induration with fluctuance ( not dinner table talk )

Soundtrack! ( you will like this one ;)  


Will keep this post brief, but the topic deserves a mention, and after all, aren't geezers supposed to talk about their ailments?

The only reason I post this is because you blog followers with MDS may well find yourselves with similar complications brought on by being neutropenic.. ( No way to fight infections )

The National Center for Biotechnology Information NIH

Anorectal sepsis affects 5–7% of hospitalized leukemic patients and represents a major cause of mortality. Bacteremia and septic shock have been observed in leukemic patients with perianal abcesses. Grewal et al. have compared operative and nonoperative management of these patients and concluded that anorectal abcesses in neutropenic leukemic patients may be safely drained; however, the mortality was identical in both groups, averaging 20% (11). The neutrophil count is an important prognostic factor; severely neutropenic patients are prone to develop indurations without fluctuance and should be nonoperatively managed, whereas leukemic patients with borderline neutrophil counts may present with fluctuant lesions amenable to surgical drainage (12). Nonoperative treatment often includes parenteral antibiotics and radiation therapy.

Technical, but informative:
Pub Med abstract from National Institute of Health


So when I was at the Nadir point of my first Chemo Cycle my white blood cell count was really low, an infection reared it's head.

Some of the bacteria that are ok in your gut are not good if they find their way into say, the mucus ducts that lube the tube down under.  Some of those rascally bacteria that probably were present there all along, but had been held at bay  by my white cell army,

rose up and infected me, causing a perianal abscess. This has to be lanced and drained and results in a fistula in ano,  a little side road that allows one to fart in harmony.  See the seton in the picture below.

After enduring this situation for 8 months of sitz baths and antibiotics, disposable underwear and gauze packing, I decided to have a fistulotomy.

I won't link to the videos of this procedure, as they are quite graphic. I reviewed them and mentioned them to the surgeon who had done the lance and drain procedure.  He said, "yeah, youtube is great if you have to remind yourself about a procedure you have not done in a while". Though I don't question his ability with the knife, I have encountered the "No Cut, No Cure" mentality before, and I politely asked him if he knew any other surgeons from whom I could get a second opinion, say maybe up in Greenville?

He referred me to Dr. Brillant, who saw me twice before the surgery. Coincidentally , his Mother had just been diagnosed with MDS, and he was getting up to speed on what to do about her treatments. I got pumped up with the white celll promoter Neupogen, Platelets and two bags of Red Cells,  and went under the knife at Pitt Memorial Hospital in Greenville.

Ok, enough of this....let the soundtrack song play out. I understand Buffet covered this song in concerts.
Better than Road Rage.