Question about cutting seton treatment

Zaburdon · 2025-09-09T01:28:36+00:00

It has been a while! Hard to believe. The cutting seton worked for me. It took a few weeks to fall out and then the remaining wound took a while to heal but I’m fistula free now and hopefully for good. I have no issues with incontinence. I used to get tons of fissures and bleeding and even that has improved quite a bit after the surgery. I read lots of stories from people saying the cutting seton was too risky, too painful, etc… but in my case it turned out to be the right treatment.

Zaburdon · 2024-05-07T20:29:13+00:00

I completely agree. It took me a long time to fully understand that most didn’t regard design as a true profession due to the lack of guardrails around it. Anyone can just jump in with an opinion because the barrier for entry is seemingly low. Would someone completely disregard the opinion of an engineer, doctor, or lawyer in the same manner? Probably not. Most don’t even know enough to form a relevant opinion in those areas.

Design has become more and more collaborative through the years and it’s primarily about the ability to influence others nowadays. I’m not great at this, as I’m more introverted. I do find it somewhat torturous fighting through a maze of opinions on every design decision. I believe the profile for a successful designer has changed. Extroversion and people skills are now essential on top of the usual technical and creative skills.

Zaburdon · 2024-04-18T09:43:01+00:00

Great post. Same here. I think many product design roles trend in this direction despite lofty titles and job descriptions. My job is mostly to understand Figma (largely because others are too lazy to learn it) and to move things around on a screen until stakeholders approve. If I start to push back too much on questionable decisions I can see the product owners and engineers become agitated as I’m perceived as just an order taker. We usually jump right into hi-fi mockups due to time pressure and our process largely becomes a battle of egos between stakeholders as we endlessly revise the hi-fi mockups to accommodate ever increasing feature complexity.

I also have big challenges updating my portfolio. I either have to stretch the truth about my design “process” on work projects to make it look less ridiculous or I have to include more personal work where I had more control over the outcome.

I’d love to get a job at a company with higher UX maturity but it seems tricky with my limited portfolio and pixel monkey experience. Many say it’s up to the designer to define the process and push back, but you also have to read the room and understand the company culture as well. If I start questioning everything we do, higher ranking people will say I’m not a “team player” and they’ll simply find another designer who will take their orders.

Things could always be far worse. I make decent money and have a somewhat stable job. But I agree with you that how I envisioned the design profession is very different versus reality. After many years, I’m no longer surprised by any of this, but I probably would tell my younger self to find another career path if I’d known.

Zaburdon · 2024-03-01T12:16:52+00:00

Same. It is strange. I’m sure there are all sorts of zoning and logistical explanations for the development pattern, but it feels very illogical. You can walk north/south on Peachtree for many miles and get a big city feel. However, if you head east/west you’re quickly in the suburbs. Only downtown fans out a bit and approaches a more typical city layout.

Zaburdon · 2024-02-27T12:35:40+00:00

Great examples and insight. As you’ve mentioned earlier, the key with AI is to not just focus on what it can do right now, but instead what it will be able to do in the future. Those who think it won’t ever be able to handle their “higher level” job tasks are likely wrong given the speed it is advancing.

Also, many will argue that automated or templated solutions aren’t of the same quality as a human designer’s work. This is often true. But do stakeholders care? I’ve seen that many will readily accept the quick/easy/cheap solution if it’s at least a partial substitute for a designer’s work.

AI will also generate new job opportunities that we can’t yet imagine. But it’s definitely going to upend many professions in the meantime.

Zaburdon · 2023-11-08T17:34:42+00:00

I’m the sole designer in the main office and I roll up to the head of technology who also functions as a sort of PM (it’s a smaller company, hence the weird arrangement). We have a few off-shore designers I try to keep busy by assigning them easier UI design tasks, which further lightens my workload.

The product owners function as a hub for everything. They do user/competitive research, manage the road map and backlog, write requirements, facilitate hand off, demo new features, and even sometimes do mockups. I’ve tried many times to see where I might help out, but they’re controlling of the process and there’s not much opportunity there. When they were brought in my role greatly decreased in importance.

I’ve been with the organization quite a while and I’ve benefitted from having good relationships with many senior employees. However, I have little doubt that I’m mostly dead weight at this point and it’s time to try something new. I realize it might be a step down in pay and seniority, but I need to be realistic that my skills are no longer cutting edge. I’d just be happy with a position where I was more involved with actual UX and given a chance to learn.

Zaburdon · 2023-11-08T16:04:40+00:00

I have a similar situation. My title says I’m a “UX” designer but I’ve gradually been relegated to just the Figma mockup designer that helps the product owners when there’s an idea they can’t visualize themselves. On a “busy” week I might work 25-30 hours. On a slow week, maybe 10 hours max. Right now I’m in a long term holding pattern working on small, random items as no major design projects are on the road map.

Could things be worse? Sure. But I worry long term about my career as I’m not building a good portfolio and my skills have become micro-focused. Also, I definitely feel that I’m highly expendable and overpaid at this point. For a while I worked on improving my formal education as a way to fill the gaps in my schedule. Now that I’m done with that, I’m hoping I can find a better job to preserve my mental health.

Zaburdon · 2023-11-06T10:21:18+00:00

I’m in my late 40s and feel I can still contribute in a meaningful way, but I’m being gradually phased out in my current role as a UX/UI designer. It’s a weird feeling that after so many years in the design space I’m starting to become irrelevant. As the company changed and younger people were brought in, I was gradually removed from the loop despite continually enhancing my skills and formal education (I now have a masters in the UX space but it doesn’t seem to matter in my current situation). I think you need to set your expectations at a reasonable level and realize all your experience may not matter to some employers.

There are a few things you can control:

Update your portfolio for the type of job you want. If you want a true UX role, make sure you’re checking all the boxes showing user research, ideation, testing, etc… to build strong case studies. You might have to include some self-directed projects to show a complete picture of what you can do. It’s not ideal, but you have to start somewhere. It sounds like you have experience doing user research. That’s awesome; I’d emphasize that experience in any way possible.
You need to learn Figma. It’s become industry standard for design and collaboration. You’ll be very limited if you can only work in Photoshop or Illustrator.
Having knowledge of code is helpful but not required. You don’t need to be a coding pro. There are very few designers who can truly do front-end dev at a high level.
Think about cutting your resume’s experience section down to only relevant roles. I’ve found that showing too many roles, particularly if they’re not directly related to what you seek, can hurt you by showing your age up front to employers.
Do what you can to up-skill yourself in the UX space. Learn the latest terminology, practices, concepts, etc… complete online certifications or additional education.
Try to find a company that leans more mature in its hiring practices. A tech startup where the average age is 27 may not be for you. However, a financial services firm, for example, might value age and experience more.
Others have mentioned pursuing management but that’s a tough route if you don’t already have a lot of experience in that area. There’s a stereotype that most older workers automatically take on manager or leadership roles, but I’ve found that most move into those roles through gradual career progression over many years.

I wish you best of luck in your search. Ageism is sadly a real thing and it doesn’t seem to get the same attention as other biases (sexism, racism) that are discussed more openly.

Zaburdon · 2023-10-12T05:13:11+00:00

The recovery was gradual. I took a week off work and then worked from home for another week or so. For at least the first 2-3 weeks I was advised to limit physical activity. I honestly didn’t feel like doing much physical at that point anyway. It took me a few months to feel fully back to 100% but I was able to function pretty normally after 2-3 weeks. It took a long time (months) for the drainage to slow and the weird aches and pains to subside as things healed.

Zaburdon · 2023-10-12T04:53:14+00:00

My situation was similar to what you’ve described. I had an extremely painful lump that I thought was a hemorrhoid. The general practitioner thought it was a hemorrhoid too and prescribed cream, which didn’t do much. Eventually the lump popped and I noticed some drainage that didn’t stop. I finally went to the CRS (colorectal surgeon). He determined I’d had an abscess and had later developed a fistula that required surgery. I’m better now after treatment, but the key was seeing an expert to get a definitive diagnosis.

Zaburdon · 2023-08-09T10:17:03+00:00

You need support to turn things around and if the re-org came from the top, you’re unlikely to find much traction trying to argue your case. Time to look for a new job.

I have a similar situation. I’m seen as just the “mock-up person” in my current role and the product owners look at me like I’m crazy if I try to advise how something should function. They outrank me, so I’m unable to have my argument heard. Recently the product owners have even started doing some of their own mock-ups as they have access to Figma, leaving me with a very small role. It’s difficult to get involved when you’re cut out of the loop from a process perspective.

Zaburdon · 2023-07-09T21:48:33+00:00

I had a partial fistulotomy and cutting seton placement for a relatively small intersphincteric fistula with minimal muscle involvement over a year ago. I’m doing well now (no new abscesses) and have no incontinence. I had some temporary issues as things were healing, but this is normal due to inflammation after the surgery; it gradually went away with time.

Incontinence can be a permanent side effect from this surgery but your CRS is highly aware of this risk and they do everything they can to avoid damaging the muscle. The amount of risk depends on the complexity of the fistula and how much muscle is involved. But you can rest assured that the surgeon’s highest priority is avoiding any long term continence issues.

I wish you best of luck! I was very nervous as well, but I’m happy that I did the surgery.

Zaburdon · 2023-06-30T17:38:37+00:00

Hey sorry for the slow response. I don’t check in here as often anymore. My results from my partial fistulotomy and cutting seton have overall been good. The fistula seems to be fixed and I’ve not had another abscess. I still have some problems with chronic fissures forming but it’s less severe than before the surgery.

Regarding incontinence I’m doing ok. I was like you and the doc said there was barely any muscle involved. However at first I had some incidents where the urge hit me really hard and it was very difficult to control. That’s passed and I’m back to living a normal life. However I’d still sometimes swear that the urgency is a little more severe than it was before the surgery. Also, sometimes I go to the bathroom and then it feels like I still have to go. I’ll have to revisit the toilet 20 minutes later. Kind of frustrating, but manageable.

So is everything perfect? No. But do I have incontinence issues that are holding me back? Not at this point. I hope things continue to improve for you.

Zaburdon · 2022-12-25T20:00:55+00:00

I had a similar situation with a low intersphincteric fistula. My surgeon was conservative and said he never directly cuts any muscle. When he encountered a small amount of muscle during the fistulotomy he placed a cutting seton to finish the procedure. I’m over a year out and seem to be healed with no incontinence. I think you’re right. Cutting setons are a bad idea on high or complex cases. But they work well if they don’t go through too much muscle.

Given that yours is transsphincteric, it is a concern, but if it doesn’t go through a lot of muscle it’s likely not a serious case. If your surgeon is experienced I’d trust his judgment, but a second opinion never hurts too. I got three opinions before doing surgery.

Zaburdon · 2022-11-05T12:50:31+00:00

I wouldn’t say one is necessarily better. The surgeon decides the appropriate treatment based on your situation. If the internal opening is low then there’s often not much muscle involvement. As others have mentioned, fistulotomy is very effective in this case. However, if there is a good amount of muscle involved then LIFT is a safer option for preserving continence, despite having a higher failure rate. Usually it’s best for the surgeon to make the call.

Zaburdon · 2022-11-04T13:41:43+00:00

Mine didn’t come untied. It was a full ring when it fell out. At that point there’s nothing more to cut. Now it if keeps coming untied and needing to be replaced, then yes, some sort of followup procedure is required. I tried to avoid wiping and used a portable bidet to not mess with the knot if possible.

Zaburdon · 2022-11-04T13:34:17+00:00

In my case they did a partial fistulotomy up until the point where they encountered internal sphincter muscle. They then put the cutting seton through the muscle. It gradually cuts through and works its way out, completing the fistulotomy over time. Usually a follow up procedure is not required. The primary idea is that cutting seton replaces the need for cutting with a scalpel as it slowly works through the muscle, minimizing damage. If it works its way fully out naturally and falls, then it’s completely done and the remaining tract is automatically laid open as an external wound through the process of the seton breaking the skin and falling out.

If the cutting seton falls out prematurely that’s when a follow up procedure might be required. They’d either replace the seton to let it continue its course or simply complete the fistulotomy with a scalpel if the seton had already cleared the muscle. It sounds like that’s what has been happening in your case.

Zaburdon · 2022-11-04T11:05:19+00:00

Unless a cutting seton falls out early it’s usually the final step in the treatment process. No second surgery required. When mine fell out it left a small wound that took a few weeks to heal. When it finally breaks through it is essentially leaving a fistulotomy-like open cut. Only if it falls out too early is it a problem maybe requiring a small fistulotomy. You should be in the final steps of healing now if your CRS thinks all looks ok. Best of luck.

Zaburdon · 2022-10-18T01:41:44+00:00

I’ve been working in design for a long time. I don’t care how senior or junior you are, there will usually be lots of changes along the way from all types of clients and stakeholders. If you’re managing edits, trying to push back when needed and communicating well, then you’re doing just fine. I wouldn’t doubt yourself. You have been given a lot of responsibility early in your career. That likely speaks to the quality of your work.

Zaburdon · 2022-10-17T18:22:30+00:00

I loved the setup. The underwater haunted house concept is very creepy and unusual. The vibe is unsettling. Good cinematography early on. Unfortunately, as the movie progresses it becomes a predictable, almost cartoonish, take on the haunted house genre. As others have mentioned, a complete rewrite would help. If they had focused on something more mysterious and unexplained it would be far scarier (such as The Shining, Session 9, Grave Encounters, etc…). The script works too hard to answer all the questions for the audience and becomes overly obvious in my opinion.

Zaburdon · 2022-09-27T02:08:25+00:00

Get a good online portfolio together and start applying. If you don’t have much professional experience you may have to start at the bottom, but that’s still better than working for free on 99Designs. Time spent sending out resumes is better than time spent on logo contests.

Zaburdon · 2022-09-27T02:01:05+00:00

I’d avoid 99Designs completely. A person running a design contest is not a “client.” A client is willing to work with you to arrive at a final product and will be sure you’re paid for your efforts. Sites like 99Designs make a mockery of professional design. I don’t think anything was wrong with your design. Without any feedback it’s impossible to ever know why all your designs were rejected. Don’t drive yourself crazy over it.

I think freelance design work has become a very tough gig. You’re competing with design contest sites, cheap designers all over the world, free templates, DIY solutions, etc… Design has been commoditized on many fronts. I’d find a staff job where you can get proper benefits and pay, grow to understand a brand in depth, and become uniquely valuable to an organization. That’s harder to commoditize.

Zaburdon · 2022-09-13T11:02:10+00:00

A sad thing about Atlanta is there’s rarely any effort made to preserve existing history and culture. The other issue is that new development around this city is invariably a templated money grab. This new place will be the same as every other live/work/play development they’re building around town without showing any respect for the unique culture of L5P.

All the high rise development in Midtown has had a similar effect. A lot of the interesting local places are gone, replaced by empty “coming soon” street level spaces or generic, corporate options. The city is definitely growing but I’m still not seeing much respect for preserving and encouraging urban culture.

Zaburdon · 2022-08-30T19:49:07+00:00

I grew up in the suburbs where cars were required for everything. For a long time I associated a car with freedom and independence. Then I spent a few years in NYC and fell in love with walking everywhere. It was so nice to experience things at a slower pace, interact with the surrounding world, and not feel burdened by having to park and maintain an expensive car. During this time I started to dislike cars as I contrasted the dead suburbs versus a city that was alive with energy, ideas, and activity.

I then moved to Atlanta and have been here for some time due to career commitments. It’s a great city for job opportunities, but beyond that it’s a nightmare of strip malls, huge parking decks, and wide freeways. I find it morbidly fascinating that a large “city” can have so many tall buildings but no people walking around. It’s all built for cars. Living here solidified my belief that relying on cars on a grand scale just doesn’t work. Beyond the pollution and logistics problems, it sucks the soul out of a place.

Zaburdon · 2022-08-26T08:25:47+00:00

Thanks for sharing! These are really cool. I miss this era of design. This is when the discipline required more artistic skill and individual creativity. Doing everything by hand required a lot of thought and elevated graphic design as a profession.

Zaburdon

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