Hey Sidra,
I was just wondering what'd happened to you -- sounds like things are going a-okay for you, which is great news! I'd usually be one to complain about hard work, but now that I've have this fissure, I certainly wouldn't mind being able to do some real work!
My pain has been slightly reduced these last two days or so, but I don't know yet if it's actual progress in the right direction or just the fissure setting me up for a nasty crash back to reality. I guess only time will tell. I'm trying not to get my hopes up because I know how suddenly that hope can vanish.
For the last few days I've been on a strict diet: Fiber One cereal for breakfast, veggie soup or sushi for lunch, and more veggie soup (with pieces of boiled chicken and/or fish) along with soy beans and more cereal for dinner. I take Valium before and after BMs, alternate between nifedipine and nitroglycerin every other day, and also take a full dose of Miralax every day.
So far this diet has produced soft stools (consistency is usually like pudding or frozen yogurt although there are sometimes hard lumps in there), and pain during BMs is noticeably reduced. Usually the worst pain is felt when the bowels first open, and after that the pain is relatively mild. It's mostly when I go several times in a row that things get more irritated down there. I don't get the terrible spasms too much anymore, and when I do I take a Valium and it usually gets it under control.
As it stands now, I'm going to see if I can make this hold up for a few more days. It's taken a bit of the urgency off rushing in for either botox or LIS, but both options are still on the table for when I want to exercise them. I still get some pain (stinging raw kind of pain) around the anal region after a BM, but it's not as bad as last week. And the bleeding seems to have reduced a good bit (knock on wood!!!). Right now my wife is on maternity leave, so she drives me to and from work everyday, which helps to keep the pressure off my bum too.
Last Wednesday, when I was wheeled crying into the ER, the ER doc told me something interesting. He said they usually never prescribe opiate painkillers (oxycodone in my case) for fissures, but in some severe spasm cases like mine, they can help to break the cycle of spasming with short term use. So he told me to take oxycodone for a day or two, continue the Valium, and up the dose of Miralax during that time to fight off the constipatory effects of the opiate. The day after I left the ER, I had a supremely painful BM with bad spasms, and I did exactly as he said, and I haven't had as severe of a reoccurence just yet (knock on wood big time again!). I don't know if that's just the Valium keeping things at bay, or if there's some wisdom to the ER doc's advice, but I've got my fingers crossed that he was legitimately onto something.
I've got a follow up with one of the colorectal surgeons I'm seeing in a few weeks here, so I guess I'll see how things are going at that time. This surgeon has already pre-authorized botox with my insurance company, so if I can last until then without begging for LIS, I'm thinking about giving botox a go. But who knows, right, all it takes is one hard stool to send me right into crying like a small child mode :) Thanks for asking, hopefully you continue to improve, it sounds like you're making some darn good strides!