How to use nitroglycerin ointment?

Try more Miralax!!

Yea up that miralax, NG !
The anaesthetic does seems to slow things down a little...
Good news you have an earlier appointment, just hang on in there
My fingers are crossed !

Awesome on the earlier appointment!! You'll be better in no time! You can use my line with them..."surgery or death!" Tell them you're not leaving the office (literally) without a surgery date. Keep us updated, please!

I agree with Cheryl and Tabby, going up in the Miralax should help offset the Percocet constipation, hopefully! Fingers are crossed there! And I join in with Sidra in thinking how awesome it is you are getting an earlier appointment. Now I may be wrong, but I think you'll get authorization for either procedure. It's really going to come down to what the surgeon indicates. If it is botox, I hope it works for you.

If you haven't already, I think you should review the botox posts and threads here and get a good feel through our boardies' experience. Keep in mind that we have seen several cases that still required LIS, so if your CRS leans that way (LIS) keep an open mind in that direction.

Kim/NG,

Tabby and I are the Miralax (and IBS) experts!
Cute pic, Kim!!

Thank you everyone. I can't stress enough how grateful I am for all of you. I will keep you all posted, thank you so much for being so sympathetic toward some random dude who just whines all the time.

I tried keeping the Miralax the same (full dose per day) and for some reason it gave me abdominal cramps and diarrhea today. Have had to go poop 6 times already, and I can feel it's not over yet, it's just a little bit of watery stool every time. Weird. I'm not sure where the heck my balance between hard/soft stool lies, I just wish it would all exit in one or two BMs at once as opposed to over a whole bunch of small but super urgent ones that torment me dall thru the day

I think I am going with whatever the surgeon can do first. If it's botox then I'll try that. If it's quicker to get LIS then I'm doing that. I don't care anymore, each day is becoming more and more hellish, I'm completely housebound at this point.

The questions I have so far to ask the surgeon are:

* Can botox be ordered on short order (like next week)?

* Can LIS be ordered on short order as well?

* Should I get a colonoscopy to check for Crohn's or ulcerative colitis first, or should I wait until the fissure is somehow contained?

* If I do have Crohn's or ulcerative colitis, does that change how we go about treating my fissure?

Once I know the answers, I think my path forward will be clear. Basically, if I'm told that LIS is my best bet, regardless of whether I have some other bowel disease, then I'm almost certainly going to opt for LIS. Enough is enough. I'm on a diet of only boiled cabbage and broccoli everyday now and am strung out on valium and percocet all day, with the occasional nitro headache, so I can barely tell you what day or time it is.

Sometimes physicians are so hard to deal with. In the ER, the doctor knew exactly the kind of severe pain that fissures can cause (guess I got lucky), was very sympathetic, and immediately explained that he should put me under to check for absesses, ulcers, and anything more sinister that could explain the pain. No absesses found, but he did find those ulcers. No other physician I've seen even considered doing a more thorough investigation, it was always ""eat more fiber and drink lots of water"!!! When I'd asked for painkillers before, all they did was tell me to take some ibuprofen or tylenol, which I'll tell you right now, didn't even begin to touch the pain! I don't know if the ER doc I got actually personally suffered a fissure before or what, but he sure seemed to know a lot about them (including the fact that my fissure was 5 degrees off the typical location which warrants screeing for bowel disease) and was the only one willing to send me home with "fissure strength" painkiller; it doesn't fully cover up the pain, but it sure does worlds more than stupid OTC stuff every did!

Oh and Sidra, I agree, I'm going to demand a roadmap forward when I see the surgeon. My wife is driving me there which will help. Truthfully speaking, I'm not always an easy dude to like upon first appearance, I wear baggy pants and have tattoos all over my arms and body (not gang related, just a big body art fan), and sometimes I think that gets me the short end of the stick as far as sympathy. My wife is a tiny, petite, and very sweet, and she's 8 months pregnant with twins so she looks like she'll pop any second now, and I've noticed that people give her more sympathy. She's good at not taking bullsh*t and will definitely make some demands on my behalf too I guess it's a bit of a lesson in human nature, I used to be kind of bitter about the way it all works, but I can't be too mad, after all many prejudices in life help keep us safe

And Cheryl, Tabby, now that I know who the Miralax experts are around here, I may have to bug you guys even more! When Colace didn't do squat for me, I tried Miralax, and it worked way better. But a lot of times I have trouble "harnessing the power" of this beast called Miralax, so dosing is a challenge for me. It seems to have vastly different levels of efficacy depending on what I ate, meat (which I've stopped eating these days for the most part) it barely puts a dent in, salads it turns right into water, etc. It's the only stool softener that works reliably for me, but getting any kind of consistent poop consistency from day to day seems darn near impossible. First things first, though, for now I'm taking a full dose (17g) per day until I get the courage to experiment with it some more.

NG,

You might try DIVIDING your dosages. That works better for me. I take mine @ 2:00 pm and then at bedtime. More ability to adjust the amount that way (twice daily). Is your wife Chinese also? Good luck!

Hey Cheryl, my wife is Filipino. A lot more Filipino than I am Chinese truth be told I came to the US (Missouri) with my parents when I was 2 years old, and my wife only came here (California) after finishing high school in the Philippines.

I currently take half a dose of Miralax after lunch and half a dose after dinner (I don't eat breakfast -- never have). I think what I have to consider more carefully when dosing is what I ate. So far I've been taking the same amount of Miralax regardless of whether I ate salad or fish. I'm thinking of trying less for easy-to-digest foods and more for high protein foods. But mostly I'm trying to eat as little as possible and using valium and oxycodone to cover the pain until the CRS authorizes me for one of the more invasive treatments.

And dang you wake up early

My husband gets up for golf, and we are 2 hours ahead of you!! Maybe you could try drinking Ensure??

Yup Ensure is on my list of things to take if/when I get the fissure in hand. I'm scared to add anything to my diet right now, made a big ol'' pot of cabbage soup today that will be my every meal (along with some bran cereal) for at least the next few days...

Haha yeah you folks are indeed 2 hours ahead of us. I haven't slept yet, though, I'm a bit of an insomniac, so technically it's still Saturday for me

Surgery or death ! Needs must, Sidra

NG ! YOU DONT EAT BREAKFAST

Yes, try drinking Ensure for breakfast if nothing else (the one with fiber).

Hey guys,

Nope, I don't eat breakfast, never have my entire life. I used to skip lunch pretty regularly too. It's a bad way to live, but I was always worried about pooping too much, and was busy because I did a lot of business travel, had to have extended meetings with clients, etc. I've got a comfortable job real close to home with no travel now though

I saw the local CRS today, and I guess the ball's in my court now. She gave me some nifedipine ointment to try since the nitro wasn't doing much. It's 0.2% nifedipine, seems lower concentration than the 0.3% I usually read about online, she I doubt that'll make much of a difference. She says, however, that at this point, LIS may be my best option. She says she's done hundreds of them, and no patients have ended up permanently incontinent, although a few had temporary bleeding for a day or two, and two did get infections at the incision site that required an additional surgery to treat. She says most people have very good results with it. If I want to schedule LIS, she says lead time is no more than 1-2 weeks tops, usually within 1 week. So I have that option in hand if and when I want to exercise it. This local CRS doesn't believe in botox, she says she tried it a few times during her residency and it didn't do much, plus there's lack of clarity over exactly where to inject it, how much to give, etc. I liked her approach, seemed like a good person, was pretty knowledeable about fissures, and is only about 15 minutes from where I live. One other bonus is that she says if she does LIS, she will put me under and examine my rectum for any possible indicators of inflammatory bowel disease, and will abort the surgery if she sees any since then surgery would then be a poor idea. She also says that she'd never prescribe hydrocortisone (which my other physician did) for fissures since they can slow down the healing process.

Now, my other option is a CRS in San Francisco. Immediate downside is it's 60+ miles away from where I live. This other CRS has me on Valium (which does seem to help the spasms some) and 0.2% nitro / 2% hydrocortisone / 5% lidocaine right now. If it doesn't help in 3 weeks, she wants to do botox and indicates it has a 75% success rate in her experience. Insurance will cover the botox injections if I go this route as they have already pre-authorized it.

So basically the summary at this point is...

LOCAL CRS:
-- Is 15 minutes from home.
-- Doesn't believe in botox.
-- Says not to use hydrocortisone.
-- Says to try nifedipine for a short while.
-- Says LIS is my best option (and can get me in on short order), barring presence of Crohn's disease or ulcerative colitis.

SAN FRANCISCO CRS:
-- Is 1+ hour from home.
-- Says to use nitro / lidocaine / hydrocortisone ointment and Valium.
-- Wants to try botox if there's no effect from the ointment.

What do you guys think? Any things that make you lean one way or the other? I know you can't make the decision for me but I value you guy's feedback.

Right now, I'm leaning toward trying the nifedipine for a week, and going for LIS if there's no improvement. This way, I'll have a better chance at being on the road to recovery when my twins arrive. If I do the botox, and it doesn't work, then I figure LIS will have to wait until the effects of the botox wear off, which will push the timeline out at least another month.

I'm going to browse the old threads on the forum and see what others in the same boat have decided in the past now, but any input is most welcome and appreciated.

Hrm ok just read through a number of the previous threads on botox therapy, and so far I'm not terribly encouraged... I wasn't aware that it could take several shots over several months to even assess efficacy. And during the time that the sphincter muscle is paralyzed, it seems like LIS indeed isn't an option. It seems that a lot of people get temporary relief from botox that eventually fades. I think I'm leaning strongly toward rolling the LIS dice if nifedipine and nitro don't get me anywhere over the rest of this week. After reading some of the stories from others who had trouble getting botox or LIS authorized, or who couldn't get botox covered through insurance, etc., I'm at least grateful that no matter what I choose, it will be covered by insurance and can be scheduled without too much of a wait!