Surgery Scheduled 5-30-12

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Re: Surgery Scheduled 5-30-12

Postby Fissulyna » 21 May 2012, 02:18

*ughhhhhh Image , that is really tough and I am sooo sorry to hear that you are in such rural area and do not have much choice in doctors and procedures Image !!!! NOT FAIR !!!!!! Image
Listen, this is what I would probably do if it was me, but please understand that we are all different and this is just me trying to help with some exchange of ideas - I wish I can help you more : ((((
I agree that LIS would probably help with fissure itself ! And that is not "small " issue !!!!! Fissure sometimes does not hurt much (some people luckily do not have extreme, cutting, searing pain with fissure ), but me personally would constantly worry about possible infection and fistula forming and would do everything possible to heal it even if there was NO pain Image
Now, if your fissure is causing even more pain for you than LIS will help you with local spasms as well as fissure pain and local irritation which can be really big deal as well !!! I had second LIS just to get rid of that part - fissure occasionally and constant irritation of anal mucosa (burning, itching, redness , etc. ) - I just did not want to deal with stupid butt - PERIOD !!!! But, as you can see, I had very little patience for all of that nonsense happening to me and wanted to get rid of it - no matter what !!!
Now, somebody else might act completely differently Image You just need to make decision that seems the best for you personally - what are you ready to do , how much you are ready to put up with, what risks are you ready to take, etc. etc.
If you had amazing doctor and top-notch CRS, I would perhaps "push you" somewhat to "try" LIS and see if it helps, but to be honest with only one certified CRS and one general surgeon that you did not even have chance to meet and did not examine you, I am somewhat guarded and would actually suggest you see another CRS even if that means traveling little bit further and the ultimate BEST would be if you could visit some teaching hospital that has whole team of doctors that specialize in PFD
If that is not possible, than at least ask for "third opinion". I am especially upset that you do not have access to Botox Image Image since perhaps it can help with your PFD issue :roll: ( I will have to Google that !!!!!).
Regarding "extreme risk of incontinence" - where the heck did he find that stat. ????? Image It is VERY VERY LOW , I saw 5 CRSs and ALLL confirmed that it almost never ever happen and NONE of them had it happen, not in 30 and 25 years of practice respectively !!!!!! Image They all said that literature usually refers to "gas incontinence" which is also very, very rare !!!! DO NOT do LIS with that CRS who said that - maybe HE has so little experience with LIS or maybe he had a mishap himself with a patient Image - just do not go to him.
Also, did ANY of doctors that examined you see a fissure ??? If not, it still does not mean it is not there ! It happened to me before my second LIS - nobody could see it but all of the symptoms were there. I finally found CRS who told me that fissure can be easily hidden in one of the NUMEROUS folds and lo and behold that was the case !!!! He performed colonoscopy and made photo of my fissure to show me the "beast" - it was there VERY visible on a photo Image !!!
Please try to get that third opinion Image - it would be the best to have some more exams and more expert opinions before you go through LIS. But if you have no other option, than perhaps , have that LIS and "try" to see if it will at least take off the edge of you pelvic issues Image but only with CRS who tells you that he NEVER had incontinence happen to his patient !
I hope I was of any help *sigh, I so wish I can find you better doctors Image
Still never loose hope !!!! Image This only means that you just need to be more persistent in search for help : ))) !!!!
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Re: Surgery Scheduled 5-30-12

Postby sailorgal » 21 May 2012, 05:48

I agree with fissulina, mm, re: importance of seeking multiple opinions and finding one that you feel 100% confident with who is not diagnosing you via email. I reached my limit in fissure pain last January and underwent a fissurectomy with Botox. No 2nd opinion. And my decision was governed more by desperation than having done my thorough homework with getting additional opinions to shop around. I just had no clue what I was in for and had no reason not to trust my Crs (board certified in well known, reputable NYC hospital) even though in the end I ended up switching bcz after 3 additional months of agony and learning that I did not jive with her bedside manner & communication style (it is soooo important for a successful outcome), I simply never healed and upon further inspection from my new guy, I "healed" in such a way that I couldn't fully heal (flap of scar tissue formed over fissure creating a pocket). Now I'm 1 week after my 2nd Botox with the new guy and I'm experiencing relief I haven't gotten in 6 months. Grant it, I'm sure it's a mix of thIngs: my mental attitude going in this time was totally different (positive, confident, hopeful), I've pretty been thru it all so knew what to expect (in the worse case scenario), and the fissure back in January was much larger, I had way more tissue cut out etc. bottom line is if you can help it at all, I would shop around a little for a CRs and onethat preferably try Botox as that is much less invasive. There is a recent study published in dec 2011 about the risk of latent incontInence in people post LIS 10 years out. My Crs and I discussed this, he agrees there is not a lot of data on that subject yet bcz most studies are of immediate incontenince. Since I'm a 35 y/o female who might have children, I am at a greater risk than men, for examPle. So, I wanted to make sure I truly exhausted all nonLIS treatments first. There's still no guarantee that the Botox will do the trick. But it was worth it to me to try it a couple times to see.
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Re: Surgery Scheduled 5-30-12

Postby mm92599 » 21 May 2012, 09:01

Thank you very much for taking the time to respond. I really appreciate the opinions. To answer a few questions, I have seen about 4 different surgeons over the past 6 years. 3 of the surgeons were board certified and 1 was a general surgeon who performed mostly colorectal surgeries. Only 1 of the 4 surgeons has actually diagnosed me with having an anal fissure. The CRS who has diagnosed me actually diagnosed one in 2006, 2008 and again in 2009. All of which were said to be "superficial" and "partially healed" at the time of my appointments. At follow up appointments 6 weeks later, the fissure had healed. I actually have seen 2 different CRS' at the Mayo Clinic in Arizona and neither one of them saw a fissure during an exam. However, I do feel very different this time as compared to the times that I have visited these other CRS', but I guess you never actually know. The CRS in Dallas who is recommending LIS is one that I have never seen, but the recommendation is based upon my history of fissures in the past. I have been treated for PFD at a clinic specializing in PFD out in San Francisco and have had numerous injections and daily internal and external physical therapy over the course of about 3 weeks. I found the PT helpful, but I did not have anyone to continue treatment upon returning home and so the treatment for me was not effective if I could not continue for a long period of time. I would really like to pursue biofeedback, but have put that idea on hold because of the severe pain from what I believe to be an active fissure. i would not be able to tolerate having a sensor placed in my rectum at this time. As for botox, I agree that this would be a better option to try before LIS, but I'm not sure who I could get to do it and I have also heard that many people experience thrombosed external hemorrhoids due to the botox injection. I've had thrombosed hemorrhoids and they are absolutely horrible. i would rather have a fissure than a thrombosed hemorrhoid. It's a tough decision for me because I've been advised by others to avoid LIS, but I wonder if it is my best chance at healing. One of those things that you really don't know until you do it.
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Re: Surgery Scheduled 5-30-12

Postby Fissulyna » 21 May 2012, 11:46

You are very welcome : )))) !!!!
Now that you explained your whole journey with PFD and fissure pain, I have more clear picture of what you have tried and what are you dealing with. I am very glad you visited really great centers for pelvic problems and that also your fissure was clearly seen by one CRS - so there is no doubt you really DO develop fissures, for one, and second - you obviously can very clearly distinguish between PFD pain and fissure pain and that is very important. My biggest concern was that you had perhaps referred PFD pain that now radiates into the anus also and causes sphincter spasms :(, but it is now obviously not the case - you do have a fissure problem as a separate issues , it seems *sigh
I am also glad to see that you do go "far and away" to find good doctors and that is really important Image
I can not blame you about Botox since I had strong aversion to needles being stuck in my poor anus and just could not make myself go though it for "temporary" results - but again, it was me and Botox definitely has its place in butt issues !!! My butt though needed permanent fix since my anal pressure was WAAAAAAYYYYY above normal - spasm or no spasm Image , every CRS commented that and even after the first LIS when I visited another CRS he thought I am exaggerating perhaps but when he put his finger in he exclaimed "oooooohhhhhh Image " lol lol with surprise LMAO since it was still "kicking" full force even though it was cut just 6-7 mos earlier !!!!
At the end , it is all about what is the objective situation with our butts but even more so WHAT WE personally subjectively feel comfortable with doing about it ! I am sure there are patients who are seen by 5 CRSs and told to definitely do LIS and they do not due to immense fear of surgery or anesthesia and than there are who are told to try healing it conservatively but are just fed up with it and want their life back no matter what and many, many, many more "shades" in between ; ))) !
If you will never try Botox, than yes, LIS is the only other option (or dilation ???)- you just need to find good CRS with great record and also have clear picture in your mind of what YOU would like to do and try and feel comfortable with it ! I personally had NO doubt LIS was for me - I was in such pain Image that walking around with colostomy bag and being without pain looked to me more "attractive" solution !!!! That is how I went for LIS first time. Second time I had no fear of incontinence because first LIS proved to me I had sphincter made of Kevlar Image and I just did not want to live my life according to my "butt" status - period Image
Wishing you the best of luck with your healing and with whatever you decide to do Image
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Re: Surgery Scheduled 5-30-12

Postby jr2 » 02 Jun 2012, 21:03

Hi mm...
Just wanted to bump this up and find out how you are doing, whether you decided to travel and have surgery or not.
Thinking of you and hoping you are okay.
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Re: Surgery Scheduled 5-30-12

Postby mm92599 » 03 Jun 2012, 15:57

JR...So I opted to not have the actual surgery during this trip, but to reschedule for another time. My wife was encouraging me to maybe give it a little more time to see if I could get the fissure to heal and then pursue biofeedback to treat the underlying problem. However, I am not going to give it much longer before proceeding with LIS. Basically, I was told by this CRS that I could schedule the surgery for a friday and that I should be able to go home in a week. I decided that I if did have the surgery, only my wife and I would travel and we would fly rather than to drive. Just too far to drive home after the procedure and too much potential for issues during the drive. There is definitely a part of me that feels like I make a mistake in not having the surgery done this past week as the Dr. told me that he could do it on Wednesday morning and by now I'd be well on my way to recovery. I guess I'll just give it a little more time and then if things don't improve, I'll schedule the actual procedure. Thanks for following up.
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Re: Surgery Scheduled 5-30-12

Postby jr2 » 03 Jun 2012, 20:49

mm
That actually sounds like a good plan. Flying definitely takes the stress out of dealing with any mishaps that might happen on the drive, and stress is something you definitely want to minimize. When and if the time is right for both you and your wife, which is important on both counts when you are traveling for surgery, you will know it's the right thing at the right time.
Wishing you all the best, and also my hope that you heal without the need for surgery at all.
Please keep us posted as you are able .
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