Hi Juno. Well, technically, I HAVE had surgery. My vas was in March 2005, and my pain started October 2005. I ended up with reversal surgery in June 2006. Back then, they tried Neurontin (gabapentin) and a GF block but the results weren’t sufficient. Cord denervation was brand new then, I think only Dr. Levine in Chicago was doing it, so I opted for reversal. Pain free by November/December 2006.
Interestingly, he found I was leaking from both vas tips. We both agreed reversal was going to be beneficial post-op even before the pain went away based on that.
That lasted nearly 10 years other than a 5-6 month relapse starting late 2008 running through early 2009. That relapse, though, convinced me I was dealing with nerve pain because my SAs were pretty good, in the 50-100MM range. Never regretted reversal though because it fixed the leaking which, I THINK (but cannot prove) was causing autoimmune problems (T = 300, PSA = 4.2). That bout was conquered with gabapentin and celebrex.
The longest bout began April 2016. I came VERY close to cord denervation, then I later came VERY close to having laproscopic GF neurectomy. I was leaning toward Dr. P. over Dr. Shoskes at home at the Cleveland Clinic for denervation, but never actually scheduled it. I had cord blocks with botox in June and October 2018. By November, the pain started dropping, enough to convince me I was a candidate for cord denervation, but not yet enough to call myself recovered.
I kept going forward with the general surgeon (who offers neurectomy) because it had been determined I also had a hernia. I wanted to know if that needed repair. If it did, I figured neurectomy was the way to go since he could fix the hernia at the same time.
He ordered a dynamic ultrasound to examine the hernia. He suggested having the radiologist do a GF block at the same time to confirm one last time that the GF was my issue. I thought it’d be just an anesthetic, but while on the table, the radiologist asked if I wanted him to included a steroid. I said “sure, why not” to get that steroid superimposed on what Dr. P. had given me. Pretty sure that injection knocked out the last remnant of pain, dropping me from 2-3 most times to 0-1 most times.
Long story, I know.
My sense is that my reversal was necessary not for congestion (since I was leaking, I wasn’t congsted) but to stop the autoimmune response. PSA and T have started correcting right away and are quite good (PSA 0.8, T 650-750). Dr. P. suggested that the reversal gave me a “mini denervation” by removing scar tissue. That makes sense to me. I
So, based on my own personal experience, I’m a fan of injections.
I never tried Metformin but on @MikeO’s experience, if I relapse again, I’d give it a shot.