Cauterization / Silver Nitrate

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Cauterization / Silver Nitrate

Postby dan2012 » 26 Jul 2012, 19:21

Hello,
I just came back from my CRS - the background is AF for 9 weeks, using Diltiazem / Nifedipine for almost 6. It seems that my fissure is a bit different from most in the forum - like everybody else, it began with blood and spasms to the point where I'd spend a good deal of my day in pain. It was never excrutiating, but always strong enough to make me want to do nothing.
Today, I still bleed every other day or so, but my pain is pretty much gone. I had 3 instances of pain in teh past 2 weeks, and all cases were very mild and lasted no more than 1 hour. I actually spent 6 full days with no pain whatsoever. My CRS said that my fissure is healing given my drastic improvement of pain, but she can still see the fissure open (and bleeding).
I will go on vacation in a couple of weeks, so she said that I should keep using Nifedipine since it's helping me so much and my pain is almost zero. Now the oddity - after I'm back, she will try CAUTERIZING the fissure with Silver Nitrate!
This CRS is awesome and routinely performs LIS and many other procedures (including some very advanced for cancer for instance) so I'd bet that she knows what she's talking about. I just found odd that I hardly see this approach mentioned in the forum. She said that she only goes for LIS after trying all other more conservative options - not because LIS is bad or dangerous, but because she is pretty conservative.
Anyone with Silver Nitrate experience?
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Re: Cauterization / Silver Nitrate

Postby Buttinpain » 27 Jul 2012, 11:07

Hi dan2012,
I had the cauterization with silver nitrate. Here's my story:
Went to CRS the first time in March, 2012 with what I thought was bad piles, bleeding but not to bad. He said I had a fissure. I was very swollen down there with an extremely tight S muscle. He cauterized me on the spot. Numbed me with little sharp needles (which was great after, felt normal first time in months) and used silver nitrate. Didn't feel a thing, maybe a little coldness. He also prescibed nitro .02%. He said to come back in month and he would do botox and cauterize again. He does not like to do LIS surgery and uses as last resort.
So after numbing faded was in major pain!! My bum was on fire!! I have a high tolorence for pain but that was bad! Called doc for pain meds and he gave me hydrocodine. The day after cauteriztion, there was a lot of blood, more than any other time. No blood on third day. Took pain meds for two days and pain started to subside. Still not great but bearable with advil. Started all the usual measures: healthy diet, water, baths, nitro and miralax. Went back for second visit and I explained that nitro was working pretty good and wanted to keep using before botox. He checked fissure and said was healing.
Now today, it's been almost 3 months since I've been to doc. Finally feel like it's healing. Still have quite a bit of pain but subsides by afternoon. Feel like my S muscle is not very tight. Now just trying to get my fiber/stool softener correct so I don't have 3-4 BM's per day.
I question myself, that if I would have gone back after an additional month, if getting an additional cauterization would have helped me heal faster. Still not sure. I don't think I would have done botox, don't really feel that I need that as muscle feels okay. Each week I think I'll call and make appt and say, Oh, I'll give it one more week. I've made a few changes recently (got off miralax - lots of burning after BM) and started magnesium and other stool softeners so will see how that goes for a week and reaccess then. Will keep you posted.
So, would I do it again, the catuerization. Yes. I keep reading that you have to damage the tissue so it will heal properly. It was a quick and easy way to do that and cutting away the tissue around the fissure didn't sound so great to me.
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Re: Cauterization / Silver Nitrate

Postby dan2012 » 27 Jul 2012, 11:20

Hello Buttinpain,
Thanks a lot for the information! I was a bit surprised because this technique is rarely used - and the result, based on the few testimonials I found, has been all over the place (some people had a lot of success, others no result), so my conclusion is that this technique is effective only with some types of fissures.
One thing that isn't very clear is whether you had a lot of pain to begin with - I'm similar to you in the sense that I'm "bleeding but not too bad", but I feel very little pain, maybe 1-2 in this forum scale for 3-5 minutes after a BM and 0 during the rest of the day. Just like you, I have 3-4 BMs per day and I don't really feel "tight down there" :).
So basically I want to know if the cauterization, after the first few "fire days", made pain appear where there was little to begin with.
Interesting that you mention that Miralax caused burning. It really helped my stools but I wonder if it is related to the burning I occasionally feel. This burning doesn't feel like the usual "fissure fire", I thought it was hemorrhoids, maybe it is.
If you try Miralax again, here is one thing that is working well: a little bit of Miralax right after each meal. By little, I mean no more than 1/4 TEA spoon. I actually have 1/8 tea spoon after lunch and just a itsy bitsy with breakfast and dinner. Seems to soften things up.
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Re: Cauterization / Silver Nitrate

Postby Buttinpain » 27 Jul 2012, 12:05

Hey,
Yes, I agree, I could not find out much information on cauterization on any websites. In this forum, there was a lady who was getting married and her fissure healed up within 2 weeks. Was very positive.
I was having a lot of pain prior to the procedure. Thought it was a thrombosed hemorhoid as I have always had problems with them. Actually had them removed 10 years ago, but "Their Back"! I wasn't bleeding to bad. I would bleed a few days, drops in toilet and on paper then it would stop. Start again after a few days. I know it's weird but had less pain when I was bleeding, not sure why.
The cauterization created more pain the first few days. After "fire days" was still in a lot of pain, much more than prior to catuerization. This got better as the days went on. I think all the pain was due to my S muscle being so very tight with lots of spasms. Once that was under control, was so much better! Since you don't feel "tight down there" the cauterization could help you heal faster. Of course, it could also cause your S muscle to freak out and create more pain. Maybe in the long run it will be worth it. Hard call!
It's only been one day but only had 2 BM's today and not much burning at all. Think the Miralax was making the BM's kind of soupy and would not all come out so would sit in colon and burn. Again, we'll see how it goes but thanks for suggestion on Miralax, might try that next.
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Re: Cauterization / Silver Nitrate

Postby dan2012 » 27 Jul 2012, 18:34

I think I bleed a bit more than that, but then, I have some internal hemorrhoids too. Like you, I also observe less pain when I bleed, a few times it was very weird when I had zero pain, hardly felt the BM, but there was some significant blood along.
This was actually making me anxious so I decided to stop looking at the stools after the BM - Just flush while I'm sitting and let the pain tell me whether I'm getting better. I have another CRS appointment scheduled anyway, so if I'm not hurting and I'm not anemic, I just don't care about my stools having blood or not anymore... It really helped me relax, actually!
I hear you about things maybe getting worse for a while with cauterization. But well, I'm willing to get this resolved once and for all, and since the Dr really feels that LIS isn't really the best option for me right now, I'd go for some experiments as long as I don't have some permanent setback.
Please let me know how you do with the Miralax. And as always with Miralax, go easy on your dosage - this thing WORKS, and sometimes too well (first time I took it, full dose, I was having 5-6 BMs a day!)
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Re: Cauterization / Silver Nitrate

Postby Buttinpain » 08 Aug 2012, 10:03

Hi dan2012,
Are you back from holiday yet? Just wanted to check on you to see how your appt went and if you had the cauteriztion done.
I'm still working on the miralax, stool softeners and prune combo to get everything right. Still not perfect yet but started another topic to hopefully get other ideas.
Hope all is well with you!
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Re: Cauterization / Silver Nitrate

Postby dan2012 » 10 Aug 2012, 08:27

Hello buttinpain, thanks for the follow up!
No, actually my vacations just started (check other thread in general forum called "setback and long plane flights"). So I didnґt yet have the silver nitrate. I'm doing relatively well - more blood than pain proper, and I'm able to do pretty much anything besides eating what I like :)
I'll check the other topic, and I'm curious to know if you are having pain/blood now, since it has been some time since your silver nitrate application.
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Re: Cauterization / Silver Nitrate

Postby Buttinpain » 12 Aug 2012, 08:38

Hey dan2012,
Yes, saw your other thread. Glad all worked out well for you on the trip. Are you having a lot of blood or just a little? I would think if you are having only minor pain and little blood it is healing and maybe the cauterization will not be necessary. The cauterization will create another wound to heal as well as the fissure. Of course, if blood is bad may well stop bleeding and promote healing. Very curious to see what the doc says when you go back it, if you do.
I'm still working on the best BM (also check other thread) but yes, still a tiny bit of blood probably once a week probably due to BM being to hard or pressure and feel like I need to go. Pain is bearable - good and bad days.
Hope you have a relaxing vacation!
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Re: Cauterization / Silver Nitrate

Postby dan2012 » 13 Aug 2012, 04:29

Sometimes it's a lot, sometimes a little. It's not with every BM, but I'm bleeding every day. The reason this is happening is that I'm still trying to figure out the food since I'm abroad. I think I loaded too much on insoluble fiber because I had 3 very bulky BMs. This increased the pain significantly, but the pain right now seems to be mostly from the hemorrhoids, as it's really not hurting much on the fissure site.
So it's hard to tell whether I'll need cauterization when I'm back. If this helps getting this over even if it means a few more days of higher pain, I'll go for it! :)
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