by NeuropathicGuy » 17 Aug 2009, 15:27
Hey guys,
Nope, I don't eat breakfast, never have my entire life. I used to skip lunch pretty regularly too. It's a bad way to live, but I was always worried about pooping too much, and was busy because I did a lot of business travel, had to have extended meetings with clients, etc. I've got a comfortable job real close to home with no travel now though :)
I saw the local CRS today, and I guess the ball's in my court now. She gave me some nifedipine ointment to try since the nitro wasn't doing much. It's 0.2% nifedipine, seems lower concentration than the 0.3% I usually read about online, she I doubt that'll make much of a difference. She says, however, that at this point, LIS may be my best option. She says she's done hundreds of them, and no patients have ended up permanently incontinent, although a few had temporary bleeding for a day or two, and two did get infections at the incision site that required an additional surgery to treat. She says most people have very good results with it. If I want to schedule LIS, she says lead time is no more than 1-2 weeks tops, usually within 1 week. So I have that option in hand if and when I want to exercise it. This local CRS doesn't believe in botox, she says she tried it a few times during her residency and it didn't do much, plus there's lack of clarity over exactly where to inject it, how much to give, etc. I liked her approach, seemed like a good person, was pretty knowledeable about fissures, and is only about 15 minutes from where I live. One other bonus is that she says if she does LIS, she will put me under and examine my rectum for any possible indicators of inflammatory bowel disease, and will abort the surgery if she sees any since then surgery would then be a poor idea. She also says that she'd never prescribe hydrocortisone (which my other physician did) for fissures since they can slow down the healing process.
Now, my other option is a CRS in San Francisco. Immediate downside is it's 60+ miles away from where I live. This other CRS has me on Valium (which does seem to help the spasms some) and 0.2% nitro / 2% hydrocortisone / 5% lidocaine right now. If it doesn't help in 3 weeks, she wants to do botox and indicates it has a 75% success rate in her experience. Insurance will cover the botox injections if I go this route as they have already pre-authorized it.
So basically the summary at this point is...
LOCAL CRS:
-- Is 15 minutes from home.
-- Doesn't believe in botox.
-- Says not to use hydrocortisone.
-- Says to try nifedipine for a short while.
-- Says LIS is my best option (and can get me in on short order), barring presence of Crohn's disease or ulcerative colitis.
SAN FRANCISCO CRS:
-- Is 1+ hour from home.
-- Says to use nitro / lidocaine / hydrocortisone ointment and Valium.
-- Wants to try botox if there's no effect from the ointment.
What do you guys think? Any things that make you lean one way or the other? I know you can't make the decision for me but I value you guy's feedback.
Right now, I'm leaning toward trying the nifedipine for a week, and going for LIS if there's no improvement. This way, I'll have a better chance at being on the road to recovery when my twins arrive. If I do the botox, and it doesn't work, then I figure LIS will have to wait until the effects of the botox wear off, which will push the timeline out at least another month.
I'm going to browse the old threads on the forum and see what others in the same boat have decided in the past now, but any input is most welcome and appreciated.