I cannot give any opinions on the Xtreme Gamer version, but last year I went from a original Audigy card, circa 2003 I believe, to an Fatality. I saw a nice boost in audio quality in my higher end headphones that made even old MP3 lower bit rate files I had sound much better. I also noticed a slight boost in FPS in games like COH and BF2, and the newer environmental EAX sounds were a nice addition as well. I'm not sure what issues (other than maybe ones with Vista) you're describing. Also, not quite sure what its loaded with crap is. It may come with more software, but I barely install any of the stuff Creative sends with it anyways.
Now, if I hadn't had $150 is Best Buy gift cards and they had the Xtreme Gamer in stock when I was shopping there, I wouldn't have bought the Fatality. I agree it was overpriced at the $150, but it was on post-xmas sale at $110 and I said what the heck. I highly doubt the X-ram does a terrible amount in games that support its features anyways.
Outside of that and an initial IRQ conflict, I have no complaints about the card.