I haven't posted here in a while, probably due to my rather embarrassing and wrong predictions for the Rugby World Cup. Oh well, I got it wrong, I'm over it.

Today I thought I'd talk about something that is, quite frankly, a pain in the butt. For the past roughly 3 years I've been receiving treatment for a pilonidal sinus. For those of you who don't know what this is, it's a cyst in the cleft between your buttocks. Basically you end up with a tunnel between two surface wounds down there.

Now obviously this is a bad place to have a wound as it's sweaty, dark and warm, perfect for breeding bacteria, not to mention it's proximity to the anus. For many, myself included, it's not painful most of the time, however it is a major inconvenience. Currently I can't go without an absorbent pad to soak up the discharge from the wound.

But let's go back 3 years to where my story starts. I knew something wasn't quite right down there, but I ignored it hoping it would just go away on its own. Fat chance, one night up surfing the net I stood up to go to bed and noticed a blood stain on the seat where I'd been sitting. I could deny it no more, I needed to see a doctor. Immediately he knew what the problem was and started me on daily dressings. Great, I thought, just what I need, a daily drive across town!! After a week of this one of the more skilled nurses asked if anyone had checked if the two wounds were connected, and shock horror they were. Off to see the surgeon.

My surgeon was very nice, even though he was running 30 minutes late but then again, all surgeons do. He explained to me how this cyst had formed and that it had become infected and ruptured. He would attempt to make the wound into a clean cut and then get it to heal from the bottom up. So off I go to surgery, and hope that it's all fixed up.

After the surgery I got visits from the district nurse, a nurse who would come to my house and dress the wound for me. All was going very well, until the wound got to "almost healed" at which point it would heal a little, and then break down. This cycle repeated a few times until I went back to see the surgeon. He was disappointed that it hadn't healed up properly, but he told me it's not uncommon. About 10-15% of people require multiple surgeries for this condition. So back under the knife I go again, a little more complicated this time as I also had another procedure done at the same time to repair a broken scaphoid (but that's another story for another time). This time my surgeon puts in some stitches in the wound to initiate healing.

My god having stitches in your butt is uncomfortable!! Thankfully they were only there for a week. Well, most of them were. My surgeon removed most of them on the first attempt, but found more on 2 subsequent visits. But unfortunately, the cycle repeated itself and my surgeon was at a loss to explain why. So I was referred to a plastic surgeon.

The plastic surgeon told me he sees a few patients like me, people who general surgeons haven't been able to fix. So for the third time, I went under the knife. This time was worse than the other two. Unfortunately the complications I suffered were largely unforseeable. Firstly the rather large dressing that was placed over the wound became saturated and leaked, a lot! I had this changed the day of the surgery, and again the day after. Not bad for a dressing that was meant to last the weekend.

By this stage the second complication was starting to creep in, I was prescribed Vioxx as an anti-inflamitory after the surgery. Unfortuately Vioxx is known to cause mood swings in some people, combine that with the fact I am bipolar my head was pretty screwed up. Fortunately I recognized that I was going hypo-manic early and discontinued the drug. That didn't stop me from having a pretty nasty temper for about a week though.

Once these complications were sorted out I got down to the routine of having my dressing changed daily. Now that's not so bad until you realise that my dressing was held in place by some super-adhesive plastic squares called Tegaderms. Having these peeled off your butt on a daily basis is not fun. Imagine having your legs waxed everyday! Now at this point I figured the hole that the surgeon had cut was around the same size as before, comfortably fitting a finger, but this time it was more like a fist! To keep the top part of the wound apart the nurses used a dressing that looked like a squishy golf ball, and the whole thing fitted quite snuggly.

During this time I made steady progress, and was even able to lessen my trips to the hospital by having my mother dress the wound at home 4 times a week. Before every dressing I would scrub the wound with a surgical sponge to keep it clean and bug free. As I said, progress was good. About 6 weeks after the surgery I had a holiday planned on the Gold Coast, I had hoped to be entirely healed by then as I had been told there was a 6 to 8 week recovery time from this procedure. Unfortunately I wasn't healed, and my wonderful partner had to step in and dress the wound daily for me. By this stage it had gone down in size by about 4 fold. I didn't think this holiday time would do the wound any good, but if it was roughly the same size as when I went away I would have considered that a success. It turned out that the salt water in the sea did it a lot of good and healing continued.

After the Gold Coast I had daily dressings with the Tegaderms for a bit longer. During this time I developed some very large pus filled sores on my butt cheeks, stomach and chest. I was tested for diabetes (hey, it runs in the family) but that came up negative. My doctor told me it was a simple skin infection called cellulitis, which actually occurs under the skin. The most likely cause, having Tegaderms ripped from my backside every day for a few months. A short course of anti-biotics cleared that up, although some sores did recur from time to time. Still, not a very pleasant affair.

Soon the dressings were much smaller, and I was able to do them myself, insert a small piece of rope-like material into the wound, cover with absorbant pad. I'd had the rope, called Algisite, since the start of the whole ordeal but I was glad to be able to take care of things myself. Weekly check-ups at the hospital made sure things were going nicely, but now I began to enter the most frustrating period. Everytime I went into the hospital whoever looked at the wound told me how great it looked and how much smaller it had gotten, which was nice, but started to lose some impact after hearing it on every visit for two months.

Finally, after another month of "wow, that looks great, it's healing nicely, it's a really small hole now" I asked my surgeon what we could do. He suggested a fairly aggressive treatment with silver nitrate, a horrible black photoreactive powder that was used in early photography. Twice a week I would have the powder applied to the wound, something that I'm told is normally quite painful. For some reason, I have little to no sensation in the area of my wound (I suspect the legacy of 3 surgeries) I felt almost nothing on every visit.

On one visit my surgeon spotted that there were in fact two holes now, as the wound had healed in the middle, and decided to continue with the silver nitrate treatment. I was a little frustrated as this had happened before, a second hole in a harder to see place had gone undetected for who knows how long. However within a couple of weeks my surgeon was confident the second hole was either gone, or was never there to begin with.

Which brings me to the most recent chapter. Nearing Christmas I was seen by 2 registrars who hadn't seen my wound before and was told I could almost be discharged. After 10 months I was a little sceptical of this statement and it was quickly withdrawn when I informed them of the ongoing nature of this wound. Then, shortly into the New Year another registrar, who had seen me many times when my surgeon was unavailable, had a good poke around and discovered that the second hole was only covered by a thin layer of skin, and was connected to the first hole under the skin. Pretty much how it all began, albeit on a much smaller scale.

We continued with the silver nitrate until my surgeon came back from his holiday and could look at it. When he saw it, he could only find one hole, however some proddy from a nurse revealed the second hole, again covered by a thin layer of skin. I was told that it needed to be opened up again, as you can't heal a tunnel beneath the skin. At this point I asked about the most drastic surgical solution, the Karidakis procedure. This had been mentioned to me before but left as a last resort. From my perspective, 3 years and 3 surgeries had failed and we have reached the last resort.

My surgeon said he would wait six weeks and if I wasn't healed he would do the procedure. However he did leave me a little confused as to whether he wanted to open up the tunnel or attempt to heal it with the silver nitrate.

So that's my sinus story far, I'll be sure to update my blog as the saga progresses. But for now, if you have a story about your pilonidal sinus, I'd love to hear it, especially how long it took to heal. stories@planet-x.co.nz