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Three-month update


#1

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:

  1. The original vasectomy got this ball rolling back in 2005.
  2. 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”
  3. Bicycling in early 2016 aggravated the GF, created scar tissue, whatever and here I am

Sequence of events:

  1. 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.

  2. 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.

  3. 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.

  1. 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.

  1. 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.

Next Step?

  1. 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.

  2. 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.

  3. 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.


#2

What a story but sounds like you have identified the culprit and just need to decide on the treatment. Did Dr Williams mention how often he performs neuractomy for VAS victims and any long term success rates?


#3

I forgot to mention one important point that Dr. Williams brought up to me and I’ve experienced personally. He said that many Pain Management specialists pride themselves using the absolute minimum amount of anesthetic and steroid, almost like a contest to see who can use the least. Then, he said, they’ll do the injection without guidance. The result: they miss the nerve or don’t anesthetize it enough for good diagnostics.

He told me this without knowing my experience with Pain Mgt. In each case, mine told me how he’d “only inject a teaspoonful”. Also, I was sedated, but I’m pretty sure he never used ultrasonic guidance. I know with the II/IH block, he used some signal that beeped louder and faster as he supposedly approach the nerve.

Dr. Williams, on the other hand, was meticulous in finding the nerves via ultrasound. In addition, he coated each nerve with several syringes worth of anesthesia to ensure each was anesthetized. It freaking worked, I know that for certain.

He’s a very good diagnostician.


#4

Our of interest @raising4girls, do you ride a MTB or a road bike? Did you wear any padded shorts as well?


#5

I always were padded shorts and a jock. 90% of my riding is on a hybrid bike on paved paths. I haven’t ridden off-road on my mountain bike since having back surgery. I don’t own a true road bike.


#6

what a story @raising4girls and thank you for sharing. It seems you got some of the best dr’s in the business treating you. Whatever choice you make it sounds like you have been very systematic in your process and thoughts to come to your conclusions and decisions. Hope you the best and keep us updated. I went to see a Osteopath today my self to help with my left side leg/back/shoulder pains. He did one stretch of my right leg over left and i felt this massive burning pain on left side, i believe is either the external inguinal ring or the GF branch. The area where your leg meets your groin the top of the Y. I circled the part i think is where i felt the burning sensation. Any thoughts of it being one over the other. I never felt that type of pain before but often i do find that area sore/tender.
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#7

@NC79 your pains sound similar to mine but my pains are on the right side with occasional left side pains. I also have pain in that spot on occasion. I need to update my story soon with things I have tried and outcomes. My main pain these days are in right neck and right shoulder blade. Of course my whole right side is tight but lower back not that bad anymore. Maybe the PRF of illioinguinal nerve helped lower back or maybe it was time, meds, PT, or chiropractor


#8

I get occasional, and random pains, etc in all the areas/branches on your chart and then some. I’m almost certain they originate from behind my left testicle in an area I have referred to as my ‘hot spot’ for well over 5~ years.

In my case, I do believe my issues are more related to varicocele, and/or varicocele nerve damage/hypersensitivity. Could be a bit of a blend of conditions though (blood, nerve, sperm). I’ve speculated that is exactly the case for many years.


#9

hey @RingoStar i feel the same that my so call hot spot is behind my left testicle as well, i know am still dealing with a case of an extended epi due to congestion. But wondering if that has triggered these nerve pains in those branches which is causing my leg pains. Going to uro @ end of month and will discuss my nerve block procedure and timing. I want to do at least one block for diagnostic purposes and if it doesn’t work then i know am dealing with purely epi/congestion. If it does work then i can verve a different way with treatment like multiple block and even botox injections… My uro seems to think that a block won’t work for me but is willing to do it to rule things out.


#10

Yea, I hear you @NC79. If you’ve read many of my posts, you already know I’m not a fan of blocks determining what anyone suffers from far as root of their problem/s. I never was, and never will be.

Also, if blocks were so non-problematic, safe (which they aren’t), don’t cause any problems of any sort, don’t cause any scarring, etc, etc as some seem to believe as fact, why do some high end pvps reversal surgeons charge men an extra 1k if they had a single block, cord block, etc prior to their reversal?


#11

I am also not sure how to feel about blocks but have had 6 or so. The one thing I know for sure is when I have been given a II nerve block which I have had 4. I feel pain relief in my back and inner stomach instantly that has helped for weeks at a time. I have not had one in 3 months. I had a spermatic cord block but only felt minimal relief in testicles and back but that was early. It made things worse for a while. I tried a GF block Monday but did not feel any significant change to pain but my pain levels are different now. I wanted to rule GF out or determine if this could be my issue. I will give it a few more days for the steroid to kick in before calling it a bust. Its hard to say what all this means but it would appear my issue would be my II nerve. It could be the steroid reducing inflammation or helping with scar tissue with the blocks but who knows. I plan to give it a month and try another II block and see what happens. I tried PRF no ablation of the II nerve in August which seemed to make inner stomach pain worse for a month before settling down. At the time I was thinking WTF? PRF made things worse and thought it was time to leave well enough alone but my lower right side back pain has been better since then which was debilitating. I have more pain in upper back into neck now with neck being the worse. I have minimal to zero pain in testicles. I am better at 7 months compared to where I was at 4-5 months but who know if this is mental or physical. Maybe I am learning to live with it. I am still planning a reversal before the end of the year unless I continue to improve or I find a better option. You would think I am a good candidate for neurectomy or denervation but with reversal on the table still I feel I need to try it. The root cause of my issue is a Vasectomy on the right side and damage to the right side vas deferens so It would make some since to try to repair this damage to fix the root cause with reversal and clean up.


#12

This is a really tough one with your back pain being your biggest complaint (I’ve been there). Related? Most docs will tell you know, but I’ve signed onto @Acschiro’s views that vas-induced damage to the GF or II can lead to core dysfunction and weakness which leads to back issues. His theory certainly can be applied to my case.

Interesting that you pin some/all of the blame on damage to the vas itself. We tend not to hear that as much as a diagnosis but I’ve often wondered about it. During SC denervation, they cut the vas (vasectomizing you if you’re not a PVP guy or re-vasectomizing you if you’ve had a reversal) or they scrape the sheath around the vas if you prefer to retain fertility. That tells me urology believes the vas itself can be a source of pain.

Have you had any evaluations of your back and neck? MRIs, CT scans. If you’re having no scrotal pain, even if the vas caused the back pain, I can help but wonder if back treatment is the way to go.

This cascading of effects from a “simple” little snip is frustrating. Others here have had a truckload of problems. I never related my LB pains and subsequent fusion to vasectomy, but now I think it was.

I can definitely understand your desire for reversal. I was there. I just wanted to be put back together.


#13

For what it’s worth @Ben, I know of a pvps guy that had a story with similarity’s to yours. He eventually ended up with frozen shoulders, other issues considerably above the waistline, and claimed reversal pretty much cured all that stuff. He didn’t claim to be 100% pain free in the scrotom, but claimed he was much improved, and had zero regrets regarding having a reversal. He had it 5~ years post vas, and would’ve had it sooner if circumstances had been different.

Obviously results will vary man to man.


#14

I was the same way. Back then, I felt blindsided by the vasectomy, I definitely felt like it was over sold to me considering the risks, complications, the reality of what it would be like afterwards, etc. I didn’t hear much about the risks beyond a vague written warning. Instead, my head was filled with all these glorious story’s regarding how many men were happy with their outcomes, reasonable and relatively short recovery timelines, improved sex life’s, etc. Nonsense.

I didn’t want to be leaking anymore, didn’t want any of the bs I was experiencing that I’d bever been truly informed about beforehand. Reversal certainly wasn’t something a urologist told me was absolutely necessary. It was my choice.

The second time around was no different. It was ultimately my choice again.


#15

I had a back MRI early and nothing really stands out. I provided it to my chiro and he stated the back was not the issue. I also had a EMG and as nerve conduction test to try to identify nerve damage and the one thing they said was we can rule out your back as causing pain source so that leads me back to VAS. Started 2 weeks after VAS. I was not properly numb on right side. Surgeon Actually said I missed the Vas with the original Shot of numbing meds and had to give a second. I was clamped for 4-5 minutes not numb. Maybe my brain can’t let go of the pain or nerves can’t reset. So many theories on this site.


#16

You’ve done your homework, that’s for sure. I can’t argue with your compiled diagnosis or plan. This is tough because we are all somewhat rolling the dice. I contend (but do not know) that some men respond differently to having sperm in the bloodstream. You, I, others here could be those cases.

Some have postulated an autoimmune effect. Others like @Choohooo have postulated more of a central nervous system response (if I understand him correctly). Very few docs look at the big picture. Orthos look at the back, uros the sack, neuros and plastics the nerves. Choohooo got a full work up at the Mayo Clinic that few of us get or attempt because our problems SEEM more contained. But, as we peel back the layers, our issues all go back to the vasectomy.

Good luck with your decision. It’s hard to argue against reversal especially relative to other surgical interventions.


#17

I must admin @Ben you definitely have tried to treat your issues aggressively and kept pushing forward. Wish there was an easy to follow chart of what treatments plans based on your symptoms for us poor guys to follow… wishful thinking of course. All i know this is a roller coaster of a ride i didn’t sign up for and when i say to myself just put me back the way i was… comes with it’s own set of risks and mental hardship but at this point for me its the next logical step if i don’t physical/mentally improve.


#18

@NC79 I’m with you on put me back together but understand the risks with reversal and drawbacks. In some way it may be a blessing to have the issues right away. If this started a year down the road with no testicle pain good chance I’m chasing multiple rabbit holes.