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Pilonidal Cyst; Overview, Cause, and Treatment

Pilonidal cyst, also known as tailbone cyst, occurs at intergluteal cleft (area between two buttock cheeks).

The term pilonidal means nest of hair.

At times, an infection may arise in the cyst resulting in the formation of abscess know as pilonidal abscess.

Cause of the Pilonidal Cyst

Many embryologists consider it as congenital remnants. It is present as a defect at birth in the sacrococcygeal region of the body.

Other argues it to be acquired.  The acquired theory proposes that it arises due to prolonged pressure leading to ingrown hair and debris accumulation.

Excessive sweating increases the moisture in the area that promotes the growth of anaerobic bacteria.

It also explains the reason for its high recurrence and development of this disease in the hands of the barber, sheep shearer, and dog groomers.

Risk Factors of the Pilonidal Cyst

• Male > Female
• Young adults
• Excessive hair in the area
• Occupations
• Drivers (own hair)
• Barber (Customer hair)
• Dog groomer, Sheep shearer (Animal hair)
• Obesity
• Poor hygiene
• Narrow intergluteal cleft
• Family history

Signs & Symptoms

It commonly reports as painful swelling and occasional purulent drainage in tailbone area

Other symptoms are

• An unpleasant smell
• Blood discharge
• Tenderness
• A previous history of  pilonidal cyst
• History of trauma
• Fever
• Excessive moisture in the affected area

Diagnosis & Treatment

A complete history and physical examination mainly establishes the diagnosis rarely requiring advanced investigations.

Treatment of the pilonidal cyst varies with the severity of the disease.

Patients with relatively minor symptoms require a more conservative approach. Strict hygiene with hair removal usually resolves the issue.

An acute infection of the cyst resulting in purulent drainage needs extra attention. Rest, hygiene modification, antibiotic coverage, and local antiseptic dressings are the key measures.

In some cases, it is necessary to perform an incision and drainage of the cyst removing the debris and granulation tissue under general or local anesthesia.

The chronic form of the disease demands a more aggressive management. A surgeon resects the sinus with the cystic lining under general anesthesia.

Choosing the Right Surgeon

Surgery Group LA (Los Angeles) is a team of board-certified surgeons with a vast experience in pilonidal cysts.

Schedule an appointment with us for the evaluation and recommendations for you or your loved one’s condition so you can make an informed decision.

Hernias in the Covid Era

Not all abdominal hernias require surgery and this is particularly true during the Covid lockdown. However, hernias causing pain or intestinal upset can and should be surgically repaired even during the Covid lockdown. During times like these, necessary, urgent, or emergent surgery CAN be performed safely. It is important to avoid delays in medical and surgical treatment. Delays in surgical treatment can result in a worsening of medical and surgical conditions.

An overview of hernia can enhance one’s understanding of it helping in making a decision when to see a doctor and when to go for elective or emergency surgery.

Hernia: Etiology, Diagnosis & Treatment

A hernia is a protrusion of an organ through the wall of the cavity containing it. 

It can appear as a bulge in the abdomen or groin region. 

A defect in the muscular wall holding abdominal contents in place results in an opening or a weak spot in the wall allowing displacement of abdominal fat or intestine.

Etiology

A hernia may develop due to congenital abnormalities or anatomical variations. Physiological conditions and diseases that increase intra-abdominal pressure can further aggravate the underlying problem. These include:

• Persistent cough
• Smoking
• Obesity
• Straining while urinating or defecating, e.g., in constipation
• Heavy weight lifting
• Enlarged prostate
• Abdominal fluid

Types of Hernia & Associated Risk Factors

The following table summarizes types of hernia along with their location, features, and risk factors.

Type of Hernia	Location	Features &Risk Factors
1.Inguinal hernia (Most common)	Groin	MaleOlder adultsSmokersConstipation  patientsPrevious history of hernia
2.Umbilical hernia	At the navel	Babies with premature birth or low birth weights
3.Femoral hernia	Just below the groin	Female>MaleCauses strangulations
4.Hiatal hernia	Upperpart of stomach	Over weightAge over 50
5.Incisional hernia	At the site of a previous surgical incision	Recent  surgeryWeight gain after surgery

Sign & Symptoms

Hernia often presents as a palpable lump under the skin that may or may not be associated with pain.

Sign & symptoms vary with each type of hernia.

A reducible hernia is a hernia that can be pushed back into the abdomen. It can become more prominent with any activity increasing the intra-abdominal pressure, e.g., standing, heavy weight lifting or straining.

However, a non-reducible hernia doesn’t show any variation in size. It is a more chronic form which can lead to strangulation of blood vessels and kinking of the intestine. Nausea, vomiting, and other abdominal symptoms may appear as a result of obstruction.

Treatment

An asymptomatic hernia requires a more conservative approach.

 It includes dietary modifications, changes in lifestyle, exercise, quitting smoking, and some medications. Your doctor may recommend watchful waiting.

A truss is sometimes advised especially for inguinal hernia. It is a belt-like device that aids in the reduction of protruded content.

Surgical treatment for hernia depends on the type of hernia & circumstances and done mainly to prevent complications.

Open surgery repairs the hernia using a big incision pushing herniated tissue back and securing to its original positions often using a mesh to prevent recurrence. 

 This procedure can be performed under local andspinal anesthesia thus avoiding general anesthesia. So it is particularlyadvised to medically compromised patients.

Laparoscopic surgery, is a minimally invasive surgical technique. It uses smaller (keyhole) incisions that allow entry to thin camera and surgical instruments. This technique demands special surgical skills. There are higher chances of recurrence of hernia if an inexperienced laparoscopic surgeon performs the repair.

Laparoscopic surgery has several advantages over open surgery.

It includes;

• Reduced time of hospital stay
• Less chances of infection
• Aesthetics
• Quick recovery
• Fewer complications
• Less chances of bleeding

Robotic Laparoscopic Surgery is the most contemporary technique used for hernia repair. It utilizes keyhole incisions and insertion instruments similar to conventional laparoscopic techniques. Robotic arms are attached to instruments. A surgeon, sitting on the operating console, directly controls the robotic arms. The operating console is equipped with various tools but mainly master controllers and stereo vision.

This state of the art technology further adds the following advantages to laparoscopy.

• Comfortable sitting posture of the surgeon-less likely to be tired
• Full range of motion of robotic arms-a limitation of a human arm
• Elimination of physiological tremors
• Superior cross infection control protocol-less chances of infection

Why Choose Us?

Surgery Group LA (Los Angeles) is a team of highly skilled board-certified surgeons with vast experience in robotic laparoscopic, conventional laparoscopic and open hernia repair surgeries.

 Conservative management and avoidance of surgery is the desired treatment in these patients. This exactly matches our mission statement.

Schedule an appointment with us for the evaluation and recommendations for you or your loved one’scondition so you can make an informed decision.

Melanoma- The Notorious Skin Cancer
Melanoma also known as malignant melanoma is a type of skin cancers. In the US 9500 cases of skin cancers are diagnosed each day. Melanoma represents only 5% of the total number of skin cancers but accounts for the vast majority of skin cancer
deaths in the US. Each year the US spends approximately $ 8.1 billion on skin malignancies out of which $ 3.3 billion is spent on melanoma.

How does Melanoma develop?
Melanoma results from uncontrolled and defective growth of a type of skin cell called a melanocyte. Melanocytes account for the color of skin through the production of a dark pigment called “melanin”. More melanin in skin means more dark color. These cells are also responsible for the development of moles. Exposure to prolonged and high doses of ultraviolet (UV) radiation leads to DNA damage in melanocytes. Most cases of melanoma are related to UV damage by the sun. UV damaged cells start reproducing in an unchecked way leading to malignancy. Genetic mutations running in families can also contribute to the development of melanoma. A previous history of melanoma in the family increases the chances of developing the disease many fold.

Who Is At Risk?
Followings are the risk factors associated with melanoma;
 Fair Skin Color
 Increased exposure to the sun- Risk doubles for those with more than 5
sunburns

 Living in Australia, North America, and Europe
 Age approaching the 70s
 Family history of melanoma
 Presence of moles
 Male gender

Prevention?
Avoiding the avoidable- This is the key practice to prevent melanoma. One can’t change one’s genetic makeup but observe the following;
 Regular checkups 
 Reducing exposure to UV light
 Avoid tanning procedures
 Wear sunscreen of SPF at least 30
 Avoid the sun between 10 am to 4 pm

When to See a Doctor? 
Early signs of melanoma may include a newly developing mole near an existing
mole, or anywhere else in the body. A change in the color of a mole is suspicious too. Unlike the non-lethal benign mole, melanomas have irregular borders and different levels of pigmentation. They grow slowly over time and are somewhat funny looking spots as compared to symmetrical round mole. Favorite sites for melanoma in males are head, neck, and trunk region while in females they tend to develop on arms and legs.

Diagnosis & Treatment
If your doctor suspects a melanoma based on history and clinical examination, a biopsy will be advised.  A biopsy is a procedure in which a small part of a lesion is removed by a physician for examination under a microscope by a pathologist.
Melanoma cells have a typical appearance that can be recognized by an
experienced pathologist. 

A biopsy for a suspected melanoma will either result in a diagnosis of a benign mole, an atypical mole or a malignant melanoma. Benign moles require no further treatment. Atypical moles, otherwise known as atypical melanocytic nevi need to be surgically removed completely. The treatment of malignant melanoma depends on characteristics including the depth of the melanoma. Thin melanomas are generally treated with wide excision of the melanoma with some surrounding normal skin. Thicker melanomas may require removal of some lymph nodes in the area of the melanoma in a procedure known as a sentinel lymph node biopsy. Once a diagnosis of melanoma is made, it will be important to be evaluated by a surgeon with expertise in the management of malignant melanoma. Some patients with more advanced melanoma may need to be seen by a medical oncologist and treated with immunotherapy following surgery.

Prognosis of the Disease
Early detection and treatment of melanoma is the single most important factor in limiting the course of the disease. Timely diagnosed and managed patients have a survival rate of 99% after 5 years. The survival rate drops with an increase in the depth of the lesion and delays in treatment.

Eating kale can decrease your risk of cancer!

That’s thanks to sulforaphane, a substance in kale that has been shown to help fight the formation of cancer at the molecular level.

Eat garlic to prevent cancer!

Sulfur-rich foods, like garlic and cruciferous veggies, can help protect against diseases like diabetes and cancer. Sulfur helps metabolize food and protects your body from inflammation and oxidative stress.

Lower your risk of cancer by eating grapefruit!

Lycopene is an antioxidant in grapefruit that combats the body’s cell aging triggered by harmful free radicals. For the most lycopene, reach for a ruby red.

Click here for more health tips.

Reduce your risk of cancer with broccoli! 

The cruciferous vegetable contains a compound called sulforaphane, which has shown to have anti-cancer properties in multiple studies. 

Eat coriander to get more cancer-fighting antioxidants. 

Compounds in the herb have been shown to lower inflammation as well as slow the growth of cancer cells in the lungs, prostate, breast, and colon. 

Click here to learn more health benefits of this fantastic herb.

Eating flaxseeds could help prevent breast cancer. 

Flaxseeds contain phytoestrogens, which may prevent cancer in the first place – as well as can prevent recurrences. 

Permanent hair dyes could increase the risks of breast cancer.

New research published in the International Journal of Cancer found that women who use permanent hair dye and/or chemical straighteners have a 7% higher chance of getting cancer than those who do not. Surgery Group of LA’s Elizabeth Arena M.D. was asked to comment on it. Dr. Arena said, “Like anything else, this is something that would need to be looked into.”

Click here to learn more about this new finding.

Menopausal night sweats may cause brain fog in women who’ve had breast cancer. 

Research presented at The North American Menopause Society found sleeping longer increases vasomotor symptoms like hot flashes and night sweats, which can increase cognitive decline. 

Hormone replacement therapy (AKA HRT) has been linked with breast cancer.

A new study done at the University of Oxford cautions that doing five years of menopausal hormone therapy increases the incidence of breast cancer in women.

Common household items might contribute to an aggressive form of breast cancer.

Research presented at the Society for Endocrinology conference said that detergents, antiseptics, and some prescribed medications could be the culprits. 

Click here to read more. 

The average age of male breast cancer diagnosis is 56.

In a study published in the ACS Journal Cancer, researchers have found a few differences in how male breast cancer and female breast cancer development.

For instance, male breast cancer tends to occur later in life, and it more commonly moves into lymph nodes, making it harder to treat.

A blood test could soon be used to detect early breast cancer.

Researchers at the University of Nottingham have found that a panel of tumor-associated antigens could be used to do the test – which would be less expensive and easier than mammography! Until then, we suggest getting screened.

A recent study, presented at the 2019 annual meeting of the American Association for Cancer Research, or AACR, in Atlanta, brought about another round in the controversy surrounding surgery for stage 4 breast cancer patients.

The study reveals that patients with stage 4 HER2-positive breast cancer that has been treated with systemic therapy (which could include chemotherapy, targeted therapy, or endocrine therapy), had a 44% increased chance of survival.

The authors of this study, Ross Mudgway, and Dr. Sharon Lum conducted a retrospective cohort study of 3,231 women with HER2-positive stage 4 breast cancer, using records from the National Cancer Database from 2010-12.

Dr. Elizebeth Arena, a Breast surgeon with the Surgery Group of Los Angles, believes the study asks an important question about how to best treat women with Stage IV disease, but cautions her patients about the findings from this preliminary study.

“Traditionally women with Stage IV breast cancer are unlikely to undergo breast surgery since cancer has already spread to other parts of the body. As we see remarkable advances in response to medical treatment, we need to identify which patients can benefit from every treatment option, including surgery. This is an exciting new time in breast cancer treatment, and questions like this will best be answered with clinical trials that are currently underway.”

The study also examined socio-economic factors about stage 4 breast cancer patients who were offered surgery.  They discovered that women with Medicare or health insurance were more likely to have surgery and less likely to die of their disease than those without Medicaid or health insurance.

Dr. Joshua Ellenhorn, a Clinical Professor of Surgery at Cedars Sinai, agrees that disparities in health care due to race and socioeconomic factors must be addressed.  He explains that the decision about whether or not to recommend surgery to patients involves numerous other factors.  “Resecting a tumor in patients with Stage 4 Metastatic Breast cancer makes sense if the patient can expect an increase in overall life expectancy.  It doesn’t make much sense if there is a metastatic disease that will end the patient’s life.”

Furthermore, Dr. Ellenhorn, believes that more research is needed to help doctors identify which patients will live longer if they are offered surgery.  Patients who have questions about breast cancer should feel comfortable about their treatment plan and their surgeon.  At the Surgery Group of Los Angles, our surgeons help patients understand the risks and benefits of using surgery with curative intent when treating breast cancer.

Have you heard about the benefits of drinking celery juice? If you haven’t, you’ve been living under a rock.  You can’t get away from the hype of this latest craze.  In this blog, Dr. Ellenhorn will weigh in about this latest trend every blogger has been hyping.

Anthony Williams aka The Medical Medium, who has no nutrition or medical training, claims that he is able to converse with the Spirit of Compassion, who “provides him with extraordinarily accurate health information that’s often

far ahead of its time”. 

Williams claims that celery juice can heal because it is full of “undiscovered cluster salts”. He has convinced throngs of influencers, including Gwyneth Paltrow, to convince the rest of us that celery juice is medicinal and can “cure chronic and mystery illnesses” and “kill off unproductive bacteria in the gut”.

Dr. Ellenhorn believes that Anthony Williams is making some hefty claims. “Pseudoscience is not science”. If drinking celery juice cures many of today’s most hostile diseases, it would have scientific evidence to back it up. Considering how popular drinking celery juice has become, we should see a marked decline in the number of diagnoses of disease.

Dr. Ellenhorn is adamant that drinking celery juice cannot harm people but what can be harmful is when celery juice is used to treat a disease that requires medical intervention.  The claims that celery juice can cure diabetes, is just astounding. Drinking celery juice will not cure diabetes. However if you are a diabetic and are making healthier choices when it comes to eating and exercising, you are already helping yourself. Drinking celery juice is not the cure, it is simply a part of making healthier food choices, and thereby you are lowering your glucose levels. It’s not about the celery juice but about making overall better choices.

So the bottom line is this. The celery juice craze is here and will be replaced by something else. Celery farmers are celebrating along with everyone who is certain that their bodies are alkalized. So go ahead, and raise that 16 oz glass of celery juice, consume it on an empty stomach, but understand that what you’re drinking is simply hydrating…just like water.

It’s hard to believe that in 2019, we are so prone to falling for outrageous claims but hey it can’t hurt.

Earlier today cultural icon and host of Jeopardy, Alex Trebek, announced that he has been diagnosed with stage four pancreatic cancer.

Dr. Joshua Ellenhorn, a pancreatic surgeon at Surgery Group LA, says that Trebek’s prognosis is not good, and likely fatal.

“Pancreatic cancer is an incredibly aggressive disease”, said Dr. Ellenhorn, “Over the past four decades, there have been numerous advances in the treatment of pancreatic cancer.”

Despite these advances, there have only been, “modest improvements in lengthening survival. The overall long-term survival of pancreatic cancer, once it has metastasized has not changed over the past 50 years. Metastatic pancreatic cancer or stage 4 pancreatic cancer remains a uniformly fatal diagnosis.”

Unfortunately, there is no test available that can predictably diagnose pancreatic cancer at an early stage, “Even when diagnosed at an early stage, pancreatic cancer is ultimately Fatal in the majority of patients.”

Trebek joins several other celebrities who have diagnosed with the condition. Luciano Pavarotti, Michael Landon, and Steve Jobs were diagnosed with forms of pancreatic cancers as well.

It is unclear what type of pancreatic cancer Mr. Trebek has. Dr. Ellenhorn notes that “There are two main types of pancreatic cancer. The first type is very aggressive and includes the majority of patients including Luciano Pavarotti and Michael Landon. That is ductile add no carcinoma of the pancreas commonly referred to as pancreatic cancer.”

The second type of pancreatic cancer “is a neuroendocrine tumor of the pancreas which is the type Steve Jobs had. Less aggressive and slower growing.”