C. Diff Say What?

While I am on the hunt for/creating my own surgical illustrations, let’s take a break from fistulas to discuss a nasty little bacteria called Clostridium Difficile (C. diff). This is a bacteria that lives in all of our intestines, and is normally kept at bay by good bacteria.

Why would I bring up this ugly little bacteria here on Fistula Survival Guide? Because many of you suffering with colorectal fistulas will undergo surgery, and more often than not after surgery you will be put on one or two antibiotics. Unfortunately, strong antibiotics (such as Cipro, which is commonly prescribed after surgery to prevent infection) can kill off the good bacteria in our intestines, which can allow c. diff to flourish and develop into c. diff colitis (I may refer to it as simply c. diff throughout this article).

This happened to me after my second surgery. I was having horrible diarrhea (more so than is usual for me even with IBS), stomach cramps, and nausea, but when my doctor at the time didn’t think much of it, I chalked it up to being sensitive to the antibiotics. I went ahead and charged forward with surgery number three, my very first advancement flap surgery. Weeks after the surgery, when I should have been healing and feeling better, I was still in huge amounts of pain, still feeling horribly sick to my stomach, and worst of all the surgery was not healing.

As fate would have it, my doctor left and I was sent to a new colorectal surgeon. Concerned about the frequency of my diarrhea, nausea, and lack of healing, my new doctor ordered a stool sample. Lo and behold, I was plagued with the dreaded c. diff colitis. In most cases, given a regiment of a certain antibiotics (Flagyl is the first one I was given), it will go away. I was in the unfortunate 20% that required almost 6 months of treatments, different medicines, and even participated in a study for a new c. diff medicine (turns out I was in the group given Vancomycin, which was not the new medicine). Eventually, the vancomycin cured me, but it was a long and grueling process.

After you have had c. diff colitis, you will need to be forever cautious when you have to take antibiotics, and alert your doctor to the fact that you had c. diff. Seriously–for the rest of your life. Be careful. I am not trying to scare you, but this is a disease that can and has killed people. Those are extreme cases, but it is not something to be taken lightly.

The main reason I bring this ickiness up is that there are certain things you can do to reduce your chances of getting c. diff. After surgery, while you are on antibiotics, here are a few suggestions I have (as usual, PLEASE CONSULT YOUR DOCTOR, this is just advice from my own experience, most of it given to me by my doctors):

*TAKE YOUR FLAGYL. Seriously, if you are taking Cipro or any other really strong antibiotic, do not skip your doses of Flagyl. This will help keep the c.diff at bay.

*I highly recommend taking a good probiotic (my doctor told me about florastor, which is a yeast-based probiotic, so it isn’t counteracted by the antibiotic). This beneficial bacteria can help combat c.diff

*Turmeric! Take lots of turmeric! It cannot hurt you, and is naturally anti-bacterial, anti-inflammatory, and helps to improve your intestinal flora. You can get it as a capsule, or just loose powder, which can be mixed into your juice, water, or food (the powder is cheaper and found in most spice sections at grocery stores).

*Pay attention to your body. If you feel like something is wrong, it is worth it to talk about it with your doctor. If you have been on antibiotics for 30 days or longer and start experiencing consistent watery diarrhea, fever, nausea, weight loss, loss of appetite, ASK FOR A STOOL SAMPLE TO BE TAKEN. My first doctor did not order one, despite my complaints of almost all of these symptoms. You can ask for/insist on a stool sample.

For more information, I recommend this PDF:

http://effectivehealthcare.ahrq.gov/ehc/products/115/891/cdiff_cons_fin_to_post.pdf

and this awesomely helpful website:

http://www.cdiffsupport.com/aboutcdiff.html#What_is_Clostridium_Difficile_-_in_easy

If you have a serious case, and are not recovering, I highly recommend going to an infectious disease specialist. Ultimately that is what I ended up having to do, and that is where I was given the right treatment.

To reiterate, I am not trying to scare you. I just wish I had been aware that this even existed when I was going through the Fistula of Doom. I hope you have found this helpful! Take good care of yourselves, and always keep hope. I healed. It took a long time, but I did make a full recovery. Remember that you are not alone.

In fistula solidarity,
Leah R. Chatterjee

Let’s Talk About Sitz, Baby

One of your main tasks during this whole ordeal is going to be managing your pain and discomfort. That is why I’ve dedicated an entire entry to the Sitz Bath:

Image

This is a Sitz Bath, your new best friend through almost every stage of dealing with the dreaded perianal/anal fistula. This wonderfully simple device will do more to ease your pain and discomfort than anything else out there (my opinion, and probably your doctors’ opinions, and that of anyone else who has had an anal fistula). It is very easy to use, you just fill it up with the hottest water your bottom can stand, place it over your toilet seat (lift the two lids first), and sit. You can also add stuff to the water, like witch hazel, but honestly just plain water works great. You can use the Sitz bath as often as you want. Shoot, you could spend most of your day in it if you wanted.

The Sitz bath really helps the draining, and if you have a seton band (we’ll get into these soon, but basically it’s a band that is placed in the fistula to facilitate draining) it will provide a lot of relief for the inevitable skin irritation caused by the band rubbing against your skin. Post-surgery Sitz baths will really help with the pain, and will assist you in keeping the area clean when it is too tender to use toilet paper.

When I was first diagnosed two and a half years ago, I was a bit shy about using the Sitz bath at first. It was kind of annoying to lug it out, deal with drying myself off afterwards, cleaning the thing…it’s a process! My doctor kept pressing me to use it more often, so finally I gave in and started using it at least three times a day. What a huge difference it made! I promise I am not being paid to advertise for products, I just want you to know what worked best for me.

Go out, buy yourself a sitz bath (they are fairly cheap and found at most drug stores), fill it up, and SIT.

Next week I’ll talk about diet and helpful supplements!

Until then,

Leah R. Chatterjee