Hello! This page isn’t linked by any other page in my blog or website, so I don’t anticipate anyone will see this page besides who I send a link to. It’s just for friends and family to get insight into what’s going on and how I’m doing. That said, there’s no particular security on it either—if the link were to get out for some reason, anyone could access it. Nothing on here is super duper private—just potentially TMI—so I’m fine with that risk.

So, I got butt surgery. After 3 abscesses, I finally (April 16) had a procedure to address the underlying problem—a perianal fistula (translation: an extra non-standard butthole). Apparently it was a complex fistula, because they put a seton in, a string threaded through my butt that’s partially poking out.

Now, here’s where I’m confused. I only knew a seton placement was a possibility from the paperwork. The doctor didn’t explain to me that there was a possibility something was going to be left in. The notes I got afterwards say that it will be removed with time, but they don’t say whether this will take place at my follow-up appointment on May 4, or on some subsequent appointment, or in another full-anesthesia surgery.

Looking at Google, these are all possibilities. If it’s a “draining seton,” they would need to do a separate procedure to close the fistula when they take it out. If it’s a “cutting fistula,” which seems far more likely, they might need to manually tighten it! If it is a cutting fistula, that means it’s cutting through muscle very gradually so the muscle heals back, and manually tightening it will result in more cutting, so in that case, there might not be an end to the pain anytime soon—in the next anywhere between 3 weeks and 16 weeks, depending on where I look online, and possibly going in every 2 weeks to have the doctor tighten it in the meantime.

(Obviously, I’ve reached out to the doctor for clarification. No response yet.)

Speaking of the pain, this is among the worst pain I’ve had in my life, but inconsistently. At times, it’s worse than anything from when I fell off a cliff in a hiking accident in 2010. At other times, it’s not bad at all, and I even was able to go to the movies. It’s not been linearly improving at all.

I don’t want to take the pain meds too much, since I’d like to be able to use my brain for things. That said, the pain’s especially nasty when I’m trying to sleep. The only thing that really works for the pain is a long hot bath, which is really annoying b/c I end up taking several in the night. There is really no comfortable sleeping position, and no non-painful way to lie down. I don’t want to doze off in the bath because that seems like it might be dangerous.

I’ve also learned that I automatically clench my butt in response to many emotions, even minor ones. A slight whisp of anxiety, fear, or cringe can provoke a butt-clench, which currently is extremely painful, and if I’m lying down can result in pain for many minutes. I have learned to anticipate and cancel butt clenches, or to move so that my butt isn’t pressing against anything when it clenches, both of which mitigate this fact.

The last issue is nicotine. The OR nurse told me that while a hospital would never recommend nicotine, there was no reason not to go back to Zyn. However, my follow up research indicates to me that if this is a cutting seton (which it almost certainly is), they’re relying on muscle healing relatively quickly as the seton cuts. Nicotine slows down healing, so that might mess with my healing—possibly resulting in incontinence.

I’m not sure if my follow up research is accurate. I put in a clarification to the doctor. The notes I got say this:

Do not smoke. Nicotine and other chemicals in cigarettes and cigars can slow healing and cause lung and heart damage. Ask your healthcare provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your healthcare provider before you use these products.

This is unacceptable. There are two possibilities of what this means:

• Possibility #1: This is a guilt-trip saying, hey, now that we’ve got you in the hospital, your friendly reminder that we want you to quit smoking, even though it is entirely or almost entirely irrelevant to your procedure. As a nicotine consumer through Zyns, I would just ignore this. 97% of this notice reads like this.
• Possibility #2: There is a specific reason why nicotine consumption will result in a worse outcome for recovery from this procedure. This is contained in two words that you might miss: “slow healing.” If it can actually result in not healing properly at all, that is an inexcusable understatement.

Both possibilities are unacceptable health care communication. Smokers and nicotine users all already know that doctors want them to quit. Most of this is saying that smoking’s bad for you. It really does read like possibility #1, like they’re using this scary language to try and have a stab at getting you to quit, which is sort of a distraction from the surgery and something that the majority of smokers would ignore (one thing at a time, at the very least).

If there is a specific reason why smoking or nicotine consumption will result in less effective healing, or perhaps catastrophic side effects like incontinence, you need to say that clearly, front and center, and not even mention the other effects. Mentioning the heart and lung damage, which have nothing to do with this surgery, reduces credibility that there’s any particular reason to avoid nicotine after this surgery.

The statement “e-cigarettes and smokeless tobacco still contain nicotine” is particularly egregious, because this statement doesn’t even assert that there’s any problem with nicotine, just with smoking. I know that e-cigarettes and smokeless tobacco don’t have the same side effects as smoking, but I genuinely don’t know whether they “slow healing” or not—or whether that’s a catastrophic thing or just an inconvenience that they’re leveraging to try and guilt-trip me into quitting.

Nevertheless, I did discuss Zyn with my OR nurse, and she said I could use it. I’m really glad I did follow up research. If my brief use of Zyn after surgery increases my risk of incontinence, it will be because of poor communication about nicotine, because of the conflated goals of “just quit please” and “wait there’s a specific reason to not use it here” burying the specific reason.

This is all coming from a questionable (and I would say false) assumption that there are no legitimate reasons to consume nicotine, but that’s a whole other essay. I am giving up nicotine for now—which is a huge deal transition that I was not prepared for, that I would’ve wanted a heads up on, and that I would’ve wanted to consult with my psychiatrist for, and that might cause lots of problems in my life. My PCP had actually recently recommended I pause my most recent attempt to tamp down on nicotine use.

If nicotine use is actually dangerous after this surgery, my doctor should have flagged this with me specifically. My nicotine use is on my chart. This is unacceptable. If they’re just trying to use this opportunity to guilt-trip me into quitting smoking, then they should clarify that it’s not that big a deal in their notice rather than mentioning “slowing healing.” It’s really unclear to me whether nicotine is actually dangerous after this surgery, and after doing follow up research I don’t trust the OR nurse to actually know the answer.