Hi Powderblue,
First off, I want to say - don't despair! Lots of people come to the forum, vent, ask for and get good advice, and they do heal, and then they go away and live their lives. There are lots of success stories, so read them, and look for encouragement! People can and do heal. I have healed! There are more and more days when I feel no pain or fear. I'll never totally forget my fissure, because now I know I have to look after my body. And that's positive, because it is good for all of me, not just my butt!
You have my positive wishes and support, and since everyone here knows what you are going through, you'll get loads of good wishes and prayers.
You know that the number one most important thing is soft stools, right? So drink water - lots and lots of water. Laxatives and stool softeners if you need them. Fibre in moderation because fibre can make big bulky stools. You may have to experiment to find the right diet and laxative regimen for you.
The other important thing is to relax your anal sphincter. Diltiazem is a good medication, but if it makes you itch, or is ineffective, don't hesitate to try one of the other meds - nifedipine or nitroglycerine. Gentle heat is an excellent way to relax the sphincter, whether in a bath or sitz bath, or using a heat pad or hot water bottle.
Yes, the fissure can take over your mind. It's hard not to obsess over this painful condition that is so very difficult to talk about. Try not to let it affect your work. Easier said than done! I let it affect mine..........I was sub-par at work for months. I don't have good techniques for keeping it out of your mind, but somebody here probably has a suggestion.
Good luck Powderblue. We are all rooting for you!