Botox Tomorrow

Botox Tomorrow

Tomorrow, I will have botox shots in my anus for my anal fissure.

Ironically, since I've been fasting, the anal fissure seems to be healing.  I am afraid he'll get in there and say it doesn't need botox shots.  I called twice to warn him.  (See below).

I start the fleet enemas tonight after dinner (2), and tomorrow morning before the procedure (1).

I will have stool in there.  When you don't eat, the stool that is already in there just sits there, and as it sits there, it hardens, because water is drawn out of it in the intestines.  It gets rock hard and dangerous.  This is why fasting is not considered a viable option for treating fissures.

It would have to be done under careful doctor supervision, perhaps by totally emptying the entire colon first, as they do before a colonoscopy with the oral stuff.

Since I have done this before with fasting (four days of fasting before my colonoscopy), I know what to expect:  the insertion will be very painful the first time because of the fissure.  A bunch of terrible burning stuff will come out, including lumps (I hope they aren't too hard).  The second time, of course, if will hurt worse, and the third time, worse yet, since the enema nozzle and the burning shit and enema mixture will damage the fissure area.

I think, if I could fast long enough with doctor supervision and assistance, I could heal without the botox.  However, I am now committed to the Botox.  I'm afraid now that the doctor will say it's not bad enough for botox shots!  It has been getting better every day.

I tried yesterday to call and talk to the doctor.  I got Catherine, who's intelligent and sensible, but Barbe wasn't available and Catherine was with a patient.  She gave me to Yvonne, who seemed like and must be a total moron--she delivered the WRONG MESSAGE, the exact Opposite message, to the doctor, who was then wanting to switch me to having the OPERATION tomorrow!!! (AS reported later by Catherine when she called me back).  NO NO NO!!!  I told her NO, that wasn't what I said.

I called Catherine back again today to reiterate that I am IMPROVED, not worse. (Thank God I didn't get Yvonne). I asked Catherine to PLEASE tell the doctor, as I was worried he might actually be upset by the fact that I'm so improved.  However, after three Fleet enemas, I might be back to ground Zero.  Also, of course, he will be also shoving that sigmoidoscope up in my butt, which has the potential for tearing and damaging the fragile healed parts.

I'm likely to come away feeling MUCH WORSE than I feel now, between the enemas, shots and sigmoidoscope.

I wish I could talk directly to the doctor, but he's never available when I call.

I am trying to be practical and realistic in my expectations.  I am willing to have things turn out better than I fear.  I just don't want them to turn out worse.  

I hope they give me something for pain.

Support in an email

I am up in the night because my pain in the butt hurts too much to sleep.

I just received this nice note from my friend Pam, which while it doesn't take the pain away or help me sleep, it does help my heart:


Your pain is unfair --and dreadful. May the procedure go well, and act faster and more swiftly than anticipated.

In spite of it all, you add to the world's beauty, with an artist's eye and hand, and your courageous spirit that keeps rising every time it's smacked down.

You are loved and admired.

Mary is one very intelligent, brave, beautiful person, with talent and gifts. May this current curse be the last one you have to endure before the blessings rain upon you

Answering Questions about Bearing the Acute and Difficult Pain

A friend (Pam) asks:  What do you do when in such severe and protracted pain?  Can anything distract?   Temporarily?  What do you do physically?  Damn, I wish I could help.  Also wish they'd DO MORE for the pain!!!   Pain amelioration is not an advanced science, for sure.  More damn !!!!!!!!!!!!!!!!!!!!

I answer:

During the super acute phase of the pain, I stand in the bathroom applying hot compresses to my butt leaping around crying.  This lasts like 40 minutes (or more) after every poop, and though the hot compresses seem to help a little, they do not help enough.

Nothing distracts.  The pain is too intense--It is all there is.  It seems unbearable.  (But I am, of necessity, bearing it).  I stand by the sink, apply a hot compress with one foot up on the toilet and then repeat over and over.  I leap about, run back and forth, sweat profusely, cry and scream.

Eventually, hopefully, the pain fades a little to semi-acute stage.  During this stage, I run back and forth from the heating pad to the bathroom to repeat above, only with groaning and moaning instead of screaming and crying.  Sometimes, during that stage, I can walk around the house or even outside BRIEFLY, before returning to the hot compresses.  I am having pain, which is pretty bad, but the walking helps some. 

That stage usually doesn't last more than about 20 minutes.

The next stage is the sitting on the heating pad stage, which at first hurts so much I can hardly sit, but then the pain gradually fades after 15-20 minutes and I can sit and work on the computer.  It still hurts!  The distraction of the computer helps.  At this point, there is still too much pain to say, cook or prepare a meal or do anything away from the heating pad.

With every poop, the whole cycle repeats again.  Depending on the timing and severity of the poops, I may never get past the acute or semi acute stage before the pain is ramped up by the next poop.  Each poop is progressively worse and I've been averaging 3-4 a day (which the doctor says is NORMAL.)

Another thing the cycle the pain is the pain meds.  I am taking both Ibuprofen and acetaminophen and trying to do it so they overlap each other.  It’s a complicated schedule, but as the various doses wax and wane, so the pain, to some extent.  Even if I am on a FULL DOSE of BOTH MEDS, the pain during and after pooping is still nearly unbearable.  And the poops seem to like to schedule themselves at one of the waning points of meds.

If I am lucky, the pain fades to the point where I can stand long enough to prepare a meal or maybe take a walk or do some exercises, or some small chores.  Yesterday I never got that good.  So far today, I have not had breakfast.  I am on the heating pad, but the pain is fairly bad and I am thrashing around.  I have not been able to do anything yet today.   Yesterday, as I was trying to relieve the pain on the heating pad, by shifting one way and then the other, I knocked the chair over with me in it.

The doctor (Barbe) tells me there are no stronger pain meds that do not cause constipation (or, all stronger pain meds cause constipation).  (Earlier today, I wanted to go to the hospital and beg for morphine.)

Always, there is the fear of the next poop. 

Loneliness and Isolation

I read that isolation and loneliness contribute to depression and that isolation and depression contribute to dementia.  In any case, isolation isn't fun.

I'm home alone all day.  Keith comes home, and then, leaves again as soon as possible.  Today, he went to Home Depot, and then R'dale to do some work.  The work does need to be done.  AND he probably doesn't want to be with me when I am miserable.  I do not blame him.  I am miserable when I'm miserable.

I am also lonely.

And no one can come visit.  And really, no one can call.  Scott called this morning to be supportive, and I was in so much pain I couldn't concentrate or make good conversation or even be a good listener. I am stuck.  Alone.

I can read Cowbird stories, theoretically, or send emails, or go on facebook, but most of the day, I was in too much pain to sit and read or type.

Jiggling (Pain Remediation)

I've discovered jiggling as a pain remediation for my "anal fissure.".  I discovered it by accident, by doing it inadvertently.

Sometimes, the very warm/hot compresses do not help.  Sometimes, they make it feel worse.

Sometimes, I can't sit on the heating pad.  It's weird when the one thing that usually helps the pain doesn't.

But lately, one thing that is currently helping is jiggling.  There are different methods for jiggling.

• on the toilet, with the toilet paper, gently pressing and jiggling the anus
• using warm washcloths pressed against the anus and gently jiggling them
• jiggling the butt cheeks gently. 
• jiggling the legs back and forth very quickly to produce a jiggling in the anal area
• walking

Depending on the level of the pain, jiggling can make it lesser or almost gone.  But the minute I stop jiggling, the pain returns full force.  I think that it relaxes the sphincter, but this is only a personal theory.  I have yet to read anything about this anywhere else.

NOTE:  GENTLY is the operative word here.  too much, too fast, too hard makes it worse rather than better.

Problems with jiggling:  When the pain is bad, jiggling works best in the bathroom by the sink with warm but not too hot water.  I have to keep replenishing the washcloth with just the right temperature water, and applying it to the anus and jiggling.  When the pain is bad, I may be doing this for 45 minutes.  Unlike sitting on the heating pad, where I can use the computer or paint or something, or having a sitz-bath, where I can read, I cannot do anything else.  And it's tiring.

Another thing is, I don't know if it does anything positive toward healing, or whether it just alleviates the pain a little.  This is in addition to Ibuprofen and acetaminophen.  (Which, by the way, I took some of BOTH today because the pain was so bad.)

LATER:  I've stopped jiggling as much as possible.  I was thinking the jiggling was helping to relax the anal sphincter, but I worrying that it may damage the torn flesh.

Butt Report for May 19, 2013

Butt Report for May 19, 2013

I actually did have an incrementally better day today than two previous days. A slightly “less-pain” day.

What exactly does that mean?  

I didn't have to take any "extra" Ibuprofens (the day before I took 7 instead of 6--and one day I took 8) and I didn't have to supplement with Acetaminophen (The day before I took 6 of those in addition to the ibuprofens).  And I didn't have to get up twice in the night because I was in too much pain to sleep and take more pain meds and apply hot compresses.  

But I also don't consider missing my own featured poetry reading and leaping about in pain and having to sit on a heating pad all day a "good" day.  

I took exactly 6 Ibuprofens yesterday.  It doesn't stop the pain, but it does take the edge off a little.  That is a slightly improved day.  

I have 9 days left before I can speak with the doctor again.  9 days before I can call for an appointment, then if there is to be a botox shot, there are several days of prep required.  And I don't know how quickly they schedule you.  Then 72 hours before the botox takes effect, and then the thing still has to heal on its own.  I am not eager to do the botox, but this is wearing and exhausting.   :-(

Risk factors for Anal Fissures

• Risk factors in the development of anal fissures include chronic constipation, passage of hard and/or large stools, straining during defecation, and prolonged diarrhea.

• Diets low in fiber and water may increase the risk of straining during defecation and constipation and thus may increase the risk of anal fissure development.

• Diets high in agents that may increase the risk of constipation, including caffeine, may increase the risk of straining during defecation and of constipation and thus may increase the risk of anal fissure development. Spicy foods may aggravate symptoms of anal fissures.

• Aging is a risk factor for anal fissures. Aging is often accompanied by decreased blood flow to the anus, increasing the risk of nonhealing wounds.

• The potassium-channel activator nicorandil may increase the risk of anal fissure. Use of this agent is associated with increased anal ulcerations. However, the available research is limited.

• Pregnancy and childbirth may increase the risk of anal fissures. In pregnancy, up to one-third of women develop anal fissures and external hemorrhoids. Constipation and dyschezia (retaining stool in the rectum) during pregnancy may be the main risk factors during pregnancy.

• In infants, risk factors include infrequent diaper changes and constipation, often due to inadequate fluid intake. Infants with a previous episode of abscess or pus at the time of surgery were more likely to have recurring anal fissures. Early introduction of cow's milk may increase constipation and therefore the risk of anal fissures.

• Other risk factors in adults include harsh anal hygiene (rough toilet paper), chronic wetness around the anus, rectal irritation, bariatric procedures for obesity, constant saddle vibration (in professional mountain bikers), the use of bidet toilets, sexual abuse, and inflammatory bowel disorders such as Crohn's disease.

from here

Note:  Other risk factors in adults include chronic wetness around the anus.  What about sitz baths and all the hot compresses I've been using to alleviate the pain?  The more pain I have, the wetter I've been keeping my anus--is that making things worse?

Going to the Opera with an AF

dark night of the soul #130515

In the morning, I was able to do my exercises and make and eat breakfast even after pooping 3 X --which may not seem like that much of a miracle--but for me, it was very hope inducing.  Then, I pooped a fourth time and fell into agony. All hope was lost.  The rest of the day I spent in pain.  Since I'm only allowed 6 ibuprofens per day, I ran out.

Last night, we went to the Opera, Aida.  IT WAS TORTURE for me, and I (mostly) wished I hadn't gone.  The opera was pretty good--but I had a lot of trouble enjoying it, and it was complicated by the fact that I hadn't slept the night before--I was so tired.  The costumes, pageantry and music were terrific.  If only I wasn't in so much pain and discomfort.  I felt like I was disturbing everyone jumping up and running around, but I couldn't sit still.

The pain was bad driving, and sitting in the seats was just terrible.  I had to keep getting up and walking around.  When I got home, I couldn't sleep because of the pain.  I sat on a heating pad with a wet washcloth under my butt and worked on an art piece.  Went to bed at 12:45.

Butt Report for 9:30 AM Tuesday May 14, 2013

The Dire Wolf of Pain among the Posies
Pain, and the efforts of others to pretend the pain
is something less than it is
click image to view larger.

About half an hour ago, I had to urge to use the toilet.  I'd already gone twice.  (The doctor says that's normal for anal fissures--the pain causes the sphincter to tighten).

poop #1--painful, no visible blood, painful afterwards.  Applied hot compresses.
poop #2--very painful.  Some blood, not too much.  Quite painful afterwards, still hurting from poop 1.
poop #3:  VERY PAINFUL.  FRESH red blood.  HURTS A LOT!!!  right now.

Most days I sit on the heating pad until 3:00 or later.  Sometimes until bed.  The heating pad relieves the pain, but I can't do much of anything.  Some days I can't even get up to prepare myself breakfast until after noon, even after 2 PM.  Some days, Keith has to make dinner because I'm in too much pain.

I don't see any light at the end of the tunnel.  It's easy for other people to say "things will get better," but I've had this since March, nine and a half WEEKS, every single day, day after day, and it is VERY PAINFUL!  Sometimes agonizing.  Sometimes I scream and leap around, it hurts so much.

The pain never goes away.  NEVER.  Sometimes, in the LATE afternoon and evening, it subsides to a burning pinch.  When it reaches this point, I can tolerate it enough to do certain things, walk, cook, eat, paint.  If I am doing something that really engages me, I forget about it, sometimes, and then I feel it again the minute I stop concentrating (on painting, for example).

I feel it all night long, whenever I wake up.  (I wake up a lot.)

The pain is exhausting.  It makes me tense, tired and cranky.

I don't like taking so many Ibuprofens.  It's bad for me!  But it is all I am allowed to take and I can't tolerate the pain without it. It doesn't help that much, but it does help some; it take some of the edge off.  Also, I stopped taking half-aspirins as a blood thinner because I was bleeding so much.  So any benefit I might get from taking the half-aspirins is lost.

The doctor says these things can heal by themselves.  He also says the operation is VERY painful.  AGONIZINGLY PAINFUL.  WORSE than the fissure itself.  He says the pain lasts 2-3 MONTHS, and that during that time, one is totally incapacitated.  He had the operation himself, so he knows what he's talking about.

But the fact that fissures can heal by themselves doesn't inevitably mean that they will.  MANY people require operations.  And the fact that it has healed in the past does not necessarily mean it will heal by itself this time.  The tear causes scarring, and each time you get it, the scarring gets worse.  Which means that the sphincter is shrunk slightly and ripping is more likely to occur.  It keep tearing it open every time I defecate. That's what the bleeding is.

I am sorry this is so gross to talk about.  But it is even grosser to have it, and sad/difficult not be able to talk about it.  It's depressing to be in pain every day.

(I have been talking about it, more than last time.)

The botox shots are a temporary fix, and the doctor says they are 70% effective.  They wear off in three months.  What they do is loosen the sphincter so that hopefully, the poop can come out without tearing it.  It still has to HEAL on its own.

If, in two weeks, I'm still not improved, I will talk to the doctor about the botox shots.  This is a hospital procedure which requires anesthesia.

Right now, as I am writing this, I am in quite a bit of pain.  I keep leaping up and running in the bathroom to apply hot compresses to my butt.  And then I sit on the heating pad.  I have not had breakfast.  I have not done my exercises, I have not washed up or gotten dressed, my entire morning so far has been pain and pain remediation.

There is a small amount of incremental improvement, however.  The pain, while bad enough to make me cry during and immediately after the third poop today, is not so agonizing that I leap around and shriek in agony (nearly unbearable pain).  I had some of that, early on.

I had two bad about three day days ago, and those were BAD, but not AS BAD as some I'd had earlier.  Those two bad days were followed by three incrementally improved days.  I would NOT say good days, considering that I am still incapacitated, essentially, and still suffering from a great deal of pain.

The other incremental improvement is that I could begin to function (do things) slightly earlier in the day the last couple days.  Like maybe 2:30 in the afternoon instead of 3.

The last time I had some incremental improvements, I was hoping for healing, gradual day-day-improvements.  Instead, I got worse again.  :-(

*

On a totally different not, we had 4-5 days of very hot weather (which, sadly, pushed the the flowers past very quickly), and Keith turned off the heat in the house.  It's FREEZING in here.  I am wearing 6 layers of clothes, a scarf and a hat and am still cold.

Jogging in Place in the Shower

Jogging in Place in the Shower

I want desperately to take a shower.  I haven’t been able to take on in a number of days because of the pain.  It’s been hot, and I’ve had to use a heating pad nearly continuously, and that causes sweatiness.

But the pain makes it hard to stand.

Some of the things that help the pain include:

• Ø  hot water, hot baths, hot compresses
• Ø  walking, running or leaping about, depending how bad the pain is
• Ø  hugs and touch, massage
• Ø  ibuprofen (takes the edge off a little)

No one is here to hug me.  I’m an hour and a half into this round of ibuprofen.

The hot water helps some.  When it doesn’t help enough, I march in place under the water.  When it still hurts too much, I jog in place.  The washing and shampooing become hurried and urgent.  Luckily, no one is here to see me. 

I wonder how far I’ve run, if I were going forward.  Three quarters of a mile?  I‘m going pretty fast and that’s about how much ground I’d cover on foot in the time it takes to wash up, shampoo, shave my legs.  Shaving my legs at a dead run is pretty tricky though, I have to slow down to easy jog for that, then quick speed up to knock the pain down.  Owy.  Well, I did it!  I'm clean!

During the high-pain phase of the flare-up, I ran around the house (upstairs only, for the most part) reorganizing things because it hurt too much to sit.  Moving rapidly around seemed to help.

Set-back

Dire Wolf

I’ve pooped twice, and the second time was bad!  I was literally jumping around, could not sit down.  It’s definitely worse today than it has been all week—more bleeding, more pain.  It seemed to be getting incrementally better day-by-day this week—in very small increments.  Today, I had a setback, a backslide.  I’m sitting now, but have done very little sitting today.  Dunno how long I can stay sitting.  I’m afraid to try to walk outdoors.  I was going to try to shower today, but I can’t unless the pain subsides. Ow it hurts.  Wahn!

It took 25 minutes t write this note because I was in too much pain to sit down long enough to even write a sentence at once.

I was feeling a little better.  I tried not to get my hopes up, but it's really hard to not wish and hope that I am getting BETTER.  Now my hopes are dashed again.  I am very sad.

Suicide

Tulip Collaboration
with Gail Slaughter
(She took the photograph; I painted it)

This first section is copied from the New York Times and is only part of the total story there:

Suicide rates among middle-aged Americans have risen sharply in the past decade, prompting concern that a generation of baby boomers who have faced years of economic worry and easy access to prescription painkillers may be particularly vulnerable to self-inflicted harm.

More people now die of suicide than in car accidents, according to the Centers for Disease Control and Prevention, which published the findings in Friday’s issue of its Morbidity and Mortality Weekly Report. In 2010 there were 33,687 deaths from motor vehicle crashes and 38,364 suicides.

Although suicide rates are growing among both middle-aged men and women, far more men take their own lives. The suicide rate for middle-aged men was 27.3 deaths per 100,000, while for women it was 8.1 deaths per 100,000.


“It’s vastly underreported,” said Julie Phillips, an associate professor of sociology at Rutgers University who has published research on rising suicide rates. “We know we’re not counting all suicides.”


Another factor may be the widespread availability of opioid drugs like OxyContin and oxycodone, which can be particularly deadly in large doses.

*     *     *     *

I've written about suicide before.  More than once.  It may be a real option for me, later.

Last time I had this condition, I began to seriously consider suicide.  The unrelenting nearly unbearable pain, the worst pain of my life, went on and on and on.  How would I do it?  Sleeping pills, of course.  I guess.

So now, I'm reconsidering.  Thinking about suicide again.

I'm not ready to do it--I generally like being alive, except for this pain.  And, I'm afraid of the pain of dying and afraid of death itself.  I keep hoping for healing.  For some relief from the pain.  But when it's bad and I consider the options, suicide seems like one of them.

I recently threw away eleven bottles of sleeping pills.  I should have saved them.  If I do do it, I want to do a good job, not a half-assed one.  I do have more, and the others were expired.  I don't take sleeping pills any more.

*     *     *     *

Tulips, on the other hand, are one reason to stay alive.

How much fiber?

Les Fleurs
digitally altered photograph by me

I read on Livestrong and elsewhere that I was eating too much fiber, and I cut back--and that may have contributed to my current problem

Dr. Beeai and Dr. Barbe are always saying to have fiber--(but not bran.)  They never suggested I was in danger of eating TOO MUCH fiber.

I found an entry Wikipedia that says:  "the intake of dietary fiber could hinder the absorption of vitamins, minerals, and proteins.[3] Dietary fiber helps the gastrointestinal tract absorb excess water and remove food wastes, but an excessively high intake of dietary fiber will also negatively affect the absorption process in the intestinal tract. Taking a fiber supplement can decrease the absorption of minerals by decreasing the transit time, lowering the concentration of minerals by accumulating more fecal matter, and can also cause the minerals to become trapped in the feces, leaving the body without absorption. This could affect individuals who may not be meeting, or barely attaining, their body's mineral or nutrient needs. [4]

I have not seen yet anything giving a healthy range of fiber, and then,t hat may have to be modified for my needs, if I ever et over this problem.

So I looked it up, found this:  How much fiber do you need? Women need 25 grams per day and men should get 38 grams per day, according to an Institute of Medicine formula based on getting 14 grams of fiber for every 1,000 calories. Of course, my needs may be a little different (especially right now).  But I need something to shoot for eventually, I hope.

The Fiber Issue (And Canasa Again)

Everything I read says that "lifestyle" changes help ameliorate and heal anal fissures.  I've been taking bran, a combination of wheat bran, oat bran and other brans, since 2010 when I had this before.

Dr. Beeai says bran is too harsh.  Also, the mixture that I take causes flatulency, which hurts and which often pushes out some of the poop, I think because of the stool softeners.

Dr. Beeai recommended Colace (only during the healing period) and Dr. Barbe recommended Metamucil (Psyllium) (he said I could also take Colace during the healing period.)  The Colace seems to make it harder for the gas to escape and uncomfortable pressure builds up.  :-(

I've tried Metamucil numerous times, and it seems to do JUST THE OPPOSITE of what it's supposed to do.  Dr. Barbe said I'm not doing it right, that I need to drink it with LOTS of water.  So I tried that and was worse the next day.  It may have been a coincidence.  But I'm afraid to try it again.

Diane says it not only softens the stool, but it comes out coated in gel.  The implication is that this eases the passage.  But I'm so afraid of increasing my pain.

Meanwhile, I am still taking the "harsh," gas-inducing bran, afraid to stop for fear of a butt-ripping constipation situation.  This may be making things worse.  I just don't know.  :-(

Also, I am back to using the Canasa and Prep H suppositories, which may make the situation worse rather than better in the long run, I just don't know.  But when I quit the Canasa, the pain got gradually worse and became agonizing to the point where I was literally leaping about in pain and none of the things that I've been using to ameliorate the pain were working.  It was whole days of torture.  When I started the suppositories again, the pain, while very painful, was at least bearable.

But supposedly, neither of the suppositories I am using are for this condition.  And Dr. Beeai says the Canasa is strong and should not be taken any more than absolutely necessary.

Eighteen days of Canasa and Prep H did not "cure" the problem, only backed it off slightly.  In AA, they say, "Insanity is doing the same thing and expecting different results."  And maybe that is exactly what I am doing--I am trying again, because it DID work in 2010, in spite of it's not working this year when I first tried it and in spite of Dr. Barbe saying it was not for anal fissures but for Proctitis (then why did it work last time?). I felt the same then as I do now.  As far as I can tell.  And maybe I should be taking the Canasa without the prep H (which I am using after each BM) or the Prep H without the Canasa (which I take at night before bed.)  I just don't know.  :-(

Yesterday, I pooped three times, and each time hurt worse.  Then, I had insomnia.  I couldn't sleep late to make up for it because I had to pee really bad and when I got up to pee, I had to poop, too.  And then, too much pain to sleep.  I didn't poop much, which means I will have to poop at least once more.  If I have a small poop when I first get up, it is more likely that I will have multiple poops because the sphincter spasms and cuts off the poop.  I had fresh blood.

I am taking all these medications that I would prefer not to be taking, from daily Ibuprofens to the Canasa and Prep H.  I'm so tired from the pain and from insufficient sleep.

Pain Remediation

1)IBUPROFEN (barely cuts the edge when it's bad)(but helps some otherwise)
2)HOT COMPRESSES (washcloth), applied GENTLY to the injured part.
3)HOT BATHS or sitting on hot WET towels on a heating pad (protected by plastic and a dry towel)
4)WALKING--walking helps, but only if it's not to agonizing to begin with.
5)TOUCH, MASSAGE helps when the pain is not too terrible--relaxes.  Pain tends to cause me to tense up.  This makes the pain worse.
6)ENGAGEMENT/DISTRACTION: doing something deeply engaging helps with the pain isn't too bad.  When the pain gets too bad, I am unable to do anything else, including read.

These things help with the pain.  I hope they also help with healing.  I'm not sure about that, though.

NOTE:  If possible, take the ibuprofen and sit on a hot pad for half an hour BEFORE pooping.  This is not always possible.

I read that fish oil helps to reduce inflammation and that helps with pain reduction, but I do not know if this is true.

I also read that "bad food" (candy, sweets, snacky things etc, and red meat, especially fatty red meat), exacerbates pain.  I don't know if this is true either, but it seems that healthy food is more likely to improve healing than crap food.  However, different people have different ideas about what is healthy and what is not.  Sometimes, it's hard to know.  Food that is close to nature seems like what we evolved to eat, but that includes red meat.

I am sure getting good sleep helps heal, and here I am up with insomnia.

Waiting

Here is why my doctor wants me to wait:  

Surgical therapy is usually reserved for acute anal fissures that remain symptomatic after 3-4 weeks of medical therapy and for chronic anal fissures.

it's BEEN 3-4 weeks already, though.


A newer therapy for acute and chronic anal fissures is botulinum toxin (BOTOX®). The toxin is injected directly into the internal anal sphincter and, in effect, performs a chemical sphincterotomy. The effect lasts approximately 3 months, until the nerve endings regenerate. This 3-month period may allow acute fissures (and sometimes chronic fissures) to heal and symptoms to resolve.[7] If BOTOX® injection provides initial relief of symptoms but there is a recurrence after 3 months, the patient may benefit from surgical sphincterotomy.[8, 9]

In a review of 4 prospective, randomized, controlled trials, Shao et al concluded that surgery, specifically, lateral internal sphincterotomy (see Intraoperative Details), is more effective than BOTOX® treatment for healing chronic anal fissures.[10] In their analysis of the studies, which involved a total of 279 patients, the investigators found that the absolute benefit increase rate was 23% for the surgical patients in comparison with the BOTOX®-treated patients, with BOTOX® therapy associated with a lower fissure healing rate and a higher recurrence rate than was surgery. However, minor anal incontinence occurred more frequently with lateral internal sphincterotomy than it did with BOTOX®.

I read that the people who suffer the most are those whose sphincter muscles spasm, which I think is what happens with me.



It doesn't happen with everyone, and I do not know what makes the difference.

This information (minus my comments) came from here.