What is kshar sutra and a bit about clinic visits

 

What is kshar sutra?

I have just assumed everyone reading knows what kshar sutra is/involves...but as we know, one shouldn’t assume! So I figured I’d include a very basic description here for those who need it, but also for the purposes of recording as much as I can about the treatment and all aspects of the journey for future fistula fighters.

Kshar sutra is a technique where a thread is inserted through the fistula tunnel – like the seton we have at home, but oh so much more than that. The thread undergoes a specific process of coating. Numerous layers of varying Ayurvedic medications are used (aka herbs, plants, natural, healthy!) each of which play an important part in the healing process. Unlike the setons placed at home, this one is changed regularly, a fresh thread is placed and the herbs do their thing. The general idea (to my understanding – which won’t be precise of course!) is to essentially train that fistula out of your body gently from the inside. So the thread is inserted through the tunnel and tied externally relatively firmly. As you move/walk and just in general, it is working internally to gently cut the fistula track, drain it and clean it, and the medications control any infection. I imagine it to be kind of like when your body rejects a piercing and it works its way out of your body (silly analogy I know, but it helped me have a visual – and again, I may be wrong!). Anyway.

The way Dr Bhat works is to have the initial surgery whereby he cleans the fistula and places the initial thread. Once he feels your wound has healed sufficiently and sees it’s ready, he will change that thread and continue to do so as per however many days in between he feels necessary. It’s a gradual, gentle and sometimes painful process, but that thread gets smaller and smaller as it works that horrid fistula out of your body, to the surface. It’s hard to be precise about how long this will take to work because, understandably, it’s dependent on a plethora of things – how complex your case is, other underlying conditions, how your body heals…to name a few. Now I haven’t reached this point yet, but apparently at the end, you go in for a normal thread change appointment, and the general consensus is you feel a bit of a burn and a snap/sting and then doc announces you are fistula free (this is where you cheer and cry and take photos and get presented with a certificate lol). You will be left with a wound which will need another couple of weeks’ visits to doc to check on daily. He needs to ensure it’s healing accurately from the bottom up, rather than closing over from the surface and potentially leaving a tunnel under the surface (if that makes sense). There are times where other procedures may need to take place, and things change as the treatment happens, but this is it in a nutshell. Layman’s terms. Doc just knows by looking what and when things need to happen.

So yeah! That’s my understanding of the treatment and this is why it can be a long process. It’s much more gentle on the body than procedures available at home. Sure it’s painful at times but honestly, those with fistulas can handle it. You know what I’m talking about!

 

Going to the clinic is always an adventure. The moment you step out of your accommodation you are in chaos essentially! The roads are permanently busy (I think most of us have head stories about traffic/driving in India) but I love it, I hope I will still be saying that months in to this! There’s a lot to see as you drive and I savour it – the sad parts are hard like the beggars and the stray animals and stuff. So be prepared for that (can you ever really prepare?). There is no order when driving except an occasional red light. Cars come within an inch of each other (literally) and constant beeping of horns are how they alert each other of their presence. So far I have only witnessed one angry driver, but otherwise it just is what it is.

At the clinic, I generally see fellow fistula fighters from the Israeli group and we have a little chit chat and check in on each other. There is a network of people from Israel that have a support group within their country for sharing all this information. For years patients have been coming for treatment from Israel and I am super grateful to have them here to talk to (I cannot stress enough how much the support helps and I think is paramount to healing. This is different support to friends and family who are also vital but in a different way). There’s about 7 people at my accommodation from Israel, and more at other hotels. There are other treatments people come here for including fissures and hemorrhoids and many patients are afflicted with multiple problems.

The staff at the clinic are just awesome. Friendly, genuine, lovely. The incense and background chanting rhythms make it a pleasant, calming atmosphere. You can attend the clinic at any time you please – ie there is no appointment time. Early is best for traffic generally as drive time can vary greatly dependent on time of day (for me so far it’s been minimum 30 minute drive and maximum 1 hour). Also the clinic closes for a couple of hours in the middle of the day so really at the start or end of these times are generally pretty quiet. In between there can be longer wait times – the longest I’ve waited was about 20 minutes but I got to watch the world go by outside the clinic while waiting and chat with others and staff. I enjoy that aspect as I’m a chatterbox at times, and I like hearing about everyone’s experiences. You know you’re not alone and what you feel is normal. You feel each others pain and joy and talk frankly about things without any concern about grossing someone out or giving too much information.

When it’s your turn, you lie on the bed with legs in stirrups and doc comes in and does his thing. It’s all over very quickly and he’s juggling multiple patients at once. A man in demand that’s for sure! There are times of course where you have longer appointments with him, updates on where you’re at and whatnot. He is a very interesting man and I can already see his tactics in preparing you mentally. He always tells you you are strong, can see if there is pain in your face and is gentle, he knows how to distract you if something may hurt, he’s got a cheeky side. Yeah, I really respect him.  

One thing I learnt pretty quickly is to ensure you ask as many questions as you want or have. You will not always get offered this information and it’s up to you to also be in charge of your treatment. I feel absolute trust in doc’s hands, and most of the time I just don’t want to know (I can’t deal with wounds personally!), but when you have questions you ask. About medication he has provided (eg do I still need to take this?), about what you can and cannot do physically…you get the gist. 

Ok, I think I’ve rambled enough. If you’ve lasted til here – thanks! Honestly, I could talk for days about this whole journey and still not even touch the surface. 

Pics of some of the gifts in the clinic: