In October of 2006 I went to my primary care clinic with what turned out to be a peri-anal abcess. I was told at the time by the doctor who was seeing patients that day that he wanted to admit me to the hospital because it was possible that this could be fatal. Without going into detail I don’t have a lot of faith in doctors in general and even less in hospitals. Upon his admission that the only thing that they would be able to do for me in a hospital would be administer antibiotics I declined to be admitted to the hospital at that time. He ended up giving me a shot of what he said was a heavy duty antibiotic and a prescription of pills I was to take daily. I was told that if the abcess, which was about the size of my closed fist in the primary location but also extended from there up into my groin to the lymph node with the extension being about the shape and size of a banana, that if it began to drain that I should return to the doctor’s office immediately or if my fever spiked to go immediately to the nearest ER.

Two days later the abcess began to discharge as I was taking a shower. Upon arrival back at the clinic another doctor looked at it and determined that it should be “opened & drained” and then packed with what he called a “wick” which would keep the wound open allowing it to drain. I have an over-developed reaction to intense pain and informed him of this and he said that I wouldn’t feel anything other than pressure because he had an “anesthetic” that would, in effect, “freeze” the area during the “quick” procedure. Unfortunately for him he did not understand the severity of my instinctive reaction to intense pain. When he made the “puncture” or incision I was laying on my back, I remember an INTENSE PAIN and my scream being very loud. According to the nurse that was present when the doctor made his incision I reacted violently by screaming and kicking the doctor in the head which sent him flying back off of his rolling stool and into the wall behind him leaving him lying on the floor stunned until I finally calmed down. When I had calmed down and the pain had decreased to a “manageable” level I was given an oral pain killer, bandaged up and it was suggested that allow the abcess drain on its own for a few days but that if it got any worse that I should go to the ER.

Well, the incision the doctor had made did allow for the primary portion of the abcess to drain but after three days I received a call from the clinic saying that I needed to come back in immediately. When I did go back they told me that I had been incorrectly diagnosed and prescribed the wrong medication. They informed me that I had something called MRSA which is a resistant form of “Staph” a bacterial infection. This time I was seeing the same doctor that I had initially seen and he again recommended my admission to a hospital. When I declined yet again he gave me a referral to a surgeon to get a recommendation on the best course of treatment to deal with the remaining portion of the abcess which was not draining, the portion that extended up into the lymph node in my groin which was still the size and shape of a banana. I was also given a new prescription antibiotic to take.

After taking the prescription and two trips to the surgeon the remaining portion of the abcess appeared to be absorbed into my body which was not considered to be good but wasn’t an outcome that the doctors new how to react to. It was deteremined that if my condition didn’t worsen that our best course of action would be to “wait and see.” When my condition didn’t worsen I was told that my body appeared to have dealt with the remainder of the abcess on its own and that I could consider myself “cured.” This was the last week of October 2006.

In April of 2007 I experienced an intense pain in my rectum during a bowel movement which incapacitated me to the point that I fell off of the toilet and it was an hour before I was recovered enough to get back on my feet and take a look. When I did I discovered a large piece of tissue/flesh about the size of my thumb from the tip to the first joint was extruding from my rectum. Also alot of the tissue around the rectum was swollen and puffy. All of this was still quite painful. In the time since I had the abcess I had become unemployed and no longer had healthcare insurance so I set up an appointment through a non-profit agency and the first date that they had available was in July of 2007. I was initially diagnosed with an anal fissure and was told that it would heal on its own over time and was given another presciption for antibiotics. Over the next four months I went to other facilities that allow for “walk-in” examinations. Finally in October of 2007 I was diagnosed with an anal fistula and referred to a colorectal surgeon that was under contract with one of the non-profit clinics that examined me. Upon seeing me for the “initial consult” he determined that I needed a colonoscopy and that I needed to inform the clinic that had referred me to him that he would require an authorization before he could schedule the procedure. The initial consultation with this surgeon was in November 2007. The procedure was finally authorized and performed in January 2008.

The last time that I spoke to this surgeon was just prior to the colonoscopy procedure as I was being put under by the anesthesiologist. Both I and my doctor primary doctor at the clinic then had to wait nearly four weeks to receive a report on the outcome of the colonoscopy or recommendation for any further treatment. Finally, upon my calling the surgeon’s office and being informed that they were waiting on an authorization approval from my clinic so that they could schedule the procedure that would actually deal with the fistula which was a surprise to my doctor and the clinic’s staff since they had not received any such request. After I informed them they provided the authorization for the procedure that he wanted to perform. After waiting another 3 weeks expecting to hear from them regarding the scheduling of this procedure, though I still had not been given the name of, I was told that they had already scheduled the procedure for a day that was less than two weeks away. Fortunately I had no pre-existing plans and did agree with the date but was given very little information about the procedure itself. I was told that I needed to contact my clinic in order to have some labs performed within the next 4 days, that I would need to arrive at 9 a.m. and that I would probably be released sometime after 5 p.m. that night. After telling them that I would call my clinic to set up an appointment for the labwork we said goodbye.

As soon as I hung up I realized that I had not been told exactly where I needed to be at 9 a.m. so I called them back. They told me the hospital’s name and I hung up before calling right back to ask them if I was going to need someone to pick me up from the hospital and if so could she be more specific about my likely release time. I was told that I should arrange for someone to drive me home and that they could not be more specific about when I would be released. After hanging up the third time I realized that they still had not told me what procedure the surgeon was going to perform on me or, really, much of anything else. I resolved to ask my doctor when I went in for my labwork in a few days.

Unfortunately my doctor was not in at the time I went in to have my labwork done. However one of the other staff members informed his assistant about my lack of knowledge concerning the procedure to be performed or any pre or post operative guidelines I should know about. My doctors assistant called the surgeon’s office and was told that they had already seen me, informed me about the procedure and given me a “folder” of information with everything that I needed to know. Well, when the assistant informed me of what they had been told I got rather upset and letting them know in no uncertain terms that that was NOT the case. That the last time I had “seen” the surgeon in question had been nearly six weeks prior just as they were putting me under general anesthesia That I had been discouraged from even showing up at their office until they received an authorization for the next procedure and even when they got that they schedule a time for me to come in to discuss/describe the procedure. They just gave me a time and date to show up for the procedure. Well the assistant went back and apparently spoke to one of their administrators and they called the surgeon’s office back and finally got an agreement that they would contact me directly within the next couple of days to answer my questions. That was last Thursday, March 20, 2008.

The assitant from my clinic called me Friday afternoon asking if I had been contacted yet and I told him that I had not. Today is Sunday, March 23rd, Easter Sunday. I have resolved to travel to the surgeon’s office tomorrow, Monday, March 24th and will remain in their office until I am satisfied that I have been fully informed. Afterwards I will visit the hospital where the procedure is to be performed and let them know the situation and request that the procedure be monitored since I have no real confidence in this doctor but have no other real options left open to me. The research that I have done online on fistulas all say that the longer they are left untreated the more damage they will do to the rectal muscles and when combined with MRSA which is incurable and in my case considered, ultimately, to be terminal I really don’t have any other choice at this point. I’ve been dealing with my fistula for nearly a full year now. I hope that it hasn’t taken too long, that the fistula hasn’t done too much damage but at this point I’m not holding my breath.

My recommendations:

1) avoid “local” anesthesia when dealing with an abcess, especially one that is located peri-anal.

2) if you have health insurance get a referral to a physician experienced in dealing with “Staph” and MRSA due to the potentially fatal consequences of an incorrect diagnosis since this bacteria is responsible for a high percentage of all abcesses

3) Get a 2nd opinion and get other medical professionals involved, the more involved a doctor’s peers are the less likely they will be to “cut corners” or not be thorough

4) If it doesn’t sound/feel right, trust your instincts. You have spent more time in your body and know more about it than anyone else in the world. Find a doctor that will listen to your concerns and take you seriously.