Elphie - thanks for all the detail about you're experiences - that is a big help to me as I prepare to see the doc tomorrow. You sure have been through quite an ordeal already and I definitely think you deserve to have a successful surgery. I'm looking forward to it for you.
Savaici - CT is my favourite city! It is truly so beautiful. A big reason I want to recover is so that I can go back to Africa. It's my second home and I miss it very much. I also have trouble soaking in the tub because I've lost so much weight. Now I use two bath pillows - on for under my head and another on for under my butt. I find the flatter ones a bit better. It's not perfect, but it helps me soak a bit longer than I otherwise would. I hope your ob/gyn can help you out. I'm really sorry you are in so much pain. I know how you feel! Someday I really don't know how I'm going to get through the day. That's why I joined this forum - it offers me a lot of hope :)

Hi all – just got home from a visit to the CRS. I’m emotionally drained, in a great deal of pain, confused and overwhelmed.
As expected, I was prescribed an ointment – a particular compound with diltiazem that my CRS developed (I can only get it at the pharmacy next to his office in Toronto). I was told to use this for 4-6 weeks, and if that doesn’t work, then we go for the surgery. (My surgeon described himself as ‘conservative’, which is why he wants me to give the ointment a go first). I have a follow-up appointment on May 10. This is progress, of course. At worst, I suffer until May and then get surgery. At best this ointment works and life is better. Under any other circumstances, I’d be quite happy … but the appointment itself was very upsetting and I could use some help getting it into proper perspective.
First: when I told him I have a fissure, he asked me, in rather accusing tones, how I got it. I didn’t know what to say. That didn’t matter because before I could give a coherent reply, he asked me very aggressively whether or not I was having anal sex. Before I could confirm or deny, he insisted that, of course, I couldn’t be having anal sex because I wouldn’t do that. (I wanted to say that I only have anal sex with well-endowed horses, but it’s been a while since I left the farm.) We eventually got past the possibility that I engage in what he obviously takes to be deviant sex; the next topic was how thin I am. Why am I losing weight? I need to eat more fiber. I tried to explain that I went on a high fiber diet last summer and it caused problems with rapid transit and loose stools and that now my doctor and I are trying to sort out whether or not I have IBS. He snapped at me: “Fiber doesn’t cause IBS”. After he poked me in the ass, told me I have a fissure, and prescribed diltiazem, I tried to ask some questions. Getting information about using the ointment, success rates, recurrence rates, etc., was like pulling teeth, and I didn’t get to ask much about the surgery at all.
One my way out, he asks me if I am a spiritual person. I must have looked puzzled, because he added that I strike him as a ‘holy’ kind of person. I confessed that I am not particularly spiritual or religious. He replied that I must know that God loves me. I met my husband outside the office and cried for a good fifteen minutes.
Sorry for the book. I am a bit freaked out here and really need some support. I will admit that I wasn’t too impressed with the religion being introduced into the meeting. I’ve never encountered such open and personalized Christianity in a doctor’s office before. What if I was a devout Hindu? What bothers me especially is the implied homophobia in his interrogation about anal sex. I shudder to think what he may have done to gay men who have come to him for help – that *really* upsets me. I’m trying not to cry as I’m typing this now. I hurt so much and the only person who can help me seems to want to promote his own religious-anti-deviant-sexuality agenda. My husband and I had a long talk about the distinction between a doctor’s personal views and their surgical competence … but I’m so sore and sad that I’m not thinking straight.
Any thoughts, insights, advice would truly be appreciated! I’m going to go finish my cry.

Do not think about his views. Think about if he can help heal you through medical or surgical ways. That's it...

I'm sorry u were treated this way! Although my doc is kinda cold and not so sympathetic, I can also tell he's impatient with me when I cry, he's never made me feel I had to defend myself and I've never met a doctor who introduced religion into any discussion, I think that's outrageous! Have you "googled" this doc? I googled mine and found comments about him online which made me feel better. Hopefully the ointment helps and your relationship with him is short lived. If only a fissure could b prayed away! Or any other disease for that matter! Sorry, I'm ranting but I'm angry for u!
It's true his skill is more important here so try to focus on that. Your followup appt isn't too far either, with my CRS it's around 3 months between appointments. It's good u had your husband with u, I cry all the way home everytime mine has gotten used to it. Be ready for him when u go back, maybe write your questions out and bluntly hand them to him when u see him and simply tell him these r the things left unanswered at your last appt and things u need, and have a right to know. I had to get a little agressive with mine at my last appt becuz he has put me off so many times I knew I'd have to fight for help. I got thru to him finally and decided to b more insistent from now on. This man wasted a year of my life when he knew my muscle was too tight to heal so now I'm bitter. Please don't let this happen to u! I know in Ontario we r not writing a cheque for our medical service but we pay just the same and deserve the best treatment possible! Everyone does! You'll b ok, hang in there, I'm pulling for u!

Your doc sounds like a real winner! Who cares how you got it!!! A doctor is supposed to help heal.
Now the good news...My DO is one of the best in the state of Ohio. He recommended that I try the diltiazem. My doctor gave me a lot of information on this. Statistically, it works for about 60% of patients. My problem was that I could not get it to the fissure, as the fissure was too high. Of the 60%, the success rate is very high that the fissure will not return. The best news...If it works, no surgery!!! :D :D
BUTT...if you do have to have surgery, this site seems very helpful. Good luck with it all.

Hi Hope...
I am so sorry to hear about what you went through at your CRS appointment :( .
The others have given you great suggestions for dealing with it, but I just wanted to offer my sympathy. If he is truly the only doctor available to you, then I guess you will have to be strong, keep your husband by your side, and keep pushing ahead. But I think bedside manner is just as important as surgical skill...the bottom line is that someone like this shouldn't be allowed to continue practicing surgery; he sounds borderline crazy to me. I would have felt just as crushed as you did after having an appointment like that... :(
Is it at all possible to see a different doctor if you need another appointment after trying the diltiazem? Toronto is big, surely there's another surgeon you could see? I'm not really familiar though with how the Canadian health system works.
The bright side is that it sounds like he's willing to do surgery next if the ointment doesn't work. And that will most likely fix the problem, and permanently remove him from your life!

Hi everyone – thank you so much for your support and great advice. I really need it!
That appointment was the last thing I needed, given my already very fragile emotional state. I think all of you are right that there is good news in some of this – namely that the follow-up is very soon and the surgery is the next option. Thanks for helping me keep sight of that.
Alpinestrawberry – thanks so much for your sympathy, and I will be looking into alternative surgeons when I see my doc tomorrow. The problem with the Canadian system is the wait times. I may be able to find another surgeon … but in all likelihood, s/he wouldn’t be able to see me until six months to a year from now!
Even so, I’ll look into it. My surgeon sounded borderline crazy to me too … I just have to sort out whether or not my loss of respect for him means that I shouldn’t trust is surgical abilities. Tough call!
Elphie – thanks for your brilliant advice about bringing a list of questions with me to the next appointment – that’s a great idea and I’ll definitely do that. I have googled him, but I couldn’t find any useful information about him. There is another doc at that clinic I found on ratemydoctor – same complaints as mine: accuses patients of having anal sex and one gay fellow who posted got less than sympathetic treatment. I’m glad to know I’m not the only one who cries after these kinds of appointments! And it’s comforting to know that others would be upset and angry about such an experience too. Sometimes I don’t know if I’m over-reacting to things because I feel so awful. Thank you so much for being there to be angry at my surgeon with me :o
Thanks so much for the good news about the diltiazem, garwha – that makes me feel better. My surgeon says 80% success rate and no recurrence as long as I stay on a high fiber diet. Frankly, I don’t believe him. The 60% your doc cited makes more sense to me. I will give this my best shot, but it is very difficult to apply the stuff! It’s hard to get ‘up there’ and it stings a bit for a while. Do you find that it makes you feel like you have to have a BM? I’m not sure what I should do if I ‘go’ after I’ve applied it … apply more? Leave it alone??
I really wish I could have had a civilized conversation with the surgeon. He just told me that anal sex and not enough fiber causes fissures … but neither of those things apply to me, so I don’t know what that means. Does it matter what caused the fissure as far as treatment options go? Can people with loose stool still get an LIS?
Damn … I’m still pissed. As I was denying the anal sex, I felt like I was betraying my LGBT friends and a cause I feel pretty strongly about.
It really means a lot to me that there are so many great people here who offer such great advice and moral support. I feel better now and will go try to tackle my day

hopetoheal wrote:I really wish I could have had a civilized conversation with the surgeon. He just told me that anal sex and not enough fiber causes fissures …

Really? He hasn't heard of women getting them from childbirth? Pretty common cause, for myself and many others. Uh huh, and what about Crohn's? Every patient deserves to be treated with dignity, no matter what their lifestyle, and no, it doesn't matter what caused the fissure, the doctor should only be interested in making it better. After all that is what they're paid to do, not to pry into the details of your private life and question your religious beliefs. It makes me very angry for you. So, if someone comes in with colon cancer, does he accuse them of causing it through poor diet? Even if you have no other choice but to continue getting treatment from this doctor, when it's all said and done, I would write a letter of complaint to his office.
It's amazing to me that some doctors lack basic compassion and people skills. I was very fortunate to have a surgeon whose kindness was on par with his surgical ability, and I really wish everyone could have the same. I was so fragile emotionally, I would have just fallen apart if I'd been treated like a subhuman. At least your husband sounds supportive, and agrees with you that the doctor was off-kilter; my husband just wanted me to hurry up and get the problem fixed so I'd stop crying (and in a sense, he was right)!
I meant to say earlier, regarding the spasms: I never noticed actual spasms either, but there was burning pain after a BM, which I'm pretty sure was caused by the spasms. My sphincter was in a permanent clench, it never let up! And I think someone with loose stools can still get an LIS done, I've had diarrhea a few times since the surgery 3 weeks ago and I have no issues with incontinence. Also, and it's just my theory, but I think that having the fissure can upset your digestive tract. I've had IBS-type issues my whole life (more on the diarrhea side), but they seemed worse to me with the fissure. Now that the surgery is past, my stomach seems to be settling.
Surgery is nothing to fear as long as the surgeon has a good track record. I hope the ointment helps you though. Maybe you could at least limp along with it until another surgeon with better reviews was available? I limped along forever (5 years, on and off with pain), but I know that's not for everyone.

Good questions! I completely agree with you, that lifestyle should have nothing to do with treatment, and I’ll definitely consider writing a letter. I really don’t want anybody else to go through that. I’m so glad you had such a great doctor. That’s so important for a condition like this.
Thanks for sharing your experiences too – i think you’re right that spasms can cause burning. I also think you’re right that fissure can cause major digestive upsets. I think I messed myself up a bit going over-board on the fiber initially, since things have settled down since I stopped talking Metamucil twice a day and eating nothing but high-fiber food. But my digestive system is still not right and gets upset when the fissure is bad. I was wondering myself if fissures can contribute to digestive problems, and what you said makes me feel like I’m not completely crazy for thinking that! I’m so glad that IBS-like issues didn’t cause problems with the surgery for you ( that’s very reassuring to me too!)
I will be exploring other options for surgeons, but I honestly can’t see myself struggling with this much longer – you are truly one tough cookie living with a fissure for 5 (!!!) years. Wow! Where did you find the strength??? Are you now healing nicely? I really hope you are enjoying a quick recovery!

It never ceases to amaze me the arrogance of some of these doctors. I think it's a good idea to google him, but it's true too that even if he is a total pratt when it comes to a bedside manner, if he is a good surgeon with a good reputation, that is what counts. Sorry you had to experience such nonsense, AS WELL as being in pain.
I love CT so much, and miss the life every day. The braais, the bright blue sky of the southern hemisphere, the Milky Way!! I went to school in Cape Town, in Wynberg. I will talk more about CT in the off topic link tomorrow, Hope.