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Epididymitis or Congestive Pain


#22

thanks @raising4girls and @PVPSux for your input I have read @Acschiro posts and he definitely knows what he’s talking about!! I have gone to 6 acupuncture treatments so far, 2 a week and don’t feel any better… Not sure how long it takes. During treatment am nice and relaxed but day after same or worse pain. Currently am dealing with entire left side pain neck/back of shoulder that radiates down back of arm into wrist and fingers (tingling/numbness pain). As for left bottom half, left testicle/outter hip, left glute (deep pain), left outter hip, left hamstring/thigh, and pain that shoots down to foot (in the arch of the foot). Am convinced this is all because of the constant deep pain in my left testicle for over 3 months that just brought on all this referred pain.
Just did another US of scrotum yesterday of course all normal. No more enlarged epi which my last US showed I had. Left hip/pelvic US all normal, xray’s of both hips/pelvics and SI joints all good, Xrays of entire spine did show mild bone spurs in my cervical and lumbar joints so am not sure if that is contributing to the left pain. Oh also did a testosterone test and levels show normal but on the low side.
Testosterone = 8.6 nmol/L Range = 8.4 - 28.8 nmol/L
Testosterone Free = 254 pmol/l Range = 196-636 pmol/L

Wondering now if being on the lower side of normal range is also a contributing factor. Sorry for the long winded post just so frustrated and down.
Regiment = vimovo nsaid, acupuncture, omega fish oil, tsbp of papaya seed powder
Doc prescribed me Zoloft antidepressant but am scared about taking based on the known side affects…
Also seeing a rheumatologist to figure out if I have autoimmune issues…


#23

I’d say that a free testosterone level of 254 is a pressing concern. I think aches and pains are a side effect of low T.


#24

@raising4girls Just went to my dr. and mentioned that yes my T level’s are on the low side but still normal. Wish i knew what they were pre-vas. On top of that i have ferritin levels which i have been battling for the last couple yrs so not surprised about that not sure if its a contributing factor to the all the pain… Does any have recommendations on how to increase T-levels naturally supplement or exercise wise. Dr. mentioned i should start weight training.


#25

I honestly don’t know why my T levels have gone up. Not juicing and only periodically lift machine weights at the gym. I have a better-than-average (American) diet, but I’m no health nut by any stretch. Too much red meat, too much junk food, but at 5’9" and 170 lbs., my docs think I’m in great shape for 53. My T-level have been consistently above 600 for the past 4 years since my new GP started checking.


#26

Doesn’t surprise me your symptoms are all on the same side of testicle pain. The pain is basically following the kinetic chain of muscles used to walk, do normal movements, etc. it’s all linked to core muscles and psoas muscle more
than likely. Psoas helps pull the hip into the socket and keep it centered as well as core muscles, when it stops your gluteal muscles, piriformis especially and other deep external rotators pick up the slack but not biomechanically correct. Once they go
then you start with back knee etc. think of it this way the genitofemoral nerve runs directly through psoas. Every time the muscle contracts to lift you leg forward when walking it squeezes the nerve so your brain says don’t do that. Also the cardinal
sign of Gf neuralgia is a novice skier or bent forward at the waist to keep from stretching the nerve. So what occurs next is you quit extending your leg at the hip on that side because it pulls the nerve and caused pain so instead of using hip you either
hyperextend knee, si joint rotates anteriorly too much to get over hip or you wind up with a gluteal lurch or hyperextension of back to get over the leg. Psoas muscle is directly connected kinetically with the trapezius on the same side this when it goes
into spasms your traps do also next thing you know entire side of body is failing all from a stupid small sensory nerve that only controls pulling the testicle up. It’s amazing how the body compensates to avoid pain and unfortunately testicle pain is one
of the worst pains and such a sensitive area that’s why body reacts that way. My original MRIS of pelvis hips and low back were normal all done within 2 months of vas. Had another mri of lower back 2 years ago discs were normal but showed a loss of the lumbar
lordosis (backwards curve in spine). Body intentionally took it out to slacken nerve. Most recent scan shows bottom disc has now thinned lost water content and starting to bulge all do to how I walk etc.

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#27

Thanks for continuing to educate everyone on the chain reaction set off by GF and/or II/IH damage. I never linked my lumbar problems to the vasectomy, but it’s GOT to have been what started it.


#28

Thanks @Acschiro for you detailed and informative response. I did have a recent xray of spine and they found mild bone spurs (osteophytes) in my lumbar region of spin l3 and l4 region. I wonder know if those bone spurs are causing narrowing of the channel of the genitofemoral nerve which is now causing all this left groin/testicle/leg pain. Acschrio what would you suggest from a treatment standpoint going to start physio next week. Also doing acupuncture right now but only focusing on back side of body right now before starting front. I read a post where you mentioned neurokinetic therapy i wonder if they would be best to confirm if psoas and core muscles are out of whack and its GF related. Also would an MRI show nerve problems like Genitofemoral Neuralgia


#29

MRI won’t pick up Gf nerve, would rule out disc or spur pushing on nerve, my guess most likely neither your spurring is at L3-4, Gf branches are usually L1-2 but there are different variations.


#30

How soon did the testicle pain start post vas? I don’t know your story so a quick summation on when vas was and when pain started and location it first started then spread to would give me a more accurate picture. Where are the
spurs if they are anterior like most spurs not the cause. Mri would have stated foraminal encroachment causing effacement or impingement of nerve root if that was the cause. I shoot xrays everyday you’d be surprised what percentage above the age of 40 have
some mild spurring at different levels. Rarely do spurs by themselves cause nerve impingement usually accompanied by a disc herniation unless you actually have some form of stenosis. What are the exact words on report of MRI?

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#31

Hi @Acschiro here is a quick summary and thanks again for any insight and info:

  • vas was end of Jan pain started 3 weeks later in left testie with a dull deep constant pain lasting for aprox 3 months then pain transitioned into left groin outer hip back of leg back of knee and foot.
    3 scrotal ultrasounds 1st when deep pain started (normal) 2nd 2months later showed enlarged epi 3rd just last week showed all normal currently left testis pain is intermittent not constant anymore pain is now more groin and leg.
  • also pain in upper left trap and flank area and left neck shoulder that radiates down arm to wrist (I have had pain in trap and flank pre vas but neck and shoulder arm pain is new)
  • no mri done just ultrasounds and x-rays
    Xrays says:
    Minor spondylosis deformans L3-L4 or small anterior osteophytes at L3-L4
    Mild osteoarthrosis at the unconvertable joints C4-C5 causing mild compromise of the adjacent of the adjacent foramina
  • also had testosterone levels checked and
    Testosterone = 8.6 nmol/L Range = 8.4 - 28.8 nmol/L
    Testosterone Free = 254 pmol/l Range = 196-636 pmol/L

#32

Anterior osteophytes have absolutely nothing to do with this it is a preexisting condition dut to the MILD spondylosis deformans. It is the bodies natural way of dealing with it. spondylosis deformans is basically another term for osteoarthritis. Means your discs have mildly thinned. They diagnose it as mild moderate or severe. I would not think it has anything to do with your pain either I see it Everyday in the office and unless you also have a disc herniation there directly pushing on nerve which I highly doubt it I wouldn’t even let them go down that route you will just be throwing money at it unless your insurance is good. A MRI of lumbar spine would rule that out. The nerve between L3-4 is the L3 nerve root and would most likely give pain down anterior thigh along quadriceps muscle and usually not below the knee, sometimes it can give some hip pain. Interestingly mine started very similar severe testicle pain immediately after surgery due to large hematoma. The 3-4 day can’t remember now I was lying on back with knees bent and ice on my boys and entire lateral thigh went numb and tingly along the Lateral femoral cutaneous nerve. The hip surgeon I just saw to fix my labral tear in left hip told me that during dissections he has noted that a percentage of the population has a direct nerve connection between the LFCN and the genitofemoral. Basically the pain reflexes up the genitofemoral directly across the communicating branch and down my outer hip and lateral thigh. Within 6 weeks I was numb and tingly entire saddle region (think sitting on a saddle riding a horse) bilateral down posterior thighs to the knees. At this point my left hip began to feel really loose and pop when I walked due to muscle instability from psoas muscle going crazy due to Gf nerve running directly through it. By 3 months right lateral thigh went numb and then both anterior thighs. Basically Gf nerve at that point was producing so much pain it was reflecting back through the spinal cord and shooting out entire lumbosacral plexus to all nerves especially pudendal region. I had a megablock done bilaterally by Dr. P before 6 months because the pain was unbearable. For 3-4 hours after block I could sit without pain for first time in months and had absolutely none of the leg symptoms which proved that the GF nerve was controlling it all. Based on how your symptoms are traveling and moving around I’d bet the farm you are dealing with nerve damage to either the Gf nerve II nerve IH nerve or a combination of the above. Only way to find out what is going on is to start doing nerve blocks and see what happens. I would not let them block L1-2-3 nerve roots that just gives us a level not which nerve is the problem. I’d start with a nerve block of the genitofemoral nerve. This can be done via ultrasound or just having it done locally at the inguinal ring where it goes into the spermatic cord. If it relieves your pain bingo bango you know what the problem is. If not next I would have them block the ilioinguinal nerve and iliohypogastric nerve just medial to the ASIS on your pelvis. You need to figure out if it is nerve damage and which one first and foremost, quit taking the well it could be epididymitis, etc. bullshit while they postpone treatment. The longer you wait the harder it is to fix the pain because the body can centralize the pain to the spinal cord and brain. Basically the brain will continue to interpret pain even if the nerve is fixed. The longer you wait the more likely it is for this to really settle in. I completely disagree with watch and wait for 3-6 months, it might work but if not your rolling the dice at permanent long term pain. I say this just because the way your body is already compensating due to the pain and the way it is spreading tells me it is most likely nerve related. If the first GF block works even if for 2-3hours then you can look at long term solution options to try and correct this. Also I prefer for the block to be done without any form of anaesthesia or sedation or relaxation meds via IV they can directly allow the brain to stop interpreting the pain just from then and could give a false positive. Ex propofol or other mild anaesthesia done to not make you completely aware of what they are doing similar to a colonoscopy where they put you on the verge of being unconscious but not fully out. They will stay in your system for a few hours and could make you interpret the pain is gone or it helped when it could just be the drug. I prefer a direct injection of lidocaine or something similar with possibly a steroid to reduce inflammation. They basically lay you down on table palpate inguinal ring where the nerve is and inject all around it. The lidocaine usually reacts immediately for 3-4 hours of pain relief, the steroid is designed to kick in 3-7 days later. If it helps 50% or more I would talk with doc about doing a series of injections every week or two weeks for at minimum of 3-4 injections. If you can block the pain input from being sent to spinal cord and brain long enough sometimes the body will relearn to ignore the damaged nerve. If blocks help but pain keeps returning then I’d look into the more drastic treatments of genitofemoral nerve removal above the spermatic cord done at the inguinal ring or some hernia docs and PVPS docs are now doing them laparoscopically which in my opinion makes the most sense basically the least invasive and you are cutting the nerve above the damaged section and embedding it into muscle so another neuroma doesn’t form, vasectomy reversal which I believe works in a lot of patients because while preparing to reconnect the vas they clean up all the scar tissue around and the nerve could be trapped in the scar tissue or you could have had a neuroma form (also helps with epididymitis because you are no longer having blowouts and the remove any sperm granulomas which could help with autoimmune), spermatic cord denervation where they microscopically remove the nerves around the spermatic cord which are fibers of the GF and II nerve but leave blood supply to testicle or even testicle removal where they remove entire spermatic cord and testicle (solves both nerve problem and congestion problem). You can also have radiofrequency ablation or cryoablation of the nerve. Unfortunately all of us on this board have reacted differently to all the above mentioned surgical options so it’s a roll of the dice. Right now though you need to know for sure if this is nerve damage so I would be very aggressive about getting a nerve block to determine. The longer you wait the more your body adapts and possibility of long term pain exists. Hope this helps, you can PM me if you have any specific questions. I’ve had I believe every surgery they offer except radiofrequency ablation of nerve I had cryoablation which Dr. P does most pain docs prefer radiofrequency.


#33

Also have somebody watch you walk. With Gf neuralgia we quit extending the thigh to avoid pulling the Gf nerve so the body figured out a way to get over the leg, sometimes it uses the SI joint and it becomes painful and rotated anteriorly to give the proper extension to walk, others will hyperextend their back instead of leg which leads to the lower back problems. Bad thing is I’ve seen 25+ doctors and the most recent hip specialist was the first to start asking me about pelvis lower back hip knees and feet because I had 0 degrees of hip extension stated because I didn’t extend hip due to pain then tore up entire left hip and now right hip because I quit using them properly. He wanted to know what was happening to the other joints and muscles along the kinetic chain. He has seen this scenario in the past and understood how the pudendal sciatic pelvis hip etc all went bad. We are in the process of fixing both hips now and when done he is recommending I remove Gf nerve on left already had it done on right and I still have some hip extension on the right.


#34

Thank you so much @Acschiro for you very detailed and insightful post it is truly appreciated. I will definitely reach out as being in Canada seeing a specialist who would do this type of procedures can be a wait for sure. Guess I need to know where to start and who to talk to about getting this done what specialist does this. I do have a referral to Dr. Jarvis here in Toronto who I know does this but I probably won’t get to see him until October… is this best left in the hands of a pain specialist or a nerve specialist? Also seeing a rheumatologist not sure if they can help… Thanks again


#35

I have only had the Illionguinal nerve blocked but not the GF. I may ask to have GF block since both of the nerve issues can cause the same symptoms. A lot of my pain is in the SI joint in lower back maybe from compensating while walking. It looks like the GF would be easier to damage during the VAS as well compared to illionguinal nerve.


#36

Who would perform or request these type of nerve blocks a urologist? Nerve specialist or pain specialist


#37

I use pain management for my blocks


#38

Blimey. thanks for the info. Your explanation of potential nerve issues is great. Thank you again!


#39

Your welcome unfortunately I learned it from the school of hard knocks! I have a basic background in anatomy but once my problems started I along with Choo Choo really hit the anatomy books and research articles to try and figure out our bizarre neurosymptoms which both started within 2-3 days of our vas. Only problem is now when I talk w some docs they don’t want to hear what I have to say because I know as much if not more about the subject than they do. I had an appt with one pain doc who had direct orders from dr dellon a world renowned peripheral nerve surgeon to perform a pudendal and Gf block. He read my chart and basically looked at me and said I’m not doing this it isn’t going to help you and removing any nerves like dellon wanted to do will only make you worse. You just need pain meds or a neurostimulator. I told him we were done if he couldn’t follow simple instructions. Whole conversation was 5 min. Low and behold a month later I get a bill for $500.00 for a level 4 exam (1-5 based on time and difficulty). I contacted his billing office and asked how they could bill a level 4 when he literally spent no more than 5 min w me and wouldn’t even listen to problem and that it should have been coded a level 1 (5-10 min). They said all their specialists bill level 4 because they are a specialist and have more difficult cases. I said ok how about I call anthem and inform them of your policy on coding and how I spent 5 min with doctor and was billed a level 4 which accounts to known insurance fraud. Problem was instantly resolved


#40

Hello @Acschiro, thank you for your detailed messages. Am still reading them for the 2nd time, to ensure I understand everything correctly. My pain is mainly focused in the inguinal canal + very tender testicle, which occurred around 2 years after vas. From what you have learned, what are long term prospects for this pain with conservative treatments?

Unfortunately in UK pain specialist clinics are not as developed as in US


#41

Just to give an update and for my own journal. I went to see Dr. Jarvi urologist in Toronto area who runs a men health clinic for scrotal pains along with other services like vasectomy. After consult with him he stated my left epi is still tender and i have 2 issues left epididymitis and left adductor tendinitis. He put me on a 1 month does of nortiptyline 10mg 2x daily and then one month off and see. He also referred me to physio center that specializes in pelvic health. I asked several questions more specifically to nerve injury and cord blocks and he mentioned anytime your dealing with scrotal pain you dealing with nerve related pain but he doesn’t think i need nerve blocks at least as of now. He thinks that like @Acschiro mentioned that i was guarded during my deep pain issues and i compensated my walk which could of caused my adductor issues. i also asked about my T levels and how there in the lower range of normal and he replied not to investigate right now as when your in long term pain it will affect your levels. So am praying the meds and physio clear me of this leg and scrotal pain… if not will see what next steps are