Have not written much recently of my AF saga. Still in pain a lot of the time, using Nifedipine which I think has helped heal the skin close to my rear, but only relieves the spasms a little.
From my GP I've just had a prescription filled for a cream called Nitro-Bid, which is 2%. I tried twice to tell him that this was too strong, but on seeing him yesterday, he consulted his little book of treatments and said no, this is the one, and to try it. I am terrified of doing this, as had an awful reaction to this when they thought I had had a heart attack a few years ago and they put it on my skin. The worst headache for days on end. Most horrible pain.
So, I am wondering if anyone else has used this Nitro at 2%, and also, if anyone has tried to 'cut' the dose down to 0.2% by adding anything to it??
So very happy that this board is here. It keeps me sane on bad days.
Thanks to everyone out there. You AF friends are great!!
Em

Hey Sav I'm so sorry you are having pain
I have not heard of the meds your doc gave you, but I have heard of people cutting 2% nitro with petroleum jelly (1:10 ratio). I've also heard of people using slightly stronger concentrations of nitro, even up to .5%. But that would definitely depend on how you react to it.
I really hope this works, Em!
Sending healing vibes to you!

Some folks have used nitro at 2% (usually also by accident because the doctor was clueless), but there's no data on whether it's any more or less effective at that concentration. I'm guessing you just have the original tube of Nitro BID.
That's definitely wrong if you're going by the prescribed treatment for fissures. Fissure nitro is supposed to be 0.2%. I know some members have also used higher concentrations but basically all of the clinical studies focus on 0.2%, and I think I might have read a couple that tried 0.4%.
There has never been a clinical study using 2% nitro for fissures (I have a subscription to UpToDate.com and double checked just now to be sure).
You should have a compounding pharmacy create the proper concentration for you. Don't try to do it yourself. Compounding pharmacies have ointment mills that will make sure the active compounds are evenly distributed and in a base that's appropriate for you on that part of the body.
But first you need the doctor to give you the right strength. Tell him flat out that he's wrong. Bring him some literature or something. 2% is wrong and 0.2% is right.
BTW I've been given wrong strength stuff by doctors before too. In my case it was the other way around. Diltiazem is supposed to be 2% and my doctor gave me 0.2%. But when I called to correct him, he acknowledged that I was right.
The fissure ointment concentrations are as follows:
NITRO: 0.2% (occasionally 0.4%)
NIFEDIPINE: 0.2% (occasionally 0.3%)
DILTIAZEM: 2%

Thanks so much for both your responses, Hope and NG. What a life of struggle with docs!! I know my GP meant well, but if he thought that I was going to put2% Nitro on one of the most delicate parts of my bod, he was mistaken.
Anyway, I managed to get in touch with the nurse of the CR surgeon I saw in Boston, and though she seemed more keen on me getting down there again for Botox jabs, I managed to persuade her to 0.2% Nitro which is winging its way to me, along with a repeat prescription of 0.2% Nifedipine. She told me not to use both at the same time, or I will not be able to tell which works, which sounds sensible. I can't say there has been a tremendous change with nearly 9 weeks of Nifedipine. Still difficult to poop; Stijl difficulty with that not-totally-empty sensation. But, the skin around the offending part has healed, but not sure if that's the Nifedipine orVaseline...
I did have a quick word with her about LIS, which was mentioned as a last resort, so to speak, on the specialist's report. To this she said that the doctor does not like to do this on older patients, me being in that range. I will need to research that...LIS for the over 40, 50, 60, 70, and so on. The way I feel now, I could put up with a little incontinence and no pain! And that is where things stand for now!
Em

I just got a prescription for 2% of nitro today, but had the pharmacy contact my doctor and changed it to 0.2%, tonight will be my first time trying it. What is the proper procedure to apply? A little around the area, or some on a q-tip and put it inside? My cuts seem to be external as I can see it when I look in a mirror, but I'm sure they extend inside aswell. Also with 0.2% will there be headaches?

Personally, I am going to start with half a baby pea size on the tip of my finger. My CRS said to put it outside, so I am going with that. Be careful that you don't get it any where else, as the residual can give you a headache too. You may not get a headache; I may not get one either. But just be prepared for it. It is supposed to wear off after half an hour anyway, and the effects are supposed to get less after a couple of weeks. This is my take on it. Do come back and say how you react to it. Em

Cool, I'll do the same then, gonna try it tomorrow morning before my BM, I'll post my results

savaici wrote:I did have a quick word with her about LIS, which was mentioned as a last resort, so to speak, on the specialist's report. To this she said that the doctor does not like to do this on older patients, me being in that range. I will need to research that...LIS for the over 40, 50, 60, 70, and so on. The way I feel now, I could put up with a little incontinence and no pain! And that is where things stand for now!
Em

Em,
My doctor in Boston told me he won't do LIS on younger patients (I am 35)!!!! It's a conspiracy not to do LIS on ANY
patient around here! What is wrong with these doctors? They don't want the responsibility or are they incompetent?
The hospitals like Mass General, Beth Israel, B&W (and doctors I assume) are on the top of the list. What gives?

just an update, I put the cream inside with a q-tip 30mins before I used the bathroom, I got a very slight headache, but nothing too crazy. It may have helped a bit, I noticed it wasn't too painful, but very itchy after, so I went right into the tub for 30mins or so after. Overall I'm going to keep trying it since I'm not getting a bad headache from it. I used a small amount, only enough to cover the cotton on the tip of the Q-Tip.

I wish that I could try with a Q-tip, vrscdx, but I am terrified of poking myself (have a slight shake) and making things worse. I am a little worried about the itch (others on here have that reaction and I have had reaction to Vaseline inside) so think I will continue the Nifedipine for now on the outside and see how it goes. Keep reporting back!