Second Opinion & HRA
Due to the confusion in regards to my followup protocol (my January 30th appointment where my colorectal specialist stated he wanted to do a high resolution anoscopy as opposed to a routine checkup of area), I decided to visit a colorectal doctor in the city of Chicago itself. I talked with a good friend beforehand and he felt that talking to a doctor in the city may be beneficial as they may see more cases of HPV then they may in the burbs where I'm at.
I wasn't really feeling the idea as I thought my primary was on the right course as far as wanting to do a High Resolution Anoscopy despite the initial miscommunication. I changed my mind though when it seemed like "divine intervention" had me find an old card from a specialist who actually is one of the few ones that provide anal pap smears. I had meant to do an anal pap smear in 2009 but never got around to scheduling an appointment and subsequently lost the card. So I scheduled a time to see the second doctor and the date happened to fall the day before I was to have my HRA.
So on March 6th I made my way to see the Chicago doctor. A CTA ride and bus trip later (went wrong way on bus initially), I made it to the doctor with 15 minutes to spare. It wound up being the best visit ever. Based on my history the Chicago doctor confirmed that my colorectal specialist was on the right path. I felt a little more comfortable asking him sex questions and he totally put me at ease. He reassured me on what I knew before but needed to hear again. Basically HPV is very common (as high as 80%) and that it shouldn't stop me from ever having anal again. He confirmed what I thought in that he would say give the body 2 to 3 months to heal from surgery before resuming (assuming of course you don't get recurrences...*LOL*). Interestingly he told me that sometimes warts are found in his patients when he does a colonoscopy.
He also took the time to explain more clearly the relationship between warts, anal dysplasia, and anal cancer. Basically the warts itself have the anal dysplasia. There are various warts that are removed but there may be tiny microscopic ones that are missed which would require the HRA. The warts are analyzed by a pathologist and they determine the level of the anal dysplasia. The results will be either low grade (AIN1), medium grade (AIN2), or high grade (AIN3). The higher the grade the riskier it is for things to turn precancerous. Ideally they would perform an HRA to ensure that all warts including the microscopic ones are removed. Since there's no guarantees that the warts won't come back, the need for repeated HRAs is there. The frequency of the HRAs would depend on what is found. Assuming best case scenario of no warts or anal dysplasia found, they would recommend another HRA in a year's time. If nothing is found a year later, they may push back the HRA to another three years, and so on. If anal dysplasia is still present, they may want you to return in six months after the HRA to ensure that no more is found and then whether to come back in another six months or longer would depend on the results. Obviously the fear is if you wait too long to get treated the AD can become a higher grade one and eventually being precancerous and later on lead to anal cancer. Though reaching that final stage takes a long time it's better to be proactive and attack it at the wart/AD level.
While it's kind of disappointing that it seems the HRA are indefinite (regardless of whether anything is found or not), it did make me feel better understanding the process more. If it wasn't such a hassle to get to his office (since I live way out in the burbs), I'd love to have him as my specialist. He did put me at ease knowing my current specialist is on the right track.
So I had the HRA yesterday despite the front desk sending me to the wrong area initially and then the confusion of the nurse in that area in getting me to the right spot. The doctor told my friend that everything went well though he didn't mention whether I had any more anal dysplasia or microscopic warts or not. So I'm currently experiencing the same post surgical body changes as I did my two previous out patient surgeries. Hate not being able to feel any sensations when I pee but hopefully later today that should come back. Totally not looking forward to that first poop post HRA but I should be on the right path for recovery.
I wasn't really feeling the idea as I thought my primary was on the right course as far as wanting to do a High Resolution Anoscopy despite the initial miscommunication. I changed my mind though when it seemed like "divine intervention" had me find an old card from a specialist who actually is one of the few ones that provide anal pap smears. I had meant to do an anal pap smear in 2009 but never got around to scheduling an appointment and subsequently lost the card. So I scheduled a time to see the second doctor and the date happened to fall the day before I was to have my HRA.
So on March 6th I made my way to see the Chicago doctor. A CTA ride and bus trip later (went wrong way on bus initially), I made it to the doctor with 15 minutes to spare. It wound up being the best visit ever. Based on my history the Chicago doctor confirmed that my colorectal specialist was on the right path. I felt a little more comfortable asking him sex questions and he totally put me at ease. He reassured me on what I knew before but needed to hear again. Basically HPV is very common (as high as 80%) and that it shouldn't stop me from ever having anal again. He confirmed what I thought in that he would say give the body 2 to 3 months to heal from surgery before resuming (assuming of course you don't get recurrences...*LOL*). Interestingly he told me that sometimes warts are found in his patients when he does a colonoscopy.
He also took the time to explain more clearly the relationship between warts, anal dysplasia, and anal cancer. Basically the warts itself have the anal dysplasia. There are various warts that are removed but there may be tiny microscopic ones that are missed which would require the HRA. The warts are analyzed by a pathologist and they determine the level of the anal dysplasia. The results will be either low grade (AIN1), medium grade (AIN2), or high grade (AIN3). The higher the grade the riskier it is for things to turn precancerous. Ideally they would perform an HRA to ensure that all warts including the microscopic ones are removed. Since there's no guarantees that the warts won't come back, the need for repeated HRAs is there. The frequency of the HRAs would depend on what is found. Assuming best case scenario of no warts or anal dysplasia found, they would recommend another HRA in a year's time. If nothing is found a year later, they may push back the HRA to another three years, and so on. If anal dysplasia is still present, they may want you to return in six months after the HRA to ensure that no more is found and then whether to come back in another six months or longer would depend on the results. Obviously the fear is if you wait too long to get treated the AD can become a higher grade one and eventually being precancerous and later on lead to anal cancer. Though reaching that final stage takes a long time it's better to be proactive and attack it at the wart/AD level.
While it's kind of disappointing that it seems the HRA are indefinite (regardless of whether anything is found or not), it did make me feel better understanding the process more. If it wasn't such a hassle to get to his office (since I live way out in the burbs), I'd love to have him as my specialist. He did put me at ease knowing my current specialist is on the right track.
So I had the HRA yesterday despite the front desk sending me to the wrong area initially and then the confusion of the nurse in that area in getting me to the right spot. The doctor told my friend that everything went well though he didn't mention whether I had any more anal dysplasia or microscopic warts or not. So I'm currently experiencing the same post surgical body changes as I did my two previous out patient surgeries. Hate not being able to feel any sensations when I pee but hopefully later today that should come back. Totally not looking forward to that first poop post HRA but I should be on the right path for recovery.
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