Tuesday, July 27, 2010
Shave hair?
Q: When you say “we have not used laser”, I wonder what you do recommend. Is hair removal essential? Pilonidal.org seems to say so. A:......... Opinions change. I once thought so, and many good people still do, my attention is currently focused on the pit and the abscess, poorly drained and anaerobic because sealed at the surface as the buttocks and the cleft are squeezed closed 24/7. Hair plays a part and removal is never hurtful but I see removal as not essential. .....
Saturday, July 24, 2010
Flight Home?
A patient asked about travel after a cleft lift. I replied.......With surgery on August 3 and visit to the office on August 6, I mispoke, a trip on August 3 would be possible but uncomfortable for I expect you to be in the hospital overnight. The sutures will not be removed August 6th, they dissolve. You and the wound would probably tolerate the flight August 6. A trip on August 10-12 would sound reasonably comfortable following the usual course after a cleft lift. Each day brings a stronger wound and more comfort.
Wednesday, July 14, 2010
Response to pilonidal query
A patient wrote, "I have a few questions for you which I was hoping you might answer:"
How and why do people like me keep developing sinuses again and again? Two answers--the buttocks fall together and seal close the cleft, much like the Zip-Lock on a re-sealable plastic bag, seals 24/7, creating a poorly drained anaerobic abscess which will not let surgical wounds in the cleft to heal. Second reason--more common in earlier disease, pits in the midline, enlarged hair follicles, continue to inject bacteria into underlying fat where bacteria generate abscesses--painful pus under pressure.
Is it a bad idea to wait till December to have another surgery? There are ways to get the problem likely solved by Sept 15--on the basis of your good photographs we likely would recommend a cleft lift operation.
I can probably get my internship shortened if need be.
Will the pain keep rising/stay constant, or is there ANYTHING
I can do
to alleviate it? e.g. If I stay off my backside for a couple of weeks,
will it get better? Not likely.
Am I allowed to exercise i.e. play soccer and squash, or is that bad
for the situation? Little difference
How do I remove the hair in that area because it is difficult to
reach? The hair removal creams say not to apply to perianal regions so
what other methods can I use? We have not found hair removal of much help. Some doctors do.
I received the list of cleft lift surgeons who do your procedure, but
do you know of any personally that have good records with this? No. Telephone calls to surgeons in your area are a nuisance for you but give much information
How effective is the cleft lift? It is usually the best way to fix
this problem? What is the recovery time associated with the cleft
lift, as I will have a maximum of 4 weeks in December of winter breaks
to get this taken care of? After Cleft Lift surgery 90% are ready to go back to class in 2-4 weeks--ready to fly cross country in 5-7 days.
If there is any other advice or information you could give me, I would
really appreciate it. Study the material at http://www.pilonidal.org/
How and why do people like me keep developing sinuses again and again? Two answers--the buttocks fall together and seal close the cleft, much like the Zip-Lock on a re-sealable plastic bag, seals 24/7, creating a poorly drained anaerobic abscess which will not let surgical wounds in the cleft to heal. Second reason--more common in earlier disease, pits in the midline, enlarged hair follicles, continue to inject bacteria into underlying fat where bacteria generate abscesses--painful pus under pressure.
Is it a bad idea to wait till December to have another surgery? There are ways to get the problem likely solved by Sept 15--on the basis of your good photographs we likely would recommend a cleft lift operation.
I can probably get my internship shortened if need be.
Will the pain keep rising/stay constant, or is there ANYTHING
I can do
to alleviate it? e.g. If I stay off my backside for a couple of weeks,
will it get better? Not likely.
Am I allowed to exercise i.e. play soccer and squash, or is that bad
for the situation? Little difference
How do I remove the hair in that area because it is difficult to
reach? The hair removal creams say not to apply to perianal regions so
what other methods can I use? We have not found hair removal of much help. Some doctors do.
I received the list of cleft lift surgeons who do your procedure, but
do you know of any personally that have good records with this? No. Telephone calls to surgeons in your area are a nuisance for you but give much information
How effective is the cleft lift? It is usually the best way to fix
this problem? What is the recovery time associated with the cleft
lift, as I will have a maximum of 4 weeks in December of winter breaks
to get this taken care of? After Cleft Lift surgery 90% are ready to go back to class in 2-4 weeks--ready to fly cross country in 5-7 days.
If there is any other advice or information you could give me, I would
really appreciate it. Study the material at http://www.pilonidal.org/
pilonidal questions
It sounds like you feel tired of a pilonidal problem, correct? For you would like this problem solved quickly and permanently, right? You are headed for a good solution for you are learning and asking questions. This is my reply to a seeker with 6 years of failed pilo.
Learn about what other questions to ask by studying the web site http://www.pilonidal.org especially http://www.pilonidal.org/medical_profs.htm and then check the list under Find a Surgeon on http://pilonidal.org home page for MDs near you. We depend on patients like you to keep the list up to date so tell us at sasha@pilonidal.org what you learn.
It is fair to call these MDs, who have heard of the cleft lift operation, to ask them of their current methods and how they turn out. Do not be discouraged. You may have to make 5-10 calls. You are on the right track. Conventional treatments often work well. From your description it sounds like a cleft lift would likely solve your problem. There is even a chance that a simpler operation, pick pits, might be worth a try. We could make a better informed comment if we had a photo taken according to Michele's instructions.
Post a comment if you have further questions after you study the material at the web site www.pilonidal.org .
Good luck!
Learn about what other questions to ask by studying the web site http://www.pilonidal.org especially http://www.pilonidal.org/medical_profs.htm and then check the list under Find a Surgeon on http://pilonidal.org home page for MDs near you. We depend on patients like you to keep the list up to date so tell us at sasha@pilonidal.org what you learn.
It is fair to call these MDs, who have heard of the cleft lift operation, to ask them of their current methods and how they turn out. Do not be discouraged. You may have to make 5-10 calls. You are on the right track. Conventional treatments often work well. From your description it sounds like a cleft lift would likely solve your problem. There is even a chance that a simpler operation, pick pits, might be worth a try. We could make a better informed comment if we had a photo taken according to Michele's instructions.
Post a comment if you have further questions after you study the material at the web site www.pilonidal.org .
Good luck!
Tuesday, July 6, 2010
PILONIDAL-small primary
I reviewed the pictures of your nuisance stacked on all the other nuisances, right?. I suspect you feel frustrated and heartily fed up, correct? For you would like this healed promptly and permanently, right?
I think this kind of problem, in our hands, has responded best to pick pits. Nature can always interfere with recovery but I think you have an excellent chance to achieve healing with pick pits, though a case could be made for the cleft lift operation.
Your are on the right track to healing for you have learned about the disease and are asking good questions. The incising doctor did exactly the right thing--incised to one side of the midline and stopped to let the edema fade for 10 days. Your problem started with the pit visible in the midline. It injected bacteria into fat under the midline and that started the abscess. You are well advised to learn about pits. Destroy the pit and the problem is likely solved. The treatment of pits is new so the topic is unfamiliar.
You have a tough task, as if you are unacquainted with tough tasks! But fortunately you have lots of time. Start by reading Pingree on the web site. The list of surgeons is those that know of cleft lift--fewer know of pick pits but the list is a place to start. You probably will have to call 10-15 before you get your problem solved. Do not be discouraged--you will solve this nuisance by Sept-Oct! Rosengart is a good source
If you have have looked at the list of surgeons at the pilonidal.org site at this address: http://www.pilonidal.org under Find a Surgeon. and have considered working with one of them in your area, and still feel a visit to us is your best option then we would be glad to see you.
Call or e-mail if you have further questions after you study the material at the web site www.pilonidal.org especially at http://www.pilonidal.org/medical_profs.htm.
I think this kind of problem, in our hands, has responded best to pick pits. Nature can always interfere with recovery but I think you have an excellent chance to achieve healing with pick pits, though a case could be made for the cleft lift operation.
Your are on the right track to healing for you have learned about the disease and are asking good questions. The incising doctor did exactly the right thing--incised to one side of the midline and stopped to let the edema fade for 10 days. Your problem started with the pit visible in the midline. It injected bacteria into fat under the midline and that started the abscess. You are well advised to learn about pits. Destroy the pit and the problem is likely solved. The treatment of pits is new so the topic is unfamiliar.
You have a tough task, as if you are unacquainted with tough tasks! But fortunately you have lots of time. Start by reading Pingree on the web site. The list of surgeons is those that know of cleft lift--fewer know of pick pits but the list is a place to start. You probably will have to call 10-15 before you get your problem solved. Do not be discouraged--you will solve this nuisance by Sept-Oct! Rosengart is a good source
If you have have looked at the list of surgeons at the pilonidal.org site at this address: http://www.pilonidal.org under Find a Surgeon. and have considered working with one of them in your area, and still feel a visit to us is your best option then we would be glad to see you.
Call or e-mail if you have further questions after you study the material at the web site www.pilonidal.org especially at http://www.pilonidal.org/medical_profs.htm.
Thursday, July 1, 2010
News from Norway
Dear Dr. Ruiken, (To you on the "pilonidal" emailing list, I will send this time "open Cc:", instead of "blind Bcc:" so you can see what a spread your news reaches!)
Dr. Ruiken, you feel heartened by your experience, right? For you try always to bring health to patients, correct? This is very good news from Norway! Publish and teach! Thank you!
I will share your experience with some 70+/- from around the world and add your name to the email list and to the list of doctors who do cleft lift. Learn of new and improved pit picking for early pilonidals, and of saline overload in the USA which needs similar work!
John Bascom, MD
65 W 30th Ave. #3710
Eugene, OR 97405
Phone 541-434-4118
Begin forwarded message:
From:
Date: July 1, 2010 4:03:38 AM PDT
To:
Subject: SV: doc list
Hello,
i am working in Norway, at the "Ålesund sjukehus".
To years ago i started operating pilonidalcysts with "cleft lift procedure".
At the beginning i was alone, now we are three who do this procedure. Very little "open procedure" (excise and lay i open).
We have don 42 operasjons:
38 primer tilhealing
2 seromas med spontan perforation
1 infeksjon med sugical opning at it was good 4 weaks after operasjon.
1 with an 1 cm dehiszens in the scar. I took 1 year to get rid of this open 1 cm: He cam from an other city, and in our treatment with barbering the hair it was good after 3 weeks.
I can say that this experience with good results will motivate oss to continue with "cleft lift".
Greetings
Roland Ruiken
seksjonsoverlege dagkirurgi
Ålesund sjukehus
Helse Sunnmøre HF
6020 Ålesund
Norge
Fra: John Bascom [mailto:jbascomr@pacinfo.com]
Sendt: 29. juni 2010 16:15
Til: Rosen, Nelson G.
Emne: doc list
Nelson, Bcc:pilonidal
TTT Things Take Time! Keep throwing mud at a wall--some of it will stick! Look at Sandy's list- http://www.pilonidal.org/pdfs/PiloMDs_NON-USA_06_2010.pdf - 100 surgeons from the US and 70 from all over the world know of cleft lift. And when Sandy started a web on pilonidals there were NONE! Plus this message and others addressed to pilonidal goes by email to some 70+ professionals from over the world. Give us your experience and we will spread it around. Keep learning! Publish! Thanks for your past contributions and thanks for your teaching of the younger generation. And in August we will host a surgeon from Denmark to Oregon who comes to learn. And I, at urging of Sandy, have just started a blog. Do you have anything the world should know? Send it and I will get it out--the world may not listen but at least it will be off your mind. JUB
On Jun 28, 2010, at 10:36 AM, Rosen, Nelson G. wrote:
Very frustrating to read.
I am a pediatric surgeon but have not been turning away anyone who would benefit from a lift.
I have not been successful at encouraging my adult colleagues to adopt these techniques. I guess you can lead a horse to water, but that doesn't make the horse any smarter.
-Nelson Rosen
Nelson Rosen, MD, FACS, FAAP
Director, Trauma Center
Steven and Alexandra Cohen Children's Medical Center of New York
Rm. 158
269-01 76th Avenue
New Hyde Park, NY 11040
Assistant Professor of Surgery and Pediatrics
Hofstra School of Medicine
Office (516) 470-3636
Fax (718) 347-1233
Dr. Ruiken, you feel heartened by your experience, right? For you try always to bring health to patients, correct? This is very good news from Norway! Publish and teach! Thank you!
I will share your experience with some 70+/- from around the world and add your name to the email list and to the list of doctors who do cleft lift. Learn of new and improved pit picking for early pilonidals, and of saline overload in the USA which needs similar work!
John Bascom, MD
65 W 30th Ave. #3710
Eugene, OR 97405
Phone 541-434-4118
Begin forwarded message:
From:
Date: July 1, 2010 4:03:38 AM PDT
To:
Subject: SV: doc list
Hello,
i am working in Norway, at the "Ålesund sjukehus".
To years ago i started operating pilonidalcysts with "cleft lift procedure".
At the beginning i was alone, now we are three who do this procedure. Very little "open procedure" (excise and lay i open).
We have don 42 operasjons:
38 primer tilhealing
2 seromas med spontan perforation
1 infeksjon med sugical opning at it was good 4 weaks after operasjon.
1 with an 1 cm dehiszens in the scar. I took 1 year to get rid of this open 1 cm: He cam from an other city, and in our treatment with barbering the hair it was good after 3 weeks.
I can say that this experience with good results will motivate oss to continue with "cleft lift".
Greetings
Roland Ruiken
seksjonsoverlege dagkirurgi
Ålesund sjukehus
Helse Sunnmøre HF
6020 Ålesund
Norge
Fra: John Bascom [mailto:jbascomr@pacinfo.com]
Sendt: 29. juni 2010 16:15
Til: Rosen, Nelson G.
Emne: doc list
Nelson, Bcc:pilonidal
TTT Things Take Time! Keep throwing mud at a wall--some of it will stick! Look at Sandy's list- http://www.pilonidal.org/pdfs/PiloMDs_NON-USA_06_2010.pdf - 100 surgeons from the US and 70 from all over the world know of cleft lift. And when Sandy started a web on pilonidals there were NONE! Plus this message and others addressed to pilonidal goes by email to some 70+ professionals from over the world. Give us your experience and we will spread it around. Keep learning! Publish! Thanks for your past contributions and thanks for your teaching of the younger generation. And in August we will host a surgeon from Denmark to Oregon who comes to learn. And I, at urging of Sandy, have just started a blog. Do you have anything the world should know? Send it and I will get it out--the world may not listen but at least it will be off your mind. JUB
On Jun 28, 2010, at 10:36 AM, Rosen, Nelson G. wrote:
Very frustrating to read.
I am a pediatric surgeon but have not been turning away anyone who would benefit from a lift.
I have not been successful at encouraging my adult colleagues to adopt these techniques. I guess you can lead a horse to water, but that doesn't make the horse any smarter.
-Nelson Rosen
Nelson Rosen, MD, FACS, FAAP
Director, Trauma Center
Steven and Alexandra Cohen Children's Medical Center of New York
Rm. 158
269-01 76th Avenue
New Hyde Park, NY 11040
Assistant Professor of Surgery and Pediatrics
Hofstra School of Medicine
Office (516) 470-3636
Fax (718) 347-1233
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