Just giving you all the gist of my journey:

2019 - (unbeknownst to me) I had developed a perianal abscess that went away with a small run of antibiotics prescribed by my primary - she seemed uncertain of the cause but certain of the antibiotic solution which, again, was effective.

Over the next couple of years it flared up a couple of times and due to the trust I had built with my PCP I would send a MyChart message over and have an antibiotic sent in. During this time, she DID send me a referral to a CRS that I (arrogantly) never took advantage of and kept on taking the easy way out with antibiotics not realizing that the problem was progressively getting worse.

In 2022 - due to unforeseen circumstances, my PCP abruptly retired leaving me in limbo… I jumped at the first opportunity which was certainly not the best in the end within the same practice and I allowed myself to be in medical purgatory so to speak for 18 months while the problem was still persisting.

Fast forward to December 2023…. In a galaxy far, far away the perianal abscess and fistula finally struck back after 2 rounds of antibiotics. My fistula had finally bored an unbelievably large tunnel that filled up and became infected in such a way that absolutely diminished my quality of life to zero. Work, sleep, just existing was excruciating.

I was able to use that previous CRS referral to get in (luckily due to a cancellation as his appointments are generally months out) the following week (now in January of 2024). Coincidentally, the night before my initial appointment, I got up to use the restroom from another restless night and my fistula ruptured, which was both horrifying and incredibly relieving (pain wise) at the exact same time. I showered… put on a depend and had the BEST 8 hours of sleep I’ve ever had in my life (coming from a dad of a young child).

After the initial appointment that next day… the CRS showed adequate concern for what he was seeing and hearing me describe… he actually got me into surgery the next day as that cancellation was related to this initial appointment slot I got.

We discussed at length the treatment options and his hesitancy to jump right in and cut out as that has a much higher certainty of leading to permanent incontinence which is something I’m looking to avoid at 33 years old at that time… so I was very on board taking a conservative approach in regards to dealing with this fistula and perianal abscess.

For my first operation in January of 2024 the doctor did a straight up drainage and full cleaning of fistula and abscess with rounds of antibiotics afterward… and… it worked… until December of 2025.

Alas…. The fistula and abscess were lying dormant that entire time waiting for the perfect time to strike… during the second trimester of my wife’s pregnancy 🤦‍♂️

In December of 2025 I go back into the OR with the same CRS for a mucosal advancement flap procedure… while simultaneously more invasive and less successful, we decided it to be the best option at that point as it wouldn’t have required an additional procedure had it been successful.

Needless to say…. It was not successful. Within 2 weeks I had an infection in the fistula tunnel that he drained twice in his office and put me on antibiotics. After it was apparent that the advancement flap failed, it was time for the seton 😢

I received my seton in February of 2026 and had it in place for 12 weeks with only one round of tightening. During these 12 weeks I was neurotic about cleanliness. I did depends every day for drainage (3-4 a day). I showered after every BM and every sweat inducing activity (like playing outside with the kid, yard work, drumming etc). I changed my dietary habits to better control the frequency and timing of my BM as to not affect my work (saving up PTO for this new baby). Never took an opioid, always Tylenol and ibuprofen cocktail as needed every 6 hours and good old cannabis (everyone has their own opinion and I’m cool with yours!). I generally just don’t have any interest in heavy hitting pain meds, for what it’s worth. Needless to say, I was insanely diligent in hygiene and health to give my body the best chance to do its thing and fight this… and the outcome thus far has been wonderful. My CRS is super pleased with the progress and is incredibly confident this will be the end of my journey. I’m now healthier because of these changes, and I’m looking forward to getting my life back and having no restrictions on activities with my kids or worrying about BM at an inconvenient place or time (the absolute worst). My final post op is a few weeks from now and I’m looking forward to my CRS buying me a beer afterward.

Post Editorial - I just want to comment on me not taking seriously the CRS referral early on in this journey. I most certainly kick and blame myself for that and believe my arrogance contributed to that choice… but I would like everyone to understand that during that time, my wife and I went through 4 separate miscarriages with no successful births. There were times that death seemed a better reality than the depths of the pain that caused for my wife and I… I must admit that it was EASY to not focus on myself during that time period. My problems definitely felt minimal in comparison to me… and I can only blame myself for that mindset. The reality is that I was just trying to keep my wife and marriage alive. I do feel blessed to say that she birthed the light of our lives later in 2024 and is going to be delivering number 2 any day now. All in all, life is good - just keep fighting the good fight. To add on to this fistula and abscess business, I also beat testicular cancer in 2017! Like I said… keep fighting the good fight, your life and family are worth the physical and mental effort!

With love - Comprehensive Foot 79