When two things, X and Y, happen in sequence, the logical way of thinking would be to assume Y happened because X happened. A philosophical way of thinking would suggest that X happened because Y was bound to happen. I got anal fistula in 2007, as I was bound to learn something about Ayurveda through personal experience.

During the summer of 2007, I was traveling in the Europe for about 5 weeks. This was a  memorable summer for many reasons. Midway through the travel, I had some pain in my butt. Though I had travel insurance, I did not go to a doctor during my visit. I returned by a Lufthansa flight from Frankfurt to Bangalore. Had traveled to Paris two weeks before the travel, when the pain had started. During the long flight, I was reading the Da Vinci Code and did not get up much. Having just seen Paris, I could relate to the book and of course, even otherwise, it is an engrossing read. When I reached home, the pain had grown.

As it always happen after a long travel, there were too many things pending at work. I finally went to the health centre three days after my return. The Doctor examined me and concluded that I had a cyst in my butt and suggested some anti-biotic. It didn’t work. After three different doses of anti-biotic, I was only getting drowsy all the time. I was advised to see an expert. Fortunately for me, the expert, (Dr. Vijayaraghavan from RMV Clinic, Sanjay Nagar) identified the cause. He said I had an internal infection which was perhaps covered by a fistula/sinus tract. The body forms this protective cover when there is an internal infection. This helps in containing the infection from spreading. However, the same protective cover prevents any external medicine from curing the infection. No wonder none of the antibiotics worked for me. If I had treated the infection immediately, anti-biotics may have worked. I did not.

I got an MRI done and the tract was visible. The expert surgeon informed me that surgery was the only option in allopathy at that time. He also told me that surgery may not give me a permanent cure and it could lead to recurrence and worse, incontinence. I did not know this word at that time and the surgeon clarified. What a terrible thing to have following a surgery! Dr. Vijayaraghavan told me that he would put me on a table right away if he was sure it would cure me.  When you hear so much about hospitals and doctors suggesting unwanted surgeries and medications, we do have great physicians like him too!

The surgeon was surprised by my otherwise fit status. I wasn’t having any fever or headache. He advised me to do sitz bath with the hope of bursting the cyst and draining the pus collected in the tract. After several days of sitz bath, the cyst did burst through my buttock but not the anus. Hence my condition became a sinus tract technically. If it had opened in the anus, it would have been an anal fistula. Fistula is more commonly known than sinus.

The surgeon advised me to keep a pad to take care of the occasional discharge and clean the area with dettol regularly. My wife was helping routinely in keeping the external skin clean. I slowly learned to clean my back with a help of a mirror and I could continue with my work without any disruption. The surgeon had told me: Learn to live with it. I tried Siddha medicine for a few months but no change. This was continuing for a year. Every morning and evening, I did sitz bath and kept the wound clean.  I had traveled around the world in this condition. I had learned to live with it. My travel bag used to have sanitary pads.

I was in a committee, formed by the Department of Science and Technology, India and this was also a reason for frequent travel. I was carrying a tube filled with air as I could not sit anywhere. I stopped driving two wheelers and had bought three tubes, one for my office and one in the car and one in my handbag to use wherever I had to sit, home, taxi, train, flight, meetings…

Dr. Brakaspathy was the person from DST who was in the committee. After looking at me in a couple of meeting, sitting on a tube, he inquired and found out about my condition. He suggested that I try kshara sutra treatment in Ayurveda.  He had this problem many years ago and got this treatment from the All India Institute of Medical Sciences (AIIMS), New Delhi. The AIIMS gives allopathic treatment for all and apparently had Ayurvedic cure for fistula.  Dr. Brakaspathy wasn’t aware of other places giving this treatment. His brother had the same problem and had several surgeries. He had incontinence too and could not travel much.

I had not known about this treatment and I had a tough time remembering the name. After returning to Bangalore, one day I decided to do something about my sinus tract problem.  Thanks to Google, I found out about Dhanwantri Ayurveda hospital (http://www.dhanvantarihospital.com/) and Dr. S. S. Hiremat. I had also found out about a Piles Clinic in Ganga nagar. I drove to the piles clinic first but could not meet with any physicians as I didn’t have an appointment. I then drove to Rajaji Nagar to Shree Dhanvantri Ayurveda Hospital. Dr. Hiremat was there and I had to wait for some time. He examined me and said he had cured many many patients of sinus tract with kshara sutra treatment.

Dr. Hiremat was a liberal Ayurveda doctor. He looked at my MRI and we fixed a sunday morning for my first treatment. Dr. Hiremat explained to me the treatment. A thread coated with some medicine would be inserted into the sinus tract. Before this a probe would be pushed through the sinus tract and by piercing the tract, it would be opened at the anus, making it a fistula too. Now the thread could be pushed through the external opening and brought out through the anus. This thread would be used for two purposes. The medicine in the thread would fight infection. Also, it will pull the sinus tract towards external skin cutting through the sphincter muscle.

I had met several doctors during the first 15 months before meeting Dr. Hiremat. Once, I was discussing with my colleague, Ramakrishnan a polymer chemist. During this discussion, we were wondering why not inject the medicine in to the tract, as the external medicine taken would not be able to penetrate the tract and fight the infection. It seemed like that is what Ayurveda was doing for millenia. I learned later that Kshara sutra was described by Susruta, who is considered the “father of surgery” (See this wikipedia link for more details:  https://en.wikipedia.org/wiki/Kshara. I accessed it on 18 October 2015).

When Dr. Hiremat looked at my MRI and examined me, he mentioned that the sinus tract could be cured in 3-4 months. When the treatment started, he also prescribed some anti-biotic and pain killer. Why suffer pain, he would say. I had to visit his clinic once in a few days when the thread would be changed. On the first day, we had a surprise. The standard length thread that is used for most cases, was not long enough. My sinus tract had really grown long. He had to tie two threads together to cover the length and form a loop. The thread would be tied and some band aids put to keep the knot from opening. Once in a few days, I had to go to his clinic and get the thread changed.

It is difficult to believe now. My treatment continued for 15 months. Every few days I had gone to his clinic. On a few occasions, I had traveled abroad for about a week and missed the routine. Dr. Hiremat told me that my sinus tract was really long and in his experience, I had the longest treatment. Another person had close to but less than a year. As I was going through this treatment, some friends advised me to have a surgery and be done with it. I was reminded of Dr. Brakaspathy’s brother. Moreover, Dr. Hiremat had told me that I was the first patient to come to him before having a surgery. Almost all his patients come to him after trying one or more surgery. After several months, Dr. Hiremat could use only one thread. The tract was becoming smaller and getting closer to the external skin.

After 15 months of this treatment, towards the end of November 2009, I was completely cured. It is going to be six years now and so far there has been no recurrence or incontinence, touch wood! After the summer of 2007. I had talked to many and looked for several treatments. Towards the end of my treatment, I read about some treatments in allopathy which used a plug. The idea is the same. The medicine is coated in a biodegradable polymer and pushed into the tract. This is advantageous as there is no need to make the tract open in two places. I found a recent paper in a Journal published in Korea which discusses this treatment. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296947/) These authors seem unaware of Ayurveda or Kshara sutra. They do mention about the recurrence and incontinence resulting from surgery. I wish allopathy and ayurveda doctors in India had collaborated with scientists and come up with this plug.

I do not know what were the medicines used in the thread and Dr. Hiremat informed me that 14 different plants are used, if my memory serves me right. This year’s Nobel prize in Medicine has been shared by Prof. Youyou Tu from China. She had read the ancient texts in China and had done painstaking work in isolating and identifying the drug artemisinin. Thinking back, it should not have taken 15 months for my cure. If only scientists from India could work with Ayurveda doctors, with an open mind, we could discover many drugs. For that, we need an open mind, be rational and have patience. We need to standardize the procedures. I had recently met with a scientist trying to work with Ayurveda practitioners. She did not find it easy to do this.

Dr. M. S. Valiathan had written three books on Ayurveda. I hope we can make use of the modern techniques available today and understand Ayurveda better. If not to win the Nobel prize, certainly for serving humanity.