i went to see her in january because of anemia due to excessive blood loss and i was told to take iron supplements--i guess that constipated me because the fissure pain started up fairly soon after...i've stopped taking the iron so my anemia has worsened again and this morning i had the worst feeling...i used the nitro cream i was prescribed and while i was taking the dogs out i almost fainted--i had to sit down--i think it was a combination of the anemia with the nitroglycerin (which i don't think helps the AF anyway...)
i've read where many people like the dialtizem cream better, but i see that it is also a drug for heart patients...i'm guessing the side effects might be similar? i also read somewhere that it can be taken orally as opposed to made into a cream with similar results for AF patients--anybody take it orally? i also see where short term use of valium can be beneficial--i'm considering asking the doc about that...
i did get a prescription for canasa and only use it when i'm desperate (with insurance it was still more than $4 each suppository) it, in tandem with the sitz baths with epsom salts, seem to keep most of the pain at bay...i've tried to stop using tramadol and darvocet because of them constipating me--i still use ibuprofen and tylenol, tho...
i've dealt with these things about twice a year for the last 13 years but i'm still not sure what to do

Hey dee,
Both nifedipine and diltiazem are blood pressure drugs that are used for fissures too. I've tried nifedipine in the past and had no noticeable side effects. I'm only on day #2 with diltiazem so I can't say much there yet. I've never tried either orally -- I think nearly everyone here has used them topically.
I've used valium and it worked great for spasms.
Iron supplements definitely constipate, but frankly I'd say anemia is a more serious concern than a fissure, so definitely try to find a way to treat the fissure while continuing the supplements.
Best of luck today!

thanks ng,
the doc prescribed lidocaine and valium so i'll see if that helps...i had some bloodwork done tonight and a few minutes after i left i got a call from the doctor--apparently i'm anemic enough to warrant a blood transfusion tomorrow (normal number is supposed to be 12 and i'm at 6)...i'm actually kind of glad--i always kind of feel like a hypochondriac and don't want to go to the doctor (i guess it's because i work in an ER and see people come in for really lame reasons--maybe 50% of the people who come in need to be there...)--i'm just glad i didn't psyche myself into nearly fainting yesterday--i actually had a reason because of the anemia--possibly mixing with a little too much of the nitro cream...
she also blessed me on the use of darvocet for the pain and sleeping pills...i don't like using narcotics if i'm not to the point of tears--i have no desire to get hooked...
with the blood transfusion maybe i can put off the iron supplements for a while (and i got referred to a specialist for the bleeding problem so hopefully i can get that taken care of!)
i'm actually going to skip the stool softener tonight (the transfusion is supposed to last 6 hours so i don't want to have to go while i'm at the hospital...) but i have been doing plenty of fiber...
one thing the doc suggested was putting vinegar in the sitz bath instead of epsom salts so i guess i'll try that next time...

Good stuff, I think the valium will help some for sure. I never felt like I got much out of lidocaine (mine was 5% concentration), but maybe you'll get more mileage. It can't hurt, that much is certain.
Did you end up asking your doc about nifedipine or diltiazem? Both should be better side effects wise if the nitro is bothering you. I had some moderate-severe (but still tolerable) headaches with nitro, zero side effects with nifedipine, and some moderate side effects with diltiazem. I did a little reading and apparently Diltiazem is from the nondihydropyridine class of calcium channel blockers and is more selective for heart muscle. Nifedipine is from the Dihydropyridine calcium channel blocker class and less selective for heart muscle. They both lower blood pressure and increase blood flow to the affected area, but apparently the mechanisms are entirely different and they differ in whether they affect the heart. Personally I would have stuck with nifedipine if it were based just on side effects, but it didn't work for me.
Sounds like it was a good thing you had an appointment today. I'm sure you already know since you work in the ER, but anemia is dangerous if untreated so it's nice that they got you scheduled in for a transfusion tomorrow. Good luck with it, hopefully you have some good reading materials or something to take with you to keep you busy for the 6 hours :)

right now the routine is going to be 1/2 a 5 mg valium pill twice a day, lidocaine after the sitz bath, and darvocet (or tramadol or tylenol or ibuprofen) as needed for pain...
i did mention diltiazem and i don't know if it's because of the anemia or because the nitro wasn't working she decided to try the lidocaine first--i'm willing to give it a go...
and honestly if i get the bleeding under control (and therefore the anemia) wouldn't it make sense that i'll be able to have better blood flow to the fissure and make healing easier and quicker--the two worst bouts i've had with the fissures were when i was anemic--last fall and now--all the other times the pain left within less than a week...i'm hoping that once i have plenty of blood the body will heal itself (at least until the next time--although i've learned a lot just by looking at this site)...
in any case that's what i'm hoping--the transfusion to get the blood back in my body and the specialist being able to stop the bleeding so i can keep my blood...
i'm actually planning on sleeping during the transfusion--i'm awake now so i hopefully can do so...i have to work tonight (i do three 12 hour shifts each week) so i need to sleep today...
it will be nice to stop feeling the fluttery feeling in my chest...and the SOB even without exertion...

Yeah getting the blood situation sorted out does sound like top priority for sure. Hopefully the rest will follow after that. Maybe passing on the diltiazem for now is indeed best -- better not to have too many things going on at once I suppose.
Between being up tonight and taking valium (assuming you don't normally take benzodiazepines) you should be good to go for sleeping tomorrow :) Do you work as a nurse at the ER or something? Just curious since you're up rather late for Central Time and mention 12 hour shifts. Anyhow hope things go well tomorrow!

My GP never wanted to give me Fe infusion : ((. I was 6 also. She actually never heard of that possibility and told me to eat Fe rich food LMAO
Sometimes I just leave doctors office in a complete daze - wondering if I should laugh or actually cry ???
Thankfully my Mom sent me some fantastic Fe supplement for Europe and now my Fe is ABOVE normal LMAO
I reaaaaaalllllyyyy want to go back to Europe *sigh - anybody wants to switch ROFL ??? : ))))

What is ROFL, Fiss?????????

cheryl: rofl=rolling on the floor laughing
i was given a transfusion of red blood cells (2 pints)--my hemoglobin was about half of what is "normal" because over the last 8.5 months i had lost so much blood...i don't think i'm up to normal yet (my heart still races a little too easily) but it's MUCH better--which (in my mind at least) means there's going to be enough blood to get to the fissure and eventually heal it...i honestly think that my last two bouts with fissure pain were so prolonged because i didn't have the blood available to get to the fissure--because that's what the nitro cream is supposed to do, right?
NP guy: i work at an ER registering patients...not a nurse, but i am able to ask the nurses and the doctors questions anytime i need to...free medical advice is nice every once in a while :)
i've also decided that MOST of my problem can be traced back to my pathetic thyroid...i'm hypothyroid (profoundly so when i'm not on meds--in january my TSH was 84, last week--after a couple months of high doses of levothyroxin--it was 20, normal is under 4) the doc said that there's a good chance that the blood loss was due to hormonal reasons...and not having enough blood to heal the fissure i believe prolonged the healing (before the blood loss the longest i ever had to deal with one was less than one week)--so i guess i've learned my lesson about making sure i take my thyroid meds...
this past week i also had a pap smear to rule out cancer and other abnormalities...
now if i can just get rid of this fissure pain--it's improved over the past week--i'm using less meds (both oral and topical) and crying much less often--valium and sitz baths are my friend...

Hey Dee, guess that explains the hours during which you're awake and online :)
Nice to hear that you're getting some symptomatic relief from the fissure. Just be sure to keep up your regimen even if the pain starts to go down a notch since these things are real persistent -- I learned that one the hard way myself :)