Yup Ensure is on my list of things to take if/when I get the fissure in hand. I'm scared to add anything to my diet right now, made a big ol'' pot of cabbage soup today that will be my every meal (along with some bran cereal) for at least the next few days...
Haha yeah you folks are indeed 2 hours ahead of us. I haven't slept yet, though, I'm a bit of an insomniac, so technically it's still Saturday for me

Surgery or death ! Needs must, Sidra :)
NG ! :o YOU DONT EAT BREAKFAST

Yes, try drinking Ensure for breakfast if nothing else (the one with fiber).

Hey guys,
Nope, I don't eat breakfast, never have my entire life. I used to skip lunch pretty regularly too. It's a bad way to live, but I was always worried about pooping too much, and was busy because I did a lot of business travel, had to have extended meetings with clients, etc. I've got a comfortable job real close to home with no travel now though :)
I saw the local CRS today, and I guess the ball's in my court now. She gave me some nifedipine ointment to try since the nitro wasn't doing much. It's 0.2% nifedipine, seems lower concentration than the 0.3% I usually read about online, she I doubt that'll make much of a difference. She says, however, that at this point, LIS may be my best option. She says she's done hundreds of them, and no patients have ended up permanently incontinent, although a few had temporary bleeding for a day or two, and two did get infections at the incision site that required an additional surgery to treat. She says most people have very good results with it. If I want to schedule LIS, she says lead time is no more than 1-2 weeks tops, usually within 1 week. So I have that option in hand if and when I want to exercise it. This local CRS doesn't believe in botox, she says she tried it a few times during her residency and it didn't do much, plus there's lack of clarity over exactly where to inject it, how much to give, etc. I liked her approach, seemed like a good person, was pretty knowledeable about fissures, and is only about 15 minutes from where I live. One other bonus is that she says if she does LIS, she will put me under and examine my rectum for any possible indicators of inflammatory bowel disease, and will abort the surgery if she sees any since then surgery would then be a poor idea. She also says that she'd never prescribe hydrocortisone (which my other physician did) for fissures since they can slow down the healing process.
Now, my other option is a CRS in San Francisco. Immediate downside is it's 60+ miles away from where I live. This other CRS has me on Valium (which does seem to help the spasms some) and 0.2% nitro / 2% hydrocortisone / 5% lidocaine right now. If it doesn't help in 3 weeks, she wants to do botox and indicates it has a 75% success rate in her experience. Insurance will cover the botox injections if I go this route as they have already pre-authorized it.
So basically the summary at this point is...
LOCAL CRS:
-- Is 15 minutes from home.
-- Doesn't believe in botox.
-- Says not to use hydrocortisone.
-- Says to try nifedipine for a short while.
-- Says LIS is my best option (and can get me in on short order), barring presence of Crohn's disease or ulcerative colitis.
SAN FRANCISCO CRS:
-- Is 1+ hour from home.
-- Says to use nitro / lidocaine / hydrocortisone ointment and Valium.
-- Wants to try botox if there's no effect from the ointment.
What do you guys think? Any things that make you lean one way or the other? I know you can't make the decision for me but I value you guy's feedback.
Right now, I'm leaning toward trying the nifedipine for a week, and going for LIS if there's no improvement. This way, I'll have a better chance at being on the road to recovery when my twins arrive. If I do the botox, and it doesn't work, then I figure LIS will have to wait until the effects of the botox wear off, which will push the timeline out at least another month.
I'm going to browse the old threads on the forum and see what others in the same boat have decided in the past now, but any input is most welcome and appreciated.

Hrm ok just read through a number of the previous threads on botox therapy, and so far I'm not terribly encouraged... I wasn't aware that it could take several shots over several months to even assess efficacy. And during the time that the sphincter muscle is paralyzed, it seems like LIS indeed isn't an option. It seems that a lot of people get temporary relief from botox that eventually fades. I think I'm leaning strongly toward rolling the LIS dice if nifedipine and nitro don't get me anywhere over the rest of this week. After reading some of the stories from others who had trouble getting botox or LIS authorized, or who couldn't get botox covered through insurance, etc., I'm at least grateful that no matter what I choose, it will be covered by insurance and can be scheduled without too much of a wait!

I am glad you read through the botox threads and have a realistic impression, NG, at least as provided here on this forum. Actually, most people who have joined this board and reported on their botox results *do* find that they must go on to LIS. That is why when your current CRS gave such a high success rate for botox, I was skeptical. Still, to be fair, that may be for people who have not had their fissures for vefry long, and usually we get people here who have been suffering for months if not years. It may be more efficacious for newer fissures vs. the more long term. Still, I am only guessing!
Glad to know you have insurance authorization for either route, that is super!!

Yessir, Kim, the previous threads on botox were indeed highly enlightening. I still have to read up some more on them later, and compare against people's feedback following LIS. The local CRS I saw today painted such a rosy story of LIS recovery that it seemed a bit too good to be true too. She says that most people have pain and some bleeding for a day or two after surgery, but that usually after the 3rd day BMs are nearly entirely painfree. I know from reading here that such a beautiful outcome isn't always the case. To her credit, she did say that's the experience of the majority of her patients, and some do have complications and slower healing. But she seemed like a genuine person, and I don't have much reason to doubt her. She says it's an outpatient procedure and I would be out of there only hours after surgery. I even filled out the LIS authorization today so if I want it done, I just have to call and schedule it, no additional paperwork needed.
I know that all it will take is one (or two or three) bad BMs to put me down into the doldrums again, but for now I'm at least glad that I have two choices laid out in front of me, and that it's now entirely my call. After reading some of the past threads, I'm at least thankful that I didn't have to wait months or years to get these options offered to me, or (should I go that route) pay for botox out of pocket, like so many others have. I probably committed countless appointment scheduling faux pas in the process, but I guesss sometimes that's what it takes to get some results!!

Great new, NG...your new CRS sounds just like my guy (thank goodness). Sorry I haven't been on here, literally worked 16 hours yesterday and had no computer access..I did think about you and your appointment though and was hoping you'd get out of there with a possible surgery in the works. Sounds like it went really well..keep us updated on what transpires. So glad you sound much better mentally..just knowing that the wheels are in motion helps with that.

Sidra,
Thank you, you're absolutely right, even though the BMs still hurt badly everyday, and I still get some disturbing bleeding with BMs sometimes, just knowing that I have two options on the table for how to proceed does mentally help a lot. This local CRS did seem very good overall, the only minor gripe I guess I can say is that she says she'd never prescribe Valium for fissures, and I *swear* the Valium I got from my other CRS really has helped reduce (but not eliminate) the intensity of the post-BM spasms. That Valium has been a lifesaver as far as allowing me to do as many normal things a day as possible.
In fact your very first post is the one that really struck a nerve with me and got me to be really aggressive about scheduling multiple CRS appointments and finding out what all of my options are. Like yourself, my wife and I are travel fiends, and reading your post made me think (very nostalgically) about all the great things we used to do and places we would visit, that I no longer could while I've got this malady. That got me both sad and motivated at the same time, so I got on the horn and bugged every CRS with a good rep within a 60 mile radius of here.
Today's BMs so far haven't been too good feeling, but the "psychological out" I have now is something that I bear in mind as that fleet of aircraft carriers tries to make its way out of my butt :)

So, NG, what's happening with everything? I've been working a ton this week so I haven't written, but I have checked the forum. I'm feeling roughly 90% normal...hope you are getting close to a point of no return, like I did. Let me know what's going on.