By Femi Ogunyemi

Thanksgiving, that special Thursday where America stands still, has come and gone.
Friends and family gather from all corners of the world to celebrate and give thanks for the blessing of the harvest and of the preceding year.

It is celebrated on the fourth Thursday of November in the United States and on the second Monday of October in Canada.

Traditionally, if you believe the financial pundits, the day after, known as Black Friday, is a major shopping day in the country. The prices of TVs, electronics, computers and “everything” is, supposedly, slashed. This buying frenzy is said to then continue till the following Monday whereby buyers, supposedly flock to online shops and besiege the internet with transactions.

This day is “Cyber Monday”.

Thanksgiving is NOT celebrated in the UK.
Well, that has changed.

A few days earlier, I had read in an obscure line in a UK newspaper, of Thanksgiving presents, gifts and turkey sales rising in the Queen’s own country. The article labelled the Borough of Lambeth in South London as the leading cheerleaders (my label) for Thanksgiving in the UK.

The day after Thanksgiving, on CNN in Atlanta, I was surprised to see pictures of shoppers wrestling, sprinting, shouting and employing mixed martial arts techniques to snap up Black Friday bargains in….London!

Where am I going with this story?     Sipping coffee as I watched this early morning pandemonium on TV, the scenes prompted a recall of a patient of mine a few years ago.
She was in her late twenties, athletic built, and not the typical demographic of a chronic pain clinic.

She presented in mid February, in the thick of winter, with a history of pain in her “bottom”. coccydynia. She said she had difficulty sitting or leaning against the buttocks. 

When I examined her there was exquisite tenderness at the tailbone area.
“Been there about three months,” she reported. “It’s a bit better now but sometimes its agony.”

After reviewing her story and excluding other possibilities, I told her she had coccydynia.

“Cocksi who!” She said eyes and mouth wide open.

In these days of “diagnosis by Google”, whereby individuals comb the virtual world for symptoms and signs that lead to their own self-diagnosis, I explain diagnoses to my patients.

Coccydynia is inflammation of the tailbone (coccyx or bony area located deep between the buttocks above the anus). It is associated with pain and tenderness at the tip of the tailbone between the buttocks. The pain is often worsened by sitting.

It is often caused by an injury, butmay occur seemingly spontaneously. There are many causes of tailbone pain that can mimic coccydynia, including sciatica, infection (including shingles of the buttocks), pilonidal cysts, sacroiliitis, and fractured bone (broken tailbone or tailbone fracture).

“What now?” She asked.

Rest, avoiding reinjury to the affected area, anti-inflammatory medications, and pain medications can relieve symptoms. Sitting on a pillow, cushion, or buttock support can help. Some patients with persistent coccydynia are treated with local cortisone injection.

This injection is simply performed in the doctor’s office and can potentially dramatically relieve the pain and even resolve the symptoms for many. Physical therapy with exercises can be helpful in the recovery. Rarely, when patients have unrelenting pain, a surgical resection of the coccyx (coccygectomy or surgery to remove the coccyx bone) can be performed to remove the irritated bony prominence.

We spent many minutes trying to determine if, how and when she may have injured her tailbone.

Finally, with a conclusion of “idiopathic cause”, which means the doctor does not know, the consultation ended.
 
As she got up to leave, she said ” I’m heading straight back to the gym. Maybe if I tighten those glutes, the pain will be more tolerable.”
This was contrary to my advice to rest. “You workout a lot?”

“Yes, I do. Comes in handy when you gotta fight your way through bargain hunters sometimes…..”

She stopped. She suddenly remembered last Thanksgiving.

And the 55in TV she badly wanted. The only one in store. 

She turned to me at the door…mouth and eyes wide open…..”Doc!!”
We both burst into laughter.