anything else. I’m sure there are many people who hear these words and feel inspired!

I digress. I do find them inspiring.

Because I do believe we have the power to heal ourselves in different ways, just not alone. What I realised today is that I sort of interpreted these words to mean we should be able to do it on our own. And when I realised that, it made think about how healing, in my opinion, is never in isolation. We are never the only ones who heal ourselves. There are so many people who are part of our healing journey and play vital roles – some more noticeably than others.

Take for example the blog you stumble across that tells you about clearing your meridians to kick-start you every morning. Or the magazine you pick up in a Dr’s office that has an article on self-love. How about your acupuncturist, your counsellor, or your mother? Then there’s the surgeon you choose because he really honours you in the process and makes space for your opinions. Or your friend who you have coffee with every week, and she helps you get clear on what you’re really feeling.

It may seem like a lonely journey at times.

And you may be one of those people who has interpreted these words as I have before: that you should be able to do it all on your own. However, our input is pivotal in our healing journey. Creating a team around you is vital, and it’s all part of the process. But owning your power in that journey is key. The inspirational books, podcasts, groups and forums that you’re part of, the few people in your life who you can really open up to and trust…you’re not doing it alone. You are doing it with a team that you are case manager of. You get to create that team.

power-to-heal-myselfMaybe I have a new interpretation of “you have the power to heal yourself“. I do actually believe that you have the most power in your healing journey. The power lies with you to listen to your Inner Wisdom/Guidance/Knowing, whatever you want to call it, and then do what feels right. If you keep giving the reigns to your acupuncturist, homeopath, Dr, counsellor, you’re giving away that power. When I listen to everyone else’s opinions and they drown out that voice inside of me that only speaks the loving truth, I’m giving away my power.

When you take the power back, and create a team around you that really supports all aspects of your healing, then I believe all sorts of beautiful shifts are possible.

And yes – I can heal myself.

Listening to my Inner Wisdom

The need for Inner Wisdom

On Monday, the 23rd of January, I had the perfect opportunity to practice tapping into my Inner Wisdom. This is what I’ve been studying since September. Learning tools that I can use with myself and also with others, and now here I was faced with a decision where my Inner Wisdom was key. It was just over a week after my first fistula surgery in Brisbane with Dr Naidu, and my mum (Av) and I had been staying 1 ½ hours north in Noosa with my Aunt and Uncle.

Today we were heading back down to Brisbane to go and see Dr Naidu for a follow up. Av and I had packed up all of our things at Wally and Debbie’s in preparation to fly home in a few days’ time. We didn’t quite know what we were going to do but we planned to leave on Wednesday.

Feeling pretty positive about how things were going we met with Dr Naidu. He looked at my surgery site and he made the call that he wanted to see me for another surgery that Friday. There was too much leaking and he was worried that we needed a bigger seton to help the flow. Unfortunately he was really unwell, so I couldn’t ask all the questions that I wanted to.

Av and I walked out the room in a daze. We headed towards the café, as it was lunchtime and after I rudely shouted at her in front of everyone because she was unsure of her order, we went and sat down at a table.

Lashing out

“Just because you’re struggling doesn’t mean that you can be rude to me in front of other people,” she said to me. “I know,” I replied and burst into tears. She wanted to come around from the other side of the table to comfort me, but I put my hand up. I sat looking out the window of the 5th level, looking down at the buses coming and going below me. I wondered what next? I had no idea. Where I had felt so certain that we were going home, I now felt like a boat without any rudder. I felt a mess and completely lost. “I don’t know where to next,” I said.

Av was out of her depth. I had been the one who organised everything on the trip – accommodation, car, flights, toll and so on – so without my guidance and my knowledge of technology Av felt lost. What could I say to her? At the same time I didn’t want her comfort either. I just wanted it all to be over. I couldn’t face more struggle and more decisions about my bum.

We still somehow managed a giggle at the absurdity of it all, in between tears and me morosely staring out the window.

A plan

Av eventually called Wally and Debbie. Wally laughed when she said that she had no idea what we were going to do next, and they insisted that we come back up to Noosa. I felt relieved. At least we had a plan and at least we were going to be in a beautiful home with beautiful distractions again. Right now I could do with some of those.

So without lunch, only a coffee for Av, we headed straight back onto the motorway and back up towards Noosa. It was a long journey. My mind was buzzing and I didn’t know what to do. I had spent hours uncomfortably sitting in a vehicle already and I just wanted to get out and not have to make any decisions! I knew that I was about to have to practice diving deep into my Inner Wisdom. Diving deep and figuring out what my Inner Wisdom knew was the right thing to do. I had an inkling that more surgery wasn’t for me but I had to do some diving and rolling and tumbling with the ideas to make sure that I felt solid in my decision.

It wasn’t going to matter what anyone thought. In this moment, I knew that I had to feel into my body what was right. What did my gut tell me? It wasn’t a small decision either; staring down the barrel of another general anaesthetic and more pain. This wasn’t going to be taken lightly.

Inner Wisdom practice

I was so thankful for the Inner Wisdom preparation I had been doing for the last few months. As self love students, we have had to create a daily practice of checking in with our Inner Wisdom – what she needs and wants to share with us – so that in the moments when we need her we have developed a relationship with her and find it easier to listen. We need to understand the process in order to be able to share it with others.

Now was the moment.

In the evening, on a visit to the wholefoods store I talked to Av about why I had been so thrown. What was it about our surgeon visit that shocked me the most, because really I had already said I wouldn’t be up for more surgery if the option arose. After talking it through and distilling the ideas, I realised it was that what I had had done was supposedly not enough. Bugger that!

By nightfall I knew what I needed to do. I knew my body needed a rest from more pain and I decided to move into a space of trust that what I had had done was enough and that my body could take it from here. The next day I received an email from the hospital confirming the anaesthetist for Friday, and that made me realise I hadn’t let the surgeon know that I wasn’t going ahead.

A decision is reached…

I composed a text message to him:

Dear Dr Naidu, I have decided that my body is not ready for more surgery yet, and I trust that the seton that is in there will do more than not having anything. We will fly home on Friday and I will keep you updated on progress.

A few minutes later he called.

Usually I would have had stomach flips at going against the decision of a surgeon, or fear that I was doing the wrong thing. But this time, only calm. I felt grounded and very certain in my decision. So when I spoke to him I was clear and he was very respectful that I knew my body best. I finished the telephone conversation feeling empowered and very much knowing that I had followed my truth.

I was walking on air when I left the office. What an amazing feeling!

Here I had direct proof that my daily Inner Wisdom practice was paying off!

Would you like to share an example of following your Inner Wisdom? I would so love to hear xx

Postscript: I am back home now and healing is going well – I am flowing as much as I can in trusting my body and its innate healing abilities.