Functional Medicine and Pilonidal Surgery

How do we use Functional Medicine in pilonidal patients?

Treating pilonidal disease has many challenges. Of course, it is necessary to choose the right operation, perform it correctly, and care for it properly after surgery. However, there are times when all those things are done correctly, yet wounds fall apart or do not heal. As surgeons, we look for consistency regarding how our patients recover, and are often mystified when things don’t go as expected.

If a surgeon performs a cleft lift every month or two, it is hard to get a good handle on the differences between patients regarding their types of pilonidal disease, locations of wounds and sinuses, and body shapes. However in a clinic like ours, where we are dealing with pilonidal patients and cleft lift procedures on a daily basis, it becomes dramatically more clear when a patient is not healing as expected.

When we are approached by patients who have had failed operations elsewhere, it is very helpful if we can recognize the reasons for their previous failures. If it is because they have had an operation with a high failure rate, and the pattern of the failure is as expected, it is reasonable for us to proceed with revisional surgery in order to try to salvage the situation.

However, if the previous failures seem to be more dramatic and unexpected than usual – we have to investigate why that happened so it doesn’t happen again. One of our strategies is to maximize our patient’s nutritional status, and the details of that is on this web page.

However, there are other times when we perceive that there may be other metabolic factors involved and feel that they need further investigation. This is where Functional Medicine plays a role.

What is Functional Medicine?

In the words of Dr. Mark Hyman:

FUNCTIONAL MEDICINE … seeks to identify and address the root causes of disease, and views the body as one integrated system, not a collection of independent organs divided up by medical specialties. It treats the whole system, not just the symptoms.

Another way to look at this, as it applies to treating failed pilonidal surgery, is that we are searching for the root cause of the surgical failures to prevent them from continuing to be a problem with the next operation. We do this by looking at the whole patient, not just the surgical site. The kinds of problems that we are looking for are nutritional deficiencies, uncontrolled inflammation, auto-immune diseases, intestinal problems, and environmental toxicities. We want to define and control these issues to help insure that future surgery has the highest chance of being successful.

Who benefits from a Functional Medicine evaluation?

If in assessing the medical and surgical history that you have sent us, plus our evaluation of the photos of the operative site, Dr. Immerman feels that there are factors beyond the basic pilonidal issues involved, we may recommend a battery of tests looking at nutritional parameters, toxicity, inflammation, and autoimmune diseases. If these point to metabolic issues, we will recommend a Functional Medicine evaluation, and possibly a period of treatment, before considering additional surgery.

We can help you find a Functional Medicine practitioner for this. You can continue to have your regular family physician in addition to a Functional Medicine physician – often the testing and treatment recommendations are so different between these two medical disciplines that they don’t overlap at all.

If you want to search for a practitioner yourself, the Institute for Functional Medicine (IFM) website has a great search engine to help with that.

A few things to know about Functional Medicine clinics:

  • They usually do not accept insurance as payment, and visits will have to be paid out-of-pocket.
  • Some of the testing may be covered by insurance, but much of it is not.
  • Most visits can be performed virtually.
  • These practitioners are often booked months in advance, so do not be surprised if there is a significant wait for your first appointment.
  • You may find that the practitioners listed on the IFM website are of various qualifications: MD (medical doctor), DO (osteopathic physician), RN (nurse), NP (nurse practitioner), Dietitian, or DC (doctor of chiropractic). We’re happy to help you figure out who is best for your situation.
  • After performing a number of tests, you may be prescribed specific diet recommendations.
  • You may be prescribed various vitamins and supplements, that are usually not covered by insurance.
  • There may be follow-up testing after a period of time to see what kind of progress you have made.

This sounds like a big deal! Is it really worth it?

Yes! This may be the most important action you take for your general health, not just your pilonidal problem. This may prevent future diseases, and help turn around current issues.

If we recommend that you see a Functional Medicine practitioner, it is in your best interest to do so.

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