Re: Wart story

Dr. Sonya writes:

Thu, 5 Oct 1995

Well, I stop reading a.t. for a while, and look what comes up! A medical condition right up my alley, so to speak. I've read all the previous posts in this thread, and I am amazed by those of you who dared to Try This At Home. However, I'm not worried that your bathroom surgery will put me out of a job, as Mr. Gerheim succinctly stated below.

Nevertheless, there were several items that need clarification, and I am compelled to do this in my usual fashion.

Al Gerheim writes: "Basically the wart will grow and send out roots into your foot, eventually starting new warts around the original wart. Well, he told me that he did this one wart that was so big and entrenched in the guy's foot that when he applied the liquid nitrogen the wart SQUIRMED and resisted! "

Eh....not quite. Reading this made *me* squirm because it is incorrect.

F A C T S A B O U T W A R T S

1. Warts are discrete benign papules (raised bumps) and plaques (coalesced papules) caused by a virus of the papova group, the human papilloma virus (HPV). They are commonly referred to as "verruca" by us quacks.

2. There are different presentations and types of warts: Verruca vulgaris, which is what you commonly get on hands, fingers and knees. Verruca plantaris, commonly called "plantar warts", and occuring on the plantar surface (sole) of the foot; verruca plana, or "flat wart", that occur on face, top of hands.

3. The HPV is antigenically different from the condyloma acuminatum virus that causes genital warts.

4. HPV affects *only* the epidermal layer of the skin; this means that it does *not* sent "roots" or anything else into your foot. This also means that when removed properly, no scar will be formed. You gotta bust thru the dermis to cause scar formation. Those that went a little too deep when cutting out their own warts bear proof of this with their scars.

5. A wart may be differentiated from other skin lesions by the presence of puncta - those little black dots that are visible throughout the wart. These are thrombosed capillary loops, and when you cut 'em, they bleed. This is one way I know I'm dealing with a wart and not a plain 'ole callus. This is referred to as "punctate bleeding".

6. The HPV virus is one tenacious little fucker; as a result, there is no one way to get rid of 'em. This is well demonstrated by the prior testimonials from the readership. I have tried just about everything mentioned previously, as well as a few other things. Even still, the recurrence rate is probably 20% or greater. They can be very frustrating to treat.


T R E A T M E N T S F O R V E R R U C A E

1. Salicylic acid plasters, combined with debridement of wart tissue: This is one of the most common treatments. S.A. is a mild acid that is keratolytic (breaks down keratin). When applied to the wart, it turns the tissue white; this tissue is then periodically trimmed down using a scalpel. The advantage is that it isn't painful. The disadvantage is that it isn't terribly effective, and may take *months* to work.

2. Canthrone application: One person mentioned this, but confused it with S.A. Canthrone, a.k.a. cantheradin is a blistering agent, and just happens to be the same agent in spanish fly. It comes from the blister beetle, and is very nasty. I've seen this beetle, and it is very pretty - black with bright orange or yellow on its wings, telling predators to "stay the FUCK away from me!". It preys on grasshoppers that are often found in alfalfa. If the hay is cut and baled before these guys can fly away, hapless livestock can be killed if even one of these beetles is ingested. Why? Because canthrone is an irritant to the genitourinary system (hence its use as a sexual stimulant), and it literally tears up the GU tract of the animal. When applied topically, it has the same effect, and produces a large, painfull blister of the epidermis. The hope is that the wart will be removed with the blister. The reality is that the virus particles can often go to the outer edge of the blister, forming a "donut wart". I've used this one time, but don't know if it worked (I was finished with the rotation before the patient came back).

3. Liquid Nitrogen (LN2): Also referred to as "cryotherapy" or "cryosurgery". I have frozen off literally dozens of warts from hands, feet, and even genitalia while doing my derm rotation last yr. This works in a similar fashion to the S.A., but is quicker. It can be rather painful, and also takes several treatments. It is fun to do, though - I used to use these $ LN2 canisters and spray the wart until it stays blanched for 30 sec. Repeat x2.

4. Excision and curettage: I prefer to do this these days. It involves an anesthetic injection to the foot, and careful cutting around the wart. A curet (small spoon-like scoop) is then used to pop out the wart. I then like to apply a very light application of a strong organic acid called phenol to the area. This has two effects: it stops the bleeding, and hopefully will kill any remaining HPV-containing cells. It also irritates the skin so that an immune response will kick in and the body will figure out that there is something else there to get rid of. I know I'm there when I get that good scraping sound against the dermis with the curet. I once used a punch biopsy to remove a wart, and that bled like a motherfucker. It also went into the dermis (which is unavoidable). It wasn't my idea, and I'll never do it again, because I don't think it would be that effective and could leave a painful scar. Luckily, it was only on a toe and not on the bottom of the foot...

"I went to a podiatrist, and he used a laser. It was great. His assistant used a little vacuum unit to suck up all the smoke. He'd burn away, then scrape off the ashes with a knife. The first one left a nice 4 cm hole in my heel. The others were smaller, and, strangely more painful. He used a local for the treatment, then I'd have to hop around for a week, then he'd go after the other foot and I'd reverse. "

5. Laser: This is one of the few good uses for a laser. Just last week, I was in a local podiatrist's office while he used a C02 laser to remove a large, painful verruca from a young woman's foot. He has been doing laser surgery for about 20 yrs, and is very good at it. He first circumscribed the wart with a focused beam. This forms a black burned ring around the wart. As mentioned above, a plume of smoke is formed, >from the vaporized skin cells. It is imperative to vacuum the plume, as it also contains the virus particles. There have been cases of people developing warts in their upper respiratory tract from inhaled virus particles. Anyway, the wart was then curretted out. The doc went exactly the correct depth with the laser, and didn't penetrate the dermis. After the wart was popped out, he then used an unfocused beam on a lower power to coagulate and hopefully kill any remaining infected cells.

6. Intralesional bleomycin injections: This is probably what Al had done by the dermatologist. Bleomycin is indeed an antineoplastic drug (stops new cells from forming). However, this technique reqires a very fine needle, and precise placement. I understand it is also very painful. Haven't tried it, and don't plan to.

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Whew! Well, there you have it: the lowdown on the common plantar wart, and the various treatments. Sorry for the low tasteless quotient, but if you have to see one removed to appreciate the true tasteless satisfaction. Of course, I like to show my patients their offending viral offspring after I've carved and scraped it out of their foot.

"If you get 'em, go right to the top, and get a podiatrist to fry them off."

I couldn't agree any more.

As always, in the tradition of education and tastelessness forming a joyous union, I bring this information to you twisted shits that make a.t. the cesspool that it is.

Sonya, your effusive a.t. podiatrist

<-----note that the views expressed here or above do not necessarily represent those of my employer or colleagues. ____________________________________________________________________________________________ From G.T. Dwarf:

Mon 9 Oct 1995

Dr. Sonya writes re: warts and their treatment: "3. Liquid Nitrogen (LN2): Also referred to as "cryotherapy" or "cryosurgery".... It can be rather painful, and also takes several treatments."

A yes, a priceless experience, especially for warts of the genital variety (~ wavy lines flashing back to the time I discussed a case of warts I shared with an ex-SO and, naturally, shared with you all~)

Not long after we broke up, I get this phone call from her.

"Vic, I've just had a pap smear done."

"Uhuh," I reply.

"They found something. A tumor of somekind."

"Shit," I think.

"And they found something else - *warts*," she says with an accusing sneer, and proceeds to describe how they sampled her cervix with what could only be described as a spud gun, and generally harrassing me about my hygiene, to which I answer that we've been boinking each other exclusively for three years (aaah, the joy of all skin, no condom sex) and she's been down on me more times than I could count, so if she couldn't see any, how in the hell could I.

We finish the conversation, and she tells me to have a THOROUGH look. I go to the crapper, drop my pants and peel back my foreskin and commence examination. Twisting and turning, wiping the smegma off the knob, pulling back folds of skin, finally I find it.

This tiny little white lump nestled in the most inaccessable crevice under my glans. Now for those of you who've had the joy of genital warts, you will know there is only one way to get rid of them.

*Burn* the fuckers off.

This horrible feeling of impending doom descends on me. The operation is bad enough normally, but I'm unclipped, and my dick is extremely sensitive, to the point where just running a finger over the glans hurts.

I steel myself and head up to the local clinic, book in, take a seat and wait, trembling. Finally get sent in, explain the problem to the doc and naturally he wants to have look. Much umming and aahing and finally a yup, that's a wart alright. Says he can get rid of it now, and he'll be right back.

He returns with some Q-tips and a thermos full of liquid nitrogen, which is around - 196 C. The object is to snap freeze the wart and its surrounding flesh so it will die and flake off. No wanking for a while. Dips the Q-tip in the stuff and presses it firmly against the wart.

I gasp and almost put my fist through the wall. A unique pain, unlike any other. Took several minutes to regain composure as the pain subsided to a dull ache. Get dressed, leave, and go sink half a dozen beers to try and wipe the horror.

I get home and go to the bathroom to have a look. The wart's still there and the flesh around it has gone a dry white. Shower the next morning and scrape the dead skin off. The wart's still there, nestled in a recess where the healthy dick skin used to be. Checking a week later, still there. Oh no, gonna have to try again.

Go back and go through the same routine to no effect. Went back 4 times in fact. On the fourth, the doc says if it doesn't work this time, he'll have to burn it off with this electric gizmo much like a soldering iron. My heart sinks even deeper, snap freezing is bad enough, now I'm gonna have to get a needle in my dick and a red hot poker pushed against it.

At this point, I commenced a daily ritual of hating and cursing the wart. Eventually it actually did drop off, so I didn't have to face that prospect.

I do not look forward to a repeat case.

Sonya again: "It is fun to do, though - I used to use these $ LN2 canisters and spray the wart until it stays blanched for 30 sec. Repeat x2."

Fun ? I bet. But not as much fun as upending you, sticking an oil funnel down your cooter and emptying a thermos full into it. Here, in graphic detail, is what an a.t'er from a while back had to say about her cryotherapy -

____________________________________________________________________________________________

From PHBailey:

Subject: Vaginal Surgery

28 Mar 1995

Two years ago, as a result of recurring vaginal yeast infections, I had to undergo some painful and tasteless gynecological procedures. I thought I would use some of my ten free AOL hours to share every disgusting detail with you.

As I said, I had a cycle of recurring yeast infections. About 5 or 6 in one year. Those of you who have suffered (or know someone who has suffered) the itching, burning, and discharge of a vaginal infection are probably aware that it takes about two weeks to clear up an infection. That meant about 10-12 weeks per year of injecting a tubefull of Monistat up me and having it drip out all night, waking up to gooey underpants.

The first procedure was a biopsy of the cervix. Painful, but mercifully quick. First, the doc cranked me open with the speculum, then inserted a metal instrument all the way up my vagina. At the end of this metal rod is something that looks like a paper punch. Can you imagine someone removing a piece of your tender parts with a PAPER PUNCH, for crying out loud? And without any local anesthesia? I don't know how to make a guy understand this anguish. Maybe it is comparable to having somebody cut a piece of dickflesh off. Anyway, the biopsy showed some pre-cancerous cells.

My doctor decided the best treatment for my dysplasia would be to freeze off the top layer of my cervix. Sort of like erasing away the outer layer to reveal a sublayer of health, pink cervical tissue. Such freezing is called cryotherapy (or cryosurgery). (Another option would have been to cauterize the tissue by applying silver nitrate or using a heated instrument. Following cauterization, a scab forms over the cervix. The cervix scab falls off in a couple of weeks.)

But back to my cryotherapy. In this procedure, the doctor applied liquid nitrogen to the cervix and destroyed the abnormal tissue by freezing it. The procedure started in the usual way: me on my back, legs splayed wide, feet in stirrups. The doctor wheeled up between my legs, adjusted the gooseneck lamp for optimum light, and inserted my old buddy, Mr. Speculum. She cranked the speculum wide. Now came the fun part. Sitting on the floor was a tank of liquid nitrogen, with a plastic hose attached. At the other end of the hose was a metal rod-like instrument probably about 6 inches long. The tip of the rod was squished flat, about the size of a quarter.

The doctor inserted the rod into my vagina and pressed the flat round end against my cervix. She turned the liquid nitrogen on, which flowed through the plastic tube, then through the metal part of the instrument, and finally out onto my cervix. For the cervix to be completely frozen, the doctor has to hold the instrument against it for five minutes.

Normally, five minutes doesn't seem that long. But after about 30 seconds, I started feeling an odd sensation on my cervix. A sensation that grew more sharply painful as each second passed. Then the cramping started. Worse than menstrual cramps. More like early labor pains, I'd guess. The pain shot through me, from the top of my uterus, down as far as my lower thighs. And all the while, it felt like I had an ice cube on my cervix. Oh, and did I mention that because there are (supposedly) no nerve endings in the cervix, no anesthesia is used during this procedure? I'd like to find the doctor who first claimed that the cervix has no nerves. If he (and it probably is a he, so bite me) is still alive, I'd tell him that I d like to use him as a subject to test my hypothesis that the scrotum has no nerves and then twist his hairy, shriveled nutbag with a pair of pliers. When he started whining about the pain, I'd tell him "it was all in his head because everyone knows the scrotum has no nerve endings."

Well, I survived this excruciating procedure and hobbled home with my post-surgical instructions and a big box of sanitary pads. I was told to expect a watery discharge for a week to ten days. What I got was more like the Johnstown Flood for six weeks. I was not prepared for this diluvian discharge. During the day, as I attempted to perform my normal routine (work, run errands, have a life), I could not venture forth without an adequate supply of maxipads. If I did not change the pad hourly, my pants would be soaked through and the odor would just about kill a moose. As I said before, the discharge was urine-like in consistency, but had the aroma of the production room in a processed cheese factory. Fortunately, I was working in a processed cheese factory at the time, so I wasn't too worried about someone noticing on the putrid smell. ( Hey girl, what did you do? Fall in a vat of cheeze sauce? )

Nighttime was the worst. I had to wear three maxipads to bed. And I'd still wake up in the middle of the night soaked through my panties and nightgown. My boyfriend was quite understanding about not having any sex for a couple of months, but I m sure ol' Woody probably went limp every time my man got a whiff of me. Not exactly conducive to romance.

The other gross part, I guess, was the douching. I was told to douche twice a day to help dislodge all the decaying bits of flesh from my cervix. The nurse told me to squirt the douche-water with extra vigor and really blast the dead stuff away. This was always a real treat: squatting in the shower, douche bottle in hand, watching tiny bits of dead flesh come surfing out the love canal.

Now I'm having trouble with my bowels. I have a hunch that there's a colonoscopy in my future.

P.H.B.