Pilonidal Cyst Surgery and Recovery

This past Monday (March 2, 2026) I had my surgery scheduled for pilonidal cyst surgery removal with Dr. Bidhan Das. I spent the night with my parents on Sunday and enjoyed some great food and dessert (I most likely overate) given I could not eat or drink anything after 8 P.M. This makes sense given the area of the body that is being dealt with. 

I read over the instructions and had to use anti-bacterial soap on my body the night before (which I already had). We had to be at the surgery center by 6:00 AM. So I woke up around 4:20 AM to allow me time to take a shower and get ready, given the surgery center was roughly 30 to 40 minutes away. The interesting thing is the night before I was actually able to go to bed around 8:30 PM. when I typically go to bed around 11:00 PM. Once we got to the surgery center there were so many different people waiting for surgery at session early hour and almost every seat was taken (although there are many different procedures being performed at this facility). The pre admissions people were fairly good about getting me in. And then I talked to a nurse about my medical history and I felt as if I was asked five different times who I was in my date of birth, just to confirm they were doing the right procedure. A little before 7 A.M. I was taken back to a private bed with a TV and had my own personal own which is not usual for surgery centers or procedures centers I had been in before. The nurse came in and did an overview of what was gonna happen. The anesthesiologist came in and I spoke with her, and she had mentioned that I would be under general anesthesia with a breathing tube and she mentioned I may have a sore throat as a result of the breathing tube. The nurse who had originally had come in and told me Dr. Das had an emergency but would be in shortly and finally talked to the surgeon around 8:30 A.M. The whole team of the surgeon, nurse, and anesthesiologist and CRNA came in and the anesthesiologist mentioned they were going to give me general anesthesia and Dr. Das was saying "no we don't need to be doing that with a cyst of this size". He was pretty serious and even when he came in to talk to me he was pretty straightforward and simple procedure and asked if I had any questions which was different than his joking and funny demeanor when I saw him in his clinic. However, surgery is serious so I can understand that. They rolled me back to the procedure room (which are always cold). Before they rolled me back they gave me something that made me a little sleepy. Right before surgery they shaved part of my backside with a large electric razor which was interesting. I was laying on my stomach and the CRNA told me they would give me the anesthesia which felt fairly cold before it knocked me out cold (no pun intended)

I woke up and was in recovery around 10 A.M. and didn't feel too bad. Dr. Das came in and said everything went well and I would most likely need to do laser/hair removal to prevent it from coming back in the future. The rule for the surgery center was you had to wait an hour to recover and they would release me at exactly 10:38 A.M. The nurse put me into a wheel chair and they told my Mom to pull around the side and wheeled me out to the car. After I was in the car we headed to get some breakfast/lunch at a local diner in the area and then of course I needed my usual flat white as well and was feeling amazing after that. My Mom had to run a quick errand and I was sleepy so we did her errand and then I was back home and took a nap for about 45 minutes and felt much better. The doctors had told me not to drive at all that day but this was similar to a colonoscopy and I did feel a little tired driving back home but was okay. 

I went back home to rest and noticed that I didn't have any prescriptions so I called the doctor's office and talked to a medical assistant who had told me there would be three prescriptions for me Tramadol, a muscle relaxer, and Flagyl. On my rear I had an extensive bandage and was told to wait 48 hours to remove it and could not shower until that point either. I ended up going to Walgreens to buy some probiotics and some wound care supplies too. I was amazed at how much little pain I felt. The first day I didn't even need Tylenol! My rear felt like I had done 500 butt blasters though. The other thing I was shocked by was I had a normal bowel movement in the afternoon right after the surgery without any issues. 

The first day of surgery was probably the worst in terms of how I felt overall. When I was driving home I could feel every little bump possible. The bandage they placed on my rear almost covered my whole rear and I waited roughly 36 hours to remove it and took a shower (that felt amazing!) and placed on another bandage that was waterproof along with gauze as well. A nurse called me the day after surgery and asked me how I was doing and I said I was doing fine and she had mentioned to wait 30 minutes until after I finish eating to take my antibiotic to reduce the potential for stomach cramping. When I look in the mirror I can see a medium size cut above my rear but you have to look at it from a certain angle to see the whole thing (I would guess this should fad over time). To be honest I haven't had any pain more just soreness and the hardest thing is getting in and out of the car and just thinking about my movements before I do anything. The day after surgery I just worked from home in my bed laying down most of the day and it felt nice. Laying on my bottom is still sore and trying to navigate that. My walking is limited too to around 20-30 minutes per day to start off with. For a number of years I had been working with a personal trainer but taking a break from that so I get part of my Saturday mornings back with that. Each day that passes my backside feels a little less sore. The hardest thing still is sitting down but I purchased a donut cushion to help with that. Dr. Das had mentioned that within a week after surgery I would be feeling pretty good and I think his prediction about that will be correct. I have my follow up with Dr. Das in a couple of weeks so we will see how that goes but overall the surgery went well and less pain than I had anticipated. 

RIP Humira 2012-2026 and Going Generic

Recently I learned that my health insurance plan no longer covered the regular prescription for Humira. I had tried to place an order for Humira and on the day it was supposed to be delivered, the order got canceled. Initially I had called Accredo to ask them why the order was canceled. Accredo had mentioned that they had heard that one of the potential reasons could have been that Humira went to the generic form and I would have to reorder it. Luckily I had an appointment with my GI that week so saw him and he wrote a prescription for the generic form of Humira. This then led me on a journey for the next couple of weeks calling Blue Cross Blue Shield and Accredo every day to ensure that I would receive my medication. Typically I would have 3 Humira pens left however I did not want to be in a situation that I would only be left with one or no pens. When I talked to Blue Cross Blue Shield they had identified part of the problem was my doctor had to submit a prescription for the generic Humira. At first Blue Cross Blue Shield said that they had the wrong product number for Humira, but eventually were able to straighten that out. The next step in the process was getting the prior authorization which I ended up expediting as the general preauthorization process could take up to five to seven business days. After the prior authorization a pharmacist then has to review the prescription to make sure everything is okay. I was also able to expedite that as well, to only take a couple of days. A couple of Fridays ago I had checked the Accredo website and it said my Humira was ready to order and I was so happy and felt 10 times better that day! At one point I got emotional for worrying about if I didn't get my medication and ending up flaring and in the hospital. Now I have the generic version of Humira (Cyltezo) And really don't have any concerns about taking drug, given that it is almost biologically the same as the regular Humira. 

Humira in my mind has been a wonder drug. I remember, years ago, watching a YouTube video of a man who had Crohn's disease, who took Humira and explained that his stabbing pain completely went away even when he ate potato chips. At the time I was watching this I thought that was too good to be true. I started Humira back on June 6, 2012 and still remember a nurse coming to our house to show me how to inject myself. If I recall I initially started out with a dose and then took the drug every other week. I rarely had any issues with Humira in terms of both the drug and never had any side effects from the drug as well. the only time I had to escalate my dosage (to every week) and then was when I had C difficile back in 2013. 

Previously, I had posted about my progress with Humira at different points in time on this blog. Here I posted when I started Humira, here I posted the 3 month period, 5 months here, 7 months here, 2 year mark here, and 10 years here and when I switched to taking Humira every week here (back in June 2013) and then by November 2013 was back to taking Humira every other week. What is crazy is I remember like it was yesterday in May 2012 when I was living at home with my parents and throwing up and constantly going to the bathroom and not having solid bowel movements. At the time I remember keeping the TV in my bedroom on and watching Nick and Night to try to take my mind off my health situation. Those were truly the dark days for sure. 

Over the years I have not rotated the injection. In the past I had issues with injecting near my stomach site (especially when I was very thin). For me I have found that injecting in my thigh is the easiest as it is fairly stable and did a post about that here. 

I am still in amazement what Humira has done for me over this 13 year! I know other people sometimes will try a drug and then fail it. I have been known as was referred to as a super responder. Also, I am lucky that there are so many new drugs available for Crohn's disease that were not even around back in 2012 and always have the luxury of potentially switching to another drug if even dose escalation does not work. I am curious to see what the generic Humira has in store for me and looking to continue to be in remission. 

Bump on Top of Bottom and History With Fissures and Fistulas and Dr. Bidhan Das

Recently int the past couple of months I had noticed that I had a bump on the back of my bottom. I had noticed it after taking a hot shower. At first I knew it was not urgent and it did not hurt or have any blood or pus. I had decided to get it checked out and had a appointment with my dermatologist for something unrelated and had him look at it. Initially my dermatologist had said it was just me getting older and part of my tailbone shrinking. To me, even as a non medical professional, this did not make any sense.  Given this I decided to get a second opinion with a colorectal surgeon. Dr Bidhan Das. Previously, I had blogged about him discussing choosing a colorectal surgeon. I had my appointment on a Friday a few weeks ago. When I came into the office payment for the visited is expected upfront (however they tell you what the cost is). When I entered the office Dr. Das I noticed that almost every chair was taken and on the way out, I noticed that some people were even sitting outside the office on the floor. This tells me the type of popularity that he has as a doctor. As I write this he has over 500  reviews nearly all of which are positive. I was called in fairly quickly to talk about the reason why I was there. She had mentioned that Dr Das would be in in a couple minutes. This turned out to be a roughly 30 minute wait. Don’t don’t get me wrong I know some people are very impatient when it comes to waiting for doctors. The positive of my appointment was that I had made it within the same week, which is very unusual for specialist colorectal surgery. I could hear Dr Dallas chatting with other patients However, given the rooms were close to one another, I couldn’t tell exactly what they were talking about. Dr Doss was chatting with patients, and I could hear him laughing with him as well.

I have been following Dr Das's career over a number of years and even listen to him on Gut Check (sponsored by the American Society of Colorectal Surgeons), which is a podcast for colorectal surgeons so I felt like I was in good hands. Dr. Das greeted me with warmth and started the conversation with “brother how can I help?”. I explained the issue to Dr. Das and he asked me questions in terms of how long I had noticed it, pain, and other questions. He discussed common possibilities such pilonidal disease (however very unlikely since my Crohn’s is under control) or a pilonidal cyst. I pulled down my pants and he placed his hand on the right side of my bottom first and then said moving, moving, which I felt was helpful in terms of no surprises. He asked me where the bump was and I showed him and he said “Yup I sure do feel it”. Dr. Das believes it is a benign soft tissue cyst. He had recommend I get an MRI since it was a soft tissue mass but believed it was a “nothing burger”. I felt Dr. Das was compassionate, extremely articulate, knowledgeable, and spent enough time with me and didn't have his hand on the door like many doctors do. 

I ended up getting an MRI yesterday at the hospital and had scheduled it in the early afternoon and they were able to get me in. What was funny is I was able to sleep in the MRI machine and just close my eyes. There are loud noises during the MRI but it didn’t bother me. I will be curious to see what the results say. Also I see my regular GI in a couple of weeks and will be able to get his view as well as well if he thinks there are any risks to surgery. From everything I had read the risk of surgery to remove is low given the Crohn’s isn’t active.

The results of my MRI were posted last night on MyCharts (results for an MRI within 24 hours is pretty good). The results showed a 1.9 cm cyst that was a chronic hematoma (previous blood pocket). The results were similar to what Dr. Das had predicted from our visit. He had said that once he got the results we can decide if we do nothing or have it removed. Given it is nearly 3/4 of an inch in size and sometimes it is hard to lay down (at the gym)/sitting down evenly I would be more apt to have it removed.