I had my 12 week GTN follow up appointment with my CRS this evening and i have a few things to tell you...
Firstly let me tell you about my CRS - He works on Harley Street in London, is the Chair of Surgery at one of Londons top hospitals, is director of the GI unit at UCLH, is a senior lecturer of Colo Rectal surgery at one of the top London universities, he is a trainer of surgeons and he represents the UK at overseas colo rectal conferences. So the guy is pretty experienced in his field!!
GTN - Firstly if you dont see any results within two weeks its probably not going to work for you. For those that are going to heal with GTN, they will normally do so within 6-8 weeks. The human body actually gets used to the GTN and therefore its effectiveness wears off as the weeks go by so by 8-12 weeks re-tears are very common as the GTN is hardly effective anymore (that was my problem)
BOTOX - The difference between GTN and Botox is that GTN wears off during the day in between applications whereas Botox keeps the sphincter constantly paralyzed. My CRS has just returned from a conference in Florida and the majority of CRS's agreed that Botox injections are no more effective than GTN - My CRS said if it was him he would not even consider having Botox as patients can suffer gas incontinence, they can get infection/pain from the injection site and the few who do heal generally return after the Botox has worn off. He personally thinks that the Botox procedure will no longer be used in a few years time as GTN just does exactly the same job - he only recommends it if you find it difficult to apply GTN or if you are forgetful about applying it each time
LIS - Offers between 95-100% success rates and full pain relief can be experienced in 2-4 weeks, the chances of recurrence are virtually zero. However he says it is extremely improtant to choose your CRS carefully as some almost guess the length of the cut required (he lines it up by sight with the length of the fissure). He said Sphincterotomy has got some bad press over the past few years with incontinence being quoted at 10% - this is apparently related to Sphincterotomy rather than LIS which has less than a 1% chance of incontinence. He said he has performed 1000's of LIS procedures and not had one report of incontinence. He did unfortunately say that incontinence is more common in females due to the differing sphincter characteristics between males/females (sorry ladies! - however the risk is still less than 1%)
So i am scheduled for LIS in two weeks time and to be honest i cant wait!
Davo

Awesome Davo! Happy for you man.

What a great post Davo!
So glad you are getting some closure on this.
I saw my GP today and she seems to be pro LIS as well and is referring me to a doctor that she studies under. I looked him up and he has excellent ratings on ratemds.com, but it will probably take a while.
I wonder if the body gets used to nifedipine too?
I sure do hate the stuff.
if you like your doc, you should list him in the topic where you list docs you would recommend.
Anyways, terrific news and very informative update,
thanks!
-Tanya

Good for you, Davo!
I'm glad you'll be getting this problem dealt with, so that you can go on with your life.
Please keep us posted, as to your progress, etc.

Thanks guys - I could not contain my excitement when talking to my CRS last night. I feel like a great weight has been lifted from my me and my state of mind/happiness seemed to increase ten fold over night.
I was going in expecting to be offered Botox but was extremely surprised to find out his actual thoughts on this.
For anyone who is private and in the UK the waiting time is almost none existent - he offered to do it this Thursday or Saturday morning but due to my brief overseas holiday in two weeks time we decided it was best to hold off for two weeks.

Very very good luck with it Davo. And thanks for the really impressive information from your surgeon. Nice to know that you will be in good hands, yes :D

Great news Davo, what your CRS said mirrors EXACTLY TO THE LETTER what my CRS told me as well ! :)!
As a point of reference my CRS studied at Harvard, is a Chair of Colon-Rectal Department at Harvard's Boston MGH Hospital (probably one of the best hospitals in the USA) ,published more then I ever bother to read about Anal Fissure's and CR Cancers in my lifetime etc., etc!
Now what makes me raging mad is my GP and some no name paper publishers who made me think that the chance of Incontinence with LIS is up to 30%!!!!! Thanks to THOSE FREAKING MORONS I feel that I lost almost 2 years of my life that I am never getting back and I could seriously just PUNCH THEM IN THE NOSE!!! I mean there is a seriously big discrepancy between less then 1% (which I would have done in a heartbeat) and 30% that my CRS laughed at, and that by judging from the forum members posts is just ridiculous!
On the bright side, during those bast 2 years I really got my weight in check and I kept it off javascript:emoticonp('')

Davo wrote:I had my 12 week GTN follow up appointment with my CRS this evening and i have a few things to tell you...
Firstly let me tell you about my CRS - He works on Harley Street in London, is the Chair of Surgery at one of Londons top hospitals, is director of the GI unit at UCLH, is a senior lecturer of Colo Rectal surgery at one of the top London universities, he is a trainer of surgeons and he represents the UK at overseas colo rectal conferences. So the guy is pretty experienced in his field!!
GTN - Firstly if you dont see any results within two weeks its probably not going to work for you. For those that are going to heal with GTN, they will normally do so within 6-8 weeks. The human body actually gets used to the GTN and therefore its effectiveness wears off as the weeks go by so by 8-12 weeks re-tears are very common as the GTN is hardly effective anymore (that was my problem)
BOTOX - The difference between GTN and Botox is that GTN wears off during the day in between applications whereas Botox keeps the sphincter constantly paralyzed. My CRS has just returned from a conference in Florida and the majority of CRS's agreed that Botox injections are no more effective than GTN - My CRS said if it was him he would not even consider having Botox as patients can suffer gas incontinence, they can get infection/pain from the injection site and the few who do heal generally return after the Botox has worn off. He personally thinks that the Botox procedure will no longer be used in a few years time as GTN just does exactly the same job - he only recommends it if you find it difficult to apply GTN or if you are forgetful about applying it each time
LIS - Offers between 95-100% success rates and full pain relief can be experienced in 2-4 weeks, the chances of recurrence are virtually zero. However he says it is extremely improtant to choose your CRS carefully as some almost guess the length of the cut required (he lines it up by sight with the length of the fissure). He said Sphincterotomy has got some bad press over the past few years with incontinence being quoted at 10% - this is apparently related to Sphincterotomy rather than LIS which has less than a 1% chance of incontinence. He said he has performed 1000's of LIS procedures and not had one report of incontinence. He did unfortunately say that incontinence is more common in females due to the differing sphincter characteristics between males/females (sorry ladies! - however the risk is still less than 1%)
So i am scheduled for LIS in two weeks time and to be honest i cant wait!
Davo

Awesome news Davo!!! My CRS said exactly the same thing!! I am now almost 7 weeks post op LIS, and I can't even tell you how amazing it is. I suffered for 3 long years, and just couldn't deal with it anymore. The surgery was a breeze and after my 5th day post op I was ready for anything. I have had no problems what so ever. I only have one regret, I wish I did it when the pain was brand new!! I lost so much time that I will never get back, but I am trying now!! I can eat whatever I want, run, exercise, work!! No problems. You will love your new butt!!! I am so happy you have found an excellent CRS!! I love mine. I go for my 2 month post op check next week, and will hug him again!!!

Sue, your posts helped me make the decision that i was going to push for LIS, it just so happens that my CRS is Pro-LIS too so there was no need to prepare myself for battle!
Morningstar, Great that you also have a really good CRS - The NHS actually published their incontinence figures following LIS surgery and they said that it is 10% for the first month only and then this drops down to 0.5% which mirrors what my CRS quoted.
I think with a good CRS the risks are almost zero
Davo

With this information, I wonder why I am still being told to wait and not have surgery to sort this damn thing out!! :roll: