Apologies for the long story but just thought of sharing my day by day experience as when I was going through the pain and had lot of questions I really wanted some detailed experiences to know if whatever I was going through was fine and normal but didn’t really find them at once place. I had surgical excision and open wound method used.
Occurrence:
I am now a 32 Year old male, Working for Stryker in India. I don’t really recall as to how the Pilonidal Sinus happened but I am quite hairy and use to drive a bike when I was studying my degree and I recall one instance of falling off on my back from a bus while trying to get in during my study days, so I am not sure what caused it but my guess is this is a combination of these. If I recall (since it’s too long since then), I don’t think I had this until my 12th grade, it only happened during my college and degree time when I was around 20 Years old. It initially was like a small painful scar with liquid discharge coming in sometimes, had taken some antibiotics buying over the counter medicine and had it sorted for a bit but off course it returned and continuously troubled me until one day my cousin sister saw a blood spot on the back of my trouser around the tailbone area, quite embarrassed I was with that.
So I went to see a doctor now who advised a surgery which in those days was expected to cost about INR 20K and I couldn’t afford it in those days plus it required me to be on off for a month so considering my affordability and training and educational occupancy I shrugged the idea of going through the surgery and rather chose for Homeopathy medication which didn’t really help and I got of all medication in a bit. Since then until now I kept going through this with abscesses coming and going, bursting, bleeding, severe pain at times and that kind of became a part of normal routine, I just ensured to clean the area on a daily basis and off late surprisingly the pain and the liquid discharge both reduced significantly.
I continuously have leg pain and pain in my back and consulted Orthopaedic doctors and they found nothing wrong so I think it was caused by this sinus. Finally thinking that it’s not good to carry any infection in the body I chose to consult a surgeon again in June 2014 (by the way I got to know the name only a few months back until then I was told it’s a fistula). Surgeon advised me to go through the surgery and I decided to go through it on August 4, 2014. Hospital Name: Medanta and Dr. Sandeep Malhotra (Associate Director of the department). He told me about other procedures in place but purely on the basis of recurrence rate I chose excision and open wound. He told me that hospital stay wouldn’t be more than 1 day i.e. next of the surgery I will be discharged unless I wanted to stay or it was considered important looking at the condition. Post the surgery he advised me to have daily dressing changes for two weeks and then once in two days and advised that total healing time would be anything between 4-6 weeks.
Preparation
I went to see the doctor on 29th and he prescribed a few standard tests e.g. Chest X Ray, Pre-Anesthesia Checkup (PAC), Liver & Kidney Function Test, Complete Blood Count, HBA1C (Sugar) and I added a few from my side for my satisfaction: PFT, Whole abdomen ultrasound. I had my HIV test don’t before (couple of months back so didn’t need to repeat it. All the reports were fine except my HBA1C which was diagnosed as pre-diabetes (6.2) it was 5.9 couple of months back but no risks. I got the PAC done at another hospital where I got my tests done even though this was to be done again on the day of the surgery, just to be sure that there are no concerns which need to be tested for being sure. I went to work till Friday i.e. 1st and then got these tests done on Saturday. Sunday I pretty much relaxed with just going out with my wife and son for some fun time for my son. Had my hairs removed using a hair remover cream. Didn’t sleep that well as I had to get up at 6.30 and slept late around 12.30 or1.
Surgery Day
Reached the hospital at 8.45 in the morning, I planned to get in by 8 as I wanted to get done with this as soon as possible but my wife gets me late, she is quite religious and wanted to do some prayers and also to go to a temple on the way to hospital. While I was worried about getting late but otherwise was happy as prayers did settle down few nerves. I reach the hospital (just to let you know, the hospital is the best in the city and one of the best in the country and renowned internationally too and offcourse crowded, which was one of the reasons why I wanted to reach early) and get my name listed at the reception for getting a room allocated, the admission form was pre-filled by the Doctor’s secretary in the last week itself and I had got my insurance approvals done in advance as well. The attendant/receptionist advised me to go to daycare and someone accompanied me and my wife there. I got into the daycare changed my clothes (around 9.40) and here came the nurses and they checked my weight, height, vitals, followed by the anaesthesians. All cleared around 10.30 and they asked me to sign the consent form etc to complete formalities and then they told me that they would shift me to the pre-op in 10 mins, so I called my wife in to see me before I go in for the surgery. 10.45 AM I was in pre-op and then in next 15-20 mins I was in the OT. No panic at all and I was infact talking to the anesthesia doctor about the OT lights being from my Company etc. and generally having a light moment. During the conversation, she puts a cannula on my left hand, pretty smooth I must say, they always hurt but not at this time. Very happy till now and I next few minutes I am knocked out due to the anesthesia medicine through the IV, mine was to be done under GA and was told in advance by the surgeon when I met him for prior checkup.
Don’t know what happened till 12.30 or so but when I woke up I was in Post Op recovery room with no pain but dizziness. Realised a big gauze on my back, my wife is called to see me and she comes and calls the doctor to check how did it go and he told everything fine. Shifted to my assigned room around 2.30. No discomfort until now. Around late in the evening I start having some pain in my throat like tonsils. I told the nurse and she told me to use nebulizer. Ate well (Soft diet) during night and off I go to sleep. Pretty much no pain but yeah I was conscious of the wound so was careful and only laid on my sides. I was given painkillers and antibiotics.
Day 2 post surgery day No pains at all to start with throughout the day. Felt my throat was little bad than yesterday and I felt some blisters in my mouth. Next morning doctors come and find everything fine and advised for discharged and I land home around 12.30 in the afternoon. Dressing was changed in the hospital itself and didn’t hurt at all, the doctor told that it might. Unfortunately I didn’t talk about mouth ulcers and the throat with the doctor when they came to see me. No major event and relaxed throughout the day infact walked on my own to go to the chemist shop to buy medicines etc. Slept well but on the sides only. Day 3 The nurse from the hospital comes in the morning to get my dressing changed and I go for a shower, no pain except during the cleaning. Pretty much no significant issue with the wound. But the problem was with throat and the mouth ulcers, so I called up the surgeon’s assistant to ask for medicines for the ulcers and he advised that I stop the antibiotic from the next day as that’s what is causing it and for the throat he suggested I do gargles. I just wish in hindsight that I should have been given a medication earlier only but yeah my mistake as I didn’t really brought the problem up timely. Ate normal until the afternoon but felt lot of pain swallowing the food during the night so I didn’t eat well. Didn’t have any significant pain in the wound though and was infact worried why am I not having pain as the wound was big enough (5-6 Inch long and 2 inch deep I guess don’t know this exactly though).
Day 4 Thursday 7th August Throat is completely screwed up so I call the doctor’s assistant again and he told me to see an ENT specialist and I do so (Drove my car myself and didn’t feel any problem). The ENT specialist diagnosed this as throat infection caused by the tubing inside my mouth during the anesthesia. And let me tell you this is quite maddening a pain and really screws ability to literally eat or drink anything. Pain in the wound was significantly higher with lot of heaviness and consistent feeling of pain and discomfort. Added on top of that was throat and the mouth ulcers.
Day 5 Friday 8th August My nightmare with Pilonidal Started now. By evening the pain in the wound was unbearable and I had the most painful time of my life while getting the dressings done. My evening dressing was so much pain that I was scared thinking about the dressing next morning throughout the night it. Added on top of all this was continuous pain the throat and severe ulcers in my mouth. Contacted the doctor in the evening and he said have some pro-biotic for the ulcers (ECONORM is what he suggested). For the pain he said take the pain killer prior to the dressing which I wasn’t earlier.
Day 6 Saturday 9th August -TERRIFIED WITH THE PAIN, I call up my nurse and told him that I don’t have strength to have the dressing changed, can you ask the doctor if there is any injection of medicine to numb the area. By the way I took Ultracet (Tramadol) at 9 in the morning 1 hour prior to the dressing but had no significant impact till the time I called this guy which was around 9.45 or so. Called my doctor and he refused to give any sedation or injection or using any Sprays to numb the area. He said strictly prohibited and he would not recommend them at all He rather suggested that I use the silver dressing (AG Aquacel Convatec) and change it once every 2-3 days that ways I don’t have to go through the pain on a daily basis.
Just to let you know that I was getting the dressing changed once a day with the traditional stuff. I was having bath before my dressing changes. I immediately ordered the new dressing as just to hear that I don’t have to go through the dressing changes daily was a lot of relief. While all this was happening, sadly I ended up taking Ultracet again around 10.30-11 mistaking it for the medicine for my throat as both looked similar. Didn’t realise this until evening around 7.30 when I was to take the throat medicine again and on counting my consumption since I started I found one less consumed only to figure out that I had taken the wrong medicine in the morning. I was wondering all day why I wasn’t able to get up from bed and felt fully lost and sedated the whole day and then came the bomb – started sweating like mad and was horrified to core feeling that the double dose was dangerous.
I almost passed out for next couple of hours and here came my dressing guy and I refused to go through the dressing again and told him that I want the silver dressing only. Quite an eventful day. (Sorry I am just writing at a stretch so pardon the spelling errors etc.)
Day 7 Sunday 10th August 9 AM morning, I have some breakfast (mostly liquid due to my throat), take the pain med and take a shower and here comes the guy with silver dressing. Fully horrified and not really ready to go through the pain but was also scared that the gauze was in for past 2 days and it could be dangerous so I kind of went in favour of what was best for the wound (pain was definitely much lower). Felt the pain during the dressing and cleaning but was amazed how smoothly the silver dressing went into the wound, I was actually asking the guy that did he really put anything into the wound. THE SILVER DRESSING IS THE BEST THING THE DOCTOR SUGGESTED.
Not many events during the day just had lot of liquid discharge. Next dressing scheduled for Tuesday.
Day 8 Uneventful (Monday 11th August) Everything, throat, ulcers and wound pain on lower side but still good enough to continuous bother. Infact throat and ulcers were more painful and they didn’t let me eat well. Day 9 Tuesday 12th August Dressing day, take the pain med and have a shower and dressing was much much smoother. With only once concern that liquid discharge had increased quite a lot and it had a bit of odor as well. The discharge was brownish sticky stuff. Worried if this is infection, the nurse says no worries so I felt ok. Throat and ulcers continue to be main troublers.
Day 10 Wednesday 13th August Miraculously the pain was significant low or should I say didn’t even feel any pain in the wound and actually surprised as to what really happened overnight. Continue to have my throat pain but significant lower as well, ulcers as well reduced heavily. Called the doctor and took an appointment to show the wound as I was worried about the odor and liquid discharge.
Day 11 Thursday 14th August Had the dressing in the morning before going to the hospital. Met the doctor at 11 and he sees the wound and is quite happy. He told me that odor is fine and growth is very good and there is no infection signs so nothing to be worried. Puts the same dressing back as it was just about 45 minutes old. Throat and ulcers are reduced significantly. Continued to have bath prior to the dressing. Next dressing scheduled on 16th August late evening. Biopsy report received and shown to doctor and no abnormalities and signs of Cancer etc.
Day 12 Friday 15th August (Indian Independence Day) Pain is “Zero”. Only a sensation and feeling of the wound. No heaviness, no pain and feel quite good about the whole body as I was able to move around with pretty much nothing making me uncomfortable and guess what the throat pain is fully gone, ulcers are gone.
Day 13 Saturday 16th August Uneventful, went to the mall after the dressing (which was absolutely no pain) with my son for some shopping and guess what I drove the car myself. Felt a bit uneasy and was careful all this while not to put my whole body wait on the wound but otherwise felt ok. Liquid discharge reduced significantly but good enough to leave a spot on my jeans. First day of wearing a trouser/ jeans all this while was wearing shorts made up of extremely soft cotton. Next dressing on Monday
Day 14 Sunday 17th August Tried having a shower putting a cover on the dressing and it worked. Felt quite fresh and good by now, no pain and other discomfort but still not sitting for long and sleeping sideways or on my stomach. Started working from home as I could sit for about half an hour to an hour at a stretch without any discomfort. Drove the car again and was absolutely fine.
Day 15 Monday 18th August Waited the whole day for the dressing change as I started feeling some itchiness. The guy couldn’t make it early in the day so came late evening, had a good shower and got the dressing done. Absolutely smooth.
Day 16 Tuesday 19th August Have the dressing change in the morning at 7.30 and joined office at 9 AM. Sat throughout the day (with not much discomfort) and worked till 6.30 and felt a little dizzy but was fine otherwise. Ensured one thing that I constantly got up every hour and didn’t sit for too long at a stretch. Must tell you that post Saturday dressing on Day 13, stopped taking any pain meds as well prior to the dressing and felt no pain at all. All this while my body hairs are growing up (still quite small though) and I have been asking the nurse if he find any hair into the wound, he hasn’t until now but I would ensure that the hairs are removed once I have the wound healed a bit more.
Day 17 Wednesday 20th August Dressing change at 6.30, had shower prior to the dressing, reached office at 8 worked and had quite a hectic schedule throughout the day. No problems at all. Went back home at 5.30 and slept for an hour and then watched TV and did normal activities. Still not sleeping on back.
Day 18 Thursday 21st August Dressing change at 6.30, reached office at 8.15. Logged in and writing this story updating the experience since Day 3. Done now so would get back to work.
I wish all the best to everyone and hope you recover well. I will post a summarized versions my upcoming weeks every Saturday. Few things that are important for you to do and know (while dedicing for the surgery and recovery):
1. Choose a seasoned and experienced surgeon as marking the area of infection for cutting the infected tissues out in the surgery is the most important part. While I am still going through recovering this but I always felt that if the entire infected area is removed properly then chances of recurrence would be low and I hope and pray to god that I don’t have one again. The doctor I chose didn’t recommend any MRI or something and rather went on putting in the blue die during the surgery to identify the infected tissues. By the way this is a must even in cases where MRI is done prior to the surgery. The doctor I chose actually operated my wife a few month back as well for Gallstones and he is very very good, highly recommended.
2. Get a nurse for doing daily dressings, I was never told that I need to do it twice.
3. If you can afford, then select the Silver dressing as it not only helps otherwise by allowing the dressing change frequency to be moved from 1 to 2 or 3 days, it does help reduce the pain and most importantly improves healing significantly. Removing the dressing is a cakewalk as due to the gel inside it, it becomes slippery and comes out like so easily.
4. Keep a good hygiene level, rest and sleep well and also eat well.
5. Cost of surgery was about 50K INR and per day dressing change cost was about INR 1K per dressing. Which for about 45-60 dressings would cost about another 50K-60K.
Let me know if you guys have any questions, I am putting this on the forum as well and I would be happy to share my experience.