I am having botox next Tuesday and am psyching myself out! Today has not been a good day, with anxiety at a peak, 4 bms so far and the last two with more bleeding than I've been having. My family Dr. (who I really respect) originally referred me to a general surgeon in their office in late July but by the time I saw his PA, my fissure was actually healing (and was essentially not bothering me for a month). When it came back while I was on vacation, my sister chimed in and wondered why I was even considering not going to a specialist. So when I came home, I started this process. I found I didn't need a referral for my insurance, looked in the most recent 5280 magazine (Denver's magazine) that listed "top docs" (seemed fortuitous that I saw this on the day I needed to find a Dr.). I found two CRS on their list that were also on our insurance and googled him and found him to have better ratings on "vitals" and "healthgrades". Saw him last week and he recommended the botox (I was ready and expecting the surgery to be recommended). I liked him ok although he wasn't warm and fuzzy- he was confident- said this was something I "should do" rather than "could do".
Now I feel strangely guilty for leaving my family doc out of the loop and worry if I made a good choice. Any thoughts? It is a hard thing.

Hey Bambi,
First I want to say I'm sorry your fissure is acting up so bad. I think our anxiety and nerves don't help. The first time I was scheduled for surgery before it was cancelled and rescheduled, mine was worse than it had ever been. I made a conscious effort to stay as calm as I could the 2nd time they scheduled me.
I agree with your sister about seeing a CRS (specialist). although I have read of others on this forum who have used GS and did fine.
I was actually referred by the hospital to a GI Doctor who referred me to a CRS. The first time I went to the CRS I wanted to get in fast and took the first Doctor available.
He was a jerk and I didn't like him at all. He didn't even listen or he would have known I had a fissure.
I did my own research on two other CRS in the same office and decided on the one who basically impressed me with where she got her medical degree(Yale) and worked at Mayo. I went back to her and she immediately diagnosed my fissure and was who I chose for my surgery.
I'm not sure about botox but have read of some who have healed using it. My CRS never mentioned it and I really didn't want to do anything but LIS by the time I was ready to do something. I was just afraid I would go through botox and still need LIS in the end. I'm a chicken and didn't want to go through maybe needing both before healing... I know LIS has the highest success rate, but I have read older threads where botox worked for some. As a matter a fact I've read of one member who had more than one LIS and didn't heal who went on to have botox which brought her relief.
All that I know is what I've read because I have had no experience with it but I know you may need it a few times before your fissure actually heals.
I wish I could give you good advice but I really don't know what you should do. NG(another boardie) had botox and said it was great and said he got real sloppy with his diet and felt that was the reason his fissure came back. I think you have good shot if you keep a good diet, etc... And it's a less invasive procedure than LIS. Maybe your CRS has had a really good success rate with botox:)

Dawn- you have been such a help to me in just a couple of days. I really appreciate having found this board. My fear is exactly what you were worried about- I am pretty fed up and expected him to say "let's schedule the LIS surgery"- so the botox surprised me. He said that if it is going to help, it usually does so in 4-6 weeks. Sometimes he said people opt for a second round if the fissure comes back before surgery, but I would rather just get the surgery now and be done. I guess I'll just really work on having a positive outlook and take the path set out before me at this point. But I think if it doesn't help or the fissure comes back, I would opt for the LIS rather than 2nd botox. Thanks for your encouragement and I'll check the site for the botox folks. I am very happy for you that you seem to be doing so well and I am so appreciative to finally read of the success of LIS rather than just the bad outcomes I had read about in the past. I knew someone was having good outcomes since the rates you see are very good.

Yes stay positive! I know what you mean about reading awful things and not a whole lot of positive, but many people who have had LIS don't post there stories on the internet and have had positive results. I live in a very small town and we just mentioned what I was going through to maybe 5 people and I found out about 3 people who I know personally who had LIS and had really good results. I never knew they even had it until I just talked to a few people. I know none of them posted there experience on the internet, lol.
I'm sure there are many, many more just like them with the success rate being so high. Don't let the negative effect you. That's all I read in the beginning and was horrified until I decided to only read the positive post over and over.... Smallchange (another poster) really helped me by posting his experience and I'm so happy to help someone else the way he helped me. Everyone on this board has been so supportive and I don't think I could have been so calm without there help and encouragement.
We will be here for you and I know you will be fine! It gets better even though it doesn't seem like it ever will when you are going through it. Take care and try to relax as much as you can until your botox. I just pretended like it wasn't happening until the day it came. I had plenty of anxiety from them cancelling on me twice and just decided not to let myself get that way until the last minute when I finally had my surgery.
I want to add that there are not many people left on this board from the past and that is something to think about, even the slow healers are gone now. That in itself is a positive thing. They healed and moved on :)

LOL which CRS? I saw 4-5 different ones plus a GI doc for good measure :) Different doctors have their own philosophies and approaches, so I wanted to make sure I tried everything possible, and am glad I did. To pick the doctor, I relied partially on online reviews, partially on word of mouth recommendations (luckily for me there's another board member that's local to me :)), and partially on just dumb luck (e.g., via my health insurance's doctor directory).
Personally I never got a referral from my primary care physician. You shouldn't feel bad that you "left him out of the loop." It's your body and your call. No one else should have any say but you. If you wanted a referral, then your primary doctor should be ready to offer one, but if you don't need one then it's frankly none of his or her business.
I had BOTOX after the ointments (nitroglycerin, nifedipine, diltiazem) failed to completely heal my fissure. It worked nicely and did heal my fissure for several months. I got brave and started eating badly and stopping my stool softener, though, and eventually re-tore my fissure. Some people do need more than one round of BOTOX to heal completely, although I didn't opt for a 2nd round myself.
Personally I'm a big fan of BOTOX even though the long term cure rates are significantly lower than with LIS. This is only because I always like to try less invasive measures first when they're available (personal preference). However if you do want to take just one shot at it and get it all over with, then I'd agree that LIS is your best bet. Still, you've got nothing to lose -- other than a bit of time -- by trying BOTOX, so I don't think it's a bad idea. If you do decide that you just want LIS, I'm sure you can find a CRS who will do just that though ... of the CRS's I saw, some suggested LIS right off the bat, some suggested BOTOX, others suggested more ointments, so you don't have to stick with what one doctor says.

Thanks to both Dawn and Neuropathic guy!
Wow- checking out 4-5. That is impressive and a lot of work. I think I will just go ahead with the Botox and then see what happens. I'm curious what "stool softeners" you were using- if you saw my other post, you know I'm struggling with having a hard time achieving softness without way too much frequency. I think Dawn is right that I may have some of this going on due to spasms, even though I don't feel like that is happening.
Anyway- just curious, because one of my fears is dropping things out and making myself worse. I really thought the dumb thing had gone away for pretty much the whole month of September and part of October and it came back on me. And the whole time I was really anxious about it coming back and couldn't even really enjoy the fact that it was gone. I am really trying to focus on being more positive now!
Thanks for your reality check that it is my body. I know that in my head, but I've always worried way too much about other people and what they are feeling! A good thing, but a curse