Hey, everyone. Hope you're all doing well. Just wanted to follow up on this topic...I met with Dr. Norman Sohn in NYC. Nice guy. He examined me and we discussed Anal Dilitation. In this procedure, the rectum is stretched (rather than cutting the sphincter)...see his link for more details (http://ssamed.com/analfissure.shtml).
He acknowledged the fact that AD gets a bad rap. He said the reason that's the case is because there are many, many different ways that "anal dilitation" can be performed (often with the doctor using his fingers -- sometimes two fingers, sometimes four, sometimes more -- to do the stretching). Therefore, there are many variables and results vary.
He's developed a more precise way to do it -- with dilators that he's designed -- that reduces the variables. So each time it's performed, it's performed the same way.
His results are pretty impressive. According to him, 87% of fissures are healed the first time he performs the dilitation -- which is a 6-min dilitation. If it doesn't heal, he performs a 12-min dilitation. According to him, this heals 87% of those remaining people. So in the end, the success rate is 95%, which he says is comparable to LIS. I asked him if there were any commonalities between those people who do NOT heal from this treatment -- he said, no, it's basically a mystery why that 5% doesn't heal.
The risk for incontinence in this procedure is low. Less than one percent (0.33%) will experience some loss of flatus control. As opposed to 10% (according to him) with LIS.
I asked if there would be a higher risk of incontinence when one got older. He seemed to think there would not, but he's only been doing this procedure for 19yrs so he wouldn't know.
He said he would be willing to administer Botox, but that he recommends AD instead since, according to him, Botox results are inconsistent -- only helping about 50% of the time.
I'm still trying to treat my fissure through my diet, but if I still have this thing in a month or too, I'll most likely go in for AD. If I do, I'll keep you all posted.

...although I might still try Botox first anyway...

Thanks for the info on the procedure.
Let us know what you decide and I would be interested in how you reach your decision too!
Thanks!

I think it's worth it. Especially if you can heal with the inital, smaller dilator. He's very knowedgeable about AF, and has a name among us sufferers! You'll be in very capable hands.
It would be great for the board, too, if you can provide us with information on how it goes and your recovery!
Kim

that's great news steve.
so how was your exam with him? did he use an anoscope and check the progress of your fissure? what were his thoughts about your fissure?
i am glad you got to see him for an appt.
AD does make sense but you must have someone who knows what they are doing and who can administer it properly. I would seriously doubt that using your fingers to administer AD would be helpful as it isn't a precise way of dilating the anus in my opinion. However, I would certainly not want four fingers or a fist shoved down there either!
Whatever the case, continue your good eating and hopefully you won't need anything soon enough!
:-)

Hey, Gareth. Thanks for referring me to him...
The exam was fine...he did not use an anuscope. I told him two other doctors had confirmed it was a fissure, and when he went down there, he just looked around and was able to see it without inserting anything (which was a nice change).
Like the other doctors I met, he told me the non-surgical ways of dealing with it were: fiber supplement (like metamucil), stool softener (like colace), and suppositories. If that fails, then anal dilatation. He didn't say anything about diet. He didn't tell me if it looked like it was healing. I asked him how bad it looked, and he said it looked like a "garden variety" fissure.
He was more patient than the last CRS, but I could tell he was obviously very busy and I still had to rush through my questions a bit.
He seemed pretty nonchalant about the whole thing. It's not a serious problem, and it generally doesn't lead to anything worse. It's up to me whether I want to try AD. He said they could basically perform the procecure at the drop of a hat (some patients are in so much pain, they need it right away). It really doesn't sound all that bad.
I'm still not convinced any surgery will help me because I'm still having hard/bulky BMs. Surgery won't fix THAT.
My current situation: I am in less pain than two months ago (and less pain during BM), but I bleed basically every day in spite of:
--two months on a new diet where I eat 90% organic food, predominantly whole grains, some grain products, all bran buds, lots of veggies, some fruit, some fish, some chicken. Zero junk food. Zero alcohol.
--metamucil
--colace
--fish oil supplements / flax oil supplements
--aloe juice
--squatting
--sitz baths (sometimes with epsom salts)
--blow drying / cocoa butter
--suppositories
--nifedipine twice a day
--vaseline / A&D ointment
I've experimented with all of the above...sometimes doing one thing, sometimes another, and various combinations...
Next, I plan on seeing a gastroenterologist. I've seen enough CRSs. I know my surgical options at this point. I want a different perspective -- one that focuses on my constipation, which I think may still be a problem. I felt like the three CRSs I've been to basically responded mechanically, without any regard to my specific situation.
I may also see a nutritionist.

I think the nutritionist is an excellent idea. I've been thinking about seeing one myself. As we all know, diet plays a huge part in the healing process and I feel that most doctors seem to overlook it.

I don't know if this will help, but speaking of constipation...I noted that when the summer heat really started to increase here in so cal, I was getting harder bms than before even though I was eating the same as before and drinking more water. I then started drinking at least 1 glass of gatorade a day and the prob cleared up. apparently, I was missing salts and other things and was dehydrated despite the extra liter of water. That was the reason for the harder bm. Just thought that maybe this would help you too...

great write up steve.
i am glad you are more confident with where you want to go next on your journey. sometimes, just getting there is the hard part.
some other options to consider:
1. visit chinatown and go to a chinese doctor. i went to one there in chinatown myself which i thought was excellent. i will have to look for the business card to give you the exact location. i see a chinese doctor here in dc for acupuncture and when i told her about my constipation issues, she gave me chinese herbs to handle that. this was actually before going on travel for my denver trip. while i was taking those chinese herbs, everything was amazing. i had a good work travel experience and coming back despite eating really bad food for the most part. because i was doing so well and more regular, we stopped the herbs. well, i asked her for the herbs this monday again because i had dabbled in eating some pizza with cheese and also indulged in some ice cream which has left me not as soft as i had been and also somewhat irregular. i also have caved into my weakness for eggs in the morning and all of these are all yang. which i am already a super yang person and that yang + yang = constipation or hard stools.
2. find out if you are more yin or yang in body. this will help you in determining what types of foods will really be beneficial to you in helping you attain softer stools.
3. ayurveda. there are three doshas. pitta, vata, kapha. you will be dominate in one and maybe a combination of two. you can check here:
http://www.whatsyourdosha.com/
to see what your dosha is. then use ayurvedic principles to help you on finding out what is better for your body as well.
****
there are so many avenues to follow.
so there is a lot of hope to be had.
yes, i think the summer can contribute to more constipation as we perspire more and may be running a bit more on the dehydrated side. summer is for eating more watery foods like seaweed salads, salads, fruits, veggies, and grains and soups and teas.
i'll keep my fingers crossed for you and just let you know that i don't always have soft bms either. but i guess life would be boring if i did, huh? heheehehee....

Buttgirl, thanks I'll try gatorade.
Gareth, thanks for all the advice. Yeah, I'd actually like to see a Chinese doctor. If you find that business card, let me know. I'd definitely appreciate it.
I'll look more into the yin/yang stuff as well as ayurveda.
Mentally, I'm way better than I was two months ago. I suspect I've slightly alterered my brain chemistry through my major diet changes, thus making me calmer.