VY Advancement flap?

No Steve, no change. It definitely did not work in my case.

The flax seed oil/prunes regime is a great natural laxative and works a lot better for me than commercial stool softeners/bran fibre. Definitely eased some of the early morning agony.

If fissurectomy and botox do not work I am, as you know, inclined to a flap although yet another complication to consider is the advancement v rotational flap. I do not know who does the latter but it is mentioned in some studies.

I am also thinking about whether it would be preferable to have the first procedure done by someone who is going to follow it, if necessary, with a flap as Mr B is inclined to do the LIS. There again as I have limited money I am also having to think whether to go straight for the flap. The fissurectomy and botox alone will cost about £1500.

Let me know about the acupuncture.

Hi Peter

Hope you still managing ok with the flax.

Had MRI scan followed by appt with Mr B. Scan thankfully clear of anything more serious. Spoke to a few people whilst waiting to see Mr B and he does have a reputation as being top in his game. I also like the guy which for some looking for treatment may not matter but for me need confidence in someone which i feel have for him. Seen 4 consultants and he by far best (although results so far am aware not great for both of us) We discussed fissurectomy options which i forgot to ask last time. He said he only performs about 7% of Chronic fissures with fissurectomy as doesnt see benefit of opening up wounds further and in my case definetly wouldnt recommend as it looks like its partially healed. Did he say yours was still open?healing?

Option will go for is more botox next week if no better then LIS.

Interesting that so many who have had botox have been told 3 to 4 weeks before improvement when Mr B stating days (see `long road` thread et al)

Steve

Meant to say Re accupuncture.

He got back and could find no further evidence for 80% claim (google `anal fissure accupuncture blue poppy`)

Strangely though he gave me a treatment Saturday and last few days been little better. Have been looking for other explanations and poss just one of the lesser pain weeks but makes you think, at least this rational thinker anyway.

Steve

Steve, the scan looks like a good idea. At least you know yours is healing.

I wonder why it does not appear to be offered more often.

You are getting me concerned about the fissurectomy. I wonder why Mr B thinks that opening up the wound further would be a good idea in my case. He did not say if it was open or healing. Maybe another higher dose of botox would be a better next step although the studies involving fissurectomy and botox look decent.

The differing views on the time frame for botox working is also confusing

Flax seed oil/prunes are good for me although obviously we are talking reduced pain not improvement of the condition as such in my case. I have not implemented the full vitamin regime regime although perhap I should.

Acupuncture may be placebo or may coincide with general improvement or as you say a weekly change. It is difficult to work out what does what but facing surgery, anything is worth a try in my view.

Peter

Unsure whether Botox has just started kicking in but last few days been virtually pain free. Am used to the usual good day but never for this long. Am hesitent on thinking have it cracked but am hopeful. U any different? Am hoping the 3 week before improvement opinion is working for us both.

Steve

Steve, that's fantastic news. I'm really pleased for you.

I don't suppose the acupuncture had anything to do with it?

Weren't you due to have more botox this week?

I'm still the same and after what you told me have been debating whether to have a botox top up or proceed to the fissurectomy plus botox. Money comes into it as well in my case especailly if it doesn't work as I will have to fund another alternative.

Fingers crossed that you have made a breakthrough. Being virtually pain free is absolutely massive after all this time. I can't imagine it. Very,very good news.

Peter

Thanks so much for your kind words. I equally hope you can find a breakthrough with this also. Still good this end. Sat down most of yesterday so a little uncomfortable but no more than that. I did wonder if Accupuncture could of been the diff and he actually called me this morning to notify he could find no more details/support of the report i mentioned re accupuncture and fissure. When i told him of improvement he did say he carried out a `dragon` treatment which is a treatment he has used prev with great results but not specific to any condition. I am naturally sceptical of some alternative treatments and claims but facts are that i went to see him followed by 3 improving days and 4 virtually pain free ones so maybe i should be a little more open minded. (Thanks for suggesting it initially) Yes, it could also have been the botox but guess who knows. I was pencilled in for more botox this week but have put on hold until see how this pans out. Hopefully will not need now. My accupuncturist guy might be worth you having a chat with, he is always happy to discuss on phone although unsure how practical to visit as he is in Bristol. Am happy to give you his number if you wish. Its a tough choice for you re Botox or fissurectomy. Guess more botox cannot do any harm - fissurectomy it appears after chat last week he doesnt favour but guess your situation may warrant it if he discussed it as option with you. Got all my fingers crossed for you Pete.

Steve

Possibly spoke to soon. After sitting again at work all day pain back to how it was. Positive is had best 4 days in 9 months - still dissapointed but guess nature of this is that it gives you occasional false hopes. Steve

Steve, that's tough but maybe it is a prelude to better days.

I wonder whether the fact that you are partially healed is grounds for optimism? Can you end up partially healed but never fully healed or does it mean that it will eventualy heal if you put up with it long enough?

Thinking about it I never did ask any of the consultants what happens to

long term sufferers who do not undergo LIS. Is there ever any healing ior just a lifetime of agony?

I am re reading the studies on fissurectomy and botox but if you have not had a scan to show that the fissure is fibrotic what justification is there for the fissurectomy?

Hi Peter

The scan i had was to check for abcess/infection (or something worse) after he felt lump which was prob a skin tag. Visually he could see that it was partially healed but gave me option to have scan.

Apparantly only 10 % of chronic fissure improve spontaneously. He told me the people who can just put up with it are those with low or average sphincter pressure. Because i am opposite the constant spasms are the cause of pain so its difficult in patients with hypertonia to just leave. I phoned Mr B who is now away for two weeks so am bit annoyed with self never got botox top up when had chance last week. Going to go back on diltiazem to see me through. Finding sitting down a lot is a killer for me at moment. Hope you are fairing better. If get desperate guess there is always the accupuncturist and his 10 intensive sessions.

Steve

Steve

Steve, as always you are a mine of information.

I also have high sphincter pressure which is no doubt the reason for the difficulty of healing and according to Mr B a contraindication for adv flap.

I tried to get more info on fissurectomy plus botox from the Oxford group who published the fissurectomy plus botox study but I was, of course, offered an appointment to discuss. I said that I only needed a couple of questions to be answered about their current success and did not need a full blown consultation. Anyway I have sent an e mail.

If the acupuncture hasn't worked for you it is not going to work for me.

Totally off topic, I developed an unconnected hernia about the same time as the fissure and have been going through the same paralysing decision making with consultants giving different opinions - open surgery v keyhole/Tepp v Tapp/mesh v non mesh/ chance of long term nerve pain etc- . Not surprsingly if you have read this thread I have elected for \"watchful waiting\" -otherwise known as being unable to make up my mind. I do not however have a parallel internet discussion going on regarding the hernia.

Sounds tough Peter. Fissure decision is hard but combined with which hernia treatment is something you could do without. The positive is that coming at same time means double the hassle now leading to probable permanent resoulution in a shorter time.

Sadly my situation has got worse. Last 24 agony. a large swelling developed at site of botox injections. Looks like thrombosed haemmeroids. Unsure who or what to blame for it - Mr B or myself for sitting lots this week. Considering A&E tonight as pain is pretty bad but Saturday nights in Bristol hosp arent great so may try to hold on until monday and see anyone wo is free. Last week was worried about 1 op when likelihood now may need two. Feels cruel world tonight.

Steve

Steve, this is really terrible. I can only wish that you get over the pain and have a speedy recovery. Hopefully you are better this morning.

Talk about bad timing- Saturday night for A&E anywhere is not going to be clever.

Can you get a thrombosis from the botox after all this time? On the other hand what else could have caused it? It is bizarre that this has all happened after the apparent improvement. Can you get access to another consultant immediately?

Peter

Thanks for support. Seen a consultant today and confirmed is thrombosed hem. Said was just unlucky and if can bare the pain it should get better on its own within 6 weeks. If i cant then minor op. With 9 months practice managing fissure pain will see if can ride it out. Discussed need for fissure sgy and he was reluctant to perform due to risks of sphincterotomy.

How is decision making going with hernia & fissure?

Steve

Steve, was that related to the botox injection? Hopefully the reassurance that it will resolve itself with time will help you manage it.

I seem now to have provoked a painful haemorrhoid as well although it is lower grade pain compared to yours.

I managed to have a limited e mail correspondence with a consultant in Oxford who has featured in a number of the botox studies. He appeared to have fairly standard advice: LIS if high resting pressure, flap maybe if

low resting pressure, fissurectomy plus botox if edges fibrotic.

I also saw another NHS consultant this morning. Same hospital as previously but unlike the previous consultant who wanted to go straight for LIS he thought that fissurectomy plus botox was definitely the next step with good chance of success. Did not think that botox alone was a good idea. Thought that LIS was premature. Thought that there was a high failure rate with the flap- although I wonder if that is the case where they are doing a lot of them?

Anyway prior to this morning I was getting pretty resigned to having LIS. The recent review in the World Journal of Gastrointestinal surgery supports that approach if you have high resting pressure following failed medical intervention and botox. Unfortunately this site prevents me posting the link but you can google it.

One important point from the article -if you go for LIS -does seem to be that the division of the anal sphincter should only be up to the apex of the fissure to limit incontinence risks.

Anyway to avoid being cut I am now jumping at the fissurectomy plus botox. I know that Mr B does not want to do it in your case although he wanted to do it in mine but this mornings consultant said that the edges woud inevitably be fribotic and needed cleaning out. This was without visual examination.

As usual all contradictory and there is an element of finding someone to say what you want to hear but for now that is where I am heading.