Taken the decision to have a coccygectomy

Carol - McKinney, Texas, USA - cyackinous@yahoo.com

Posted 2019-12-21

Since falling on my tailbone on a hard, wide, wooden, low arm of chair in November 2018 and "snapping my tailbone at the joints", I've been on a long journey of life altering pain, doctors, conservative treatments and finally made the tough decision to have a coccygectomy. My surgery was this past Monday, 12/16. I used this wonderful website extensively as a resource to help me find the right treatment and to make my decision, so I'd like to share my story with others.

Immediately following the trauma, I had intense pain, but nothing that led me to rush to the ER. I was hoping it was just a bad bruise that would heal on it's own. The next morning getting out of bed, the pain was really bad and aching, but each day following got better and I was able to shift positions to deal with the pain. Everything I read on line suggested these injuries mainly heal on their own with time, so that was my plan and I didn't go to a doctor because it was manageable and I figured I would get the same advice. I was even training for my first half marathon and was only 1 month out at the time of the injury, and because I did not feel pain when standing and running, I continued and successfully ran the race in my goal time. I even did a second half marathon a few months later since I was already trained. About 4 months after my injury and after a very long plane ride to Australia for work (17 hours one way), my pain started to be more intense and continuous. It was radiating pain not only upon directly sitting upon my tailbone, but also standing and laying flat on my back where my tailbone was slightly protruding. I couldn't sleep well and sitting at work was becoming unbearable. That's when I decided it was time to see an orthopedic doctor.

I went to a doctor in the ortho group I have seen before for a different injury, and he was not very helpful and certainly not empathetic. His X-rays indicated I dislocated my tailbone about 30 degrees. Although he was "nice" and did all the conservative treatments typically recommended - NSAIDs, in office steroid shots in the muscle, coccyx cushion - he did not explain things in any sort of detail and dismissed my pain. I continued to have pain despite those measures, so he ordered and MRI and suggested targeted injections under anesthesia. When the MRI came back, he said it was all good and clear. I asked him what that meant considering he previously told me my tailbone was dislocated and my pain has not subsided. I asked him which direction my tailbone was dislocated in and he said "he couldn't remember" and that "I must have broken my tailbone as a kid and it's just flaring up". I knew exactly when I broke it the previous year and was so shocked by his response. He never once showed me my scans or my MRI. I couldn't believe his lack of engagement or explanation. That's when I decided not do to the injections with him, and asked him to prescribe physical therapy and chiropractic care so I could start taking my treatment into my own hands while I searched for a more knowledgable doctor. The Chiro care helped a little with my overall alignment, as everything else with my back and neck were getting out of whack due to compensating my sitting so I would not put direct pressure on my tailbone. The best thing that happened was finding a pelvic floor PT (Cara Hartoon). She was so knowledgeable about my injury and was able to tell my coccyx was hypermobile from her physical examination. She tried to mobilize it, but was very honest with me that she felt PT would not fix my problem and I likely needed surgery, She put my in touch with Dr. Robert Myles who had helped so many of her patients. He practices in the FT Worth area, but I would drive anywhere at this point to get treatment from the right person. BTW - both Dr. Myles and Cara Hartoon are listed as recommended specialists in the DFW area on this site (see Doctors and specialists in the USA, Texas). I highly recommend both!

Dr. Myles was extremely empathetic and has tons of experience helping patients with coccydina and tailbone injuries. He also wanted to try the conservative treatments first. Oral steroids, more effective NSAIDs that didn't rip up my stomach, and then 3 rounds of targeted steroid injections under anesthesia. He did extensive X-rays and walked me through the results to show me exactly what parts of my tailbone were dislocated and loose. He has the best bed side manner and really cares. He also wanted to try everything else before surgery, but after I met all the criteria (over 1 year from trauma, some success with injections, hypermobile coccyx), he agreed the surgery was likely going to be the solution. He has done 200-300 of these procedures and has learned from the doctors who developed much of the methodology that is used today. As this surgery is very prone to the incision opening post operation and also infection, he has learned that implementing several practices really help speed recovery and minimize these problems. He makes the incision as small as possible. He does an internal z-flap of securing and sticking the muscles under the skin to keep it closed with dissolvable stitches. He then does another set of stitches on the skin that he keeps in for 3 weeks. He attaches a provena drain over the wound site upon closing - this keeps the fluid out of the top and internal layers, keeps it completely sealed from bacteria that cause infection, and applies some structure on the wound to prevent it from splitting open. I will have that on for 1 week. I am also doing daily hyperbaric oxygen treatments to increase o2 in my blood to accelerate healing. I will do 7-10 sessions over the 2 to 3 weeks following my surgery.

So, I had the surgery this past Monday, first thing in the morning. The procedure was less than 1 hour. Dr. Myles confirmed the 2 lowest segments of my coccyx were very loose and indeed pushing on the parts of my body directly where I was experiencing the pain. The top segment was very stable, so he left that one and only removed the bottom 2. I was able to go home around 9 PM that night so I could sleep in the comfort of my own home. I'm on Day 4 post surgery and doing quite well. The pain is manageable with Hydrocodone and Gapabentin, It mostly hurts if you put pressure on the incision - which you are not supposed to anyway, so I'm steering clear of that. The hardest part of this so far is that I'm not allowed to sit directly on my bottom for 2-3 weeks! It's very hard to say the least, as I'm a very active person. So I'm standing, laying on my sides and trying to get out of the house to slowly walk to keep my sanity. Also, going to the hospital by my house for the 2 hour hyperbaric O2 treatments have been breaking up the day. I have to lay on my side in the passenger seat when driving there. It's hard to tell for sure, but I do believe I no longer feel the poking of my tailbone into the muscles like I was feeling before. As I'm not sitting, I'm not able to tell if the pain of sitting directly on the tailbone is gone. Only time will tell - but I'm optimistic.

I hope to share an update in a few weeks and that I continue to heal and have less pain. My Christmas gift to myself this year was to give me a painful 2020 and beyond. I'm truly hoping that's the case!

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