Why people come here

So I haven’t posted in a while, and on a whim I looked at the stats. This past week my number one post was an old one about a problem my son had with his testicles.

Just to update: they are fine.

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Vestigial Appendages.

It would seem that the doctors disagree.

I find doctoral politics amusing.  I’ve watched two unfriendly cardiologists differ strongly in opinion over a patient, to the point of ignoring each other’s good points just to stick to the diagnosis they feel is correct.  I’ve watched my sister-in-law go through the pain of medical school, and can easily see how someone who survives that could get a god complex.  Not that I think that’s the case today.  But I’m putting the cart before the horse, so to speak.

At the Emergency Room, we were given a diagnosis of viral infection.  The treatment for such for my boy’s swollen right testicle (a phrase I’ve yet to tire of saying) is, well, nothing.  Oh there are the usual…  get plenty of rest, drink lots of fluid…  But really, no magical medical cure.  Being a virus, we don’t have much to combat with.  It hasn’t caused untoward symptoms, other than the obvious swelling of places best not swelled.  No fever, no sickness, no milky discharge (another fun phrase).

So with the diagnosis of infection, the treatment is restricted movement and time.

Today, the urologist gave us an entirely different diagnosis.  Torsion of an appendix.  Not the one on the intestine that we are so familiar with, and I am currently doing without since an appendectomy in 1983.  But like the appendix of the intestine that caused me great pain in 6th grade, this appendix is inside the scrotum and can also become infected.  Additionally, it can undergo torsion, getting wrapped up by the various tubes and such found in the scrotum, and lose its blood supply.

In the past, this was a surgery.  Today, it is left alone… left to die and heal without invasive procedures.  It seems the body can heal itself, at least in this case, faster than the body heals from surgery.  A few days discomfort as opposed to a few weeks.  So,with this new diagnosis, what is the treatment?

Restricted movement and time.

So I don’t really care what the doctors diagnose.  The treatment, and in fact the timeframe, are identical.  Do nothing, keep a six year old boy still, and let time heal.  Now, how I’m supposed to keep a six year old boy still for 7-10 days…  they had no answer.

But we’ll do the best we can.  Just like with the infection, the torsion means that with the swelling comes a slightly elevated risk of testicular torsion, which is quite serious and does require surgery.  So while keeping the boy still, I also have to make sure that any pain he may feel is not testicular torsion.  Any doubt, and we rush back to the hospital.

So yea…  I get to sit on the boy for a while.  It’s about driven me insane tonight.  I’m quite at my wits end with this “treatment.”  But we checked again tonight, and the swelling is going down, even as the redness increases.  The localized fever seems to be decreasing as well.  So, time is healing, I suppose.

I do want to say this.  The boy has had his privates on display for various pokes and prods for 5 days now.  He’s not gotten upset over it yet.  I’m not saying he liked it, but that he has dealt with it… with as much grace as a 6 year old boy can.  No tears, no screams, just a “please be gentle” and a few uncomfortable winces.  I’m proud of him for his stoic nature.

The Case Of The Expanded Testicle

My son has been complaining of a pain in his groin.  When asked to show where the pain is, he indicates his upper inner thigh and along the front of his hip.  It started hurting last Wednesday, and by Friday he was actually asking to go to the doctor.  Only this was, it only hurt when he wasn’t having fun.  Kids running around acting crazy?  No pain.  Kids sitting around not doing anything?  PAIN!

Friday night we put him in a hot bath, which has helped the last couple of days when he was hurting at night.  I wanted to give him ibuprofen since it is also a muscle relaxant as well as a pain reliever, but we didn’t have any child safe so I ran to the store.  When I got back, he was in the tub and I noticed it…  his right testicle was larger than his left… and it was red.

Okay, this is serious.  This could be a sign of testicular torsion which is really serious.  Testicular torsion requires surgery, and quickly.  If not repaired within 8 hours, it is highly possible the testes will have to be removed.  That’s pretty serious…  half neutered at 6 years old!

So I snatched him up and ran him to the hospital  The nurses were afraid of the same thing.  (On a side note, that was nice.  I was half afraid they’d laugh me off as one of “those” parents.)  They rushed us back, the doctor saw us in minutes.  He explained the concern, including the possible impending emergency surgery, and scheduled us a rush ultrasound.  He was worried about not getting the ultrasound quick enough.  He explained the concern, said he didn’t think it was torsion, but had to act as if it was.  He put the on call urologist on stand by for emergency surgery and ran off to push us through the ultrasound system.

Let me tell you something.  I’ve had a few ultrasounds.  I know you mothers have too, and you know that they gel you up and press that big wand into you.  I wouldn’t say they press it hard, but I think firm is a fair description.  Now I’ve even had an ultrasound of my testes done.  And with “healthy” testes… or at least testes not in pain… that was physically uncomfortable.  (The emotional discomfort is a whole other blog post.)

So imagine, my male friends, that someone just kicked you in the nuts and decided to cover them in cold snot and press against them with a stick.  That’s pretty much what they did to my son.  Okay, they didn’t kick him in the nuts, but he had a SWOLLEN TESTICLE that was tender to the touch.  And they covered it with the magic ultrasound jelly.  Then pressed against it, firmly, with a long wand.

I cried just watching it.

Male Reproductive SystemLuckily, it wasn’t torsion.  It is most likely epididymitis, which is an infection of the epididymis.  Which, to those of you who don’t remember your male sexual organ anatomy, is the long, tightly coiled tube that collects sperm prior to ejaculation.  It isn’t uncommon for males to get this viral infection, but usually in adults it either runs its course in a couple of days with mild discomfort, or is brought about from venereal disease.  (I’m hoping my six year old isn’t that advanced.  His urinalysis bears out that he was not.)  In rarer cases of adults, but more frequently in children, the epididymis can swell quite a bit with the infection.

It can be quite painful, and any unusual movement of the scrotum can bring on bouts of sudden pain.  Hence the reason it only hurt him sometimes.  He could run around for most of the day with no problems, then move just right and he is crying on the floor.

So what do they do about it?  Absolutely nothing.  It is a virus, it has to run its course and the body has to defeat it.  He’s not even running a fever.  He feels fine, or as fine as a child could feel who feels like someone is kicking him in the nuts on occasion.

So we get sent home in the wee hours of Saturday morning with a dose of Lortab and instructions to keep him still, make him get lots of rest, and see your pediatrician and a urologist as soon as possible.

Saturday he spent most of the day laying around.  The Lortab really sent him into outter space, and it didn’t wear off for nearly 18 hours.  He got a little feisty Saturday night.  Sunday he was almost normal, except a time or two he would hurt himself.  Okay, when he put the infant’s riding toy on the slide, and attempted to ride it down I probably should have stopped him.  But hey, it was his testicle, not mine.

Sunday night was pretty painful, and he ended up asking for some medicine.  Ibuprofen was given, since I didn’t want to make him loopy for school the next day.  Monday morning he went off to school armed with a P.E. excuse and instructions for his teacher to keep him as still as possible during recess, while acknowledging the impossibility of that request.  (Amazingly, she found some library books on dinosaurs he hadn’t read yet, and that worked!)

I started calling doctors and managed to get him in to the pediatric urologist Tuesday afternoon.  I got him in to his pediatrician Monday afternoon.  Dr. Klemm is a fantastic doctor, and I’d highly recommend him to all you parents, but he isn’t taking new patients.  (Dr. Klemm, if you google your name and get this and I’m wrong, let me know, cause YOU ROCK.)  Dr. Klemm didn’t treat this lightly.  Of course, this is the man who told me that my son was so sick with pneumonia that we needed to rush him to the hospital, in fact they already had a bed waiting and the only reason they hadn’t called an ambulance for him is that we can get him there faster, so go already… and he did so with such sweetness and kindness that it was almost as if he was asking us to tea.  So despite his reassuring tone, I could tell he was taking this very seriously.

When he checked my son’s privates out, I almost passed out.  What was a significant swelling on Friday, was today a monster swelling ball of redness.  And, before going into the doctor, my son was already walking gingerly.  Upon seeing the massiveness that was my sons right testicle, I understood why.

The ginger walking continued the rest of the day.  Tonight, his swelling is even a bit bigger.  Not much, but if this goes on…  I was hoping that Dr. Klemm would give him some magic shot and all would be well!  Oh, don’t bother with that specialist tomorrow.  Instead, Dr. Klemm called the urologist and consulted with him.  Again, another reason I know that this is serious despite the calm and reassuring tone of Dr. Klemm’s voice.

So in the morning I get to take my son back to the hospital.  He has another ultrasound scheduled.  Since the swelling has increased, so has the risk of testicular torsion.  If he has sudden onset of increased pain, trouble urinating or a few other symptoms that I’m too squeamish about to discuss here (and really, have you read this post?  If I’m squeamish, it has to be bad) then we’re to rush to the ER and expect almost immediate surgery.

After the ultrasound, and come on, at a good bit swollen and he nearly couldn’t take it.  Now his right testicle is swollen like an overripe tomato, this should be fun.  We have an appointment with the urologist at three.  Again, to show how serious this is, the urologist has had an emergency surgery pop up.  He called all his appointments for tomorrow and canceled the entire afternoon…  except us.  He rescheduled us.

So tonight, as I write this, I’m worried for my son.  It is hard to deny activity to an active six year old.  He’s getting cabin fever something fierce.  Yesterday in the nice sunshine, he just had to go outside, so he pulled out a chair and just sat in the sun.  For an hour.  Cause it was nicer than sitting inside, staring at more TV.

And because he is in pain.  No parent wants their child to be in pain.

And because he is in danger of a serious complication, no matter how relatively small that danger is.

I know I’m acting like a baby over this.  I know friends who have kids who by my son’s age had already had dozens of surgeries.  I have friends who have kids who have long term medical issues that won’t be resolved for years, if then.  I even have, as said as it is to say, friends who have lost a child.   And I’m concerned with a little testicle.  But it is my son’s testicle, and I’m devastated.  To the point of barely being able to function.

So if you read this before Tuesday, send me positive vibes.  If you don’t, follow my twitter for updates on him, and I’ll post here later in the week.  Reality is that rest and time are the cure.  And hoping nothing happens that cause torsion.  So we’ll be watching and waiting.

On a completely unrelated side note, the WebMD.com article on epididymitis includes the usual treatment of bed rest.  The link for “bed rest” takes you to “bed rest during pregnancy.”  I don’t know how to word this, or show this, in a way that I can submit to failblog.com, but let’s be honest… linking to an article about bed rest during pregnancy when discussing an infection that only happens to men?  FAIL!