Past, present and future

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Past, present and future

Postby dan2012 » 16 Jul 2012, 07:43

Hello folks!
I post from time to time so lots of you already provided me with great info/support. I just wanted to touch base and ask a couple of questions about recovery.
Fissure for 8 weeks now, diltiazem for 4. The good news is that I'm feeling MUCH better. In teh beginning, I'd have substantial pain (2-8 hours) and bleeding (red water) after each BM. Right now, I'm basically spending 22 hours of the day pain free, and 2 hours of pain at most. I have 3 BM a day and it's being really hard to get under that. My pain generally happens after my 2nd BM, but it's really not a big deal (well, compared to the beginning at least - 1 Tylenol makes it go away generally). About bleeding, I still see a bit of blood in the stool every other day, but it's now rare (once a week at most) that I"ll see any blood in the water itself.
I've been stable, as described above, in the past 2 weeks. I visited by CRS last week as she said the fissure is "Healing" - she was pretty adamant about that. However, I'm teh kind of guy who likes to prepare for the worst (since i have a small child and no family around besides my exhausted wife) and I'm trying to figure out some arrangements for the case I need a LIS. This means that I could have my parents in town, but all of this needs to be decided in advance since they live abroad.
So here's my question... Is it worth persisting in the conservative treatment after all this time? It seems that most people in teh forum have way more pain and discomfort than I do, but make no mistake, it's not a walk in the park for me either (you guys understand, I'm sure!). It's kind of weird to think about LIS in a case where I'm certainly impacted by the condition, but my life is "almost normal". Can the fissure stay at "90% healed" like it is right now but get no better? I think I saw some people that got to 90% but got much worse later, so that's what I wonder.
I'd appreciate any thoughts or ideas!
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Re: Past, present and future

Postby thisfissurecankissmybutt » 16 Jul 2012, 10:36

Hi Dan:
I understand wanting to prepare for the worst - "just in case." It's sounds like we are a lot alike. I have been planning for the worst for the past 10 months! I finally decided to put all of this "behind me" and scheduled my surgery for July 24th. Fortunately, my in-laws are coming to help with the kids, so I also understand wanting to have some extra help around.
However, according to my CRS, it can take 6 weeks for the fissure to completely heal once you have started diltiazem, which means you have another 2 weeks. If it were me, I would make an appointment with my CRS at the 6 week point and if the fissure isn't fully healed then you can start thinking seriously about LIS.
There certainly are many stories of people who came very close to healing but, for one reason or another, never reached 100% healing. However, according to my CRS, about 75% of his patients do heal within 6 weeks of using diltiazem (and he said this figure is probably actually higher as many patients don't consistently use the diltiazem as recommended), so it sounds like you have a good shot at fulling healing in the next 2 weeks.
If you do choose to have LIS, the good news is it isn't emergency surgery, so you can plan ahead. In the meantime, you can ask your CRS if you can keep using diltiazem which will at least help keep you as comfortable as possible until the surgery.
Good luck!
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Re: Past, present and future

Postby dan2012 » 16 Jul 2012, 11:09

Thank you for the help! Actually, I'm one of the people who are not using Diltiazem properly, in a way... I can only use about 10-20% of the recommended dosage because it really dries my stools and gives me terrible constipation. So this is something I've been trying to manage in teh past weeks.
My doctor gave me nifedipine in case I want to give it a try, and today I'm going to get the prescription filled. Maybe switching to nifedipine will help me bridge the last 10%... She actually wants to give it 6 more weeks until the appointment, so in theory I still have 5 weeks.
I also heard some people took 12-16 weeks to heal with Diltiazem. There are a few in the forums, but I need to sort out if it's worth trying for that long or if I'm just postponing the inevitable (which, by the way, includes a Botox option, she always tries Botox before LIS, but I haven't seen many successes here)
And good luck with your surgery! What I read is that while it's not the option we'd initially pick, it's an option that will get you rid of the problem for good!
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Re: Past, present and future

Postby thisfissurecankissmybutt » 16 Jul 2012, 12:14

Hi Dan:
I have used Diltiazem and Nifedipine - personally, I liked Nifedipine better. While I didn't get any side effects from either one, Nifedipine was much easier to apply and worked better for me. In fact, my fissure healed while using Nifedipine! Unfortunately, it healed improperly as a superficial fistula (hence the upcoming surgery).
While it's true there are people who have healed after 12 to 16 weeks (or longer), my understanding is that the probability that you'll heal after 6 weeks is low (meaning, most people that are going to heal are going to heal within that 6 week timeframe) - so you just have to decide which option is best for you. Obviously, there is no harm in waiting another 5 or 6 weeks, especially if you haven't been able to use the Diltiazem properly. If it were me, I would try the Nifedipine and if you are seeing continued results I would definitely follow your CRS's recommendation and see how things go. I think you'll like the Nifedipine, especially if they mix it with large amounts of lanolin and petroleum jelly like my pharmacist does.
As for the Botox, my CRS recommended against it - in fact, he no longer uses Botox unless a patient absolutely insists on it.
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Re: Past, present and future

Postby dan2012 » 16 Jul 2012, 12:56

I think you make a very good point. Thinking about it, it's pretty clear that I'm responding to the chemical treatment (the before/after difference is huge), but the wrong amount might not make it very comparable to the usual "6 week" timeframes you see in research around there. Maybe if I had the right amount, this would be over already.
I look forward trying the nifedipine and being able to do the "3x per day, 1/2 pea size" application. Right now I can only do in the morning with a barely noticeable amount, maybe 1/8 pea size. If the Nifedipine doesn't dry my stools, I'll then give it the usual 6 weeks and if this fails, I'll think more about other options.
Yeah, I'm insecure about the Botox. There is reputable research on it, and it's unlikely to give me constipation like Diltiazem, but I need to weigh it against just going to LIS and getting this over with. Let's see...
I really hope the best on your surgery and look forward hearing your success story when you're done ;-)
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