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Anorectal Care/Pain Management Tips
Mar 30, 2002

I wrote to you a couple of times before, around 12/23/01 and 1/8/02. I was diagnosed with anal warts/HPV in December, had surgery to remove them, and they found an external squamous cell carcinoma in the perianal region. I had a second surgery to "clear" more area around where the lesion was. You had said on 1/8 that I probably didn't need radiation or chemo for an external perianal cancer, but my oncologist and colorectal surgeon recommended some radiation anyway (electrons, not protons, and a shallow depth and field) because of the risk of recurrence with HIV. I had the radiation, 25 sessions, but had to take a 10-day break after session 16 and another few day's break after session 22 for skin desquamation and radiation proctitis. It's been about a week since my last treatment (hooray) and I'm already better. Other than watching carefully for wart recurrence, I'm fine. But I wanted to offer some very practical self-care tips that I think helped me through all this in case others are looking for help as I did. I used Vitamin E and Vitamin C supplements, a few times a day, plus Selenium (anti-oxidant) and N-Acetylcysteine supplement once per day. After bowel movements, I often had pain about an hour afterward that would sometimes last for hours at night. This often required a "cocktail" of pain meds that included Darvocet (basic pain management), Valium (to relax spasmed muscles down there), and Vicodin at times (not very often, maybe 10 nights since December) to sleep, each med taken about an hour apart until I could tolerate it or go to sleep. I also used Prax lotion topically to soothe, also sometimes a French product called Biafine lotion, and Vitamin E oil (which I think really helps heal up the perianal area after surgery). I also ate high-fiber (lots of salads, but not exclusively). The best thing was discovering Metamucil, and I use a teaspoon morning and evening in fruit juice. This makes bowel movements sooo much easier and is just generally good for you anyway (my colorectal surgeon says). And, for direct pain management, sitting in a hot bath helped -- which I did after bowel movements and again hours later if I still had pain. I hope this helps someone! What do you think of this? Do you think I should have done something differently? I'm also concerned if I have to have surgery again for warts -- I'm thinking of trying Aldara. I'm 37, male, with t-cells stable around 250 and vl stable around 1,000 for several years now.

I'm also worried because I'm on Nandralone (deca-durabolin) steroid to help me gain back the weight I lost in December (17 pounds; I was 170); is that a risk of "encouraging" wart growth too if it encourages lean body mass growth? What about Androgel (I use both since I've had low testosterone)? I think my warts went untreated for a long time before December, but now I have regular (monthly) monitoring with a good colorectal surgeon. Thanks for any feedback!

Response from Dr. Dezube

I appreciate that you are sharing your pain management tips with others. You "walked the walk" and probably can speak to anorectal care as an expert. Sounds like you're doing well. I would particularly endorse Metamucil since it can really make bowel movements soooo much easier, exactly as you mention. Although this sounds a bit corny, we doctors tell patients to "take it in the p.m. (evening), for a BM (bowel movement) in the a.m. (morning).

Aldara really does work against external warts; Aldara should be applied two or three times per week. It's best to apply it at night and to wash it off in the morning.

As for your query about nandrolone and androgel, I am not aware of any data suggesting that they cause warts.


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