Dr. Crile's viewpoint

Discussion in 'Pilonidal News' started by ATHiker95, Sep 2, 2008.

  1. ATHiker95

    ATHiker95 New Member

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    Many years ago (back in the late 70's), I saw Dr. Crile (a renowned cancer surgeon) at the Cleveland Clinic for treatment of my pilonidal issue. He did the procedure indicated below (crochet hook, rubber drain). This resolved the issue for the next 30 years - only recently has it started to trouble me some again - unfortunately, Dr. Crile has passed away. Nonetheless, I thought folks might be interested in the comments from his book.

    From: Surgery: Your Choices Your Alternatives by Dr. George C. Crile, Jr.,M.D. 1978

    The acute abscesses that occur over the tailbone are called pilonidal cysts. The open, draining sinuses that occur in the same area are called pilonidal sinuses. Pilo means "hair" and nid means "nest"; these are "hair nest" diseases. They are of special interest because, of all of the absurd overtreatments that through the centuries surgeons have devised, the prime example is the operation for pilonidal disease.

    Pilonidal disease it the result of ingrown hairs. In hairy persons the cleft between the buttocks directs the hairs downward toward the little depression that many people have just at the tip of the tailbone where, in the development of the embryo, the nervous system turned in from the skin. The hairs penetrate the skin of this tender area and embed themselves in the tissues, where they fester, causing abscesses or draining sinuses. Sometimes there are only a few hairs and sometimes there is a large collection, forming a sort of hair ball. All that needs to be done is to have the hair removed. Often it can be done in the office, under local anesthesia, by opening the abscess and inserting a little rubber tube which is anchored in place for two or three weeks until the hairs have been extruded and the 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 The tube is then withdrawn, the buttocks are shaved or treated with a depilatory to remove all hair, and the area is soon healed.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.

    But what is the standard operation done in hospitals throughout the country? The standard operation for pilonidal cyst or sinus is to cut the whole thing out just as if it were a cancer. Since the area is infected, healing is slow. Often the surgeon 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 surgeons do 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 (skin like) 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, because hair follicles are growing within it, whereas pilonidal disease 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.

    In the 1940's, studies were made by surgeons and pathologists that showed beyond doubt that there were no hair roots or follicles in pilonidal abscesses or sinuses. Undeterred, surgeons kept on cutting them out to get rid of the last nonexistent root.

    Pilonidal cysts or sinuses affect young men. The condition is aggravated by bumpy riding - it was called "jeep disease" in WW II. Radical operations done for this disease caused more prolonged disability than any other surgical condition at the San Diego Naval Hospital. When I worked there, there was always a ward full of pilonidal convalescents. Some of them took a year to heal.

    You can't blame fee-for-service surgery for the radical pilonidal operations that were done on military personnel during the war. It is the teaching that must get the blame. This in turn may have been influenced by the fee-for-service system, because it is surgeons who teach surgery, and most of them get their income from fee-for-service surgery. There would be little incentive for them to switch from an operation for which they get paid hundreds of dollars to a simple office treatment for which they get paid very little. It would also be impossible for a teacher of surgery to teach a treatment he was not practicing. Hence, even though the true nature and proper treatment of pilonidal disease has been known for more than thirty years, radical surgery still is the most commonly recommended treatment. Please , if anyone wants to hospitalize you for an operation for previously untreated pilonidal disease, refuse the operation and go looking for another surgeon!"



     
  2. justbob

    justbob New Member

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    This is a fascinating article and leaves me somewhat angry at the surgeons who continued doing this when they knew full well there had to be a better way.
    Not all surgeons are aware of that of course. But certainly some of them are.

    I was encouraged to get that kind of procedure until I read more about it and learned that it had such a super-high recurrence rate that 'living with it' (if possible) was often-times preferable. It was 9 years ago that happened and I've been living with it ever since. (probably to get cleft-lift or some better type of procedure in the near future).

    It's almost like trusting ones doctor is the biggest mistake one can make in certain circumstances. You have to be able to do the research yourself on the internet to find out what's REALLY going on because otherwise somebody like me would have no way of knowing that the guy telling me to do it badly and that's how it's always done is simply unaware of the better options available.
     
  3. ATHiker95

    ATHiker95 New Member

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    Justbob,
    Yep, know exactly what you mean. I was lucky back then. I just happened to be watching Phil Donahue (maybe some of you might remember him :) and he had Dr. Crile on talking about breast cancer. The Doctor seemed pretty sharp and was talking about other alternative operations as well. Well, it just so happened that a few days later I was in a bookstore and happened to notice Dr Crile's new book. I was curious and opened it to browse through it and about fell over when I saw this article about pilonidal surgeries. Like you, my doctor was prepared to take a large chunk out of my behind and Dr. Crile's method sounded a whole lot better! Turned out it was relatively easy to get in to see him at the Cleveland Clinic and within a 1/2 hour I was fixed up and gone with a few pain killers. It's a shame more docs didn't listen or haven't listened to what he suggested. Many docs I've shown that to just scratch their head and say that's not what they were taught. Geez.

    Mark
     
  4. quix-stick

    quix-stick New Member

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    I'm doing NaNo, too!

    Best of luck with this.
     
  5. gollum's damn ring

    gollum's damn ring New Member

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    it would be nice to hear more opinions on this.
    someone who perhaps disagrees that this is how to deal with the situation.
    todays standard treatment is still to create lare cavity wounds.
     
  6. ALEXANDER

    ALEXANDER New Member

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    very interesting article. with everything you read about treatment of pilos, this sounds way too easy of a solution. does anyone know of any doctor who does this 'rubber tube' procedure? i would love to consult with them and get their opinion for treatment regarding my son's pilo problem. i would think that dr. crile would have taught this technique to other physicians. the cleveland clinic doctors are known for working together to solve medical problems. please respond with any info. many thanx.
     
  7. Mandotolson

    Mandotolson New Member

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    My only problem with this is 1. I am a female 2. I do not have a hairy butt. and 3. I do not hair growing inward to cause this. I indeed do have hair follicles from within or something. My best guess is in my early 20's I was snowboarding and broke my tailbone. In my X-Ray it showed the tip up my bone floating away from my bone. I think my problem is that! To say Hairy butts and men get this is just not accurate. However I do agree there has to be a better way than digging a hole in my rear and waiting for it to heal. I did not have such an extreme surgery. My hole was miner. I did have mine drained 5 times and removed once. It has returned after 3 years of no activity. Another odd thing is mine happens monthly while I am ovulating??? ODD and Painful!!!
     
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  8. MommaRain

    MommaRain New Member

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    faulty science. the doc makes assumptions that have already been disproven
     
  9. Mugen

    Mugen New Member

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    I think this is really interesting but as other mentioned, there's case by case reasons why someone develops the cyst. I do agree though that the lack of mainstream attention to the condition and the pain that arises at times encourages a situation of get it out! which is understandable. This leads the removal of tissue and tracts to seem almost as a removal of cancer. It does have similarities in severity and the bacteria that causes the infections is a breeding antagonist that can tunnel, but I really think we'll see some simpler ideas of healing in the future.
     
  10. Jedrasy

    Jedrasy New Member

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    My two cents on the matter. This was taken from the 70's when a large majority of the cases seen came from men (whom categorically have hairy clefts). I agree that for most people the best option is to not have the cyst excised.

    I am a medical scientist and have met with a handful of specialists and a number of surgeons to discuss pilonidal. Fortunately for me, early on in my pursuit for answers, I met a specialist who helped me to understand the cause of Pilonidal disease. Unfortunately, most medical doctors are taught to diagnose a problem as recalled from a textbook and do not stop to think about origin and cause. Which leads to excision, long recovery, possible recurrence, and other detrimental effects. This is not necessarily their fault as that was their training and they also are under pressure to serve the masses, not so much the individual. To be noted, as many people can attest to on this site, excision solved their problem. However, I am on the side that excision should only be done in the fewest of cases.

    While we call the open wound a Pilonidal Cyst, it doesn't mean that it is a cyst and/or that it is hair related. It just gets categorized as such.

    During in utero development, as the skin is being formed, it has been postulated that some of the last skin to be formed is in the natal cleft (butt crack). For some people, they may just have a thin layer of skin present at the dimple site. For others, like myself, not only is the skin thin in the cleft at the dimple, but the deep cleft (thanks to genetics) compounds the issue by not allowing as much aeration as do more shallow clefts. In addition, for reasons unknown (at least to me), women during their menstrual cycle may notice more tenderness in the cleft at the site of the dimple. I have ideas as to why this may be, but nothing founded. Suffice it to say, it does occur.

    Basically, from my understanding and literature research, Pilonidal disease occurs due to tissue injury and subsequent infection. Depending on the thickness of skin around the dimple site, an injury as simple stretching one cheek too far may be enough to cause a tear and then subsequent infection. Or it could be like falling while snow boarding as was previously mentioned (I also went snowboarding and fell and opened up the ol' pilonidal). Alternatively, no tissue damage may be necessary and it could be that the dimple opening is large enough that bacteria present on the skin or introduced from wiping, may enter into the dimple and start an infection. A deep cleft may lead to the ability of some bacteria that don't need oxygen to replicate and in addition, it makes for proper open wound healing more difficult. This really isn't a cyst at all, but a cavity in which bacteria can reproduce. Once lanced and open, it becomes more of wound care. With that opinion stated, some people really might have a cyst and the best treatment would be to have it excised.

    For me, excision is not an option as it would only cause unnecessary injury. I also have a hunch that for me, it would not be successful and I would have to have it done again. I don't have much luck with medical procedures. I met with one surgeon and showed him Dr. Bascom's cleft lift work. He mentioned that he was aware of the surgery and that he also was aware of the success, however, he would not preform it. Basically he would get more money by doing the surgery again on the same patient. At least he was honest.

    I have been living with Piolonidal for 13 years now. Much to my chagrin, it goes away and then decides to say "Hello!" randomly. I have treated the open wound 9 times now. I resort to self-treatment that the first specialist I met with recommended. He showed my wife how to do the minor procedure, knowing that most medical doctors would suggest I go and get the excision. For maintenance, I shave (rather my wonderful and gracious wife does), pluck hairs around the dimple, and soft scrubbing when showering or bathing. If the Pilonidal is open, I determine if it is infected (pus, redness, tenderness, smell . . .[I did a PhD in microbiology and now have a nose for what different types of bacteria smell like). If it is infected, I go the doctors to get an antibiotic. Whether or not it is infected, I cauterize the opening with a silver nitrate stick (bought on Ebay). This is also affectionately known as a "Fire stick." :) It will only react with wetness. So if you touch dry skin it will not hurt. The wet wound will turn brown. I then use a little portion of Hydrofera Blue foam (antibacterial, also purchased from Ebay) that I wet and then my gracious wife puts it in the cavity along with some gauze on top to keep the foam in place. It is important for this to stay put to keep the wound from closing back in on itself. You want to have the skin grow from the bottom up. I change the gauze twice daily for a week, then retreat with silver nitrate, change gauze twice daily for another week, then change gauze once a day until the wound is closed (about 2-3 weeks). In the mean time, I am able to function normally (sit, run, play sports, ect).

    Fortunately, I only had to deal with tunneling the first go around and I had the first specialist, numb me and then cut open the tunnels.

    Obviously, this not something I want to keep doing, but until I have insurance that will cover and a surgeon that will perform Dr. Bascom's Cleft lift, I endure.

    This really is a pain in the rear. I understand we all have our own ways of coping with it. I hope we can all put our good friend Pilonidal to rest someday. Anything, I have written above is my opinion and has worked for me. It may not be best or work for you or you may not agree. That is fine. I think it is a good way for pilonidal management, but I think anyone interested in this type of treatment should talk to their Dr. first. It is really frustrating going through the rounds of Drs and appointments and then differing opinions. Hence, I do my self-treatment to save money, time, and pain.

    Anyway, I don't even know if this is the right forum to post to. I haven't been on the site in a couple of years, but decided to give my rare opinion. This may or may not be helpful, but I hope it can be to someone who like, me lives with a caboose reminder.
     
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