Cleft Lift Recovery Log 11/12/18

#1
Inspired by the JonH thread, I'll try to update this to maybe help some others.

Backstory. I had a closed pilonidal excision back in April 2018. A few weeks after that, I had a small sinus open up. We tried silver nitrate treatments for a couple months, but there was no progress. I scheduled a cleft lift procedure with Dr. Immerman and had the procedure done on 11/12/18. He was great and informative, and his office staff + the staff and facilities at the Oak Leaf center were top notch.

Day 1. Pain is uncomfortable, but not near what the closed excision was. I was prescribed tramadol, but am asking for something a little stronger to take the edge off. My wife said I moaned a lot in my sleep, and I woke up several times. I am worried about my travel back home on the airplane after this initial surgery anesthesia wears off and I start getting the full effect of soreness.

The cut seems to go from right near my anus all the way up to my lower back, so maybe 12" long? I'm draining about 20ml of fluid every 12 hours right now. I haven't tried to sit down yet. I would highly recommend getting a handheld shower wand. If you are going to be in a hotel for this procedure, maybe request a handicapped room, they usually have the wands and handlebars beside the toilet. Using the shower wand will help keep the anus area clean after a movement, but don't go overboard and follow your doctor's instructions for sanitation. A stool softener is highly recommended, and the doctors and nurses basically made me promise to take them. You do not want to strain since the incision is so close to everything down there.

So far so good. Not sure what I would do without my wonderful wife helping me.
 
#3
Thank you. Your thread helped push me to make the choice to have this done by a specialist. When I got back to the airport, a guy that worked there asked if I had just had surgery since I was limping and wearing pajama pants. Long story short, he has had pilonidal trouble for the past 8 years or more, and still packs his every day and just deals with it. He wasn't aware of any further treatments that could fix it. I gave him a little info, and will try to keep in contact and maybe he can get some relief also.


Day 3. We just got back home. The flight was ok, the car drives in between were worse for me. I have sat about 3 times for about 5 minutes each, twice in chairs that had arms on them so I could take some weight off as necessary. One time I sat on a flat bar stool and it was ok. Dr. Immerman insists that sitting straight up and down will not cause any 'damage' to the wound, but it is still tender to sit on and I don't want to aggravate it too much right now. I'm sure everything back there under the skin is very swollen and irritated. I am much more mobile than I was after the first surgery.
 
#4
Day 5. The pain is still not near what the first excision was. I can definitely get by without taking any medication. I sat yesterday 2 times at 30 minutes each with only mild discomfort, and I'm gonna try 3 times today (or more) as long as nothing hurts too bad.

So far so good I guess. Nothing is especially tender or painful considering the amount of cutting that went on just a few days ago.
 
#5
Day 7. Got my drain removed since my fluid draining was less and less each day and totaling up less than 20mL a day. Removing the tape that kinda held the tube in place was the worst part. There was virtually no pain when the drain was pulled out.

Day 11. The steri strips came off yesterday. They were starting to peel off on their own so I just finished the job. Still taking it slow and easy, and the pain is still negligible. Sitting on certain couches and chairs during Thanksgiving visits was uncomfortable but definitely manageable without any medication. I was able to bend down and tie my shoes for the first time with no real discomfort. I could tell it was a little tight, but that's it. It was a month before I could do that with my last surgery.
 
#6
Thanks so much for sharing your experiences as you go through the surgery and healing process. Considering the surgery for myself sometime in the future. Wishing you a speedy recovery!
 
#7
You're welcome. I hope someone can get some info out of this, or gauge their healing process with my own in some way.

Day 15. The discomfort is almost gone when walking at full speed, and when "bending down" to pick up stuff off the ground. I put it in quotes because I will normally scoot something over near a table or counter with my foot, then take 1 leg off the ground to reach down and pick it up to avoid too much stress on the area. I'll have to be careful and remind myself I'm still not 100% healed back there and to take it easy. There is still discomfort when sitting on certain chairs, but I would no longer call any of the discomfort "pain."

I try to sit straight up and down like my doctor said, so I spread everything out, help get some air under there, and possibly help stretch everything correctly to allow full movement before all my internal sutures fully dissolve. Not sure about the stretching skin thing, but it makes half sense in my head.

I sent some pictures to my doctor, and he said everything looks normal. Still 4 weeks to go before I will start testing any body weight squats to parallel, then maybe a couple weeks after that easing into squatting all the way down like if I was in the yard messing with the bushes or something.
 
#8
Day 21. Not a whole lot of change, everything is going well right now. I went back to my local surgeon/wound care office to have a checkup, and everything looks okay. I sent some pictures a couple days ago to Dr. Immerman for his files, and he also said everything looked normal then. (I see my doctor here since Dr. Immerman is a thousand miles away, and sometimes pictures don't do things justice. I am also blown away by how fast Dr. Immerman responds to emails. He and his office staff were great, and I wouldn't expect less from them after dealing with them the past couple months, but I know they get busy like any other surgical office. It's just nice to have such a fast response time, usually within a few hours.)

I am still taking it very easy despite feeling ok. Only very minor discomfort now when sitting on oversized sofas, or if I'm having to bend a little too much than I need to be. I'm changing gauze at minimum 3 times a day, and keeping everything dry and clean. Hopefully everything will continue to go well. Other than an oversized/overstuffed chair/sofa, I'm sitting way more comfortably than even 7 months after my initial closed excision surgery.
 
#10
Hello may I ask you a question? Did you travel out of state for your surgery, if so, did you have any issues with your insurance? I'm having one issue after another with my insurance either not being accepted or being out of network as I'm going out of state. What has your personal experience been like?
 
#11
I did travel out of state. Luckily, Dr. Immerman's office was "Out of Area" but not "Out of Network" per my insurance administrator. I basically "applied" to have the surgery done in August of this year, and it was not "approved" until October, so almost 3 months total. There was a process of going back and forth with my first in-town surgeon, the insurance administrator, and the office in Wisconsin.

1. In-town surgeon - We have a good relationship, and I really like him, his staff, and facilities. Unfortunately my first closed excision surgery resulted in a recurrence. He operated in early April, by the 3rd week we knew there was a hole there. I started researching further treatments by May, and in early August I contacted my insurance company. I talked to my in-town surgeon about a cleft-left, he knew what it was, but was not trained in it, so he did not want to do it himself. My surgeon here is also a wound care specialist. He suggested silver nitrate treatments once a week until it looked like the sinus would close up to save me from going through another surgery, and was very much against a wound-vac. My sinus was smaller than some cases, maybe the size of a dime or a little larger, but only a few millimeters deep, so he was hoping it would heal up.

2. Insurance Company - Told them about my discussion with my in-town surgeon, and that I would try the silver nitrate for a couple months and reevaluate if no progress was being made. At the same time, I presented them with information and links to Dr. Immerman's website, cleft-lift literature and case study findings that I had found by googling around and reading on this forum. They took that info and presented it to their bosses or consultants or whatever it is insurance does to deem a procedure "medically necessary." I got a call a couple weeks later from a case handler in another state, we talked about my condition, my previous surgery, my current treatments, my plans on a cleft-lift, and why I chose Dr. Immerman (I sent her links to the same information), and my worries about what would happen if I did not move forward with another surgery.

3. Dr. Immerman's office - Told them my information, and sent them some pictures per their request to see if I was even a candidate for the cleft-lift. They got back to me quickly that I was, and then I requested my doctor in-town to send all of my records to Wisconsin.

After the fact finding and information exchanging, I went forward with the silver nitrate treatments for about 6-8 weeks, I can't remember exactly, but no progress was being made on the wound healing up. The treatments were not pleasant, the wound would bleed and ooze a lot of fluid for the next 5 days, and it kept the area very tender, and it was hindering my movement because it was so tender and I thought I was damaging the wound further. I let my insurance administrator know this, and they received the doctor's records that indicated my wound was staying the same size, and that treatments would go on for a long time, if they even worked. About 2 weeks after that, I was approved for surgery, and the approval would last through the end of the calendar year. It was then up to me to schedule the surgery when it was convenient for me to travel, and Dr. Immerman had an opening. I think it was a 2 week lead time.

SO FAR (knock on wood), the healing from the cleft-lift has been excellent. My first surgeon fully excised all of the cyst, so the cleft-lift was more "cosmetic" than deep tissue removal.
 
#12
I did travel out of state. Luckily, Dr. Immerman's office was "Out of Area" but not "Out of Network" per my insurance administrator. I basically "applied" to have the surgery done in August of this year, and it was not "approved" until October, so almost 3 months total. There was a process of going back and forth with my first in-town surgeon, the insurance administrator, and the office in Wisconsin.

1. In-town surgeon - We have a good relationship, and I really like him, his staff, and facilities. Unfortunately my first closed excision surgery resulted in a recurrence. He operated in early April, by the 3rd week we knew there was a hole there. I started researching further treatments by May, and in early August I contacted my insurance company. I talked to my in-town surgeon about a cleft-left, he knew what it was, but was not trained in it, so he did not want to do it himself. My surgeon here is also a wound care specialist. He suggested silver nitrate treatments once a week until it looked like the sinus would close up to save me from going through another surgery, and was very much against a wound-vac. My sinus was smaller than some cases, maybe the size of a dime or a little larger, but only a few millimeters deep, so he was hoping it would heal up.

2. Insurance Company - Told them about my discussion with my in-town surgeon, and that I would try the silver nitrate for a couple months and reevaluate if no progress was being made. At the same time, I presented them with information and links to Dr. Immerman's website, cleft-lift literature and case study findings that I had found by googling around and reading on this forum. They took that info and presented it to their bosses or consultants or whatever it is insurance does to deem a procedure "medically necessary." I got a call a couple weeks later from a case handler in another state, we talked about my condition, my previous surgery, my current treatments, my plans on a cleft-lift, and why I chose Dr. Immerman (I sent her links to the same information), and my worries about what would happen if I did not move forward with another surgery.

3. Dr. Immerman's office - Told them my information, and sent them some pictures per their request to see if I was even a candidate for the cleft-lift. They got back to me quickly that I was, and then I requested my doctor in-town to send all of my records to Wisconsin.

After the fact finding and information exchanging, I went forward with the silver nitrate treatments for about 6-8 weeks, I can't remember exactly, but no progress was being made on the wound healing up. The treatments were not pleasant, the wound would bleed and ooze a lot of fluid for the next 5 days, and it kept the area very tender, and it was hindering my movement because it was so tender and I thought I was damaging the wound further. I let my insurance administrator know this, and they received the doctor's records that indicated my wound was staying the same size, and that treatments would go on for a long time, if they even worked. About 2 weeks after that, I was approved for surgery, and the approval would last through the end of the calendar year. It was then up to me to schedule the surgery when it was convenient for me to travel, and Dr. Immerman had an opening. I think it was a 2 week lead time.

SO FAR (knock on wood), the healing from the cleft-lift has been excellent. My first surgeon fully excised all of the cyst, so the cleft-lift was more "cosmetic" than deep tissue removal.

Awesome glad to hear the healing process is going good so far.
Overall, how long would you say you had to completely be in bed/not do much of anything at all? Whenever I get my cleft lift, I will only have 7 full days off from work as that's all I get for vacation time. I'm scared 7 days won't be enough but I don't have a choice.
From your experience do you think in your case 7 days would be enough time before you had to return to a moderately active job?
 
#13
I went back to work on my 8th day, because my 7th day I had my drain removed and I did not want to be at work with that drain in.

7 days will be fine if your employer knows you had surgery and is okay with you possibly leaving early and just taking it easy. I was able to walk around fine, and sit fine on certain chairs. I only climbed a few flights of stairs, and when I did it felt fine but I went slow. I did not climb any ladders, and still haven't yet just to be safe. However, my local surgeon was adamant about me NOT going back to work for 2 weeks because the surgeon who worked on me was so far away. If I fell or got in a car wreck etc and tore it open, he could help fix it, but he wouldn't know exactly what went on during the cleft-lift surgery, and how everything in there was supposed to be put together, if you see what I mean.

Long story short, I felt fine going back to work at 7 days, but I took it easy and only worked from 7am-1pm and went home to rest. My employer was very understanding. However, I am a salary employee, not an hourly, so that may impact your decision/ability to take off. Also, if you injure it at work, the company could be liable in some respect, and they may not want that risk and want you to take it easy, or leave early, etc.
 
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