Posts by Christian Smith2

I wrote about my experiences a few years back. Here is the follow-up. I dealt with hemorrhoids that bled, just like many others describe. I went to see Dr. Ivanovic at Mercury for an exam and scheduled surgery for three months later (DG HAL RAR). That was how it went back then, about five years ago. Dr. Ivanovic performed the surgery at Mercury using spinal anesthesia. The procedure itself went perfectly. I stayed attentive and kept communicating with the anesthesiologists. I was admitted to the ward and everything was fine until the anesthesia started wearing off. Then the pain set in, which only subsided slightly with heavy painkillers. I barely slept at all that night. The next day, my wife drove me home—I just lay there in the car. For the first week, the pain was intense, though it lessened every single day. After about ten days, I would say I was pain-free. However, I was careful not to strain myself; I watched how I sat, mostly staying lying down or in a semi-reclined position. After three weeks, it felt like the issue was resolved, though I was still being cautious. I went in for a checkup 42 days after the surgery, and they confirmed everything was fine. It is not pointless to get a checkup after 42 days. Healing simply doesn't happen that fast. But, as I mentioned, those first 3–4 days post-op are brutal, and from there, it only gets better.
My advice? Be careful after surgery. Don't even think about going back to work after a week. Watch your diet, watch how you sit, don't lift heavy weights, etc.
My hemorrhoids were Grade III/IV. Today, over five years after the operation, everything is fine and I haven't had any issues with hemorrhoids or bleeding.

Kate Kim7 said:Christian Smith2 and Michael Diaz4, thanks for the info. It’ll be useful for me and anyone else where this is the last resort. I found out mine are grade 3-4 external hemorrhoids according to the report; they scheduled me for surgery in about a month. Still haven't decided if I'm going through with it. A bit of panic set in. 🤦🐔

Panic hit me too. But once I was actually in the hospital and saw what other people were undergoing surgery for—the actual diseases they face—this DG HAL RAR seemed like a minor thing. I opted against general anesthesia and went with spinal instead. I could hear everything during the procedure and even chatted with the anesthesiologists. It took about 45 minutes, according to my watch.

Here is some insight from my own experience. I dealt with hemorrhoids that weren't necessarily painful, but caused significant bleeding and prolapse. It went on for quite a while. About three years ago, I underwent surgery at a medical center in Washington, D.C. (performed by Dr. Ivanovic). They used the DG HAL method. That’s short for Doppler-guided artery ligation. Essentially, they ligate the point where the arteries transition into veins, which stops the blood flow to the hemorrhoids. In my case, they also performed an additional RAR—basically reconstructing the area by suturing and pulling the weakened tissue back inside. This depends on the severity of the condition. Full recovery takes about six weeks, which is also when the follow-up occurs. The first few days are the hardest, but it gets easier from there. For instance, I felt great after just three weeks. But most importantly, I haven't had any issues in the three years since the surgery, despite how much they interfered with my daily life before.

IBM and RBC work through Medicare, but Chase is the only one doing it that way. Maybe someone else picked up on that method since then, who knows? You can find info on private clinics online, and they'll give you a price if you call them.
Most other hospitals just stick to the old-school way. I wouldn't bother going there.

Emily Watson62 said:Hi everyone, I wanted to share my experience too! ...

Glad you're feeling better. Is a full recovery in 7 days even realistic after a DG IBM RBC procedure? Maybe just for IBM, but with RBC, you need more time. Just take care of yourself. Watch your digestion and don't strain. They didn't tie off eight veins; they tied an artery. It’s an arterio-venous shunt—basically, the terminal branches of the hemorrhoidal arteries are ligated to cut off blood supply to the hemorrhoid. That’s why it's called HAL (hemorrhoidal artery ligation). Another clinic does what's called THD, which is essentially the same thing under a different name (likely just a different device manufacturer). THD stands for transanal hemorrhoidal dearterialization. RAR stands for recto-anal repair, where the tissue that's prolapsed is repaired with stitches rather than being cut. DG means Doppler-guided, meaning they use Doppler to locate the vessels.
Wishing you a successful recovery.

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Carl Phillips2 said:Oh, please... "unclean livers"... if medicine were actually that simple, it would basically just be math. If every organism weren't unique, then 2 + 2 would always equal 4 without any variables. That's a completely different field entirely.
There is a whole range of endogenous and exogenous factors creating disease risk. At the end of the day, we are just trying to help one another based on actual experience, not by copying empty nonsense from the internet. We all know how this works.
For instance, my liver is perfectly clean; every test result is right in the middle of the normal range—ideal by every parameter. I don't drink, I don't smoke, and I stay away from processed meats or canned goods. Yet, I still deal with gout, cancer, and no thyroid, plus I have war injuries... and now I'm facing surgery for hemorrhoids for the second time. So what now?🙂

A solid response. Some people oversimplify everything. Even some doctors fail to treat patients as individuals, relying instead on templates. We are all unique. I developed hemorrhoids despite not drinking, smoking, or eating spicy food. Genetics played a huge role, along with my bad habit of reading the news on the toilet. I don't do that anymore.
When did you have your hemorrhoid surgery, and which method was used?

I am sending you a private message.

Just a quick correction. It isn't a Medazol diet; it's a colitis diet. Medazol is administered over seven days just to prevent infection at the surgical site. Regardless, the main thing is that you feel better. Be patient—it isn't that simple. Recovery is fast after HAL, but RAR is a different story entirely. Remember, there is tissue stitched and compressed inside. That's going to hurt for a while. It all depends on the individual and the severity of the illness.

brighthawk29 said:Reporting in 4 days after the HAL RAR procedure. Grade 3-4, still in pain, taking Ketonal... my issue is I had severe diarrhea yesterday. I'm on Medazol and Detralex, so I'm worried these might be side effects. Has anyone else experienced this?

Provide more detail. Where did you have the surgery? What does your discharge paperwork state? What dietary guidelines were you given? Diarrhea can stem from medication; it isn't just Medazol—Ketonal can also cause such side effects. You didn't mention it, but I assume you were prescribed something for your stomach, like Controloc, since Ketonal is an NSAID and impacts the digestive system. What is your Ketonal dosage?
Medazol is an antibiotic, and like any antibiotic, it disrupts intestinal flora, which can trigger digestive issues.
Following a HAL RAR procedure, the digestive system is vulnerable because you likely haven't eaten for at least two days due to prep and surgery, followed by a specific diet high in simple sugars and low in fiber, and then the medications. Under these conditions, the digestive system easily loses its balance. Every detail matters. It would be wise to contact your surgeon or primary care physician. Be sure to report every medication and exact dosage along with your current diet. There is supportive therapy available for these situations. Hang in there; it will be fine.

rapidbear10 said:Hi everyone. There is so much misinformation flying around, so I’ll share my own experience. I went to the Los Angeles clinic in a local neighborhood where they just took my money and left me with nothing but excruciating pain. After that, I went to a hospital for a corrective procedure. That surgery was actually great; you’re walking by the second day, though using the restroom is a bit rough for the first few days, and that's it. No topical creams will save you from the chemical reality of it all. The only thing that helps with the inflammation is Hadensa, an Austrian cream. Local products are useless. Hopefully, this helps someone.

Can you be more specific? What kind of procedure did you have at the Los Angeles clinic, and what was the "corrective" surgery at the hospital? Also, what stage of hemorrhoid disease were you dealing with?

Michael Diaz4 said:Hello... I know you've been posting about your issues since last year. What stage are your hemorrhoids at?

Stage two, though they're approaching stage three. It's time for surgery—just artery ligation without the transanal rectal mucopexy. So, General Hal should suffice, skipping the RAR. My symptoms involve occasional bleeding (rarely), but there's a constant downward pressure. After using the restroom and cleaning up, lying down is the best option. If I do this before bed, which is my routine, the next day is fine. But if it happens during the day, the pressure is uncomfortable. It also depends on the weather since I have low blood pressure. Generally, it’s bothersome, especially when standing. There's no pain or thrombosis, but it's increasingly interfering with daily life. Since I still only need the DG HAL, I decided to get it done before the RAR becomes necessary.

Checking in after quite some time. My hemorrhoids are essentially hit or miss. It isn't unbearable, but they’ve started interfering with my daily life. I actually postponed a trip recently because of them. Consequently, I've decided to go through with the General Hal procedure. They accept Medicare at Mercury. While there's a longer wait with Dr. Ivanovic, you can get seen quickly by the others. They claim to perform about five or six operations. Does anyone have experience with the other surgeons at Chase Bank besides Dr. Ivanovic?

Checking in after quite a while. I dealt with hemorrhoid issues for a long period, and back in July, I finally decided to go through with the DG NASA surgery. My symptoms involved frequent bleeding. The hemorrhoids would prolapse occasionally, though they always retreated on their own. Pain wasn't intense, just intermittent. Most likely, I have Stage III hemorrhoids. I completely overhauled my diet and bathroom habits. I tried various creams and teas, but nothing normalized things until I fixed my bowel movements. Every morning, immediately upon waking, I prepare a large bowl of muesli mixed with water. I microwave it, let it cool, and allow the grains to swell and soften. I add a bit more water. I eat this every single day. I must say, the situation has improved. No more bleeding, no more pain. The hemorrhoids haven't vanished—I can't make them disappear—but they no longer prolapse, bleed, or hurt. I am not claiming diet is a cure, but with this regimen, my bowel movements are regular, occurring every evening before bed. The consistency is perfect—neither too soft nor too hard. I have also perfected my bathroom technique. I go easily, without any straining whatsoever. I no longer sit on the toilet for more than 30 to 60 seconds. That is all. Perhaps this helps someone. However, this is for milder cases and good for prevention. If I were to return to my old lifestyle—skipping breakfast and lacking fiber—everything would revert. This watery muesli isn't tasty, but it is edible. One should be careful if they have sensitive stomachs. For me, combined with plenty of vegetables, my movements have stabilized (daily and ideal consistency), and so far, there are no issues.

There is plenty of discussion regarding hemorrhoids on this forum, but one point must be reiterated: stool consistency is vital. Michael Diaz4 correctly notes that it shouldn't be hard, yet diarrhea isn't ideal either. Hard stool simply causes mechanical damage to the mucosal lining. This heat is particularly detrimental to the condition. If fluids aren't replaced, stool becomes hard, and problems follow. Many people suffer from hemorrhoids without any genetic predisposition. The reason is banal. They read on the toilet. With that habit, even the most resilient will find themselves searching this forum in a few years. Blood in the stool is the most common sign of internal hemorrhoid bleeding. Naturally, a diagnosis requires a medical exam. Some fear what they might hear after an exam more than the exam itself. Let them take comfort in knowing hemorrhoids are common; there is no reason to fear seeing a doctor. If hemorrhoids are confirmed, they can find peace. If it is something more serious, early diagnosis is better than later. Do not be afraid. Many people suffer from hemorrhoids.

I called the clinic, and they told me I need to show up in person so they can decide whether to proceed with surgery. Some of the info on clinic websites doesn't sit right with me. For instance, one site claims they handle hemorrhoids using the classic Morgan Milligan method under local anesthesia with a quick recovery. That sounds questionable to say the least. But let's talk about newer methods.
It was developed by Morinaga, and initially, it was just referred to as either DG HAL or THD—essentially the same thing under different names. It involves ligating the arteries. Later, in 2005, the method was modified to include tissue reconstruction. Hemorrhoids (the blue parts in the diagrams) are enlarged vessels held in place by connective tissue. If that tissue becomes too loose, it has to be fixed or stabilized. If a surgeon only performs arterial ligation without being able to handle the reconstruction, then in my view, it’s a half-finished job. It's like opening a tire shop where you change the rubber but skip the balancing. The name doesn't matter; what matters is the actual work performed. One should ask the doctor specifically about this before any procedure. Does it make sense to perform ligation alone if reconstruction is required?
Reading through these posts, it seems people are confusing things, particularly the difference between external and internal hemorrhoids. We all have them; otherwise, the rectum wouldn't close properly. Problems arise when they enlarge, stretch, the supporting tissue weakens, or surface damage occurs from hard stools. The distinction between external and internal is purely anatomical. External ones are at the anal edge, while internal ones are further inside. Internal ones are larger and usually cause bleeding. Pain kicks in when they become inflamed or swollen, or when a thrombosis develops. Once they rupture, the pain subsides. Looking at the diagrams, you can see the arteries supplying the internal hemorrhoids are targeted for ligation. From what I can gather, the arteries feeding external hemorrhoids aren't even positioned where this method could reach them. But that's just my layperson's take based on the images. My wife has had external hemorrhoids for ten years since giving birth, and they haven't been an issue. What causes the most confusion is this: staging only applies to internal hemorrhoids. As I mentioned, they are larger and thus more problematic. Plus, they face higher pressure during bowel movements. They are cramped and have nowhere to go when pressure increases or stools are hard. External ones are right at the opening and can bulge out easily. If they get inflamed, creams and sitz baths should handle it. Only internal hemorrhoids are graded into four stages. Stage 4 is when they prolapse and won't go back in. That is the core issue. These are internal hemorrhoids that have prolapsed outward; they aren't "external" just because they are visible—they are internal ones that have moved out. Don't confuse anatomy with clinical manifestation. When internal hemorrhoids prolapse that far, simple ligation won't pull them back in because the tissue is too stretched. That's why reconstruction is necessary. Call it whatever you want, but the actual procedure is what counts.

Here is another link. This seems to be the best explanation available. It's long, but detailed. The only downside is it was written in 2008, so it lacks recent study results.

http://www.pelviperineology.org/dece...morrhoids.html

A quick correction. We aren't looking for a vein; we are talking about an artery. That is why the term THD exists (arterialization), or according to DG HAL terminology, where AL stands for artery ligation. By ligating the artery, you close the arteriovenous shunt, which addresses the root cause. For lower-grade hemorrhoids without prolapse, only the artery ligation is performed. If using DG HAL terminology, that is all there is to it. However, when there is prolapse—meaning the tissue is too stretched or loose—RAR is required. This involves using sutures to pull the tissue back inside to "compact" it, as shown in the video. Consequently, surgery involving the RAR procedure is more difficult and requires a longer recovery. Simple artery ligation is easier to endure. The question remains: does anyone here even seek surgery while they are still in that early stage?
If the surgeon performs the procedure correctly, there shouldn't be any issues. Unfortunately, I am far from Sarajevo, so I will likely opt for one of the private clinics in a major US city this fall or winter. I am waiting to hear about other members' experiences.

Note: I am not a doctor, so do not take this as gospel. These are just my layman's conclusions based on the literature I have read.

Here is a helpful video. http://www.youtube.com/watch?v=05FuzfakqmI

Hello everyone.

I have been lurking until now, but I decided to chime in with my own experience. I am not here to offer advice, but perhaps my story will help someone.
I have dealt with hemorrhoids for ten years, though without major issues. Every couple of years, I might have had a day or two of discomfort, and that was it. My mistake was staying on the toilet too long; I did it to avoid that uncomfortable sensation of the sphincter closing immediately after a bowel movement. However, for the last two years, I have been bleeding. It follows a pattern: a week of bleeding, then a week of nothing. Hard stools always trigger it, and once it starts, it won't settle down for at least a week. This has been the cycle for a year or two. Often, there is a significant amount of blood in the bowl. I didn't worry because there was no pain. Then, two months ago, I felt weak and had bloodwork done. The results showed severe anemia and catastrophically low iron levels. To be honest, looking back, I ate quite healthily—no high blood pressure or high cholesterol—but I had actually cut out foods high in iron, like beef and organ meats, while consuming plenty of things like tea that inhibit iron absorption.
After seeing those terrible blood results—low hemoglobin and low iron—I decided to take this seriously. I took two weeks of medical leave and added another two weeks of vacation. For one month, I stayed home and maintained extreme discipline. This included a mandatory morning routine of eating plenty of cherries and berries. Every day for lunch, I ate heavy meat and liver. I drank massive amounts of fluids and consumed high-fiber foods like whole grains daily. On top of that, I took iron supplements. Within a month, my blood work was nearly back to normal. My bowel movements became regular, twice a day, with ideal consistency. Since I was home, I followed every movement with a warm shower. During that month, I had zero hemorrhoid issues and zero bleeding. Furthermore, the actual movement lasted only seconds before the sphincter closed naturally. I didn't wait around for minutes like I used to. I thought I had finally gained control. Then, I went back to work—an office job, lots of sitting. No matter how much water I drink, it isn't enough. Within days, the hard stools returned—not voluminous, just dense and difficult to pass. And again, the bleeding started, though not heavily since I close the sphincter quickly.
Since I cannot change my job, nor do I want to because I am satisfied with it, I realized surgery is inevitable. The classic method is out of the question. I haven't seen a doctor yet. I contacted one private clinic in a large US city (K), and they told me that if I come in for an exam, the surgery can be done immediately. They bring in a surgeon from Israel, so appointments must be booked. However, I am not seeking surgery during the summer; I am waiting for fall or winter. From what I read on this forum, people have had bad experiences with that other clinic. I haven't read the entire post because it's massive, but I read most of it. I would like to know if anyone has had surgery at Dr. Krpan's clinic and can share their experience. As I understand it, THD and DG HAL RAR are the same method, just different names. The principle is using Doppler guidance to locate the arteries and tie them off. This stops the blood flow to the hemorrhoidal tissue, causing it to shrink over time. If the hemorrhoids are more advanced, tying the arteries isn't enough; the tissue must be reconstructed, which means pulling it back inside. That is why it is called RAR (recto anal repair). THD stands for transanal hemorrhoidal dearterialization, which includes the process I described. Some use the term HALO. Because this involves tying and reconstruction rather than cutting tissue, the surgery isn't invasive like the traditional way. Additionally, the classic method removes tissue without tying off the arteries, making recurrences more likely. Not to mention the recovery time. Now the question remains: why do our surgeons still use the old Morgan Milligan method instead of this newer technique that has been standard in England for a decade? In my view, the new method is simpler to perform than the classic one. But that is the problem with our disorganized healthcare system.
I said I wouldn't offer advice, but here is one anyway. Is it not always wise to seek a second or even third medical opinion? My own experience with a different illness taught me that. Had I sought another doctor sooner, could I have avoided so many complications?
As for surgery, isn't skill and experience the deciding factor? One might know the theory, but can they execute it? It is an art form requiring intuition alongside knowledge. The issue remains: how does one find the elite when they are so rare? I searched online to see if such specialists exist in the US, but found nothing.
Furthermore, I haven't seen anyone post a video demonstrating the actual procedure here (apologies, I haven't read the entire thread).

Here are some links. The first two are diagrams; the latter two are actual footage. Watch them if you wish.

http://www.youtube.com/watch?v=888q9...eature=related

http://www.youtube.com/watch?v=6Ah7PhbBg8Q

http://www.youtube.com/watch?v=xrwRO7vTsd8&NR=1

http://www.youtube.com/watch?v=5KarLDbbXaA&NR=1