Follow-up: "How's it hanging?"

It's been three weeks to the day now since I had my varicocele surgery (or varicocele repair, or varicocelectomy, or whatever you want to call it). This morning I finally had my follow-up appointment with the urologist to see how things are going. It was also our chance to finally get some answers.

From the American Urological Association web site, about varicoceles:

What can be expected after treatment?

Recovery time after surgical repair is rapid. Pain is usually mild.

LIKE HELL IT IS. I was supposed to go back to work last Thursday; that didn't happen. I tried at the start of last week to quit the prescription pain pills and go to OTC Tylenol, but after a day and a half of that, it became apparent that the Tylenol wasn't doing jack squat to relieve the pain, so I stayed on the prescription pills and stayed out of work. I tried last Wednesday (the day before I was supposed to go back to work) to go out to lunch with my wife, but that was the first time I'd left the house since the surgery, and I quickly discovered that just sitting upright in the car was still quite a painful experience. So our nice lunch out turned into let's-hit-the-drive-thru-and-go-home.

The incision site seems to be healing well. It still aches sometimes, and gradually aches more the longer I sit up or stand, but that part isn't so bad and might be in keeping with the AUA's statement above. The part that the AUA (and virtually every other medical resource) fails to mention is the post-op pain in the affected testicle itself. "Mild"? No - anything but! For the first two and half weeks after the surgery, the slightest touch against the gland caused literally nauseating pain - like getting kicked in the balls every time you try to move - and while the incision was healing, the gland pain didn't decrease at all. I discovered that wearing a jock strap for support (WITHOUT the cup) at least allowed me to walk more or less normally, but showering and using the restroom and anything else that required moving the gland even slightly was still an excruciating experience. On the 10-point pain scale, this was at least an 8.

This past Sunday, however, I cautiously noted that the pain in the gland was beginning to show signs of lessening - while still not comfortable by any means, maybe it's a 6 now instead of an 8. Given that improvement, I decided to go ahead and return to work on Monday, which went okay - I was fuzzyheaded due to still being on the prescription pain pills, and my boss graciously agreed to let me leave an hour early, but the pain didn't get too bad until near the end of the day. My job involves sitting in a desk chair for 8 hours, though, and that was easily the longest I had tried to sit up continually since the surgery... so I hurt more when I got up on Tuesday than I had when Monday ended. I stayed at work all day on Tuesday, but the pain never went away, so I was only too glad to get home and lie down again.

That led us to this morning. I woke up hurting again (though at least less now than a week ago), and dreading another doctor visit (though at least I knew a little better what to expect this time). It was hardly less embarrassing than before - casually dropping your drawers to put your groin on display again, and this time with the promise that the exam will HURT - but at least this time it was over more quickly. No ultrasound, which surprised me, but I guess the doctor didn't need it. The good news is that the doc is overall pleased with the healing; in spite of the pain, he said that everything looks good, so he doesn't need to see me again for three months. The bad news is that, when asked how long the pain should be expected to last, he said, "Months. Weeks. At least a couple of months. There's a chance it could be permanent."

Yeah... thanks for that. Fortunately that's not a big chance, though, and with the signs of gradual improvement this week, that makes me hopeful that there will be an end in sight - even if it's still several weeks away. It would have been nice to know to expect this before the surgery, or even to be told afterwards without having had to call the nurse twice. As far as pain relief goes, he recommended Aleve for its anti-inflammatory properties, which also would have been nice to know before now. He said he wouldn't expect Tylenol to be able touch this (which it didn't), as Tylenol and even hydrocodone do nothing for inflammation. I speculated that the pain in the testicle was due at least partially to the remaining veins being forced now to handle increased blood flow, which the doc confirmed; he also said that the spermatic cord is inflamed after being messed with in the surgery, so that's why Aleve should help. I took my first dose a few hours ago, so we'll find out just how much it helps soon.

After yesterday's painful work experience, I came home to rest this afternoon, and the doc recommended that I talk to my boss about shorter workdays, at least while the severe pain lasts. All complaints aside, though... the general news we got this morning was exactly what I was praying we would hear: Healing well. Everything looks good. And now we don't have to worry about anything doctor-related again for another three months. That's a great Christmas gift.

"Do I have what it takes?"

So in many ways, I had to figure out on my own what it means to "be a man," and I thought I was doing a pretty okay job of it... but now I feel like Nature (or God) said, "Nope, time's up. Sorry, you failed! Here's your punishment," and yanked the cosmic rug from under me.

For a man faced with infertility, the diagnosis feels like a referendum on his masculinity. True, the diagnosis doesn't (or shouldn't) change who and what the man is, but... that's not how it feels. Our culture has strong stereotypes of expectation for both genders, and much pain is caused for members of both genders when those expectations are not met - men just aren't likely to talk about it as much. But that's a part of the male stereotype: a man is not supposed to talk about how he feels, not supposed to let on when he's struggling. Men are supposed to be strong, and stoic, and rational, and disciplined, and self-sufficient. Sex is unfortunately, and unfairly, a core part of our cultural definition of maleness, too; "real men have sex (and lots of it)," our society would say. Sex is something that men are supposed to be good at, virility a sign of a man's strength, so if he's not a superstud, then it can only mean that he's not "man enough." That stereotype is also BULLSHIT, as likely most men would agree... but in honest moments, those men would also admit they feel pressure to live up to the stereotype nonetheless. What the rational mind knows doesn't make the emotional wound any less real.

I've lamented already about the lack of good resources for dealing with male infertility. The question of "are you man enough?" is not a new one to me, however. I also mentioned before that I grew up without a father, as my parents split while my mom was pregnant with me. Honestly, that never bothered me very much growing up; I couldn't miss what I never had. But it left me wounded in ways that I never realized until I matured enough to understand what I had missed. This crisis of fatherlessness hit home a few years ago, after I had graduated college and began to develop a deeper friendship with a man who has become a father figure to me. Two books were huge helps to me at that time, and I returned to them recently; while they may have been written to address the fatherless wound, their fundamental purpose is to help a man answer the questions that most men carry around inside themselves, whether they're ever vulnerable enough to admit it or not.

The first of these two books is To Own a Dragon by Donald Miller (now re-published under the regrettably inferior title Father Fiction). Miller writes in a very accessible, often humorous, conversational and compelling style, recounting the tale of his own crisis of fatherlessness in adulthood, and relating many of the lessons he learned from mentor & co-author John MacMurray, with whom he lived for a few years as an adult. Many of Miller's experiences mirror my own, so reading his story encouraged me in knowing that I'm not alone. Young men (and women) are wounded when their fathers walk out on them, and the wound introduces a fundamental question that follows those young men into adulthood - "Am I a real man? Am I doing this right? Have I become what I'm supposed to be?" There is no book I would recommend more highly to any man who has experienced fatherlessness, or to fathers raising sons of their own, or even to women who want to better understand their fatherless men. But while the book has nothing to do with infertility, the questions it highlights and the hope it offers are encouraging to me even now.

The other book I just re-read is The Way of the Wild Heart by John Eldredge. This one was written as a sequel to Eldredge's Wild at Heart, which is much better known, but I didn't get nearly as much from that one as from this. Eldredge's writing style is much more dry than Donald Miller's, but no less piercing and insightful, and this book resonated with me even more now. It's subtitled "A Map for the Masculine Journey," written for "unfinished men" looking for an answer to the fundamental question, "Do I have what it takes?" That couldn't be more relevant for me right now, and this book has less to do with fatherlessness or any other specific issue, and more to do with becoming the men that God wants us to be. Maybe there's not yet a book to help men emotionally and psychologically in dealing with infertility, but certainly this is the next best thing. I don't agree with everything that Eldredge has to say, but he hits the nail on the head far more often than not, and his work here has once again been a huge blessing to me. If you're a guy at any stage of life, whether you grew up fatherless or not, I'd say this book is worth your time to find and read.

Switching gears... the nurse did actually call us back, just minutes after my previous post was completed.  And evidently what I'm experiencing is indeed normal after this surgery, even if the pain is sometimes quite intense. It's supposed to get better after 2-3 weeks, she said, though it hasn't improved very much yet... so it's just a waiting game now, I suppose. And I hope she's right. God, grant us patience, courage and strength. And healing.

Post-Op

I last posted 11 days ago - six days before my scheduled surgery. Now I'm five days past that surgery, and grateful that I feel well enough to post again. Still VERY sore, and frustratingly limited in mobility. But gradually getting better, bit by bit and day by day.

The days leading up to the surgery seemed to go by in a blur - maybe because we only had eight days notice from the time it got scheduled until I underwent the knife, so there was much to do in a short time to prepare. Thanks to a very understanding boss, fortunately, I was able to get things settled at work relatively easily, and thanks to a very understanding wife, we were able to get things ready at home. Both fortunately and unfortunately, the afternoon before my surgery was when my wife was scheduled for her final test with our fertility doc - good because at least it gave me something (and someone) else to focus on that day, but bad because I still felt horrible for having to put her through it. I felt even worse with how uncomfortable she felt after the procedure was over, and worse still because I knew she'd have to be taking care of me starting the next day. But my wife is amazingly strong and came through it like a champ, and we received the EXCELLENT news, and peace of mind, that once again her results came up 100% clean. As bad as I feel about this whole situation, I'd feel at least 1000x worse if I knew my wife was going to have to undergo treatments too.

So then it came down to me. We got to the hospital right at our scheduled time of 9:30, got checked in and only waited a few minutes before they called me up. Sent us back to the Outpatient Surgery center, then waited a few minutes more before the nurses took me back to get me prepped for the procedure. After getting my vitals, drawing my blood, starting a saline IV and answering a slew of health questions I had already answered many times before ("Do you have diabetes? High blood pressure?" "For the third time, no!"), they brought my wife back to send me off, then wheeled me out to urology. Where I sat. And waited. And waited. And waited. And I got irked, then waited some more. Then finally, an hour after we were supposed to get underway, my doctor finally showed up to answer any final questions I had. Then, three minutes later, he was gone. Two nurses showed up to put a "relaxing" drug in my IV, then wheeled me into the OR. I remember the room being very bright, with a slew of multi-eyed light fixtures like spiders on the ceiling. I remember the nurse looking at me upside down.

Then I woke up. In the worst pain of my life. The nurse in recovery asked me what my pain level was, and I muttered something about a six, but I probably should have said higher than that. My first question was, "The pain in the testicle is even worse than before surgery... is that normal?" She muttered something in the affirmative, told another nurse I never saw something about "give him the other 25 somethings of some drug," then tried to find my incision in all the wrong places (for which she later apologized) before she got it right. She asked again what my pain level was, and I muttered about a seven, to which she said, "Really?" and zipped off to find me a hydrocodone and a Coke. The drug showed up, then the Coke, then my wife, then about 45 minutes later, I dared to move enough to stagger to the restroom so I could pee and then take a wheelchair ride out of that place. Once home, I collapsed on the couch for a few hours, then very gingerly climbed the stairs to bed, and didn't come down again for three and a half days.

I had what was called an "inguinal varicocele surgery," or "inguinal varicocele repair." It's evidently the most invasive of the varicocele surgical options, with the longest recovery time, but it's also got the highest success rate and lowest chance of complications. So I'll take it. The bandage/dressing covered the entire left half of my pelvis, and we were instructed to leave it there for two days, but I was too drugged and too sore to care most of the time. Finally on Saturday morning, we got to remove it and I was excited to have my first post-op shower... but that excitement quickly turned to shock when I saw the incision itself. It's a full 4" long, below the waist but above the hip, and lined completely with blood. About three times the size I expected, and immediately I felt like a veal cutlet. At least we know now WHY I'm so sore.

But it's getting better, day by day. The incision site itself is still very sore, but fortunately we've seen no signs of infection or other complications from the surgery. I still need my wife's help every time I stand up or sit down, but the pain is lessening each day, and I'm gradually going longer and longer between pain pills. The affected veins in the scrotum... don't seem that much different than before, though likely not as swollen, and my urologist told me not to expect a huge change in that right away. What he didn't tell me to expect is the soreness and tenderness of the testicle itself, which is still worse than before the surgery... I wish I knew if that was normal. But we've got a call into the doctor's nurse, and from what we've looked up, it is indeed normal. So I'm mostly just trying to relax, trust in the healing process, and be patient. I'm out of work on doctor's orders until 12/1, then I go back for a follow-up with the doc on 12/7.

How am I doing? Besides sore, of course? It varies, I guess, with mood, which maybe varies with pain. I like to be Mr. Independent, so I hate leaning so hard on my wife for so much, but she's been absolutely golden in all of this. Getting mad at me for trying to do too much on my own, and for apologizing too much when I do ask for help, but I don't blame her. I couldn't do this without her, physically or emotionally, and I thank God for her many, many times each day. Sometimes I'm just frustrated at all I can't do, and starting to get a little stir crazy; even as an introvert, I still like to leave the house each day, and I haven't left now for almost five days, with several more days yet to come. A lot of times, honestly, I don't want to do anything but sleep - whether due to dizziness (caused by pain meds), or due to pain (requiring pain meds), or just general exhaustion (caused by healing a four-inch gash in my groin). I'm grateful that things have seemingly gone as smoothly as they have thus far, and EXTREMELY grateful for the help and support of my wife in all of this. Likewise from family and friends, to a lesser extent. But sometimes, too, I get depressed... looking in the mirror at a huge new scar, thinking "this is the new me," and wondering if things will ever heal, ever stop hurting, wanting to live like normal in my body again. I realize this is mostly the result of expecting too much, too soon. It's a lesson in patience for me, too.

So the doc didn't call us back today, but hopefully he will tomorrow. I'm feeling enough better already that I'm wanting to move around more, so I think it's time to move around again. Bit by bit, day by day. Hurting, but healing.

On failure

I feel many different things when I say that our infertility problem - the underlying medical issues - lie 100% with me.

That's the one point in my first post that I meant to elaborate on but didn't, because the post got long and the hour got late. That's the point that's been the chief consumer of my emotional energy ever since we first got the news about our diagnosis last month.

How DO I feel? Well, yeah, this week I've been mostly concerned about the surgery, and I'm sure that will continue right on through until they knock me out. Before the surgery was set, though, and likely again after it's done... I have good days and bad days. Or, more accurately, good moments and bad moments. Sometimes I think about it, and it really doesn't bother me much, as I'm distracted by other things. But other times... well, take your pick.

I feel angry, and I am almost NEVER angry - but why did I win the genetic lottery for a diagnosis like this? I feel broken. I feel defective. I feel inferior. I feel like I've failed my wife, and failed at being a man. My parents split while I was on the way, so I was raised in a house full of women - mom, grandmom, and older sister - without any significant positive male role models until I was 18. So in many ways, I had to figure out on my own what it means to "be a man," and I thought I was doing a pretty okay job of it... but now I feel like Nature (or God) said, "Nope, time's up. Sorry, you failed! Here's your punishment," and yanked the cosmic rug from under me.

I am so HUGELY, INCREDIBLY grateful that all of my wife's tests have come back clean so far. She has one test remaining, scheduled now the afternoon before my surgery, and I pray with every fiber of my being that that test comes back clean too. It's bad enough having to watch her go through all these tests and exams; I never want to have to watch her go through treatment, or surgery, or the emotional strain that goes with it. If we must have a problem, I would MUCH, MUCH rather it be entirely with me - I would take that burden on 100 times out of 100. But... on the other side of that coin... I feel guilty. Because we DO have a problem. And because that problem is entirely caused by MY body. And while I know in the rational part of my brain that I never asked for this, I didn't cause this and couldn't have prevented this... emotions are not rational. And so while my head can say, "It's a medical problem," all day long, my heart says, "It's my fault."

I feel like this whole great heartache is my fault. If it wasn't for my body's issue, we wouldn't be dealing with any of this. So then, I have to live with the knowledge... every doctor's visit we have. Every test that either one of us has to undergo. Every procedure they do, all of the pain it causes. Every night we're up until 3:00am wrestling with "what ifs." Every tear that is shed. Every time we want to have sex but can't, because I have to store up for another semen sample. Every step of every mile along this entire journey, regardless of where we end up and whether we ever succeed or not... it's all because of me. It's all because of my body. And therefore, to my heart... it's all my fault. And sometimes that gets overwhelming.

After I got over the initial blow of the first bad news of that blasted sperm count, the next day I set out to find resources for guys in my situation. Unfortunately, that only ended up making me feel worse - not because of what I found, but because of what I didn't. For female infertility, there's a vast wealth of info and support out there. For couples, there's still quite a bit available, and that's cool. But for guys... there's really not much. Most of what exists regarding male infertility, in books and online, is all clinical info about causes and treatments. And that's great information to have, helpful for talking to doctor's, but I was looking more for a "by men, for men," how-to-deal handbook. It doesn't exist. The few articles and books that pay any significant attention to the psychology of the issue all say pretty much the same thing: "Guys don't take this well, and they need an outlet for it or they'll get self-destructive. Go find a support group." But, you guessed it - support groups for guys don't exist either.

I can imagine why; no one would go. Guys don't talk about their feelings, and guys CERTAINLY don't want to talk about this, so getting together with other guys to talk about something like this would be roughly equivalent to the 7th Circle of Hell. I'm sure that's why no books exist of guys talking about this, too. Regarding next week's surgery, most guys would rather lose an eye, or go deaf, or have career-ending ACL surgery than have anything go wrong with anything even remotely close to the genital region of their bodies. I'm no different than those guys in that regard. So I don't blame the guys that have been here in the past for stepping up to the plate on this. But it is disappointing for guys trying to deal with it now. Like me.

At least in part, I suppose, that's another purpose of this blog. Maybe some other guy dealing with this issue later on will be looking for info like I did, and he'll stumble across these entries. He won't have to talk to anyone, but he'll know that he's not alone. And maybe that will help, in some small way.

It's late again. Another blasted semen analysis in the morning, because the urologist wants a better baseline before the surgery next week. Fine. Then paperwork has to be filled out by the doc to justify the leave from my job. Then my third-to-last workday before the surgery. Time for bed.

Pilot Post

So here we go. My wife is The Haywire Heart. At her gentle encouragement, I've started this blog to help me vent my own thoughts. Like virtually every guy out there, I don't spend much time or energy talking about my feelings. I don't wear my heart on my sleeve. I'm an introvert and a quiet person and I only share past the surface of myself with a very select, trusted few. So while I know that probably no one will read this, or only stray, anonymous visitors, that's really better for me. The point of the exercise, at least for me, is to release these thoughts out into the void.

My wife and I just celebrated our third anniversary last month. For the first two years of our marriage, we agreed that we wanted to have time to ourselves, to be just ourselves, so she was on birth control to prevent possible pregnancy. We both agreed before we got married, however, that we eventually wanted to have kids, so just shy of our second anniversary, the birth control was stopped.

Then another year passed. And things stayed the same as they were on the birth control. Still no pregnancy, but now it wasn't actively being prevented, and it certainly wasn't from any lack of trying. So we went to see our family doctor, who referred us to an OB/GYN for my wife. So the OB wanted to run some preliminary tests on the both of us to see if anything was amiss. Then came the bombshell that no aspiring parents-to-be ever want to hear - we're infertile.

Infertility is a couples problem - it takes two to make a baby, so it likewise takes two to combat the problem when something gets in the way of that goal. But it's impossible for me to talk about my feelings in this situation without talking about the specific medical issues behind it. I'm thrilled to be able to say that all of my wife's tests so far have come back 100% clean and normal - that is incredibly good news to me. But I feel many different things when I say that our infertility problem - the underlying medical issues - lie 100% with me.

The first test the OB wanted to do with me was a semen analysis. So, rather uncomfortably, I submitted a semen sample one Friday morning last month, then we waited. Then the nurse called my wife on Monday afternoon, and the news was not good - low sperm count, and poor sperm morphology. That was a huge stab through the heart of our hopes, but we were forced to wait until Friday again before the OB could talk to us. Then we went that Friday, and the OB told us some very encouraging things about success rates for couples in our situation. Our chances were much better than we had feared, and my wife left feeling much better after that appointment. I left feeling better about the overall situation, too... but feeling even worse about myself.

The OB gave us the exact numbers from my test, and my count isn't just low - it's VERY low. 4.25 million, and the LOW end of normal is 20 million, so that's only about 20% of the LOW end. The high end of normal is 150 million, so I'm at less than 3% of that. And my sperm morphology isn't just poor - it's at the absolute bottom end. A rating of 0, meaning that ALL of my sperm are abnormally shaped; a rating of 8 is acceptable, and a rating of 14 is normal, but 0 is still 0% of any number. It was pretty damn hard for me to walk out of there feeling better after learning that.

The OB then referred us to a fertility specialist, so another week passed, and again on a Friday morning, we were in a new doctor's office. The fertility specialist wanted to do some additional tests on my wife, which again all came back 100% clean and normal, and I was extremely relieved to hear that. Then he reviewed the numbers from my previous semen analysis, declared that this was "male factor infertility," and referred us (again) to a urologist. He also asked for some hormone testing on me, which he expected to be normal, but it's a matter of ruling out every possibility, so the test needed to be done.

That test was done on Monday of last week, then the urologist appointment was scheduled for Monday of this week, in the hope that those lab results would be back in time to take them with me to see doctor #4. It took until Monday morning, but come back they did... and not as "normal" as doc #3 had hoped. Not badly abnormal this time, as my LH and FSH levels were both fine and comfortably within the normal range. But total testosterone is low. I didn't have much time to process this before it was time to head off to the urologist, so I just let the wave carry us along and showed my test results to doc #4. It turns out that the "low T" could actually be a result of what he believed my underlying issue to be, so that could be more symptom than cause, plus the treatments for "low T" can actually LOWER the sperm count. So for now, we're leaving that one alone.

Then came the exam from the urologist, and the ultrasound from his nurse. I'm 31 now and hadn't been naked in front of a doctor since I was about 3, so I left feeling rather like I had been hung on display in a meat shoppe window. Here, let's let EVERYBODY I don't know come and take a look at my balls! But the exams, while they did find a problem, at least ruled out the scariest of the possible diagnoses - cancer, et. al. - and the problem diagnosed is what we suspected it to be. I'd rather know my opponent than try to fight in the dark.

So I have a varicocele - basically like a varicose vein, just in a very unfortunate and sensitive area. These are actually really common (up to 20% of men may have them), and generally don't cause any issues for most guys when they do occur. But, like everything else medical, there's a range of severity, and mine appears to be rather large. This is a problem for sperm production because it raises the temperature in the region, and temperature control is the whole reason a guy's balls are outside his body in the first place. But it's also a problem because the purpose of veins is to carry toxins away from their region to be purged from the body, but if the blood doesn't flow properly, those toxins can linger and have the chance to get back into where they shouldn't be. A varicocele can furthermore leech testosterone from your system, which could lead to the hormone test result I mentioned earlier. The obvious solution, then, is to have it fixed.

Surgery. I got the call this morning, and I'm scheduled now for varicocele surgery on the morning of November 16. I'm glad that we don't have to wait too long, because waiting is the hardest part. But that's also a lot sooner than I expected, so I'm not sure I'm ready for this yet. The urologist told me that it's rather like hernia surgery, not too terribly invasive, with really low risks of any complications. But it's still surgery - and surgery on a very private area, too - so it's still honestly scary to me. I've never had surgery before, never been in a hospital for anything, so this is all uncharted territory for me. I feel like I'm flying blind.

How DO I feel? Hell yeah, I'm scared. My mind is rational enough to know that the surgery shouldn't really be a big deal, but emotions are not rational, and no less real. It's difficult at the moment for me to focus on anything else besides the surgery in this situation, especially knowing that its only about a week away, but I've already felt much more and I'm sure I will again soon, once I've had more time to process all that's happened in such a short period.

Most of this is rambling, I fear, but I guess that's sort of the point. The other point is that my wife has been an INCREDIBLE support in all of this, and there's no way that I could do this without her. More to come in coming days, no doubt...