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Alternative to painful Pilonidal surgery

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Alternative to painful Pilonidal surgery

Posted by Been there! on November 26, 2002 at 20:12:30:

I happened to have a pilonidal cyst some 25 years ago. I was in quite a bit of pain as most of you can relate to. I called a surgeon and he said that it could be cut out (times haven't changed much). Well, it so happened that I was watching Phil Donahue that day and his guest was a Dr. George Crile (whose father was one of the founders of the Cleveland Clinic). Dr. Crile was talking about breast cancer and his new book (Surgery: Your choices Your Alternatives). I saw it the next day in the bookstore and happened to be leafing through it when I came to p.90 (hardcover) and noticed he had a section on pilonidal cysts. He offered a simple remedy for the problem, so I decided to call and make an appt. I then drove the 6 hours to the Cleveland Clinic and Dr. Crile performed this procedure: "All that needs to be done is to have the hair removed. Ofen it can be done in the office, under local anesthesia, by opening the abscess and inserting a litttle rubber tube which is anchored in place for two or three weeks until the hairs have been extruded and hte cavity has filled in. The tube is then withdrawn, the buttocks are shaved or treated with a depilatory to remove all hair, and the area is soon healed. In the case of a draining sinus, the hairs that cause the trouble often can be removed by scraping out the tract with a little crochet hook. Again the buttocks are shaved and usually the sinus heals up. When it doesn't it can be opened by a minor operation and scraped clean of all hair. "

It was this procedure that I had done, and 25 years later, I'm still doing ok, although I have gotten lazy about shaving the area and occasionally it will get sore and then my wife (lucky her), inspecting the area will almost always notice some hairs entering the pore and with tweezers will extract them and then shave the area. Each time, that did the trick and it didn't get worse.

Dr Crile goes on to say: "But what is the standard operation done in hospitals throughout the country? The standard operation for pilonidal cyst or sinus is to to cut the whole thing out just as if it waere a cancer. Snce the area is infected, healing is slow. Often the surgeion doesn't shave the buttocks, with the result that the irritation from the hair as the patient walks keeps scraping the wound open so that it never heals. Then the surgeon admits the patient for a skin graft. Often a week or more of hospitalization is involved, as well as the discomfort of a large operation in a sore place.

Why do surgeonsdo all this when the disease is so easily cured by a simple office treatment? The question is impossible to answer, except in terms of economics and habit.

A century ago when pilonidal disease was first described by an English surgeon, he noted that by looking closely the hair could be seen growing into it from without. Then someone else described a congenital misplacement of tissue in the pelvis that causes what is known as a presacral dermoid (skinlike) cyst that contains skin, hair, and teeth. Very, very rarely, one of these drains externally from the same area as a pilonidal sinus. The dermoid cyst, of course, has to be removed, becasue hair follices are growing within it, whereas pilonidal diseasd can be treated by simply removing the hair that grows into it from without. Somehow the two conditions got confused in the minds of surgeons and of teachers in medical schools, so that removal of the whole cyst or sinus became standard practice for the treatment of ingrown hairs. " He goes on to talk about how doctors are trained and how the "fee for service" system inclines them to do an operation where they make lots of money vs a simple procedure. His final admonition: "Please , if anyone wants to hospitalize you for an operation for previously untreated pilonidal disease, refuse the operation and go looking for another surgeon!"

So that's my .02 worth. You might wish to show that to your doctor when he offers only the surgical choice. Or try to find a copy of the book and take with you.



Re: Alternative to painful Pilonidal surgery

Posted by cris on November 27, 2002 at 08:47:06:

In Reply to: Alternative to painful Pilonidal surgery posted by Been there! on November 26, 2002 at 20:12:30:

Just a couple of questions: What causes the hairs to grow from without to within, and why always above where Presacral dermoids would lurk, if they were there? Why don't the hairs grow that way on the inner thigh, for instance, or 4 inches laterally or superiorly to where they always seem to grow?
Also, I was always under the impression that ingrown hairs started from within and never made it out, thus growing spirally within the skin, forming a pocket eventually. This idea of hairs stabbing in from above, with uncanny accuracy, is a scary one for me!



Re: Alternative to painful Pilonidal surgery (Archive.)

Posted by Walt Stoll on November 27, 2002 at 10:47:56:

In Reply to: Alternative to painful Pilonidal surgery posted by Been there! on November 26, 2002 at 20:12:30:

Hi, Been.

Congratulations for your success. If only most people were so lucky. Some of Crile's suggestions are worthwhile.

If course, Cris has the real question. The congenital, buried nidi, theory is still the only one that explains ALL the observed vagaries of this condition. I am convinced that only docs wanting their name on something will challenge this theory before THEIR theory explains ALL of the observed phenomena. By the way, this is the definition of a successful theory.

Walt



Re: Alternative to painful Pilonidal surgery (Archive.)

Posted by Been There! on November 27, 2002 at 11:56:27:

In Reply to: Re: Alternative to painful Pilonidal surgery (Archive.) posted by Walt Stoll on November 27, 2002 at 10:47:56:

So if I understand correctly Dr. Stoll, perhaps Dr. Crile is somewhat correct (and in my case, I was fortunate) but not totally correct. Did I understand that correctly?

I should say that the reason I wandered over here is that I am starting to have a flare up it looks like. I'm praying to god that isn't the case, but I feel pressure, although there is not redness or obvious swelling. Last night I felt particularly crummy and felt flushed. Don't know if this has anything to do with it or not - may be coincidence.

So I'm applying hot soapy rags and hoping it will disappear. I've had close calls in the pasts and then have gone back to religiously shaving the area, only to get lazy again and then it will start to irritate me suddenly. Each time, my wife has examined it and with tweezers been able to pull a few hairs out of the pore and that seemed to stop the irritation and it went back to normal. This time, she removed a tiny sort of whitish material (dead cell material?) but the pore still looks partially clogged and she doesn't want to go mucking around in there, which is probably smart. So would you suggest I keep at the hot washcloth idea? Also - although I know antibiotics aren't too successful in reaching this area, and I don't really have a great desire to start them, do you have any thoughts on whether olive leaf extract in capsule form would be perhaps helpful as a means towards eliminating bacteria?

And finally, do you think I need to revisit a doctor about this if the hot washcloths do the trick? I'm afraid I'll run into docs who will just want to carve out the whole area, which scares the .... out of me (especially since I have rheumatoid arthritis and take methotrexate (15mg/week) and worry that I would not be a good healer). That's what they wanted to do 25 years ago, and it still looks like that is the inclination. Should it get badly infected again, would you think that Crile's method again would be a good choice to start with vs the carve out method? (as a more conservative approach).

Your thoughts would ease this old worrier's mind some, believe me!

Thanks!
Been there!



Re: Alternative to painful Pilonidal surgery

Posted by Been There on November 27, 2002 at 12:07:22:

In Reply to: Re: Alternative to painful Pilonidal surgery posted by cris on November 27, 2002 at 08:47:06:

You may find the following link of interest. It talks some about the "invading" hairs.

http://www.emedicine.com/emerg/topic771.htm

Been there!

Follow Ups:


Re: Alternative to painful Pilonidal surgery

Posted by Been There! on November 27, 2002 at 15:56:45:

In Reply to: Alternative to painful Pilonidal surgery posted by Been there! on November 26, 2002 at 20:12:30:

I recently noted a new technique posted on Medscape.
http://www.medscape.com/viewarticle/443622

This sounds promising for those with refractory disease.

Been There!

Follow Ups:


Re: Alternative to painful Pilonidal surgery (Archive.)

Posted by Walt Stoll on November 28, 2002 at 09:43:00:

In Reply to: Re: Alternative to painful Pilonidal surgery (Archive.) posted by Been There! on November 27, 2002 at 11:56:27:

Thanks, Been.

To respond to your first paragraph: Yes!

If you hot compresses get you through this flareup you do not need any profesional help.

When they do not is when you need help.

Let us know how you do.

Walt



Re: Alternative to painful Pilonidal surgery (Archive.)

Posted by Been There! on November 28, 2002 at 11:14:32:

In Reply to: Re: Alternative to painful Pilonidal surgery (Archive.) posted by Walt Stoll on November 28, 2002 at 09:43:00:

Thanks Dr. Stoll,

How many days would you normally give it to expect the hot rags to work? It's been a couple now and whereas it doesn't seem to be worse, it's not a whole lot better. Still has a tendency to make feel nauseous and gives me this rather strange tension feeling in my upper body.

Do these things always find a drain spot? This one isn't really showing a redness or swelling, just hurting somewhat and the overall malaise feeling. My old ones had a sinus. Maybe this one hasn't advanced far enough in severity to start finding a tract to the outside? Do they sometimes just drain right out of the pore itself or do they always funnel to an alternate site?

Sorry for all the questions - trying to understand this!

Thanks again
Been



Re: Alternative to painful Pilonidal surgery (Archive.)

Posted by Walt Stoll on November 29, 2002 at 13:40:16:

In Reply to: Re: Alternative to painful Pilonidal surgery (Archive.) posted by Been There! on November 28, 2002 at 11:14:32:

Hi, Been.

Since the natural history of each flareup is to gradually get worse, just holding the status quo is a victory of sorts.

If it is even a little better in a couple of days you are winning. You might have to keep up the soaks for a week till this flareup is over.

Walt

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