I'm eating cereal without milk. No, that's not it. I have a pilonidal cyst.

A whaaaa? I'll explain.

A pilonidal cyst is not a cyst (boy, we're getting nowhere fast!) It's actually an abcess, but somebody way back when thought it was a cyst, so that's what they went with. The word "pilonidal" comes from Latin (bonus points if you knew that already.) "Pilo" refers to hair, and "nidal" refers to a nest. So, literally, a nest of hair.

Told you it was gross.

But the thing is, that's not exactly true either. There have been several theories as to how these things start. One was that they were congenital - you were either born with a sort of "dimple" that allowed foreign matter to enter and begin the abcess, or you were not. If you were not, then whatever you had couldn't be a pilonidal. Nowadays, if you go to a doctor who holds to this theory, you're recommended to find a different doctor. And those congenital dimples are considered normal and harmless, and sometimes they fill themselves in.

Another theory was that these things occurred only in particularly hair males, and that it was basically an ingrowth of one or more of those hairs that started the abcess (hence the name pilonidal). But the truth is they occur in women too - obviously - and almost, if not equally, as often. And it seems to have nothing to do with the amount of body hair, though being extra hairy does seem to make it a bit worse.

I'll explain the current theory in a minute. First, I wanna tell you where these things happen.

*giggle*

A pilonidal cyst typically occurs in the, um, natal cleft. That's doctor-speak for butt crack. I don't know why they call it that. My best guess is that it's the cleft you're born with, as opposed to cleavage of a higher elevation, which doesn't develop until later in life. But I really don't know. Anyway, they typically occur on the left of midline (mine is) just at the top of your butt. They can happen as high up as your tailbone, and they can happen lower along the, ahem, cleft.

The working theory says that the skin in that area is particularly delicate. Every time you stand up, for example, gravity makes your rear sag just a bit, and that pulls on the skin, distorting your pores. Meantime, your natal cleft is basically your body's rain gutter - hairs and dirt falling from all along your head and back end up there. To us, a hair seems fairly soft and not that big a deal; to tender, distorted skin it's like a log, or at least a big stick, going past. So the idea is that some of these pores get pulled open, and hairs and dirt irritate the skin and even get inside the pore, and boom! Abcess.

And I've got one. It's not too bad, most of the time. I have to pay attention to how I sit. Slumping or reclining, or any position that puts pressure on the tailbone, will eventually cause a flare-up. If I'm careful, I can avoid flare-ups, but usually at least once or twice a month I'll forget myself, and the next day you can be sure I know it. Then it takes a few days of especially careful sitting (and sleeping on my side!) for things to calm down again. Plus usually I have to get it to drain a bit.

I hope you weren't eating when I said that.

The first time I remember this happening, I was thirteen. I had been in the car for a few hours on the way to a youth conference, and when we got there, I noticed something really hurt. I had my mom look at it, and the best either one of us could come up with was a spider bite. To the rest of the world, I said I had a bruised tailbone - who wants to admit to getting bitten on the butt by a spider? Really. Nowadays, I know it was really the car ride; car seats are awful for putting pressure on your tailbone.

Over the next few years, I had some minor flare-ups, though I didn't know what they were at the time. Enough to cause pain, not enough to show any visible swelling or anything like that. I chalked it up to some hard falls I took while learning to ice skate. Maybe I really had bruised or even fractured my tailbone, wrote it off as soreness from the fall, and now it had healed badly and was irritating the surrounding area?

Then, when I was sixteen, the first "big one." It hurt, a lot, and swelled up nicely; the bump was maybe 1.5-2" long and about 1/2" wide. It was kind of comical, actually, it looked like my butt crack was a mouth, sticking its tongue out at me. I'm one of those people who can't help poking at things. I took some of my insulin syringes and tried to lance the thing myself. No luck. Then, a few days later, it started to itch. I noticed some skin peeling, took some tweezers to help it along and...WOW. I'll spare you the description except to say that it really smelled funky, and it felt a lot better afterwards.

It was kind of cool, actually. The uncool part was my mom asking me, at random intervals for months later, "How's your...thingy? You know, on your butt?" "MOM!!"

By now, I was having more flare-ups, about once or twice a month. It was very frustrating, painful, and confusing. I had NO idea what was wrong with me. Cancer crossed my mind more than once. Then, last summer, the real big one.

I was having a flare-up when it was time to move out of the dorm. I think that's what caused it. A lot of walking up and down stairs, carrying things, a lot of friction in an already upset area. I woke up the next morning in my parents' house and it hurt. The next day, it was even worse. It was the most swollen I had ever seen it. In a very short time, I was basically incapacitated. I could just barely sit down on the edge of a couch or chair. I couldn't even lie on my side anymore, which usually works; I had to sleep on my back (you can imagine the backaches and neckaches I had in the meantime!) And I slept all day, because it was the only way I could avoid the pain. Getting up in the morning involved several minutes of pacing my room and screaming, it was just that agonizing to come back to consciousness.

Then came Sunday.

"Mom! I don't think I can go to church. I can't get even my loosest jeans on. It hurts too much."

"Can you wear what you're wearing now?"

"You mean...my pyjama pants? Well, yeah, they're soft, but...to church??"

I was really thinking, I mean, I can't sit, I can barely lie down, I can't wear anything but P.J.s...surely this is one of those times when you say, "It's okay, honey, you don't have to go"?

But no. Not my parents.

20 minutes in the car to get to church, every bump in the road was something awful. Sitting gingerly on a hard pew for 90 minutes. People asked me if I was okay, what was wrong, I looked sick. How do you tell a little old church lady that your butt is swollen like nobody's business?

Fortunately, there was a young woman there, a friend of our family, who was studying to be a nurse. I took her into the bathroom with me and dropped trou - she took one look at me and said, "You have a cyst!" I was so relieved to finally, finally know what it was. I had tried to go to a doctor before, you see, but I could never manage to time an appointment with a flare-up. The one time I mentioned it to my regular diabetes doctor, she shrugged and said "We all have our aches and pains." I personally thought sixteen was a little young for having random aches and pains already, but what could I do?

But now, now I was armed. I could walk in and say, "I have a cyst. On my butt. Fix it." On the way home from church, I asked to be taken to a doctor the next day. My mom says,

"Sure, but on one condition. I want you to take a shower before we go."

This taps into a bit of history. My parents were always, ALWAYS after me about my hygiene. I was in my third year of college, remember! This had been going on, pretty much ever since they stopped supervising me in the bath. "Did you really wash your hair?" "Maybe you should wash it twice." "Don't you want to be clean??"

It was true, I hadn't taken a shower in days. I was waking up literally screaming in pain, I couldn't walk or sit or sleep...hygiene is the farthest thing from my mind! And here, my mother is so frickin' worried about what I look like going out in public, instead of the fact that I am in so much pain...I wanted to hit somebody. I wanted to hit my mom, actually. And I'm not usually a violent person. But I would have done anything to get to a doctor and be treated, so I agreed.

And I managed it. It was agony, but I got up and into the shower and made it through. Then I went back to bed until it was time to go. I woke up a little after noon, and told my mom I was ready to go.

"Oh, we can't go now."

What??

"Well, I have work at 2:30 on Mondays, and it's already after noon."

"Why didn't you get me up??"

"You were sleeping. I figured you needed your rest." She goes back to her book.

"Mom! You knew I wanted to go!!"

I go back to my room and cry my lungs out. I was so desperate, I could not imagine waiting even one more day to see a doctor. And I am so befuddled by my mom! Usually, when I'm sick, she would come and put her cool hand on my forehead, sit with me a while, bring me meals and drinks. She was usually a good caretaker. But suddenly, she's so indifferent! Did she not hear me crying? Did she just not care? I still don't really understand what happened with her.

Fortunately, when my dad got home from work, I was able to talk him into taking me to an emergency clinic. I paid $230 of my own money (they said they'd pay me back since it was a medical expense, but has that happened? No...same as the over $400 they owe me for my hospital bills I paid that they promised to pay back) to have the thing professionally lanced and drained.

God. I'd never felt better in my life!

And on my way out, as they gave me my receipt, I saw for the first time, the words "Pilonidal cyst." I finally, finally know what was wrong! I had a place to start my research, and I could go in even better prepared than before.

Now I'm in Canada. When my residency is finalized here, I'll have social health insurance, and I'll be able to have the whole thing surgically excised. I'm not sure I'll do it yet - the idea is more than a bit frightening, and it may or may not be totally necessary. But at least if I ever need treatment again, it won't cost me hundreds of dollars!

Oh, one last thing. There's a website all about pilonidals, in case you're interested. That's where I learned most of what I know now. I recommend not looking at the pictures unless you're really curious or have a really strong stomach, though! Or if you just have very strange fetishes. That's okay too.

Now that I've grossed you out, or else bored you to death with long personal histories, I hope you have a great day!