Paul #5 Update
Paul E Garcia
From yesterday's second opinion. After the customary urine sample, a PA on
staff at the Uro's office asked me some questions and spent a decent amount of
time taking my history, noting pre-Vas medical history, the particulars of the
procedure, and post-V issues. He asked questions that indicated he had some
idea of the symptoms I was having (occasional pain, ache after physical
exertion).
After the physical exam, the Uro prescribed 10 days of Doxycycline. His report
to my regular doctor noted an epididymal mass 1 x 1.5 cm, slightly tender to
direct touch, no induration. The preliminary diagnosis is epididymal
cyst/spermatocele. The Uro is requesting authorization for a scrotal Ultrasound
and two follow-up appointments (the first of which is on 8/25). The urine
sample (analyzed in house) came back completely clean.
Paul E Garcia
David
"Paul E Garcia" <paule...@cs.com> wrote in message
news:20030730005823...@mb-m28.news.cs.com...
> Permission to post to website granted.
OK - I'm a bit behind on things at the moment as I've been spending the
evenings revamping the porch, but wil do it later in the week.
Cheers,
David
www.vasectomy-information.com
trifold
Good they are going for the ultrasound. Keep us posted.
Paul E Garcia
Wound up taking the full 20 days of Doxycycline prescribed by the Uro; it
helped quite a bit, so I suspect I had some lingering infection after the
earlier Cipro.
Just had the ultrasound 8/26 and follow up Uro visit 8/27. The ultrasound
showed no abnormal growths, so that rules out spermatocele/hydrocele or any
other type of cyst or mass. The Uro's opinion is that the discomfort is
persistent back pressure (the usual time for abatement is 3-4 months and I'm at
7+); although he is optimistic that the pressure and pain will subside
eventually (hopefully in less than one year). He recommends Advil for any pain
episodes and avoidance of activities that cause discomfort.
In case the pain doesn't subside, I asked the Uro about the OE conversion; he
also doesn't do them, for the usual reasons. Also, the third Uro I arranged
directly through the HMO doesn't do them either (I called and asked so as not
to waste my time).
I contacted the HMO to reschedule the additional consult with a Uro that does
OE (so that I'm getting good advice on all my options). I explained that the
surgeon offering the OE conversion doesn't return my calls, and that both Uros
won't do it. I expected a call back from the referral group but instead the
quality of care group wants to know more about my situation.
So, at this point I feel much better (almost 100% usually with prescription
NSAID) but still don't think I'm getting the whole picture without seeing a Uro
with experience with the OE procedure. So, since the HMO seems willing to find
me one and arrange a referral, we'll see what happens now.
Any thoughts or questions? David, please update website if you'd like.
David
> I contacted the HMO to reschedule the additional consult with a Uro that does
> OE (so that I'm getting good advice on all my options). I explained that the
> surgeon offering the OE conversion doesn't return my calls, and that both Uros
> won't do it. I expected a call back from the referral group but instead the
> quality of care group wants to know more about my situation.
>
> So, since the HMO seems willing to find
> me one and arrange a referral, we'll see what happens now.
>
> Any thoughts or questions? David, please update website if you'd like.
OK - I'll update it over the weekend, thanks for the update.
The thing that strikes me as very positive here is that the people
with the purse strings are genuinely trying to help resolve this. The
other good sign is that they clearly believe there *is* a problem in
need of a resolution, as opposed to being keen to tell you to take the
tablets and bugger off. They are clearly keen to gather as much
information about the case, and are clearly trying to find the right
specialist for you. Compared to what we are often told is the usual
reaction to complaints, this is extremely helpful.
Hope things work out, and please keep the updates coming!
trifold
My thoughts are that you are proceeding admirably--and that "the
system" *seems* to be working. What does the quality of care group do
exactly? Are they a policing agency, to see doctors are treating you
right? And will the referral people contact you only after you talk
with the quality of care people? On the open ended stuff, assuming
the pain does not abate: I'm curious what the doctors who refuse to
do it out of fear of reversal and/or possible ASA will recommend
instead, if indeed pesistent back pressure is the source of the
problem. Seems to me, ruling out OE leaves reversal as the only
option. But given the cost and complexity of that procedure, I don't
see why they wouldn't want to try OE first. Another question I
have--maybe you do, too!--is what doctors think are the causes of your
unusual backpressure problems. This is an issue that does not seem
well understood, and you'd think they'd want to learn from a case such
as yours. Were you sealed more closely to the testicles than usual?
Was the sealing method more complete than usual, so that in your case
there is no leakage at all? Is the sperm "reabsorption" doctors say
prevents backpreessure in most of us simply not occuring in you in the
same way as usual? Or are you producing more sperm than usual, so
there is more to be absorbed? Finally, has anyone talked with you
about administering extra testosterone as a way of reducing sperm
production? I ask this because we have heard of this as a remedy in
other cases, but know it is rare (and because I wonder about side
effects).
Anyway, I hope you get good news soon--and/or that the problem
resolves on its own, as your doctors seem to expect. In any case, it
is good the new meds. are having good effect. Please keep us posted!
Giraud
> Another question I
> have--maybe you do, too!--is what doctors think are the causes of your
> unusual backpressure problems. This is an issue that does not seem
> well understood, and you'd think they'd want to learn from a case such
> as yours. Were you sealed more closely to the testicles than usual?
> Was the sealing method more complete than usual, so that in your case
> there is no leakage at all? Is the sperm "reabsorption" doctors say
> prevents backpreessure in most of us simply not occuring in you in the
> same way as usual? Or are you producing more sperm than usual, so
> there is more to be absorbed? Finally, has anyone talked with you
> about administering extra testosterone as a way of reducing sperm
> production? I ask this because we have heard of this as a remedy in
> other cases, but know it is rare (and because I wonder about side
> effects).
Interestingly, my uro seemed to admit that persistent backpressure
problems do sometimes happen. He said that some men resolve quickly, some
resolve after 1 year, and some never have it go away completely (he
followed this with, "and that kinda sucks" - no kidding, dude!).
He is also the one who said if, after a year, I still have problems with
it, he'd be willing to do an OE conversion. He didn't mention any
downside to this that I can remember. I was surprized, since he did
not offer the OE option before my op.
As for me, I will be at a year next month. I still think I am seeing slow
progress (i.e. less frequent pain), and the pain, when there, is fairly
mild (i.e. only a minor bother). Like Trifold, it seems more present
after great sex - my new hypothesis is that the pulling up action of the
muscles stress the tender epididimi and leave a lingering ache. It is
slight, and I can understand Trifold's "sex hangover" comment (i.e. the
feeling from the sex makes me not care too much! ;). Also, at age 38,
I have a number of little aches and pains, so it sort of mixes in with all
of that (but of course it's more noteworthy down in that part of the body)!
I have a feeling that I will still have some lingering ache sometimes after
the 1 year mark, but I hope that the trend slowly continues in the good
direction. I will leave OE as an option for me, but I hope not to have to
open that can of worms (who knows, I could stir up problems worse than
what I feel now).
Giraud
Paul E Garcia
>with the purse strings are genuinely trying to help resolve this.
This much seems to be true; the problem is that the Uro's I'm being referred to
ARE telling me to just deal with it.
>The
>other good sign is that they clearly believe there *is* a problem in
>need of a resolution, as opposed to being keen to tell you to take the
>tablets and bugger off.
Same as above. The Uro's don't feel there is anything to resolve. They do
enough work to rule out non-Vasectomy causes and stop there.
>They are clearly keen to gather as much
>information about the case, and are clearly trying to find the right
>specialist for you.
This seems to be true. I'm encouraged that two Uro's now have determined I
don't have any non-Vasectomy issues; hopefully this will make it easier to go
to the next step.
>Hope things work out, and please keep the updates coming!
So far, nothing new except that I kept my regular MD in the loop and (in light
of two concurring diagnoses supported by diagnostic tests and treatment)
expressly requested a referral to a specialist who will actually treat the PVP
or, barring that, a re-consult with the surgeon. I did remind my MD that I was
advised PVP treatment would be provided.
Paul E Garcia
>exactly? Are they a policing agency, to see doctors are treating you
>right?
Yes. They got involved when I called looking for a specialist who treats PVP
and reported that the two Uro's offered no PVP treatment and that the surgeon
wasn't returning my calls.
>And will the referral people contact you only after you talk
>with the quality of care people?
The referral process actually is initiated by my regular doctor. I contacted
her again on the advise of the quality of care group.
>I'm curious what the doctors who refuse to
>do it out of fear of reversal and/or possible ASA will recommend
>instead, if indeed pesistent back pressure is the source of the
>problem.
Reversal.
>Seems to me, ruling out OE leaves reversal as the only
>option. But given the cost and complexity of that procedure, I don't
>see why they wouldn't want to try OE first.
I agree, I also don't know why OE was not offered as a first step.
>Another question I
>have--maybe you do, too!--is what doctors think are the causes of your
>unusual backpressure problems.
The first Uro said the origin of the problem is unknown but did note that the
swelling was at the junction of the epi and vas. The second Uro explained that
sperm production is expected to slow down in the first few months as a response
to backpressure, inferring that my nuts haven't gotten the message.
>Were you sealed more closely to the testicles than usual?
Not having seen another vasectomy, I don't know what the usual is. In my case,
both incisions start near the top of the scrotum so I would say that I'm ok
there. In any event, it seems that if sperm are being overproduced and/or
sperm breakdown is not happening at the usual rate, problems would arise
regardless.
>Was the sealing method more complete than usual, so that in your case
>there is no leakage at all?
I'm not sure what the usual is. My vas were sutured at the ends, then folded
over and sutured again. No clips or cautery. The surgeon does appear to
consider no leakage to be the optimal outcome.
>Is the sperm "reabsorption" doctors say
>prevents backpreessure in most of us simply not occuring in you in the
>same way as usual? Or are you producing more sperm than usual, so
>there is more to be absorbed?
See above.
>Finally, has anyone talked with you
>about administering extra testosterone as a way of reducing sperm
>production?
Nobody has offered any PVP treatment. The Uro's rule out other causes, then
recommend I get on with my life.
>Anyway, I hope you get good news soon--and/or that the problem
>resolves on its own, as your doctors seem to expect.
So do I. Somewhat concerningly, this second uro hedged his bet on my
prognosis; he said he was optimistic I would improve but made no
representations as to the degree of relief I would have and did state that the
Vas are never the same after the surgery.
Paul E Garcia
>problems do sometimes happen.
My uro's did also. The surgery group are the ones who claimed to never have
had a problem with the traditional vasectomy.
>He is also the one who said if, after a year, I still have problems with
>it, he'd be willing to do an OE conversion. He didn't mention any
>downside to this that I can remember.
Did your Uro say there were no downsides, or just didn't mention any. I'd be
curious to hear what he would say if asked. My Uro's both claim ASA issues and
increased failure rate; in fact, the second Uro stated that the only time
recanalization occurs is when the seal on the testicular end becomes undone.
> I will leave OE as an option for me, but I hope not to have to
>open that can of worms (who knows, I could stir up problems worse than
>what I feel now).
I'm doing the same, and trying to find a doc who will do it should it come to
that. In regard to the OE risk, I'd rather take the increased risk of
fertility than endure the discomfort.
Giraud
> I'm doing the same, and trying to find a doc who will do it should it come to
> that. In regard to the OE risk, I'd rather take the increased risk of
> fertility than endure the discomfort.
I hear you. It's interesting: given the choices of hoping for improvement
over time and more surgery, I tend toward the former, but if I knew I'd
always have pain that was bothersome, I'd probably go for the fix attempt.
I noticed something interesting last night: my right side (the side that
aches sometimes) seems to be tender at the vas cut area - in fact, after
"probing" around, I found a couple of spots that were particularly tender.
One of those spots felt a small hard spot, which I assume is a clip (my
uro uses them). Now I wonder if the ache I feel is more localized to that
area or to the epi area. It's sometimes hard to "feel" where it's coming
from.
I wonder if the clip is irritating tissue, either by poking into it or
otherwise. Anyway, it'll be interesting to see if this changes over time.
Giraud
trifold
> I noticed something interesting last night: my right side (the side that
> aches sometimes) seems to be tender at the vas cut area - in fact, after
> "probing" around, I found a couple of spots that were particularly tender.
> One of those spots felt a small hard spot, which I assume is a clip (my
> uro uses them). Now I wonder if the ache I feel is more localized to that
> area or to the epi area. It's sometimes hard to "feel" where it's coming
> from.
>
> I wonder if the clip is irritating tissue, either by poking into it or
> otherwise. Anyway, it'll be interesting to see if this changes over time.
Hi Giraud, As I understand it, clips eventually are covered by a kind
of scar tissue that should reduce any irritation. I don't know how
long this is supposed to take.
trifold
>
> As for me, I will be at a year next month. I still think I am seeing slow
> progress (i.e. less frequent pain), and the pain, when there, is fairly
> mild (i.e. only a minor bother). Like Trifold, it seems more present
> after great sex - my new hypothesis is that the pulling up action of the
> muscles stress the tender epididimi and leave a lingering ache. It is
> slight, and I can understand Trifold's "sex hangover" comment (i.e. the
> feeling from the sex makes me not care too much! ;).
When I got those "sex hangovers" the first year after, I suspected a
similar cause: since it usually happened after particularly good sex
(long delayed ejac or multiple ejacs), my guess was that the way
testicles pull up tight when on the edge might have been irritating
something, causing the mild sorenesss.
>
> I have a feeling that I will still have some lingering ache sometimes after
> the 1 year mark, but I hope that the trend slowly continues in the good
> direction. I will leave OE as an option for me, but I hope not to have to
> open that can of worms (who knows, I could stir up problems worse than
> what I feel now).
A good decision, imho. After 5 years, I am mostly bothered now if I
don't have sex. (Which, come to think of it, has been my situation
since about 12!)
ROB
Paul,
I would look into fertility specialists in your area, I talked to my
uro and that was his suggestion. His speciality is fertility and he is
the premier Uro here in my state.They are more familiar with the
plumbing and are more *in touch* with it as it were.
All good medicine,
GREENFEATHER
Paul E Garcia
> I would look into fertility specialists in your area, I talked to my
>uro and that was his suggestion. His speciality is fertility and he is
>the premier Uro here in my state.
Thank you for the suggestion. I'll make sure to mention it for my next
referral.
Paul E Garcia
I'll just make sure that I don't get send back to the first uro (who represents
himself as a fertility specialist).
trifold
Just be sure he understands you don't want to be reconnected!
Paul E Garcia
>
Undoubtedly.
Just wondering: is it really that hard to find a Uro who'll do the OE? I ask
because I recently found out that the reason my referrals took so long is that
my regular doctor's staff was searching high and low in vain to find a Uro who
would do the O.E.
So, if I want to see one, I'm going to have to find him myself and hope he
accepts my insurance.
Anybody know of a director of Uro's who does the OE?
Paul E Garcia
That should be "directory".
trifold
I don't know of an OE specific directory. It does seem the OE method
has not yet caught on in general, if we can judge by how often guys
report here that doctors they talk to have never heard of it, have
heard of it but don't know how to do it, have heard of it and don't
like it for one reason or another.