Hi Guys,
After 10 weeks of partially successful GTN usage and being told by my CRS that i have almost healed I have unfortunately had another setback with a partial re-tear. My CRS said if i have to go back i would be admitted for a camera inspection and Botox.
After reading all your posts and researching on the internet it seems that Botox is as useful as a chocolate fireguard and that most people who have Botox end up having LIS.
So do i push for LIS? Am i putting myself at un-neccessary risk by by-passing Botox (This is presuming he would allow this)
I do also realise that the only people who post on here about Botox not working are the unlucky ones and the people it has worked on maybe stop posting altogether.
Can you give me any inspiration?
(This is an online comparison i found)
Botox
Uses Botulinum Toxin A
Treatment takes up to 3 months
Success rate are 50% with 50% requiring treatment again
Few side-effects
Sphincterotomy
Uses surgical operation and requires local or general anaesthesia
Same day admission and discharge. Operation takes 20 to 30 minutes
Very effective with 90-95% success rate
Incontinence observed in 5% of the patients

Most stuff I've read has better stats for botox. Like 70%.
Sometimes it takes a couple rounds.
I think you need to evaluate how bad your spasms are. It seems that the worse the spasms, the less likely that botox will do the trick.
So is your inability to finish healing from over tightness, or spasms or both?
Plus 10 weeks isn't that long on the creams. I've heard of success on them that took months. Not sure if you want to wait that long...
It seems there are often setbacks, but if there is a general overall incline of recovery...
Of course I am at about the same timeline as you, so these are all questions I am dealing with too, but haven't come to a conclusion about yet. I don't think I will do an LIS though. I don't get spasms and I'm not crazy tight. Doubt it would cure me. Would like to get off the darn Nefidipine though!
Is there nobody near you that does Controlled dilation?
What is a camera inspection? Is that where they go further up your colon?
-Tanya

Hi WOI,
My spasms aren't too bad and i dont seem to suffer from too much tightness, i think the reason i am not healing is because i have two external hemmys which seem to pop out and pull at the AF each time i sit on the toilet. (I could be wrong though)
Also the 70% Botox success rate - yes i have read that too but i also read that GTN has a 70% success rate yet that does not seem the case.
With regards the creams - GTN is supposed to be taken for 6-8 weeks, if the CRS advises it to be taken longer it can be but i think the healing problem maybe something else such as the hemmys.
In the UK there is no controlled dilation that i have heard of - the order of progress is lidocaine/prosoctesydal/GTN/Botox/LIS.
As for the camera inspection it seems that most CRS's will normally insert a camera into your bowel to ensure nothing else is going on before they inject botox or do LIS. This is called sigmoidoscopy and it helps them identify things like Hemmys/Chrons disease/Bowel disorders/etc.
I think i will go and see my CRS this week so will let you know what happens (I fairly much know though that he will give me Botox the following week)
Davo

Are you going to ask your crs if he/she can do anything for the hemmies? Not sure what the options are for external hemmies...
good luck with the sigmoidoscopy!
It is good that they are so proactive. Some of the other UK people on this forum seem to have to wait and wait.
-Tanya

I would beg for LIS!! Like I said in your other post Botox is putting a bandaid on a chronic situation, but that is just me. The success rate with LIS and a great CRS is outweighs the repeated Botox appointments and also being put under more than once. Incontinence with LIS is less than 5%. I didn't care if I had to wear a diaper after surgery, which I don't, have not had incontinence at all, but the thought of having spasms or shards of glass all day everyday is what made me opt for LIS and I am so glad I did.

Sue - I will be begging and i will try and refrain from violence but i cant promise anything :D
In a strange way i am looking forward to whatever he offers as i just want rid of this damn fissure! I actually think i am more nervous of the general anaesthetic rather than the surgery (even though i have had this before as a child and it was a breeze)
Anyway i just need to get through a few days now!
Davo

I've had Botox twice, they were a few years apart. It works for me but only temporary. It does allow my fissure to heal but I do get re-tears every now and then. Also, don't think it's good to chronically be dependent on Botox. It is a poison. I'm now scheduled for LIS.