I’ve been through a number of therapies, doctor visits, and tests in the last 3 months. Reader’s Digest version is that I’m pretty well-convinced, now, that I have damage to a branch of the GF and/or scarring that is impinging or entrapping the GF. Either way, the culprit is a branch of the GF or the GF itself.
My strong, Captain Obvious suspicions are:
- The original vasectomy got this ball rolling back in 2005.
- My 2006 reversal removed some scar tissue (hence my thought this may be scar tissue related) and allowed recovery to the degree that I lived normally pain-free from late 2006 thru April 2016 but was a “ticking time bomb”
- Bicycling in early 2016 aggravated the GF, created scar tissue, whatever and here I am
Sequence of events:
In late June, I had a cord block with botox under GA with Dr. P. 7-10 days later, my pain dropped dramatically and I was 75-100% pain-reduced, very often pain-free. I was living a normal, enjoyable life again. Pain returned around August 20. Dr. P., of course, believes I’m a good candidate for SCD.
September 7, I had an in-office cord block with my Cleveland Clinic uro (only one in Ohio who does SCD). At first, my normal pain went away but I felt other pains I attribute to the needle. By around 2 hours post-injection, I felt really good and that lasted another 6 hours. The pinching feeling around the epi was gone. The CC uro believes that if the pain dropped 75-100%, my judgment, he’d perform SCD on me. My choice. Didn’t try to sway me one way or the other.
September 24, I visited Dr. Williams at the Dellon Institute. Long discussion followed by ultrasound-guided blocks, first of II/IH and then the GF. Before and after both blocks, he did a full scrotal exam. Before and after the II/IH block, and I winced any time he came near the left epi or immediately above it. The II/IH block did nothing for me which jives with the no-impact II/IH block I had at the CC in June 2016.
After the GF block, which came after the II/IH block, I noticed a dramatic drop in pain. I walked around, sat, jumped up and down no problem. He did an exam and bounced my left cord, epi, and testicle like a basketball and I felt nothing. No pain whatsoever, just irritation in the groin where he did the injections.
- As he was looking for the GF, Dr. Williams identified a small inguinal hernia on the left side. He was not able to find it (nor has anyone else) via palpation, he just stumbled across it while looking for the GF via ultrasound. He said he does not believe it’s my pain source. I tend to agree with @Acschiro that the hernia and my lower back problems that also began post-vas 2005 and resulted in L5/S1 fusion in 2012 are indicators of core weakness/dysfunction caused by a dysfunctional GF nerve. I think he’s right, but I doubt I’ll get anyone in the medical community to agree.
For one, I had a bi-lateral hernia at age 10. Second, my father had hernia surgeries TWICE (in fact, they did his vasectomy up in the groin while repairing his hernia the second time). So, hernias and LB problems run in my family pre-vasectomy in men and with women like my sister. At a minimum, I think the vasectomy accelerated my inevitable LB and second-time hernia problems.
- Dr. Williams wants the hernia evaluated before touching the GF. He cannot fix it (not because he’s not capable but because he’s not authorized for general surgery). If it needs to be fixed, he said he’d do “co-surgery” with a general surgeon if I opted to have the GF removed/re-sectioned. He does think I’m a good candidate for GF neurectomy though he said I should assume a triple neurectomy because it’s too easy to damage the II/IH while removing/resectioning the GF.
I’m going back to Dr. P. for a Hail Mary pass. We’re going to do two (2) cord blocks spaced 4-6 weeks apart to see if we can get a longer response. This is mainly to buy me time.
See a general surgeon or plastic surgeon in Cleveland who would address the hernia question and, potentially, do the GF neurectomy. I’d love to find someone like Williams closer to home but, that said, I’m totally comfortable with Williams.
Back to Williams, most likely, after getting a recommendation on the hernia, for another GF injection. He said he wants to do 2 different sets to confirm we found the culprit.
I’m really torn on whether to have surgery or not, though I’m leaning toward surgery unless Dr. P’s last ditch blocks last 6 months or so. I’m not in writhing pain 100% of the day. If sedentary, it’s better described as discomfort. But, $350/month for Lyrica and $100 for cialis/oxytocin just for “discomfort” isn’t a deal I can accept long-term. I’m missing out on things and constantly have to plan activities around my pain. My 24 y/o told us her and her boyfriend are probably going to get engaged soon…I cannot imagine getting through a day as the Father of the Bride, for example, in my current state. I don’t do the evening networking or public speaking that I should be for my job because I hate standing for extended periods and just want to be home at night. I’m surviving, not thriving. At the same time, and I know many can relate, I can still provide for my family; making it worse could be a financial disaster.
I had a great outcome from my L5/S1 fusion. No more back or leg pain. That makes me pro-surgery.
This forum is decidedly anti-SCD. I appreciate everyone’s input on that subject, especially those that have tried it. Still, I admire the uro’s practicing SCD because it’s got to be better than epi removal. That appears to still be the go-to for many uro’s, and I haven’t read a single guy get better. This forum and my exhaustive tests have convinced me epi removal is an absolute no-go option as I’d opt for orchiectomy in virtually all cases over epi removal.
So, right now, I’m leaning toward GF neurectomy, most probably with Williams, unless I can find an equivalent at the Cleveland Clinic who could simultaneously address the hernia IF EVEN NEEDED.
Dr. P.'s advice was to live with the hernia and have it checked 1-2 times per year due to potential for making matters worse.
If I get the hernia corrected, I’d most likely opt for triple neurectomy since hernia surgeries so often hurt the II/IH.
I’m just worried about how well I’ll tolerate the numb feeling post-neurectomy. Will it be numb like when you’re loaded with novacaine? If so, that sucks too and I’m not sure I want to make that trade. If it’s no sensation, then I’m in.
Sorry for the rambling. Feel free to opine.