Pilonidal Cyst

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.

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.

 

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.

 
 

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).

 

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.

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.

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...

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.

Here's the bit you all wanted to see. Pictures!

On Friday, I went to the doctor's office for the first dressing change. The nurse was a bit weirded out when Lisa pulled out the digital camera to take pictures. But here you go...

The original dressing.


The wound. Click the picture for a bigger version.
 

 

I'll fill this bit in later. Need to lie down for a while. Here are some highlights:

The episode of "stopped breathing" apparently was due to me having a vasovagal (I passed out). No big deal, but it sure sounds scary.

Recovery went fine. The numbness in my legs wore off. They got me lunch and they made me pee before I left.

I'll put more in here later...

Surgery date is Thursday, September 22 - Lisa's birthday. (I owe her big-time for this.)

Aunt Becky watches the kids and take them to school. Lisa and I head out at 7:30 to be at the Day Surgery wing of the hospital at 8:00. They bring me in at 8:15, I disrobe and get on the gown. They put on some cool leggings to prevent blood clots. The anthesthesiologist asks whether I want to be out completely or just numb and starts my IV. My gut reaction is to be out completely and I tell him so. The surgical nurse asks which anesthesia I chose and she explains that the recovery with the "just numb" option is a bit easier.

If I go completely under, the intubate me (put that thingy down my throat) and I have to expel all the gases before I can leave. With the "just numb" option, they administer a spinal (not unlike an epidural) and then they regulate everything but my breathing (i.e. give me the drugs that ensure I don't care what planet I'm on). Part of me wants to be awake for the whole thing and I decide to switch to "just numb".

I kiss Lisa and they wheel me in. The nurses are great and try to distract me with small talk. I tell bad jokes and they probably start to wish I was completely out. They have me sit up and the anthesthesiologist puts in the spinal. The first thing I feel is like a bee sting - he injects the needle just to the left of my spine, in the middle of my back. Then, it feels like he hotwired a line from the injection site to my left buttock. It's cold fire. Electric shock. Very strange. Then I can feel the numbness start. They lay me back. Then it's time to flip me over on my stomach on the operating table.

My arms are out to the side, and my head is on a pillow. The doctor starts to shave my butt - "Mr. McDonald, I'm shaving you now" - with an electric razor. I try to relax. Soon I start to feel nauseous. The anthesthesiologist is apparently giving me the weird drugs. I tell them that I am starting to feel nauseous. "I will give you something to help that," he says.

The next thing I know, I have opened my eyes and I am looking at the shirt of a nurse I have not met before. My heart is beating out of my chest. It's the same feeling you get when you just miss getting into a huge car accident. I am pretty darned lucid right now. "My heart is breathing really fast," I say. "Yeah," says the nurse who I have not heard before now. "He gave you something because you stopped breathing." Well, apparently, he gave me something more, because I don't care anymore...

I come out of the haze as they are flipping me onto my back on the wheeled cart. The surgical nurse tells me that Dr. Rosenbloom is taking pictures. I look over and even though I don't have my glasses on, I can see him taking pictures of whatever they cut out of me. I ask him to show me. He pauses, then holds up a bloody, mess. I can barely see it even squinting, but I'm happy. He tells me he'll get me the pictures when I meet him in two weeks.

They wheel me off to recovery...

About three years ago, I noticed a blood blister on one side of my tailbone, just above the crack of my butt, that would sometimes get inflamed and enlarged. This usually happened in the warm seasons, when I would sweat more and be a bit more active. It seemed to occur more often when I biked more often. It was about the size of a pencil eraser. When it got infected, it would fill with blood and pus and become painful. The sac would grow to about the size of a pea. Eventually, it would break and a smelly pus-like substance would leak out. I'd treat it with triple antibiotic cream and wait for it to scab over.

Not too terribly painful, really. More annoying than anything. Over time though, it got to be more than annoying and I finally went to the doctor about it. He immediately diagnosed it as a pilonidal cyst. I had no idea what that was, but he said that if it didn't bug me too much, I could live with it and treat it like I had been. I went home and looked it up on the internet. Most of the pages I hit didn't say much. They talked about a "sinus" and "drainage". I didn't worry too much.

Two years pass. The blood blister thing seems to have grown a bit. I also noticed two smaller holes about 2 inches lower, right in my crack. The whole area seems to feel tender pretty often. If I slouch in my chair (as I usually do - I have horrible posture) for long periods of time, it aches. In May of this year, the blood blister got huge. Apparently, this thing really got infected. The blister grew to the size of a grape. Very painful. Lisa lanced with a pin and it drained for a few days. Not having a doctor, I went to Lisa's primary care physician. He immediately diagnosed it correctly and recommeded that it be removed. He referred my to Dr. Rosenbloom.

On May 17, I meet Dr. Rosenbloom for the first time. He explains everything to me. He draws me a picture, explaining what would be cut out. He explains that this is most common in individuals when they are about 20, and it's fairly uncommon to have it get to this point when I am 34. He says he never schedules these for the Spring or Summer, since I will not be able to swim or be active until it is healed. And then the kicker. It takes between 2 - 6 months to fully heal. Apparently, these need to heal from the "inside out". This means that the wound is packed and not allowed to scab over. He says that they will try to procure a "wound vac" for recovery. This is a sponge cut to the size of the wound with a vacuum hose attached to the sponge and leading to the vacuum device that I will wear on my belt. He says this will cut the recovery time in half.

I get home and that night Lisa looks it up on the internet. She finds the excellent site, pilonidal.org, and shows me some of the blogs. "You HAVE to blog this!" she tells me. After checking out the site and getting a little sick to my stomach, I realize she's right. I do.