35 yo male, 220lb, 6ft, athletic, USA Although this is still just day zero post-pit picking, I wanted to write this with the hope that I could add some content that didn't involve crazy surgeries. All of those surgery videos on the Internet and even some of the discussions on this website freaked me out...a lot. My heart goes out to those with recurring troubles. I worried that I had a complex case and that I was doomed to spend months on my stomach recovering from a wide excision. From my perspective, it seems that much of the medical community determined that the old standard treatments are worse than this disease, and in a lot of cases, minimally invasive procedures are the first, second, and third option. My first advice to you, dear pilo sufferer, is to find a surgeon that understands this, and listens to your thoughts and concerns about your treatment path. If you are reading this, then you are taking a great step in taking an active role in your treatment. They call it "practicing" medicine for a reason. They should continuously learn about better ways to help you, and most of all, listen to YOU. Today is Friday, January 29, 2016 at 3:30PM. I am sitting in the doctor’s office waiting for my pit picking to begin. My pilo story starts when I was 19. I had one of those really bad abscesses that you have no doubt seen on the Internet. It was pretty painful and it smelled, and I suffered through it for 4 days before I went to the university hospital. When I showed to the doctor, he quickly reached the decision to lance it. But before he could, it burst by itself and the doc drained it by pressing on it a lot. Some of you know the immediate relief that provides. To this day, I remember the pain and the relief very clearly. After I healed from that, I didn't have a problem for about 15 years, over which time, I was careful about wiping (down at the top half, and up at the bottom half), and I also scrubbed / picked out hairs while in the shower almost daily. For those 15 years, there was no hint that I ever had a pilonidal problem. Fast forward to late 2014, I developed that tell-tale sore at the top of my crack with a pit in the mid line. I never really associated it with pilonidal disease since it was never really painful. Rather, it was slightly annoying with a little bit of itching accompanied by mostly clear drainage. Throughout 2015, I thought it was a sore that I kept irritating while going a crazy amount of sit-ups and rowing in CrossFit. After several months, I decided to look it up on the Internet and eventually saw all of the horrors on YouTube. I spent half of my 2015 Christmas vacation researching, reading studies, looking at home remedies, making spreadsheets about treatment options and making lists of doctors. I even had a couple of sleepless nights reading this site. Obsessing. On 12/31/15, I went to a GP for a confirmation of my suspicion. The GP basically looked it up on his computer, compared the diagram on the screen with what he saw on me, and agreed that it was a pilo. I didn’t have any pain and it wasn’t acutely infected, but he gave me some keflex anyway and said he would refer me to a surgeon. As luck would have it, he referred me to a surgeon who is mentioned on pilonidal.org and has an amazing reputation from all sources I checked. A month later, this morning at 10AM, I went to my consult with the surgeon, Dr. Sankar Adusumilli in Raleigh NC. He told me I have a simple case with only one "gland" affected, so clearly I wouldn't need anything like a wide excision or a flap. He offered to give me a local anesthetic and do a pit picking in 5 minutes right then and there. He said I could go back to my office straight from there, and would need about a week of healing after that. Thinking about my holiday full of pilonidal obsession, I was relieved that it could be so simple. He said it could come back, but at my age, it would likely go away after the procedure. If it would come back, he described re-treatment with being as simple as going to the dentist to have the pit picking done again. I asked about other options, including FilaC laser with endoscopy, which is gaining traction in Germany and India. He said this normal Bascom pit picking is equivalently safe and effective for cases like mine, and much lower cost. Faced with the decision at that moment, I freaked out at how fast things were going. Not being the kind of person who makes instant decisions, I said I would consider it and call to make another appointment when I was ready. He was very gracious and understanding about my hesitation. As I drove away from his office, I felt kind of silly to be so conservative, so I called to see if I could get it done the following Friday. To my surprise, they said they could fit me in later today! As I drove, I cleared my schedule at work and turned toward home so my wife drive me back to the Adusumilli’s office, just in case the pain was a bigger issue than than he predicted. So, here I sit. At 3:30PM on the same day of my consult, I am waiting for Adusumilli to perform the pit picking procedure. My wife and 9 month old daughter are in the waiting room. I'm equal parts nervous and excited. I look forward to normal sit-ups without leaning to one side, and not having to worry about bikes, swimming in pools, or doing mud runs... all of which are things that I had done frequently over the years, but only started to worry about in the last month or so. He just walked in.... Wish me luck. ... It is 6:30PM, same day. I am back at home now. The procedure went fine. The doctor stuck me 5-6 times with the needle for the local anesthetic. It felt like a strong pinch for the first 3, but I barely felt the last few. It was very similar to when the dentist injects local anesthetic before you get a filling. From then on, I felt nothing in that area. He talked me though the first parts of the procedure, then asked me about my work. In retrospect, this was probably equal parts getting my mind off of the procedure, and listening for changes in my voice to determine if I was feeling pain. About 3 minutes in, I asked how things were going. He said I didn't have a lot of hair in there, but he got all of the follicles as he went pretty deep to do a thorough job. He did not close the incision, so no stitches or strips. He said the pit (which I thought was kind of big, at about the size of a half grain of rice) would close as the incision healed. Apparently, I have start of another pit, but with some hair removal, it would not progress and wouldn't be a problem at all. After I was on my feet, I asked about risk of recurrence based on what he saw and did. He said I have a low recurrence risk and, at my age, I very well may never have to worry about it again. Even if I do, he recommended for me to have this done again. The cost is around $200 per procedure. About 2 of the 7 total minutes was taken up by them putting on gauze and using a comical amount of tape to keep it on. They gave me a bag of gauze and tape, and he wrote a prescription for Ultram, which sounds badass. It is a non-narcotic, so it is not for really serious pain. Immediately after the procedure, my wife and I picked up food and went to the pharmacy. It was about an hour of sitting in the car during rush hour. I was pretty comfortable overall. I don't know if it is all the tape or the way the gauze is packed over the wound, but I could feel a little discomfort while sitting in the car. I walked around the store, and throughout the house, picked up my baby a few times, and have gone up and downstairs just as I did before. No sharp or dull pains really. For the quantitative folks, my pain level is a 1 or 2 out of 10. By 5:30PM, we were eating dinner. I did not really like sitting at the table for dinner, but again no significant pain. The local anesthetic has probably worn off completely by now, 6:50PM. I will hold off on the pain meds until I need them. Looking forward, my doctor recommended hair removal creams. During my research earlier this month I had a consult for laser hair removal, and I plan to move forward with that as my prevention method. I looked for big name places that use ND:Yag lasers. Some 2015 studies show improvement in recurrence rates when doing his as follow-on care vs hair removal creams. My doctor’s objections to this plan were primarily the cost and potential for skin irritation. I have time to think it over as a I heal to a point where I would try either method. It is 8:30PM now, and I feel fine, so I plan to get the prescription tomorrow. Getting all of this tape off will be fun in the shower. I have no restrictions on showering or activity, although the doctor suggested I take Saturday off from running. I intend to keep updating as time goes on. If you don't see another post from me, imagine me running on a trail, hitting personal lifting records, and generally slaying dragons in life, without a hint of concern about my pilonidal disease. All the best to you.