Anyone had a saddle sore that required excision?

[BdaGhisallo]

Just wondering what to expect. I have a saddle sore, or a cyst as the doc called it, down on my butt. I'm on my second course of antibiotics and the sucker keeps on keeping on. Doc mentioned that if this second course didn't work then we could have it excised. She said it was no big deal.

This thing has been haunting me since mid August and, iirc, it's a recurrence of one I had back in the spring of '07. The first course of antibiotics took the pain and inflammation away and shrunk it mostly, but there still remained a small and firm lump under the skin. Ten days back on the bike and it's flared up again!

I would like to get it sorted once and for all, so I think I'll be making the call to the doc on Monday morning to schedule it, but am just a little concerned at the prospect of a scalpel down there and the recovery time entailed.

Anyone have any idea on what I can expect?

[thwart]

Ask Laurent Fignon...

Oh, wait... can't do that any more. :crap:

He had lots of issues with one in the final stages of the '89 TdF.

IIRC, Merckx had to have one opened/surgically addressed during a TdF as well.

Hey, at least you're in good company...

[eddief]

you motivated me to google the subject as I believe I am haunted by one or both of these: Folliculitis and Furuncles. I tend to use rubbing alcohol as basic hygiene and this guy says no.

An educated-sounding treatise for the rest of us:


http://www.liquicell.com/assets/pdf/Saddle%20Sores%20(P.%20Kortebein).pdf

[ThomasAylesbury]

I have a the same issue. My doc tells me do not use any of the chamois creams and for me it help. Doc will numb you up and cut out and stitch, 1 02 stitches, disolving type. Really simple and the worst part is getting numbed up. I have had several cut out. I ride with the stitch. Doc will tell you no probably unless they know you. Use shorts with no seams. Tom

[malcolm]

I can tell you from years of treating abscesses if it is much more than a few cm, that is the fluctuant part, it will likely not get better with antibiotics alone and will require I&D, draining. If they are small, not much more than a pimple it may get better with topical stuff. I personally wouldn't use alcohol it is too drying and will lead to cracking and more infections.

It is a simple procedure with local anesthesia. An abscess or collection of pus I would never suture closed and usually will pack open for a couple of days. A true cyst if not infected can be dissected free and the skin closed. Most of these things on your backside are not true cysts, but are abscesses.

This day and age many if not most are community acquired MRSA and the appropriate antibiotic initially is either sulfa (bactrim), clindamycin or tetracycline, usually in that order of preference. Some folks will use two together or add rifampin to treat mrsa.

As to what you can expect after it is incised. It sounds like you have/had a partially treated abscess. Once they get to a certain size, antibiotics will get them better as in the surrounding cellulitis/inflammation will go away and they may be or seem smaller but if the collection of pus is large enough they will flare back up. Once this happens further antibiotics alone is usually futile and they will need I&D. I usually make as small a hole as possible and pack the cavity with gauze for two to three days. Once that is removed I have the patient keep the skin incision open with daily soaks and a q-tip stuck into the hole a couple times per day. Over the course of a week or so maybe less for a small one you will feel it (cavity) fill up and become shallower. If the are infected and fairly angry I&D will make them feel better quickly but it will remain sore a week or longer.

Huge caveat it is very difficult to treat something you can't see so take all this with a grain of salt and do what your doctor says. One other thing is MRSA has become rampant of the past decade, but some old school FP/GP types don't appreciate its prevalence and still try and treat with penecillins and cephlasporins, so if you have had appropriate treatment and not getting better make sure you are on an antibiotic that covers MRSA

[Z3c]

Ask Laurent Fignon...

Oh, wait... can't do that any more. :crap:

He had lots of issues with one in the final stages of the '89 TdF.

IIRC, Merckx had to have one opened/surgically addressed during a TdF as well.

Hey, at least you're in good company...

C'mon man, the Fignon comment is in poor taste and should be edited away..

[Dekonick]

I can tell you from years of treating abscesses if it is much more than a few cm, that is the fluctuant part, it will likely not get better with antibiotics alone and will require I&D, draining. If they are small, not much more than a pimple it may get better with topical stuff. I personally wouldn't use alcohol it is too drying and will lead to cracking and more infections.

It is a simple procedure with local anesthesia. An abscess or collection of pus I would never suture closed and usually will pack open for a couple of days. A true cyst if not infected can be dissected free and the skin closed. Most of these things on your backside are not true cysts, but are abscesses.

This day and age many if not most are community acquired MRSA and the appropriate antibiotic initially is either sulfa (bactrim), clindamycin or tetracycline, usually in that order of preference. Some folks will use two together or add rifampin to treat mrsa.

As to what you can expect after it is incised. It sounds like you have/had a partially treated abscess. Once they get to a certain size, antibiotics will get them better as in the surrounding cellulitis/inflammation will go away and they may be or seem smaller but if the collection of pus is large enough they will flare back up. Once this happens further antibiotics alone is usually futile and they will need I&D. I usually make as small a hole as possible and pack the cavity with gauze for two to three days. Once that is removed I have the patient keep the skin incision open with daily soaks and a q-tip stuck into the hole a couple times per day. Over the course of a week or so maybe less for a small one you will feel it (cavity) fill up and become shallower. If the are infected and fairly angry I&D will make them feel better quickly but it will remain sore a week or longer.

Huge caveat it is very difficult to treat something you can't see so take all this with a grain of salt and do what your doctor says. One other thing is MRSA has become rampant of the past decade, but some old school FP/GP types don't appreciate its prevalence and still try and treat with penecillins and cephlasporins, so if you have had appropriate treatment and not getting better make sure you are on an antibiotic that covers MRSA

Correct me if I am wrong, but shouldn't a culture also be grown to determine the actual offending critter?

[BdaGhisallo]

Malcolm,

Thanks for all that info. It's only about 6-7mm long at it's greatest so I am thinking that treatment would be less severe. My GP didn't seem to think it would be that big a deal. I recently had a carcinoma excised and, since it was on my arm, it wasn't that big of a deal. The fact that this one is where I can't see it is what worries me.

As this thing has been been a problem for two months, and because it is likely a reoccurence of one from three years back makes me determined to get it sorted once and for all.

Thanks All for all the responses.

Geoff

[RADaines]

Correct me if I am wrong, but shouldn't a culture also be grown to determine the actual offending critter?

Yes, that is the ideal. However, it is more than likely Staph aureas. Most skin infections are staph but not necessarily MRSA.

[Dekonick]

Methicillin resistant critters abound... yummy!

[thwart]

C'mon man, the Fignon comment is in poor taste and should be edited away.. Having re-read this, you may be right. Never type until caffeine is on board.

I have nothing but the highest respect for him. The saddle sore thing may have had more to do with his infamous 2nd place finish than aerodynamics did.

[malcolm]

I culture in the private setting vs the er mainly to establish the dx of mrsa. Reality is many of these are now mrsa and if you keep that in mind when you treat empirically there is no need for a culture. Cultures should be taken when you have had a reasonable treatment fail and for frequent re occurrence.

In the ER I almost never cultured them. In the private setting people come in with expectation and try as you might sometimes you can't satisfy them unless you meet the expectation even if clinically it makes little difference. Biggest lesson I've had to learn moving from the er to a private clinic, it is after all a business and if it isn't going to do harm sometimes you just have to give up.

FWIIW, I spent 18 years in a very busy er, when I was in my residency we saw a handful of abscesses a week virtually all were run of mill stap and penecillin or a 1st generation cephalsporin would more than take care of it. When I quit full time emergency medicine a little over a year ago, if I was on the walk in side of the er I would do anywhere from 3-10 or more in a twelve hour shift. I could count on one hand how many I had drained on toddlers and now you see them everyday. May be regional but I think it is nation wide.

One other thing on the backside/perineum you will occasionally grow other stuff. Still mostly staph and lots of those are mrsa, actually where I am I would say most are mrsa.

[zray67]

""""

[sfghbiker]

don't get it cultured. waste of everyone's time and money. you will just grow what is on the skin. yield from these cultures is very low. I+D and treat with antibiotics that have coverage for MRSA.

[Dekonick]

Personally, I'll take MRSA v.s. cdif. The cdif spores are sneaky little buggers... talk about hard to kill... :crap: I think that the superbugs are becoming a problem. Hopefully there are some new antibiotics in the works...

[rugbysecondrow]

Sounds like a pain in the ass.

[Ken Robb]

Sounds like a pain in the ass.

It was only a matter of time before SOMEONE wrote this. :rolleyes:

[rugbysecondrow]

It was only a matter of time before SOMONE wrote this. :rolleyes:
When I got to the end of the first page and it wasnt said, I felt a duty to pick up the slack.

[FlashUNC]

Sean Kelly had to abandon a tour because of a saddle sore.

An unhappy gooch is no joke.

[BdaGhisallo]

Sean Kelly had to abandon a tour because of a saddle sore.

An unhappy gooch is no joke.

'87 Vuelta it was. I think he was about three or four days from the end. Lucho Herrera inherited the lead and kept it until the end. Kelly came back in '88 and got his win.

[Dekonick]

don't get it cultured. waste of everyone's time and money. you will just grow what is on the skin. yield from these cultures is very low. I+D and treat with antibiotics that have coverage for MRSA.

Thanks for the info - didn't know the resulting culture would be of no value. What I am interested in knowing is the spread of CA MRSA vs others. How bad can it get?

If you get CA MRSA, how much of a risk do you pose to your family and others? From what I understand it is pretty easy to 'share'...

[Louis]

Hopefully there are some new antibiotics in the works...

And let's hope that they don't start giving those to cattle also.

[malcolm]

don't get it cultured. waste of everyone's time and money. you will just grow what is on the skin. yield from these cultures is very low. I+D and treat with antibiotics that have coverage for MRSA.


I would agree and disagree. There really is no need to culture unless something unusual is going on. I agree with the waste of time and money, but if you are sending cultures directly from pus and getting a low yield then you need a new lab. Of the ones we send I would guess we grow an organism over 90% of the time, mostly staph and more often than not mrsa.

For Dekonick, Cdiff can be a great weight loss plan.

[Louis]

Of the ones we send I would guess we grow an organism over 90% of the time, mostly staph and more often than not mrsa.

I'm wondering: Have you ever tried an experiment by sending multiple samples from the same source to a) the same lab (without them knowing the source) and b) a number of other labs, just to see how consistent they are?

[malcolm]

Thanks for the info - didn't know the resulting culture would be of no value. What I am interested in knowing is the spread of CA MRSA vs others. How bad can it get?

If you get CA MRSA, how much of a risk do you pose to your family and others? From what I understand it is pretty easy to 'share'...


Haven't kept track of actual numbers but you occasionally see whole families with abscesses. I would say that while it isn't uncommon it is the exception rather than the rule. Once or twice a year I'll see several guys from the same wrestling team and football teams with abscesses.

The usual case is an isolated abscess, drain it, place them on abx, it gets better and that is that, but you always have a few folks that just can't seem to get rid of them. I've seen people get new ones within days of finishing abx. Most ID doc have their own version of an elaborate eradication scheme. Usually some version of bactroban oint under the nails, in the groin and the nares daily for a week and then weekly for several months. Often with hibiclens baths. We always had a few of these at any given time in the er and same with the clinic.

[malcolm]

I'm wondering: Have you ever tried an experiment by sending multiple samples from the same source to a) the same lab (without them knowing the source) and b) a number of other labs, just to see how consistent they are?


Louis those things have been done as part of studies. The paper trail and billing issues make it virtually impossible for a private clinician to do. I've used several labs both hospital based and free standing over the years and most do well with frank pus. Body fluids and blood are another story. Most of the problems with cultures and lab in general from private offices is handling and pick up. Send it in on friday and it sits in the specimen container all weekend.

We did have an er clerck send a chewed up tootsie roll to the lab as a stool specimen once. It was quite funny but I think she was fired, but ultimately hired back if memory serves

[JD Smith]

Ask Laurent Fignon...

Oh, wait... can't do that any more. :crap:

He had lots of issues with one in the final stages of the '89 TdF.

IIRC, Merckx had to have one opened/surgically addressed during a TdF as well.

Hey, at least you're in good company...

Ask Oscar Freire. Rather than having a sore affect one stage race, he had an entire season go down the crapper.
http://www.cyclingnews.com/news/freires-season-over
"World Champion Oscar Freire (Rabobank) will most likely not compete in any further races this season. That he will be missing his favourite competition, the World's, has already been announced, but it now looks like the chances of seeing him back in a race this season are almost down to zero.
Freire still has saddle sore problems despite his operation in June."
(The article is from September '05.)

[anomaly]

FWIIW, I spent 18 years in a very busy er, when I was in my residency we saw a handful of abscesses a week virtually all were run of mill stap and penecillin or a 1st generation cephalsporin would more than take care of it. When I quit full time emergency medicine a little over a year ago, if I was on the walk in side of the er I would do anywhere from 3-10 or more in a twelve hour shift. I could count on one hand how many I had drained on toddlers and now you see them everyday. May be regional but I think it is nation wide.

One other thing on the backside/perineum you will occasionally grow other stuff. Still mostly staph and lots of those are mrsa, actually where I am I would say most are mrsa.
I ended up with MRSA inside my nose after a sinus surgery and it damn near killed me.

[anomaly]

Personally, I'll take MRSA v.s. cdif. The cdif spores are sneaky little buggers... talk about hard to kill... :crap: I think that the superbugs are becoming a problem. Hopefully there are some new antibiotics in the works...
Hopefully doctors stop prescribing antibiotics for every little thing.

Hopefully people take their full course of antibiotics when they are prescribed.

[malcolm]

Hopefully doctors stop prescribing antibiotics for every little thing.

Hopefully people take their full course of antibiotics when they are prescribed.


Don't hold your breath on either account.

[Dekonick]

I would agree and disagree. There really is no need to culture unless something unusual is going on. I agree with the waste of time and money, but if you are sending cultures directly from pus and getting a low yield then you need a new lab. Of the ones we send I would guess we grow an organism over 90% of the time, mostly staph and more often than not mrsa.

For Dekonick, Cdiff can be a great weight loss plan.

:) no thanks...

[Dekonick]

Hopefully doctors stop prescribing antibiotics for every little thing.

Hopefully people take their full course of antibiotics when they are prescribed.

Agree 100%

[BumbleBeeDave]

It was only a matter of time before SOMEONE wrote this. :rolleyes:

Just turn the other cheek and move on. :rolleyes:

BBD

[Ken Robb]

Just turn the other cheek and move on. :rolleyes:

BBD

It's no big deal butt it does chap my hide. :)