DEAR DR. ROACH: I am writing because my son had a pilonidal cyst removed in March of 2010, almost three years ago. For the first six months, I kept the area clean and free of hair. After six months passed, the surgeon referred him to the wound clinic. He has had many different treatments for the wound, but it still hasn’t healed. I am tired of cleaning the wound in between his visits to the wound center. He feels that everything and everybody is against him. He is only 21, and this operation has already robbed him of three years of his life. I hope you have some type of solution for us, because we are at the end of our ropes. — B.A.

ANSWER: This is not the first time I have seen this. The operation on a pilonidal cyst is a difficult surgery, and this is one surgery where it pays to search far and wide for a person who has done the most operations and who has had good outcomes. In the teaching institutions where I have trained and worked, it usually has been a plastic surgeon, but it depends on where you are.

Since this hasn’t healed in so long, I strongly suspect there is an anatomical problem that will need to be corrected surgically. Surgeons often are reluctant to operate on people who have previously been operated on by someone else. However, the time is long overdue for a consultation with an expert. Find the best teaching hospital nearby — many have websites where you can look up expertise by surgical problem. Otherwise, you can call the referral line almost all hospitals have now, and ask who has special expertise in pilonidal cysts. I can understand how you would be reluctant to undergo surgery again, but I think you need to consider it.

DEAR DR. ROACH: I am 66 years old and have high blood pressure, diabetes and high cholesterol. To keep them in control, I have to take enalapril, metformin and Crestor. Please let me know if I can take them at prescribed times all together, or if I should give some time gap between each medicine. If so, how much of a time gap is ideal? — J.M.

ANSWER: Most medicines can be taken together safely. Some medicines are better at certain times of the day. Enalapril is usually best when taken in the morning, Crestor in the evening. However, the difference often is subtle, and taking it the same time each day is the most important thing. Metformin usually is taken just before or while eating. Your pharmacist is probably the best source of information on this subject.

DEAR DR. ROACH: I am 72, and have had generalized fatigue. My testosterone level was 150. My prostate exam showed slight enlargement, and my PSA has always been normal. The urologist is ready to put me on testosterone gel. What are your thoughts? — S.B.

ANSWER: Testosterone replacement for men is a hot topic now. Many men are deficient in testosterone, and it can cause symptoms, including fatigue and lack of sexual desire. Normal values are typically 260-1080. With your complaint about fatigue, I think it’s definitely worth a try.

Testosterone increases PSA levels, but the risk of prostate cancer is low. Testosterone should not be used in someone who has had prostate cancer.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters or mail questions to P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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