response 1 of 18:

Jun 19 02:46 UTC 1999

Update!

The seeming infection got worse last night & today.  Bit of fever a few
times this afternoon; noted more-widespread pain & tenderness more often.
A few calls to the phone numbers (four different!) on the back of my
insurance card weren't reassuring - their PPoM network has *NO* "urgent
care" walk-in locations in Washtenaw County; virtually all the network
dermatologists are University of Michigan people (only reachable through
a hostile phone system that i didn't work at penetrating); assuring me
that they would actually cover it would require a two-week wait after
they got a doctor's report on the condition.  I decided to go to St.
Joe Hospital's "Urgent Care" this evening.  (Rumors that have reached 
my ears make St. Joe out to be lots better than the U and my sister 
works there - not completely the cool & rational decision.) 

Walked in the "Urgent Care" door (no appointment) about 7:20.  Couple
minutes to find that check-in was with the ER nurse (being after 5PM).
Maybe a 10 minute wait, then a quick check-in - just a few questions
that struck me as obviously meaningful.  Off to an empty semi-private
exam room with extra stuff (supplies for casts, etc.).  Take my driver's
license for a few minutes, give me a St. Joe ID card & papery plastic
ID bracelet.  A staff doctor appeared about 7:50, a minute of listening
to history & symptoms and he echoed the Mayo Clinic book's diagnosis.
He noted that the on-its-second-infection cyst could be removed in out-
patient surgery, but not 'till after the infection was gone - it was 
lance & drain time.  Nurse & supplies appeared at his summons, there
was a humorous minute's pause while he read how to get an unfamiliar
brand of knife out of its sterile package, then a little painkiller
shot, lance, skwish out some gunk, mop up, push hard to skwish out more,
mop, put in a wick to help it drain, then leave.  Another nurse had 
appeared to dress it, give me a dipth/tetanus shot ("the arm will be
sore tomorrow - which arm do you want this in?"), tell me a bit about 
dressing it myself & what symptoms mean trouble, get my signature on a 
"I know I've gotten some treatment but I ain't cured yet" release form, 
give me a prescription for antibiotics, and see me off with the leftovers
from the dressing stuff they'd opened for me.   

Ignoring the 15 minutes i waited in their pharmacy for the $16 bottle of
pills, i was done & out in an hour.  Never felt rushed, but they *moved*.
I got the impression of extremely competent VIP treatment....which i hope
will not describe the bill.  I didn't sign anything but the release, give 
them any card but the driver's license, nor pay before leaving - they 
assured me that Billing would get to it & mail me the damage report.  
($72 basic overhead "room" rate, plus {unknown}.) 

response 3 of 18:

Jun 21 05:26 UTC 1999

I had a pilonidal cyst removed a few times, and the wick change was 
absolutely unbearable.

response 5 of 18:

Jun 22 19:42 UTC 1999

The very swollen/infected/spreading-sort-of-feelings all vanished quickly
with the lance & skwish.  It's still (at lance + 91 hours) about as sore 
and tender as it was a few hours after lancing.  It's also still running
a bit of dilute blood and aches at times.  Progress since the first night
seems to consist of the wound & big initial scab shrinking while the wick
gets pushed out...all slowly.  (From what they told me at St. Joe & my 
dim memories of the last time, this is par for the course.)  The hair
around it has 'most all gotten pulled out, so changing bandages now hurts
*far* less than it did at first....

About when did your uncle get his cyst removed?  Sounds like it's just
another little-outpatient-surgery these days.....but no idea yet what 
the lance & skwish job cost.  My sister who works there said St. Joe can 
be **really** slow about billing people....used to be that they never
did bill sometimes...<i crosses his fingers>....

response 7 of 18:

Jul 16 22:34 UTC 1999

Hurray!  Got the St. Joe bill yesterday (call it treatment+4 weeks).
Only $123.00!!!  Mailed the check today.  (Yep, i did the "i won't
get a dime from my 'insurance' for this....how much will it cost?"
thing.  I definitely think it helped.)  

St. Joe still has the Assoc. in Internal Medicine group for those who
are insurance-impaired.  The first available appointment was weeks away
when i asked.....

Meanwhile, my lanced cyst is still open and blood/gunk/etc. slowly drool
out with occasional spurts.  Still going through 3-4 SuperSize Band-Aids
as dressings.  Hope it will close up & heal soon....having the cyst itself
removed (minor surgery) is pretty much the alternative.....

response 9 of 18:

Jul 23 02:29 UTC 1999

The doctors i saw today agreed that nothing unusual was going on, it
wasn't infected, etc.  They also agreed that i'll need surgery to 
get it "fixed" unless something really unusual happens - since the
cyst itself hasn't calmed down in four weeks, it probably isn't gonna.

IBB i got the St. Joe Urgent Care doctor's "personal" bill....and it's
over $230!!!  Looks like i *really* should have done Packard Community
Clinic for initial lance & drain - they've seen me twice now for follow-
ups (same-day appointments!) and they're willing do to the complete
surgery for far less than that.  

PCC's cyst, lump, & bump doctor said i'd get more expert treatment from a 
general surgeon and gave me references to three...he guesses three times 
his price for a surgeon if done in the office, yet more if at a outside 
facility. 

Not sure what i'll do at this point.  The unresolved cyst is far more
annoying than pressing.  PCC and St. Joe seem like known quantities,
one caring and cheap, the other 5-star service at a 5-star price.  In
between (i'd guess) are the surgeons, who are otherwise total unknowns. 
Checking out the insurance angle and asking around seems like a start. 

response 11 of 18:

Jul 24 12:12 UTC 1999

Getting out every last bit of the cyst "wall" (what they called it) 
was the reason the PCC doctors gave me for preferring a (presumably 
more practiced at the procedure) general surgeon.  With the cyst
inflamed, that wall is bigger, more fragile, and tougher to get out.

This does give me a reason to delay treatment - any amount by which
the inflammation goes down will boost the chances of success of the
operation - no matter who does it.

response 13 of 18:

Aug 17 04:06 UTC 1999

Procrastination pays!  :)

Changing the dressing (actually just a Biggie Band-Aid patch) last night,
i noticed that the cyst had shrunk considerably since i last really poked
at it (say, from diameter-of-a-quarter to diameter-of-a-nickel).  Some
very mild prodding painlessly yielded some gunk, so i started poking it
harder.  Took time, but with little pain i got a *lot* of gunk out, and
i couldn't feel anything left of the cyst when i was done.  I'll probably 
have the PCC doctors check it out in a week or so if it stabilizes this
way.  It would be very cool if i got out of needing surgery, but smaller
incision, better odds, and fewer stitches are not to be looked down upon! .

response 15 of 18:

Aug 21 15:18 UTC 1999

While you're waiting (assuming there's nothing dangerous going on that you're
avoiding/ignoring) keep the bandage on as firmly as possible, but not so much
as to cut off circulation to your fingers.  A good way to see if it's too
tight is to press on the fingertip, it blanches white as your pressure drives
out the capillary blood, then release the pressure and time how long it takes
to get the color back.  Usually it is within 2-5 seconds, but as long as 8
or 9 seconds is still adequate to avoid danger from too tight a dressing. 
doesn't even matter if your fingers are cold and blue, as long as the
cold/blue color returns within 10 seconds after pressing on it there is
adequate blood flow.

the idea of keeping the bandage on very firmly is to do just what you did by
poking at it.  If there's any sort of opening, and you have pressure on it,
the "gunk" will be forced out onto the bandage and the 'cyst' will continue
to shrink.  Might want to consider using an OTC topical antibiotic on the
cyst, under the bandage, to prevent any infection getting in by the same
route.

Keep up the good work.

response 17 of 18:

Aug 23 23:28 UTC 1999

The three (or 4?) doctors who've looked at my shoulder seemed to agree
that it was a boring-textbook-case of sebaceous cyst.

Being something of a procrastinator and unexcited by the prospect of
surgery, i'm hoping that recent trends will continue - the cyst's size
and activity will continue to fade, the opening in the skin will close
and heal, and i will be able to ignore it again for ~13 years (as i did
when it originally flared up back in college).