Pilonidal Cyst

Welcome

2006-02-14T13:04:00.000-06:00

For those of you just getting here, here is a good place to start: http://www.brianmcdonald.net/pilonidal/2005/09/history.html

WARNING: Some gross pictures on here. Don't blame me if you get puke on your keyboard.

Picture Update

2006-02-14T12:52:00.000-06:00

Sorry! It has been quite some time since I've updated. I quickly got used to not having to shower and pack the wound twice a day...

An extra big booty picture this time. You can see the wound has healed nicely. If I remember, I'll have Lisa take a picture in a month or so.

All Better Now

2006-01-25T14:49:00.000-06:00

Well, I just got back from my last doctor appointment! The good doctor Rosenbloom gave me the all clear, so all is good. He said that the wound is completely healed over. I can stop taking showers twice a day and can get back to my regular twice-monthly schedule.

He also said that in 4-6 weeks, the skin will be as strong as it is going to be and will look great. I'll post a picture when I can.

So, almost exactly 4 months from surgery, I am all better. Yay!

Smaller and Smaller

2006-01-12T10:24:00.000-06:00

It's been a month since the last update. I've been to the doctor every two weeks since then, and he has used the silver nitrate sticks to remove some of the proud flesh every time. He always says that it looks good. He characterized the process as "two steps forward, one step back", as the new granulation tissue fills in. Sometimes the tissue grows a bit more than it should, or incorrectly, and needs to be removed with the silver nitrate.

The good doctor usually takes pictures, but I brought mine and had him take one. On the left is the picture from yesterday. On the right is one of the first pictures of the wound. Pretty nice progress after about 4 months...

Almost Done

2005-12-12T22:09:00.000-06:00

This picture really shows how far this has come. The doctor took this last Wed. right after using some more silver nitrate sticks on a bit of the proud flesh. Not nearly as much as the first time. The good doctor also said that the wound looks great and I'm almost done.

Post-Cauterization

2005-11-29T16:16:00.000-06:00

So I got two pictures for you.

The first is the picture from the doctor in the office. You can see the remnants of the cauterized "proud flesh".

The second is the day after. Most of the dead tissue has sloughed off.

"Proud Flesh"

2005-11-23T14:00:00.000-06:00

Went to see the doc again this morning. He said the wound looks great, for starters. He also said that I am growing some "proud flesh", which he described as scar tissue that we don't particularly want. He said that it is a result of the dry dressing and is very common. He then proceeded to use some silver nitrate sticks to burn off the "proud flesh". Surprisingly enough, this did not hurt much at all. A little sting, but that's it. He took some pictures and will email them to me soon. I'll post them as soon as I get them. He said that the "proud flesh" will undoubtedly recur and he'll treat them the same way.

Another appointment in two weeks.

Google up "proud flesh pilonidal excision" and you'll find some interesting stuff.

Looking Good

2005-11-05T10:38:00.000-06:00

Hey, all. Sorry I haven't updated this in a while, but there hasn't been much to report.

I went to the doctor on Wednesday, November 2nd for a 2-week checkup. The pimples are going away, but my fair skin makes this process take a while. He said the wound looks great. He instructed me to stop using saline for the dressing - I should go with dry gauze for the pieces that go into the wound. Also, I can stop using the ABDs (the larger dressings). This makes Lisa extremely happy, since I can now dress the wound myself in the mornings and I do not have to wake her up. The doctor also said that I have about a month left. Yay!

In other news, my digital camera broke. I can only take pictures with the timer. Here's a shot of the wound as it looks now. You can sort of see that the wound depth is getting smaller. You can see that wound is definitely "beefy red", too.

Doctor Visit Yesterday

2005-10-20T11:39:00.000-05:00

I had another doctor appointment yesterday. Upon viewing the wound, he said "It looks better than I could have hoped!" Kudos to Lisa for the her superior dressing-changing skillz. I mentioned that one spot around the edge was a bit tender and he remarked that this is just where one of the sutures is coming through and that I should not be concerned. The past few days has unleashed a few pimples around the area, which is why I haven't taken any pictures of the wound (you are welcome). He said that less saline will probably do the trick. He mentioned that the wound is definitely filling in on all sides. No mention of how long left.

So, fairly good news. I'll take some pictures for you when I am zit-free. Yay, acne!

So Far, So Good

2005-10-13T09:36:00.000-05:00

I'm doing well, thanks for asking. Totally off pain meds. Lisa has the distinct pleasure of changing my dressing twice a day. I drove myself to work every day this week with no trouble (other than the usual Chicago traffic). No idea how long this will take, but I'm guessing two months.

The doctor sent me three pictures. The first is the "before" picture, which is great, since I forgot to have Lisa take one. The next two are pictures of the removed cyst. Very cool. He asked that I not post to my blog, but let me know and I can probably email them to you.

Thursday - Today

2005-10-06T13:45:00.001-05:00

And so we are caught up. It has been two weeks since the surgery. Today, feeling pretty good. I now have plenty of supplies. Pain is minimal - I'm off the vicodin.

Here is a pic of the dressing supplies. Lisa wets 2 pieces of 3x3 gauze with saline and inserts them into the wound, being careful to cover every bit of the wound with the gauze. This gets covered by two pieces of dry gauze. A little tape holds them in place. Then two thicker pieces of gauze, called "ABDs", get placed over that. This gets taped around all sides, with a space on the bottom open for me to poop.

Wednesday - Oct 5

2005-10-06T13:06:00.000-05:00

Doctor visit today at 10am. Carol drove me in to the office and Jeremy picked me up afterwards to go back to work. Thanks, guys. I also need to give a shout out to Steve, my neighbor for driving me to and from work all week. We owe you guys dinner.

Anyway, the doctor appointment was great. I went in and they took my vitals and got my booty nekkid. They pulled off the dressing and the nurse said "it looks really clean!" which made me happy.

The doc finally came in with Kathleen and said the wound looks good. He asked a bit about the story with the wound vac and then said we'd talk in his office after they re-dressed the wound. Kathleen put new dressing in and I was off to the doc's office.

The first thing I asked for were the pictures. He asked me to email him and he'd send them my way.

The next topic was the wound vac. He said that it works for some folks and not for others. That particular area is very sensitive due to the numerous nerve endings there near the tailbone. He was very upbeat and positive and said that we should discontinue the wound vac and change dressing of simple gauze and saline twice a day. I am to shower after the dressing removal and clean out the wound. Then, Lisa gets to apply new dressing. (She's a saint for doing this - thanks, honey.)

He said that in about a week the wound will get very red. "Beefy red", he called it. And that it would bleed quite a bit. Not to worry, this is normal.

So we got to fire the home health organization and send back the suck-o-matic. Not bad. Ful healing of the wound will take more time, but I am feeling really good now that all that pain is gone.

Tuesday - Oct 4

2005-10-06T13:03:00.000-05:00

Felt good Tuesday. Took one vicodin overnight for the pain. Other than that, just Tylenol. Being back at work is great, although tiring. My body gets really tired at the end of the day.

Quite a bit of frustration with the home health organization. I am VERY unhappy with the organization as a whole - not much follow-through, lots of talk. I was supposed to get some supplies delivered, and they didn't make it, although some other mysterious supplies did make it.

I had thought that we would be using the calcium carbonate dressing, but since we were out, it was back to plain old gauze and saline, although we are running out of both.

Monday - Oct 3

2005-10-06T12:54:00.000-05:00

Hey, all. I'm ok. It has been some time since my last post and a lot has gone on. I'll detail the past few days.

Monday morning, I went to work. It was good to be back, and Lisa was happy that I was not at home. :-) Anyway, I showed everyone the wound vac and explained how it worked.

Later that morning, I called the doctor's office and spoke with Kathleen, one of the very nice nurses there. I explained all that had gone on and all the pain I had been through. I told her about the home health organization not really knowing what settings should be for the wound vac and some confusion on exactly how things should be working. She listened patiently and explained that I should not be in that much pain and said the the doctor was in surgery today, but she would talk to him and get back to me.

She called back later and said that the doctor wanted the wound vac removed that evening. Kathleen had already talked to the home health organization and the nurse was coming out that night.

So, Laurence came out that night. It took 20 minutes for the foam to come out. Quite a lot of pain involved. I was very relieved to have it out when it was all done. Laurence put in some plain old gauze and saline and covered with dry gauze. Ah, sweet relief.

Here's the second wound vac canister and how the wound looked Monday night - very red. Looking good.

Wound Vac Dressing Change #1

2005-10-02T20:16:00.000-05:00

At 8:00am today, Laurence came to change the wound vac dressing. Lisa and I had already turned off the wound vac and had soaked the sponge with saline. Still, the sponge would not come out. It took 40 minutes to get the sponge off and it hurt like hell. The good news is that the wound looks VERY good. See the first picture below.

Laurence put the bridge on the left side this time. She got the whole shebang setup and we decided to lower the intensity and pressure of the wound vac in the hopes of avoiding the sponge adhering to the wound again.

Lots of pain afterwards - I sat around and tried to nap when I could.

The last picture shows the first wound vac canister replacement.

PAIN

2005-10-01T11:01:00.000-05:00

And lots of it.

What I didn't mention in the previous post was the intense pain I was in after we turned on the wound vac. I mentioned previously that Thursday night we noticed a tender spot on the right side of my wound. Very painful. Well, it got worse when they manipulated me getting the wound vac installed. Not horrible pain, but the spot got touched pretty often. At that point, I was still off the vicodin and taking Tylenol.

So the moment of truth comes, Rachel has me turn on the wound vac. It has a 15 second countdown before the suction begins. When the timer winds down, there is nothing. Apparently, there is a small hole somewhere. Rachel and Laurence find that some of the tape has come up a bit. They simply press down with a finger and WHAM! Every nerve in my body fires and I grab the edge of the bed. I may have actually flown off the bed and hit my head on the ceiling.

Eventually the pain recedes a bit and I can get up and put on my clothes. I decide that going back on the vicodin is worth the bit of head-swimmy that it does to me. Everyone agrees.

Rachel wants me to walk a bit and try to sit. Walking is fine. Sitting is painful. I get back up and I get the nausea/sweats/light-headed feeling that comes before passing out and I sit down and then lie down. Rachel is kind enough to fan me with a folder. A few minutes later, I feel better and get up. My dreams of going into work for the rest of the day are dashed.

I did work from home the best I could. But it took about 4 hours before I could get back in front of the pain. Once that happened, I was just tired.

Many thanks to Jason and Jeremy for covering for me at work. I had some scheduled installs that couldn't be rescheduled. They stepped up big time.

Anyway, the pain is now under control, but still is there. Although I hate the vicodin, it seems I'll be on it for a bit longer.

NEXT: Laurence and I set the schedule for wound vac changes. Every Sunday at 8am. Every Tuesday and Thursday at 6pm. So tomorrow, I find out if turning the damned thing on again will kill me or not.

Wound Vac

2005-10-01T10:43:00.000-05:00

Friday morning at 8:30 is wound vac time. The KCI (wound vac manufacturer) representative, Rachel, arrives at 8:10. The home health nurse, Laurence, arrives at 8:30 and we get to it.

The old dressing comes off and Rachel discusses how this will work. The dressing kit comes with tons of clear tape that is a bit stretchy. It's designed to make an airtight seal against my skin. Think of Saran Wrap with one side being a bit sticky. The kit also has a big piece of foam, tubing and a connector piece for the tubing to mate to the foam.

They start cutting the foam. One big piece needs to fit in the wound. Another needs to form a "bridge" to the side so the tubing connector can be installed. And the whole thing needs to be taped with the clear tape stuff.

In the pictures below, you can see the whole shebang. Very cool. Notice that the last three pictures show the foam after the wound vac has been turned on. Note that the foam gets sucked against my skin and has a very low profile.

LOTS of pictures here, but this is a really neat device and getting it installed correctly takes some skill. The clear tape must adhere to form a perfect seal.

7th Dressing Change - Lisa

2005-09-30T10:37:00.000-05:00

Ok, this picture is from Thursday morning. Lisa changed the dressing in the morning and I got a ride into work with Steve, my neighbor. The day went well - I felt great and got a lot of work done. Steve picked me up at about 3:15pm and we came home.

That evening, Lisa changed my dressing right after dinner and went out to karate. By the time she came home, I was in more pain that I had been since the surgery. Very intense pain. We called Shannon, our neighbor nurse, and whe recommended a dressing change again. She came over to check. Lisa took off the old dressing and they both inspected me. I had a VERY sensitive area on the right side of the wound. They both said that the skin on my butt to the right side of the wound looked swollen, but the wound itself looked good. They repacked and I was advised to ice my booty and take a vicodin to sleep. The next morning would be the Wound Vac install.

6th Dressing Change - Lisa

2005-09-28T16:49:00.000-05:00

So Lisa changed the dressing again. This time, the dressing was VERY full of exudate and other assorted goob (that's the technical term). Wound looks the same, and I don't have a fever, so all seems well.

Pic 1: What came out of me.
Pic 2: The wound, with a ruler.

Wound Vac Arrives

2005-09-28T11:54:00.000-05:00

The wound vac got delivered this morning via FedEx. The KCI representative described it as about the size of a clock radio. That is probably accurate, although it does weigh more than my clock radio. Here are some pictures of the boxes and the unit.

I am still working with my home health care case manager to schedule the "installation".

Feeling pretty good today. Working from home so I could sign for the wound vac. Hopefully, I'll be able to go to work tomorrow morning.

5th Dressing Change - Lisa

2005-09-27T15:11:00.000-05:00

Another dressing change today. Had to do this one early because some of the gauze fell out.

The wound vac shows up via FedEx tomorrow.
The gauze stuff that goes into the wound is called calcium alginate (yes, as in the sea). Supposedly, it gets rid of the aforementioned exudate very well.
Pain is a lot better today. We'll see how that goes.
Got quite a few cards today. Thanks to all. Much appreciated.

Two pictures: The first is before today's dressing change. No flash, so it's hard to see. The second is the box of torture devices (stuff for the dressing).

4th Dressing Change

2005-09-26T16:30:00.000-05:00

Just one picture today. New home health nurse: Laurence (a woman). She proclaimed the wound looks fine; the redness means healing. She will come again Friday, when they expect the wound vac to show up. Until then, Lisa gets to do the honors.

Here's the wound today. It really looks gross, doesn't it? The mucus, pus-like stuff is apparently exudate, which she cleaned out before packing.

Sunday Night Update

2005-09-25T20:12:00.000-05:00

Some quick info bits for you. These are things I've forgotten to include or other random tidbits.

The measurements of the wound is 8cm x 4cm x 3.25cm deep. According to everyone who is a health professional, it's a small one. But then again, they didn't just get a golf ball removed from their ass either...
My temperature has been regular. I'm supposed to watch it closely. If it goes over 100.4 degrees, I'm supposed to call the doc. That could mean infection, which would be really bad news.
I normally don't sleep on my stomach; I usually sleep on my side. Lately I have been switching between both sides and the stomach for comfort. Every night at 4am I seem to get these pretty bad leg aches that go away if I turn on my stomach.
Sitting hurts. A lot. I got one of those blow-up donuts and it helps a bit, but I still have to shift around often.

All for now - Jackson wants me to read to him before bed. More tomorrow.

3rd Dressing Change - Lisa

2005-09-25T14:27:00.000-05:00

I hopped in the shower after Lisa pulled off the tape and gauze. After the shower, I laid down on the bed and Lisa (with Shannon, my nurse neighbor overseeing) snapped on the gloves and got down to business. She did a great job. Saline on the gauze "rope" and into the wound. Check out her handiwork and the gauze she took out:

Feeling pretty good today, even though the Bears are getting their ass handed to them this afternoon...

2nd Dressing Change

2005-09-25T14:23:00.000-05:00

Will, from Orsini Home Health showed up at 1pm on Saturday to deliver the medical dressing supplies for the home health nurse(s). He delivered a big box filled with gauze, saline, tape, hand cleaner, etc.

Roberta, from Orsini Home Health showed up at about 3pm on Saturday. She called when she was 30 minutes away, so I had time to take a Vicodin and shower. Lisa pulled off the tape and pulled the gauze from the wound. I then took a shower and had the warm water run down my back into the wound. It did not sting, as I thought. It did feel really strange and I touched the wound with my fingers. THAT was weird. Big hole back there!

Roberta showed Lisa how to put on the clean dressings. Pretty easy, really. Roberta had me fill out some paperwork and she was on her way. I am supposed to get a call from the regular home nurse on Sunday for the Monday appointment.