Frustrated - I think you and I are on the same timeline btw. The first acute one, you're right, I did heal it. It was this recent new AF (or could be re-tear of old site) that really did me a number... the problem is that my first AF was treated by another CRS in Los Angeles, since then I've moved to Phoenix Arizona. I miss my CRS from LA, she was awesome.
The funny thing is that I've got my BMs soft enough that the BM itself is about a 4/5 out of 10 painful but the spasms 1-2 hours later are about 7-9 out of 10 painful. They hurt me more than anything else... they also radiate as if the bunghole is the center of the universe... radiates pain to my tail bone, left the hole, even towards the front along the side of my "man sack". It's just crazy.
Spoke to my CRS today, he again said, preserve or we can start talking surgery. Even though he's sick of me calling every week, I've got on his calendar for this Wednesday just so him and I can talk face to face about LIS.
I also have a new second CRS scheduled for Thursday, do you think it's wise to have a second opinion? I'm just too scared to let him "look" as it caused a re-tear last time.
Damn this thing...

yes i agree also about botox my CRS told me its a waste of time and then u have to wait weeks/months to see if it work when u could have already been healed or on your way to healing by the LIS.
I think getting a 2nd opinion is a great idea, i did, it just makes you feel like they got it right and you are doing the right thing. (if they say the same thing).
Both times i went to the CRS with both docs i told them i didnt want anything going in coz i didnt want to make matters worse, they both said thats fine and they didnt really need to coz they can see from the outside.
good luck with the appointments and let us know how you go!

Appointments are Wed & Thurs. I can tell you that my "healing" seems to have flat lined... I have a bowel movement in the morning that is followed by 8-9 hours of burning, stinging and spasm pain. Everyday like clockwork, the pain stops by 4 pm (BM at 7 AM)....
I just don't get it. Why the long spasm episode everyday? The burning stinging feeling sucks, feels like a flesh wound with salt in it. Coming up to 3.5 weeks total.

That was me after Botox. Hope u get surgery, good luck tomorrow. I have 9 days to go!

Good Luck with your appoointment tomorrow. It's crazy how what you're experiencing is so similar to what I went through. The pain would start exactly 45 min after the bathroom, peak at 3 hours in, and slowly decrease over the next 3 to 4 hours. I have Crohn's Disease so the CRS said I needed to be careful. I tried Botox first because LIS could cause problems if my Crohn's ever becomes active. It was a bummer when it didn't work but LIS luckily did and it should work for you too. Don't stress about the incontinence issues...they're exaggerated. I have my first follow up with my CRS since my LIS tomorrow and I'll ask him if he used the open or closed technique.

Boognish - I'm so glad to hear from you - I thought I was crazy to think that I'm the only one having this crazy spasm pain for so long after every freaking BM. By evening and during the night, its as if I'm healed! There is no freaking pain. 45 mins after a bowel movement completely changes that....
The bowel movement does have some pain "at the end" almost like the spasm is being awaken.
Please do share how your check-in goes with the doc!

Tell me about it...the spasms were my biggest problem. It would hurt so bad that even talking set them off. I needed 3 Sitz baths in a row (45 minutes each) to get the pain down to a 5 from a solid 10.
The spasms happen because BMs slightly tear, re-open, and rub bacteria over this fissure. The internal sphincter muscle freaks out causing painful spasms for many hours. We apparently have two sphincter muscles and can't control the internal one, so it snaps like a rubber band for hours on end. Botox will stop that and creams could sooth the external muscle, but go for the LIS (it's more controlled).
I also would be pain free by the evening, and I don't mean to rub-it-in about how good I feel today, but the relief that I'm experiencing post LIS blows any relief while suffering with the fissure out of the park. I think that we forget what it feels like to be normal after suffering with fissure pain for a while. I still needed to sit on soft surfaces during periods of relief but I'm sitting on a hardwood floor as I write this.
I hope that you are able to get the LIS quickly after you meet with your CRS. I only needed to wait a week after I decided to go for it. It's a good idea to get a second opinion. Especially, if the first pushes the Botox.

Thank you so much for the info, and to think we're both 28 years old guys worrying about this... unbelievable!
You're totally right about the sitz bath, while I haven't taken 45 mins ones (get sore after a while)... they are the only thing that stop the spasm pain. I'm going to try "heat packs" tomorrow as well to see if that works.
My 1st CRS which is tomorrow seems pretty good that he hasn't even mentioned Botox, he started talking surgery if Nitro didn't work.