After about 16 months, I finally got in to see a CRS. I had to drive almost two hours to get to her, but it was worth it. She took one look and immediately saw the fissure and associated papilla. Up to this point, I've been unsure whether I had a fissure or hemorrhoid since my original fissure "healed". The symptoms weren't quite as bad, and my GI thought she felt a hemorrhoid so I figured that's what it was. The CRS thinks this fissure and my first one are one and the same, even though the pain seems to be from a different location. I was extremely relieved to finally know what the heck is going on. P.S., if you have painful butt problems, avoid the GIs and go straight to a CRS if possible.
So, she managed to schedule me for a LIS/papilla excision next week. She was pretty convinced that it was necessary, since I've tried pretty much everything else up to now. It was a pretty easy decision for me. I really can't take much more of being in pain all of the time and only being half as productive as I should be.
I'm not nervous yet, but I'm sure that I will get that way as the date gets closer. Not looking forward to the enemas.