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5 Months off the Bike

February 24, 2010

THE PRECURSORS

I generally consider myself a private person.  Owing to the delicate nature of this topic, posting such personally sensitive information is very difficult for me. Speaking collectively men prefer not to discuss the details of their anatomy when it involves any kind of affliction that would portray them as anything less than manly. But given the circumstances, I feel it is my duty to expose this issue to the public, and if it saves even one person from a similar fate, it will have been well worth any embarrassments on my part.

I am not a huge fan of medicine in this country, an explanation of which is beyond the scope of this message. Suffice it to say, I believe that pharmaceutical corporations influence our countries doctors starting at education and continuing through frequent sales visits. It is this heavy influence that has transformed us into a medicated generation, where in its stead, prevention should prevail. It should come as no surprise that I only keep catastrophic insurance with a high deductible, as I do not feel the need to see a doctor unless I am in a major accident. In November of 2009 I had reconstructive surgery to fix a deviated septum, a problem I have had since getting elbowed in the nose during a high school wrestling practice. I had no choice but to take a few weeks of rest from training or any kind of exercise to recover.

Now, for the first time in a long while my family actually reached our deductible. Consequently, a few months back my wife was seeing her OBG/YN, and was told that she was at high risk if she got pregnant again because of her experience giving birth to our twin boys. Her doctor advised her that I should have a vasectomy, just in case. My wife mentioned this, and suggested that I follow her advice soon since we had met our insurance deductible and I was not able to ride anyway. I was totally opposed to the idea, and made no bones about my opposition on multiple occasions. I reluctantly spoke to the Urologist about any possible complications or side effects, and I was only told that it was a “minor procedure” and there may be some swelling, or bleeding, but nothing to worry about. I asked about time off the bike and was assured 10 days would be the maximum. I was very busy at work with a major software release, and did not have the time to research it on my own. That is where I made my first big mistake, I trusted the doctor.

THE EVENT

A perfect storm of finances, timing, misplaced trust, and personal ignorance, caused me to do something that I will forever regret. On December 4, 2009 I made the single worst decision of my life, I got a vasectomy.  I was told that the procedure itself would be fairly painless, a pin prick and some tugging. After waiting naked for 1 hour and 20 in what felt like a meat locker, the urologist made his entrance. He started with the right side, and the experience was exactly as described. He then told me that the left side would be even easier because I was already partially numb. He was dead wrong. After fumbling about a bit, he said “I am having a difficult time getting a hold of the vas”. I suddenly felt vice grips get a hold of me and refuse to loosen. The pain was so excruciating, I gasped a few times and was starting to feel light headed and I told the doctor I might throw up or pass out. He made some joke that I don’t remember, maybe he thought I was squeamish, but it was purely the pain. For the next 10 minutes I felt a little like William Wallace as my innards were being torn apart. Now I have had my share of pain, chipped rotator cuff, snapped the transverse process on 3 vertebrae, split my arm open to the bone, etc. And I would gladly experience any one of those catastrophes again before going through that surgery.

The first few days after went by as expected, and I started to feel like I was starting to recover at about day four. Then, the pain started to change and worsen.  I could not sleep as there was no position that was comfortable. I had left over pain pills from my nasal surgery, but they didn’t help all that much and I prefer not to take drugs whenever possible. If I did finally dose off, I would soon be woken up from shooting nerve pain that emanated from my testicles ending all the way up to my hips and back.

THE TIMELINE

2 Weeks – At this point I was starting to seriously worry, so I went back to see the urologist. The doctor was busy, I guess, because I was only seen by the physician’s assistant. I am not that familiar with recent changes in our medical system, but I logically figured any post operative complications would at least be addressed by the doctor that performed the surgery. It all seemed very cold and dispassionate to me, even a little weird being inspected by a man that was not an actual doctor.  But at that point, I would have allowed George Michael to handle my genitals if I thought he could provide some answers. Of course he only found some inflammation on the left side (I can’t imagine why), and told me that I was just a slow healer.

3 Weeks – No change in my condition. Constant pain, no cycling, no sex, no playing with the kids, it was the worst Christmas ever.  I walked out to the living room like a cowboy on thin ice, and eased myself onto the couch. I pretended to smile and be happy for the family, but quickly retired to the bedroom, where I spent the better part of the day stuffing ice into my jock with the facial expressions of a junkie shooting up.

4 Weeks – I would still wake up every morning feeling like I had had the surgery the day before. I called the doctor (got the PA again), and he reassured me that I had just gone through a “Major Surgery” and was just a slow healer. Whatever happened to “Minor Procedure?” He then suggested some kind of nerve related drug treatment. I quickly looked up side effects, and declined. In addition to the myriad of side effects many of these drugs cause, most only serve to cover up symptoms or mask pain. I prefer to know how (or if) I am improving.

5 Weeks – Still no change, and the psychological effects were starting to get to me. I started to feel that there was a good chance I would never want to have sex again, never be able to ride my bike again, in addition to being severely limited in activities I could do with the kids. I would go to sleep every night around 7pm anxious to wake up feeling better, but it would never happen. Each morning I woke up to the same pain level, and could see no change in site. Paraphrased from Dr. Anthony Ellis: While the condition often referred to as “Post Vasectomy Pain Syndrome (PVPS)” effects only 6% to 30% (depending on the study and pain level), the sufferer is destroyed in a unique way. Few understand, since most who have had a vasectomy recover in a few days, without any ill effects, or at least any ill effects that they can readily attribute to the operation. For the victim it feels like you traded the greatest things in life for chronic pain in the most delicate of locations. And since it involves your genitals, you also lose the ability to receive support from others as you battle the problem as no one wants to hear about your testes. There appears to be a lack of acceptance of the diagnosis amongst Urology practitioners and medicine in general. After reading multiple support groups and forums, it seems that most of the men with PVPS have seen four or five doctors prior to getting pointed toward available treatments. Some are offered mutilating procedures (epididymectomy or removal of a testicle) without being offered the known evidence based treatments for PVPS (vasectomy reversal or microsurgical neurolysis).

In addition to my personal life, the effects were really starting to wedge themselves into the lives of my family. My darling wife has been absolutely tormented by the entire situation. Knowing full well that I had the surgery at her request, feelings of guilt in addition to having to pick up the slack at home has been difficult for her to say the least. I am very involved with my kids, making breakfast, taking them on activities, etc. My children are smart and very cognizant of the uneasy atmosphere that is permeating our home. Continually fielding questions like “Why can’t daddy wrestle with us anymore”, “Why doesn’t daddy make breakfast for us anymore”, “Why can’t daddy take us sledding”, “Why does daddy go to bed after dinner”, or “why is mom crying all the time?” has been difficult on us both.  At this point I started to feign happiness to the boys, and pretend to be comfortable regardless of my pain levels.

6 Weeks – I started to feel like things were getting better, but this only lasted a couple of days. I was sitting at my desk in my big comfy chair working through what I thought was a comfortable pain level of 3, when out of the blue the pain spiked up to a nine and stayed there. It was so bad my hands were shaking and I couldn’t even work at my computer. It was a Friday near the end of the day, so I called the Urologist’s office, gave a brief timeline of my pain and indicated that my current pain level was unbearable.  I needed to see the doctor right away. Now I am not one for pity, but I thought I would at least get the standard “that sounds terrible” or “I am so sorry what can we do”, at the very least a concerned voice. Much to the contrary, the nurse was a total robot, and sounded almost as if she had heard this a million times and was trained to somehow not acknowledge it. She dryly indicated that the doctor was busy, but that they could fit me in on Tuesday afternoon.  I asked what I was supposed to do for four days, and in the same apathetic voice, was told to take Tylenol. I was so dumfounded at the whole experience, all I could mutter through a timid and tearful voice was “OK”. After lying in bed all weekend, the pain finally subsided back to the standard 5 or 6 that I felt all the time. Tuesday morning I called and cancelled the appointment. And while I believe the doctor never set out to do anything malicious, I did not feel comfortable seeking help from the person that caused the damage to begin with. Not to mention I was scared to death to return to that office. Eventually he called me to find out why I cancelled my appointment, and I related my status. He was apologetic, and tried to remedy the situation by offering some exploratory surgery to remove parts of my male anatomy.  Knowing full well that this would only lessen or even eliminate my chances to ever truly heal, I politely declined.

7 Weeks – I thought I might be starting to feel a bit better. The constant dull ache had pretty much disappeared, and I only experienced pain during activity. In other words, I thought I could at least start a long, dull, and uninteresting life of sedentary obesity. I was wrong. More level 9 pain spikes throughout the week. Since I could do little more than sit at my desk and work, I spent more time reading medical journals, researching the procedure, side effects, and experiences of other men. A plethora of horror stories abound on the internet, and I probably would not have put much stock in any of them, except I myself was living the same unimaginable nightmare.  The first thing I discovered was that PVPS is much more common than any Urologist will ever admit. Most never even present it as a possibility to their prospective patients and many even deny its existence.  If you are a sufferer, expect to be swept under the rug by medical practitioners as they are mostly clueless about it. Vasectomy is big business, and for most urologists, it is their bread and butter. It only makes sense that they would not bring it up or put it on any consent forms, it might scare away customers, and that is bad for business.

Most PVPS victims don’t have symptoms for years after the surgery. Depending on how well your body “adapts” to the change (I refuse to use the word heal, nobody heals from vasectomy), you may experience an immediate autoimmune response from the blood sperm barrier being broken, or suffer from congestive problems years down the road. If you are lucky enough to not sustain any nerve damage, tissue damage, or any of the other afore mentioned complications during the surgery itself, you may eventually suffer from either a testosterone deficiency,  erectile dysfunction, or a multitude of smaller risk factors. Although you probably won’t make the link, vasectomy is a large unknown variable in the equation that equals your health and fitness into old age. Future problems like decreased athletic performance or prostate cancer will probably be attributed simply to old age, since the rate of degeneration is an unknown.  There are medical studies in addition to first hand experiences that have shown there to be a concrete link between such problems and male sterilization.

8 Weeks – Only after thorough research, accompanied by strong fears of future complication, I decided to see a vasectomy reversal specialist. I felt a strong need to do all that I could to have things put back the way they were. And since each day felt no better than the last, I really did not feel like I was ever going to get better, and I did not want to suffer any longer. Insurance will not pay for reversal because it is usually deemed a matter of fertility, so I knew after paying for plane flights, rental car and surgery; I would have to come up with around $10,000 all out of my own pocket. I was reluctant to spend the money, since reversal surgery itself caries no guarantee of pain alleviation, but my wife reassured me: “If you are suicidal, you might as well try reversal”. Hard to argue with, but still, I couldn’t help but think of all the bike gear I could have purchased with the money. I would have much rather have bought a brand new Cannondale Carbon Scalpel Mountain Bike, but who would ride it?

THE NEXT STEP

So I packed my bags (actually my wife packed for me), and exactly two months after the initial procedure, we flew down to Tucson while my mother-in-law watched the kids. There I met with a world renowned vasectomy reversal expert. He indicated to me that most of his patients are there for fertility reasons but that he does receive a few “pain” patients each month. The staff was so incredibly kind and professional; it made the office back in Utah look totally Mickey Mouse. I woke up in the post-op room with an immediate feeling of relief. For the first time in weeks, it didn’t feel like a woman wearing high heels was standing on my lower abdomen. And though I must attribute much of my initial comfort to the anesthetic, there was a definite feeling of pressure relief. As part of the surgery, the doctor must cut the cauterized ends of the vas deferens and take a sperm sample. After the surgery the doctor indicated to me that the left side had an amazing amount of scar tissue for only 2 months, and when he clipped the end off, fluid gushed for a long time as if under great pressure. He told me that he only ever sees this with his pain patients.

It has now been 6 weeks since I left Tucson, and I am getting better each day. The recovery has not been linear, and has provided its own share of painful days. I write this now, because I feel better today than at any other day since my vasectomy. What took 15 minutes to destroy, took a skilled surgeon 3 hours to put back together. And while reversal is considered a much more invasive surgery with a longer recovery, I feel much better now after 6 weeks then I felt even 8 weeks after a vasectomy. So does that still mean I am a slow healer? I for one feel that it only proves there was a definitive physiological problem caused by vasectomy itself. For me, I believe that reversal was the right decision, and put my body back into a state where it has the ability to truly heal, yet there is still a lot of healing to do.

THE RECOVERY?

It is my belief that the single biggest reason few ever hear about this problem is that most men suffer in silence, being abashed or perhaps not wanting to be labeled; even informing the doctor of the situation is not common (which also leads urologists to believe that their procedure is safe and effective). I believe that advances in information proliferation through the internet, is the primary reason the issue has found any light at all in recent years. Studies have been documented in medical journals for over 40 years, but until recently have not been so readily available. In a study done way back in 1970 a large group of vasectomized men were asked if they were satisfied with the operation. The result was 92%. Oddly, when the same group was asked if they suffered a decrease in sexual desire 53% responded yes. The researcher commented: “The need to convince ourselves is served by convincing others”.

On December 4, 2009 I walked into that doctor’s office in the best shape of my life with a 10+ on the “Quality of Life” scale, and have been living a 2 since. Being able to ride a bike again is still not a guarantee, and if the doctor had given any warning at all that such an outcome was even a remote possibility, I would not have gone through with it. Long term (possibly lifelong) chronic pain was not in the informed consent, and any Urologist that is not upfront about it is acting unethically and is more interested in making money then actually helping patients. In the end I have to blame myself for not doing the research first and for not seeing vasectomy for what it is: The totally illogical assumption that clamping off a pipe and not shutting off the pump, will indefinitely have no ill effects.

So have I sufficiently embarrassed myself yet, or do I need to post a photo of me only wearing the extra supportive bikini briefs I have had to fashion for the past 3 months?

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