Asdf,

I'm sorry to hear that you are having such a difficult time healing from this torture; just wanted to wish you all the best in whatever decision you make. Only you know how much more you can take and I wish you good luck. May you be healed soon, I'm praying for you!

ASDF,
When you talk to your Kenalog doctor, be sure to ask how he decides how much streaching of the anus is necessary with the manual dilatation. There are risks with manual dilatation: rectal tear, incontinence, blood clot. Many doctors think the manual dilatation is crude because if the sphincter muscle tears durning dilatation, the amount of tear is not controlled. If you already have low resting pressure, is the manual dilatation still done?

In the old days they used the four finger rule to determin how much dilatation was done. If the old four finger rule was used on me, they might as well rip my heart out at the same time.

Thank you Alyssa.

Yes I plan on asking about the dilation part, and especially since I have had some surgery to region and already may have some sphincter weakening as a result. Check out his link here:

http://www.columbiasurgery.net/2014/04/ ... ry-update/

Supposedly the dilation is very light, and not the "four-finger" thing that you had mentioned...

today was possibly a setback day...I *think* I could visually see blood streaks on the BM this morning, but they were light and so I am not sure... so frustrating. I think I am just going back to the CRS this week to get it looked at. If he says anything other then "You are healed," I am going to do the kenalog thing the following week. I can't live like this.

Hi Asdf,
So sorry you are having ongoing issues, good luck with the CRS, I'm praying for you..... Xxxxx

Asdf, thanks for the little article on kenalog. It's always nice to have another option to heal. Do you know how the steroid actually works to heal the fissure. Like Botox and LIS try to relax the area so the fissure can heal, how does kenalog work to heal? Hope you feel better and keep us posted.

Thanks Rachael. This website is literally the only thing helping me keep my last shred of sanity. I have to remember though, I have improved significantly since that first hemmie surgery. I had a stricture and two wounds that were described to me as "ferocious". I am now down to just one wound, and have even gone at least 2 weeks without finding blood in my BM. So I have to be grateful for where I've gotten, at least, and hope that I can make the last few steps to heal up for good and maybe even in time to enjoy this summer.

Hi Apes,

So I'm certainly not the expert, but I do know that if you have non-healing wounds in other, more conveniently located, areas of your body, steroids are often used to help push the wound through it's granulation phase, which is where chronic wounds usually get stuck... Wounds go through natural phases (try googling chronic wounds), bleeding, clotting, granulation, then collagen is produced and the wound margins contract while the surface epethelial layer covers the wound bed. For instance, I actually had a birthmark removed from my chin because I kept bumping it with the razor in the morning, and although the wound did heal, the scar was slightly raised because of excessive granulation under the skin. The dermatologist injected the scar with a steroid, and the scar softened and is now essentially flat with my skin. So the reasoning is simply to apply the techniques of other chronic wounds to the fissure. I can't guess how much of the healing comes from the dilation part and how much comes from the kenalog/cleaning part, though.

Thanks asdf

Saw my CRS yesterday and he confirmed for me that there is still a wound there...And I bled again a bit just now with the morning BM which required a little pushing unfortunately. I wasn't constipated, it just wasn't the kind of dreamy soft smooth effortless poop that my tender unhealed butt requires. That settles it in my mind. I'm going to have that procedure 1 week from today. My CRS agreed that going to 40 treatments without a healed wound sounds a bit ridiculous given that people go into those chambers with massive sickly wounds usually to avoid an amputation. If insurance will still cover it, I'm going to resume HBOT a few days after the procedure too. I don't see any downside other than that clearing your ears sometimes requires a valsalva maneuver, which is the same pushing that occurs when you have a rough BM, so that alone could be the only downside of HBOT...but I have gotten so good at diving though that I can usually clear my ears without using it at all.

I'm pretty nervous about complications from the procedure actually, as it's kinda experimental and I genuinely have very little faith in a doctor's word or the human race at all anymore, but I won't give up until I am healed and back in the gym 5 days a week and running jumping biking swimming maybe even surfing without fear of aggravating or insulting my chronic anal wound. Oh and eating whatever I want and even drinking once in a while with my friends would be nice. If this doesn't work, I will be going for another flap, a bigger one, with more tissue, like a house flap, and if that fails...I'll find something else and try try again.

Asdf, I think this is really exciting. Hope of healing. You seem like such an active person, all positive thoughts in your direction. This is going to work and in the process you Are going to help countless people in this community. Do you reside in NY or are you traveling for the procedure?

Thanks. I live in a suburb of the city so it's not too far of a ride for me. I'll probably take public transportation in and then an ambulette or a cab home... I am going to see Feingold tomorrow for the pre-op blood test and paperwork. I plan on asking a lot about the dilation part and explaining that my butt has been through a lot so he can go easy on that part of the procedure.