Should I believe my Doctor?

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Should I believe my Doctor?

Postby msimon » 27 Aug 2014, 16:40

So first of all, this Doctor is the one that GAVE me the fissure as he tore me inserting the anoscope when banding a hemmie. This was despite me asking if he had a smaller tool (I know they exist as a previous Doctor used one on me) as I tear easily. In he went and my heart sank when he pushed it toward the back I felt the sharp pain and blood trickle. He made light of it but I knew this was going to be trouble for me as I also have pelvic floor dysfunction. The fissures I have gotten myself over the years have always been so tiny and heal up within a week. Well, almost 9 months later and 3 rounds of botox and now a second fissure, I am at a loss. He's been a great Doctor since, in that he sees me on short notice and never rushes me and answers my multitude of questions. The problem I have now is if I should believe his answers. Here is what he has told me:

1) The fissure usually heals within 2 weeks of LIS

2) he made nothing of removing the sentinel tag and putting a stitch in. When I asked if there is a problem with healing where the tag is removed since it is also posterior where there is apparently poor blood flow he seemed to think nothing of it.

3) When asked about incontinence he said that 1 in 250 would have a "skidmark" here or there.

4) when asked if he would do a more conservative cut or if he always severs the sphincter he said he does not do partial cuts and this scares me. He said he only cuts as long as the fissure is, which concerns me because he couldn't see the top of it. I have a weak pelvic floor and don't know how much looseness I can handle. I have botox there now and often can't even feel my bum, which is not good when you want to have a BM.

5) When asked about activity restrictions he seemed to indicate that I just wouldn't want to ride a bike but what I have read on here sure makes it sound a lot more painful and lengthy recovery.
Anyway, I am asking these questions because I feel like he is sugar coating things too much and I have to wonder why he wouldn't be honest with me. It makes me suspicious. :thanx:
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: Should I believe my Doctor?

Postby Scientist2516 » 27 Aug 2014, 19:45

I have not had LIS, and I'm not talking from personal experience but............
I agree with you that he is just breezing past your concerns.

However, I have read that cuts that are too conservative tend not to heal as well, because the sphincter can still spasm if it's not cut all the way. See if your research agrees with that.
Nifedipine/lidocaine, no help
Diltiazem, effective, but caused major rash
Nitroglycerine, effective.
Topical estrogen for final healing.
Gentle heat to bottom - pain relief, muscle relaxant
Kondremul mineral oil
Time - lots of time.
Status - Healed!
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Re: Should I believe my Doctor?

Postby Roidsfizzman » 27 Aug 2014, 20:30

Hi Msimon,

I am sorry that you are having to go through so much pain and stress due to a doctor's procedure. I would highly recommend a second opinion from another CRS as your doctor is providing your with sugar coated information. You should also ask for a resting pressure test before doing LIS because you have a lot going on in the area.

#1) In the best case, the fissure may heal in 2 weeks. You should expect 6 to 8 weeks for the fissure and incision to heal or you may be disappointed because it took longer. It took me 6 weeks after LIS before I had my first normal butt day.

#2) If the sentinel tag will prevent the fissure from healing, then it should be removed as part of the LIS procedure. If the sentinel tag does not give you any discomfort or cleaning issues and is not near the fissure, leave it alone when doing LIS. There is plenty to heal after LIS; the cut in the sphincter muscle, incision, and fissure.

#3) There are no studies to show that the LIS incontinence is 1 in 250 as the rate is higher. The incontinence rate varies with the LIS procedure, person and doctor. A quality doctor should be able to give you an accurate estimate of your risk.

#4) There are two typical LIS cuts the length of the fissure and a longer cut to the Dentate line. The conservative cut is the length of the fissure.

#5) After LIS you do not want to do any heavy lifting for a couple of weeks.
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Re: Should I believe my Doctor?

Postby Apes » 28 Aug 2014, 07:47

1) The fissure usually heals within 2 weeks of LIS Unless it Doesn't

2) he made nothing of removing the sentinel tag and putting a stitch in. When I asked if there is a problem with healing where the tag is removed since it is also posterior where there is apparently poor blood flow he seemed to think nothing of it. Unless my sentinel tag is ruining my way of life nobody is cutting me

3) When asked about incontinence he said that 1 in 250 would have a "skidmark" here or there. People on this site that I trust more say incontinence is very low

4) when asked if he would do a more conservative cut or if he always severs the sphincter he said he does not do partial cuts and this scares me. He said he only cuts as long as the fissure is, which concerns me because he couldn't see the top of it. I have a weak pelvic floor and don't know how much looseness I can handle. I have botox there now and often can't even feel my bum, which is not good when you want to have a BM. No Clue

5) When asked about activity restrictions he seemed to indicate that I just wouldn't want to ride a bike but what I have read on here sure makes it sound a lot more painful and lengthy recovery.
Anyway, I am asking these questions because I feel like he is sugar coating things too much and I have to wonder why he wouldn't be honest with me. It makes me suspicious. :thanx:[/quote]
Sorry to say I would not use a doctor that screwed up in the first place. Don't know whether he is telling the truth or covering his ass. If he scores up again I would only have myself to blame. At a minimum I would get a second and third opinion.
Wish you the best...
Fissure 2/13/14 from Colonoscopy
Nitro no help
Nifedipine no help
Botox 5/5/2014 work in progress
HEALED 10/2014
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Re: Should I believe my Doctor?

Postby Rachael 1984 » 28 Aug 2014, 16:09

Hi Msimon,
I would seek a second opinion..... I demanded one after my first CRS was fooling around, telling me to keep trying to heal and telling me he didn't think I had a high resting pressure. I wasn't happy with him and I knew my bum wasn't right! It may take a new CRS with a different view to give you an answer that you need..... Please keep fighting, you will find the right person.... Go with your gut instinct.... Good Luck.

Did you get my PM? !
Hem Banding sept 2012
2Fissures
Nitro- Effective short term
April 2013-Botox-Effective short term
Diltazem-No effect, developed Rash
July 2014-Diagnosed High Resting Pressure
LIS performed on 17.9.14
Ongoing pain/re-tears. Awaiting pressure test results.
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Re: Should I believe my Doctor?

Postby msimon » 28 Aug 2014, 17:13

Thanks everyone. Yeah, I do have a big problem trusting this guy. He's been really good with me since, however, when he cut me he sure didn't even seem to be concerned. In fact it wasn't until I made a big deal of it that he apologized! I almost felt like I shouldn't be concerned as it can happen...never happened before and I have had banding done at least 3 other times and been scoped more times than that...

Anyway, the problem is that we have very few CRS Doctors in my city and I already went to another one and even after I told him how I got the fissure he seemed to think I should stick with that Doctor. He agreed to treat me but insisted on doing a sigmoidscope under sedation is required before he will discuss anything with me, as he couldn't see my fissure that day. I now have 2 fissures and wonder if the scope would be necessary...I digress. Anyway, I am thinking I may pursue this avenue instead...but for now, I hope the botox will work out. So far, it seems to be making things worse :(
Dec '13 Fissure from anoscope
3 X internal sphincter botox
'08-'15 Botox for pelvic floor dysfunction
Nov '14 LIS/sentinel tag removal
Feb '15 Deroofing of recurrent infection from LIS
summer '15-healed but still ongoing muscle dysfunction/pain
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Re: Should I believe my Doctor?

Postby Rachael 1984 » 30 Aug 2014, 08:30

Hi msimon,

Maybe you could have the camera and maybe they might see the Fissures, if they are higher up they may not be able to see them on eye exam? I have the same issue and when the CRS looks he can't see them, but then they re-tear and I know they are always lurking there..... I'm having the camera too when I have my LIS.
Hem Banding sept 2012
2Fissures
Nitro- Effective short term
April 2013-Botox-Effective short term
Diltazem-No effect, developed Rash
July 2014-Diagnosed High Resting Pressure
LIS performed on 17.9.14
Ongoing pain/re-tears. Awaiting pressure test results.
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