The LemonMan's Diary

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Re: The LemonMan's Diary

Postby LemonMan » 18 Dec 2016, 16:08

Thanks for the tip erbear - I'll certainly check it out.

So quick update. Have been working on my new plan since the 5th of November. It's now the 18th of December, so about six weeks in. In terms of pain, I'm in a better place but not completely out of pain. Having taken diltiazem before I was out of pain by this stage, so possibly combining this with Medihoney isn't working quite as well as I had hoped. I'm going to stick to this plan for another six weeks to see what happens, but to be honest I'm thinking botox is the next step for me.

There is something I have noticed in the last few weeks more than previously. I call it the daily "twinge" - basically some point in the day I will get a short sharp pain. I guess it feels like a tear. I kind of feel like it wants to heal, but daily life isn't giving it the opportunity to properly stick together - if that makes sense.

The last time I saw my consultant he said he thought I had been 'treating the symptoms'. I wish I knew what he meant by this. Diltiazem gets you out of pain after around 6 weeks normally - but if you are not healing, what exactly is happening?? Without understanding the answer to that question I can only surmise that I am in fact healing, but maybe not sufficiently to stop a recurrence? The other question I have is why not take Diltiazem for, say, as year? All the research I've seen has been for between 6 to 12 weeks. Apart from the itchiness some people get, I wonder why you just wouldn't keep using it indefinitely for a chronic condition... What's the major side effect I am missing I wonder?

I've also been trying to see my fissure. I believe I can feel it, but it's practically impossible it to see it. That might sound strange to some, but I believe my fissure is fairly deep inside the sphincter. I thought I had spotted it a few days back, but a day later I couldn't see it again. I feel if I could see it properly I would have a better understanding of whether it was healing or not. My surgeon seems to be able to spot it almost straight away - it's so annoying lol

Now for Medihoney. Well my experience is I feel it has definitely been cleaning out the fissure at least, and for that reason I am going to continue to use it for now. One of the dangers of fissures is they can eventually develop into an abscess due to local bacteria, and the Medihoney does have antibacterial properties that I believe help. It also seems to help with the pain a little. Just to be clear this is general pain associated with a chronic fissure - not spasms. It's not the miracle cure I was hoping for though, but seems to have worked for a few people here (unless this is just marketing - gosh I hope not).

Oh well, not much can be done except to struggle on. Hopefully in the new year I'll get my NHS referral and 2017 will be a better year. I think most people agree it hasn't been the best for many reasons. But chin up, things are better than six weeks ago. Maybe in six weeks time... :-)

LemonMan
Aug 14: Anal Abscess diagnosed
Dec 15: Anterior Anal Fissure diagnosed
Jan 16: Anoheal - Thought was healed end of Jan
Apr 16: Anoheal - Thought was healed end of May
Sep 16: Fissure back. Started Anoheal again
May 17: Botox and banding - fingers crossed
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Re: The LemonMan's Diary

Postby Mypoorbutt » 18 Dec 2016, 16:28

Hi LM,
Glad to hear your feeling better than 6 weeks ago sorry to hear your still feeling pain.
I agree I don't think the medi honey can heal a fissure if your sphincter is still spasming or too tight to allow proper blood flow. I have started using it again after my LIS in the hope that it may help, I'm also going to order some comfrey too.
I don't know about diliatazem but I have been on my GTN for over a year now my CRS says he has people who have been on it for 2 years....mainly people who don't want LIS or complicated cases but I certainly wouldn't want to stop using it yet.
Yes I get the twinge sometimes too...if I get up or change position quickly it really does feel a bit like a tearing sensation, still getting it after my LIS.
I have never been able to see my fissure but neither could my GP or two consultants my current CRS saw it straight away though....he did say there was only a tiny bit visible the rest was deeper inside. My fissure is a posterior one.
Good luck with your regime and think of adding comfrey too it, it is one of the best things at healing skin...you could google it...I hope you get your referral soon how long have you been waiting now??
Take care
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Re: The LemonMan's Diary

Postby LemonMan » 18 Dec 2016, 17:28

Hi MPB,

I will certainly google Comfrey - thanks for the tip.

I think you are right, after a quick google around the internet I've found no evidence of any real side effects for prolonged use of Diltiazem.

I've even found this excellent article written in 2008 that concludes "Topical treatment is effective for patients with chronic anal fissure in the short-term and long-term, but for many patients, it is not a definitive treatment. It can be offered to those who are ready to take repeated treatments" It lists both Diltiazem and GTN. "http://www.e-asianjournalsurgery.com/article/S1015-9584(08)60078-0/pdf"

Certainly my GP doesn't seem to have a problem with a repeat prescription.

Also the following article abstract shows "Fifty-one patients (75 per cent) experienced healing of the fissure after 2–3 months of treatment with topical diltiazem. Seventeen patients who did not heal were treated for a further 8 weeks with topical diltiazem. Eight of these patients subsequently healed with diltiazem" http://onlinelibrary.wiley.com/doi/10.1 ... 6AD.f03t02

So I reckon you can use it for longer than the 6-8 weeks I was initially advised to use it.

It's comforting to know I'm not alone in not being able to see my fissure. When you meet a CRS who can see it, you tend to stick to them like glue lol.

Hopefully my NHS referral will come in soon. I've been waiting about 6 weeks for an appointment letter, but that seems to be the norm in my part of town. I also have a knee injury that is being worked on that has taken three years to progress to the point I have a diagnosis of "Advanced Tendinitis" - but it makes me laugh really because it is nothing compare to the fissure.

From reading your LIS diary I know you are still struggling on. Keeping my fingers crossed things improve for you to full recovery.

Best, LemonMan
Aug 14: Anal Abscess diagnosed
Dec 15: Anterior Anal Fissure diagnosed
Jan 16: Anoheal - Thought was healed end of Jan
Apr 16: Anoheal - Thought was healed end of May
Sep 16: Fissure back. Started Anoheal again
May 17: Botox and banding - fingers crossed
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Re: The LemonMan's Diary

Postby Mypoorbutt » 19 Dec 2016, 07:37

I don't understand why they would confine it to 12 weeks especially if it is helping sometimes doctors can get bogged down in procedure and forget the patient.
Oh yes I agree when my CRS was like oh yes there it is...I felt like hugging him lol...I mean I knew it was a fissure and was being tarted for one but to actually have someone see it I felt so much better.
Well I certainly hope your fissure gets treated a lot quicker than your knee.
Yes it's been rough but I'm actually able to work and live normally now thanks to the new meds. Still getting a bit of pain but no spasms for a while thankfully.
Thanx LM
Fingers crossed for you
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Re: The LemonMan's Diary

Postby LemonMan » 22 Dec 2016, 06:13

Hello All,

Well got my first appointment on the NHS. 10th of March lol - Well at least I have an appointment now. I guess I'm lucky in that I am seeing the same consultant I saw privately, and he has agreed to see me in the NHS. If I had paid the £3000 fee for the operation he would have done it within a week. But I opted for the NHS route because I'm not sure one dose of botox is going to cut the mustard. For some reason I feel guilty about moving from the private sector to the NHS, but I'm not sure why exactly.

Unfortunately I have to still go for an initial consultation to be assessed before things can be progressed to botox. So I am guessing I am looking at the summer before that happens. So until then I'm on Diltiazem and hoping the pain deminishes. Maybe by then I will be healed - wouldn't that be wonderful? Here's hoping!

I remember someone on here said they had some luck with topical estrogen, so I'm going look into that and see if that will help. Anything!!! lol

LemonMan
Aug 14: Anal Abscess diagnosed
Dec 15: Anterior Anal Fissure diagnosed
Jan 16: Anoheal - Thought was healed end of Jan
Apr 16: Anoheal - Thought was healed end of May
Sep 16: Fissure back. Started Anoheal again
May 17: Botox and banding - fingers crossed
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Re: The LemonMan's Diary

Postby Mypoorbutt » 22 Dec 2016, 14:58

Wow LM march....that's a bit late, you could always phone up once a week to see if they have any cancelations.
I did exactly the same I paid for the private consult then went on his NHS list, there was no way I could afford the £3000 for the Botox and to be honest my dad would be turning in his pro labour grave if he knew I went private. I figure that hey I have worked for 20+ years so I should be and am eternally grateful for the NHS but I have also now started paying into private healthcare. (My dad would go nuts lol)
Fingers and toes crossed that you heal in the mean time
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Re: The LemonMan's Diary

Postby LemonMan » 28 Dec 2016, 14:47

Well about 7 weeks into my plan. Have decided to ditch Medihoney. The theory was all there but in practice when using medihoney I could feel myself re-tear almost everyday. Since I stopped using it that sensation has reduced significantly. One of the properties of Medihoney or Manuka Honey (same thing) is it is supposed clean out a wound by removing dead skin cells (there's a medical term for this, but I've forgotten it). Perhaps this is what is causing the re-tears? I dunno. Perhaps on the plus side this exfoliation of dead cells will help with the diltiazem.

Over the Xmas break I've had time to think things through. Basically it seems the key to healing this condition is to reduce the pressure of the sphincter, while at the same same time not over stretching the sphincter. Seems like this can be done either chemically (with diltiazem, GTN, botox etc) or permanently with LIS surgery. Seems to me that the reason temporary methods fail is because there is not enough time for the fissure to heal before the sphincter tone goes back to normal. Therefore the longer you can maintain a relaxed sphincter the better your chances of healing permanently.

With regard to other treatments I think that these can't really work because they don't do the key thing - of relaxing the sphincter. Don't get me wrong I can see that some people have had various successes with various things, but by enlarge I think the proven medical approaches are the best chance of fixing the issue. You could argue that those people who have had success with various unorthodox treatments may have just healed anyway without any treatment.

Medihoney may have cleaned me up, and who knows perhaps it will give Diltiazem a better chance over the coming weeks. I have an appointment with my surgeon on the 10th of March. It's a long time to wait, but at least I'm in the NHS system now and I'm hoping things won't get worse from now to then at least.

Things don't feel quite right down there at the moment with a bit of swelling , but I have been here before and things have improved, so fingers crossed. I think possibly I am aggravating some hemorrhoids. It's difficult to know what is going on really and sometimes the mind moves into panic mode. I have to keep reassuring myself that things will get better.

I've also decided to keep a pain diary over the next month or so, so I can monitor any improvement (or otherwise).

Sending good thoughts to all fellow sufferers.

Best LemonMan
Aug 14: Anal Abscess diagnosed
Dec 15: Anterior Anal Fissure diagnosed
Jan 16: Anoheal - Thought was healed end of Jan
Apr 16: Anoheal - Thought was healed end of May
Sep 16: Fissure back. Started Anoheal again
May 17: Botox and banding - fingers crossed
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Re: The LemonMan's Diary

Postby LemonMan » 02 Feb 2017, 16:36

You've got to love the NHS (or not in this case). Found out today my appointment has been cancelled and now I'm seeing a different consultant - despite requesting a consultant because I'd seen him privately. No explanation given.

Pretty devastated actually. Thanks NHS. The last time I went through the NHS system for a perianal abscess they misdiagnosed me and passed me from department to department for a whole year until I had no option but to get emergency private surgery. I remember sitting in my GP's office covered in sweat begging him for a recommendation for a private surgeon. Sorry to say but I have lost all faith. It's so depressing. Guess I have to remind myself at least we have the NHS in the UK. Could be worse I guess. I suppose it's being let down and given false expectation that really takes the biscuit.

Hey ho, LemonMan
Aug 14: Anal Abscess diagnosed
Dec 15: Anterior Anal Fissure diagnosed
Jan 16: Anoheal - Thought was healed end of Jan
Apr 16: Anoheal - Thought was healed end of May
Sep 16: Fissure back. Started Anoheal again
May 17: Botox and banding - fingers crossed
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Re: The LemonMan's Diary

Postby Mypoorbutt » 03 Feb 2017, 04:59

Wow LM that's proper crap....no pun intended
Could you not phone the surgeons secretary up and ask to have a word...if you paid to see him privately and he agreed to put you on his NHS list then you really shouldn't have been cancelled as that is basically a waste of your money. I would def phone him up and see if he will put you back on his list.
Is your new op with a general or colorectal...
Can't believe they have done that to you...phone, email and blooming complain
How is your pain right now hope it's not too bad
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Re: The LemonMan's Diary

Postby LemonMan » 05 Feb 2017, 20:49

Thanks MPB. That was a very depressing day for sure. I'm really not the sort to complain, especially when a service is "free at the point of delivery" (which conveniently forgets national insurance and tax of course), but I did call them up and they told me I would still see the same consultant even though my letter says a different consultant - they said it was a "glitch in the system, and that's just the way it works". Guess I will find out when I get there. Fingers crossed.

Pain is a little better at the moment at least compared to Xmas. I've given up everything now except for Movicol and Manuka honey, which I previously gave up and have now come back to. Diltiazem was just causing me too much inflammation and think causing its own issues. I am sure the hemmerhoid I have now is down to that. I'm using Manuka honey simply to keep any potential infection at bay. The last thing I want now is another abscess forming. I've also seen some pretty impressive videos online about its wound healing potential, so I figured I would give it another go. Seems to have worked for some people here. It feels like it is doing something. Good or bad? I'm not sure. I can report there has been some improvement in pain levels, but I think this is mainly from stopping Diltiazem (ironically).

Hope things are improving for you?

Best LemonMan
Aug 14: Anal Abscess diagnosed
Dec 15: Anterior Anal Fissure diagnosed
Jan 16: Anoheal - Thought was healed end of Jan
Apr 16: Anoheal - Thought was healed end of May
Sep 16: Fissure back. Started Anoheal again
May 17: Botox and banding - fingers crossed
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