Who should you see for hemorrhoid treatment. What factors should you consider when choosing a specialist. How do gastroenterologists and proctologists differ in treating hemorrhoids. What are the latest treatment options available for hemorrhoids.

Understanding Hemorrhoids: Causes, Symptoms, and Prevalence

Hemorrhoids are a common medical condition affecting millions of people worldwide. These swollen blood vessels in the lower rectum and anus can cause discomfort, pain, and bleeding. But what exactly causes hemorrhoids, and how prevalent are they?

Hemorrhoids typically develop due to increased pressure in the lower rectum. Common causes include:

• Straining during bowel movements
• Chronic constipation or diarrhea
• Pregnancy
• Obesity
• Prolonged sitting
• Lack of fiber in the diet

Symptoms of hemorrhoids may include:

• Itching or irritation in the anal area
• Pain or discomfort
• Swelling around the anus
• Bleeding during bowel movements
• A lump near the anus, which may be sensitive or painful

Studies suggest that up to 75% of adults will experience hemorrhoids at some point in their lives. The prevalence increases with age, with about 50% of people over 50 years old having experienced hemorrhoid symptoms.

Gastroenterologist vs. Proctologist: Understanding the Difference

When seeking treatment for hemorrhoids, patients often wonder whether they should consult a gastroenterologist or a proctologist. Both specialists can treat hemorrhoids, but they have different areas of expertise.

A gastroenterologist is a physician specializing in the digestive system, including the esophagus, stomach, small intestine, colon, and rectum. They diagnose and treat a wide range of gastrointestinal disorders, including hemorrhoids.

A proctologist, also known as a colorectal surgeon, specializes specifically in disorders of the colon, rectum, and anus. They have extensive training in both non-surgical and surgical treatments for conditions like hemorrhoids.

Is one specialist better than the other for treating hemorrhoids? The answer depends on the severity of your condition and the required treatment. For mild to moderate hemorrhoids, either specialist can provide effective treatment. However, for severe cases requiring surgery, a proctologist may be the better choice due to their surgical expertise.

Choosing the Right Specialist: Factors to Consider

Selecting the right doctor for hemorrhoid treatment involves several considerations. Here are key factors to keep in mind:

1. Specialization: Choose a doctor who specializes in treating hemorrhoids and other colorectal conditions.
2. Experience: Look for a physician with extensive experience in hemorrhoid treatment, especially if you’re considering surgical options.
3. Treatment options: Ensure the doctor offers a range of treatment options, from conservative approaches to advanced surgical techniques.
4. Bedside manner: Select a doctor who makes you feel comfortable discussing your symptoms and concerns.
5. Recommendations: Consider recommendations from your primary care physician, friends, or family members.
6. Reviews and ratings: Research online reviews and ratings from other patients.
7. Insurance coverage: Verify that the specialist is covered by your insurance plan.

Latest Advancements in Hemorrhoid Treatment

Hemorrhoid treatment has evolved significantly in recent years, with new techniques offering less invasive options and quicker recovery times. Some of the latest advancements include:

Procedure for Prolapse and Hemorrhoids (PPH)

PPH is a minimally invasive surgical technique that reduces the size of internal hemorrhoids by cutting off their blood supply. This procedure typically results in less postoperative pain and faster recovery compared to traditional hemorrhoidectomy.

Transanal Hemorrhoidal Dearterialization (THD)

THD is another minimally invasive procedure that uses Doppler ultrasound to locate and tie off the arteries supplying blood to the hemorrhoids. This technique can effectively treat both internal and external hemorrhoids with minimal discomfort.

Rubber Band Ligation

While not a new technique, rubber band ligation has been refined over the years. This non-surgical procedure involves placing small rubber bands around the base of internal hemorrhoids to cut off their blood supply, causing them to shrink and fall off.

Laser Therapy

Laser hemorrhoidoplasty is a relatively new technique that uses laser energy to shrink hemorrhoids. This procedure is associated with less pain and faster recovery compared to traditional surgical methods.

The Importance of Specialized Care for Hemorrhoids

Seeking specialized care for hemorrhoids is crucial for several reasons:

• Accurate diagnosis: Specialists can differentiate hemorrhoids from other conditions with similar symptoms, such as anal fissures or colorectal cancer.
• Tailored treatment plans: Experts can develop personalized treatment strategies based on the severity of your condition and individual needs.
• Access to advanced treatments: Specialists are more likely to offer cutting-edge treatments that may not be available from general practitioners.
• Reduced risk of complications: Experienced specialists are better equipped to handle potential complications during treatment.
• Comprehensive care: Specialists can address related issues and provide guidance on prevention and long-term management.

Can general practitioners effectively treat hemorrhoids? While general practitioners can manage mild cases, they may not have the specialized knowledge and equipment to handle more complex situations. For persistent or severe hemorrhoids, consulting a specialist is often the best course of action.

Non-Surgical Treatment Options for Hemorrhoids

Before considering surgical interventions, doctors typically recommend non-surgical treatments for hemorrhoids. These may include:

Lifestyle Changes

Simple lifestyle modifications can often alleviate hemorrhoid symptoms and prevent recurrence:

• Increasing fiber intake
• Staying hydrated
• Regular exercise
• Avoiding straining during bowel movements
• Maintaining good hygiene

Topical Treatments

Over-the-counter creams, ointments, and suppositories can provide relief from pain, itching, and inflammation associated with hemorrhoids. These may contain ingredients such as hydrocortisone, witch hazel, or lidocaine.

Sitz Baths

Soaking the anal area in warm water for 10-15 minutes several times a day can help reduce pain and inflammation. This simple remedy can be particularly effective after bowel movements.

Oral Medications

In some cases, doctors may prescribe oral pain relievers or anti-inflammatory medications to manage hemorrhoid symptoms.

Are non-surgical treatments always effective for hemorrhoids? While these treatments can provide relief for many patients, some may require more advanced interventions if symptoms persist or worsen.

Surgical Options for Hemorrhoid Treatment

When non-surgical treatments fail to provide relief, or for more severe cases of hemorrhoids, surgical options may be considered. These include:

Traditional Hemorrhoidectomy

This surgical procedure involves removing the hemorrhoidal tissue. While effective, it can be associated with significant postoperative pain and a longer recovery period.

Stapled Hemorrhoidopexy

Also known as stapled hemorrhoidectomy, this procedure uses a special stapling device to reposition the hemorrhoidal tissue and cut off its blood supply. It typically results in less postoperative pain compared to traditional hemorrhoidectomy.

Doppler-Guided Hemorrhoidal Artery Ligation

This minimally invasive technique uses ultrasound to locate and tie off the arteries supplying blood to the hemorrhoids, causing them to shrink.

What factors determine the need for surgical intervention? The decision to pursue surgery depends on various factors, including the severity of symptoms, the size and location of the hemorrhoids, and the patient’s overall health and preferences.

Recovery and Aftercare Following Hemorrhoid Treatment

Proper recovery and aftercare are crucial for successful hemorrhoid treatment outcomes. Here are some key aspects of the recovery process:

Pain Management

Following treatment, especially surgical procedures, patients may experience pain and discomfort. Doctors typically prescribe pain medications and recommend sitz baths to alleviate these symptoms.

Dietary Considerations

A high-fiber diet and adequate hydration are essential during recovery to prevent constipation and reduce strain during bowel movements.

Activity Restrictions

Patients are usually advised to avoid heavy lifting and strenuous activities for a period after treatment. The duration of these restrictions depends on the type of treatment received.

Follow-up Appointments

Regular follow-up visits with the treating physician are important to monitor healing and address any complications.

How long does it typically take to recover from hemorrhoid treatment? Recovery time varies depending on the treatment method. Non-surgical treatments may allow for immediate return to normal activities, while surgical procedures can require several weeks of recovery.

Proper aftercare is crucial for preventing hemorrhoid recurrence. This includes maintaining a healthy lifestyle, practicing good hygiene, and addressing any underlying conditions that may contribute to hemorrhoid development.

Preventing Hemorrhoid Recurrence: Long-Term Strategies

While hemorrhoid treatments can be effective, prevention is always preferable. Here are some long-term strategies to reduce the risk of hemorrhoid recurrence:

Dietary Modifications

A diet rich in fiber helps prevent constipation and reduces strain during bowel movements. Aim for 25-30 grams of fiber daily from sources such as fruits, vegetables, whole grains, and legumes.

Hydration

Drinking plenty of water (typically 8-10 glasses per day) helps soften stools and prevent constipation.

Regular Exercise

Physical activity promotes healthy bowel function and helps maintain a healthy weight, reducing pressure on the lower rectum.

Toilet Habits

Avoid spending excessive time on the toilet and resist the urge to strain during bowel movements. Use the bathroom as soon as you feel the urge to go.

Weight Management

Maintaining a healthy weight can reduce pressure on the lower rectum and decrease the risk of hemorrhoid development.

Can lifestyle changes alone prevent hemorrhoid recurrence? While these strategies significantly reduce the risk of recurrence, some individuals may be more prone to hemorrhoids due to genetic factors or underlying medical conditions. Regular check-ups with a specialist can help identify and address potential issues early.

By implementing these preventive measures and working closely with a healthcare provider, individuals can significantly reduce their risk of experiencing recurring hemorrhoids and maintain better overall colorectal health.

Choosing the Best Surgeon for Hemorrhoid Treatment

Medically reviewed by: Gary H. Hoffman, MD

Choosing the right physician for your hemorrhoid treatment is an important decision. Not only do you need someone skilled and well-trained, but you need someone who can make you feel comfortable during exams and procedures. Most importantly, you need a doctor who can diagnose and treat your condition, taking into consideration your unique needs.

Some of the things to keep in mind when choosing a proctologist or surgeon for your hemorrhoid treatment include:

Choose a Hemorrhoid Specialist

If your hemorrhoids respond to a change in diet and over-the-counter treatments, your primary care physician will probably have enough experience in treating the annoying condition to ensure you have the information you need to heal quickly. If the hemorrhoids don’t respond to this type of conservative treatment though, you will want to consider talking to a specialist about your options.

A proctologist, sometimes known as a colon and rectal specialist, deals with hemorrhoids every day. Thanks to their training and experience, they can diagnose your condition, grade, and treat your hemorrhoids more effectively. They can also often offer more effective treatments to stop rectal bleeding and shrink inflamed hemorrhoidal tissues, often based on the latest research. These treatments are usually less invasive and are not as painful as conventional treatments.

If your condition requires surgery, you will definitely want to consult with a colon and rectal surgeon. General surgeons may only do a few hemorrhoidectomies a year, while a specialist may do many each week. The learning curve, especially when it comes to cutting-edge techniques, is steep. A general surgeon may not get enough practice to be competent at performing  these specialized procedures, in some cases.

Experience Is Key

If you hope to pursue a less invasive option than a traditional open hemorrhoidectomy, choosing a specialist with experience performing these cutting-edge procedures is key. While PPH is a minimally invasive procedure for hemorrhoids, it requires a high level of skill and experience to perform properly and minimize the risk of complications.

For example, our surgeons perform Procedure for Prolapse and Hemorrhoids, or PPH, on a regular basis. Dr. Gary Hoffman not only conducted research that proves the advantages of this procedure over a more traditional hemorrhoidectomy, he also continues to work on further streamlining the procedure and advancing the instrumentation used.

Even if you do not end up undergoing PPH, you want a doctor who has the experience to understand the best options based on your unique symptoms. When a doctor does not see a condition regularly, they have a much higher risk of misdiagnosis, prescribing the wrong treatment, or missing warning signs of complications.

A colorectal surgeon will have extensive experience with hemorrhoids, as is required for them to obtain board certification. This means you get a higher level of care for your condition, from routine screenings to diagnosis to in-office treatments to surgery, when necessary.

Find a Good Doctor

Not only do you want to find an experienced doctor, you want to find a good doctor. In many cases, the personality of a colon and rectal surgeon and how comfortable they make discussing these topics is as important as their training.

While colon and rectal surgeons have advanced training in diagnosing and treating hemorrhoids and other colorectal issues, they also need to have a bedside manner that helps you relax and feel at ease explaining your symptoms. They need to make it as easy as possible on you to undergo routine screenings, as well as non-surgical and surgical treatments.

We recommend starting by asking your friends and family for a recommendation. You doctor may also have good advice about specialists. Lastly, keep researching online. Read reviews and learn more about individual physicians and practices through their websites.

Talk to Us to Learn More

At Los Angeles Colon & Rectal Surgical Associates, our surgeons pioneered the use of less invasive hemorrhoid treatments that significantly reduce postoperative pain. We focus on using the latest advances to effectively treat hemorrhoids and other perirectal and perianal conditions. We also offer preventative and diagnostic support, in additional to routine screenings. Call (310)273-2310 today to schedule your confidential consultation.

Hemorrhoid Treatments | The University of Kansas Health System

Hemorrhoids are a condition many people experience but few feel comfortable talking about, even with their doctors. Specialists at The University of Kansas Health System understand this topic can be difficult to discuss and are ready to work with you to find the best solution to getting rid of hemorrhoids.

Almost 3 out of 4 adults will experience hemorrhoids occasionally, and a number of treatments may be recommended for them.

What is a hemorrhoid treatment?

Hemorrhoids, also called piles, are swollen veins that develop around your anus (external hemorrhoids) or in your lower rectum (internal hemorrhoids). There are many causes of hemorrhoids, but even so the cause is often unknown. Hemorrhoids may go away on their own, but if your symptoms get worse or don’t improve after a week of home treatments, you should see your primary healthcare provider.

Treatments for hemorrhoids range from lifestyle changes to surgical hemorrhoid removal. The type of treatment your doctor recommends will depend on the severity of your hemorrhoids. More invasive forms of hemorrhoid treatment can often be avoided by seeing your doctor at the first sign of hemorrhoids and getting treatment early. The sooner you seek intervention, the easier the condition is to treat.

We offer a variety of appointment types. Learn more or call 913-588-1227 to schedule now.

Who can have hemorrhoid treatments?

There are several types of hemorrhoid treatment, and your doctor can help you find the best treatment for your individual diagnosis. If you are experiencing hemorrhoids, the first step to take is to see your regular doctor. You may also ask your doctor to refer you to a gastroenterologist, who has expertise in the digestive system, or to a colorectal surgeon for evaluation and treatment. You may also want to consult with your obstetrician or gynecologist if you are experiencing hemorrhoids postpartum or during pregnancy, or if they are a result of pelvic organ prolapse.

Your surgical specialist may recommend a colorectal exam for diagnostic purposes. The diagnostic process may include guidance for preparation and stages including gathering your medical history, physical examination, digital examination of the sphincter, and scope of the anal canal and lower part of the rectum. This process will help your specialist determine the best treatment for you.

How do hemorrhoid treatments work?

How a hemorrhoid treatment works depends on what kind of treatment it is. Our physicians offer in-office assessments to determine your best treatment. Lifestyle changes to treat hemorrhoids or the use of over-the-counter medications, creams or suppositories work to reduce swelling and bleeding. In-office or surgical treatments may use a form of surgical ligation – cutting off the flow of blood to the hemorrhoid, or surgical removal of the hemorrhoid.

Lifestyle changes and over-the-counter treatments

Often, with a milder case of hemorrhoids, lifestyle changes can relieve symptoms in as little as a week. Some changes your doctor might recommend for your lifestyle include adding more fiber to your diet, drinking more water, getting additional moderate exercise and avoiding sitting for long periods of time. You may also need to supplement your diet with stool softeners if you have trouble getting enough fiber. Maintaining these lifestyle changes will help prevent hemorrhoids from developing as well.

In addition to lifestyle changes, over-the-counter medications such as hemorrhoid creams and medicated pads can offer relief from symptoms. Rectal suppositories that contain hydrocortisone are also helpful.

Another home remedy that can provide relief from symptoms of hemorrhoids is a sitz bath. For a sitz bath, sit in about 3 inches of warm water for about 15 minutes at a time several times a day. This can be done in a bathtub, or by using a sitz bath that sits on your toilet seat for more convenience.

Lifestyle changes and over-the-counter remedies may not be able to completely clear up hemorrhoids. Other options include:

• Office-based ligation – Rubber-band ligation cuts off blood supply to the hemorrhoid, causing it to fall off.
• Surgical procedures – Not all hemorrhoids respond to ligation, so our team offers advanced surgery options to remove excess tissue or reduce the size of hemorrhoids.

What happens during hemorrhoid treatments?

When lifestyle changes and over-the-counter hemorrhoid treatments don’t help your hemorrhoids or relieve your symptoms, it may be time to see a specialist. The specialist may recommend an in-office or surgical treatment.

• 
  
  Rubber band ligation
  
• 
  
  Hemorrhoidectomy and Doppler-guided THD
  

Rubber band ligation is may be offered by your regular doctor or gastroenterologist in their office. This method of treatment is used for bleeding or prolapsed internal hemorrhoids (fallen through your anal opening).

To perform the treatment, the doctor places a rubber band around the base of the hemorrhoid. The band cuts off the blood supply, causing the hemorrhoid to shrivel up and fall off, usually within a week. Scar tissue forms in the remaining part of the hemorrhoid and may shrink the remaining part of the hemorrhoid and should prevent nearby veins from bulging into the anal canal.

Hemorrhoid removal – hemorrhoidectomy – is when your surgeon removes the excess tissue that causes bleeding. A hemorrhoidectomy is an effective and complete method of treating recurring hemorrhoids that don’t respond to other forms of treatment.

The Doppler-guided transanal hemorrhoidal dearterialization is an alternative to a traditional hemorrhoidectomy, and has been FDA-approved since 2008. In this procedure, the surgeon uses a Doppler signal to precisely locate the hemorrhoidal arteries. Sutures are then used to tie off the blood flow. This prevents blood from flowing into the hemorrhoid, but allows the blood to flow out, reducing its size. There is no surgical removal of any tissue. The procedure takes only about 30 minutes.

The THD Doppler-guided procedure is an option for someone who may not be a good candidate for traditional hemorrhoid surgery, including patients who take blood thinners. This same-day procedure is less painful than traditional surgery and allows patients on blood thinners to continue them. Recovery time is also shorter than with a hemorrhoidectomy.

Why choose us for hemorrhoid treatments

The care teams at The University of Kansas Health System provide comprehensive assessment and develop the best hemorrhoid treatment plan for each patient. Our surgeons are fellowship-trained and have the most advanced training for evaluating patients’ needs and performing the the right surgical treatment. As part of an academic medical center, our health system providers have access to the most innovative therapies in the treatment of hemorrhoids.

Find a doctor

Doctors at The University of Kansas Health System are care providers and researchers at the forefront of new medical discoveries. From primary care to complex conditions, we offer hundreds of specialists.

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Radio wave treatment of hemorrhoids | Proctology Zaporozhye

What is this method?

Radio wave excision of hemorrhoids is based on the removal of the formation using a special electrode (radio knife) that emits high frequency radio waves. A radioknife is a device that removes a node without contact with directed radio waves.
Manipulation is carried out under anesthesia. The formation is excised close to the base of the node. The walls of the veins stick together under the influence of high temperature. The wound is cauterized, small vessels are sealed. This completely eliminates blood loss. The radioknife does not touch the surface of the skin; damage to nearby healthy tissues is excluded. Wound healing is faster than after using other excision methods.

There is no shame in being healthy!

The procedure painlessly relieves hemorrhoids

It provokes contraction of the sphincter muscles and does not affect the nerve endings. The method surpasses others in accuracy, safety, and effectiveness. These procedures are less traumatic and bloodless. Radio wave surgery allows you to achieve the desired results from the first procedure.
The main advantages of radio wave hemorrhoid treatment:

short hospital stay

Without the risk of bleeding

Rapid healing of the wound

without burns and necrosis of tissues

What is this method

,

radio wave excision of hemorrhoidal nodes is based on the removal of formation using a special electrode (radio -beam), which radiates radio waves of high frequency. A radioknife is a device that removes a node without contact with directed radio waves.

Manipulation is carried out under anesthesia. The formation is excised close to the base of the node. The walls of the veins stick together under the influence of high temperature. The wound is cauterized, small vessels are sealed. This completely eliminates blood loss. The radioknife does not touch the surface of the skin; damage to nearby healthy tissues is excluded. Wound healing is faster than after using other excision methods.

Indications and contraindications for use

It is recommended to perform this operation in the third or fourth stage of the disease, and not in the initial form of hemorrhoids. It is advisable to carry out immediately for excision of external and internal hemorrhoids.

Preparation

Before the procedure, the patient undergoes general tests, a cleansing enema, and the surgical field is prepared.

How to remove hemorrhoids

Remove the nodes in a certified clinic under aseptic conditions in the operating room. The process takes no more than half an hour. It is carried out under anesthesia. The radio wave removes hemorrhoids, the vessels are sealed, bleeding does not occur.

Recommendations during the recovery period

After the operation, the patient is advised to carefully observe personal hygiene. The wound must be regularly treated with ointments with a disinfecting and wound healing effect.

Where to perform this operation

Radio wave removal of hemorrhoids can be done in Zaporozhye in the clinic of proctology. It has modern equipment and highly qualified surgeons. Sign up and come visit us!

Postolenko Nikolai Dmitrievich

head of the department,
chief freelance proctologist
of the Department of Health Protection
of the Zaporozhye City Council,
Candidate of Medical Sciences,
Associate Professor,
work experience 21 years,
higher
qualifying category.

Author:
124 scientific papers,
2 patents of Ukraine
for inventions,
2 innovations,
2 scientific and methodological manuals,
2 methodological recommendations.

Read online “Citizens. Stories, notes, miniatures”, Oleg Anikienko – Litres

© Oleg Anikienko, 2021

ISBN 978-5-0053-3402-2

Created in the intellectual publishing system Ridero

Thin connections 90 079

Citizens – book whose heroes are ordinary people. The town is lost somewhere in the northern forests and swamps. And the people in it are small, with their own successes and sorrows. To what extent are they woven into the general connections of life? What are their dreams? Who will help them achieve their goals?

The book is made up of stories, as well as sketches, notes and miniatures. Section “From the folder with clippings” – artistic reflections, memories. “Urban scenes” – sensations, views, stops – shots of city streets. Such a mosaic is intended, according to the author, to create a “picture” of provincial life…

And the stories are different in form. One is written in the spirit of a play, the other is like an excerpt from a movie script. There is a story – a review, a psychological novella, a stylization of a document, computer correspondence, erotica (where without it?) So, apparently, it was more interesting for the author to create. Although, reading is probably more difficult.

You can feel the threads and connections in the book. In almost every story, a character needs help or provides it to another. The quality of human connections of today is the main thing in the book. And in each story there are thoughts, eyes of people. These images, their voiced or silent requests, are not artificially composed. A – heard, felt. We wish the reader the same.

Concert

How difficult life can be sometimes! For several days, Zhivkov had been tormented at the bedside of his sick son. How many times he sat in the stuffiness of the apartment, met doctors, prepared medicines, from which he was seized by longing. And all these days, spent as if in a fog, it seemed to him that someone was leading him, pushing him, and he, as if tied by strings, was fulfilling someone else’s will.

Lately, Zhivkov has become convinced that his fate did not work out. Dreams of a career, serious studies are gone. There were even smaller dreams, but even they, barely flaring up, were left behind by the lights of the past…

Dejectedly, Zhivkov looks around the room. Here is the chair on which he liked to sit after noisy, exhausting work. An ordinary armchair, which is produced by the thousands, and then placed in front of the same identical TVs. Here he rested from the roar of machine tools. Sometimes he fell asleep in the armchair, forgetting to turn off the TV.

He himself did not notice how he ended up on the street, between the panels of gray houses. The cloudy sky fell on his shoulders. The snow, picked up by the wind near the ground, burst under the collar and pricked his cheeks. How, by what fate, did he end up in a land where there is so little sun overhead? Who is to blame for everything?

In the depths of his soul, Zhivkov felt that his son’s illness was only one of the reasons for his failures. It’s just that there, in the past, he himself lost impulses and desires, and with them the fullness of life.

Zhivkov walked, overwhelmed by heavy thoughts, not sorting out the road. The blizzard either intensified, then suddenly subsided, pushing the corners of the houses towards him. He remembered the lecturer who spoke in their workshop and her words: “A person’s happiness is in himself. Only he is the creator of his life!” He wanted to shout then: “It’s not true! You had everything! Money, time, teacher, finally! Yes, the same teacher and friend whom he never met in his life. All by himself, all by his own mind!

Chilled and covered in snow, Zhivkov stopped at the building where the wind was ruffling the poster. In blurry letters, a visiting group called him to a concert. The face of the musician from the poster seemed familiar to him. To the right was a cash register window.

– Concert! he thought contemptuously, sitting down in an armchair. – Again, one of “these” . .. What do they care about him, Zhivkov! Already sitting and feeling his fingers warming up, he became worried. About fifteen people were sitting in armchairs like dark figures. Zhivkov did not know any of them, but he felt his kinship with them. He stared hard at the stage. Instruments lay and stood around, and next to it were black boxes of equipment. On one of the boxes, a corner broke off, on the other, the lining was bubbling.

The musicians stood calmly tuning their instruments. They didn’t seem to care how many spectators were in the hall. But they felt people. Zhivkov understood this when one of them smiled reassuringly into the hall, and his instrument, wrapped in shiny pipes, swayed and froze.

Zhivkov kept looking at the musicians. They seemed to him dim, everyday, not like artists. But for some reason I wanted to believe them…

He didn’t wait for the music to start. I realized that it already sounds in it. Some kind of note, similar to the breath of the wind, seized him. Gradually, the sound grew, other sounds, semitones, were woven into it, trying themselves in a strange harmony. Everything was like a weak blizzard that surrounded the person peering into it. The lights in the hall went out imperceptibly, and now the musicians were visible as gloomy shadows. The violinist inaudibly brought out the melody, the drummer waved enthusiastically …

Zhivkov suddenly saw himself as a little boy, standing next to his mother and helping her in the kitchen. The boy stood with his head bowed to one side and his stomach exposed – a consequence of his illness. Then he saw a schoolboy pensively listening to music by the green eye of the radio. For some reason, the fat teacher yells at him. How many of them were classmates, teachers… He never met “his” teacher. Only once, when he succeeded in some task, did the teacher look at him carefully. Now he doesn’t remember any of them, and he forgot that teacher, but he remembers her look.

And there he is, a teenager, drunk on wine and throwing up in a children’s arbor. Attractive breasts of girls, noisy dances, fights… How much was accidental, unnecessary in his life! And above all this – strict parents. They worked hard and taught how to live.

The hard years of the army have passed, smeared with a gray spot. He did not like to remember them. The first woman… the birth of a son. The child was born weak, premature. Here he is, swollen, in the hospital, and next to him are the same children with spots under their eyes. They always asked to sit with them. Where were their parents? Who are they?

Zhivkov listened and did not believe: the music spoke about him, about those failures and joys that fell to his lot. Everything was clear to him. And most importantly, she did not condemn him for the fact that he walked through life directly and honestly, without pushing others with his elbows.

But now, having told about the past, the music also spoke about the future. Something simple, light filled him. Her son would get better, she said, and he would go to school again. He himself is valued at work, waiting. You just need to take matters into your own hands. We need to take care of our son again, as he once took care of himself. Zhivkov suddenly realized clearly how much had not been done in his life. And the years that he lived seemed to him a trifle in front of that peak, which you can still climb.

… The light illuminated the faces of the musicians, their figures in plaid shirts and jeans. They were visibly tired and were now silently putting away their instruments. He wanted to say something kind to them. He approached the pianist. The musician’s eyes looked calm, and again it seemed that this guy looked like him in his youth, when he also wanted to do something for people, but never got around to it.

Renewed, Zhivkov went out into the street. The blizzard had subsided, and now the snow was softly lit from the windows. He looked around: on the signboard of the House of Culture, the glass was cracked in two places. Two broken cracks crossed the snow-covered glass. Something meaningful seemed to him in this sign.

Zhivkov walked home, feeling more and more springy step. My instinct told me that the crisis was over, and it was time to get down to business again. The son is recovering … Perhaps someone will turn out of him in life. In any case, a lot depends on Zhivkov. And who, if not him, should become a teacher, a friend to his son? He will break this chain of “failures” and “non-meetings”. Maybe this is his “big task”? Well, at least for the first time…

One turn

In early spring, ice icicles are knocked down in the city. Our land is snowy, and the roofs covered with gray slate suffer along with the people. They start cleaning from the main streets. We have three of them – Lenin, Pervomaiskaya and Communist. There is not enough special equipment for all the houses, and the men, tied with ropes, balance on the roof with wooden mallets.

– Levey, Vasek… Hit again! Where?!

Icicles fall, rattling against the tin cornices, and break into sparkling fragments. But there is little fun. The sun is still weak, and the townspeople are sleeping at bus stops, hiding in their collars.

Home-made “hedgehogs” are displayed on the sidewalks around the houses. The structures are knocked together from window frames picked up from garbage cans. Ribbons and wire are tied to trees and urns. Women, bypassing the fences, cautiously come out onto the road and scold the cleaners.

– For you, aunt! – the janitors are offended, pushing the ice.

In the spring, signs on houses finally become necessary. The paint on them has peeled off, but you can still read: “Caution, the snow is melting!” The signs hang all year round, screwed tightly to the corners of buildings. In summer, foreigners stop by these posters. Visiting guests laugh, point fingers and take pictures with their phones. Fun!

But the townspeople are imperturbable. We have New Year’s lights hanging for years. Perhaps ugly, but convenient. But we don’t have terrorists, any skinheads and prostitutes at train stations.

Citizens need support in spring. People are tired and relax in their own way – some get drunk, and some rest, falling asleep at concerts at the local philharmonic.

We also have a park by the river. The trees here have grown and are cut annually with chainsaws. Once there was also a cathedral with a huge bell tower. Demolished in the 30s. But the main attraction of the park is the view of the river. Residents do not appreciate this feature. It’s hard to believe, but in two hundred years the city has not built an embankment. The shore is not well maintained – rusty chains and cables, some kind of concrete rings, poles. Broken bottles all around, traces of fires…

Three years ago we decided to pour a concrete embankment. Rolled two hundred meters. The approach to the shore was fenced off with a high fence. It’s so tight, don’t go near the water. So this fortress is standing … The builders have disappeared, there is no money – a crisis. Or did they steal? But you can’t remove the fence, what if there is money?

Well, what, you order, to raise the soul? Even the ice drift is not visible. Although, of course, you can drill a hole in the board. Look, enjoy… Or drag a ladder. Riding the fence, you can see off the floating ice floes and welcome the renewal of life.

Summer… More than once there was a feeling that something was missing in the city. But what? And you can’t say for sure… Maybe because the city aura is not visible? You don’t feel the spirit of the city, its unique originality… You will arrive in a different town. And the first person you meet: “Tell me about us?” And – “tra-ta-ta” … – you can’t stop. Eyes are burning, hands are like mill wings.

– Where are you from? he asks.

– From Ust – Syrovsk …

– Yes? What is he?

Think about it. How to tell that you want to love easily, but it turns out to be strained. That the face of the city seems to be correct, but … insipid. That we don’t have a circus and our own clowns with smart eyes and good hands.

Surprisingly, no new fountains have been built in the city in a quarter of a century. It’s like we live in the desert. A couple of existing fountains – near the city hall, and near the cinema. So-so fountains, no fuss. As if there are no sculptors. After all, you can put a dragon under the stream. Or a busty mermaid.

A joke, of course. But there is so little life in these memorials of ours! And everything looks like the monuments of other towns. Well, maybe the hand didn’t hang like that, a different angle… The city is deaf to the small sculpture. After all, there are green squares, lawns. Well, put some funny animal there. No more bronze workers. Individuality is created by small things…

I was reading how a Mexican town was saved from visiting sorcerers. Three local magicians flew around their town in a helicopter, whispering and shaking something. The magic ritual didn’t take much strength. But since then, only local miracle workers have been in charge inside the town.

The “work” of the sorceress Stella is still fresh in my memory. She came to our city with bulls – bodyguards, ruined dozens of citizens. And our newspapermen helped her. They made this ad! They knew that she was a thief, but they wanted to “cut down money”. They knew that it was not they who would get caught, but those poor women who carry the last money, if only their son would not drink “troy”.

And a question for the local magicians. What were you silent about? Corporate solidarity? Or scared? Don’t they see a biofield over the city that is needed for a protective ring? It means that they will come in black clothes, with a black inside…

And the soul is uncomfortably worried, indignant. Must have an aura! Strong, strong! Maybe our mages are bad?

Every year we celebrate the “city day”. Concerts on the venues, a stray pop star… “Oh, what a man he is, I will give birth to his son…” And, of course, a lot of booze. Holiday! The central square is like a dump in the morning. Beer cans are loaded onto a dump truck.

I have a green cricket in my soul. What is it, the spirit of our city? Is it really only beer, even good beer, that unites the townspeople? And you think: what if you create a place that unites citizens regardless of age and faith? Something like a cult field, a hill. What makes our city stand out? Confluence of two rivers! So, maybe we can arrange festivities here?

Imagine a green field by the mother river. City people flock to the shore in the morning. Young, old, bosses, subordinates… They get to know each other, exchange homemade baskets, books. There are bright smiles on their faces. Everyone feels that something important is happening. We are citizens!

Look, they are already hugging here. The bard bawls, the ballerina dances, and the clown walks around and blinks slyly at everyone. Field. No pushing, no drunks. Nearby is a seething mouth. And something slowly rises above the field. Eh – ma! The people threw back their heads. Quietly floats to the sky a haze – a rainbow. Not gray and drooping, like that of a sick person. And perky, proud…

Autumn… There are no more mosquitoes, and pieces of gauze darkened by dust are being removed from the windows. In autumn, old buildings look better – pre-revolutionary mansions of merchants, thick-walled houses of the “fifties” . .. Stucco molding, rusticated corners of solid houses, sandriks, castles and rosettes are still preserved – in a word, what was called architectural excess.

I am walking along the street where the famous “house under the spire” is being plastered. I turn onto Karl Marx – it’s quiet here, and autumn throws a yellow, red leaf on the ledges under the windows. In one of the low windows, through the dark expanse of glass, I see a man and a woman kissing. Beautiful and mysterious.

But you can sing a serenade near this house with loggias. Spain seemed to be, and the linen in the openings was ours, washed out. I like to look at the eaves of old houses – a row of alternating modulons caresses the eye. Although some of them fell off, and the slate was beaten at the edges. And there – capitals, like fashionable hats, sit on columns.

I walk along the park, past the art museum, and in the air there is a barely audible smell of winter. Or imagined? And, it seems, the openwork grate creaks like cast iron. ..

And again winter… And again – spring…

Another year has flown by. There is a smell of warmth, rooks are bustling about… Icicles have already been knocked down from the roofs, and the blackened snow is melting on the roadsides. You walk the streets of the city, trying to gain spiritual strength. It’s hard to hope for something when there is only an oppressive gray veil above you. When it seems that both you and people are no longer as interesting as before.

You wait for the blue of the sky like a drunkard for a drink. And the blue will not deceive – it will appear! The huge blue sky will suddenly open up and overturn the entire city. You walk along the streets, peering into the faces of passers-by. What are they, city dwellers?

You go to the kiosk and buy a newspaper. Kioskers! Those soft intelligent faces. Their restrained, benevolent smiles. The beautiful in the invisible. How have you not seen this before?

Completed one revolution around the star. We flew around it together with a neighbor in the porch. It is not necessary to congratulate each other. It is enough to say hello a little warmer.

– Hello, they say… Is it spring again?

– Yes, I … this and that … And you don’t get sick.

– Thank you. Are we flying further?

Meeting

Like a leaf torn off by the wind, she wore it throughout her life. In the fall, she ended up in a diner, where she managed to get a job after leaving the telephone exchange. Here she recovered her nerves. But she never wanted to be a waitress.

The days at that time were clear and fresh, and she felt this freshness on the faces of the visitors without leaving the hall. Work in the cafe turned out to be easy, and the people were not angry, but indifferent. It was a little boring, but remembering her previous breakdown at the station, she did not want to return.

The three of them worked, each on their own row, and she got the tables away from the kitchen. The eldest of the waitresses, Valentina, spoke little and thought only of her husband, the driver of the local car depot. When her husband drove up in a car, Valentina carried packages to him through the kitchen, delayed, and her tables had to be washed away. The third in the cafe was Capa, who was fired from the restaurant for cheating on the customers.

The windows of the cafe, high, arched, overlooked the alley on which the old buildings, now museums, have been preserved. It was quiet here, and the poplars, which were not sheared here, grew, giving shade. She especially liked the reddening rowan leaves against the dry, cool sky.

During breaks, they sat down with Capa at the window, covered with a curtain, and talked about something. Capa talked about her ex-husband, a pilot, with whom she broke up, unable to share his salary. It was strange to hear about the stinginess of the pilots, their arrogance and licentiousness, and sometimes it seemed as if Capa had not dreamed about it.

Sometimes they forgot themselves over a glass of port wine and, turning on languid music, dreamed. Capa saw a white car running along the seashore, and next to her was a handsome dark-haired man who had stepped off a sticker of cologne … She peered into Capa’s face and almost believed her. She was young, impudent and full of desires. And to herself, what did she see?

Her “ex” left her with two children, and she was barely making ends meet. I had to work as a cleaner until the girls grew up. But even now she does not want to return home, where every corner, every thing reminds of how everything got. There was another person in her life, but he could not even become a normal tenant.

How ridiculous are the old illusions now! So she says “man” instead of “man”, smokes a lot and is increasingly applied to wine, from which, at least for a while, her mood is lifted. But strange moments still happen to her when, waking up in the morning, she is languishing from a stranger she has seen, with whom she has just talked, loved . .. And no matter how hard she tries to remember his features, they blur, leave, leaving a feeling of bitterness from her incomprehensible, floating somewhere life.

…She immediately noticed the two at the window. One big, overweight, with sagging cheeks, was saying something cheerfully to a comrade. The other is small, slender, with a neat haircut. His eyes were blue and serious. She understood that they were from those “intelligentsia”… She was always drawn to such people. She considered them smarter than herself and envied their bright, interesting life.

She stood with a rag in her hands and listened to the conversation. Fragments of phrases could be heard… “sincerity”, “expression”, “one’s own way in art”, some other words that looked alien in this cafe. The words were so smart and foreign, like those foreign things that were occasionally in her apartment.

Something seemed to be wrong with them. They argued cheerfully, each confident in his own way. The fat man gesticulated, imitating someone in the faces. And the little one ate beautifully, looking at his friend with a smile. But she felt his concern, and she was drawn to help him.

When she approached them, both were already leaving. The little artist stood so close, and she could see his bright open forehead. He looked at her, and she felt a breeze swirling in her chest, so gentle and disturbing. She answered something, and both looked at each other in surprise. The fat man smiled peacefully, and the little one thanked him again.

She watched them go, pulling back the curtain. The big one walked, swaying carelessly. And the little one, in a narrow cloak with a belt, looked sternly ahead. They continued to talk, and none of them looked back.

And for some reason she wanted to cry. I wanted to whimper, as once in childhood, when melancholy rolled over, and my mother stroked her head and said that everything would be fine.

Three tons of oil

For the first six months, I only scrubbed the floors in the barracks. He also worked in the kitchen, washing aluminum plates with mustard, peeling potatoes, and carrying jars of food to tables. I also had to rub the toilets with soda… But, finally, the “demobilizations” dispersed, they were replaced by “grandfathers”, and the places of those went to the “scoops”.

Then I was entrusted with the post of courier. Simply put, I became a telegram peddler. The most valuable thing here is the opportunity to run through the forest alone for ten whole minutes. Saves from nervous breakdowns. I turned off the road, approached the trees, touched them and spent a minute or two on this.

So, here. I run to the headquarters, ring the bell, and the secretary, accepting the paper, signs. We met. The guy, I tell you, looked like a cunning mole.

– Trapuzin! He held out a loose hand. Perhaps his chubby cheeks and shifty eyes betrayed a certain trait in him. Such a soldier always takes a smaller shovel and a larger spoon. And if he drags a log along with everyone else, he will stand in the middle. He will puff and push, but in reality, only hold on to the log. But Trapuzin knew anecdotes, and was well-read in comparison with the environment in the barracks.

For four months I ran to the headquarters with telegrams. Yes, and later I went to the secretary, already working on the communication device in the bunker. Sometimes we lingered in the empty headquarters, where only the orderly at the banner remained. Trapuzin closed the secret behind us and shared the news.

“That’s what you are…” he said, taking a dramatic puff on the cigarette he asked the officers for. – There will be exercises…

– When? Soon?

I understood that he was offended by me for not talking about my military equipment. And he convinced me that my combat “car” was just a few boxes with buttons.

Once he calculated:

– Each of us eats a cube of butter every day. twenty five grams. And how much for the whole service? In two years? Eighteen kilos!

“Well, that’s purely arithmetical,” I remarked. – “Young” eats less, “scoop” more, and “grandfather” – you can’t smear it on rations.

…I feel like I’m standing in a dining room with a greasy cement floor. “Sit down!” the team yells. Ten soldiers squeeze through the tables (five on each side). On the edges of the tables adjacent to the wall, “newbies” and “young ones” crawl through. Behind them are “scoops” and, finally, important “grandfathers” sit down at the aisle. Ensigns sit at a separate table and eat with forks.

Butter is given to the soldiers in large chunks, and the “grandfathers” start dividing, – cut into portions. The pieces will be different. And when the plate approaches the “salagas”, only crumbs remain on it. And the longer a soldier serves, the closer he moves from the poor end of the table to the merchant’s…

– On average, however, – Trapuzin raises a fat finger – the result is the same. What you didn’t finish in the first year, you catch up in the second. Taiga Law!

“Everything depends on us,” I gloomed. – We will all be “grandfathers”.

“In principle, you can,” Trapuzin said condescendingly. – Forget half-eaten, half-smoked… Such a revolution…

We were daydreaming. Only a month separated us from the term of “dedication to grandfathers”. Are we going to be like everyone else? Shall we beat, humiliate others? No, we’ll start a new life! Serve with conscience, help the “young”… And others will follow us. And counting the butter eaten by the division in two years, someone will say: “We ate three tons. And everyone got it equally. Both joys and hardships…”

… It’s a pity that the revolution didn’t work out… And although our call was not malicious, we understood that it was temporary. And Trapuzin? Apparently, dedication to grandfathers weakened his will. Six months before the end of his service, he forged documents and was transferred to a farm.

Oh, that was a bunch of thugs! The scoundrels did not want to serve and in every possible way interfered with others. Metlov, Kulakov, Shmurgalov! – I still remember you. And still, I hate it.

Having found work more difficult, Trapuzin changed dramatically. From a well-fed hamster, the secretary became the most vicious “grandfather” of the division. And it is clear that our conversations about conscience aroused particular rage in him. I avoided meeting him. And he kept looking, pursuing me, as if the culprit of his failure. And no one, except for the two of us, knew what stood between the two “grandfathers” – a piece of butter or something more.

Sometimes, when I remember the army, I think about those guys who worthily endured the test of a soldier’s life. But there were others. I remember Trapuzin, other rednecks… Who is to blame for everything? Officers supporting the dictates of violence in the army? Or that mother telling her son: “Don’t miss yours! Crush the weak! Get out … Otherwise, they will crush … take away … ”

We do not know how to live together. Not in the barracks, not in your own country.