My Anal Fistula Journey

My name is Evan Sloves from California, U.S. On October 10, 2017, I began a long trip halfway across the world to receive ksharasutra treatment for an extremely complex anal fistula from Dr. Ramesh Bhat of Bangalore, India. Five months later, on March 13, 2018, Dr. Bhat uttered the words I’ve been waiting over three years to hear—“Today, is a celebration day. You are fistula free!” Dr. Bhat is an extremely talented Ayurvedic surgeon, but beyond that, he is a very compassionate and humble human being. To put it simply, he saved my life.

As I reflect back on my experience, I am humbled by the fact that simple Ayurvedic surgical techniques mentioned in 500 BC are still in practice today in India. After giving up three years of my life, I had to travel across the globe to benefit from this simple, ancient technique. This was the only way for me to get my life back. 26 “modern” surgeries (including stem cell therapy) performed at multiple top hospitals in the United States failed to cure me. Ksharasutra was the only technique that was able to help me overcome this very challenging disease. What follows is my story.

My journey began one night in December 2014. I woke up in the middle of the night with a swollen anus. I had no idea what could have caused this. In the coming days, it felt like I was sitting on a golf ball or a rock. This began my almost three-year search for a solution in the United States. It wasn’t until the spring of 2015 that I was diagnosed with an anal fistula. An anal fistula is a chronic abnormal communication (tunnel) between the epithelialized surface of the anal canal and the perianal skin. My anal fistula was caused by an abscess from an infected anal gland.

Over the ensuing three-year period, I endured 26 exams under anesthesia and/or surgeries at 5 top U.S. hospitals, including numerous abscess “incisions and drainages”, seton drain placements, partial fistulotomies, and a failed stem cell fistula plug, which was part of a clinical trial. After my last U.S. surgery, on September 8, 2017, I was told that fixing my fistula would be difficult and would need to be done with a colostomy (stoma). I would also need “a very extensive advancement flap,” along with hyperbaric oxygen chamber treatments, before and after the flap, due to extensive scarring. All of this was with a success rate of approximately 60 percent.

Needless to say, this all took a toll on me physically and, more importantly, mentally and emotionally. I didn’t see an end in sight. This situation not only affected me personally, but it also took a huge toll on my family. I’d had enough. It was time to try to take control of this situation.

During the summer of 2017, I began to research alternative methods to heal a fistula not available in the United States. It was during this time that I finally caught a break. My wife found a fistula support forum online, joined it, and convinced me to join. It was through that forum, independent research, and a blog posted by a former patient, that I found Dr. Ramesh Bhat in Bangalore. His credentials are outstanding—he holds a PhD and a Master of Surgery in Ayurveda, as well as a BAMS Degree with Gold Medal for First Rank. He is also part of the teaching faculty at Sri Sri College of Ayurvedic Sciences and Research Hospital, affiliated with Rajiv Gandhi University of Health Sciences, Bangalore. Additionally, he has successfully solved thousands of fistula cases. After speaking with a number of former patients, I knew he was the only doctor for my complex case.

At that point, I emailed Dr. Bhat my surgical and radiology reports to see if he could help me. His words were simple: “My responsibility is to make you alright. Relax and plan.” I then asked if I should try an advancement flap first. Again his words were simple and encouraging: “Don’t try anything. Just come to Bangalore. I will treat you . . . Don’t waste time.” After a few more exchanges, I was convinced this was the right choice for me. I told Dr. Bhat that I wanted to come to India for treatment. Once again his words were very comforting: “You are welcome to India to get healed by the Indian System of Medicine. Relax and enjoy the weekend.”

It was time. My journey to India was about to begin. After traveling for 26 hours, I arrived in Bangalore on Tuesday, October 10, 2017. What is amazing is how much can get done in India in such a short amount of time. On Wednesday, I went for a TRUS Scan (ultrasound) which was extremely telling. During the ultrasound, the radiologist stated, "Now we have the answers as to why you haven't been healing." What the radiologist saw during the ultrasound was quickly confirmed by Dr. Bhat during my initial exam. My seton drain wasn’t in the fistula internal opening. It was through a false surgical opening (an artificial internal opening approximately 4 mm below my actual internal opening). In essence, I had two internal openings. Dr. Bhat then took me into his office, read through the radiology report and quickly stated, “We can fix this.” I was extremely relieved to hear those words. He then immediately sent me for an ECG, chest x-ray, and blood work in preparation for surgery. On Thursday, I checked into the hospital in advance of surgery. On Friday, I had a quick, painless surgical procedure under spinal anesthesia in which Dr. Bhat performed a partial fistulotomy and inserted my first ksharasutra thread (into the correct internal opening). The reason Dr. Bhat performs a partial fistulotomy in addition to the ksharasutra thread is his belief that by fully removing the portion of the tract not through the muscle very strong scar tissue will form, leading to a better overall outcome.

After surgery, Dr. Bhat clearly explained to me how complex my fistula was, as it involved my entire sphincter muscle. He explained that it would take between six and eight months to heal, given we needed to go extremely slowly to preserve my continence. Most likely, it was going to take the full eight months. At first, that news was a bit upsetting, but Dr. Bhat—with his kind words—stated, “What is six to eight months to be rid of this fistula for the rest of your life?” He of course was right.

Over the next two and a half weeks, I went to Dr. Bhat’s clinic daily for wound packing/dressing changes to ensure my wound healed internally, from the bottom up, with very strong scar tissue. At the end of that time, I also had my first thread change to begin the process of cutting and healing the unhealthy fistula tract. Between October 29, 2017 and March 10, 2018, I had 18 thread changes (19 threads in total). The goal was to cut the muscle very slowly, so the wound simultaneously healed from behind. The level of care and follow up were superb. I saw Dr. Bhat at least weekly. He would only change the thread if he felt the tissue behind the fistula had healed completely. This meant I sometimes went weeks between thread changes, and in one instance, I had two threads in one week. He adjusted the care based on what he saw each week. Some weeks he inserted kshara powder to help heal the tract. And one week, in the middle of my treatment, I went in again for daily wound packing/dressing changes, and he also used Ayurvedic oils internally to help heal the internal opening.

On March 12, 2018, my ksharasutra thread fell out on its own. The very next day, exactly five months from the date of my initial surgery, Dr. Bhat examined me and declared me fistula free! I remained in India a few additional weeks for daily wound packing. I arrived back in the United States on April 9, 2018. That was exactly six months from the day I arrived in India, two full months ahead of the initial assessment and from what I was expecting. I am now healthy and fistula free!!!

What is simply amazing is the level of care I received in India. From the daily clinic visits, if necessary, to the weekly assessments by Dr. Bhat. He also is always just a text away. If I have anything on my mind, I am able to reach out to him directly. He always responds promptly with simple words of encouragement such as “Don’t worry,” and “Everything is normal. Enjoy.” He was also treating many other international patients while I received my treatment. By sharing this experience with them, we quickly forged lifelong friendships. I spent time in India with patients from the United States, Australia, Israel, and Canada. He understands how far away from home many of us are, and he treats us as if we are part of his family. Although it was extremely hard to be away from my family, I thoroughly enjoyed my time in India and meeting great people I otherwise would never have had the opportunity to meet. This enriching experience not only healed my fistula, but allowed me to see life through a different lens. Everything just seems brighter. I will be forever grateful to Ayurveda (the Indian system of medicine), Dr. Bhat, and his wonderful team of nurses.

Below are some other helpful resources:

• Blog from an Israeli patient of Dr. Bhat detailing her successful healing journey along with many informative links.

• Website from another patient with helpful information regarding treatment and Bangalore travel tips.

• "Threads of Hope" video created by two of Dr. Bhat's patients. It is extremely inspiring and details the stories of numerous patients on their journey to health.

• Kshar Sutra Facebook Support Group.

• A case of refractory anal fistula treated with Ksharastura authored by Dr. Bhat, and published by the European Society of Coloproctology, detailing the case of my complex fistula.

Please feel free to reach out to me with any questions at rbilabronze@yahoo.com.

Below are some pictures documenting various aspects of my journey. I hope they are helpful.