VY Advancement flap?

You did Steve!

Post of 11th July: \"told will start noticing diff after 48 hrs\"

I will be delighted if the benefit does in fact appear later. I'll give Mr B a ring and see what he says. I really cannot now recall what he might have said timewise.

Hi Pete

Any progress yet?

I thought yesterday was a turning point as woke up in morning feeling great with no pain at all. Last night started getting bad again and this morning as bad as ever so guess dont know what to make so far. Had to use instillagel for pain which have always avoided up until now.

A bit down as this bloody thing gives so many false hopes.

Hope you are fairing better.

Steve

That's bad news Steve.

No progress on my side at all. I tried yesterday to speak to Mr B's sec to

get his opinion on the timeline if the botox is going to work and am waiting for someone to get back to me.

It is difficult not to be pessimistic. I may try acupuncture or similar as the last throw of the dice but deep down I fear that an op is looming.

If LIS works by reducing muscle tension permanently you would have thought that a chemical sphicterotomy via botox would have the same effect -at least temporarily.

Hi Pete

I had same prob trying to get through on phone this week. Just had call back though to say can see this evening so will discuss with him then. Will let you know what he says as may save you the cost of a trip up. Just some further info which may help if you get to stage of considering sgy, especially re Advancement flap. There is a website called **** Its a new, helpful and valid site that if you can spare ?15.00 and ask a question to a guy called Mr **** who is a respected colorectal surgeon in Scotland he will respond with detailed info on what he recommends if you tell him your story. He is pro adv flap but will recommend what he feels is right rather than just what technique he is trained in. He can answer/dispel any myths re adv flap and poss side effects.

Steve

[color=orange:2243144135][size=9:2243144135][b:2243144135][i:2243144135](Sorry but Patient Admin have removed a Doctor, Consultant and or Hospital name from this posting, as it is the policy of Patient UK not to publish these on this forum.) [/i:2243144135][/b:2243144135][/size:2243144135][/color:2243144135]

[color=green:2243144135][size=9:2243144135][b:2243144135][i:2243144135](Sorry but Patient Admin have removed either a telephone number, an email address, a postal address and or web address, from this posting, as it is the policy of Patient UK not to publish these on this forum.

If you wish to communicate directly with people, you should register, for free, with the forum (click Register in the menu list below the green banner above). You and other registered members will then be able to communicate with each other via Private Messaging (PM) or e-mail.) [/i:2243144135][/b:2243144135][/size:2243144135][/color:2243144135]

Steve, I got through to the sec. She said that she would try to get hold of Mr B and see what he wanted to do but her impression was that improvement should be noticeable after a few days -so your initial view of 48 hours now seems correct. Anyway I wait to hear what he says to you.

I have read some of the posts on the site although the person posing the questions seems to have had fair improvement pre botox.

I guess I need to know why LIS would work if Botox doesn't and whether having had botox you cannot have LIS until the muscle has returned to normal. After that do you go LIS or adv flap? We know Mr B will say LIS first but I have an aversion to being cut-however irrational.

Steve, spoke to Mr B. He said that you should expect to see results in the first week so looks like it hasn't worked for me.

LIS is a more radical version so should work where botox fails.

His view is that by my symptoms of hours of pain/soreness after passing there is a spasm problem that would be best addressed by LIS rather than adv flap.

However the next step if you want to proceed incrementally is to have a repeat botox injection at a higher dose together with a fissurectomy.

I suspect that I will try that but I do not know if I am not just delaying the inevitable.

Hi Peter

Seen Mr B yesterday and similar advice as to what he gave you. Said it looks like a spasm problem and would recommend another increased dose of Botox which he could of done there and then. Decided against it. My thinking was that i would of expected some improvement with standard dose given. If i had felt in part better i would have prob gone with it. After inspection he gave me option of MRI scan to ensure no abcess (or worse) although doesnt think likely. Decided to go with it for peace of mind. If all clear decided on the LIS. Think have to bite the bullet as quality of life, food regimes, and generally making those around me miserable.

We discussed adv flap and LIS in detail. Firstly you can have LIS without waiting for botox to run its course. Incontinence risk 5% gas and occasional leakage. He has had no cases of this or any incontinence in any LIS he has carried out. Saying that he mentioned he doesnt do many thesedays due to the new conservative treatments about. Adv flap for me he said simply wouldnt work. For you it might.

He didnt mention fissurectomy, if i had remembered would have asked. Another consultant i had prev seen did say botox without fissurectomy may fail. Prob with this is that there is only a 75% success rate with still a small chance of incontinence. I think this is choices and risks we have from what i gather:

LIS - Success rate 95-100%. Incon risk 5% (less for men)

Adv Flap - Success rate - Unknown although from few studies done 75%-85%. Incon risk 0% - Infection and wound healing issues, Big op.

Fissurectomy & botox - Success rate 75% - Incon risk Small

More botox - Success rate 80% apparantly. Incon risk 0%

For me LIS appears best option so unless a miracle happens that looks like where i am heading.

Steve

Steve, thanks for the useful summary of the options.

We are may be similar in that ongoing spasm points to LIS as the best

intervention but I am still reluctant to have something as radical as cutting and permanent weakening of the sphincter muscle.

The published results on fissurectomy and botox even on those who were previously botoxed seem decent and my inclination is to to try that before moving on. I obviously can't say that it is right for you but I think that you may at least wish to discuss it if as appears you did not do so.

I know that we have been advised that the adv flap is not appropriate in our cases but it looks like a more conservative and appealing option to me and I would want to have it ruled out completely before having LIS.

Mr B although not in favour did not agree that it was a \"big\" operation and quite frankly I can't see how creating a flap to cover a lesion should be.

Presumably Mr D did not rule you out as being unsuitable?

Good luck with whatever you decide. Hopefully we can both get past the daily agony before too long.

Peter

Have you got personal email address. Will fwd info on adv flap from scottish consultant i mentioned but was blocked on here.

Are you any better at all?

Steve

No improvement at all Steve.

During the last 6/7 months I have had a few better days and some better weeks but overall the suffering just continues with no hope in sight.

I went to the site you mentioned and read all the advice given by Mr C-B thanks. You didn't get any additional advice did you?

If I go for the fissurectomy and botox Mr B will not now be able to do it for another month I was told today.

Peter

A month seems long time to wait once you have decided what you want dont it. I am resigned to surgery but which seems to vary by the hour. Guess all you can do is gather all the facts and choose what fits or feels right.

Still in lots of pain. You mentioned accupuncture prev, does this work?

Steve

Steve, I am looking at who else might do it because of the wait. There is a group of consultants who have published a fair amount on fissures in Oxford and I am looking at them.

I tried one acupuncturist who did not have a clue but they should be able to help with pain control if nothing else I would have thought. I am going to try another.

My current position is that fissurectomy with more botox is worth a shot and I want a second opinion on the adv or rotational flap not being appropriate in my case. I am not going to be cut easily.

I know the pain Steve. We both face and deal with it everyday.

Peter

You might find it useful to spk to Tony D re adv flap. To be honest i didnt really like the guy when i met him but am aware this could be clouding my decision in what i decide now. I actually went with my partner and she thought he was fine so maybe just me. As an impartial observer you have always seemed to favour this approach from day 1 so could be the useful second opinion you say you need. He does a lot of ops which maybe reassuring. He does surgery in Bristol on Fridays with no long wait after consultation, unsure about other areas.

Chris

Steve, you are right. I do have an aversion to having my sphincter muscle function impaired albeit this may not be significant.

LIS may be the better fit for my condition but I still like the sound of the adv flap better. I would however not try either before the fissurectomy plus botox.

I will think about Mr D as well as the Oxford group I mentioned.

Obviously paying privately this all gets to be pretty costly.

By the way have you read the \"Maybe this will help someone\" thread?

I have been using the flax seed oil and prunes and it has certainly had way more effect than the bran and stool softeners I had been been taking. I have not implemented the rest of the regime and do not expect a cure but my early morning agony has certainly been eased somewhat

although nowhere near the point of avoiding further treatment.

Thanks for that Pete!

After you mentioned it I Spoke to accupuncturist guy i know who was going to check the validity of a report claiming 80% success rate on Chronic fissures. Am naturally sceptical but asked him to look into it. Apparantly you would need to commit to 10 sessions every other day & the needle placements were in his words `as uncomfortable for him to place as they would be for me to take`. He is always honest with me so will let you know what he says.

Any changes from the botox or still same?

Steve