I was given a prescription for diltiazem ointment and off to the compounding pharmacy went I. Same pharmacy that I have used for my cats' prescriptions (except I didn't ask for my medication to be chicken-flavored as I have often done for my cats!)
When I picked up the ointment, the pharmacist told me (with obvious pride) that they use a "wound gel" base for diltiazem ointment, while the other local compounding pharmacies only use a petroleum sort of base. She said they choose to use wound gel because it will adhere directly to the wound and protect it... it will "stay put" and not slide around like petroleum... and she added that it smells good and has its own healing properties. This all sounded logical in the moment. (And, wow, this pharmacist just seemed so dang proud and excited about their creation, it was a little odd!)
It was only as I drove home that I thought.... "hmmm, wound gel, adheres to the wound - wait, I have an internal fissure and there's no way in hell I'm getting this stuff up there!" My doctor told me to just apply on the outside - and even if an internal application was needed I wouldn't have been able to tolerate it anyway! So the wound gel concept was not as logical as I initially thought. Who needs a wound gel if you're not applying it to the wound?

This stuff is thick and semi-transparent with a bluish tint. It smells like cloves (the only redeemable aspect, in my opinion!) What bothers me is that it is so thick, and seemingly impermeable, that I can't use lidocaine for relief after I use it. It's as if the lidocaine cream just sits on top of it and can't get through to the skin. I can only slather so much stuff up there before I become a danger to myself! I'm also finding that it causes my sentinel pile to swell and hurt - I'm guessing due to increased blood flow. (But perhaps that would happen with any diltiazem regardless of the specific compound.)

What do you guys know about diltiazem compounding, ingredients, bases, and potentially different effects with different compounds...? Based on what this pharmacist said, it seems there is definitely some variation out there. I did mention this to the CRS but he didn't have any concerns about the compound itself.

However, my CRS does feel the diltiazem isn't working... so LIS is scheduled... but I can't help but think maybe there's something 'off' with this diltiazem which is limiting the positive effects. (Admittedly... I could be off in left field with this, just searching for a way to avoid the LIS!)

I'd be so grateful for any diltiazem info, experiences, descriptions, etc.

Thank you everyone for all of the great information and support you are sharing in this forum - I'd be lost without it!

So I am not familiar with dilltiazem. I was given compounded niphedipine. It is an ointment that comes in a little tub. I was told to put on outside as well, but I have actually been rubbing it inside as I am so impatient- I hope that doesn't cause issues, but I figured it might help. Then sometimes when I need distraction from pain I use the calmaseptine which is a mentholy toothpaste like cream. That does really stick.
I am holding off on surgery. I will try other things first- don't really know diff between all these topicals however!

My diltiazem was in a vaseline mix and that worked well because my CRS wanted it applied outside and said that the skin would absorb the drug. He did NOT want me to stick it up my anus at all, and I can see how your wound gel compound might be a bad fit for you too. Many on this forum have been instructed to put it up inside though, so your pharmacist may be working on that assumption instead.

Thank you for your replies! Chachacha, that's a really good point - the pharmacist may very well have assumed I'd be applying this internally.
I guess I have no reason to believe that the particular compound is to blame for the medication's lack of efficacy. Sometimes I think I'm just grasping at straws to find answers and explanations. Despite having developed a basic understanding of how AFs work, I'm still a bit dumbfounded by all of it. I'll keep up with the diltiazem even though it's not working and I'm fairly certain that I'll need to go through with LIS at the end of June anyway.
Trying to keep my sunny side up and hope all of you can try and do the same!