So, I have an appointment with a well reviewed CRS (hooray)! It's not for a month yet, but that gives me time to prepare for it mentally and physically. I think if he says I'm a surgical candidate, I'm going to jump on it and not mess with the botox or anything. After five years of on-again off-again fissures and 3 months of nitro ointment, I want a permanent solution, if that's even possible at this point.
I wonder though, should I try to get myself healed up as much as I can before the appointment, so I'm not in as much pain when he pokes around? Or should I just let my ass tear itself to shreds so he can see it at it's worst? Weird question perhaps. Hopefully either way he's going to know exactly what he's seeing...I'm sure he's seen a million of these things.

hi alpinestrawberry,
believe it or not, from 2004 up to 12-27-2010, i was never given any ointments or creams, etc.
my new CRS prescribed me the diltiazem 2% and lidocaine 5% on 12-27-10 and in two days, i was a new man. i've never done the other stuff. this was my first experience with the ointments. i was mostly in pain but there was no bleeding present at that time. the CRS had performed 2 anoscopies on my ass on 12-13-10 and that took a while to settle from the pain. still in some discomfort when i saw her on 12-27-10 for pre-op visit.
i was skeptical that the diltiazem would even have an effect for me since my fissure problems have been from 2004-2008 and with a rest period between mid 2008-to december 2010. the pharmacist, bless his heart, who prepared the compound for me, said it would cure me. i winked at him and said let's see since my fissure wasn't fresh off the block.
but i had the best time in japan - endured two long 13 hour flights, and it wasn't until i actually got back to the USA, that i had some irritation. in japan, it was like i was cured.
i didn't take the botox route either.
i asked in a previous posting under 'considering surgery or had it', from those with LIS, how their pain/situation was the day before and day of surgery to see if maybe there could be a pattern of outcomes post-surgery. there haven't been too many responses though.
i virtually went into surgery with no pain. i may have had an irritation, which was not painful at all, that was due to the watery releases from the enemas (i did four of them prior to surgery) - altho the enemas themselves did not hurt at all to administer.
i would recommend to attempt - without driving you crazy - to try to maintain as less injury down there as possible. i think that the more healthy tissue you have - ie, less injury, pain, and bleeding - possibly, it could help in recovering a bit quicker. that is my guess, not actual fact.
so, yes, i would not worry too much about controlling the condition of your butt when you see CRS - let things happen how they will - but don't go out of your way to be careless either. just be mindful.
take care.
i am happy that you have your appt next month.
**
even if your CRS is out of network, your medical coverage should cover some of the expenses, no? also there are many creditors out there that deal with providing credit to pay off expenses due to medical procedures at credit card interest rates. just a thought as this way it may help you prepare a budget that you can live with.

Actually, I think he may be in network after all. Our insurance company has done their best to make their website virtually impossible to navigate, but this time somehow I was able to pull up the doctor's name under 'listed providers' so I should be good. I was very relieved to see him listed there.

Don't let your bum go bad, look after yourself as much as possible. A month doesn't sound long but it will if your bum decides to punish you! Also you might have to wait for treatment which prolongs the pain. Don't do it, just do everything you can to help yourself. If the CRS is good they will be able to 'see' whats going on and question you sufficiently about your problems without you needing to worry.