Ouch! Does it hurt on the couch?

Pinodial Sinus Cyst Surgery in BangaloreWe all know how it feels when we take the pleasure of laying around on our favorite couch when we need it the most. Yeah, it’s the most relaxing thing ever right. Sit, lay back, roll over, read something or even watch TV, you feel the most like you are holidaying.

Now just think if these leisure’s of life are taken away and one is left with pain. If sitting for long duration, wearing tight clothing, and regular pain due to friction in one’s buttocks or just above it, creates an everyday problem in their day to day activities then the chances are high that they might have a sinus known as Pilonidal sinus cyst.

But nothing to worry “Every Problem has a solution attached to it, the only thing is we have to find it”. So, keep calm and let’s see how we can make the best out of one’s couch.


Pilonidal sinus cyst , So how it all started?

Once during the Second World War, thousands of US army jeep travelled for several days, in between the travel their condition became so bad they were not able to take rest for more than an hour at the same place further it got so widespread that they all developed the same disease it was nicknamed as “jeep seat” or “jeep disease” initially then later on due to advancement in science and technology it was renamed as “Pilonidal sinus cyst.”


What is this Pilonidal sinus cyst and how is it caused? 

It is a cyst or a lump on the cheek of the buttocks which is generally painful, causes swelling, makes the area red, often results in high fever and might cause weakness as well. This can also lead to “Pilonidal sinus cyst” in the long run which means pus that has built up within the tissue of the buttocks.

In a study done in the UK regarding Pilonidal sinus cyst, it is told that around 300 in every million people generally at age of 15 to 40 suffer from this.

Although the exact cause for this is not known doctors believe that changes in the hormonal tendencies, hair growth, and excessive sweating can be few of the reasons. Also, recent trends show that people who have a sitting job, having an irregular lifestyle and having hygienic issues can develop such kinds of diseases as well.


What are its symptoms which arise due to Pilonidal sinus cyst? 

The symptom can start from itchiness, as many people in the age range consume oily or fatty foods due to their busy work schedule and lack of time, resulting in reddening the area due to regular inching.

The next can be a hair loss in the affected area, making it more vulnerable resulting in more friction while sitting, walking or wearing tight clothes. Thus, if not treated at this stage may cause a cyst which may have higher implication causing thick pus or maybe blood draining from the abscess causing a foul smell.

It can cause regular pain, increasing the swelling and also can boil which can be pretty heartening.

Researchers also have proved that if not taken care at an early stage than the cyst can cause a permanent damage to the tissue of the skin.

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How can a Pilonidal sinus cyst be treated? 

Generally, a Pilonidal sinus cyst can be diagnosed by at what stage it is and sometimes by location as well. The doctor has to examine the cyst to confirm a diagnosis; regular tests are also taken care focusing more towards the reason for the same.

Though there are many Treatment methods right from Conservative treating, antibiotic therapy, Lancing, or phenol injection it lot depends upon one’s day to day activity and hereditary issues.

For an early stage of symptom, it is recommendable to go with a conservative method wherein there is no such sign of inflammation and hair loss, the doctor can prescribe few medicines, paying high attention to regular hygiene and essential food. Also making sure one`s wearing clean clothes on a regular basis.

The second stage is antibiotic Therapy which means treating the wound externally. The doctor first analysis it as to what might have caused by asking several questions about day to day routine and then treats it accordingly. Lancing and Phenol Injection are processes which are used in the modern era of medicine, this is an external process which makes sure that the abysses in the body is completely removed it also be removed via a  small surgery but it also depends upon the patient how intense the cyst is and will operate it accordingly.

Above are some of the different ways on how to treat pilonidal sines but is it always recommendable and advisable to go for a medical consultation when symptoms arise.



What are the Precautions one need to take care?

So now we all have seen what Pilonidal sinus cyst is so it’s better if we take care beforehand. Some of the precautions can be as follows: –

  1. If there is excessive body hair then its recommendable to trim it so that it doesn’t get pulled off often.
  2. Reducing oily foods and removing junk food in one`s daily intake can be a great ad on.
  3. Avoid Sitting for a long duration at one place.
  4. If in family anybody had a history of Pilonidal sinus cyst then it’s better to go for a check up on a regular basis.
  5. Having regular baths or maybe taking bath twice a day.
  6. People, who are obese, make sure that they maintain a healthy diet and focus more on green leafy vegetables in their diet plan.

Though any disease can happen at any point but as they all say “Prevention is better than cure”. So why to take a second chance, let’s take action before it becomes a bigger issue in future.

And follow the above steps as it can help to reduce the occurring of such kinds of diseases and at least provide space in our busy lives for a leisurely couch experience.

Written By Ashlesh Kamath


Does your hernia wet your cornea ?

does your hernia wet your cornea

Does your hernia wet your cornea ?

What is a hernia? Do you have it? If you do have it, how do you know? Is it painful? Is it hereditary? What exactly causes it? Does the belly bump cause hernia, the lump? Do you need surgery to correct it? So many questions! Let’s start with addressing the first one.

What are the different types of hernia?

Depending upon the site of the uneventful, there are different types of hernias. Umbilical hernia, femoral hernia, incisional hernia, epigastric hernia and hiatal hernia. In this article, inguinal hernia is being discussed.

A Hernia – It’s an abnormal protrusion of an organ or part of it through a weak point in the body. Inguinal hernia is the most common one among hernias, affecting mainly men than women in 7:1 ratio, respectively. You don’t want equality in these matters ladies, trust me! Hernia can be direct or indirect. In GOT (game of thrones), remember Hodor? The scene where the white walkers attack Bran and they’re running for their lives? Hodor holds the door, So that the white walkers don’t kill Bran and turn him into one of them. If Hodor played security at the entrance of the tower and the white walkers still got in? It would be an indirect hernia. Here, the white walkers can be the abdominal viscera mainly the colon and Hodor is the deep inguinal ring. Similarly and also how it happened in GOT, Hodor stood at the back door of the tower and white walkers crawled out eventually. Here, it’s a direct hernia and the iconic Hodor, being the posterior wall of the inguinal canal.

What is this inguinal canal?

It is a muscular canal containing structures running through it. They are the spermatic cord (in males), round ligament (in females), Ilioinguinal nerve, there is a genital branch of what’s called a genitofemoral nerve and lastly remnant of processes vaginalis. The weak area of all groin hernias is the site between the inguinal ligament and the iliopubic tract called the myopectineal orifice of Fruchaud.

What causes hernia?

Sometimes, people are born with it. There can be a collagen disorder due to which the ligaments become weak, prune-belly syndrome is congenital and acquired collagen deficiency is due to smoking. Yes, smoking not only causes cancer but also hernia. They forgot to put that on the pack. Basically, anything increasing the intra-abdominal pressure adds to the causation of the hernia like coughing, constipation, ascites, obesity, pregnancy, straining during micturition and lifting heavy weights. Hernia cases have been recorded post appendectomy as well. does your hernia takes too much time to recover the answer to this question is, it takes a couple of weeks to recover and the way you maintain your daily diet.

Younger you are indirect hernia is a possibility and older you get direct hernia occurs. Inguinal hernia usually presents itself as a groin swelling and is painful in nature and it might be radiating to the umbilical region.


Normal investigations done for diagnosis are,

  • The routine blood tests and urine examination. The elderly might need an additional bunch few tests like a chest X-ray, ECG and PFTs. Urinary complaints are checked for prostatic enlargement and urethral problems.
  • Ultrasound can detect a sac where hernia cannot be diagnosed by clinical assessment. It is useful in postoperative swellings, hematoma and recurrence.
  • CT (computed tomography) for giant hernias.
  • MRI (magnetic resonance imaging) is ideal for sportsperson, to differentiate between muscle spasm and a hernia.

Treatment for a hernia depends on its presentation. Herniotomy, herniorrhaphy and hernioplasty are the three important operative techniques which are performed. For adolescent patients with hernia, herniotomy is preferred.

Herniorrhaphy – Modified bassini’s herniorrhaphy is in practice now for patients who have a good muscle tone with indirect and direct hernia. In this procedure, the surgeon repairs the stretched out ligament and herniotomy is also conducted. Shouldice repair is another type of herniorrhaphy where herniotomy is done with correction of the hernia using the surrounding tissues by absorbable and non-absorbable sutures in different layers.

The third operative method is the hernioplasty, which is done in patients with or without good muscle tone having indirect or direct hernia and also in recurrent hernia. This approach is done so as to strengthen the posterior wall of the inguinal canal. Firming up is done by repairing the weak posterior wall by a prolene mesh or Marlex mesh. A thick fibrous layer is hence formed as it acts as a foreign body and our immune system provides the required cement to it. An artificial deep ring is also done. This mesh technique is quiet brilliant as it has a long life, preferably socioeconomic; risk of infection is minimal when handled in a sterile environment and also due to its amazing biocompatibility. Prolene darning is also done in a few cases, which is basically sewing up the loose ends and making it stronger.

There are few other techniques like the Kuntz operation usually done in elderly, Mcvay, Nyphus repair, Stoppa repair, Marcy repair. Newer advancements are game changing procedures like the Dasarda technique, creating a hernia system which is exceptional and mesh plug repairs are gaining popularity as they have much better patient compliance.


Laparoscopic surgery or open surgery? In my opinion, open is a better choice for this condition. But both have their own pros and cons. Open surgery does interfere with the bowl function. Also, if there are any complications during the laparoscopic surgery the surgeon would have to open up and go old school. Plus, open surgeries are cheaper as compared to laparoscopic but the recovery period varies indistinguishably.

Complications are often common after a surgery. They can be during, before or after the surgery. They aren’t worrisome but few need to be attended by the surgeon. Care must be taken to avoid post-operative wound infection by the patient or their care takers. In very few cases patients complain of lower abdominal pain a characteristic dragging pain months after surgery which might be due to injury to the surrounding nerves. This is treated by nerve blocks with anaesthetic agents and steroidal injections.

If hernia is not treated at the right moment it can give rise to a number of complications which are troublesome like,

  • An obstructed hernia.
  • A strangulated hernia is quiet notorious as it can cause shock and sepsis and need immediate surgical care as the bowel might get gangrenous.
  • A Sliding hernia is an incarcerated hernia in which the fecal matter may slide into it.
  • Inflammation is yet another impediment which might range out from a simple hernia to a life threatening one.
  • Recurrent hernia is common is 10 percent of the lot who has been treated earlier.


With all due advancements in the surgical and medical field hernia is one of the most common cases till date which need effective, relentless and instantaneous treatment. So, don’t ignore a lump because it is not so Gump.

Written By (Dr) Apoorva Manjunath

When something that you love makes you weak in the knees!

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When something that you love makes you weak in the knees!

Before your mind runs wild, let me make it clear that this isn’t completely dirty and painful. Or is it? Each person is on their own, picking up what they like and love persuading towards that particular activity. While you’re at it, doing what you love there are often times when a small misjudgment or a miscalculation might end up giving months of terrible and excruciating pain. One such incident might be A LIGAMENT TEAR.

Ligament tear usually occurs in the joints of our body when a great force is applied on a particular joint. Let’s focus on the knee joint as of now. Knee joint has 4 ligaments namely,

  • Anterior cruciate ligament(ACL)
  • Posterior cruciate ligament(PCL)
  • Medial cruciate ligament(MCL)
  • Lateral crucial ligament(LCL)

These ligaments hold the knee joint in place and help in locking and unlocking the joint. When you walk, run, dance, gym or jump these ligaments work continuously. When the knee joint is locked, the greater force applied on it ends up tearing the ligament depending upon the direction of this unaided force.

Injury to PCL – Ligament tears are also common in a road traffic accident. Usually in a car accident, the posterior cruciate ligament is torn. The harm occurs when the tibia is forced backwards to the femur. This is rather rare in a sport person whose anterior cruciate ligament is at risk.

Injury to ACL – Twisting a semi flexed knee, which already made you say “ouch” is quite cumbersome to deal with as it often causes injury to the medial meniscus and MCL. (O’Donoghue triad)

Injury to MCL – Any force the pushes the tibia towards the femur in an inside fashion causes the rupture of this ligament.

Injury to LCL – MCL and LCL are attached to the either side of the joint, medial is on the inner side and lateral on the opposite. So the damage to the lateral ligament occurs when the force is applied to adduct the tibia to the femur.


So now, describing the proper anatomy. The knee joint is a hinge joint.

A hinge joint is one which is made up of more than 2 bones, and moves along one axis only. Elbow joint is another such synovial joint. Knee joint consists of the tibia and the femur, a tibio-femoral joint. Then there is patella which glides over the front of the tibial end of femur, forming patello-femoral joint. The knee Ligaments act like the joint’s best friend, providing support and stability. When this harmony is disturbed, a painful unstable state happens to be.

The ligament injury can be associated with,

  • Chipping of the bone to which the ligament it is attached.
  • A mid-substance tear ( tear in the ligament)
  • Severity may vary on the tear being complete or incomplete.
  • One ligament involvement or more.

The combination depends upon the force acting on the joint. More severe the injury   more intricate the treatment regimen gets.

Diagnosis can be made through clinical examination and a detail on the event of the grievance. Complications that present with the tear are dislocation of the joint, blood clots, swelling. The pain maybe localized over the torn ligament. Radiological examination of the knee joint is important to check if the bone has been chipped off, which might have been avulsed from the ligament attachment. Contrary to the Stress X-rays, MRI is a non-invasive method to diagnose ligament injuries. Arthroscopic examination may be needed in few cases.

Treatment of this condition was conventionally done by non-operative methods. Now that there are better techniques and with the recent advances better results are achieved through operative reconstruction. Operative reconstruction has become popular in high demand athletic individuals like Tom Brady, Alex Morgan Adrian Peterson and a lot more NBA players. Celebrity or not we are all made up of the same cells and same anatomy and ligament injury can be treated and normal functioning of the knee can be obtained and hence decreasing your time not spent on doing what you love.

Methods that are undertaken are,

  • Conservative method – The blood clot/ hematoma is aspirated and the knee is immobilized in a cylinder cast or a knee immobilizer. If the injury is grade I or grade II, conservative method is successful for treatment. Followed by this, strengthening physiotherapy is required.
  • Operative methods – These are to be done when there is a combination of ligament injuries, involving multiple ligaments especially in young athletes or dancers. Usually the surgery is done 2-3 weeks after the injury when the inflammation is fairly reduced.

What do the surgeons do actually? They first go by repairing the ligament. It is performed on grade III ligament tears, which means the ligament is completely torn. If the surgery is done after the 2-3 weeks, an additional reinforcement is provided by a tendon or fascial graft as the original torn ligament would have lost the strength due to complete tear.


Secondly, they reconstruct the instable knee injuries which present later than usual. An allograft or an autograft of a tendon or a fascia lata is used; a synthetic graft can also be used. Auto is better than allo as there are lesser chances of rejection.


Knee ligament tears are very common and are often undiagnosed. Ligament tears are usually not seen on X-rays and might get neglected. The usual presenting symptom is the instability of the knee joint. Treatment is biased depending upon the activity level of the patient. If you’re a ninja then you’ll probably need surgery. If you’re person who probably has a sedentary lifestyle, the doctor might perhaps recommend physiotherapy. Usually the ACL tends to get damaged more often than the others. ACL reconstruction is done with the help of an autograft and bio-absorbable screws. Arthroscopic ACL reconstruction is the surgery of choice as it is minimally invasive, and results are outstanding as the patients revert back to normal with negligible risks.

By Dr Apoorva Manjunath.