DEAR DR. DONOHUE: I have a minor opening at the base of my spine. It has some hairs in it. It bothers me a little when I sit down in a certain way. I checked this in my medical book, and it describes it as being a pilonidal sinus. Does it require surgery in a hospital, or can it be handled as an outpatient? If it needs surgery, how long does it take to heal? – W.C.

ANSWER:
Pilonidal sinuses (also called pilonidal cyst and pilonidal disease) are in the middle of the back in the area just above the buttocks. They result from hair being driven into the skin. The hair incites a foreign-body reaction, just like a sliver of wood. In the good old days, when Army jeeps had little to no shock absorption, pilonidal sinuses were called jeep driver’s disease. The jostling that a jeep driver had to endure pounded hairs into the skin of the lowest part of the back. Today’s jeeps are as comfortable as plush limousines; they don’t cause this.

If you shave the involved area of all hair and keep it clean with daily showers, that might be the only treatment you’ll ever need. It will stop other hair from being driven into the skin.

If the pilonidal sinus is infected, swollen or painful, a doctor has to incise it so it can drain. The doctor would put you on antibiotics to kill lingering germs. Recovery from this treatment is quick.

On the other hand, should the sinus become repeatedly infected or if it is painful and swollen, then it calls for more-involved surgery. There are a couple of ways to remove the sinus.

In one operation, after all the involved tissue is removed, the surgeon closes the skin. Recovery can last around four weeks. You might be able to perform a job that doesn’t require a lot of movement during recovery, but hard physical labor is impractical.

In another kind of surgery, the surgical wound is left open to heal on its own. Recovery is more than a month with this procedure. The selling point of the second surgery is a lesser chance of having a recurrence. Speak to a surgeon for an opinion on the necessity of surgery and on the best kind of surgery for you.

DEAR DR. DONOHUE: I suffered from frequent migraine headaches for 18 years. Imitrex worked, but only in the injectable form. A year ago, I started taking Lamictal, and my headaches disappeared. You might mention this to your readers. – C.S.

ANSWER:
Imitrex (sumatriptan) is one of seven “triptan” drugs that have been a milestone in migraine headache treatment. People who were unable to get relief from older, standard migraine medicines found these drugs amazing.

There are some migraine sufferers for whom the triptans don’t work their wonders. Those people might benefit from the combination of a triptan with an anti-inflammatory drug like naproxen.

Or they might have to take a medicine that’s not a standard issue for migraines. Tegretol, Neurontin and Topamax, all seizure medicines, are used to prevent migraine headaches. Lamictal is another seizure medicine. You’re proof it works, but it might not do so for everyone.

DEAR DR. DONOHUE: Our 16-year-old grandson has membranoproliferative glomerulonephritis (MPGN). Will you kindly write about this disease? Please touch on the transplant question. We are told a transplanted kidney will suffer the same process. – F.R.

ANSWER:
Glomerulonephritis is kidney inflammation and membranoproliferative is one variety of kidney inflammation that has two microscopic, distinctive features. One is the thickening of the membrane that the kidney filters rest on, and the second is a massive increase in the number of cells in those filters.

In type I MPGN, antibodies are responsible for those changes. This kind might be associated with another illness, like hepatitis or lupus. Treatment of any associated illness often improves kidney function.

In type II MPGN, an autoimmune attack on the kidney is responsible for its malfunction.

No magical medicine reverses either type, but prednisone is sometimes used to improve matters.

If transplantation becomes necessary, the process can appear in the transplanted kidney, but it almost always does so in a milder form.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com


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